bluuebunny/crossref_metadata_2025 huggingface dataset:
Communication effectiveness of nurses working in a variety of settings within one large university teaching hospital in western Japan
Authors: Ito Misae , Lambert Vickie A.
Published: March 2003

This survey study measured the communication effectiveness of 176 nurses working on a variety of clinical units within one large university hospital in western Japan. The vast majority of the nurses demonstrated fair effectiveness in their communication skills. Although some of the nurses did demonstrate slightly higher communication effectiveness scores, few of the nurses’ demographic characteristics appeared to influence how well they communicated. The major limitations of the present study were the use of one hospital for data gathering, and the possible lack of cultural sensitivity of the communication questionnaire.
Reflective practise in clinical teaching
Authors: Lau Annie Kit Ling , Chuk Kai Cheung , Wei So Winnie Kwok
Published: March 2003

The present paper describes the process of reflective practise in clinical teaching through a workshop entitled ‘Effective Clinical Teaching’. The clinical teachers were invited to analyze the content of a videotape in which various clinical teaching scenarios were presented. Following this, they discussed a series of questions designed to promote reflective activities and evaluated the interaction among the student, the client and the clinical teachers in each scenario. The teachers also identified the positive and negative aspects of the teaching approaches portrayed on the tape. Finally, the participants made recommendations that would improve the interaction and suggested alternate teaching strategies to enhance the learning outcome. In addition, there was sharing of clinical teaching experiences among the clinical teachers. Through this process of reflection on action, the clinical teachers were able to understand various teaching approaches as perceived by students, and to address the issues that might hinder student learning in clinical settings. Different reflective activities have also been proposed to enhance student's reflective learning skills.
Experience of Middle‐ and Old‐Aged Women's Aging
Authors: Chung Seung Eun
Published: March 2003

Many studies on aging have explored the effects of disease and other problems on the elderly. These studies have resulted in a view of aging that focuses on losses. How aging is perceived may affect the adaptation of the elderly to life changes. Therefore, there needs to be a better understanding of aging from the perspective of the middle‐aged and older‐aged adults. This qualitative study used a hermeneutic phenomenological approach to discover meaning in the aging experience. The purpose of this study was to explore the experience of middle‐aged and older‐aged women. Participants consisted of 10 women (five middle‐aged women and five older‐aged women) aged 40 years or more who lived in Chongiu. Multiple strategies for data collecting were utilized including an in‐depth face‐to‐face interview and an analysis of the literature on aging, based on Van Manen's methodology of phenomenological research. The following themes emerged: (i) middle‐aged women: changing of physical shape, the attachment of youth, loss of self‐confidence, and preparing for one's own old age; (ii) old‐aged women: changing of physical function, being ousted from the younger generation, rhythmical pattern of life and death, and reflection on life.
Illness Behavior by the Elderly in a Korean Clan: Focus on Health‐Care Seeking Behavior
Authors: Cho Myoung Ok
Published: March 2003

Purpose:  In an aging society such as in Korea, developing an efficient health delivery system for the elderly has become an emergent social problem because of the increasing elderly population and the complexity of degenerative diseases. Therefore, nurses, as deliverers of health care, must, more deeply, understand the health behavior of the elderly. An answer to the question, ‘How do the elderly choose a health‐care system, and why do they do this?’ was sought.

Method:  This ethnographic study was conducted over three sessions. In January 1990, data on socio‐cultural context were gathered. Information on health and illness behaviors was collected from June 1994 to November 1994. From July 1995 to February 2001, the previously collected data were compared and confirmed. The subjects of this study, initially, were 10 women, aged 60 years or more. Five more women were added to the study in February 2001. The role of the researcher was that of cultural learner in the position of participant–observer. The data analysis procedure involved reflective thinking, comparison, and creativity.

Results:  The findings revealed that the elderly managed their health problems through all available types of health care (i.e. professional, traditional, and folk system). The conditions for their choice of a health‐care system were found to be their affinity to the resource person in everyday life, the characteristics of the health problem, their confidence in the particular system and their available economic resources. It was concluded that the elderly must maintain favorable interactions with her/his neighbors in order to gain needed health management.
Long‐term (4 year) efficacy and tolerability of doxazosin for the treatment of concurrent benign prostatic hyperplasia and hypertension
Authors: Fawzy Ahmed , Hendry Angela , Cook Eileen , Gonzalez Francisco
Published: March 2003

Background: The α1‐adrenoceptor antagonist doxazosin has proved successful in treating patients with concurrent benign prostatic hyperplasia (BPH) and hypertension in short‐term studies. However, both conditions are chronic and may worsen over time. The aim of this study was, therefore, to examine the tolerability and efficacy of doxazosin in the long‐term treatment of concurrent BPH and hypertension.

Methods: This study was a longitudinal extension of earlier double‐blind trials. Patients were enrolled into the study on a rolling basis. From a total of 178 BPH patients with hypertension enrolled into the study, 28 had reached 48 months of open‐label treatment with doxazosin at the time of the final data cutoff.

Results: Treatment with doxazosin resulted in sustained benefits for BPH patients over the whole study period, with significant improvements in the severity (12.2%, P < 0.001) and bothersomeness (13.2%, P < 0.001) of BPH symptoms, and in the maximum urinary flow rate (26.6%, P < 0.05) from baseline to the end of the 4‐year period. There was also a significant and sustained reduction in diastolic blood pressure. The efficacy of doxazosin treatment for both BPH and hypertension was maintained over the 4‐year period, despite the tendency of these conditions to worsen with time. Comparison of adverse events in patients with long‐ and short‐term hypertension and BPH demonstrates that the safety of doxazosin is not altered during long‐term therapy.

