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A 78-year-old man was aware of lightheadedness and darkness at a routine outpatient visit, and his blood pressure was declined at 87/51 mmHg. Contrast-enhanced CT scan showed an extravascular leakage image at jejunum. We diagnosed as small intestinal hemorrhage. Because he was in hemorrhagic shock, emergency surgery was performed. A tumor was found coincident with the bleeding site, and partial resection of the small intestine including enlarged lymph nodes was performed. Based on the pathological findings of T-cell origin and positive for serum anti-HTLV-1 antibody, he was suspected as adult T-cell leukemia/lymphoma(ATLL). Endoscopic examination of the upper and lower gastrointestinal tracts, bone marrow examination, and PET-CT scan were performed, but no other lesions were found. We report a case of the T-cell lymphoma with suspected solitary ATLL of the jejunum.

A 77-year-old man visited a clinic because of nausea and chest discomfort. On blood test, hepatobiliary enzymes were elevated, and he referred to our hospital. Contrast-enhanced CT revealed stenosis of the extrahepatic bile duct and brush cytology of the bile duct showed adenocarcinoma. We therefore performed pancreatoduodenectomy for extrahepatic bile duct cancer. Pathological diagnosis was small cell neuroendocrine carcinoma, pT3N2M0, Stage ⅢA. The patient did not receive adjuvant chemotherapy and 3 months later contrast-enhanced CT and MRI showed multiple liver metastases. The patient was treated with cisplatin plus irinotecan in the first-line, cisplatin plus etoposide in the second-line, and amrubicin in the third-line and accordingly he died 1 year and 3 months after the surgery. Chemotherapy for neuroendocrine carcinoma of the bile duct is recommended as in small cell lung cancer, but the prognosis is extremely poor. We report this case with a review of some of the literature.

A 77-year-old man complaining of gross hematuria was referred to our hospital for further examination and treatment. The contrast-enhanced computed tomographic (CT) scan revealed a left ureteral tumor, multiple bladder tumors, para-aortic lymph node metastasis, left supraclavicular lymph node metastasis, multiple liver metastases, and multiple lung metastases. Transurethral resection was performed. One of the multiple bladder tumors, located at the bladder neck, was pathologically diagnosed as urothelial carcinoma, pT1, high grade, G2．We diagnosed the patient with metastatic ureteral cancer (T4N2M1, stage IV). We stated gemcitabine, cisplatin (GC) therapy, but stopped after the first course due to gemcitabine drug eruption. We changed the regimen to methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) therapy and the cycle was completed without complications. However, CT scan showed disease progression. After palliative irradiation of the primary lesion, we administered pembrolizumab. Although he was asymptomatic, we diagnosed him with ocular myasthenia gravis because of a high level of serum anti-acetylcholine receptor antibodies and a temporary ptosis in his past history. In spite of the possibility of relapse of myasthenia gravis, treatment with pembrolizumab was continued with his consent since there were no other treatment options. After two courses of pembrolizumab, he was hospitalized due to disease progression and died about three weeks after admission. Myasthenia gravis is a possible immune-related adverse event of pembrolizumab, However, there have been few reports on the successful treatment with this agent in patients with previously diagnosed myasthenia gravis. We report, here, a case of metastatic ureteral carcinoma safely treated with pembrolizumab without relapse of ocular myasthenia gravis.

According to the risk classification of recurrence, the standard treatment for gastrointestinal stromal tumor(GIST)is complete surgical resection and postoperative adjuvant therapy with imatinib; however, the usefulness of neoadjuvant therapy is unclear. We report a case of giant GIST in the pelvis suspectedly having bladder infiltration that was radically resected and underwent preoperative imatinib therapy. A 52-year-old man visited a clinic because of abdominal pain, fever, and frequent urination. An abdominal mass was determined, and the patient was referred to our hospital for detailed examination and treatment. Contrast-enhanced CT revealed a 17 cm diameter irregular mass from the lower navel to the pelvis, and the bladder boundary was partially unclear. Transrectal biopsy was performed using endoscopic ultrasonography, and according to the Fletcher classification, a high-risk GIST was diagnosed. After preoperative imatinib therapy of 400 mg/day was administered for 3 months, surgery was performed. The tumor was strongly adhered to the bladder, but no invasion was observed, and partial small intestine resection was performed. The surgical margin was negative without capsule damage. On day 34 postoperatively, imatinib therapy was resumed, and as of 1 year postoperatively, the course is well without recurrence.

