Signet-ring cell carcinoma of the prostate effectively treated with maximal androgen blockade

Primary signet-ring cell carcinoma (SRCC) of the prostate is very rare and has a poor prognosis, even when treated with aggressive therapy. We report herein a case of a 72-year-old man with prostatic SRCC. The patient had a tumor that extended directly to the rectum. Maximal androgen blockade was started and 20 months later, the patient was alive without evidence of recurrence. The present case of prostatic SRCC responded well to medical therapy, however, tumors can recur after a long period of time. Therefore, adjuvant therapy is recommended.     

Preliminary Phase II Study of Adriamycin (ADM) in Patients with Non-Small Cell Lung Cancer (NSCLC)

A phase II study of adriamycin (ADM) (60 mg/m² was performedin 22 patients with non-small cell lung carcinoma (NSCLC). Therewere no responders in the 19 evaluable patients (16 with adenocarcinoma,two with squamous cell carcinoma and one with large cell carcinoma).The major side effects were alopecia (89%), leukocytopenia (73%),thrombocytopenia (58%) and upper gastrointestinal symptoms. Although ADM at 60 mg/m² did not appear to have sufficient antitumoractivity against NSCLC in this study, it is necessary to evaluatefurther the efficacy of ADM against NSCLC with another treatmentschedule.     

Antiemetic Efficacy of High-Dose Intravenous Metoclopramide and Dexamethasone in Patients Receiving Cisplatin-Based Chemotherapy: A Randomized Controlled Trial

High-dose intravenous (IV) metoclopramide has shown efficacywith few side effects for the treatment of nausea and vomitingon the day of cisplatin administration. From November 1984 toJanuary 1986, two randomized trials in an antiemetic study wereconducted. In trial I, the antiemetic effect of a short courseof high-dose dexamethasone was compared with that of high-dosemetoclopramide in 29 patients with lung cancer receiving chemotherapycon taining cisplatin (80 mg/m² IV) in a randomized controlledtrial. Dexamethasone was given IV at a dose of 16 mg 1/2 hrbefore and 8 mg, 1 1/2, 3 1/2 and 5 1/2 hr after cisplatin.Metoclopramide was given IV at a dose of 2 mg/kg, 1/2 hr beforeand 1 1/2, 3 1/2 and 5 1/2 hr after cisplatin. Major emeticcontrol (0–2 episodes of vomiting) during the 24 hr aftercisplatin administration was achieved in 55% (6/11) and 67%(12/18) of the patients receiving dexa methasone and metoclopramide,respectively, without serious toxicity. The dura tion of nauseaor anorexia was similar for the two treatment groups. In trial11, the combination of metoclopramide and dexamethasone wascompared with metoclopramide alone to assess the additive antiemeticeffect of the two drugs in 23 patients with lung cancer receivingcisplatin at a dose of 120 mg/m IV in a randomized cross-overstudy. A major antiemetic response was observed in 27% (3/11)and 92% (11/12) of the patients receiving metoclopramide aloneand metoclopramide plus dexamethasone, respectively (p <0.005). The duration of nausea and anorexia was similar forthe two treatment groups. Pa tients tended to prefer the combinationof metoclopramide and dexamethasone; however, the differencewas not statistically significant (p = 0.14) in the small numberof patients entered in this study. Despite excellent controlof acute chemotherapy-induced emesis, 45% of 52 patients experienceddelayed nausea and vomiting more than 24 hr after cisplatinadministration even among those who had had an excellent short-termresponse to the antiemetic agents.     

