bluuebunny/crossref_metadata_2025 huggingface dataset:
MORPHOLOGICAL ANALYSIS OF ILEAL GRAFTING FOLLOWING ILEOCYSTOPLASTY IN THE RAT: A KINETIC AND ULTRASTRUCTURAL STUDY OF THE INTESTINAL EPITHELIUM
Authors: Makiura Yaeko , Okada Yusaku , Tomoyoshi Tadao , Maeda Toshihiro
Published: July 2007

lleocystoplasty was performed in rats and the morphological and cell‐kinetic changes occurring in the ileal grafts were determined at intervals up to 18 months postoperatively. The intestinal mucosa underwent no progressive changes but included villous and avillous regions associated with crypts of various sizes at all time intervals. Newly appearing and densely packed epithelial cells, shaped like petals, were always present in the lower parts of the villi associated with crypts showing no elongation, but seldom present in those with elongated crypts in the villous mucosa. Bromodeoxyuridine studies showed that the petal‐shaped cells interfered with cell migration. No petal‐shaped cells were observed in avillous mucosa in which the rate of cell turnover depended on crypt size. Fine‐structural changes in absorptive epithelial cells in both types of mucosa included features of prematurity or hypermaturity in the cytoplasm and close adherence to the basal portions of adjacent cells and to the basal lamina. These changes may possibly contribute to the prevention of reabsorption of urine. However, some of the mechanisms responsible for adherence of the basal parts might incidentally interfere with the normal cell kinetics of the intestinal epithelium, resulting in dense packing of cells and the formation of multiple types of mucosa in ileal grafts.
RADIONUCLIDE EVALUATION OF THE URETERO‐ILEOCECO‐PROCTOSTOMY (ILEOCECAL RECTAL BLADDER)
Authors: Kato Tetsuro , Sato Kazunari , Kakinuma Hideaki , Kobayashi Mitsuru , Tamura Kiyohiko
Published: July 2007

Technetium 99m diethylenetriaminepentaacetic acid renoscintigraphy was applied to 14 patients to obtain comprehensive information on the kidney and urinary tract 12.6 8.8 months (mean SD) after uretero‐ileoceco‐proctostomy (ileocecal rectal bladder) diversion. The total glomerular filtration rate (GFR) was within the normal range in all patients, and the diuretic renogram was normal in 19 of 28 kidneys, dilated‐nonobstructive in 7 and obstructive‐intermediate in 2. The mean colonic reflux was 16.6 18.4% of total excretion and the mean total residual in the colon and rectum was 38.815.5%. In the second study, performed 12.4 3.5 months later in 9 patients, the GFR of bilateral and individual kidneys remained stable, 17 of 18 kidneys were normal as judged by both renography and pyelography, and the occurrence and degree of colonic reflux decreased. There was a tendency for the rectal capacity to increase, while the total residual tended to decrease solely due to the decrease in colonic residual. These results indicate that the ileocecal rectal bladder functions well as an internal continent reservoir and that radionuclide investigation is a valuable and cost‐beneficial means for the follow‐up of urinary diversions.
THERMAL DAMAGE TO NORMAL AND HYPERPLASTIC PROSTATES DUE TO TRANSURETHRAL BALLOON LASER THERAPY IN DOGS
Authors: Suzuki Takanori , Kurokawa Kohei , Suzuki Kazuhiro , Imai Kyoichi , Yamanaka Hidetoshi
Published: July 2007

Fourteen dogs were studied to determine the level of thermal damage to the normal or benign hyperplastic prostate. Prostates were heated transurethrally by a balloon laser probe (Nd: YAG laser) at various temperatures for 20 min. Coagulative necrosis was observed in the prostate when it was heated above 45.4C for 20 min. Tissue damage in the bladder neck occurred above 49.4C, damage to the urethral mucosa occurred above 46.5C, and damage to the urethral sphincter occurred above 43.2C. It was calculated that there was a 50% probability of necrosis of the prostate gland occurring when prostatic tissue was treated at 45.0C for 20 min. Striated muscle cells in the urethral sphincter were more heat‐sensitive than smooth muscle cells of the bladder neck or transitional cells of the urethral mucosa. This basic information is essential for the safe application of Nd: YAG laser hyperthermia to the prostate gland.
CLINICAL EXPERIENCE WITH YOLK SAC TUMORS AND TERATOMA IN CHILDREN
Authors: Terai Akito , Kawakita Mutsushi , Yoshida Osamu
Published: July 2007

Between 1971 and 1993, 12 children with testicular germ cell tumors were treated at the Department of Urology, Faculty of Medicine, Kyoto University. Seven patients had yolk sac tumors and 5 had mature teratoma. Of the 7 patients with yolk sac tumors, 6 had stage I and 1 had stage III tumors. Initial management of the stage I tumors consisted of high orchiectomy in 5 patients and high orchiectomy plus retroperitoneal lymph node dissection in 1 patient. Of these 6 patients, 4 were cured by surgery alone but lung metastases developed in the other 2 patients. One of them was salvaged with thoracotomy and chemotherapy but the other died of tumor. The patient with stage III tumor had bulky tumor spread to lung and retroperitoneum, but seems to have been cured by chemotherapy followed by resection of the residual mass although follow‐up is still inadequate (14 months). Six of the 7 patients (85.7%) are alive 13 months to 21 years after diagnosis. Five patients with mature teratoma were treated by high orchiectomy or, more recently, enucleation and all are alive 4 months to 22 years after surgery.
SURVIVAL AND PROGNOSTIC FACTORS ASSOCIATED WITH METASTATIC NONSEMINOMATOUS TESTICULAR AND EXTRAGONADAL GERM CELL TUMORS
Authors: Kawakita Mutsushi , Terachi Toshiro , Hida Shuichi , Takeuchi Hideo , Yoshida Osamu
Published: July 2007

