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M Sahashi

Publications and source records attributed to M Sahashi.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Laparoscopic nephrectomy; results of initial 14 cases and procedure for renal cell carcinoma].

Since July 1991, we have performed laparoscopic nephrectomy for removal of damaged kidneys in thirteen patients. In addition, we recently developed a new procedure of laparoscopic nephrectomy for renal cell carcinoma and successfully removed the kidney with renal cell carcinoma. Patients' age ranged from 18 to 80 years with the average being 50 years. There were 8 male and 6 female patients. Original disease was calculous disease in 5 patients, vesicoureteral reflux in 4, renovascular disease in 2, ureteropelvic junction obstruction in 1, ectopic ureter in 1 and renal cell carcinoma in 1. The mean size of the diseased kidney was 9 x 5 x 4 cm in the initial 13 cases and 13 x 7 x 6 cm in the case with renal cell carcinoma. The size of the tumor was 2.5 x 2 x 2 cm. In the first 13 patients, nephrectomy was performed as described previously. In the patient with renal cell carcinoma, a new procedure was applied. In the new procedure, five trocars were introduced into the abdominal cavity through the lateral abdominal wall. The kidney was removed en bloc together with the adrenal gland, perirenal fat and Gerota's fascia in the same fashion as traditional radical nephrectomy. Thirteen kidneys were successfully removed, but one failed because of dense adhesion to the surrounding tissue. Three of the 13 patients required additional laparotomies to control bleeding or to remove missed stone.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[The effects of the treatment for acute rejection with OKT3 monoclonal antibody treatment on the long-term results of cadaveric kidney transplantation].

Although the efficacy of OKT3 monoclonal antibody (OKT3) upon the steroid resistant rejection is well known, its beneficial effect on long-term result of kidney transplantation has not yet been well examined in Japan. A retrospective group study was performed to analyze the effect of OKT3 on the cadaver kidney allograft. Between September 1987 and October 1990, a total of 77 patients from four different hospitals were classified into 2 groups. Thirty-four patients from 2 hospitals were entered OKT3 therapy group and 43 patients from the other hospitals were entered steroid therapy group. Initial immunosuppression comprised low-dose cyclosporine (6 mg/kg), steroid and antilymphocyte globulin in both groups. In OKT3 therapy group, acute rejection episodes those were considered steroid resistant were observed in 7 patients. They were treated with OKT3 monoclonal antibody. Of the seven patients, six recovered normal renal function. The mild rejection in OKT3 therapy group was treated with high-dose steroid. Minimal follow-up was 2 years. The 2-year graft survival was 82.4% in OKT3 therapy group and 74.4% in steroid therapy group. Although the improvement on the 2 year graft survival with OKT3 treatment was 8%, the difference between two groups was not statistically significant.

Adolescent↗
PubMed1993

[Clinical results in the treatment for primary carcinoma of the renal pelvis and ureter].

One hundred and five patients with renal pelvic and ureteral tumor entered our treatment program between 1982 and 1991. Of 105 patients, 81 had resectable transitional cell carcinoma and were treated with radical or total nephroureterectomy (57 vs. 24) and/or lymph node dissection (66). Adjuvant chemotherapy was added in 26 patients with high stage disease and with lymph node disease. There were 61 male and 20 female patients. Their ages ranged from 36 to 86 years, with a mean of 62 years. The follow-up period was 3 to 114 months, with a mean of 31 months. The estimated 5-year survival was 67% in all 81 patients. Classified according to the pathological stage, 5-year survival was 70% in pTis + pTa disease group, 91% in pT1 group, 88% in pT2 group, 53% in pT3 group, and 27% in pT4 group. Under the grading system, 5-year survival was 100% in grade 1 disease, 74% in grade 2, and 26% in grade 3. It was 78% in 52 patients with negative node disease and 26% in 15 with positive node disease. There were 51 patients (61%) with no recurrent disease. Seventeen patients (21%) had recurrence in the bladder after a median latent period of 8-month, and 15 (19%) patients had recurrence in the retroperitoneum, liver, lung and (or) other site after a median latent period of 8 months. The results of this series were quite similar to those of previous reports. The efficacy of lymph node dissection and adjuvant chemotherapy could not be confirmed.

Adult↗
PubMed1992

Combination chemotherapy for advanced urothelial-tract carcinoma.

