Search

This paper reviews the background to cancer tumors. Fluorescence spectral analysis has been quantitatively applied to the detection of protoporphyrin IX (Pp‐IX) in transplanted squamous cell carcinoma (SCC) tissue and intra‐operative brain astrocytoma (glioblastoma) tissue after the administration of 5‐aminolevulinic acid (5‐ALA). Coincidence with the emission spectra of Pp‐IX incorporated into the tumor tissues (cryo‐sections) and a standard Pp‐IX in the miceller solution was confirmed. A calibration curve of the fluorescence intensity of Pp‐IX against a known concentration standard of Pp‐IX was established. From the fluorescence detection method (calibration curve), it was found that the longer alkyl‐chain length (methyl‐ and hexyl‐) 5‐ALA induced Pp‐IX in the SCC tissue. Furthermore, an ultrasound treatment enhanced the uptake of Pp‐IX during the topical administration of 5‐ALA derivatives. In the case of intra‐operative observation for the fluorescence intensity of Pp‐IX in the brain astrocyt...

The potency of aluminum-chloro-tetrasulfonated phthalocyanine (AlS4Pc) as a photosensitizer in photodynamic therapy was evaluated in in vitro and in vivo studies. Compared with hematoporphyrin derivative (HpD), the following advantages of AlS4Pc were revealed: (1) AlS4Pc was less toxic than HpD in vitro without hight irradiation. (2) AlS4Pc showed more photodynamic-dependent cytotoxicity and anti-tumor effect in the red area of the spectrum (>660 nm) at which tissue penetration is high. (3) AlS4Pc appeared to be removed more rapidly from normal tissues such as muscle and skin. (4) AlS4Pc showed less photodynamic-dependent cytotoxicity in vitro and milder cutaneous phototoxicity in vivo with UVA irradiation. On the basis of these observations, AlS4Pc shows considerable promise as a photosensitizer for PDT.

An organ culture system using collagen gel matrix (CGM) was modified and established successfully as a rapid and convenient method for determination of anti-cancer drug sensitivities. The cell viability of a tumor fragment was measured by the reduction of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) to a colored formazan product, which allowed for quantitative and simple analysis. The sensitivities of KK-47 bladder tumor from nude mice to various anti-cancer drugs tested corresponded closely to those determined in the originial CGM assay system using tritiated thymidine, which has a high clinical correlation. Our modified method can be used as a practical and highly reproducible chemosensitivity test in vitro.

In a randomised trial based on a parallel design to determine the prophylactic effect of thiazide on stone formation, 210 calcium urolithiasis patients with idiopathic hypercalciuria were allocated either to treatment with trichlormethiazide (4 mg/day) or no treatment with only close follow-up; 35 patients were excluded for various reasons, including voluntary withdrawal. The background of the remaining 175 patients (82 in the thiazide group and 93 in the control group), including age and sex, was similar for both groups. In patients treated with thiazide there was a statistically significant fall in urinary calcium output. Statistical analyses also demonstrated that the stone formation rate in the thiazide group was significantly less than that in the control group. Adverse clinical reactions probably due to the drug were observed in 9 patients. These findings indicate that trichlormethiazide has a prophylactic effect on calcium urolithiasis in patients with idiopathic hypercalciuria.

To assess the clinical significance of coagulase-negative staphylococci (CNS) in patients with urinary tract infection (UTI), the clinical characteristics of a total of 117 patients (106 complicated UTI patients, 11 uncomplicated UTI patients) from whom CNS were isolated at urinary colony counts of 10(5) or more per ml were studied. Of the complicated UTI patients, 95 patients (89.6%) suffered from no symptoms while 11 (10.4%) had fever of 38 degrees C or greater, which was strongly suspected to be due to genitourinary tract infections. Six of these patients were managed by indwelling urinary catheters. On the other hand, all of the patients with uncomplicated UTI were young women and had typical symptoms of acute cystitis. These results suggest that CNS, which hitherto have been considered mere contaminants or benign colonization rather than true pathogens, can also cause complicated UTI requiring chemotherapy under certain conditions such as indwelling urinary catheterization and acute cystitis in sexually active women.

