[Treatment of hydrocele testis by injection of tetracycline solution]

Eleven cases of hydrocele testis were treated with injection of a 1% or 2% dedoxycycline hydrochloride or minocycline hydrochloride, and a cure was obtained in 9 cases (81.8%). Of these 9 cases, 7 cases were cured after one injection, and 2 cases after 2 injection. Both of the latter 2 cases in which physiological salt solution was used as the dissolving solution experienced scrotal pain immediately after injection. Among the cases in which 1% lidocaine was used as the dissolving solution only 1 injection (11.1%) was associated with slight pain out of 9 injections. This treating method is highly effective and little or no pain is experienced if lidocaine is used. In conclusion, we recommend this method as a treatment for hydrocele testis.

[Anti-tumour effect of UFT on human renal cell carcinoma heterotransplanted into nude mice]

1) Using two histologically different human renal cell carcinomas heterotransplanted into nude mice, the antitumour effect of UFT was investigated, and an attempt was made to analyze the properties of the tumour strains where a drug efficacy was noted. 2) The two strains used were the JRC 1 strain (tumour doubling time of 9.4 days, clear cell type, papillary histologic pattern, grade 3) and the JRC 11 strain (tumour doubling time of 2.72 days, granular cell type, anaplastic histologic pattern, grade 4). 3) Two dose groups were set up, one receiving 10 mg/kg of tegafur (FT) and 22.4 mg/kg of uracil and the other receiving 20 mg/kg of FT and 44.8 mg/kg of uracil. Each group was further divided into an early administration group (start of administration 3 days after the tumour transplantation) and a late administration group (start of administration at a time when the transplanted tumour proliferated to weight of 100 to 300 mg). 4) Effect as noted in the tumour proliferation inhibition rate was seen only in the group receiving 20 mg/kg of FT and 44.8 mg/kg of uracil in both early and late administration groups of the JRC 1 strain. Among these groups only the early administration groups showed a histological positive effect. 5) The fact that the measured 5-FU intra-tumour concentration in the JRC 1 strain was only 1/4 that of the JRC 11 strain demonstrates more susceptibility of JRC 1 strain to UFT. Moreover, intratumoral concentration of 5-FU differed markedly even with the same administration method and dosage level. This result indicates that intra-tumour concentration will be different if the histological pattern differs.

[A case of metastasis of gastric cancer to spermatic cord]

A 63-year-old man underwent total gastrectomy and partial resection of the transverse colon for Borrman IV gastric cancer on August 27, 1985. On August 8, 1986, 11 months after the operation, he visited our department with chief complaint of swelling of both groins. The spermatic cord was swollen to about 3 cm in diameter from both groins to inside of the scrotum and was hard as a club. The diagnosis of bilateral spermatic cord metastasis of gastric cancer was established and a biopsy was carried out. Histopathologically the diagnosis of spermatic cord metastasis of gastric cancer was confirmed.

[Treatment of nonseminomatous testicular tumor with liver metastases]

Therapeutic course of 2 cases of nonseminomatous testicular tumor with liver metastasis is reported. One case had mixed tumors including embryonal carcinoma, choriocarcinoma and yolk sac carcinoma, and was positive pulmonary metastasis already at the initial examination. In the other case having mixed tumors of embryonal carcinoma and choriocarcinoma, metastasis to the supraclavicular lymph node was detected at the initial examination. In both cases liver metastasis occurred after complete response could be obtained by treatment chiefly consisting of PVB therapy. For liver metastasis four-drug combination treatment using cisplatin, vinblastine, adriamycin and actinomycin D was performed with partial response. However, this patient eventually died. The other case received VAB-6 therapy with complete response for liver metastasis. It is advisable to consider other modalities therapy in addition to conventional chemotherapy in cases of testicular tumor with liver metastasis since the prognosis is poor in these cases.

[Outcome of patients in metastatic renal cell carcinoma with or without embolization]

Nineteen cases of metastatic renal cell carcinoma were embolized (embolization group) and 18 cases were not (non-embolization group). The median survival time after nephrectomy for the 14 cases in the embolization group, 23 months, was more favorable than the 11 months obtained for the 13 cases in the non-embolization group. In the case of one organ metastasis, the median survival time was 33 months for 9 cases in the embolization group and 11 months for 10 cases in the non-embolization group, with a remarkable difference in survival time between the two groups. Therefore, the survival rate can be improved by performing nephrectomy after embolization in the case of single organ metastasis. On the other hand, in the case of multiple organ metastasis prolongation of survival time cannot be expected even when embolization is performed with or without nephrectomy.