An 81-year-old man with esophageal cancer had undergone subtotal thoracic esophagectomy and retrosternal reconstruction using a gastric tube. He developed anemia. Gastrointestinal endoscopy was performed, which revealed a tumor in the posterior wall of the lower part of the gastric tube. Biopsy revealed well-differentiated adenocarcinoma. There was no lymph node metastasis and no distal metastasis on CT. We performed partial resection of the stomach tube because of his age and physical condition. We identified the position of the tumor by upper gastrointestinal series CT and gastrointestinal endoscopy. The tumor was located on the posterior wall of the lower part of the gastric tube and the back of the sternum lower border. Marking was performed by gastrointestinal endoscopy before operation. We simulated the operation and decided to perform laparostomy without sternotomy incision. We cut the anterior wall of the gastric tube in front of the tumor using the endoscope. We could then confirm the diagnosis of cancer, and clipped and removed the tumor from the posterior wall. The resected site was sutured with 4-0 absorbable thread. The pathological diagnosis was T1a(M)N0M0, ly0, v0, PM0, DM0, pStage ⅠA.

We report a case of mediastinal lymph node recurrence of esophageal cancer after endoscopic submucosal dissection (ESD). We first administered chemotherapy and then performed esophagectomy. A 78-year-old man underwent ESD for early esophageal cancer at a different hospital in January 2015. H e was diagnosed pathologically with scc, pSM1, pHM1, pVM0, ly0, v0. Additional treatment was not administered because of his age. In June 2017, chest enhanced CT showed swollen mediastinal lymph nodes. This was diagnosed as a recurrence of esophageal cancer, and he presented at our hospital. We first performed chemotherapy for that lesion, because the swollen lymph node was large and may have invaded the surrounding organs. We then performed esophagectomy.

We report a rare case of liver recurrence of gastric cancer 14 years and 3 months after curative gastrectomy. An 81-yearold man underwent total gastrectomy, D2 lymphadenectomy, Roux-en-Y reconstruction, and cholecystectomy for advanced gastric cancer in November 2002. H e was diagnosed pathologically with M, Type 5, 53×42 mm, tub2>tub1, pT4a, ly2, v2, pN1, pPM0, pDM0, M0, pStage ⅢA(JGCA 15th). Postoperative adjuvant therapy was not administered. He was followed up for 5 years after surgery without adjuvant therapy, and he did not exhibit recurrence. In February 2017, he experienced difficulties in swallowing and visited our hospital. Abdominal contrast-enhanced CT showed an 8×5 cm liver tumor in the lateral segment. Part of the tumor protruded to outside of the liver, and the tumor invaded and pushed the jejunum in the Roux limb. We performed liver biopsy and diagnosed him with liver metastasis of recurrent gastric cancer. Late relapse after gastrectomy, especially after 10 years or more, is very rare.

In elderly patients, surgical procesure is decided considering the general condition and surgical invasion. The aim of this study was to clarify the appropriate rage of lymph node dissection for elderly colorectal cancer patients. One hundred forty one colorectal cancer patients aged 75 years or more, who underwent R0 colorectal resection with D2 or D3 lymph node dissection in clinical T3/T4 or clinical N+, were enrolled in this study. The patients whose tumor located in the rectum below the peritoneal reflection(Rb)were excluded. Five-year overall survival(OS)rate and disease specific survival(DSS)rate were 79.1% and 89.4%, respectively. More than 2 preoperative co-morbidities and macroscopic type 3-5 were independent prognostic factors in OS, whereas the rage of lymph node dissection was not risk factor. When comparing the outcomes of D2 and D3 dissections by age, D3 dissection was better tendency in DSS in patients aged under 80, however, D2 dissection was better tendency in patients aged 80 or more. In elderly colorectal cancer patients, there was no difference in prognosis between D2 and D3 dissection, and especially in patients aged 80 years or more, D2 might be sufficient if R0 resection was possible.

