bluuebunny/crossref_metadata_2025 huggingface dataset:
FLOW CYTOMETRIC DETERMINATION OF THE DNA CONTENT IN TRANSITIONAL CELL CARCINOMA OF THE BLADDER: PREDICTABILITY OF PLOIDYWITH REGARD TO PELVIC LYMPH NODE METASTASIS
Authors: Lee Sang Eun , Kim Young Kyoon
Published: July 2007

Flow cytometry was used to evaluate 93 deparaffinized transurethral resection or cystectomy specimens to investigate the predictability of DNA profiles with regard to pelvic lymph node metastasis. The pathological stage and grade were also compared with the status of the pelvic lymph node. The incidence of aneuploidy in the total specimen group was 55 out of 93 (59%). Aneuploidy and pathologic stage were significant risk factors for pelvic lymph node metastasis (p = 0.0091, 0.0008 respectively) but histologic grade was not correlated with pelvic lymph node status (p = 0.7418). Aneuploidy was noted in all of the 11 specimens exhibiting lymph node involvement compared with 44 of the 82 (54%) without lymph node involvement (p=0.0091). There was no positive pelvic lymph node involvement in patients with diploid tumor compared with 11 of the 55 (20%) patients with aneuploid tumors. In conclusion, the recognition of a DNA aneuploid stemline in a primary transitional cell carcinoma of the bladder is statistically correlated with a greater likelihood of pelvic lymph node metastasis. This suggests that preoperative DNA flow cytometry for primary tumor might be helpful in selecting patients who should be offered additional treatment such as neoadjuvant chemotherapy before definitive treatment or a more conservative approach such as transurethral resection.
A COMPARISON OF PROSTATE CANCER PATIENTS IN JAPAN AND THE USA
Authors: Imai Kyoichi , Takahashi Yasuo , Nakata Seiji , Karr James P , Hubeiv Robert
Published: July 2007

Clinical characteristics of prostate cancer patients were anatyzed to compare the rates of progression of prostate cancer between patients in Japan (Gunma Urological Oncology Study Group: GUOSG) and the USA (Roswell Park Cancer Institute: RPCI), between 1980 and 1989. The stage of disease was more advanced and the age was greater in GUOSG patients compared with RPCI patients. However, the prostate cancer death rate of stage D patients at RPCI was significantly higher than that of the GUOSG. Moreover, the survival rate of stage A patients in the GUOSG was better than that of RPCI patients. The possibility of biases which may affect both the clinical characteristics and survival rates in the 2 populations studied is discussed. To determine whether there is a real difference in the rate of prostate cancer growth between the 2 countries will require a prospective study, ideally conducted in large population groups.
EVALUATION OF A SIMPLE TEST TO ESTIMATE URINE SATURATION WITH CALCIUM OXALATE IN STONE‐FORMING PATIENTS
Authors: Sanchez Ariel , Gonzalez Adriana , Sarano Hector Daniel , Reinaldi Silvia
Published: July 2007

In 43 patients with recent‐onset calcium oxalate nephrolithiasis (25 male, 18 female; age range:–61 yr), urine saturation with calcium oxalate (CaOx) was calculated using a computer program (Equil‐AT). The results in kJ/mol (normal < 2.0) were compared with those obtained with a simple test consisting of the addition of increasing amounts of calcium and oxalate to 3 tubes containing 10 ml urine. Development of turbidity in tube I denotes urine supersaturation with CaOx; turbidity in tubes II or III indicates lesser degrees of saturation, while a lack of turbidity (NT: no turbidity) shows undersaturation. Both saturation estimates were performed using aliquots of 24‐hour urine collections. Twenty‐one samples developed turbidity in tube I, 9 in tube II, and 6 in tube III, while 7 showed NT. There were no significant differences in Equil‐AT values between II and III and between III and NT (p < 0.05 for I vs II and I vs III). High computer‐calculated saturation values were found in 86% of group I samples and 22% of group II samples. None of the urines exhibiting turbidity in tube III or NT had high saturation values as estimated by Equil‐AT. The turbidity test was also performed using freshly voided morning urine samples from the same patients. The results agreed with those obtained using the same test on aliquots of 24‐hour collections, although in 10.8% of patients the morning test indicated higher levels of saturation. It is concluded that the turbidity test is a rapid, inexpensive and accurate way of estimating urine saturation with CaOx in the outpatient clinic.
INTRAVESICAL ANTITUMOR THERAPY IMMEDIATELY AFTER TRANSURETHRAL RESECTION OF BLADDER CANCER
Authors: Fujita Kimio
Published: July 2007

Patients with superficial transitional cell cancer of the urinary bladder were entered into a randomized trial to compare the effects of immediate and short‐term postoperative instillation of peplomycin sulfate with simple irrigation. Although the recurrence‐free rate of the 46 peplomycin‐treated patients was lower, the difference was not significant. Repeated washing of the bladder at the end of transurethral resection might partly replace the role of cytotoxic therapy.
AUGMENTATION DURACYSTOPLASTY IN NEUROGENIC BLADDER DYSFUNCTION
Authors: Arikan Nihat , Özdiler Erol , Yaman Öder , Gögüs Orhan
Published: July 2007

Background

Augmentation cystoplasty is the treatment of choice for patients with neurogenic bladder dysfunction in cases that are unresponsive to other medical treatment. Although intestinal segments as bladder substitutes are preferred over the other alternatives at present, they are not ideal bladder replacements due to several potential hazards. The purpose of this study was to determine whether or not augmentation duracystoplasty can be an afternative to augmentation enterocystoptasties.

Methods:

Ten patients with neurogenic bladder dysfunction unresponsive to conservative measures, underwent augmentation duracystoplasty by using the modified Bramble‐Clam technique. The follow‐up period was T‐28 months.

