Inorganic phosphorus (Pi) in CSF is a biomarker for SLC20A2-associated idiopathic basal ganglia calcification (IBGC1)

INTRODUCTION

Idiopathic basal ganglia calcification (IBGC), also called Fahr's disease or recently primary familial brain calcification (PFBC), is characterized by abnormal deposits of minerals including calcium mainly and phosphate in the brain. Mutations in SLC20A2 (IBGC1 (merged with former IBGC2 and IBGC3)), which encodes PiT-2, a phosphate transporter, is the major cause of IBGC. Recently, Slc20a2-KO mice have been showed to have elevated levels of inorganic phosphorus (Pi) in cerebrospinal fluid (CSF); however, CSF Pi levels in patients with IBGC have not been fully examined.

METHODS

We investigated the cases of 29 patients with IBGC including six patients with SLC20A2 mutation and three patients with PDGFB mutation, and 13 controls. The levels of sodium (Na), potassium (K), chloride (Cl), calcium (Ca), and Pi in sera and CSF were determined by potentiometry and colorimetry. Moreover, clinical manifestations were investigated in the IBGC patients with high Pi levels in CSF.

RESULTS

The study revealed that the average level of Pi in the CSF of the total group of patients with IBGC is significantly higher than that of the control group, and the levels of Pi in CSF of the IBGC patients with SLC20A2 mutations are significantly higher than those of the IBGC patients with PDGFB mutations, the other IBGC patients and controls.

CONCLUSION

Results of this study suggest that the levels of CSF Pi will be a good biomarker for IBGC1.

Sonographic Detection of Subcutaneous Foreign Bodies in 3 Cases

Subcutaneous masses caused by foreign bodies are frequently encountered in daily practice. Although the majority of foreign bodies such as metals can be detected by radiography, substances such as vegetative materials or wood are difficult to detect. To our knowledge, only a few studies have described the sonographic characteristics of foreign bodies. Herein, we report 3 cases where we studied the sonographic characteristics of the foreign bodies in the dermis and subcutaneous tissue. Our results revealed the following 3 foreign bodies: (1) glass, (2) vegetative material, and (3) a pencil core. Thus, sonographic examination is useful for the detection of foreign bodies.

[Effects of Aging and Sex Differences on the Median Nerve: Relationship Between Nerve Conduction Study and Ultrasonographic Cross-Sectional Nerve Area]

OBJECTIVE

The aim of this study was to evaluate the relationship between nerve conduction and sonographic measurements of the median nerve, and to investigate the effects of aging and sex on nerve structure.

METHODS

Measurements from both hands of 82 healthy volunteers were included in this study (45 men and 37 women, 38.9 ?17.7 years). The cross-sectional area(CSA) of the median nerve was evaluated at the carpal tunnel inlet (MA) and at the midpoint of the forearm (MB).

RESULTS

The CSA of the median nerve at the MA was significantly correlated with age (r=0.501, P< 0.001), and distal motor latency (r=0.269, P<0.001). Although this study demonstrated the effects of the sex dif- ferences and aging on the CSA of the median nerve at MA, there was no significant effect at the MB.

CONCLUSIONS

Our study suggests that aging could affect median nerve structure, especially at the anatomical entrapment point. [Original].

[Change in Serum Levels of New Hepatic Fibrosis Marker "Mac-2 Binding Protein Glycosylation isomer (M2BPGi)" in Patients with Chronic Hepatitis C during the Treatment of Pegylated Interferon and Ribavirin]

The sustained virological response (SVR) rate in the patients with HCV has currently reached to 90% by the progression of anti-viral therapy. However, several reports demonstrated that hepatocellular carcinoma develops even in the patients with SVR. It is widely accepted that liver fibrosis plays a pivotal role in hepatocellular carcinogenesis. Thus, an accurate staging for liver fibrosis is necessary to improve long-term prognosis of hepatitis C patients. Recently, Mac-2 binding protein glycosylation isomer (M2BPGi) was identified as a novel hepatic fibrosis marker. In the present study, we compared the value of M2BPGi in serum before and after the anti-viral therapy in hepatitis C patients. The value of M2BPGi in patients with F2, F3, or F4 stagings was significantly higher than that in F1 staging. Moreover, the value of M2BPGi significantly decreased after the treatment with pegylated interferon plus ribavirin similarly to other liver fibrosis-related markers. In addition, the value of M2BPGi in patients with SVR was significantly decreased after the anti-viral therapy (P < 0.0001). The reduction of M2BPGi in SVR patients was thought to reflect the improvement of liver fibrosis, in conjunction with the reduction of viral load, after the treatment. In conclusion, the measurement of M2BPGi in serum might be useful in monitoring the improvement of liver fibrosis by anti-viral therapy.

[Evaluation of peripheral neuropathy in the patients with type 2 diabetes mellitus by laboratory examination: relationship between albuminuria and ankle-brachial index]

The aim of this study was to investigate the influence of peripheral neuropathy on laboratory examinations and to evaluate the relationship between nerve conduction velocity (NCV), albuminuria, and ankle-brachial index (ABI) results in patients with type 2 diabetes mellitus (DM). One hundred twenty-six patients with type 2 DM who had undertaken the nerve conduction study for an initial screening test of diabetic complications were included in our study. We divided patients to 4 groups according to the stage of microalbuminuria and ABI results. Two factors negative (2FN) group (n = 75), urinary albumin creatinine ratio (A/C) < 30 mg/gCr and ABI > or = 1.0; A/C group (n = 25), A/C > or = 30 mg/gCr and ABI > or = 1.0; ABI group (n = 14), A/C < 30 mg/gCr and ABI < 1.0; two factors positive (2FP) group (n = 12), A/C > or = 30 mg/gCr and ABI < 1.0. Neuropathy, retinopathy, hypertension, macroangiopathy, and hyperlipidemia were seen in 57.9%, 38.1%, 59.5%, 22.2%, and 56.3%, respectively. Lower leg NCV in 2FP group was significantly lower than other groups. Our study indicated that impaired diabetic peripheral neuropathy may be detected by combining decreased ABI with increased A/C results.

BMI is associated with larger index tumors and worse outcome after radical prostatectomy

BACKGROUND

To investigate the impact of body mass index (BMI) on tumor characteristics and biochemical recurrence (BCR) after radical prostatectomy (RP) for prostate cancer (PCa) in Japanese men.

