bluuebunny/crossref_metadata_2025 huggingface dataset:
A case of complete testicular feminization: Laparoscopic orchiectomy and analysis of androgen receptor gene mutation
Authors: Kanayama Hiro‐omi , Naroda Takushi , Inoue Yoshio , Kurokawa Yasushi , Kagawa Susumu
Published: March 2003

Background: Analysis of an androgen receptor gene mutation and a bilateral laparoscopic orchiectomy were performed on a 19‐year‐old patient diagnosed as a case of complete testicular feminizaton.

Methods: DNA sequencing of an androgen receptor gene mutation and laparoscopic orchiectomy were performed.

Results: A novel point mutation substituting a proline residue (CCG) for a leucine residue (CTG) was observed in codon 892 of exon 8 in the hormone‐binding domain of the androgen receptor gene. Bilateral intra‐abdominal testes were resected uneventfully by means of laparoscopic orchiectomy.

Conclusion: We conclude that genetic analysis of androgen receptor gene mutation is essential for diagnosis of teon and laparoscopic orchiectomy is a useful therapeutic alteration as a minimally invasive treatment.
Strip biopsy of superficial bladder tumors using an electrosurgical snare
Authors: Tachibana Masaaki , Miyakawa Ayako , Horiguchi Yutaka , Nakamura Kaoru , Murai Masaru
Published: March 2003

Background/Methods
: Transurethral strip biopsy of bladder tumors using an electrosurgical snare was tested to determine whether or not this technique provides any advantage to the histologic examination of bladder cancers and to the management of superficial bladder tumors as a routine treatment.

Results/Discussion
: Our research results confirm that the strip biopsy technique can be applied as an alternative transurethral management procedure for treatment of superficial bladder tumors. Moreover, the results demonstrate that the procedure can also provide significantly greater histologic diagnostic advantages for bladder cancers than are possible through cold cup biopsy or transurethral resection.
The study of PSA gene expression on urogenital cell lines
Authors: Takahashi Toshiko , Hoshi Senji , Satoh Makoto , Kaneda Takashi , Suzuki Ken‐Ichi , Nakagawara Kan‐Ichi , Orikasa Seiichi
Published: March 2003

Abstract
Purpose
: Reverse transcriptase–polymerase chain reaction (RT–PCR) offers a potentially more sensitive assay for detecting cells expressing prostate‐specific antigen (PSA) mRNA in peripheral circulation. But the sensitivity and specificity are variable depending on the position of the PSA amplification. To increase sensitivity and specificity, the whole PSA cDNA (1466 bp) was separated into eight different parts.

Methods
: We examined RT–PCR on 12 urogenital cell lines, including three prostate cancer (LNCaP, PC3, DU145), five human renal cell carcinoma (SMKT‐R3, TOS‐1, TOS‐2, R4, ACHN), two urinary bladder cancer (YTS‐1, KK‐47) and two testicular cancer (NEC8, NEC14) cell lines. The sizes of the eight fragmented PSA used in the experiment were PSA‐1 (1–257 bp), PSA‐2 (1–322 bp), PSA‐3 ( 172–507 bp), PSA‐4 (172–851 bp), PSA‐5 (595–1347 bp), PSA‐6 (682 967 bp), PSA‐7 (682–1347 bp) and PSA‐8 (863–1466 bp).

Results
: All cell lines had positive signals from PSA‐6, PSA‐7 and PSA‐8. The positive signals from PSA‐1, PSA‐2 and PSA‐3 were detected in some other cell lines in addition to the three prostate cancer cell lines. Only LNCaP which produces the PSA protein had a positive signal from PSA‐5. PC3 and DU145 (which do not produce PSA) and LNCaP had a positive signal from PSA‐4. Therefore, the inner primer PSA‐4′ (578–782 bp) used to increase sensitivity and specificity. Nested RT–PCR on the 12 cell lines, using the PSA‐4 and 4′ primers, detected more clear bands in the three prostate cancer cells.

Conclusion
: Nested RT–PCR using PSA‐4 (outer primer) and PSA‐4′ (inner primer) may be useful for detecting prostate cancer cells in the peripheral blood.
Transmurally absorbed intravesical chemotherapy with dimethylsulfoxide in an animal model
Authors: YAMAN ÖNDER , ÖZDILER EROL , ÖZEN SINAN , GÖGˇÜŞ ORHAN
Published: March 2003

Background: The purpose of the present study was to investigate the hypothesis that dimethylsulfoxide (DMSO) enhances the absorbtion of the intravesical chemotherapeutics.

Methods: Fifty male Wistar rats received 1.5 mg N‐methyl‐N‐nitrosourea (MNU) intravesically every other week (weeks 0, 2, 4, 6 and 8) for a total of five doses. After week 14, rats underwent intravesical installation of either epirubicin (1 mg) or epirubicin + DMSO (50%) every other week (weeks 14, 16, 18, 20 and 22). The absorbtion of epirubicin was estimated histologically by observing its fluorescence in the bladder.

Results: We observed papiller and/or hyperplastic formations in rat bladders (10/50 rats) due to installation of MNU. Epirubicin fluorescence was observed in the entire bladder wall of normal or hyperplastic regions in rats that were given DMSO prior to epirubicin. However, epirubicin was observed only in normal‐appearing mucosa or in superficial layers of hyperplastic regions.

Conclusions: The concomittant addition of DMSO with intravesical epirubicin enhances the absorbtion of epirubicin to the entire bladder wall. In this way, epirubicin cytotoxicity and antitumor activity can be potentiated. This can be useful for both the treatment of superficial bladder cancer (especially in local recurrence and progression) and invasive bladder cancer (especially in regional chemotherapy).
Primary tumor of the ureteral stump following a nephrectomy for renal cell carcinoma
Authors: Suzuki Takehiro , Tsuchiya Norihiko , Otomo Ryou , Kakinuma Hideaki , Satoh Shigeru , Sato Kazunari , Ogawa Osamu , Kato Tetsuro
Published: March 2003

Background: A 64‐year‐old man presented with asymptomatic macroscopic hematuria during a follow up for a localized renal cell carcinoma (RCC), which was treated by a right radical nephrectomy 6 years earlier.