Results:

At present, seven of 10 patients are completely continent for with clean intermittent catheterization. The remaining three patients required oral oxybutinin therapy, postoperatively, to achieve continence although lower dosages than those required in the preoperative period. We did not observe any serious pre‐ or postoperative complications.

Conclusions:

Based on these preliminary findings we think that duracystoplasty can be considered as a treatment alternative for hyperreflexic and/or low compliant neurogenic bladders.
LOBAR DYSMORPHISM OF THE KIDNEY
Authors: Sakai Shigeru , Yanase Masahiro , Koroku Mikio , Shimamura Shohgo , Hiromura Tadao
Published: July 2007

We report a case of a 38‐year‐old woman with lobar dysmorphism of the kidney. Lobar dysmorphism is a pathology classified under renal pseudotumor, which has received little attention. It is presumed that these cases will increase in number with advances in imaging diagnosis. Dynamic CT scan is useful for the diagnosis of this disease.
Immunohistochemical Study of the Proliferating Ability and Malignant Potential of Transitional Cell Carcinoma in the Human Urinary Bladder
Authors: Yoshikawa Hiroyasu , Ikeuchi Takao , Kai Yoshio
Published: July 2007

Actively dividing cells produce a number of proteins that may serve as useful antigenic markers in immunological studies of cellular proliferation and malignant potential. We investigated the expression of PCNA, p53 and c‐a erbB–2 proteins in transitional cell carcinoma of human urinary bladder using an immunohistochemical method, and compared the results with the histologic grades and stages. Immunohistochemical studies on these proteins using monoclonal or polyclonal antibodies were performed with formalin‐fixed paraffin sections of tumor tissue from 40 patients with bladder cancer.

Generally, higher‐grade and higher‐stage tumors expressed PCNA and p53 and c–erbB–2 proteins with greater frequency than tumors of a lower grade or lower stage. These results suggest that the detection of each antigen might be useful in estimating the malignant potential of transitional cell carcinoma as an adjuvant study, because of its applicability to paraffin‐embedded tissue sections and its simple, rapid technique.
Intra–Arterial Infusion Therapy Following Alteration of Pelvic Blood Flow and Concurrent Radiation Therapy for Invasive Bladder Cancer
Authors: Umeyama Tomokazu , Mashimo Tooru , Nakazato Haruki , Tokunaga Takashi , Uehara Hisao , Shinozaki Tadatoshi , Kawashima Miho , Akimoto Tetsuo
Published: July 2007

Intra–arterial infusion therapy following alteration of pelvic blood flow and concurrent radiation therapy was performed in 13 patients with muscle invading bladder cancer (T2, 2; T3, 6; T4, 5). The internal iliac artery of the opposite side was embolized and the ipsilateral gluteal and obturator arteries were embolized by metallic coils. A catheter was placed in the ipsilateral internal iliac artery. CDDP was administered daily at a dose of 7–9 mg/body over 1 minute. Radiation was done by Microtron using 10 MV x–ray. Total dose was 4500–7060 cGy.

Evaluation was done by cystoscopy, radiography and biopsy. Eight patients achieved complete response (CR) histologically. Others had partial response (PR). All CR patients had no recurrence. The observation period was between 3 and 29 months, with a mean of 11 months. This treatment modality is effective for locally advanced bladder cancer.
Sodium Chloride–Dependent Oxalate Absorption in the Human Gut
Authors: Yamakawa Kensuke , Kato Takahiro , Kawamura Juichi
Published: July 2007

We investigated the effect of sodium chloride intake on oxalate and calcium metabolism in the human body. In healthy subjects with a simultaneous intake of sodium oxalate (4 μmoles/kg body weight) and sodium chloride (1.2 mmoles/kg body weight), the change in oxalate–creatinine ratio was 2.04 ± 0.74, and 3.25 ± 1.29 (means ± SD), respectively, after 2 and 4 hours of oxalate intake (n= 8). The magnitude of the change in the ratio was significantly greater in the case with simultaneous intake of sodium chloride and sodium oxalate in comparison to the case with an intake of sodium oxalate alone (P < 0.05 and P < 0.01 after 2 and 4 hours of intake of oxalate, respectively). In subjects with an intake of sodium chloride alone, the change in calcium–creatinine ratio was 49.07 ± 29.96 and 0.363 ± 0.309 (means ± SD), respectively, after 2 and 4 hours of sodium chloride intake (n= 3). The results suggest that high sodium intake can be one of the risk factors for urolithiasis.
Dissolution of Residual Microfragments with Citrate Therapy after Extracorporeal Shock Wave Lithotripsy
Authors: Morimoto Shigeyoshi , Uehara Masaki , Yamauchi Toshiki , Yasukawa Shu , Ohkawa Tadashi
Published: July 2007

Residual microfragments after ESWL were studied for their presence and for possibility of dissolution with citrate therapy. Among 123 patients with renal stones who became stone–free following ESWL, a computed tomogram (CT) identified remaining microfragments within the treated kidney in 31.7% of the patients, even though stone fragments were not detectable on ordinary x–ray (KUU). The experiments, in which calcium oxalate stone fragments collected after ESWL were incubated in buffer solutions with citrate 0 to 4 mmol/L, showed that citrate dissolved the stone fragments. Using human urine as a solution, the dissolving effect was greater in spot urines after alkali citrate administration than in control urines. Eighteen patients with microfragments underwent a follow–up CT 3 months later. The results showed that the microfragments had disappeared in 6 of 11 (54.5%) patients who had been taking alkali citrate, whereas microfragments remained unchanged in all 5 patients without medication. Our results suggest that citrate therapy would be advisable as a prophylaxis for stone recurrence especially after ESWL treatment.
Fournier's Disease: Adjunctive Hyperbaric Oxygen Therapy to Classic Therapy
Authors: Baykal Kadir , Albayrak Selami , Inal Haluk , Elbuken Emin , Dundar S Kadir , Onol Yavuz
Published: July 2007