Intra- and inter-nephron heterogeneity of gluconeogenesis in the rat: effects of chronic metabolic acidosis and potassium depletion

The intra- and inter-nephron heterogeneity of renal gluconeogenesis within rat proximal tubules and the effects of chronic metabolic acidosis and chronic potassium(K)-depletion were studied using isolated proximal tubules of rats by directly measuring glucose synthesized. The gluconeogenic activity from pyruvate and glutamine in control rats was almost limited to within the early proximal tubule (S1: 45.4 +/- 5.7 pmol/mm/60 min from pyruvate; 58.0 +/- 6.0 from glutamine). Very low, but detectable gluconeogenesis was observed in the middle portion of the proximal tubule (S2: 9.9 +/- 2.2 from pyruvate; 4.8 +/- 1.1 from glutamine). The rate of glucose production in the terminal proximal tubule (S3) was negligible. Furthermore, gluconeogenesis from glutamine of superficial (SF) nephrons was significantly higher than that of juxtamedullary (JM) ones, whereas no difference was seen in gluconeogenesis from pyruvate. In acidotic and K-depleted rats, significant increase could be seen in S1 and S2, but the increase in S3 was not significant. By the serial determination in acidosis, the glucose production from both substrates was found to be the highest at the second 1 mm segment from the glomerulus, and it decreased downward along the proximal tubule. In acidosis, glucose production from both substrates in SF nephrons and that from glutamine in JM ones were elevated significantly compared with the control, but that from pyruvate in JM nephrons did not change. These results suggest that S1 of the SF nephron plays the most important role in gluconeogenesis in the control, whereas S1 of the JM nephron and S2 contribute to gluconeogenesis in acidotic and/or possibly K-depleted rats.

Evidence that alpha-1-adrenergic stimuli specifically increase gluconeogenesis of the isolated proximal convoluted tubule in the rat

Isolated kidney-cortical tubule suspensions and microdissected nephron segments from fed rats were used to study the action of catecholamines on gluconeogenesis. Gluconeogenesis from rat tubule suspension incubated with 5 mM pyruvate was stimulated maximally by 10(-5) M methoxamine, an alpha 1-selective agonist, and 10(-6) M noradrenaline by 29.2 +/- 5.2% (mean +/- SEM) and 32.6 +/- 2.9%, respectively. These effects were completely inhibited by 10(-7) M prazosin, a beta 1-selective antagonist. Yohimbine, an alpha 2-antagonist, also inhibited the effect, but only at a higher concentration (5 X 10(-5) M). Gluconeogenesis was not stimulated by isoproterenol, a alpha-agonist, at any concentrations between 10(-5) and 10(-7) M. With microdissected nephron segments, only the proximal tubule possessed gluconeogenic activity. Within the proximal tubule, the proximal convoluted tubule (PCT) revealed higher gluconeogenic activity than the proximal straight tubule (PST). Methoxamine at 10(-5) M stimulated gluconeogenesis in PCT, whereas in PST no increase of gluconeogenesis was observed. From these results, it can be concluded that an alpha 1-adrenergic agonist specifically stimulates renal gluconeogenesis in PCT, but not in PST.

[Acute myeloid leukemia with intracranial tumor formation--case report]

A 44-year-old house-wife was admitted to the hematological clinic of our hospital on December 21, 1981 for the treatment of acute myeloid leukemia. Hematological examination showed severe anemia, leukocytosis and thrombocytopenia. She was soon started on DCMP therapy (Daunomycin, Cytosine arabinoside, 6-MP and prednisolone). After several repeats of remission and aggravation, she suffered from vertigo, nausea and vomiting in early August of 1982. The CT scan and angiography showed a mass lesion in the middle of the posterior cranial fossa. On August 26, surgical extirpation of the tumor locating in the vermis of the cerebellum was performed successfully. On gross examination the tumor revealed smooth yellowish-red surface, elastic in consistency and measured 40 X 40 X 30 mm in size. Histologically it comprised the leukemic cells. The pathology of the central nervous system due to leukemic cells was discussed in relation to the pertinent literature, including the CT findings and the indication of the surgical treatment.

Atrial natriuretic peptides stimulate renal gluconeogenesis

Atrial natriuretic peptide (5-28AA; ANP) and atrial extract (ANS) stimulated rat renal gluconeogenesis in cortical tubule suspension in a dose dependent fashion only from substrates that enter gluconeogenesis via phosphoenol-pyruvate carboxylase. The effects of ANP and ANS were significantly potentiated by cAMP and cGMP, whereas methoxamine showed no effect. Extracellular calcium revealed a key role for ANP and ANS response to gluconeogenesis: a concentration of calcium higher than 1 mM was essential. Isolated cells from cortex which lost cell membrane polarity by warming but responded solely to cAMP and cGMP showed no effect by ANP nor ANS. These data suggest that ANP or ANS may act mainly from the basolateral site in the proximal tubule cell and promote gluconeogenesis through cAMP and/or cGMP system.

