bluuebunny/crossref_metadata_2025 huggingface dataset:
PROSTATE SPECIFIC ANTIGEN AND PROSTATE ACID PHOSPHATASE DECLINES AFTER ESTRAMUSTINE PHOSPHATE WITHDRAWAL: A CASE REPORT
Authors: Nishiyama Tsutomu , Terunuma Masahiro
Published: July 2007

We report a case of advanced prostate cancer in which an initial response to hormonal therapy with surgical castration and estramustine phosphate (EMP) was followed by disease progression, as shown by sequential elevations in serum prostate specific antigen (PSA) and prostate acid phosphatase (PAP) and the development of new symptoms, during maintenance endocrine and anticancer chemotherapy. Discontinuation of EMP resulted in sustained reductions in serum PSA and PAP levels and a sustained improvement in symptoms.
A CASE OF ARTERIAL PRIAPISM TREATED BY EMBOLIZATION
Authors: Kawachi Yoshio , Watanabe Ryota , Now Kensho , Murata Masami , Sumi Yukiharu
Published: July 2007

An 18‐year‐old unmarried man, who had shown arterial priapism caused by mild perineal trauma sustained during skate‐boarding, has been successfully treated by autologous clot embolization at the common penile artery. He was able to have a normal erection and ejaculate 5 d after embolization.
THE INHIBITORY EFFECT OF KAMPOU EXTRACTS ON IN VITRO CALCIUM OXALATE CRYSTALLIZATION AND IN VIVO STONE FORMATION IN AN ANIMAL MODEL
Authors: Koide Takuo , Yamaguchi Seiji , Utsunomiya Masato , YoshiokaY Toshiaki , Sugiyawia Kiyoshi
Published: July 2007

Kampou medicine is a traditional Japanese therapeutic system which originated in China and was used to treat various diseases for hundreds of years until it was superseded by Western medicine. In recent years, there has been a resurgence of interest in Kampou medicine among many physicians. Unfortunately, however, little evaluation has been performed using objective scientific methods until now, and the pharmacodynamics of Kampou medicine are still unclear. Generally speaking, Kampou medicine has been shown to have fewer side‐effects than Western medicine based on the experience gained from its long usage. We first selected 16 Kampou extracts for screening as possible calcium oxalate stone prophylactic agents in vitro. This resulted in the selection of two kinds of Kampou extracts, Takusya and Kagosou, as potential Kampou extracts for stone prophylaxis. Next, these two Kampou extracts were tested in vivo for their effects on stone formation in an animal model. Takusya showed significant stone prophylaxis, while Kagosou did not. Lastly, Chorei‐to, which contains Takusya and has been approved for prescription as a Kampou medicine for urolithiasis patients in Japan, was examined in vivo at two different concentrations. As a result, a low dose of Chorei‐to which corresponded to the human daily dose per unit of body weight exhibited apparent stone prophylaxis, despite the disadvantage of decreasing citrate excretion. In contrast, high doses of Chorei‐to did not exhibit stone prophylaxis in viva These results suggest that Chorei‐to has conflicting effects on stone prevention as a whole, but the Takusya extract in Chorei‐to seems to play a major role in stone prophylaxis and the remaining four Kampou extracts seemed to interfere with the prophylactic effect of Takusya on calcium oxalate stone formation.
BACKSCATTERED ELECTRON IMAGING OF CRYSTAL MATRIX PROTEIN ON THE SURFACE OF CALCIUM OXALATE CRYSTALS USING COLLOIDAL GOLD
Authors: Suzuki Koji , Nakajima Chiaki , Moriyama Manabu , Miyazawa Katsuhito , Tsugawa Ryuzo
Published: July 2007

In order to clarify the presence and localization of crystal matrix protein (CMP) upon calcium oxalate crystals, scanning electron microscopy (SEM) and backscattered electron imaging (BEI) techniques were used. This protein exhibits a remarkable affinity with calcium oxalate crystals and may be important in stone pathogenesis. In this paper, rabbit anti‐human CMP polyclonal antibody was used as first antibody, and for the second antibody, goat anti‐rabbit IgG conjugated with 20 nm immunogold was used. Freshly prepared crystals from male urine were fixed in SEM fixative, then blocked and washed with phosphate‐buffered saline and bovine serum albumin (PBS/BSA). First and second antibodies were reacted in PBS/BSA. Crystals were then dehydrated and finally coated for SEM study. The SEM technique showed bipyramidal shaped dihydrate calcium oxalate crystals in every sample and even at high magnification, colloidal gold could barely be seen. BE 1 clearly demonstrated the presence and localization of the gold on the surface of the crystals as well as on the macromol‐ecules eluted from the crystals by dissolving them in ethylenediamminetetraacetic acid solution.
CHANGES IN RAT BLADDER FUNCTION FOLLOWING EXPOSURE TO PAIN AND WATER STIMULI
Authors: Saito Masahiko , Kondo Atsuo , Miyake Koji
Published: July 2007

Changes in rat bladder function following the exposure to physical stress were studied in vitro. Rats were divided into two stress groups and two control groups and maintained for 6 months under specific conditions. The stress groups, consisting of animals subjected to water or pain stress and control groups were kept in cages floored with wooden chips or wire net. The body weight of the stressed groups was significantly lower than that of the controls. Gastric ulcer occurred in none of the groups. The detrusor response of the water group to acetylcholine was significantly greater than that of the two control groups. In the pain group, the contractile response was induced by norepinephrine. In the other three groups, however, norepinephrine evoked a relaxation of muscle strips. The contractile response of the bladder to both serotonin (5‐hydroxytryptamine) and ATP (adenosine 5′‐triphosphate) did not differ between the four groups.
LOW‐COUNT ORGANISMS CONCEALED BY DOMINANT UROPATHOGENIC ORGANISMS IN URINE OF PATIENTS WITH ASYMPTOMATIC BACTERIURIA
Authors: Sakai Yoshiyuki
Published: July 2007