Conclusions: This study demonstrates that doxazosin appears to be well tolerated and efficacious in the long‐term management of concurrent BPH and hypertension.
Augmentation ileocystoplasty and ileal ureter replacement for distal ureteral cancer in a patient with a contracted bladder
Authors: Yamada Yuji , Takenaka Atsushi , Gotoh Kiyohiko , Yamanaka Nozomu
Published: March 2003

Background
: A male patient with a solitary kidney and contracted bladder due to urinary tuberculosis presented ureteral obstruction caused by primary lower ureteral cancer.

Methods
: Distal ureterectomy and urinary tract reconstruction consisting of ileal bladder augmentation and ileal ureter replacement with an antireflux procedure was performed.

Results/Conclusions
: Postoperatively satisfactory voiding without residual urine was achieved.
Pelvic lipomatosis associated with proliferative cystitis: Case report and review of the Japanese literature
Authors: Masumori Naoya , Tsukamoto Taiji
Published: March 2003

AbstractPurpose: We report only the second known patient with pelvic lipomatosis associated with proliferative cystitis in the Japanese literature, a 43‐year‐old mildly obese Japanese male who demonstrated radiographic findings characteristic of pelvic lipomatosis.

Methods: Cystourethrography revealed an elevated pear‐shaped bladder and an elongated and anteriorly displaced prostatic urethra. Computed tomography demonstrated excess intrapelvic fat that exhibited a density identical to that of subcutaneous fat tissue. Cystoscopic and histologic examination revealed concomitant proliferative cystitis composed of von Brunn’s nest, cystitis cystica and cystitis glandularis, but no malignant cells.

Results/Conclusions: As a result of dietary control for 15 months, the proliferative cystitis improved mildly, but the amount of fat was unchanged.
Radiotherapy for local progression in patients with hormone‐refractory prostate cancer
Authors: Furuya Yuzo , Akakura Koichiro , Akimoto Susumu , Ichikawa Tomohiko , Ito Haruo
Published: March 2003

Purpose: The aim of the present study was to investigate the effect of radiotherapy on the local progression of hormone‐refractory prostate cancer.

Methods: From 1986 to 1995, 38 patients were diagnosed with local progression without distant progression after hormonal therapy at Chiba University Hospital. Eleven cases were treated with irradiation for local progression. External beam irradiation was delivered to the prostate at a dose of 50–66.6 Gy.

Results: In patients treated with radiotherapy, the duration from initial treatment to local recurrence was 6–80 months (mean Â±Â± Â± SD: 33.9 Â± 22.9 months). The follow‐up period after irradiation was 7–64 months (mean Â± Â± Â± SD: 25.4 Â± 18.8 months). Three and 5 year cause‐specific survival rates from radiotherapy were 46.2 and 23.1%, respectively. Radiotherapy had a marked effect on symptoms associated with local progression and no patients suffered from the symptoms after the radiotherapy. Complications of radiotherapy were limited.

Conclusions: In patients with hormone refractory local progression without distant progression, low morbidity, low mortality radiotherapy offers a variable therapy to other palliative treatments because radiotherapy is able to control local symptoms for a long period of time.
Metanephric adenoma of the kidney
Authors: Imamoto Takashi , Furuya Yuzo , Ueda Takeshi , Ito Haruo
Published: March 2003

Background: Metanephric adenoma is a rare renal neoplasm that is histologically and clinically unique. We found this neoplasm in a 62‐year‐old female, whose renal tumor was incidentally detected on abdominal ultrasound examination.

Methods/Results: Ultrasound, computed tomography and magnetic resonance imaging were compatible with those of renal cell carcinoma. With a diagnosis of renal cell carcinoma, right partial nephrectomy was performed. This tumor showed histologic similarity to developing metanephric tubular epithelium. It was composed of uniformly small epithelial cells, which formed tubules.

Conclusions: The patient has been well and healthy for 20 months after surgery. The unique features of metanephric adenoma should be clinically and pathologically recognized because of its invariably benign course.
A bladder preservation regimen using intra‐arterial chemotherapy and radiotherapy for invasive bladder cancer: A prospective study
Authors: Miyanaga Naoto , Akaza Hideyuki , Okumura Toshiyuki , Sekido Noritoshi , Kawai Koji , Shimazui Toru , Kikuchi Koji , Uchida Katsunori , Takeshima Hitoshi , Ohara Kiyoshi , Akine Yasuyuki , Itai Yuji
Published: March 2003

Background
: A prospective study was performed to investigate combined treatment with intra‐arterial chemotherapy and radiation therapy for bladder preservation in locally invasive bladder cancer.

Methods
: Patients with invasive bladder cancer, stage T2–3N0M0, were included in the study. Intra‐arterial chemotherapy was performed with three injections of methotrexate and cisplatin at 3‐week intervals. Simultaneously, the patients underwent X‐ray irradiation (40 Gy) of the small pelvic space. Where a post‐treatment transurethral resection (TUR) biopsy showed no residual tumor, the tumor site was irradiated by a 30 Gy proton beam and the bladder was preserved. Where tumors remained, radical cystectomy was performed.

Results
: Between 1990 and 1996, 42 patients were treated according to this protocol. Post‐treatment TUR biopsy and urine cytology showed no residual tumors in 39 of 42 cases (93%). The bladder was preserved in accordance with the study protocol in 36 cases. A median follow‐up of 38 months showed 3‐year non‐recurrence in 72% of bladder‐preserved patients and the rate of bladder preservation was 84%. The nine recurrences included eight cases of superficial bladder recurrence. One cancer death occurred among the bladder‐preservation patients, giving 3‐year survival and cause‐specific survival rates of 84% and 100%, respectively. Although bladder function decreased slightly in compliance, bladder capacity was retained in almost all cases.

