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Gliomatosis peritonei (GP) is a rare condition characterized by mature glial tissue implants widespread in the peritoneum, which is occasionally followed by treatment for immature teratoma (IM). The present study reported a case of GP with fluorodeoxyglucose (FDG) accumulation and contrast enhancement followed by treatment for IM. A 30-year-old female, 2-gravida and 0-para, underwent laparotomy with hysterectomy, bilateral salpingo-oophorectomy, and partial omentectomy followed by four cycles of chemotherapy with bleomycin, etoposide, and cisplatin for IM (Grade 2) of stage IIIC. At the 6-month follow-up, computed tomography (CT) revealed a 1-cm mass with contrast enhancement on splenic flexure. Positron-emission tomography (PET)/CT revealed intense FDG accumulation at the same site. Although α-fetoprotein, which was elevated preoperatively, remained normal, she was diagnosed with IM recurrence. The patient underwent three cycles of chemotherapy with paclitaxel, ifosfamide, and cisplatin, but the size, the degree of contrast enhancement and FDG accumulation of the mass did not change after chemotherapy. A diagnostic laparoscopy was performed. which revealed multiple small peritoneal implants, including a 1-cm mass at the splenic flexure. The 1-cm mass was dissected at the splenic flexure and some other implants. Mature well-differentiated glial tissue with non-atypia was identified in all tissue, and a diagnosis of GP was made. The patient is currently undergoing regular follow-up. Few reports are available regarding FDG-PET/CT imaging of GP. GP should be considered as the differential diagnosis of FDG-avid mass followed by IM therapy. A laparoscopic diagnosis is useful to obtain an accurate diagnosis of GP.

The primary toxicity of hydrogen peroxide results from its interaction with catalase, which liberates water and oxygen. We report the case of a 14-year-old Japanese girl with portal venous gas that was caused by oxygen liberated from intentionally ingested hydrogen peroxide. Although she had a past history of atrial septal defect, recovery without cardiac or neurological sequelae was achieved using hyperbaric oxygen therapy. Emergency physicians must be aware of the danger of liberated oxygen due to hydrogen peroxide ingestion., Competing Interests: No potential conflict of interest relevant to this article was reported.

We present a case of holmium : YAG laser resection of superficial bladder tumor (HoLRBT). A 73-year-old male was referred to our hospital with elevated prostatic specific antigen. Due to difficulty of urination, holmium : YAG laser enucleation of the prostate was performed under the diagnosis of benign prostatic hyperplasia. During the surgery, superficial bladder tumor was incidentally identified, and HoLRBT was performed. After the operation, histopathological examination revealed urothelial carcinoma, G2 ＞ G1, pTa. The patient has been subsequently followed up for 9 months, and there areno evidence of recurrence. Changing the holmium : YAG laser energy setting can potentially be effective and safe to approach a superficial bladder tumor.

In adult high-frequency oscillatory ventilation (HFOV), stroke volume (SV) and mean lung pressure (PLung) are important for lung protection. We measured the airway pressure at the Y-piece and the lung pressure during HFOV using a lung model and HFOV ventilators for adults (R100 and 3100B). The lung model was made of a 20-liter, airtight rigid plastic container (adiabatic compliance: 19.3 ml/cmH2O) with or without a resistor (20 cmH2O/l/sec). The ventilator settings were as follows: mean airway pressure (MAP), 30 cmH2O; frequency, 5-15 Hz (every 1 Hz); airway pressure amplitude (AMP), maximum;and % of inspiratory time (IT), 50% for R100, 33% or 50% for 3100B. The measurements were also performed with an AMP of 2/3 or 1/3 maximum at 5, 10 and 15 Hz. The PLung and the measured MAP were not consistently identical to the setting MAP in either ventilator, and decreasing IT decreased the PLung in 3100B. In conclusion, we must pay attention to the possible discrepancy between the PLung and the setting MAP during adult HFOV.

