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In September 2013, a 50-year-old woman presented to our hospital with right abdominal pain as the main complaint. Careful examinations led to the diagnosis of ascending colon cancer. In October 2013, resection of the right half colon and removal of the D3 lymph nodes were performed. As postoperative adjunctive chemotherapy, 6 courses of CAPOX therapy were initiated. PET-CT conducted 17 months after the surgery revealed an enlarged right para-aoric lymph nodes and abnormal FDG accumulation. Lymph node recurrence was diagnosed. In April 2015, 10 courses of CAPOX plus BEV therapy, followed by 12courses of capecitabine single agent, were initiated. PET-CT revealed complete remission of the right para-aoric lymph nodes. However, abnormal FDG accumulation was detected in the right ovary and uterine corpus. After careful examinations in March 2017, we performed expanded total hysterectomy, bilateral resection of the appendicular organs, resection of body reticular region, and removal of the lymph nodes and those at the right side of the aorta for the ovarian and uterine cancer. Pathologically, intimal cancer in the right ovary and uterine corpus was diagnosed. Examination of the right para-aoric lymph nodes resected at the same time showed complete remission on images, although histological complete remission was found with scarring. Currently, 63 months after the initial surgery, the patient is alive without recurrence.

We reported 2 cases of colorectal cancer receiving neoadjuvant chemotherapy(NAC)with the aim of curative resection or anal preservation. Case 1: A 50-year-old man was diagnosed with locally advanced rectal cancer with sacral invasion. Because of the sacral invasion, we performed preoperative chemotherapy. He was treated with 12 courses of CapeOX plus Bmab and 3 courses of capecitabine plus radiation therapy(45 Gy in total). After chemoradiation therapy, a lower anterior resection was performed. The pathological finding was pT3pN0pM0, pStage Ⅱ. Case 2: A 69-year-old man was diagnosed with lower rectal cancer. Colonoscopy revealed a tumor near the dentate line. Because the patient desired anal preservation, we performed preoperative chemotherapy. He was treated with IRIS plus Bmab. After 3 courses of chemotherapy, the tumor had reduced in size. The pathological findings were no residual tumor cell, pN0. In our hospital, we have preserved the anus in 2 patients after NAC. Including the above 2 cases, we have performed curative resection in 7 cases. The mean observation period after surgery was 30 months; 1 case died from cancer recurrence(41 months after resection)and other 6 cases lived without cancer relapse.

We report 2 cases of locally far-advanced rectosigmoid cancer that were initially unresectable, but were successfully excised after treatment with CapeOX plus Bmab chemotherapy(capecitabine, L-OHP, and bevacizumab). Case 1: A 72-year-old man who complained of severe constipation initially received sigmoid colostomy because of far-advanced rectosigmoid cancer. After 4 courses of CapeOX plus Bmab chemotherapy administration, the size of the primary tumor remarkably decreased and curative resection could be performed. There has been no signs of recurrence for 27 months. Case 2: A 73-year-old man who complained of tenesmus initially received ileostomy because of far-advanced rectosigmoid cancer that directly invaded the appendix, ileum, and urinary bladder. After he received 3 courses of CapeOX plus Bmab chemotherapy, the primary tumor was found to have shrunk remarkably. Therefore, surgery was performed and the tumor was resected curatively. From these experiences, we conclude that some patients with locally far-advanced colorectal cancer can be treated effectively with CapeOX plus Bmab chemotherapy in a neoadjuvant setting.

We compared the efficacy, safety, and patient preferences for two α1-adrenoceptor (AR) antagonists with different affinity for AR subtypes, naftopidil (Naf) and silodosin (Silo), for the treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia (male LUTS/BPH). New patients diagnosed with male LUTS/BPH were randomly divided into either the Naf-Silo group or the Silo-Naf group (Naf : 50-75 mg once daily for 2 weeks followed by 75 mg once daily for 4 weeks ; Silo : 2-4 mg twice daily for 2 weeks followed by 4 mg twice daily for 4 weeks). A survey was conducted to evaluate patient drug preferences after completion of the study and the reasons for the preferences. Naf and Silo improved the total International Prostate Symptom Score (IPSS) compared with baseline. There was no significant difference between Naf and Silo in improvement in the IPSS total score. Adverse effects were more frequent with Silo than with Naf (P=0. 002). No significant difference in patient preference for the drugs was observed. These findings indicate that Naf and Silo provide similar clinical efficacy, with no difference in patient preference for the drugs, although adverse effects were significantly more frequent with Silo than with Naf.

