bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intra–Arterial Infusion Therapy Following Alteration of Pelvic Blood Flow and Concurrent Radiation Therapy for Invasive Bladder Cancer
Authors: Umeyama Tomokazu , Mashimo Tooru , Nakazato Haruki , Tokunaga Takashi , Uehara Hisao , Shinozaki Tadatoshi , Kawashima Miho , Akimoto Tetsuo 
Published: July 2007

Intra–arterial infusion therapy following alteration of pelvic blood flow and concurrent radiation therapy was performed in 13 patients with muscle invading bladder cancer (T2, 2; T3, 6; T4, 5). The internal iliac artery of the opposite side was embolized and the ipsilateral gluteal and obturator arteries were embolized by metallic coils. A catheter was placed in the ipsilateral internal iliac artery. CDDP was administered daily at a dose of 7–9 mg/body over 1 minute. Radiation was done by Microtron using 10 MV x–ray. Total dose was 4500–7060 cGy.Evaluation was done by cystoscopy, radiography and biopsy. Eight patients achieved complete response (CR) histologically. Others had partial response (PR). All CR patients had no recurrence. The observation period was between 3 and 29 months, with a mean of 11 months. This treatment modality is effective for locally advanced bladder cancer.
Management of Late Complications of Continent Urinary Diversion Using the Kock Pouch and the Indiana Pouch Procedures
Authors: Okada Yusaku , Shichiri Yasumasa , Terai Akito , Kakehi Yoshiyuki , Terachi Toshiro , Arai Yoichi , Yoshida Osamu 
Published: July 2007

Background: Continent urinary diversion (CUD) is performed on patients after total cystourethrectomy due to invasive bladder cancer or other diseases requiring urinary diversion. Since 1984, we have performed CUD using either the Kock pouch procedure or a modified Indiana pouch method. During the long‐term follow‐up, increasing numbers of late complications occurred, especially after the Kock pouch procedure. We summarized the frequency of postoperative complications, their management, and outcome of CUD using these 2 methods.Methods: Between 1984 and 1995, CUD using the Kock pouch method was performed on 102 patients, and on 61 patients using the Indiana pouch method, with a mean follow‐up period of 83 and 50 months, respectively. The patients were between 24 and 82 years old, with a mean age of 59 years. In most patients, the Kock pouch was constructed according to the original method, except for the use of a Dacron fabric collar, and the Indiana pouch was made using the ileal patch method.Results: Of 95 patients followed up for more than 3 months after CUD using the Kock pouch method, efferent and afferent nipple valve malfunction occurred in 21 (22%) and 26 (27%) patients, respectively. Efferent complications occurred during the first year after surgery, whereas afferent complications occurred several years after surgery. Open repair surgery (excluding ileus) was necessary for 36 (38%) patients. Of 59 patients followed for more than 3 months after CUD using the Indiana pouch method, 7 patients with stomal stenosis, 2 patients with stomal prolapse, and 1 patient with stricture at the ureterocolonic anastomosis were treated surgically. An hourglass‐like deformity of the pouch was seen in 2 patients, on whom the original Indiana pouch method was performed. As a whole, 13 patients (22%) were retreated with open surgery. Urinary calculi occurred in 42 (44%) patients after CUD using the Kock pouch method and in 11 patients (19%) using the Indiana pouch method. The outcome was excellent, good, fair, and poor in 31, 37, 24, and 8% of the patients after CUD using the Kock pouch method, and in 36, 17, 42, and 5% of the patients after CUD using the Indiana pouch method.Conclusions: We performed CUD using either the Kock pouch or the Indiana pouch method with a success rate of approximately 90%. The rates of revision, reoperation and stone formation were higher with the Kock pouch procedure than with the Indiana pouch procedure, while varying degrees of incomplete incontinence and difficulty in catheterization were seen more often in the latter.
PSA Value Adjusted for the Transition Zone Volume in the Diagnosis of Prostate Cancer
Authors: Kurita Yutaka , Ushiyama Tomomi , Suzuki Kazuo , Fujita Kimio , Kawabe Kazuki 
Published: July 2007