Integral photodynamic therapy with hematoporphyrin derivative was performed on 35 patients who had resistant transitional cell carcinoma of the bladder, mainly carcinoma in situ. The light source was an argon ion pumped dye laser (wavelength 630 nm.) using rhodamine B. Two types of laser light scattering diffuser developed at our department were used: a motor driven laser light scattering diffuser with computer regulation, and an endoscope modified light scattering diffuser tipped with a small quartz bulb containing a lipid nutritious solution as the scattering medium. The total energy density used was 10 to 30 J./cm.2. Of the 35 patients 24 (68.6%) achieved a complete response and 5 (14.3%) a partial response at 3 months. In 10 of the 24 patients there was no recurrence with an average tumor-free interval of 20.9 +/- 16.7 months, ranging from 5 to 60 months. Bladder capacity was decreased to approximately 150 ml. for 3 months after the integral photodynamic therapy without any evidence of hydronephrosis on excretory urograms, except for 2 patients who had a contracted bladder before photodynamic therapy. Integral photodynamic therapy may prove to be useful for the treatment of carcinoma in situ of the bladder.

We previously examined the effects of overdistension on the neuromuscular system of canine urinary bladders and reported that bladder overdistension led to nerve degeneration and subsequent supersensitivity through a decrease of blood supply to the bladder. We have accordingly in this study evaluated these changes in human subjects with infravesical obstruction. The responses to acetylcholine of bladder strips obtained from patients with detrusor instability were not significantly different from those of bladder strips from patients without detrusor instability, but the dose-response curve of these groups showed a shift to the right compared to that of the unobstructed control patients. As compared with the response of bladder strips in patients without an episode of retention, the response in patients who received prostatectomy within 30 days demonstrated no significant difference, although in patients who received prostatectomy after more than 30 days there was a statistical difference. These results indicated a significant decrease in sensitivity of the detrusor muscle in patients with infravesical obstruction and suggest that bladder overdistension caused by infravesical obstruction may lead to supersensitivity of the detrusor muscle secondary to denervation.

The accumulating data have shown that a single or certain combinations of proto-oncogenes are genetically altered and acquire oncogenic activities in certain tumor types, through a point mutation and/or overexpression. In the present study, Northern blotting analysis was applied to clinical samples of renal cell carcinomas (RCC) to elucidate expression levels of the c-myc, c-fos and Harvey ras genes in this tumor form. In 11 cases of 23 tumors examined (48%) was shown more than 3-fold expression level of the c-myc gene compared with the matching normal RNA, the c-fos gene in 6 cases (26%), and the Harvey ras gene in one case (4%) showing the concomitant overexpression of two other genes. Overexpression of both the c-myc and c-fos genes was detected in 5 cases (22%). Although the distinct correlation between overexpressions of any genes and the clinical background was not induced, it is considered that these aberrations of proto-oncogenes are involved in oncogenesis of a certain subgroup of RCC.

We applied restriction fragment length polymorphism (RFLP) analysis to 24 cases of renal cell carcinomas (RCC), 18 cases of prostate adenocarcinomas (PC), and 11 cases of transitional cell carcinomas (TCC) in the renal pelvis to study the oncogene amplification and inactivation of tumor suppressor genes. All of the cases showed no amplification nor gross rearrangements of the Harvey ras, c-myc, c-fos, c-myb, EGFR and PDGFR. In contrast, RFLP analyses demonstrated allelic losses interpreted as inactivational events of TSGs among the tumor forms studied. RCC had allelic losses on the short arm of chromosome 3 (3p) (68%), the long arm of chromosome 18 (18q) (33%), Y chromosome (29%), and 17p (27%) at high frequencies. PC showed frequent allelic losses on 16q (67%), 8p (50%), 18q (43%), 10p (40%), and 10q (38%). TCC had allelic losses on 17p (73%), 11p (64%), and 9p (40%). It was likely that the cases with the more malignant grade tumor had the more allelic losses.

