Biomedical subjects

Isao Hara

Publications and source records attributed to Isao Hara.

At least 109 records · Page 6Linked to original sources

PubMed2004

Successful treatment for squamous cell carcinoma of the female urethra with combined radio- and chemotherapy.

We report on two cases of women with locally advanced squamous cell carcinoma of the urethra. Patient 1 also displayed regional lymph node metastasis. Treatment comprised combined radiotherapy to 60 Gy and chemotherapy with 5-fluorouracil and cisplatin. Complete response was obtained in both patients, including the inguinal lymph nodes of Patient 1. Patient 1 experienced recurrent inguinal lymph node metastasis on the contralateral side at 42 months after initial treatment, and the same treatment was performed followed by surgical excision. Both patients remain alive with no evidence of disease, at 12 months after recurrence in Patient 1, and at 27 months after treatment in Patient 2.

Aged↗

PubMed2004

Advances in the management of non-seminomatous germ cell tumors during the cisplatin era: a single-institution experience.

BACKGROUND: The objectives of the present study were to review chronological changes in the long-term survival of patients with non-seminomatous germ cell tumor (NSGCT) who were treated at a single institution after the introduction of cisplatin-based combination chemotherapy. METHODS: One hundred and twenty patients with NSGCT who were treated between January 1978 and October 2001 were enrolled in this study. To evaluate chronological changes in treatment outcome between 1978 and 2001, data were analyzed according to the timing of initial treatment in two consecutive 12-year periods. The numbers of patients who were treated during 1978-1989 and 1990-2001 were 59 and 61, respectively. Patients were classified according to criteria of both the Japanese Urological Association (JUA classification) and the International Germ Cell Cancer Collaborative Group (IGCCCG classification). RESULTS: The mean follow up of surviving patients during the periods 1978-1989 and 1990-2001 was 84 months and 63 months, respectively. The overall 5-year survival rate of patients with NSGCT significantly increased from 72.8% during the period 1978-1989 to 83.6% during the period 1990-2001 (P = 0.02, log-rank test). A significant improvement in survival was found in the patients with stage III disease, according to the JUA classification, and in the patients with poor-risk disease, according to the IGCCCG classification (P = 0.004 and 0.05, respectively). CONCLUSIONS: The overall 5-year survival rate of patients with NSGCT increased significantly from 72.8% during 1978-1989 to 83.6% during 1990-2001. This improvement resulted mainly from an increased survival of patients with metastatic poor-risk NSGCT.

Adult↗

PubMed2004

Clinical outcome of retroperitoneal lymph node dissection after induction chemotherapy for metastatic non-seminomatous germ cell tumors.

BACKGROUND: Retroperitoneal lymph node dissection (RPLND) following induction chemotherapy has been considered a critical component in the comprehensive management of advanced non-seminomatous germ cell tumors (NSGCT). The objectives of the present study were to review the clinical outcome of patients who underwent RPLND and to evaluate the probability of necrosis alone, based on some readily available clinical data for these patients. METHODS: Forty-seven consecutive patients with NSGCT were treated with first-line chemotherapy at our institution between January 1993 and September 2002. Twenty-four of these patients, who underwent RPLND with normal values of tumor markers after induction chemotherapy, were included in the study. The cause-specific survival rate was calculated using the Kaplan-Meier method. Various predictive factors for the histology were analyzed using multivariate analysis. RESULTS: The pathological findings at resection were necrosis alone in 62.5% of cases, teratoma in 25.0%, and viable cancer in 12.5%. The cause-specific 3-year survival rate of patients who underwent complete and incomplete resection was 100% and 50.0%, respectively. Among several clinical factors, prechemotherapy tumor size less than 50 mm was found to be an independent predictor of necrosis alone (hazard ratio = 4.45, P= 0.04). CONCLUSION: Metastatic tumor size before chemotherapy appears to be one of the most important factors for the prediction of necrosis alone in the resected specimens of RPLND. The prognosis of patients might be influenced by the degree to which resection has been completed.

