Sexual function using the EORTC QLQ-TC26 in testicular cancer survivors: A multi-institutional, cross-sectional study

OBJECTIVE

To evaluate sexual function after treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Testicular Cancer 26 (EORTC QLQ-TC26) questionnaire in Japanese testicular cancer (TC) survivors in a multi-institutional, cross-sectional study.

METHODS

This study enrolled TC survivors who visited any of eight high-volume institutions in Japan from 2018 to 2019. After obtaining informed consent, participants completed the EORTC QLQ-TC26 questionnaires. We evaluated sexual function after treatment for TC using the EORTC QLQ-TC26 and analyzed the impact of treatment on sexual function in TC survivors.

RESULTS

A total of 567 TC survivors responded to the EORTC QLQ-TC26. Median age at the time of response was 43 years (interquartile range [IQR] 35-51 years), and median follow-up period after treatment was 5.2 years (IQR 2.2-10.0 years). Sexual function, particularly ejaculatory function, was significantly lower after post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) than after Surveillance or Chemotherapy groups (p < 0.05). In the PC-RPLND group, nerve-sparing procedure preserved postoperative ejaculatory function after RPLND compared with the non-nerve-sparing and offered improved ejaculatory function with time. On multivariate analysis, RPLND was a significant predictor of post-treatment ejaculatory dysfunction, particularly without nerve-sparing (odds ratio 3.0, 95% CI 1.2-7.7, p < 0.05). In addition, TC survivors with nerve-sparing RPLND had higher sexual activity than those without.

CONCLUSION

This survey of the EORTC QLQ-TC26 showed that sexual function and activity in TC survivors after RPLND was reduced in the absence of nerve-sparing techniques.

Effectiveness of patient and staff cohorting to reduce the risk of vancomycin-resistant enterococcus (VRE) acquisition: a retrospective cohort study during a VRE outbreak in Japan

BACKGROUND

Patient and staff cohorting is part of a bundle approach in the response to multi-drug-resistant organisms, but its effectiveness is not fully clarified. This study compared the risks of acquiring vancomycin-resistant Enterococcus faecium (VREfm) at a hospital during a VREfm outbreak based on contact characteristics in order to better understand the effectiveness of cohorting.

METHODS

Exposure came from contact with patients with VREfm (infectors), including existing patients with VREfm and patients who acquired VREfm during the study period. Contact was defined as length of contact time, degree of sharing space, and care by the same nurses as those caring for infectors between January and March 2018. The outcome was VREfm acquisition as determined through monthly stool or rectal screening cultures. Incidence rates were calculated based on contact patterns, and incidence rate ratios (IRRs) were compared.

FINDINGS

Among 272 inpatients (4038 patient-days), 43 patients acquired VREfm with the same or similar pulsotype. Incidence rates were 8.45 per 1000 patient-days when susceptible inpatients were on the same ward as an infector but cared for by different nurses (reference), 16.96 when susceptible inpatients were on the same ward as an infector and cared for by the same nurses [IRR 2.01, 95% confidence interval (CI) 0.62-10.28], and 52.91 when susceptible inpatients shared a room with an infector (IRR 6.26, 95% CI 1.61-35.40).

CONCLUSION

Compared with susceptible inpatients in a different room from infectors and not being cared for by the same nurses, the risk of VREfm acquisition could be six times higher for susceptible inpatients who are in the same room as infectors, and could be double for susceptible inpatients cared for by the same nurses as infectors.

Association of financial toxicity with quality of life in testicular cancer survivors

OBJECTIVES

Most testicular cancer (TC) survivors have long-term survival. However, the association between financial toxicity (FT), which is an economic side effect of cancer treatment, and the quality of life (QOL) of TC survivors is still unclear. Thus, the impact of FT on the QOL of TC survivors was examined in a multi-institutional cross-sectional study.

METHODS

We recruited TC survivors from eight high-volume institutions in Japan between January 2018 and March 2019. A total of 562 participants completed the EORTC QLQ-C30, EORTC QLQ-TC26 and the questionnaires on demographics, including annual income. Financial difficulty in the EORTC QLQ-C30 and low income were used to assess financial distress (FD) and financial burden (FB), respectively. FT was defined as FD and FB. The QOL scores were compared, and a multivariate logistic regression analysis for FT was performed.

RESULTS

With severe FD, TC survivors had more treatment side effects, physical limitations, and anxiety concerning employment and future. The TC survivors who reported low income were worried about their jobs and the future. The QOL of the survivors with FT exhibited high impairment, except for sexual activity. In particular, the TC survivors with FT were physically limited and anxious concerning the future. The multivariate logistic regression analysis revealed that four or more chemotherapy cycles were substantial risk factors for FT (4 cycles, odds ratio (OR) = 4.17; ≥5 cycles, OR = 6.96).

CONCLUSIONS

TC survivors who received multi-cycle chemotherapy were prone to experience FT, resulting in a decline in their health-related QOL.

