Kazuhiro Ishizaka

Background: Urachal carcinoma (URC) is a rare tumor of the urinary bladder, of which the histology usually resembles that of colorectal adenocarcinoma. Achievement of cure in patients with metastatic URC is difficult, and the survival rate of these patients has remained unsatisfactory despite various efforts.Case: A 74‐year‐old female patient presented to us complaining of gross hematuria. Abdominal and thoracic computed tomography revealed a mass in the dome of the bladder with a single lung nodule. The two tumors, which were resected by partial cystectomy and video‐assisted thoracic surgery, respectively, were diagnosed by postoperative histopathology as adenocarcinomas. Subsequent to the surgeries, bilateral ovarian metastases and another lung metastasis, which appeared metachronously, were also resected. The repeated cytoreductive surgery combined with administration of S‐1 plus cisplatin chemotherapy at each instance of disease progression eventually yielded a durable progression‐free survival; even at 5 years after the initial therapy, the patient remained asymptomatic with no limitation of activities despite the failure to achieve “cure”.Conclusion: Not only some degree of sensitivity of the tumor to chemotherapy, but also the repeated cytoreductive surgeries might allow prolonged survival with a good quality of life in elderly patients with metastatic URC, even in the absence of cure and failure of genetic testing to suggest any potentially effective second‐line drugs. To improve the survival of patients with metastatic URC, complementary therapy suggested by the results of genomic profiling may be necessary along with other multimodality therapy, including sequential metastasectomy and chemotherapy.

Purpose: We report on two cases of retroperitoneal lymph node metastasis of testicular cancer with left inferior vena cava.Methods/Results: A 25‐year‐old man with a left testicular cancer with pulmonary and retroperitoneal lymph node metastases received three courses of VIP (etoposide, ifosfamide and cisplatinum) chemotherapy. Subsequent abdominal computed tomography (CT) revealed round lesions enhanced with contrast agent on both sides of the aorta inside the degenerated lymphadenopathy. These lesions were regarded as a duplicated inferior vena cava (IVC) and this was confirmed at retroperitoneal lymph node dissection. The second case is of a 21‐year‐old man with a left testicular cancer with pulmonary, liver and widespread lymph node metastases. Subsequent to a course of VIP chemotherapy, super high‐dose chemotherapy was administered. Abdominal CT revealed a round mass enhanced with contrast agent on the left side of the aorta adjacent to the degenerated lymphadenopathy, which was regarded as the transposed left IVC and this was confirmed at lymph node dissection.Conclusions: In both cases, initial CT failed to detect the lesions as the left IVC and there was a possibility for the misinterpretation of such venous anomalies with residual lymphadenopathy.

Object. The hypogastric nerve (HGN) plays a crucial role in the primary functions of ejaculation: sperm transport through the vas deferens, secretion of prostatic fluid, and bladder neck closure. This study was undertaken to explore the possibility of restoring HGN function to the seminal tract and preserving its cross-innervation mechanism to the seminal tract after HGN—HGN reattachment. Methods. Responses of the vas deferens/epididymis, prostate, and bladder neck to electrical stimulation of the lumbar splanchnic nerve (LSN) or the HGN and occurrence of antegrade ejaculation as a result of manual penile stimulation were examined in dogs that had undergone HGN—HGN reattachment. Eighteen months after the procedure had been performed bilaterally, 23 LSNs were electrically stimulated. In 17 LSNs this stimulation elicited elevation of vasal pressure (12 nerves bilaterally); in 18 LNs, bladder neck pressure; and in 15 LSNs, prostate contraction. After retransection of the right HGN in the dogs that had underg...

To examine whether there are sex-related differences in urinary bladder function, we evaluated the function and distribution of beta-adrenoceptor in the male and female rabbit urinary bladder. Ten male and ten female rabbits were studied. The function and distribution of beta-adrenoceptors were studied by measuring changes in contractile forces from isoproterenol, a beta-adrenoceptor agonist, and forskolin, an adenylate cyclase activator, and by measuring beta-adrenoceptor densities using radioligand receptor binding techniques. Isoproterenol caused significantly greater relaxation in female trigonal muscles than in male trigonal muscles. It caused similar relaxation responses in the male and female detrusors. The Bmax values for [3H]dihydroalprenolol (DHA) binding in trigonal muscles were significantly higher in the female than in the male, whereas Bmax values for [3H]DHA binding in the male and the female detrusor were similar. In contrast, forskolin caused similarly marked relaxations in the male and the female detrusor and trigonal muscles. These findings demonstrate that there are sex-related differences in the function and the distribution of beta-adrenoceptors in rabbit trigonal smooth muscles.

Slow frequency GnRH pulses have been proposed to preferentially increase circulating FSH levels by increasing FSH synthesis and pulsatile release. Examination of this proposal using various in vivo models, however, has produced conflicting results. To examine directly the effects of GnRH pulse frequency on the pituitary, we compared the effects of 2.5-nM GnRH pulses administered every 1 h or every 4 h vs. no GnRH, using perifused rat pituitary cells. FSH secretion (total area under the response curve) was 2-fold greater (P less than 0.01) with every hour than with every 4 h GnRH pulses. This difference resulted from the increased number of GnRH pulses and increased (P less than 0.05) interpulse FSH secretion, whereas FSH pulse amplitude was unchanged. FSH beta mRNA levels at the completion of the 11-h perifusion were increased 4.5-fold by GnRH every h (P less than 0.01) and 3.3-fold by GnRH every 4 h (P less than 0.05) above levels in untreated cells. FSH beta mRNA levels were greater (P less than 0.05) at the faster GnRH pulse frequency. Because more frequent stimulation delivered more GnRH during the study, cells were next stimulated with 2.5 nM GnRH every 1 h for nine pulses, 7.5 nM GnRH every 4 h for three pulses to equalize the GnRH dose, or 2.5 nM GnRH every 4 h for three pulses. Interpulse FSH secretion and FSH beta mRNA levels were again greater (P less than 0.05) with every hour than every 4 h GnRH pulses. Interpulse LH secretion, FSH and LH pulse amplitude, and LH beta and alpha-subunit mRNA levels were not different between the groups. GnRH doses of 0.1-10 nM every hour increased FSH and LH pulsatile secretion dose-dependently, but FSH beta, LH beta, and alpha-subunit mRNA levels were similar. In conclusion, our data reveal that reducing the frequency of GnRH pulses from every hour to every 4 h reduces both FSH beta mRNA levels and FSH interpulse secretion, but does not change GnRH-stimulated FSH pulsatile release. We suggest that the finding by others that slow frequency GnRH pulses increase circulating FSH levels under certain experimental conditions in vivo may instead be explained by complex hormonal interactions or changes in FSH clearance.