Silodosin (URIEF), a new so-called 3rd generation alpha-1 blocker, is widely expected to be effective and useful for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), due to its high specificity to alpha-1A receptor. We evaluated the efficacy of Silodosin, on 187 males 50 years old or over with the diagnosis of BPH. Silodosin significantly improved the International Prostate Symptom Score (IPSS) and quality of life (QOL) score from the day after administration was started. Among 166 patients whose data were available for the analysis of efficacy of Silodosin, 77.5% showed apparent subjective improvement. Eighty three patients, who had been taking another alpha-1 blocker but without satisfactory effects, showed almost the same improvements in IPSS and QOL score after switching to Silodosin as the remaining 83 patients who had no preceding treatment with an alpha-1 blocker. The improvements were not only in voiding symptoms but also in storage symptoms. The patients, who had serious storage symptoms, responded rather well to Silodosin and showed significant improvement. Taken together, Silodosin showed a quick effect for improving subjective symptoms and QOL, and was found to be useful for the management of LUTS with BPH.

A 55-year-old man was admitted to our hospital because of severe dyspnea 30 minutes after inhalation of waterproofing spray. He had used the spray outdoors and had then smoked a cigarette with spray-contaminated fingers. Chest radiography and computed tomography (CT) revealed diffuse ground glass opacities in both lungs. In pulmonary function tests, the lungs showed a moderately decreased diffusing capacity and there was slight hypoxemia. Transbronchial lung biopsy specimens demonstrated extensive alveolitis and marked eosinophil migration. Without any specific treatment, the patient recovered clinically in 4 days. We speculated that acute lung injury in this patient may have been induced by not only direct inhalation of the waterproofing spray itself, but also by inhalation of spray by-products resulting from decomposition due to heat. When waterproofing spray is used, precautions should be taken to avoid both inhalation and heating of the fumes.

A 68-year-old woman underwent surgical treatment for renal cell carcinoma associated with tumor thrombus extending into the right atrium. Although the tumor thrombus reached the level of the right atrium, there were no other apparent metastases. Combination therapy with interferon alfa plus tegafur/uracil (UFT) was attempted with the expectation of reducing the tumor thrombus, but there was no change. Successful management was achieved with right radical nephrectomy, right auriculotomy, and partial cavectomy using cardiopulmonary bypass under high-grade hypothermia. After removal of the tumor and thrombus, blood loss was 13,900 ml during the patient's recovery. She had mild heart failure for about two weeks after the operation, but recovered. She was discharged on the 40th day after the operation. Proper preparation for blood transfusion is the key point of this operation.

Background: Radical cystectomy was usually performed for the patient with advanced bladder cancer. The choice of surgical procedure whether bladder preserved therapy or radical cystectomy has sometime plagued us in bladder cancer treatment. Because we don't have clear guideline for the treatment of locally advanced bladder cancer (T2-T3a N0M0). We devised a radical treatment for the patients with locally advanced bladder cancer without radical cystectomy., Patients and Methods: We performed re-TUR treatment after 3 weeks of initial TUR for 13 patients with grade 2 and locally advanced bladder cancer diagnosed with pelvic CT scan, transurethral ultrasonography or bimanual examination under the anesthesia., Results: We could successfully preserve all cases of bladder with the use of this devised TUR (periods 9-45 months median 22 months). This method has significantly reduced the cystectomy rate in such locally advanced cases compared with the cystectomy rate prior to 1993 (p < 0.001)., Conclusion: This method has significance on treatment for locally advanced papillary bladder cancer as bladder preserving therapy with careful observation.

A 51-year-old man underwent radical cystectomy with tubeless cutaneous ureterostomy. Methicillin-resistant Staphylococcus aureus (MRSA) enteritis developed postoperatively. MRSA caused critical infections such as pneumonia and sepsis, which subsequently progressed to adult respiratory distress syndrome, massive melena and multiple organ failure. The patient was rescued by intensive management including mask continuous positive airway pressure, systemic vancomycin administration and intraarterial embolization to stop jejunal bleeding.