Methods: X‐rays and a ureteroscopic examination revealed multiple papillary tumors filling the right ureteral stump. Surgery was performed to excise the ureteral stump and bladder cuff. The tumor was histologically a grade 2–3 transitional cell carcinoma without muscle invasion.

Results/Conclusions: Only four patients with a ureteral stump carcinoma, including the present case, have been reported after a nephrectomy for RCC. Considering that this patient had a past history of multiple cancers, genetic or environmental factors may have contributed to the etiology of the ureteral stump tumor.
Nephrogenic adenoma of the bladder in a chronic hemodialysis patient
Authors: Ashida Shingo , Yamamoto Akihiro , Oka Natsuo , Masuda Syusaku , Yuasa Kenji , Terao Naotami , Shiozu Tomoyuki , Nakamura Syoichiro , Iwata Jun
Published: March 2003

Background: Nephrogenic adenoma is an uncommon, benign metaplastic lesion occurring in the urothelium, usually as a response to chronic irritation or trauma. It is rarely encountered in hemodialysis patients. Endoscopically, these lesions can easily be mistaken for malignant tumors.

Methods/Results: We report on a case of nephrogenic adenoma of the bladder in a chronic hemodialysis patient that was large and mistakenly diagnosed as transitional cell carcinoma in the initial biopsy. Histopathological examination of the total cystectomy specimen demonstrated the correct diagnosis of nephrogenic adenoma.

Conclusion: Increased awareness by urologists and pathologists of nephrogenic adenoma may lead to its more accurate diagnosis.
High‐dose chemotherapy with peripheral blood stem cell transplantation for advanced testicular cancer
Authors: Miyazaki Jun , Miyanaga Naoto , Kawai Koji , Shimazui Toru , Takeshima Hitoshi , Akaza Hideyuki
Published: March 2003

Background
: The present study was performed in order to investigate the efficacy and safety of high‐dose chemotherapy for the treatment of patients with advanced testicular cancer.

Methods
: Seven patients were treated with high‐dose carboplatin, etoposide and cyclophosphamide followed by peripheral blood stem cell transplantation. Five patients received one cycle and two patients received two cycles of the high‐dose chemotherapy.

Results
: Of the seven patients, one achieved a complete response and four achieved partial responses with markers negative. As a result of subsequent surgery for residual tumors, three of the four partial responders showed no residual cancer cells. One patient who did not undergo surgery received radiotherapy after the high‐dose chemotherapy and the residual tumors disappeared. All five patients who had either a complete or partial response are still alive and without evidence of disease at 12, 27, 30, 37 and 40 months. One patient is alive with disease at 7 months and one died of progressive disease at 6 months. The hematologic recovery after high‐dose chemotherapy was rapid and non‐hematologic toxicities were usually mild and manageable.

Conclusions
: High‐dose chemothrapy followed by peripheral blood stem cell transplantation is safe and effective for use in patients with far‐advanced testicular cancer, particularly when the high‐dose chemotherapy is conducted as the initial treatment. Further larger and long‐term follow‐up studies are needed to define the role of high‐dose chemotherapy on testicular cancer.
Urachal tuberculosis
Authors: Fujimoto Ken , Samma Shoji , Akiyama Tatsuya , Tanaka Nobumichi , Hirayama Akihide , Nakayama Akifumi
Published: March 2003

Background
: We report on an extremely rare case of urachal tuberculosis that was confirmed using a polymerase chain reaction test of paraffin‐embedded material.

Methods/Results
: A 62‐year‐old man presented with pollakiuria. With a diagnosis of urachal abscess, the patient underwent en bloc resection of the cystic mass. A bacterial culture test of the content showed no organism. The histopathologic findings suggested urachal tuberculosis. The AMPLICOR polymerase chain reaction test by using paraffin‐embedded sections revealed the existence of Mycobacterium tuberculosis in the resected tissue. The only positive finding in systemic screening examinations for tuberculosis was old tuberculosis scars in the upper right lung. It was supposed that hematogeneous spreading from the lung lesion may result in urachal tuberculosis after a long latent period.

Conclusions
: Although urachal tuberculosis is an extremely rare condition, tuberculosis must always be kept in mind when observing any infectious diseases.
Use of bladder mucosal graft for urethral reconstruction
Authors: Özgök Yaşar , Tan M Özgür , Kilciler Mete , Tahmaz Lütfü , Erduran Doğan
Published: March 2003

Background: The ideal tissue for complex urethral reconstruction has yet to be determined, especially in patients with deficient preputium. The use of bladder mucosa as a free graft could be an alternative in these problem cases.

Methods: Bladder mucosa graft urethroplasty was performed on 14 patients with penoscrotal or scrotal hypospadias. The mean age of the patients was 18.7 (range 14–23) years. Ten cases were subjected to primary urethral reconstruction while four cases had previous hypospadias repair.

Results: Complete urethral replacement by the bladder mucosa tube was performed in six patients. Meatal problems occurred in two (33.33%) patients and proximal fistula formed in one (16.67%) patient. A bladder mucosa graft was combined with preputial or tunica vaginalis grafts distally in eight cases, and one patient in the tunica vaginalis group developed fistula at the anastomosis of the bladder mucosa and tunica vaginalis grafts. The overall complication rate was 28.6%.

Conclusions: Our initial results showed that bladder mucosa grafts can be used successfully for urethral reconstruction especially when combined with preputial or tunica vaginalis grafts distally.
Clinical, urodynamic and endoscopic characteristics of the Stanford pouch ileal neobladder constructed with absorbable staples
Authors: Uygur M Cemil , Tan M Özgür , Altugˇ Ugˇur , Yilmaz Cenk , Erol Demokan
Published: March 2003

Abstract Purpose The clinical, urodynamic and endoscopic aspects of the Stanford pouch ileal neobladder formed with absorbable staples were investigated.

