Biomedical subjects
Publications and source records attributed to H Tazaki.
Herein a case of renal cell carcinoma presenting as Budd-Chiari syndrome is reported. Ten percent of patients with renal cell carcinoma have shown inferior vena cava invasion. However, Budd-Chiari syndrome is a relatively rare condition where the hepatic venous outflow into the inferior vena cava is blocked by tumor thrombus, and the prognosis is very poor.
Natural killer (NK) cell activity and recycling capacity of NK cells in patients with carcinoma of the prostate (CaP) was determined by combining the 51Cr-release cytotoxicity assay and single cell cytotoxicity assay in agarose. The NK cell activity in patients with advanced CaP (stage D) was significantly lower than the NK cell activity of normal controls and that of patients with localized CaP (stage B and C). The number of active NK cells in the peripheral blood lymphocytes was similar in all groups tested including normal controls, patients with localized CaP, and patients with advanced CaP. Maximal killing potential (Vmax) and maximal recycling capacity (MRC) were significantly reduced in patients with advanced CaP as compared to patients with localized CaP or normal controls. Obtained results indicated that the depressed NK cell activity in advanced CaP was not due to a reduced number of active NK cells but due to the decreased recycling capacity of the individual NK cells.
In order to evaluate flow cytometric deoxyribonucleic acid measurement (FCM) of bladder washing in the diagnosis of bladder carcinoma, the sensitivity of voided urine cytology, bladder washing cytology and bladder washing FCM was tested in 76 samples from 56 patients with histologically proven bladder carcinomas. The positive rates were 43.2% and 75.7% in bladder washing cytology and bladder washing FCM, respectively. On the other hand, 36.5% and 57.1% positive rates for once- and three-times-voided urine cytology, respectively, were obtained. Bladder washing cytology and bladder washing FCM were positive in 20% and 70% patients with a histological diagnosis of atypia or dysplasia, respectively. The sensitivity of bladder washing FCM according to the tumor grade was 33.3%, 81.9% and 88.9% for grade-1 (G-1), G-2 and G-3 tumors, respectively. The sensitivity of bladder washing cytology according to the tumor grade was 0, 40.9% and 77.8% for G-1, G-2 and G-3 tumors, respectively. The sensitivity of three-times-voided urine cytology was 25.0%, 55.6% and 83.3% for G-1, G-2 and G-3 bladder tumors, respectively, and it was superior to that of single bladder washing cytology. These results indicate that FCM is more sensitive than voided urine cytology and/or bladder washing cytology in patients with bladder carcinoma. FCM may indicate urothelial neoplasia before it is apparent on urine cytology, especially against a background of inflammation. Therefore, FCM is valuable for case finding in suspect populations or for follow-up cases with diagnosed bladder cancer.
Flow cytometric DNA analysis (FCM) of adrenal tumors was studied to evaluate whether FCM will be a useful examination for differentiating between benign and malignant adrenal tumors. 10 specimens of surgically resected (for renal cell carcinoma confined within the middle or lower pole) normal adrenal glands and 20 specimens of surgically resected adrenal tumors were submitted for the study. Hyperplastic adrenal cortex as well as normal adrenal gland showed normal diploid pattern. On the other hand, some of the cortical adenomas showed tetraploid patterns, which has been known to be an index of malignancy in most of the flow cytometric intervention to other solid tumors. Conn adenomas were especially apt to show this tendency, in which as much as 86% showed tetraploid pattern. Proliferation Index (PI) (ratio of S + G2 +M cells for the whole population of analyzed cells) were as much as 9.45 +/- 6.97% in normal adrenal cells, whereas it was much higher in cortical adenomas (17.75 +/- 8.53%). As a matter of fact, PI of hyperplastic adrenal cortex was within the same range as that of the normal adrenal glands. In pheochromocytomas, aneuploid pattern, which has been believed to be a definite index of malignancy, was shown in 60% of the cases, tetraploid pattern in 20%, and normal diploid pattern in only 20%. As a matter of fact, a case of non functioning cortical adenocarcinoma and a case of malignant pheochromocytoma were judged to show typical aneuploid pattern. Thus, the application of the flow cytometric diagnosis for adrenal tumors was supposed to require some refinement in understanding the significance of aneuploidy or tetraploidy.
