Search

Background Although angiotensin receptor blockers (ARBs) are now one of the first-line drug classes for the management of hypertension, recommendations for the management of chronic heart failure (CHF) are limited. The supplemental benefit of angiotensin receptor blocker in hypertensive patients with stable heart failure using olmesartan (SUPPORT) trial investigates whether an additive treatment with an ARB, olmesartan, reduces the mortality and morbidity in hypertensive patients with stable chronic heart failure. Methods and results The SUPPORT trial is a prospective randomized open-label blinded endpoint study. Between October 2006 and March 2010, 1147 stable CHF patients treated with evidence-based medications were successfully randomized to either olmesartan or control group. In the olmesartan group, the ARB was initiated at the dose of 5.0–10 mg, and was then increased up to 40 mg/day, when possible. No ARBs were allowed in the control group. Primary outcome measure in the SUPPORT trial is the composite of all-cause death, non-fatal acute myocardial infarction, non-fatal stroke and hospital admission due to worsening heart failure. The participants will be followed for at least 3 years until March 2013. Conclusions The SUPPORT trial will elucidate the supplemental benefits of an ARB, olmesartan, in hypertensive patients with CHF.

We retrospectively investigated the efficacy and safety profile of weekly low-dose docetaxel (DTX) with estramustine in comparison with triweekly standard-dose DTX treatment for Japanese patients with castration-resistant prostate cancer (CRPC).Between April 2002 and January 2011, 75 CRPC patients were treated with triweekly DTX (60-75 mg/m(2) every 3 weeks) (standard-dose group), and 76 CRPC patients were treated with weekly low-dose DTX (20-30 mg/m(2) on days 2 and 9 with estramustine 560 mg on days 1-3 and 8-10) every 3 weeks (low-dose group). Prostate-specific antigen (PSA) response and progression-free and overall survival were analyzed in each group.Median serum PSA level of the standard-dose group and low-dose group was 25.0 and 35.5 ng/ml, respectively. In the standard-dose and low-dose groups, 57.8 and 65.2 % of patients, respectively, achieved a PSA decline ≥ 50 %. There was no significant difference in either median time to progression between the standard-dose group (10.0 months) and low-dose group (7.1 months) or in median duration of survival between the standard-dose group (24.2 months) and low-dose group (30.6 months). Multivariate analysis with a Cox proportional hazards regression model showed that DTX treatment protocol did not influence the risk of death. Incidences of grade 3-4 neutropenia, febrile neutropenia, and thrombocytopenia were significantly higher in the standard-dose versus low-dose group (58.7 vs. 7.9 %, 16.0 vs. 3.9 %, and 8.0 vs. 0 %, respectively).For Japanese CRPC patients, weekly low-dose DTX combined with estramustine has similar efficacy to standard-dose DTX but with fewer adverse events.

In this paper, we describe a hybrid simulation technique for electrostatic discharge (ESD) events in contact discharge mode. The proposed technique is based on circuit, electrostatic field, and full-wave simulations. The circuit simulation is performed to obtain the currents which is used as the input excitation in the subsequent full-wave simulation. A circuit to be analyzed is the equivalent circuit model of an ESD generator attached with a ground strap and a target object. Meanwhile, we perform the electrostatic field simulation in order to calculate electric field distribution around the generator charged before the discharging phase. Finally, a computational domain excluding the ESD generator and the ground strap is analyzed by means of the full-wave simulation based on the finite-difference time-domain (FDTD) method. In other words, we do the full-wave simulation for only a part of the whole computational domain by using the input currents as external effects to the target object. Because the hybrid simulation can take a low computational cost relative to existing full-wave techniques, it can reduce the total CPU time and the amount of memory consumption. We compare the accuracy and the CPU time of our approach with those of the conventional FDTD solver to show the adequacy of the hybrid simulation method.

Installation of the photovoltaic power system on the roof of houses is increasing rapidly. The photovoltaic power system has two typical problems, one is large power output change depending on climate change, and the other is over voltage in distribution line due to reverse power flow. These problems will be remarkable subjects for large amount of installation of photovoltaic power system in near future. This paper discussed countermeasures for these problems. We propose an output power smoothing method that a dc capacitor is assumed and stored energy is controlled to make the output smooth, an idea for determining the capacity of the capacitor based on measured data is explained. We also propose a flexible control for a photovoltaic power system with active power and reactive power controls against conventional one that has constant unity power factor, because reactive power is able to contribute over voltage suppression in distribution line. Proposed controllers are applied to a photovoltaic power system for a single phase ac output with three wires, and performance is confirmed by ATPDraw simulation.