Between December 1982 and November 1990, 31 patients with advanced urothelial carcinoma were treated with one of two combination chemotherapy regimens. A total of 20 patients were treated with 3 mg/m2 mitomycin C and 300 mg/m2 cyclophosphamide given intravenously every 10-14 days and with 180 mg/m2 5-fluorouracil (5-FU) given intravenously every day for as long as possible (CF-Mito regimen). After the patient had been discharged from the hospital, the same treatment with CF-Mito was performed except that 180 mg/m2 5-FU was replaced by 400 mg/m2 UFT (a mixture of tegafur and uracil) given orally. A total of 11 patients whose tumor had relapsed during the first-line treatment were given 60 mg/m2 cisplatin, 40 mg/m2 Adriamycin, and 40 mg/m2 methotrexate intravenously every 28 days (PAM regimen). In all, 20 patients received 4-44 (mean, 9.7) courses of CF-Mito over a period of 1.5-24 (mean, 5.3) months. The results obtained in these 20 patients with evaluable lesions included no complete remission (CR), 4 partial remissions (PRs), 9 cases of stable disease (SD), and 7 cases of progressive disease (PD). The PR duration was 1.5-22 (mean, 7.5) months. The side effects encountered in this group included anorexia, nausea, vomiting, myelosuppression, diarrhea, stomatitis, liver damage, and heart failure. In all, 11 patients received 3-7 (mean, 4.1) courses of PAM over a period of 3-14.5 (mean, 5.2) months. All 11 patients had evaluable lesions, and their responses included no CR, 5 PRs, 3 cases of SD, and 3 cases of PD. The PR duration was 1-3 (mean, 1.6) months. The side effects encountered in this group included anorexia, nausea, vomiting, myelosuppression, heart failure, and hair loss.

Adult↗
PubMed1992

Endopyeloureterotomy via a transpelvic extraureteral approach.

Endopyeloureterotomy has been accepted as a procedure to relieve obstruction of the ureteropelvic junction and upper ureteral stenosis. However, in patients with a long stenotic segment poor results are often obtained with the conventional technique. To resolve this problem we developed a new technique using a 22F urethrotome and a transpelvic extraureteral approach. In this technique the renal pelvis was incised for 1 to 1.5 cm. from the ureteropelvic junction in the direction of the parenchyma using the cold knife of the urethrotome under direct vision. For upper ureteral stenosis the dilated pelvic and ureteral posterolateral walls were incised 1 to 1.5 cm. from the stenotic segment toward the ureteropelvic junction. Then, the stenotic segment was treated with the urethrotome after it was advanced into the retroperitoneal space through the incision in the renal pelvis. We treated 21 patients with the new technique between August 1988 and August 1990. Our series included 3 patients with the high insertion type of ureteropelvic junction obstruction and 4 with a long stenotic segment. The success rate was 95% without any severe complication. These results indicate that our new technique could become a useful procedure for endopyeloureterotomy.

Adolescent↗
PubMed1992

Small hyperechoic renal tumors displaying no fat content on CT.

We report two cases of small renal adenocarcinoma and one case of small angiomyolipoma, which were identified as hyperechoic tumors by ultrasonography. None of the three tumors displayed fat content on plain CT. Since CT cannot reliably identify the intratumoral structure of small hyperechoic renal tumors, we recommend intraoperative pathological examination when CT findings do not correspond with the results of ultrasonography.

Adult↗
PubMed1992

[A case with arteriovenous fistula from renal injury].

We report on a 58-year-old male treated with transcatheter embolization for arteriovenous fistula due to renal injury. The patient was transferred to our hospital on December 10, 1989, with left renal injury and left temporal bone fractures. Enhanced CT revealed parenchymal fracture with peri-renal hematoma in the left kidney. Antibiotics were prescribed to prevent bacterial infection of the injured kidney. Urine cleared and pain in the left loin area disappeared 17 days later. However, on December 28, gross hematuria and pain in the left flank suddenly reappeared. He was given a blood transfusion and was diagnosed with re-bleeding from the injured kidney. Renal angiography performed on January 10, 1990, revealed arteriovenous fistula of the kidney. Transcatheter embolization was done using a metal coil to close the arteriovenous fistula. The patient has had no further problems or complaints. Excretory pyelogram showed no hydronephrosis in the left kidney. TcDMSA renoscintiscan showed a defect in the mid-portion of the kidney. These results suggest that transcatheter embolization can be useful to alleviate arteriovenous fistula in cases of renal injury.

Arteriovenous Fistula↗
PubMed1992

[Urodynamic findings in patients with a urethral Kock pouch after radical cystectomy].