Background: The aim of this study was to evaluate the safety of laparoscopic-assisted colorectomy(LAC)for elderly patients more than 70 years old., Methods: The outcomes of 131 patients more than 70 years old who underwent LAC between April 2013 and March 2014 were retrospectively analyzed.Morbidity and mortality were evaluated using the Clavien-Dindo classification., Results: Postoperative complications exceeding Grade II in the Clavien-Dindo classification were found in 20 patients(15.3%).No mortalities were observed in this study., Conclusions: LAC can be performed safely for elderly patients older than 70 years.

Fluorescence (FL), chemiluminescence (CL) and bioluminescence (BL) have been extensively focused on luminescence assays. Various FL and CL compounds have been synthesized and evaluated their FL and CL properties. This review describes development of highly selective and sensitive FL and CL reagents by derivatizing luminol, indole and polyphenol. Luminol derivatives were used for measuring enzyme activities and ultraviolet ray power. Indole derivatives with large stokes shift and long-lasting CL properties were developed. Compound which had enhancement effect on polyphenol CL was found. Highly sensitive CL polyphenol dendrimers were synthesized.

Background/purpose: Twenty-two institutes have organized Keio University Prostate Cancer Study Group to study clinical efficacy and safety of Leuprolide acetate (Leuplin) for the treatment of advanced prostate cancer (clinical stage D1 and D2). Cotreatment of Leuplin and Estramustine phosphate disodium (Estracyt) has been performed to investigate its clinical efficacy., Materials and Methods: One hundred and two cases of advanced prostate cancer were treated either with Leuplin alone (group I), Leuplin and Estracyt (group II) or Estracyt alone (group III). After 12 weeks treatment, clinical effects against subjective symptoms (pain, voiding difficulty, performance status and body weight), serum testosterone level, tumor size and serum PSA level were examined to investigate short-term effect of each treatment. The treatment had been continued for 24 months and the treatment effects including progression free survival and overall survival were analyzed., Results: Clinical efficacy after 12 weeks treatment were examined among 97 cases (group I; 35 cases, group II; 36 cases, group III; 26 cases). The background of those patients in each group was statistically equal. Treatment effects against subjective symptoms and serum testosterone level statistically revealed no significant difference among 3 groups. Treatment effects against primary tumor, bone metastatic lesion, lymphnode metastatic lesion and serum PSA level were investigated and anti-tumor effect was characterized by total efficacy rate (complete remission rate plus partial remission rate) of each treatment group. Treatment efficacy rates for each lesion and PSA demonstrated no statistical difference among 3 treatment groups. Total efficacy rate of group I, II and III were 88.2%, 84.0% and 78.3%, respectively, which statistically revealed no significant difference. Total efficacy rate of each group after completing 24 months treatment was; group I 80.0%, group II 55.6% and group III 83.3%, which statistically showed no significant difference among 3 treatment groups. The median day for progression free survival of group I, II and III were 661, 731 and 517, respectively. The overall survival rate of group I, II and III after completing 24 months treatment were 77.5%, 83.0% and 72.4%, respectively. Both progression free survival rates and overall survival rates revealed no significant difference among 3 groups. Side effects during 24 months treatment were seen in 8.6% of group I, 47.2% of group II and 26.9% of group III, and these occurrence rates were significantly different among the groups (p = 0.0013)., Conclusion: Although number of the cases had not been able to continue the treatment for their side effects, the statistical characterization demonstrated that cotreatment of Leuplin and Estracyt had no greater treatment effect than monotreatment of each drug.

Two renal cell carcinoma (RCC) cell lines, JMSU2 and JMSU3, derived from the primary sites of mixed cell type and spindle cell type RCC, respectively, have been established and maintained for 31 and 22 months. Karyotypic analysis revealed human karyotypes with modal numbers of 84 and 55, respectively. Consistent chromosomal abnormalities were 1p+, 3p-, 6q- or 8p- in the JMSU2 cells and 1p-, inv (5p + q-) or loss of sex chromosome in the JMSU3 cells. Electron microscopy revealed abundant glycogen granules, lipid droplets and microvilli. The JMSU3 cells transplanted to nude mice produced tumors with a spindle cell pattern similar to that of the original tumor. High concentrations of cytokines, such as interleukin-6 (145,000 pg/ml), interleukin-8 (35,300 pg/ml) and granulocyte-colony stimulating factor (6,340 pg/ml), were detected in the culture supernatant of the JMSU3 cells. Interleukin-1 beta (IL-1 beta) dose-dependently inhibited the proliferation of the JMSU2 and JMSU3 cells in culture. Tumor cytotoxic factor/hepatocyte growth factor (TCF/HGF) dose-dependently enhanced JMSU3 cell proliferation, but suppressed JMSU2 cell proliferation. These findings suggest that IL-1 beta and TCF/HGF have regulatory roles in the proliferation of RCC.