Characteristics of placental-like alkaline phosphatase (PLAP-like enzyme) in seminoma was studied. By use of lectin affinity chromatography, PLAP-like enzyme in seminoma revealed extra sugar chains compared to placental alkaline phosphatase (PLAP), indicating heterogeneity of the carbohydrate moiety. However, the glycosylation patterns were found to be essentially similar between seminoma and normal testis. On isoelectric focusing, differences in migration patterns were revealed between seminoma-derived and normal testis-derived PLAP-like enzyme as well as between PLAP-like enzyme and PLAP. The differences in charge were mainly due to differences in sialylation of the molecules. The complex pattern of PLAP-like enzyme from seminoma on isoelectric focusing was not altered by neuraminidase treatment, indicating a considerable charge heterogeneity within the population of the enzyme molecules from the tumor.

A 77-year-old man was referred to the urological clinic with asymptomatic gross hematuria. Cystoscopy revealed a papillary tumor within the diverticulum of the bladder. A transurethral resection was performed and histopathological examination revealed adenocarcinoma. One month later, partial cystectomy was performed and histopathological examination indicated goblet cell metaplasia without residual tumor cells. The patient is currently well with no evidence of tumor.

A total of 231 isolates of Candida species including 163 of Candida albicans (132 of serotype A and 31 of serotype B), 42 of Candida tropicalis, 17 of Candida glabrata, 7 of Candida parapsilosis and 2 of Candida krusei were collected from clinical specimens in two medical centers, one in Japan and the other in the United States. The in vitro antifungal activities of amphotericin B, 5-fluorocytosine, miconazole and fluconazole were evaluated for the above isolates by means of a photo-read broth microdilution method for determination of the 30% inhibitory concentration (IC30). The results showed that IC30 values of fluconazole were generally great compared with those of the other drugs, regardless of Candida species. The isolates of C. albicans serotype B showed a significantly lessened susceptibility to 5-fluorocytosine compared with those of serotype A (p less than 0.01). This method has the advantage of objective measurement, thus minimizing observer variability as compared with the agar dilution test.

Treatment of a melanoma has been a very important problem to be solved in dermatology, especially considering that melanoma cells were resistant to radiation therapy and were easily metastasized. It was reported that the target of these treatments are membrane in both cases of PDT (chemical attack) and of SDT (physical attack).

An 18-year-old woman with a bladder hemangioma is described. The tumor had a low signal intensity with multilocular pattern on T1-weighted magnetic resonance (MR) images and high signal intensity on T2-weighted MR images. MR images were useful in evaluating tumor character and its extent.

We treated a 61-year-old patient with a diagnosis of bilateral ureteral carcinoma in situ with percutaneous perfusions of mitomycin C. After 16 sessions of mitomycin C therapy instilled through bilateral nephrostomy tubes, the urine cytology results became negative for malignancy. Bilateral ureteroscopy and cold-cup punch biopsies of the ureter revealed no evidence of disease. The patient did not experience side effects. He has remained free of disease during a 12-month follow-up period. Percutaneous perfusion of mitomycin C appears to be one of the effective and safe treatments for the carcinoma in situ of the upper urinary tract.

The chorioallantoic membrane of chick embryos was used to examine the responses of three tumour cell lines to anticancer agents, alone and in combination with hyperthermia. Fifteen minutes of hyperthermia at 42.5 degrees C produced the most favourable anticancer effect in the B16-F10 grafts. The use of Adriamycin (ADM) alone and the combined use of hyperthermia and either cisplatin (CDDP), cyclophosphamide (CY) or ADM resulted in a significantly higher rate of tumour regression in the B16-F10 grafts from a murine melanoma. In the KK-47 grafts derived from a transitional cell carcinoma of the bladder, the use of CY alone and the combination of CY and hyperthermia produced a significant tumour regression rate. In the T24 grafts neither the use of CY or CDDP alone, nor the combination of these drugs with hyperthermia demonstrated any significant effect. This method of screening anticancer agents was found to be rapid, simple to perform and inexpensive.