The patient was a 60 year-old male who first visited a doctor because of back pain on the right side in May 2003. As a result of thorough examination, he was diagnosed with right renal pelvic cancer (cT4, N2, M1), and was referred to our department for treatment. In spite of systemic chemotherapy and radiation therapy in combination with cisplatinum on the primary tumor were performed from May 2003 to December 2005, the number and size of hepatic metastases increased. Consequently, considering hepatic metastasis as the specific prognosis factor, the patient was given a total of 14 cycles of hepatic arterial infusion chemotherapy (HAIC) from January to October 2006. As a result, the hepatic metastases completely disappeared. Then HAIC was tentatively discontinued and the patient was followed up. However, as new lung metastases were found by CT in March 2007, radiation therapy was performed on the lung metastases. As hepatic metastasis was recognized again by CT in April 2007, HAIC was resumed and the patient was given a total of 6 cycles starting from May 2007. During that period, two transurethral resection of bladder tumor were performed against the recurrence within the bladder while transarterial embolization was performed against the bleeding in the right kidney. The patient was regarded as a long-term survivor surviving for about five years after his initial consultation.

Alternative Antiandrogen Therapy with Flutamide in Patients with Castration-Resistant Prostate Cancer : A Single Center Experience We analyzed the clinical effects of flutamide (FLT) as a second-line agent for maximum androgen blockade (MAB) in patients with castration-resistant prostate cancer who received bicalutamide (BCL) as the first-line MAB agent. This study included 44 cases with progressive prostate cancer who had relapsed after first-line MAB, with BCL at 80 mg/day. After checking for antiandrogen withdrawal syndrome (AWS), they were given FLT at 375 mg/day as second-line MAB. A partial response (prostate-specific antigen [PSA] decline ≧50%) and no change (PSA decline of 0-50% or increase ＜25%) by second-line MAB with FLT were achieved in 34.1% (15/44) and 25.0% (11/44), respectively. The median duration of PSA response was 8.2＋/-4.5 months. In multivariate analysis, Gleason score (≦7 vs ≧8), the first-line response (CR vs PR＋NC), and the second-line response (PR＋NC vs PD) were significantly predictive of cause-specific survival from first-line hormonal therapy relapse to cancer death. Our results confirm previous findings that alternative antiandrogen therapy is effective as a second-line hormonal therapy.

Emphysematous cystitis is a rare lower urinary tract infection. A case of emphysematous cystitis with diabetes mellitus and transverse colon cancer is reported. The patient was an 81-year-old woman complaining of nausea and vomiting. Urinalysis showed hematopyuria. Plain abdominal film and CT scan showed gaseous shadow in the bladder wall. Urine culture contained Escherichia coli. A urethral catheterization and administration of antibiotics resulted in the marked improvement in the clinical course. To our knowledge, 53 cases of emphysematous cystitis have been reported in the Japanese literature including this case and the clinical features are reviewed.

Atsunari Kawashima*, Yasutomo Nakai, Suita, Japan; Masashi Nakayama, Osaka, Japan; Takeshi Ujike, Sakai, Japan; Go Tanigawa, Ken Takeda, Osaka, Japan; Yutaka Ono, Higashiosaka, Japan; Toshiaki Yoshioka, Osaka, Japan; Tsuyoshi Takada, Ikeda, Japan; Yuichiro Yamaguchi, Minoh, Japan; Mototaka Sato, Koji Hatano, Masatoshi Mukai, Akira Nagahara, Daizo Oka, Hitoshi Takayama, Suita, Japan; Kazuo Nishimura, Osaka, Japan; Norio Nonomura, Suita, Japan

To secure integrity of industrial product, various uncertainties surrounding the design technology must be treated properly. To do this, the uncertainties underlying during the following phases: evaluation of loads, modeling technique of systems of interest, evaluation of material strength, maintenance and inspection and so on, have to be clarified and effective measures to grasp the degree of the uncertainty and to reduce the inherent uncertainty have to be established.The present paper shows the classification of the uncertainties and the fundamental relation with the design technology, and mentions a reliability design method based on probabilistic and statistical techniques, which has been getting popular in many engineering fields, and finally raises some future problems of design methods from the viewpoint of the uncertainties.

We report a case of primary malignant lymphoma of the prostate. An 84-year-old man was referred to our hospital with a chief complaint of urinary retention. Magnetic resonance imaging showed a large mass below the bladder and in front of the rectum. Histological and immunocytochemical studies of transperineal biopsy of the prostate showed diffuse large B-cell non-Hogkin's lymphoma. Radiological assessment of the disease confirmed stage IV according to the Ann Arbor classification. Although the tumor was markedly reduced in size after four cycles of combination chemotherapy with cyclophosphamide, adriamycin, vincristine, and prednisolone, he died with brain metastasis 4 months after the diagnosis.

