[Experience with laparoscopic nephrectomy]

Laparoscopic procedures are promising techniques which allow less invasive surgery not only for intra-abdominal organs but also for retroperitoneal organs. Laparoscopic nephrectomy was first described by Clayman et al. We removed the left kidney of a 36-year-old male patient using laparoscopic procedures according to Clayman's technique. The kidney had developed hydronephrosis due to congenital ureteropelvic junction stenosis. In the peritoneal cavity the freed kidney was pushed into a Lapsac, minced using scissors and forceps, and removed without elongation of the wound. During the operation, pneumoperitoneum with CO2 gas induced increases in PaCO2, central venous pressure, pulmonary artery wedge pressure and cardiac output, all of which the patient tolerated well. The patient was discharged from the hospital on the 9th postoperative day. Laparoscopic nephrectomy is a useful alternative to the conventional open surgery in selected cases, when surgical techniques and instruments are improved appropriately.

[Clinicopathological analysis on invasion and metastasis in superficial bladder cancer]

We analyzed the clinico-pathological features of the initial tumors in 205 patients with superficial bladder cancer, admitted to Kyoto University Hospital between 1974 and 1988, to investigate the prognostic factors for progression to the muscle invasive disease or metastasis. Of 205 patients, 35 (17%) exhibited muscular invasion alone (12 patients) and/or metastasis (23 patients). Tumor multiplicity, higher grade and positive urinary cytology were the significant risk factors for later malignant progression. Expression of A, B, H-blood group isoantigens in the bladder tumor were significantly decreased from the onset in the patients with initially T1 tumor but not in those with Ta tumor. Significant loss of expression was also found at the time of progression in the initially Ta cases. Thus, loss of A, B, H-blood group antigen expression seems to be correlated with the malignant potential of superficial bladder cancer. However, more feasible and reliable diagnostic markers such as molecular genetical and biochemical markers remain to be developed to predict the malignant potential of the superficial bladder cancer.

The streptococcal preparation OK-432 specifically augments the susceptibility of human urinary bladder tumor cells to autologous peripheral blood lymphocytes

The streptococcal preparation OK-432 was tested for its ability to enhance the susceptibility of fresh urinary bladder tumor (UBT) cells to autologous peripheral blood lymphocytes (PBL) in patients with UBT. PBL treated with OK-432 at 0.1 Klinishe Einheit (KE)/ml for 18 hours killed the human T24-lined UBT cells and freshly separated autologous UBT cells more efficiently than untreated PBL. Treatment of K562 erythroleukemia cells with OK-432 at 0.1 KE/ml for 18 hours had no effect on their susceptibility to lysis by fresh PBL. In contrast, treatment of T24 and fresh autologous UBT cells with OK-432 resulted in an enhancement of their susceptibility to PBL. The susceptibility of autologous UBT cells to both large granular lymphocytes (LGL) and T-lymphocytes was also enhanced by treatment of tumor cells with OK-432. Binding of PBL to T24 and fresh autologous UBT cells was also augmented by treatment of the tumor cells with OK-432. The frequency of binding of OK-432 to fresh UBT cells was positively correlated with the increased target sensitivity to autologous PBL. The inhibition of RNA synthesis in fresh UBT cells by OK-432 was also associated with the elevated susceptibility to autologous PBL. These results indicate that OK-432 activates the autologous tumor killing system through stimulation of effector cells and elevation of target susceptibility to effector cells in patients with UBT, and suggest that the OK-432-augmented target sensitivity to PBL may be oriented specifically to UBT cells and local immunotherapy with OK-432 may be remarkably beneficial in the treatment of UBT.

