Adenocarcinoma arising from the prostatic duct mimicking transitional cell carcinoma

A 71-year-old man was first diagnosed with primary transitional cell carcinoma of the prostate with a skip lesion on the distal urethra. The patient received three courses of intra-arterial chemotherapy of cisplatin (CDDP) and pirarubicin (THP-ADM) followed by a radical prostatectomy. Histopathologic examination of the prostatectomy specimen revealed adenocarcinoma invasion along the prostatic duct extending to the peripheral acini, which was diagnosed as ductal adenocarcinoma. The clinical and histopathologic features of this case are entirely different from usual adenocarcinomas of the prostate. This rare histopathologic feature should be recognized as 'ductal carcinoma of the prostate', to distinguish it from papillary adenocarcinoma or adenocarcinoma with endometrioid features. The patient has had no sign of recurrence 14 months after the operation. CDDP-based chemotherapy followed by radical prostatectomy may be one of the promising therapeutic modalities for this rare entity.

Evaluation of surgical risk in preoperative biliary drainage patients by blood chemistry laboratory data--with special reference to rate of reduction of serum bilirubin levels

BACKGROUND/AIM

In Japan, it is generally accepted that biliary decompression should be performed before surgical operations on patients with obstructive jaundice. However, even when adequate decompression and effective reduction of serum bilirubin levels are achieved before surgical operations, it is not uncommon for unforeseen postoperative complications to occur. In this study, we analyzed the effectiveness of biliary drainage prior to pancreatoduodenectomy in patients with malignant obstruction of the papilla of Vater clinically manifested by obstructive jaundice.

PATIENTS AND METHODS

We retrospectively examined the serial blood chemistry laboratory data of 44 patients with periampullary carcinoma who had preoperative obstructive jaundice and underwent pancreatoduodenectomy during the last 10 years. We divided the cases into three groups according to the rate of decrease in serum bilirubin levels, "b": group I, b <-0.09; group II, -0.09<b<-0.05; and group III, -0.05<b. There were no significant differences between the three groups in regard to sex, location of tumor and method of biliary decompression, however, there was significantly higher morbidity rate in group III.

RESULTS

The level of biliary enzymes (gamma-GTP, ALP) tended to be higher in group I and lower in group III. Although TB and DB decreased to below 5 mg/dl before pancreatoduodenectomy in all three groups, transaminase levels instead rose in group III just before pancreatoduodenectomy.

CONCLUSION

This suggested that liver damage continued to progress after biliary decompression when the reduction rate was low, and thus we should carefully monitor such patients for postoperative complications.

Accumulation of new quinolones in the blood of elderly patients

The correlation between serum levels of five new quinolones (norfloxacin, ofloxacin, enoxacin, ciprofloxacin and lomefloxacin), age and 24 h creatinine clearance was studied in 180 patients. One of five new quinolones was orally administered, before transurethral resection of the prostate, at the dosage of 200 mg three times daily for 3 consecutive days. Serum levels were checked 5.5 h or about 17 h after the final administration. Creatinine clearance was found to be negatively correlated with aging (P < 0.001). After oral administration, the level of certain accumulated new quinolones in serum increased with the age of patients (P < 0.001-0.1). This tendency was more marked for ofloxacin, lomefloxacin and enoxacin than for ciprofloxacin and norfloxacin. The investigators concluded that the level of accumulated new quinolones in serum with aging is correlated to the 24 h urinary excretion rate of each new quinolone. These results indicate that ofloxacin, lomefloxacin and enoxacin, which have higher 24 h urinary excretion rates, should be administered at lower doses according to the age of the patient, in order to prevent adverse reactions.