PURPOSE Since 2003, screening with prostate specific antigen (PSA) has been conducted to detect prostate cancer. We investigated the results between 2003 and 2007. PATIENTS AND METHODS Screening with PSA alone was performed for males aged over 50 years who desired prostate cancer screening. We used a PSA cutoff value of 4.00 ng per milliliter. RESULTS In 2003, there were 18,161 males aged over 50 years in Ikeda City. 3,738, 3,905, 4,129, 4,410, and 4,515 of the males underwent PSA screening in 2003, 2004, 2005, 2006, and 2007. The rate of elevated PSA levels was 7.9%-9.8% (median 9.1%). 161, 81, 70, 75 and 60 of the males visited us for secondary screening, and prostate biopsy was performed in 130 (80.7%), 57 (70.4%), 45 (64.3%), 38 (50.7%), and 42 (70.0%). Prostate cancer was detected in 91, 33, 29, 20 and 25 males, respectively. These values corresponded to 2.43%, 0.85%, 0.70%, 0.45% and 0.55% of the males who underwent primary screening. The incidence of prostate cancer was 0.96% during the 5 years. Clinical stage was B in 137 (69.2%), C in 52 (26.3%), D in 7 (3.5%), and unknown in 2. Surgery was performed in 87 (43.9%), endocrine therapy in 61 (30.8%), irradiation in 37 (18.7%), and follow up without treatment in 7 (3.5%). Treatment for 6 (3.0%) is unknown because they desired treatment at another hospital. CONCLUSIONS 198 males were diagnosed with prostate cancer between 2003 and 2007. The clinical stage B was present in 137 (69.2%), and the early treatment was achieved. This may lead to a future decrease in the mortality rate.

We present the case of a patient with renal cell carcinoma treated preoperatively with sorafenib. Complete resection of the left renal mass measuring 7.2 x 6.6 cm seemed to be difficult at diagnosis because of large renal hilar lymph nodes. With a short period of sorafenib administration, marked shrinkage of the renal mass and lymphadenopathy was observed after the patient experienced fulminant hepatic failure and a severe hand-foot skin reaction. Two-dimensional computed tomography revealed 60%, 78% and 84% reduction in the primary renal tumor, lung metastatic nodules and lymph nodes, respectively. Tumor shrinkage allowed for complete resection of the left kidney and the lymphadenopathy. Pathological findings revealed that over 90% of the renal tumor was substituted by necrotic fibrotic tissue and that the residual neoplastic component was diagnosed as clear cell carcinoma. The lymph nodes that were resected were negative for malignancy. At 6 months after radical nephrectomy, a new computed tomography scan revealed no evidence of disease with the disappearance of lung nodules.

A 79-year-old man was admitted to our hospital with a chief complaint of pollakisuria. He was diagnosed as having bladder tumors and bladder stone by cystoscopy. Transurethral resection of bladder tumors (TURBT) and transurethral cystolithotripsy were performed and histology revealed non-muscle-invasive hepatoid adenocarcinoma that produced alpha-fetoprotein (AFP) and urothelial carcinoma. The serum AFP level was present at a high level of 39.08 ng/ml. After five months' follow up, recurrent tumor were detected in the bladder. TURBT was performed and the pathologic finding showed non-muscle-invasive (not hepatoid) adenocarcinoma that produced AFP. After eight months' follow up, a recurrent tumor was detected in the bladder again. TURBT was performed and the pathologic finding showed non-muscle-invasive urothelial carcinoma. However, the serum AFP level remained above 35 ng/ml. After the 3rd TURBT, intravesical intillations were performed, which led to a normalization of the serum AFP level. Nineteen months after his final hospitalization, the patient has had no evidence of recurrence.

Cases 1 and 2 were a 84-year-old, 64-year-old female relatively. Case 2 had a history of uncontrolled diabetes mellitus. Both cases were referred to our hospital with a chief complaint of high fever. Initial diagnosis was acute pyelonephritis based on the findings of pyuria and right costovertebral angle knock pain. Abdominal computed tomography (CT) scan revealed a gas shadow in the right renal pelvis and calyx with right ureteral stone. The definitive diagnosis was emphysematous pyelonephritis (EPN). We selected transureteral catheterization into the right ureter immediately. Escherichia coli was identified from urine culture. Conservative therapy with antibiotics was also effective and general condition improved. Herein we discussed the etiology, symptomatology, choice of treatment and prognosis of emphysematous pyelonephritis. Recently CT is an effective imaging method for diagnosis at an early stage. Antibiotics therapy combined with transureteral drainage of gas-forming urolithiasis is effective as the initial conservative therapy.

We herein report four cases of sarcomatoid renal cell carcinoma. These cases comprised 4.1% of the 98 patients with renal cell carcinoma treated in our department during the past 13 years. It is confirmed that renal cell carcinoma with a sarcomatoid component often shows local invasion, distant metastasis, rapid growth and poor prognosis. In Mian's series, the percentage of sarcomatoid component (25% vsor = 25%) was associated with decreased survival time, but was independent of stage. The pathological stage was pT3b N0 M0 in case 1, pT1b N0 M1 in case 2, pT3b N0 M1 in case 3 and pT1a N0 M1 in case 4. The pT1 sarcomatoid renal cell carcinoma in case 2 and case 4, who developed poor prognosis, was composed of 60 and 80% sarcomatoid change, respectively. However in case 3 with a pathological stage of pT3, the patient is alive 35 months after resection, because the extent of sarcomatoid component was 25%. The prognosis of patients with sarcomatoid renal cell carcinoma depends on not only disease stage and tumor grade but also the pathological extent of sarcomatoid component.

