Objective response criteria in prostate cancer.
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Clinical Trials as Topic↗
Biomedical subjects
J Shimazaki
Publications and source records attributed to J Shimazaki.
[Prognosis of the patients with prostate cancer clinically confined within the pelvis].
Between 1975 and 1989, 90 patients with prostate cancer in clinical stage A2 to C underwent pelvic lymphadenectomy. Median follow-up period was 38 months. Almost all of the patients with pN0-1 (49) and 4 of pN2 were treated by curative treatment, such as radical prostatectomy (7) or radiation therapy (45). The remaining pN2 (26), pN3 (4) and pM1 LYM (6) received endocrine therapy. Pelvic lymph node metastasis were noticed in 50 cases (56%). Rates of positive node and degree of nodal extension were related to clinical stage and histological grade. Disease-free survival of the patients with pN0-1 was better than that of the patients with more than pN2. There was no difference in disease-free survival between the patients with pN0 and pN1. We concluded that the patients with pN0 and pN1 were the candidates for curative therapy and recommend that the patients with more than pN2 be treated with endocrine therapy.
Adenocarcinoma↗
[Clinical effects of clenbuterol-HCL in urge incontinence and stress incontinence].
A total of 49 patients complaining of pollakisuria and incontinence; 20 patients with overactive neurogenic bladder and 29 patients with stress incontinence, were treated with clenbuterol, and the effects of the drug were studied. Subjective symptoms were improved markedly in 8 patients (17%), moderately in 14 patients (29%), and slightly in 10 patients (21%). The symptoms were unchanged in 15 patients (31%) and aggravated in 1 patient (2%). In objective observation, the volume at first desire to void (P less than 0.01) and the maximum urethral closure pressure (P less than 0.05) significantly increased. The objective symptoms were improved markedly in 2 patients (5%), moderately in 12 patients (27%), and slightly in 11 patients (25%). The symptoms were unchanged in 15 patients (34%) and aggravated in 4 patients (9%). Overall improvement was graded as marked in 7 patients (15%), moderate in 17 patients (35%), slight in 11 patients (23%), unchanged in 13 patients (27%) and aggravated in none. In neurogenic bladder, the overall improvement was graded as marked in 2 patients (11%), moderate in 4 patients (21%), slight in 4 patients (21%), unchanged in 9 patients (47%) and aggravated in none. In stress incontinence, the overall improvement was graded as marked in 5 patients (17%), moderate in 13 patients (45%), slight in 7 patients (24%), unchanged in 4 patients (14%) and aggravated in none. Side effects were noted in 12 patients (25%) and they were all not serious. Finger tremor was the most common side effect (5 patients).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Progression and selection in heterogeneous tumor composed of androgen-responsive Shionogi carcinoma 115 and its autonomous subline (Chiba subline 2).
Shionogi Carcinoma 115 (SC 115) is an androgen-dependent mouse tumor, and Chiba subline 2 (CS 2) is its androgen-independent subline which differs from SC 115 in cell size, amount of androgen receptors, and karyotype. To shed light on the mechanism of clonal selection of androgen-independent tumors, mixed tumors with SC 115 and CS 2 were prepared, and growth of these tumors was examined in vivo and in vitro. When the mixed tumor was transplanted in mice, CS 2 showed a predominant growth over SC 115. In a culture of mixed tumor cells, however, CS 2 showed no selective growth advantage. The suppressive interaction which occurred in vivo was due neither to transferable substances, nor to some immunological factor(s). It may be, at least partially, attributable to necrosis formation in SC 115, which developed with an increase in the size of the tumor.
Androgens↗
Surgical experience in two-stage hypospadias repair.
Hypospadias can be categorized as glandular, penile, scrotal or perineal hypospadias. Diversified surgical procedures have been devised for the reparation of this congenital anomaly. The surgical method consists of 3 chief parts: avoidance of fistula formation, resection of the chordee and construction of the distal urethra. Infrequently a fistula following operation in this disease can be cured by urethral drainage, but in the majority of cases surgical repair is indispensable. Subsequently operative or postoperative complications must be decreased. The technical performance and accompanying problems for these points in the management of hypospadias are described.
