Xanthogranulomatous Pyelonephritis with Incomplete Double Ureter

Introduction. Xanthogranulomatous pyelonephritis (XGP) is a type of chronic renal inflammation that usually occurs in immunocompromised middle-aged women with chronic urinary tract infection or ureteral obstruction induced by the formation of ureteral stones. XGP with an incomplete double ureter is extremely rare. Case Presentation. A 76-year-old woman was referred to our department to undergo further examination for a left renal tumor that was detected by ultrasonography. Dynamic contrast computed tomography (CT) revealed an enhanced tumor in the upper renal parenchyma. Laparoscopic radical nephrectomy was performed based on a preoperative diagnosis of renal cell carcinoma. Histological sections showed the aggregation of foam cells; thus, XGP was diagnosed. Conclusion. We herein report a rare case of XGP in the upper pole of the kidney, which might have been associated with an incomplete double ureter

トクシマ シミン ビョウイン ノ トリクミ

Since the innovation of the Diagnosis Procedure Combination（DPC）system at the TokushimaMunicipal Hospital in 2008, we have encountered shortening of average hospitalization and developedbetter medical standardization measures.Cancer patients tend to visit several hospitals because they expect special cancer treatment,and it becomes difficult to devote enough time for them in the outpatient clinic.At the hospital, medical care cooperation is provided through a team approach, and the work isshared among medical staff such as the pharmacist, nurse, and medical social worker. However, itis necessary to discuss the patients’ medical care issues with their respective family doctors toresolve these problems.We report the regional critical pathway at the Tokushima Municipal Hospital as a tool for familydoctors to cooperate in the care of cancer patients

チョウ カイテン イジョウショウ オ トモナッタ オウコウ ケッチョウガン ニ タイシテ フククウキョウ ホジョカ ケッチョウ セツジョジュツ オ シコウ シタ 1レイ

A ６４-year-old woman with complaint of intermittent abdominal pain for one year was admitted to our hospital. She had been diagnosed as transverse colon cancer by barium enema and colonoscopy at the former hospital. Abdominal enhanced CT showed that the duodenal third portion was not detected at the back of superior mesenteric vessel. She underwent laparoscopic surgery based on a diagnosis of transverse colon cancer with intestinal malrotation. We could perform laparoscopic-assisted transverse colectomy using abdominal enhanced CT which was effective for not only preoprerative diagnosis of accompany of intestinal malrotation but also anatomical anomalies of vessels. The right sided colon which was not fixed to the retroperitoneum in cases with intestinal malrotation could be pulled out easily from the small incision wound. We also considered that colectomy and dissection of its lymph nodes to these cases could be safety performed using by laparoscopy and through small laparotomy

Retroperitoneoscopic radical nephrectomy with a small incision for renal cell carcinoma: Comparison with the conventional method

<p>Abstract</p> <p>purpose</p> <p>When retroperitoneoscopic radical nephrectomy for renal cell carcinoma was introduced into our institution, we performed a combined small skin incision method. In this method, a small incision was made to approach the retroperitoneal space prior to setting trockers and thereafter a LAPDISC was placed in the incision to start the retroperitoneoscopic procedure. In this study, we compared the outcomes between the combined small skin incision method ("A method" hereinafter) and the conventional method ("B method" hereinafter).</p> <p>material and methods</p> <p>Among the cases of T1N0M0 suspicious renal cell carcinoma treated at Yokohama City University between May 2003 and June 2009, the A method was performed in 51 cases and the B method was performed in 33 cases. The factors in the outcomes compared between the A and B methods were the duration of procedure, volume of bleeding, volume of transfusion, weight of the specimen, incidence of peritoneal injury, rate of conversion to open surgery, and perioperative complications.</p> <p>results</p> <p>The duration of the procedure was 214.4 ± 46.9 minutes in the A method group and 208.1 ± 36.4 minutes in the B method group (p = 0.518). The volume of bleeding and the weight of the specimen were 105.5 ± 283.2 ml and 335.1 ± 137.4 g in the A method group and 44.8 ± 116 ml (p = 0.247) and 309.2 ± 126 g (p = 0.385) in the B method group. There was no significant difference in all factors analyzed.</p> <p>conclusion</p> <p>The A method would be highly possible to produce stable results, even during the introduction period when the staff and the institution are still unfamiliar with the retroperitoneoscopic surgery.</p

