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Biomedical subjects

Kentaro Ichioka

Publications and source records attributed to Kentaro Ichioka.

49 records · Page 3Linked to original sources
PubMed2003

Use of complementary and alternative medicine by patients with localized prostate carcinoma: study at a single institute in Japan.

BACKGROUND: The use of complementary/alternative medicine (CAM) has recently received considerable attention throughout the world. We evaluated the prevalence and predictors of CAM use among Japanese patients with localized prostate cancer. METHODS: A total of 177 patients with localized prostate carcinoma underwent radical retropubic prostatecotomy or external beam radiation therapy between January 1994 and January 2001. Of them, 138 (78%) answered a self-administered questionnaire on CAM use and were eligible for this study. The overall prevalence, types of CAM used, and costs of CAM were assessed. The effects of age, prostate-specific antigen (PSA) level, clinical stage, pretreatment Gleason score, patients' income, patients' final educational status, and general health-related quality of life at baseline and 1 year after treatment, as estimated using the European Organization for Research and Treatment of Cancer Prostate Cancer Quality of Life Questionnaire on the prevalence of CAM use, were evaluated. RESULTS: Twenty-seven patients (20%) had once used or had been using some types of CAM. Herbal medicine and vitamins were the most common types of CAM used. Preoperative Gleason score was significantly associated with CAM use, as determined by the chi(2) test ( P = 0.0198), and PSA level and posttreatment physical function domain were marginally associated with CAM use, as determined by the Mann-Whitney U-test ( P = 0.0734 and P = 0.0597, respectively). Patient age, income, and final educational status had no impact on CAM use. CONCLUSION: A relatively small proportion of Japanese patients with localized prostate cancer have tried CAM compared with the proportions of patients described in previous reports from Western countries.

Age Factors↗
PubMed2003

Body image alteration after flank incision: relationship between the results of objective evaluation using computerized tomography and patient perception.

PURPOSE: We evaluated subjective and objective alterations in body image and configuration of patients who underwent urological surgery via a flank incision. MATERIALS AND METHODS: Eligible for study were 17 patients who underwent urological surgery via an 11th rib transcostal incision. Preoperative and postoperative abdominal computerized tomography were used for evaluation. The intra-abdominal contents surrounded by the vertebral bones and muscles forming the body trunk were divided into 4 subspaces. The areas of these 4 portions were measured and the calculated ratio of the contents of each portion determined preoperatively was compared with that determined postoperatively. Of the 17 patients 15 answered a questionnaire on the perception and bother of body image alteration. We compared their subjective answers with objective results using computerized tomography. RESULTS: The ratio of the ipsilateral-dorsal portion significantly increased postoperatively from 18.7% to 21.9% at the L2 level (p <0.001), 19.7% to 23.1% at the L3 level (p = 0.002) and 18.3% to 21.2% at the L4 level (p = 0.003). Posterolateral bulging was typically observed at the L2 level. Of the 15 patients who answered the questionnaire 9 (60%) perceived and 4 (27%) were bothered by body image alteration to at least a moderate extent. The ratio of increase in the ipsilateral-dorsal portion was significantly higher in the 9 patients who perceived at least moderate body image alteration than in the remaining 6 (2.2% versus 4.6%, p = 0.031). CONCLUSIONS: The intra-abdominal contents deviated in the ipsilateral-dorsal direction with the patient supine after flank incision done via the 11th rib transcostal approach. This change, typically represented by posterolateral bulging, results in an altered patient body image.

Abdominal Wall↗
PubMed2003

Nocturia and benign prostatic hyperplasia.

OBJECTIVES: To examine the frequency of and risk factors for nocturia in patients with symptomatic benign prostatic hyperplasia (BPH), and the degree of improvement of nocturia after treatment for BPH. METHODS: A total of 505 consecutively selected, newly diagnosed patients with symptomatic BPH were evaluated in studies examining frequency of and risk factors for nocturia. We analyzed the relationships between nocturia assessed by International Prostate Symptom Score (IPSS) and other parameters, including age, prostate volume, serum prostate-specific antigen level, and uroflow variables. Other studies examining the impact of conservative and invasive treatments on nocturia were also conducted using 165 patients receiving tamsulosin and 138 undergoing transurethral resection of the prostate (TURP). RESULTS: Overall, 359 of the 505 patients (71.1%) answered that they arose at least twice for urination at night. Patient age, score of urgency, and functional bladder capacity were each significantly associated with nocturia. Tamsulosin therapy and TURP significantly reduced the number of episodes of nocturia in 17.9% and 32.2% of patients, respectively. These rates of improvement were lowest for nocturia among the seven individual symptom scores. CONCLUSIONS: In this study using selected cohorts, the frequency of nocturia in patients with BPH was higher than that in community-based studies. Although we cannot estimate patients' satisfaction by the observed changes in scores, the rates of improvement were lowest for nocturia among the seven symptoms of IPSS after conservative and invasive treatments for BPH.

Adrenergic alpha-Antagonists↗
PubMed2003

Intraoperative electrical stimulation of cavernous nerves with monitoring of intracorporeal pressure to confirm nerve sparing during radical prostatectomy: Early clinical results.