This paper presents a simplified procedure to estimate the probability of failure for nonlinear MDOF shear-type systems optimally designed due to the seismic excitation. The excitation is idealized as a nonstationary stochastic process. With the aid of the response modification factor-ductility factor relationship established by the authors for these systems, “an equivalent linear criteria” of such systems is introduced. Then, a linear response and the equivalent criteria can be used to evaluate the limit state probability as a solution to the classical first excursion probability problem at least in approximation. An example of a three-story building is demonstrated and the results are compared by using a simulation method.

Segmental infarction of the testis represents a rare entity in that there have been fewer than 40 cases documented in the literature. Like global infarction, segmental infarction of the testis can masquerade as a mass lesion or torsion of the testis. Reported herein is a very rare case of segmental testicular infarction due to atheroembolism in a 58-year-old man. The patient presented with severe left testicular pain and underwent left high orchiectomy on the clinical diagnosis of testicular torsion. The testis had a segmental hemorrhagic necrosis around which many cholesterol emboli were observed. This is the first report to describe cholesterol embolism-associated segmental testicular infarction.

We report a case of local recurrent aggressive angiomyxoma presenting as a para-urethral tumor. A 28-year-old woman visited our hospital with a complaint of a painless vulval mass. Magnetic resonance imaging (MRI) of the pelvis showed the para-urethral tumor to be 2.5 x 3.0 cm. The tumor was resected, and diagnosed histopathologically as aggressive angiomyxoma. The patient showed a painless vulval mass again at 64 months after the first resection. MRI of the pelvis showed the paraurethral tumor to be 2.5 x 3.0 cm. The tumor was resected, and diagnosed histopathologically as aggressive angiomyxoma. The patient showed no recurrence at 4 months after the second resection.

This paper, using the weighted integral method, proposes a new stochastic finite element method for estimating the response variability of multi-dimensional stochastic systems. Young's modules is considered to have spatial variation and is idealized as a multi-dimensional stochastic field. An essential feature of the proposed method is that the continuous stochastic field is rigorously taken care of by means of weighted integrations to construct element stiffness matrices, as the results, the issue involving the stochastic field is transformed into a problem involving only a few random variables. This may lead to substantial improvement in computational efficiency. Numerical examples show that the proposed SFEM is concluded as an efficient and accurate method.

This paper, introducing a weighted integral method, formulates the new stochastic finite element method for estimating the response variability of stochastic systems consisting of line elements. The essential feature of the proposed method is that the continuous stochastic field is rigorously taken care of by-means of weighted integrations to construct not only the element stiffness matrix but also the equivalent nodal forces. As a result, the issue involving the stochastic field is transformed into a problem involving only a few random variables, and then the perturbation or Monte Carlo simulation methods is utilized. This has lead to substantial improvement in computational efficiency whether the perturbation or Monte Carlo simulation method is used. Furthermore, the accuracy of the solution from the proposed method is independent of the way in which discretization is performed, while this certainly is not the case for the conventional methods.

Castleman's disease (CD) is a rare disorder characterized by a benign proliferation of lymphoid tissue. Most cases tend to present as a mediastinal mass. A few extrathoracic cases involving nodal and extranodal locations have previously been reported. To the best of our knowledge, however, only one case of CD of the kidney has been published in an English report. We herein report a rare case of CD presenting as a left renal tumor. A 70-year-old male was examined by computed tomography for a follow-up for colonic diverticulitis and a left renal mass measuring 2.0 cm in diameter was incidentally found. The patient underwent a left partial nephrectomy for a left renal mass and a histopathological analysis demonstrated the hyaline vascular type of CD. Based on our findings, CD should be included in the differential diagnosis of renal tumors.

We report a case of liposarcoma of the spermatic cord associated with rectum cancer. A 78-year-old man visited our hospital with a complaint of painless left inguinal mass. He also showed constipation and bloody bowel discharge, rectum cancer was diagnosed by further evaluation. Ultrasonography, computed tomography and magnetic resonance imaging revealed a 2 x 4 x 6 cm mass in the left spermatic cord. Left high orchiectomy for the left inguinal tumor and Hartmann's procedure for rectum cancer was performed. Histologically, the mass in the left spermatic cord was well differentiated liposarcoma and rectum cancer was poorly differentiated adenocarcinoma. He died from rectum cancer with no evidence of recurrence of liposarcoma of the left spermatic cord after follow up for 6 months.

