Salvage chemotherapy with paclitaxel, ifosfamide, and nedaplatin in patients with urothelial cancer who had received prior cisplatin-based therapy

Background and aims: The aim of the present phase II study was to evaluate the efficacy of combination chemotherapy of paclitaxel, ifosfamide, and nedaplatin (PIN regimen) in patients with recurrent urothelial cancer who had been treated with cisplatin-based chemotherapy. Patients/methods: Eligible patients were those with histologically confirmed urothelial cancer who had progressed or relapsed after cisplatin-based chemotherapy. The PIN regimen consisted of paclitaxel 175 mg/m² on day 1; ifosfamide 4.5 g/m2 divided over days 1, 2, and 3; and nedaplatin 70 mg/m² on day 1; PIN was given every 28 days. Results: Among the 32 patients enrolled in the study (median age, 66 years), complete and partial responses were obtained in 5 patients and 19 patients, respectively, with an overall response rate of 75% (95% confidence interval [CI], 59–91%). The median time to progression was 8 months (range, 0–50+ months) and the median survival was 22 months (range, 4–52+ months). The 1- and 2-year overall survival rates were 53.7 and 42.9%, respectively. All patients experienced Grade 3 or 4 neutropenia, while Grade 3 or 4 thrombocytopenia was seen in 8 patients; Grade 3 or 4 anemia was seen in 6 patients; Grade 3 neuropathy was observed in 1 patient, for whom the PIN therapy was discontinued. There were no treatment-related deaths. Conclusion: The PIN combination was highly active and tolerable in previously treated patients with urothelial cancer as a second-line treatment.Research support: none     

Posterior urethral valves. Experience with 21 cases

Twenty-one cases of posterior urethral valves experienced in the last 26 years were reported with special references to the morphological and functional sequelae of the upper and lower urinary tracts after the valve ablation. Furthermore, several problems, such as transient urinary diversion, vesicoureteral reflux (VUR), lower ureteral obstruction, transurethral valve ablation, bladder function and renal insufficiency, were also discussed. The age at the first examination ranged from 0 day to 13 years. Eight boys were first examined under one year of age. Although the most frequent complaint was urinary infection, some characteristic features were observed in each age group. In all of the children the valves were classified as type I (Young). Seven children had severe ones. Endoscopic examination was thought to be essential to find mild ones. VUR was found in 16 children (28 ureters). Grade IV was encountered most frequently (13 ureters) with prominent laterality to the left side. The severity of the renal scar paralleled to the grade of VUR. Most of the dwarf kidneys were thought to be hypodysplastic. Valve ablation was performed immediately after the diagnosis in 17 of the 21 children. Eight children were under one year of age when their valves were ablated. As a principle, VUR was followed conservatively after the valve ablation. VUR highly tended to disappear or improve when it was of low grade or valve ablation was performed under one year of age. However, when the ureteral orifices were disappearance of VUR was rare and recovery of renal function was not observed. In 5 children antireflux surgery was added. Although a dilated upper urinary tract without VUR was found in 2 children (2 ureters), it disappeared promptly after the valve ablation.(ABSTRACT TRUNCATED AT 250 WORDS)     

An autopsy case of generalized seizures, myoclonus, blindness and deafness

We have reported the clinical and autopsy findings in a case with generalized seizures, myoclonus, blindness and deafness which was accompanied by stroke-like episodes. This case was diagnosed as mitochondrial encephalomyopathy, lactic acidosis & stroke-like episodes (MELAS) from these findings. Solitary and continuous lesions of softening were distributed in both hemispheres, more severely in the frontal and occipital poles. These lesions did not correspond to a vascular supply. The pulvinar, lateral and medial geniculate body of the thalamus, cerebellar vermis and dentate nucleus had small lesions of softening. The cortical lesions occurred mainly in layer 4, and the most prominent lesions among them appeared cystic, involving the subcortical white matter, but nerve cells in layer 1 and 2 were preserved. Proliferation of small blood vessels was seen around the softening areas. Electron microscopy revealed increased mitochondria in endothelial cells of these vessels, abnormal dense bodies in skeletal muscle cells and tightly packed mitochondria in choroid plexus epithelial cells. Immunohistochemical study suggested that vimentin positive cells were seen around lesions and proliferated vessels are different from those seen in the intact tissues.     

Treatment of urological anomalies detected by prenatal ultrasonography

By the recent advance in ultrasonography, an increasing number of patients with prenatally detected urological anomalies have been reported. Herein, we present 19 cases experienced in the last 3 years in our institution and review the problems in their diagnosis and treatment. In all cases but 2 ultrasonography revealed fetal abnormalities after the 30th gestational week. No cases with abnormal amniotic fluid or severe fetal growth retardation were experienced. No cases were treated in utero. However, 7 cases required an early delivery because of progressive hydronephrosis or enlargement of tumor mass. Postnatally 6 cases were treated by emergency drainage such as percutaneous nephrostomy and placement of an indwelling catheter. However most of the cases with proven urinary tract dilatation were evaluated by diuretic renogram and followed conservatively thereafter. In equivocal cases, pressure-flow study was added. Spontaneous involution of multicystic kidney was also experienced. Erroneous interpretation can occur in fetal diagnosis and the accuracy of prenatal diagnosis was 52.6% in our series. In determining the management of prenatally detected urological anomalies, several factors such as reliability of ultrasonography, fetal renal function, maturity of the lung and the volume of amniotic fluid, must be taken into consideration. Considering the increasing number of fetuses thus detected, it is very important for the pediatric urologists to make consensus on the fetal intervention and postnatal management.     

Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging.

BACKGROUND: Cardiovascular disease is the leading cause of death in chronic kidney disease (CKD) patients. Tissue Doppler velocity imaging (TVI) is a new objective method that accurately quantifies myocardial tissue velocities, deformation, time intervals and left ventricular (LV) filling pressure. In this study, TVI was compared with conventional echocardiography for the assessment of left ventricular (LV) function in pre-dialysis patients with different stages of CKD. The results obtained by TVI were used to analyse possible relationships between LV function and clinical factors such as hyperparathyroidism and hypertension that could influence LV function. METHODS: Conventional echocardiography and TVI images were recorded in 40 patients (36 men and 4 women, mean age 60+/-14 years, range 28-80 years) and in 27 healthy controls (21 men and 6 women, mean age 58+/-17 years, range 28-82 years). Twenty-two patients had mild/moderate CKD (CCr>29 ml/min; Group 1) and 18 patients had severe CKD (CCr相似文献   

Thyroid gland flap for glottic reconstruction after vertical laryngectomy

A thyroid gland flap was devised and applied in five cases of vertical partial laryngectomy to correct the laryngeal defect. The upper pole of the thyroid gland, dissected along with the superior thyroid artery and vein, was placed in the wound after removal of the tumor to compensate for the loss of bulk, and relined using a cervical skin flap. Good phonatory function was obtained without any disturbance of respiration or deglutition. The thyroid gland flap was adjustable to the size of the defect and easily placed in the larynx. Follow-up study for 6 to 18 months after the surgery revealed that the flap was less likely to shrink than the other flaps because of its abundant blood supply.     

CRONKHITE-CANADA SYNDROME ASSOCIATED WITH SIGMOID CANCER

The case of a 78-year-old man with the characteristic clinical and pathologico-anatomic pictures of the Cronkhite-Canada syndrome associated with sigmoid cancer is reported. He died ten months after the onset of his diseaee. Autopsy Andings of the patient are described in detail. The other fifty three cases of the syndrome are reviewed, and clinical and pathologico-anatomic features of the Cronkhite-Canada syndrome are discussed.