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Akito Terai

Publications and source records attributed to Akito Terai.

88 records · Page 5Linked to original sources
PubMed2003

Intraoperative electrical stimulation of cavernous nerves with monitoring of intracorporeal pressure to confirm nerve sparing during radical prostatectomy: Early clinical results.

BACKGROUND: We performed intraoperative cavernous nerve stimulation with an intracavernous pressure (ICP) monitoring system to confirm nerve sparing during radical pelvic surgery and assessed the results. METHODS: Nineteen cases of radical prostatectomy and three of radical cystoprostatectomy were examined. Electrical stimulation of the site where the neurovascular bundle (NVB) was determined to run was performed and changes in ICP were measured before and after prostate removal. RESULTS: Of the 22 patients, bilateral NVBs were preserved in six patients while unilateral NVB was preserved in 16. Before dissection, all NVBs examined exhibited positive responses (ICP changes of>5 mmHg) to nerve stimulation. After removal of the prostate, positive responses were observed in 22 (79%) of 28 macroanatomically preserved NVBs. Of 16 sides on which the NVB was not preserved, there were positive responses in five (31%). In these patients, some nerve fibers were macroscopically observed lateral to the original site of NVB. Finally, bilateral or unilateral nerve sparing was confirmed electrophysiologically in 20 (91%) of the 22 patients. CONCLUSION: Intraoperative stimulation of the NVB while monitoring ICP changes is a simple and reliable method of accurately evaluating the preservation of cavernous nerves. This system may provide further insight into the mechanism of postoperative erectile dysfunction.

Aged↗
PubMed2003

Successful treatment of primary aldosteronism due to computed tomography-negative microadenoma.

We report a case of aldosterone-producing microadenoma that was correctly diagnosed and thus treated less invasively by laparoscopic adrenalectomy. A 58-year-old woman presented with palpitation and muscular weakness. She exhibited hypertension, hypokalemia and increased aldosterone excretion with suppressed renin activity. Therefore, primary aldosteronism was suggested. Although adrenal scintigram and computed tomography findings in the adrenal glands were normal, adrenal venous sampling tests indicated an overproduction of aldosterone in the right adrenal gland. We diagnosed an aldosterone-producing microadenoma in the right adrenal gland and performed an adrenalectomy. The patient became normotensive postoperatively and histopathological examination demonstrated a microadenoma, 5 mm in diameter.

Adenoma↗
PubMed2003

Living related renal transplantation for end-stage renal disease after liver transplantation from a brain-dead donor.

We report a case in which a living related renal transplantation was successfully performed for end-stage renal disease that had progressed after a liver transplantation from a brain-dead donor for liver cirrhosis associated with type C hepatitis. Because the transplanted liver function had been excellent with the use of tacrolimus and mycophenolate mofetil, the same immunosuppressive agents with prednisolone were employed for the renal transplantation. Both grafts are functioning well without recurrence of hepatitis at 10 months after the renal transplantation. From our experience, renal transplantation should not be contraindicated even if the patient has undergone liver transplantation or has hepatitis C viral infection.

Hepatitis C, Chronic↗
PubMed2003

Health-related quality of life after radical prostatectomy in Japanese men with localized prostate cancer.

PURPOSE: We evaluated retrospectively health-related quality of life (HRQOL) after radical prostatectomy (RP) in Japanese men with localized prostate cancer. METHODS: The study was based on self-reported HRQOL of 280 patients. Patients were divided into seven groups: time 0 (T0), baseline before operation; T1, 1-3 months after RP; T2, 4-6 months after RP; T3, 7-12 months after RP; T4, 13-24 months after RP; T5, 25-36 months after RP; and T6, more than 36 months after RP. We measured the general and disease-specific HRQOL using the RAND 36-item Health Survey 1.0 (SF-36) and the University of California, Los Angeles Prostate Cancer Index (UCLA PCI). RESULTS: The general HRQOL of the postoperative groups was assessed by SF-36. The postoperative groups showed almost the same or higher scores than those of the baseline group. Urinary function scores decreased substantially after surgery. In contrast, there was no difference in urinary bother between the baseline and postoperative groups. Sexual function deteriorated substantially in all postoperative groups. Similarly, the sexual bother score significantly deteriorated after RP. The sexual bother score of men aged 65-years or younger was significantly worse than that of their counterparts in the T1-2 groups. CONCLUSION: Despite reports of problems with sexual activity and urinary continence, general HRQOL was mostly unaffected by RP. Although there was a substantial decrease in urinary function, recovery from urinary bother was rapid. Since the deterioration of sexual function was marked through the postoperative period, careful attention should be paid to this issue during preoperative counseling, especially for younger patients.

Aged↗
PubMed2003

Distribution of afaE adhesins in Escherichia coli isolated from Japanese patients with urinary tract infection.

