Measurement of Paα line from pellet ablation cloud in Heliotron J

The Pa_α line (1875.13 nm) in the near-infrared (NIR) region was evaluated to apply Stark broadening of the line spectrum to the electron density measurement of the small-pellet ablation cloud in Heliotron J, a medium-sized helical-axis heliotron device. Pa_α is three-to-four times broader than the visible H_β line (486.13 nm) for the same electron density. Using a portable NIR spectrometer, preliminary proof-of-concept experiments determined the marginal density, below which the broadening was undetectable. The lower detection density limit can be decreased using a narrower entrance slit or a denser grating.

Outcome of maintenance systemic chemotherapy with drug-free interval for metastatic urothelial carcinoma

OBJECTIVE

Aiming to achieve long-term disease control, maintenance systemic chemotherapy (MSC) with a 1-3-month drug-free interval is continued in selected patients. We report our experience of MSC for metastatic urothelial carcinoma (UC).

METHODS

Of 228 metastatic UC patients treated with systemic chemotherapy, 40 (17.5%, 40/228) had continuously undergone MSC. Data on the regimen, cycle number, and reason for the discontinuation of MSC were also collected. We analyzed OS from the initiation of MSC until death or the last follow-up, using the log-rank test to assess the significance of differences.

RESULTS

The median number of cycles of chemotherapy was 6, and the responses were CR in 6, PR in 20, SD in 13, and PD in 1 before MSC. Gemcitabine plus CDDP or carboplatin was mainly performed as MSC (70%, 28/40). MSC was repeated quarterly in 30 (75%, 30/40), every two months in 8 (20%, 8/40), and with other intervals in 2 (5%, 2/40). Overall, a median of 3.5 cycles (range: 1-29) of MSC was performed. The reason for the discontinuation of MSC was PD in 24 (60%, 24/40), favorable disease control in 9 (22.5%, 9/40), and myelosuppression in 3 (7.5%, 3/40), and for other reasons in 2 (5%, 2/40). MSC was ongoing in 2 (5%, 2/40). The median OS was 27 months from the initiation of MSC. PS0 (P = 0.0169), the absence of lung metastasis (P = 0.0387), and resection of the primary site (P = 0.0495) were associated with long-term survival after MSC.

CONCLUSIONS

In selected patients, long-term systemic chemotherapy could be performed with a drug-free interval. Our maintenance strategy with cytotoxic drugs may become one of the treatment options for long-term disease control.

Combination therapy of meloxicam, a selective COX-2 inhibitor, and interferon alfa in metastatic renal cell carcinoma: A phase II study on efficacy and toxicity

5105

Background: Cyclooxygenase (COX)-2 plays a major role in the development of cancer through numerous mechanisms. We have previously confirmed that COX-2 is expressed in a renal cell carcinoma (RCC) and it has an important role in tumorigenesis and angiogenesis (Int J Cancer 2004). Some preclinical studies suggest that a selective COX-2 inhibitor may augment the antitumor effects of immunotherapeutic agents. We conducted a phase II trial of the combination of meloxicam, a selective COX-2 inhibitor, and interferon (IFN)-alfa 2a in metastatic RCC in order to test the hypothesis that meloxicam enhances the response to the immunotherapy. Methods: Eligible patients had metastatic RCC, no prior systemic therapy, performance status 0–2, measurable disease. Patients received IFN 3–5 MIU 3x/week and meloxicam 10 mg/daily orally. This was a single-stage trial. Primary end points were RECIST response rates and toxicity. Results: Twenty-one patients were enrolled. Patients characteristics included: median age 63 years (49–75), male/female: 16/5, PS 0/1/2: 11/6/4, prior nephrectomy: 16 (76%). MSKCC prognostic categories were good: intermediate: poor (24%: 48%: 29%). A median follow-up was 8 months (range 3–29+) and 18 of 21 (86%) patients are still alive. Toxicities were mostly grade 1 or 2 (fever, fatigue, anorexia, depression), except 1 patient with grade 3 liver dysfunction. Among 20 patients evaluable for response, complete response (CR) was observed in 3 patients (15%) and partial response (PR) in 5 (25%), yielding an overall response rate of 40% (95% CI: 17–63). An additional 5 patients (25%) had stable disease. Five of 6 patients classified as poor risk by MSKCC prognostic classification obtained a CR or PR, as did 3 of 14 patients as good or intermediate risk (p=0.038). Median time to progression for 20 patients was 6 months (1–29+). Conclusions: The overall response rate of 40% for the combination of meloxicam and IFN-alfa in metastatic RCC is greater than that of IFN-alfa alone reported previously, suggesting that meloxicam can enhance the response to immunotherapy. Further investigation with this combination is warranted.

No significant financial relationships to disclose.