[Detection of mutant adenine phosphoribosyltransferase genes by polymerase chain reaction-single strand conformation polymorphism analysis]

Polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis is a rapid and sensitive method to identify point mutations in a given sequence of genomic DNA. We tried to apply the PCR-SSCP to the diagnosis of adenine phosphoribosyltransferase (APRT) deficiency, which is an autosomal recessive hereditary disease leading to 2,8-dihydroxyadenine urolithiasis. Genomic APRT genes, with or without mutations, were amplified and labeled simultaneously with 32P-dCTP by PCR. When run in a 6% polyacrylamide gel containing 10% glycerol, two types of mutant genes, APRT*Q0 and APRT*J, gave bands clearly distinct from those of the respective normal APRT genes. Since heterozygotes as well as homozygotes for these mutant APRT genes can be detected in 2 days, PCR-SSCP should be a valuable method in the diagnosis of APRT deficiency and in screening a large population for APRT mutant genes.

[Phase I study of a new platinum complex 254-S, cis-diammine (glycolato)-platinum (II)]

A new platinum complex 254-S had a superior preclinical therapeutic indices compared to cisplatin, showing decreased renal and gastrointestinal toxicities. Phase I clinical study with a single dose schedule was conducted to investigate the safety, toxicity, pharmacokinetics and possible efficacy against various advanced cancers by a cooperative study of 10 institutions. The drug was administered by i.v. infusion for 60 min dissolved in 250 ml of 5% xylitol solution, without the use of hydration and antiemetics. At least 3 patients at each dose level of 10, 20, 40, 80, 100 and 120 mg/m2 were tested and 28 patients were entered into this study. Myelosuppression, especially thrombocytopenia, appeared strongly at dose level of 80 mg/m2 and dose limiting thrombocytopenia was found in 2 of 5 patients. Leukocytopenia was also dose-related but moderate. Platelet and WBC nadirs occurred around 3 weeks after administration with recovery in about one week. Although slight elevation of BUN and creatinine were temporarily observed in a few cases, no significant renal toxicity was observed. Anorexia, nausea and vomiting were observed in the majority of patients, but milder than cisplatin. In conclusion, 254-S has demonstrated reduced non-hematologic toxicities as compared to cisplatin. This drug appears to be well tolerated and 120 mg/m2 was maximum tolerated dose. The recommended dose for phase II studies was thought to be 100 mg/m2 by i.v. infusion every 4 weeks.

[Indiana continent urinary reservoir: technical modifications and late complications]

From October, 1987 through September, 1991, 39 patients underwent construction of Indiana pouch for cutaneous urinary diversion. There were 35 men and 4 women, and their ages ranged from 38 to 77 years (a mean age of 62 years). After the first 8 cases, Indiana pouch was constructed with several modifications which included complete detubularization of the cecum, construction of the pouch augmented with U-shaped ileal patch, and the use of stapled plication. There was no major early complication related to the pouch but one postoperative death of blood transfusion related graft versus host disease. End results were evaluated in 37 patients who were followed for 3 to 49 months. Late complications related to urinary reservoir occurred in 8 patients. The early two patients experienced pouch deformity due to incomplete detubularization of the colonic segment. Two patients had difficult catheterization due to a dilatation of the plicated ileum. One patient had metabolic acidosis requiring hospitalization. Patients perform self-catheterization 4-5 times during the day and 0-2 times at night for volumes ranging from 300 to 1,000 cc. Of 37 patients 34 achieved acceptable urinary continence and one had significant leakage requiring cutaneous bag. The remaining two patients suffered mild nocturnal incontinence. Follow up examination with excretory urography showed no upper urinary tract obstruction except one with unilateral hydronephrosis due to ureteroanastomotic stricture. Reservoirgraphy showed no reflux into the upper urinary tract in all the follow up cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Urinary tract infection caused by Corynebacterium sp.--a case report and an experimental study]

We repose of chronic cystitis associated with alkali urine, struvite stones and a subsequent vesicorectal fistula caused by Corynebacterium sp, probably Corynebacterium group D2. We also studied in vitro and in vivo stone formation caused by Corynebacterium renale isolated clinically. C. renale inoculated into normal human urine increased urine pH and formed struvite crystals after a 24-hr incubation. Bladder stones were also formed in rats experimentally infected by C. renale as well as P. mirabilis. Some urea splitting species of Corynebacterium such as C. group D2 and C. renale may play a role in the formation of human struvite stone.