Recurrence pattern for superficial bladder cancer

AIM: Patients with superficial bladder tumors sometimes have long recurrence-free intervals. We evaluated whether patients with long recurrence-free periods had subsequent recurrences. We also clarified how these patients should be followed. MATERIALS AND METHODS: We enrolled 244 patients with superficial bladder cancer (62 pTa and 182 pT1) treated by transurethral resection of bladder tumor (TURBT) and adjuvant chemotherapy with pirarubicin. Median follow up was 75.5 months. Patients were stratified by the length of their recurrence-free interval. RESULTS: Recurrences occurred in 124 patients (50.8%). Of 185 patients who did not have a recurrence for the first 3 years, subsequent recurrences occurred in 65 patients; in more than half the first recurrence developed after 5 years or more. Ta tumors had a low recurrence rate (14.5%) with the first recurrence often developing after a long recurrence-free period. Of 40 patients who remained recurrence-free for 3 years or more after at least one recurrence occurred, 16 patients (40%) had subsequent recurrences. Furthermore, most of these patients who remained free of recurrence for more than 5 years eventually had a recurrence. The overall progression rate was 15.6%, and this did not relate to the length of the recurrence-free interval. CONCLUSION: When patients did not have a recurrence for the first 3 years, tumors subsequently often recurred, even in pTa tumors. In patients with at least once recurrence, subsequent recurrences appear to occur irrespective of the length of the recurrence-free period. Thus, we recommend that all patients with superficial bladder tumors be followed for as long as possible.     

Characteristics of patients with staghorn calculi in our experience

PURPOSE: To elucidate the factors contributing to staghorn stone formation in patients. MATERIALS AND METHODS: The records of 82 patients (44 men and 38 women) with complete staghorn calculi were reviewed retrospectively for clinical presentation, metabolic disturbances and anatomical abnormalities. RESULTS: There were 79 unilateral and three bilateral cases. The patient performance of the activities of daily life was assessed with the modified Rankin scale (MRS) and it was found that 69 patients were functionally independent (84.1%, MRS 0-1) and 10 patients had a severe disability (12.2%, MRS 4-5). Seven patients had chronic indwelling catheters (8.5%). A positive urine culture was found in 24.4% of patients. Analysis of stone composition revealed magnesium ammonium phosphate and mixed calcium oxalate-phosphate were the most frequently identified types of stone (32.1% and 22.2%, respectively). Urinary pH was low in patients with uric acid stones (mean 5.4). Hyperuricemia, cystinuria and hypercalciuria were found in 14.6%, 2.4% and 37.8%, respectively. Hypercalciuria was found more frequently in calcium-stone cases. Eleven patients (13.4%) showed structural abnormalities of the kidney. CONCLUSIONS: Our data show that the patients with severe disability, urinary tract infection and hypercalciuria could be recognized more frequently in staghorn calculi compared with common urolithiasis. However, in Western countries, the frequency of both urinary tract infection and struvite stones is much higher than in our data. Other Japanese authors have also reported the low frequency of struvite stones in staghorn calculi, suggesting that various factors other than urinary tract infection possibly contribute to the formation of staghorn calculi in Japan.     

The Incidence of Cardiac Metastasis in Primary Lung Cancer and the Management of Malignant Pericardial Effusion

The incidence of metastasis to the heart and pericardium was35% in post-mortem studies of 150 cases of carcinoma of thebronchus. Twenty-one patients with malignant pericardial effusion fromcarcinoma of the bronchus were treated at the National CancerCenter Hospital during the last three years. Fifteen patientswere treated by creating a pericardial window through a subxiphoidapproach without complications or mortality, in these 15 patientscardiac compression caused by pericardial effusion was promptlyrelieved by the creation of the pericardial window. There wasno reaccumula tion of the effusion in five of six patients treatedby the pericardial window procedure with intrapericardial instillationof chemotherapeutic agents and eight of nine patients treatedby creating the window without local chemotherapy. On the otherhand cardiac tamponade was controlled in one of three patientsby repeated pericardiocenteses. The median survival periodsfrom the initiation of treatment for the effusion up to deathwere 4 mo in six patients treated by the pericardial windowprocedure with intrapericardial instillation of chemotherapeuticagents, 2 mo in nine patients treated by the window techniquewithout local chemotherapy and 0.8 mo in six patients in whoma pericardial window was not created. The median survival of15 patients treated by the pericardial window procedure (2 nio)was not significantly longer than that of six patients not sotreated. We have come to the conclusion that the creation of a subxiphoidpericardial window is a safe, effective and reliable treatmentprocedure for the manage ment of malignant pericardial effusion,but the prognosis for survival in patients with malignant pericardialeffusion may depend principally on the extent of the primarytumor and the performance status of patients at the initiationof treatment for the effusion.     

