THE PROPHYLACTIC USE OF THIO-TEPA AND UROKINASE IN TRANSITIONAL CELL, CARCINOMA OF THE BLADDER

The prevention of recurrences of bladder cancer was attempted in 80 patients (33 patients of our department and 47 patients of affiliated hospitals in the Hokuriku area) by means of the combined intravesical instillation of thio-TEPA and urokinase and in 28 patients of our department by the instillation of thio-TEPA alone. The recurrence rates of both therapies for the postoperative 36 months were 7.3 and 32.6 per cent in patients in our department, respectively, indicating a significant drop in the recurrence rate in the group subjected to the combined therapy. The recurrence rate of the group of 80 patients was 18.5 per cent. Leucopenia was found in 17 of 80 patients receiving the combined instillation therapy. However, this was not attributable to the use of urokinase. To clarify the mechanism involved in the action of urokinase in combined therapy, further physio-pathological and biochemical studies as well as long-term clinical follow-up studies are needed

Extensive Fournier's gangrene: a case report

症例は51歳男で, 感冒様症状・下痢・腹痛を主訴に他院を受診し, 急性腸炎の診断で入院した.翌朝, 血圧が低下し筋性防御が出現したため自施設への転院となった.転院時, 会陰部は強い腐敗臭を放っており, 陰嚢から左臀部にかけて黒色の壊死を認めた.腹部単純X線写真では腸管が著明に拡張し, 麻痺性イレウスの像を呈していた.X線CTで陰嚢内・腹壁皮下組織・直腸膀胱周囲・後腹膜腔にガス像を認めた.これらの所見からFournier壊疽及び急性腹膜炎と診断し, 緊急デブリドマンと開腹術を行った.壊疽は肛門直腸周囲で特に激しく, 後腹膜腔へと続いていた.腹腔内には強烈な悪臭を放つ膿性の腹水が貯留し, 腹膜や小腸の一部にも壊死が及んでいた.術後は抗生剤やメシル酸ナファモスタット, カテコラミン等の投与を続けたが好転せず, 手術から29日目に多臓器不全のため死亡した.摘出標本と腹水からBacteroides fragilis, α-Streptococcus, Enterococcus faecalisが培養されたWe report a case of extensive Fournier's gangrene that could not be rescued despite emergent debridement. A 51-year-old man presented at another hospital with cough, diarrhea and abdominal pain. He was diagnosed with acute enteritis and hospitalized. The next morning, he became severely hypotensive and his scrotum was swollen and black. The perineal skin also was black. Septic shock and disseminated intravascular coagulation were suspected. He was transferred to our emergency room, and was immediately diagnosed with Fournier's gangrene and acute peritonitis. Computed tomographic scan revealed soft-tissue gas in the scrotum, the retroperitoneal cavity and the abdominal wall. Emergent debridement and laparotomy was performed. Gangrene was also seen at the intestinal wall and the peritoneum, however, resection of intestine was not done because of his poor performance status. Although potent antibiotics and catecholamine were administered, he died of multiple organ failure 29 hours after the operation. This is the first case of Fournier's gangrene extending into the abdominal cavity reported in the Japanese literature

Study of plastic scintillator based reactor neutrino detector

Recently nuclear power plant becomes one of the important electric power sources to reduce the greenhouse gasses emission. Nuclear reactor fuel consists of the uranium-235 (235U) enriched uranium and produces the thermal energy via nuclear fission process. Through the reactor operation, uranium-238 (238U) fission also produces the plutonium- 239 (239Pu), which should be strictly under controlled to avoid the diversion to the nuclear weapon for a nonproliferation and safeguard. At this point, monitoring of the nuclear power plant operation and its fuels exchange have important role for the peaceful nuclear energy usage. In this study, we produce the prototype of nuclear reactor monitor based on the plastic scintillator detecting anti-neutrinos, which produced through the several times of beta-decay from the nuclear fission products. In addition, we apply the monitoring performance simulation assuming the 1 ton size detector placed very closely to the reactor core

SERUM PROTEINS AND TUMOR MARKERS IN RENAL ARTERIAL AND VENOUS BLOOD IN PATIENTS WITH RENAL CANCER

In order to investigate an in vivo production of some serum proteins which are most commonly elevated in renal cancer patients and tumor markers in renal cancer tissue, their concentrations in renal arterial and venous blood samples have been determined in 11 patients with renal cancer. In other 2 groups, one consisting of 13 renal cancer patients without metastasis and another 13 renal cancer patients with metastasis, pre- and post-operative changes of concentration of 36 serum proteins in peripheral blood have been studied as well. The 36 serum proteins were quantitatively determined by a micro-single radial immune diffusion method described by Migita and 5 tumor markers, beta-human chorionic gonadotropin (β-HCG), alpha-fetoprotein (AFP), ferritin, carcinoembryonic antigen (CEA) and beta-2 micro globulin (BMG), were determined using commercially available radioimmunoassay kits, From the data obtained from the 11 patients, it was not possible to assure the production of any serum protein in renal cancerous tissue, A large variety of serum proteins showing a decrease of the concentration in renal venous blood had a relatively close relationship to patients with a large tumor lesion, Although a sporadic increase of several serum proteins in the venous blood was observed, it was not limited to a specified patient. Productions ofβ-HCG, BMG and ferritin in renal cancerous tissue were strongly suggested ml, 1 and 5 patients, respectively, In a group of the 13 patients without metastasis, abnormal levels of Alb, α1AT, α1AG, Hp, C 9 and Hx returned to a normal range after nephrectomy, and these post-operativeα1AT, α1AG, Hp and Hx levels showed a significant difference as compared with P8st-operative levels of those proteins in the 13 patients with metastasis. These results suggested that post-cperative changes of the 4 serum proteins would be a useful parameter for the occurrence of a deteriorating event in the subsequent course, e.g., tumor recurrence or metastasis development

TREATMENTS OF ADVANCED GENITOURINARY CARCINOMA PATIENTS WITH CIS-DIAMMINEDICHLOROPLATINUM

A trial ofcis-diamminedichloroplatinum (CDDP) has been performed at a dose of 14 to 23 mg/m2 in 9 patients with an advanced measurable genitourinary carcinoma, including 6 patients with nonseminomatous testicular tumor, 2 with urothelial tumor and I with prostatic carcinoma. 1) Two protocols were used for 6 testicular tumors; 3 patients received a single administration of CDDP, and 3 patientsreceived a combination chemotherapy with CDDP, bleomycin and vincristine. A complete remission was achieved in 2 of the 6 patients. A partial remission was obtained in 3 patients. The collective response was elicited in 83% of the patients (5 of 6). The 2 complete responders were seen in the combined chemotherapy, and they are free of disease for 11 and 21.4 months. 2) Three patients (2 urothelial tumors and 1 prostatic carcinoma) received the single administration of CDDP for 5 consecutive days every 3 weeks for 3 courses. There were partial remissions in 2 urothelial tumors for 4 and 7 months, but no response was seen in the prostatic carcinoma patient. 3) Despite of substantial gastrointestinal, mild renal toxicity and others, the chemotherapy was manageable in all patients. CDDP appears to be consistently useful in a chemotherapy model for genitourinary carcinomas, particularly testicular tumors