Methods A Stanford pouch ileal neobladder was formed using absorbable staples after radical cystoprostatectomy in 30 male patients with the diagnosis of muscle invasive carcinoma of the bladder between 1995 and 1998. The mean age of the patients was 62 (range 41–70) years. Patients were followed with arterial blood gas, serum biochemistry, pouch cystography, urodynamic tests and endoscopy.

Results Five (16.7%) patients had early postoperative complications and three were related to the neobladder. One year postoperatively, low grade (I, II) vesicoureteral reflux was present in five (16.7%) cases. The mean preoperative and 6 months postoperative serum creatinine levels were 1.07 ± 0.3 mg/dL and 1.2 ± 0.4 mg/dL, respectively, but the difference was not statistically significant (P = 0.1). Six months postoperatively the mean serum chloride level was 109 ± 4.5 (range 100–113) mmol/L and the mean arterial blood pH was 7.37 ± 0.2 (range 7.3–7.4). Two (6.7%) patients required oral alkaline supplementation because of high chloride levels. All the patients except one were continent throughout the day after 1 year. However, nocturnal enuresis was present in 25 (83.3%) cases. The pouch capacity was increased gradually up to 12 months postoperatively and the mean pouch capacity 12 months postoperatively was 460 ± 95.8 mL. Micturition occurred spontaneously in most patients while some needed abdominal straining. None of the patients had a residual urine of more than 60 mL. The mean maximum flow rate 6 months postoperatively was 9.8 (range 5.4–15.0) mL/s. After 6 months the stapled edge was noticed as a nodular line. One year postoperatively only a white scar could be observed at the suture line.

Conclusion The Stanford pouch ileal neobladder constructed using absorbable staples was able to provide a good capacity–low pressure reservoir with a low rate of complications.
Primary testicular plasmacytoma with hydrocele of the testis
Authors: Suzuki Kazumi , Shioji Yasunobu , Morita Tatsuo , Tokue Akihiko
Published: March 2003

Abstract A case of primary testicular plasmacytoma complicated with hydrocele of the testis is reported. An 86‐year‐old man presented with hydrocele of the right testis. High inguinal orchiectomy was performed as the preoperative aspiration cytology of the hydrocele fluid showed atypical cells. Immunohistochemical study of the right testis revealed testicular plasmacytoma positive for IgG. He remained well 9 months after the orchiectomy. This is the second reported case where the preoperative diagnosis of testicular plasmacytoma was made based on the hydrocele fluid cytology.
Novel therapeutic strategy for advanced prostate cancer using antisense oligodeoxynucleotides targeting anti‐apoptotic genes upregulated after androgen withdrawal to delay androgen‐independent progression and enhance chemosensitivity
Authors: Miyake Hideaki , Hara Isao , Kamidono Sadao , Gleave Martin E
Published: March 2003

Abstract Progression to androgen‐independence remains the main obstacle to improving survival for patients with advanced prostate cancer. In this review, findings are summarized that have recently been demonstrated to establish novel therapeutic strategy targeting several genes playing functionally important roles after androgen withdrawal and during androgen‐independent progression. The authors initially characterized changes in gene expression after androgen withdrawal in the androgen‐dependent Shionogi and LNCaP tumor models using cDNA arrays. Based on these results, they focused on genes highly upregulated after androgen ablation (i.e. bcl‐2, bcl‐xL, TR.PM‐2, IGFBP‐5), which have anti‐apoptotic or mitogenic activities, and thereby confer a resistance to androgen withdrawal as well as cytotoxic chemotherapy. The authors further demonstrated the efficacy of an antisense oligodeoxynucleotide (ODN) strategy for patients with advanced prostate cancer through the inhibition of target gene expression, resulting in a delay in the progression to androgen‐independence by enhancing apoptotic cell death induced by androgen ablation and chemotherapy. The authors also showed the effectiveness of combined antisense ODN therapy and cytotoxic chemotherapy by achieving additive or synergistic effects. These findings provide a basic significance for the design of clinical studies using antisense ODN either alone or in combination with chemotherapeutic agents in patients with advanced prostate cancer.
Intravenous digital subtraction angiography and helical computed tomography in evaluation of living renal donors
Authors: Watarai Yoshihiko , Kubo Kozo , Hirano Tetsuo , Togashi Masaki , Ohashi Nobuo , Usuki Tomoaki , Takeuchi Ichiro , Nonomura Katsuya , Koyanagi Tomohiko
Published: March 2003

Abstract Objectives: The present study was carried out to evaluate the accuracy of helical computed tomography (CT) and intravenous digital subtraction angiography (IV‐DSA) on anatomical assessment of renal vasculature for living renal donors.

Methods: Forty‐two healthy potential renal donors were prospectively evaluated and 35 subsequently underwent donor nephrectomy after helical CT and IV‐DSA evaluation. The vascular and non‐vascular findings were compared between the findings on helical CT, IV‐DSA and surgery.

Results: Ten prehilar branches and five accessory renal arteries were found at nephrectomy. Overall, operative findings agreed with the findings by IV‐DSA in 89% and by helical CT in 83%. In delineating accessory arteries, IV‐DSA had a sensitivity of 60% and specificity of 97%, whereas helical CT had a sensitivity of 40% and specificity of 100%. In delineating prehilar branches, IV‐DSA had a sensitivity of 90% and specificity of 100%, whereas helical CT had a sensitivity of 70% and specificity of 100%. Accessory arteries and prehilar branches that were not detected by helical CT or IV‐DSA, were less than 2 mm in diameter and did not require vascular reconstruction. Renal veins were delineated in 63% by IV‐DSA, whereas they were clearly imaged by helical CT in all cases, including a case with a circumaortic renal vein. Non‐vascular findings were obtained in 64% by helical CT, including two renal tumors. None of these findings were obtained by IV‐DSA.