A Case of drug-induced immune hemolytic anemia during alpha-interferon (alpha-IFN) therapy for renal cell carcinoma is reported. A 61-year-old woman was admitted to Tochigi cancer center for the treatment of left renal cell carcinoma. She underwent left radical nephrectomy. From 7th post operative day, alpha-IFN (6 x 10(6) IU) was administered every other day. Diclofenac and indomethacin were administered for pain and high fever induced by alpha-IFN. Hemoglobinuria was first noted on 20th post operative day. Immune hemolytic anemia was suspected by blood examinations including Coombs' test, serum haptoglobin, serum LDH and serum GOT. alpha-IFN therapy and administration of diclofenac and indomethacin were discontinued and prednisolone therapy (50 mg daily) was begun. Hemoglobinuria disappeared by 5 days and laboratory data became in normal range by 3 weeks. Drug-induced immune hemolytic anemia was diagnosed by the process of laboratory data, especially of direct Coombs' test. Though drug-induced immune hemolytic anemia is a rare adverse side effect during alpha-INF therapy for renal cell carcinoma, it seemed an important complication.

We experienced a case of renal leiomyoma. A 51-year-old woman was referred to the Department of Urology, Tochigi Cancer Center with a complaint of right renal incidentaloma pointed out on CT scan. The renal mass was removed by enucleation. Histological examination revealed the tumor composed of monotonous proliferation of spindle shaped cells without atypia. Thus, the diagnosis of leiomyoma was confirmed. DNA flow cytometric analysis of this tumor was performed and diploid pattern was shown.

We experienced a case of retroperitoneal dedifferentiated liposarcoma with tumor thrombus in the inferior vena cava. A 45-year-old man was pointed out a retroperitoneal mass on ultrasound examination. He was referred to the Department of Urology, Tochigi Cancer Center for critical evaluation. Image diagnostic procedures showed a retroperitoneal mass surrounded by loose tissue and large thrombus in the inferior vena cava. The tumor was removed surgically with right lobe of the liver and segment of the inferior vena cava. Histological examination revealed the tumor composed of the peripheral well differentiated liposarcoma and the central dedifferentiated liposarcoma. Characteristic radiological findings of retroperitoneal liposarcoma with dedifferentiation could be pointed out.

Tumor infiltrating lymphocyte (TIL) is commonly observed in renal cell carcinoma (RCC) tissues. First step of lymphocyte accumulation in cancerous tissues is the lymphocyte migration toward cancer cells. However, no conclusion has been drawn which cytokine is involved in TIL of RCC. The purpose of this study is the identification of a lymphocyte chemotactic factor (chemokine) produced by a newly established RCC cell line. A new human renal cancer cell line (TC-2) was established from a primary site of a 52-year-old man. A marked lymphocyte infiltration was noticed at the cancer tissue. A tissue culture has been continued for 24 months. Flow cytometric analysis of this cell line revealed DNA aneuploidy. A human karyotype, with a modal number of 72, and consistent abnormalities, such as 4q+ and 5q-, were demonstrated by Giemsa banding analysis. Approximately 2.9 fold of lymphocyte chemotactic activity was detected in the culture supernatant of TC-2 cells (TC-2CM) as measured by in vitro migration assay. Sixty percent of this activity was abrogated by adding the neutralizing antibody against interleukin-8 (IL-8) into TC-2CM. Analysis of surface markers of migrating lymphocytes disclosed that lymphocytes expressing CD3, CD8 and CD16 phenotype predominantly showed migration. These results suggested that chemotactic activity for lymphocytes derived from TC-2 cells was partly IL-8.