During the period from April 1984 to July 1993, we investigated the clinical efficacy of local hyperthermia used to treat 110 patients with urological malignancies. We investigated the long-term outcome of 40 (36.4%) responders who exhibited an immediate, partial or better response to the therapy. The one-year survival rate was 75% for retroperitoneal tumor, 65% for bladder cancer, 33% for each of renal cell carcinoma and prostatic cancer and 29% for renal pelvic and ureteral cancer. The 5-year survival rate was 48% for bladder cancer, 29% for renal pelvic and ureteral cancer, 25% for retroperitoneal tumor, and 0% for renal cell carcinoma and prostatic cancer. Subsidence of intolerable pain caused by cancer invasion was achieved in 29 of 42 patients (69.0%), indicating an improvement in patient's quality of life through pain relief.

Photodynamic therapy utilizing Photofrin has proven to be an effective modality that can be used in the treatment of a wide variety of solid tumors and luminal cancers. An argon pumped dye laser or excimer dye laser was used to deliver 630 nm light via quartz fibers passed through the biopsy channel subsequent to i.v. injection of photosensitizer. In this study, 64 patients with superficial cancers were treated in this manner but only 58 patients, including 21 with roentgenographically occult lung cancer, 8 with stage I lung cancer, 5 with esophageal cancer, 12 with gastric cancer, 8 with cervical cancer and 4 with bladder cancer were evaluable. Complete remission was obtained in 48 out of 58 cases (82.8%). There was no serious complication except skin photosensitivity, which was seen in 13 patients. We conclude that photodynamic therapy is efficacious in the treatment of superficial cancers where complete remission may be achieved.

Thirty-three patients with malignant bladder tumours were treated by hyperthermic intravesical perfusion. The study group included 25 patients with superficial T1 bladder tumours, 4 with T2 tumours and 4 with T3 tumours. Physiological saline solution containing 40 micrograms/ml peplomycin with/without 2% ethanol was used as a perfusate. Perfusion was carried out for 2 h 3 times per week and this regimen was repeated every other week, totalling 6 sessions in 3 weeks. Three patients achieved a complete response (CR), 5 a partial response (PR) (more than 50% tumour reduction), 8 a minimal response (MR) (25-50% tumour reduction) and the remaining 17 patients showed no response (NC). Complete, partial and minimal responses were obtained only in patients with T1 tumours. The NC patients included 4 with T2 and 4 with T3 lesions. Profuse haematuria from invasive tumour was markedly reduced after treatment. A major side effect was irritation of the bladder and urethra. Our results indicate that hyperthermic perfusion with ethanol and peplomycin is clinically safe, is accompanied by very little pain and may be useful for the management of superficial bladder tumours in elderly patients.

Eighteen patients with inoperable head, neck and upper chest wall cancers underwent radiofrequency hyperthermia in combination with chemotherapy and radiotherapy (HCR therapy). Of the eighteen patients, three showed complete response (CR); eight, partial response (PR); four, no change (NC); and three. progressive disease (PD). The overall efficacy (%CR+PR) was 61.1%. The efficacy tended to be higher in the patients treated with a maximal intratumoral temperature over or equal to 43-degrees-C (71%) than that in patients treated with under 43-degrees-C (25%). As the local control of the tumors was not related with their prognosis it is important that the patients should undergo not only regional hyperthermia but also systemic chemotherapy. Eight patients, who had suffered from heat burns, have all been cured by conservative therapy. These results suggested that HCR therapy might be useful in treating inoperable superficial malignant tumors, and be well tolerated under protection from skin bums.

Whole bladder wall photodynamic therapy using hematoporphyrin derivative and argon-dye laser light 630 nm was performed on 40 patients with mainly carcinoma in situ of the bladder. Two types of laser light scattering diffuser developed at our department were used: motor-driven and endoscope-modified laser light scattering diffusers. The total energy density used was 10 to 30 Joules/cm 2 . Of the 40 patients, 29 (72.5%) achieved complete response and 5 (12.5%) partial response at 3 months follow-up. In 9 of the 40 patients there was no recurrence and average tumor-free time was 27.1 months, ranging from 12 to 84 months.