Conclusion: Helical CT and IV‐DSA provide comparably sufficient information on renal artery vasculature. However, helical CT provides significantly more information on venous and non‐vascular findings as a single‐imaging modality.
Growth fractions of human renal cell carcinoma defined by monoclonal antibody Ki‐67. Predictive values for prognosis
Authors: Yuba Hiroshi , Okamura Kikuo , Ono Yoshinari , Ohshima Shinichi
Published: March 2003

Background:

We used immunohistochemical techniques to elucidate the role of growth fractions of renal cell carcinoma in the clinicopathology of the condition and patient survival.

Methods:

Fifty‐two fresh‐frozen nephrectomy specimens were immunostained with Ki‐67 monoclonal antibody. Ki‐67 indexes were determined to examine the relationship between tumor size, grade, stage and survival curve. This study included 43 men and nine women with the mean age 58.4 ± 11.7 years, who had been followed up for 39 ± 25 months.

Results:

The Ki‐67 index ranged from 0.6 to 14.1%, averaging 4.6 ± 5.8%. It was 2.8 ± 2.4% in tumors <5 cm, 4.7 ± 3.6% in tumors ≥5 cm and 7.1 ± 9.0% in tumors ≥10 cm. The Ki‐67 index of grades 1, 2 and 3 tumors was 2.3 ± 1.1%, 3.3 ± 2.7% and 12.0 ± 10.4%, respectively. Grade 3 tumors had a significantly higher Ki‐67 index than grade 1 or grade 2 tumors. There was no correlation between the Ki‐67 index and tumor stage. Patients with a Ki‐67 index < 5.6% had a better prognosis than those with an index > 5.6% (P = 0.029). However, multivariate analysis demonstrated that tumor size (P = 0.034) and grade (P = 0.038) were higher in hazard ratio than the Ki‐67 index.

Conclusions:

Most renal cell carcinomas had low growth fractions. Although a high Ki‐67 index should indicate a poor prognosis, Ki‐67 did not correlate to metastasis. We believe it is necessary to investigate the factors, other than growth potential, that affect metastasis.
The correlation between penile tumescence measured by the erectometer and penile rigidity by the RigiScan
Authors: Suzuki Kazuhiro , Sato Yoshikazu , Horita Hiroki , Adachi Hideki , Kato Ryuichi , Hisasue Shinichi , Itoh Naoki , Tsukamoto Taiji
Published: March 2003

Background:

The goal of this study was to evaluate the correlation between increments of penile tumescence and penile rigidity measured by the erectometer and the RigiScan, respectively.

Methods:

Nocturnal penile tumescence (NPT) was measured in 25 volunteers (mean age, 49.5 years). The erectometer and the RigiScan were used simultaneously for a total of 47 nights. We studied the correlation between maximum penile circumferential changes determined by the erectometer and penile rigidity patterns measured by the RigiScan.

Results:

Maximum circumferential changes during NPT measured by the erectometer were well correlated to those determined by the RigiScan (correlation coefficient, 0.719). In addition, penile circumferential changes measured by the erectometer corresponded well to the penile rigidity pattern determined by the RigiScan (P = 0.0001). Specifically, maximum penile circumferential changes of more than 30 mm and less than 10 mm had 70% positive predictive value and 100% negative predictive value for predicting the normal rigidity pattern, respectively.

Conclusions:

Penile circumferential changes measured by the erectometer were well correlated to penile rigidity measured by the RigiScan, particularly when the increments were larger than 30 mm or less than 10 mm. These results suggested that the erectometer was a useful tool to estimate the penile rigidity patterns of the RigiScan.
New semiautomatic suturing device (Maniceps) for precise vesicourethral anastomosis during radical retropubic prostatectomy
Authors: YAMADA YOSHIAKI , HONDA NOBUAKI , NAKAMURA KOGENTA , MITSUI KENJI , HIBI HATSUKI , TAKI TOMOHIRO , KAMIJYOU AYUMI , AOKI SHIGEYUKI , KATO KEITARO , KOKUBO HIROTO , FUKATSU HIDETOSHI
Published: March 2003

Performing vesicourethral anastomosis following retropubic radical prostatectomy may, under some anatomical conditions, be difficult. We describe the use of a new suturing semiautomatic device for deep surgical operations (Maniceps) to facilitate vesicourethral anastomosis. Maniceps is a pair of forceps both jaws of which have a groove at the tip. A 7 mm straight needle is set on the needle‐holder jaw. By closing and reopening the forceps, the needle is moved onto the needle‐receiver jaw. The use of Maniceps in vesicourethral anastomosis ensure the procedure is safe, easy and effective.
Retroperitoneoscopic ureterocutaneostomy for obstructive uropathy with advanced bladder cancer: A case report
Authors: NAKAMURA EIJIRO , TERACHI TOSHIRO , KAMOTO TOSHIYUKI , OKUNO HIROSHI , TERAI AKITO , KAKEHI YOSHIUKI , OGAWA OSAMU
Published: March 2003

Abstract A 71‐year‐old man who had previously undergone left nephroureterectomy for renal pelvic tumor developed advanced bladder cancer with obstructive uropathy. He complained of severe macroscopic hematuria, dysuria and presented with postrenal failure. To rescue the renal function and improve ease the patient’s symptoms, retroperitoneoscopic ureterocutaneostomy was performed. The operation time was 90 min and blood loss was kept to a minimum. He was able to walk and eat on the first postoperative day, and he left the hospital on postoperative day 21 with satisfactory renal function. Retroperitoneoscopic ureterocutaneostomy is simple, less invasive and a reproducible procedure for poor prognostic advanced cancer patients with obstructive uropathy.
Follow‐up of clinical stage I testicular cancer patients: Cost and risk benefit considerations
Authors: KAKEHI YOSHIYUKI , KAMOTO TOSHIYUKI , KAWAKITA MUTSUSHI , OGAWA OSAMU
Published: March 2003

Background
: Regardless of the way it is managed, a high cure rate has been achieved for recurrent low‐stage testicular cancer. Achieving a balance between survival and the patient’s inconvenience and expense during follow‐up, has therefore become an important issue.