We compared organisms isolated by selective culture media with those isolated by routine bacteriological methods using the same urine specimens. Urine was obtained by suprapubic bladder aspiration from 84 patients suspected of having asymptomatic bacteriuria, including 31 catheterized patients. The selective media included mannitol salt agar, Enterococcus faecalis agar, nalidixic acid cetrimide agar, and desoxycholate hydrogen sulfide lactose agar with polymyxin B or cefsulodin. Colony counts on the selective media approximated to those on heart infusion agar, except for desoxycholate hydrogen sulfide agar with polimyxin B, where the number of organisms was underestimated. In 24 patients the selective media detected a total of 32 strains not reported by the hospital laboratory. The unreported strains included coagulase‐negative staphylococci (41%), other cocci (38%), enterobacteriaceae (9%) and glucose‐nonfermenting gram‐negative bacilli (9%) and fungi (3%), with the number of organisms being mostly <105/ ml. The majority of the unreported strains coexisted with dominant gram‐negative bacilli or enterococci. These results indicate that low‐count organisms coexisting with dominant organisms tend to be missed by the routine bacteriological methods.
ASSESSMENT OF SEXTANT BIOPSY OF THE PROSTATE FOR DETECTING CANCER PRIOR TO THERAPY IN PATIENTS CLINICALLY DIAGNOSED AS BENIGN PROSTATIC HYPERPLASIA
Authors: Egawa Shin , Uchida Toyoaki , Kawakami Tatsuhiro , Kuwao Sadahito , Koshiba Ken
Published: July 2007

Pathological results and perioperative morbidity were compared in 199 patients who had undergone prostatectomy and/or biopsy in order to determine the extent to which systematic biopsy is effective for detecting prostate cancer prior to therapy in patients clinically diagnosed as having benign prostatic hyperplasia. Seventeen (8.5%) cancers were detected in 199 patients following surgery and/or biopsy. Digitally‐guided biopsy as a means of detecting prostate cancer was found to be just as effective as ultrasound‐guided biopsy. Seven (12.5%) cancers were detected in 56 patients who had undergone biopsy and transurethral resection. Preprostatec to my biopsy detected only two of three patients with stage TIb disease. All four stage TIa and one stage TIb failed to be diagnosed. Of 90 patients who had biopsy prior to surgery other than TURP, seven (7.8%) cancers were found. Four of these were advanced. The incidence of postoperative fever > 38.0 °C and duration of postoperative pyuria did not differ significantly between groups with or without biopsy. Preoperative biopsy did not contribute to perioperative morbidity. Tumors detected by systematic biopsy are usually large and clinically significant. Positive biopsy results are often diagnostic, but the pathological features of a tumor together with clinical parameters should be considered to reduce the chance of overdiagnosing an insignificant tumor. Sextant biopsy would be most applicable to patients scheduled for any type of therapy other than TURP especially in those with markedly elevated serum PSA levels. This procedure may be beneficial particularly for younger patients with long life expectancy who will benefit from definitive therapy.
USEFULNESS OF DIGITAL RECTAL EXAMINATION, SERUM PROSTATE‐SPECIFIC ANTIGEN, TRANSRECTAL ULTRAS ONOGRAPHY AND SYSTEMATIC PROSTATE BIOPSY FOR THE DETECTION OF ORGAN‐CONFINED PROSTATE CANCER
Authors: Gohji Kazuo , Okamoto Masayuki , Morisue Koichi , Fujii Akio
Published: July 2007

The detection rate of organ‐confined prostate cancer by digital rectal examination (DRE), serum prostate‐specific antigen (PSA), and transrectal ultrasound (TRUS) of the prostate, as well as the value of a directed, guided transrectal core biopsy for the prostate (TRUS‐guided biopsy) combined with systematic biopsy, were evaluated. The subjects were 171 patients with urinary symptoms suggestive of prostatic disease excluding those with clinical stage C and D prostate cancer. Twenty‐five patients (14.6%) had prostate cancer, 127 (74.2%) had benign prostate hypertrophy, four (2.3%) had prostatic intraepithelial neoplasia, eleven (6.4%) had inflammation, and four (2.3%) had normal prostate tissue. The incidence of detection of hypoechoic findings by TRUS in the patients in whom nodules were detected by DRE or who had elevated serum PSA was higher than that in patients with negative diagnostic findings. In 22 of the 25 patients with prostate cancer, the cancer was detected by recognition of a hypoechoic area on TRUS. In 10 of these 22 patients, prostate cancer was also detected by systematic biopsy in isoechoic areas. Prostate cancer was detected by systematic biopsy in three patients without hypoechoic findings. The positive predictive value for patients with abnormal findings on all three tests was 64.3%, which is significantly higher than that for patients with any other combination of findings (p < 0.05). Our results indicate that the combination of DRE, serum PSA and TRUS is useful for the detection of organ‐confined prostate cancer, and that TRUS and TRUS‐guided prostate biopsy combined with systematic biopsy should be performed in patients with abnormal findings for both DRE and PSA. Our results also demonstrate that systematic biopsy is useful for the detention of prostate cancer from the isoechoic area visualized by TRUS.
MINI‐LAPAROTOMY STAGING PELVIC LYMPH NODE DISSECTION FOR LOCALIZED PROSTATE CANCER
Authors: Arai Yoichi , Ishitoya Satoshi , Okuba Kazutoshi , Kanba Tornomi , Shichiri Yasumasa
Published: July 2007