To assess prognostic factors in patients with metastatic nonseminomatous germ cell tumors, 50 patients with testicular germ cell tumors (TGCT) and 10'patients with extragonadal germ cell tumors (EGGCT) were studied. The clinical staging system for testicular tumors proposed by The Japanese Urological Association and The Japanese Pathological Society was applied. All patients with EGGCT had primary sites in the retroperitoneum. The 3‐year survival rates of TGCT and EGGCT were 71.9% and 60.0%, respectively, and there were no differences in patient characteristics. Patients had significantly worse survival rates if the following applied: choriocarcinoma in the primary tumors, serum lactate dehydrogenase level greater than twice the upper limit of normal, liver, brain, or mediastinal metastases, or retroperitoneal tumors greater than 10 cm. It was concluded that the poor‐risk group could be defined as those patients having lymph nodal disease only (stage II or III A) with retroperitoneal tumors greater than 10 cm, having pulmonary disease (stage III B) with retroperitoneal tumors greater than 5 cm, or liver, bone or brain metastases (stage III C), and these criteria will predict the prognosis for patients with advanced disease because the good‐risk patients (53% of all patients) and poor‐risk patients (47%) in this study had 3‐year survival rates of 88.7% and 49.7% (p less than 0.0001), and complete response rates of 96.9% and 60.7% (p less than 0.005), respectively.
CONSERVATIVE MANAGEMENT OF NON‐TRAUMATIC SUBCAPSULAR RENAL HEMATOMA: A CASE REPORT
Authors: Mita Koji , Kobukata Yoshikatsu
Published: July 2007

The case of a 78‐year‐old woman with a non‐traumatic subcapsular renal hematoma is described. She complained of right flank pain and fever and the findings following abdominal echography, computerized tomography (CT) scan and renal angiography agreed with a diagnosis of subcapsular renal hematoma without renal tumor. Percutaneous drainage of the hematoma improved her clinical symptoms and the lesion as seen on CT scan. Ten months later, no change in the right kidney could be seen on CT scan and echography. We conclude that conservative management is the first choice for subcapsular renal hematoma without a definite etiology, especially in an elderly patient.
M‐VEC (METHOTREXATE, VINBLASTINE, 4‐EPIRUBICIN AND CISPLATIN) COMBINED WITH GLYCOSYLATED RECOMBINANT HUMAN GRANULOCYTE COLONY‐STIMULATING FACTOR (rhG‐CSF) FOR THE TREATMENT OF TRANSITIONAL CELL CARCINOMA OF UROTHELIUM: REDUCTION IN TOXICITY PRODUCED BY rhG‐CSF
Authors: Ueda Mitsutaka , Igaiva Mikio , Kadena Hitoshi , Usui Tsuguru
Published: July 2007

Forty‐six patients with urothelial cancer were treated with a systemic chemotherapeutic regimen consisting of methotrexate, vinblastine, 4'‐epirubicin and cisplatin (M‐VEC) in conjunction with glycosylated recombinant human granulocyte colony stimulating factor (rhG‐CSF); then 33 were evaluated for response. Complete response was observed in 7 patients (21%) and partial response in 13 (39%). As far as the toxic effects of this treatment are concerned, mucositis of a minimum grade and leukopenia greater than grade 3 occurred in 5% and 10% of the patients, respectively; there were no cases of nadir sepsis and drug‐related death. Minor toxicity such as nausea and vomiting occurred in 81% of patients, and no patient required either dose‐reduction or a delay of more than 5 d before starting of the second cycle. Thus, it may be concluded that M‐VEC chemotherapy combined with rhG‐CSF is useful in the treatment of urothelial cancer, especially when used as a neoadjuvant.
SERUM LEVELS OF A TISSUE INHIBITOR OF METALLOPROTEINASES‐1 (TIMP‐1) IN BLADDER CANCER PATIENTS
Authors: Naruo Seiichi , Kanayama Hiro‐omi , Takigawa Hiroshi , Kagawa Susumu , Yamashita Kyoko , Hayakawa Taw
Published: July 2007

Tissue inhibitors of metalloproteinases (TIMP‐1 and ‐2) are common inhibitors of matrix metallo‐proteinases (MMPs), thereby blocking degradation of extracellular matrix components. TIMP‐1 and ‐2 have been reported to exhibit inhibitory activities against tumor invasion and metastasis. We measured the serum TIMP‐1 levels in 16 healthy volunteers and in 69 patients with bladder cancer using a sandwich enzyme immunoassay, and evaluated the correlation between serum TIMP‐1 levels and clinicopathological features. Patients with bladder cancer showed significantly higher serum TIMP‐1 levels (251.1 96.0 ng/ml; p<0.01) than those of healthy volunteers (168.5 33.2ng/ml), and a positive correlation between the TIMP‐1 level and invasion and metastasis was observed. This is considered to be the result of the reactive production of TIMP‐1 in cancerous tissues. Thus, serum TIMP‐1 levels may become a reliable clinical marker of the progression of bladder cancer.
DIURNAL RHYTHM OF SERUM gM‐SEMINOPROTEIN IN PATIENTS WITH UNTREATED PROSTATE CANCER: COMPARISON OF THE ORIGINAL AND REVISED ASSAY KITS
Authors: Akimoto Susumu , Akakura Koichiro , Ohki Takemasa , Shimazaki Jun
Published: July 2007

