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Biomedical subjects

J Kawamura

Publications and source records attributed to J Kawamura.

At least 37 records · Page 2Linked to original sources
PubMed2000

Aneurysm of the left sinus of Valsalva causing aortic, mitral regurgitation and myocardial ischemia.

An aneurysm of the left sinus of Valsalva producing aortic and mitral regurgitation with myocardial ischemia was treated successfully by reconstructing the left coronary sinus while preserving the aortic cusp combined with coronary artery bypass grafting. Aortic and mitral regurgitation occurred due to distortion of the left aortic cusp by a huge aneurysm that also compressed and obstructed the main trunk of the left coronary artery. The postoperative course was uneventful and follow-up showed aortic and mitral regurgitation to be absent and the coronary graft to be patent. Aortic valve-sparing surgery thus proved to be an appropriate procedure for this case.

Adult↗
PubMed2000

Loss of regulation of circulating 1,25-dihydroxyvitamin D with paradoxically decreased serum phosphate levels in individuals with recurrent kidney stones.

A low serum phosphate concentration is characteristic in individuals in whom kidney stones form, this being related to serum 1,25-dihydroxyvitamin D, parathyroid hormone and urinary phosphate excretion. In order to determine whether these parameters are related to recurrence of stone formation, they were analyzed in single and recurrent stone formers as well as controls. An inverse correlation between serum levels of phosphate and 1,25-dihydroxyvitamin D was observed in control subjects, indicating that a drop in serum phosphate results in upregulated circulating 1,25-dihydroxyvitamin D level in controls. While the circulating low phosphate level upregulated the 1,25-dihydroxyvitamin D level in single stone formers, the elevation was less than expected from the drop in serum phosphate in recurrent stone formers. The results thus suggest that loss of upregulation of 1,25-dihydroxyvitamin D by serum levels of phosphate might be important for stone formation. The possibility of deregulation of 1,25-dihydroxyvitamin D to maintain physiological requirements in stone formers and prevent further nephrolithiasis therefore warrants attention.

Adult↗
PubMed2000

A new staging criterion for bladder carcinoma using gadolinium-enhanced magnetic resonance imaging with an endorectal surface coil: a comparison with ultrasonography.

OBJECTIVE: To evaluate the accuracy of a new staging criterion, submucosal linear enhancement (SLE) on gadolinium-diethylenetriamine-pentaacetic acid-enhanced T1-weighted magnetic resonance imaging (MRI) using an endorectal surface coil (endorectal enhanced MRI), and to compare the accuracy of this method with that of transurethral ultrasonography (TUUS). PATIENTS AND METHODS: The study included 71 patients with bladder tumours (63 men and eight women, mean age 65.5 years, range 31-85). The SLE coincided with abundant submucosal vascular beds, as reported in a previous study. When the SLE beneath the tumour maintained continuity, the tumour was diagnosed as superficial (</= T1), but if the SLE was interrupted by the tumour, the disease was considered invasive (>/= T2a). Superficial muscle invasion (less than half the muscle layer) and deep muscle invasion (more than half the muscle layer) were classified as T2a and T2b, respectively. When the tumour formed an extravesical mass, the tumour was classified as T3b. RESULTS: The staging accuracy for bladder tumours using SLE on endorectal-enhanced MRI or TUUS was 83% and 60%, respectively (P < 0.01). Using the SLE, muscle invasion of bladder tumour was diagnosed with an accuracy of 87%, a sensitivity of 91% and a specificity of 87%; this was significantly better than with TUUS (P < 0.01). CONCLUSION: The criterion of SLE on Gd-DTPA enhanced T1-weighted MRI using an endorectal surface coil is useful for staging bladder tumour, and the staging accuracy is significantly better than with TUUS.

Adult↗
PubMed2000

The usefulness of power Doppler ultrasonography for diagnosing prostate cancer: histological correlation of each biopsy site.

