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A 75-year-old male undergoing hemodialysis because of diabetic nephropathy was referred to our hospital complaining of high fever and swelling of the left kidney. Our initial clinical diagnosis was severe pyelonephritis. He was initially treated with intravenous antibiotics and his clinical symptoms subsequently improved but only temporarily. The high fever soon recurred, accompanied by progressive thrombocytopenia. His general condition deteriorated despite conservative treatment. He then underwent nephrectomy of the left kidney. However, the thrombocytopenia persisted and his general condition did not improve. The pathological diagnosis was malignant lymphoma (non-Hodgkin's lymphoma, diffuse large B-cell type). He received chemotherapy, but his status rapidly deteriorated and he died 1.5 months after the operation. Primary renal malignant lymphoma is very rare, because the kidney lacks lymphatic tissue.

A 71-year-old man was found to have growing nodules in his right lung, and an anterior mediastinal tumor. A positron-emission tomography (PET) scan demonstrated accumulation in one of the nodules and in the anterior mediastinal tumor. The rapid intraoperative pathological diagnosis was adenocarcinoma from the lung nodules and low grade malignancy from an anterior mediastinal tumor. Right upper lobectomy and lower partial lobectomy with mediastinal tumor resection was performed. Postoperative pathological examination revealed the coexistence of lung cancer and a typical carcinoid of the thymus. To the best of our knowledge, we report the first case of thymic carcinoid accompanied with adenocarcinoma of the lung.

A 69 year-old man was admitted to our hospital with bloody sputum and abnormal shadows in his chest X-ray film and CT. According to the bronchoscopic examination, he was diagnosed as suffering from small cell lung cancer (SCLC). Aside from SCLC, erythroderma, lymphoadenopathy and abnormal lymphoid cells in his peripheral blood were recognized on admission. Considering possible disorder blood complications, we conducted examinations including a biopsy of the skin and superficial lymph nodes, which revealed the characteristics of Sézary syndrome. We provided local treatment for Sézary syndrome and did systemic chemotherapy with carboplatin and etoposide for SCLC. After four cycles of chemotherapy, the patient showed a partial response. We report a very rare case of SCLC with Sézary syndrome in which we were able to provide chemotherapy effectively and safely.

Objectives: We investigated a clinical features and outcomes of prostate cancer detected in Tone Central Hospital., Materials and Methods: We investigated clinical features of 532 patients with pathologically confirmed prostate cancer detected in our hospital between 1987 and 2006. Furthermore, we compared survival rates of screen detected prostate cancer (SC group) with those of non-screen detected prostate cancer (NSC group) for 362 cases diagnosed with prostate cancer after 1999. 362 cases consist of 223 patients in SC group and 139 patients in NSC group., Results: Since 1987, the annual number of newly diagnosed patients has gradually increased and we recognized stage migration, a tendency toward an annual decrease in the incidence of stages A and D and an increase in that of stage B. The stage distributions of SC group (223 cases) and NSC group (139 cases), respectively, were 0.4% (1/223) and 9.4% (13/139) in stage A (p = 0.0011), 71.3% (159/223) and 31.7% (44/139) in stage B (p < 0.0001), 24.2% (54/223) and 23.7% (33/139) in stage C (p = 0.9182), and 4.0% (9/223) and 34.6% (46/223) in stage D (p < 0.0001). The 3, 5 and 7-year overall survival rates, respectively, were 95.6%, 92.7% and 84.1% in SC group, and 83.2%, 74.3% and 60.8% in NSC group (p < 0.0001). Furthermore, the 3, 5 and 7-year cause-specific survival rates, respectively, were 98.8%, 97.3% and 95.9% in SC group, and 90.2%, 87.7% and 79.4% in NSC group (p < 0.0001)., Conclusions: Clinical stage distribution has been changed between 1987 and 2006. Furthermore, overall and cause specific survival rates were better in screen detected prostate cancer than non-screen detected prostate cancer, because of increases in earlier stage of prostate cancer in SC group.

A 74-year-old man who had been treated for autoimmune hemolytic anemia was admitted to our hospital for dry cough and shortness of breath. Chest X-ray revealed multiple round opacities. The pathological examination of a percutaneous biopsy specimen revealed B-cell malignant lymphoma of the diffuse large-cell type. Gallium scintigraphy showed positive accumulation only in the lungs, and thus a diagnosis of primary pulmonary lymphoma was made. He received several courses of R-CHOP therapy and achieved partial remission. Primary pulmonary malignant lymphoma associated with autoimmune hemolytic anemia is extremely rare. Although the underlying mechanism remains to be clarified, it is likely that Epskin-Barr virus infection leads to the development of malignant lymphomas in some cases.

A 41-year old man was hospitalized for abdominal pain and melena. Two years before, he had contracted Crohn's disease, which was brought into remission by using mesalazine and oral corticosteroids. When Crohn's disease appeared to flare up again, the dose of corticosteroids was increased. Afterwards, when a gradual decrease in this dose was initiated, melena developed once again, along with a dry cough. Chest radiography revealed diffuse patchy shadows. A significant increase of lymphocytes was observed in the bronchoalveolar lavage fluid. Mesalazine was suspended and steroid pulse therapy was initiated in combination with azathioprine. Although the symptoms were alleviated and the patchy shadows disappeared, the bronchiectatic shadows remained. A broncho-bronchiolitis associated with Crohn's disease was finally diagnosed despite the need for a differential diagnosis of mesalazine-induced disease due to the long-term administration of mesalazine before the onset of the pulmonary lesion. Also, the pathological findings were inconsistent with many other reported cases, the onset of the pulmonary lesion coincided with the flare-up of an intestinal disease, and the pulmonary shadows remained long after the suspension of mesalazine.