This report describes a case of teratoma with retroperitoneal lymph nodes involved with malignant teratoma (enteric adenocarcinoma) after extensive chemotherapy for the original testicular cancer. A 18-year-old man with a mixed cell tumor (embryonal carcinoma+teratoma+yolk sac tumor) received three courses of VAB-6 chemotherapy for bulky mass following inguinal orchiectomy. He was referred to Tochigi Cancer Center for treatment of a residual mass. He was treated with resection of the mass combined with left nephrectomy due to severe adhesion and pathological diagnosis of the resected lymph node was mature teratoma with a massive necrotic tissue. Two courses of BEP chemotherapy were given to the patient following the surgery. Six months after completion of chemotherapy, a retroperitoneal mass of 1.5 cm in diameter, was detected by CT scan. Standard retroperitoneal lymph node dissection was performed and the pathological diagnosis of the lymph node was teratoma with malignant transformation containing enteric adenocarcinoma. Teratomatous portion of the primary lesion was precisely re-examined and adenocarcinoma, similar histology to the retroperitoneal mass, was identified. He received two courses of EAP chemotherapy (Cis-platin+etoposide+doxorubicin) as an adjuvant chemotherapy following the surgery and he is alive with no evidence of recurrence for 21 months. Presence of non germ cell malignancy after chemotherapy in testicular cancer has been regarded as a rare phenomenon. Flow cytometric DNA analyses of both embryonal carcinoma and teratoma in the primary lesion, mature teratoma and teratoma with malignant transformation of the retroperitoneal lymph node disclosed that these tumors were all aneuploid tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

In this report, we demonstrated that Interleukin-6 (IL-6) production could be induced by stimulating renal cell carcinoma cell lines, namely ACHN, Caki-1 and TC-1 cells with Interleukin-1 beta (IL-1 beta). IL-1 beta had no effects on cell proliferation in ACHN cells. However, IL-1 beta could suppress cell proliferation in Caki-1 and TC-1 cells. Flow cytometric cell cycle analysis by double staining method with propidium iodide and Proliferating cell nuclear antigen (PCNA) disclosed IL-1 beta caused cell accumulation at G1 phase. Fine granules were visualized in perinuclear area of TC-1 cells treated with IL-1 beta under microscopy. High electron density granules and spherically dilated rough endoplasmic reticula were observed by electron microscopic examinations. In TC-1 cell culture, IL-1 beta excretion into the supernatant was demonstrated by bioassay and ELISA. These results suggest that IL-1 beta functions as an "autocrine growth inhibitor" against TC-1 cells. Half-maximal inhibition of IL-1 beta and IFN-alpha was 6.5 pg/ml, and 720 U/ml, respectively for TC-1 proliferation and combination of these cytokines showed enhanced activity in cell growth inhibition.

We evaluated 18 patients with renal pelvic and ureteral carcinoma focusing on the operative treatment. All the patients underwent nephroureterectomy and partial cystectomy, except for two patients, with CIS of the ureter and renal insufficiency, and one with invasive bladder carcinoma, in whom partial ureterectomy and total cystectomy were performed, respectively. Lymphadenectomy were performed in all the patients and resected lymph nodes were from renal hilus, para-aorta or vena cava, according to the affected side, intra aorto-caval and all the pelvic nodes in the affected side. Lymph node metastases were found in 4 patients (22%), 2 in the primary and distant nodes and the other in the regional nodes only. Skipped lesion of the lymph node metastasis was not rare and lymph node dissection from the renal hilus to the pelvis on the affected side should be included in the operative treatment of renal and ureteral carcinoma.

We report the results of prospective randomized study which was designed to evaluate prophylactic effects of intravesical bacillus Calmette-Guerin (BCG) in the treatment of superficial transitional cell carcinoma of the bladder. A total of 44 cases who had no previous treatment of bladder cancer were randomly assigned to BCG or control groups after TUR. BCG group (23 cases) received intravesical instillation of 80 mg BCG (Tokyo strain) at one week intervals for 6 weeks, at two week intervals for 12 weeks, and at one month intervals for 20 months. In BCG groups, 3 cases had recurrence at 6 months and 1 case at 9 months, while the other 19 cases had no recurrent disease for 3 to 34 months (average 20.3 months) of follow-up. Control group (21 cases) had no further treatment after TUR. In control group, recurrence was seen at 3 months in 3 cases, at 6 months in 5 cases, at 9 months in 2 cases, at 12 months in 3 cases and at 21 months in 1 case. Only 7 cases in the control group were free of recurrence for 8 to 45 months (average 32.3 months) of follow-up. One and two year-recurrence rates in BCG group (18.4%, 18.4%) was significantly (p less than 0.01) lower than those in control group (63.2%, 68.9%). Among the complications of intravesical BCG were cystitis (76.2%), low grade fever (13.0%), and several days' persistent gross hematuria (13.0%). Most of these signs were self-limited and only in 2 cases instillation of BCG was discontinued.(ABSTRACT TRUNCATED AT 250 WORDS)

