Recent advances in the molecular genetics of urogenital tumors.
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Disease Progression↗
Biomedical subjects
O Yoshida
Publications and source records attributed to O Yoshida.
In vitro enhancement of natural killer cell activity by BCG and the antagonistic inhibition of the susceptibility of K562 cells to lysis by peripheral blood lymphocytes in patients with urinary bladder tumor.
The effect of bacillus Calmette-Guerin (BCG) on the natural killer (NK) activity of peripheral blood lymphocytes (PBL) and the susceptibility of K562 cells to lysis by PBL in patients with urinary bladder tumors (UBT) was evaluated using a 4-h 51Cr release assay. The addition of BCG 0.1-1 mg/ml to the assay increased NK activity. In contrast, BCG at higher concentrations (10 mg/ml) reduced NK activity. This effect of BCG was also observed in healthy donors. Pretreatment of PBL with BCG 0.1-1 mg/ml also resulted in increased NK activity, while higher concentrations of BCG depressed it. Treatment of K562 cells with BCG 1-10 mg/ml for 3 hours reduced their susceptibility to lysis by PBL. Kinetic studies showed that the reduced susceptibility became apparent 3 hours after initiation of culture of K562 cells with BCG and lasted 12 hours. The susceptibility of BCG-treated K562 cells to lysis by purified NK cells and lymphokine activated killer (LAK) cells was also reduced. Both live and dead BCG exerted an inhibitory effect on the target cells. The effector-to-target binding assay demonstrated that treatment with BCG reduced the number of PBL conjugates with K562 cells. These results indicate that BCG increases the NK activity of PBL, while rendering K562 cells resistant to PBL lysis by inhibiting the effector-to-target binding. BCG at lower concentrations (0.1-1 mg/ml) may be useful in patients with UBT. The possible mechanisms responsible for the effects of BCG on K562 cells and their possible clinical implications are discussed.
Aged↗
Laparoscopic varicocelectomy: invasiveness and effectiveness compared with conventional open retroperitoneal high ligation.
The invasiveness of laparoscopic varicocelectomy and open retroperitoneal high ligation of the internal spermatic veins were compared and the surgical effects on fertility of these two procedures determined. 48 of 97 men diagnosed with varicocele testis underwent laparoscopic varicocelectomy, while the remaining 49 underwent open retroperitoneal high ligation of the internal spermatic vessels. Operating time, number of post-operative days to walking, length of hospital stay and analgesic use were measured as peri-operative indicators of invasiveness. In addition, seminal parameters were determined in order to evaluate the effects of these procedures on fertility. The operating time required for laparoscopic surgery was significantly longer than that for open surgery (96.6 vs 78.1 min., p = 0.0078). The patients in the laparoscopic surgery group began walking earlier post-operatively than did those who underwent open high ligation (0.97 vs 1.42 days, p = 0.00037). Length of hospital stay for the laparoscopic patients was shorter than for the open surgery group (7.05 vs 9.55 days, p = 0.00001). There were no statistical differences between the groups in terms of semen quality or improvement in the post-operative rate of pregnancy of partners. These findings indicate that laparoscopic varicocelectomy is associated with a shorter period of convalescence than open high ligation of the internal spermatic vessels.
Adolescent↗
Clinical experience with yolk sac tumors and teratoma in children.
Between 1971 and 1993, 12 children with testicular germ cell tumors were treated at the Department of Urology, Faculty of Medicine, Kyoto University. Seven patients had yolk sac tumors and 5 had mature teratoma. Of the 7 patients with yolk sac tumors 6 had stage I and 1 had stage III tumors. Initial management of the stage I tumors consisted of high orchiectomy in 5 patients and high orchiectomy plus retroperitoneal lymph node dissection in 1 patient. Of these 6 patients, 4 were cured by surgery alone but lung metastases developed in the other 2 patients. One of them was salvaged with thoracotomy and chemotherapy but the other died of tumor. The patient with stage III tumor had bulky tumor spread to lung and retroperitoneum, but seems to have been cured by chemotherapy followed by resection of the residual mass although follow-up is still inadequate (14 months). Six of the 7 patients (85.7%) are alive 13 months to 21 years after diagnosis. Five patients with mature teratoma were treated by high orchiectomy or, more recently, enucleation and all are alive 4 months to 22 years after surgery.
Adolescent↗
Survival and prognostic factors associated with metastatic nonseminomatous testicular and extragonadal germ cell tumors.