To compare levels of y‐seminoprotein (gM‐Sm) assayed by original and revised assay systems, blood was obtained every 4 h over a 32‐h period from 8 untreated prostate cancer patients. Serum levels of prostate specific antigen (PSA) were also examined. In 6 patients, the coefficient of variation (CV) of the serum levels assayed by the revised assay was significantly different from that of the intra‐assay samples. In contrast, the CV of the gM‐Sm serum levels assayed by the original assay differed significantly from that of the intra‐assay samples in only 2 patients. The fluctuations in gM‐Sm assayed by the revised assay were, at least in part, similar to those of the PSA serum levels in all patients. The mean CV of the gM‐Sm serum levels assayed by the revised assay was significantly larger than that for levels measured by the original assay. After treatment, the rate of decrease in gM‐Sm serum levels determined by the original assay differed from that in the serum levels of PSA and prostatic acid phosphatase. These results indicate that the original assay for gM‐Sm do not detect diurnal differences in serum gM‐Sm levels, even at levels below 20 ng/ml. These observations indicate that the analysis of data obtained using the original gM‐Sm kit should be interpreted with caution.
CONGENITAL PATENT URACHUS IN AN ADULT: A CASE REPORT
Authors: Takano Yuji , Okatani Koh , Okamoto Shinji , Enoki Noboru
Published: July 2007

A rare case of the congenital patent urachus in an adult is reported. The patient, a 42‐year‐old man, was admitted with the chief complaint of macroscopic hematuria. During the cystoscopy perfusion water discharged from the umbilicus. Diagnostic imaging revealed a tubular fistula between the bladder and umbilicus and the patient underwent ‐urachal resection and partial cystectomy. Microscopically the lumen was lined by transitional, columnar and squamous epithelium and there was no evidence of malignancy. To date 11 cases of congenital patent urachus in an adult have been reported in Japan. From a review of the Japanese literature, the common chief complaint is urine discharge from the umbilicus accompanying cystitis and/or urachal inflammation. Urachal resection is performed in all cases. We also clarified the epithelial histology of the patent urachus in this patient.
A CASE OF A METHYLMETHACRYLATE FOREIGN BODY IN THE BLADDER WALL
Authors: Nonomura Mitsuo , Kanaoka Toshio , Soeda Asaki , Matsuo Mitsuo
Published: July 2007

The authors report a rare case of bone cement protruding into the bladder wall. The patients exhibited an abnormal mass in the bladder wall during ultrasonography and was admitted to our department 21 mo after right hip joint replacement. Partial resection of the urinary bladder including the bone cement was performed. The patient made an uneventful recovery postoperatively. This is the third case reported of a foreign body in the urinary bladder associated with bone cement.
PRIMARY MALIGNANT LYMPHOMA OF THE PENIS: A CASE REPORT
Authors: Watanabe Kenji , Kurizaki Yoshiki , Ogazva Akimi , Ishii Keiko , Kawakami Hirotaka
Published: July 2007

We report a rare case of primary malignant lymphoma of the penis developing a bulky scrotal mass. Tumor excision and radiotherapy were followed by abdominal recurrence. Salvage chemotherapy was unsuccessful and the patient died 9 months later.
THE STATUS OF BLADDER. P. RESERVING THERAPEUTIC STRATEGIES IN THE MANAGEMENT OF PATIENTS WITH MUSCLE–INVASIVE BLADDER CANCER
Authors: (c) K Koiso , (cc) W Shipley , (cc) F Keuppens , Baert L , Hall R , Hudson M'Liss A , Khoury S , Kubota Yoko , Kubota Yoshinobu , Poppel H van
Published: July 2007

The recommended treatment for medically fit patients with muscle–invading bladder cancer is usually radical cystectomy. However, transurethral resection of the tumor, partial cystectomy, irradiation and systemic chemotherapy are each effective in some patients. These latter treatments allow bladder preservation and cure as an alternative to radical cystectomy although when used unselectively the survival rates are inferior to those of radical cystectomy.

The updated results of conservative surgery, radiation therapy and systemic chemotherapy as monotherapy, as well as strategies of combined modality treatment were reviewed. Based on this review many areas of consensus were reached which include:

1. The primary goal of any treatment for a patient with muscle–invading bladder cancer is survival; bladder preservation in the interest of quality of life is a secondary objective.

2. Only a small proportion of carefully selected patients may be cured by transurethral surgery alone, or by partial cystectomy alone.

3. Radiation therapy is currently the standard bladder–preserving therapy against which all other bladder–preserving methods must be compared.

4. Systemic chemotherapy as monotherapy is inadequate and cannot be recommended.

5. The addition of cisplatin–containing systemic chemotherapy to radiation therapy or conservative surgery appears to improve local control. While no multi–modality therapeutic regimen has yet been shown to be clearly optimal with regard to local efficacy and minimizing toxicity, monotherapy for bladder preservation is probably not desirable as a routine approach.

6. Deferring the patient from immediate cystectomy does not appear to compromise survival, nor does the addition of primary systemic chemotherapy appear to significantly increase the morbidity of cystectomy or radiotherapy.

7. All patients treated by .bladder–preserving therapy must return to the urologist for regular cystoscopic follow–up so that additional therapy may be started at the earliest opportunity if relapse occurs.

8. Bladder substitution is suboptimal compared with a normally functioning, disease–free bladder.

9. If alternatives to cystectomy are not considered, little progress will be made in the treatment of muscle–invading bladder cancer.