Fournier's diseasv is a very rate and highly iatal necrolizing fasciitis of genital and perineal tissues. Conventional treatment of Fournier's disease includes surgeal debridement and antibiotic therapy. We describe a case of Foumier's disease where we added hyperbaric oxygen therapy to the conventional treatment regimen.
Inverted Transitional Cell Carcinoma of the Ureter
Authors: Kawachi Yoshio , Ishi Kazuhisa
Published: July 2007

An inverted urothelial tumor (transitional cell carcinoma, inverted type, grade 1), consisting of a large (3.5 ± 1.2 ± 1.2 cm) tumor with stalk (0.3 cm in diameter) and surrounding broad base polypoid foci (0.5 ± 0.6 ± 0.5 cm altogether), was found in the lower segment of the left ureter of a 59‐year‐old man. He has taken oral anticancer drugs and kanpo medicine as a follow‐up for 61 months, and is now free of disease. Differential diagnosis, inverted urothelial papilloma and carcinoma, and adequate treatment are discussed.
Management of Late Complications of Continent Urinary Diversion Using the Kock Pouch and the Indiana Pouch Procedures
Authors: Okada Yusaku , Shichiri Yasumasa , Terai Akito , Kakehi Yoshiyuki , Terachi Toshiro , Arai Yoichi , Yoshida Osamu
Published: July 2007

Background: Continent urinary diversion (CUD) is performed on patients after total cystourethrectomy due to invasive bladder cancer or other diseases requiring urinary diversion. Since 1984, we have performed CUD using either the Kock pouch procedure or a modified Indiana pouch method. During the long‐term follow‐up, increasing numbers of late complications occurred, especially after the Kock pouch procedure. We summarized the frequency of postoperative complications, their management, and outcome of CUD using these 2 methods.

Methods: Between 1984 and 1995, CUD using the Kock pouch method was performed on 102 patients, and on 61 patients using the Indiana pouch method, with a mean follow‐up period of 83 and 50 months, respectively. The patients were between 24 and 82 years old, with a mean age of 59 years. In most patients, the Kock pouch was constructed according to the original method, except for the use of a Dacron fabric collar, and the Indiana pouch was made using the ileal patch method.

Results: Of 95 patients followed up for more than 3 months after CUD using the Kock pouch method, efferent and afferent nipple valve malfunction occurred in 21 (22%) and 26 (27%) patients, respectively. Efferent complications occurred during the first year after surgery, whereas afferent complications occurred several years after surgery. Open repair surgery (excluding ileus) was necessary for 36 (38%) patients. Of 59 patients followed for more than 3 months after CUD using the Indiana pouch method, 7 patients with stomal stenosis, 2 patients with stomal prolapse, and 1 patient with stricture at the ureterocolonic anastomosis were treated surgically. An hourglass‐like deformity of the pouch was seen in 2 patients, on whom the original Indiana pouch method was performed. As a whole, 13 patients (22%) were retreated with open surgery. Urinary calculi occurred in 42 (44%) patients after CUD using the Kock pouch method and in 11 patients (19%) using the Indiana pouch method. The outcome was excellent, good, fair, and poor in 31, 37, 24, and 8% of the patients after CUD using the Kock pouch method, and in 36, 17, 42, and 5% of the patients after CUD using the Indiana pouch method.

Conclusions: We performed CUD using either the Kock pouch or the Indiana pouch method with a success rate of approximately 90%. The rates of revision, reoperation and stone formation were higher with the Kock pouch procedure than with the Indiana pouch procedure, while varying degrees of incomplete incontinence and difficulty in catheterization were seen more often in the latter.
PSA Value Adjusted for the Transition Zone Volume in the Diagnosis of Prostate Cancer
Authors: Kurita Yutaka , Ushiyama Tomomi , Suzuki Kazuo , Fujita Kimio , Kawabe Kazuki
Published: July 2007

Background: The aim of the present study was to improve the accuracy of the prostate‐specific antigen (PSA) density for detecting prostate cancer by using the transition zone (TZ) volume instead of the total prostate volume.

Methods: From April 1994 to October 1995, we examined 164 consecutive patients (52–88 years old), with an elevated PSA and/or abnormal digital rectal examination. All patients underwent a transrectal ultrasound‐guided biopsy. The PSA density for total prostate volume (PSAD) and for TZ volume (PSAT) were calculated from the transrectal ultrasound measurements.

Results: Forty‐four of the 162 patients (27.2%) had histological confirmation of prostate cancer on biopsy. The area under the receiver‐operator characteristic curve was 0.667 for. PSA, 0.663 for PSAD, and 0.826 for PSAT. These areas were not significantly different for PSA and PSAD. However, PSAT was significantly superior to PSAD in differentiating benign hyperplasia from prostate cancer (P< 0.01).

Conclusion: The TZ volume‐adjusted PSA density (PSAT) is useful for selecting patients for prostate biopsy from those with suspected prostate cancer.
Pros‐EightTM Transurethral Radiofrequency Thermotherapy for Benign Prostatic Hyperplasia: Preliminary Clinical Results
Authors: Yoshida Osamu , Terai Akito , Shichiri Yasumasa , Okada Yusaku , Ishitoya Satoshi , Okubo Kazutoshi , Suzuki Yuji , Arai Yoichi
Published: July 2007

Background: We have developed a new transurethral thermotherapy device using 8MHz radiofrequency (RF) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH). We report the safety and effectiveness of the initial clinical experience with this device

Methods: Sixty patients with symptomatic BPH were subjected to a single 1‐hour treatment under local anesthesia. The treatment device uses extracorporeal RF capacitive heating in combination with radiative heating and conductive cooling of the urethra.

