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Biomedical subjects

M Sahashi

Publications and source records attributed to M Sahashi.

At least 19 recordsLinked to original sources
PubMed2001

Prospective and randomized comparison of combined androgen blockade versus combination with oral UFT as an initial treatment for prostate cancer.

OBJECTIVE: This prospective and randomized clinical study was initiated to compare the efficacy and safety of combined androgen blockade with combination with UFT in patients with untreated prostate cancer. METHODS: A total of 142 patients were entered in this study between April 1990 and December 1992. All patients received bilateral orchiectomy and 200 mg/day of diethylstilbestrol diphosphate. Of these patients, 70 patients were administered an additional 400 mg/day of UFT after randomization. Either treatment was continued for at least 1 year or until objective progression occurred if the initial response was equal to or better than no change. The endpoints of this study were progression-free survival, cancer-specific survival and change of QOL scores. RESULTS: A total of 136 patients were evaluable and 131 patients (96.3%) could be followed up with a median follow-up period of 1469 days. Both groups showed similar initial treatment response at 12 weeks, adverse effect and change of quality of life score during the first year after initiation of the treatment. There was a significantly longer progression-free survival and better but not significant cancer-specific survival in the endocrine chemotherapy group. The patients with earlier stage and initial serum prostate-specific antigen values <40 ng/ml showed a good indication for this endocrine chemotherapy. CONCLUSION: This endocrine chemotherapy was confirmed to be tolerable and significantly effective in the delay of disease progression, which leads to longer survival in patients with prostate cancer.

Aged↗
PubMed1998

[Long-term results and quality of life of hemi-Kock orthotopic ileal neobladder after radical cystectomy].

We analyzed the long-term results and the quality of life in patients who received orthotopic lower urinary tract reconstruction using the Kock ileal neobladder. Between July 1990 and October 1993, 37 consecutive patients including 2 females received orthotopic hemi-Kock neobladder after radical cystectomy. In these patients, we analyzed the urinary continence, complications and urethral recurrence, and performed a questionnaire survey by mail. Good continence all day had been achieved in 71% of the patients 4 years after surgery. The rate of the pouch-related complications requiring reoperation was 27%. There was no urethral recurrence. Compared with preoperative conditions, 42% were not satisfied with urination. In these dissatisfied patients, the need to use pads in the daytime, sensation of residual urine and weak urine stream were significantly more frequent than in satisfied patients. In summary, the rate of complications was higher than that of other methods. However, the Kock orthotopic ileal neobladder is a stable procedure providing good function over the long-term.

Adult↗
PubMed1997

In vivo evaluation of acyclovir prodrug penetration and metabolism through rat skin using a diffusion/bioconversion model.

PURPOSE: In order to evaluate the in vivo penetration of prodrugs which undergo metabolism in skin, we analyzed the in vivo penetration profiles of acyclovir prodrugs based on a two-layer skin diffusion model in consideration of metabolic process. METHODS: Acyclovir prodrugs (e.g., valerate, isovalerate and pivarate) were used as model prodrugs and the amounts excreted in urine were measured after percutaneous application. In vivo penetration profiles were then estimated by employing a deconvolution method and the penetration of acyclovir prodrugs was analyzed using a diffusion model. Subsequently, diffusion, partitioning and metabolic parameters were compared under in vitro and in vivo conditions. RESULTS: Although total penetration amounts at the end of the experiment were similar for the three prodrugs, the ratio of intact prodrug to total penetration amount differed significantly. Moreover, the excretion and absorption profiles were also very different for each prodrug. Enzymatic hydrolysis rate constants calculated under in vivo conditions were considerably larger than those obtained in the skin homogenate and in vitro penetration experiments. CONCLUSIONS: The present skin diffusion/bioconversion model combined with computer analysis enables us to comprehensively account for diffusion, partitioning and metabolism during in vivo percutaneous absorption. Nevertheless, different enzymatic hydrolysis rate constants obtained under both in vivo and in vitro conditions demonstrate the difficulty of obtaining accurate values for in vivo enzymatic activity from related in vitro experiments.