METHODS

We evaluated data from consecutive patients who had undergone RP. Data analyzed included age, preoperative serum PSA, prostatic volume, BMI (continuous or categorized (≤ 25 kg/m(2)) values), clinical and pathological findings including index tumor volume (ITV), and current status in areas such as smoker or nonsmoker and presence or absence of diabetes. We analyzed association between BMI and BCR, especially based on ITV using univariate and multivariate analysis.

RESULTS

We analyzed data from a total of 703 patients. The median follow-up time was 38.4 months. BCR was diagnosed in 154 patients (21.9%) at a median of 9.7 months postoperatively. Multivariate linear regression analysis adjusted for preoperative variables showed a significant positive association between BMI and ITV (continuous BMI: P=0.002; categorical BMI: P<0.001, respectively), especially for higher-grade tumors (Gleason score ≥ 7). Cox proportional hazards analysis showed a significant association between continuous BMI and BCR after surgery (preoperative variables, hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.02-1.16, P=0.008), independent of clinical and pathological findings. In patients with high-risk cancer, the positive association between BMI and BCR was strengthened (preoperative variables, continuous BMI, HR 1.16, 95% CI 1.07-1.26, P<0.001; categorical BMI, HR 2.11, 95% CI 1.29-3.45, P=0.003, respectively).

CONCLUSIONS

Greater BMI significantly correlates with higher rates of BCR after surgery; BMI is a preoperative variable associated with high-grade ITV. Our results suggest that the biological environment created by greater BMI may contribute to increasing tumor aggressiveness.

[Diagnostic ability of ultrasonography for the rotator cuff tear: comparison with ultrasonography and MRI findings]

Ultrasonography (US) is a non-invasive method which can assess not only solid tissue organs but also soft tissues such as tendons and nerves. However, it has not been fully understood that US is a useful tool for the depiction of periarticular structure. We compared the diagnostic accuracies between US and magnetic resonance imaging (MRI) in the patients with rotator cuff tear (RCT). Seventy patients, who underwent arthroscopic surgery, preoperative US and MRI examinations at Gifu University Hospital from January 2010 to April 2013 (49 male, 21 female, mean age 59.7 +/- 15.9) were included in this study. The diagnostic accuracy, sensitivity and specificity of US and MRI were 94.3% and 94.3%, 95.8% and 97.9%, 90.9% and 84.6%, respectively, when the intraoperative finding was regarded as a gold standard. These results suggest that US is useful for the diagnosis of RCT as equal as MRI.

[A retrospective study of the relationship between bacterial numbers from central venous catheter tip cultures and blood cultures for evaluating central line-associated bloodstream infections]

Catheter-related bloodstream infection (CRBSI) is an infectious disease requiring special attention. It is a common cause of nosocomial infections; catheter insertion into the central veins particularly increases the risk of infection (CLA-BSI: central line-associated bloodstream infection). We examined the relationship between the number of bacterial colonies cultured from shredded central venous catheter (CVC) tips and from blood cultures in our hospital from 2011 to 2012. Coagulase-negative staphylococci topped the list of microbe isolated from the CVC tip culture, followed by Pseudomonas aeruginosa, Staphylococcus aureus, and Candida spp. S. aureus and Candida spp., with growth of over 15 colony-forming units in the CVC tip culture, were also detected at high rates in the blood culture. However, gramnegative bacilli (Enterobacteriaceae and P. aeruginosa) did not show a similar increase in colony number in the CVC tip culture. Because microbes adhering to shredded catheter tips are readily detected by culture, this method is useful as a routine diagnostic test. In addition, prompt clinical reporting of the bacterial number of serious CLA-BSI-causing S. aureus and Candida spp. isolated from CVC tips could contribute to earlier CLA-BSI diagnosis.

[Clinical significance of hyaline casts in the new CKD risk classification (KDIGO 2009)]

Chronic kidney disease (CKD) significantly contributes to the increased number of dialysis patients with end stage renal disease. A new CKD risk classification (KDIGO 2009) established in 2011, which is defined by albuminuria and estimated glomerular filtration rate (eGFR) values, demonstrates the relative risks of CKD in great detail. In this study, we evaluated the clinical significance of urinary casts by categorizing a risk Group 1 to 5 according to the KDIGO 2009 classification. In the high risk CKD group (risk group 3 and over), we found a significantly higher number of patients who had > 100 hyaline casts/whole field (WF) in their urine than those that had < 100 hyaline casts/WF. Further, we determined the diagnostic accuracy for the high risk CKD group when the cutoff value for the number of hyaline casts was set at > or = 100 hyaline casts/WF (sensitivity: 44.7%, specificity: 96.5%). The eGFR value was significantly lower in the group with > or = 100 hyaline casts/WF, particularly in hypertensive patients, than that in the group with < 100 hyaline casts/ WF. Of interest is that the eGFR value was significantly lower in patients with 100-999 hyaline casts/WF and > or = 1,000 hyaline casts/WF than that in patients with < 100 hyaline casts/WF in A1 stage. Thus, our present study suggests that the presence of > or = 100 hyaline casts/WF indicates decreased eGFR, and the urinary casts counting may be important and useful for the screening and early detection of high-risk CKD.

Successful treatment of monomorphic primary central nervous system post-transplantation lymphoproliferative disorder 5 years after kidney transplantation

A 31-year-old man underwent living-related kidney transplantation in 2004 as a consequence of primary focal segmental glomerulosclerosis (FSGS). Four years after the transplantation, we confirmed nephrotic syndrome caused by recurrent FSGS. We performed plasmapheresis and low-density lipoprotein adsorption. We also combined steroid therapy with a reduction in the dose of tacrolimus and an increased dose of mycophenolate mofetil. The nephrotic syndrome improved dramatically with this combined therapeutic approach. However, 10 months after these treatments, he revisited our hospital because of altered consciousness. We detected multiple tumor masses in his brain that were ring enhanced on contrast magnetic resonance imaging. Consequently, we suspected primary central nervous system post-transplantation lymphoproliferative disorder (CNS-PTLD). We performed a craniotomy to biopsy the brain tumors. The biopsy specimen showed Epstein-Barr virus-associated diffuse large B-cell lymphoma. There is no definitive treatment for CNS-PTLD. Therefore, we treated the primary CNS-PTLD successfully with whole-brain radiation and discontinuation of immunosuppression therapy.