[Neoadjuvant chemotherapy (M-VAC) for locally invasive bladder cancer]

Eight patients with locally invasive bladder cancer (stages T2-T4, N0, M0; 7 men and 1 woman; mean age, 72.0 years; age range, 56 to 80 years) were treated with 2 cycles of neoadjuvant chemotherapy consisting of methotrexate, vinblastine, adriamycin and cisplatin (M-VAC). Seven of them underwent radical cystectomy after chemotherapy, while the bladder was preserved in one patient. Seven patients were free of disease during a mean follow-up period of 26.2 months (range 20-30 months). However, one patient whose pathological stage was pT2, N1 died with disease 27 months after radical cystectomy. The patient whose bladder had been preserved showed no recurrence after a follow-up period of 27 months. Pathological examination of the resected specimen after chemotherapy revealed no tumor tissue in three patients; one with negative cytology and two with positive cytology. Downstages were observed in two patients. Results showed that the toxicity of neoadjuvant M-VAC therapy is acceptable and that M-VAC therapy is effective against locally invasive transitional cell carcinoma of the bladder. The problem remains of how to assess the clinical stage more accurately before chemotherapy and radical cystectomy.

[Laparoscopic pelvic lymphadenectomy in patients with localized prostate cancer]

Laparoscopic pelvic lymphadenectomy is a newly developed technique of lymph node dissection in patients with malignancy of the pelvic organs. Three patients with localized prostatic cancer underwent laparoscopic pelvic lymphadenectomy. The patients were 77 years old with stage C disease, 73 with stage B1, and 65 with stage A2. Five to ten lymph nodes were removed from each patient after laparoscopic procedures lasting 220 to 270 minutes. There were no complications during the procedures and their convalescence was uneventful. All lymph nodes were negative by pathological examination and a radical retropubic prostatectomy was done 2 weeks after the lymphadenectomy in two patients. The other patient was treated with external radiotherapy and bilateral orchiectomy. Patients with stage C cancer, a high serum level of prostate specific antigen or a high grade tumor are the best candidates for this less invasive staging procedure. The disadvantage of this procedure is long operation time and complications due to CO2 pneumoperitoneum.

Allelic losses at chromosome 17p in human renal cell carcinoma are inversely related to allelic losses at chromosome 3p

Recent studies have demonstrated that allelic losses at chromosome 17p are associated with the genesis of a wide variety of human cancers. In order to assess whether the rearrangement of chromosome 17p was responsible for the genesis of renal cell carcinoma (RCC), we used restriction fragment length polymorphism analysis of chromosome 17p. We studied 48 RCCs, including 6 metastatic RCCs, from 43 patients with 5 polymorphic probes to loci within or near the p53 gene. Allelic losses at chromosome 17p were detected in only 6 of the 36 informative cases (17%), and no definitive correlation was demonstrated between allelic losses at 17p and the tumor stages. The 6 RCCs with allelic losses at 17p were histopathologically classified as a clear cell type in one, a mixed cell type in one, and granular cell types in the other four cases. Allelic losses at 17p in the clear cell type of RCC were infrequent (6%, 1 of 18), and were not detected even in the metastatic tumor from a highly advanced case. This finding suggests that allelic losses at 17p could be random genetic rearrangements in the case of the clear cell type of RCC. On the other hand, allelic losses at 17p in the granular cell type of RCC were demonstrated with a significantly higher frequency (44%, 4 of 9). We previously reported that allelic losses at 3p were specific to the clear cell type of RCC (Ogawa et al., Cancer Res., 51:949-953, 1991). Examination of the association of allelic losses at 17p with those at 3p revealed that none of 5 informative RCCs with allelic losses at 17p showed allelic losses at 3p. Conversely, 17 of 25 informative RCCs with retention of 17p alleles lost alleles at 3p. Thus, an inverse relationship was demonstrated with statistical significance (P less than 0.01). These data suggest that the types of rearrangement on chromosome 17p and/or chromosome 3p can differentiate between the histopathological subtypes of RCC.