BACKGROUND: We performed intraoperative cavernous nerve stimulation with an intracavernous pressure (ICP) monitoring system to confirm nerve sparing during radical pelvic surgery and assessed the results. METHODS: Nineteen cases of radical prostatectomy and three of radical cystoprostatectomy were examined. Electrical stimulation of the site where the neurovascular bundle (NVB) was determined to run was performed and changes in ICP were measured before and after prostate removal. RESULTS: Of the 22 patients, bilateral NVBs were preserved in six patients while unilateral NVB was preserved in 16. Before dissection, all NVBs examined exhibited positive responses (ICP changes of>5 mmHg) to nerve stimulation. After removal of the prostate, positive responses were observed in 22 (79%) of 28 macroanatomically preserved NVBs. Of 16 sides on which the NVB was not preserved, there were positive responses in five (31%). In these patients, some nerve fibers were macroscopically observed lateral to the original site of NVB. Finally, bilateral or unilateral nerve sparing was confirmed electrophysiologically in 20 (91%) of the 22 patients. CONCLUSION: Intraoperative stimulation of the NVB while monitoring ICP changes is a simple and reliable method of accurately evaluating the preservation of cavernous nerves. This system may provide further insight into the mechanism of postoperative erectile dysfunction.

Aged↗
PubMed2003

[Interstitial laser coagulation for benign prostatic hyperplasia: clinical results of the Indigo diode laser system].

We report our experience with interstitial laser coagulation of the prostate (ILCP) using an Indigo 830j diode laser system for benign prostatic hyperplasia (BPH). From March 1998 to November 2000, we treated 45 patients between 51 and 95 years old (average 71.5) with symptomatic BPH. The mean prostatic volume before ILCP was 62.0 cm3. We experienced no serious complications. Three months after ILCP, the mean international prostate symptom score (I-PSS) quality of life (QOL) index and post-void residual volume (PVR) decreased significantly from 18.0 to 9.2, from 4.4 to 2.1 and from 103.6 ml to 44.5 ml, respectively. The mean maximum flow rate (MFR) increased from 7.6 ml/sec at baseline to 9.2 ml/sec 3 months after ILCP, but the difference was not statistically significant. Before and after ILCP, 8 patients were available to evaluate pressure-flow study data. The detrusor pressure at the maximum flow rate decreased significantly from 118.3 cmH2O at baseline to 78.6 cmH2O 3 months after ILCP. The improvement of the I-PSS, QOL index, MFR and PVR continued and at 24 months reached 5.7, 1.8, 11.6 ml/sec and 54.6 ml, respectively. In our assessment of the questionnaire addressing the patient's satisfaction after the treatment, the majority of the patients who answered the questionnaire were pleased with the results of ILCP. We assessed the relation of the overall treatment efficacy with the number of punctures and the total amount of the laser energy delivered, but we did not find any relation. Our clinical results suggest that the ILCP using Indigo 830j is an effective modality and the short-term treatment efficacy is favorable.

Aged↗
PubMed2002

Retroperitoneoscopy-assisted total nephroureterectomy for upper urinary tract transitional cell carcinoma.

OBJECTIVES: To apply retroperitoneoscopy-assisted nephroureterectomy (RTN) and examine its benefit compared with traditional open nephroureterectomy. The reference standard of treatment for upper urinary tract transitional cell carcinoma is standard total nephroureterectomy (STN) with excision of a bladder cuff. METHODS: Retroperitoneoscopic radical nephrectomy was performed, followed by open distal ureterectomy with excision of a bladder cuff. The specimen was removed en bloc from the lower pararectal incision that was used during distal ureterectomy. From January 1999, 17 patients with upper urinary tract transitional cell carcinoma underwent this procedure at our institution. For comparison, the most recent 17 STNs were also reviewed. RESULTS: The operative time was longer in the RTN group than in the STN group but not to a significant extent (239.5 versus 286.8 minutes; P = 0.2663). On the other hand, the estimated blood loss, duration to potential discharge, and recovery to normal activities were significantly reduced in the RTN group (151.1 versus 299.6 minutes, 2.7 versus 4.2 days, and 15.9 versus 19.3 days; P = 0.0262, 0.0479, and 0.0363, respectively). From an oncologic standpoint, local recurrence occurred in 1 patient of the RTN group and 4 patients of the STN group (median follow-up of 8.8 and 23.0 months, respectively). No significant difference was detected in the disease-free survival rate between the two groups (P = 0.6775). CONCLUSIONS: RTN can make total nephroureterectomy less invasive. From an oncologic standpoint, although it revealed a disease-free survival rate comparable with the standard open procedure with limited follow-up, further follow-up of additional cases with simultaneous extended lymphadenectomy is necessary to evaluate the effectiveness of this procedure.

Aged↗
PubMed2002

Symptom-specific quality of life in patients with benign prostatic hyperplasia.