Adult↗

PubMed2004

Extraperitoneal laparoscopic retroperitoneal lymph node dissection in supine position after chemotherapy for advanced testicular carcinoma.

AIM: To evaluate the feasibility and usefulness of extraperitoneal laparoscopic retroperitoneal lymph node dissection (RPLND) in the supine position after chemotherapy for advanced testicular carcinoma. METHODS: Three patients with advanced testicular cancer underwent chemotherapy. Although serum markers were decreased compared with the normal range, residual masses requiring surgical resection were recognized by computed tomography scanning. We applied extraperitoneal laparoscopic RPLND. The patients were placed in the supine position and the first trocar was inserted two finger widths medial to the anterior iliac spine. The retroperitoneal space was dilated using a preperitoneal distention balloon. Two more ports were inserted into the retroperitoneal space and surgery proceeded thereafter. RESULTS: The residual tumors were completely resected by laparoscopy. The procedure required 250-310 min and the bleeding volume was below 50 mL. Although the histopathological findings consisted only of necrosis in all of the patients, one patient recurred at the same place. CONCLUSIONS: Extraperitoneal laparoscopic RPLND in the supine position for residual tumors after chemotherapy is technically feasible and useful in terms of postoperative recovery. With regard to cancer control, further evaluation should be necessary.

Adult↗

PubMed2004

Global analysis of gene expression profiles in ileum in a rat bladder augmentation model using cDNA microarrays.

BACKGROUND: The objective of the present study was to globally characterize the changes in the gene expression profile in the ileum after long-term urine exposure in a rat ileal augmented bladder model using cDNA microarrays. METHODS: Bladder augmentation using the ileum was performed in female 8-week-old rats. The ileal epithelia used for bladder augmentation were harvested 1 and 3 months postoperatively and changes in the gene expression in these tissues were compared with that of intact ileal epithelia from sham-operated rats using cDNA microarrays consisting of 1176 rat genes. RESULTS: Marked changes in gene expression in the ileum used for bladder augmentation were observed for 30 genes (16 up-regulated and 14 down-regulated genes). The differentially expressed genes include those associated with signal transduction, cell adhesion and stress response. Subsequent evaluation of changes in two randomly selected genes from the 30 differentially expressed genes by semiquantitative reverse transcription-polymerase chain reaction demonstrated the reliability of the present cDNA microarray analyses. CONCLUSION: The present experiments identified an extensive list of genes differentially expressed in the ileum after bladder augmentation, providing valuable information for the pathophysiological assessment of patients who undergo urinary reconstruction and representing a source of novel targets for treating complications after urinary diversion.

Animals↗

PubMed2004

Long-term survival after bilateral adrenalectomy for metachronous adrenocortical cancer.

We report the case of a female patient with bilateral metachronous adrenocortical cancer who survived long-term after adrenalectomy. In 1991, the patient underwent left adrenalectomy to remove a huge adrenal mass (10 x 9 cm) displaying no hormonal abnormality. Histological diagnosis was adrenocortical cancer. A right adrenal mass (7 x 6 cm) was found 4 years after left adrenalectomy. Right adrenalectomy was performed, and histological diagnosis was again adrenocortical cancer. The patient remains alive with no evidence of disease 8 years after last surgery.

Adrenal Cortex Neoplasms↗

PubMed2004

Clinicopathological outcome of radical retropubic prostatectomy for 200 men with prostate cancer in a single institution in Japan.