10. Randomized phase III trials must be performed to establish the role of optimal combined modality treatment for bladder preservation, but patient recruitment into such trials may prove difficult unless urologists are prepared to open their minds to the possibility that cystectomy may not be the best treatment for all patients with muscle–invading bladder cancer. Further, urologists must be prepared to have their patients randomized into phase III protocols and investigators must not allow premature publication of findings.
OBSERVATIONS ON THE GROWTH RATE OF RENAL CELL CARCINOMA
Authors: Fujimoto Naohiro , Sugita Atsuo , Terasawa Yoshio , Kato Masakazu
Published: July 2007

We retrospectively reviewed the records of 18 patients to investigate the growth rate of renal cell carcinoma (RCC). Growth rates were calculated from two or more gross measurements of neoplastic foci in the kidney (6 cases) and lung (12 cases). RCCs in primary sites grew slowly and the tumor volume doubling time (DT) raged from 372 to 579 days (468 ± 84.6). Pulmonary metastases present in 12 cases grew rapidly, with a DT ranging from 20 to 154 days (89.4 ± 43.0). Tumors in both the kidney and lung were composed of cancer cells with equal proliferative activity, as determined by immunohisto chemical analysis of argyrophilic nucleolar organizer regions and proliferating cell nuclear antigen activity. Thus, our results suggest that, in addition to the proliferative activity of cancer cells, the microenvironment of the specific region is an important determinant of the growth rate of cancer cells.
INCREASED INCIDENTAL DETECTION AND REDUCED MORTALITY IN RENAL CANCER—RECENT RETROSPECTIVE ANALYSIS AT EIGHT INSTITUTIONS
Authors: Homma Yukio , Kawabe Kazuki , Kitamura Tadaichi , Nishimura Yoji , Shinohara Mitsuru , Kondo Yasushi , Saito Isao , Minowada Shigeru , Asakage Yasuyuki
Published: July 2007

A retrospective survey of renal cell carcinoma between 1975 and 1993 at eight collaborating institutions was conducted with special reference to the incidental detection and mortality of renal cancer. The analysis demonstrated a recent dramatic increase in the frequency of incidental renal cancer, which now comprises two‐thirds of all renal cancers, and a simultaneous recession in non‐incidental or suspected renal cancer. Incidental renal cancer has remained unchanged during the last decade as far as patient demographics, occasion and method of detection, and the degree of tumor extension are concerned. On the other hand, the annual number of deaths from renal cancer has significantly decreased, and kidney‐sparing surgery has been more frequently performed. These results indicate that incidental renal cancers are now in the majority, and earlier detection may contribute to improving the mortality and morbidity from the disease as a whole.
INTERSTITIAL LASER COAGULATION FOR BENIGN PROSTATIC HYPERPLASIA: PRELIMINARY CLINICAL RESULTS
Authors: Arai Yoichi , Kanba Tomomi , Ishitoya Satoshi , Okubo Kazutoshi
Published: July 2007

We report our early experience in the clinical application of interstitial laser coagulation of the prostate (ILCP) in the treatment of benign prostatic hyperplasia (BPH). Neodymium: YAG laser energy is transmitted via a specially designed interstitial thermotherapy light‐guide. The light guides were inserted transurethrally into each lobe of the prostate by direct puncture, under direct visualization. The prostatic urethra is preserved during the procedure. From December 1993 to March 37 patients with symptomatic BPH were treated with ILCP. Treatment outcome was evaluated by the International Prostatic Symptom Score (I‐PSS), flow rate, postvoided residual urine volume and quality of life score. Significant improvement in I‐PSS and peak flow rate was observed at 3 months: I‐PSS decreased from a mean of 19.3 to 10. and the peak flow rate increased from a mean of 7.2 to 9.4 ml/sec (p < 0.0001). The mean postvoided residual urine volume significantly decreased from 91 to 47 ml (p < 0.01). Two days after ILCP the serum prostate‐specific antigen had increased by 860%, evidence of the significant tissue damage produced by laser irradiation. The quality of life score significantly decreased from a mean of 4.8 to 2.1 (p < 0.0001). No serious side‐effects were observed. The early clinical results suggest that ILCP is safe and effective as a treatment of BPH and is less invasive than some other methods.
A CASE OF METASTATIC YOLK SAC TUMOR OF TESTIS IN A CHILD
Authors: Terai Akito , Ishitoya Satoshi , Hashimura Takayuki , Takeuchi Hideo , Yoshida Osamu
Published: July 2007

We report a case of testicular yolk sac tumor in a child aged 3 years and 6 months with multiple bulky metastases to lung and retroperitoneum (stage 11182). After three courses of chemotherapy with a PV 8 regimen (cisplatin, vinblastine and bleomycin). complete and partial responses were obtained for lung and retroperitoneal lymph node metastases, respectively. The patient was followed‐up closely. However, on the basis of a re‐elevated alpha‐letoprotein (AFP) after 4 months' follow‐up, he was treated with three courses of salvage chemotherapy with a modified VAB‐6 regimen (cyclophosphamide. etoposide. actinomycin D, bleomycin and cisplatin), lollowed by retroperitoneal lymph node dissection. Histologically, only necrotic tissue was found. There is no evidence of recurrence 24 months after lymphadenectomy. There is very little information in the literature on the appropriate management of postchemotherapy residual mass in pediatric testicular tumors.
TREATMENT OF BENIGN PROSTATIC HYPERPLASIA WITH HIGH INTENSITY FOCUSED ULTRASOUND: AN INITIAL CLINICAL TRIAL IN JAPAN WITH MAGNETIC RESONANCE IMAGING OF THE TREATED AREA
Authors: Nakamura Kaoru , Baba Shiro , Fukazawa Ritsu , Homma Yukio , Kawabe Kazuki , Aso Yoshio , Tozaki Hiroshi
Published: July 2007

Background

High intensity focused ultrasound (HIFU) is a method of delivering acoustic energy to a focal point and is expected to induce tissue thermal ablation. Transrectal HIFU was applied to symptomatic benign prostatic hyperplasia (BPH) for relief of intravesical obstruction without injury to surrounding tissue. The clinical effectiveness and safety of transrectal HlFU were investigated. Methods: Thirty‐seven Japanese men with symptomatic BPH were treated with HIFU. The treatment was minimally invasive; operating time was less than 40 minutes, and a post treatment indwelling catheter was left in place for 3–4 days.