By September 1988, we performed 58 ureterorenoscopies (52 for primary ureteral calculi, 3 for ureteral biopsy, 2 for ureteral stricture and 1 for ureteral foreign body) using a Ureteromat (Uromat Storz, West Germany). Continuous saline irrigation with the Ureteromat has obviated mechanical dilation of the ureteral orifice in 93.1% of the cases, which made this endoscopy as easy as the conventional cystourethroscopy. In 4 cases (6.9%), however, balloon dilation of the ureteral orifice was necessary for the passage of a rigid ureterorenoscope. Of 52 ureteral calculi, 37 were assigned for transurethral ureterolithotripsy (TUL), whereas transurethral ureterorenoscopy (TUURS) was indicated to flush the remaining 15 calculi up into renal pelvis for later extracorporeal shock wave lithotripsy. TUL was successful in 81.1% (30/37). The causes of failure were stone migration in 6 cases and ureteral avulsion by electrohydraulic lithotripsy necessitating open surgery in 1 case. The irrigation with the Ureteromat facilitated the manipulation of intraluminal ureteral lesions always under clear vision; by-passing the impacted stone with a guide wire and flushing-up of the calculi were successfully performed in 100%, in spite of the co-existing edematous and inflammatory mucosal changes. In 7 cases where ureteroscope could not be advanced well up to the lesion because of spasm in the iliac ureter, the irrigation pressure was transiently increased up to 200 mmHg to allow safe and easy dislodgement of impacted calculi under fluoroscopic guidance. This procedure was also effective to introduced a ureteral stent over a guide wire in 2 cases of ureteral stricture, which could not be achieved by conventional cystoscopic procedure. Immediate postoperative complications were fever in 8.6% and gross hematuria lasting for more than 4 days in 8.6%.(ABSTRACT TRUNCATED AT 250 WORDS)
The incidence of transitional cell carcinoma (TCC) of the bladder has been increasing in men with a peak incidence occurring in the sixth decade. However, development of tumors under the age of 30 is relatively rare. In this regard, it has been reported that vesical tumors in the young group is less malignant and rare to recur when compared with those in the elderly group. Recently, flow cytometric DNA histograms (FCM) provides quantitative and objective informations for detection and evaluation of malignant potential of bladder neoplasms. Here we report patients with tumor of the bladder under 30 years old and assess the clinical properties and biological characteristics of their tumors based on FCM. A total of 11 patients from 1975 through 1988 were reviewed. Their mean age at the diagnosis was 22.6 years old (range from 22 to 29 years old). Male/female ratio was 2.7:1. The mean follow-up period was 4 years and 7 months (range from 8 months to over 13 years). An asymptomatic gross hematuria was found in all of the patients, which is the most common sign. Filling defects of the bladder on excretory urograms were observed in six out of the 11 patients (54.5%). Cystoscopically, the size of tumors was less than 2 cm in diameter. Ten patients had a single tumor and one patient had multiple tumors at the time of the initial diagnosis. Endoscopically tumors were papillary in all but one patient, who had a non-papillary tumor. Their urine cytology showed class I in one, class II in eight, class III in one, class IV in one and class V in none.(ABSTRACT TRUNCATED AT 250 WORDS)
Recent research trends on carcinoma of the bladder with special references to the current concepts of its pathogenesis, the basic problems on its diagnosis and treatment were reviewed and discussed. 1) The transitional epithelium as the origin of transitional cell carcinoma (TCC) is understandable as an intermediate of squamous and glandular epithelium and the biology on the basal cells is seemed to be the most interesting. 2) Multistage carcinogenesis theory is adapted in the carcinoma of the urinary bladder and the research will be directed to clarify mechanisms to maintain the dormant cell in the state and to develop new technology for quantitative analysis of its promoters and antipromoters. 3) Grading of TCC by the conventional histology is not adequate in the future that new objective criteria to evaluate the structural atypia is expected other than the current DNA analysis by flow cytometry. 4) Endoscopy for diagnosis of the bladder carcinoma should be available to observe whole urinary system and the recorded images should be analyzed by the objective method developed by new technology. 5) New direction of the treatment of the bladder carcinoma will be headed to find a BRM as an antipromoters in the short range strategy.
