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Biomedical subjects

K Nutahara

Publications and source records attributed to K Nutahara.

At least 37 records · Page 2Linked to original sources
PubMed1996

Significance of serum free prostate specific antigen in the screening of prostate cancer.

PURPOSE: The significance of serum free prostate specific antigen (PSA) in the screening of prostate cancer was examined. MATERIALS AND METHODS: A prospective clinical trial was conducted on 701 male volunteers 50 years old or older. Serum free PSA was determined and biopsies were performed if PSA was greater than 4 ng./ml. or if digital rectal examination was suspicious for cancer. RESULTS: Of the men 187 (27%) had a PSA of greater than 4 ng./ml. (11%) and/or a suspicious digital rectal examination (19%). Of 116 biopsies performed in the 701 men cancer was detected in 13 (1.9%). PSA detected more tumors (12 of 13, 92%) than digital rectal examination (9, 69%). Receiver operating characteristic analysis showed that the optimal free PSA-to-PSA ratio (free PSA ratio) was 12%. The positive predictive value for cancer according to PSA with free PSA ratio (50%, 10 cancers in 20 biopsies) was significantly greater (p = 0.0473) than that according to PSA alone (24%, 12 cancers in 50 biopsies), which indicated that 30 of 50 biopsies were avoided with only 2 cancers missed when PSA and free PSA were used for biopsy indication. CONCLUSIONS: Free PSA determination might eliminate unnecessary biopsies in men with a PSA of more than 4 ng./ml. with minimal missed cancers.

Aged↗
PubMed1995

[Association of malignant neoplasms of other organs in patients with primary hyperparathyroidism].

There are several reports of an increased occurrence of nonparathyroid cancer in patients with primary hyperparathyroidism. Whether there is a cause and effect relationship has not been established. Especially, the coexistence of the parathyroid and thyroid tumors appears significantly high. Recently PRAD 1 was determined the one of the oncogenes of parathyroid adenoma. Interest in PRAD 1's role with respect to oncogenesis has been intensified by its incrimination in other, nonparathyroid, human tumors. If properly conducted surveillance programs do indicate a higher likelihood of cancer in patients with primary hyperparathyroidism, the current philosophy that the patient with mild and asymptomatic hyperparathyroidism does not need the surgery must be reevaluated.

Adenoma↗
PubMed1994

Mediation of renal cyst formation by hepatocyte growth factor.

Hepatocyte growth factor (HGF) is a potent mitogen for renal tubular cells, and HGF and its receptor (c-met proto-oncogene product, Met) can induce lumen formation in epithelial cells. We measured the concentration of HGF in cyst fluids from patients with renal cystic diseases. The concentration of HGF was high in proximal cyst fluid (mean 2.45 vs 0.42 ng/mL in distal cysts). Cyclic AMP concentration was higher in distal than in proximal cysts (663 vs 6.0 pmol/L). mRNA of HGF and Met were co-expressed in cyst walls from cases with polycystic kidney disease. These findings suggest that HGF is a growth factor that may mediate human renal cyst genesis.

Base Sequence↗
PubMed1993

Laparoscopic adrenalectomy: the initial 3 cases.

Laparoscopic adrenalectomy was performed on 3 patients with primary aldosteronism. Traction with 2 steel skewers placed subcutaneously over the costal arch was combined with conventional intraperitoneal carbon dioxide gas insufflation. This combination provided a good operative field at 8 mm. Hg insufflation pressure. The laparoscopic approach to the adrenal gland requires neither a large skin and muscle incision nor resection of rib(s), and offers lower morbidity and rapid convalescence. Laparoscopic adrenalectomy is a new minimally invasive operation for the treatment of adrenal adenoma.

Adrenalectomy↗
PubMed1993

[A survey of postoperative steroid replacement in 40 patients with Cushing's syndrome].