Humans↗
The effect of adrenal surgery on plasma atrial natriuretic factor and sodium escape phenomenon in patients with primary aldosteronism.
Plasma concentrations of atrial natriuretic factor and some vasoactive substances were determined in 8 patients with aldosterone-producing adenoma, 10 with idiopathic adrenal hyperplasia, 10 normotensive subjects and 12 patients with essential hypertension. Plasma atrial natriuretic factor concentration in patients with aldosterone-producing adenoma was the highest among the examined groups. Adrenal surgery reduced plasma concentrations of atrial natriuretic factor and aldosterone concomitant with the elevation in urinary sodium excretion, plasma renin activity and urinary sodium-to-potassium ratio. Withdrawal of trilostane (3 beta-hydroxysteroid dehydrogenase inhibitor) in patients with idiopathic adrenal hyperplasia increased plasma concentrations of atrial natriuretic factor and aldosterone, and decreased the urinary sodium-to-potassium ratio, plasma renin activity and urinary sodium excretion. However, reduced urinary sodium excretion following trilostane treatment returned to the control level successively despite the high levels of plasma atrial natriuretic factor and aldosterone. Acute infusion of saline remarkably increased plasma atrial natriuretic factor concentration in patients with idiopathic adrenal hyperplasia and aldosterone-producing adenoma. These results suggest that a high level of atrial natriuretic factor is a characteristic feature in patients with aldosterone-producing adenoma caused chiefly by the expansion of extracellular fluid volume, and circulating atrial natriuretic factor may contribute to regulation of the sodium escape phenomenon in patients with aldosterone-producing adenoma or idiopathic adrenal hyperplasia.
Adenoma↗
Age-related differences in norepinephrine and non-collagenous protein in human vas deferens.
The existence of norepinephrine or non-collagenous protein in some tissues is believed to reflect the sympathetic discharge of the structures and plays an important role in contractile ability. Specimens of vas deferens were obtained from 44 subjects in various decades of life from age 20 to 84, and levels of norepinephrine, non-collagenous protein, collagen and elastin were determined. The level of norepinephrine and non-collagenous protein declined with increasing age. Both parameters inversely correlated with age. Collagen and elastin increased with advancing age. The regression line and coefficient of correlation between both variables showed significantly positive correlations. It is suggested that the contractile ability of human vas deferens, as defined by norepinephrine and non-collagenous protein contents, decreases with age, and the age-related increase in collagen and elastin may be of importance in reducing the contractile capability of this structure.
Adult↗
Disturbances of micturition in patients with a spinal arteriovenous malformation.
Neuro-urological studies were performed on 9 patients with a spinal arteriovenous malformation (S-AVM). The micturitional history revealed that all 9 patients had voiding symptoms, obstructive in 9 and irritative in 3 patients. All patients still had obstructive symptoms after treatment of S-AVM. Six of the 9 patients had a large volume of residual urine before treatment; 5 showed urinary retention. Four of the 5 patients (80%) for whom urodynamic studies were performed before treatment had micturitional dysfunction; 2 patients had detrusor hyperreflexia, 1 with detrusor external urethral sphincter dyssynergia (DSD) and 1 with a normal sphincter, 1 patient had an autonomous bladder with DSD and 1 patient had an atonic bladder with DSD. Only 1 patient had a normal bladder and sphincter. Findings of the urodynamic studies after treatment in 9 patients showed detrusor hyperreflexia in 3 patients (2 with DSD and 1 with normal sphincter), autonomous bladder in 1 patient with DSD, atonic bladder in 4 patients (2 with DSD, 1 with incompetent sphincter and 1 with normal sphincter) and normal bladder with normal sphincter in 1 patient. Lower urinary function after treatment of S-AVM was improved in 2 patients, unchanged in 4 patients and worsened in 3 patients. The above results showed 80% of S-AVM had a severe neuropathic bladder manifested mainly by disturbance of micturition. Treatment of S-AVM does not necessarily improve the lower urinary tract function.
Adult↗
[Recurrence and prognosis of renal pelvic and ureteral carcinoma].