Changes in sexual function and ejaculatory function in patients who had undergone holmium laser enucleation of the prostate (HoLEP) were investigated using questionnaires. In this study, 77 patients on whom HoLEP was performed at our department from July 2010 to December 2010 were included. Of the 77 patients, the number of patients who could achieve an erection increased from 36 (46.8%) preoperatively to 52 (67.5%) postoperatively after HoLEP. Although postoperative ejaculatory dysfunction was found in 38 (73%) of 52 patients, 47 (90%) experienced orgasms, regardless of ejaculation, which is a high rate. With respect to ejaculatory satisfaction, patients who experienced an ejaculation had significantly higher satisfaction levels than those who did not. These results suggest that changes in postoperative ejaculatory function might affect satisfaction levels of ejaculation.

GLIPR1 is a p53 target gene known to be downregulated in prostate cancer, and increased endogenous GLIPR1 expression has been associated with increased production of reactive oxygen species, increased apoptosis, decreased c-Myc protein levels and increased cell cycle arrest. Recently, we found that upregulation of GLIPR1 in prostate cancer cells increases mitotic catastrophe through interaction with heat shock cognate protein 70 (Hsc70) and downregulation of Aurora kinase A and TPX2. In this study, we evaluated the mechanisms of recombinant GLIPR1 protein (glioma pathogenesis-related protein 1-transmembrane domain deleted [GLIPR1-ΔTM]) uptake by prostate cancer cells and the efficacy of systemic GLIPR1-ΔTM administration in a prostate cancer xenograft mouse model. GLIPR1-ΔTM was selectively internalized by prostate cancer cells, leading to increased apoptosis through reactive oxygen species production and to decreased c-Myc protein levels. Interestingly, GLIPR1-ΔTM was internalized through clathrin-mediated endocytosis in association with Hsc70. Systemic administration of GLIPR1-ΔTM significantly inhibited VCaP xenograft growth. GLIPR1-ΔTM showed no evidence of toxicity following elimination from mouse models 8 hr after injection. Our results demonstrate that GLIPR1-ΔTM is selectively endocytosed by prostate cancer cells, leading to increased reactive oxygen species production and apoptosis, and that systemic GLIPR1-ΔTM significantly inhibits growth of VCaP xenografts without substantial toxicity., (© 2013 UICC.)

Objectives: The objectives of this study are to explore the potential benefits of combining AdGlipr1 (or AdGLIPR1) gene therapy with radiotherapy using subcutaneous prostate and bladder cancer models., Materials and Methods: Combination adenoviral vector-mediated gene therapy and radiotherapy were applied to 178-2 BMA and TSU-Pr1 cells in vitro and colony formation and apoptosis were analyzed. In addition, combination therapies were administered to mice bearing subcutaneous 178-2 BMA and TSU-Pr1 tumors, and tumor growth suppression and survival extension were compared with the monotherapies (AdGlipr1/AdGLIPR1 and radiotherapy) or control vector Adv/CMV/βgal, as well as single-cycle treatment with 2-cycle treatment., Results: Combination treatment significantly suppressed colony formation and increased apoptosis in vitro. In vivo, combination therapy produced significant 178-2 BMA and TSU-Pr1 tumor growth suppression and survival extension compared with the monotherapies or the control. Further tumor growth suppression and survival extension were observed after 2 cycles of the combination treatment., Conclusions: Combining AdGlipr1 (AdGLIPR1) with radiotherapy may achieve additive or synergistic tumor control in selected prostate and bladder tumors, and additional therapeutic effects may result with repeated treatment cycles., (Copyright © 2014 Elsevier Inc. All rights reserved.)