Adrenalectomy for Cushing's syndrome due to adrenocortical adenoma was performed on 40 patients at Tokyo University Hospital between 1960 and 1990. There were 32 women and 8 men aged 2 to 59 (mean 35.7) years. Three different operative approaches to the adrenal gland were employed: lumbar approach in 24 cases, dorsal in 8, and transabdominal in 8 of whom 7 patients were operated before 1970 without definite preoperative localization of the lesions. Postoperative administration of cortisone and hydrocortisone as a steroid replacement has been reduced in duration and dosage in recent 10 years. Average treatment period was 3 years and 1 month in the 1970's, and 9.5 months in the 1980's, respectively. The mean daily dosage of steroid hormone was 517.5 mg (mean) on the operative day and 43.1 mg after three weeks in the 1970's, while 187.5 mg and 18.4 mg in the recent five years, respectively. Nonetheless, even in the recent 6 patients, metabolic alkalosis and hypopotassemia because of steroid excess were observed in a few days after the surgery. These observations indicate that period and dosage of steroid replacement have been reduced in these years and could be further shortened by means of rapid tapering in the early postoperative phase.

Adenoma↗
PubMed1993

[Transurethral resection of papillary tumor in the lower end of the ureter: report of two cases].

Two cases of papillary ureteral end tumors, treated by transurethral resection are presented. Case 1: A 71-year-old female visited us for asymptomatic macroscopic hematuria. Cystoscopy revealed a papillary pedunculated tumor in the bladder protruding from the right ureteral orifice. Under a diagnosis of superficial tumor at the right ureteral end, transurethral resection was performed using a rigid ureteral resectoscope. Pathological examination revealed transitional cell carcinoma, grade 2 without muscular invasion. There is no evidence of recurrence after 25 months of follow up postoperatively. Case 2: On a routine cystoscopy after transurethral resection of bladder tumor in a 68-year-old male, papillary pedunculated tumors protruding from the right ureteral orifice were found. Under a diagnosis of superficial tumor at the right lower ureter, transurethral resection was performed using cold cup forceps and loop electrocoagulation. The tumor was transitional cell carcinoma, grade 1 without invasion. No evidence of recurrence was detected 15 months postoperatively. Transurethral resection of the ureteral tumor at the lower end appeared to be useful for the selected cases. The indications, complications and follow up for this procedure were discussed.

Aged↗
PubMed1992

Percutaneous reduction of cyst volume of polycystic kidney disease: effects on renal function.

Percutaneous reduction of cyst volume was performed in 10 patients with autosomal dominant polycystic kidney disease and its effects on renal function were studied. Although creatinine clearance, urinary excretion of beta 2-microglobulin and N-acetyl-beta-D-glucosaminidase, and renal uptake of 99mtechnetium-dimercaptosuccinic acid did not change significantly, a transient increase in urinary protein and a decrease in inulin clearance were observed. Complications, such as hematuria, fever and decreases in hematocrit, were slight and transient in most patients. This procedure holds little promise for altering the course of polycystic kidney disease.

Adult↗
PubMed1992

[A case report of laparoscopic adrenalectomy].

Laparoscopic left adrenalectomy was performed on a 47 years old male patient with primary aldosteronism. Subcutaneous steel traction method was utilized in addition to intraperitoneal CO2 insufflation method. The combined use of steel traction method reduced CO2 insufflation pressure below 12 mmHg and might reduce possibility of CO2-related complications. A left adrenal gland was approached by a resection of phrenic colic ligament and a traction of a transverse and descending colon. Laparoscopic adrenalectomy has distinct advantages over open adrenalectomy in terms of avoidance of skin and muscle incision and rib resection, and early convalescence. This less invasive method might prevail in near future.

Adrenal Gland Neoplasms↗
PubMed1992

[Laparoscopic nephrectomy. Animal experiment and clinical application].