To assess prognostic factors in patients with metastatic nonseminomatous germ cell tumors, 50 patients with testicular germ cell tumors (TGCT) and 10 patients with extragonadal germ cell tumors (EGGCT) were studied. The clinical staging system for testicular tumors proposed by The Japanese Urological Association and The Japanese Pathological Society was applied. All patients with EGGCT had primary sites in the retroperitoneum. The 3-year survival rates of TGCT and EGGCT were 71.9% and 60.0%, respectively, and there were no differences in patient characteristics. Patients had significantly worse survival rates if the following applied: choriocarcinoma in the primary tumors, serum lactate dehydrogenase level greater than twice the upper limit of normal, liver, brain, or mediastinal metastases, or retroperitoneal tumors greater than 10 cm. It was concluded that the poor-risk group could be defined as those patients having lymph nodal disease only (stage II or III A) with retroperitoneal tumors greater than 10 cm, having pulmonary disease (stage III B) with retroperitoneal tumors greater than 5 cm, or liver, bone or brain metastases (stage III C), and these criteria will predict the prognosis for patients with advanced disease because the good-risk patients (53% of all patients) and poor-risk patients (47%) in this study had 3-year survival rates of 88.7% and 49.7% (p < 0.0001), and complete response rates of 96.9% and 60.7% (p < 0.005), respectively.
Adolescent↗
Evolving experience with continent urinary diversion using the Indiana pouch.
The Indiana continent urinary reservoir procedure for urinary diversion was performed in 46 patients. After the first 8 cases several modifications were made to the Indiana pouch. These modifications include complete detubularization of the colonic segment, construction of the pouch augmented with a U-shaped patch of ileum and, more recently, the use of stapled plication. The mean postoperative follow-up period was 46 mo (range 4.5-74.1 mo). There was 1 perioperative death and this case was excluded from the follow-up study. Late complications related to the urinary reservoir occurred in 12 (26.7%) of the 45 patients. Stone formation was observed in 5 patients. Out of 45 patients, 42 achieved complete urinary continence while 2 suffered mild nocturnal incontinence and 1 had significant leakage. Three had unilateral hydronephrosis due to ureteroanastomotic stricture. Reservoirgraphy demonstrated no reflux into the upper urinary tract in all of the follow-up cases. Loopography of the efferent limb showed that a staple-plicated ileum functions better than a suture-plicated one in terms of reliability of the continence mechanism and ease of catheterization. The Indiana pouch should be considered for any patient requiring cutaneous urinary diversion because it is technically easy to perform and it has a low revision and high continence rate.
Adult↗
Transurethral microwave thermotherapy for benign prostatic hyperplasia: patient characteristics in good and poor responders.
Transurethral microwave thermotherapy (TUMT) has been shown to produce a clinical benefit in patients with symptomatic benign prostatic hyperplasia. In order to identify the features of the ideal candidate, a retrospective analysis was conducted in 32 patients who were followed for 2 mo or more. Good responders (GR) were defined as having their Siroky peak flow rate (PFR) standard deviation (SD) increase by < 0.5 or a decrease in the International Prostatic Symptom Score (I-PSS) of > 10 (22 patients). Poor responders (PR) were defined as having their PFR SD increase by < or = 0.5 and their I-PSS decrease by < or = 10 (10 patients). The prostate volume, pre-TUMT I-PSS and intravesical opening pressure were significantly greater in the GR group, while there were no significant differences between the 2 groups for the other baseline patient characteristics: age, prostate length, PFR, PFR SD, post-voiding residual volume and quality of life. Concerning the operational parameters, significantly more total energy was delivered to the prostate in the GR group (mean 131 kJ) than in the PR group (mean 101 kJ). Moreover, the 7 patients with anti-androgen therapy pre-TUMT received less total energy and 5 of the 7 were poor responders. These results suggest that patients with apparent obstructive symptoms and with moderate enlargement of prostate could benefit more from this less invasive therapy. Clinical response seems to be dose-dependent and patients with a history of recent anti-androgen treatment may have a less favorable response.(ABSTRACT TRUNCATED AT 250 WORDS)
Allylestrenol↗
Urinary bacteriology of continent urinary reservoirs and calculus formation.
