Rationale for the use of alpha-blockers in the treatment of benign prostatic hyperplasia (BPH).
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Adrenergic alpha-Antagonists↗
Biomedical subjects
K Kawabe
Publications and source records attributed to K Kawabe.
Decreased cyclosporin A absorption after treatment with GoLytely lavage solution in rats.
Recently we observed a case in which the cyclosporin A absorption decreased after treatment with GoLytely lavage solution in a kidney transplant patient. In this study, we confirmed the decrease of the blood concentration of cyclosporin A after oral administration by GoLytely (Macrogol 3350) based on experiments with rats. The peak blood cyclosporin A concentration, and the area under the blood drug concentration-time curve from 0 to 24 h in the GoLytely-administered group were significantly lower than the control group. In the case of gastrointestinal dysfunction such as diarrhoea, or in treatment with laxatives such as GoLytely lavage solution, whole blood cyclosporin levels must be carefully monitored, and intravenous cyclosporin A may be more suitable for providing adequate immunosuppression.
Analysis of Variance↗
Transmission of the human polyomavirus JC virus occurs both within the family and outside the family.
JC polyomavirus (JCV) is a ubiquitous symbiote in the human population, infecting children asymptomatically and then persisting in renal tissue. We reevaluated the urinary excretion of JCV in subjects in various age groups using PCR. The detection rate for urinary JCV DNA was 9 to 17% until the age of 20 years; this rate increased dramatically to about 46% at the ages of 20 to 29 years and then increased gradually with age. Therefore, it appears that in most people excretion of JCV begins at the age of 20 to 29 years, which is earlier than suggested previously. Next, we studied the way in which JCV is spread in the human population. We selected eight Japanese families in which both parents and children excreted JCV in their urine. Their JCV subtypes were determined by PCR amplification of a JCV DNA fragment; this was followed by restriction enzyme analysis. JCV species in all JCV-positive family members were classified into either of the two subtypes, subtypes CY and MY, which are prevalent in the Japanese population. The following features of JCV subtype distribution were seen in the families: (i) both subtypes were detected in children of five of the eight families, and (ii) of 21 children who excreted JCV, 14 children excreted the same subtypes excreted by their mothers or fathers, while the remainder (7 children) excreted subtypes different from those excreted by their parents. These features suggest that JCV is transmitted both within the family and outside the family. The data also indicate that vertical transmission is not common in the spread of JCV.
Adolescent↗
Plasminogen activators and plasminogen activator inhibitor 1 in urinary tract cancer.
The plasminogen activation system is considered to play an important role in cancer growth and metastasis. Both plasminogen activators (PAs) and their fast-acting inhibitors are produced in tumor cells and their surrounding tissues. In order to clarify the influence of the existence of malignant tumor in urinary tract on the systemic fibrinolytic activity, we designed a study in which we compared the plasma levels of PAs and their inhibitors between before and after radical resection of tumors. Fourteen patients with renal cell carcinoma and 14 patients with transitional cell carcinoma participated in the study. In both groups, plasma levels of tissue-type plasminogen activator and urokinase-type plasminogen activator before the operation were higher than those 15 days after operation. The plasma level of plasminogen activator inhibitor 1 (PAI-1), however, did not change after the operation in the renal cell carcinoma group, and it decreased slightly in the transitional cell carcinoma group although it was not significant. When these values of the groups with or without metastasis were compared to other organs or lymph nodes, the PAI-1 level before operation was significantly higher in the group with metastasis than that without metastasis. In the three groups divided by the degree of atypia, PAI-1 level in the most atypical group was the highest. These results suggest that the fibrinolytic system in the plasma of cancer patients may play an important role in tumor growth and metastasis.
Carcinoma, Renal Cell↗
Laparoscopy-assisted radical nephrectomy without pneumoperitoneum.