We report our early experience with mini‐laparotomy staging pelvic lymph node dissection (PLND) for clinically localized prostate cancer. We have used virtually the same original technique described by Steiner and Marshall. A 5 cm lower midline abdominal incision provides excellent exposure, allowing complete PLND under direct visualization. If radical retropubic prostatectomy is indicated by the state of the pelvic lymph nodes, this can be performed only by extending the same incision. Nine patients with histologically proven prostate cancer underwent mini‐laparotomy staging PLND. The average intraoperative time for mini‐laparotomy PLND was 33 minutes (range, 25–50 minutes). The intraoperative blood loss was 44 ml (range, 20–90 ml). The mean number of pelvic lymph nodes removed was 6.9 (range, 5–10 nodes) on the right and 10.8 (range, 8–21 nodes) on the left. Eight patients underwent immediate radical retropubic prostatectomy and one had radiation therapy. There were no complications directly related to the mini‐laparotomy staging PLND. Mini‐laparotomy staging PLND is an attractive alternative to laparoscopic PLND, especially for patients at low risk of lymph node metastasis.
LAPAROSCOPY‐ASSISTED RADICAL NEPHRECTOMY IN COMBINATION WITH MINILAPAROTOMY: REPORT OF INITIAL 7 CASES
Authors: Nishiyama Tsutomu , Terunurna Masahiro
Published: July 2007

We recently developed a new procedure for laparoscopy‐assisted radical nephrectomy in combination with minilaparotomy to remove kidneys with renal cell carcinoma. A pararectal incision approximately 7 cm in length was performed from the subcostal region. A 12‐mm trocar was placed at the mid‐clavicular line at the level of the umbilicus. An 11 ‐mm trocar was placed at the tip of the rib. Under laparoscopic and trans‐minilaparotomic observation, intra‐abdominal manipulation was begun. The contents of Gerota's fascia were freed from the surrounding tissues and removed through the abdominal incision. Seven patients have been successfully treated with this procedure. The operating time for this procedure was shorter than the time of laparoscopic nephrectomy. There were none of the adverse hemodynamic or ventilatory effects associated with pneumoperitoneum in this procedure. This procedure also resulted in less postoperative pain and a shorter convalescence period when compared with open nephrectomy.
ECTOPIC URETER OPENING INTO THE SEMINAL VESICLE IN AN INFANT: A CASE REPORT AND REVIEW OF THE JAPANESE LITERATURE
Authors: Terai Akito , Tsuji Yutaka , Terachi Toshiro , Yoshida Osamu
Published: July 2007

A case is presented of an ectopic ureter opening into the seminal vesicle associated with hypodysplastic kidney In an infant. We reviewed 135 cases (139 ureteral units) of male ectopic ureter from the Japanese literature and, of the 139 ectopic ureters, 109 were single‐system ectopic ureters, and 26 ureters were associated with the ureteral duplication. Sixty‐three and 73 ureters opened into the urinary tract and seminal tract. respectively. In patients 15 years or older, 65 cases of ectopic ureter opened into the seminal tract and 33 cases opened into the urinary tract, whereas in children under 15 years, the ectopic orifice was located more often in the urinary tract (26 cases) than in the seminal tract (8 cases). Presenting symptoms differed according to the location of the ectopic orifice. Ectopic ureters opening into the urinary tract most often presented with urinary tract infection and abdominal or lumbar pain. On the other hand, voiding and ejaculatory symptoms as well as perineal or genital pain were characteristic in ectopic ureters opening into the seminal tract. Of the 83 associated renal segments that were surgically removed, dysplasia. hypoplasia and aplasia were found in 24. 14 cases, respectively. It was noteworthy that 48 of the 53 single ectopic ureters opening into the seminal vesicle were associated with ipsilateral renal dysgenesis.
SLING OPERATION FOR MALE URINARY INCONTINENCE AFTER ILEAL NEOBLADDER RECONSTRUCTION: A CASE REPORT
Authors: Minowada Shigeru , Sasaki Yukihiro , Kano Munehide , Okano Yoshinori
Published: July 2007

In July 1992. sling surgery was performed on a 62‐year‐old male patient with urinary incontinence following ileal neobladder reconstruction. Incontinence ceased immediately after this procedure which was conducted using five nylon sutures and two dacron tubes to protect the posterior urethra.
INTRA‐ AND INTERINDIVIDUAL VARIATION IN THE PHARMACOKINETICS OF TACROLIMUS (FK506) IN KIDNEY TRANSPLANT RECIPIENTS—IMPORTANCE OF TROUGH LEVEL AS A PRACTICAL INDICATOR
Authors: Ihara Hideari , Shinkuma Denji , Ichikawa Yasuji , Nojima Michio , Nagano Shunsuke , Ikoma Fumihiko
Published: July 2007

Background:Tacrolimus (FK506) is currently used as the primary immunosuppressant in clinical kidney transplantation in some centers. The purpose of this study was to evaluate the pharmacokinetics of this drug and to see if trough level, which has been used widely in therapeutic drug monitoring, can be used as an appropriate substitute for other pharmacokinetic measurement tests.

Methods:The blood concentration‐time curve was studied in 10 kidney transplant recipients on 26 Occasions after oral dosage of 2 to 18 mg every 12 hours. Whole blood concentration was measured by two‐step irnmunoabsorption assay. Methylprednisolone was used as a concomitant immuno‐suppressive drug.

Results:

The blood concentration‐time curves showed remarkable interindividual variation. lntraindividual variation was also found, but the degree of variation was slight compared with interindividual variation. On 17 occasions of measurement in one patient, the dose was significantly correlated with trough (r = 0.684). Cmax (r = 0.838) and AUC0–12 (r = 0.817). In nine patients on nine occasions, however, the dose was not significantly correlated with trough (r = 0.351), Cmax (r = 0.270) or AUC0–12 (r = 0.355). tmax ranged from one to four hours (mean + SD; 2.8 + 1.3) and fluctuated in both intra‐ and interindividual measurements. In spite of a wide variation in the blood concentration‐time‐curve patterns, a highly significant linear relationship between trough and Cmax or AUC0–12 was observed in both intraindividual (Cmax, r = 0.876; AUC0–12, r = 0.926) and interindividual (Cmax, f = 0.943; AUC0–12, r = 984) measurements.