Transient ligation of umbilical vessels elevates placental tissue oxygen index (TOI) values measured by near-infrared spectroscopy (NIRS) in clawn miniature pig animal model

We recently found a significant elevation in placental tissue oxygen index (TOI) values in cases of fetal growth restriction using near-infrared spectroscopy (NIRS), indicating high oxygenation in the placental tissue. We hypothesized that insufficient fetoumbilical blood flow is causatively associated with high oxygenation levels in placental tissue. We transiently (for 15 sec) ligated the whole umbilicus, umbilical arteries, or veins of pregnant Clawn miniature pigs (102-113 days of gestation) and assessed the changes in TOI values of the placenta and fetus. The ligation significantly increased placental TOI values (p<0.01, respectively), but concomitantly decreased fetal TOI values (p<0.01, respectively), suggesting a decline in oxygen inflow from the maternal to fetal circulation in the placental tissue to be causative of the elevated placental TOI values. These observations suggest the promising clinical use of placental TOI values measured noninvasively by the transabdominal application of NIRS to assess the fetoplacental circulation.

[Urinary protein to creatinine ratio and urinary sediments are useful for the screening of chronic kidney disease]

Chronic Kidney Disease (CKD) is an important risk factor of the End Stage Renal Disease (ESRD). In this study, we investigated whether the protein to creatinine ratio (the ratio of P/C) determined by the semiquantitative urinary stick test and urinary sediments are useful for the early detection of CKD. One hundred sixty patients were classified to four or five groups by P/C ratio and various biochemical markers were analyzed. As a result, the 300 mg/g x Cr of P/C group showed a significantly increased serum cystatin C level. The positive rate of the P/C ratio in CKD stage was significantly increased compared with the conventional protein qualitative analysis. Further, the amounts of urinary sediments in CKD stage 1 to 2 were increased, such as hyaline cast, and pathological casts were increased in CKD stage 3 to 5. Thus, our present study suggests that the ratio of P/C and urinary sediments are useful for the screening of CKD.

Relationship of Porphyromonas gingivalis with glycemic level in patients with type 2 diabetes following periodontal treatment

INTRODUCTION

The aim of this study was to assess the relationship between serum glycemic levels and subgingival microbial profile alteration following periodontal treatment in patients with type 2 diabetes mellitus.

METHODS

We studied 30 periodontitis patients with type 2 diabetes mellitus who received full-mouth subgingival debridement by analyzing their subgingival microbial profiles using a polymerase chain reaction method at baseline and various time-points for 12 months following treatment. Concurrently, probing pocket depth, bleeding on probing, and metabolic parameters, including glycated hemoglobin A1c (HbA1c), blood sugar level, C-reactive proteins, total cholesterol, triglyceride, and high-density and low-density lipoprotein cholesterol, were recorded.

RESULTS

Periodontal conditions were significantly improved after treatment, and the occurrence rates of periodontal bacterial species, including Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, and Prevotella intermedia, were also reduced. Interestingly, P. gingivalis was detected more frequently in subjects with increased HbA1c values after periodontal treatment than in those patients with decreased HbA1c values. Furthermore, P. gingivalis with type II fimbriae was detected only in HbA1c-increased subjects, while improvements in HbA1c values were observed only in subjects without type II clones.

CONCLUSIONS

These results suggest that glycemic level in diabetes is affected by the persistence of P. gingivalis, especially clones with type II fimbriae, in periodontal pockets.

Morphological features of cartilage observed during mandibular distraction in rabbits

Ossification during distraction osteogenesis can be classified as intramembranous or endochondral. It is not known whether cartilage in the distraction gap is transformed into new bone. The aim of this study was to investigate the morphological features of ossification in the transition of cartilage to bone during mandibular distraction osteogenesis in a rabbit model. A cortical osteotomy was performed and custom-made devices were applied. Immediately after surgery, the devices were lengthened by 0.25 mm every 12h for up 10 days, during which time four rabbits were killed at 0, 5 and 10 days and examined using histological staining and immunohistochemical methods. Apoptotic cells were identified by an in-situ detection assay for nuclear DNA fragmentation using a modified TUNEL procedure, with several sections analyzed using software for histomorphometric analysis. The results showed that the amount of cartilage in the distraction gap was significantly decreased. The cartilage had ossified in two ways, termed endochondral ossification and transchondroid bone formation.

A simple method for bone positioning of mandibular segments

A simple bone-positioning technique is reported, using a combination of bone plates and a flexible tube filled with acrylic polymer. The flexible tube is solidified by injection of acrylic monomer. This technique is applicable for bone positioning after mandibular resection as well as positioning of the proximal segment after sagittal split ramus osteotomy. This technique has the advantages of greater simplicity and flexibility compared to previously reported methods of bone positioning.

[Clinical laboratory system in a complete electronic hospital]

The use of a Laboratory Information System (LIS) and Laboratory Automation System (LAS) are clearly superior to manual results in terms of completeness and legibility. As the current clinical information system (CIS) in Gifu University Hospital consists of a complete electronic medical record system, the clinical laboratory was re-engineered to simplify workflow, pay attention to quality assurance, and decrease various costs by an intelligent laboratory management system. We named the new system Gifu Premiotic Intelligent Laboratory System (GPILS). Further advances will concentrate on the cost-effective use of LIS, and the potential use of GPILS in our laboratories will be discussed. In addition, because one of our clinical laboratories currently provides various useful clinical laboratory-oriented information to physicians and patients, we have developed new tools named the "Reference Data Base (RefDB)". In the near future, several different types of computer technology for various clinical laboratory information will lead to the development of highly specific platforms for LIS corresponding to a complete electronic medical record system.

[Clinical significance and problems in HCV measurement--comparison of CLEIA method with PCR method]

Infection of a hepatitis C virus (HCV) is confirmed by the presence of HCV antibody or HCV-RNA. Recently, a highly sensitive method to examine HCV-core antigen has been developed. In this study, to evaluate the clinical significance of HCV-core antigen determination, we examined serum HCV infection markers, HCV-core antigen, HCV-RNA (AMPLICOR) and HCV-antibody (third generation) concentrations. We determined 225 serum samples, and three patients receiving the treatment with interferon. In 102 HCV-RNA positive samples, significant correlation was observed between HCV-RNA and HCV-core antigen (r=0.734, p<0.0001). However, three out of 102 (2.9%) cases were included within the negative range of HCV-core antigen (20 fmol/l). The HCV-core antigen value in three patients receiving the treatment with interferon paralleled with the amount of HCV-RNA. The determination of HCV-core antigen by CLEIA is a useful and time-saving method, but an attention should be paid to the presence of false-negative cases.