Methods
:

Prognoses and recurrence patterns were investigated in 39 patients with stage I non‐seminomatous germ cell tumor of the testis (NSGCT), and 82 patients with stage I seminomatous germ cell tumor of the testis (SGCT), who underwent high orchiectomy between 1970 and 1997 at our institution. We considered the cost benefits and the risks by reviewing our results together with other reported results.

Results
:

Patients with clinical stage I NSGCT under surveillance showed no progression later than 4 years after orchiectomy. The ability to detect progression using chest X‐ray alone appeared very low. There was no infradiaphragmatic recurrence after adjuvant radiotherapy for patients with stage I SGCT. Only two of 204 patients showed progression, which included eight of our patients who underwent two cycles of adjuvant carboplatin therapy.

Conclusions
:

Four years of intensive follow‐up is probably sufficient for patients with stage I NSGCT under surveillance, and routine chest X‐rays may be required only during the first year of surveillance. The benefit of using adjuvant radiotherapy for patients with stage I SGCT is that we could remove abdominal and pelvic CT scans from the routine follow‐up protocol. Randomized trials will clarify whether the adjuvant carboplatin therapy is less toxic, provides better prognosis and is more cost‐effective than adjuvant radiotherapy.
Efficacy of 3‐D computed tomographic reconstruction in evaluating anatomical relationships of colovesical fistula
Authors: Shinojima Toshiaki , Nakajima Fumio , Koizumi Jun
Published: March 2003

A case of colovesical fistula is reported. The anatomy of the pelvis was determined preoperatively with 3‐D computed tomography (CT), and the fistula, including adjacent structures, could clearly be seen. Compared with conventional axial CT imaging, 3‐D CT provided better and more complete visualization of the anatomical relationships, which facilitated the surgical procedure and provided a good outcome.
Usefulness of prostate‐specific antigen velocity in screening for prostate cancer
Authors: Ito Kazuto , Yamamoto Takumi , Ohi Masaru , Kubota Yutaka , Fukabori Yoshitatsu , Kurokawa Kohei , Suzuki Kazuhiro , Yamanaka Hidetoshi
Published: March 2003

Background: The cut‐off value of prostate‐specific antigen velocity (PSAV) was investigated in relation to the initial prostate‐specific antigen (PSA) value in subjects with initial values of 1.0–4.0 ng/mL, and the usefulness and limitations of PSAV as a screening test for prostate cancer were examined.

Methods: In this study, 4883 men who underwent mass screening for prostate cancer two or more times between 1987 and 1998 and had initial PSA levels of 1.0–4.0 ng/mL were investigated. The subjects ranged in age from 42 to 96 years (mean: 68.0 ± 6.6 years). The cut‐off value of PSAV was set at 0.1–1.5 ng/mL per year, and the sensitivity, specificity, efficiency and positive predictive value (PPV) of PSAV for detecting prostate cancer were determined according to the initial PSA value. A similar examination of the average PSAV was carried out in 2888 subjects with three or more visits for mass screening for prostate cancer.

Results: The diagnostic efficiency of PSAV was optimal with cut‐off values of 0.3 and 0.75 ng/mL per year in those subjects with initial PSA levels of 1.0–1.9 and 2.0–4.0 ng/mL, respectively, but the PPV was low at 1.8% in subjects with initial PSA levels of 1.0–1.9 ng/mL. When the cutoff value of PSAV was set at 1.2 ng/mL per year in individuals with initial PSA levels of 1.0–1.9 ng/mL, the PPV increased to 7.3% and the sensitivity was 40%. The diagnostic efficiency of the average PSAV was optimal at the cut‐off values of 0.2 and 0.4 ng/mL per year in subjects with initial PSA levels of 1.0–1.9 and 2.0–4.0 ng/mL, respectively, but the PPV was low at 2.2% in the subjects with initial PSA values of 1.0–1.9 ng/mL. When the cut‐off value of PSAV was set at 0.75 ng/mL per year in individuals with initial PSA levels of 1.0–1.9 ng/mL, the PPV was 9.8% and the sensitivity was 46%.

Conclusion: It is possible to improve the diagnostic accuracy of prostate cancer screening using the cut‐off value of PSAV and average PSAV in subjects with initial PSA levels of 1.0–4.0 ng/mL. The cut‐off values of PSAV should be set at 1.2 and 0.75 ng/mL per year in individuals with initial PSA levels of 1.0–1.9 and 2.0–4.0 ng/mL, respectively. The cut‐off values of the average PSAV should be set at 0.75 and 0.4 ng/mL per year in individuals with initial PSA levels of 1.0–1.9 and 2.0–4.0 ng/mL, respectively.
Prostatic cystadenoma presenting as a large multilocular mass
Authors: Matsumoto Kazumasa , Egawa Shin , Iwabuchi Keiichi , Baba Shiro
Published: March 2003

A case is reported here of a patient with a giant multilocular prostatic cystadenoma who presented with gross hematuria and underwent extensive surgical resection. A 35‐year‐old man presented with asymptomatic gross hematuria. Magnetic resonance imaging of the pelvis demonstrated a multilocular mass replacing the prostatic gland. At exploration the urinary bladder was found to be displaced anterolaterally and severely adherent to the large tumor. The pathological features were consistent with multilocular prostatic cystadenoma. There have been no signs of tumor recurrence during 24 months’ follow‐up after surgery. Although the natural history of prostatic cystadenoma remains unknown, complete surgical excision may not always be necessary. Physicians should at least be aware of the possibility of this disease entity before making treatment decisions.
Intra‐abdominal testis with loop‐like epididymis and intra‐canalicular vas and vessels
Authors: ANWAR AHMED , KUROKAWA YASUSHI , SHINTANI TERUMICHI , ONISHI TOMOICHIRO , KANAYAMA HIRO‐OMI , KAGAWA SUSUMU , WAKATSUKI SHINGO
Published: March 2003

