Hinyokika kiyo. Acta urologica Japonica
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Case Reports
[Clinical experiences of endotoxin removal columns in septic shock due to urosepsis: report of three cases].
Clinical experiences of endotoxin removal using polymyxin B immobilized fiber column (PMX) in three septic shock patients are reported. The patients were referred to our hospital with complaints of high fever and severe pain during urination. Physical examination and laboratory data revealed severe hypotension, tachycardia, and pyuria. ⋯ After antibiotic therapy and anti-shock therapy, direct hemoperfusion using polymyxin B immobilized fiber column (PMX) was carried out. Thereafter, cardiovascular instabilities were improved without increasing the supply of catecholamines. PMX therapy for systemic inflammatory response due to infection was effective in treatment of cardiovascular instabilities.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Inhibition of disease flare with diethylstilbestrol diphosphate and chlormadinone acetate administration for two weeks prior to slow-releasing leuprolide acetate in prostatic cancer patients.
To determine whether administration of estrogen or gestagen prior to luteinizing hormone-releasing hormone (LH-RH) agonist prevents disease flare in prostate cancer patients, we pretreated the patients with either diethylstilbestrol diphosphate (DES-P) 300 mg daily (N = 17) or chlormadinone acetate (CMA) 100 mg daily (N = 16) or none (N = 16) for two weeks before the initial injection of leuprolide acetate (L). Blood samples for prostatic specific antigen (PSA), testosterone (T), and luteinizing hormone were collected before CMA and DES-P administration, before and at 2, 7, 14, 28, 56, and 84 days after the first administration of leuprolide. The treatment with DES-P and CMA prior to LH-RH agonist induced an early decline of PSA. ⋯ In the patients pretreated with DES-P or CMA, the mean serum T level never exceeded the pretreatment baseline after L administration. On the other hand, in the patients without DES-P or CMA, both serum T and PSA levels increased after the first administration of L. These results clearly demonstrate that pretreatment with DES-P 300 mg daily or CMA 100 mg daily for 2 weeks is quite effective to prevent disease flare after the first administration of L in patients with prostatic cancer.
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Emphysematous cystitis is a rare lower urinary tract infection. Patients with diabetes mellitus, neurogenic bladder, and recurrent urinary tract infection are generally at higher risk of this disease. ⋯ Emphysematous cystitis was improved by antibiotic therapy and urinary drainage. CT scan was a sensitive method for detecting early signs and confirming the diagnosis.
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Review Case Reports
[Vesicovaginal fistula due to a vaginal foreign body: a case report].
An 18-year-old female consulted a clinic complaining of pollakisuria and urinary incontinence. She was referred to our department for operation under the diagnosis of vesicovaginal fistula due to a vaginal foreign body confirmed by intravenous pyelography and cystoscopic examination. About 7 months earlier, she inserted a hair spray can into the vagina but could not remove its cap. ⋯ After 2 months, transabdominal repair of the vesicovaginal fistula was performed. After operation, dysuria and urinary incontinence were not observed. Few cases of vesicovaginal fistula due to a foreign body in the vagina have been reported, and there have been only 6 reported cases in Japan including ours.
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Since 1980, 73 patients with advanced testicular cancer have been treated with chemotherapy and 43 patients received post-chemotherapy (salvage) surgery. The median age of all patients was 31 years old, ranging from 17 to 63 years. The histology of the primary testicular tumor was pure seminoma in 23 patients and non-seminoma in 50 patients. ⋯ Residual cancer was still found in 8 of the 32 (25%) marker normalized cases. Residual cancer could not reliably be predicted or discriminated from necrosis or mature teratoma by the prognostic criteria. Therefore, salvage surgery remains essential in the treatment of advanced testicular cancer.