This is a report on a surgery performed in February, 1995 describing the donation of a living donor's horseshoe kidney used for renal transplantation. The recipient was a 31 years-old male on hemodialysis since 1994. The donor was the healthy 55 years-old father of the recipient who had an uncomplicated horseshoe kidney. The isthmus was perfused by an accessory artery. Via transperitoneal approach, the horseshoe kidney was mobilized for in situ perfusion. A microwave coagulator was used to divide the isthmus, and the cut surfaces were closed by mattress sutures and fibrin glue. The left kidney was transplanted into the recipient's right iliacfossa. While his post-transplant course was complicated by urinary leakage, the graft remained free of rejection until and beyond the 6 months post transplant period when he was discharged at s-Cr 1.7 mg/dl. The donor's convalescence was uneventful. During the 20 months post-transplant period both the donor and recipient are doing well.

An 81-year-old woman was admitted to our hospital with left flank pain. Excretory urography revealed left hydronephrosis. Abdominal computed tomography (CT) revealed a large heterogenous tumor in the upper pole and marked hydronephrosis and hydroureter in the lower portion of the left kidney. Left total nephroureterectomy was performed under the diagnosis of renal pelvic and ureter tumor. The pathological diagnosis was of renal cell carcinoma (spindle type, grade 3) in the kidney and transitional cell carcinoma (grade 2) in the ureter. Postoperative chemotherapy was not given. Convalescence was uneventful and fifteen months after the operation she is alive with no recurrence or metastasis.

The analysis of corticosteroids (CDS) was preliminarily investigated using a DU PONT 830 High Pressure Liquid Chromatography (HPLC) equipped with a UV detector and a Permaphase column ETH. 1) Firstly, the best condition for the separation of mixed CS was investigated. In a linear gradient elution, ten authentic steroids, varying greatly in polarity (including native CS such as DOC, Corticosterone and Cortisol) were sharply separated in about 20 minutes. Recovery of the steroid injected into the column was 96 approximately 100%. 2) Standard CS added to the chloroform extracts from plasma or urine were also clearly separated in the same condition as above. In the experiment using predonisolone and estrone-propionate in different doses, the synthetic steroids were quantitatively separated, giving a linear calibration curve. 3) Sensitivity of the steroid determination was ng order photochemically in a plot study, but the method, using a UV detector, was not sufficient to apply to small amount of samples extracted with choloroform. To solve this problem, radioimmunoassay was applied to the eluate containing biological steroid, which was roughly separated using the synthetic steroid marker. As for the determination of plasma corticosterone using this method of HPLC combined with radioimmunoassay, the results were satisfactory for practical use; the mean based values and SD of 10 normal controls were 0.4+/-0.2 microgram/100ml for corticosterone, and they showed 4 to 5-fold increases to 250 microgram of synthetic ACTH injection.

The high pressure liquid chromatographic (HPLC) technique was developed to separate and quantitate the synthetic corticosteroids (s-CS) which are widely used clinically. 1) 12 kinds of s-CS in alcoholic solvent and 2) some of their metabolites in the plasma and urine of healthy subjects with oral administration of s-CS were investigated for the preliminary work. The results are summarized as follows: 1) Cortisol sodium phosphate, Dexamethasone 21, disodium phosphate, Paramethasone acetate, Cortisol acetate, Cortisone acetate, Methylprednisolone acetate, Prednisone, Dexamethasone, 9 alpha-fluorocortisol, Betamethasone, Triamcinolone, and Prednisolone in ethanol were clearly separated by HPLC from Cortisol (F). In the suitable condition of the HPLC (LC-2 type) with a Zorbax SIL column, organic solvent (cyclohexane:dichloromethane:ethanol = 9:4:1)-carrier mobile phases and UV detector, the retention time of each s-CS was obviously different from that of F. The calibration curve was obtained in a linear line with regards to each s-CS. The mean recovery was 97.6% and the coefficient of variation were 1.6 (intraassay) and 7.2 (interassay)%. The sensitivity of the steroid determination was 200pg order. 2) The serial changes in plasma concentrations of s-CS; CS-metabolites and endogenous F were shown in 3 healthy males and 2 females following oral administration of the s-CS. The separated metabolites in number and quality depended on the kind of s-CS. Prednisone and other kinds of the acidified products were separated from prednisolone in the plasma and urinary samples of the healthy subjects as well as Addisonian patients. In conclusion, the HPLC method is useful for the separation and quantitation of the UV-absorbing CS of human plasma and urine. The obtained chromatograms may be an indication of the metabolic state of the subject with treatment of s-CS.