[A Case of Pleural Empyema with Fistula Caused by Endobronchial Metastasis of Renal Cell Carcinoma]

A 52-year-old man complained of asymptomatic gross hematuria and cough. Chest and abdominal computed tomography (CT) revealed a right renal tumor, mediastinal lymph node metastasis, and right endobronchial metastasis. The right endobronchial metastasis was causing obstructive atelectasis in the lower lobe of the right lung. After tumor biopsy, the pathological diagnosis was clear cell renal cell carcinoma. Combination immunotherapy with ipilimumab and nivolumab was initiated, but CT showed enlargement of the metastatic lesion and lung abscess after two courses of treatment. The therapy was then switched to axitinib. Six days after initiation of axitinib, the lung abscess perforated into the pleural cavity, which resulted in the formation of pleural empyema with fistula. Ten days after initiation of axitinib, obstruction of the bronchus was relieved due to shrinkage of the right endobronchial metastasis, which resulted in development of a pneumothorax. Placement of a thoracic drainage tube and administration of an antimicrobial agent improved the pneumothorax and inflammatory response, but the drainage tube could not be removed. Long-term insertion of the thoracic drainage tube considerably diminished the patient's quality of life, and after 4 months, he was transferred to another hospital to receive the best supportive care.

Fertility and reproductive technology use in testicular cancer survivors in Japan: A multi-institutional, cross-sectional study

OBJECTIVE

To evaluate fertility and use of reproductive technology of testicular cancer survivors in a multi-institutional, cross-sectional study.

METHODS

This study recruited testicular cancer survivors who were followed after treatment for testicular cancer at eight high-volume institutions between 2018 and 2019. The participants completed the questionnaires on marital status, fertility and use of reproductive technology.

RESULTS

A total of 567 testicular cancer survivors, with a median age of 43 years, responded to the questionnaire. Chemotherapy was given to 398 survivors, including three cycles of cisplatin-based chemotherapy in 106 patients and four cycles in 147 patients. Among 153 survivors who attempted sperm cryopreservation, 133 (87%) could preserve sperm. Of the 28 survivors whose cryopreserved sperm was used, 17 (61%) fathered children. Of the 72 survivors who fathered children without the use of cryopreserved sperm, 59 (82%) fathered naturally. Whereas 33 (20%) of 169 survivors treated without chemotherapy fathered children without using cryopreserved sperm, 39 (10%) of 398 treated with chemotherapy fathered children (P < 0.05). Furthermore, the paternity rate was 12% and 5% in testicular cancer survivors with three and four cycles of cisplatin-based chemotherapy, respectively (P < 0.05). However, of 121 survivors who wanted to have children, 14 (12%) received counseling about infertility treatment.

CONCLUSIONS

Testicular cancer survivors preserving their sperm have a higher paternity rate after chemotherapy, especially after four cycles, than those not using cryopreserved sperm. Physicians who give chemotherapy for testicular cancer need to take particular care not only with respect to recurrence of testicular cancer, but also to post-treatment fertility.

Force-induced IL-8 from Periodontal Ligament Cells Requires IL-1β

During orthodontic tooth movement, mechanical stresses induce inflammatory reactions in the periodontal ligament (PDL). We hypothesized that chemokines released from PDL cells under mechanical stress regulate osteoclastogenesis, and investigated the profiles and mechanisms of chemokine expression by human PDL cells in response to mechanical stress. In vitro, shear stress and pressure force rapidly increased the gene and protein expressions of IL-8/CXCL8 by PDL cells. Consistently, amounts of IL-8 in the gingival crevicular fluid of healthy individuals increased within 2 to 4 days of orthodontic force application. The PDL cells constitutively expressed low levels of IL-1β, which were not further increased by mechanical stress. Interestingly, neutralization of IL-1β abolished IL-8 induction by mechanical stresses, indicating that IL-1β is essential for IL-8 induction, presumably though autocrine or paracrine mechanisms. Finally, experiments with signal-specific inhibitors indicated that MAP kinase activation is essential for IL-8 induction.

Enhanced polarization of hydroxyapatite using the design concept of functionally graded materials with sodium potassium niobate

The present work aims to enhance the electrical activities of hydroxyapatite (HA) without affecting its bioactivity through the development of functionally graded materials (FGM) using biocompatible sodium potassium niobate (NKN) piezoelectrics as an intermediary layer.

[Breast cancer metastasized to the pararenal fat 26 years after mastectomy : a case report]

A 66-year-old woman was referred to our hospital with a right renal tumor in October 2010. In 1984, she underwent a mastectomy because of left breast cancer. In 2006, she underwent a lobectomy because of right lung cancer. A follow-up computed tomography of the lung cancer revealed a right renal tumor which extended to the right quadratus lumborum muscle. An exploratory laparotomy was performed and the tumor was found to be malignant by an intra-operative examination. Then, we performed a right radical nephrectomy together with the excision of quadratus lumborum muscle. Pathological examination revealed breast cancer metastasized to the pararenal fat. We could not find any invasion of the tumor into the renal parenchyma. We followed her for 2 months after the operation without any evidence of recurrence, but she suddenly expired due to an unrelated accident.

[Clinical diagnosis and treatment of extragonadal germ cell tumors]

Extragonadal germ cell tumors (EGGCT) are very rare and account for only 2% to 5% of all malignant germ cell neoplasms. Although multimodality treatment, including cisplatin-based chemotherapy and postchemotherapy surgery, has improved the prognosis of patients with EGGCT, few findings are available for these tumors. This article presents the clinical outcome and management of EGGCT patients.