Changes in quinolinic acid production and its related enzymes following D-galactosamine and lipopolysaccharide-induced hepatic injury

Increases in quinolinic acid (QUIN), a neurotoxic L-tryptophan metabolite, have been observed in human serum and cerebrospinal fluid and in animal models of severe hepatic injury. The aim of this study was to evaluate the changes in QUIN accumulation and its related enzymes after acute hepatic injury induced by D-galactosamine and endotoxin. Gerbils were given an intraperitoneal injection of pyrogen-free saline alone as control, lipopolysaccharide (LPS) alone (150 ng/kg), D-galactosamine alone (500 mg/kg) or a combination of D-galactosamine with LPS. Concentrations of QUIN, its related metabolites, and related enzyme activities were determined. D-Galactosamine treatment significantly decreased activities of hepatic aminocarboxymuconate-semialdehyde decarboxylase (ACMSDase) resulting in increased QUIN concentrations in serum and tissues. The magnitude of QUIN responses was markedly increased by endotoxin due to the increased availability of L-kynurenine, a rate-limiting substrate for QUIN synthesis. Further, infiltration of monocytes/macrophages, which is a possible major source of QUIN production in the liver, was shown by immunohistochemistry after hepatic injury induced by D-galactosamine and endotoxin. Increased serum QUIN concentrations are probably due to the increased substrate availability and the decreased activity of aminocarboxymuconate-semialdehyde decarboxylase in the liver, accompanying the increased monocyte/macrophage infiltration into the liver after hepatic injury.

[The present status of convergence in PSA reference values--from the surveillance in the Tokai-Hokuriku district]

The number of patients with prostatic cancer is recently increasing in Japan and it is well known that serum PSA determination is routinely used as a tumor marker of prostatic cancer. However, the reference values of PSA are widely varied, because the reactivities of the antibody to free PSA and ACT-PSA are different in each kit. Thus, there is no compatibility among values determined by available kits. In this study, we sent a questionnaire on PSA determination to 180 hospitals with more than 200 beds. The recovery rate to the questionnaire was 80.5% (145/180) and the determination was performed in house at 47 hospitals out of 145. Stamey in Stanford University recommended to set the ratio of complex PSA to free PSA 9:1 in the reference material. It is expected that PSA ad hoc committee in Japan reported that the inter-kit variability is becoming small. It can be said that the standardization for PSA determination is progressing. To discriminate prostatic cancer from benign prostatic hypertrophy, free PSA ratio or complex ACT-PSA is recommended. Further accumulation of data on PSA will be necessary to confirm this matter.

[Clinical significance of MMP-3 in patients with rheumatoid arthritis: comparison with other inflammatory markers(IL-6, IL-8)]

We determined serum metalloproteinase-3(MMP-3) and inflammatory cytokine(IL-6, IL-8) levels in patients with rheumatoid arthritis(RA). Sera were obtained from 307 healthy subjects(female 140, male 167), 54 RA patients, and 17 osteoarthritis (OA). The MMP-3 concentrations in healthy female and male were 43.3 +/- 15.3 ng/ml and 90.7 +/- 26.0 ng/ml, respectively. The serum MMP-3 levels in male were significantly higher than those in female (p < 0.0001). MMP-3 levels in RA patients(259.1 +/- 34.2 ng/ml) were significantly higher than OA(43.6 +/- 6.1 ng/ml) or healthy controls. There was a significant correlation between MMP-3 and CRP(r = 0.586), IL-6(r = 0.345) levels in serum. In contrast, no significant correlation was observed between MMP-3 and IL-8(r = 0.19), or CA-RF(r = 0.052) levels. However, there were some cases with high MMP-3 levels in CA-RF-negative patients definitely diagnosed as RA. These findings suggest that MMP-3 determination is useful for the early diagnosis and the follow-up during the treatment for RA patients.

Peripheral primitive neuroectodermal tumor of the vulva: report of a case with imprint cytology

BACKGROUND

Peripheral primitive neuroectodermal tumor (PNET) of the vulva is an extremely rare disease, and, to our knowledge, only two cases have been previously reported.

CASE

A 45-year-old woman presented with a mass in the right labium major. Three years after removal of the tumor, she noticed a new lesion in the same place and underwent a partial vulvectomy. The imprint cytology of the recurrent tumor showed a monomorphic appearance, composed of small round cells with scant cytoplasm against a hemorrhagic background. These tumor cells were loosely connective, but rosettelike structures were observed focally. On pathologic examination, the neoplasm was composed of small round tumor cells showing sinusoidal, diffuse or micropapillary growth. Immunohistochemically, the neoplastic cells stained positively for neuron-specific enolase, vimentin and HBA 71 and negatively for cytokeratin, HBA 45 and muscle-specific actin. The morphologic characteristics of the disease were well expressed in the imprint cytology, and this influenced the selection of immunohistochemical studies.

CONCLUSION

Cytologic examination for vulvar tumors, even imprint cytology, can be a useful tool in obtaining an accurate pathologic diagnosis of a rare disease, such as peripheral PNET.

Initial experience of percutaneous renal cryosurgery under the guidance of a horizontal open MRI system

OBJECTIVE

The aim of this study was to obtain preliminary results of cryoablation of renal tumors by using a percutaneous approach guided by a horizontal open MRI system, and to assess the safety and efficacy of this procedure.

MATERIALS AND METHODS

Four patients with renal tumors underwent percutaneous cryosurgery with local anesthesia using a horizontal open MRI system (AIRIS II, Hitachi Medical Corp., Tokyo, Japan). The size of the mass was radiographically documented as 4 cm or less in diameter. A 2- or 3-mm cryoprobe was advanced into the renal mass under real-time MR monitoring. Growth of the iceball during cryoablation was monitored by two-dimensional MR images. Follow-up dynamic CT and physical examination were done after two weeks and six weeks.

RESULT

MR imaging demonstrated the iceballs as sharply marginated regions of signal loss that expanded and engulfed the renal mass with clear contrast between the iceball and surrounding tissue. Cryoablated tumors resolved, and there were no serious complications and no clinically significant changes during the procedures and follow-up study.

CONCLUSION

In this limited clinical trial of percutaneous renal tumor surgery, cryoablation demonstrated its feasibility with minimal morbidity. Intraprocedual MR-guided cryosurgery can be used as a safe modality, although further studies are necessary to determine the long-term efficacy of this procedure.

[Pulmonary infarction caused by the spontaneous migration of the vena caval tumor thrombus of right renal cell carcinoma: a case report]

A 70-year-old male with right renal mass incidentally found by annual check-up using ultrasound, was referred to Department of Urology, Jikei University Affiliated Kashiwa Hospital. He was diagnosed as having right renal cell carcinoma with vena caval tumor thrombus extending above the diaphragm (T3c) preoperatively. The day before the scheduled day of operation, right pulmonary infarction caused by spontaneous migration of vena caval tumor thrombus of right renal cell carcinoma developed. Although arterial blood gas findings were poor, he only had low grade chest pain without shock. Therefore, we successfully performed right radical nephrectomy and thrombectomy of right pulmonary artery the next day. He was discharged 42 days postoperatively, but, he died from acute heart failure 9 months after the operation.