In adult high-frequency oscillatory ventilation (HFOV) with an R100 artificial ventilator, exhaled gas from patient's lung may warm the temperature probe and thereby disturb the humidification of base flow (BF) gas. We measured the humidity of BF gas during HFOV with frequencies of 6, 8 and 10 Hz, maximum stroke volumes (SV) of 285, 205, and 160 ml at the respective frequencies, and, BFs of 20, 30, 40 l/min using an original lung model. The R100 device was equipped with a heated humidifier, Hummax Ⅱ, consisting of a porous hollow fiber in circuit. A 50-cm length of circuit was added between temperature probe (located at 50 cm proximal from Y-piece) and the hollow fiber. The lung model was made of a plastic container and a circuit equipped with another Hummax Ⅱ. The lung model temperature was controlled at 37℃. The Hummax Ⅱ of the R100 was inactivated in study-1 and was set at 35℃ or 37℃ in study-2. The humidity was measured at the distal end of the added circuit in study-1 and at the proximal end in study-2. In study-1, humidity was detected at 6 Hz (SV 285 ml) and BF 20 l/min, indicating the direct reach of the exhaled gas from the lung model to the temperature probe. In study-2 the absolute humidity of the BF gas decreased by increasing SV and by increasing BF and it was low with setting of 35℃. In this study setting, increasing the SV induced significant reduction of humidification of the BF gas during HFOV with R100.

The functioning of an arteriovenous fistula (AVF) used for vascular access during hemodialysis has been assessed mainly by dilution methods. Although these techniques indicate the immediate recirculation rate, the results obtained may not correlate with Kt/V. In contrast, the clearance gap (CL-Gap) method provides the total recirculation rate per dialysis session and correlates well with Kt/V. We assessed the correlation between Kt/V and CL-Gap as well as the change in radial artery (RA) blood flow speed in the fistula before percutaneous transluminal angioplasty (PTA) in 45 patients undergoing continuous hemodialysis. The dialysis dose during the determination of CL-Gap was 1.2 to 1.4 Kt/V. Patients with a 10% elevation or more than a 10% relative increase in CL-Gap underwent PTA (n = 45), and the values obtained for Kt/V and CL-Gap before PTA were compared with those obtained immediately afterward. The mean RA blood flow speed improved significantly (from 52.9 to 97.5cm/sec) after PTA, as did Kt/V (1.07 to 1.30) and CL-Gap (14.1% to -0.2%). A significant correlation between these differences was apparent (r = -0.436 and p = 0.003). These findings suggest that calculating CL-Gap may be useful for determining when PTA is required and for assessing the effectiveness of PTA, toward obtaining better dialysis.

Objective: We examined the relationship between morcellation efficiency and enucleated tissue weight in holmium laser enucleation of the prostate (HoLEP) for patients with benign prostatic hyperplasia (BPH) retrospectively., Methods: From January to December 2010, 140 patients with BPH were treated by HoLEP combined with mechanical morcellation with up side down technique by a single surgeon., Results: The mean age was 70.6 years, and the mean enucleated tissue weight was 46.8 g. The mean morcellation time was 9.9 min, and the mean rate of morcellation was 6.7 g/min. No complications were reported relating to morcellation such as bladder injury. Although morcellation time and enucleated tissue weigh were proportionally related (Estimate equation: Y = - 1.186 + 0.813 * X, R^2: 0.814), larger glands with more than 80 g of tissue enucleated did not match this distribution map. Five cases with more than 100 g of enucleated tissue weight required much longer operation time (range 66-90 min) and were disproportioned to tissue weight. Morcellation efficiency tended to decrease when enucleated tissue weight exceeds 80 g and less than average in almost all cases. Morcellation efficiency significantly worsen when enucleated tissue weight exceeds more than 100 g., Conclusions: Morcellation efficency may decrease in larger gland exceeds 80 g.