[Cardiac tamponade due to pericardial metastasis from renal cell carcinoma : a case report]

A 52-year-old man received partial left nephrectomy for renal cell carcinoma (clear cell carcinoma, G1, pT1aN0M0) in January, 2003. After 7 years, he was diagnosed with mediastinal lymph node metastasis and we performed interferon-alpha therapy. After 7 months, he presented with dyspnea. Chest X rays showed a large globular cardiac shadow. Echocardiography revealed massive pericardial effusion with features of cardiac tamponade. Under echocardiographic guidance, 1, 020 ml hemorrhagic pericardial fluid was aspirated ; the fluid revealed class V and our diagnosis was pericardial metastasis of renal cell carcinoma. We performed treatment with sunitinib for 5 months after pericardiocectesis. Metastatic mediastinal lymph node size was maintained showing stable disease by computed tomography and cardiac effusion was not increased, but he died unexpectedly at home.

JTT-130, a novel intestine-specific inhibitor of microsomal triglyceride transfer protein, ameliorates impaired glucose and lipid metabolism in Zucker diabetic fatty rats

AIM

Microsomal triglyceride transfer protein (MTP) takes part in the mobilization of triglyceride-rich lipoproteins from enterocytes and hepatocytes. We investigated the effects of JTT-130, a novel intestine-specific MTP inhibitor, on impaired glucose and lipid metabolism in Zucker diabetic fatty (ZDF) rats.

METHODS

Male ZDF rats were fed a regular powdered diet with or without JTT-130 as a food admixture (0.01-0.02%) for 6 weeks. Food intake, body weight, blood biochemical parameters, fecal lipid contents, hepatic lipid contents, tissue mRNA levels and glucose utilization in adipose tissues were assessed. An intraperitoneal glucose tolerance test (IPGTT) and histological analysis of the pancreas were performed.

RESULTS

JTT-130 treatment decreased food intake, glycated hemoglobin, plasma levels of glucose, triglycerides and total cholesterol, hepatic levels of triglycerides and cholesterol and hepatic mRNA levels of glucose-6-phosphatase, phosphoenolpyruvate carboxykinase and fructose-1,6-bisphosphatase. JTT-130 treatment increased fecal levels of free fatty acids and cholesterol, plasma levels of glucagon-like peptide-1 and peptide YY, mRNA levels of glucose transporter 4 (GLUT4) and lipoprotein lipase in adipose tissues and GLUT4 in muscle and glucose utilization in adipose tissues. Plasma insulin decreased after 2 weeks and increased after 4 weeks of JTT-130 treatment. Plasma glucose in the JTT-130-treated rats was lower with higher plasma insulin than in the control rats during the IPGTT. The islets of the JTT-130-treated rats were larger and contained more insulin than those of the control rats.

CONCLUSIONS

JTT-130 ameliorates impaired glucose and lipid metabolism in the ZDF rats thereby suggesting that JTT-130 could be useful for prevention and treatment of type 2 diabetes.

Surveillance for stage I testicular seminoma at a single institution in Japan: Retrospective analysis of prognostic factors for relapse

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Background: Treatment options for clinical stage I seminoma include adjuvant radiotherapy (RT) as well as surveillance and adjuvant chemotherapy (CT). Data available from the surveillance, adjuvant RT and adjuvant CT series suggest that all treatment strategies achieve a complete cure in almost 100% of the patients with stage I testicular seminoma. The success of surveillance of patients with stage I nonseminomatous germ cell tumors and the establishment of curative CT for advanced disease have led to re-examination of the standard treatment approach. We report the results of a retrospective analysis of the prognostic factors for stage I testicular seminoma.

Methods: We retrospectively reviewed the survey of 87 patients with stage I testicular seminoma who were admitted in an institution between January 1982 and January 2009. We examined if the following tumor characteristics could possibly predict the relapse: age at diagnosis, tumor size, pathological T (pT) stage, elevation of beta-hCG level and/or LDH level, invasion of the rete testis, vascular invasion and lymphatic invasion. The cause-specific survival rate was calculated using the Kaplan-Meier method.

Results: During a median follow-up of 8.1 years (range, 1.2-25.7 years), 13 (14.9%) relapses were observed, with an actuarial 5-year relapse-free rate (RFR) of 87.9%. The univariate analysis showed that the following characteristics were not predictive of relapse: age at diagnosis (RFR: 89% [<36 years] vs. 88% [≥36 years]), tumor size (RFR: 90% [<5.6 cm(median)] vs. 85% [≥5.6 cm]), pT stage (RFR: 91% [pT = 1] vs. 84% [pT = 2 and pT = 3]), elevation of beta-hCG level (RFR: 89% [normal] vs. 87% [elevated]), invasion of the rete testis (RFR:90% [absent] vs. 80% [present]), vascular invasion (RFR:86% [absent] vs. 87% [present]), and lymphatic invasion (RFR: 88% [absent] vs. 87% [present]). The overall 5-year survival rate was 97%.

Conclusions: Prognostic factors for relapse could not be identified in this retrospective analysis of the patients admitted in a single institution. To identify the prognostic factors for risk-adapted treatment for stage I testicular seminoma, we need to study a large sample population in Japan.

No significant financial relationships to disclose.