The objective of this study was to retrospectively evaluate the clinicopathological outcome of radical retropubic prostatectomy (RRP) performed at a single institution in Japan. A consecutive series of 200 patients with prostate cancer who underwent RRP and pelvic lymphadenectomy between March 1985 and April 2003 were included in this study. The median age at RRP and the observation period were 69 years old and 43 months, respectively. Clinicopathological findings were reviewed to determine parameters providing predictive information about biochemical recurrence-free, cause-specific, and overall survivals. The pathological stage was pT0 in 7 patients (3.5%), pT2a in 43 (21.5%), pT2b in 58 (29.0%), pT3a in 42 (21.0%) pT3b in 36 (18.0%), and pT4 in 14 (7.0%). Lymph node metastasis was detected in 32 of 200 patients (16.0%). Forty-seven patients (23.5%) received neoadjuvant hormonal therapy, while 48 (24.0%) underwent hormonal therapy alone or hormonal therapy plus radiotherapy following RRP as an adjuvant treatment. During the observation period, 4 patients (2.0%) died of prostate cancer, 11 (5.5%) died of other diseases and biochemical recurrence occurred in 23 (11.5%), when biochemical recurrence was defined as prostate specific antigen (PSA) persistently greater than 0.4 ng/ml. Five-year biochemical recurrence-free, cause-specific, and overall survival rates were 83.6%, 97.7% and 91.4%, respectively. Furthermore, multivariate analyses showed that lymph node metastasis or clinical stage was an independent predictive factor for cause-specific or overall survival, respectively. These findings suggest that it would be possible to achieve a favorable cancer control for patients with localized prostate cancer, including locally advanced cases, by the RRP-based combination therapies.

Aged↗

PubMed2004

Health-related quality of life in patients with testicular cancer: a comparative analysis according to therapeutic modalities.

Investigating health-related quality of life (HRQoL) in testicular cancer patients has become important, because of an increasing number of young survivors with recent advance of multimodal therapy. The objective of this study was to compare the HRQoL in patients with advanced testicular cancer according to the types of treatment they received. Among 130 patients included in this study, 40 underwent surveillance monitoring (group A), 64 received cisplatin-based combination chemotherapy (group B), and 26 underwent infradiaphragmatic radiotherapy (group C). HRQoL in these 3 groups were evaluated using the SF-36 survey containing 36 questions that assess 8 aspects, including physical functioning, role-physical functioning, bodily pain, general health, vitality, social functioning, role-emotional functioning and mental health. Furthermore, HRQoL in group B were analyzed according to the experience with retroperitoneal lymph node dissection (RPLND) or high-dose chemotherapy with peripheral blood stem cell transplantation (PBSCT). The follow-up period of the chemotherapy group was significantly shorter than that of the remaining 2 groups; however, scale scores were not affected by the duration of follow-up in these 3 groups. There were no significant differences in any scale scores among the 3 groups. In comparison with the general population in the USA, social functioning in the 3 groups with testicular cancer was significantly lower, whereas vitality in these groups was significantly higher. Furthermore, in group B, there were no significant differences in any scale scores between patients with and without RPLND, while patients undergoing standard-dose chemotherapy alone had a significantly higher score for mental health than those undergoing high-dose chemotherapy following standard-dose chemotherapy despite the absence of a significant difference in the remaining 7 scores irrespective of the experience with high-dose chemotherapy. These findings suggest that 7 of the 8 scale scores of HRQoL examined by the SF-36 survey were satisfactory in patients with testicular cancer regardless of the 3 treatment modalities, and that there were no significant differences in any scale scores among these groups. Moreover, the HRQoL was not affected by experience with RPLND or high-dose chemotherapy except for mental health in patients undergoing high-dose chemotherapy. Therefore, the overall HRQoL in patients with testicular cancer may be generally favorable and not affected by differences in treatment type.

Adult↗

PubMed2003

Introduction of midkine gene into human bladder cancer cells enhances their malignant phenotype but increases their sensitivity to antiangiogenic therapy.