OBJECTIVE: To correlate the findings of power Doppler ultrasonography (PDUS) of the prostate with those of site-specific transrectal ultrasonography (TRUS)-guided biopsy. PATIENTS AND METHODS: The study comprised 28 patients referred to our institution for TRUS-guided prostate biopsy because of an elevated PSA level and/or abnormal digital rectal examination. PDUS findings were graded 0, 1 or 2; grades 0-1 were considered as negative and grade 2 as positive. The blood volume of each biopsy site was also determined using the mean number (MN) value that represents the average vascularity in a 5-mm square sample. PDUS values were correlated with the histological findings of 147 biopsies with 19 focal lesions. RESULTS: Grade 2 was assigned to 19 sites, grade 1 to 52 sites, and grade 0 to 76 sites. Fourteen of the 19 PDUS findings of grade 2 sites revealed carcinoma and five were grade 1. Ten of 35 TRUS-positive sites were carcinomas, three benign prostatic hyperplasia (BPH) and 22 normal. The MN value for prostatic carcinoma was 4.33, for BPH 11.7 and for normal tissue 4.7. The overall sensitivity of PDUS was 74%, the specificity 96% and the positive predictive value 74%. CONCLUSIONS: Because TRUS alone cannot detect all cancers, PDUS should be used routinely in all patients undergoing TRUS-guided biopsy, to improve the diagnostic yield of prostate cancer.

Aged↗
PubMed2000

Prognostic significance of Ki-67 expression in advanced prostate cancers in relation to disease progression after androgen ablation.

OBJECTIVE: This study was performed to examine the expressions of Ki-67 antigen, bcl-2 and p53 oncoprotein and to assess their capacity to predict the short-term response to the initial endocrine treatment and disease progression in prostate cancer. METHODS: Formalin-fixed and paraffin-embedded tumor tissues from a total of 73 patients with untreated prostate cancers were collected by transrectal ultrasound-guided biopsy. All patients with stage C or D prostate cancers had received continuous endocrine treatment. Ki-67 antigen, p53 and bcl-2 oncoprotein were detected by immunohistochemical methods. RESULTS: Short-term response to initial endocrine therapy judged at 3 months showed a significant correlation with Ki-67 labeling index (LI) and bcl-2 expression. Multivariate analysis showed that only a high Ki-67 LI was an independent potential predictor of prostate-specific antigen failure or the appearance of new metastasis. CONCLUSIONS: The findings suggested that the Ki-67 LI was the most useful parameter to predict disease progression after the initial endocrine treatment. Additional studies must be performed to evaluate the prognostic significance of both cell proliferation and apoptosis in detail.

Aged↗
PubMed2000

Effect of increased intrareservoir pressure on upper urinary tract function in continent urinary diversion patients assessed by radioisotope renography.

To assess upper urinary tract function and determine an ideal continent reservoir capacity, we investigated the relationship between intrareservoir pressure and functional parameters using radioisotope renography. Forty-three patients for whom ileal reservoir construction was performed by Kock pouch (n = 33) or Hautmann's ileal neobladder (n = 14) approaches between November 1984 and September 1996 were studied. After the reservoir contents were catheterized, (99m)Tc-MAG 3 renoscintigraphy was carried out and time activity curves in the kidney (renogram) and reservoir (reservoirgram) were recorded, while saline solution was poured into the reservoir for monitoring of intrareservoir pressure. Three basic abnormal curves were noted in the excretory phase on renograms: a normal downward curve followed by an upward curve, a continuous upward curve associated with or without a sharp decline after the catheterization of the reservoir contents, and episodes of spike waves. Based on these curves, renograms were classified into five types: normal, high pressure, retention, obstruction, and reflux. Abnormal types were noted with 51 of 65 renal units (78.5%) in the Kock pouch group and 15 of 25 renal units (60.0%) in the neobladder group. This examination method may be useful for evaluating urodynamics in the upper urinary tract of patients with a continent ileal reservoir and provide data on adequate voiding volumes for the individual patient.