Testicular-sparing surgery for the prepubertal testicular tumor. Experience of two cases with large cell calcifying Sertoli cell tumors

PURPOSE

We review prepubertal germ cell tumors of testis in our institute and the Japanese registry and present 2 cases with a large cell calcifying Sertoli cell tumor (LCCSCT) and discuss the possibility of testis-sparing surgery.

MATERIALS AND METHODS

Incidence, age, pathology and clinical stages of prepubertal germ cell tumors are surveyed for 30 years at our department and 10 years of the malignant tumor registry of the Japanese Society of Pediatric Surgery. Two representative prepubertal boys with LCCSCT are presented. One of them was treated by partial orchiectomy.

RESULTS

The majority of testicular germ cell tumors in the prepubertal age were composed of embryonal cell carcinoma/yolk sac tumors or teratoma, occurred in preschool age, were limited to clinical stage I and did not metastasize irrespective of histology. Benign behavior which included recovery from hormonal derangement, no tumor recurrence and negative antisperm antigen was observed in 2 cases with LCCSCT who underwent either radical orchiectomy or partial orchiectomy.

CONCLUSION

Partial orchiectomy should be considered as a standard option in prepubertal schoolboys with a testicular mass if surgically feasible. This surgical treatment is safe and preserves fertility and is psychologically advantageous. It is not recommended for yolk sac tumors that may recur, however they are rare in prepubertal boys and can be differentiated preoperatively by prudent evaluation.

Surgical repair of anterior hypospadias with fish-mouth meatus and intact prepuce based on anatomical characteristics

PURPOSE

A variant form of anterior hypospadias, called a megameatus and intact prepuce (MIP), is thought to be less amenable to conventional distal hypospadias repair. The feasibility of using the standard technique with a parameatal-based foreskin flap is described herein.

MATERIALS AND METHODS

Nine children with the MIP variant underwent repair. A foreskin flap for urethroplasty was harvested from either the ventral (Mathiew) or unilateral site. The glans was split along with the cleft glanular groove to create the glans wings. The flap was laid on the urethral plate to form a neourethra, and glanulomeatoplasty was completed by approximation of the glans wings. Sleeve reapproximation of the penile foreskin was performed for uncircumcised skin closure.

RESULTS

The functional and cosmetic results of the procedure were excellent in 8 cases including 1 with temporary postoperative edema of redundant foreskin. The last case underwent excision of the ventral excess foreskin for cosmetic reasons.

CONCLUSIONS

Although the etiology of the MIP variant remains obscure, the urethral plate distal to the meatus is uniformly pliable and healthy in this variant. Furthermore, the ventral portion just proximal to the meatus is well developed and not atretic so that the parameatal ventral foreskin is safely harvested for onlay urethroplasty.

Structural changes of collagen components and diminution of nerves in congenital ureteropelvic junction obstruction

PURPOSE

Three-dimensional arrangements of smooth muscle cells, collagenous component and peripheral nerves of congenital ureteropelvic junction (UPJ) obstruction were studied in order to clarify the pathogenetic mechanism of interaction among these neuro-myo-stromal components.

MATERIALS AND METHODS

The UPJ and upper ureters were obtained from 14 patients with congenital hydronephrosis (7 intrinsic and 4 extrinsic obstruction) and 7 normal controls. Three-dimensional arrangement of each structural component was observed by scanning electron microscopy, and the nerve distribution was analyzed with immunohistochemistry for protein gene product 9.5.

RESULTS

The UPJ of intrinsic obstruction had structural features as follows. Muscle fascicles were sparse and thin. Each muscle cell was thin in diameter. Intercellular spaces were six to seven times wider than controls. Collagen fibrillar sheaths of smooth muscle cells (pericellular collagen fibrils attached to the basement membrane) were interwoven to form a dense felt-like structure against thin lace-like sheaths in controls. Interstitial collagenous component showed dense and compact structure against loose network of wavy collagen bundles in controls. In the muscular layer, nerve distribution was decreased to about one-third of controls. In contrast, non-stenotic portion of intrinsic UPJ obstruction as well as materials from extrinsic UPJ obstruction showed no structural difference as compared with controls.

CONCLUSIONS

In the intrinsic obstruction, nerve fibers were depleted in the muscular layers in the ureteric walls, resulting in dysfunction and atrophy of muscle fibers and an increase of collagen fibers in the muscle layers with abnormal accumulation of intercellular and interstitial collagen. These changes may disrupt the mobility of UPJ and lead to both mechanical and functional obstruction.

Quantification of renal function with a count-based gamma camera method using technetium-99m-MAG3 in children

To evaluate renal function quantitatively without blood sampling in children, renal uptake by gamma camera renography using 99mTc-MAG3 was compared with plasma clearance by a single blood sample method as the reference.

METHODS

Twenty children (15 boys, 5 girls; aged 2-14 yr) with nephrourological diseases were examined prospectively in this study. The patient received an intravenous administration of 5 MBq/kg 99mTc-MAG3 which was prepared using a commercially available kit. Gamma camera renography was performed and the renal uptake per injected dose (%RU) of the 1-min period of postinjection was calculated from a background-corrected renogram curve by computer. The plasma clearance (Clmag) of 99mTc-MAG3 was calculated by the single blood sample method at 35 min postinjection.