Acyclovir↗
PubMed1996

Laparoscopic adrenalectomy via the retroperitoneal approach: first five cases.

Between February and November 1994, we performed laparoscopic retroperitoneal adrenalectomy in five patients with benign adrenal tumors to confirm the efficacy of this operation. Using digital dissection and a balloon, we created a working space in the retroperitoneal cavity before we dissected the adrenal gland and removed it under laparoscopic observation. The adrenal glands of all five patients were removed without any complications. The mean operative time was 3.4 hours, and the mean estimated blood loss was 148 mL. The average postoperative hospital stay was 10 days, and the average full recovery time was 19 days. We concluded that the retroperitoneal approach is an advantageous and safe procedure in the laparoscopic removal of the adrenal gland with benign tumor.

Adrenal Gland Diseases↗
PubMed1996

[Hautmann's ileal neobladder: experience of 37 cases].

Between April 1993 and August 1995, a Hautmann's ileal neobladder was created in 37 men after total cystectomy for bladder cancer. Ureteroileostomy was performed using a submucosal tunnel instead of the Le-Duc Camey procedure. There was no operative mortality and only a few early complications. The mean postoperative follow-up time was 16 months, with a range of 3 to 31 months. Hydronephrosis occurred in 3 patients, being caused by stenosis at the uretero-ileo anastomosis in 2 and by proximal stenosis in 1. Neobladder-ureteral reflux did not occur in any of the patients. Postoperative ileus developed in 3 patients, and one required laparotomy. Stenosis of the urethro-ileal anastomosis developed in 3 patients, who were successfully treated by transurethral incision. Thirty five patients achieved daytime continence, while 2 patients had slight incontinence. Twenty nine patients achieved nighttime continence, and most of the patients awoke 1-4 times to prevent overflow incontinence. The mean maximum flow rate, average flow rate and post-voiding residual urine volume were respectively 15.3 ml/sec, 5.5 ml/sec and 81 ml at 6 months postoperatively, and 14.9 ml/sec, 5.4 ml/sec and 76 ml at 12 months. Four patients with more than 100 ml of residual urine required sterile intermittent catheterization 2-4 times a day. Urethral recurrence was detected in 2 patients. One was treated with transurethral resection and cisplatinum-based systemic chemotherapy, and the other required urethrectomy and urinary diversion using a new continent efferent limb.

Aged↗
PubMed1995

[The efficacy of endopyeloureterotomy via a transpelvic extraureteral approach].

To evaluate the efficacy of endopyeloureterotomy via a transpelvic extraureteral approach for the treatment of ureteropelvic junction obstruction or upper ureteric stenosis, we analysed the results of 85 patients treated with this procedure between Aug. 1988 and June 1993. Eighty-five patients underwent 87 procedures. Each patient has been followed-up more than 6 months postoperatively. Of 87 procedures, 71 were performed in patients with ureteropelvic junction obstruction and 16 were in patients with stenosis of the upper third ureter. Primary disease was 59 and secondary disease was 28. Twenty-one procedures were performed in patients with the stenotic segment over 2 cm. The operative procedure was performed by first incising with a 22 Fr. urethrotome (ACMI Co.); the dilated renal pelvic or ureteral wall posterolaterally as long as 1-1.5 cm junction from the stenotic segment toward ureteropelvic junction, then bringing the urethrotome out retroperitoneally through the incision and finally incising the stenotic segment with the cold knife under direct vision. A 12-16 Fr. PTCS tube (Sumitomo Behkuraito Co.) was left in place for 3 weeks as a stent. Mean operative time was 101 min and average length of incised segment was 3.7 cm. Complication included pneumothorax (1 case), pseudo ureter (1 case) and renal arterial anexryma (1 case). Followed-up period ranged from 6 to 64 months with the average being 26 months. Of 87 procedures, 80 (92%) achieved a disappearance or improvement of the obstructive change and 7 failed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Pelvic lymph node involvement in primary bladder cancer. A clinicopathological study of radical cystectomies].

