Yanagawa M

Radiofrequency Ablation Combined with Renal Arterial Embolization for the Treatment of Unresectable Renal Cell Carcinoma Larger Than 3.5 cm: Initial Experience

The purpose of the study was to evaluate the feasibility, safety, and therapeutic effects of the combination of renal arterial embolization and radiofrequency (RF) ablation to reinforce the anticancer effect on renal cell carcinomas (RCCs) measuring 3.5 cm or larger. This study was undertaken to evaluate this combined therapy on large RCCs-based tumor geometry. Eleven patients with 12 RCCs 3.5 cm or larger in diameter (3.5–9.0 cm) underwent combined therapy. Two were exophytic tumors, and the remaining 10 tumors had components extending into the renal sinus fat. Tumor vessels were selectively embolized in nine patients and the renal artery was completely embolized in two patients with polyvinyl alcohol or ethanol mixed with iodized oil. RF ablation was percutaneously done under the computed tomographic (CT)–fluoroscopic guidance. Response to treatment was evaluated by dynamic contrast-enhanced CT and magnetic resonance (MR) imaging. Tumor enhancement was eliminated after a single RF session in nine tumors (75%), after two sessions in two tumors (17%), and after four sessions in one tumor (8%). Both exophytic tumors (100%) and 7 of 10 tumors having components in the renal sinus fat (70%) were completely ablated with a single RF session. All tumors remained controlled during a mean follow-up period of 13 months and showed significant reduction in tumor sizes (5.2 ± 1.7 cm to 3.6 ± 1.4 cm, p < 0.001). A delayed abscess developed in the ablated lesion in a patient, which was percutaneously drainaged. Combined therapy as described in this report is a feasible, relatively safe, and promising treatment method for large RCCs regardless of tumor geometry.

Incidence of urolithiasis in northeast Thailand.

Background:

Decreased expression of KAI1 metastasis suppressor gene is a recurrence predictor in primary pTa and pT1 urothelial bladder carcinoma.

Objective:  To examine the expression of the KAI1 metastasis suppressor gene and to evaluate its relationship with tumor recurrence in primary pTa and pT1 urothelial bladder carcinoma.

The formation of oxalate from glycolate in rat and human liver

In this study, we attempted to elucidate the metabolic pathway and enzymes actually involved in oxalate formation from glycolate in rat and human liver. In rat liver, the formation of oxalate from glycolate appeared to take place predominantly via glyoxylate. The oxalate formation from glycolate observed with crude enzyme preparations was almost entirely accounted for by the sequential actions of glycolate oxidase and xanthine oxidase (XOD) or lactate dehydrogenase (LDH). Under the conditions used, no significant activity was attributable to glycolate dehydrogenase, an enzyme reported to catalyze the direct oxidation of glycolate to oxalate. Among the three enzymes known to catalyze the oxidation of glyoxylate to oxalate, glycolate oxidase and XOD showed much lower activities (a higher Km and lower Vmax) toward glyoxylate than those with the respective primary substrates. As to LDH, none of the LDH subunit-deficient patients examined showed profoundly lowered urinary oxalate excretion. Based on the results obtained, the presumed efficacies in vivo of individual enzymes, as catalysts of glyoxylate oxidation, and the in vivo conditions assumed to allow their catalysis of oxalate production are discussed.

The usefulness of power Doppler ultrasonography for diagnosing prostate cancer: histological correlation of each biopsy site

Objective To correlate the findings of power Doppler ultrasonography (PDUS) of the prostate with those of site‐specific transrectal ultrasonography (TRUS)‐guided biopsy.

Normal bladder wall morphology in Gd-DTPA-enhanced clinical MR imaging using an endorectal surface coil and histological assessment of submucosal linear enhancement using [14C]Gd-DOTA autoradiography in an animal model.

OBJECTIVE The purpose of this study was to investigate normal bladder wall morphology in gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA)-enhanced magnetic resonance (MR) imaging using an endorectal surface coil and to perform histological assessment of submucosal linear enhancement with experimental [14C]-gadolinium-tetraazacyclododecane-tetraacetic acid (Gd-DOTA) autoradiography. METHODS AND MATERIAL MR imaging of the bladder was performed using an endorectal coil in 13 consecutive patients with bladder carcinoma and T1-, T2-, and Gd-DTPA-enhanced spin-echo images of the bladder wall were compared. After injection of [14C]Gd-DOTA into a hamster, autoradiograms of the bladder wall were obtained and compared with serial histological sections. RESULTS The normal bladder wall appeared as a homogeneous layer of intermediate intensity on T1-weighted images. After administration of Gd-DTPA, the bladder wall was visualized as three layers: an inner thin layer of low intensity, a middle layer of marked enhancement, and a thick outer layer of intermediate intensity. The autoradiograms demonstrated dense accumulation of [14C]Gd-DOTA in the submucosal layer. Thus, the inner, middle, and outer layers corresponded to the mucosa, submucosa, and muscularis propria, respectively. The thickness of the bladder wall demonstrated on T2-weighted images was almost equal to that of the outer layer on enhanced T1-weighted images. Thus, T2-weighted images revealed only the muscle layer as an intermediate-intensity band. In the preliminary clinical study, MR imaging invariably showed accurate stages of the bladder carcinoma in 13 patients. CONCLUSION In MR imaging of the normal bladder wall, the submucosa was strikingly enhanced after Gd-DTPA administration, separating the bladder wall into three layers. This may have a potential role in the staging of bladder tumors.

