Search

A 71-year-old man was referred to us with a right renal mass that was discovered by computed tomography (CT) examination for acquired hemophilia and leukemoid reaction. He presented with persistent low-grade fever and purpura on the lower legs caused by acquired hemophilia. Contrastenhanced CT scan showed a right renal tumor 6.0×7.4 cm in diameterwith inhomogeneous enhancement. The result of his urine cytology was negative. After improvement of his coagulation by treatment with immunosuppressants and steroids, he underwent open nephrectomy. Histology of renal tissue revealed urothelial carcinoma (G3, pT4, N1). After surgery, his complete blood counts and coagulation improved without administration of immunosuppressants and steroids. Therefore, he was diagnosed with renal pelvic cancer with acquired hemophilia and leukemoid reaction.

74歳女.左腎細胞癌の診断を受け根治的左腎摘除術を行った.術後6年で右背部の腫瘤を自覚し, その後左大腿部の疼痛を伴う腫瘤を訴えた.針生検により病理組織学的に腎細胞癌の左大内転筋内転移と診断された.胸部CTでは肋骨に骨破壊を伴う腫瘤を認め, 肺野では多発性結節状陰影を認めた.以上の腎細胞癌転移に対しnIFN-α筋注を行った.投与約1週間後より左大腿部の疼痛は軽快傾向となり, 同部位の腫瘤も縮小傾向を示した.投与開始2ヵ月半後には大腿部の腫瘤は触知不能となった.大腿部CTおよびIV-DSAで投与開始7ヵ月後には転移巣は50%以上縮小した.しかし10ヵ月後より増大傾向を示し, 13ヵ月後のCTでPDと判定した.肋骨転移は投与開始7ヵ月後には転移巣は40%の縮小を認めたが, 14ヵ月後には増大傾向を示した.肺野転移は投与開始7ヵ月後には小さな転移巣は消失したが, 最大の転移巣が増大傾向を示した.14ヵ月後にはさらに増大傾向を示したが, 新病変は認めなかった.投与開始後23ヵ月後の現在, 外来で継続加療中である, The skeletal muscle is a very rare site of metastasis in renal cell carcinoma. We report the third case of skeletal muscle metastasis of renal cell carcinoma effectively treated with interferon-alpha. The patient was a 74-year-old woman who had undergone radical nephrectomy on the left side for renal cell carcinoma on April 23, 1990, and had been observed as an outpatient. In June 1997, she was admitted with a diagnosis of metastasis in the left great adductor muscle and right sixth rib, as well as multiple lung metastasis. The metastatic lesion in the great adductor muscle decreased in size by more than 50% following concomitant intramuscular administration of natural interferon-alpha (nIFN-alpha). In the other metastatic lesions, nIFN-alpha-sensitive and resistant metastatic foci were intermingled. Thus, the primary focus in the present study was presumably composed of several clones with different sensitivities to nIFN-alpha.

49歳男, 41歳男, 及び41歳男の計3例で肉腫様腎細胞癌を経験したが, 全例入院時, 側腹部痛, 胸部痛, 全身倦怠感の様な症状があり, 腎摘除術が行われた.2例は術後1年以内に転移により死亡したが, 1例は術後7ヵ月の現在転移・再発なしに生存している, We report 3 cases of sarcomatoid renal cell carcinoma, which is an uncommon neoplasm consisting of a typical renal cell carcinoma associated intimately with a sarcomatoid component. All patients were symptomatic at hospitalization and underwent nephrectomy. Two patients died of metastatic renal cancer within a year, and another is alive without evidence of metastasis for 12 months after the surgery. Because sarcomatoid renal cell carcinoma has a highly malignant behavior and poor prognosis, an adjuvant treatment effective in controlling the disease is awaited.

The patient was a 67-year-old woman who had undergone radical hysterectomy and postoperative radiotherapy for cervical cancer at the age of 46 years. Spontaneous rupture of the urinary bladder occurred twice in 1997, and conservative treatment was performed on each occasion. She was admitted to our hospital for the third time of spontaneous rupture of the urinary bladder. She underwent bilateral cutaneous ureterostomy because of panperitonitis and paralytic ileus. A review of 11 cases of recurrent rupture of the urinary bladder reported in Japan including the present case revealed that, patients who had been conservatively treated tended to be subject to recurrence. However, the risk of recurrence remains when a partial cystectomy is performed. Therefore, especially in recurrent cases, augmentation cystoplasty or urinary diversion should be considered as the treatment for spontaneous rupture of the urinary bladder due to radiation cystitis.

Cefbuperazone (CBPZ) was administered to inpatients with complicated urinary tract infections (UTI) at our department. Clinical efficacy and safety were evaluated in 22 chronic cases by the criteria for evaluation of clinical of antimicrobial agents on urinary tract infection. Overall clinical efficacy was excellent in 8 cases, moderate in 9 cases and poor in 5 cases with an effectiveness rate of 77%. Twenty-four of the 34 strains isolated from the patients were eradicated and eradication rate was 71%. Neither subjective nor objective adverse reactions were observed. Abnormal changes in laboratory tests were found in 9 patients, but were probably not related to CBPZ administration. Judging from these results, CBPZ is considered to be an effective and safe antibacterial for the treatment of complicated UTI.