An immunohistopathological study using monoclonal antibodies for alkaline phosphatases demonstrated placental alkaline phosphatase (PLAP)-like substance in the tumor cells of 11 pure seminomas, 1 seminoma with embryonal carcinoma and 1 seminoma metastasis. Liver alkaline phosphatase (LAP) could also be demonstrated in all seminomas but a third intestinal alkaline phosphatase (IAP) was not demonstrable in any tumor. The PLAP-like substance and LAP had considerable enzyme activities. This provides two tumor markers of seminomas detectable in histopathological specimens.

The composition of 2,755 calculi obtained from the upper urinary tract (1,409 by spontaneous passage and 1,346 by urological procedures) was analyzed using an infrared spectrophotometer, and the spontaneous passage rate was investigated in relation to the composition as well as other variables, such as stone size, and patient age and sex. Mixed stones of calcium oxalate and calcium phosphate were most frequently found, followed by those of calcium oxalate. The mean size (the maximum diameter) was largest in struvite stones and smallest in calcium oxalate ones. The sizes of stones from women were significantly larger than those from men (p < 0.01). As expected, the stone passage rates were inversely related to increasing stone size. The size of 55.6% of the stones passed was < or = 5 mm, and that of 96.6% of the stones < or = 10 mm.

The composition of 3,084 urinary calculi was determined using an infrared spectrophotometer. Mixed calcium oxalate-calcium phosphate stones were most frequently implicated. Of the urinary calculi analyzed 199 were associated with urinary tract infection. Escherichia coli was most frequently isolated (43 strains) and urease-producing organisms, such as Proteus mirabilis, were cultured from 40 patients. The core culture of 20 staghorn calculi yielded 15 isolates from 14 stones. There were 13 identical species isolated from the urine and stone specimens of 13 patients (65%), including 7 strains of P. mirabilis. These results suggest that cultures of urine specimens of urolithiasis patients, especially those with staghorn calculi, may help to elucidate the bacteriology of the stones.

Renal candidiasis is uncommonly encountered because there are no universally accepted diagnostic criteria of this disease. The presence of a Candida bezoar is considered to distinguish renal candidiasis from benign colonization1,2), but seems to be of limited value in rapidly diagnosing renal candidiasis. Recently, to make a rapid diagnosis of invasive candidiasis and candidemia, serodiagnostic parameters such as a circulating candidal metabolite3,4> and antigens4N6) have been developed to great advantage. However, they have not yet been sufficiently evaluated in renal candidiasis. Herein, we report a case of calculus pyonephrosis due to Candida albicans with special reference to serodiagnostic parameters.

We evaluated a latex agglutination test commercially available in kit form for the identification of Candida pyelonephritis in candiduria patients. Tests were performed on sera from 11 patients with fever and candiduria plus other positive candidal sites (group A), 12 patients were fever and candiduria alone (group B), 17 afebrile patients with candiduria alone (group C), and 27 afebrile patients without documented candiduria or bacteriuria (group D). Positive antigenemia with a titer of 1:4 or greater was detected in 9 candiduria patients with fever: 7 (63.6%) in group A and 2 (16.7%) in group B. The incidence of group B, in which Candida pyelonephritis was strongly suspected, was significantly less than that of group A and did not significantly differ from that of groups C and D. These results suggest that this test has little value in the diagnosis of Candida pyelonephritis without disseminated candidiasis.

A series of 31 patients with advanced urothelial cancer were treated with combination chemotherapy consisting of 1-4 cycles of methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC). Of the 31 patients, 29 had measurable and evaluable lesions. A complete remission was achieved by 4 of these 29 patients (14%) for 1-46 months. A partial remission was observed in 14 of the 29 patients (48%) for 1-9 months. Whereas bony and hepatic metastatic lesions did not respond, some nodal (7/12), pulmonary (4/8), and pelvic lesions (2/3) as well as primary bladder tumors (4/6) and a tumor marker (1/2) responded. Complete tumor remission was observed in nodal (2/12) and pulmonary (1/8) metastatic lesions, in invasive lesions to the prostate and seminal vesicle (1/1), and in primary lesions in the bladder (2/6), ureter (1/1), and urethra (1/1). Two of three patients with non-transitional cell tumors attained a partial remission for 1-7 months. Complete remission of the pulmonary lesions was obtained in a case of squamous cell cancer of the bladder with pulmonary metastases. The toxicity of this regimen was generally tolerable and included moderate to severe myelosuppression, mild to moderate nausea and vomiting, renal toxicity, and mucositis. These results suggest that the M-VAC regimen holds promise for the treatment of advanced metastatic transitional cell cancer as well as non-transitional cell cancer of the urothelium.