PURPOSE: Midkine (MK) is a member of a family of heparin-binding growth factors, which was reported to have an important role in angiogenesis. Although MK was reported to be associated with bladder cancer progression, the functional significance of MK expression in bladder cancer progression has not been elucidated. The objectives of this study were to determine whether overexpression of MK in bladder cancer cells enhances their malignant potential and to evaluate the inhibitory effect of the antiangiogenic agent TNP-470 on the growth of MK-overexpressing bladder cancer cells in vivo. EXPERIMENTAL DESIGN: We introduced the MK gene into human bladder cancer UM-UC-3 cells that do not secrete a detectable level of MK protein and generated the MK-overexpressing cell line UM-UC-3/MK. The biological activity of secreted MK was evaluated using a human umbilical vein endothelial cell proliferation assay. To investigate the in vivo effects of MK overexpression on tumor growth, each cell line was injected s.c. and orthotopically into nude mice. To evaluate the therapeutic effects of the antiangiogenic agent, mice were given TNP-470 after s.c. injection of each cell line. The microvessel density of tumors was quantitated by immunohistochemistry of CD31. RESULTS: The heparin affinity-purified conditioned media of UM-UC-3/MK cells significantly enhanced human umbilical vein endothelial cell proliferation. MK expression had no effect on in vitro growth but conferred a growth advantage on both s.c. and orthotopic tumors in vivo. Furthermore, enhanced tumor growth was closely associated with increased microvessel density. Significant inhibition of tumor growth by TNP-470 treatment was observed only in UM-UC-3/MK tumors and not in control tumors. CONCLUSIONS: We demonstrated that overexpression of the MK gene causes an increase in the angiogenic activity of cells through vascular endothelial cell growth, resulting in enhanced malignant potential of human bladder cancer cells. Moreover, the present findings suggest that TNP-470 could be used as a novel therapeutic adjunct to conventional agents for patients with advanced bladder cancer overexpressing MK.

Angiogenesis Inhibitors↗

PubMed2003

Factors that influence the results of salvage surgery in patients with chemorefractory germ cell carcinomas with elevated tumor markers.

BACKGROUND: A standard concept for the integration of surgery into the chemotherapy-based treatment of patients with advanced germ cell carcinoma has been that surgery should be avoided in patients with serum tumor markers (alpha-fetoprotein [AFP] and human chorionic gonadotropin [HCG]) that remain elevated. However, some patients may benefit from resection under such chemorefractory conditions. The objective of this retrospective study was to clarify the outcome and clinical prognostic variables of salvage surgery in patients with disseminated (AJCC Stage II or III) testicular germ cell carcinoma or extragonadal germ cell carcinoma who had elevated serum markers. METHODS: The authors reviewed the clinical records of 24 patients who underwent salvage surgery with elevated serum AFP and/or HCG levels after at least 3 courses of cisplatin-based, systemic chemotherapy between January, 1985 and December, 2000. The survival rates were compared between the subgroups with regard to preoperative and postoperative clinical parameters using the Kaplan-Meier method and a Cox proportional hazards model. RESULTS: Ten of 24 patients (41.7%) were rendered free of disease and alive without disease after the surgery with or without adjuvant therapy at a median follow-up of 74 months (range, 24-207 months). Among the preoperative parameters, high HCG levels were associated with significantly poorer survival (hazard ratio [HR], 8.321; 95% confidence interval [95% CI], 1.0753-64.553; P = 0.043 and P = 0.016, respectively; log-rank test). In addition, patients who had visceral lesions at resection had a significantly poorer prognosis compared with patients who had retroperitoneal and/or mediastinal lymph node lesions (P = 0.038; log-rank test). Among postoperative parameters, incomplete resection and persistently high HCG levels were associated significantly with poor survival, with a risk of death from disease of 12.516-fold (95% CI, 1.786-87.781) and 9.311-fold (95% CI, 1.796-48.256), respectively. CONCLUSIONS: Salvage surgery in patients with high serum tumors markers resulted in long-term disease free status in approximately 40% of patients in a small subset with advanced germ cell carcinoma. Patients with elevated AFP levels alone (i.e., normal HCG levels) or with lymph node lesions alone seem to be good candidates for such surgery. Complete resection of target lesions and normalization of HCG levels after surgery are mandatory to achieve long-term disease free status.

Adolescent↗

PubMed2003

Carcinoma in situ spread to mucosa of sigmoid colon neobladder.