Physical characteristics and factors related to sexual development and behaviour and the risk for prostatic cancer

A case-control study of prostatic cancer was carried out to examine the association between selected physical characteristics and factors related to sexual development and behaviour and the risk for this disease. In consideration of an endocrinologic mechanism for these putative risk factors, the association between selected factors and serum hormone level in a comparison group, free of prostate cancer, was also examined. One-hundred cases and 113 controls were included for study. An elevated risk for prostatic cancer was found for those currently married (odds ratio (OR) = 4.0), those who had been married once (OR = 2.8), and those who were currently practising a religion (OR = 2.0). Compared to subjects with one child, those with more than one child and those with no children were more common among cases than controls. Prostatic cancer risk was associated with large body size and, in particular, with greater weight (p < 0.01). Early age at attainment of adult height was also associated with prostatic cancer risk (p < 0.01). Only moderate associations were found between increased frequency of sexual intercourse and prostatic cancer risk. The levels of testosterone (T), dihydrotestosterone, salivary testosterone and T/SHBG (sex hormone binding globulin) did not vary with age. Older men had higher oestradiol levels. Further, little association between hormone levels and risk factors was found, except for married subjects having increased serum androgens (p < 0.05) and heavy subjects having decreased serum androgens (not significant).

[The effects of preoperative insertion of double-J catheter in transurethral lithotripsy (TUL)]

Transurethral lithotripsy (TUL) was performed in the cases in which the ureteral calculi were not destroyed by the extracorporeal shock-wave lithotriptor (Dornier HM-3, EDAP LT 01). Preoperative placement of double-J ureteral catheter (D-J catheter) caused ureteral dilation, allowing smooth insertion of the ureteroscope. We divided the 55 TUL cases into two groups, those with (27) or without (28) a D-J catheter placed preoperatively, and compared requirement of ureteral bougination, difficulty of ureteroscope insertion and duration of operation between the two groups. In all cases with a D-J catheter, ureteral bougination was not necessary, the insertion of ureteroscope was easier and the duration of operation was shorter than the cases without a D-J catheter. Bladder irritable symptoms were seen in some cases with a D-J catheter but did not require removal of the D-J catheter. On the follow-up term after TUL, there was no difference in the incidence of postoperative fever or postoperative ureteral stenosis, between the cases with and those without a D-J catheter.

Laparoscopic varicocelectomy: a simple technique for clip ligation of the spermatic vessels

Less invasive laparoscopic surgery is replacing the conventional open operation for the treatment of several conditions. We performed laparoscopic clamping of the internal spermatic vessels in 12 subfertile patients to treat varicocele of the testis. Seven operations were performed with the patient under general anesthesia, whereas a local anesthetic was used in the 5 most recent patients. The internal spermatic vessels were successfully clipped in all 12 patients. Postoperative physical examination with a Doppler stethoscope showed that the venous reflux had disappeared in all patients. Semen quality was improved in 7 patients with a followup of 3 to 10 months. Neither hydrocele nor testicular atrophy was observed postoperatively. Laparoscopic varicocelectomy was effective and minimally invasive, especially when performed with the patient under local anesthesia.

[A case of papillary cystadenoma of the epididymis]

We report a case of papillary cystadenoma of the left epididymis in a 37-year-old single man. He visited our clinic complaining of painless tumor in the left scrotum. The physical and radiological examinations showed no signs of von Hippel-Lindau syndrome. Surgical exploration revealed a 15 x 15 x 10 mm tumor on the head of the left epididymis. Histopathological examination suggested efferent duct ectasia with papillary formation, with cuboidal epithelium, which was finally diagnosed as papillary cystadenoma of the epididymis. This is the 16th case of papillary cystadenoma of epididymis in Japan.