Combined non-isotopic in situ hybridisation and indirect immunohistochemical analysis of hormone production in the rat pituitary gland

An understanding of the intracellular relation between hormonal expression (storage) and gene expression (production) is essential for elucidating the functional status of the individual cells in endocrine tissue such as the pituitary gland. To this end, mRNA expression was visualised by using a combined in situ hybridisation and immunohistochemistry method in routinely processed, formalin fixed, paraffin wax embedded rat pituitaries. mRNA was detected by non-isotopic in situ hybridisation (alkaline phosphatase antialkaline phosphatase method, with nitroblue tetrazolium and 5-bromo-4-chloro-3-indolylphosphate as substrates). Sections were then stained by using the immunoperoxidase method to demonstrate pituitary hormone expression. The specificity of the combined staining method was confirmed by staining adjacent sections separately. The antigenicity of rat growth hormone and prolactin was adequately preserved following hybridisation. In conclusion, this method is specific, easy to use and permits the determination of the functional status of individual cells.

Prevention by lansoprazole, a proton pump inhibitor, of indomethacin -induced small intestinal ulceration in rats through induction of heme oxygenase-1

The effect of lansoprazole, a proton pump inhibitor (PPI), on indomethacin-induced small intestinal ulceration was examined in rats, particularly in relation to heme oxygenase (HO)-1. The animals were administered indomethacin (10 mg/kg, p.o.) and killed 24 h later. Lansoprazole (30-100 mg/kg, p.o.) and omeprazole (30-100 mg/kg, p.o.) were given 30 min before the administration of indomethacin, while tin-protoporphyrin IX (SnPP: 30 mg/kg, i.v.), an inhibitor of HO-1, was injected 10 min before indomethacin or lansoprazole. Indomethacin produced hemorrhagic lesions in the small intestine, accompanied with an increase of mucosal invasion of enterobacteria, inducible nitric oxide synthase (iNOS) expression, and myeloperoxidase (MPO) activity in the mucosa. Pretreatment with lansoprazole dose- dependently reduced the severity of the indomethacin-induced intestinal lesions, with suppression of the increased MPO activity, while omeprazole had no effect. Pretreatment with SnPP significantly exacerbated these intestinal lesions and almost totally abolished the protective effect of lansoprazole. The up-regulation of iNOS mRNA expression following indomethacin was suppressed by lansoprazole in a SnPP-inhibitable manner, although the enhanced enterobacterial invasion remained unaffected. The amount of HO-1 protein in the intestinal mucosa was significantly increased by lansoprazole but not by omeprazole. Prior administration of carbon monoxide (CO)-releasing molecule-2 (CORM-2; 10 mg/kg, i.p.) significantly reduced the severity of these lesions and the enhancement of mucosal iNOS mRNA expression induced in the small intestine by indomethacin. These results suggest that lansoprazole prevents indomethacin-induced small intestinal ulceration, and this effect is associated with inhibition of iNOS expression, through up-regulation of HO-1/CO production in the mucosa.

Involvement of Cot/Tp12 in Bone Loss during Periodontitis

Periodontitis causes resorption of alveolar bone, in which RANKL induces osteoclastogenesis. The binding of lipopolysaccharide to Toll-like receptors causes phosphorylation of Cot/Tp12 to activate the MAPK cascade. Previous in vitro studies showed that Cot/Tp12 was essential for the induction of RANKL expression by lipopolysaccharide. In this study, we examined whether Cot/Tp12 deficiency reduced the progression of alveolar bone loss and osteoclastogenesis during experimental periodontitis. We found that the extent of alveolar bone loss and osteoclastogenesis induced by ligature-induced periodontitis was decreased in Cot/Tp12-deficient mice. In addition, reduction of RANKL expression was observed in periodontal tissues of Cot/Tp12-deficient mice with experimental periodontitis. Furthermore, we found that Cot/Tp12 was involved in the induction of TNF-α mRNA expression in gingiva of mice with experimental periodontitis. Our observations suggested that Cot/Tp12 is essential for the progression of alveolar bone loss and osteoclastogenesis in periodontal tissue during experimental periodontitis mediated through increased RANKL expression.

[Rectourethral fistula after radical retropubic prostatectomy: a case report]

The patient, a 56-year-old man, had surgery for anal fistula at the age of 28. In August 2007, he underwent a radical retropubic prostatectomy (RRP) for prostate cancer. Rectal injury was not recognized during the operation. However, on the 8th postoperative day, fecaluria appeared, and rectourethral fistula was diagnosed. We attempted conservative therapy including diverting colostomy and continued drainage using a urethral catheter. Subsequently, the fistula closed spontaneously 3 months after RRP. Eight months after RRP, we performed a transanal repair of rectal mucosa based on the rectal wall advancement flap procedure. The postoperative course was uneventful, and the colostomy was closed in July 2008. By April 2009, he had normal voiding and full anal continence without fistula recurrence.