Results:

me maximum urinary flow rate (ml. per second) increased from 7.6 ± 0.6 to 9.3 ± 0.6 at three months in 37 patients (P < c 0.05). During the same period the International Prostatic Symptom Soore and Quality of Life score (points) decreased from 23.6 ± 1.4 to 10.5 ± 0. 5.2 ± 0.3 to 2.6 ± 0.1 (P < 0.001), respectively. Overall response estimated by these three individual parameters were as follows; excellent 18.9 %, good 48.6 %, fair 70.8% and poor 21.6% at three months. Magnetic resonance imaging using an endorectal coil showed coagulative necrosis defined in the therapy zone at one month after treatment. Side effects were transient urinary retention in six patients (16.2%), gross hematuria in four patients (10.8%) and hematospermia in four patients (10.8%). There was almost no intraoperative blood loss.

Conclusions:

Transrectal HIFU treatment of symptomatic BPH is safe, reduces symptoms significantly. and leads to a slight increase in uroflow.
PROLIFERATING CELL NUCLEAR ANTIGEN IN ACTH‐INDEPENDENT BILATERAL MACRONODULAR ADRENAL HYPERPLASIA
Authors: Nomata Koichiro , Sakai Hideki , Suzuki Shin , Irie Junji , Kawai Kioko , Minami Yuzo , Kanetake Hiroshi , Saito Yutaka
Published: July 2007

ACTH‐independent bilateral macronodular adrenal hyperplasia (AIMAH) has been recently described as a rare cause of Cushing's syndrome and it is an unusual process of unknown etiology. This report describes a case of a 59‐year‐old man with AIMAH. The proliferating cell nuclear antigen (PCNA) has been implicated in the process of cell proliferation and is detectable throughout most of the cell cycle. This report also describes the expression of PCNA in AIMAH by immunohistochemical staining. Most of the positive expression was seen in the greater part of the epithelial cells of the cortical lesion, but not in the interstitial cells. These data suggest that some effective factor, specific for adrenal cortical cell growth, might be produced in AIMAH.
EN BLOC RADICAL CYSTOPROSTATOURETHRECTOMY WITH PRESERVATION OF SEXUAL FUNCTION
Authors: Arai Yoichi , Yoshida Osamu
Published: July 2007

Background:

Recent understanding of the precise anatomy of the cavernous nerves to the penis allows us to preserve potency in men undergoing radical prostatectomy or radical cysto‐prostatectomy. A technique of urethrectomy that preserves potency has been also developed. To date, however, delayed urethrectomy has been recommended to preserve potency. We have applied a nerve‐sparing technique to en bloc cystoprostatourethrectomy.

Methods:

Seven patients have undergone simultaneous urethrectomy with the radical cystoprostatectomy by the nerve‐sparing technique. Patient age ranged from 52 to 69 years (mean age, 61.3 years). All patients were potent preoperatively. Meticulous and complete dissection of the membranous urethra from the pelvis is the key to preservation of potency at urethrectomy.

Results:

The patients were followed for 7 to 64 months (mean, 27.3 months). Four (57%) of the patients regained potency postoperatively. Two patients were able to have erections postoperatively but are still impotent.

Conclusions:

Our clinical results show that it is possible to perform simultaneous urethrectomy and preserve potency.
CONTINENCE MECHANISM OF THE ORTHOTOPIC NEOBLADDER: URODYNAMIC ANALYSIS OF ILEOCOLIC NEOBLADDER AND EXTERNAL URETHRAL SPHINCTER FUNCTIONS
Authors: Kakixaki Hidehiro , Shibata Takashi , Ameda Kaname , Shinno Yuichiro , Nonomura Katsuya , Koyanagi Tomohiko
Published: July 2007

Background:

The main objectives of bladder substitution are the preservation of the upper urinary tract and maintenance of urinary continence. Orthotopic bladder substitution makes it possible to achieve urinary continence as well as normal passage of urine through the urethra. Creation of a low pressure reservoir and careful preservation of the distal sphincter mechanism are considered to be of utmost importance for the maintenance of urinary continence after orthotopic bladder Substitution. However, sphincter behavior after orthotopic bladder substitution has not been fully elucidated. The purpose of this study was to evaluate the vesicourethral continence mechanism after orthotopic bladder substitution in male patients.

Methods:

Urodynamic evaluation was performed in 14 male patients after cystoprostatectomy for bladder cancer and an ileocolic neobladder using a cecourethral anastomosis.

Results:

Good continence was achieved in 86% (12/14) of the patients during the day and in 79% (11/14) at night. On cystometry, maximum capacity of the neobladders was 434 ± 21 ml (mean ± SEM), and basal pressure at maximum capacity was 15.6 ± 0.9 cm water. Phasic neobladder contraction with amplitudes ranging from 14 to 40 (26.6 ± 2.7) cm water were noted in 11 of 14 patients. Sphincter electromyography demonstrated an increase in the frequency of action potentials of the external urethral sphincter during neobladder filling from empty to 80% of capacity (from 8.9 ± 1.6 to 14.6 ± 2.1 spikes per second; mean percentage increase, 64%, in patients with daytime continence). Maximum urethral closure pressure on urethral pressure profile was 49.9 ± 3.5 (range, 30 to 64) cm water in patients with daytime continence, while in two patients who were incontinent during the day and at night maximum urethral closure pressure was lower (16 and 24 cm water) and the recruitment of action potentials of the external urethral sphincter during neobladder filling was impaired (percentage increase, 15% and 20%).