Application of high-surface-area ZrO2 in preconcentration and determination of 18 elements by on-line flow injection with inductively coupled plasma atomic emission spectrometry

A flow-injection analysis (FIA) system incorporating a micro-column of ZrO2 has been used for the development of an on-line multi-element method for the simultaneous preconcentration and determination of Al, Bi, Cd, Co, Cr, Cu, Fe, Ga, In, Mn, Mo, Ni, Pb, Tl, V, Sb, Sn, and Zn by inductively coupled plasma atomic emission spectrometry (ICP-AES). The conditions for quantitative and reproducible preconcentration, elution, and subsequent on-line ICP-AES determination were established. A sample (pH 8) is pumped through the column at 3 mL min(-1) and sequentially eluted directly into the ICP-AES with 3 mol L(-1) HNO3. With a sample volume of 100 mL and an elution volume of 1 mL signal enhancement 100 times better than for conventional continuous aspirating systems was obtained for the elements studied. The reproducibility (RSD %) of the method at the 10 ng mL(-1) level in the eluate is acceptable - less than 8% for five replicates. Recoveries between 95.4% and 99.9% were obtained for the elements analysed. ZrO2, with a specific surface area of 57 m2 g(-1) and a capacity of approximately 5 mg g(-1) for the elements studied, was synthesized by hydrolysis of ZrCl4. The preconcentration system was evaluated for several simple synthetic matrices, standard water samples and synthetic seawater. The effect of foreign ions on the efficiency of preconcentration of the elements studied was investigated. The application of a micro-column filled with high-surface-area ZrO2 and flow injection inductively coupled plasma atomic emission spectrometry enables preconcentration and simultaneous determination of 18 elements at low concentrations (ng L(-1)) in different water samples.

[Clinical statistics on patients and operations during a 20-year period (1978-1997) at Department of Urology, Jikei University School of Medicine]

A statistical analysis was made of diseases, patients, and operations at our department in the four affiliated hospitals of Jikei University School of Medicine from 1978 through 1997. Our findings were as follows. Newly diagnosed urogenital malignancies, except testicular tumors, have been increasing in the last two decades among both outpatients and inpatients. Urogenital infections, including tuberculosis, have gradually been decreasing in the last two decades. The treatment of urinary stone diseases was markedly altered by the induction of extracorponeal shock wave lithotripsy.

[A case of patent urachus in an adult male]

A 31-year-old man was referred to our hospital for evaluation of urachal rest. The history of his present illness dated back to birth, when the umbilicus was projected and urinary discharge was noted. At that time, the symptom of discharge had spontaneously subsided. At the age of 22, however, the patient again experienced discharge from the umbilicus. Although he did not seek treatment, after six years this symptom disappeared. Around this time, however, pyuria was revealed during medical examination, and abdominal ultrasonography (US) suggested the presence of urachal rest. At the time of hospitalization, physical examination revealed that the patient's right testis was not palpable. He was diagnosed with patent urachus with hemilateral aplasia and monorchism by US, computed tomography, magnetic resonance imaging and cystoscopy. The patient subsequently underwent radical operation. Patent urachus in adults is very rare, and only a few cases have been reported. To our knowledge, only one previously reported case involved a recurrence after spontaneous healing. Further, this is the first report of a patient with patent urachus with hemilateral aplasia and monorchism. Radical operation is generally recommended, based on the fact that very few cases heal conservatively.

[A case of Sipple syndrome whose bilateral pheochromocytomas were resected separately after a 3-year interval]

A 23-year-old woman who had undergone total thyroidectomy and parabronchial lymphadenectomy at the Department of Otolaryngology in our hospital was suspected to have a thyroid carcinoma. Histological examination revealed a medullary carcinoma of the thyroid and normal parathyroid glands. Because a computed tomographic scan after surgery revealed a tumor of the left adrenal gland, the patient was examined at our department two months after the thyroidectomy, 1994. Endocrinic examinations and 123I-MIBG scintigraphy revealed a left adrenal pheochromocytoma of Sipple syndrome. She then underwent left adrenalectomy. Histological diagnosis was pheochromocytoma of the left adrenal gland. Three years after the surgery, a right adrenal tumor was detected by computed tomography. Although results of endocrine examinations were normal, 131I-MIBG scintigraphy showed a hot spot in the right adrenal gland. Right adrenal pheochromocytoma was diagnosed 3 years after surgery for a contralateral adrenal pheochromocytoma. Although surgery was recommended, the patient consented to right adrenalectomy, 1 year later after marriage and before becoming pregnant. Histological examination of the resected specimen revealed pheochromocytoma of the right adrenal gland.

Speciation of selenium compounds with ion-pair reversed-phase liquid chromatography using inductively coupled plasma mass spectrometry as element-specific detection

For selenium speciation analysis, the hyphenation of chromatographic separation with element-specific detection has proved a useful technique. A powerful separation system, which is capable of resolving several biologically and environmentally important selenium compounds in a single column, is greatly needed. However, that has been difficult to achieve. In this paper eight selenium compounds, namely, selenite [Se(IV)], selenate [Se(VI)], selenocystine (SeCys), selenourea (SeUr), selenomethionine (SeMet), selenoethionine (SeEt), selenocystamine (SeCM) and trimethylselenonium ion (TMSe+), were separated by using mixed ion-pair reagents containing 2.5 mM sodium 1-butanesulfonate and 8 mM tetramethylammonium hydroxide as a mobile phase. The separation of these anionic, cationic and neutral organic selenium compounds on a LiChrosorb RP18 reversed-phase column took only 18 min at a flow-rate of 1.0 ml/min with isocratic elution, and baseline separation among the six organic Se compounds was achieved. Inductively coupled plasma mass spectrometry (ICP-MS) was employed as element-specific detection. A comparison of ICP-MS signal intensity obtained with a Barbington-type nebulizer and with an ultrasonic nebulizer (USN) was made. Different signal enhancement factors were observed for the various selenium compounds when a USN was used. The speciation technique was successfully applied to the study on chemical forms of selenium in a selenium nutritional supplement. Selenomethionine was found to be the predominant constituent of selenium in the supplement.