In this study we evaluated 77 patients with superficial bladder cancer who were treated with either intravesical bacillus Calmette-Guerin (BCG) (44 patients) or doxorubicin hydrochloride (Adriamycin, ADR) (33 patients) for prophylaxis of tumor recurrence after transurethral resection. The estimated actuarial probability of non-recurrence rate at three years for the BCG group was 73.0%, and the actuarial non-recurrence rate for the ADR group was 27.3%; a statistically significant difference (p = 0.0013). A comparison between the two groups was also made according to the patient's background, including whether the tumor was initial or recurrent, solitary or multiple, and the tumor grade. In all areas of the study, except for grade-1 tumors, the BCG group was significantly superior to the ADR group. The efficacy of BCG therapy as a result of different BCG treatment protocol was evaluated for six weekly instillations 1) without further maintenance instillation, 2) followed by 12 months of maintenance, and 3) followed by more than 18 months of maintenance. Long-term maintenance BCG instillation group (more than 18 months) showed the most favorable results, however, the differences were not statistically significant. These results indicate that intravesical BCG instillation was significantly superior to ADR in the prevention of bladder cancer recurrence and that six weekly intravesical BCG instillations may provide adequate prophylactic effects against recurrence of superficial bladder cancers.
Total of 37 patients with measurable lesions originating in advanced urothelial cancers received M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) combination chemotherapy and have been followed for a minimum of 12 months. The study included initial diagnoses of 24 bladder cancers and 13 upper urinary tract cancers in patients whose mean age was 62 years. The patients received a mean of three cycles of M-VAC. Clinical complete remission was observed in five of the 37 patients (13.5%) and partial remission was achieved in 10 patients (27.0%) after mean treatment of 2.4 and 2.1 cycles, respectively, for an over-all objective response rate of 40.5%. The mean duration of response was 11.6 +/- 7.1 months and 4.4 +/- 3.5 months for complete and partial remissions, respectively. A mean of 5.2 +/- 1.7 cycles of M-VAC was given for complete remissions and 3.5 +/- 1.4 cycles in partial remissions. An over-all survival rates after one and two years were 28.125% and 5.859%, respectively. Two of the five patients who had once marked complete remissions died after a mean survival time of 14.5 +/- 4.5 months and three survived with a mean duration of 20.3 +/- 5.4 months. Meanwhile, all of the patients who had achieved partial remissions died after a mean survival of 9.1 +/- 5.4 months except for one patient who survived more than 12 months. These results indicate that M-VAC combination chemotherapy for advanced urothelial cancer is extremely efficacious in initial responses.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephrotoxic effects of cis-Diammine-1,1-cyclobutane dicarboxylate platinum II (CBDCA) were investigated in male 6 weeks old Wistar rats. The animals were divided into 4 groups: Group I (each received a single intraperitoneal injection of CBDCA 80, 120 mg/kg); Group II (a single intraperitoneal injection of CBDCA 80, 120 mg/kg after withdrawal of food and water for 2 days); Group III (intravenous administration of CBDCA 15, 30 mg/kg for 7 consecutive days after withdrawal of food and water for 2 days); Group IV (controls). Rats from each group were sacrificed at 3, 7, 10 and 14 days following the start of the experiment. Serum levels of BUN and creatinine were then measured and renal histopathological examination was conducted by light and electron microscopy. In