Oral anticoagulation (OA) has been considered as a strict contraindication to transurethral resection of the prostate (TURP). In recent years, some studies have shown that holmium laser enucleation of the prostate (HoLEP) has less blood loss compared to TURP. Thus we have performed HoLEP in patients with benign prostatic hyperplasia (BPH) under continuous OA from September 2009, and herein we report our first nine cases. Patients received HoLEP by a single surgeon at our institution. HoLEP was performed successfully in all patients. The mean times to complete enucleation and morcellation were 48.2 and 5.1 minutes, respectively. The mean tissue weight of enucleation was 37 grams. The mean hemoglobin and sodium loss after HoLEP were 1.7 g/dl and 1.3 mEq/L, respectively, and the catheterization time was 1.6 days. Blood transfusion, clot retention or transurethral resection syndrome were not observed in any cases. HoLEP has excellent hemostatic properties, and is a safe and effective procedure for patients with symptomatic BPH under the condition of continuous OA.

Holmium laser enucleation of the prostate (HoLEP) is a safe and effective treatment for patients with symptomatic benign prostatic hyperplasia (BPH), but is a difficult operation. To shorten the learning curve, we evaluated the surgical outcome of successive bilateral lobe enucleations with HoLEP. Performed by an inexperienced endourologist and an expert. Between March and July on 2009, we evaluated 20 cases of HoLEP performed by a beginner who underwent successive bilateral lobe enucleations and 20 cases of HoLEP performed by an expert. Enucleation time was shortened when successive bilateral lobe enucleations were performed by the beginner using HoLEP (115 vs 92 minutes, p<0.05). The enucleation time was significantly shorter in the expert group than in the beginner group. However, there were no significant differences in morcellation time, enucleated tissue weight, hemoglobin decrease level, sodium decrease level, catheterization time or significant incontinence time between the two groups. The postoperative evaluations was excellent in both groups. We conclude that HoLEP is a safe and effective operation. However, close supervision by an expert is required. In addition, learning from the easier part of enucleation to elaborate skill sets required to perform HoLEP is prerequisite for success.

A 50-year-old male was referred to our hospital for a left renal mass which was incidentally found during a medical check-up. Abdominal ultrasonography, computed tomography, and magnetic resonance imaging showed a weak enhancement tumor devoid of fat densities at the lower pole of the left kidney. Under the diagnosis of renal cell carcinoma, radical nephrectomy was performed. Histopathological examination revealed large epithelioid cells, and immunohistochemical staining showed strongly positive for HMB-45. The patient was diagnosed with epithelioid angiomyolipoma of the kidney. Epithelioid angiomyolipoma is a rare variant of angiomyolipoma, which is sometimes occurred aggressive clinical behavior. However, our case remains without evidence of recurrence or metastasis after radical nephrectomy, and showed relatively better prognosis than in previous reports.

Sarcoma is a rare malignant lesion in the urinary bladder and remains unknown of its natural history. We report a case of primary bladder sarcoma with long-term follow-up. A 35-year-old man suddenly presented with severely gross hematuria. Computer tomography was showed solitary lesion at the anterior wall of the urinary bladder without distant metastases. Transurethral resection of the bladder tumor (TURBT) was performed. Pathologic findings demonstrated sarcoma in the urinary bladder without remnant lesions. Immunohistochemical staining using conventional antibodies was not classified as the origin of this sarcoma. There have been no signs of recurrence during twenty years' follow-up after the treatment.

A 73-year-old male, who had undergone hormonal therapy due to stage D2 prostate cancer, complained of fever up and appetite loss. Abdominal computed tomography showed emphysematous pyelonephritis and right ureteral stone. At first, we could not perform any surgical treatment due to disseminated intravascular coagulation and septic shock. After endotoxin absorption therapy, we performed transurethral retrograde drainage, and successfully treated the emphysematous pyelonephritis. Endotoxin absorption therapy should be performed before surgical treatment in cases of emphysematous pyelonephritis with severe general condition.