A 45-year-old woman was transferred to our hospital for further examination of a persistent fever, marked leukocytosis and abnormal shadow on chest CT scan. At the time of admission, her leukocyte count was 48,800/microliter and her chest CT scan showed a solitary nodule in the right upper lobe with hilar and mediastinal lymphadenopathy. A US-guided biopsy revealed a large-cell carcinoma. She was given radiation (total 60 Gy) and 4 courses of chemotherapy with paclitaxel (150 mg/m2) in combination with carboplatin (AUC = 5). The primary tumor and swollen lymph nodes disappeared and leukocyte count normalized. Although 3 years have passed, no recurrence has been observed.

Prostate cancer is the most common urogenital cancer, and is increasing rapidly. We performed an epidemiological study on prostate cancer in Gunma Prefecture, Japan. Registration of prostate cancer patients diagnosed at clinics and hospitals in and around Gunma Prefecture was started at Gunma University in 1985. The epidemiological characteristics of prostate cancer patients in Gunma Prefecture were analyzed by these data. The incidence and crude incidence rates have increased five-fold, from 114 and 12.0 in 1985 to 539 and 53.9 in 2000, respectively. The age-adjusted incidence rate (adjusted to the world population) was increased three-fold, from 8.3 in 1985 to 24.2 in 2000. The age-specific incidence rate showed an increase with age. The cancers in clinical stages A and D decreased, while those in stages B and C increased. No change in distribution was observed in pathological differentiation. Prostate cancer has increased rapidly during these 16 years in Gunma Prefecture. It is important to perform PSA testing aggressively in males age 50 or older, and detect prostate cancer in an early stage.

We report a case of dermatomyositis associated with prostatic carcinoma. A 69-year-old male was admitted to the Department of Internal Medicine with the chief complaint of general fatigue, appetite loss and facial anthema. Abdominal ultrasound demonstrated swollen periaortic lymph nodes and the margin of prostate was unclear. Prostatic carcinoma was suspected based on digital rectal examination, so he was admitted to our department. Serum prostate specific antigen level was 190 ng/ml. He was examined by a dermatologist because of deterioration of anthema. Dermatomyocitis was demonstrated by dermatoses (edema erythema at face, neck and limbs, nail fold thrombosis and poikiloderma), high serum level of creatine phosphokinase and a decrease in muscular strength (especially at the proximal musculus). There was no interstitial pneumonitis or malignancy of the digestive system. On needle biopsy of the prostate and quadriceps femoris muscle, prostatic carcinoma (poorly differentiated adenocarcinoma, Gleason score 5 + 5) and myositis were suspected. The stage of prostatic carcinoma was T4N1M1. The patient was treated by administration of diethylstilbestrol phosphate and prednisolone for prostatic carcinoma and dermatomyositis, respectively, but he died of multiple metastasis of the tumor 1 year and 5 months later. Dermatomyocitis is associated with malignancy more frequently than any other collagen disease. In Japan, it is frequently complicated by gastric, lung and mammory cancers, but rarely by prostatic carcinoma. To our knowledge, this is the fourth case of prostatic carcinoma associated with dermatomyocitis in Japan.

We performed a systematic review of the effectiveness of anti-emetics for prophylaxis of cisplatin-induced delayed emesis using meta-analysis. We selected 12 reports of randomized controlled trials from MEDLINE (1966-2003. 4) and The Cochrane Library Issue 1, 2003. Nine of these reports were evaluated as high quality and the others as low quality according to the evaluation criteria of Jadad et al., and only the high-quality reports were subjected to meta-analysis. The statistical results obtained from all 12 reports were also compared with those obtained from the 9 reports of high quality. Corticosteroids significantly reduced the occurrence of delayed emesis. Metoclopramide tended to reduce the occurrence of delayed emesis, although not to a significant extent. In contrast, 5-HT3 receptor antagonists did not show a significant prophylactic effect on delayed emesis. Combination treatments using corticosteroids with metoclopramide or 5-HT3 receptor antagonists did not show significant additional benefits over corticosteroids alone. In conclusion, treatment with corticosteroids without additional metoclopramide or 5-HT3 receptor antagonists appears to be preferable for the prevention of delayed emesis induced by cisplatin.

The patient was a 12-year-old boy, who was brought to our hospital with a chief complaint of swelling and pain in the right scrotum. Color Doppler ultrasonography showed blood flow in the right testis and increased blood flow at the right epididymis. Our diagnosis was right epididymitis, and the swelling of the scrotum was improved by antibiotics. Since there was recurrence, right epididymectomy was performed. Histological diagnosis was chronic epididymitis. Postoperative, screening for abnormalities in the urinary tract revealed no malformations. Recurrent epididymitis in a child without genitourinary malformations is a very rare pathology.