RESULTS

The %RU of the 1-min period in the 1-3 min postinjection correlated well with Clmag. The best correlation was observed 1-2 min postinjection. The regression equation between total %RU (X) and Clmag (Y) (ml/min/1.73 m2) was Y = -98.509 + 20.373X (r = 0.910, s = 84.19) with standardization by BSA. The best fit regression equation between individual %RU (X) and Clmag (Y) (ml/min/1.73m2) was Y = -43.799 + 19.917X (p = 0.932, s = 43.27).

CONCLUSION

The renal uptake method based on separate counts by gamma camera renography using 99mTc-MAG3 does not require a blood sample for quantification of renal function and may be potentially more practical in children.

Three-dimensional arrangement of collagen and elastin fibers in the human urinary bladder: a scanning electron microscopic study

To clarify the arrangements of collagen and elastin fibers of the urinary bladder, we examined 9 human (male, aged 42 to 72) urinary bladders by scanning electron microscopy with chemical digestion methods. The mucosal layer was divided into 3 portions according to the collagen arrangement: the superficial portion interwoven densely by collagen fibrils, the middle portion layered by flat bundles of collagen fibrils and the deep portion made of a loose network of twisted collagen bundles. In the muscular layer, the smooth muscle fascicles were firmly covered with collagen sheets, while each muscle cell in a fascicle was accommodated by a thin sheath of collagen fibrils. The serosal layer consists of wavy collagen bundles piled up in a sheet, which was intercalated by clusters of adipose cells. Elastic fibers were, on the other hand, sparse throughout the bladder wall, except for denser networks around the blood vessels and muscle fascicles and beneath the peritoneal mesothelium. The arrangements of these components were discussed in relation to the mechanical function and compliance of the urinary bladder.

Scanning electron microscopic studies of smooth muscle cells and their collagen fibrillar sheaths in empty, distended and contracted urinary bladders of the guinea pig

This study was performed to clarify the structure of muscle cells and the arrangement of surrounding collagen fibrils in the guinea-pig urinary bladder by scanning electron microscopy with two different chemical-digestion methods. Morphological changes in the muscle cells and the collagen fibrils under stretching and contraction were also examined. The smooth muscle cells in the empty bladder were shaped like an unbranched stick 130 microns long. They elongated to 360 microns in the distended bladder, and 48 microns in the contracted bladder. These cells have short lateral processes touching the neighboring muscle cells in an end-to-side fashion. Longitudinal striations on the cell surface due to rows of caveolae and dense bands were recognizable irrespective of the extended or contracted conditions. Transversely arranged wrinkles, which were considered to be produced by surface enfolding during contraction, were marked on the surface of contracted muscle cells. Each muscle cell was accommodated by a thin lace-like sheath made of both separate and small-bundled collagen fibrils. That part of the fibrils in one sheath often extended to participate in another sheath suggested that the collagen sheaths not only modulate cell shape but also provide a structure serving the co-ordinated motion of neighboring muscle cells.

Scanning electron microscopic studies of tissue elastin components exposed by a KOH-collagenase or simple KOH digestion method

A KOH-collagenase or simple KOH digestion method was employed for scanning electron microscope (SEM) studies of elastin components in the rat thoracic aorta, mouse urinary bladder, and human ductus deferens. Immersion of the fixed tissues in 30% KOH solution for 8-10 min at 60 degrees C, with or without subsequent collagenase treatment, successfully removed collagen fibrils and basal laminae while leaving cellular and elastin elements unchanged at their original shapes and locations. The internal elastic lamina of the rat aorta appeared as a solid sheet formed by elastin fibrils 0.1-0.2 microns thick, while the medial elastic laminae were more fibrous because of the presence of numerous fine elastin fibers on their surface. Adventitial elastin fibers were of a cord-like shape complicatedly entangled among the adventitial fibroblasts. These fibers were seen as bundles of fibrils 0.1-0.2 microns thick. In the mouse urinary bladder, elastin formed a thin lace-like sheet just beneath the serosal covering of the peritoneum. This sheet was composed of small bundles of fine (0.1-0.2 microns thick) fibrils. The external connective tissue of the human ductus deferens was made up of a three-dimensional loose network of elastin fibers 0.1-1.5 microns thick. These fibers also appeared as bundles of the fine fibrils. These findings indicate that the present method is useful for SEM studies of elastin as well as cellular components in various tissues and organs. This study also maintains that elastin fibers and laminae are basically composed of unit fibrils of 0.1-0.2 microns thickness. As elastin components are arranged specific to individual organs and tissues, it is reasonable that these components are concerned in the characteristic mechanical properties of these tissues and organs.