Results: In the 49 patients evaluahle at 3 months, the mean International Prostate Symptom Score decreased from 17.8 to 13.1 (P < 0.0001) and the Quality of Life score decreased from 4.4 to 3.4 (P < 0.0005). Maximum flow rate increased from 8.1 to 9.7mL/s (P< 0.05) at 3 months. Overall effectiveness by Homma's response criteria was as follows; excellent 4.1%, good 10.2%, fair 38.8% and poor 46.9%. Side effects were minimal. Gross hematuria was seen in 3 patients and erosion of the external urethral meatus was seen in 2 patients, but none had urinary retention.

Conclusions: In this initial clinical trial, transurethral RF thermotherapy was safe and resulted in modest symptomatic improvement. Further investigations for optimizing the treatment protocol seem warranted.
Malignant Melanoma of the Kidney Presenting as a Primary Tumor
Authors: Tajima Kazuhiro , Saito Kaoru , Umeda Yoshiki , Murata Tetsuya , Satani Hiroyuki
Published: July 2007

We report a case of malignant melanoma of the kidney presenting as a primary tumor. This tumor was found incidentally in a 74‐year‐old woman. The patient underwent a right radical nephrectomy, and has been living tumor free for 2 years and 3 months. This is the first reported case of primary renal malignant melanoma. We discuss the probability that this tumor is renal in origin and directly linked to the origin of malignant melanoma.
Preoperative Localization of Parathyroid Adenomas Using 99mTc‐MIBI Scintigraphy in Patients with Hyperparathyroidism
Authors: Ebisuno Shoichi , Inagaki Takeshi , Yoshida Toshihiko , Yamamoto Motoki , Tabuse Yoji , Kohjimoto Yasuo , Ohkawa Tadashi
Published: July 2007

Background Technetium (Tc) 99m methoxyisobutyl isonitrile (99mTc‐MIBI) has recently been introduced for parathyroid imaging, as well as for myocardial imaging. We studied the usefulness of 99mTc‐MIBI scintigraphy for preoperative localization of abnormal parathyroid glands.

Methods The usefulness of 99mTc‐MIBI scintigraphy for detection of hyperfunctional parathyroid lesions was evaluated in 5 patients with primary hyperparathyroidism. The results of localizing the abnormal glands by using 99mTc‐MIBI were compared with those obtained by using thallium (Tl) 201‐technetium (Tc) 99m (2ulTI‐99mTc) subtraction scintigraphy, computed tomography, and ultrasonography.

Results The delayed (2 hours) imaging of 99mTc‐MIBI scintigraphy was highly useful for accurate localization of the abnormal parathyroid lesions. The diseased glands were detected in all cases where 99mTc‐MIBI scintigraphy was used, and using 99mTc‐MIBI scintigraphy provided more information than did computed tomography, ultrasonography, or 201Tl‐99mTc subtraction scintigraphy. Conclusion: This method is simple and essential for detecting hyperfunctioning parathyroid glands, especially those with small or ectopic lesions. This technique should be widely applied as a localizing diagnostic method for hyperparathyroidism.
Functional Outcome and Late Complications in Patients with Continent Urinary Reservoirs
Authors: Taguchi Keisuke , Hirose Takaoki , Ito Naoki , Kumamoto Yoshiaki , Tsukamoto Taiji
Published: July 2007

Background We reviewed the functional outcome and late complications of continent urinary reservoirs (CUR) constructed with a cecocolonic segment, including the Indiana pouch, in 37 patients treated in our clinic.

Methods The CUR procedure was performed on 37 patients, creating partially detubularized (PD) reservoirs in 9 patients, totally detubularized (TD) reservoirs in 16 patients and reservoirs with an ileal patch (IP) in 12 patients. Continence was achieved by the nipple valve in 10 patients and by ileal plication in 27 patients. The mean follow‐up period was 46 months (range, 15 to 87 months). The function of the reservoir was evaluated by measurement of the intrareservoir pressure.

Results Patients with the TD reservoir had less frequent appearance of involuntary, phasic elevation of the intrareservoir pressure (30.8%) than those with the PD reservoir (62.5%). In contrast, this phasic elevation was found in only 1 patient with an IP reservoir. The IP reservoir had the largest capacity accompanied by the lowest maximum intrareservoir pressure. Total incontinence was observed in 2 patients with ileal plication due to disruption of the plicated sutures on the terminal ileum. Frequent difficulty in catheterizing the reservoir was found in 2 patients, and reservoir‐ureter reflux was found in 3 renal units. The serum chloride level was significantly elevated after surgery, however, in most patients the levels remained within normal limits.

Conclusion Our experience of the outcome and late complications of reservoirs indicates that the cecocolonic reservoir with an ileal patch and stapled ileal plication, i.e., the Indiana pouch, is a better choice for continent urinary diversion for patients who need a cystectomy.
PCNA and p53 in Urinary Bladder Cancer: Correlation with Histological Findings and Prognosis
Authors: Inagaki Takeshi , Ebisuno Shoichi , Uekado Yasunari , Hirano Atsuyuki , Hiroi Akihisa , Shinka Toshiaki , Ohkawa Tadashi
Published: July 2007

Background This study aimed to immunohistochemically examine the expression of proliferating cell nuclear antigens (PCNA) and pS3 protein in transitional cell carcinomas (TCC) of the urinary bladder, and to investigate possible correlations of this expression with the tumor grade or stage, tumor recurrence, and prognosis of the disease.