D-Arabinitol, a major candidal metabolite, is reported to be a useful parameter to diagnose disseminated candidiasis. Conventional determination of serum D-arabinitol levels using gas-liquid chromatography is complicated and time-consuming compared with the enzymatic fluorometric assay, newly available in kits. D-Arabinitol concentrations were determined by both enzymatic fluorometric assay kits and gas-liquid chromatography, and a significant correlation (r = 0.943, p less than 0.01) was found between the two methods in 25 sera from 15 patients with candiduria. D-Arabinitol/creatinine ratios were determined using the enzymatic fluorometric assay in 39 candiduria patients (21 febrile and 18 afebrile) and 22 patients without candiduria as the control. The ratios in the febrile patients were significantly greater than those in the afebrile and the nondocumented candidiasis groups. These results suggest that knowledge of the serum D-arabinitol concentration may help to promptly diagnose invasive candidiasis, particularly Candida pyelonephritis. In addition, enzymatic fluorometric assay kits are considered to be advantageous in that they require little time and are simple to use, as compared with gas-liquid chromatography.

We previously reported that bladder overdistension led to denervation and subsequent supersensitivity of the detrusor muscle to acctylcholine. Therefore, to exclude the influence of bladder overdistension, we produced a low-pressure bladder in female mongrel dogs using an indwelling urethral catheter, and performed pelvic neurectomy (decentralization). We examined the effects of decentralization on the neuromuscular system of the bladder. The contraction response levels of bladder strips in dogs 1 and 2 weeks after neurectomy was low, and significantly different from that of bladder strips in the control group. The doseresponse curves of dogs 4 and 8 weeks after neurectomy showed a shift to the left when compared to those of the control group, indicating a significant increase in sensitivity of the bladder strips. Many cholinergic terminal and varicosity profiles had a normal ultrastructure in all of the groups subjected to neurectomy, while some had degenerating profiles representing clear axoplasm without any recognizable organelles. Microphotographs of bladders obtained from dogs with spontaneous catheter loss showed degenerating axons, which were observed more frequently than in bladders kept empty with indwelling urethral catheters. Micturition in the dogs with spontaneous catheter loss was achieved by overflow incontinence without catheterization. These findings suggest that post-synaptic nerve degeneration may be augmented by impairment of micturition, followed by decentralization. Our observations also suggest that post-synaptic nerve degeneration (denervation) plays an important role in the increased sensitivity of the detrusor muscle to acetylcholine in the parasympathetically decentralized urinary bladder, whether denervation is due to trans-synaptic degeneration or impairment of micturition.

The role of serum alkaline phosphatase as a tumor marker for testicular germ cell disease was investigated in 26 patients with testicular seminoma and 13 with nonseminomatous germ cell testis tumors. Placental alkaline phosphatase-like enzyme was elevated in 50% of the stage I seminoma patients and in all patients with stages II to III disease. In addition, liver (tissue unspecific) alkaline phosphatase was elevated in 10 and 83% of the patients, respectively. Lactic dehydrogenase and beta-human chorionic gonadotropin (beta-HCG) were detected in 50 to 60% of the patients with stage I seminoma. By combining placental alkaline phosphatase-like enzyme, lactic dehydrogenase and beta-HCG, 75% of the stage I and 100% of the stages II and III seminoma patients could be identified correctly. Placental alkaline phosphatase-like enzyme in serum also occurred with nonseminomatous germ cell tumor but less frequently, while liver alkaline phosphatase was not detected at all. Thus, placental alkaline phosphatase-like enzyme and liver alkaline phosphatase were predominantly determined in the serum of patients with seminoma. In studies of tumor tissues from 31 of these patients, those with normal serum placental alkaline phosphatase-like enzyme levels had significantly lower tissue placental alkaline phosphatase-like enzyme levels than patients with elevated serum levels (p less than 0.01). Seminoma tissues showed significantly higher levels of placental alkaline phosphatase-like enzyme and liver alkaline phosphatase than nonseminomatous germ cell tumors (p less than 0.01), explaining the infrequent elevation of serum placental alkaline phosphatase-like enzyme and liver alkaline phosphatase found in patients with nonseminomatous germ cell tumors.