[Ureteral obstruction caused by endometriosis: a report of two cases]

Two cases of endometriosis causing ureteral stenosis are reported. Case 1. A 46-year-old woman was hospitalized with the complaint of right flank pain. Intravenous pyelography showed right hydronephrosis and retrograde pyelography revealed ureteral stenosis at the distal third ureter. Exploration revealed an abnormal periureteral mass, which was excised together with the distal part of the ureter. A right ureteroneocystostomy was performed with the Boari technique. Case 2. A 39-year-old woman was hospitalized with the complaint of pain in the left lower quadrant. A left retrograde pyelography showed stenosis of the ureter at 4 cm proximal of the bladder. An exploratory laparotomy revealed blue berry spots on the left side of the uterus and dense fibrous tissue around the ureter, which was successfully dissected out. The pathological diagnosis of both cases was extrinsic ureteral endometriosis. Ureteral endometriosis has rarely been described and the literatures on 30 cases reported in Japan were reviewed.

[A case of advanced seminoma treated effectively with single agent carboplatin therapy]

Cisplatin has played a major role in the treatment of germ cell tumors. However, it causes renal damage, severe nausea and vomiting. It is also neurotoxic and ototoxic. Carboplatin is an analog of cisplatin which, does not cause renal damage at therapeutic doses. It is not neurotoxic or ototoxic and it produces less gastrointestinal toxicity than cisplatin. We used carboplatin alone as an initial chemotherapy in a 36-year-old man with stage IIB seminoma. Following left radical orchiectomy the patient received 4 courses of carboplatin chemotherapy. After the first course of chemotherapy, tumor markers (LDH, beta-HCG) returned to the normal range. After 4 courses, the size of the retroperitoneal metastases was significantly reduced. The toxicity of 4 courses of carboplatin chemotherapy was generally milder than that of cisplatin-based combination chemotherapies such as PVB or VAB-6. There were no episodes of septicemia, thrombocytopenic bleeding or renal deterioration. The patient did not suffer from alopecia, neuropathy, symptomatic hearing loss, severe nausea or vomiting. Nine months after the completion of carboplatin chemotherapy, the patient remains well and free from disease progression. This case strongly suggests that single agent carboplatin therapy could be an effective and less-toxic treatment for advanced seminoma.

Modulation by cis-diamminedichloroplatinum (II) of the susceptibilities of human T24 lined and freshly separated autologous urinary bladder transitional carcinoma cells to peripheral blood lymphocytes and lymphokine activated killer cells

The effects of cis-diamminedichloroplatinum (II) on the susceptibilities of human T24 lined and freshly separated autologous urinary bladder transitional carcinoma cells to lysis by peripheral blood lymphocytes of patients with urinary bladder cancer was analysed in a 12-hour 51Cr release assay. Treatment of T24 cells with cis-diamminedichloroplatinum (II) at 10 micrograms./ml. for three hours enhanced their susceptibility to peripheral blood lymphocytes and lymphokine activated killer cells. Kinetics studies demonstrated that the enhancement of their susceptibility became noticeable by three hours and continued until 12 hours. The susceptibilities of autologous tumor cells to both large granular lymphocytes and T lymphocytes were also enhanced by treatment of them with cis-diamminedichloroplatinum (II). There was no significant difference in the number of peripheral blood lymphocytes binding to cis-diamminedichloroplatinum (II)-treated T24 cells as compared with untreated T24 cells. Treatment of T24 cells with mitomycin C did not change their natural killer sensitivity. Pretreatment of T24 cells with cis-diamminedichloroplatinum (II) and lysosomotrophic agents (L-leucin-methyl-ester or chloroquine) reduced the enhancement of their susceptibility to natural killer cells by cis-diamminedichloroplatinum (II) alone. On the other hand, pretreatment of peripheral blood lymphocytes with cis-diamminedichloroplatinum (II) had no influence on the cytotoxicity against T24 cells. These results indicate that cis-diamminedichloroplatinum (II) may have an augmenting effect on the susceptibility of tumor cells to the cell-mediated cytotoxicity partly through a modification of cell membrane independently of its antimetabolic activity and this modification may be one of the possible mechanisms responsible for tumor regression after chemotherapy with cis-diamminedichloroplatinum (II).