This is the first case of carcinoma in situ (CIS) of a transitional cell carcinoma that had spread into a neobladder constructed using a bowel segment associated with local recurrence at the ureteral-neobladder anastomosis. Considering that the CIS lesion was found in macroscopically intact epithelium remote from the main tumor, this strongly suggests that CIS could arise from solid tumor by implantation. Although some studies have reported secondary malignancy occurring in the neobladder, most have been adenocarcinoma that arose from the replaced bowel segment. To our knowledge, the present case is the first of widespread CIS of transitional cell carcinoma in an orthotopic neobladder.

Aged↗

PubMed2003

Prediction of the extent of prostate cancer by the combined use of systematic biopsy and serum level of cathepsin D.

BACKGROUND: The objective of this study was to assess the usefulness of combined systematic prostate biopsy with the serum level of cathepsin D, which has recently been shown to be a useful marker for prostate cancer, to predict the disease extension. METHODS: Seventy-two patients with clinically organ-confined disease who underwent radical prostatectomy were evaluated for serum prostate-specific antigen (PSA) and cathepsin D levels, systematic biopsy, and pathological stage. RESULTS: The incidence of extraprostatic disease in patients with more than half the biopsy cores positive or > or = 15 ng/mL cathepsin D was significantly higher than that in patients with less than half the biopsy cores positive or < 15 ng/mL cathepsin D, respectively; whereas cancer in bilateral lobes or > or = 10 ng/mL PSA could not be used as a predictor of extraprostatic disease. Furthermore, in patients with more than half the biopsy cores positive and > or = 15 ng/mL cathepsin D or those with more than half the biopsy cores positive and > or = 10 ng/mL PSA, extraprostatic disease was significantly more common than in those with less than half the biopsy cores positive and < 15 ng/mL cathepsin D or those with less than half the biopsy cores positive and < 10 ng/mL PSA, respectively. Furthermore, the prediction of the incidence of extraprostatic disease using these three variables was significantly more accurate than using two of the variables (percentage positive biopsy cores plus serum cathepsin D or PSA). CONCLUSION: Systematic biopsy together with serum cathepsin D and/or PSA was a useful predictor of the extent of prostate cancer. Patients with more than half the biopsy cores positive, > or = 15 ng/mL cathepsin D and/or > or = 10 ng/mL PSA could avoid prostatectomy because there is a significantly high probability that they already have extraprostatic disease.

Aged↗

PubMed2003

Clinical outcome of conservative therapy for stage T1, grade 3 transitional cell carcinoma of the bladder.

BACKGROUND: The objective of this study was to retrospectively investigate the effectiveness of transurethral resection of bladder tumor (TURBT) and intravesical instillation therapy for stage T1, grade 3 (T1G3) transitional cell carcinoma (TCC) of the urinary bladder. METHODS: Between January 1995 and December 1997, 97 patients with T1G3 TCC of the urinary bladder were treated by TURBT and adjuvant intravesical instillation with bacillus Calmette-Guérin (BCG) or other anticancer agents. The recurrence-free survival rates were evaluated according to several clinicopathological factors. The cases that progressed to muscle invasive disease were also analysed. RESULTS: In this series, the median follow-up period was 25 months (range, 5- 41) after the initial TURBT. Intravesical recurrence was noted in 44 patients (45%), and the 1, 2, and 3 year recurrence-free survival rates were 72%, 58%, and 42%, respectively. Multivariate analyses revealed that the risk of intravesical recurrence was significantly higher for patients who did not receive BCG therapy, irrespective of age, gender, tumor size, multiplicity, pathological stage, concomitant carcinoma in situ, and lymphovascular involvement. Moreover, after a median of 10 months, disease progression occurred in seven patients (7%), of which only one patient was treated by BCG therapy after initial TURBT. CONCLUSION: These findings suggest that intravesical instillation with BCG combined with TURBT is an effective conservative treatment for T1G3 TCC of the bladder. Patients with negative prognostic factors should be treated by BCG rather than other anticancer agents after TURBT.