Phase II Study of 7-N-(p-Hydroxyphenyl)-Mitomycin C (KW2083) in Patients with Advanced Non-Small Cell Carcinoma of the Lung and Metastatic Pulmonary Tumors

Twenty-six patients with non-small cell carcinoma of the lungand 25 with metastatic pulmonary tumors were treated by intravenousinjection of 7-N-(p-hydroxyphenyl)-mitomycin C (KW2083), a derivativeof mitomycin C, either at a single 70-mg/m² dose or at a doseof 20–30 mg/m² once a week for 3 weeks. Two patients withadenocarcinoma among 21 evaluable patients with non-small cellcarcinoma of the lung, and one with embryonal cell carcinomaamong 21 patients with metastatic pulmonary tumors achievedpartial response lasting 5 to 7 weeks. In these three patients,KW2083 was administered by a single 70-mg/m² dose, and no patientswho received a dose of 20–30 mg/m² weekly achieved objectiveresponse. Myelosuppression, primarily thrombocytopenia, waspronounced with either treatment regimen and it was the majordose-limiting toxicity.     

Pulmonary Toxicity Induced by Pepleomycin 3-[(S)-l'-Phenylethylamino] Propylamino-Bleomycin

Chemotherapy regimens containing pepleomycin, a derivative ofbleomycin, were used for 81 patients with advanced primary lungcancer and 32 patients with metastatic pulmonary tumors. Amongthe patients with non-small cell carcinoma of the lung, partialresponses were observed in three of 27 patients treated withpepleomycin + carbazilquinone and four of 26 patients treatedwith pepleomycin + mitomycin C (published in Cancer TreatmentReports, 1983). Five partial responses (primary organ: larynx,esophagus, lung, pancreas and uterus; one patient each) in 23evaluable patients with metastatic pulmonary tumors were observedduring treatment, for an overall response rate of 21.7%. Inpatients with primary lung cancer, no correlation between theincidence of the decrease in partial arterial oxygen tension(PaO₂) during treatment and age was observed. Decrease in PaO₂during treatment was found more frequently in patients withabnormal pulmonary function before treatment than in patientswith normal pulmonary function, but the mean lowest values ofPaO₂, in the two groups were the same. Intravenous weekly injectionof pepleomycin is less likely to result in a decrease in PaO₂,than two daily intramuscular injections. Definite pulmonarytoxicity occurred in seven of the 113 patients (6.2%). Eachof the seven received a total dose of over 60 mg and their ageswere over 60 yr, although no correlation between the incidenceof pulmonary fibrosis and total cumulative dose of pepleomycinwas observed. Six of the seven patients died of pulmonary fibrosisin spite of prednisone treatment. Clinical, radiologic and histopathologicfindings associated with pepleomycin were the same as thoseof bleomycin pulmonary toxicity. Further studies are neededto determine the appropriate dose schedule and route of administrationof pepleomycin with regard to its benefit and toxicity.     

A stone developed within the dilated intravesical ureter following ureteroscopy

A 58-year-old man presented with a stone within the dilated intravesical ureter, which was probably attributable to a previous ureteroscopy. Transurethral incision of the right intravesical ureter and lithotripsy were carried out without subsequent urinary tract impairment. Although some complications resulting from ureteroscopy, such as ureteral stricture, ureteral perforation and vesicoureteral reflux, have been reported, this complication is considered to be very rare.