Conclusions
: This regimen is useful for bladder preservation in T2–3 locally invasive bladder cancer. Information from more cases and the results of more long‐term observations are needed, as is an evaluation of appropriate subject selection and factors associated with quality of life issues, particularly regarding bladder function.
Acute pancreatitis caused by extracorporeal shock wave lithotripsy for bilateral renal pelvic calculi
Authors: Abe Hiroyuki , Nisimura Taiji , Osawa Shuichi , Miura Takafumi , Oka Fumiatu
Published: March 2003

An elderly woman with a history of cholecystectomy and a re‐operation for postoperative peritonitis underwent extracorporeal shock wave lithotripsy (ESWL) for right and left renal pelvic calculi, 11 × 6 and 12 × 5 mm in size, to which 2400 and 1400 shots at 20 kV were given, respectively, on the same day. During the evening after the operation, the patient started to complain of upper abdominal pain. Laboratory examination on the next day revealed elevations in blood and urine amylase levels and a diagnosis of pancreatitis was made. Conservative treatment, including administration of protease inhibitor, did not improve her symptoms; abdominal distension became marked and she underwent laparotomy. Necrosection and indwelling of several drain tubes in abdomen were performed with an operative diagnosis of acute necrotic pancreatitis. With daily irrigation of drain tubes and treatment for methicillin‐resistant Staphyloococcus aureus infection of the lungs and abdominal cavity, septicemia and duodenal fistula, the patient gradually recovered and was discharged on postoperative day 151. It was suggested that ESWL was responsible for the acute pancreatitis. Either an obstruction of the pancreatic duct by fragments of common duct stone, or mechanical injury of the pancreas due to adhesion between the pancreas and surrounding tissue caused by the lapalotomy, was considered as a possible cause of pancreatitis. To our knowledge, there has been no previous report of severe acute pancreatitis and the present case suggests that ESWL may cause severe pancreatic even in cases without stone shadow in the bile, common duct or pancreatic duct.
Pathologic examination of renal cell cancer by means of step‐sectioning
Authors: Tsuchiya Kiyotaka , Jinbo Hiroyuki , Kurita Makoto , Matsumoto Kazuhisa , Okamura Keigo , Uchida Tatsuya , Kobayashi Mikio , Yamanaka Hidetoshi , Sugihara Shirou
Published: March 2003

Abstract
Background
: Because incidental detection of small renal cell cancers (RCC) has recently become increasingly common, nephron‐sparing surgery for these cases has been more widely performed. Renal cell cancer was investigated by means of step‐sectioning in order to determine which cases were suitable for nephron‐sparing surgery and how it should be performed.

Methods
: Pathology specimens obtained from 90 cases of radical nephrectomy were examined in 5 mm sections. We excluded large and invasive tumors from the present study. Particular attention was given to satellite tumor nodules (STN), pseudocapsules of the main tumor and vascular invasion.

Results
: Satellite tumor nodules of cancer (STN‐Ca) were found in seven of 90 cases (7.8%). Tumor size and grade was not correlated with the existence of STN‐Ca. The distance between the main tumor and STN‐Ca varied, with the pathology of the STN‐Ca mostly resembling that of the main tumor. Pseudocapsules of the main tumor were incomplete in 53 cases (58.9%), but extracapsular invasion of more than 1 mm was not seen in tumors less than 50 mm in diameter. Through step‐sectioning, a further six cases with microscopic vascular invasion were found. Vascular invasion within the main tumor was confirmed in 16 of 17 cases (94.1%) and within normal renal tissue in only one case.

Conclusions
: The incidence of existing STN‐Ca was not high (7.8%) in the present study, we had not any characteristics in the cases with STN‐Ca. As STN‐Ca were rarely near the main tumor, we could not expect to resect STN‐Ca with main tumor, resection to more than 1 mm outside the pseudocapsule was needed for complete resection of main tumor less than 50 mm in diameter. Normal renal tissue between the tumor and pelvis is a requirement for selecting appropriate cases in nephron‐sparing surgery, but we could not remove the risk of leaving STN‐Ca completely.
Effect of prostatic neuropeptides on migration of prostate cancer cell lines
Authors: Nagakawa Osamu , Ogasawara Masaru , Murata Jun , Fuse Hideki , Saiki Ikuo
Published: March 2003

Abstract
Background:
A previous study by the same authors demonstrated that among various neuropeptides in the prostate, calcitonin gene‐related peptide (CGRP) and gastrin‐releasing peptide (GRP) increased the invasive capacity of PC‐3 prostate cancer cells through enhancement of cell motility, while substance P (SP) inhibited the invasiveness through suppression of motile response.

Methods:
The effect of 10 kinds of neuropeptides were investigated, including CGRP, GRP, SP, neuropeptide Y (NPY), vasoactive intestinal polypeptide (VIP), calcitonin (CT), leucine‐enkephalin (L‐ENK), methionine‐enkephalin (M‐ENK), glucagon and parathyroid hormone‐related protein (PTH‐rP), on the invasion of DU‐145 prostate cancer cells through a reconstituted basement membrane (Matrigel) and the haptotactic migration of DU‐145, TSU‐pr1 and LNCaP prostate cancer cells using a Transwell cell culture chamber assay.