Concluslons:We conclude that trough level is a practical acceptable indicator of the blood levels of tacrolimus, and can be used to monitor blood concentration.
PROGNOSTIC SIGNIFICANCE OF MICROVESSEL COUNT IN LOW STAGE RENAL CELL CARCINOMA
Authors: Yoshino Shuji , Kato Mikio , Okada Koichi
Published: July 2007

Background:

It has been postulated that tumors beyond a certain size are dependent on angiogenesis, which might also be related to distant metastasis. We therefore assessed the prognostic significance of tumor microvasculature in renal cell carcinoma.

Methods:

Tumor specimens from 84 patients with primary renal cell carcinoma were examined by immunohistochemical staining for factor VIII. Individual microvessels were counted in a 200 × field overlying the area of highest neovacularization.

Results:

The mean number of microvessels in patients with metastases was significantly higher than that in patients who were disease‐free for more than three years (P= 0.004). The survival of patients with less than 30 microvessels per 200 × field was significantly higher than that of patients with more than 30 microvessels per 200 × field (P= 0.007). Multivariate analyses revealed that these microvessel counts were the only significant predictor of prognosis in 45 patients with T1‐2 and MO tumors (P= 0.028).

Conclusions:

Assessment of tumor microvasculature is therefore probably one of the most important prognostic predictors in renal cell carcinoma.
IN SITU PERFUSION BY RETROGRADE CANNULATION OF A TUMOR ARTERY FOR NEPHRON‐SPARING SURGERY
Authors: Masaki Zenjiro , Ichigi Yasuhisa , Kuratomi Kazunari , Iguchi Atsushi , Sato Shinji , Nakamura Koji , Hirata Yuji; , Tokuda Yuji , Nohtomi Takashi
Published: July 2007

Background:

Although ice slush cooling or ex situ perfusion with bench surgery is most widely used for protecting ischemic renal damage which possibly accompanies complicated nephron‐sparing surgery, each has its own disadvantages. The former does not allow excessively long ischemia and the laller requires complicated procedures as autotransplantation. In order to mitigate against these problems, we devised a novel method of in situ renal perfusion with intracellular hyperosmolar solution.

Methods:

One renal segmental artery mainly supplying a tumor was isolated and cannulated with a small feeding tube. The tube was introduced through a small arteriotomy incision directed towards the proximal side, advanced until its tip remained in the main or first branch of the renal artery, and then it was anchored to that artery. After the main renal artery and vein were clamped, the kidney was perfused with cold Euro‐Collins' solution through the tube, while the venous blood and perfusate were drained from the left gonadal vein or small venotomy incision of the right renal vein. Results: In one case of renal cell carcinoma and three cases of angiomyolipoma, two of which ruptured, nephron‐sparing surgery was carried out under in situ hyperosmolar perfusion. Ischemic time of these four cases was an average of 96 minutes, varying from 45 to 145 minutes. All the kidneys functioned well postoperatively,

Conclusions:

The method presented here is very simple, requires no unusual dexterity and safely allows for a long period of renal ischemia. This method is best indicated in cases where simple clamping of the renal pedicle with ice‐slush cooling appears insufficient, yet ex situ surgery with autotransplantation seems excessive.
URINARY IMMUNOGLOBULINS IN PATIENTS WITH CONTINENT URINARY RESERVOIRS AND ILEAL CONDUITS
Authors: Terai Akito , Arai Yoichi , Kawakita Mutsushi , Okada Yusaku , Yoshida Osamu
Published: July 2007

Background:

Although bowel segments are commonly used for reconstructing the urinary tract, a high incidence of bacteriuria is observed in patients with urinary intestinal diversion. The normal gastrointestinal tract possesses a potent mucosal immune system characterized by secretory immunoglobulin A (slgA) as the major humoral defense factor. However, the significance of urinary IgA secretion as the mucosal defense mechanism in patients with urinary intestinal diversion has remained obscure. In this study, urinary levels of slgA as well as serum‐type IgA were measured in patients with continent urinary reservoirs (Kock and Indiana pouches) and ileal conduits. Methods: Twenty‐four‐hour urine samples were collected in a total of 80 patients with urinary intestinal diversion (22 Kock pouch patients, 21 Indiana pouch patients and 37 ileal conduit patients). The amount of slgA and serum‐type IgA were measured by enzyme‐linked immunosorbent assay (ELISA).

Results: Urinary IgA levels showed great inter‐ and intra patient variability in all three groups. Indiana reservoir urine contained significantly greater amounts of slgA (mean 32.0 mg/24hrs) than Kock reservoir urine (11.9 mg) and conduit urine (4.9 mg), whereas Kock reservoir urine contained significantly more slgA than conduit urine. However, the corresponding difference was not observed in regard to serum‐type IgA. In none of the three modes of urinary diversion did 24‐hour slgA excretion show any correlation with the length of time after surgery.