addition, the total platinum concentration in the serum was measured in Group I, and X-ray microanalysis was performed after intraperitoneal administration of CBDCA (100 mg/kg) and cis-Diamminedichloroplatinum (II) (CDDP) (6 mg/kg) for 2 consecutive days (Group V). The results showed increased levels of BUN in each group due to catabolism. No significant increase in serum creatinine was observed and there appeared to be no evidence of renal dysfunction. For all groups, localized vacuolar degeneration in the epithelial cells of the tubules was predominantly apparent. Electron microscopy revealed only degeneration of the epithelium mainly in the proximal tubules and also showed reabsorption of platinum from the lumen of the tubules.(ABSTRACT TRUNCATED AT 250 WORDS)
Retrograde prostatic urethroplasty with balloon catheter was first described by Castaneda et al. in 1987. This procedure is performed using local anesthesia with modified angioplasty balloon catheter. We applied this technique in 5 cases, including benign prostatic hypertrophy in 4 and prostatic cancer with urethral stricture in 1. Improvement in clinical symptoms was seen in 4 patients. Uroflowmetry was performed in 3 patients and flow was improved. Urinary retention recurred a few days after the procedure in one other patient. This was though to be related to the predominant hypertrophy of the middle prostatic lobe. A strong urge to void is commonly present at the time of balloon dilatation. Transient hematuria is seen after the procedure. To prevent the risk of postprocedural incontinence, it is very important to avoid dilating the external sphincter. Further investigation is necessary for the evaluation of long-term results, but this procedure can be performed in poor risk patients since it is less invasive. Hence, retrograde prostatic urethroplasty with balloon catheter is thought to be useful treatment for urethral stricture in poor risk patients.
A case with priapism in a 66-year-old male due to malignant lymphoma is reported. Physical examination revealed an erected penis and enlarged lymph nodes in left neck and bilateral inguinal areas. Rectal digital examination of prostate revealed an irregular surface and swollen hard left lobe. Open biopsy of the bladder and vesicostomy were carried out. Several nodular lesions in the trigone and in the left wall were excised. Pathologically the diagnosis was malignant lymphoma, diffuse, large cell type and clinical stage was stage IV. CHOP therapy with bleomycin and methotrexate was performed. Priapism disappeared 7 days after the initiation of the chemotherapy, but impotence has been noticed after the chemotherapy for more than one year. This will be the first case with priapism due to malignant lymphoma reported in Japan so far.
Changes in the susceptibility of various infectious microorganisms to antimicrobial agents from 1982 to 1986 were evaluated. The microorganisms investigated were Escherichia coli, Klebsiella spp., Citrobacter spp., Enterobacter spp., Proteus spp., Serratia marcescens and Pseudomonas aeruginosa isolated from patients with urinary tract infections. We compared susceptibilities of microorganisms obtained from simple urinary tract infections with those from complicated infections with or without indwelling catheter. Among penicillins, mecillinam (MPC) showed the strongest activity against E. coli obtained from the patients: 3.13 to 6.25 micrograms/ml of MPC inhibited the growth of over 90% of the isolates. Among the second and the third generation cephalosporins, cefotiam and cefmenoxime (CMX) showed the strongest activity and the growth of isolates was inhibited at concentrations of 0.39 to 0.78 microgram/ml and below 0.10 to 0.20 microgram/ml, respectively. The activities of penicillins against Klebsiella spp. were weak. CMX