OBJECTIVES Treatment trends and outcomes for prostate cancer in our hospital were reported. MATERIAL AND METHODS A total of 482 patients with prostate cancer treated in our hospital between January, 1990 and December, 2004. RESULTS The age distribution was from 51 to 99 years-old, with the mean age of 72.9 years-old at onset. The number of prostate cancer patients, especially asymptomatic patients with PSA elevation, have increased recently. As for the clinical stage, 92 cases (19.1%), 238 cases (49.4%), 48 cases (10.0%) and 104 cases (21.6%) were stage A, B, C and D, respectively. 425 cases (88.2%) received some form of endocrine therapy. Retropubic prostatectomy or external beam radiation therapy was performed in 77 and 57 cases, respectively all cases. The cause-specific 5-year survival rate of the 482 cases was 79.7%, comprising 100% for stage A1, 96.8% for stage A2, 89.4% for stage B, 79.9% for stage C and 42.9% for stage D. The cause-specific 5-year survival was significantly better in the latter patients (1997-2004) than the former patients (1990-1996) in stage C (p = 0.0226), D (p = 0.0448). In stage C patients, the retropubic prostatectomy (with endocrine therapy) group, increased in the latter period and showed longer cause-specific 5-year survival than the endocrine therapy group (p = 0.0027). In stage D2 patients, chemo-endocrine therapy with VP-16, ADM and CDDP refractory and cause-specific 5-year survival was longer than endocrine therapy alone (p = 0.0467, P = 0.0381). CONCLUSION Our results suggest that retropubic prostatectomy with endocrine therapy and chemo-endocrine therapy are useful for stage C and D prostate cancer patients, respectively.

We report a case of primary mucosa-associated lympoid tissue (MALT) lymphoma of the urinary bladder associated with left renal pelvic carcinoma. A 84-year-old woman showed microscopic hematuria during follow up for hypertention. Left renal pelvic tumor was found and she was referred to our hospital for further evaluation and managemant. She showed pyuria and Escherichia coli was detected by urine culture. Intravenous pyelography and computed tomography revealed the left renal pelvic tumor and solid bladder tumor. Transurethral resection of bladder tumor and left total nephroureterectomy were performed. Histologically, the left renal pelvic tumor was urothelial carcinomaadenocarcinoma, G2, pT2 and the bladder tumor was MALT lymphoma. Ga-scintigraphy showed no hot uptake suspicious of metastatic lesion. Then, external beam radiotherapy (36 Gy) was performed to the urinary bladder. She has been alive for 14 months with neither renal pelvic tumor nor MALT lymphoma showing any evidence of disease progression.

A 91-year-old man presented with nocturnal frequency and urge incontinence of a few days duration due to involvement of prostate cancer (PCa) accompanied by a large cyst in the left lobe of the prostate gland and urinary bladder wall. Channeling transurethral resection of prostate was performed to relieve the main symptoms and the resected material was histologically diagnosed as papillary cystadenocarcinoma arising from the epithelium of microscopic retention cysts. Following shrinkage of the large cyst, the patient is doing well on a combination regimen of a luteinizing hormone-releasing hormone analogue and bicaltamide. Papillary cystadenocarcinoma of the prostate was originally defined as papillary PCa arising from, not accompanied by, prostatic cysts. Cysts associated with PCa are subdivided into primary (or true) and secondary (or pseudo) cysts. Cancer cells in primary cysts originate from the epithelial lining. Papillary growth type cysts belong to this group and are regarded as papillary cystadenocarcinoma. The secondary (or pseudo) cysts, which have no epithelial lining and consist of hemorrhagic and/or necrotic contents are associated with invasive PCa. In the present case, the microscopic retention cysts revealed by histologic examination were of the primary type. This case of papillary cystadenocarcinoma, arising from a primary cyst, is the 13th such report from among previously reported cases in Japan.

Purpose We reviewed significance of multiple biopsies obtained from bladder mucosa in 59 patients of renal pelvic and ureteral carcinoma treated at Osaka Police Hospital between 1990 and 2003. Materials & methods The patients consisted of 41 males and 18 females. The median age was 68 years, ranging from 42 to 91 years. Multiple biopsies were carried out in principle to examine the following 5 cystoscopically normal-appearing bladder mucosal sites: (1) trigone, (2) posterior wall, (3) left lateral wall, (4) right lateral wall and (5) dome. Positive case of multiple biopsies was defined as patients having abnormalities in at least one biopsy specimen such as bladder tumor (BT) or dysplasia. Median follow-up period was 54 months. Results & conclusions Of the 59 patients, 6 had positive multiple biopsies. Among them 3 had carcinoma n situ (CIS), and others had dysplasia. 4 patients with positive multiple biopsies had past or concurrent history of BT and received adjuvant intravesical instillation therapy. Positive rate of multiple biopsies significantly differed between patients with and without past and/or concurrent BT (4/15: 27% vs 2/44: 5% p = 0.03), indicating that multiple biopsies were useful to detect abnormal lesion accompanied with past and/or concurrent BT. 3-year bladder recurrence free rate was 61%. Postoperative bladder recurrence rate did not significantly differ between positive (1/6 17%) and negative (20/53: 38%) cases of multiple biopsies. Univariate analysis indicated stage (p = 0.03) and venous involvement (p = 0.02) to be significant prognostic factors for bladder recurrence free rate, but not multiple biopsies, although multivariate analysis with Cox's proportional hazard model revealed no independent prognosticators. Low recurrence rate of patients with positive multiple biopsies was possibly due to adjuvant intravesical instillation therapy to prevent bladder recurrence.