Effects of bacillus Calmette-Guerin on cytotoxic activities of peripheral blood lymphocytes against human T24 lined and freshly isolated autologous urinary bladder transitional carcinoma cells in patients with urinary bladder cancer

The effects of bacillus Calmette-Guerin (BCG) on the cytotoxic activities of peripheral blood lymphocytes against human T24 lined and freshly separated autologous urinary bladder transitional carcinoma cells in patients with urinary bladder cancer were analyzed in a 12-hour chromium 51 (51Cr) release assay. The results of this study indicate that BCG activates the tumor killing system through stimulation of effector cells and elevation of target cell susceptibility in patients with urinary bladder cancer, suggesting that BCG-augmented cytotoxicity may be oriented specifically to urinary bladder cancer cells. This could explain the remarkable clinical benefits of intravesical instillation of BCG against urinary bladder cancer.

Clinical evaluation of nafamstat mesilate (FUT 175). A new anticoagulant for plasmapheresis

Nafamstat mesilate (FUT), a new anticoagulant with a short half-life of biologic activity, was used in six patients who had a history of bleeding (two from the eye, two nasally, and two orally) during plasmapheresis (PP) due to overdosage of heparin. FUT (1.2 mg/kg/hr) was injected into the arterial blood line during PP. Prothrombin time (PT), activated partial thromboplastin time (APTT), bleeding time (BT), and complete blood count (CBC) were measured before and after PP. Values of PT (17 +/- 1.4 sec) after treatment were nearly 1.5 times the levels of PT (12.5 +/- 0.8 sec) before treatment. Levels of APTT after PP (70.4 +/- 4.1 sec) were nearly double the values of APTT before PP (36.8 +/- 2.6 sec). There were no significant differences between red blood cell (RBC), hemoglobin (Hgb), or platelet counts before and after PP. No patient developed thrombosis, hemorrhage, or other side effect during PP. In conclusion, the optimal dosage of FUT was 1.2 mg/kg body weight/hr during PP. FUT is recommended as a useful anticoagulant during PP treatment of patients with an increased risk of bleeding.

Localization of CuZn-superoxide dismutase in the human male genital organs

We performed an immunohistochemical analysis using a polyclonal antibody to determine the localization of CuZn-superoxide dismutase (SOD), a scavenger of superoxide anion radicals, in the human male genital organs. In the testis, intense immunoreactivity of CuZn-SOD was shown in both the cytoplasm and nucleus of the spermatogonia of the seminiferous tubules. Spermatocytes, further differentiated germ cells and Sertoli cells showed no or weak immunoreactivity. In the ductus epididymis, the principal cells showed no or weak immunoreactivity except for the stereocilial region, while the basal cells showed relatively intense immunoreactivity. In the ductus deferens, the prostate and the seminal vesicles, columnar and cuboidal epithelia showed CuZn-SOD immunoreactivity. The immunoreactivity was more intense in the epithelia of the ductus deferens than in the prostate or the seminal vesicles. Basal cells in the prostate also showed intense immunoreactivity. Collectively, the present immunohistochemical results suggest that CuZn-SOD in the male genital organs is localized where it could play an important role in cell differentiation, including spermatogenesis. The CuZn-SOD could also play a role in local defence mechanisms against tissue damage mediated through superoxide anion radicals, as well as in providing SOD to the seminal plasma.

[Clinical significance of the stereological estimation of mean nuclear volume in human bladder carcinoma--relation to tumor grade, stage and prognosis]

Quantitative analysis of the malignant potential in cancer cells is a method currently under discussion. Recently the stereological estimation of cancer cells has been utilized in making an objective and quantitative pathological diagnosis. In this study, we estimated the mean nuclear volume (MNV) of untreated bladder carcinomas in 128 patients by stereological methods and attempted to quantitatively analyze the malignant potential of the carcinoma. The MNV was significantly enlarged as the tumor advanced in grade and stage. MNV was largest in grade 3 tumors (340.2 +/- 100.1 microns3) followed by grade 2 tumours (206.2 +/- 90.6 microns3) (P less than 0.01), and grade 1 tumors (130.6 +/- 46.7 microns3) (P less than 0.01). MNV was larger in pT1 tumors (278.2 +/- 126.9 microns3) than in pTa tumors (156.9 +/- 60.5 microns3) (P less than 0.01). MNV was also larger in invasive tumors (T2, T3 and T4: 318.2 +/- 104.0 microns3) than in superficial tumors (Ta and T1: 203.5 +/- 109.2 microns3) (P less than 0.01). Patients were then divided into two subgroups, one with large nuclei (MNV greater than or equal to 197.3 microns3), and the other with small nuclei (MNV less than 197.3 microns3). Survival and disease-free rates in patients with small nuclei (5-year survival rate: 92.9%, 5-year disease-free rate: 24.4%) were significantly better than in patients with large nuclei (5-year survival rate: 58.0%, 5-year disease-free rate: 12.5%). For patients with grade 2 tumors, those with small nuclei had a good survival rate (5-year survival rate: 95.5%), similar to that of patients with grade 1 tumors (5-year survival rate: 95.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinosarcoma of the prostate