showed strong activity against Klebsiella spp; 91.7% of the isolates from patients with simple infections were inhibited at 0.39 microgram/ml of the agent; 90.7% and 91.6% of isolates from patients with complicated infections with or without indwelling catheter were inhibited at 0.78 microgram/ml and 1.56 microgram/ml of the agent, respectively. Gentamicin (GM) also showed strong activity against isolates from patients with simple infections and weaker activity against isolates from patients with complicated infections with the catheter; 0.78 microgram/ml of ofloxacin (OFLX) inhibited the growths of 90% of the isolates from these patients. Penicillins showed weak activity against Citrobacter spp. obtained from the patients. Among the second and the third generation cephalosporins, CMX and latamoxef (LMOX) showed strong activities against the Citrobacter isolates; about 50% of the isolates were inhibited at 0.20 microgram/ml of either agent. 1.56 microgram/ml of minocycline inhibited the growth of 75 to 90% of the isolates and 1.56 microgram/ml of OFLX inhibited the growth of 93 to 100% of the isolates. Against isolates of Proteus spp. penicillins also showed weak activities. Among them, however, piperacillin (PIPC) inhibited the growth of over 90% of the isolates at concentrations ranging from 0.78 to 1.56 micrograms/ml. Among the second and third generation cephalosporins, CMX and LMOX showed strong activities; 0.20 microgram/ml of CMX inhibited the growth of 94.4%, 90.4%, and 83.1% of isolates from the 3 types of the patients, respectively. 0.20 microgram/ml of LMOX inhibited the growth of 94.4%, 91.8%, and 88.3% of the isolates, respectively. Enterobacter spp. showed resistance to the beta-lactam antibiotics.(ABSTRACT TRUNCATED AT 400 WORDS)
The incidence of urothelial cancers in a group of 231 dyestuff plant workers who had been exposed to benzidine (BZ) or to beta-naphthylamine (BNA) was surveyed from 1962 to 1988. Fifteen out of 231 patients (6.5%) were found to have bladder cancer with the mean age at onset of 57.1 +/- 8.7 years. The estimated average period of engaging in this dyestuff exposure for these 15 patients was 92.4 +/- 47.3 months. The mean latent periods from the initial and last exposure until tumor development were 28.8 +/- 5.7 years and 16.6 +/- 7.0 years, respectively. Good negative correlation was observed between exposure periods and latent periods from the last exposure to onset (R = -0.06814). All 15 patients demonstrated tumors in the bladder, and one patient had a metachronous upper urinary tract cancer after treatment for bladder cancer. All tumors were histologically transitional cell carcinomas except for one adenocarcinoma. For initial treatment, five underwent total cystectomy, eight had transurethral resection (TUR) of the tumor, and one had partial cystectomy. Five out of 8 patients who had TUR have developed recurrent bladder tumors, and two of those patients underwent total cystectomy for second treatments. The mean follow-up period was 8.6 +/- 5.2 years, with two dying of cancer. For detection and monitoring, flow cytometric (FCM) analyses were available in five cases with bladder tumor and in two follow-up cases after bladder preserving treatments.(ABSTRACT TRUNCATED AT 250 WORDS)
We report a case of 14-year-old woman of fibromuscular dysplasia (FMD) with involvement of the thoracic aorta. Our case is characterized by a segmental stenosis of the thoracic aorta with multiple systemic arterial branch lesions. Atypical coarctation of the thoracic aorta was replaced with Dacron woven graft and the specimen of the lesion demonstrated medial fibroplasia. There have been reported only 9 cases of FMD of the aorta so far and all were female except one case. This report is the first case report of FMD of the thoracic aorta.