A case report of left renal cell carcinoma with tumor thrombus extending into the right atrium is reported. A 76-year-old woman was found to have a left renal tumor with tumor thrombus extending into the inferior vena cava and right atrium by computed tomographic-scanning. Left nephrectomy and removal of an intra-atrial tumor thrombus were performed under a cardiopulmonary bypass. The post-operative course was uneventful and the patient was discharged from the hospital 22 days postoperatively. The pathological diagnosis was clear cell carcinoma. After surgery, the patient received interferon-gamma. However, the patient developed lung metastases 26 months after the operation and is currently being observed while receiving interferon-alpha.

We evaluated the efficacy of gemcitabine-cisplatin (GC) therapy as a second line chemotherapy for recurrent urothelial cancer previously treated with or resistant to methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) therapy. Four patients who had recurrent cancer after adjuvant M-VAC therapy and five patients with resistant lesions to M-VAC were treated by GC. Of the nine patients, three completely responded to GC and three obtained partial response. These complete responders were cancer-free for 34, 32 and 24 months. In one partial responder, the metastatic masses have been decreasing in size for 12 months after completion of GC therapy. Our findings suggested that GC would be useful as a second line chemotherapy for urothelial cancer previously treated with M-VAC.

We report a case of pyogenic spondylitis caused by Enterobacter cloacae as a rare complication of transurethral resection of the prostate (TURP). A 79-year-old man underwent TURP. Immediate after removal of urethral catheter on postoperative day (POD) 7, he developed high fever40 degrees C with increased acute inflammatory reaction. Urine and blood culture detected E. cloacae and methicillin-resistant Staplylococcus aureus. He complained of lumbago since POD 9. Two-week administration of imipenem and teicoplanin resulted in resolution of fever as well as laboratory data, so intravenous antibiotics were changed to oral gatifloxacin. However, his lumbago worsened and gait disturbance appeared. On POD 39, diagnosis of pyogenic spondylitis was finally obtained by Ga-scintigraphy and magnetic resonance imaging. Aspiration of the intervertebral disk (L4-5) revealed E. cloacae as the causative organism of pyogenic spondylitis. His condition improved after conservative treatment with teicoplanin, meropenem and ciplofloxacin for 9 weeks.

The reported rate of erectile dysfunction after nerve-sparing prostatectomy varies according to physicians. Because exact preservation of the neurovascular bundle (NVB) solely depends on the judgment of the physician, he or she should try to correctly identify the NVB and also avoid neurophysiologic injury of the NVB during the procedure. The purpose of the present study is to assess the status of the NVB preservation by physician's judgment at the operation, the changes in intracavernous pressure related to intraoperative electrical stimulation and postoperative histopathological examination.Thirty-eight patients who underwent nerve-sparing radical prostatectomy judged by intraoperative electrical stimulation of the NVB were included in this study. Bilateral, unilateral and non-nerve-sparing procedures were performed in 18, 17, and 3 cases, respectively. The NVB preservation evaluated by intraoperative physician's judgment was compared to that evaluated by postoperative histopathological examination. Furthermore, the NVB preservation evaluated by intraoperative electrical stimulation was compared to that by physician's judgment and postoperative histopathological examination.For 68 of 76 NVB (89.5%), intraoperative subjective judgment and histopathological assessment were identical. For 66 of 76 NVB (86.8%), electrical stimulation findings and the physician's judgments were identical, and for 70 of 76 NVB (92.1%), electrical stimulation findings and histopathological findings were identical.Even if physicians are convinced of a successful nerve-sparing procedure, there are some cases in which the NVB is not preserved accurately or neurophysiological damage is suffered. Therefore, intraoperative electrical stimulation of the NVB as well as the cavernosal nerve is very useful in evaluation of NVB preservation.

A 72-year-old woman consulted our hospital for a cystic mass in the right kidney. Ultrasonography and drip infusion pyelography revealed a right renal cystic mass 10 cm in diameter and right hydronephrosis. Computed tomography (CT) and magnetic resonance imaging revealed a giant mass with partial calcification in the right renal hilus. The mass was diagnosed the fusiform aneurysm 10 cm in diameter occurring in the main stem of right renal artery by selective abdominal angiography and 3-dimensional CT. We performed total nephrectomy and the histological finding was atherosclerosis. A total of 485 cases of renal artery aneurysm have been reported in Japan. These cases and 15 cases of renal artery aneurysm more than 5.0 cm in diameter are herein reviewed.