Conclusions:

Since the amounts of slgA in these patients were much greater than reported in urinary tract infection as well as in normal subjects, the major portion of urinary slgA seemed to be secreted by the intestinal segments. Long‐term slgA secretion in urinary intestinal diversion, especially continent urinary reservoirs, may be an important host defense system.
HIGH INTENSITY FOCUSED ULTRASOUND FOR BENIGN PROSTATIC HYPERPLASIA
Authors: Uchida Toyoaki , Yokoyama Eiji , Iwamura Masatsugu , Koshiba Ken , Terai Akito , Terachi Toshiro , Ohishi Kenji , Yoshida Osamu
Published: July 2007

Background:

Transurethral resection of the prostate (TURP) has been the gold standard of treatment for patients with symptomatic benign prostatic hyperplasia (BPH). The present paper discusses the safety and effectiveness of transrectal high intensity focused ultrasound (HIFU) for treating patients with symptomatic BPH.

Methods:

HlFU was conducted on 28 patients with BPH. At one, three and six months after treatment, all patients were examined for parameters including International Prostate Symptom Scores (I‐PSS), Quality of Life (QOL) inquiry, uroflowmetry, and transrectal ultrasound for determining prostate volume.

Results:

I‐PSS and QOL showed statistically significant improvement at one, three, and six months postoperatively (P< 0.0001 ‐0. Wilcoxon signed‐rank test). Ten of 28 (35.7 Oh), 13 of 28 (46.4%), and 6 of 15 (40.0%) cases were categorized as effective cases with HlFU treatment at one, three, and six months follow‐up.

Conclusions:

Focused ultrasound is an exciting new technology by which tissue can be destroyed at a site distant from the source of energy without damage to surrounding tissue. Clinical experience with alternative power settings, more accurate spacing of treatment lesions, and further development of HlFU machines may improve the results. Longer follow‐up of patients with further clinipl evaluation of HlFU is necessary to define the efficacy of this technique.
INCREASING THE THERMAL DOSE IN TRANSURETHRAL MICROWAVE THERMOTHERAPY PRODUCES NO IMPROVEMENT IN THERAPEUTIC EFFICACY
Authors: Terai Akito , Shichiri Yasumasa , Onishi Hiroyuki , Arai Yoichi , Oishi Kenji , Takeuchi Hideo , Yoshida Osamu
Published: July 2007

Background:

Transurethral microwave thermotherapy (TUMT) is a minimally invasive treatment for benign prostatic hyperplasia (BPH). It has been reported that increased thermal dose and higher intraprostatic temperatures resulted in improved clinical response. Recently we treated BPH patients with the prostatron device using a new version of software (Prostasoft 2.5), which was intended to increase thermal delivery by allowing maximum power up to 70W. The safety and clinical results were compared between the patients treated with Prostasoft 2.5 and those treated with the currently available software (Prostasoft 2; maximum power up to 50W).

Methods:

A total of 105 patients were treated successively with two treatment protocols. Sixty‐three patients were treated with Prostasoft 2 between September 1992 and July 1993. while 42 were treated with Prostasoft 2.5 between August 1993 and April 1994. Therefore, this investigation was a retrospective nonrandomized study. There was no significant difference in the baseline patient characteristics between the two groups.

Results:

Total thermal dose delivered to the prostate was significantly higher in the Prostasoft 2.5 group than that in the Prostasoft 2 group (137 kJ versus 116 kJ, P < 0.05). No serious complications were encountered in either group. Six months after TUMT, in both the Prostasoft 2.5 and Prostasoft 2 groups there was an improvement in patient condition as measured by the mean I‐PSS, OOL, and peak How rate values, as well as the overall therapeutic efficacy. The two groups differed in the amount of posttreatment improvement from between 8% and 22%, but this difference was not statistically significant.

Conclusions:

Our study suggests that higher thermal dose attained by Prostasoft 2.5 does not necessarily result in more pronounced clinical improvement, although clinical response to TUMT has often been reported to be dependent upon thermal dose.
EPIDEMIOLOGICAL CHARACTERISTICS OF PROSTATE CANCER IN GUNMA PREFECTURE, JAPAN
Authors: Nakata Seiji , Sato Jin , Imai Kyoichi , Yamanaka Hidetoshi , Ichinose Yoshio
Published: July 2007

Background Prostate cancer is rare in Asia, but the number of patients is increasing in Japan. We conducted an epidemiological study of prostate cancer in Gunma Prefecture, Japan, to investigate the trends and characteristics of the disease.

Methods: The subjects were 1.411 prostate cancer patients newly diagnosed between 1985 and and 656 patients who died from prostate cancer between 1981 and 1992. The incidence and mortality rates were calculated by year, demographic region and age.

Results: The yearly incidence rate showed an increase but the mortality rate showed no marked fluctuations. There was no significant difference between urban and ruraI districts in either incidence or mortality rate. The incidence rate tended to be high in the northern part of the prefecture, but no marked variation in mortality rate was seen. The incidence and mortality rates in districts with a history of manganese mining were high compared to those in districts without mining. In contrast, the incidence and mortality rates in districts with a history of zinc mining were comparatively lower. Both incidence and mortality rates showed a marked increase with age. The age‐specific incidence showed a double logarithmic relationship to age.

Conclusions: The increase of the yearly incidence rate might be due to changes in lifestyle and environmental factors, improved diagnostic techniques, and increased awareness among the general public regarding prostate disease. Further investigation is needed to clarify the pattern and the causes of regional differences in the incidence and mortality rates. The possibilities that manganese and zinc might be related to prostatic carcinogenesis are suggested. Int J Urol 1995:2:191–197
THE THREE‐CIRCLE SINGLE J CATHETER A MORE STABLE URETHRAL CATHETER FOR PRESSURE FLOW STUDIES
Authors: Homma Yukio , Imajo Chieko , Kawabe Kazuki
Published: July 2007

We describe a single J urethral catheter which has been specially designed to facilitate stabilization during voiding in pressure flow studies. It has a tip with three circles, which prevents the catheter from slipping out even when there is a sudden increase in intra‐abdominal pressure.
LAPAROSCOPIC GONADECTOMY FOR TESTICULAR FEMINIZATION SYNDROME
Authors: Tsugaya Masayuki , Hayashi Yutaro , Mogami Tohru , Iwasee Yutaka , Kohri Kenjiro
Published: July 2007