Laparoscopic nephrectomy was carried out on 6 sows in order to develop the procedures of clinical laparoscopic nephrectomy and the equipment necessary for this operation. Based on the animal experiments, it was shown that (1) retroperitoneal approach was difficult due to narrow space. (2) there must be at least 5 cm distance between each trocar and 4 or 5 trocar 1 cm in diameter were basically required. (3) The procedure consisted of incision and dissection of the peritoneum around the kidney, cutting and ligation of the ureter, dissection along the medial side of the ureter to approach the renal pedicle and clipping and cutting of the renal vessels. (4) The equipment required for this surgery must be functionally equivalent to those used in the open surgery. (5) In addition, the specifically designed equipment, such as a morcellator and an instrument to ligate renal vessels are necessary. The first clinical case of laparoscopic nephrectomy was a 34 years old man with a right non-functioning hydronephrosis due to ureteropelvic junction stricture. The surgery was successfully performed with a 110 ml blood loss. It took 7 and half hours because of abundant peri-renal fatty tissue and large extra-renal pelvis. The convalescence was uneventful. Laparoscopic nephrectomy can be applied on selected cases and the development of equipment will make the surgery more popular.

Animals↗
PubMed1992

[Clinical application of extracorporeal shock wave lithotripter (Dornier MFL-5000) for upper urinary tract stones].

The results of clinical application of an extracorporeal shock wave lithotripter (MFL-5000, Dornier, Germany) were presented. The treatments were performed from August 1989 to November 1989 at the University of Tokyo. A total of 40 sessions were carried out on 32 patients with 51 upper urinary tract stones. On the X-ray films obtained three months after the last sessions, 10 patients (34.5%) were free from stone fragments and 4 (13.8%) had stone fragments equal or less than 4 mm. After treatment no serious adverse effect was observed. Macroscopic hematuria was observed in almost all patients, pyrexia in 7 (21.9%), and flank pain in 6 (18.8%). On the laboratory data after treatments, there were slight and transient changes which were milder than those of the first generation lithotripter. It is concluded that MFL-5000 is useful and safe in the management of patients with upper urinary tract stones.

Adult↗
PubMed1991

Calcium metabolism in acidotic patients induced by carbonic anhydrase inhibitors: responses to citrate.

Calcium metabolism and its response to citrate were examined in 51 patients with glaucoma receiving carbonic anhydrase inhibitors (acetazolamide or methazolamide). Metabolic acidosis, hypocitraturia and increased incidence of nephrolithiasis were induced by both drugs. However, the acidosis was milder with methazolamide administration. Normocalciuria was observed in 29 patients and was shown to be a result of low filtered calcium. Renal hypercalciuria in 16 patients was associated with elevated parathyroid hormone but nephrogenic cyclic adenosine monophosphate remained within normal limits. Citrate in the form of potassium citrate (4.3 mmol.) and sodium citrate (4.0 mmol.) did not correct the metabolic acidosis or hypocitraturia but consistently decreased fasting and 24-hour urinary calcium excretion in patients with renal hypercalciuria. This event did not occur in patients with normocalciuria or absorptive hypercalciuria. These results suggest that a small amount of citrate could reverse renal hypercalciuria without correcting the metabolic acidosis.

Acetazolamide↗
PubMed1990

Long-term consequence of nephrectomy.

Renal function and blood pressure were assessed in 139 patients after unilateral nephrectomy. Followup ranged from 1 to 57 years, with a mean of 13.0 +/- 1.1 (standard error). Serum creatinine, creatinine clearance, beta 2-microglobulin clearance and blood pressure remained stable during followup. No significant effect of years after unilateral nephrectomy, blood pressure or cause of nephrectomy was observed on creatinine clearance. However, urine excretion of protein (correlation coefficient 0.475, p less than 0.01) and N-acetyl-beta-D-glucosaminidase (correlation coefficient 0.464, p less than 0.01) increased as a function of years after unilateral nephrectomy. Creatinine clearance tended to be low in elderly patients or patients who underwent nephrectomy at an advanced age. Our studies show that despite the late development of proteinuria and tubular injury, unilateral nephrectomy is not associated with deterioration in kidney function or elevation of blood pressure during long-term followup.

Acetylglucosaminidase↗