Adult↗
PubMed2000

Distinguishing patients with senile dementia of Alzheimer type and normal elderly subjects utilizing xenon CT-CBF and multivariate analysis.

Local cerebral blood flow (LCBF) was measured in 17 patients with senile dementia of Alzheimer type (SDAT) and 17 normal controls, utilizing stable xenon computed tomography (Xe CT-CBF). In patients with SDAT, LCBF values were decreased in the cerebral cortex and subcortical structures including the thalamus, basal ganglia and white matter of both hemispheres. Linear discriminant function analysis of LCBF values separated patients with SDAT from normal elderly subjects, with an error of 8.8%. Variables helpful in distinguishing SDAT patients from normal subjects were LCBF values for the frontal and temporal cortex. Multiple regression equation for predicting cognitive performance scores from LCBF values showed the best correlations with LCBF values for the frontal and occipital cortex and thalamus. Xe CT-CBF measurements provide useful information concerning diagnosis and brain function in patients with SDAT.

Aged↗
PubMed2000

[Cyclophosphamide-induced renal pelvic tumor--a case report].

We report a case of transitional cell carcinoma in the left renal pelvis, which occurred in a 24-year-old man. He had been treated with cyclophosphamide (CPM) for a period of 27 months for retroperitoneal rhabdomyosarcoma diagnosed at the age of 10. At first 1.2 g CPM had been given twice intravenously for 3 months, followed by oral administration of 41 g CPM for 23 months. Drip infusion pyelography revealed a filling defect in the left renal pelvis. A left renal pelvic tumor was strongly suspected on computerized tomography and magnetic resonance imaging. Left nephroureterectomy was then performed. Histological diagnosis of the left renal pelvic tumor was transitional cell carcinoma, grade 2, pT1N0M0. No recurrence was defected 17 months later. This case seems to be the second case of cyclophosphamide-induced upper urothelial carcinoma reported in Japan.

Adult↗
PubMed2000

[A case of female paraurethral cyst diagnosed as epithelial inclusion cyst].

The patient was a 36-year-old woman with a chief complaint of pain of the urethral meatus. A cyst existed just below the urethral meatus. The paraurethral cyst was removed completely. Histologically, the cyst was lined by stratified squamous epithelium. According to the criteria proposed by Das, paraurethral cysts are classified into 4 groups: epithelial inclusion cysts, Müllarian cysts, Gärtner duct cysts, Skene duct cysts. In this case, the cyst seemed to be an epithelial inclusion cyst. In the Japanese literature, paraurethral cysts have been incompletely classified from an etiological perspective. Differential diagnoses based on the histological findings of the cysts may be important to determine the etiology.

Adult↗
PubMed2000

[Successful TS-1 therapy in a patient with non-resectable gastric cancer and renal dysfunction].

A 73-year-old woman presented to our hospital with epigastric pain and swelling of the left upper limb. Enlarged lymph nodes with adhesion were palpable in the left cervical region and supraclavicular fossa. Tests were performed with the thought that the left upper limb swelling was secondary to venous compression by the enlarged lymph nodes. Gastroscopy detected a torose lesion on the anterior wall at the gastric angle and biopsy revealed that it was moderately differentiated adenocarcinoma. MRI showed metastasis to the sixth cervical vertebra and the first thoracic vertebra. Based on these findings, she was diagnosed as having progressive gastric cancer with metastasis to Virchow's lymph node and the cervical and thoracic vertebrae. Because it was considered impossible to perform radical gastrectomy, chemotherapy was given. Since renal dysfunction was suggested by a serum Cr of 1.5 mg/ml and a Ccr of 26.2 ml/min, TS-1 was administered at a lower dose (50 mg/day for 4 weeks) than usual, followed by 2 weeks off therapy to complete 1 course. During TS-1 therapy, the plasma 5-FU concentration at 4 h was 129.5 ng/ml, indicating that an effective plasma level of the drug was achieved. TS-1 therapy was considered effective because it reduced the diameter of the primary tumor and the lymph node metastasis, with only mild adverse reactions including myelosuppression.

