Biomedical subjects
Publications and source records attributed to H Kusuyama.
We report a case of Lesch-Nyhan syndrome (LNS) with urinary xanthine calculi. At eight years of age calculi in the renal pelvis were successfully disintegrated by extracorporeal shock wave lithotripsy (ESWL) without any complications. Follow-up sonography is very useful for management of patients with LNS, particularly when they are on allopurinol therapy.
In a 44-year-old man with persistent back-pain for 3 months duration, radiological and echological investigations revealed prostatic mass lesion with multiple osteoblastic involvements. Transrectal biopsy to the prostate demonstrated pathohistologically poorly differentiated adenocarcinoma (Gleason's score 4-4:8). Serum ACP, ALP and IAP were elevated at the initial diagnosis pathologically. The clinical and pathological stage was D2, without metastasis to lung and liver. Combination chemo-endocrine therapy (methotrexate, adriamycin, pepleomycin, Estracyt and tegafur) with bilateral orchiectomies was performed exclusively as initial treatment. These consecutive treatments brought remarkable reduction of the prostatic mass lesion, decrease of tumor markers to normal range, rapid improvement of subjective symptoms and distinct decrease of abnormal activity in bone scintigram. More than 3 years survival was obtained, and normal performance-status was kept. Prostatic cancer in middle-aged adults is reviewed and discussed.
Seventeen patients with renal stones and 17 patients with ureteral stones were treated using the newly developed piezoelectric shock wave lithotripter, THERASONIC. To determine the effect of shock wave on renal function, urinary N-acetyl-beta-D-glucosaminidase (NAG) activity, urinary beta 2 microglobulin (BMG) concentration, serum BMG concentration and creatinine clearance (Ccr) were measured. Urinary NAG activity and urinary BMG concentration in renal stone patients were significantly elevated immediately after the treatment and returned to the pretreatment value within 24 hours. Neither serum BMG nor Ccr showed significant change in any of the patients. Therefore, we conclude that the renal tubular damage, which is transient and subtle, is the effect of shock wave lithotripsy using THERASONIC machine.
The THERASONIC lithotripsy treatment system, a newly developed piezoelectric lithotripter, uses both an X-ray and ultrasound system and enables stone localization effective. Treatment of urinary stones with THERASONIC was begun in June, 1989 and 57 treatments have already been performed on 38 patients. Successful treatment, defined as either stone free or with a residual stone less than 4 mm in diameter on flat X-ray film, was accomplished in 95% of the renal stones and over 50% of the ureteral stones. The overall success rate was 74%. Blood pressure and laboratory values did not show any significant change during or after the treatment. No major complication has been observed except for one perirenal hematoma which was resolved with conservative therapy.
A 69-year-old man initially came to our hospital with the chief complaint of dysuria and hematuria. On rectal examination, the prostate gland was found to be grossly enlarged and rock hard in consistency. Abnormal laboratory data included: lactate dehydrogenase, alkaline phosphatase, acid phosphatase and prostatic acid phosphatase. Chest X-ray revealed multiple nodular lesions in both lung fields. Pathologic findings of the prostate needle biopsy revealed moderately well differentiated adenocarcinoma. Early combined hormonal and chemotherapy (adriamycin, TGF, methotrexate, bleomycin) was performed. After two courses of this regimen, the pulmonary lesions vanished completely. In addition, partial disappearance of osteoblastic lesions on bone scans was recognized.
Explore the source record for details and available documents.
A 58-year-old man visited the urological clinic in Prefectural Tohkamachi Hospital with complaint of swelling of bilateral scrotal contents. He had no history of fever, pain or difficulty of urination. Physical examination revealed a giant mass of adult-head size in right scrotum and left inguinal hernia of fist growth. Surgical extirpation of the right scrotal mass and left inguinal herniorrhaphy was performed and the mass was diagnosed as obsolete hydrocele testis and weighed 1,600 g. The excised hydrocele sac showed marked thickening and dark brown pus amounted to about 1,400 ml, which was negative in bacterial culture. Histological examination revealed partial deposits of cholesterol and calcification in tunica vaginalis with extremely atrophic testis and destructive spermatogenesis. The findings suggested the existence of long-term infection in hydrocele testis. The etiology and pathogenesis of this disease is discussed.