Baxter infusor was evaluated for the degree of its safeness, and effectiveness, to use in a chemotherapy. The study covered a total of 36 cases, each receiving an average 11 days of care under this therapy. In seventeen of those cases, the patient had received outpatient care, or had spent day and night at their homes. In nine of the total 36 cases, the infusor had been set for use by the patients or by their family. Results were evaluated with a focus on three factors: the patients' quality of life, the infusor's ease of use and its comparability to conventional systems. As to quality of life, those patients generally appreciated the infusor as an improvement to conventional systems with 10 of them citing "an ability to live with their family", 16 citing "freedom to move around", and 35 citing "satisfying functional performance", as reasons for their favorable acceptance. 97% of the patients had found the infusor easy to use, and all had found it simpler and easier to use than the conventional system. Their overall rating for the infusor was "good" to "excellent" in 97% of the cases. And 33 out of the 36 patients thought the infusor safe and effective if used at the homes.

Operative treatments for bone metastases were performed in 7 patients with an advanced renal cell carcinoma. Spinal instrumentation using a Harrington's rod and Luque's wire was the method employed in 4 cases as the initial treatment. In one other case, an anterior fusion by an autologus bone transplantation was used, followed by a posterior fusion. In the 2 remaining cases an endoprosthetic replacement for a metastasis in the right femur and a transplantation of a Kotz's knee joint was done for a metastasis in the left tibia, respectively. In 5 patients with vertebral column lesions, the stabilization of spinal instability was effected by the spinal instrumentation. Three patients with vertebral metastases recovered sufficiently to walk by themselves. This beneficial result was invaluable from the viewpoints of physiotherapy and nursing care.

Eight patients underwent pouchmetry at 12 months after creation of the colonic continent urinary reservoir (CUR) for supravesical diversion. Pouchmetry revealed a volume-dependent tonic and phasic increase in pouch pressure in 3 patients who had undergone pouch construction using the partially detubularized right colon (Heineke-Mikulicz type closure after splitting the transverse and ascending colon at the antimesenteric border), whereas the volume-dependent phasic increase in pouch pressure was much less remarkable in 5 patients whose pouch was constructed using the totally detubularized right colon (Heineke-Mikulicz type closure after splitting the whole colonic segment including the cecum). The maximum pouch pressure at the pouch volume of 400 to 500 ml was significantly higher (p less than 0.05) in the partial detubularization group (46 +/- 6.0 cmH2O, mean +/- S.D.) than in the total detubularization group (12 +/- 1.6 cmH2O). In creation of the low-pressure pouch using the right colon, detubularization should extend to the whole portion of the isolated colonic segment.

A 49-year-old male patient was admitted to our hospital complaining of right scrotal mass. Serum tumor markers, HCG, beta-HCG and AFP, were all elevated. After right high inguinal orchiectomy, a pathological report revealed a mixed-type germ cell tumor, which was composed of choriocarcinoma, embryonal carcinoma and seminoma. Because of persistent elevation of these tumor markers, RPLND was performed. There were viable tumor cells in the dissected lymph node specimens. As pulmonary metastases developed after RPLND, the patient was treated with 3 courses of VAB-6 combination chemotherapy (vinblastine, actinomycin-D, cyclophosphamide, bleomycin and cis-platinum). Pulmonary metastases disappeared and tumor markers returned to normal range except for moderate elevation of serum HCG. Two months later, pulmonary metastases developed again with re-elevation of tumor markers. Four courses of EP salvage chemotherapy (etoposide and cisplatinum) were given. After EP chemotherapy, the patient was given etoposide orally for about 7 months. During this period, no abnormality was found except for slight elevation of serum HCG. Five months after discontinuing chemotherapy, serum HCG returned to normal and complete remission was obtained.