A small renal cell carcinoma of the right kidney was completely removed from a 59-year-old women by laparoscopic radical nephrectomy without requiring a pneumoperitoneum. A 5-cm midline laparotomy incision was made and 3 small retractors were used for suspending the abdominal wall. Under laparoscopic observation, we safely positioned three trocars. The kidney was then removed en bloc together with the adrenal gland, perinephric fat and Gerota's fascia. The resected mass was enclosed in an entrapment sac and removed via the 5-cm abdominal incision without morcellation of the tissues. Three trocars could be positioned safely under direct observation and there were no adverse hemodynamic or ventilatory effects because the operation was performed without intraperitoneal carbon dioxide insufflation. There were no significant operative or postoperative complications. This procedure appears to be advantageous for the treatment of small renal cell carcinomas.
Carcinoma, Renal Cell↗
Re-examination of arousing and de-arousing effects of cigarette smoking.
An attempt was made to replicate arousing and de-arousing effects of cigarette smoking originally reported by Golding and Mangan. Changes in electrodermal activity, heart rate, and magnitude in the EEG alpha (7.5-11.5 Hz) and beta (13.5-20 Hz) bands were measured under conditions of both mild sensory isolation as well as stress induced by loud white-noise. Under both conditions, real smoking as well as sham smoking an unlit cigarette increased beta activity and the skin potential response. In contrast, only real smoking produced a significant increase in heart rate, decrease in alpha activity, and increase in skin potential. De-arousing effects reported by Golding and Mangan for white-noise stress were not replicated.
Adult↗
Primary culture of smooth muscle cells from benign prostatic hyperplasia.
Primary cultures of smooth muscle cells (SMCs) were derived from the human prostate obtained from four patients with symptomatic benign prostatic hyperplasia (BPH) undergoing open prostatectomy, using collagenase digestion and preferential adhesion techniques. SMCs attached to the plastic substrate by 6 to 10 h, proliferated by 2 to 3 days, and reached confluency by 10 to 14 days with a "hill-and-vallery" pattern. Immunocytochemical staining of cultured SMCs using anti human muscle-specific actin monoclonal antibody (HHF35), confirmed that more than 90% primary cultured cells were positive for HHF-35. Transmission electron microscopy of SMCs revealed dense myofibrils (6-8 nm width) showing focal density, and was compatible to smooth muscle cells. This primary culture will be utilized to provide a useful model to investigate the character of smooth muscle cells and their role in the development of BPH.
Cell Division↗
[Treatment of advanced prostatic cancer--chronological change between 1975 and 1991].
A chronological analysis of the clinical features and treatments of advanced prostatic cancer, stages C and D, was performed in 154 cases treated from 1976 through 1991. These cases were divided into two chronological groups: 61 cases treated between 1976 and 1983, and 93 cases between 1984 and 1991. Concerning demographic features and diagnosis, the number of patients with lymph node metastasis was higher in the latter group. There was also increase in cases who were urologically asymptomatic and detected by checkup digital rectal examination or by the elevation of serum prostatic tumor markers. Histopathological differentiation was consistent between the two groups; more than 70% of cancers were moderately and poorly differentiated adenocarcinoma. As for the treatment, total prostatectomy was performed in eight cases in the latter against none in the earlier, but hormonal therapy remained the main treatment throughout the periods: 74.2% in the earlier and 70.7% in the latter. However the methods of the therapy have clearly changed; estrogens and castration were used less often in the latter period, while LH-RH analogues and antiandrogens replaced them although the therapy was equally effective in 82.3% of the cases in the earlier and in 90.4% in the later period and five-year survival rate and the progression-free survival rate at three years showed no significant difference between the two periods. These results showed 1) refined quality of diagnosis 2) a change in mode of hormonal therapy and 3) no detectable improvement of survival in these 16 years. Development of more effective therapies would be warranted for a better survival.
Aged↗
[Transurethral microwave thermotherapy for benign prostatic hyperplasia: a 1-year follow-up study].
