Recurrence of renal cell carcinoma more than 5 years after nephrectomy

OBJECTIVES: We evaluated clinical features and predictive factors for the recurrence of renal cell carcinoma (RCC) developing more than 5 years after nephrectomy. METHODS: We retrospectively reviewed 239 patients with RCC who underwent surgery for the primary lesion. To identify factors that affected recurrence more than 5 years after nephrectomy (delayed recurrence) and its clinical outcomes, we performed a multivariate analysis using Cox's proportional hazards model and a survival study. RESULTS: Recurrence developing within 5 years after nephrectomy (early recurrence) was found in 57 patients and delayed recurrence in 11 patients. The multivariate analysis revealed no clinical and pathologic features influencing delayed recurrence in 114 patients who survived more than 5 years after nephrectomy without having early recurrence. The patients with delayed recurrence showed better clinical outcomes than those with early recurrence when the rate was determined from the time of recurrence. CONCLUSIONS: Although delayed recurrence is not a rare event for patients with RCC, no clinical and pathologic factors at the time of the initial treatment can predict the recurrence. Patients who are free of recurrence for more than 5 years after surgery for a primary lesion should be carefully followed up for delayed recurrence.     

Laparoscopy in a Case of Primary Sclerosing Cholangitis with an Ultrasonographically Detected Portal Thrombus

A case of sclerosing cholangitis is presented. The patient was a 65 year-old male and visited a hospital because symptoms of a biliary tract infection suddenly appeared. These symptoms improved in the short term with antibiotic therapy. As a high level of serum CA19–9 was found and the double wall structure of the intrahepatic bile duct and a portal thrombus were observed during an abdominal ultrasonography, the patient was transferred to our clinic for further examination of his hepatobiliary system. A malignant lesion was suspected from an endoscopic retrograde cholangiography and celiac angiography, although the patient's serum CA19–9 level rapidly decreased after admission. A liver with a smooth surface, some focal wide depressions, and an increase of white markings was observed laparoscopically. An adenomyomatosis-like lesion was observed in the gallbladder. Bile duct destruction with periductar fibrosis was histologically proven. This is a case of histologically diagnosed sclerosing cholangitis but without the typical findings usually found during an endoscopic retrograde cholangiography.     

Peptic Ulcer in Infants: Three Case Reports and a Review of the Japanese Literature

Abstract: Three cases of peptic ulcer in children under two years of age are reported, and 33 cases of infants with peptic ulcer reported in Japan between 1955 and March, 1989 are reviewed. Case 1 was an 8-month-old male complaining of melena, and endoscopic examination showed a gastric ulcer on the lesser curvature of the antrum. Cases 2 and 3 were a 15-month-old mule and an 18-month-old male, respectively, with complaints of melena and hematemesis. Endoscopic examination revealed an active duodenal ulcer in both cases. All 3 infants were successfully treated with H₂ blocker and/or antacid. In these 3 cases, infection or drugs were speculated to be predisposing factors, and the fathers of these three infants all had histories of duodenal ulcer. Among 33 cases of infants under 2 years old with peptic ulcer in Japan, 9 had a gastric ulcer and 24 had a duodenal ulcer. Seventeen were treated with conservative therapy and 16 were operated on because of perforation or bleeding. We should always keep in mind that peptic ulcer does occur in infancy, and that endoscopic examination should be promptly performed when peptic ulcer is suspected.     

Treatment of Acute Nonlymphocytic Leukemia by Concurrent Administration of N4-Behenoyl-1-{beta}-D-Arabinofuranosylcytosine, Aclacinomycin A, 6-Mercaptopurine and Prednisolone: A Pilot Study

N⁴-behenoyl-1-ß-d-arabinofuranosylcytosine (BH-AC),a newly synthesized derivative of cytosine arabinoside witha longer plasma half life and marked dose independency in itsanti-L1210 leukemia effect, and aclacinomycin A, a new anthracyclineantibiotic which is as effective as daunorubicin against L1210leukemia and reportedly induces no alopecia and is much lesscardiotoxic, were combined with 6-mercaptopurine and prednisolonein a pilot study of the effect on acute nonlymphocytic leukemiaof adults. The treatment schedule consisted of daily administrationof BH-AC, 116 to 234 mg/m² as a 2-hr intravenous infusion; aclacinomycinA, 12 to 16 mg/m² as a 30-min intravenous infusion; 6-mercaptopurine,100 mg/m² orally; and prednisolone, 40 mg/m² orally. A course of treatment was continued until the bone marrow becameseverely hypoplastic, not extending over 14 days. Eight patientswere entered in the study, one of whom was nonevaluable becauseof early death from renal failure. Six out of the seven evaluablepatients attained complete remission and the other good partialremission. Only one course of treatment was administered tofive of the patients who attained complete remission. It shouldbe noted that complete remission was obtained in two of threepatients not responding to treatment with daunorubicin, cytosinearabinoside, 6-mercaptopurine riboside and prednisolone in combination.The median duration of complete remission and survival were5 + (range: 4 + to 6 +) mo and 9 + (range: 6 + to 27+) mo, respectively. The most frequent side effects were malaise and gastrointestinalsymptoms, which were well tolerated. Flat T waves were notedin the electrocardiogram of one elderly patient; the changewas not clearly attributable to the drugs employed. Mild alopeciawas seen in two patients. This regimen was quite effective asa remission inducer in acute nonlymphocytic leukemia of adults,and deserves further study.     