[Study of the long-term administration of ofloxacin to the patients following transurethral resection of the prostate]

The present study was undertaken to evaluate the clinical efficacy of long-term administration of ofloxacin (OFLX) to the patients following transurethral resection of the prostate. The patients were randomly divided into two groups: A and B. All the patients were administered flomoxef (FMOX) intravenously for 3 days following transurethral resection of the prostate (TUR-P). In group A, 100 mg of OFLX twice daily was thereafter administered for 4 to 15 weeks to 22 patients until they showed an improvement in pyuria. In group B, which served as a control, neither OFLX nor any other antibiotics were administered to 26 patients until they showed an improvement in pyuria. No patients complained of urination trouble due to infection. At the same time, cultures of bacillus in the urine were also examined 4 days, 7 days and 2 weeks after TUR-P with these two groups. The mean days necessary for the improvement of pyuria were 64.9 +/- 20.5 in group A, 66.3 +/- 18.4 in group B. At 2 weeks after TUR-P, bacillus in the urine were negative in 19/22 patients in group A, and 14/26 in group B. Chi-square test showed significance for these two groups. Accordingly, OFLX was useful for bacillus in the urine, but OFLX was not so useful for shortening the continuance of pyuria of post TUR-P. No patients complained of nausea or any other complications during the study.

[Norfloxacin concentration in human prostatic tissue after 3 days administration]

The penetration of norfloxacin into prostatic tissue was evaluated on 36 patients with benign prostatic hypertrophy. Norfloxacin was administered orally in a dose of 200 mg three times daily for 3 days preoperatively, blood samples were taken simultaneously at the time of tissue sampling. The patients were divided into 2 groups, groups 1 and 2. In group 1, tissue sampling was done after about 17 hours of final administration of the drug. The mean concentration of norfloxacin in prostatic tissue was 0.38 +/- 0.18 micrograms/g and 0.18 +/- 0.09 micrograms/ml in serum. In group 2, sampling was done after 5.5 hours of final administration. The mean concentration of norfloxacin in prostatic tissue was 0.89 +/- 0.32 micrograms/g and 0.49 +/- 0.25 micrograms/ml in serum.

[Ofloxacin concentration in human prostatic tissue after 3 days of administration]

The present study was undertaken to evaluate the penetration of ofloxacin into prostatic tissue. Thirty-one patients with benign prostatic hypertrophy were entered in the study. Ofloxacin was administered orally in a dose of 200 mg three times daily for 3 days preoperatively. Blood samples were taken simultaneously at the time of tissue sampling. The patients were divided into 2 groups. In group 1, tissue sampling was done about 17 hours after the final drug administration. The mean concentration of ofloxacin was 6.88 +/- 3.98 micrograms/g in prostatic tissue and 2.14 +/- 0.81 micrograms/ml in serum. In group 2, sampling was done 5.5 hours after the final administration. The mean concentration of ofloxacin was 6.73 +/- 2.99 micrograms/g in prostatic tissue and 2.90 +/- 1.50 micrograms/ml in serum.

[Astromicin sulfate concentration in human prostatic tissue after an intramuscular injection]

The present study was undertaken to evaluate the penetration of astromicin sulfate into prostatic tissue. Twenty eight patients with benign prostatic hypertrophy entered the study. Astromicin sulfate was administered as an intramuscular injection in a dose of 200 mg one hour preoperatively. Blood samples were taken simultaneously with the tissue sampling at the transurethral resection of the prostate. The mean concentration of astromicin sulfate in prostatic tissue was 3.79 +/- 1.01 micrograms/g and that in serum was 10.25 +/- 2.70 micrograms/ml.

[Enoxacin concentration in human prostatic tissue after 3-day administration]

The penetration of enoxacin into prostatic tissue was examined Thirty-five patients with benign prostatic hypertrophy entered the study. Enoxacin was administered orally in a dose of 200 mg three times daily for 3 days preoperatively. Blood samples were taken simultaneously at the time of tissue sampling. The patients were divided into groups 1 and 2. In group 1, tissue sampling was done after about 17 hours of final administration of the drug. The mean concentration of enoxacin in prostatic tissue was 1.87 +/- 1.23 micrograms/g and 1.05 +/- 0.458 micrograms/ml in serum. In group 2, sampling was done after 5.5 hours of final administration. The mean concentration of enoxacin in prostatic tissue was 2.51 +/- 0.725 micrograms/g and 1.78 +/- 0.586 micrograms/ml in serum.