PURPOSE: Afimbrial adhesin is known to be one of the most prevalent virulence factors in uropathogenic Escherichia coli. A recent report showed that the new subtype afaE8 predominated in afa positive isolates from patients with pyelonephritis (55.6%), suggesting that this subtype may be an important factor in ascending urinary tract infections. MATERIALS AND METHODS: A total of 457 E. coli strains consisting, of 194, 76 and 107 isolates from patients with cystitis, pyelonephritis and prostatitis, respectively, and 80 isolates from the rectal flora of healthy individuals were subjected to polymerase chain reaction to determine the afa operon as well as afaE subtypes. RESULTS: We identified 32 afa positive isolates of 377 strains (8.5%) and 2 of 80 strains (2.5%) from urinary tract infection isolates and normal flora, respectively. When afaE subtypes were determined, the afaE3 subtype predominated in afa positive isolates from cystitis (64.7%), pyelonephritis (66.7%) and prostatitis (50%). However, the afaE8 subtype was absent from urinary tract infection isolates, while only 1 isolate from the stool of a healthy adult harbored this subtype. CONCLUSIONS: Our data show that the afaE3 subtype predominated in pyelonephritis as well as in other urinary tract infections, indicating that the afa gene may be important in urinary tract infection. However, the distribution of afaE subtypes may be diverse in different areas of the world.

Adhesins, Escherichia coli↗
PubMed2003

Distribution and genetic association of putative uropathogenic virulence factors iroN, iha, kpsMT, ompT and usp in Escherichia coli isolated from urinary tract infections in Japan.

PURPOSE: Many virulence factors (VFs) have been reported in uropathogenic Escherichia coli. Recently we found a putative uropathogenic island including a gene encoding uropathogenic specific protein (USP). We have described the association between usp and other VFs reported previously. In the current study we examined epidemiological associations among 5 putative uropathogenic VFs. MATERIALS AND METHODS: In 427 E. coli strains, including 194, 76 and 107 isolates from patients with cystitis, pyelonephritis and prostatitis, respectively, and 50 isolates from the stool of healthy adults, we detected catecholate siderophore receptor (iroN), iron regulated gene A homologue adhesin (iha), group II capsule (kpsMT) and outer membrane protease T (ompT) by polymerase chain reaction assays. We analyzed their distribution and genetic association. RESULTS: Relative prevalence ratios of iroN, iha, kpsMT, ompT and usp were 2.0 to 4.3 times more frequently in urinary tract infection isolates than in fecal isolates. Isolates from prostatitis were frequently associated with iroN, ompT and usp, whereas isolates from pyelonephritis frequently harbored usp. Together with iroN and iha we noted S-/F-fimbriae and iucD aerobactin (OR 95.9 and 187.2), while usp showed a close association with kpsMT and ompT (OR 38.3 and 38.4, respectively). CONCLUSIONS: Of the putative uropathogenic VFs examined iroN, iha, kpsMT, ompT and usp were frequently associated with urinary tract infection. Especially iroN and usp were most frequently associated with prostatitis. Some VFs were closely associated with a specific anatomical site of infection. Strong associations among several VFs might indicate not only well-known genetic linkages, but also unknown functional linkages among these VFs.

Adult↗
PubMed2003

[Interstitial laser coagulation for benign prostatic hyperplasia: clinical results of the Indigo diode laser system].

We report our experience with interstitial laser coagulation of the prostate (ILCP) using an Indigo 830j diode laser system for benign prostatic hyperplasia (BPH). From March 1998 to November 2000, we treated 45 patients between 51 and 95 years old (average 71.5) with symptomatic BPH. The mean prostatic volume before ILCP was 62.0 cm3. We experienced no serious complications. Three months after ILCP, the mean international prostate symptom score (I-PSS) quality of life (QOL) index and post-void residual volume (PVR) decreased significantly from 18.0 to 9.2, from 4.4 to 2.1 and from 103.6 ml to 44.5 ml, respectively. The mean maximum flow rate (MFR) increased from 7.6 ml/sec at baseline to 9.2 ml/sec 3 months after ILCP, but the difference was not statistically significant. Before and after ILCP, 8 patients were available to evaluate pressure-flow study data. The detrusor pressure at the maximum flow rate decreased significantly from 118.3 cmH2O at baseline to 78.6 cmH2O 3 months after ILCP. The improvement of the I-PSS, QOL index, MFR and PVR continued and at 24 months reached 5.7, 1.8, 11.6 ml/sec and 54.6 ml, respectively. In our assessment of the questionnaire addressing the patient's satisfaction after the treatment, the majority of the patients who answered the questionnaire were pleased with the results of ILCP. We assessed the relation of the overall treatment efficacy with the number of punctures and the total amount of the laser energy delivered, but we did not find any relation. Our clinical results suggest that the ILCP using Indigo 830j is an effective modality and the short-term treatment efficacy is favorable.