Adjuvants, Immunologic↗

PubMed2003

Predictors of prostate cancer on repeat transrectal ultrasound-guided systematic prostate biopsy.

BACKGROUND: We analyzed the outcome of repeated transrectal ultrasound (TRUS)-guided systematic prostate biopsy in Japanese men whose clinical findings were suspected of prostate cancer after previous negative biopsies. METHODS: Between January 1993 and March 2002, 1045 patients underwent TRUS-guided prostate biopsy. Among them, 104 patients underwent repeat biopsy due to indications of persistent elevated serum prostate-specific antigen (PSA), abnormal digital rectal examination (DRE) or TRUS, increased PSA velocity, and/or previous suspicious biopsy findings. Several clinicopathological factors were evaluated for their ability to predict the detection of prostate cancer on repeat biopsy. RESULTS: Prostate cancer was detected in 22 of 104 patients (21.2%) who underwent repeat biopsies. PSA concentration and PSA density at both the initial and repeat biopsies, and PSA velocity in men with positive repeat biopsy were significantly greater than those in men with negative repeat biopsy. The incidence of abnormal findings in DRE and TRUS at initial biopsy in men with positive repeat biopsy was also significantly higher than that in men with negative repeat biopsy. However, neither the presence of prostatic intraepithelial neoplasia nor number of biopsy cores at initial biopsy had a significant association with the results of the repeat biopsy. Furthermore, multivariate analysis revealed that PSA and PSA density at both the initial and repeat biopsies, PSA velocity, and DRE and TRUS findings at initial biopsy were independent predictors of malignant disease on repeat biopsy. CONCLUSION: Despite an initial negative biopsy, repeat TRUS-guided biopsy should be carried out to exclude prostate cancer in cases of suspicious clinical findings, such as elevated PSA or PSA-related parameters, or abnormal findings of DRE or TRUS.

Adenocarcinoma↗

PubMed2003

Pathological findings of radical prostatectomy specimens in Japanese men diagnosed on single core positive prostate biopsy in eight with a Gleason score less than 4.

BACKGROUND: The objective of the present study was to analyze the pathological findings of radical prostatectomy specimens diagnosed on single core positive prostate biopsy in eight systematic transrectal ultrasonography (TRUS)-guided biopsies with a Gleason score </= 4. METHODS: Between January 1993 and March 2001, 975 patients underwent TRUS-guided prostate biopsy, and 32 patients were diagnosed as having prostate cancer based only on one positive core with a Gleason score </= 4. In this study, 14 of the 32 patients who underwent radical prostatectomy without any neoadjuvant therapies were enrolled, and the pathological findings of their radical prostatectomy specimens were evaluated. RESULTS: The clinical stage of the 14 patients was T1c in 10 and T2 in four. Cancer was detected in the prostate apex in seven patients, the middle in two, the base of the peripheral zone (PZ) in three, the lateral horn of the PZ in one and the transitional zone (TZ) one. Pathological stage of the 14 patients was pT2a in four, pT2b in six, pT3a in three and pT3b one. Gleason score of the radical prostatectomy specimens in 11 patients was also </= 4. Of the 10 patients diagnosed with cT1c, extraprostatic disease was found in only one radical prostatectomy specimen. All three patients whose cancer was detected from the base of the PZ showed pT3 disease. During the median follow-up period of 47.5 months, all patients were alive with no evidence of disease. CONCLUSION: The prognosis of patients who were diagnosed with one core positive prostate biopsy with a Gleason score </= 4 is generally favorable; however, advanced disease tended to be observed in patients who were diagnosed with cT2a and/or whose cancer was detected from the base of PZ.

Aged↗

PubMed2003

Comparison of quality of life following laparoscopic and open prostatectomy for prostate cancer.