Background: The aim of the present study was to improve the accuracy of the prostate‐specific antigen (PSA) density for detecting prostate cancer by using the transition zone (TZ) volume instead of the total prostate volume.Methods: From April 1994 to October 1995, we examined 164 consecutive patients (52–88 years old), with an elevated PSA and/or abnormal digital rectal examination. All patients underwent a transrectal ultrasound‐guided biopsy. The PSA density for total prostate volume (PSAD) and for TZ volume (PSAT) were calculated from the transrectal ultrasound measurements.Results: Forty‐four of the 162 patients (27.2%) had histological confirmation of prostate cancer on biopsy. The area under the receiver‐operator characteristic curve was 0.667 for. PSA, 0.663 for PSAD, and 0.826 for PSAT. These areas were not significantly different for PSA and PSAD. However, PSAT was significantly superior to PSAD in differentiating benign hyperplasia from prostate cancer (P< 0.01).Conclusion: The TZ volume‐adjusted PSA density (PSAT) is useful for selecting patients for prostate biopsy from those with suspected prostate cancer.
Pros‐EightTM Transurethral Radiofrequency Thermotherapy for Benign Prostatic Hyperplasia: Preliminary Clinical Results
Authors: Yoshida Osamu , Terai Akito , Shichiri Yasumasa , Okada Yusaku , Ishitoya Satoshi , Okubo Kazutoshi , Suzuki Yuji , Arai Yoichi 
Published: July 2007

Background: We have developed a new transurethral thermotherapy device using 8MHz radiofrequency (RF) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH). We report the safety and effectiveness of the initial clinical experience with this device Methods: Sixty patients with symptomatic BPH were subjected to a single 1‐hour treatment under local anesthesia. The treatment device uses extracorporeal RF capacitive heating in combination with radiative heating and conductive cooling of the urethra. Results: In the 49 patients evaluahle at 3 months, the mean International Prostate Symptom Score decreased from 17.8 to 13.1 (P < 0.0001) and the Quality of Life score decreased from 4.4 to 3.4 (P < 0.0005). Maximum flow rate increased from 8.1 to 9.7mL/s (P< 0.05) at 3 months. Overall effectiveness by Homma's response criteria was as follows; excellent 4.1%, good 10.2%, fair 38.8% and poor 46.9%. Side effects were minimal. Gross hematuria was seen in 3 patients and erosion of the external urethral meatus was seen in 2 patients, but none had urinary retention. Conclusions: In this initial clinical trial, transurethral RF thermotherapy was safe and resulted in modest symptomatic improvement. Further investigations for optimizing the treatment protocol seem warranted.
Preoperative Localization of Parathyroid Adenomas Using 99mTc‐MIBI Scintigraphy in Patients with Hyperparathyroidism
Authors: Ebisuno Shoichi , Inagaki Takeshi , Yoshida Toshihiko , Yamamoto Motoki , Tabuse Yoji , Kohjimoto Yasuo , Ohkawa Tadashi 
Published: July 2007

Background Technetium (Tc) 99m methoxyisobutyl isonitrile (99mTc‐MIBI) has recently been introduced for parathyroid imaging, as well as for myocardial imaging. We studied the usefulness of 99mTc‐MIBI scintigraphy for preoperative localization of abnormal parathyroid glands. Methods The usefulness of 99mTc‐MIBI scintigraphy for detection of hyperfunctional parathyroid lesions was evaluated in 5 patients with primary hyperparathyroidism. The results of localizing the abnormal glands by using 99mTc‐MIBI were compared with those obtained by using thallium (Tl) 201‐technetium (Tc) 99m (2ulTI‐99mTc) subtraction scintigraphy, computed tomography, and ultrasonography. Results The delayed (2 hours) imaging of 99mTc‐MIBI scintigraphy was highly useful for accurate localization of the abnormal parathyroid lesions. The diseased glands were detected in all cases where 99mTc‐MIBI scintigraphy was used, and using 99mTc‐MIBI scintigraphy provided more information than did computed tomography, ultrasonography, or 201Tl‐99mTc subtraction scintigraphy. Conclusion: This method is simple and essential for detecting hyperfunctioning parathyroid glands, especially those with small or ectopic lesions. This technique should be widely applied as a localizing diagnostic method for hyperparathyroidism.
Functional Outcome and Late Complications in Patients with Continent Urinary Reservoirs
Authors: Taguchi Keisuke , Hirose Takaoki , Ito Naoki , Kumamoto Yoshiaki , Tsukamoto Taiji 
Published: July 2007