[Clinical efficacy of cefpirome sulfate against Bacteroides species, Prevotella species and Porphyromonas species. Society of Anaerobic Bacterial Infections in the fields of obstetrics and gynecology in Gifu]

The injectable cephalosporin cefpirome (CPR) was launched in Japan in 1993. It has widely been used in the various infectious diseases. We therefore studied the clinical and bacteriological efficacy of CPR against infections caused by Bacteroides species, Prevotella species and Porphyromonas species frequently isolated from the obstetric and gynecologic infections. Thirteen institutions were involved in this study which ran from March 1994 to January 1999. The administration dosage of CPR was 2 to 4 gram per day administered by drip infusion or intravenous infusion. The duration of treatment was from 3 to 15 days. The evaluations were performed before and after the treatment. CPR was administered to 194 patients with obstetric and gynecologic infections, and 146 of 194 cases were acceptable for the evaluation of drug efficacy. Bacteroides species were identified in 102 patients. Clinical efficacy in 146 cases was excellent in 12 patients, good in 110, fair in 9 and poor in 15 patients. The eradication rate for Bacteroides species could be in 37 cases out of 54 evaluable cases; Prevotella species in 38 out of 49; and Porphyromonas species in 5 out of 5. The overall assessment of bacteriological efficacy was "eradicated" in 91 cases out of 133 (68.4%). Adverse reactions including abnormal findings in laboratory tests were seen in 8 patients (4.76%). Based on these results, CPR promises efficacy and safety in the treatment of obstetric and gynecologic infections due to Bacteroides species.

[Clinical studies on inverted papilloma of the urinary tract]

BACKGROUND

Inverted papilloma of the urinary tract is believed to be a benign neoplasm based on its histologic morphology and clinical behavior. In recent years, however, several investigators have warned against too optimistic an approach, emphasizing the possibility of malignant cellular transformation within the lesion, or its eventual association with other urothelial tumors such as transitional cell carcinoma or carcinoma in situ. We here report on 35 clinicopathologically diagnosed cases of inverted papilloma, and present the clinical significance attributed to these lesions in view of the current literature.

PATIENTS AND METHODS

From 1976 to 1997, 35 cases of inverted papilloma of the urinary tract were treated at our hospital. This report presents the clinical features of these cases, the results of prognosis research, an investigation of the cases in which inverted papilloma and transitional cell carcinoma were found to co-exist, and a discussion of the recurrent cases of inverted papilloma found in previous literature.

RESULTS

The patients ranged from 24 to 77 years of age, with a mean of 54 years, and included 4 women and 31 men. The most frequently occurring symptom was grosshematuria, and more than 90% of the 35 cases occurred in the bladder. In 2 of the 35 cases, transitional cell carcinoma coexisted with the inverted papilloma, at a different location in the bladder in one case and within the same neoplasm in the ureter in the other case. Clinical courses after treatment were followed in 29 of the 35 cases, with a follow-up period of from 8 months to 19 years (mean follow-up, 5 years and 4 months). Of these 29 cases, 2 showed recurrence, one at 16 and one at 30 months after the initial resection. Many previous reports show that the association of inverted papilloma and transitional cell carcinoma is stronger in the upper urinary tract and recurrence of inverted papilloma almost always happens with 2 years.

CONCLUSION

This study suggests that some cases of urinary inverted papilloma show recurrence or malignant potential. Our results indicate that all cases of urinary inverted papilloma should be treated and followed as cases of low-grade transitional cell carcinomas. Consequently, all cases must be followed for two years or more after the initial operation.

Diagnosis of pheochromocytoma using [123I]-compared with [131I]-metaiodobenzylguanidine scintigraphy

BACKGROUND

Patient with pheochromocytoma (PCT) cannot be cured without operation, therefore, preoperative determination of the localization of PCT should be performed accurately. [131I]-Metaiodobenzylguanidine (MIBG) scintigraphy is a gold standard for the diagnosis of PCT. However, [123I]-MIBG is also found to accumulate in PCT. In order to clarify the usefulness of [123I]-MIBG scintigraphy for the local detection of PCT, we compared the distribution of [123I]- and [131I]-MIBG in patients with or without PCT.

METHODS

[131I]- and [123I]-MIBG scintigraphy was performed in 29 and 16 patients, respectively. In the former group, 14 patients had PCT, 12 had hypertension without any adrenal disorder and three had other diseases. In the latter group, eight patients had PCT, two had hypertension without any adrenal disorder and six had other diseases. The sensitivity, specificity and accuracy of [123I]-compared with [131I]-MIBG scintigraphy were compared.

RESULTS

The sensitivity of [131I]- and [123I]-MIBG scintigraphy was 85.7 and 90%, respectively. The specificity of each test was 100%. The accuracy of [131I]- and [123I]-MIBG scintigraphy was 93.1 and 95%, respectively. The quality of images obtained using [123I]-MIBG was better than with [131I]-MIBG, because [123I]-MIBG generated a higher dose of gamma-rays with a higher specificity than [131I]-MIBG. In addition, normal adrenal grands were visualized in 50% of patients tested with [123I]-MIBG scintigraphy.

CONCLUSIONS

These results indicate that [123I]-MIBG scintigraphy is a valuable tool for the local detection of PCT, as is [131I]-MIBG scintigraphy. Furthermore, it is possible that [123I]-MIBG can be used as an alternative to [131I]-MIBG for the detection of PCT. Our study was not a prospective study and the background of the patients was not matched. Further prospective studies are needed in order to determine the efficacy of [123I]-MIBG scintigraphy for the diagnosis of PCT.

[Magnetic resonance images of hematospermia]

BACKGROUND

We performed MRI (magnetic resonance imaging) in the pelvic region of 70 cases with hematospermia and conducted a study on the abnormal MRI findings to which hematospermia could be attributed.

METHODS

We conducted a study on the morphological anomaly and change in the signal intensity in the prostate gland and of the seminal vesicle as well as on the presence or absence of dilation in the plexus venous surrounding the deferent duct or the prostate gland out of the abnormal MRI findings. As for the seminal vesicle, the patients whose seminal vesicle was seen in higher intensity than the prostate gland in T1 weighted images were diagnosed as having hemorrhagic focus and the patients whose seminal vesicle was seen in low intensity both in T1 and T2 weighted images were diagnosed as having fibrosis caused by chronic inflammation.

RESULTS

Abnormal MRI findings were seen in 40 out of the 70 cases (57%). Anomaly in the prostate gland was indicated in 6 (9%) cases. Abnormality in the seminal vesicle was indicated in 30 cases (43%) including hemorrhage of seminal vesicle in 25 cases, chronic inflammation in five cases and cyst of seminal vesicle in one case.