The authors studied a 1-year effect of transurethral microwave thermotherapy (TUMT) using the PROSTCARE apparatus (Bruker Spectrospin Wissembourg, Frace) on 35 patients with symptomatic benign prostatic hyperplasia (BPH). The device is equipped with a unique non-invasive system "radiometry" for the measurement of the intraprostatic temperature to regulate the microwave emission power and to eliminate classic surface controls. All of the 35 patients received a single thermotherapy session (60 minutes), the average intraprostatic temperature was 43.6 +/- 1.2 degrees C (mean +/- SD) and the average power output was 43.9 +/- 4.1 Watt. The clinical effects were evaluated at 2 months, 6 months and 1 year after TUMT by a specially designed score scale for subjective symptoms and objective findings as compared with the pretreatment score. Assuming that more than a 25% reduction of the total score indicates "effective", 71.4%, 71.4, and 48.6% of the treatments remained effective at 2 months, 6 months, and 1 year after TUMT, respectively. The maximum prostatic urethral pressure profile decreased from 64.1 +/- 17.1 to 51.7 +/- 15.6 cmH2O (p < 0.05) at 2 months after TUMT. The thermotherapy by PROSTCARE is effective in approximately 50% of patients at least 1 year and there were no major complications associated with TUMT during the follow up period.
Aged↗
[Objective and subjective response in stage D2 prostate cancer patients with cancer pain].
Fourty-eight patients with stage D2 prostate cancer, initially treated with endocrine therapy at the University of Tokyo between 1981 and 1990, were followed up and analysed. For the assessment of a subjective response, pain score, narcotic score, and performance stages (PS) were used. Of the fourty-eight patients, twenty-one suffered from cancer pain due to bone metastases. These patients showed significantly (p < 0.01) more lesions of bone metastases and higher PS, compared with patients without cancer pain. The progression free survival of these patients was significantly (p < 0.01) lower than that of patients without cancer pain, although the actuarial survival was not significant. In twenty-one patients with cancer pain, the objective and subjective response rates to endocrine therapy were 75% and 86%, respectively. The duration of pain relief was 1.25-54 (median 19) months. Those rates to anti-cancer chemotherapy in refractory patients (8 patients) previously treated with endocrine therapy were both 25% and those to additional administration of flutamide (FUL) or diethylstilbestrol (DES) in refractory patients (6 patients) were 33% and 100%, respectively. Although the duration of pain relief was 0.78-8 (median 2) months, the additional administration of DES or FLU led to pain relief and improved quality of life (QOL) in all 6 patients. Endocrine therapy such as LH-RH agonist and non-steroidal pure anti-androgen, which has no severe side effects, would be of great usefulness in stage D2 prostatic cancer patients with pain on the basis of efficacy and safety.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Two siblings with 2,8-dihydroxyadenine urolithiasis].
We treated two children with 2,8-dihydroxyadenine urolithiasis for over 7 years. The male prepositus was admitted to the hospital because of anuria when he was 10 months old. Bilateral urinary stones had caused the anuria. The stones were 2,8-dihydroxyadenine and his APRT activity was low. He has been treated with about 5.0 mg/kg/day of allopurinol without purine diet restriction. His sister, 3 years old at that time, also was found to have a renal stone. She has been treated with about 3.3 mg/kg/day of allopurinol without restricting purine. The allopurinol therapy without purine-restriction resulted in normal growth of both children with neither the recurrence of stone nor renal impairment.
Adenine↗
Urinary symptoms and urodynamics in a normal elderly population.
Age-related changes in the lower urinary tract function were investigated by means of symptomatology and urodynamics. In the symptom study subjectively normal 168 males and 101 females aged over 30 were administered a questionnaire regarding urinary symptoms. The prevalence of symptoms gradually advanced with age and nocturia more than 2 times was dramatically increased up to a half in those aged over 70. In the urodynamic study involving 65 males and 51 females with low symptom scores, significant reduction with advancing age was noted for maximum flow rate in both sexes (males: r = -0.295, p < 0.05, females: r = -0.591, p < 0.01) and maximum detrusor pressure in females (r = -0.513, p < 0.01). There was a significant increase in residual urine in males (r = 0.473, p < 0.05); otherwise no consistent changes in cystometry and urethral pressure profile related to aging were detected. These results indicate that urinary symptoms and urodynamic variables may change with age even in "normal" subjects, and warrant a careful interpretation of them in the elderly subjects.
Age Factors↗
Induction of an immunosuppressive state by lymphocytopheresis in kidney allograft recipients.