Between 1984 and 1992, 131 patients with bladder cancer underwent radical cystectomy and pelvic lymph node dissection with urinary diversion. There were 110 male and 21 female patients, aged between 35 and 86 with a mean of 64 years. The follow-up period ranged from 1 month to 113 months, with a median of 34 months. The five-year survival estimated by the Kaplan-Meier method was 66.9% over all 131 patients. The five-year survival rates were 83.3% for stage pTis patients, 66.7% for stage pTa, 97.0% for pT1, 70.7% for pT2, 47.9% for pT3a, 26.2% for pT3b, and four-year survival was 25% for pT4 disease. Under the grading system, the five-year survival was 80.0% for cases of grade 2 disease and 63.6% for grade 3. There were two grade 1 patients who died of other diseases 15 and 16 months after surgery. Of all 131 patients, 22 (16.8%) had lymph node involvement. The five-year survival was 34.5% for patients with positive lymph nodes in comparison with 73.8% for those without lymph node involvement. The frequency of lymph node involvement was 26.1% in the non TCC group and 14.8% in the TCC group including 23.7% of the grade 3 and 4.3% of the grade 2 cases. Pathologically, the patients with higher stages had a higher frequency of lymph node involvement, and there was a significant difference in the frequency between pT3a (14.3%) and pT3b (47.8%) disease. The five-year survival of patients with positive lymph nodes was 40.0% for pN1, 32.1% for pN2 disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Urodynamic study of storage and evacuation of urine in patients with a urethral Kock pouch.

PURPOSE: The urodynamics of pouch-urethra function were investigated in patients with a urethral Kock pouch to understand mechanisms involved in the storage and evacuation of urine, and elucidate any problems of long-term outcome. MATERIALS AND METHODS: Urodynamic evaluation was performed in 18 male patients who underwent bladder replacement with a urethral Kock pouch following radical cystectomy. RESULTS: Good urinary continence was achieved with normal frequency of voiding. On urodynamics pressure within the pouch remained low during the storage phase (mean 33.2 cm. water) but markedly increased during the evacuation of urine (mean 77.3 cm. water). In 8 patients (44%) extremely high pressure within the pouch (80 to 150 cm. water) was noted at voiding. Clean intermittent self-catheterization was initiated in a patient with high pressure within the pouch at voiding in whom pouch-ureter reflux developed 7 months postoperatively. The external urethral sphincter was impaired to some extent postoperatively but it contracted in response to filling of the pouch with a marked increase in urethral pressure from a mean of 31.6 to 66.3 cm. water. CONCLUSIONS: Urodynamic and radiological studies will be necessary periodically since high pressure within the pouch at voiding might jeopardize the antireflux mechanism, leading to reflux and renal impairment.

Adult↗
PubMed1995

[Clinical outcome of radical prostatectomy and pelvic lymph node dissection].

Between September, 1987 and September, 1993, a total of 44 consecutive patients had undergone radical retropubic prostatectomy and pelvic lymphadenectomy for the treatment of prostate cancer. The patients were between 56 and 77 years (mean, 68 years). Eleven patients had clinical state A2 disease, 21 had stage B disease, and 12 had stage C disease. Fourteen of the 44 patients (32%) had positive lymph node metastases. The 5-year survival rate for patients with pT1, pT2 and pT3 was 100%, 71% and 87%, respectively. It was 77% in patients with positive node disease and 90% in patients with negative node disease. The 5-year disease-free survival rate for patients with pT1, pT2 and pT3 was 82%, and 78%, respectively. It was 54% in patients with positive node disease and 88% in patients with negative node disease. In 14 positive node patients, metastases were located in obturater nodes in 8 patients (57%), hypogastric nodes, in 6 patients (43%), external iliac nodes in 6 patients (43%), common iliac nodes in 4 patients (29%) and presacral nodes in 2 patients (14%). We confirmed that radical retropubic prostatectomy is effective treatment for locally confined prostate cancer and removal of obturater, hypogastric lymph nodes and the internal chain of external iliac lymph nodes is important in detecting metastases.