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Susceptibilities to various antibacterial and antibiotic agents of bacterial strains isolated from urinary tract infections at 8 hospitals in Japan from July to October in 1986 are summarized as follows. 1. Enterococcus faecalis was susceptible to sulfamethoxazole/trimethoprim (ST) and imipenem (IPM) with MIC90s of 0.78 and 1.56 microgram/ml. Minocycline had the strongest activity against Staphylococcus aureus; the MICs for all strains tested were lower than 0.39 microgram/ml. The MIC80s of dicloxacillin, and arbekacin (HBK) were 0.20 and 0.78 microgram/ml, respectively. Among the cephems, the MIC80 of flomoxef was 25 micrograms/ml, whereas those of cefmenoxime (CMX) and cefotiam (CTM) were 50 micrograms/ml. 2. Escherichia coli was most susceptible to ofloxacin (OFLX) among the oral antibacterial and antibiotic agents tested. OFLX showed the minimum inhibitory concentration against 90% (MIC90) of the 274 strains of E. coli tested to be lower than 0.10 microgram/ml. The antibacterial activities of the third generation cephems such as CMX and latamoxef (LMOX) were the strongest among the injectable antibiotics tested. The MIC90s of CMX and LMOX were lower than 0.10 and 0.20 microgram/ml, respectively. CTM and cefmetazole, the second generation cephems, were also highly active against E. coli with MIC90s of 0.39 and 1.56 micrograms/ml, respectively. 3. Among the oral antibacterial and antibiotic agents tested, OFLX was the most active against Klebsiella pneumoniae. Its MIC90 was 0.78 microgram/ml. Among the injectable antibiotics tested, CMX was the strongest with an MIC90 of 0.20 microgram/ml; MIC90 of CTM and LMOX were 0.39 microgram/ml. 4. The tested antibacterial and antibiotic agents were generally less active against Citrobacter freundii than against other bacteria. The MIC80 of OFLX was 0.39 microgram/ml. Gentamicin (GM) and ST were slightly active against C. freundii. Among the cephems, CMX had the MIC80 of 25 micrograms/ml. 5. Enterobacter cloacae was less susceptible to the cephems tested. OFLX, GM, and mecillinam were active against this bacteria with MIC80s of 0.78, 0.78 and 1.56 micrograms/ml, respectively. 6. Among the oral antibacterial and antibiotic agents and penicillins examined, piperacillin (PIPC) was the most active against Proteus mirabilis. Its MIC90 was 0.39 microgram/ml. Those of sulbenicillin, cefaclor, ampicillin, OFLX, and ST were 0.78, 0.78, 1.56, 3.13 and 3.13 micrograms/ml, respectively. CMX was highly active against P. mirabilis with an MIC90 of less than or equal to 0.10 microgram/ml; LMOX followed with an MIC90 of 0.20 microgram/ml among the injectable antibiotics tested. CTM was also active against this bacterium; the MIC90 was 0.39 microgram/ml. 7. The antibacterial and antibiotic agents were generally only slightly active against Proteus vulgaris.(ABSTRACT TRUNCATED AT 400 WORDS)
From July to October in 1986, hospital data on 717 isolates of causative microorganism from patients with urinary tract infections and background information on 562 patients were collected. The urinary tract infections were divided into 3 groups; simple infections and complicated infections with or without the use of indwelling catheter. We investigated such factors as the patients' sex, age, and drug treatments, and the isolates obtained from the infections. From 1981 to 1986, about 25% of the patients with simple infections were males and about 60 to 70% among those with complicated infections were males each year. During these 6 years, no noticeable changes occurred in sex and age distributions of patients with any type of the infections, but the species of isolates changed remarkably. In 1982 and 1983, the isolation rates of Enterococcus faecalis (Streptococcus spp. or Streptococcus faecalis) obtained from the patients were about 8% in both of male and female patients. In 1984, the rate in females increased to 17.9%. In 1985, the rates in males and females were 14.9% and 7.6%, respectively. Similar rates were also observed in 1986: 16.1 and 7.4%. The isolation rate of Staphylococcus aureus in 1982 was 0.7%, as was in 1983. In however, increased to 1.7% in 1984 and to 3.2% in 1985. It was 2.5% in 1986. The isolation rate of Gram-positive bacteria was 11.1% in 1982; it increased to 18.9% in 1983 and to over 20% between 1984 to 1986. Among Gram-negative bacteria, the isolation rate of Pseudomonas aeruginosa form patients with complicated urinary tract infections with a catheter was high and over 20% in both 1985 and 1986. When antibacterial agents were administrated for 3 days, changes in number of species of isolates tended to be more pronounced in complicated infections with or without the use of catheter than in simple infections. According to date obtained in 1986, when antibiotic agents were administered for 8 or more days, the changes were definitely more drastic in complicated infections than in simple ones. An upmost care in the selection of antibiotic drugs according to their antibacterial spectra and activities, therefore, appears necessary, and an attention should be paid on future changes in species of bacteria isolated from infections.