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Atrophy↗
[Thiazide treatment for calcium urolithiasis in patients with idiopathic hypercalciuria].
The prophylactic effect of hydrochlorothiazide on stone formation was studied in 66 patients with calcium urolithiasis, (49 men and 17 women between 25 and 76 years old, mean 52.2 +/- 11.7 years) due to idiopathic hypercalciuria. Urinary calcium excretion was significantly decreased during treatment when compared to the baseline value. The stone formation rate was also significantly reduced when compared with that before treatment. With regard to side effects, hyperuricemia was observed in 21 patients, hypokalemia in 9 patients, hypotension in 3 patients, and glycosuria in 4 patients. Thiazide treatment was concluded to be effective for preventing the recurrence of calcium stones in patients with idiopathic hypercalciuria. However, this therapy should be used only in conjunction with the careful monitoring of possible adverse reactions.
Adult↗
[Living related kidney transplantation after removing the aneurysm of graft: a case report].
A case of living related renal transplantation using a kidney with renal arterial aneurysm is reported. The size of the renal arterial aneurysm was 15 mm in diameter. After ex vivo aneurysm removal, the graft was transplanted to the right iliac fossa. The total ischemic time was 79 minutes, and the urine flow started 5 minutes after declamping. In Japan, eight patients are reported to have successfully received a renal graft after removing its aneurysm extracorporeally. Renal transplantation is possible even when the donor kidney has a renal arterial aneurysm.
Adult↗
[An incidentally found asymptomatic pheochromocytoma: a case report--successful removal laparoscopic adrenalectomy].
A 31-year-old male was admitted to our hospital for further examination of a right adrenal mass, which was incidentally discovered by abdominal ultra-sonography in another hospital. The adrenaline and noradrenaline in the plasma and the adrenaline and VMA in the urine were slightly elevated, and catecholamines in the blood from the right adrenal vein were markedly increased. Glucose tolerance test showed a borderline case. Otherwise, there was no clinical sign. Asymptomatic pheochromocytoma originating from the right adrenal gland was suspected in the preoperative diagnosis. Laparoscopic right adrenalectomy was performed. Although the blood pressure was stable preoperatively, paroxysmal hypertension was observed during the tumor manipulation. Blood pressure was well controlled during the operation with ATP, nitroglycerin and phentolamine. Blood loss was less than 150ml, and there was no surgical complication. The resected tumor specimen was 32[28[33mm in size, weighed 14g, and histological examination showed typical pheochromocytoma. The post-operative course was unremarkable and glucose tolerance test was normalized after the operation. This is the first case of the successful removal of pheochromocytoma using the laparoscopic procedure.
Adrenal Gland Neoplasms↗
Different expression of calpain in skeletal muscle of Japanese quail (Coturnix coturnix japonica) lines selected for body weight.
Calpain activity was determined by western blot analysis of steady-state concentrations of m-calpain (calpain requiring millimolar Ca2+ for activation) and also by northern blot analysis of steady-state concentrations of mRNA encoding m-calpain in three lines of quail: a random-bred control line (RR) and two lines selected for body weight, one for increased body weight (LL) and another for decreased body weight (SS). The m-calpain activities in skeletal muscle were higher in the SS line and lower in the LL line. From western blot analysis, enzyme levels of calpain were almost the same for all three lines. At the level of gene expression, the mRNA concentration encoding m-calpain was higher in the LL and lower in the SS line. These results suggest that the regulation of calpain activity in skeletal muscle is a three-step process, regulation at the transcription level, regulation at the enzyme level, and regulation of the activation of calpain.
Animals↗
Laparoscopic adrenalectomy: clinical experience with 12 cases.
Laparoscopic adrenalectomy is a new procedure for the treatment of adrenal tumors. The clinical experience with this operation in 12 patients is reported. While adrenal tumors are relatively small and seem to be good candidates for laparoscopic surgery, this procedure is difficult because of the anatomical location. In our study laparoscopic adrenalectomy appeared to be successful, although massive bleeding occurred in 3 patients. These problems should be overcome as the technique is improved and new laparoscopic instruments are introduced.
Adrenal Gland Neoplasms↗