[Clinical study of occupational uroepithelial cancer]

We studied 438 persons who were engaged in the production and use of aromatic amines (benzidine sulfate, beta-naphthylamine, alpha-naphthylamine and dianisidine). Among these 438 persons, 88 new cases of occupational uroepithelial cancer had occurred from 1949 to 1995. The incident rate of occupational uroepithelial cancer was 20.1%. The average exposure period of these 88 cases to the aromatic amines was 7.40 years (range, 0.75-26.75), and the incidence rate of tumors increased with the length of exposure to aromatic amines. The average latent period was 26.79 years (range, 1.33-48.50), and the average age of first onset was 52.59 (range, 24-79). Recently it has been determined that the longer the latent period, the older the age of first onset. Of these 88 cases, the tumor sites were bladder in 67 cases (76.1%) and upper urinary tract (renal pelvis and/or ureter) in 5 cases (5.7%). The other 16 cases (18.2%) were the bladder and upper urinary tract. The screening examination for chemical workers using urinary cytology was begun in 1962. In our cases, urine cytology was a useful method for diagnosing occupational uroepithelial cancer. As for initial treatment of the 88 cases, transurethral surgery was most frequently performed, that is on 58 cases (65.9%). However, eight cases (9.1%) had to undergo a total nephroureterectomy, and six cases (6.8%) had a total cystectomy. Recurrence was observed in 61 cases (69.3%) out of the 88 patients with an average of 1.81 times. The other organic cancers developed in 39 cases (8.9%) out of 438 workers who were exposed to aromatic amines and in 8 cases out of 88 patients (9.1%). Prognosis of the 88 patients is that, the number of alive and dead is 51 (58.0%) and 37 (42.0%) respectively on December 31, 1995. Twenty-eight patients (31.8%) died of uroepithelial cancer, and five patients (5.7%) died of other organic cancers. The survival rates of 5, 10, 15 and 20 years was 87.9%, 74.0%, 65.9% and 56.3%, respectively. From these results, patients with occupational uroepithelial cancer and workers who are exposed to aromatic amines should undergo long term observation.

[Chemosensitivity test by subrenal capsule assay (SRCA) in transitional cell carcinomas]

From November, 1986 to October, 1989, the antitumor activities of several chemotherapeutic agents were tested by subrenal capsule assay (SRCA) in cases of 23 transitional cell carcinomas. Overall sensitivities of tested drugs to transitional cell carcinomas were compatible to clinical data and correlated with individual clinical courses. This method has some problems, but can be carried out at any institute and serve as an aid to the selection of chemotherapeutic agents.

[Clinical observations of plasma fibronectin in patients with urological malignant disease]

Fibronectin (FN) is a high molecular weight glycoprotein widely distributed in the body and has a number of biological activities. Recently, there have been reports on the relationship between plasma fibronectin (pFN) levels and malignant diseases, but the significance of pFN is still unclear. Using immunoturbidimetric assay, we measured pFN levels of 24 healthy controls and 61 patients with urological malignant diseases, and obtained the following results. 1. pFN levels before treatment. 1) pFN level was 379 +/- 60.6 micrograms/ml and 356 +/- 123.7 micrograms/ml in the healthy controls and patients, respectively. There was no significant difference. 2) pFN level in patients with metastases was 320 +/- 92.9 micrograms/ml and had no statistical difference as compared with patients without metastases (371 +/- 132.7 micrograms/ml) and controls, despite the decrease in the mean value. 3) pFN level in patients with poor prognosis (300 +/- 107.8 micrograms/ml) was significantly lower than that in patients with good prognosis (410 +/- 157.2 micrograms/ml) and controls (p less than 0.05). 2. pFN levels during conservative treatments for advanced disease. pFN level in patients with a rapid progressive disease (287 +/- 64.4 micrograms/ml) was significantly lower than that in patients with a slow progressive disease (327 +/- 43.3 micrograms/ml) (p less than 0.01). These data suggest that low pFN level predicts rapid progression of the disease and poor prognosis in patients with a urological malignant disease.

Ureterostomy in situ for ureteral splinting and temporary urine drainage

Ureterostomy in situ is a simple technique for supravesical urinary diversion. Although it was described about 30 years ago, the method has yet to become popular. We employed mainly this method as ureteral splinting and as temporary urine drainage in 24 patients with ureteropelvic operation, and recommend it as a useful method for technical simplicity and other merits.