To elucidate changes in hormone metabolism, especially thyroid, cortisol and sex hormone metabolism, during acute local heat stress, serum-free thyroxine (FT4), free tri-iodothyronine (FT3), reverse T3 (rT3), thyroxine binding globulin (TBG) and a number of other hormone levels [thyroid-stimulating hormone, thyroglobulin, calcitonine, luteinizing hormone, follicle-stimulating hormone, prolactin, growth hormone, cortisol and testosterone] were measured sequentially in 11 male patients with bladder cancer during and after local radiothermotherapy treatment. Hyperthermia was administered using 8 MHz radiofrequency (RF) capacity equipment. The core temperature was raised from 37 to 42 degrees C and maintained at 42 degrees C for 1 h. No significant change in hormone levels except for a slight decrease in TBG levels was observed. The clinical results indicated that 8 MHz RF hyperthermia at 42 degrees C can be applied safely as a therapeutic measure in patients with bladder tumours. Further studies concerning the changes in TBG are necessary in patients with other tumours, especially those with the complication of subclinical hyperthyroidism, to detect any corresponding rises in FT3 and FT4 levels. The effects of using higher temperatures also need to be examined.

We studied the incidence of the postoperative bacteremia developing in 44 patients undergoing transurethral resection of the prostate under prophylactic use of antibiotics. In 15 of the patients, postoperative endotoxinemia was also investigated. Postoperative bacteremia was found in 10 (22.7%) of the patients, in only one of whom septicemia developed. The incidence of bacteremia was not influenced by the kind of antimicrobial agent administered prophylactically, but was significantly higher in the patients with preoperative urinary tract infection or prostatitis on histological examination of resected prostatic tissue (p less than 0.01). Concerning species isolated from the blood, gram-positive cocci were isolated more frequently than gram-negative bacteria, and Staphylococcus epidermidis was the most common species. In 7 (70%) of the bacteremia patients an identical species was isolated from preoperative urine cultures. In the patients with bacteremia, significant increases in white blood cell count and maximal body temperature were found within 3 hours after the procedure as compared to before the procedure. To lower the postoperative bacteremic rate, appropriate and adequate antimicrobial agents must be used preoperatively in patients with infection of the genitourinary tract. As to blood endotoxin, the endotoxin levels in the patients with postoperative fever did not significantly differ from those of the patients without this complication.

Biochemical analysis of renal cyst fluid was performed in 53 patients with simple renal cysts including 2 infected cases. The composition of noninfected cyst fluid tended to parallel that of serum. Additionally, the penetration of amikacin into cyst fluid was studied in 2 infected and in 11 noninfected patients following a single 200-mg intramuscular injection of amikacin. Drug levels in the fluid were below detection limit in the noninfected and approximately half or less of the serum values in the infected patients. These data may explain one of the reasons why infection of simple renal cysts is highly resistant to antimicrobial chemotherapy. The value of treatment by percutaneous aspiration and drainage of infected cysts is emphasized.

Placental alkaline phosphatase (PLAP) levels in sera and tissues from 40 patients with testicular tumor were measured using a monoclonal immunocatalytic assay. The mean value of the PLAP levels of seminoma tissues was found to be 92-fold higher than that of normal testes, being significantly high compared with that of nonseminoma tissues. The mean value of the serum PLAP levels from patient's with seminoma was also significantly higher than that from patients with nonseminoma. In 2 groups of seminoma and mixed type tumor cotnaining seminoma and nonseminoma components, the PLAP levels of tissues from patients who had high levels of the serum PLAP (≥100mKAU) were significantly higher than those from patients who had normal serum PLAP levels (, 出版者照会後に全文公開 / 許可を得て公開