Conclusions:

An ileocolic neobladder has characteristics of a low pressure reservoir with a satisfactory continence rate. The vesicourethral continence reflex is well preserved in patients with continence after orthotopic bladder Substitution.
THE STATUS OF BLADDER‐PRESERVING THERAPEUTIC STRATEGIES IN THE MANAGEMENT OF PATIENTS WITH MUSCLE‐INVASIVE BLADDER CANCER
Authors: Koiso K. , Shipley W. , Keuppens F. , Baert L. , Hall R. , Hudson M'Liss A , Khoury S. , Kubota Yoko , Kubota Yoshinobu , van Poppel H.
Published: July 2007

The recommended treatment for medically fit patients with muscle‐invading bladder cancer is usually radical cystectomy. However, transurethral resection of the tumor, partial cystectomy, irradiation and systemic chemotherapy are each effective in some patients. These latter treatments allow bladder preservation and cure as an alternative to radical cystectomy although when used unselectively the survival rates are inferior to those of radical cystectomy.

The updated results of conservative surgery, radiation therapy and systemic chemotherapy as monotherapy, as well as strategies of combined modality treatment were reviewed. Based on this review many areas of consensus were reached which include:

1. The primary goal of any treatment for a patient with muscle‐invading bladder cancer is survival; bladder preservation in the interest of quality of life is a secondary objective.

2. Only a small proportion of carefully selected patients may be cured by transurethral surgery alone, or by partial cystectomy alone.

3. Radiation therapy is currently the standard bladder‐preserving therapy against which all other bladder‐preserving methods must be compared.

4. Systemic chemotherapy as monotherapy is inadequate and cannot be recommended.

5. The addition of cisplatin‐containing systemic chemotherapy to radiation therapy or conservative surgery appears to improve local control. While no multi‐modality therapeutic regimen has yet been shown to be clearly optimal with regard to local efficacy and minimizing toxicity, monotherapy for bladder preservation is probably not desirable as a routine approach.

6. Deferring the patient from immediate cystectomy does not appear to compromise survival, nor does the addition of primary systemic chemotherapy appear to significantly increase the morbidity of cystectomy or radiotherapy.

7. All patients treated by bladder‐preserving therapy must return to the urologist for regular cystoscopic follow‐up so that additional therapy may be started at the earliest opportunity if relapse occurs.

8. Bladder substitution is suboptimal compared with a normally functioning, disease‐free bladder.

9. If alternatives to cystectomy are not considered, little progress will be made in the treatment of muscle‐invading bladder cancer.

10. Randomized phase III trials must be performed to establish the role of optimal combined modality treatment for bladder preservation, but patient recruitment into such trials may prove difficult unless urologists are prepared to open their minds to the possibility that cystectomy may not be the best treatment for all patients with muscle‐invading bladder cancer. Further, urologists must be prepared to have their patients randomized into phase III protocols and investigators must not allow premature publication of findings.
Cytokine Gene Modification of Bladder Cancer Cells for the Establishment of Bladder Cancer Vaccine
Authors: Saito Shiro , Tazaki Hiroshi , Heston Warren D. W. , Fair William R.
Published: July 2007

A bladder tumor vaccine in mouse models was established by introducing interleukin–2 (IL–2) gene into mouse bladder cancer cells (MBT–2). Mice injected with non–modified MBT–2 cells did not reject subsequent challenge of MBT–2 cells. Mice injected with IL–2–gene–modified MBT–2 cells (MBT–2/IL–2) rejected subsequent challenge of unmodified MBT–2 cells but not 38C13 cells, which have the same genetic background but different antigenicity. According to these results, an injection of MBT–2/II.–2 can establish specific immunity against parental MBT–2 cells in mice, which is also demonstrated by cytotoxic T lymphocytes assay. Vaccinations with MBT–2/IL–2 cured 60% of bladder cancer which had been pre–established in mice. These results suggest that tumor cells genetically modified with IL–2 gene can act as a tumor vaccine which is expected to be a new method for immunotherapy of cancers.
Treatment of Advanced Renal Cell Carcinoma with a Combination of Human Lymphoblastoid Interferon–Alpha and Cimetidine
Authors: Kinouchi Toshiaki , Meguro Norio , Maeda Osamu , Saiki Shigeru , Kuroda Masao , Usami Michiyuki , Kotake Toshihiko
Published: July 2007

Human lymphoblastoid interferon (IFN)–alpha was administered intramuscularly at doses of 5 megaunits/day 5 to 7 days a week to 32 advanced renal cell carcinoma patients. To augment the antitumor effect of IFN, cimetidine was also administered orally in doses oi 800 mg/day. This combination therapy resulted in a complete response (CR) in 6 patients (19%), a partial response (PR) in 7 (22%), a stable disease (SD) in 11 (34%), and a progressive disease (PD) in 8 (25%). The response rate (CR+PR) was 41%. The pulmonary metastases were more receptive to IFN therapy than those at other sites. The median times to response were 2 months for PR, and 4.5 months for CR. The survival of the responder patients was significantly longer than the nonresponder patients. These results suggest that IFN–alpha and cimetidine combination therapy may be of use in the management of advanced renal cell carcinoma.
Newly Developed Equipment and Methods in the Treatment of BPH: Analysis of Present Status
Authors: Tazaki Hiroshi , Baba Shiro , Nakamura Kaoru , Tachibana Masaaki , Nakashima Jun , Nakagawa Ken , Deguchi Nobuhiro
Published: July 2007