A very rare case of carcinosarcoma of the prostate is reported. The patient was a 77-year-old man in whom both primary and metastatic tumors presented the pathology of carcinosarcoma of the prostate. The carcinosarcoma was resistant to anti-androgen therapy, and the patient showed low level of serum prostatic acid phosphatase and was free from bony metastases despite multiple metastases to the lung, liver, pancreas, para-aortic lymph nodes, spleen and penis. The sarcomatous component consisted of chondrosarcoma and fibrosarcoma, both of which were positive for vimentin. The carcinomatous component was positive for both keratin and prostatic acid phosphatase.

Clinical study of bone-related relapse in prostate carcinoma

Prostate carcinoma is usually highly responsive to initial endocrine therapy. However, when relapse occurs, the subsequent clinical course is very poor. In this study, we tried to reveal the clinical aspects of bone-related relapse in 392 patients who received endocrine therapy for prostate carcinoma. In 17 stage B patients who had relapsed, 76% experienced relapse within 4 years following the start of treatment, 76% within 3 years in 27 stage C patients, and 71% within 2.5 years found in 45 stage D patients. Pre-treatment levels of serum enzymes and initial response of the primary lesion and of serum enzymes failed to predict relapse. The Gleason sum tended to be correlated with relapse. In particular, patients with a Gleason sum of 9-10 had a lower non-relapse rate during the follow-up period than patients with lower sums. With the recent use of more sophisticated measurements of PSA and/or PAP, the reduction rate or interval to normalization of the markers must be more relevant to predicting relapse.

Phase II study of cis-diammine(glycolato)platinum, 254-S, in patients with advanced germ-cell testicular cancer, prostatic cancer, and transitional-cell carcinoma of the urinary tract. 254-S Urological Cancer Study Group

A multicenter cooperative study was conducted to evaluate the clinical efficacy and safety of cis-diammine(glycolato)platinum (254-S), a second-generation anticancer platinum complex, in the treatment of genitourinary cancers. 254-S was given i.v. at 100 mg/m2 at 4-week intervals. As a result, 2 complete responses (CRs) and 8 partial responses (PRs) were obtained in 35 patients with transitional-cell carcinoma (TCC) of the urinary bladder or pyeloureter, 3 PRs were obtained in 16 subjects with prostatic cancer, and 6 CRs and 6 PRs were obtained in 15 patients with testicular cancer, generating objective response rates of 28.6% [95% confidence interval (CI), 14.6%-46.3%], 18.8% (95% CI, 4.0%-45.6%), and 80.0% (95% CI, 51.9%-95.7%), respectively. Bone marrow suppression was the dose-limiting toxicity, although it was reversible. Although no hydration was performed in approx. 40% of the patients, the incidence of nephrotoxic effects was low and most of those encountered were mild, the exception being one patient who showed severe renal insufficiency after the first treatment. Nausea and vomiting occurred in approx. 70% of the patients, but most gastrointestinal toxicities were controlled without antiemetic treatment. In addition, liver-function impairment was rarely observed. We conclude that 254-S is a promising cisplatin analogue for the treatment of genitourinary cancers and is worthy of further investigation in large-scale, randomized comparative studies with other platinum derivatives in both single-agent and combination regimens.