BACKGROUND: We investigated which factors are most bothersome to preoperative patients with benign prostatic hyperplasia (BPH). METHODS: A total of 423 newly diagnosed patients and 388 preoperative patients with symptomatic BPH were evaluated. International prostate symptom score (IPSS) and IPSS quality-of-life (QOL) assessment score were used for assessment of symptoms and symptom-specific QOL of the patients with BPH. Uroflow variables were measured in all patients. Other objective variables such as prostate volume, transition zone volume, Schaefer's obstruction grade, and detrusor pressure at maximal urinary flow were evaluated in 209 preoperative patients. We analyzed the relationships between symptom-specific QOL and other variables. Statistical analyses were performed using Spearman's correlation coefficient and a stepwise linear regression model. RESULTS: Symptom-specific QOL scores had moderate to good correlation with IPSS (P < 0.0001; r = 0.525-0.560). Filling symptom subscore had a slightly greater impact on symptom-specific QOL than voiding subscore in both groups of patients. Weak stream, feeling of incomplete emptying, and nocturia significantly decreased symptom-specific QOL in both groups of patients. While newly diagnosed patients suffered from frequency as well, urgency had the strongest impact on symptom-specific QOL of preoperative patients. Objectively measurable variables had no association with symptom-specific QOL. CONCLUSION: Japanese patients with BPH generally suffer from weak stream, feeling of incomplete emptying, and nocturia in all disease phases. Frequency is problematic for newly diagnosed patients and urgency is problematic for preoperative patients as well. Symptom-specific QOL of BPH patients cannot be estimated by physically measurable variables.

Adult↗
PubMed2002

The natural history of simple renal cysts.

PURPOSE: Although simple renal cysts are common in older patients, little is known concerning their natural history. We examined the natural history of renal cysts by investigating the prevalence and sequential changes in their size and number in individuals. MATERIALS AND METHODS: We collected data on 14,314 individuals who participated in a multiphasic health screening program at our institute in 1999. An ultrasound renal cyst prevalence survey was performed. As a longitudinal study, 45 patients with renal cysts were followed a mean of 6 years from January 1993 to December 1999. RESULTS: In the prevalence survey 1,700 individuals (11.9%) had at least 1 renal cyst on ultrasound. The ratio of men-to-women with cysts was 2:1. The prevalence of renal cysts increased more than 7-fold with age from 5.1% in the fourth to 36.1% in the eighth decade of life. Our longitudinal study revealed that the majority of cysts increased in size and number. The average increase in size and the rate of enlargement were 2.82 mm. and 6.3% yearly, respectively. Cysts in patients younger than 50 years grew more rapidly than those in patients 50 years old and older, at a rate of 3.94 and 1.84 mm. yearly, respectively (p = 0.010). Multiloculated cysts progressed more rapidly than simple cysts (6.93 versus 2.18 mm. yearly, p <0.0001). CONCLUSIONS: The prevalence of renal cysts increases with age and shows a remarkable difference in incidence by sex. Renal cysts progress in size and number, and appear to grow more rapidly in younger patients. The natural history of multiloculated cysts may be distinct from that of simple cysts and warrants further investigation.

Adolescent↗
PubMed2002

[A case of urolithiasis due to vitamin D intoxication in a patient with idiopathic hypoparathyroidism].

We report a case of urolithiasis in a patient with idiopathic hypoparathyroidism treated with vitamin D therapy. A 30-year-old woman with idiopathic hypoparathyroidism, who had been treated with vitamin D therapy with 2-4 micrograms/day of alpha-calcidol for 9 years, was admitted for recurrence of bilateral renal stones and progressing left hydronephrosis. Laboratory data revealed normal serum calcium level and remarkable hypercalciuria. The dose of oral administration of alpha-calcidol was reduced to 1 microgram/day and 2 mg/day of trichlormethiazide was started. Now her serum calcium concentration and the total amount of urine calcium was completely under control. Bilateral renal stones are no longer progressive and tetany has not been recognized. We considered it essential to monitor closely not only the serum but also the urine calcium level in the vitamin D therapy for idiopathic hypoparathyroidism.

Adult↗
PubMed2002

[Testicular sperm extraction for non-obstructive azoospermia: results with conventional and microsurgical techniques].

Testicular sperm extraction (TESE) was performed on patients with non-obstructive azoospermia using the conventional or microdissection technique. First, conventional TESE was attempted on all patients. If the sperm was retrieved successfully, the TESE procedure was terminated. Microdissection TESE was indicated only for patients for whom the conventional sperm retrieval was unsuccessful. Sperm was successfully retrieved with conventional TESE from four (24%) of 17 patients with non-obstructive azoospermia. The remaining 13 patients underwent microdissection TESE and sperm was successfully retrieved from four of them. Application of the microdissection technique resulted in an improvement in sperm retrieval rates from 24% with conventional TESE to 48% when combined with the microdissection technique. None of the patients showed any acute or chronic complications after TESE. Intracytoplasmic sperm injection (ICSI) was performed on five of the eight patients with successful sperm retrieval and the partner of four of these patients became pregnant and progressed to delivery. These results indicate the usefulness of microdissection for improving the sperm retrieval rate in men with non-obstructive azoospermia.

Adult↗