Purpose: Radial artery cannulation is a common medical procedure for anesthesia and critical care. To establish the ideal wrist position for radial artery cannulation, we performed ultrasound examinations of the radial artery to investigate the effect of the angle of wrist extension on radial artery dimensions., Clinical Features: Measurements were performed in 17 healthy subjects and 17 surgical patients scheduled for coronary artery bypass graft (CABG) surgery. The radial artery was echographically visualized near the styloid process of the radius at the wrist. Radial artery dimensions were measured at wrist joint angles of 0, 15, 30, 45, 60 and 75 degrees ., Observations: In both groups, radial artery height was affected by the wrist joint angle. Vessel height was decreased at 60 degrees (one way ANOVA P = 0.027 vs 0 degrees ) and 75 degrees (P < 0.001 vs 0, 15, 45 degrees ) in healthy subject and at 75 degrees in CABG patients (P < 0.001 vs 0 degrees ). The mean differences in radial artery height at 0 and 75 degrees were 0.33 +/- 0.09 mm and 0.20 +/- 0.06 mm for healthy and CABG patients, respectively. Vessel width was not affected by wrist joint angulation up to 75 degrees of extension., Conclusion: Our results demonstrate that in healthy subjects, radial artery dimensions are unaltered when the wrist joint is extended up to an angle of 45 degrees . Extension at 60 degrees for healthy subjects and 75 degrees for CABG patients, however, results in a decrease in the height of the radial artery, which could possibly render arterial catheterization more difficult.

A 29-year-old woman presented with bilateral hydronephroses concomitant with acute renal failure. Retrograde pyelography demonstrated bilateral ureteral strictures located at the lower segment of ureters. Computed tomography revealed inflammation of the left ovary and severe colon adhesion. She received the operation, i.e. left ovariectomy and colon adhesiotomy, because of a possibility of gynecological disease including endometriosis and malignant tumors. Clinical and pathological findings showed non-specific inflammation in the pelvis and ovary. A pelvic inflammatory disease due to a genital Chlamydia trachomatis was highly suspected and she was treated with targeted antibiotics. There have been no signs of hydronephroses or renal failure during six years' follow-up after the treatment. We discus this rare case of bilateral hydronephroses due to genital Chlamydia trachomatis.

We report a very rare side effect, anaphylactoid purpula, after intravesical administration of bacillus Calmette-Guerin (BCG). A 83-year-old man presented with purpura located on his bilateral lower legs. He had received transurethral resections four times for superficial bladder tumors. Intravesical therapy using BCG was performed. During the treatment course, asymptomatic purpura was suddenly seen in the lower legs after the third administration. Lymphocyte stimulation test was highly positive for BCG. He was diagnosed with anaphylactoid purpura caused by BCG. Conservative treatment was selected because there were no concomitant diseases in other organs. There have been no signs of recurrence of tumors or purpura during the one-year follow-up. However, physicians need to be cautious of anaphylactoid purpura which could lead to severe diseases, such as renal failure, gastrointestinal dysfunction and systematic arthritis.

Objectives: To analyze the prognostic impact of the pT3a factors, perirenal fat or adrenal gland involvement, in patients with pT3b renal cell carcinoma (RCC)., Methods: A total of 43 patients with pT3b RCC who underwent radical nephrectomy, with complete resection of tumor thrombus, at our institution from March 1972 to September 2005 were enrolled in this study. The presence of pT3a factors was reviewed, and the disease-specific survival was compared according to the reclassification as pT3b only or pT3b with pT3a., Results: After review by a single pathologist, 23 patients (53.5%) were identified as having pT3b only and 20 patients (46.5%) as having pT3b with pT3a. The mean disease-specific survival time in those with pT3b only was significantly longer at 70.9 +/- 9.1 (SE) months compared with 25.0 +/- 4.4 (SE) months in those with pT3b with pT3a (P = 0.0032). On univariate analyses, the presence of pT3a factors (P = 0.0065), preoperative metastasis (P = 0.0025), surgical specimens positive for lymph node metastasis (P = 0.0183), and spindle cell factor (P = 0.0233) were recognized as predictors of a poor prognosis., Conclusions: The presence of perirenal fat or adrenal gland involvement in patients with pT3b RCC renders the prognosis significantly worse. Careful postoperative examination should be required, along with reclassification for Stage pT3b with pT3a in RCC.