Materials and Methods The immunohistochemical status of the PCNA and p53 proteins were determined on paraffin‐embedded sections from 128 patients with TCC of the urinary bladder, using PC‐10 and D07 as the primary antibodies. Positive stainings were represented by scores (Labeling Index; LI, %) calculated as the percent of positive cells among all neoplastic cells counted. The findings were compared to the patients' histopathological features. Patients who underwent transurethral resection were divided into groups with low and high scores for PCNA and p53, respectively, and the tumor recurrence rate was compared among the groups. Patients who underwent total cystectomy were similarly divided into low and high score groups, and survival rates of the groups were compared.

Results PCNA expression was observed in 66 of 128 patients (51.6%), with a mean labeling index of 26.6%. Overexpression of p53 was observed in 65 of 1 28 patients (50.8%), with a mean labeling index of 35.3%. There were significant correlations of the PCNA and p53 indices with both histological grade and stage of the tumor. In the TUR group, there were no statistically significant differences in recurrence rate between the groups with high or low scores for either PCNA or p53. In the total cystectomy group, there was a significant correlation between survival rate and positive staining for PCNA, but not for p53. The relationship between 2 parameters, PCNA and p53 scores, was not significant (linear correlation coefficient, r= 0.67).

Conclusions PCNA and p53 status in transitional cell carcinomas of the urinary bladder is related to the histopathological findings. We also suggest that immunohistochemical staining for PCNA provides significant clinical information which may be useful in the initial selection of therapy. However, overexpression of p53 does not appear to represent an independent prognostic marker in bladder tumors.
Horseshoe Kidney with Retrocaval Ureter and Ureteropelvic Junction Obstruction: A Case Report
Authors: Shigeta Masanobu , Nakamoto Takahisa , Nakahara Mitsuru , Hiromoto Nobuhiko , Usui Tsuguru
Published: July 2007

We report a rare disorder, horseshoe kidney accompanied by retrocaval ureter and ureteropelvic junction obstruction, in a 42‐year‐old man. This is the third case in the world literature.
Carcinosarcoma in the Region of the Female Urethra
Authors: Konno Naoko , Mori Masaya , Kurooka Yuji , Kameyama Shuji , Homma Yukio , Moriyama Nobuo , Tajima Atsushi , Murayama Takeo , Kawabe Kazuki
Published: July 2007

A 61‐year‐old woman with acute urinary retention was found to have a carcinosarcoma in the region of the urethra. Evaluation of the computed tomogram suggested a urethral tumor, which was resected by a transperineal approach. She received local radiotherapy after surgery, and is alive at 1 ‐year follow‐up with a tumor metastasis to the pelvis.
Prognostic Factors for Renal Cell Carcinoma: A Multivariate Analysis of 320 Cases
Authors: Masuda Hiroaki , Kurita Yutaka , Suzuki Akihiko , Kanbayashi Tomoyuki , Suzuki Kazuo , Fujita Kimio
Published: July 2007

Background We performed a multivariate analysis of clinical variables in 320 patients with renal cell carcinoma to identify important prognostic factors for long‐term survival.

Methods We retrospectively reviewed the medical records of 320 patients who presented with renal cell carcinoma. Survival curves were calculated by the Kaplan‐Meier method and statistical differences were determined by the log‐rank test. Significant prognostic factors were evaluated by Cox's multivariate proportional hazard model.

Results The median follow‐up period was 29 months. The overall survival rates at 1, 5, and 10 years were 90.0%, 77.6%, and 69.9%, respectively. Seventeen of the 19 prognostic factors evaluated were shown to be significant by the log‐rank test: patient age, sex, performance status, body temperature, erythrocyte sedimentation rate (ESR), levels of hemoglobin, a2‐globulin, C‐reactive protein, fibrinogen, immunosuppressive acidic protein (IAP), size or involvement of tumor (T classification), regional lymph node involvement (N classification), extent of metastasis (M classification), pathologic grade, tumor cell type, mode of tumor infiltration, and the modality of treatment (curative surgery). Among them, the body temperature, ESR, a2‐globulin, fibrinogen, IAP, and mode of tumor infiltration were excluded from multivariate analysis because of missing data. Curative surgery was also excluded because it is a treatment modality and different from the other variables which are clinical or pathologic characteristics. From the remaining 10 variables, multivariate analysis showed that age (P = 0.0389), N classification (P = 0.0289), and M classification (P <0.0001) were important and independent prognostic factors for long survival.

Conclusion This analysis showed that age, N classification, and M classification were the most important factors predicting long‐term survival of patients with renal cell carcinoma.
Transurethral Balloon Laser Thermotherapy for Urinary Retention in Patients with Benign Prostatic Hyperplasia Who Are at High Surgical Risk
Authors: Furuya Seiji , Ogura Hiroshi , Tanaka Yoshinori , Tsukamoto Taiji , Daikuzono Norio , Liong Men Long
Published: July 2007

Background Twelve patients with benign prostatic hyperplasia and urinary retention, who were considered to be poor candidates for prostatectomy, were treated by transurethral balloon laser thermotherapy (TUBAL‐T). The mean patient age was 78.9 years (range, 66 to 93 years) and the mean duration of bladder catheterization was 11 weeks (range, 2 to 48 weeks).

Methods Irradiation into the prostatic tissue was done through 360 with a neodymium: yttrium aluminum garnet (Nd:YAG) laser balloon placed in the prostatic urethra, with pain relief provided by using local topical anesthesia. The total laser dose was from 45,000 to 1 23,376 J, with an average of 73,089 J. The irradiation time was from 40 to 54 minutes, with an average of 45.2 minutes.

