Clinical study of bladder cancer: Proteinuria as a predictor of recurrence and efficacy of intravesical bacille Calmette–Guerin therapy

AIM: We studied the clinical characteristics of bladder cancer, with special attention to the clinical and pathological variables that affect tumor stage, relapse and efficacy of intravesical therapy. METHODS: We reviewed the medical records of 152 patients of the Saiseikai Central Hospital who had been diagnosed as having bladder cancer between 1981 and 2001. RESULTS: The age of the patients ranged from 24 to 88 years, with a median of 63.5 years. The median follow up was 52.4 months (range, 0.5-259.5 months). There was no difference in the incidence of gross hematuria as a presenting symptom among the patients with invasive cancer, superficial cancer and carcinoma in situ (CIS). However, the incidence of urinary frequency and painful urination did differ significantly between patients. Although patients with invasive cancer had a longer time to hospital visit than those with superficial cancer, this time difference was not statistically significant. Presence of proteinuria, multifocality and intravesical bacille Calmette-Guerin (BCG) therapy were the significant predictors of relapse after transurethral resection (TUR). Presence of proteinuria was shown to adversely affect the efficacy of intravesical BCG therapy. In the BCG-treated group, 3-year relapse-free survival was 78.4% for patients without proteinuria and 40.0% for those with proteinuria; this difference was statistically significant (P = 0.0277). CONCLUSIONS: Time to hospital visit did not influence the pathological stage of cancer in patients included in the present study. Presence of proteinuria, multifocality and BCG therapy were the significant predictors of relapse after TUR. Presence of proteinuria was shown to adversely affect the efficacy of intravesical BCG therapy. Proteinuria might be helpful in predicting tumor relapse and efficacy of intravesical BCG therapy in clinical settings, along with other markers.     

Scrotal dartos flap for the prevention of the urethrocutaneous fistula on hypospadias urethroplasty

BACKGROUND: Urethrocutaneous fistula is a common complication of urethroplasty for severe hypospadias, even when a microsurgical technique is applied. PATIENTS AND METHODS: From June 2001 to July 2003, we applied the scrotal dartos flap wrapping technique to prevent the occurrence of urethrocutaneous fistula in 14 patients with hypospadias. RESULTS: Hypospadias was repaired without fistula formation in all but one patient, who developed a tiny fistula which was later closed successfully by a simple procedure. CONCLUSIONS: We recommend the scrotal dartos wrapping technique for covering the neourethra with a well-vascularized flap because of fewer complications, although the procedure to obtain the vascularized flap may take longer.     

Case of α-fetoprotein-producing transitional cell carcinoma of the renal pelvis

An alpha-fetoprotein-producing transitional cell carcinoma of the renal pelvis is extremely rare. To our knowledge, this has not been reported previously. We present the first case of an alpha-fetoprotein-producing transitional cell carcinoma of the renal pelvis in a 70-year-old female.     

Adenocarcinoma arising from a mature cystic teratoma of the testis

A 52-year-old male diagnosed pathologically with metastatic adenocarcinoma of the skin was referred to our department. Physical examination revealed a right scrotal mass the size of child's head and several skin tumors. Right high orchiectomy and resection of skin tumors were performed. Histopathological examination revealed a well-differentiated, mucinous adenocarcinoma originating from the gastrointestinal epithelium in a mature cystic teratoma (dermoid cyst) of the testis and metastatic mucinous adenocarcinoma of the skin. We made a diagnosis of teratoma with malignant transformation (TMT) of the testis. Combination chemotherapy with low-dose cisplatin/5'-deoxy-5-fluorouridine (CDDP/5'-DFUR) was initiated, but the patient died 8 months after orchiectomy. At autopsy, similar mucinous adenocarcinoma of the testis and the skin were observed at the metastatic sites.     

Bone γ-Carboxyglutamic Acid Containing Protein in the Perinatal Period

ABSTRACT. We measured bone γ-carboxyglutamic acid-containing protein (BGP), calcium (Ca), phosphorus (P), and alkaline phosphatase (Al-P) in paired maternal and cord sera, and urinary γ-carboxyglutamic acid (γ-GIa) in neonates. The circulating BGP was 41.21±2.47 ng/ml and 7.44±0.87 ng/ml in the cord (n=15) and the maternal (n=14) sera, respectively. The urinary γ-GIa in the neonates was 147.68 ± 10.75 μ.mol/g creatinine (n=15). The cord serum BGP was significantly higher than the normal adult level. The maternal serum BGP was at the same level as in other adults. It is conceivable that the fetus may produce BGP during gestation, as the cord serum BGP level was significantly higher than the maternal level and there was no correlation between the cord and maternal serum BGP concentrations. The reason for the elevated circulating BGP level in the cord serum is not known, but increased bone turnover may be a factor. The cord serum BGP may include not only carboxylated but also non-γ-carboxylated BGP because of fetal vitamin K deficiency.