[Malignant paraganglioma responsive to CVD therapy and radiation therapy : a case report]

The patient, a 55-year-old man, had undergone surgery for retroperitoneal paraganglioma at the age of 45. In February 2006, he visited our hospital with the chief complaint of metastatic tumors detected by a thorough checkup. Computed tomographic (CT) scan revealed a large tumor in the right kidney hilar region and a left supraclavicular lymphadenopathy. Histopathological and immunohistochemical findings of the biopsy specimen taken from the left supraclavicular lymph node led to the diagnosis of recurrent malignant paraganglioma. 123I-MIBG scintigram showed no radioisotope accumulation consistent with the tumor. From April 2006 to September 2006, he received 8 cycles of CVD therapy (cyclophosphamide, vincristine, and dacarbazine). The tumor temporarily responded and was reduced to one-third in size, but soon it became resistant to CVD therapy. In March 2007, because the tumor had begun to grow, he received the 9th course of CVD therapy, but the tumor response was PD. Subsequently, palliative radiation therapy of 50 Gy in 25 fractions was administered and was temporarily effective. The CVD therapy and radiation therapy were considered to be effective for this case. In May 2008, he died 25 months after the start of CVD therapy.

Stage I nonseminomatous germ cell tumors of the testis: Clinical outcome of 45 patients on a surveillance protocol after orchiectomy alone at a single institution in Japan

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Background: In Japan, risk-adapted treatment for patients with clinical stage I nonseminomatous germ cell tumor of the testis (NSGCTT) has been performed in very few institutions. This retrospective study was performed to evaluate histopathologic prognostic factors with stage I NSGCTT for whom careful follow-up with a surveillance protocol was possible at a single institution. Methods: We included 45 patients with a median age of 31 years (range 16 - 58) who were managed with a surveillance strategy after orchiectomy in our department between 1972 and 2006. Mean duration of follow-up was 8.1 years (range 1.4 –30). The patients were monitored at follow-up evaluation for tumor marker (AFP, beta-hCG) levels and by abdominal CT scan, chest x-ray, and physical examination. Primary testis tumor samples were assessed for prognostic factors including lymphatic and/or vascular (LV) invasion and pathological components such as the presence of embryonal carcinoma. Log-rank analyses were performed to identify prognostic factors. Results: All patients were alive and disease-free. Relapses occurred in 16 (35.6%) patients after a median follow-up of 5.7 months (range 3–45). In 11 patients (68.8 %), relapse was detected in the retroperitoneal lymph nodes. Two patients (12.5%) had metastases in the retroperitoneal lymph nodes and lungs, two patients (12.5%) had metastases in the lungs alone, and one patient (6.2%) had metastases in the retroperitoneal lymph nodes, lungs, and brain. LV invasion was identified in 17 patients, 53% of whom had relapsed, and relapse was found in 25% of 28 patients without LV invasion (p<0.01). Of 31 patients with an embryonal carcinoma component, 13 patients (42%) developed metastases, whereas 21% of those without an embryonal carcinoma component developed metastases (p=0.04). After chemotherapy and/or surgical treatment for relapse, the 5-year overall survival rate was 100%. Conclusions: As in previous reports, the presence of an embryonal carcinoma component and LV invasion appeared to be factors suggesting a high likelihood of relapse. The surveillance protocol described here is a reliable strategy for stage I NSGCTT patients if careful long-term follow-up is possible.

No significant financial relationships to disclose.

Reduction of irradiation volume and toxicities with 3-D radiotherapy planning over conventional radiotherapy for prostate cancer treated with long-term hormonal therapy

BACKGROUND

As hormonal therapy has an influence not only on outcome but also on toxicities, we compare the efficacy of three-dimensional radiotherapy planning (3D-RTP) and of conventional radiotherapy (Conv-RT) in association with long-term hormonal therapy in reducing toxicity of treatment.

PATIENTS AND METHODS

A retrospective case-control study was performed comparing the frequency of radiation toxicity between 63 Conv-RT and 52 3D-RTP patients with locally advanced prostate cancer (intermediate to high risk) treated with combined hormonal therapy. The average duration of neoadjuvant treatment was 7 months (1-38 months) and that of adjuvant treatment was 38 months (4-94 months). Patients were treated with 70 Gy of box field radiotherapy for the same clinical target volume (60 Gy prostate + seminal vesicle and 10 Gy boost to prostate).

RESULTS

Treatment volumes (= X(RL) x Y(SI) x X(AP), where X(RL) = right left length of anterior-posterior portals, X(AP) = anterior posterior length of lateral portals and Y(SI) = superior inferior length of anterior-posterior portals) were significantly smaller in the 3D-RTP group (630 +/- 130 cm3) than in the Conv-RT group (1036 +/- 223 cm3) (p < 0.0001). Acute side-effects in urological tracts (GU) were associated with XRL (p = 0.02), Y(SI) (p = 0.008) and treatment technique (Conv-RT vs. 3D-RTP: p = 0.01). The frequency of acute gastrointestinal tract (GI) toxicity was associated with X(RL) (p = 0.02), X(AP) (p = 0.03). Late GU toxicities were associated with YAP (p = 0.02) and X(RL) (p = 0.03). Treatment technique was the determinant of late GI toxicities (p = 0.03). Frequency of late GI toxicities of G2 or more was reduced from 35% in the Conv-RT group to 15% in the 3D-RTP group (p = 0.03, odds ratio = 0.43). Patients with late GI toxicity received longer periods (39 +/- 19 months) of adjuvant hormonal therapy than the patients without (31 +/- 18 months, p = 0.04). Prostate-specific antigen (PSA) failure-free survival rates at 3 years were 92% for the 3D-RTP group and 90% for the Conv-RT group (73% at 5 years, 67% at 10 years). Overall survival rates were 97% (3-year), 91% (5-year), and 91% (10-year) in the Conv-RT group, compared to 100% at 3 years in the 3D-RTP group.