Results:
It was found that GRP, CGRP and PTH‐rP increased the invasive capacity of tumor cells. In contrast, SP, VIP, CT, L‐ENK, M‐ENK, NPY and glucagon had no significant effect. These three neuropeptides also increased the haptotactic migration of tumor cells to fibronectin. In addition VIP, CGRP and GRP increased the haptotactic migration of LNCaP prostate cancer cells and GRP and PTH‐rP increased the migration of TSU‐pr1 cells.

Conclusion:
The results indicated that some prostatic neuropeptides increased the invasive potential of prostate cancer cells partially through enhancement of cell motility.
Retrovesical desmoplastic small round cell tumor in a patient with urinary frequency
Authors: Murosaki Nobukazu , Matsumiya Kiyomi , Kokado Yukito , Yoshioka Toshiaki , Yasunaga Yutaka , Aozasa Katsuyuki , Okuyama Akihiko
Published: March 2003

Abstract A 21‐year‐old man with urological symptoms was found to have a large abdominal tumor in the retrovesical space between the bladder and the rectosigmoid colon. Radiologic findings revealed little evidence confirming the diagnosis. A transrectal biopsy failed to disclose the histopathologic origin of the tumor. An exploratory laparotomy with a complete surgical resection was impossible, so a wedge biopsy was performed. Combined histologic and immunohistochemical findings revealed the features of desmoplastic small round cell tumor (DSRCT). Despite subsequent multi‐agent chemotherapy, the patient died as a result of the growing tumor and liver metastasis. There have been only two prior reports of this neoplasm in the urological literature.
An unusual cause of renal colic: Hydatiduria
Authors: Ünsal Ali , Çimentepe Ersin , Dilmen Gülçin , Yenidünya Sibel , Saglam Remzi
Published: March 2003

Hydatid disease of the urinary tract is seen rarely. Hydatiduria may be a finding of renal involvement, but it is a rare cause of renal colic. A case is reported of renal hydatid disease that was diagnosed during the investigation of renal colic. A 38‐year‐old woman presented with renal colic. She had a history of episodes of renal colic and occasional voiding of grape‐like material. No calculus was found in the urinary tract by plain film or ultrasonographic examination. The histopathologic examination of this material revealed daughter cysts that are pathognomonic for hydatid disease. Ultrasound and computed tomography confirmed this diagnosis and right nephrectomy was performed without cyst perforation or any spilling of cyst content. Albendazole, 10 mg/kg per day, was given for 4 weeks (2 weeks preoperatively and 2 weeks postoperatively).
Synchronous occurrence of bladder carcinosarcoma and testicular seminoma
Authors: Gürbüz Yesim S , Müezzinoglu Bahar , Çimen Kazim , Dillioglugil Özdal
Published: March 2003

Abstract We report a case of urinary bladder carcinosarcoma with simultaneous testicular seminoma. A 60‐year‐old male presented with painless gross hematuria and a left testicular mass. The bladder tumor was deeply infiltrating muscular tissue and had histologic features of both carcinoma and sarcoma. Testicular tumor was diagnosed as classical seminoma. Radical cystectomy, pelvic and left‐modified retroperitoneal lymphadenectomy were performed. The lymph nodes did not show metastasis. At the 26 months follow‐up, the patient is free of disease.
Suicide gene therapy on LNCaP human prostate cancer cells
Authors: Yoshimura Ichiro , Suzuki Satoshi , Tadakuma Takushi , Hayakawa Masamichi
Published: March 2003

Abstract The efficacy of combination suicide gene therapy was evaluated using a Herpes simplex virus‐thymidine kinase/ganciclovir (HSV‐TK/GCV) system and an Escherichia coli cytosine deaminase/5‐fluorocytosine (CD/5‐FC) system on the LNCaP human prostate cancer cell model. Two types of plasmid vectors with the HSV‐TK gene were constructed. A constitutive chicken β‐actin promoter drove one and a prostate‐specific antigen (PSA) promoter drove the other. Similarly, a pair of plasmids with the CD gene under a cytomegalovirus (CMV) promoter and the PSA promoter was also constructed. LNCaP cells were transfected in vitro with either or both of those plasmids using a cationic lipid reagent. Transfected cells were treated with GCV and/or 5‐FC. The percentage of viable LNCaP cells 7 days after treatment with HSV‐TK/GCV or CD/5‐FC under a constitutive promoter was 40% and 41% of controls, respectively. The cell viability when two suicide genes were combined was 23%. The cell viabilities after four days with PSA promoter‐HSV‐TK vectors, CD vectors and a combination of both were 79%, 88% and 88%, respectively. Suicide gene therapy using either HSV‐TK/GCV, CD/5‐FC, or both, was effective in the LNCaP model. An additive effect was observed when the two suicide genes were used together. The PSA promoter did not seem to be effective enough to elicit cytotoxicity under the experimental conditions used here.
Histologic upgrading of prostate cancer occurs frequently over a short period of time: Single hospital experiences of radical prostatectomy
Authors: Mukouyama Hideki , Niimura Kenji , Ogawa Yoshihide
Published: March 2003

