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1.
Hinyokika Kiyo ; 59(10): 663-7, 2013 Oct.
Artículo en Japonés | MEDLINE | ID: mdl-24262708

RESUMEN

We report a case of Henoch-Schönlein purpura that developed after radical cystectomy. The patient was a 70-year-old man who visited our hospital with a chief complaint of asymptomatic macroscopic hematuria and was diagnosed with invasive bladder cancer. After providing one course of gemcitabine and cisplatin therapy as neoadjuvant chemotherapy, radical cystectomy was performed. Due to postoperative formation of an abscess just beneath the rectus abdominis muscle, the patient was administered antibiotic treatment. Purpura developed on postoperative day 23, and was diagnosed as Henoch-Schönlein purpura based on skin biopsy. Symptoms disappeared approximately 3 weeks later, after initiating treatment with diaphenylsulfone and prednisolone.


Asunto(s)
Cistectomía , Vasculitis por IgA/etiología , Anciano , Humanos , Riñón/fisiología , Masculino , Complicaciones Posoperatorias , Neoplasias de la Vejiga Urinaria/cirugía
2.
Hinyokika Kiyo ; 59(8): 485-9, 2013 Aug.
Artículo en Japonés | MEDLINE | ID: mdl-23995523

RESUMEN

We evaluated clinical outcomes of radical prostatectomy in 244 patients who had undergone radical prostatectomy as initial treatment from January 2000 to December 2011, and were followed up for more than 6 months. Biochemical recurrence after prostatectomy was defined as prostate-specific antigen (PSA) level of at least 0. 2 ng/ml. We evaluated potential risk factors for significant associations with biochemical recurrence. Median follow-up period after prostatectomy was 49 months (range, 6-144). Of the total, 192, 31, and 20 patients were at pathological stage pT2, pT3a, and pT3b, respectively. In 83 patients with the positive surgical margin, apexes were mostly in the positive area. Of the 68 patients with PSA recurrence, PSA non-relapse rate was 66.6% for 5 years. Multivariate analysis was performed for seminal vesicle invasion, PSA nadir, surgical margins, and Gleason score. Thirty-two patients with PSA recurrence underwent salvage radiotherapy, and the biochemical recurrence rate at 5 years was 73.8%. The group in which the PSA level before salvage radiotherapy was <0.5 ng/ml had a low rate of biochemical recurrence. We must consider the recurrence of poorly differentiated or non-confined cancer after radical prostatectomy. These results suggest that early use of salvage radiotherapy is effective for patients with biochemical recurrence after radical prostatectomy.


Asunto(s)
Antígeno Prostático Específico/análisis , Prostatectomía , Neoplasias de la Próstata/cirugía , Anciano , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Neoplasias de la Próstata/radioterapia , Estudios Retrospectivos , Terapia Recuperativa
3.
Hinyokika Kiyo ; 59(8): 545-9, 2013 Aug.
Artículo en Japonés | MEDLINE | ID: mdl-23995535

RESUMEN

We report a case of drug-induced pneumomediastinum by bleomycin in testicular cancer, which is extremely rare ; to our knowledge, only 3 cases have been reported. A 28-year-old man presented with a left testicular mass. He underwent radical left inguinal orchiectomy that demonstrated a seminoma, pT3N0M0. Ten months after surgery, para-aortic lymph node metastasis appeared, and he received three cycles of bleomycin, etoposide and cisplatin (BEP) chemotherapy. On day 13 of the fourth course of BEP, he complained of snowball crepitation of the neck and computed tomography revealed subcutaneous emphysema, extensive mediastinal air, and intraspinal air accumulation without pneumothorax. The pneumomediastinum and subcutaneous emphysema tended to deteriorate until 15 days after the onset of pneumomediastinum, but fortunately he had no signs or symptoms of infection. These findings resolved spontaneously after 1 month.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Enfisema Mediastínico/inducido químicamente , Adulto , Antibióticos Antineoplásicos/administración & dosificación , Antibióticos Antineoplásicos/efectos adversos , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Antineoplásicos Fitogénicos/administración & dosificación , Antineoplásicos Fitogénicos/efectos adversos , Bleomicina/administración & dosificación , Bleomicina/efectos adversos , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Etopósido/administración & dosificación , Etopósido/efectos adversos , Humanos , Masculino , Neoplasias Testiculares/tratamiento farmacológico
4.
Hinyokika Kiyo ; 58(10): 549-52, 2012 Oct.
Artículo en Japonés | MEDLINE | ID: mdl-23235277