Abstract A case of intra‐abdominal testis with loop‐like epididymis and intra‐canalicular vas and vessels is presented. A 3‐year‐old male with left impalpable testis since birth was admitted to our department. Physical examination and ultrasonography were inconclusive. Laparoscopy revealed a small left abdominal testis with surrounding adhesions close to the left‐obliterated umbilical artery. The vas deferens and spermatic vessels were entering into the internal inguinal ring. The processus vaginalis was patent. At inguinal exploration the testis was atrophic and the epididymis was loop‐like, joining the vas deferens in the inguinal canal. The spermatic vessels continued to the atrophic testis in a loop‐like manner. The testis, epididymis and the vas deferens were removed. Histopathological examination of the testis revealed Sertoli cells only. If inguinal exploration had been performed without laparoscopy, the presence of the vas deferens and spermatic vessels in the inguinal canal with the absence of the testis could have been misdiagnosed as vanishing testis. Abdominal testis would thus have been missed, with increased risk of complications, particularly malignancy.
Annual changes of the incidence and clinical characteristics of magnesium ammonium phosphate urinary stones
Authors: OGATA TAKAHIDE , AKAKURA KOICHIRO , MIZOGUCHI KEN‐ICHI , MIKAMI KAZUO , NOZUMI KUNIYOSHI , ITO HARUO
Published: March 2003

Background: Magnesium ammonium phosphate (MAP) urinary stones account for the majority of staghorn stones and frequently cause a non‐functioning kidney. In the present study, we examined the annual changes of the number and clinical characteristics of MAP stones.

Methods: The annual incidence of MAP stones was investigated in 2619 patients with urinary stones in whom composition of the stone was analysed at Chiba University Hospital between 1964 and 1999. In addition, the annual number of patients with MAP stones was examined at Funabashi Clinic. In a total of 644 patients with MAP stones, age and sex of the patients, location and size of the MAP stones, urinary cultures and etiological factors were analysed.

Results: The number of MAP stones in the lower urinary tract was relatively constant. In contrast, MAP stones in the upper urinary tract had dramatically decreased since 1989, resulting in an increase in the rate of MAP stones in the lower urinary tract. Age distribution of the MAP stone patients ranged from 10 years to > 80 years, with the majority aged 30–60 years. The proportion of larger MAP stones in the upper urinary tract increased. There was no significant difference in prevalence of urine cultures. Among etiological factors for MAP stones, difficulty on urination tended to be common in recent years.

Conclusion: The number of MAP stones, especially in upper urinary tract, has been decreasing during the last decade. At present, treatment of urinary tract obstruction seems important for the management of MAP stones in lower urinary tract.
Calcium nephrolithiasis and distal tubular acidosis in type 1 glycogen storage disease
Authors: IIDA SHIZUKA , MATSUOKA KEI , INOUE MICHIRO , TOMIYASU KATSURO , NODA SHINSHI
Published: March 2003

A 36‐year‐old man was admitted to hospital due to right flank pain as a result of ureteral stones. He had been followed up for type 1 glycogen storage disease since the age of 11 years. He had four episodes of spontaneous stone birth during the previous 2 years, and each stone was composed mainly of calcium oxalate. Intravenous pyelography showed right hydronephrosis due to ureteral stones and bilateral multiple renal stones. We carried out transurethral ureterolithotripsy (TUL) on the right ureteral stones. The composition was a mixture of calcium oxalate and calcium phosphate. Laboratory evaluation demonstrated the association of distal renal tubular acidosis (RTA). These observations suggest that hypocitraturia and distal RTA are strongly correlated to recurrence of calcium nephrolithiasis. The patient's serum uric acid and urinary citrate excretion levels normalized after allopurinol and potassium citrate administration.
Chromophobe cell renal carcinoma with acquired cystic disease of the kidney in a long‐term hemodialysis patient
Authors: FUJIMOTO KIYOHIDE , ANAI SATOSHI , OKAJIMA EIJIRO , CHO MASAKI , YOSHIDA KATSUNORI , OZONO SEIICHIRO , HIRAO YOSHIHIKO , KIKKAWA AKIRA
Published: March 2003

Abstract We report a rare case of chromophobe cell renal carcinoma found in a 52‐year‐old female who had received hemodialysis therapy for 13 years. She was diagnosed as having a left renal tumor 7.5 cm in diameter with acquired cystic disease of the kidney (ACDK) by ultrasonographic examination during periodical systemic screening. As abdominal computed tomography scanning and enhanced color Doppler ultrasonography suspected that the hypervascular tumor was renal cell carcinoma, she underwent translumbar nephrectomy in July 2000. The histopathological diagnosis was chromophobe cell carcinoma with pT2 and grade 2 malignancy. Chromophobe cell carcinoma is uncommon among renal tumors with ACDK found in long‐term hemodialysis patients.
Concentration gradient of oxalate from cortex to papilla in rat kidney
Authors: NAKATANI TATSUYA , ISHII KEIICHI , SUGIMOTO TOSHIKADO , KAMIKAWA SADANORI , YAMAMOTO KEISUKE , YONEDA YUKIO , KANAZAWA TOSHINAO , KISHIMOTO TAKETOSHI
Published: March 2003

Abstract
Background:
The kidney eliminates the major fraction of plasma oxalate. It is well known that oxalate is freely filtered by glomeruli and secreted by the proximal tubules. However, the renal handling of oxalate in distal nephrons, which is considered as playing an important role in stone formation, remains obscure.

Methods:
At 15–180 min after intravenous injection of 14C‐oxalate to rats, the intrarenal localization of radioactivity was quantitatively measured by the radioluminographic method using a bioimaging analyzer. Tissue radioactivity was compared with plasma, and urinary radioactivities were measured by a liquid scintillation counter. The control study was conducted with 14C‐inulin.