Aged↗
PubMed2003

[Two-week administration of low-dose Hachimi-jio-gan (Ba-Wei Di-Huang-Wan) for patients with benign prostatic hyperplasia].

We evaluated the efficacy and side effects of two-week administration of low-dose "Hachimi-jio-gan (Ba-Wei Di-Huang-Wan)" for 41 patients with benign prostatic hyperplasia and searched for any predictors of good response to this agent. Although two of the 41 patients could not finish administration due to epigastric discomfort, there were no other side effects. "Hachimi-jio-gan" significantly reduced scores of emptying, weak stream, total score and quality of life score according to the International Prostate Symptom Score, although the degree of reduction was inferior to that induced by tamsulosin administration. "Hachimi-jio-gan" significantly improved max flow rate, and the degree of this improvement was superior to that induced by tamsulosin administration. Approximately 40% of patients were good responders to "Hachimi-jio-gan" therapy. Severe sensation of incomplete emptying was a predictor of good response.

Aged↗
PubMed2002

Retroperitoneoscopy-assisted total nephroureterectomy for upper urinary tract transitional cell carcinoma.

OBJECTIVES: To apply retroperitoneoscopy-assisted nephroureterectomy (RTN) and examine its benefit compared with traditional open nephroureterectomy. The reference standard of treatment for upper urinary tract transitional cell carcinoma is standard total nephroureterectomy (STN) with excision of a bladder cuff. METHODS: Retroperitoneoscopic radical nephrectomy was performed, followed by open distal ureterectomy with excision of a bladder cuff. The specimen was removed en bloc from the lower pararectal incision that was used during distal ureterectomy. From January 1999, 17 patients with upper urinary tract transitional cell carcinoma underwent this procedure at our institution. For comparison, the most recent 17 STNs were also reviewed. RESULTS: The operative time was longer in the RTN group than in the STN group but not to a significant extent (239.5 versus 286.8 minutes; P = 0.2663). On the other hand, the estimated blood loss, duration to potential discharge, and recovery to normal activities were significantly reduced in the RTN group (151.1 versus 299.6 minutes, 2.7 versus 4.2 days, and 15.9 versus 19.3 days; P = 0.0262, 0.0479, and 0.0363, respectively). From an oncologic standpoint, local recurrence occurred in 1 patient of the RTN group and 4 patients of the STN group (median follow-up of 8.8 and 23.0 months, respectively). No significant difference was detected in the disease-free survival rate between the two groups (P = 0.6775). CONCLUSIONS: RTN can make total nephroureterectomy less invasive. From an oncologic standpoint, although it revealed a disease-free survival rate comparable with the standard open procedure with limited follow-up, further follow-up of additional cases with simultaneous extended lymphadenectomy is necessary to evaluate the effectiveness of this procedure.

Aged↗
PubMed2002

Retroperitoneoscopic ureterocutaneostomy for obstructive uropathy with advanced bladder cancer: a case report.

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.

Aged↗
PubMed2002

Lectin-reactive alpha-fetoprotein (AFP-L3%) curability and prediction of clinical course after treatment of non-seminomatous germ cell tumors.

OBJECTIVE: Alpha-fetoprotein (AFP) is an important tumor marker for non-seminomatous germ cell tumors (NSGCTs) that greatly affects diagnosis and the evaluations of therapy and therapeutic policy. However, it is sometimes very difficult to make the distinction between tumors and falsely elevated AFP levels due to benign liver disease. We assessed the usefulness of lectin-reactive alpha-fetoprotein (AFP-L3%), which has been reported to be superior to total AFP in both sensitivity and specificity in hepatocellular carcinomas, for the evaluation of predictions of clinical courses after the treatment of NSGCTs. METHODS: Frozen sera of 25 tumor-bearing patients with testicular cancers whose AFP levels were 5.0 ng/ml or higher were used. The total AFP levels and the ratio of L3 fraction to total AFP (AFP-L3%) were measured by liquid-phase binding assay (LBA). RESULTS: The total AFP levels were 6.3-14 907 ng/ml (median: 105.9 ng/ml). The median AFP-L3% was 69.9% (range;: 1.1-88.1%). Except for one patient, 24 patients (96.0%) with evident disease showed high levels of AFP-L3% of >50%, regardless of their total AFP levels. In nine patients whose sera were sequentially measured, AFP-L3% was considered highly useful for the detection of residual tumors (n = 2) and recurrence (n = 1) and for the exclusion of false-positive cases (n = 1). CONCLUSIONS: When the total AFP level increases slightly (e.g. to 5-20 ng/ml), a measurement of AFP-L3% may provide additional useful information for monitoring NSGCT patients and in distinguishing falsely elevated AFP.

