New method to create a vascular arteriovenous fistula in the arm with an endoscopic technique

AbstractWe describe a new technique in which the basilic vein is transposed subcutaneously with endoscopic surgery to create a vascular access in the arm. The vein was harvested with the Endoscopic Vascular Surgery System (Olympus Co, Tokyo, Japan). We could harvest a vessel about 25 cm long with endoscopy. After vessel transposition, an arteriovenous fistula was created in the usual manner. In all 10 patients, we created an effective blood access as scheduled before surgery. We could use the arteriovenous fistula 6 days after surgery and get blood flow in all cases. (J Vasc Surg 2002;36:635-8.

Intravesical Non-Alkalinized Lidocaine Instillation for Interstitial Cystitis/Bladder Pain Syndrome Patients

ABSTRACT Purpose: The effectiveness of daily or weekly instillation of non-alkalinized lidocaine for patients suffering interstitial cystitis and/or bladder pain syndrome was evaluated retrospectively. Patients and Methods: Five female patients (40 -71 years old) diagnosed as interstitial cystitis by cystoscopic findings and a 68-year-old bladder pain syndrome patient were enrolled. All patients, having interstitial cystitis, had undergone hydrodistention therapy previously and had not improved their symptoms by empirical therapies. Daily or weekly (upon their severity of symptoms) intravesical instillation of 20 ml of 4% non-alkalinized (pH 6.0 -7.0) lidocaine solution was performed for several times, and patients were asked to keep them in the bladder as long as two hours each time. Previous medications such as anti-cholinergic drugs and analgesics were continued according to patient's requirements and symptoms. The treatment effect was evaluated comparing O'Leary-Sant Symptom Index for interstitial cystitis patients and visual analog pain scale before and after the series of lidocaine therapies. Results: Instillation was made 6 to 16 times. Patients with interstitial cystitis improved their symptoms from O'Leary-Sant Symptom Index 17.5 to 10, Problem Index from 14.8 to 6 in an average. Crouching pain disappeared in all these patients after the instillation therapy. Severe interstitial cystitis findings on cystoscopy disappeared completely in one patient after the therapy. One patient having bladder pain syndrome reduced her analgesics use, and bladder-filling pain decreased from 7 to 3 as a visual analog scale score. One patient complained palpitation at 11th instillation and abandoned treatment thereafter, otherwise, none of these patients showed side effect concerning lidocaine toxicity. Conclusions: Intravesical non-alkalinized lidocaine instillation therapy for interstitial cystitis/bladder pain syndrome patients were an easy, safe and effective treatment

Incidental Presacral Myelolipoma Resembling the Liposarcoma: A Case Report and Literature Review

Presacral myelolipomas are rare, benign, asymptomatic tumors composed of mature adipose tissue and hematopoietic elements, but fewer than 50 cases have been reported in the literature. They are usually discovered incidentally during imaging studies and are often misdiagnosed as liposarcoma, which have a malignant nature, because the imaging findings of myelolipoma can be similar to those of liposarcoma. It is challenging to distinguish presacral myelolipomas from other presacral fat-containing tumors without performing a histological examination. We should consider the possibility of a malignant tumor, and imaging-guided biopsy carries a risk of tumor spread along the biopsy tract. Therefore, surgical management might sometimes be required; however, it is not necessary in all cases. We present an incidentally detected case of presacral myelolipoma that was difficult to differentiate from other malignant tumors in a 71-year-old male

Safety Assessment of Ultrasound-Assisted Intravesical Chemotherapy in Normal Dogs : A Pilot Study