Abstract A total of 163 patients with localized prostate cancer underwent retropubic radical prostatectomy and pelvic lymphadenectomy at a single hospital from 1989 to 1998. We reviewed the patients in terms of their prognostic factors and survival. The patients without advanced diseases were diagnosed as having prostate carcinoma, using either biopsies or transurethral resection of the prostate. The carcinomas were categorized into localized prostate carcinomas (stage A, B or C) as a result of digital rectal examinations, computed tomography scans and bone scans. The patients were informed of the risk of surgery and, if they agreed to sign the consent form, underwent radical prostatectomy under general and epidural anesthesia usually 2 months after a positive biopsy. The surgical specimens were sent for pathology and were graded according to classifications of well‐, moderately and poorly differentiated adenocarcinoma. The patients were usually discharged from the hospital 2–3 weeks postoperatively and had regular follow‐up treatment. The mean age (± SD) was 68.75 (± 5.59) years and the mean follow‐up period was 47.2 months. There was a significant difference (34.4%) in pathologic grades between biopsy and surgical specimen. In a quarter of the patients (approximately 26.4%) upgrading of the surgical report occurred despite neoadjuvant therapy. Three‐year, 5‐year and 7‐year actuarial survival rates were 91.8%, 79.9% and 71.9%, respectively. Patients with organ‐confined prostate cancer underwent radical prostatectomy and survived a fairly good period of time. Histologic upgrading was frequently observed within a short period of time (2 months).
Resection of an L‐shaped kidney with renal cell carcinoma using a microwave tissue coagulator
Authors: Tsunoe Hiroaki , Yasumasu Tetsuo , Tanaka Masatosi , Kai Nobuyuki , Naito Seiji
Published: March 2003

Abstract An L‐shaped kidney is a type of crossed fused renal ectopia and consists of two moieties which were originally two kidneys. It is an uncommon condition and cases of malignant tumors in such anomalies are exceedingly rare. A case of an L‐shaped kidney with renal cell carcinoma is herein reported, in which a separation of both moieties was done in situ in order to perform a tumor resection. A literature review of this topic is also reported and the findings are discussed.
Non‐specific eosinophilic granulomatous prostatitis responded favorably to an antimicrobial agent and a hydrocortisone
Authors: Ohkawa Mitsuo , Yamaguchi Kazuyou , Kobayashi Masako
Published: March 2003

Abstract A case of non‐specific eosinophilic granulomatous prostatitis is presented. The patient was a 55‐year‐old man who was hospitalized with complaints of acute urinary retention and high‐grade fever. Results of digital examination and transrectal ultrasonography of the prostate and elevated prostatic specific antigen were suggestive of prostatic cancer. Transrectal needle biopsy of the prostate was performed. Histological examination of the specimens revealed the formation of histiocytic granulomas with eosinophilic infiltration. The patient responded favorably to combination therapy with an antimicrobial agent and a hydrocortisone.
Torsion of a benign cyst arising from the tunica vaginalis testis
Authors: Yoshimura Koji , Itoh Masaaki , Kawase Norio , Taki Yoji , Hosaka Naoki
Published: March 2003

We describe a rare case of torsion of a benign cyst originating from the parietal layer of tunica vaginalis. This case presented with acute scrotum. Surgical exploration revealed a cyst arising from the parietal layer of tunica vaginalis of which the pedicle was twisted. When a cystic mass is detected in the scrotum of boys with acute scrotum, torsion of a cyst in the cavum tunica vaginalis testis should be considered.
Early stage small cell carcinoma of the urinary bladder
Authors: Fujita Kazutoshi , Nishimura Kazuo , Nonomura Norio , Hirota Seiichi , Okuyama Akihiko
Published: March 2003

A 73‐year‐old man with primary small cell carcinoma of the bladder underwent radical cystectomy. The pathological findings revealed the tumor confined to the submucosal layer (pT1) without metastasis. No adjuvant chemotherapy was carried out. He is alive with no evidence of the disease 24 months after the operation.
The pharmacokinetics of fosfestrol and diethylstilbestrol in chronic hemodialysis patients with prostate cancer
Authors: HATORI MOTOAKI , TOTUKA YOSHIHIRO , YAMANAKA HIDETOSHI
Published: March 2003

Abstract Background: Fosfestrol drip infusion therapy is an available endocrinotherapy for prostate cancer. But since there have been few reports of its use in chronic dialysis patients, the pharmacokinetics of fosfestrol in these patients remains unclear. We conducted fosfestrol drip infusion therapy as an induction therapy in chronic hemodialysis patients with prostate cancer.

Methods: Two male patients were included in this study. One was a 68‐year‐old man who had been in hemodialysis for 15.7 years and had stage B2 prostate cancer. The other was a 74‐year‐old man who had been in hemodialysis for 4.4 years and had stage C prostate cancer. A total of 250 mg of fosfestrol was dissolved in 250 mL of 5% glucose solution and administered by drip infusion. The drug was given subcutaneously during 14 consecutive days and a luteinizing hormone‐releasing hormone agonist was injected on day 15.

Results: Serum fosfestrol levels increased rapidly after the drip infusion was started and remained at high levels during infusion, but fell quickly after the treatment ended. Diethylstilbestrol (DES) was also detected in blood after the infusion was started and its levels peaked when infusion ended. But on the next day, neither fosfestrol nor DES were detected in the blood of the patients. Moreover, neither fosfestrol nor DES was detected in the blood of the two patients before administering fosfestrol on day 15. Fosfestrol was quickly eliminated from the blood after hemodialysis was started, while DES remained in the blood during hemodialysis. The adverse reactions were mild hepatic dysfunction and gynecomastia.

Conclusions: Fosfestrol drip infusion therapy appeared to be safe as an endocrinotherapy for prostate cancer in chronic hemodialysis patients.
Changes in extent and zonal distribution of prostatic adenocarcinoma in patients preoperatively treated with neoadjuvant endocrine therapy: Analysis on whole‐mounted prostatectomy specimens
Authors: SHIN MASARU , TAKAYAMA HITOSHI , TSUJIMOTO YUICHI , NONOMURA NORIO , OKUYAMA AKIHIKO , AOZASA KATSUYUKI
Published: March 2003

Abstract Background: An increasing number of pharmacologic agents that induce reversible androgen deprivation are available for neoadjuvant endocrine therapy (NET) for prostatic adenocarcinoma (PCA). If information about the regression pattern of PCA after NET is recognized, more effective decision‐making for subsequent therapies such as prostatectomy and radiotherapy, will be possible.