Urodynamic evaluation was performed in 11 male patients, who underwent radical cystectomy with pelvic lymph node dissection for bladder cancer followed by bladder replacement with a urethral Kock pouch, 3 to 21 months after the operation. Frequency of micturition were 4.9 +/- 1.5 times (mean +/- S.D.) during the day-time and 1.5 +/- 1.2 times during the night-time. Tidal volume of micturition ranged from 300 to 550 ml and residual volume from 10 to 30 ml. Urinary continence was completely preserved in all patients (100%) during the day-time and 8 (72.7%) during the night-time. On pouchmetry, maximum capacity of the pouch was 429.2 +/- 82.4 ml, and intra-pouch pressure was 16.2 +/- 5.4 cmH2O at the capacity of 200 ml and 38.7 +/- 11.5 cmH2O at the maximum capacity. Maximum intra-pouch pressure on voiding was 80.0 +/- 19.4 cmH2O. Uroflowmetry demonstrated intermittent voiding curves in all the patients, with maximum flow rate of 15.2 +/- 6.5 ml/sec, voided volume of 405.9 +/- 80.7 ml and residual rate of 4.5 +/- 2.6%. Maximum intra-urethral pressure at the external urethral sphincter was 28.0 +/- 11.3 cmH2O when the pouch was empty and increased in response to pouch filling up to 64.7 +/- 27.0 cmH2O. Maximum urethral closing pressure and total profile length on the urethral pressure profile were 30.2 +/- 12.4 cmH2O and 20.9 +/- 9.0 mm, respectively, with the pouch empty, and 23.2 +/- 14.5 cmH2O and 20.0 +/- 7.6 mm, respectively, with the pouch full.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Nephrectomy from cadaveric donor--new procedure alternative to evisceration technique].

In Japan, it has not accepted that kidneys were harvested from a heart beating cadaveric donor. We usually removed kidneys from a donor after a donor was in cardiac arrest. To minimize warm ischemia, we employed in situ perfusion of kidneys and new procedure alternate to evisceration technique in nephrectomy from a cadaveric donor. Our procedures for the harvest of the kidneys from the cadaveric donor were presented and the clinical result of our series were reported. The kidneys was promptly perfused with chilled Ringer's lactate solution through double balloon catheter placed into the aorta, just after cardiac function ceased. Bilateral nephrectomy was performed through a long midline incision from just beneath the xyphoid bone to the pubic bone. Upon entering the abdomen, the small bowel and mesentery were retracted to the right and the posterior parietal peritoneum was incised over the great vessels and through the ligament of Treitz. The peritoneal incision was extended around the right colon so the bowel can be retracted upward and the right kidney was exposed. Then, the peritoneal incision was performed around the left colon to explore the left kidney. Both ureters were transsected as far down toward the bladder as possible. The in situ perfusion was stopped. Thereafter, the superior mesenteric artery was transsected and the duodenum and the pancreas were retracted upward. The proximal vena cava and aorta were transsected at a 2-3 cm above the level of the left renal vein, and the distal vena cava and aorta at a 5-6 cm an below the level of the left renal vein. The kidneys and the great vessels were removed in en block.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Clinical characteristics and prognosis of renal cell carcinoma. Statistical evaluation of possible determinants for distant metastasis, venous tumor thrombi, and lymph node metastasis].

To clarify the recent clinical characteristics of renal cell carcinomas and to evaluate possible determinants for metastasis and venous tumor thrombi, the authors reviewed data from 99 renal cell carcinoma patients treated at Nagoya University Hospital between 1980 and 1989. According to Robson's classification, stage I tumors were found in 48 patients, stage II in 9, stage III in 16, and stage IV in 26. Incidentally detected tumors appeared to be on the increase in recent years. Grade 1 tumors were significantly associated with low-stage tumors and expansive growth. Univariate and multivariate analyses using a logistic regression model demonstrated that venous tumor thrombi and histological grade were significantly related to distant metastasis. Univariate analysis revealed relative risks of 4.7 for venous tumor thrombus presence (pV1b-pV2 vs. pV0-pV1a, p = 0.005) and 8.5 for histological grade (grades 2 and 3 vs. grade 1, p = 0.04). Local invasion (pT3 vs. pT2a-pTb: a relative risk of 7.5, p = 0.0009) and infiltration pattern (INF beta and INF gamma vs. INF alpha: a relative risk of 11.5, p = 0.002). were associated with venous tumor thrombi. Local invasion (pT3 vs. pT2a-pT2b: a relative risk of 6.6, p = 0.03) was the only significant determinant for lymph node metastasis. The 5-year actuarial survival rate was 60.0% for all 99 patients. The 5-year survival rates for stage I and II tumors were, respectively, 91.8% and 64.8%.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Renal Cell↗
PubMed1992

[Laparoscopic nephrectomy. Preliminary report].