CONCLUSION

In conducting an examination of the patients with hematospermia, MRI is the noninvasive and reproducible method and it is possible to identify the hemorrhagic region. Therefore, MRI is thought to be useful to identify the causal organs of hematospermia.

Isotope dilution analysis of Se in human blood serum by using high-power nitrogen microwave-induced plasma mass spectrometry coupled with a hydride generation technique

To establish a method for sensitive, accurate, and precise determination of Se in real samples, isotope dilution analysis using high-power nitrogen microwave-induced plasma mass spectrometry (N2 MIP-IDMS) was conducted. In this study, freeze-dried human blood serum (Standard Reference Material, NIES No. 4) provided by NIES (National Institute for Environmental Studies) was used as a real sample. The measured isotopes of Se were 78Se and 80Se which are the major isotopes of Se. The appropriate amount of a Se spike solution was theoretically calculated by using an error multiplication factor (F) and was confirmed experimentally for the isotope dilution analysis. The mass discrimination effect was corrected for by using a standard Se solution for the measurement of Se isotope ratios in the spiked sample. However, the sensitivity for the detection of Se was not so good and the precision of the determination was not improved (2-3%) by N2 MIP-IDMS with use of the conventional nebulizer. Therefore, a hydride generation system was connected to N2 MIP-IDMS as a sample introduction system (HG-N2 MIP-IDMS) in order to establish a more sensitive detection and a more precise determination of Se. A detection limit (3 sigma) of 10 pg mL-1 could be achieved, and the RSD was less than 1% at the concentration level of 5.0-10.0 ng mL-1 by HG-N2 MIP-IDMS. The analytical results were found to be in a good agreement with those obtained by the standard addition method using conventional Ar ICPMS.

Impairment of autonomic function induced by posture change in postmenopausal women

This study was designed to determine if there is a difference in autonomic regulation induced by posture change between postmenopausal and young women. To evaluate autonomic nervous system function, spectral analysis of heart rate variability (HRV) was done in postmenopausal women (n = 13, 46-59 years of age), age-matched men (n = 8, 45-55 years of age), and young women (n = 10, 20-37 years of age) for 3-min periods of controlled frequency breathing (15 breaths/min) in supine followed by sitting positions. In the supine position, the R-R interval variation in older persons decreased significantly compared with that during the follicular phase in young women. Furthermore, the high-frequency (HF) components of HRV, which reflect only parasympathetic activity, were lower in older subjects than in young women. Following a change of position from supine to sitting, the HF component did not change significantly in the postmenopausal women or the men, but the low/high frequency (LF/HF) component ratio, which reflects the balance of autonomic nerve activities, increased significantly in the men. These results suggest that cardiac parasympathetic tone may be reduced in older persons in comparison with young women. Furthermore, arterial baroreflex control of parasympathetic nerve activity caused by posture changes is impaired in the postmenopausal women and aged-matched men. The baroreflex control of the sympathetic component is maintained in the men but not in the postmenopausal women. These differences might result in part from changes in the level of female hormones.

Visual evoked potential and electroencephalogram of healthy females during the menstrual cycle

Flash visual evoked potential (VEP) and electroencephalogram (EEG) changes during the menstrual cycle were studied using healthy females having regular menstruation, with 21 at the follicular phase (FP) and 23 at the luteal phase (LP). The following results were obtained. (1) The waveforms of Group Mean VEPs of both groups had approximately similar triphasic contours, consisting of 16 components of P 1-N 8 up to 500 msec of latency. (2) Latencies tended to be longer in LP. (3) Interpeak amplitudes tended to be larger in LP, and one VEP interpeak amplitude (P 5-N 7) of long latency component was significantly larger at LP after eliminating the effect of body height by ANCOVA for 2 CH. (4) Quantitative analysis of EEGs between FP and LP resulted in a tendency for increased alpha, and decreased beta power % at LP. Since estrogen increases the VEP amplitude, and decreases the VEP latency and the alpha activity of EEGs, the large VEP amplitude, the tendency for prolonged VEP latency, and the tendency for increased alpha power % at LP observed in this study indicate that the VEP amplitude at LP reflects the effect of estrogen, and that the VEP latency and EEGs at LP reflect the effect of progesterone.

Sex differences in visual evoked potential and electroencephalogram of healthy adults

Sex differences in flash visual evoked potentials (VEPs) and electroencephalograms (EEGs) were studied in 200 healthy adults (100 females and 100 males). Following results were obtained. (1) Waveforms of Group Mean VEPs of each sex had roughly triphasic contour, consisted of components P1 approximately N8, within 500 msec of latency. (2) Latencies of VEP components by t-test, (3) By analysis of covariance, sex differences in peak-to-peak amplitudes were still significant after eliminating effects of body height, body weight or age, but not those in latencies after eliminating the effect of body height. (4) Quantitative analysis of EEGs resulted in significantly smaller absolute amplitudes, and significantly larger theta, larger beta 1 and smaller alpha 2 power % in females. (5) Peak-to-peak amplitudes of later components in VEPs for 5CH (O1-->Cz) were significantly and positively correlated with EEG absolute amplitudes within each sex group. (6) There were few significant differences in VEP components between follicular phase and luteal phase in females. The sex differences in VEPs verified in this study may be attributed to genetically determined sex differences in neuroendocrinological systems.

Determination of different oxidation states of arsenic and selenium by inductively coupled plasma-atomic emission spectrometry with ion chromatography

Recent regulation in Japan requires more sensitive trace analysis methods for the determination of arsenic and selenium and their oxidation states As(III) and (V), Se(IV) and (VI). The hydride generation (HG) technique is usually used in combination with AAS and ICP-AES to increase sensitivity. However, hydrochloric acid is mostly used to acidify the sample solution in HG. Isobaric interferences due to chlorine-related species cause mass spectral problems when the same solution is used for the determination of these elements by ICP-MS. In this study, different oxidation states of As and Se were determined by coupling ion chromatography (IC) to an ICP-AES instrument. An HG technique was used to introduce test samples into the ICP. Nitric acid was employed to acidify the samples for HG. The concentrations of acid and base were kept as low as possible to reduce contamination. The formation of As and Se hydrides could be achieved without HCl, if the concentrations of acid and alkaline solutions were optimized. However, HCl was necessary for additional reduction of Se(VI) to Se(IV).