Adenocarcinoma↗
PubMed2000

Analysis of hypophosphatemia in calcium nephrolithiasis.

PURPOSE AND METHODS: To analyze the pathophysiology of hypophosphatemia in calcium nephrolithiasis, we investigated the relation between serum phosphorus, 1,25-dihydroxyvitamin D, and parathyroid hormone (PTH) levels in 63 consecutive patients with calcium nephrolithiasis, comparing them with 26 age-matched control subjects. RESULTS: Serum phosphorus concentrations in normocalciuric and absorptive hypercalciuric stone formers were significantly decreased compared with control subjects (P<0.001 and P<0.01, respectively). The fractional excretion (TRP) and renal threshold (TmP/GFR) of phosphorus were significantly decreased in the subjects with nephrolithiasis (P<0.01 and P<0.001, respectively). Serum phosphorus concentrations were inversely correlated with serum 1, 25-dihydroxyvitamin D in control subjects and in absorptive hypercalciuric stone formers (P<0.01 and P <0.05, respectively), suggesting that the physiologic relation between phosphorus and 1, 25-dihydroxyvitamin D is maintained in these patients. Serum phosphorus concentrations in absorptive hypercalciuric patients, although related to 1,25-dihydroxyvitamin D, were not related to PTH even though PTH and 1,25-dihydroxyvitamin D concentrations were directly related (P<0.05). The lack of a relation between PTH and serum phosphorus concentrations in absorptive hypercalciuric stone formers was similar to that in controls. In normocalciuric stone formers, there was no relation between serum 1,25-dihydroxyvitamin D and serum phosphorus, but PTH and 1,25-dihydroxyvitamin D were inversely correlated (P<0.05). CONCLUSIONS: Abnormal renal tubular function with a depressed rate of renal phosphorus transport and an abnormal 1,25-dihydroxyvitamin D concentration is common in nephrolithiasis. Differences in the relations between phosphorus and 1,25-dihydroxyvitamin D observed in hypercalciuric v normocalciuric subjects suggest that the pathogenesis of proximal tubulopathy differs among patients with nephrolithiasis.

Adult↗
PubMed2000

[Clinical study of prostate cancer: statistical analysis of 107 cases in the past 12 years].

One hundred and seven patients with prostate cancer were treated at Mie University Hospital during the past 12 years between 1988 and 1999. They were between 53 and 83 years old, with an average age of 70.8 years old. The clinical stage was defined as A, B, C and D in 3 (2.8%), 19 (17.8%), 50 (46.7%) and 35 (32.7%) patients, respectively. At initial diagnosis, the tumor was well, moderately and poorly differentiated adenocarcinoma in 26 (24.3%), 47 (43.9%) and 34 (31.8%) patients, respectively. The median follow-up period was 52.3 months. The overall 1, 3 and 5-year survival rates were 98.0%, 86.8% and 75.2%, respectively. The 5-year survival rates for stage A, B, C and D were 100%, 93.8%, 82.1% and 56.9%, respectively. A significant difference (p = 0.017) in 5-year survival rate was noted between stage C and D. The 5-year survival rate was 100% for well differentiated, 78.0% for moderately differentiated, and 53.2% for poorly differentiated adenocarcinoma. A significant difference (p = 0.0016) in the 5-year survival rate was noted between well differentiated and poorly differentiated adenocarcinoma. According to the therapy, the 5-year survival rate in stage C was 86.2% for the radical prostatectomy group and 84.0% for the endocrine therapy group. There was no significant difference between these 2 treatment groups. Endocrine therapies, classified into maximum androgen blockade (MAB) and endocrine therapy other than MAB were performed for stage D as an initial therapy. Although the prognosis in the patients treated with MAB was better than that with other endocrine therapies, there was no significant difference between these 2 endocrine treatment groups.