Results:
The radioactivity of 14C‐oxalate in the papilla was 10 times greater than in the cortex and eight times greater than in the medulla 180 min after injection when almost no radioactivity was present in the urine. In contrast, the radioactivity of 14C‐inulin was nine times less in the papilla than in the cortex at the same time.

Conclusion:
Oxalate remains in the renal papilla for an extended period. This accumulation of oxalate may be attributed to calcium oxalate crystal fixation along the deep nephron which is considered to be the first step of stone formation.
Extraperitoneal laparoscopic Lich–Gregoir antireflux plasty for primary vesicoureteral reflux
Authors: SAKAMOTO WATARU , NAKATANI TATSUYA , SAKAKURA TAMIO , TAKEGAKI YOSHINORI , ISHI KEIICHI , KAMIKAWA SADANORI , SUGIMOTO TOSHIKADO
Published: March 2003

Abstract We performed laparoscopic Lich–Gregoir antireflux plasty on 4 patients with primary vesicoureteral reflux. All procedures were conducted using the extraperitoneal approach. The average surgical time was 230 min. There were no complications. After surgery, voiding cysturethrograms showed no reflux in all patients.
Establishment and application of criteria for the elective transfer of two good‐quality embryos to reduce high‐order multiple pregnancies
Authors: Shibahara Hiroaki , Suzuki Tatsuya , Tanaka Yasuko , Hirano Yuki , Taneichi Akiyo , Obara Hiromi , Fujiwara Hiroyuki , Takamizawa Satoru , Sato Ikuo
Published: March 2003

Aim
: This study was carried out to establish criteria for the elective transfer of two good‐quality embryos to reduce high‐order multiple pregnancy rates. The pregnancy and multiple pregnancy rates per transfer were retrospectively analyzed in 128 in vitro fertilization and embryo transfer (IVF‐ET) cycles.

Results
: The analysis revealed that the pregnancy and multiple pregnancy rates were 26.6% (34 of 128) and 23.5% (eight of 34), respectively. Five twin and three triplet pregnancies were included. The pregnancy rates in women 29 years old and younger, 30–34 years, 35–39 years, and 40 years and older were 21.2 (seven of 33), 37.0 (17 of 46), 25.8 (eight of 31), and 11.1% (two of 18), respectively. There was a significant difference of the pregnancy rates between 30 and 34‐year‐old and 40‐year‐old and older women (P < 0.05). The multiple‐pregnancy rate in women 40 years and older was 0%. Three triplet pregnancies were established only in the first attempt of IVF‐ET. The pregnancy rates in women, to whom good‐quality embryos (0–4) were transferred, were 0% (none of 12) for 0, 17.2% (five of 29) for one, 41.2% (seven of 17) for two, 30.8% (12 of 39) for three, and 32.3% (10 of 31) for four and more embryos, respectively. The multiple pregnancy rates in women who had good‐quality embryos of one, two, three, and four and more transferred were 0% (none of five), 23.5% (four of seven), 16.7% (two of 12), and 20.0% (two of 10), respectively.

Conclusion
: The criteria for the elective transfer of two good‐quality embryos were established as follows: age < 40 years, a first treatment cycle, and more than three good‐quality embryos available for transfer. After the application of the established criteria, the overall pregnancy and multiple pregnancy rates were 30.4% (14 of 46) and 14.3% (two of 14), respectively, which was satisfactory as compared with those in the 128 IVF‐ET cycles before application of the criteria. An elective transfer of two good‐quality embryos can be highly recommended to avoid high‐order multiple pregnancies in subjects with the established criteria. (Reprod Med Biol 2002; 1: 23–29)
Relationships between circulating leptin concentrations and other hormonal parameters in obese and non‐obese women with polycystic ovary syndrome
Authors: Kikuchi Nobumasa , Andoh Kazumichi , Mizunuma Hideki , Minegishi Takashi
Published: March 2003

Aim: To clarify the role of leptin in women with polycystic ovary syndrome (PCOS), we analyzed whether serum leptin levels correlate with other hormonal parameters in obese and non‐obese women with PCOS.

Methods: We studied 20 obese (body mass index, BM ≥25 kg/m2) and 20 non‐obese (BMI <25 kg/m2) women with PCOS diagnosed by the existence of menstrual disturbance, elevated serum level of luteinizing hormone (LH) with normal follicle‐stimulating hormone (FSH) and the characteristic polycystic appearance of the ovaries on transvaginal ultrasound images. Blood samples for LH, FSH, estradiol, testosterone (T), androstenedione (Δ4) and leptin were obtained, and the relationships between variables were examined by calculating Spearman correlation coefficients.

Results: Mean levels of leptin, T and Δ4 in obese PCOS women were significantly higher than those in non‐obese PCOS women, but this was not the case for BMI, bodyweight and waist to hip ratio. In all the 40 PCOS women considered together, there were significant positive correlations of leptin with BMI, waist to hip ratio, and Δ4 levels. However, in each group separately, serum leptin levels in obese PCOS women correlated only with BMI and bodyweight, whereas serum leptin levels in non‐obese PCOS women correlated with serum A4 levels.

Conclusion: Although further study is needed to assess the role of leptin on ovarian function in non‐obese women with PCOS, present findings do not support the fact that leptin is involved in the development of hormonal abnormalities in obese women with PCOS. (Reprod Med Biol 2002; 1: 49–54)
High‐dose therapy and autologous transplantation for lymphoma: The Peter MacCallum Cancer Institute experience
Authors: Dowling A. J. , Prince H. M. , Wirth A. , Wolf M. , Januszewicz E. H. , Juneja S. , Seymour J. F. , Gates P. , Smith J. G.
Published: March 2003

Abstract

Background: High‐dose therapy (HDT) with autologous bone marrow or blood cell transplantation for the treatment of lymphoma commenced at Peter MacCallum Cancer Institute in 1986.