Background We reviewed the functional outcome and late complications of continent urinary reservoirs (CUR) constructed with a cecocolonic segment, including the Indiana pouch, in 37 patients treated in our clinic. Methods The CUR procedure was performed on 37 patients, creating partially detubularized (PD) reservoirs in 9 patients, totally detubularized (TD) reservoirs in 16 patients and reservoirs with an ileal patch (IP) in 12 patients. Continence was achieved by the nipple valve in 10 patients and by ileal plication in 27 patients. The mean follow‐up period was 46 months (range, 15 to 87 months). The function of the reservoir was evaluated by measurement of the intrareservoir pressure. Results Patients with the TD reservoir had less frequent appearance of involuntary, phasic elevation of the intrareservoir pressure (30.8%) than those with the PD reservoir (62.5%). In contrast, this phasic elevation was found in only 1 patient with an IP reservoir. The IP reservoir had the largest capacity accompanied by the lowest maximum intrareservoir pressure. Total incontinence was observed in 2 patients with ileal plication due to disruption of the plicated sutures on the terminal ileum. Frequent difficulty in catheterizing the reservoir was found in 2 patients, and reservoir‐ureter reflux was found in 3 renal units. The serum chloride level was significantly elevated after surgery, however, in most patients the levels remained within normal limits. Conclusion Our experience of the outcome and late complications of reservoirs indicates that the cecocolonic reservoir with an ileal patch and stapled ileal plication, i.e., the Indiana pouch, is a better choice for continent urinary diversion for patients who need a cystectomy.
PCNA and p53 in Urinary Bladder Cancer: Correlation with Histological Findings and Prognosis
Authors: Inagaki Takeshi , Ebisuno Shoichi , Uekado Yasunari , Hirano Atsuyuki , Hiroi Akihisa , Shinka Toshiaki , Ohkawa Tadashi 
Published: July 2007

Background This study aimed to immunohistochemically examine the expression of proliferating cell nuclear antigens (PCNA) and pS3 protein in transitional cell carcinomas (TCC) of the urinary bladder, and to investigate possible correlations of this expression with the tumor grade or stage, tumor recurrence, and prognosis of the disease. Materials and Methods The immunohistochemical status of the PCNA and p53 proteins were determined on paraffin‐embedded sections from 128 patients with TCC of the urinary bladder, using PC‐10 and D07 as the primary antibodies. Positive stainings were represented by scores (Labeling Index; LI, %) calculated as the percent of positive cells among all neoplastic cells counted. The findings were compared to the patients' histopathological features. Patients who underwent transurethral resection were divided into groups with low and high scores for PCNA and p53, respectively, and the tumor recurrence rate was compared among the groups. Patients who underwent total cystectomy were similarly divided into low and high score groups, and survival rates of the groups were compared. Results PCNA expression was observed in 66 of 128 patients (51.6%), with a mean labeling index of 26.6%. Overexpression of p53 was observed in 65 of 1 28 patients (50.8%), with a mean labeling index of 35.3%. There were significant correlations of the PCNA and p53 indices with both histological grade and stage of the tumor. In the TUR group, there were no statistically significant differences in recurrence rate between the groups with high or low scores for either PCNA or p53. In the total cystectomy group, there was a significant correlation between survival rate and positive staining for PCNA, but not for p53. The relationship between 2 parameters, PCNA and p53 scores, was not significant (linear correlation coefficient, r= 0.67). Conclusions PCNA and p53 status in transitional cell carcinomas of the urinary bladder is related to the histopathological findings. We also suggest that immunohistochemical staining for PCNA provides significant clinical information which may be useful in the initial selection of therapy. However, overexpression of p53 does not appear to represent an independent prognostic marker in bladder tumors.
Prognostic Factors for Renal Cell Carcinoma: A Multivariate Analysis of 320 Cases
Authors: Masuda Hiroaki , Kurita Yutaka , Suzuki Akihiko , Kanbayashi Tomoyuki , Suzuki Kazuo , Fujita Kimio 
Published: July 2007