PURPOSE: We compare the quality of life after laparoscopic prostatectomy to that after standard radical prostatectomy. MATERIAL AND METHODS: The quality of life of 52 and 54 patients who underwent laparoscopic and open radical prostatectomy, respectively, was analyzed using the European Organization for the Research and Treatment of Cancer Prostate Cancer quality of life questionnaire for general health related quality of life, International Index of Erectile Function 5 for screening erectile dysfunction and International Continence Society MaleSF questionnaire to evaluate urinary status. These questionnaires were given to patients before and 6 months after surgery. RESULTS: The general health related quality of life survey revealed no significant differences in health before and after laparoscopic and open prostatectomy. However, sexual quality of life was markedly lower after surgery (p <0.01). In addition, the International Index of Erectile Function score was markedly abrogated by surgery (p <0.05) and quality of life due to urinary incontinence was significantly disturbed by surgery (p <0.05). In contrast, quality of life due to voiding dysfunction was impaired before surgery and significantly improved by surgery (p <0.05). Patients were also asked if they would choose the same treatment if suffering from the same disease, with more patients treated laparoscopically choosing the same treatment than those treated with open surgery (p <0.05). CONCLUSIONS: While general health related quality of life was not impaired, sexual quality of life was diminished by surgery. Patients were generally satisfied with postoperative urinary status. Although patients who underwent laparoscopic prostatectomy expressed a more favorable attitude toward surgery, there was no significant difference in quality of life at 6 months after surgery between the 2 groups.

Activities of Daily Living↗

PubMed2003

[Laparoscopic pyeloplasty for a secondary ureteropelvic junction obstruction after renal trauma: a case report].

We report a case of secondary ureteropelvic junction obstruction due to renal trauma treated by laparoscopic pyeloplasty. A 25-year-old man, who had renal trauma due to a traffic accident, complained of left lumbago and was diagnosed with left ureteropelvic junction obstruction. Endoscopic balloon dilation was performed twice, but the hydronephrosis did not change. Subsequently, laparoscopic pyeloplasty was performed with no complications. After operation, lumbago disappeared and hydronephrosis and renal function improved. Secondary ureteropelvic junction obstruction is rare, and this case seems to be the first case managed by laparoscopy in Japan.

Adult↗

PubMed2002

Diverse patterns of acid-base abnormalities associated with a modified sigmoid neobladder.

In this study, we analyzed the pattern of metabolic acidosis in patients following the construction of a sigmoid neobladder and then search for the risk factors which affecting this. In 23 men aged 43-73 years and nine women aged 49-74 years who underwent sigmoid neobladder surgery, we performed physical examinations and blood tests every 3 months for 13-75 months (38.7+/-16.6: mean+/-SD). We monitored acid-base balance, serum electrolytes, creatinine, lipid and liver function in patients for up to 6 years postoperatively. Creatinine clearance over 24 h was determined preoperatively. According to pH and base excess measured during follow-up, patients were classified into three groups (normal, 17 patients; temporary acidosis, eight patients; persistent acidosis, seven patients). Patients with temporary acidosis could compensate spontaneously by 1 year without being given sodium bicarbonate; those with persistent acidosis could not compensate spontaneously and five of them required medication with sodium bicarbonate after 1 year. Serum creatinine in patients with persistent acidosis was consistently higher during follow-up than in the other two groups. Preoperative creatinine clearances in the normal, temporary, and persistent groups were 94.25+/-27.47, 95.19+/-18.63, and 69.18+/-16.18 ml/min/1.73 m(2), respectively, being significantly lower in the persistent group ( P<0.05). In this group, patients with creatinine clearances less than 70 ml/min/1.73 m(2) could not compensate for metabolic acidosis. Normal and temporary groups showed different changes of serum chloride and bicarbonate during follow-up (respectively higher and lower) although the renal functions of the two groups were similar. Chloride and bicarbonate varied reciprocally with pH and base excess. Temporal hyperchloremic metabolic acidosis was observed until a year after surgery. In conclusion, temporary acidosis can be caused in some patients in spite of normal renal function, although it is difficult to predict it. In addition, careful follow-up is required, especially in patients with a creatinine clearance <70 ml/min/1.73 m(2) who can encounter persistent acidosis.

Acid-Base Equilibrium↗