Adenocarcinoma↗
PubMed1999

Progression-linked overexpression of c-Met in prostatic intraepithelial neoplasia and latent as well as clinical prostate cancers.

The c-met proto-oncogene encoding the receptor for the hepatocyte growth factor is expressed in several cancers. In the present study, c-met protein (c-Met) was detected in eight of 22 (36%) cases of prostatic intraepithelial neoplasia (PIN), five of 15 (33%) latent and 17 of 21 (81%) clinical prostate cancers, including seven metastatic lesions, using an immunohistochemical method. All seven (100%) metastatic lesions investigated demonstrated strong staining, and a correlation between c-Met expression and histology was observed. These results suggest a significant relationship between c-Met expression and progression of prostate neoplasms, including latent cancers.

Adenocarcinoma↗
PubMed1999

N-acetyltransferase 1 genetic polymorphism influences the risk of prostate cancer development.

The potential involvement of N-acetyltransferase 1 (NAT1) genetic polymorphisms in prostate cancer (PCa) patients was analyzed in 101 patients with PCa and 97 controls with no incidental malignancy. Identification of NAT1*10, the variant allele associated with the rapid acetylator phenotype was by allele-specific polymerase chain reaction (PCR). When the NAT1*10 heterozygote and other genotypes without NAT1*10 allele were considered as low risk genotypes, NAT1*10/NAT1*10 had a significantly higher risk of PCa (OR = 2.4, 95% CI; 1.0-5.6). If our preliminary results can be confirmed in a larger population, it may be a useful marker for PCa risk.

Alleles↗
PubMed1999

Interferon-alpha and 5-fluorouracil therapy in patients with metastatic renal cell cancer: an open multicenter trial. The Japanese Study Group Against Renal Cancer.

OBJECTIVES: Recent clinical trials have implied the cytotoxic and antiproliferative effects of combining 5-fluorouracil and interferon-alpha in the treatment of metastatic renal cell cancer. We therefore conducted an open multicenter trial to test the efficacy of such a combination on this cancer. METHODS: Human lymphoblastoid interferon (3 MIU per patient) was administered subcutaneously three times weekly for 12 weeks, while 5-fluorouracil was administered (600 mg/m2/day) as a continuous infusion for the first 5 days, followed by an intravenous bolus infusion of 600 mg/m2 once a week from the 3rd week until the 12th week. RESULTS: Of the 63 patients entered into the trial, 55 were eligible and evaluable for systemic toxicities, and 53 were evaluable for their response. All patients had undergone a prior nephrectomy, and their European Cooperative Oncology Group (ECOG) performance status ranged from 0 to 3 (median 0). Three complete and eight partial responses were induced, with an overall response rate of 20.0%. The median time to progression and the median survival time were 11 and 33 months, respectively. World Health Organization grade 3 toxicities were observed in 8 patients; however, no grade 4 toxicities or toxicity-related deaths were noted. CONCLUSIONS: Combination therapy of interferon-alpha plus 5-fluorouracil at the above-described dosage and schedule produced no better responses than interferon monotherapies. Prolongation of survival could be attributable to the fair performance status of the patients. This regimen has limited value for the treatment of patients with advanced renal cell cancer.

Adult↗
PubMed1999

Paravesical granuloma after inguinal herniorrhaphy. Case report and review of the literature.

Paravesical granuloma after herniorrhaphy is an unusual complication due to infected suture material and often mimics bladder or urachal malignancy. We present 3 cases of this disease and reviewed 21 previously reported cases. Our patients underwent hernial repair 2-7 years before examination and presented urinary symptoms. They were treated with antibiotics and underwent exploration of the inguinal wound infection but the symptoms did not resolve. En bloc excision and partial cystectomy were performed and resulted in complete resolution of the symptoms. It is important to consider paravesical granuloma in patients who had undergone herniorrhaphy in the differential diagnosis of bladder or urachal tumors.

Aged↗