Benign prostatic hyperplasia (BPH) is the most common disease among the aged male population. A variety of symptoms are mainly caused by obstructive changes at the prostatic urethra. Transurethral resection (TURP) has been the gold standard of treatment, but new equipment and methods such as TUMT, HIFU, TUNA, and laser prostatectomy have been developed and are being tested for clinical application. Our experience with new equipment and methods show that their effectiveness has yet to be conclusively evaluated by objective parameters, while subjective improvements have been seen with less invasive treatments such as TUMT, HIFU and TUNA. Laser prostatectomy confirmed its advantages in hemostasis but comparison of each treatment is difficult because of different pathological changes created by different energy sources shown by MRI. Further studies are required to examine the new equipment and methods and for identification of the treatment of choice for BPH.
Clinical Evaluation of the Results of Open or Transurethral Surgery for Prostate Hypertrophy
Authors: Onodera Yasutada , Oota Michiya , Sasaki Haruaki , Yogi Saneo , Ikeuchi Takao , Matsumoto Keiichi , Kai Yoshio
Published: July 2007

We evaluated the outcome of surgery for prostate hypertrophy through measurement of the urine flow rate and the Boyarsky symptom score. The study covered 108 patients admitted to Showa University School of Medicine, Fujigaoka Hospital. Thirty–eight had been admitted for retropubic prostatectomy and the remaining 70 patients for transurethral resection of the prostate. Their ages ranged from 48 to 84 years, with an average age of 64.4 years. The urine flow rate was measured before and after prostatic operation using Dantec Urodyn 1000. The symptom scores were calculated according to the Boyarsky symptom score. The Student's t test was used for statistical analysis. Frequency (daytime, nighttime) was the most common preoperative symptom (97.2%, 96.3%), followed by impairment of stream (88.0%), and intermittency (78.7%). Frequently observed symptoms tended to raise the symptom scores. The period of admission, age and prostatic size did not correlate with the preoperative urine flow rate and symptom score. Significant improvements in the urine flow rate occurred after the operation. Frequency (daytime, nighttime) was the most common postoperative symptom (82.7%, 81.1%), followed by urgency (37.0%), then terminal dribbling (32.2%). Of 39 patients who were evaluated by symptom score and urine flow simultaneously, 6 patients (15.1%) failed to show improvement in 1 of the 2 evaluations, while 9 (23.1%) patients failed to show improvement in either. The irritative symptoms (frequency, urgency) tended not to show significant postoperative improvement.
Role of Medical Approach in the Management of Stone Disease
Authors: Pak Charles Y. C.
Published: July 2007

In the management of stone disease, the medical approach concerned with the prevention of stone recurrence is equally as important as the surgical removal of stones. The application of medical approach requires an understanding of the pathophysiology of stone formation. A wide variety of physiological or environmental disturbances have been identified in stone–forming patients. They include hypercalciuria, hypocitraturia, undue urinary acidity and hyperuricosuria. Reliable diagnostic protocols have been developed which are based on the presence of above derangements. The prophylactic treatment programs are directed at the correction or amelioration of underlying environmental disturbances. Conservative measures include a high fluid intake, dietary sodium and oxalate restriction, dietary calcium restriction (in absorptive hypercalciuria and primary hyperparathyroidism), and moderate animal protein restriction. Specific medical treatments chosen for discussion are thiazide, slow–release neutral potassium phosphate, potassium citrate and potassium magnesium citrate.
Production of Heparan Sulfate in the Process of Calcium Oxalate Microlith Formation
Authors: Nishio Shunji , Sato Takeshi , Yokoyama Masayoshi , Iwata Hidenobu , Takeuchi Masafumi
Published: July 2007

To evaluate the interaction in the renal tubules between calcium oxalate microliths and glycosaminoglycans, especially heparan sulfate, we planned an experimentally–induced calcium oxalate microlith–producing model in rats. We found by immunofluorescence study and immunoelectron microscopy using the heparan sulfate antibody that heparan sulfate was produced in the renal tubular cells in the formation of calcium oxalate microliths and that heparan sulfate exists in the microliths. Heparan sulfate/crystal interaction might play a role as a nucleating agent and promote stone enlargement.
Overview of the Present and Future of Clinical Transplantation
Authors: Lee H. M.
Published: July 2007

An historical overview of kidney transplantation including the rehabilitation status of long–term survivors, the ethical issues related to current American transplant ation, and projections for the future are presented.
Twenty Years of Renal Transplantation in Children
Authors: Hasegawa Akira , Kawamura Takeshi , Hoshinaga Kiyotaka , Ogawa Osamu , Shishido Seiichirou , Nakai Hideo , Aikawa Atsushi , Ohara Takehiro
Published: July 2007

Two hundred and sixty–eight renal transplant operations were done in 244 children over the past 20 years. The donors were parents in 229 cases, living relatives in another 1 3 eases, and cadavers in the remaining 26 cases. There were 242 first grafts, 22 second grafts, and 4 third grafts. The initial 130 grafts were carried out with conventional immunosuppressive regimens and the subsequent 1 38 were done using immunosuppression including cyclosporin–A. In lanuary 19′)5, 186 recipients (76.2%) were alive with functioning grafts, 33 (1 3.5%) were alive on dialyses, and 25 (10.2%) were dead. The management results in terms of patient and graft survival, as well as the causes of graft failure and patient death are described.
Donor–Specific Blood Transfusion Inhibits the Allograft Response: Possible Regulation by Nitric Oxide and Prostaglandin E2
Authors: Koga Shigehiko , Jaquins Andrea , Rominski Barbara , Hoffman Rosemary , Jordan Mark L.
Published: July 2007