We examined the anesthesia of transperineal prostate biopsy under saddle block or caudal block. Between July 2003 and September 2004, we performed transperineal prostate biopsy under saddle block and caudal block, in 59 and 78 patients, respectively. We evaluated the pain score with the FACES Pain Rating Scale (0-5) and examined side effects on each anesthesia. There was no significant difference in the pain score of anesthesia prick between saddle block and caudal block (1.51 +/- 1.03 versus 1.39 +/- 0.98 respectively, P = 0.629), but the biopsy prick under saddle block revealed significantly (P0.0001) lower pain score (0.05 +/- 0.22) than caudal block (1.18 +/- 1.22). Saddle block caused post-operative retention more frequently than caudal block and required the patient to rest in bed for several hours after prostate biopsy. Saddle block was useful for relieving the pain of biopsy. In future, we need to consider using a method with fewer side effects.

A 22-year-old man presented to our out-patient clinic with the chief complaint of a painless mass in the right scrotum and lymph node swelling around the abdominal aorta in October, 2002. The bilateral testicular tumors were palpated and visualized by ultrasound and magnetic resonance imaging (right phi5 cm, left phi2 cm in diameter). Computed tomography revealed a metastatic lymph node around the abdominal aorta (3 x 3 x 10 cm in size). He underwent bilateral radical orchiectomy after frozen storage. Enucleation of the left testicular tumor was not performed because of its irregular demarcation. Histological examination revealed typical seminoma of the right testis and embryonal carcinoma of the left testis. Retroperitoneal lymph node dissection was performed after 4 courses of systematic chemotherapy (bleomycin, etoposide, platinum). No viable tumor cells were present histologically in the excised lymph nodes. The postoperative course was good and uneventful at 16 months under androgen replacement therapy without disease recurrence.

We report two men with inverted papilloma of urinary bladder with urination difficulty as initial symptom. One was 51 years old and the other was 60 years old. Ultrasound revealed a tumor in the bladder and cystoscopy revealed a smooth-surfaced tumor with a stalk at the bladder trigon. They underwent transurethral resection of the bladder tumor and histopathological findings were consistent with inverted papilloma. Postoperatively, they are free of urination difficulty and have had no recurrence for 3 and 1 years, respectively.

We report two cases of female paraurethral leiomyoma. Two Japanese women (51 and 44 years old) were referred to our department with the complaint of a painless mass at the external genitalia. Both tumors were resected transvaginally and histopathologicaly diagnosed as leiomyoma without any evidence of infiltration into the surrounding tissue. One hundred and twenty-eight cases of female paraurethral leiomyoma are collected from the Japanese literature and are discussed.

Purpose: We evaluated infrared thermometry for measurement of reflux of blood via the internal spermatic vein.Materials and Methods: The change in scrotal temperature in patients with varicoceles and controls with different positions was measured with an infrared thermometer.Results: Scrotal neck temperature in the patients increased during Valsalva's maneuver with upright position (mean plus or minus standard deviation 34.62 plus/minus 1.20 to 36.05 plus/minus 1.42C), while no statistically significant increase occurred in the controls (32.91 plus/minus 0.92 to 33.42 plus/minus 1.15C). Two weeks after high ligation of the internal spermatic vein the scrotal temperature in the patients decreased to the same level (0.59 plus/minus 0.84C) as in the controls. Using this method 2 subclinical varicoceles were also found on the right side in patients with a left varicocele.Conclusions: Infrared thermometry is noninvasive, rapid and simple for documenting varicoceles, including subclinical disease.

A retroperitoneal malignant peripheral nerve sheath tumor (MPNST) in a patient with von Recklinghausen's disease is reported. A 55-year-old woman was admitted with a left side abdominal mass. Physical examination showed numerous cafe-au-lait-spots, subcutaneous masses, scoliosis, and a baby's head-sized fixed mass in the left abdomen. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 9 x 9 cm retroperitoneal mass. Two other tumors were also found. One on the left side of the T2-T3 thoracic spine, and the other posterior to the right hip joint. The retroperitoneal tumor was resected en bloc. The tumor was a solid yellow mass. Macroscopically it has a pseudocapsule of fibrous tissue, weighed 1,120 g and measured 9 x 9 x 15 cm. The histopathological diagnosis was malignant peripheral nerve sheath tumor (MPNST). Since the responsiveness of these tumors to chemotherapy and radiation therapy is poor, we did not administer adjuvant therapy. The patient is alive with no evidence of recurrence more than 6 months after surgey.