CONCLUSION

Long-term hormonal therapy has the potential to improve outcome but induce late GI toxicity. 3D-RTP simultaneously reduced treatment volume and frequency of acute urinary and late GI toxicities even with long-term hormonal therapy.

Surveillance for stage I testicular seminoma: Retrospective analysis of prognostic factors for relapse at a single institution in Japan

15630

Background: Treatment options for clinical stage I seminoma include adjuvant radiotherapy (RT) as well as surveillance and adjuvant chemotherapy. Although adjuvant RT remains the treatment of choice in most centers, the success of surveillance of patients with stage I nonseminomatous germ cell tumors and the establishment of curative chemotherapy for advanced disease have led to re-examination of the standard treatment approach. Data available from the surveillance and adjuvant RT series suggest that nearly 100% of patients with stage I testicular seminoma are cured, whichever approach is chosen. We report here results of a retrospective analysis of prognostic factors for stage I testicular seminoma. Methods: Between January 1980 and December 2004, surveillance was performed for 61 patients. Tumor characteristics (age at diagnosis, size, elevation of beta hCG level, invasion of the rete testis, vascular invasion, and lymphatic invasion) were examined as factors possibly predictive of relapse. Cause-specific survival rate was calculated using the Kaplan-Meier method. Results: With a median follow-up of 10.5 years (range, 2.35–20.8 years), 7 relapses were observed, with an actuarial 5- year relapse-free rate (RFR) of 89.2%. On univariate analysis, only tumor size (RFR: <8cm, 96%; =8cm, 76%; p=0.029) was predictive of relapse. Age at diagnosis (RFR: <36, 89%; =36, 91%), elevation of beta hCG level (RFR: 93% [normal] v 91% [elevated]), invasion of the rete testis (RFR:92% [absent] v 90% [present]), vascular invasion (RFR:89% [absent] v 86% [present]), and lymphatic invasion (RFR: 89% [absent] v 78% [present]) were not predictive of relapse. The overall relapse rate was 11.5%. Overall 5-year survival rate was 97%. Conclusions: Size of primary tumor was found to be predictive of relapse in patients with stage I seminoma managed with surveillance, on analysis at a single institution in Japan.

No significant financial relationships to disclose.

Influence of the involvement of partners in the mother class with voluntary confidential counselling and testing acceptance for Prevention of Mother to Child Transmission of HIV Programme (PMTCT Programme) in Cambodia

The National Maternal and Child Health Center in Phnom Penh, Cambodia commenced PMTCT services as the first site of the National PMTCT programme of Cambodia in November 2001. However, the acceptance of voluntary confidential counselling and testing (VCCT) in the PMTCT services was not as high as expected. The aim of this study was to evaluate influence of partner participation in the mother class to the PMTCT services. During the first visit to antenatal care, all women were invited to the class, where information on PMTCT was provided. From July 2002, when partner participation started, to May 2005, the acceptance rate to the pre-test counselling of those who attended the class alone was 18.7% (3,234/17,340), while that of the attendees with their partner was 85.1% (2,908/3,417) (p <0.001). All of the couples accepted couple counselling and disclosure of their results to their partners. In conclusion, a strong association was observed between acceptance and partner involvement. However, we should consider also other strategies for future programme improvement.

[Renal lymphangioma: report of a case]

Renal lymphangioma is a very rare benign tumor caused by failure in the development of the lymphatic communication system. Since December 1997, a 55-year-old man with chronic B-type virus hepatitis has been followed at our hospital. Neither kidney showed any sign of cysts at that time. In November 2000, ultrasound sonography showed a right renal simple cyst measuring 1.0 cm in diameter. Thereafter, the initial cyst increased to 5.5 cm and numerous right renal cysts, appearing similar to multilocular renal cysts, were detected in December 2004. Computed tomography demonstrated a right renal multilocular cystic tumor, 5.5 cm in diameter, which was enhanced by contrast medium. Radical nephrectomy was performed, and the pathological diagnosis was renal lymphangioma based on positive staining with D2-40 antibody, which is reactive to endothelial cells of the lymphatics.

Clinical outcome of postchemotherapy salvage surgery for metastatic germ cell tumors in Japan