We investigated the effective mechanisms of donor–specific hlood transfusion (DST) using a sponge matrix allograft animal model. Sponges were harvested on various days postgrafting, and both the sponge infiltrating cells and sponge exudate fluid (SEF) were collected. DST completely suppressed cytotoxic T lymphocyte activity throughout the postgrafting period. SEF *N = O concentration (measured as nitrite) in DST mice was significantly lower than in ST mice. Conversely, the amount of PGE2 in the SEF from DST mice was higher than in ST mice. L)ST may induce intragraft suppressor factors (such as PCE2), resulting in reduced immune activation with suppression of local immune response.
Microchimerism in Female Renal Transplant Recipients from Male Donors
Authors: Aikawa Atsushi , Yamashita Mioko , Arai Kenji , Hirayama Nobuaki , Ohara Takehiro , Hasegawa Akira , Kaneshige Toshihiko , Hirai Hiromi , Goto Toshihiko , Fujimura Yoshiteru
Published: July 2007

Microchimerism in 23 female renal transplant recipients from male donors was studied using nested polymerase chain reaction (nPCR) and fluorescence in situ hybridization (FISH) to detect Y–chromosome. nPCR was a sensitive and specific assay enabling a detection rate of 1/106male/female cells, compared with a sensitivity of 1/102 by standard PCR (sPCR). None of the 23 patients with a male allograft demonstrated Y–chromosome using sPCR. In contrast, 1 3 (56.5%) patients demonstrated Y–chromosome with nPCR. Of 9 patients proven to have microchimerism by nPCR, only 3 also demonstrated Y–chromosome using FISH. The existence of B cells and CD8 cells in donor chimeric cells were proved by separation with Dynabeads class I and class II. Dynamic changes of microchimerism occurred in 4 of 5 patients. Four patients were proven to have microchimerism within a year of transplantation and the microchimerism later disappeared in 3, although the sequential change was variable in individual patients. There was no correlation between microchimerism and patients'clinical factors such as donor–specific blood transfusion, HLA matching, immunosuppression, past history of acute rejection and chronic rejection. The degree of microchimerism in renal transplant recipients was relatively low, and its existence did not seem to be compatible with long–term graft acceptance. However, further studies are required to elucidate the immunological mechanism of microchimerism, and it might be an important clue to immunological tolerance.
Early Prognoses of 200 Renal Allografts Harvested from Non–Heart–Beating Cadavers
Authors: Hoshinaga Kiyotaka , Fujita Tomio , Shiroki Ryoichi , Tsukiashi Yasuhiko , Yanaoka Masanori , Naide Yorio
Published: July 2007

When the concept of brain death is not widely accepted, the viability of renal allografts of non–heart–beating cadaveric donors is one of the serious concerns for transplant surgeons. At our center, 200 kidneys were harvested from cardiac arrest donors using the regional in situ cooling technique, and they were transplanted into recipients treated with cyclosporine (CS). The ages of donors ranged from 7 months to 67 years. At the bedside a specially designed double balloon catheter, 14F, was inserted into the aorta through the femoral artery just before or immediately after the cardiac arrest. A venous drainage tube was also placed in the vena cava. Following the cardiac arrest, both balloons of the aortic catheter were inflated, and regional in situ cooling with cold Lactate Ringer's solution started using the infusion pump at 20mL/kg/min. In the OR, both kidneys were removed en bloc and preserved in Collins'type solution. They were then transplanted into 200 patients treated with CS and steroid. After the transplant operations, 33 patients (16.5%) had immediate renal function, but 14 grafts (7.0%) were not successful and the patients have never had renal function. When several factors such as donor age, warm ischemic time (WIT; 12.3 ± 14.1 minutes), in situ cooling time (IST; 78.1 ± 18.0 minutes) and total ischemic time (TIT; 619 ± 340 minutes) were associated with the post–transplant renal function, only the donor age had significant correlation both with the posttransplant dialysis period and lowest serum creatine level, as follows: 10.5 days (≤ 40 years) vs. 14.6 days (>40 years); P < 0.05, and 1.16mg/dL (≤ 30 years) vs. 1.83 mg/dL (> 50 years) P < 0.001, respectively. Our findings indicate; 1) Due to the in situ cooling technique, the renal grafts of non–heart–beating cadavers can be expected to have relatively good function in the CS–treated recipients; 2) donor age is instrumental in predicting post–transplant renal function as well as the duration of ATN; 3) WIT, 1ST and TIT have no association with the post–transplant renal function if the duration of renal ischemia is within the acceptable range.
Preventive Effects of Eastern Medication (Kampo) on the Progression of Chronic Renal Failure
Authors: Mitsuma Tadamichi
Published: July 2007

Twenty–two patients with chronic renal failure (CRF) were investigated. The patients were mainly administered decoctions of rhubarb () for 4 weeks. After that, traditional Chinese (Kampo) prescriptions, most of them involving Wen–Pi–Tang (), were given for another 4 weeks.

Following administration of these prescriptions, the levels of serum methylguanidine (MG), blood urea nitrogen and serum inorganic phosphorus improved significantly, although the values of serum creatinine (Cr) were not changed remarkably. The fact that the serum MG/Cr ratio was reduced after the therapy suggested that rhubarb possessed the potential to scavenge hydroxyl radicals by which MG was produced from Cr through creatol, as reported recently.

The serum Cr concentration was determined over an observation period of more than 40 weeks in each of the 7 cases. Evaluation of the progression rate of CRF was made from the slopes of the regression lines. After analysis, 5 of the 7 cases showed significant retardation of progression after the administration of Kampo prescriptions during 106 ± 32 (mean ± SD) weeks. Of the 5 cases, 2 were prescribed Wen–Pi–Tang, another 2 cases were treated with Wen–Pi–Tang and Bu–Zhong–Yi–Qi–Tang () and the last was treated with Ba–Wei–Di–Huang–Wan ().

This study demonstrated that the traditional Chinese prescriptions, most of them comprising Wen–Pi–Tang and/or Bu–Zhong–Yi–Qi–Tang, retarded the progression of CRF.