RESUMEN

A 70-year-old man presented in December, 2010 with priapism persistent for over a month. The patient had no history of medications for erectile dysfunction, penis trauma, or traumatic sexual activities. A blood gas measurement of the cavernosum was performed, but only fibrosis tissue was aspirated and no blood was obtained. Color-flow Doppler imaging of the penis revealed blood flow in the corpora cavernosa of the penis, suggesting the occurrence of nonischemic priapism. Enhanced chest and abdominal computed tomography revealed a left renal cyst, and the wall of the cyst showed contrast enhancement. No other obvious obstructive mass or tumor was detected in the pelvic cavity. Gradually, necrotic changes of the glans penis appeared, and total penectomy was performed. Histopathological examination of penectomy tissue specimens suggested papillary renal cell carcinoma metastases to the penis. Consequently, open left radical nephrectomy was performed. Pathological diagnosis revealed papillary renal cell carcinoma pT2, and the patient was diagnosed with stage IV (pT2N0M1) renal cell carcinoma. Treatment was provided by intravenous temsirolimus therapy that resulted in partial remission and stable disease, which in turn relieved cancer pain.


Asunto(s)
Carcinoma de Células Renales/complicaciones , Neoplasias Renales/complicaciones , Priapismo/etiología , Anciano , Carcinoma de Células Renales/patología , Humanos , Neoplasias Renales/patología , Masculino , Metástasis de la Neoplasia
5.
Nihon Hinyokika Gakkai Zasshi ; 103(1): 22-6, 2012 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-22568166

RESUMEN

Wound necrosis and groin lymphorrhea after inguinal lymph nodes dissection are serious complications. But treatment options for these complications are somewhat controversial. We report a patient who underwent an inguinal lymph node dissection for a regional metastasized squamous cell carcinoma of penis. Unfortunately, a extensive wound necrosis occurred with lymphorrhea (300 cc daily). After operative debridement, negative pressure wound therapy was started. We had used the instrument "V.A.C. (Vacuum Assisted Closure) ATS Therapy System" (KCI U.S.A.). After 11 days of negative pressure wound therapy, the good formation granulation tissue was observed and the lymphatic leakage was prominently decreased. This therapy was performed without serious complications but tolerable localized pain due to negative pressure. There were only seven reports that gave the description of an approach using negative pressure wound therapy for the less invasive treatment of lymphocutaneous fistulas and evaluated the efficacy of this therapy as an alternative medical procedure for treating lymphorrhea. This case suggested that negative pressure wound therapy could not only promote wound healing but also improve intractable lymphorrhea.


Asunto(s)
Escisión del Ganglio Linfático , Enfermedades Linfáticas/terapia , Terapia de Presión Negativa para Heridas/métodos , Carcinoma de Células Escamosas/cirugía , Humanos , Conducto Inguinal , Masculino , Persona de Mediana Edad , Necrosis , Terapia de Presión Negativa para Heridas/instrumentación , Neoplasias del Pene/cirugía , Complicaciones Posoperatorias
6.
Int J Urol ; 19(9): 881-5, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22583110

RESUMEN

A large renal stone can be treated ureteroscopically, but the treatment often requires more than one procedure. The use of stenting before ureteroscopy was recently reported. The present study investigated the effectiveness of preoperative stenting before ureteroscopic lithotripsy for large (>15 mm) renal stones. A ureteral stent was intentionally inserted in 25 patients undergoing ureteroscopic surgery. A group of 36 non-prestented patients was used as control. Median stone diameter was 21 mm in both groups. Pre-ureteroscopy stenting significantly improved the stone-free rate, defined as stones <2 mm and <4 mm (P < 0.05), whereas it did not significantly improve the stone-free rate defined as 0 mm (P = 0.12). The uretereoscopy success rate was 72.0% in the stented and 55.6% in the control group (P = 0.09). A 14/16-Fr ureteral access sheath was successfully inserted in 94.7% of the stented patients, and 74.2% of the non-stented patients (P < 0.05). Our findings showed that preoperative stenting is effective for dilation of the ureter, and also to facilitate the insertion of a ureteral access sheath in patients undergoing ureteroscopic lithotripsy for large renal stones.


Asunto(s)
Cálculos Renales/cirugía , Litotricia/métodos , Stents , Ureteroscopía/métodos , Dilatación/instrumentación , Dilatación/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/instrumentación , Cuidados Preoperatorios/métodos , Resultado del Tratamiento , Uréter/cirugía
7.
Nihon Hinyokika Gakkai Zasshi ; 103(6): 697-703, 2012 Nov.
Artículo en Japonés | MEDLINE | ID: mdl-24261193

RESUMEN

Angiosarcoma is rare and highly malignant vascular neoplasm, and primary retroperitoneal angiosarcoma is extremely rare. Preoperative diagnosis is very difficult because there are no specific imaging features, and definitively effective treatment has not yet been established. We recently treated a patient with primary retroperitoneal angiosarcoma in which a prompt and exact diagnosis was difficult to obtain. One month after surgery, local recurrence appeared, but salvage immunotherapy using recombinant interleukin-2 (rIL-2) showed good efficacy, and the patient obtained complete response. Here we report this rare case of angiosarcoma. A 60-year-old woman with abdominal pain was diagnosed with a left retroperitoneal mass on CT scan. The tumor was about 9 cm in diameter and positioned above the left kidney. Further study using MRI, 131I-MIBG scintigraphy, and enhanced CT suggested chronic expanding hematoma and the patient underwent surgical resection. Histopathological diagnosis was primary retroperitoneal angiosarcoma based on positive staining for VIII factor, CD31, CD34, and p53. One month after surgery, FDG-PET revealed local recurrence adjacent to the psoas major. We initiated salvage immunotherapy using rIL-2. The patient was treated effectively and achieved complete response. She is alive and well 19 months after surgery and rIL-2 treatment.