Laparoscopic surgery has been widely performed for removing the gallbladder and the pelvic lymph-nodes in recent years. We have applied laparoscopy technique to nephrectomy and here we describe our procedures and the clinical results. The patient is placed in the supine position under general anesthesia. After a 4 liter CO2 pneumoperitoneum is induced, five trocars are inserted into the abdominal cavity through the ipsilateral abdominal wall. The patient is then turned to the lateral position to displace the bowel medially. The ipsilateral colon is reflected medially after incision of the parietal peritoneum was made along the line of Todt to expose the retroperitoneum. The ureter was identified and dissected. It was secured with 4 clips (2 clips on the renal side and 2 on the distal side) and then cut with scissors. The renal vein and artery were then dissected and separately ligated with clips as described above. These vessels were also cut. The upper pole of the kidney was dissected out and the adrenal gland was left in place. The kidney thus became completely free within the abdomen. It was then grasped by the forceps through a 10 mm sheath positioned below the umbilicus. After incising the abdominal wall, the kidney was removed from the abdominal cavity with the grasping forceps and the sheath. By this procedure right nephrectomy was completely performed in a 56-year-old female patient and left nephrectomy in a 56-year-old male patient. The underlying disease was recurrent pyelonephritis secondary to renal calculi in both cases. The operative times were 221 min and 346 min, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1992

[Complications of Kock continent reservoir. Report of 103 cases].

We installed a Kock continent reservoir in 103 patients after radical cystectomy or pelvic exenteration between Feb. 1986 and Dec. 1989. They consisted of 81 male and 22 female patients. Patients' age ranged from 30 to 78 years with the average being 63 years. Their original diseases were bladder cancer (96 patients), prostatic cancer (2), sigmoid colon cancer (2) and others (3), The Kock reservoir was made by the procedure described by D. G. Skinner et al. The mean operation time for reservoir creation was 220 minutes. In 99 patients with a Kock reservoir for more than 3 months, the capacity of the reservoir was 200-900 ml with the average being 490 ml and the frequency of self-catheterization was 4 to 6 times a day. Early complications occurred within 3 months in 27 (26%) patients. Complications directly related to the reservoir were urine leakage (5 patients), intestine reservoir fistula formation (3) and necrosis of the reservoir (1). Late complications occurred after 3 months in 25 (25%) patients. They consisted of difficulty of catheterization (9 patients), ureteral reflux from reservoir (2), hydronephrosis (8), abscess (4), metabolic acidosis (2) and others. The results indicated that this procedure is an appropriate urinary diversion since the quality of life in the patients with a Kock reservoir is better. However, after this procedure surgical complications were not infrequent. Therefore, this procedure should be performed in selected patients.

Adult↗
PubMed1992

[A case of testicular tumor arising in the undescended testis].

A 42-year-old man with testicular tumor arising in the left undescended testis is reported. The patient had bilateral cryptorchidism and was admitted to our clinic on March 20, 1989, complaining of a mass in the lower abdomen. Colography indicated complete obstruction at the sigmoid colon, and computed tomography showed a larger mass in the lower abdomen and paraaortic lymph node swelling, as well as left hydronephrosis. We suspected that a testicular tumor had arisen in the undescended testis, and ileus was caused by the tumor mass. Since the patient was in a poor condition from preexisting ileus, chemotherapy consisting of cisplatin, bleomycin and vinblastine (PVB regimen) was immediately started without confirming the histology. After two courses of PVB regimen, bilateral orchiectomy, retroperitoneal lymphadenectomy, and left nephrectomy were performed. Pathological examination of the testis and resected lymph nodes revealed no residual tumor cells, and we could not identify the original histology. Additionally, two courses of chemotherapy were performed after surgery. The patient is well without evidence of disease one year and ten months after surgery.

Adult↗
PubMed1991

[Extracorporeal shock wave lithotripsy monotherapy in the treatment of staghorn calculi].