Results Spontaneous voiding became possible in all patients at a mean of 2.8 days (range, 1 to 7 days) after irradiation. The mean catheter‐free period was 20.5 months (range, 6 to 34 months), with the longest being 34 months. The international prostatic symptom scores, quality‐of‐life scores, and peak uroflow rates showed substantial improvement after laser thermotherapy. To date, long‐term resumption of spontaneous voiding was successfully achieved in 9 of 12 cases (75%).

Conclusion TUBAL‐T is a safe and effective alternative for treatment of urinary retention in patients with benign prostatic hyperplasia who are considered to be at high surgical risk.
Significance of the Preoperative Intravesical Instillation of Doxorubicin and the Oral Administration of 5‐Fluorouracil in Preventing Recurrence After a Transurethral Resection of Superficial Bladder Cancer
Authors: Naito Seiji , Iguchi Atsushi , Sagiyama Kazuyuki , Ariyoshi Asami , Osada Yukio , Omoto Tetsuo , Kuriya Norikazu , Kumazawa Joichi
Published: July 2007

Background: The postoperative intravesical instillation of doxorubicin (ADM) has a preventative effect on recurrence after a transurethral resection (TUR) of superficial bladder cancer. However, the significance of preoperative ADM instillation remains unclear. Although the oral administration of 5‐fluorouracil (5‐FU) has been observed to show some clinical response against bladder cancer, its preventative effect on the recurrence of superficial bladder cancer after TUR is unknown. Methods: Patients were randomized into 4 groups. All 4 groups received postoperative ADM instillation. In addition, patients in groups C and D received preoperative ADM instillation, whereas patients in groups B and D additionally received oral 5‐FU postoperatively. The nonrecurrence rate and side effects were both compared among the 4 groups.

Results: Of the 282 patients registered, 200 were evaluable, with a median follow‐up period of 21.4 months. There were no significant differences in the characteristics of the patients among the 4 groups. Group C (pre‐ and postoperative ADM) showed a significantly longer disease‐free interval than group A (postoperative ADM alone). However, there was no significant difference in the disease‐free interval between groups A and B (postoperative ADM plus 5‐FU), or between groups C and D (pre‐ and postoperative ADM plus 5‐FU). Bladder irritation symptoms were the most frequently noted side effect encountered in all groups, but the severity was generally mild.

Conclusions: Preoperative ADM instillation was found to prevent recurrence to a greater extent than the usual postoperative instillation alone, whereas oral 5‐FU was found to have no additional beneficial effect on the disease‐free interval in patients with superficial bladder cancer.
Evaluation of Prostate Specific Antigen Density and Transrectal Ultrasonography‐Guided Biopsies in 100 Consecutive Patients with a Negative Digital Rectal Examination and Intermediate Serum Prostate Specific Antigen Levels
Authors: Tarcan Tufan , Ozveri Hakan , Biren Tugrul , Turkeri Levent , Akdas Atif
Published: July 2007

Background: This study was undertaken to assess the importance of prostate biopsies in patients with a negative digital rectal examination (DRE) and elevated prostate specific antigen (PSA) levels and to investigate the role of PSA density (PSAD) and hypoechoic lesions on transrectal ultrasound (TRUS) in increasing the diagnostic sensitivity and specificity for prostate cancer (PCa).

Methods: One hundred patients with varied initial symptoms who had a negative DRE and a PSA level between 4 and 20ng/mL underwent TRUS‐guided systematic and, if present, lesion‐directed biopsies.

Results: PCa was detected in 11 patients (11%). TRUS examinations revealed hypoechoic lesions in 31 patients. Lesion‐directed biopsies revealed PCa in 1 3% (4/31) of patients with abnormal TRUS whereas, 7% (5/69) of patients with negative TRUS findings had PCa. Additional systematic biopsies detected PCa in 2 patients where lesion‐directed biopsies were negative. None (0/19) of the lesions smaller than 0.2 ml on TRUS had PCa whereas, 33% (4/1 2) of patients with lesions greater than 0.2 ml had PCa. When the subgroup of patients with negative TRUS and PSA levels between 4 and 10ng/mL were considered, 25% (1/4) of cases with PCa would have been missed if 0.15 was used as the cut‐off point for PSAD, however, this would save 61% (30/49) of unnecessary biopsies. The positive predictive value of PSA (cut‐off level lOng/mL), PSAD (cut‐off level 0.15), and hypoechoic lesions on TRUS were found to be 11.5%, 33%, and 13%, respectively. When hypoechoic lesions greater than 0.2 mL were taken as the positive finding, the positive predictive value and specificity rates of TRUS increased to 33% and 91 %, respectively, without any change in the sensitivity.

Conclusions: In patients with a negative DRE and intermediate PSA levels, the application of PSAD would have saved 49% of study patients with BPH from a biopsy, but would have missed 27% of PCa cases. By ignoring lesions smaller than 0.2 mL on TRUS, a very high specificity of 91% was achieved with a sensitivity of 36%. Thus, further investigations aimed at defining a better mode of diagnosis of PCa are warranted.
Small Cell Carcinoma of the Kidney: Case Report
Authors: Kitamura Masaya , Miyanaga Takeaki , Hamada Masaru , Nakata Yasuo , Satoh Yoshiki , Terakawa Tomoyoshi
Published: July 2007