Intravesical chemotherapy after transurethral resection is a treatment option in patients with non-muscle invasive bladder cancer. The efficacy of intravesical chemotherapy is determined by the cellular uptake of intravesical drugs. Therefore, drug delivery technologies in the urinary bladder are promising tools for enhancing the efficacy of intravesical chemotherapy. Ultrasound-triggered microbubble cavitation may enhance the permeability of the urothelium, and thus may have potential as a drug delivery technology in the urinary bladder. Meanwhile, the enhanced permeability may increase systemic absorption of intravesical drugs, which may increase the adverse effects of the drug. The aim of this preliminary safety study was to assess the systemic absorption of an intravesical drug that was delivered by ultrasound-triggered microbubble cavitation in the urinary bladder of normal dogs. Pirarubicin, a derivative of doxorubicin, and an ultrasound contrast agent (Sonazoid) microbubbles were administered in the urinary bladder. Ultrasound (transmitting frequency 5 MHz; pulse duration 0.44 mu sec; pulse repetition frequency 7.7 kHz; peak negative pressure -1.2 MPa) was exposed to the bladder using a diagnostic ultrasound probe (PLT-704SBT). The combination of ultrasound and microbubbles did not increase the plasma concentration of intravesical pirarubicin. In addition, hematoxylin and eosin staining showed that the combination of ultrasound and microbubble did not cause observable damages to the urothelium. Tissue pirarubicin concentration in the sonicated region was higher than that of the non-sonicated region in two of three dogs. The results of this pilot study demonstrate the safety of the combination of intravesical pirarubicin and ultrasound-triggered microbubble cavitation, that is, ultrasound-assisted intravesical chemotherapy

膀胱移行上皮癌患者における半定量的サバイビンmRNA測定法の検討

膀胱移行上皮癌患者におけるサバイビンmRNA発現の診断・予後因子としての有用性を検討した。リアルタイムPCR法を用い膀胱移行上皮癌患者21例の膀胱癌組織と初発例12例の自排尿中のサバイビンmRNA発現量を半定量的に測定し, すべての腫瘍組織と12例中7例の自排尿中にサバイビンmRNAの発現を認めた。サバイビンmRNAの発現量は低分化癌および浸潤性腫瘍で有意に高値であった。表在性膀胱癌症例のうちサバイビンmRNAの発現量が高い3例で再発を認めた。浸潤性膀胱癌症例ではサバイビンmRNAの発現量と局所再発あるいは遠隔転移とは関係がなかった。これらのことより膀胱移行上皮癌患者におけるサバイビンmRNAの半定量的測定は膀胱内再発についての悪性度を示している可能性が考えられた。(著者抄録)We assessed the expression levels of survivin mRNA in bladder transitional cell carcinoma (TCC) to provide additional information regarding its malignant potential. The real-time PCR method was used to detect the survivin mRNA level for 21 bladder tumor specimens, and for urinary exfoliated cells from 12 newly diagnosed bladder tumor patients. All bladder tumor specimens and 7 of 12 voided urine specimens expressed survivin mRNA. In tumor specimens, high grade, high stage tumors had the tendency to express more survivin mRNA. Of 12 superficial bladder tumor patients who had transurethral resection of bladder tumor (TURB), 3 showed high survivin mRNA expression and intravesical recurrence after the surgery. However, for the patients who had total cystectomy due to invasive tumor, no relations were observed between the survivin mRNA expression level and development of local recurrence and/or distant metastasis. Our results suggested that the quantitative analysis of the survivin mRNA may indicate local malignant potential, which contribute to the possibility of an intravesical recurrence

Giant retroperitoneal schwannoma in a 52-year-old man

Schwannoma in the retroperitoneal space is rare, and it is extremely rare in patients with no history of neurofibromatosis. We present a case of giant retroperitoneal schwannoma in a 52-year-old man who did not have neurofibromatosis. Because malignant transformation would be extremely rare in this circumstance, close imaging follow-up could avert the necessity for complete resection. The possibility of schwannoma should be considered when evaluating retroperitoneal tumors with the characteristic findings, even if there is no connection between the tumor and the intervertebral foramina. Keywords: Retroperitoneal tumor, Schwannoma, Open biopsy, CT, MRI, Malignanc