[Lymphadenectomy for renal cell carcinoma]

The techniques, results and problems of lymphadenectomy were assessed in 56 cases of renal cell carcinoma. As the approach to the retroperitoneum, the thoracoabdominal approach was used in 22 cases and transabdominal approach in 34 cases. Radical nephrectomy was performed, followed by lymphadenectomy. All of the regional lymph nodes were dissected. The mean time required for lymphadenectomy was 1 hour and 40 minutes and the mean volume of blood loss was 350 ml. As intraoperative complications, vascular injury occurred in 3 cases. In 1 of these cases the left second lumbar vein was injured. Therefore, in lymphadenectomy caution should be exercised not to give injury to this blood vessel. The postoperative complication observed included bleeding and chylous ascites in 1 case each. In performing operations one must ligate the lymphatic vessel carefully. The 5-year-survival rate for 6 cases associated with metastasis to lymph node was 33%. From this fact, it was postulated that lymphadenectomy is helpful to improve prognosis of these patients.

[The role of preoperative embolization in renal cell carcinoma]

In 84 cases of renal cell carcinoma, the effect of embolization was assessed by dividing the patients into two groups: those having undergone (42 cases) or not having undergone (42 cases) embolization. A 16% decrease in tumor volume following embolization using an MMC-micro capsule was noted. In patients without metastasis at nephrectomy, a tendency was observed for the incidence of postoperative metastasis to be lower with more favorable survival for the group with embolization than that without. On the other hand, among cases with metastasis at nephrectomy, there were more patients who survived for a longer period in the embolization group.

[Clinical study of UFT in renal cell carcinoma]

A clinical study of UFT, a mixture of FT and uracil in a molar ratio of 1 : 4, was conducted on 12 patients with renal cell carcinoma. UFT was continuously administered at doses of 300, 400 or 600 mg per day. CR was recorded in 2 patients, PR in 2, NC in 7 and PD in 2, respectively. The overall response rate was 33.3%. Concerning side effects, 2 of the 12 patients suffered from anorexia and stomatitis, but no hepatic disorders or bone marrow suppression was observed. We concluded that UFT therapy was effective for renal cell carcinoma.

[5-FU concentration in blood and tissue of patients with renal cell carcinoma after administration of UFT]

UFT (3 capsules; 300mg FT) was administered to five of 10 patients with renal cell carcinoma, and concentrations of FT, 5-FU and uracil in the serum and tissues (normal renal tissues, renal tumor tissues and liver) were determined 5.2 hours on average, after administration. The levels were also compared with these in the five patients administered 300 mg of FT. There was no difference in FT concentration between the serum and the tissues in the group administered UFT, but the concentration of 5-FU in tumor tissues was significantly higher (25.6 times) than that in the serum. The level was also higher (3.2 times) than that in normal renal tissues. There was a positive correlation between the concentration of 5-FU in the tissues and the concentration of uracil in the tissues. Although there was no difference in the concentration of FT between serum and tissues in patients administered UFT or FT, the concentration of 5-FU in patients administered UFT was definitely higher than that in patients administered FT; the concentration of 5-FU in the tumor tissues of patients given UFT was 3.9 times higher than in those given FT. Thus, UFT induced a concentration of 5-FU in tumor tissues that was maintained at a high level, suggesting that an excellent antitumor effect on renal cell carcinoma can be expected with UFT.

Angioarchitecture in experimental hydrocephalus

The angioarchitecture of microcorrosion casts in 12 hydrocephalic rats and 5 normal control rats was investigated by using scanning electron microscopy to observe the changes of the vascular bed in the cerebral mantle in hydrocephalus. Reduction in the number and caliber of the capillaries in the white matter was the most remarkable change in the hydrocephalic rats. This change increased in proportion to the severity of hydrocephalus. A similar change was observed in the basal ganglia. The change in the cortical capillaries was mild, but the cortical 'palisade' pattern had disappeared in some cases. Three-dimensional consideration of the angioarchitecture by using microvascular casts compared with microangiographic technique in rat hydrocephalus was discussed.

[Obstructive anuria: unilateral cutaneous ureterostomy with remission of contralateral ureter obstruction]

We experienced 1 case of obstructive anuria. This patient had received radiotherapy for uterine cancer. We performed unilateral cutaneous ureterostomy. Excretion of urine from the contralateral kidney occurred from the 17th postoperative day indicating improvement in renal functions. The possible mechanism for improvement of functions of the contralateral kidney is considered to be release of unilateral obstruction resulting in improvement in edema of tissues around kidney and ureter and remission of intravesical ureter obstruction caused by inflammation as a sequela of radiotherapy through improvement in inflammation.