Eighty-three patients with renal pelvic and ureteral carcinoma operated in Chiba University Hospital were followed. Age ranged between 23 and 79 years old (average 61.8 years) with the male-to-female ratio of approximately 2:1. Localization of tumors was in renal pelvis in 41 (49.4%), ureter in 29 (34.9%) and both in 13 (15.7%). Significant correlation in prognosis was obtained with macroscopic hematuria, histological classification, grade, stage and regional lymph node involvement. Recurrence was found on 49 cases (59%), 21 had intra-vesical tumor and 28 showed retroperitoneal recurrence or distant metastasis. In the former the mean tumor free interval was 14.8 months and 5 year survival rate was 62.1%. In the later the mean tumor free interval was 6.5 months and 3 year survival rate was 5%. 8 (38.1%) in 21 cases with low stage papillary transitional cell carcinoma showed recurrence and it was all intra-vesical tumor. 25 (56.8%) in 44 cases with high stage papillary transitional cell carcinoma showed recurrence. Retroperitoneal recurrence or distant metastasis was recognized in 12 cases. On the other hand 14 (87.5%) in 16 cases with non-papillary transitional cell carcinoma showed recurrence, which was all retroperitoneal recurrence or distant metastasis.
Adult↗
[Survivals of incidental renal cell carcinoma].
Between January 1987 and July 1988, 151 cases of renal cell carcinoma were nephrectomized at out institutions. Among them 41 cases (27.2%) were diagnosed incidentally. The ratio of incidental carcinoma has been increasing steadily in the past decade. Thirty-four of these cases (82.9%) were detected by ultrasound, 4 by computerized tomography, and three by excretory urography. Twenty-eight of these cases were found serendipitously during examination for other diseases, while others had no symptoms at all. Only 8 of these cases (19.5%) showed microscopic hematuria. The stage and the grade of these incidental carcinoma were significantly lower than those of symptomatic carcinoma (p less than 0.001). The survival rate of the former was better than that of the latter (p less than 0.01), especially in patients with pT1-2b tumors (p less than 0.05) or with tumors smaller than 10 cm in diameter (p less than 0.05).
Adult↗
[Magnetic resonance imaging in the diagnosis of prostatic carcinoma and benign hyperplasia].
Using a 0.5 tesla superconducting magnetic system, magnetic resonance imaging (MRI) studies were performed in 42 patients (27 prostatic carcinoma and 15 benign prostatic hyperplasia) and 2 healthy volunteers. Spin echo images were produced in the transverse, coronal and sagittal directions. T1 and T2 relaxation times were calculated from these images. The images of 2 normal prostates showed 2 separate zones: an internal zone and an external zone. The images of 8 of the 15 prostates with benign prostatic hyperplasia showed 3 zones: an internal zone, a band of low intensity and an external zone. Most of the cases of prostatic carcinoma showed extracapsular extension, so we could not detect zonal distinction of the images in 25 cases out of the 27 prostates with prostatic carcinoma. Most of the images of prostates with prostatic carcinoma showed irregular and asymmetric shape and inhomogeneous signal intensity. MRI had an accuracy of 85.7% in differentiating prostatic carcinoma from benign prostatic hyperplasia. A good correlation (r = 0.936) was observed between the weight of the whole prostate as predicted by MRI and the actual weight of the adenoma enucleated by retropubic prostatectomy. The change in volume of the prostate after hormone therapy was well evaluated by MRI. We were not able to differentiate prostatic carcinoma from benign prostatic hyperplasia on the basis of the T1 and T2 relaxation times alone. The serial measurements of the T1 and T2 relaxation times might be value in following therapeutic response of prostatic carcinoma.
Adult↗
[Conservative surgery of upper urinary tract urothelial carcinomas].