The Determination of Urinary Oxalate by Gas Chromatography

A new quantitative determination method for urinary oxalate by gas chromatography has been established. This method consists of concentration of urine to dryness followed by methylation of the oxalic acid with 7 per cent hydrochloric acid-methanol, subsequent extraction with chloroform and gas chromatographic analysis. The advantages of the technique are smaller sample sizes (only 5 ml.), rapidity (within 2 to 3 hours) and accuracy (99.14 plus or minus 1.34 per cent recovery). In addition, the treatment of the sample is simple and no specialized equipment is required. Therefore, this method is recommended to clinicians for routine determination of oxalic acid in urine. Urinary oxalate content was analyzed with this method in 62 male patients with calcium oxalate stones. Urinary oxalate concentration and excretion in 33 patients with recurrent stones were significantly higher than in the 22 controls using Welchs test.

Prognostic Factors of Peripheral Blood Lymphocyte Subsets in Patients with Renal Cell Carcinoma

In 76 patients with renal cell carcinoma (RCC) we assessed the therapeutic effects of interferon-alpha (IFN-alpha) and the outcome of curative resection by analyzing changes in peripheral blood lymphocyte subsets to try to find prognostic indices. The percentage of activated CD8-positive cells present in blood samples before IFN-alpha therapy was significantly higher in progressive disease (PD) patients who died within 8 months than in PD patients who survived for more than 18 months. The high percentage of activated CD8-positive cells present in postoperative blood samples was the most remarkable characteristic in patients in which RCC recurred. Multivariate analysis showed that the percentage of activated CD8-positive cells in postoperative blood samples was the only predictor of recurrence (hazard ratio 1.29, p value 0.02). Thus, the high percentage of activated CD8-positive cells in postoperative blood samples is, therefore, a useful indicator of poor prognosis.

Paravesical granuloma after inguinal herniorrhaphy. Case report and review of the literature.

Paravesical granuloma after herniorrhaphy is an unusual complication due to infected suture material and often mimics bladder or urachal malignancy. We present 3 cases of this disease and reviewed 21 previously reported cases. Our patients underwent hernial repair 2–7 years before examination and presented urinary symptoms. They were treated with antibiotics and underwent exploration of the inguinal wound infection but the symptoms did not resolve. En bloc excision and partial cystectomy were performed and resulted in complete resolution of the symptoms. It is important to consider paravesical granuloma in patients who had undergone herniorrhaphy in the differential diagnosis of bladder or urachal tumors.

α-FETOPROTEIN PRODUCING RENAL PELVIC AND URETER TUMOR

Elevation of serum -fetoprotein (AFP) is rarely associated with neoplasms in the urinary tract system. We report a rare case of primary adenocarcinoma of the renal pelvis and ureter producing AFP and recurrent tumor treated effectively with 175 mg./m. 2 paclitaxel on day 1, 1.2 mg./m. 2 ifosfamide on days 2 to 5 and 20 mg./m. 2 cisplatin on days 2 to 5 (TIP regimen). CASE REPORT A 44-year-old woman was admitted to the hospital complaining of a right abdominal mass. Computerized tomography (CT) and magnetic resonance imaging demonstrated a right renal pelvic tumor and hydronephrosis (fig. 1, A). Retrograde pyelography revealed a defect of the right ureter (fig. 1, B). CT showed para-aortic lymph node swelling. Serum AFP was 75,116 ng./ml. Radical nephroureterectomy with para-aortic lymph node dissection was performed based on the diagnosis of right renal pelvic and ureter tumor. Histopathological diagnosis was moderately differentiated tubular adenocarcinoma that strongly stained with immunohistochemical AFP, partially including transitional cell carcinoma that did not stain with AFP (fig. 2). There were no histological features of hepatoid carcinoma. Since recurrence of para-aortic lymph node was found on CT 1 month after the operation, methotrexate, vinblastine, doxorubicin and cisplatin as well as irradiation were administered but the para-aortic lymph node increased. As salvage therapy, TIP regimen was administered. Serum AFP decreased steadily and returned to normal range after 2 courses of TIP regimen. Lymphadenectomy was performed and viable cells were not observed pathologically. The patient was alive with no sign of recurrence 18 months after radical nephroureterectomy and para-aortic lymph node dissection. DISCUSSION