An 83‐year‐old female diagnosed with small cell carcinoma of the kidney is reported on. The clinical picture was similar to that seen with transitional cell carcinoma of the renal pelvis. A right nephroureterectomy was performed and a histological examination revealed similar morphological features to those of small cell carcinoma of the lung. Neuroendocrine differentiation was proven by a positive immunoreaction to neuron‐specific enoiase. A review of the literature indicated that in the urinary tract, most of the cases of small cell carcinoma occurred in the urinary bladder, with this case being the eleventh reported case of small cell carcinoma originating in the kidney. As with many of the other cases of small cell carcinoma of the urinary tract, this patient's tumor was associated with both adenomatous and squamous differentiation. The patient died 2 months after surgery, prior to any chemotherapy administration.
Distal Penile Gangrene in a Patient with Chronic Renal Failure
Authors: Atalay A. Cem , Karaman M. ihsan
Published: July 2007

To date, only 10 cases of distal penile gangrene in patients with chronic renal failure have been reported. This rare condition is believed to result from progressive vascular calcification due to secondary hyperparathyroidism in patients with chronic renal failure. We report an additional case of distal penile gangrene in a 41‐year‐old man who presented with chronic renal disease and pulmonary tuberculosis. Since some authors have emphasized that aggressive surgical treatment in such cases has a significant mortality rate, we took a more conservative approach to treatment.
Efficacy of Continuous Subcutaneous Infusion Therapy Using Interferon α and the Possible Prognostic Indicator of TNF‐α in Renal Cell Carcinoma
Authors: Matsuyama Hideyasu , Yamamoto Mitsutaka , Yoshihiro Satoru , Ohmoto Yasukazu , Naito Katsusuke
Published: July 2007

Background:

In an attempt to improve efficacy by escalating the dose and maintaining higher serum concentrations over a long period of time, this study examines continuous interferon α (IFNα) subcutaneous infusion therapy in patients with renal cell carcinoma (RCC).

Methods:

Seven of 11 patients with RCC had evaluable metastatic lesions. A highly purified natural human IFNα was injected subcutaneously via an infuser pump for 5 consecutive days, followed by a 2‐day rest period (25 million IU/week). The treatment was continued for a period of 15 weeks. Serum concentrations of IFNα, IL‐1α, IL‐1β, TNF‐α, and IFNγ were measured at intervals throughout the study period.

Results:

Two of the 7 patients with evaluable lesions achieved a partial response (overall response rate, 29%), while 1 achieved a partial response only to lung metastasis. These 3 cases were defined as responders. No difference was found in the concentration of serum IFNα between responders and nonresponders, however, a significantly higher concentration of serum TNF‐a was observed in responders (P<0.05, Mann‐Whitney U test). Five cases (45%) had moderate to severe adverse effects, including depression (n = 1), eyeground hemorrhage (n = 2), and general fatigue (n = 2).

Conclusion:

Appropriate patient selection may be necessary for subcutaneous continuous infusion therapy for the treatment of metastatic RCC. Also, the serum concentration of TNF‐α measured during the course of treatment reflected well on the outcome of IFNα therapy.
Value of Systematic Transition Zone Biopsy in the Detection of Prostate Cancer
Authors: Maeda Hiroshi , Ishitoya Satoshi , Aoki Yoshitaka , Okubo Kazutoshi , Okada Takashi , Maekawa Shinya , Arai Yoichi
Published: July 2007

Background:

We evaluated routine transition zone biopsies for the detection of prostate cancer.

Methods:

Systematic sextant transrectal biopsies, including 2 systematic transition zone biopsies (sextant biopsy group), were performed on 196 consecutive patients. Biopsies were based on indications from digital rectal examination and/or a serum PSA level greater than 4.0 ng/ml. During the same period, 21 patients with persistently elevated PSA levels and earlier negative systematic biopsies also had the sextant biopsy (re‐biopsy group). The sextant biopsy group was compared with 1 24 cases in our previous cancer detection program who had systematic quadrant biopsies targeted to the peripheral zone (quadrant biopsy group).

Results:

Between the sextant and quadrant biopsy groups, the difference in rate of cancer detection was not significant statistically. Of the sextant biopsy group, 64 (33%) demonstrated malignancy, including 9 (4.6%) with cancer found exclusively in the peripheral zone and 55 (28%) both in the peripheral and transition zones. No cancer was found exclusively in the transition zone. Of the re‐biopsy group, all 4 cancers (19%) were detected in the transition zone, 2 of them exclusively in the transition zone.

Conclusion:

Routine transition zone biopsies did not increase the detection rate of prostate cancer. Systematic transition zone biopsies proved useful to the patients with persistently elevated PSA values and negative results in previous systematic peripheral zone biopsies.
Chemotherapy of Metastatic Testicular Germ Cell Tumors: Relationship of Histologic Response to Size Reduction and Changes in Tumor Markers
Authors: Koshida Kiyoshi , Kadono Yoshifumi , Konaka Hiroyuki , Kitagawa Yasuhide , Imao Tetsuya , Kobayashi Tadahiro , Kunimi Kazuto , Uchibayashi Tadao , Namiki Mikio
Published: July 2007

Background Although testicular germ cell tumor is one of the most curable cancers, approximately 20% of advanced cases remain incurable. In this study we investigate factors that may predict a poor response to standard chemotherapeutic regimens and thus allow earlier initiation of more aggressive measures.

Methods We analyzed the records of 19 patients with metastatic testicular germ cell tumors (8 seminomas and 11 nonseminomas). Sixteen patients underwent surgical exploration for residual tumors following chemotherapy, and the histological findings on the resulting specimens were correlated with reductions in tumor size observed on computed tomography and with changes in tumor marker levels.

Results Complete necrosis was obtained in 10 of 12 lesions that shrank by at least 80%, while continued existence of teratoma or cancer was confirmed in 9 of 11 lesions with smaller size reductions. An initial human chorionic gonadotropin‐ß subunit (HCG‐ß) level more than 100 times the upper limit of normal appeared to predict poor histological response (teratoma/cancer) to chemotherapy. Slow fall (prolonged half‐life) of tumor markers during chemotherapy also correlated with poor histological response.