Laparoscopic gonadectomy was performed on a patient with complete androgen insensitivity (testicular feminization syndrome). In the case presented here, although the gonads were free, the omentum which was adhering to the right inguinal ring, possibly as a result of previous inguinal hernia repair, obscured the right gonad. The left gonad was located behind the sigmoid colon. We present our laparoscopic experience in managing this case of testicular feminization syndrome.
RENAL CELL CARCINOMA WITH SYNCHRONOUS BILATERAL ADRENAL METASTASES
Authors: Tsuboniwa Naoki , Kinouchi Toshiaki , Meguro Norio , Maeda Osamu , Saiki Shigeru , Kuroda Masao , Usami Michiyuki , Kotake Toshihiko
Published: July 2007

We report a patient with synchronous bilateral adrenal metastases from renal cell carcinoma who underwent left radical nephrectomy and right adrenalectomy.
A CASE OF GARTNER'S DUCT CYST WITH A RIGHT APLASTIC KIDNEY
Authors: Koroku Mikio , Sakaiy Shigeru , Yanase Masahiro , Shimamura Shohgo
Published: July 2007

We report a case of a Gartner's duct cyst with a right aplastic kidney. This was discovered when the right kidney was not identified in an examination for epigastric pain. CT and MRI proved useful in the diagnosis. An MRI showed a tubular structure ascending from the cyst and a complication of a bicornate uterus. As the patient was asymptomatic, the patient was followed without treatment.
SURGICAL TREATMENT OF RENAL CELL CARCINOMA EXTENDING INTO THE VENA CAVA
Authors: Fujioka Tomouki , Ogiu Kazunori , Matsushita Yasushi , Hasegawa Michihiko , Suto Fumio , Goto Yasuki , Ishikuru Koichi , Tanji Susumu , Aoki Hikaru , Okamoto Tornoshi , Suzuki Kaoru , Kubo Takashi
Published: July 2007

Background:

Renal cell carcinoma has a tendency to invade the vasculature and the prognostic implications of intravena caval tumor thrombectomy remains controversial. We reviewed our clinical experience with RCC patients who underwent tumor thrombectomy and radical nephrectomy.

Methods:

Surgery was carried out in 13 renal cell carcinoma patients with inferior vena cava extension over the past seven years. Diagnosis of intracaval tumor extension and thrombus formation was made by imaging techniques including ultrasonography and computed tomography. Cavography and magnetic resonance imaging were also performed in some cases.

Results:

The level of the tumor thrombus was infrahepatic (V2a) in nine cases and retrohepatic (V2b) in four. Ultrasound and magnetic resonance imaging were extremely useful in defining the extent of the thrombus in addition to detecting its presence. The caval thrombi were reached simply by ligation and division of the short hepatic veins in the V2a cases, but liver mobilization was required in the V2b cases. There were no operative deaths. Two patients who had metastases on surgery died of the disease eight and 13 months after surgery. Four of the 11 patients in whom no evidence of metastasis was found on surgery also died of the disease between nine and 16 months postoperatively. The remaining seven patients are still alive at periods of 6–74 months after surgery, with or without residual tumors. The nature of the intracaval tumor thrombi seems to affect the overall prognosis for survival. Elevated levels of acute phase reactants and immunosuppressive acidic protein were associated with short survival times.

Conclusions:

Our experience suggests that aggressive surgery should be considered in selected patients with non‐metastatic renal cell carcinoma extending into the vena cava.
PULMONARY NODULES IN PATIENTS WITH A HISTORY OF RADICAL NEPHRECTOMY FOR RENAL CELL CARCINOMA
Authors: Nakamoto Takahisa , Igawa Mikio , Mitani Shinji , Usui Akihiro , Yoshioka Shinkichiro , Nishiki Masayuki , Usui Tsuguru
Published: July 2007

Background:

Nine patients with a history of radical nephrectomy for renal cell carcinoma underwent surgical removal of newly detected pulmonary nodules at the Hiroshima University Hospital. Six patients had metastatic lung tumors two patients had bronchogenic primary carcinomas and one had a granulomatous infection.

Methods:

To determine if any characteristics can distinguish a new primary carcinoma from metastatic renal cell carcinoma, we reviewed the nine patients described above. The patients with pulmonary metastases and those with new primary lung cancers did not differ in age, sex, history of smoking, clinical stage and pathological findings of the renal primary site, on the location and size of the pulmonary nodules.

Results:

Only the interval between the nephrectomy and the appearance of the new pulmonary lesion may be a predictive factor. This interval was 48 and 51 months for the patients with new primary lung cancers but varied from 0 to 39 months for the patients with metastatic renal cell carcinoma. A solitary nodule had an equal chance of being metastatic or primary. Conclusions: These results indicate that a solitary nodule that is detected at a longer inferval after radical nephrectomy may be a new primary lung cancer. Once new pulmonary nodules are identified in a patient with a history of radical nephrectomy for renal cell carcinoma, surgical excision is required for a final diagnosis before initiating therapy for metastases.
DETECTION OF THE URINE JET PHENOMENON USING DOPPLER COLOR FLOW MAPPING
Authors: Matsuda Tadahisa , Saitoh Masahito
Published: July 2007

Background:

Ultrasonic Doppler color flow mapping was applied to detect urinary flow in this study. The purpose of the study was to provide fresh insight into urodynamic and functional studies of the kidney and ureter.

Methods:

Ultrasonic Doppler color flow mapping was performed from the abdominal surface to detect the urine jet phenomenon from the ureteral orifice in 25 healthy men and four healthy boys. In the cases in which the jet phenomenon was observed, the maximum velocity, mean velocity, successive time and frequency were measured. In 23 of the 25 men, the measurement was performed under normal circumstances and during diuresis.