Background We performed a multivariate analysis of clinical variables in 320 patients with renal cell carcinoma to identify important prognostic factors for long‐term survival. Methods We retrospectively reviewed the medical records of 320 patients who presented with renal cell carcinoma. Survival curves were calculated by the Kaplan‐Meier method and statistical differences were determined by the log‐rank test. Significant prognostic factors were evaluated by Cox's multivariate proportional hazard model. Results The median follow‐up period was 29 months. The overall survival rates at 1, 5, and 10 years were 90.0%, 77.6%, and 69.9%, respectively. Seventeen of the 19 prognostic factors evaluated were shown to be significant by the log‐rank test: patient age, sex, performance status, body temperature, erythrocyte sedimentation rate (ESR), levels of hemoglobin, a2‐globulin, C‐reactive protein, fibrinogen, immunosuppressive acidic protein (IAP), size or involvement of tumor (T classification), regional lymph node involvement (N classification), extent of metastasis (M classification), pathologic grade, tumor cell type, mode of tumor infiltration, and the modality of treatment (curative surgery). Among them, the body temperature, ESR, a2‐globulin, fibrinogen, IAP, and mode of tumor infiltration were excluded from multivariate analysis because of missing data. Curative surgery was also excluded because it is a treatment modality and different from the other variables which are clinical or pathologic characteristics. From the remaining 10 variables, multivariate analysis showed that age (P = 0.0389), N classification (P = 0.0289), and M classification (P <0.0001) were important and independent prognostic factors for long survival. Conclusion This analysis showed that age, N classification, and M classification were the most important factors predicting long‐term survival of patients with renal cell carcinoma.
Transurethral Balloon Laser Thermotherapy for Urinary Retention in Patients with Benign Prostatic Hyperplasia Who Are at High Surgical Risk
Authors: Furuya Seiji , Ogura Hiroshi , Tanaka Yoshinori , Tsukamoto Taiji , Daikuzono Norio , Liong Men Long 
Published: July 2007

Background Twelve patients with benign prostatic hyperplasia and urinary retention, who were considered to be poor candidates for prostatectomy, were treated by transurethral balloon laser thermotherapy (TUBAL‐T). The mean patient age was 78.9 years (range, 66 to 93 years) and the mean duration of bladder catheterization was 11 weeks (range, 2 to 48 weeks). Methods Irradiation into the prostatic tissue was done through 360 with a neodymium: yttrium aluminum garnet (Nd:YAG) laser balloon placed in the prostatic urethra, with pain relief provided by using local topical anesthesia. The total laser dose was from 45,000 to 1 23,376 J, with an average of 73,089 J. The irradiation time was from 40 to 54 minutes, with an average of 45.2 minutes. Results Spontaneous voiding became possible in all patients at a mean of 2.8 days (range, 1 to 7 days) after irradiation. The mean catheter‐free period was 20.5 months (range, 6 to 34 months), with the longest being 34 months. The international prostatic symptom scores, quality‐of‐life scores, and peak uroflow rates showed substantial improvement after laser thermotherapy. To date, long‐term resumption of spontaneous voiding was successfully achieved in 9 of 12 cases (75%). Conclusion TUBAL‐T is a safe and effective alternative for treatment of urinary retention in patients with benign prostatic hyperplasia who are considered to be at high surgical risk.
Significance of the Preoperative Intravesical Instillation of Doxorubicin and the Oral Administration of 5‐Fluorouracil in Preventing Recurrence After a Transurethral Resection of Superficial Bladder Cancer
Authors: Naito Seiji , Iguchi Atsushi , Sagiyama Kazuyuki , Ariyoshi Asami , Osada Yukio , Omoto Tetsuo , Kuriya Norikazu , Kumazawa Joichi 
Published: July 2007

Background: The postoperative intravesical instillation of doxorubicin (ADM) has a preventative effect on recurrence after a transurethral resection (TUR) of superficial bladder cancer. However, the significance of preoperative ADM instillation remains unclear. Although the oral administration of 5‐fluorouracil (5‐FU) has been observed to show some clinical response against bladder cancer, its preventative effect on the recurrence of superficial bladder cancer after TUR is unknown. Methods: Patients were randomized into 4 groups. All 4 groups received postoperative ADM instillation. In addition, patients in groups C and D received preoperative ADM instillation, whereas patients in groups B and D additionally received oral 5‐FU postoperatively. The nonrecurrence rate and side effects were both compared among the 4 groups. Results: Of the 282 patients registered, 200 were evaluable, with a median follow‐up period of 21.4 months. There were no significant differences in the characteristics of the patients among the 4 groups. Group C (pre‐ and postoperative ADM) showed a significantly longer disease‐free interval than group A (postoperative ADM alone). However, there was no significant difference in the disease‐free interval between groups A and B (postoperative ADM plus 5‐FU), or between groups C and D (pre‐ and postoperative ADM plus 5‐FU). Bladder irritation symptoms were the most frequently noted side effect encountered in all groups, but the severity was generally mild. Conclusions: Preoperative ADM instillation was found to prevent recurrence to a greater extent than the usual postoperative instillation alone, whereas oral 5‐FU was found to have no additional beneficial effect on the disease‐free interval in patients with superficial bladder cancer.
Evaluation of Prostate Specific Antigen Density and Transrectal Ultrasonography‐Guided Biopsies in 100 Consecutive Patients with a Negative Digital Rectal Examination and Intermediate Serum Prostate Specific Antigen Levels
Authors: Tarcan Tufan , Ozveri Hakan , Biren Tugrul , Turkeri Levent , Akdas Atif 
Published: July 2007

