Treatment of 255 patients with bladder tumors

During about 10 years from November, 1977 to March, 1987, two hundreds and fifty-five patients with bladder tumors were treated at the Department of Urology, Hamamatsu University School of Medicine and the affiliated hospitals. There were 198 males and 57 females with the highest age incidence in the seventies. Histologically, 242, 11 and 2 tumors were of transitional cell, squamous cell and adenocarcinoma, respectively. Of the 242 transitional cell carcinomas, 7 were Tis; 43 Ta, 111 T1, 33 T2, 19 T3, 5 T4, 14 M+ (with metastatic lesion), and 10 TX. As to grading, 6 was G0; 66 G1, 100 G2, 64 G3, and 6 GX. Staging was correlated with grading. The 5-year survival rates (Kaplan-Meier's method) were 64% in patients with transitional cell carcinoma; 58% in those with squamous cell carcinoma. In patients with transitional cell carcinoma, the 5-year survival rates were 100% for G0, 73% for G1, 73% for G2 and 40% for G3. As to staging, the 5-year survival rates were 67%, 81%, 81%, 35%, 41%, 40% and 12% in patients with stage of Tis, Ta, T1, T2, T3, T4 and M+, respectively. As to the initial treatment, the 5-year survival rates after TUR (137 cases), partial cystectomy (4 cases) and total cystectomy (56 cases) were 81%, 36% and 61%, respectively. The rate of intravesical recurrence after TUR was evaluated with the cumulative non-recurrence rate calculated by Kaplan-Meier's method.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of coronary artery bypass grafting for patients with totally occluded left anterior descending arteries]

Between April, 1987 and March, 1991, 21 patients with totally occluded left anterior descending arteries (TOLAD) underwent coronary artery bypass grafting (CABG) in our institute. All of them were diagnosed as angina pectoris and 15 (71%) of them have had episodes of myocardial infarction. Graftability of TOLAD was 90% (19/21) and two of the TOLADs were not suitable for CABG because severe atherosclerosis of these arteries were observed intraoperatively. There was no operative death. Short term (1-2 months) patency was 64% (7/11) for saphenous vein grafts (SVG) and 100% (8/8) for left internal thoracic artery grafts (LITA). Left ventricular wall motion assessed by left ventriculography showed impaired regional wall motion in 63% segments of the segment #2, #3 and #6 preoperatively. However, the regional wall with impaired motion decreased to 31% after CABG. Thallium-201 scintigraphy showed impaired perfusion in 62% segments of the left anterior wall, apex and interventricular septum preoperatively. However, the regional wall with impaired perfusion decreased to 42% after CABG. Exercises tolerance assessed by treadmill test was improved from 3.8 +/- 0.7 Mets preoperatively to 6.5 +/- 0.7 Mets with patent coronary bypass grafts. These data suggested that CABG can improve the wall motion of the regions perfused by TOLADs and the LIMA is more suitable than the SVG for CABG to TOLAD.     

Malfunction of prosthetic valves: pathogenesis and diagnostic measure]

Modality of the malfunction of prosthetic valve often reflects the specific features of its design and materials of the prosthesis. During past 17 years, a total of 499 cases of valve replacements were performed in our institute and among them, 50 cases received redo surgery, in which 52 prosthetic valves were replaced due to their malfunctions. Those replaced prosthetic valves were analyzed in terms of their pathogenesis, onset durations and diagnostic methods of each type of malfunction. The malfunctions included hemolytic anemia, thrombosis or tissue overgrowth and tissue failure of bioprostheses. Hemolytic anemia was experienced in 8 cases with Starr-Edwards (S-E) 2320 (n = 7) and Omni-Science (n = 1) both in the aortic position and those prostheses were replaced at 1-9.6 (mean 4.5) postoperative years (POY). The linearized rate of the complication with the S-E 2320 was 3.0%/patient-years (p-y) and its actuarial event free rate was 62% at 11 POY. Operative findings disclosed cloth wear in 5 and perivalvular leakage in 5 cases. Fourteen Hancock (H) and 3 Angell-Shiley (A-S) bioprostheses experienced tissue failure of valves and they were subjected to reoperation at 3.2-10.0 (mean 6.5) POY. The linearized rates were 4.1%/p-y for H and 4.5%/p-y for A-S with actuarial event free rates at 12 POY of 59 and 56%, respectively. Prosthetic valve thrombosis and/or tissue overgrowth were seen in 17 valves at 1.6-15.1 (mean 9.1) POY.(ABSTRACT TRUNCATED AT 250 WORDS)     

Chronic subdural hematoma secondary to metastasis of adenocarcinoma of the dura mater and skull--a case report

A 72 year-old woman was hospitalized with the complaint of headache and nausea. Under the diagnosis of right chronic subdural hematoma, a small craniotomy was performed for the total removal of the hematoma. The patient died 14 days after the operation because of the complication of acute DIC. Histologically, metastasis of adenocarcinoma was detected in the dura mater and skull. Previously reported cases of subdural hematoma secondary to cancer were reviewed in the literature. It is considered that a coagulation defect such as DIC may play a significant role in the development of subdural hematoma. It is suggested that the chronic subdural hematoma in the present case was caused by chronic DIC due to metastasis of bone marrow, and that the patient deteriorated as a result of acute DIC triggered by the surgical therapy.     

Activation of peritoneal macrophages with human cholesteatoma debris and alpha-keratin.

The effect of human cholesteatoma debris on mouse peritoneal macrophages was studied in vivo. The number of macrophages and lymphocytes increased 5 days after injection of the debris into the peritoneal cavity. A similar increase in peritoneal cells was observed when an urea-extracted fraction of the cholesteatoma debris or alpha-keratin, a major component of the debris, was injected. Both cholesteatoma debris- and alpha-keratin-elicited macrophages exhibited a greater response of luminol-dependent chemiluminescence upon exposure to zymosan, suggesting that the elicited macrophages were activated. In contrast, other constituents of the debris, such as cholesterol or fatty acid--with the exception of lipopolysaccharide (LPS)--failed to elicit or activate peritoneal macrophages at the similar doses detected in the debris. The chemiluminescent response of macrophages obtained by injecting LPS was, however, much lower than that of alpha-keratin-induced macrophages. These results indicate that cholesteatoma debris is capable of eliciting and activating macrophages, and that alpha-keratin is responsible for the activation.     

Cerebral metastasis in patients with uterine cervical cancer

We report on eight patients who developed brain metastases following uterine cervical cancer. The mean interval between diagnosis of the primary cancer and diagnosis of the brain metastasis was 28.4 months (range: 6.1-61.8 months). Nausea and vomiting due to increased intracranial pressure were the most frequent symptoms. Surgical excision of the brain lesions, followed by postoperative radiotherapy, was performed in three patients. The other five patients received only cranial radiotherapy. When the metastatic brain lesions were detected, other distant metastatic lesions were confirmed at the same time in five patients. The median survival time after diagnosis of the brain metastases was only 3.0 months.