Adolescent↗
PubMed2002

Artificial neural network analysis for predicting pathological stage of clinically localized prostate cancer in the Japanese population.

BACKGROUND: Although prostate cancer has been prevalent in Japan, there has been no particular model for predicting the pathological stage in the Japanese population. We examined whether artificial neural network analysis (ANNA), which is a relatively new diagnostic tool in prostate cancer, can be one of the predictive methods for predicting organ confinement, compared with the traditional logistic regression model, in the Japanese population for the first time. METHODS: The study population comprised 178 men who underwent radical prostatectomy at our institutions between October 1992 and May 1999. As additional pretreatment parameters to the preoperative serum PSA level, clinical TNM classification and biopsy Gleason score, the percentage of number of cores exhibiting traces of tumor, maximum tumor length in biopsy cores, PSA density and patient age were used. The predictive ability of ANNA with several parameters for a set of 36 randomly selected test data was compared with those of logistic regression analysis and 'Partin Tables' by area under the receiver operating characteristics (ROC) curve analysis. RESULTS: Of 178 patients, 97 (54.5%) had organ-confined disease but 81 (45.5%) had locally advanced disease. With three parameters, the area under the ROC curve of ANNA (0.825 +/- 0.071) was larger than those for logistic regression (0.782 +/- 0.079) and Partin Tables (0.756 +/- 0.087), but not to a significant extent (P = 0.690 and 0.541). Although the expansion of the parameters did not increase the difference in area under the ROC curve between the best ANNA and logistic regression (0.899 +/- 0.053 and 0.873 +/- 0.065, respectively), the difference between the best ANNA and Partin Tables did not reach but approached statistical significance (P = 0.157). CONCLUSION: Although more modeling optimization is necessary to improve the predictive accuracy and generalizability of ANNA, we suggest that there is the possibility for this new predictive method to evolve in the analysis of clinical staging of prostate cancer.

Aged↗
PubMed2002

[A case of giant perirenal malignant lymphoma: a case report].

We report a case of malignant lymphoma arising as a giant perirenal mass in a 62-year-old woman who presented with an enlarging abdominal mass. Computed tomography (CT) revealed a large homogeneous mass with a diameter of 20 cm arising in the retroperitoneum. It surrounded the left kidney without renal infiltration and accompanied with para-aortic lymph node enlargement. Compared with the renal cortex, the tumor showed a homogeneous isodense mass by plain CT and only slight enhancement by the contrast-enhanced CT. On the basis of these imaging studies, the tumor was diagnosed as lymphoma. Then, a US guided percutaneous biopsy was performed and the tumor was diagnosed as malignant B-cell lymphoma by the histopathological analysis. This patient was treated by systemic chemotherapy since tumor cells were also disseminated in the bone marrow. The tumor responded well to the chemotherapy and about 70% of regression was achieved after six courses of chemotherapy.

Female↗
PubMed2002

[A case of urolithiasis due to vitamin D intoxication in a patient with idiopathic hypoparathyroidism].

We report a case of urolithiasis in a patient with idiopathic hypoparathyroidism treated with vitamin D therapy. A 30-year-old woman with idiopathic hypoparathyroidism, who had been treated with vitamin D therapy with 2-4 micrograms/day of alpha-calcidol for 9 years, was admitted for recurrence of bilateral renal stones and progressing left hydronephrosis. Laboratory data revealed normal serum calcium level and remarkable hypercalciuria. The dose of oral administration of alpha-calcidol was reduced to 1 microgram/day and 2 mg/day of trichlormethiazide was started. Now her serum calcium concentration and the total amount of urine calcium was completely under control. Bilateral renal stones are no longer progressive and tetany has not been recognized. We considered it essential to monitor closely not only the serum but also the urine calcium level in the vitamin D therapy for idiopathic hypoparathyroidism.

Adult↗
PubMed2002

[A case of adenocarcinoma arising in female urethral diverticulum].

An 81-year-old woman was admitted with a chief complaint of bloody discharge from the urethra. On physical examination an elastic-soft mass was palpable beneath the anterior vaginal wall. Magnetic resonance imaging and computed tomographic scan revealed the mass around the urethra. Transvaginal needle biopsy was performed and the histopathologic finding was adenocarcinoma. The tumor was excised with the uterus, the ovary and the anterior vaginal wall. The macroscopic appearance suggested that the tumor arose in the urethral diverticulum. She had intravesical recurrence at 8 months after the operation, and partial cystectomy was performed. However there was recurrence again, and radical cystectomy was performed finally. We review 81 cases of urethral diverticular carcinoma in the literature.

Adenocarcinoma↗