Results:

In 23 (92%) of the 25 men and in three (75%) of the four boys, the urine jet phenomenon was clearly visualized under normal conditions. The measured maximum velocity, mean velocity, successive time and frequency on the left side under normal conditions for the men were 31.8 ± 15.3 cm/sec, 20.0 ± 10.2 cm/sec, 2.5 ± 1.3 sec and 1.2 ± 0.5/min, respectively. The magnitude of each of these parameters was smaller in the case of the boys.

Conclusions:

The detection of the jet phenomenon by Doppler color flow mapping is a promising new way of examining renal or ureteral function noninvasively.
SEQUENTIAL ANALYSIS OF RECURRENT CALCIUM CALCULI BY INFRARED SPECTROSCOPY
Authors: Matsuzaki Shoji , Matsushita Kazuo , Tanikawa Katsurni , Masuda Aiichiro , Matsunaga Juko
Published: July 2007

Background:

While the incidence of calcium urolithiasis increases, the precise mechanism of calcium oxalate stone formation is still controversial. Is the composition of a recurrent calcium oxalate stones always the same as previous ones? There are few reports that specifically address the question by study of sequential changes of the composition of recurrent calcium calculi.

Method:

From our medical records 70 patients with a history of two or more recurrent episodes of calcium oxalate stone disease were selected and the analyses of 190 stones were reviewed. Infrared spectroscopic analysis was done using a Perkin Elmer 1740 spectrophotometer.

Results:

Calcium oxalate monohydrate were detected in 63 stones, calcium oxalate dihydrate in 12, calcium oxalate monohydrate mixed with dihydrate in 28, calcium oxalate monohydrate mixed with calcium phosphate in 30, calcium oxalate dihydrate mixed with calcium phosphate in 20, calcium oxalate monohydrate mixed with dihydrate and calcium phosphate in 20, calcium oxalate monohydrate mixed with dihydrate and calcium phosphate in 37. Alterations of stone components during follow‐up were found in 43 stones from 40 patients. The shift of a main composition from calcium oxalate monohydrate to calcium oxalate dihydrate was found in 24 stones and vice versa in 19 stones.

Conclusions:

Sequential changes of the compositions of recurrent calcium calculi are highly likely to occur with time in individual recurrent calcium stone formers. Calcium oxalate monohydrate was a most common component of the studied recurrent calcium stones.
PLASMA ENDOTOXIN CONCENTRATIONS IN PATIENTS WITH URINARY TRACT INFECTIONS
Authors: Goto Toshihiro , Makinose Shinichi , Ohi Yoshitada
Published: July 2007

Background:

Although endotoxin elicits a variety of pathophysiological activities in hosts with gram‐negative bacterial infections, the clinical significance of plasma endotoxin levels have not been clearly defined in the patients with urinary tract infections. The purpose of the study was to measure plasma endotoxin concentrations in relation to the types of urinary tract infections and to examine their correlation with inflammatory parameters.

Methods:

Using chromogenic Limulus‐amebocyte lysate assay, plasma endotoxin concentrations were measured in a total of 63 patients with various types of nonspecific urinary tract infections. Results: The mean plasma endotoxin concentrations in patients with sterile pyuria, chronic complicated cystitis, acute uncomplicated pyelonephritis or acute exacerbation of chronic complicated pyelonephritis, chronic complicated pyelonephritis, and acute bacterial prostatitis or epididymitis were significantly higher than those in healthy individuals and in patients with acute uncomplicated cystitis. The correlation coefficients between plasma endotoxin concentrations and body temperatures, white blood cell counts in peripheral blood, erythrocyte sedimentation rates, and C‐reactive proteins were 0.678 (P 0.01), 0.503 (P 0.01), 0.416 (P 0.01), and 0.330 (P 0.01), respectively. Conclusions: Patients with urinary tract infections may respond to endotoxin locally and generally depending on the sites of infection involved. However, endotoxin levels do not always correlate to clinical findings or inflammatory parameters.
FACTORS AFFECTING THE OCCURRENCE OF UROTHELIAL TUMORS IN DYE WORKERS EXPOSED TO AROMATIC MINES
Authors: Shinka Toshiaki , Miyai Masahiro , Sawada Yoshihisa , Inagaki Takeshi , Okawa Tadashi
Published: July 2007

Background:

Past studies have analyzed individual jobs in dyestuff factories, materials manufactured and handled, age at exposure, and the duration of exposure in factories as factors related to the occurrence of urothelial tumors. None of these studies was based on long‐term observation, and the factors involved in the occurrence of urothelial tumors remain controversial. In this study, various factors that may affect the occurrence of urothelial tumors in dye workers were assessed by multivariate analysis.

Methods:

Three hundred and sixty‐three workers in nine member factories of the Dyestuff Industrial Cooperative associated were included the study. Factory A is a large dyestuff chemical factory in Wakayama City with 218 dye workers. The other eight smaller factories employ a total of 145 dye workers. Correlations of tumor occurrence with a variety of factors, such as dyestuff ‐intermediates manufactured and handled, types of job in the factory, age at the beginning of occupational exposure, and the duration of exposure were examined by multivariate analysis using multiple logistic models. Results: Urothelial tumors were found in 58 (16.0%) of the 363 dye workers in the nine member factories of the Cooperative associated examined in the present study. The incidence in workers in Factory A, 5.5% (12 patients), was significantly (P 0.01) lower than the overall incidence, while that in the eight small factories, 31.7% (46 patients), was significantly (P 0.01) higher than the overall incidence. The risk factors significantly related to tumor occurrence in the 363 dye workers were benzidine (odds ratio, 8.302) as a dyestuff intermediate, manufacturing work (odds ratio, 4.631), and a long period of exposure (odds ratio, 1.018). Correlations of the tumor occurrence with the various factors were examined by multivariate analysis using multiple logistic models. In the total of 363 workers, benzidine as an intermediate (P 0.05), manufacturing work (P 0.01) and the duration of exposure (P 0.01) were found to have contributed to the urothelial tumor occurrence. In Factory A, benzidine as an intermediate (P 0.01) and duration of exposure (P 0.05) contributed significantly to tumor occurrence.

