[Combination chemotherapy of advanced transitional cell carcinoma with cis-platinum, cyclophosphamide, adriamycin and 5-fluorouracil (CISCAF)]

Ten patients with advanced transitional cell carcinoma were treated with the combination chemotherapy (CISCAF) consisting of cis-platinum (CDDP), cyclophosphamide (CPM), adriamycin (ADM) and 5-fluorouracil (5-FU). There were 8 males and 2 females with a median age of 57 years (range 33-76). Prior to this chemotherapy, all primary lesions were resected surgically; one patient received irradiation, one interferon. CDDP (15 mg/m2) with mannitol diuresis and ADM (7 mg/m2) were given daily for 5 days. CPM (200-300 mg/m2) was given on day one, and 5-FU (200-300 mg/m2) on day 2. Courses were repeated every 3-4 weeks for 3 courses and later every 2 months. All patients were evaluable for toxicity and 9 for response. There were 3 (33%) partial and 2 minor responses. Survival difference between responders (PR + MR) vs non-responders (NC + PD) was significant during the 30-120 days of observation, but not significant throughout the whole period (generalized Wilcoxon test). The overall toxicity due to chemotherapy was generally mild, except for one irreversible nephrotoxicity and one gastric hemorrhage treated surgically.

[Chemotherapy after prostatectomy--effects of long term administration of Pivmecillinam (PMPC)]

The therapeutic efficacy of Pivmecillinam (PMPC) against urinary tract infections after prostatectomy was investigated. PMPC was orally administered at the dose of 300 mg/day for 2-14 weeks after initial intravenous postoperative chemotherapy with other antibiotics for 0-24 days (average 5.7 days). Thirty patients underwent retropubic prostatectomy and the other 59 patients received TUR-P. The chemotherapeutic efficacy for 19 patients who had over 10(3) CFU/ml of microorganisms was as follows: The effective rate was 48.4% after 2 weeks, 53.8% after 4 weeks, 66.7% after 5-6 weeks and 100% after 7-9 weeks. The prophylactic efficacy for 70 patients who had no or less than 10(3) CFU/ml of microorganisms was 64.3% after 2 weeks, 79.6% after 4 weeks, 86.7% after 5-6 weeks and 90.0% after 7-9 weeks. The overall clinical efficacy of PMPC for 89 patients was 60.7% after 2 weeks, 74.2% after 4 weeks, 83.3% after 5-6 weeks, 90.0% after 7-9 weeks and 100% after 10-14 weeks. No severe side effects were found in these 89 cases. In conclusion, PMPC is a useful drug for the long term treatment after prostatectomy.

Autologous mixed lymphocyte tumor cell culture in patients with renal cell carcinoma

Cell-mediated immunity was studied by measurement of lymphocyte response to autologous tumor cells in 19 surgically treated patients with histologically proved (mixed lymphocyte tumor cell culture) renal cell carcinoma. Tumor stage was low in 9 patients and high in 10, while grade was low in 11 and high in 8. Of 8 patients in whom a positive lymphocyte response was detected 6 had high and 2 had low stage tumors (p less than 0.05), while the grade of disease was low in 7 and high in 1 (p less than 0.05). Furthermore, the more advanced and undifferentiated the tumor the more significant the decrease in lymphocyte response (p less than 0.05). Lymphocyte response was positive in 5 of 8 patients with low stage and low grade tumors but negative in 7 with high stage and high grade disease. However, no correlation between the lymphocyte response and the degree of microscopic lymphocytic infiltration in and around the tumor was found. This study confirms that the specific immunological defense mechanism of patients with renal cell carcinoma against the tumors remains well at an earlier stage of tumor development, especially in cases with well differentiated malignancy, and showed attenuation in parallel with pathological spread or in poorly differentiated tumors.

Spontaneous regression of pulmonary metastases after nephrectomy for renal cell carcinoma

A case of spontaneous regression of pulmonary metastases from renal cell carcinoma after nephrectomy is presented. In a 57-year-old Japanese male who had already had pulmonary metastases at the time of nephrectomy, the metastatic lesions disappeared without adjuvant therapy 8 years after nephrectomy. He is still surviving without recurrence or any signs indicative of new metastasis at the present. The clinical aspects of this interesting phenomenon are discussed briefly.

Late recurrence of renal cell carcinoma after nephrectomy

Late recurrence of renal cell carcinoma is unusual. Of 43 patients who underwent curative nephrectomy more than 10 years before, 2 cases (4.7%) had late recurrence. The 2 cases, both female patients, had late recurrence 12 and 19 years from the date of nephrectomy. The clinical aspects of late recurrence are discussed briefly.

[Localized amyloidosis of the ureter: report of a case]

A case of primary amyloidosis of the ureter is presented. The patient was a 48-year-old woman with a 5-year history of asymptomatic macrohematuria. Roentgenographic examination showed left hydronephrosis and stenosis of the left distal ureter. Histological examination of the biopsied specimen during the operation revealed no malignancy; and, left partial ureterectomy and uretero- vesiconeostomy was performed. Congo red stain proved amyloid deposition after surgery. Rectal biopsy was negative for amyloid; and, other laboratory findings were within normal range. Thus it was diagnosed as a primary localized amyloidosis of the ureter. Importance of intraoperative histologic examination was discussed. This is the 22nd case in the literature.

Circulating cytotoxic anti-RCC antibody responses in renal cell carcinoma patients

The circulating anti-RCC cytotoxic antibodies of eighteen RCC patients, preoperatively, and one inoperable case were studied by 51Cr release CDC and ADCC assays, using the cultured human RCC cell line, OUR-10. Circulating cytotoxic anti-RCC antibodies were detected in eight patients as CDC antibodies. The patients with a low pathological grade had a significantly higher percentage (P less than 0.05) of positive antibody responses.