Background: Previous studies have reported that β-alanyl-l-histidine (carnosine) enhanced the process of wound healing by stimulating effusion at the initial stage of inflammation, and also enhanced runt-related transcription factor-2/core binding factor α-1 (RUNX2/Cbfa1), Sox9, bone morphogenetic protein-2 (BMP-2) and BMP-7 expressions of human periodontal ligament cells. Objectives: In order to clarify the relationship between RUNX2/Cbfa1 or Sox9 expressions and BMP-2 or BMP-7 expressions enhanced by carnosine, we determined the effect of carnosine on the expression of BMP receptors and activation of their downstream signaling molecules in human periodontal ligament cells. Material and methods: Human periodontal ligament cells were cultured with α-minimum essential medium containing 10% fetal bovine serum with or without 10−4 or 10−5 m carnosine for up to 10 days. The gene expression of BMP receptors, RUNX2/Cbfa1 and Sox9 was measured using semiquantitative reverse transcription-polymerase chain reaction. Phosphorylation of Smad1 was determined using a western blot analysis. Results: Alkaline phosphatase activity increased in cultures with carnosine. Among the BMP receptors, expression of ActR-I and BMPR-II increased in cultures with carnosine, whereas expression of BMPR-IA, BMPR-IB, ActR-IIA and ActR-IIB was not affected. Culture with carnosine increased phosphorylation of Smad1, a signal-transducing molecule for BMP-2 and BMP-7. Noggin reduced carnosine-induced up-regulation of RUNX2/Cbfa1 and Sox9 mRNA, suggesting that BMPs were responsible for up-regulating RUNX2/Cbfa1 gene expression in human periodontal ligament cells. Conclusion: These results suggest that carnosine enhance RUNX2/Cbfa1 and Sox9 expression of human periodontal ligament cells via the autocrine action of BMP-2 or BMP-7 produced by the cells.

A case of rupture of giant hydronephrosis due to blunt trauma is reported. A 49-year-old male was admitted to our hospital complaining of right flank pain and gross hematuria after falling from a roof. Radiological evaluation lead to the diagnosis of marked right hydronephrosis with severe parenchymal thinning secondary to ureteral stone, left staghorn calculus and the rupture of right kidney. Right nephrectomy was performed and the postoperative course was uneventful. Three weeks later, percutaneous nephrolithotomy (PNL) was performed for left staghorn calculus. Other articles concerning giant hydronephrosis discovered following trauma are reviewed.

Estimating a macro-spatial correlation of seismic ground motions is very important for earthquake damage predictions, building portfolio analyses, etc. in which simultaneous damages in different locations have to be taken into consideration. In this study, the residual value between an observed and a ground motion predicted by an empirical mean attenuation equation is focused on. The residual value is now modelled assuming that it constitutes a homogeneous two-dimensional stochastic field in such a way that the joint probability density function (PDF) of seismic ground can be characterized by the spatial correlation model as well as by an empirical mean attenuation equation. Once it can be given in terms of the correlation model with the PDF, stochastic prediction of the ground motion at the locations unobserved can be effectively done with using the data observed at the near-by stations.

We report a case of intrascrotal rhabdomyosarcoma in a 59-year-old-male. The patient with a mass in the right scrotum was at first diagnosed with epididymitis and treated with antibiotics. The mass however, grew gradually and right orchiectomy revealed intrascrotal alveolar rhabdomyosarcoma. Para-aortic lymph node metastasis was pointed out by abdominal computed tomography. He received multidrug chemotherapy consisting of vincristine, actinomycin-D, cyclophosphamide, adriamycin, and cisplatin (IRS-III regimen 35). A complete response was obtained 3 months after the start of the chemotherapy. The patient is alive without recurrence 2 years after the surgery.

A 62-year-old man was referred to our department because of a small mass (1.5 cm in diameter) in the right kidney. His physical examination revealed a remarkably distended abdomen due to ascites. Paracentetic cytology of the ascites was suggestive of clear cell carcinoma. Under the diagnosis of renal cell carcinoma, interferon alpha and gamma were given subcutaneously and intraperitoneally, but his clinical status became worse gradually and he died 2 years after the diagnosis. An autopsy revealed papillary renal cell carcinoma. Ascites due to peritoneal carcinomatosis is a rare presentation, especially for such a small renal cell carcinoma.

A case of epidermoid cyst of the testis is presented. The patient was a 64-year-old man who complained of a painless mass in the left scrotum. Physical examination revealed a hen-egg sized enlargement of the left scrotal contents. The ultrasonographic appearance did not show a hyperechoic partition, which is called echogenic rim, a characteristic of this tumor on the echoic examination, and was homogeneous, almost similar to that of a normal testis. Because malignant testicular tumors could not be excluded preoperatively, excisional biopsy of the left testis was performed first. Histological diagnosis was an epidermoid cyst of the testis. As the left testis was almost completely occupied by the tumor and no normal testicular tissue was recognized, we performed orchiectomy additionally. Epidermoid cyst of the testis is a rare benign tumor that accounts for about 1 percent of all testicular tumors. It clinically resembles malignant testicular tumors, and orchiectomy is often performed for treatment. About 154 cases of testicular epidermoid cyst have been reported in the Japanese literature and are reviewed briefly here.