Complete response, as determined by prostate-specific antigen level, to chlormadinone acetate withdrawal persisting longer than 2 years in patients with advanced prostate cancer: Two case reports

Antiandrogen withdrawal syndrome (AWS) is a well-established phenomenon in prostate cancer. However, responses to AWS are usually of limited duration, and a complete response (CR) is extremely rare. We present two patients who exhibited a chemical CR for more than 2 years after the discontinuation of steroidal antiandrogen chlormadinone acetate use. Whether patients who respond to antiandrogen withdrawal include a group of patients with a better prognosis remains uncertain. However, considering that the usual survival period of patients with hormone-resistant prostate cancer is approximately 12 months, both of the patients reported here, who are present in excellent physical condition, exhibiting an improved quality of life, and attending their hospital as outpatients, obviously acquired a prolonged survival because of AWS.     

Cavernous hemangioma of the urinary bladder in an 8-year-old child

An 8‐year‐old boy was admitted to Ehime University Hospital, Ehime, Japan, for the further investigation of a 5‐month episode of gross hematuria accompanied by lower abdominal pain. Magnetic resonance imaging revealed a solid tumor measuring 3 cm in diameter of the bladder wall. Cystoscopy demonstrated a red, wide‐based, nodular tumor situated on the dome of the bladder. Histological examination of tissue taken at hot biopsy showed fibrolipoma. In consideration of potential malignancy, a partial cystectomy was carried out after informed consent was given. Histological examination of the resected specimen showed it to be cavernous hemangioma.     

A formula for determining the distance from the skin to the lumbar epidural space in infants and children

In paediatric epidural anaesthesia, the distance from the skin to the epidural space is of special importance because of the great differences in size of the patients. We measured the distance from the skin to the lumbar epidural space (L3/4) in 355 paediatric patients. The epidural space was punctured using a midline approach under general anaesthesia, and was identified by the micro-drip infusion technique. There was a good correlation between the distance to the epidural space and body weight. A clinically useful formula for estimating the distance from the skin to the lumbar epidural space was derived as follows: D = (W+10) × 0.8 where D = distance from the skin to the lumbar epidural space (L3/4) (mm) and W = body weight (kg).     

Stepped care medical treatment for cirrhotic ascites: Analysis of factors influencing the response to treatment

Abstract Thirty-two patients with liver cirrhosis and ascites were treated by stepped care diuretic treatment as follows: step 1, placed on a 35 mEq sodium diet; step 2, given 400 mg/day of potassium canrenoate in addition to step 1 treatment; step 3, given 40-80 mg/day of furosemide in addition to step 2 treatment. Eleven out of 32 patients (34.4%, group 1) and 12 of 21 patients (57.1%, group 2) lost their ascites at step 1 and step 2, respectively. The remaining nine patients (group 3) required step 3 treatment. Basal urinary sodium excretion and creatinine clearance were significantly lower and β₂-microglobulin was significantly higher in group 3 than those in groups 1 and 2. Elevation of basal plasma renin activity and norepinephrine was evident only in group 3. In group 1, urinary sodium excretion decreased after the treatment. In group 2, plasma α-atrial natriuretic polypeptide was lowered and plasma renin activity and norepinephrine were elevated after the treatment. These results suggest that basal renal function and plasma renin activity and norepinephrine levels are useful indices to predict the effect of ascites treatment and that responders to sodium restriction or potassium canrenoate may be in the state of vascular overflow, while non-responders to potassium canrenoate may be in the state of vascular underfilling. In summary, this stepped care treatment is safe without any side effects, although the diuretics themselves may lead to relative vascular underfilling.     

Pharmacokinetic Study of Loprinone Hydrochloride,a New Cardiotonic Agent,in Beagle Dogs

Abstract— Pharmacokinetic parameters and bioavailability of a new cardiotonic agent, loprinone hydrochloride, in beagle dogs were determined by measuring plasma levels of loprinone after intravenous bolus and oral administration. The plasma half-life after intravenous administration of loprinone varied among individuals over the range 2·65–15·40 h. The bioavailability after oral administration of loprinone as a solution was 37·1%. Effects of enterohepatic circulation on the time-course of plasma levels after intravenous administration of the drug were also studied in bile-duct-cannulated beagle dogs. The amounts of loprinone and its glucuronide excreted in bile during 8 h after administration were 25·4 and 8·6% of the dose, respectively, indicating the possibility of enterohepatic circulation. The plasma half-life in bile-ductcannulated beagle dogs was 1·98 h. These results indicate that the variation in the half-life in beagle dogs resulted from enterohepatic circulation and that the true half-life is about 2 h. The relative bioavailability after oral administration of the drug as a powder in a capsule compared with a solution was 95·7%. In addition, the amounts of loprinone and its glucuronide excreted in bile, and the AUC of plasma level after infusion for 30 min into the portal vein in bile-duct-cannulated beagle dogs were similar to those after bolus intravenous administration. These results show that the low bioavailability reflects incomplete absorption.     

Melorheostosis of the Toe: A Case Report

A case of melorheostosis in a 57-year-old Japanese woman is presented. This case is noteworthy because of its unusual radiographic features and local findings and its unusually long follow-up period of more than 29 years. Melorheostosis progresses very slowly over a long period of time, and can show bizarre features, simulating malignant tumor.