Methods: The extent and zonal distribution of PCA with or without NET were examined in totally embedded radical prostatectomy specimens obtained from 103 patients with PCA. Seventy‐nine of the 103 patients received androgen deprivation therapy (castrated). The zonal location of PCA lesions (non‐transition vs transition zone), was identified in three slices from the inferior, middle and superior parts of the prostate. The area of the PCA lesions in these zones was measured.

Results: Prostatic adenocarcinoma was identified in 94 of 103 cases: 24 of 24 cases (100%) and 70 of 79 cases (87%) in the non‐castrated and castrated groups, respectively. The NET induced a mean of 21% reduction of the prostate volume and lowered the serum PSA level by one eighth. The frequency of capsular penetration in the castrated cases (57%) was lower than in the non‐castrated cases (83%) and confinement of the PCA lesion was found in 32% of the castrated and 17% of the non‐castrated cases. The reduction rate of the extent of the PCA lesions in the non‐transition and transition zone was 33% and 28%, respectively. The extent of the PCA lesions were smaller in the anterior parts, especially at the superior portion of the prostate.

Conclusion: Neoadjuvant endocrine therapy induced involutional changes of the PCA evenly across both the non‐transition and transition zones. The density of the PCA lesions was low in the anterior part of the prostate. This information is useful for decision‐making in post‐NET.
Renal dysplasia associated with ureteral ectopia and ipsilateral seminal vesicle cyst
Authors: GIGLIO MATTEO , MEDICA MAURO , GERMINALE FRANCESCO , CARMIGNANI GIORGIO
Published: March 2003

The simultaneous presence of renal aplasia/dysplasia, ureteral ectopia and seminal vesicle cyst represents an exceptionally rare malformation. The literature is reviewed here and a new case of such malformation, concerning a 45‐year‐old man affected by recurrent epididymitis, is reported.
Bilateral testicular tumors: A report of nine cases with long‐term follow‐up
Authors: OHYAMA CHIKARA , KYAN ATSUSHI , SATOH MAKOTO , SAITO SEIICHI , NISHIMURA YOSUKE , IMAI YOSHITADA , OIKAWA KATSUHIKO , YOKOYAMA JUN , SUZUKI KENICHI , TAKEUCHI MUTSUO , HOSHI SENJI , ORIKASA SEIICHI
Published: March 2003

Background
: The incidence and clinical features of bilateral germ cell testicular tumor (GCTT) in the Japanese population are not fully characterized. We examined the incidence, clinical features, management and outcome, sexual status, hormonal environment, implication of androgen replacement, and human leukocyte antigen (HLA) typing of bilateral GCTT.

Methods
:

We treated nine consecutive patients with bilateral GCTT from 1980 through to 1999, and reviewed their hospital and clinic charts. Testosterone, luteinizing hormone, follicle stimulating hormone, dehydroepiandrosterone, and dehydroepiandrosterone‐sulfate were measured in bilateral orchiectomized patients. Human leukocyte antigen typing was assessed with peripheral lymphocyte.

Results
:

The incidence of bilateral GCTT against the total number of patients with GCTT was 9/274 (3.3%). The median age of the first tumor was 29 (range 21–75) years. Three cases were synchronous and the remaining six cases were metachronous. In the case of metachronous tumor, the median interval between first and contralateral tumor was 8 (range 2–25) years. Standard treatment was defined as surveillance policy in stage I, chemotherapy for higher stages of non‐seminoma, and radiotherapy for stage II seminoma. Human leukocyte antigen typing was examined for seven cases. Five cases were positive for HLA‐A24. The incidence of HLA‐A24 in bilateral GCTT was identical to that of the Japanese population. The relapsing incidence of stage I disease with surveillance policy was almost identical to unilateral GCTT. A 74‐year‐old patient with stage II seminoma died of the disease at 1.3 years. The other eight patients remained well without any evidence of recurrence at a median follow‐up period of 78 (range 12–204) months. Four patients with bilateral orchiectomy did not require androgen replacement without easy fatigability. Sexual status was conserved using androgen replacement.

Conclusions
:

Long‐term follow‐up, as long as 25 years, is recommended for contralatelral relapse. Some patients with bilateral orchiectomy do not require androgen replacement. The significance of HLA‐A24 for bilateral testicular tumor is equivocal in the Japanese population.
Continent urinary reservoir formation with transverse colon for patients with pelvic irradiation
Authors: Kato Haruaki , Igawa Yasuhiko , Komiyama Itsuki , Nishizawa Osamu
Published: March 2003

Background: The creation of a continent transverse colon pouch for patients who had previously received radiation therapy for cervical cancer was attempted.

Methods: Three patients underwent construction of a continent urinary reservoir. Approximately 30 cm of a transverse colon segment was isolated for constructing a pouch. A reconfigured colon segment was used in two cases as a continent valve and the appendix was used in one case. Both ureters were implanted submucosally into the pouch in two patients and a reconfigured colon was also used to reconstruct a defect of the ureter in one patient.

Results: All patients could catheterize the pouch easily via the cutaneous stoma without incontinence. No complications were noted.