A combined therapy of hyperthermia (43.5 C) and tumor necrosis factor (10(3) and 10(4) units) for the treatment of experimental bladder carcinoma KK-47 in athymic mice was studied. Briefly, mice were injected subcutaneously with 10(7) disaggregated cells. When the tumors were 250 mm3 in size, tumor necrosis factor was administered, either intravenously or by intratumor injection. Intravenous injection was 10(3) to 10(4) units tumor necrosis factor in the tail vein and intratumor was 10(3) to 10(4) units injected directly into the center of the tumor. Immediately following injection, the tumor bearing leg was placed in a 43.5 C water bath for 20 minutes. Tumor size was monitored once a week for seven weeks and the animals were divided into control, hyperthermia alone, tumor necrosis factor alone and combined therapy. Results of the study showed no significant difference in 10(3) units of tumor necrosis factor intravenously versus control but a significant regression in hyperthermia alone. Anti-tumor effects significantly increased in hyperthermia plus 10(3) units tumor necrosis factor versus hyperthermia alone. Similar results were seen with 10(4) units tumor necrosis factor intravenously though in the combination group of hyperthermia and tumor necrosis factor, eight mice of eight died one to three days following treatment. In those receiving intratumor injections, there was no difference between tumor necrosis factor or control. Tumor necrosis factor with hyperthermia had the approximate same characteristics as hyperthermia alone and therefore there was no synergistic finding. These results reflect on the suggestion that the combination therapy of hyperthermia and systemic administration of the proper dosage of tumor necrosis factor may produce synergistic anti-cancer effects in bladder cancer patients.

We investigated 32 patients with bacteremia that occurred in the Department of Urology, School of Medicine, Kanazawa University between April, 1983 and March, 1989. This incidence represented 1.9% of the total number of inpatients. The study group comprised 29 males and 3 females, and their age varied from 25 to 82 years with a mean age of 61.7 years. Twenty-two (75%) of the 32 patients had urologic malignancies. The majority of patients were compromised hosts who had one or more (average, 3.8) factors that promoted bacteremia. Urinary tract infections existed in 26 (86.0%) patients before the bacteremic episode and urine cultures revealed a species identical to that simultaneously isolated from the blood in 19 (73.1%) of the 26 patients. Out of the 26 patients, there were 22 (84.6%) with complicated pyelonephritis and 22 (84.6%) with an indwelling urinary tract catheter. In blood cultures, the most common isolate was Staphylococcus epidermidis and gram-positive cocci were cultured at a rate of 43.9% which was higher than that (39.0%) of gram-negative rods. In contrast, in urine cultures, gram-negative rods were isolated predominantly. S. epidermidis and Corynebacterium spp. isolated less frequently in blood than in urine, indicated contaminants. However, Enterococcus spp. and Candida albicans were recognized as causative organisms of bacteremia via the urinary tract, because the urine culture demonstrated a species identical to that obtained from blood in these bacteremic patients. Antibiotic sensitivity tests demonstrated that isolates from blood tended to show tolerance to beta-lactam antibiotics, but had good sensitivity to aminoglycosides.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial and crystal adherence to the surfaces of indwelling urethral catheters was investigated by scanning electron microscopy and immunofluorescence method in relation to microbiological examination. Gram-negative bacteria were isolated more frequently than gram-positive bacteria in urine and catheter cultures. Microorganisms and crystals frequently were associated with fibrillar material, some of which was considered to be fibrin. On the surfaces of catheters indwelling for more than 1 week bacteria often were embedded in an amorphous matrix. It was believed that the thick coherent matrix adherent to the catheter served as a protected reservoir of microorganisms that persisted despite antimicrobial chemotherapy. Additionally, urease-producing bacteria attached to the catheter could have an important role in the development of calculous incrustation.

A primary squamous cell carcinoma occurring in the prostate is described. Local irradition, systemic anticancer chemotherapy using bleomycin and intraarterial administration of cis-platinum were done. Twenty-one months after the initial diagnosis there is no sign of tumor progression.