Aged↗
PubMed1995

[Indication of neobladder replacement in patients undergoing radical cystectomy for bladder cancer].

Neobladder replacement has become an important procedure in the patient undergoing radical cystectomy for invasive bladder cancer. It yields postoperatively excellent quality of life in these patients. The indications of the patients selection have not been established, since long-term clinical results have not been presented and some issues such as urethral recurrence of the original disease, growth of the cancer from the neobladder made of the gastrointestinal tract and influences arising from orthotopic micturition are still unclear. We reviewed the reports describing neobladder replacement in the patients undergoing cystectomy for the bladder cancer. At present the criteria of patients selection described by most authors can be summarized as follows, (1) male patients, (2) patients having an available gastrointestinal tract for reconstructing the neobladder, (3) patients having a good renal function and liver function and could tolerate for the surgery and (4) patients with no evidence of disease in their urethra and prostate (direct invasion of the disease). As to carcinoma in situ within the bladder, some authors included their indication and the others contraindication.

Cystectomy↗
PubMed1994

Laparoscopic nephrectomy, radical nephrectomy and adrenalectomy: Nagoya experience.

A total of 37 patients with various renal and adrenal diseases underwent laparoscopic nephrectomy, radical nephrectomy and adrenalectomy since July 1991. The underlying diseases included renal calculi, vesicoureteral reflux, ureteropelvic junction obstruction, ureteral stenosis, ectopic ureter, vascular disease, renal cell carcinoma and adrenal tumors. Twenty-nine kidneys (including 5 with renal cell carcinoma) and 5 adrenal glands were removed successfully. Three cases failed because of dense adhesion to the surrounding structures, hemorrhage from the renal vein and hemorrhage from the vena cava, respectively. Of the remaining 34 patients 3 required additional open laparotomy to control bleeding or remove lost calculi. Mean operating time was 265 minutes for nephrectomy, 383 minutes for radical nephrectomy and 199 minutes for adrenalectomy, and mean estimated blood loss was 455 ml., 430 ml. and 80 ml., respectively. Average hospital stay was 10 days for the 31 patients without open laparotomy and convalescence was completed by postoperative day 21. These results indicate that laparoscopic surgery for renal and adrenal disease is a feasible, minimally invasive procedure. In the case of laparoscopic radical nephrectomy, however, longterm followup is necessary to confirm the efficacy.

Adolescent↗
PubMed1994

Extracorporeal shock wave lithotripsy using the Dornier MPL 9000 lithotriptor.

336 patients with urinary calculi were treated between June 1988 and October 1991 with extracorporeal shock wave lithotripsy using the Dornier MPL 9000 lithotriptor. Of 352 renal units (a kidney and its ureter), 286 had renal stones, 62 had ureteral stones and 10 had both. There were radiolucent stones in 6 units. The complete disintegration rate was 94%. The mean number of shock waves was 2,973, the range being from 300 to 16,131. In 310 of 447 (64%) sessions, treatment was done without any anesthesia. The rate of complete removal was 67.3% 3 months after the last treatment. Only 11 patients required supplementary treatment consisting of percutaneous nephrolithotripsy and transurethral lithotripsy. There were no severe complications except subcapsular hematomas observed in 2 patients. The Dornier MPL 9000 is a useful lithotriptor for the treatment of urinary calculi, except staghorn calculi.

Female↗
PubMed1994

[Laparoscopic pelvic lymphadenectomy in prostate cancer].