Conclusions: In the event that a urinary diversion is necessary for a pateint who has previously had radiation therapy, the transverse colon pouch can be a useful method to improve the quality of life. In addition, versatility of the reconfigured colon segment enables the colon pouch to be adapted to adverse clinical stiuations.
Immunological protection induced by bacillus Calmette–Guérin treatment in a murine bladder tumor model
Authors: Iwasaki Akio , Kawai Koji , Hayashi Hitoshi , Ikeda Noriko , Toida Ichiro , Ohtani Mikinobu , Akaza Hideyuki
Published: March 2003

Background: It has been previously reported that MBT‐2 tumor growth is completely inhibited when mice are inoculated with bacillus Calmette–Guérin (BCG). In this study it was examined whether or not vaccination with a mixture of BCG and MBT‐2 cells also induces immunological protection against murine bladder tumors.

Methods: Seven hundred thousand MBT‐2 cells and 1 mg of BCG (Tokyo172 strain) per mouse were injected subcutaneously into female C3H/HeN mice. Four and eight weeks after vaccination with this mixture, animals were reinoculated with MBT‐2 cells alone or MBT‐2 cells cocultured with BCG.

Results: Animals vaccinated with a mixture of BCG and MBT‐2 cells showed MBT‐2 tumor growth but completely rejected the MBT‐2 cells cocultured with BCG. MBT‐2 cells cocultured with BCG developed into tumors when they were inoculated into the control animals. Splenocytes prepared from vaccinated animals showed specific cytocidal activity against MBT‐2 cells precultured with BCG.

Conclusions: The results suggest that a mixture of BCG and MBT‐2 cells induces antitumor immunological protection against BCG‐ or MBT‐2‐associated antigens presented on MBT‐2 cells precultured with BCG.
Electron microscopic study to compare preclinical Cushing’s syndrome with overt Cushing’s syndrome
Authors: Hirano Daisaku , Okada Yasuhiro , Ishida Hajime , Okada Kiyoki
Published: March 2003

Background: No significant differences in gross and light‐ microscopic features have been reported between preclinical and overt Cushing’s adenomas. In this study, the ultrastructural differences between the two syndromes was attempted to be clarified.

Methods: Two preclinical Cushing’s syndrome adenomas and two overt Cushing’s syndrome adenomas obtained from surgical extirpation were examined in an electron microscopic study.

Results: Light microscopically, the adenomas of both syndromes were composed predominantly of clear cells, with few compact cells. Ultrastructurally, the prominent differences were of development in each organelle: the preclinical Cushing’s adenomas had undeveloped mitochondria, which were smaller in size and had sparse cristae, lysosomes and polysomes, whereas the overt Cushing’s adenomas contained well‐developed mitochondria which were larger in size and were filled with abundant cristae, smooth endoplasmic reticulum (SER), lysosomes and polysomes.

Conclusions: Preclinical Cushing’s syndrome adenomas were ultrastructurally characterized by a reduced number of cellular organelles such as mitochondria and SER, which are necessary to synthesize glucocorticoid hormones. However, examination of a greater number of adenomas will be required to be able to draw conclusions on the ultrastructural differences between the two syndromes.
Efficacy of preoperative donation of autologous blood in patients undergoing radical retropubic prostatectomy
Authors: Morioka Masaaki , Yamamoto Tokunori , Furukawa Yoji , Kinugawa Keigo , Sone Atsushi , Jo Yoshimasa , Matsuki Takakazu , Nakajima Takashi , Koide Takao , Tanaka Hiroyoshi
Published: March 2003

Background: Radical retropubic prostatectomy (RRP) has resulted in substantial blood loss and the frequent need for homologous blood transfusion. In this study, the efficacy of autologous blood transfusion, from medical and financial perspectives, was evaluated in patients undergoing RRP.

Methods: Between 1994 and 2000, 80 patients with localized prostate cancer underwent RRP in our institute. Based on informed consent, preoperative donation of autologous blood (PDA) was performed in 65 out of 80 patienets. Four or six units were donated during the first 3 years; however, donation units were reduced to a maximum of 4 units since 1997 onwards. The discard rate of donated blood and frequency of homologous transfusion were examined. Changes of hematocrit (Ht) and hemoglobin (Hb) levels through donation and surgery and important factors that may affect postoperative levels of Ht and Hb were evaluated in 56 patients receiving 4‐unit donations.

Results: Overall, 2 or 4 units of donated blood were discarded in four patients and homologous transfusion was required in two patients. In 56 patients receiving 4‐unit donation, the mean Ht level at predonation was 43.3%. Following donation, this decreased to 35.7%. The administration of recombinant human erythropoietin (rHuEpo) relieved declining Ht levels following donation, but changes in Ht levels after surgery were minor. Important factors related to postoperative decline of Ht and Hb levels were operative time and blood loss.

Conclusions: The program of 4‐unit PDA can be performed safely without rHuEpo injection, and it is useful to reduce the risk of requiring homologous transfusion. However, more efficient programs to relieve patient burden and to reduce medical cost are needed.
Combined tumor consisting of non‐functioning adrenocortical adenoma and pheochromocytoma in the same gland
Authors: Sato Hirotaka , Igarashi Hiroshi , Kishimoto Yuichi , Yamaguchi Kenya , Saito Tadanori , Ishida Hajime , Okada Kiyoki , Okano Tadao
Published: March 2003

A 59‐year‐old woman was admitted to East Tokyo Metropolitan Hospital for further examination of a left adrenal mass. Catecholamine levels in the plasma and urine were within normal limits. Neither 131I‐metaiodobenzylguanidine (MIBG) nor norcholestenol iodomethyl (131I) had accumulated in the left adrenal gland. A left adrenalectomy was performed through a retroperitoneal endoscope. Sections showed a tumor consisting of two parts. Histologically one part of the tumor was completely encapsulated, with clear cells comprising a honeycomb‐like mass, regarded as adrenocortical adenoma. The other part consisted of rich cytoplasma and these basophilic, hyperchromatic cells included alveolar patterns, resulting in the diagnosis of pheochromocytoma. Thus, an extremely rare case of non‐functioning adrenal incidentaloma consisting of an adrenocortical adenoma and a concomitant pheochromocytoma in the same gland is reported here.
Ureteroscopy and pneumatic lithotripsy, followed by extracorporeal shock wave lithotripsy for the treatment of distal ureteral stones
Authors: Gurbuz Zafer Gökhan , Gonen Murat , Fazlioglu Adem , Akbulut Habib
Published: March 2003

Background: We retrospectively reviewed our experience with retrograde ureteroscopy (URS) and a pneumatic lithotriptor in 160 patients with distal ureteral stones to determine whether prior extracorporeal shock wave lithotripsy (ESWL) is a limiting factor in the ureteroscopic procedure.