[Carcinoma of the urachus: report of two cases]

Carcinoma of the urachus is a rare disease with poor prognosis. This is probably due to the difficulty of preoperative diagnosis. Radiological modalities have been considered to be of little value, but in many cases, preoperative diagnosis can be established with the aid of CT scan. In patients with urachal carcinoma, CT scan visualize the primary tumor and its extension beyond the bladder wall into the space of Retzius. Although about 150 cases of urachal tumor have been reported in the English literature, computerized tomographic findings have not been established. We present two cases and emphasize the usefulness of CT scan in preoperative diagnosis.

Predictability of renal allograft prognosis during rejection crisis by ultrasonic Doppler flow technique

Using the ultrasonic Doppler technique, renal blood flow was measured in 67 patients who underwent living related renal transplantation from January, 1976 to December, 1979. In 58 of 67 cases, 81 acute and 9 chronic rejection episodes occurred. In the initial stage of acute rejection, there are no particular changes in the pattern of systolic blood flow and by contrast marked changes of diastolic flow. The disappearance of the diastolic phase is indicative of an advanced stage of rejection, the reappearance indicative of recovery from rejection, and persistent loss accompanied by changes of systolic flow indicative of an unfavorable prognosis of rejection. In chronic rejection, there are rapid changes of neither systolic nor diastolic flow though the acceleration time in the systolic phase lengthens gradually. The ultrasonic Doppler flow technique for blood flowmetry of a transplanted kidney is a useful means of knowing the prognosis of rejection and provides an index for corticosteroid bolus therapy.

Morphologic and biochemical characteristics of human kidney cells in vitro

In vitro cultivated cells derived from normal human renal cortex were characterized morphologically and biochemically. Although the epithelial monolayer was composed of heterogeneous cells, it included cells with a surface structure similar to microvilli as well as some resembling the desmosome between neighboring cells. Enzymatic studies revealed a marked decrease in alkaline phosphatase activity, and the activity of gamma-glutamyl transpeptidase was also reduced to about one-fifth of that in the original tissue. The electrophoretic mobility of the enzyme was not identical with that of normal kidney or of the novel enzyme in renal neoplastic tissue. Lactate dehydrogenase activity was similar to that of normal kidney tissue but the isozyme pattern was completely inverted. These cells responded to the addition of 10 ng per ml of parathyroid hormone in culture medium and there was a 33 fold increase in intracellular cyclic adenosine monophosphate. Estrogen specific binding protein was not detectable in the monolayer cells. These results clearly indicated that the biologic transformation observed in the cultivated normal cells was not attributable to simple fetalism or dedifferentiation, but was a more complicated process.

Urinary macromolecular substances as natural inhibitors of calcium oxalate crystal aggregation

We studied the inhibitory effect of urinary macromolecular substances (UMM), more than 10,000 mol. wt., on aggregation of calcium oxalate crystals in a crystal-seed system and a non-crystal-seed system. In both assay systems, UMM from non-stone-farmers showed a marked inhibitory activity on crystal aggregation, whereas UMM from recurrent stone-formers showed a weak inhibitory activity. The distinction between the two types of UMM was greater in the non-crystal-seed system. The macromolecular inhibitors seemed to be composed of proteins or protein-complexes inasmuch as approximately 70 to 90 per cent of the macromolecular inhibitory activity was destroyed by protein digestion with pronase. Urinary acid glycosaminoglycans, which have been considered possible inhibitors, played a small role in the inhibition of crystal aggregation.

Gonadal findings in cryptorchid boys with Noonan's phenotype

7 patients with Noonan's syndrome, aged 5-16 years, complicated by bilateral cryptorchidism were examined by LH-RH and HCG stimulation tests, long-term HCG stimulation and testicular biopsy. 2 patients showed a good response and there was no effects in the remainder. Histological examination of the tests confirmed interstitial fibrosis in every case and showed abnormalities of the seminiferous tubules in 4 patients while in 1 patient the seminiferous tubules were composed of spermatocytes and spermatids. These hormonal and histological findings show different patterns of disturbance of the pituitary-gonadal system in male patients with Noonan's syndrome.

Intrarenal arteriovenous malformation

Our surgical experience with 7 cases of intrarenal vascular malformation is reported. Based on angiographic criteria the so-called congenital arteriovenous fistula of the kidney may be classified either as the cirsoid type, which represents a truly congenital form of arteriovenous malformation, or as the aneurysmal type, which is considered to be idiopathic or spontaneous. These 2 types of arteriovenous malformations are compared with regard to clinical presentation and the choice of surgical treatment for each type is discussed.

Angiotensin-converting enzyme in human prostate

The activity of angiotensin-converting enzyme in human prostate was measured by spectrophotometric method using Hippuryl-L-histidyl-L-leucine (Hip-His-Leu) as substrate. Benign hypertrophic prostate had significantly higher concentration of angiotensin-converting enzyme (1.99 +/- 0.36 (S.E.M.) units/g of tissue, n = 13) than normal prostate (0.44 +/- 0.1 units/g of tissue, n = 5) (p less than 0.01). More than 80% of the enzyme activity occurred in soluble fraction of normal and hypertrophied prostates. Human prostatic angiotensin-converting enzyme, partially purified from benign hypertrophic prostates, had an apparent molecular weight of 290,000 and pI of 4.1. Optimum pH of the enzyme with KM value of 1.0 mmol/l was 7.8 in 0.1 mmol/l borate/sodium/carbonate buffer. The enzyme was competitively inhibited by captopril (Ki, 1.8 nmol/l).