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Background: Salvage surgery including retroperitoneal lymph node dissection (RPLND) following chemotherapy has been considered a critical component in the comprehensive management of advanced germ cell tumors (GCT). The objectives of this study were to determine the pathologic findings and clinical outcome of patients with metastatic GCT who underwent postchemotherapy salvage surgery. Methods: From 1980 to 2004, 157 patients with metastatic diseases underwent postchemotherapy salvage surgery at three institutions. Surgical resection was indicated in the presence of residual radiographic abnormalities. The cause-specific survival rate was calculated using the Kaplan-Meier method. Results: The histology of GCT was pure seminoma in 49 patients and non-seminoma in 108 patients. As first-line chemotherapy, 30 patients were treated with PVB (cisplatin, vinblastine and bleomycin) regimen, 107 patients with PEB (cisplatin, etoposide and bleomycin) regimen and 20 patients with other regimens. Salvage surgery was performed after first-line chemotherapy in 87 patients and after salvage chemotherapy in 70 patients. As salvage surgery, RPLND was performed in 135 patients, resection of pulmonary metastasis in 38, hepatotomy in 2 and resection of metastatic brain tumors in 3. The pathological findings at surgery were necrosis in 87 (55%) patients, mature teratoma in 34 (22%) and residual cancer in 36 (23%). Five of 36 patients with residual cancer performed salvage surgery in the state of marker positive. Of the 31 patients who had residual cancer with normalized marker, salvage surgery was performed after salvage chemotherapy in 11 patients. The sites of residual cancer were retroperitoneal lymph nodes in 34 patients, lung in 4, brain in 2 and liver in 1. The cause-specific 5-year survival rates for patients who had necrosis, mature teratoma and residual cancer were 95%, 96% and 68%, respectively. Conclusions: Residual cancer could not reliably be predicted or discriminated from necrosis or mature teratoma. Therefore, salvage surgery to remove postchemotherapy residual masses remains essential in the successful treatment of metastatic GCT.

No significant financial relationships to disclose.

[Retroperitoneal lymph node recurrence of seminoma 6 years after high orchiectomy]

Late recurrence of stage I testicular seminoma is rare. We herein report a case of retroperitoneal lymph node recurrence of testicular seminoma 6 years after high orchiectomy. A 39-year-old man had a left high orchiectomy for stage I testicular tumor in November 1997. Histopathological findings revealed seminoma (pT3). In 2003, follow up computed tomography showed retroperitoneal lymph nodes swelling. Serum tumor markers had been normal since 1997. Retroperitoneal lymph nodes were dissected in April 2004. Histopathological findings were recurrence of seminoma.

Imaging characteristics of papillary renal cell carcinoma by computed tomography scan and magnetic resonance imaging

AIM

To analyse the differences in the patterns between clear and papillary renal cell carcinomas using magnetic resonance imaging (MRI) and dual-phase helical computed tomography (CT).

METHODS

We examined seven patients with papillary renal cell carcinoma, and six with clear cell carcinoma. The highest attenuation value of tumors in the corticomedullary phase (CMP) and the excretory phase (EP) was measured using the observer-defined region of interest (ROI). MRI consisted of T1-weighted and T2-weighted spin-echo imaging.

RESULTS

All five tumors except for one with papillary renal cell carcinoma showed homogenous hypointensity, but all six tumors with clear cell carcinoma showed heterogeneous hyperintensity on their T2-weighted images. In the CMP, the mean CT numbers of the papillary renal cell carcinomas were significantly lower than those of the clear cell carcinomas. The mean enhancement of the papillary renal cell carcinomas in the CMP and the EP was significantly lower than that of the clear renal cell carcinomas. The mean CT numbers of the clear cell carcinomas in the CMP were markedly increased from those on the unenhanced CT; those in the EP were decreased gradually. But the mean CT numbers of the papillary renal cell carcinomas in the EP were still slightly more increased than those in the CMP. The enhancement patterns of the papillary renal cell carcinomas in the CMP and the EP were homogenous, but those of the clear cell carcinomas were heterogeneous.

CONCLUSIONS

We can speculate the differential diagnosis from clear to papillary renal cell carcinoma using MRI and dual-phase helical CT.

[A case of five metachronous primary cancers]

We report a case of five metachronous primary cancers completely resected during 39 years. An 80-year-old woman had been diagnosed with and treated for bilateral breast cancers, gastric cancer, sigmoid colonic cancer, Bowen's disease and renal pelvic cancer. These cancers were found as metachronous cancers and were surgically treated. This is the first case of completely resected metachronous five cancers in Japan.

[Small cell carcinoma of the kidney: a case report]

A 79-year-old man presented in August 2002 with right flank pain, anorexia, and gross hematuria. Physical examination was significant for a palpable, nontender, firm, and fixed mass in the epigastric region. Computed tomography scan of abdomen revealed a 15 cm tumor occupying almost the whole right kidney with extension into the inferior vena cava. The para-aortic and retroperitoneal lymph nodes were significantly enlarged. Examinations including bone scintigram and chest X-ray revealed no metastases. The patient underwent a ultrasound sonography-guided biopsy of the renal tumor, which showed a small cell carcinoma pathologically, and immunohistochemically. The patient received palliative treatment, and died in February 2003. We reviewed 25 cases including our case, and analyzed the clinical outcome of small cell carcinoma of the kidney.

Long-term follow up study of vertical HTLV-I infection in children breast-fed by seropositive mothers

Infection of Human T-lymphotropic virus type-I (HTLV-I) was investigated by long-term follow up surveys of mother's milk-fed infants. HTLV-I infections of infants via seropositive mother's milk, that is, anti-HTLV-I antibody-positive infants, increased in number up to the age 2, but no infants became antibody-positive thereafter. Infants who had became antibody positive by age 2 remained so at age 11-12. HTLV-I infection via feeding with mother's milk was established by the age 2. While in epidemiologic surveys an increase of the anti-HTLV-I antibody-positive rate has been reported, this survey revealed that after acquisition of HTLV-I from breast feeding, there was no further horizontal transmission prior to puberty.