Methods: From January 1999 to September 2000, we performed URS and pneumatic lithotripsy in 160 patients with distal ureteral stones. Seventy‐four patients were treated with URS primarily (Group 1), while the remaining 86 patients received URS only after ESWL had failed (Group 2). For URS and lithotripsy, we used a 9.5 French rigid instrument and vibrolith (Elmed, Ankara, Turkey).

Results: In Group 1, 73 of 74 patients (98.6%) were treated successfully by URS alone, as were 81 of 86 patients (94.4%) in Group 2. Impacted stones were also observed in 17 patients from Group 2. In these patients, endoscopic observation revealed edematous inflammation above and below the calculus. Ureteral perforation occurred in one patient from Group 2, which required surgical repair. There was no significant difference in the stone‐free rates of the two groups t = 1.4 < 1.96t(∞,0.05).

Conclusion: Our data demonstrate that when ESWL fails, URS and pneumatic lithotripsy is as safe and effective as primary URS. Pneumatic lithotripsy also seems to be an effective treatment modality for impacted stones.
Prognostic significance of matrix metalloproteinases‐2 activation ratio in renal cell carcinoma
Authors: TAKAHASHI MASAYUKI , OKA NATUO , NARODA TAKUSHI , NISHITANI MASA‐AKI , KANDA KAZUYA , KANAYAMA HIRO‐OMI , KAGAWA SUSUMU
Published: March 2003

Background: Matrix metalloproteinases (MMPs) are a family of zinc‐dependent endopeptidases. MMP‐2 and MMP‐9 have been reported to be closely associated with tumor invasion and metastasis in various human carcinomas.

Methods: Tissue samples were obtained from 57 patients with renal cell carcinoma (RCC) who underwent radical nephrectomy in our hospital. We examined the expression of MMPs by gelatin zymography and assessed correlations with clinico‐pathological parameters and clinical outcomes.

Results: We detected bands corresponding to MMP‐9, proMMP‐2 and active MMP‐2. The expression of active MMP‐2 and MMP‐2 activation ratio (active MMP‐2/[proMMP‐2 and active MMP‐2]) were higher in T3 tumors than in T1 and T2 tumors. There were no significant differences in the expression of proMMP‐2, active MMP‐2 or MMP‐9 for any of the clinico‐pathological parameters. Patients with high MMP‐2 activation ratio or high MMP‐9 had significantly worse cause‐specific survival. Interestingly, among patients with stage III RCC, those with high MMP‐2 activation ratio or high active MMP‐2 had significantly worse cause‐specific survival. Univariate analysis showed that histological grade (P = 0.0001), histologic type (P = 0.0005), MMP‐2 activation ratio (P = 0.0159), stage (P = 0.0001), MMP‐9 (P = 0.0316), and T (primary tumor) category of TNM (primary tumor, lymph node, metastasis) classification (P = 0.0021) were significant predictors of clinical outcome. Multivariate analysis showed that only histological grade (P = 0.002) and stage (P = 0.0099) were independently significant predictors of clinical outcome.

Conclusion: Activation of MMP‐2 appears to play important roles in initiating metastasis, as shown by results obtained with stage III RCC patients. However, further study is needed to confirm this.
Sex difference in urethral response to electrical stimulation of efferent nerves in the pudendal sensory branch of rats
Authors: KONTANI HITOSHI , SHIRAOYA CHISATO
Published: March 2003

Background: We reported sex difference in the urethral pressure (UP) response to electrical stimulation (ES) of the hypogastric nerve in rats. The purpose of the present study was to report on sex difference in the UP response to ES of the pudendal nerves (PN) in rats before and after injection of d‐tubocurarine (d‐tc).

Methods: Wistar rats were anesthetized with urethane and α‐chloralose. The L6‐S1 trunk was exposed on the left side and resected. After resection of the motor branch of the PN the peripheral end of the L6‐S1 trunk was stimulated. Fluid was infused into the urethra through a catheter inserted into the bladder neck at a constant rate (0.5 mL/10 min) and the infusion resistance was measured as the UP. When d‐tc was injected, the rats were ventilated with an artificial respirator.

Results: Though ES of the L6‐S1 trunk caused fibrillation of the muscles near the tail and steep reduction of the UP, it caused elevation and reduction of UP in male and female rats, respectively, after intravenous injection of d‐tc (0.3 mg/kg). ES of the sensory branch of the PN caused the elevation in male rats and reduction of the UP without injection of d‐tc, and prazosin inhibited the UP elevation but the reduction was not inhibited by Nω‐nitro‐l‐arginine methyl ester.

Conclusion: In the sensory branch of the PN, the nerves innervating the smooth muscles in the urethral sphincter were contained. In male rats norepinephrine mediates the UP elevation, but the neurotransmitter that mediates the UP reduction in female rats is not known.