Asunto(s)
Antineoplásicos/uso terapéutico , Hemangiosarcoma/tratamiento farmacológico , Interleucina-2/uso terapéutico , Neoplasias Retroperitoneales/tratamiento farmacológico , Femenino , Hemangiosarcoma/cirugía , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Proteínas Recombinantes/uso terapéutico , Neoplasias Retroperitoneales/cirugía
8.
BMC Urol ; 11: 20, 2011 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-21967681

RESUMEN

BACKGROUND: Patients with spinal cord injury and a chronic indwelling urinary catheter are known to have an increased risk of bladder malignancy. However, squamous cell carcinoma (SCC) of the epidermis around a suprapubic cystostomy is relatively rare. Here, we report a case of lower abdominal SCC arising from the suprapubic cystostomy tract. CASE PRESENTATION: A 58-year-old man with a complete spinal cord injury was referred to our hospital with a chief complaint of an abdominal mass. Abdominal enhanced computed tomography (CT) showed a 7-cm mass surrounding the suprapubic cystostomy and bilateral inguinal and para-aortic lymph nodes metastasis. Histopathological examination of percutaneous biopsy specimens was performed. The diagnosis was stage IV (cT4N1M1) epidermal SCC, which was treated with palliative external radiation therapy. CONCLUSION: The SCC in this case was thought to arise from mechanical stimulus of the suprapubic cystostomy. Physicians and patients should pay careful attention to any signs of neoplasms with long-term indwelling catheters, such as skin changes around the suprapubic cystostomy site. This case presentation is only the fourth report of SCC arising from the suprapubic cystostomy tract in the literature. In cases of unresectable tumors and contraindications to chemotherapy, palliative radiotherapy may lead to disease remission and symptom relief.


Asunto(s)
Carcinoma de Células Escamosas/etiología , Cistostomía/efectos adversos , Neoplasias Cutáneas/etiología , Humanos , Masculino , Persona de Mediana Edad
9.
BMC Cancer ; 10: 667, 2010 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-21129184

RESUMEN

BACKGROUND: In this era of molecular targeting therapy when various systematic treatments can be selected, prognostic biomarkers are required for the purpose of risk-directed therapy selection. Numerous reports of various malignancies have revealed that 18-Fluoro-2-deoxy-D-glucose (18F-FDG) accumulation, as evaluated by positron emission tomography, can be used to predict the prognosis of patients. The purpose of this study was to evaluate the impact of the maximum standardized uptake value (SUVmax) from 18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) on survival for patients with advanced renal cell carcinoma (RCC). METHODS: A total of 26 patients with advanced or metastatic RCC were enrolled in this study. The FDG uptake of all RCC lesions diagnosed by conventional CT was evaluated by 18F-FDG PET/CT. The impact of SUVmax on patient survival was analyzed prospectively. RESULTS: FDG uptake was detected in 230 of 243 lesions (94.7%) excluding lung or liver metastases with diameters of less than 1 cm. The SUVmax of 26 patients ranged between 1.4 and 16.6 (mean 8.8 ± 4.0). The patients with RCC tumors showing high SUVmax demonstrated poor prognosis (P = 0.005 hazard ratio 1.326, 95% CI 1.089-1.614). The survival between patients with SUVmax equal to the mean of SUVmax, 8.8 or more and patients with SUVmax less than 8.8 were statistically different (P = 0.0012). This is the first report to evaluate the impact of SUVmax on advanced RCC patient survival. However, the number of patients and the follow-up period were still not extensive enough to settle this important question conclusively. CONCLUSIONS: The survival of patients with advanced RCC can be predicted by evaluating their SUVmax using 18F-FDG-PET/CT. 18F-FDG-PET/CT has potency as an "imaging biomarker" to provide helpful information for the clinical decision-making.


Asunto(s)
Carcinoma de Células Renales/diagnóstico , Carcinoma de Células Renales/mortalidad , Fluorodesoxiglucosa F18 , Neoplasias Renales/diagnóstico , Neoplasias Renales/mortalidad , Tomografía de Emisión de Positrones , Radiofármacos , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/secundario , Femenino , Humanos , Japón , Estimación de Kaplan-Meier , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Proyectos Piloto , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Tiempo
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