We described the clinical results and efficacy of laparoscopic pelvic lymphadenectomy for localized prostate cancer. This procedure was followed by radical prostatectomy, if metastasis was not found in frozen section. In the presence of positive nodes, optional treatment, such as TUR or castration, other than radical prostatectomy was performed. We performed laparoscopic lymphadenectomy on twenty seven patients between April 1992 and September 1993. They range from 52 to 78 years in age and consist of 4 patients with stage A2, 17 with stage B, and 6 with stage C. We dissected the obturator lymph nodes on bilateral sides. The average operating time was 162 minutes (range 86 to 320 minutes). The average number of nodes removed from the right side was 7.1 +/- 5.9 and 6.1 +/- 4.5 from the left side, which was comparable to the number of lymph nodes obtained by open dissection. Colon injury occurred in one patient, which was managed by laparotomy procedure. Nodal metastases were found in 6 patients by frozen section, and in 10 patients by permanent section. This discrepancy suggested that two-staged operation might be preferable for the localized prostate cancer. Six patients were given suitable therapies besides radical prostatectomy. Laparoscopic pelvic lymphadenectomy is a safe and useful procedure for prostate cancer, especially for the patients who are likely to have nodal metastasis.

Aged↗
PubMed1994

[Results of treatment for advanced non-seminomatous germ cell tumors of the testis based on Indiana University classification].

From 1980 to 1990, we treated 45 patients with non-seminomatous germ cell tumors of greater than or equal to stage II according to the Japanese general rule for clinical and pathological studies on testicular tumors. The patients were divided into 2 groups based on the Indiana University Classification: 26 good risk patients (score < or = 6) and 19 poor risk patients (score > or = 7). The clinical results, the % dose intensity of Cisplatin and half-lives of tumor makers were analyzed in the two groups. The per cent dose intensity of Cisplatin of the induction chemotherapy was 61 +/- 24% in 1980-1985 and 87 +/- 18% in 1986-1990. The NED rate improved from 66.7% (10/15) to 81.8% (9/11) in the good risk patients and from 33.3% (3/9) to 50.0% (5/10) in the poor risk patients between the above two periods. When the % dose intensity of Cisplatin exceeded 80%, the NED rate increased from 66.7% (10/15) to 90.0% (9/10) in good risk patients and from 33.3% (2/6) to 45.5% (5/11) in poor risk patients. The NED rate was only 25.0% (4/16) in the poor risk patients whose residual tumors were not resected. The half-lives of AFP and beta-HCG from the latter part of the first course to the second course were 6.8 +/- 1.9 days and 4.4 +/- 1.4 days, respectively, in the patients with a good prognosis, while they were 6.5 +/- 1.5 days and 4.4 +/- 2.9 days, respectively, in with a poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Laparoscopic nephrectomy without morcellation for renal cell carcinoma: report of initial 2 cases.

We recently developed a new laparoscopic procedure of nephrectomy for renal cell carcinoma and successfully removed the kidney in 2 patients. A carbon dioxide pneumoperitoneum is induced and 5 trocars are introduced into the abdominal cavity through the lateral abdominal wall. The kidney is removed en bloc together with the adrenal gland, perirenal fat and Gerota's fascia. The kidney is placed into a sack, which is pulled out through a 5 cm. incision in the abdominal wall without morcellation to allow for complete pathological examination. With this procedure right nephrectomy was performed in a 44-year-old man with a 2.5 cm. tumor in the right kidney and left nephrectomy was done in a 52-year-old man with a 2.5 cm. tumor in the left kidney. Operative time was 379 minutes and 464 minutes, respectively. There were no complications in either case. This procedure may be indicated in patients with small volume renal cell carcinoma.

Adult↗
PubMed1993

[Transrectal hyperthermia for chronic prostatitis].

Transrectal hyperthermia was performed on 13 patients with chronic non-bacterial prostatitis which failed to respond to the conventional treatments. We used "Prostathermer" (Biodan-Medical system, Israel) for heating the prostate gland. The prostate was heated at 42 degrees C-43 degrees C, for 60 minutes in 1 session. Treatment consisted of 6 sessions, and was performed during a period of three weeks on an outpatient basis. Of 11 patients re-evaluated after 3 months, 6 (55%) achieved improvement of subjective symptoms. Of 9 patients, 4 (44%) showed reduction of the number of white blood cells (> or = 10 leukocytes count per high-power field) in their expressed prostatic secretion (EPS), which however was not always correlate with improvement of subjective symptoms. No complications were encountered in our series. Our result indicates that local hyperthermia is safe, and would become new modality in the treatment for chronic prostatitis.

Adult↗