Increased hepatocyte growth factor level in cerebrospinal fluid in Alzheimer's disease

BACKGROUND & OBJECTIVE

Hepatocyte growth factor (HGF), also known as the scatter factor, is a potent mitogen for mature hepatocytes, and also has multifunctional effects on some cells in various organs. Recently, we have found expression and localization of HGF in white matter astrocytes in human brain tissues. Furthermore, immunohistochemistry using anti-HGF antibody revealed more intense immunolabeling in Alzheimer's disease (AD) than control brains. The aim of the study is to investigate the level of HGF in cerebrospinal fluid (CSF) from patients with AD.

MATERIAL AND METHODS

We examined the level of HGF in CSF from 34 AD and 15 age-matched disease control patients by highly sensitive enzyme-linked immunoabsorbent assay (ELISA) system.

RESULTS

Consistent with the immunohistochemical data, a significantly higher concentration of HGF in AD CSF was found as compared with controls. A significant correlation was also seen between CSF HGF levels and white matter high-signal foci determined on brain magnetic resonance imaging (MRI) in AD patients.

CONCLUSION

These results indicate that CSF HGF levels correspond with the white matter damage in AD brain.

Long-term follow-up study of HTLV-I infection in bottle-fed children born to seropositive mothers

Human T-lymphotropic virus Type-I (HTLV-I) infects children via mother's milk. Infection of Human T-lymphotropic virus Type-I (HTLV-I) was investigated by long-term follow-up surveys of modified milk-fed children. Our observations of modified milk-fed infants revealed that: 1 of 154 (0.6%) at year 1, 5 of 129 (3.9%) at 1.5 years, and 5 of 108 (4.6%) at year 2 were anti-HTLV-I antibody-positive. No infants or children became newly antibody-positive thereafter. Modified milk feeding could prevent the HTLV-I infection of infants from mothers in many cases, however the infants who had became anti-HTLV-I antibody-positive due to established infection by the age 2 remained positive at age 11-12 with persistent infections. Modified milk-fed infants who had been born from HTLV-I seropositive mothers did not show that they had complete protection from HTLV-I infection, but a low infection rate was seen, showing that modified milk feeding is useful to protect from HTLV-I infection.

Hepatocyte growth factor in gingival crevicular fluid and the distribution of hepatocyte growth factor-activator in gingival tissue from adult periodontitis

Hepatocyte growth factor (HGF), also known as scatter factor, is a broad-spectrum and multifunctional cytokine required for the development, growth and regeneration of various organs and tissues. The expression of HGF in human gingival fibroblasts is induced by inflammatory cytokines such as interleukin 1. Thus, although it is possible that content of HGF in gingival crevicular fluid (GCF) in periodontitis is increased, this has not so far been reported because the volume of GCF is too small to determine HGF by the available enzyme-linked immunosorbent assay (ELISA). A recently developed, highly sensitive ELISA for HGF, with a detection limit of 1 pg/ml sample, has now enabled HGF to be measured in GCF.The mean HGF content in GCF from sites with clinically healthy gingiva, defined by the absence of overt signs of gingival inflammation and a probing depth (PD) <3 mm, was 1.7 ng/ml, and that of periodontitis, defined by obvious alveolar bone loss detected by radiographic examination and a PD> or =3 mm, was 3.23 ng/ml. Although treating the periodontitis did not significantly decrease the HGF concentration despite significantly improved clinical scores such as PD and Gingival Index, the total amount of HGF in GCF did decrease significantly after treatment. HGF was expressed by gingival fibroblasts and inflammatory cells as determined by in situ hybridization. HGF-activator (HGFA), which converts inactive pro-HGF to active mature HGF, was detected in gingival epithelial cells by immunostaining. The expression of HGFA was also confirmed in gingival tissue by reverse transcription-polymerase chain reaction (RT-PCR). These findings indicate that HGF is synthesized and activated in gingiva that is clinically healthy or associated with periodontitis.

Hepatocyte growth factor in cerebrospinal fluid in neurologic disease

OBJECTIVE

To investigate hepatocyte growth factor (HGF) concentration in cerebrospinal fluid (CSF) in neurologic disease.

MATERIALS AND METHODS

We determined CSF concentration of HGF with human-HGF-specific enzyme-linked immunosorbent assays (ELISA) in 121 patients: Alzheimer's disease (AD) (33), amyotrophic lateral sclerosis (ALS) (10), Parkinson's disease (PD) (5), progressive supranuclear palsy (PSP) (3), spinocerebellar degeneration (7), acute disseminating encephalomyelitis (ADEM) (6), human T-lymphotropic virus-1 (HTLV-1)-associated myelopathy (HAM) (6), multiple sclerosis (MS) (7), aseptic meningitis (AM) (12), and peripheral neuropathy and myopathy as control diseases (32).

RESULTS

HGF concentrations in CSF were significantly higher with diseases of the central nervous system (CNS) than control diseases and were slightly higher with AD than other neurodegenerative diseases. Values were highest with ADEM but decreased during corticosteroid treatment. We found no relationship between HGF in CSF and CSF cells or protein, immunoglobulin index, or Q albumin.

CONCLUSION

It is suggested that high concentrations of HGF in CSF may be partially related to CNS pathology, especially to demyelinating disease.