From October, 1987 to September, 1989, 53 staghorn calculi of 51 patients underwent extracorporeal shock wave lithotripsy (ESWL) monotherapy by using Dornier HM3 lithotriptor. All patients were treated with double J stenting preoperatively. Mean number of shock waves was 6092 and mean number of sessions was 2.1. In 52 out of 53 kidneys (98%), the stones were disintegrated completely. Complete removal of the stone were observed in 29 kidneys (55%) 3 months after the last ESWL treatment. Complications consisted of fever attack (more than 38 degrees C) (26 patients), ileus (2), subcapsular hematoma (2) and gastrointestinal hemorrhage (1). They could be conservatively treated except one case with percutaneous nephrostomy. Supplementary procedures for the stone street were necessary in 23 patients. They consisted of ESWL (16 patients) and transuretheral lithotripsy (7). The indication of this procedure for the treatment of staghorn calculi was also discussed.

Adult↗
PubMed1991

[Extracorporeal shock wave lithotripsy using Dornier modified HM3 lithotripter comparison with the results by Dornier HM3 lithotripter].

Ninety-four kidneys with renal stones less than or equal to 20 mm in diameter were treated by extracorporeal shock wave litotripsy (ESWL) using a Dornier modified HM3 lithotripter and the results were compared with those of 98 kidneys with similar size stones treated with a Dornier HM3 lithotripter. The Dornier modified HM3 lithotripter is equipped with a new type of shock wave generator with a reduced capacity for 30% less pressure peakes at the same voltage. It has an enlarged ellipsoid leading to a smaller focus and a reduced pressure per area at the shock wave entry into the skin. All treatments of modified HM3 litotripter series were performed under only intravenous analgosedation, without epidural anesthesia. The number of shock waves in the modified HM3 series ranged 900 to 6000, with the mean values of 2863 +/- 1234, which was 1.55 times as that in the Dornier HM3 series. Complete disintegration was achieved in 94 of 94 modified HM3 series kidneys and 98 of 98 kidneys of HM3 series. Complete removal of the stone was done at 72.6% in the modified HM3 series and at 70.4% in the HM3 series 3 months after ESWL. There were no severe complications in both modified HM3 series and HM3 series. Renal damage caused by ESWL was monitored by the level of urinary enzyme, N-acetyl-beta-glucosaminidase (NAG) and beta 2 microglobulin (beta 2MG) and the level of urinary protein. The levels of NAG, beta 2MG and urinary protein in the HM3 series were higher than those of the modified HM3 series.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Statistical analysis of tumors of the renal pelvis and the ureter--determinants of prognostic significance].

Sixty-two patients with epithelial tumors of the renal pelvis and the ureter were studied with respect to 16 clinicopathological factors and their relationship to the patients survival. The cumulative survival curves are depicted by the Kaplan-Meier method and the statistical difference in the survival rates were detected in 11 factors, age, tumor number, multicentricity, tumor size, histological tumor type, stage, grade, growth pattern, infiltration pattern, lymphatic invasion and venous invasion. Cox's proportional hazard model was applied to evaluate the contribution of these 11 factors to survival. With the univariate analysis, lymphatic invasion showed the greatest hazard ratio followed by growth pattern, stage, venous invasion, age, and grade in this order. Stepwise selection of these factors based on the relative magnitude of their contribution to the survival with Cox's proportional hazard model revealed the most important factor for survival as the lymphatic invasion (hazard ratio 5.29), followed by growth pattern (hazard ratio 2.89). In conclusion, patients with tumor lymphatic invasion and tumor of non-papillary growth pattern showed poor prognosis, and adjuvant chemotherapy should be performed on them to improve their survival.

Adult↗
PubMed1991

[Bladder replacement by entero-cystoplasty after radical cystectomy for bladder cancer--the urethral Kock pouch].

From September 1989 to March 1990, 6 male patients with invasive bladder cancer, 49 to 70 years old in age, underwent bladder replacement with the ileum (the urethral Kock pouch) after radical cystectomy. Follow up ranged between 3 and 9 months. Urodynamic evaluation showed the ileal bladder to be a low pressure reservoir with a capacity that increased to more than 250 ml. The ileal bladder was emptied by straining without significant residual urine in all patients except one who was performing intermittent self-catheterization. All patients were continent in the daytime. However, all patients required pads at night because of occasional loss of a little urine. Excretory urograms revealed excellent upper tract function. The procedure is suitable whenever the urethra can be preserved after cystectomy for cancer.

Adenocarcinoma↗