We evaluated immunosuppressive acidic protein (IAP) as a tumor marker in renal cell cancer. The study was comprised of patients with renal cell cancer (6 stage A, 3 stage C, 11 stage D, 7 recurrences). The IAP positive rate of renal cell cancer was 84%, the mean was 937.5 +/- 442.1 ug/ml. The positive rate is statistically higher than in other malignant and benign urological diseases. The IAP positive rate tended to increase with cancer stage. IAP may represent a tumor marker in renal cell cancer.

Renal cell carcinoma (RCC) is one of the most insensitive urologic tumors to either radiotherapy or anticancer chemotherapy. Recently, effectiveness of interferon (IFN) against RCC has been reported. However, because this effect is somewhat limited, a new modality of treatment is needed. We herein report our experience with IFN and OK-432, a streptococcal preparation for patients with advanced RCC. Twenty patients aged from 26 years to 75 years, with an average age of 52.3 years, were entered into this study. Intramuscular injection of human lymphoblastoid interferon (HLBI) at a dose of 3 X 10(6) units was given daily for between 4 and 76 weeks. Treatment with OK-432 then followed HLBI, unless the patient achieved CR or the status of the patient seriously deteriorated during the initial treatment with HLBI. OK-432 was given to 12 patients at a dose of 5KE (Klinische Einheit) 2 days a week for between 10 and 64 weeks. Effectiveness of HLBI therapy was 20% (CR 1 case, MR 3 cases, NC 11 cases, PD 5 cases). With adjuvant OK-432 therapy for patients whose disease proved to be resistant to HLBI, effectiveness was 25% (CR 1 case, MR 2 cases, NC 6 cases, PD 3 cases). The results obtained indicated that OK-432 following IFN is a potentially active antitumor regimen in patients with advanced RCC.

Le Duc-Camey antireflux ureteroileal implantation was evaluated clinically; by applying to various types of urinary reconstruction utilizing the ileum. Nineteen ureters in 10 cases including five Kock continent ileal urinary reservoirs (Kock pouches); five ileal conduit urinary diversions and one Goodwin ileocystoplasty were performed from March 1987 to August 1988. Male and female ratio was 8 to 2 and the average age was 61.7 years old. The post operative observation period was 13.9 months on the average. The outline of the operative procedure was as follows: a 3 cm sulcus was created in the mucosa along the long axis of the ileum; the ureter was passed from the serosal surface to the luminal surface and the adventitia of the ureter and the mucosa were sutured at three points in each side using 3-0 absorbable ligature to implant the ureter in the mucosal sulcus. The ureteral end was spatulated 3 mm in the upper wall and it was fixed to the mucosa by three stitches. A ureteral stent catheter, 7-8 Fr. in diameter, was indwelled in the ureter. Additional stitches were placed to strengthen the fixation on the outside surface of Kock pouches or a Goodwin ileocystoplasty. The afferent limb was not fabricated in Kock pouches because ileoureteral reflux could be prevented by the implantation technique on the pouch. Radiological evaluation was done taking IVP, loopography, pouchgraphy and cytography periodically after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

A 41-year-old male was admitted to the hospital for frequent urination and severe retardation before voiding. Roentgenography revealed exophytic lesions which were located mainly in the trigone of the bladder, and he underwent transurethral resection. The pathological diagnosis was cystitis glandularis. There was no literature which reported cystitis glandularis causing urinary disturbance. This case, moreover, had been diagnosed as cystitis glandularis 13 years before by endoscopical biopsy. The origin of cystitis glandularis and its potentiality as a pre-malignant lesion were discussed from the clinical course for over 10 years.

A case with priapism in a 66-year-old male due to malignant lymphoma is reported. Physical examination revealed an erected penis and enlarged lymph nodes in left neck and bilateral inguinal areas. Rectal digital examination of prostate revealed an irregular surface and swollen hard left lobe. Open biopsy of the bladder and vesicostomy were carried out. Several nodular lesions in the trigone and in the left wall were excised. Pathologically the diagnosis was malignant lymphoma, diffuse, large cell type and clinical stage was stage IV. CHOP therapy with bleomycin and methotrexate was performed. Priapism disappeared 7 days after the initiation of the chemotherapy, but impotence has been noticed after the chemotherapy for more than one year. This will be the first case with priapism due to malignant lymphoma reported in Japan so far.