Conclusions:

(1 The manufacturing and handling of benzidine and duration of exposure contribute significantly to the occurrence of occupational urothelial tumor, the former more strongly than the latter; 2) the contribution of different job types to tumor occurrence may be dependent upon the industrial health and safety practices in each factory.
ACCURACY OF PROSTATIC VOLUME CALCULATION IN TRANSRECTAL ULTRASONOGRAPHY
Authors: Kimura Akira , Kurooka Yuji , Hirasawa Kiyoshi , Kitamura Tadaichi , Kawabe Kazuki
Published: July 2007

Background:

Estimation of the prostatic volume by transrectal ultrasonography is now widely used to evaluate the effect of conservative treatment and to improve the specificity of prostate specific antigen. Accurate measurement of prostatic volume is necessary for the calculation of prostate specific antigen density (PSNprostatic volume ratio).

Methods:

Three dimensional models of the prostatic contour were constructed from transrectal ultrasonotomograms taken at 5 mm intervals in 20 cases. Using these models, the accuracy of ellipsoid volume calculation and prolate ellipse volume calculation were examined. For prolate ellipse volume calculation, prostatic length was measured in two ways; length (Lv) vertical to the transverse section, and length (Lp) parallel to the prostatic urethra.

Results:

Ellipsoid volume calculation showed errors of about 20%. Moreover, ellipsoid volume calculation fluctuated markedly (up to 50%) in accordance with the change of the scanning angle of the transverse section. The error of prolate ellipse volume calculation using Lp for length increased by an average of 25% as the angle moved away from the perpendicular. The prolate ellipse volume calculation using Lv for length was the most reliable method. The degree of error was least dependent on the angle between the plane and the axis.

Conclusion: Although prolate ellipse volume calculation was more accurate than ellipsoid volume calculation, it is essential to have the three axes cross at right angles to obtain an accurate value by the prolate ellipse volume calculation.
PROSTATE‐SPECIFIC ANTIGEN IN MASS SCREENING FOR CARCINOMA OF THE PROSTATE
Authors: Shimizu Toshihiro S. , Uchida Tatsuya , Satoh Jin , Imai Kyoichi , Yamanaka Hidetoshi
Published: July 2007

Background:

Prostate‐specific antigen (PSA) has various advantages over prostatic acid phosphatase (PAP) as a marker for prostate cancer, but its role in prostate cancer mass screening remains controversial. We measured serum PSA in addition to serum PAP determination and digital rectal examination (DRE) in our mass screening program to assess the usefulness of PSA for prostate cancer mass screening.

Methods:

Serum PSA and PAP measurements and DRE were performed in 1249 patients in mass screening for carcinoma of the prostate in 1989 and 1990. Thirteen cancers were diagnosed. We calculated the mean plus standard deviations (2SD) of the PSA and PAP values of men without cancer, and assessed the usefulness of PSA for prostate cancer screening by using these figures as the upper limit of normal.

Results:

The number positive for PSA, PAP and DRE were 39, 36 and 48, respectively. If our screening had been performed without DRE, three cancers would have remained undetected, and the number would have been the same if performed without PSA. If the screening had been performed without PAP, on the other hand, no cancers would have remained undetected. The sensitivities of PSA and PAP were 54% and 23%, respectively. The screening detection rate with DRE and PSA was 0.88%, and with DRE and PAP was 0.64%.

Conclusions:

Measurement of serum PSA values with adjustment of the cut‐off value was considered more useful than PAP in mass screening for prostate cancer.
SINGLE‐STEP PURIFICATION OF PROSTATIC ACID PHOSPHATASE: IMMUNOAFFINITY CHROMATOGRAPHY WITH A MONOCLONAL ANTIBODY
Authors: Yoshiki Tatsuhiro , Ueda Masamichi , Hirano Atsushi , Okada Ken‐ichiro , Yoshida Osamu
Published: July 2007

Background:

Prostatic acid phosphatase (PAP) is an important protein which should be studied further as a tumor marker or as a biologically functional molecule. The purpose of the study was to establish a simple and reliable method to obtain highly pure PAP.

Methods:

Spleen cells from mice immunized with prostatic epithelial cells prepared from benign prostatic hyperplasia tissue were fused with myeloma cells X63Ag8–653. Hybrid cells of interest were selected using the indirect immunofluorescence method with unfixed frozen tissue sections. One clone of the hybrid cell lines was established which secreted the monoclonal antibody specifically reactive to prostatic acid phosphatase. Using this monoclonal antibody, we purified the antigen from human prostatic tissue by means of single‐step immunoaffinity chromatography.

Results:

SDS‐PAGE profiling under reducing conditions indicated that the protein recognized by this antibody consisted of several components of molecular weight 41,000–45,000. Partial amino acid sequence analysis of this protein indicated that these components involved a heterogeneously modified single polypeptide, and that this antigen is identical to human prostatic acid phosphatase. Conclusions: This single‐step method saves the time needed to purify prostatic acid phosphatase and requires only half a day for the whole procedure. Moreover, the purity of the isolated protein was extremely high. This method seems to be useful not only for purifying prostatic acid phosphatase but also for purifying other proteins from the prostate gland and for analysis of antigenic macromolecules.