Conclusion Factors which predict poor histological response of tumors to chemotherapy include size reduction less than 80%, initial HCG‐ß levels more than 100 times the upper limit of normal, and prolonged half‐life of tumor markers (placental alkaline phosphatase, a‐fetoprotein and HCG‐ß).
Azathioprine‐lnduced Megaloblastic Anemia with Pancytopenia 22 Years after Living‐Related Renal Transplantation
Authors: Kim Choi Jang , Park Kyun II , Inoue Hitoshi , Yoshida Tetsuya , Yoshiki Tatsuhiro , Tomoyoshi Tadao , Abe Hajime , Kodama Masashi , Sako Hirotaka , Nakane Yoshihiro
Published: July 2007

Macrocytosis and megaloblastic changes in the bone marrow are frequently seen in renal transplant recipients treated with azathioprine(Az). However, severe anemia is a rare side effect of Az. We recently observed a case of severe megaloblastic anemia with pancytopenia in a renal transplant recipient who had been receiving Az therapy for 22 years. The patient was a 46‐year‐old woman who had been administered Az and prednisolone at a dose of approximately 1.7mg/kg and 0.17 mg/kg daily, respectively. A bone marrow aspiration revealed megaloblastic anemia with the depletion of myeloid cells and megakaryocytes. She did not have vitamin B12 or folate deficiency. Therefore, FK506 (tacrolimus), a macrolide produced by Streptomyces tsukubaensis, which acts directly on T cells and is known to have less myelosuppression than Az, was substituted for Az. Although the leukopenia improved, the anemia and thrombocytopenia did not improve in the short term. She developed dyspnea and severe subcutaneous bleeding of the right lower extremity due to knee contusions. Hemodialysis was started to treat her uremic state. Although it was impossible to evaluate the long‐term effects of FK506 therapy for the pancytopenia in our case, the conversion from Az to a less myelosuppressive drug, such as FK506, should be considered in renal transplant recipients with severe myelosuppression caused by long‐term Az treatment.
Public Awareness and Knowledge of Prostate Cancer in Japan: Results of a Survey at Short‐Stay Examination Facilities
Authors: Egawa Shin , Suyama Kazuho , Shitara Toshiya , Uchida Toyoaki , Koshiba Ken
Published: July 2007

Background:

This study was undertaken to determine public awareness and knowledge of prostate cancer, which has not been adequately studied in Japan.

Methods:

Assessment was made of public awareness and perception of prostate cancer in Japan, based on health examination data for participants in a short‐stay physical examination program (“human dry dock”). A multiple‐choice, thirty‐point questionnaire survey was conducted at 3 human dry dock medical facilities situated in urban areas.

Results:

Many Japanese adults appeared to be inadequately aware of prostate cancer and of the means available for its early detection. One third of the participants were unfamiliar with this malignancy. Logistic regression analysis indicated smoking to be the only covariate associated with lack of knowledge of prostate cancer (P< 0.05). Seventy‐one percent of the subjects had heard of digital rectal examination, but only 1 6% and 8%, respectively, were familiar with the terms transrectal ultrasonography and PSA testing. Japanese people may possibly be less informed about prostate cancer than African‐American males. Both human dry dock facilities and subject gender were significantly associated with knowledge of digital rectal examination (P<0.05). Knowledge of transrectal ultrasonography was found to depend on participation in human dry dock programs and level of education (P< 0.05). Smoking, participation in human dry dock programs under employer direction, and health status were all identified as determinants for knowledge of PSA testing (P< 0.05).

Conclusion:

Educational programs should be established and put into effect to instill adequate awareness of prostate cancer in Japan. In a better‐informed society, more effort would be directed toward prevention and thus early stage prostate cancer would be detected more often.
Renal Cell Carcinoma of Extraordinarily Large Size: A Case Report
Authors: Uchida Junji , Sato Hisashi , Kawa Gen , Koyama Yasuki , Matsuda Tadashi
Published: July 2007

One of our patients was a 66‐year‐old woman with a T2 renal cell carcinoma weighing 3900 g. Two years after radical nephrectomy the woman was alive and well. A survey of Japanese medical literature revealed that patients with renal cell carcinomas weighing more than 2000 g have an unexpectedly favorable prognosis with a 5‐year survival rate of 76.9%.
Photoperiod affects estrogen receptor α, estrogen receptor β and aggressive behavior
Authors: Trainor Brian C. , Rowland Michael R. , Nelson Randy J.
Published: July 2007

Estrogens have important effects on male and female social behavior. Despite growing knowledge of the anatomy and behavioral effects of the two predominant estrogen receptor subtypes in mammals (ERα and ERβ), relatively little is known about how these receptors respond to salient environmental stimuli. Many seasonally breeding species respond to changing photoperiods that predict seasonal changes in resource availability. We characterized the effects of photoperiod on aggressive behavior in two species of Peromyscus that exhibit gonadal regression in short days. P. polionotus (old field mice) were more aggressive than P. maniculatus (deer mice) and both species were more aggressive in short days. We used immunocytochemistry and real‐time polymerase chain reaction to characterize the effects of photoperiod on ERα and ERβ expression. In both species ERα‐immunoreactive staining in the posterior bed nucleus of the stria terminalis (BNST) was increased in short vs. long days. Both species had reduced ERβ‐immunoreactive expression in the posterior BNST in short days. In the medial amygdala ERβ immunoreactivity was increased in long days for both species. Using real‐time polymerase chain reaction on punch samples that included the BNST, we observed that ERα mRNA was increased and ERβ mRNA was decreased in short days. These data suggest that the effects of photoperiod on ERα and ERβ expression may thus have important behavioral consequences.