Background: This study was undertaken to assess the importance of prostate biopsies in patients with a negative digital rectal examination (DRE) and elevated prostate specific antigen (PSA) levels and to investigate the role of PSA density (PSAD) and hypoechoic lesions on transrectal ultrasound (TRUS) in increasing the diagnostic sensitivity and specificity for prostate cancer (PCa). Methods: One hundred patients with varied initial symptoms who had a negative DRE and a PSA level between 4 and 20ng/mL underwent TRUS‐guided systematic and, if present, lesion‐directed biopsies. Results: PCa was detected in 11 patients (11%). TRUS examinations revealed hypoechoic lesions in 31 patients. Lesion‐directed biopsies revealed PCa in 1 3% (4/31) of patients with abnormal TRUS whereas, 7% (5/69) of patients with negative TRUS findings had PCa. Additional systematic biopsies detected PCa in 2 patients where lesion‐directed biopsies were negative. None (0/19) of the lesions smaller than 0.2 ml on TRUS had PCa whereas, 33% (4/1 2) of patients with lesions greater than 0.2 ml had PCa. When the subgroup of patients with negative TRUS and PSA levels between 4 and 10ng/mL were considered, 25% (1/4) of cases with PCa would have been missed if 0.15 was used as the cut‐off point for PSAD, however, this would save 61% (30/49) of unnecessary biopsies. The positive predictive value of PSA (cut‐off level lOng/mL), PSAD (cut‐off level 0.15), and hypoechoic lesions on TRUS were found to be 11.5%, 33%, and 13%, respectively. When hypoechoic lesions greater than 0.2 mL were taken as the positive finding, the positive predictive value and specificity rates of TRUS increased to 33% and 91 %, respectively, without any change in the sensitivity. Conclusions: In patients with a negative DRE and intermediate PSA levels, the application of PSAD would have saved 49% of study patients with BPH from a biopsy, but would have missed 27% of PCa cases. By ignoring lesions smaller than 0.2 mL on TRUS, a very high specificity of 91% was achieved with a sensitivity of 36%. Thus, further investigations aimed at defining a better mode of diagnosis of PCa are warranted.
Efficacy of Continuous Subcutaneous Infusion Therapy Using Interferon α and the Possible Prognostic Indicator of TNF‐α in Renal Cell Carcinoma
Authors: Matsuyama Hideyasu , Yamamoto Mitsutaka , Yoshihiro Satoru , Ohmoto Yasukazu , Naito Katsusuke 
Published: July 2007

Background:In an attempt to improve efficacy by escalating the dose and maintaining higher serum concentrations over a long period of time, this study examines continuous interferon α (IFNα) subcutaneous infusion therapy in patients with renal cell carcinoma (RCC). Methods:Seven of 11 patients with RCC had evaluable metastatic lesions. A highly purified natural human IFNα was injected subcutaneously via an infuser pump for 5 consecutive days, followed by a 2‐day rest period (25 million IU/week). The treatment was continued for a period of 15 weeks. Serum concentrations of IFNα, IL‐1α, IL‐1β, TNF‐α, and IFNγ were measured at intervals throughout the study period. Results:Two of the 7 patients with evaluable lesions achieved a partial response (overall response rate, 29%), while 1 achieved a partial response only to lung metastasis. These 3 cases were defined as responders. No difference was found in the concentration of serum IFNα between responders and nonresponders, however, a significantly higher concentration of serum TNF‐a was observed in responders (P<0.05, Mann‐Whitney U test). Five cases (45%) had moderate to severe adverse effects, including depression (n = 1), eyeground hemorrhage (n = 2), and general fatigue (n = 2). Conclusion:Appropriate patient selection may be necessary for subcutaneous continuous infusion therapy for the treatment of metastatic RCC. Also, the serum concentration of TNF‐α measured during the course of treatment reflected well on the outcome of IFNα therapy.