Aim: To examine the patient characteristics and outcomes of patients with non‐Hodgkin’s lymphoma (NHL) and Hodgkin’s disease (HD) treated with HDT and autologous transplantation at our Institute in the first 10 years of the service (1986–95).

Methods: A retrospective analysis was performed examining patient characteristics, prior chemotherapy regimens, pretransplant disease status, HDT regimen, source of stem cells, time for haematopoietic recovery, complications of transplantation, response rates, overall survival (OS) and progression‐free survival (PFS).

Results: Sixty‐seven patients with NHL were treated with an estimated 5‐year OS rate of 44% (95% confidence interval (CI) 32–56%) and PFS rate of 34% (95% CI 21–44%). Factors independently predictive of an unfavourable PFS on multivariate analyses were presence of constitutional symptoms at transplant (P < 0.002) and chemotherapy‐resistant disease at transplant (P = 0.02). Twenty‐three patients with HD were treated with a 5‐year predicted OS rate of 74% (95% CI 56–92%) and PFS rate of 57% (95% CI 36–77%). There was no difference in PFS for HD patients who relapsed either within 12 months of completion of front‐line therapy or after this time (P = 0.5). The transplant‐related mortality for the entire cohort was 17%, with a progressive decrease over time.

Conclusion: HDT with autologous transplanta‐ tion achieves durable PFS and OS in patients with lymphoma. Improved patient selection, therapy modifications according to prognostic factors and ongoing improvements in supportive care should improve outcomes further. (Intern Med J 2001; 31: 279–289)
Immediate and long‐term results of radiofrequency ablation of pulmonary vein ectopy for cure of paroxysmal atrial fibrillation using a focal approach
Authors: Sanders P. , Morton J. B. , Deen V. R. , Davidson N. C. , Sparks P. B. , Vohra J. K. , Kalman J. M.
Published: March 2003

Background: Atrial fibrillation (AF) is frequently initiated by focal activity originating in the pulmonary veins. We present the early and long‐term results of a focal approach to pulmonary‐vein ablation for cure of paroxysmal AF.

Aims: The aim of this study was to establish the effectiveness of focal pulmonary vein radiofrequency ablation (RFA) for cure of paroxysmal AF.

Methods: Fifty‐one consecutive patients (35 male; 45 ± 11.4 years) were considered for RFA on the following criteria: (i) symptomatic drug refractory AF, (ii) high‐density atrial ectopy, bursts of atrial tachycardia or AF, (iii) absence of structural heart disease and (iv) provision of informed consent. Pulmonary vein mapping and RFA were by single trans‐septal puncture, which was only performed in patients with adequate focal activity at the time of procedure. Focal activity was present spontaneously or was elicited by isoprenaline, burst pacing or AF induction and cardio­version.

Results: One patient was excluded from the analysis due to non‐pulmonary vein triggers. Trans‐septal mapping and RFA were not performed in 22 patients (44%) due to: (i) inadequate ectopy (17), (ii) recur­rent AF (1), (iii) inability to cross septum (2) and (iv) multiple foci (2). Of 28 patients, RFA was attempted with procedural success in 23 patients (82%), with no acute complications. Mean fluoro‐­ scopy time for patients having RFA was 29 ± 11.5 mins. Pulmonary vein stenosis occurred in one case. Ten patients had symptomatic recurrence and, of those, two had further RFA. At a mean follow up of 11 ± 8 months, 15 patients (54% ablated, 30% of the total cohort) remained free of AF without anti‐arrhythmics.

Conclusion: This series highlights the low long‐term success rate of RFA to cure AF by targeting pulmon­ary vein initiators using a focal approach. Electrical pulmonary vein isolation may provide better long‐term results. (Intern Med J 2002; 32: 202−207)
Thyrotoxic, hypokalaemic periodic paralysis in Australasian men
Authors: Tran H. A. , Kay S. E. , Kende M. , Doery J. C. G. , Colman P. G. , Read A.
Published: March 2003

Abstract

The present study describes the clinical and laboratory features of 11 patients with thyrotoxic, hypokalaemic periodic paralysis, presenting to five Melbourne teaching hospitals between 1991 and 2000. All 11 patients were Asian or Polynesian men aged 18−41 years, and most had experienced previous episodes of acute, unexplained paralysis. All cases resolved without significant morbidity. Thyrotoxic, hypokalaemic periodic paralysis is a potentially life‐threatening and terrifying condition, which is often under‐recognized and will present with increasing frequency in the community. The diagnosis should be considered in any Asian−Australian male presenting with sudden onset paralysis. (Intern Med J 2003; 33: 91−94)
Rice paddy field herbicides and their effects on the environment and ecosystems
Authors: Ueji Masako , Inao Keiya
Published: March 2003

Paddy herbicides contribute to the reduction of weeding labor, however, there are concerns about their effects on the environment and ecosystems. The environmental burden of applied herbicides is heaviest in water systems such as irrigation channels and rivers. Herbicides are generally detected in rivers in concentrations in levels of ng/L for only 2 to 3 months after use. It is to be regretted that herbicides have been implicated in accidents involving fish, the impeded propagation of algae and other non‐target organisms. Therefore, it is necessary to assess the ecological risk, and the Environment Agency in Japan compiled an interim report on how pesticides' ecological effects should be assessed. Pesticides are separately examined for their toxicity (hazard assessment) and exposure (exposure analysis). However, to the environment and ecosystems there are many problems in assessing the ecological risk of pesticides, such as selection of geographic locations, methodology of assessing the impacts on ecosystems and monitoring the effect of pesticides. New herbicides are expected to have high selectivity and low toxicity. Decreasing herbicide toxicity requires high selectivity to distinguish target weeds from crops and non‐target organisms. New groups of compounds will be developed based on a biorational approach. Moreover, it is necessary to develop an environmentally low‐impact application method such as the use of granular types and sustained‐release formulation among others. It is important that integrated methods be used to control paddy weeds by combining ecological/agronomical, mechanical and biological control methods, instead of relying solely on chemical herbicides.