ダイモウ ゲンパツ キョダイ GIST 1セツジョレイ

We report a case of giant gastrointestinal stromal tumor（GIST）primarily occurred in the greater omentum. A７８-year-old woman was referred to our hospital because of a giant abdominal tumor. Contrast-enhanced abdominal computed tomography（CT）showed a giant tumor measuring ２０×２４×１３cm in diameter in the abdominal cavity, consisting of heterogeneously enhanced solid and cystic lesions. Abdominal magnetic resonance imaging（MRI）after ３ weeks from the first medical examination showed the enlarged tumor measuring２４×２５×１７cm in diameter, the intensity of the solid lesion was low on T１weighted image, heterogeneously enhanced on T２weighted image and high on diffusion weighted image. At surgery, we confirmed the giant tumor continued to the omentum, and pressured the stomach, pancreas, and colon. The resected specimen weighed ８，３２５g containing of５，６４０ml of red-brown fluid. Histological examination showed the tumor consisted of proliferated spindle cells in a fascicular pattern and polynesic hemorrhage and necrosis. Immunohistochemically, the tumor cells were positive for c-kit and CD３４, and negative for S‐１００ protein and desmin, indicating a GIST in the greater omentum. The mitotic figures were in a４０／５０ high power field. In genetic testing, the tumor cells had exon１１mutation of c-kit gene. The woman started taking imatinib after operation and remains alive and recurrence-free

タンカンナイ シュヨウセン オ ミトメ ゲンパツセイ カンナイ タンカンガン トノ カンベツ オ ヨウシタ イジセイ ダイチョウガン カンテンイ ノ 1セツジョレイ

The patient was a 68-year-old man who had undergone right hemicolectomy for ascending colon cancer, and pulmonary resection for lung metastases. After 10 months of operations, abdominal computed tomograms revealed a liver tumor with a biliary tumor thrombus in the segment 5 and a localized dilation of the intrahepatic bile duct. Endoscopic retrograde cholangiopancreatography showed obstruction, 2cm long, of the intrahepatic bile duct （B5） and dilation of the peripheral duct. Cytological examination of extracted bile showed adenocarcinoma. A right hepatic lobectomy was performed under the diagnosis of metastatic liver tumor with tumor development in the intrahepatic bile duct or intrahepatic cholangiocarcinoma. The resected specimen showed massive infiltration of the tumor into intrahepatic bile duct （B5） with forming a tumor thrombus. Histologically, the tumor was moderately differentiated adenocarcinoma, similar to the ascending colon cancer. The final diagnosis was liver metastasis of ascending colon cancer with intrabiliary tumor growth

High testosterone levels in prostate tissue obtained by needle biopsy correlate with poor-prognosis factors in prostate cancer patients

Background: There is currently no consensus on the correlations between androgen concentrations in prostate tissue and blood and stage and pathological grade of prostate cancer. In this study, we used a newly-developed ultra-sensitive liquid-chromatography tandem mass spectrometry method to measure testosterone (T) and dihydrotestosterone (DHT) concentrations in blood and needle biopsy prostate specimens from patients with prostate cancer.Methods: We analyzed androgen levels in 196 men diagnosed with prostate cancer. All patients had undergone systematic needle biopsy, and an additional needle biopsy from the peripheral zone was conducted for the simultaneous determination of T and DHT. We analyzed the relationships between T and DHT levels in tissue and blood and Gleason score, clinical stage, and percentage of positive biopsy cores, using multivariate analysis. Results: The median T and DHT levels in blood were 3551.0 pg/mL and 330.5 pg/mL, respectively. There was a strong correlation between serum T and DHT. The median T and DHT levels in prostate tissue were 0.5667 pg/mg and 7.0625 pg/mg, respectively. In multivariate analysis, serum prostate-specific antigen and tissue T levels were significantly associated with poor prognosis; high T levels in prostate tissue were significantly related to high Gleason score (p = 0.041), advanced clinical stage (p = 0.002), and a high percentage of positive biopsy cores (p = 0.001). Conclusions: The results of this study indicate that high T levels in prostate tissue are related to high Gleason score, advanced clinical stage, and a high percentage of positive biopsy cores in patients with prostate cancer. T level in needle biopsy specimens may therefore be a useful prognostic factor in prostate cancer patients