Gleason histologic grading for prostatic carcinoma was evaluated in a retrospective analysis. The present study comprises 98 cases of prostatic adenocarcinoma followed from January, 1973 to December, 1985. Histological materials were obtained by needle biopsy, transurethral resection or by suprapubic prostatectomy. Such slides were examined by a pathologist without previous knowledge of the patients and were assigned according to the General Rules for Clinical and Pathological Studies on Prostatic Cancer (1985) or Gleason system. Most patients fell within a Gleason score of 6, 7 and 8, and had a correspondingly high stage tumors. The survival rate for the patients was analyzed according to Gleason score. Because of the small numbers of patients some scores were combined. There were no cancer deaths for the 15 patient with a Gleason score under 5. Patients with a higher score (9-10) had a poorer prognosis (32% of survival rate at 2,234 days), but there was no significant correlation between a Gleason score of 6, 7 or 8, or that of a higher score (9-10) and survival rate.
A 67-year-old man was admitted with the chief complaint of asymptomatic intermittent gross hematuria on June 22, 1978. No tumor was found cystoscopically. But urinary cytology indicated class IV. X-ray investigations showed a right renal pelvic tumor and left nonfunctioning hydronephrosis. Partial resection of the right renal pelvis and left nephroureterectomy were performed on August 11, 1978, because of his refusal to under go hemodialysis after radical surgery. A thumb-sized tumor was found in the left midureter. Histopathological diagnosis was equally transitional cell carcinoma grade 1 and 2, stage A. He refused adjuvant therapy. No recurrence or metastasis was detected until his death from myocardial infarction on October 4, 1984. Autopsy was not done.
The incidence of prostate cancer has recently increased in Japan. Since Huggins demonstrated the dramatic effect of antiandrogenic treatment, patients with prostate cancer are widely treated by bilateral orchiectomy and high dose estrogen. As the incidence of cardiovascular disease has also gradually increased in patients of prostate cancer treated by estrogen in Japan, radiotherapy, radical prostatectomy, antiandrogen such as chlormadinone acetate, cyproterone acetate and anticancer chemotherapy are now sought and tested clinically. The authors have emphasized multidisciplinary treatment according to the stage of prostate cancer. In particular, early prostate cancer without metastasis should be radically treated with radiotherapy or prostatectomy.
Cis-diamminedichloroplatinum (CDDP) combination chemotherapy has induced a high response rate in the treatment of metastatic urothelial carcinoma at our clinic. However, due to the risks of renal failure, renal function manifested by creatinine clearance (Ccr) of more than 50 ml/min is suggested to be the requirement for CDDP therapy. Unfortunately, some patients do not meet this requirement. Thus, the renal function of patients who were treated with our combination chemotherapy was evaluated and the method of CDDP administration was modified for these patients. Four patients with Ccr in the range of 38 approximately 49 ml/min were treated and 3 patients achieved objective response; complete response in 1 case and partial response in 2 cases. Transient decrease in Ccr and elevation of blood urea nitrogen and serum creatinine were observed but these changes were reversible in all but 1 of the 10 courses. The results indicate that CDDP can be administered with reasonable safety without sacrificing anti-tumor activity in patients with Ccr of less than 50 ml/min.
The incidence of carcinoma of the prostate has recently increased in Japan, but it is still considerably less frequent than in other countries. The highest incidence of carcinoma of the prostate occurs at around 70 years of age, and more than half of all cases are in stage C and D when detected in Japan. Antiandrogenic treatment is still widely used, but unfortunately, results are unsatisfactory in terms of control and survival rates. Other treatment modalities, for example, radical prostatectomy, radiotherapy or chemotherapy should be studied in order to improve the results. Although the results of patients with stage A and B are rather favorable, those of patients of advanced prostatic cancer are miserable. The reason is considered to be difficulty to cure large primary lesion and metastases. Development of treatment modality for stage C is therefore most important at present. In order to reduce size of primary lesion or metastatic pelvic lymph nodes estrogen should be given prior to operation or radiotherapy. Improvement of chemotherapy for the prostatic cancer will provide better results.