A 66-year-old woman presented with a coin-size lesion in the right lung. Bronchoalveolar lavage cytology showed class V. Thoracoscopic partial pneumonectomy of right upper lobe was performed and pathologic finding was metastatic transitional cell carcinoma (TCC). She had a history of superficial bladder tumors which were treated with transurethral resection (TURBT). All pathologic findings demonstrated low grade superficial TCC. After the pneumonectomy, recurrent tumors were detected in the bladder after three months' follow up. Intravesical instillations and TURBT were performed and the pathologic finding showed superficial TCC. There have been no signs of recurrence during the six-year follow up. The case reported here is of superficial cancer with a metastatic lesion in the lung without local invasion in the urinary bladder.

A 72-year-old man presented with gross hematuria. Cystoscopy showed a non-papillary tumor at the right side of the posterior wall. Transurethral resection of the bladder tumor (TURBT) was performed. Pathologic findings demonstrated superficial transitional cell carcinoma (TCC). However, recurrent tumors were detected at the same location after 69 months' follow up. TURBT was done for the biopsy and pathologic examination showed muscle-invasive TCC. After two courses of neoadjuvant chemotherapy (MVAC), we performed radical cystectomy with Hautmann's continent reservoir. Pathologic findings revealed small cell carcinoma without any TCC features. Immunohistochemical staining using chromogranin A and synaptophysin was positive in the latest TURBT and the radical cystectomy specimens. We report a case of primary small cell carcinoma transformed from TCC of the urinary bladder.

A 31-year-old Japanese man who had been in Africa for two years presented with gross hematuria. He had been swimming in Lake Malawi during this period. Urinary specimen consisted of hematuria and pyuria. Cystoscopy showed tumors resembling Bilharzial tubercles located in the trigone, left lateral and posterior wall and dome. Further urine examination demonstrated eggs of schistosome haematobium. The patient was highly suspected of having Bilharzial schistosomiasis in the urinary bladder. Transurethral resection of bladder tumors was performed for diagnosis. Pathological examination revealed granuloma with many eggs of schistosome haematobium. He was diagnosed with Bilharzial schistosomiasis and was treated with 3,600 mg of praziquantel daily for two days. There have been no signs of recurrence during the one-year follow up except for excretion of degenerated eggs of schistosome haematobium in the urine specimens.

Purpose: The analgetic efficacy of intraurethral instillation of anesthetic jelly in rigid cystoscopic examination for men is not clearly confirmed. This study evaluated the usefulness of intraurethral instillation of anesthetic jelly by questionnaires regarding the pain and uncomfortable feelings during and after the cystoscopic examination., Materials and Methods: A total of 62 men were enrolled in the study. Sixteen patients had not received cystoscopy previously (first cases), and 46 had prior experiences of cystoscopy more than twice (repeat cases). These patients were sequentially divided into two groups; one group (jelly-group) received intraurethral instillation of oxybuprocaine hydrochroride jelly (Benoxil jelly) prior to cystoscopic examination, and the other group (no-jelly-group) did not receive the jelly instillation. Pain during the jelly instillation to examination, and uncomfortable feelings at micturition after the examination was evaluated by questionnaires., Results: Instillation of the jelly itself caused considerable pain, which almost similar to that of scope insertion. There was no significant difference in pain score between jelly-group and no-jelly-group during the insertion of the scope to examination. The miction pain after examination was significantly severer in the jelly-group than in the no-jelly-group in repeat cases. In addition, 75% of repeat cases felt better comfortableness when jelly was not instilled, and 96% of repeat cases did not want jelly instillation for their future examination., Conclusions: Intraurethral instillation of anesthetic jelly had no efficacy for reducing the pain during cystoscopy. Instillation of the jelly itself caused considerable pain, and it made pain and uncomfortable feelings after the examination worse. These results suggested that the instillation of anesthetic jelly before rigid cystoscopy in men might not be useful enough for reducing the uncomfortable feeling during the examination.