Renal gluconeogenesis in man: comparison with rats and rabbits

To provide evidence on renal gluconeogenesis in humans and to compare with rats and rabbits, glucose production from several substrates was determined using cortical slices of the three species. In humans, the normal parts of kidney tissue were obtained from six cases of transitional cell carcinoma of the renal pelvis and four cases of renal cell carcinoma. Renal cortical slices were incubated aerobically with or without substrates, and the glucose contents were assayed photometrically. The specificity of human kidneys was evaluated by comparison with the results obtained from rats and rabbits. The rank order of renal gluconeogenesis from various substrates was as follows: Humans: pyruvate > oxaloacetic acid > lactic acid > fructose-1,6-diphosphate > L-glutamine. Rats: pyruvate > fructose-1,6-diphosphate > oxaloacetic acid > lactic acid > L-glutamine. Rabbits: fructose-1,6-diphosphate > pyruvate > oxaloacetic acid > lactic acid >> L-glutamine = 0. In general, the human kidney can produce glucose at the lowest rate among the three species. The substrate specificity of humans was more or less similar to that of rats. These results suggest the existence of a species difference in renal gluconeogenesis both in substrate specificities and quantitative activities.

[Study on gamma-GTP activity in urine and renal tissue of drug-induced nephrotoxicity in rats]

We investigated changes of urinary and renal gamma-glutamyl transpeptidase (gamma-GPT) activities in rat with renal damages caused by nephrotoxic agents in order to clarify the onset and the course of these nephrotoxicities. Cisplatin (CDDP) which is an antitumor agent, cephaloridine (CER) which is the first-generation cephem, and gentamicin (GM) which is an aminoglycoside were employed as tested nephrotoxic agents. We administered three fourth of LD50 of each agent to male Fischer 344 rats, intra-peritoneally. And the time-course changes of serum creatinine (s-Cr) value, creatinine clearance (Ccr) and urinary gamma-GTP activity were observed after administration of each agent. Finally, we measured renal gamma-GTP activities and observed pathological changes of the kidneys. The elevation of s-cr values and the reduction of Ccr appeared 3 days and 12 hours after the administration of CDDP and CER, respectively. And the peak appeared 7 days and 3 days after the administration of CDDP and CER, respectively. Increase of urinary gamma-GTP activities occurred earlier than the peak of s-cr value and Ccr in each group and as early 12 hours after the administration. In CER groups, the peak of urinary gamma-GTP activities was observed within 12 hours after the administration. And the peak of urinary gamma-GTP activities was observed at 24 hours and in 3 days after the administration of GM and CDDP, respectively. In addition, renal gamma-GTP activities reduced around 40% of those of control.(ABSTRACT TRUNCATED AT 250 WORDS)

[Determination and clinical significance of human hepatocyte growth factor in serum]

Hepatocyte growth factor (HGF) is the most potent mitogen for mature parenchymal hepatocytes in primary culture, and seems to be a hepatotrophic factor that acts as a trigger for liver regeneration after partial hepatectomy and liver injury. In the present study, we evaluated an enzyme-linked immunosorbent assay, using monoclonal antihuman HGF (h-HGF) antibody, for measuring serum h-HGF levels. Intra- and inter-assay coefficients of variation were 2.2-3.3% and 3.4-4.0%, respectively. Detection limit of this method was 0.1 ng/ml, determining by the dilution test. The substances tested did not interfere with this assay, except for high concentrations of hemoglobin. Furthermore, no interference was observed with plasminogen and lipoprotein (a), which show the structural homology to h-HGF, and with various kinds of cytokines. Reference ranges of serum h-HGF determined with 187 healthy subjects were 0.1-0.23 ng/ml. Serum h-HGF concentrations were increased in various kinds of liver diseases, in particular those were significantly higher in fulminant hepatic failure. Furthermore, prognosis of the patients with higher h-HGF values were strikingly worse than those with lower levels. We concluded that the determination of serum h-HGF plays important roles in the early diagnosis and prognosis of fulminant hepatic failure.

[A study on the passage of the upper urinary tract stones after in situ ESWL]

Two hundred patients with upper urinary tract stones underwent in situ ESWL with Lithostar during the recent 20 months at Kanagawa Prefectural Atsugi Hospital. Actual residual stone rates were calculated based on the period from the initiation of the treatment to the stone free status, and discussed according to the location and size of the stone treated. Total 200 patients were submitted to 1.67 +/- 0.97 treatment sessions with 6742 +/- 5545 shock waves. After 3 months, 148 patients (78%) showed stone free status, and 32 patients (16%) had residual stones less than 4 mm. The actual residual stone rates were 90.5%, 66.5%, 39.1%, 26.9% and 17.9% after 1, 3, 6, 12 and 20 weeks, respectively. The residual stone rate were lower in the lower ureter, uretero-pelvic junction, upper ureter, renal parenchyma or diverticulum and renal pelvis or calyx in order. As for the size, the larger the stones the higher the residual stone rates; the therapeutic results were significantly worse in patient group of stones larger than 21 mm compared to the patient group of smaller stones (p less than 1%). The destructed stones were passed gradually up to 6th week after in situ ESWL, however, after that fragments seldom passed out. Therefore, it was concluded that decision on the additional or combination therapeutic intervention, if necessary, should be made after 6 weeks. Combination therapy with endoscopic surgery and/or others was seemingly needed for the patients with stones of more than 21 mm in size and of renal pelvis and renal calyx to improve the rates of stone free.

Adjuvant chemotherapy with vinblastine, adriamycin, and UFT for renal-cell carcinoma

VAU therapy (vinblastine, Adriamycin, and UFT) was given postoperatively to 31 patients with stage I, II, or III renal-cell carcinoma, and the incidence of relapse as well as the survival of patients were studied. Administration was started at 7-14 days post-surgery; 5 mg/m2 vinblastine and 30 mg/m2 Adriamycin were given i.v. once every 4 weeks for a total of five courses, and three capsules of UFT (containing 300 mg tegafur) were given p.o. every day for 2-3 years. The postoperative observation period ranged from 2 years and 6 months to 7 years and 1 month (mean, 4 years and 2 months). The 1-year survival of patients was 100%, and the 3- and 5-year survival values were 96%. These results were significantly better (P less than 0.01) than the respective values (81%, 72%, and 60%) obtained for the historical controls, i.e., the 60 patients with stage I, II, or III renal-cell carcinoma who received no chemotherapy. Side effects such as alopecia, gastrointestinal symptoms, and myelosuppression were encountered, but all symptoms were so mild and transient that discontinuation of the treatment was not necessary. As VAU therapy might be useful as adjuvant chemotherapy for renal-cell carcinoma, it seems to merit further study.