Predictors of poor outcomes in steroid therapy for immunoglobulin A nephropathy

Background: Steroid therapy appears to be beneficial in patients of immunoglobulin A nephropathy (IgAN), as it causes a reduction in the proteinuria and improves the renal survival. Methods: A retrospective review of the 5 year follow‐up data of 60 patients with IgAN who were treated with steroids was conducted. Steroid non‐responders were defined as patients in whom the primary end‐point of a 30% decrease of the estimated glomerular filtration rate from baseline was reached. The patients were divided into two groups, namely, the steroid responder group (n = 47) and the steroid non‐responder group (n = 13), and the clinicopathophysiological characteristics were compared between the two groups. Results: Significant decrease of the proteinuria was observed in the responder group over the 5 year follow‐up period, whereas no significant change of the urinary protein excretion was observed in the non‐responder group during the same period. In regard to the pathological findings, significantly higher ratios of glomerular obsolescence and glomerular tuft adhesion to the Bowman's capsule, and significantly higher severity of interstitial fibrosis at the time of diagnosis in the non‐responder group than in the responder group were found. The rates of glomerular obsolescence and glomerular tuft adhesion to the Bowman's capsule, the severity of interstitial fibrosis, serum albumin and urinary protein excretion were identified as independent risk factors influencing the rate of renal function deterioration. Conclusion: To develop effective therapeutic modalities, it is important to have a thorough understanding of the clinicopathophysiological characteristics of IgAN patients showing poor treatment response to steroids (non‐responder group in this study).     

Interferon therapy for patients more than 60 years of age with chronic hepatitis C

Abstract Nineteen patients aged > 60 years with chronic hepatitis C (CHC) received interferon (IFN) therapy and a complete response (CR) was achieved by five of them (26%). The incidence of CH with severe fibrosis in this elderly group was significantly higher than in another 52 patients with CHC who were < 60 years of age (the younger group; P < 0.05). There was no significant difference in the hepatitis C virus (HCV) genotype distribution between the elderly group and the younger group. However, the HCV-RNA titre was significantly higher in the elderly group than in the younger group ( P < 0.05). There was no significant difference in the efficacy rate of IFN in the elderly and younger groups after standardization of the background factors. In the elderly group, the HCV-RNA titre was significantly lower in the patients achieving CR than in those with no response ( P < 0.05). These data suggest that elderly patients with a low HCV-RNA titre can still respond well to IFN therapy.     

The Association between Severity of Atherosclerosis and Lower Urinary Tract Function in Male Patients with Lower Urinary Tract Symptoms

Objectives: The present study was undertaken to investigate the association between the severity of atherosclerosis and lower urinary tract function in male patients with lower urinary tract symptoms. Methods: Male patients with lower urinary tract symptoms were examined with routine investigation. The severity of atherosclerosis was assessed by ultrasound examination of carotid artery. Patients were divided into two groups: control group and atherosclerosis group. The voiding function and storage function were compared between the two groups. Results: A total of 50 men (69.9 ± 9.1 years [mean ± standard deviation]) entered the study. There was no significant difference in age distribution (control group: 68.7 ± 7.6 years; atherosclerosis group: 72.5 ± 9.7 years) and prostate volume (control group: 26.5 ± 17.3 mL; atherosclerosis group: 22.2 ± 11.0 mL) between the two groups. In the voiding parameters, maximum flow rate in the atherosclerosis group (13.4 ± 5.5 mL/s, P < 0.05) was significantly lower than that in the control group (16.7 ± 7.7 mL/s). Postvoid residual urine volume showed no significant difference between the two groups. In the storage parameters, voided volume was significantly reduced in the atherosclerosis group (161.8 ± 46 mL, P < 0.05), as compared to control group (201.1 ± 78 mL). Moreover, daytime frequency was 7.13 ± 3.02 times in the control group, and significantly higher in the atherosclerosis group (8.75 ± 2.50 times, P < 0.05). Conclusion: Development of atherosclerosis impairs both voiding and storage function independently of age, suggesting atherosclerosis leads to lower urinary dysfunction.