In the last ten years 19 patients with urothelial cancer of the upper urinary tract underwent excision of the tumor with preservation of the ipsilateral kidney. Renal function was preserved well in all cases in 31 months of the mean follow up term. In the presence of a normal contralateral kidney, local tumor excision was done electively in 12 patients (5 lower portion of ureter, 5 low grade lesions, 2 high age), local recurrence developed 6-63 months after operation in 2 patients, and they underwent nephroureterectomy. 11 cases are alive with no evidence of disease and one is alive with contralateral renal pelvic cancer. Absolute indications for conservative surgery were solitary kidneys/non functioning contralateral kidney in 3 patients and bilateral tumor in 4 patients. Most tumors were high grade or high stage (6: grade 2,4: PT2). No one had local recurrence, but one had a metastasis to a lung, 4 were suffering from bladder cancer post-operatively. Three patients died from cancer 20-30 months after operation. Local excision of urothelial cancer should be considered not only for cases of contralateral damaged kidneys but also for low grade, low stage localized tumors. Precise preoperative evaluation of tumors using a ureteroenoscope should be made for the indication of the renal preservative operation.
Adult↗
[Factors influencing the prognosis of grade 1 renal cell carcinoma].
Between 1960 and 1988, 65 patients with grade 1 renal cell carcinoma were nephrectomized in our institutions. To delineate potentially curable cancer, the host and tumor factors influencing the prognosis were analyzed. Factors that had unfavorable effects were the presence of tumor thrombi in renal veins, fever, and elevation of erythrocyte sedimentation rate (ESR), serum alpha 2-globulin and C-reactive protein (CRP). Patients who were under 39-years-old or with pT1-2a tumor had excellent prognosis. The ratio of tumor thrombi, pT, fever, ESR, serum alpha 2-globulin and CRP levels all increased with age. In conclusion, patients with normal levels of fever, ESR, serum alpha 2-globulin, CRP and no tumor thrombi and/or with pT1-2a tumor were considered to be the potentially curable cancer patients.
Adolescent↗
[Pelvic lymph node dissection for invasive bladder cancer].
From 1979 through 1988, 64 men and 16 women (age range 36-82; mean 63 years) with bladder cancer underwent pelvic lymph node dissection and radical cystectomy with urinary diversion. Bilateral common iliac, external iliac, internal iliac, obturator and presacral nodes were removed and examined. The frequency of involvement of each nodal group was the highest at the common iliac and the external iliac nodes followed by the obturator, presacral and internal iliac nodes. The incidence of lymph node metastasis increased with the tumor grade and pathological stage. The incidence of positive nodes is 3.7% in patients with P1 tumors, 10% in P2, and 17% in P3 tumors. Of these patients, 9 were with nodal metastasis; seven died of metastatic cancer 3 to 37 months post-operatively, two were alive for 4 to 41 months without evidence of recurrence. The mean survival time was significantly longer than that of the historical control group (1975-1978 total cystectomy without node dissection).
Adult↗
[Histological effect of preoperative irradiation in bladder cancer].
Forty-seven patients with high grade invasive bladder cancer were treated with preoperative radiation therapy (910 rad by fast neutron or 3000 rad by X-ray for two weeks) followed by radical cystectomy and urinary diversion. Stage down effect was observed in 32% of patients when comparison was made between the clinical and pathological stages. Those who showed stage down effect had better prognosis when compared those without it. Histopathological effect of Grade 2B or Grade 3, according to the criteria described by Ohboshi and Shimosato, was noticed in 49% of the patients. Five year survival was as follows: 100% (PT0, PTis), 75% (PT1), 100% (PT2), 47% (PT3), 0% (PT4). These results clearly showed the improvement of prognosis compared to the historical control.
Adult↗
[A case of refractory testicular cancer showing complete response to high-dose chemotherapy with autologous bone marrow transplantation].
A patient with stage III testicular cancer was treated by 3 courses of BEP therapy and a partial response was obtained. Afterwards he underwent resection of pulmonary residual tumors and was treated by 2 courses of PE therapy immediately after operation. However, a new pulmonary tumor appeared after the first course of PE therapy was completed. He was treated by high-dose chemotherapy (etoposide 1200 mg/m2, cyclophosphamide 120 mg/kg, CDDP 60 mg/m2) with autologous bone marrow transplantation. Three weeks after high-dose chemotherapy his metastatic pulmonary tumor showed cavity formation which disappeared after 3 months. Fifteen months after the high-dose chemotherapy, no evidence of disease has been seen even without maintenance therapy.
Adult↗
[Prostatic cancer and its androgen-dependency].
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Androgen Antagonists↗