[A case of spinal lipoma with the chief complaint of dysuria in an adult and review of the pertinent literature].
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Biomedical subjects
Publications and source records attributed to K Uchida.
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Fundamental and clinical evaluation on ceftriaxone (Ro 13-9904, CTRX), a new cephalosporin antibiotic, was performed in the field of obstetrics and gynecology and the following results were obtained. The concentration of CTRX after intravenous injection was determined in the arterial and venous blood, and in the internal genital organs and a favorable tissue transfer was observed. The clinical efficacy rate was not very high (40%); good in 2 out of 5 cases with gyneco-obstetric infections, but it is notable that efficacy was recognized in the case which B. fragilis was detected. Neither adverse reaction nor laboratory test abnormality was seen to be attributable to CTRX in any case.
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Renal cell carcinoma is the third most frequent cause of urological cancer death in Japan. The first is bladder cancer and the second is prostatic cancer. However, there has been no clinical trial of mass screening for early detection of renal cell carcinoma. With a view to discovering a method of early detection for renal cell carcinoma, we analyzed the procedures for discovering renal cell carcinoma in 33 patients who were treated at our hospital. In 10 patients, carcinoma had been discovered accidentally without gross hematuria, abdominal mass or flank pain. Seven of these patients were first suspected of having renal cell carcinoma by ultrasonography, two by intravenous pyelography (IVP) and one by computed tomography. Seven out of nine patients operated on were surgically diagnosed as having stage I and two as having stage II. Ultrasonography is far better than IVP from the points of view of noninvasiveness, ease of performance and accuracy. In our study, ultrasonography was the most useful method for early detection of renal cell carcinoma. However, for the mass screening of renal cell cancer by ultrasonography, it is necessary to make its specificity and sensitivity clear and to debate its cost effectiveness.
Forty-three patients with chronic renal failure and secondary hyperparathyroidism underwent parathyroid surgery. The first 20 patients were submitted to subtotal parathyroidectomy, and the last 23 patients underwent total parathyroidectomy and parathyroid autotransplantation in the forearm. Non-invasive image diagnosis, CT, ultrasonography and scintigraphy are valuable for 1) making a definite diagnosis of secondary hyperparathyroidism, 2) locating the tumor 3) determining the effectiveness of treatment, and 4) differentially diagnosing thyroid tumors. For surgical treatment, we recommend total parathyroidectomy and autotransplantation in the forearm because the second operation for recurrence may be done more safely and easily than after subtotal parathyroidectomy.
A case of lipoma of the spermatic cord is presented. The patient is a 68-year-old with the chief complaint of indolent swelling of the left scrotal content which had been noticed about a month ago. A firm elastic and walnut-sized mass with positive transillumination was palpable in the left spermatic cord, but ultrasound sonography demonstrated that it was a solid mass. Though the tumor was punctured with a 18-gauge needle, nothing could be aspirated. The tumor was removed and histologically diagnosed as lipoma originating in the left spermatic cord. Including the present case, 38 Japanese cases of lipoma of the spermatic cord are reviewed.
The clinical aspects of 64 patients with superficial bladder cancer (Ta, T1, T2 according to the TNM classification, International Union against Cancer or Stage O, A, B1 according to Marshall) admitted to the Tsukuba University Hospital were analyzed retrospectively. Treatment of these patients was mainly by transurethral surgery. The overall 10-year survival rate was 73%. Eight patients died and four of them showed an invasive change, the so-called metamorphosis, during the follow-up period. Patients with papillary, pedunculated tumors had better survival rates than those with papillary, sessile tumors. Patients with tumors less than 1 cm in size had better survival rates than those with tumors 1-3 cm in size. There were no statistical differences in survival rates between patients with single and multiple tumors. Up to seven years from surgery, the patients with T2 tumors had lower survival rates than those with Ta-T1 tumors. The patients with grade I tumors had better survival rates than those with grade II tumors. There were no significant differences in recurrence rates related to the grade of the tumor. It is thought that the prognosis of superficial bladder cancer in our series depended mainly on the shape, size, number, depth and grade of the tumor.
A 77 year-old woman presented with the chief complaint of a mass in the right upper quadrant. The examination on admission including IVP, echography, Ga scintigraphy, barium enema, CT scan, and angiography revealed that the right kidney and ascending colon were displaced by the mass. Under the diagnosis of retroperitoneal tumor, operation was carried out. Most of the mass was resected with the right kidney. The pathological diagnosis of the resected tumor revealed well differentiated liposarcoma. Convalescence was uneventful and the patient has been well and free from disease for 14 months. Based on our experience and the review of the pertinent literature in English and Japanese, we emphasize the importance of definite surgery and close follow up, as liposarcoma is frequently recurrent.
THP-adriamycin was administered in a dose of 5 to 20 mg, 3 times a week, and the results showed 4 cases of CR, 5 cases of PR, 3 cases of MR and 2 cases of NC with the accumulated total dose of less than 100 mg. Histological effects were slight in a total dose of less than 50 mg, while the effects appeared in a total dose of 60 to 70 mg and further effects were obtained after about 1 week of the termination of the therapy. Leukopenia occurred in 6 of 14 cases. The side effects of THP-adriamycin were milder than those of ADM.
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Seminoma is one of the most radiosensitive of the solid tumors. Radiotherapy provides a high cure rate for patients with stage I and II seminoma, but the survival rate of the patients with clinically advanced stage III seminoma is only about 30% in the literature. Our case of advanced metastatic seminoma was treated with cisplatinum, vinblastine and bleomycin. Metastatic tumors in the lung disappeared after chemotherapy but recurred shortly. Then regional radiation was given and the tumors disappeared completely. Subsequent prophylactic chemotherapy was given. In view of the observed chemosensitivity of seminoma, it appears that all patients who present initially with metastatic or bulky retroperitoneal disease should be treated with multiple drug chemotherapy including cis-platinum. Residual tumors can be treated by radiation and surgical resection, which will improve the cure rate of advanced metastatic seminoma.
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Between July, 1976 and June, 1984, 43 adults with acute lymphocytic leukemia were treated with a V(V') P [vincristine (vindesine), prednisolone] followed by DV(V')MP [daunomycin, vincristine (vindesine), 6-mercaptopurine, prednisolone] and V(V')AP [vincristine (vindesine), 1-asparaginase, prednisolone] regimen. They were all previously untreated and aged 15 and over. Complete remission (CR) was attained in 41.9% of cases by V(V')P alone, the CR rate being increased up to 62.8% by the sequential administration of DV(V')MP, and to 74.4% by the further administration of V(V')AP. The median duration of CR was 5.6 months; it was 10.9 months for patients with the maintenance therapy and 1.3 months for patients without it. For patients who achieved CR, the median survival time (MST) was 21.3 months compared to 2.7 months for those who failed to achieve CR. As for the maintenance therapy, MST was 22.3 months for patients who received it, and 9.5 months for patients who did not. Factors associated with significantly lower rate of CR were: lymphadenopathy and hepatomegaly and/or splenomegaly. The CR rate was somewhat lower for patients aged over 20 and with hyperleukocytosis (above 40,000/cmm). Shorter remissions tended to be associated with ages over 20 and with hepatomegaly and/or splenomegaly. Patients who obtained CR by the sequential administration of the V(V')AP regimen showed somewhat shorter CR duration compared with to those who obtained CR by V(V')P alone and by the sequential administration of DV(V')MP. Survival was significantly shorter for patients who failed to achieve CR, with B-ALL and with hyperleukocytosis. Shorter survival was also observed among patients with ages above 60 compared to those with ages below 20.