In order to investigate urinary bacteriology in relation to calculus formation in continent urinary reservoirs, a retrospective study was conducted of 19 patients with the Kock pouch and 23 patients with the Indiana pouch. Analysis of a total of 151 urine cultures showed that asymptomatic bacteria (any bacterial count) were present in 92% of urines from the Kock pouch and 74% from the Indiana pouch. The incidence of organisms and total bacterial counts were similar for both pouches. The most prevalent organisms were Escherichia coli, Pseudomonas sp., Klebsiella sp., Proteus sp., Enterobacter sp., and Enterococcus sp. Urinary calculi developed in 42% of the Kock pouch patients and 13% of the Indiana pouch patients. More than half of the patients had multiple stone recurrence. Infectious stones developed in 32% of the Kock pouch patients, usually on the foreign materials, and 9% of the Indiana pouch patients. In general, no clear relationship was established between urinary bacteriology and calculus formation although Proteus sp. or Providencia sp. was determined to be the causative organism in some infectious stones. Furthermore, metabolic stones developed in 32% of the Kock pouch patients and 9% of the Indiana pouch patients. Because calcium phosphate was a constituent of 80% of the metabolic stones, the presence of urinary factors promoting calculus formation was suspected.
Humans↗
Intra-arterial infusion chemotherapy in combination with a biscoclaurine alkaloid, Cepharanthin, to treat bone metastasis arising from renal cell carcinoma.
A 64-year-old man with iliac bone metastasis from left renal cell carcinoma was treated by intra-arterial infusion chemotherapy using vinblastine and epirubicine in combination with a biscoclaurine alkaloid, Cepharanthin. A good response was confirmed by computed tomography scan and the symptoms related to the metastatic lesion were much improved. Partial resection of the left iliac bone was performed when no viable cancer cells were found in the metastatic lesion.
Alkaloids↗
Microsurgical epididymovasostomy for obstructive azoospermia: factors affecting postoperative fertility.
Azoospermia due to epididymal obstruction can be treated by microsurgical epididymovasostomy with high patency rates. Twenty-four azoospermic patients with epididymal obstruction due to a variety of causes underwent 26 microsurgical epididymovasostomies. The overall patency rate following surgery was 80.8% and impregnation was achieved by 10 patients (41.7%). Factors affecting the postoperative impregnation rate were etiology and duration of obstruction. Patients with an obstruction for < or = 15 years, caused by epididymitis or post-vasectomy epididymal blow-out, achieved a higher impregnation rate than the others (8 of 9 vs. 2 of 11, p = 0.0019). The motility of epididymal sperm or the presence of serum antisperm antibodies had no apparent effect on postoperative fertility. Microsurgical epididymovasostomy is particularly effective in patients with epididymitis or vasectomy patients with a short-term obstruction.
Adult↗
[Study of clinical usefulness of an antiandrogen, TZP-4238, as a drug for treatment of benign prostatic hypertrophy--its influence on sexual function].
Using chlormadinone acetate (CMA) as the control drug, a double-blind study was carried out to examine not only the effects of 17 alpha-acetoxy-6-chloro-2-oxa-4,6-pregnadiene-3,20-dione (TZP-4238;) on subjective urinary symptoms but also, especially, that on the sexual function in patients with benign prostatic hypertrophy (BPH). The clinical efficacy rate in relation to the subjective urinary symptoms was about the same in the two treatment groups; 45.9% in the TZP-4238 group and 50.0% in the CMA group. However, the incidence of adverse effects on the sexual function showed a marked difference between the two groups. The TZP-4238 group revealed a lower suppressive effect on the function than the CMA group (45.1% vs. 71.4%). In relation to their causation of other adverse effects, there were no differences between the two drugs. Accordingly, in consideration of the facts that TZP-4238 with less influence on the sexual function affords a superior quality of life to elderly patients, while achieving effective treatment by means of a convenient single daily administration, TZP-4238 was surmised to be a more useful drug than CMA as an antiandrogen for the treatment of BPH.
Aged↗
Role of molybdenum in chronic hemodialysis patients.
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Blood Proteins↗
[Prune belly syndrome with atresia ani and urethral stricture: a case report].
A case of prune belly syndrome associated with urethral stricture and atresia ani is reported. Cystostomy and colostomy were performed on his birthday. Cutaneous vesicostomy, bilateral ureterocystoneoplasty and proctoplasty were performed when the patient was one year old, and urethrotomy was performed when he was four years old. He was closely followed for six years and six months, and had developed without any serious episodes. We collected 128 cases of prune belly syndrome from the Japanese literature including this, and made a brief discussion of this syndrome with urethral stricture and atresia ani.
Anal Canal↗
[Endoscopic stone disintegration using the Lithoclast].
We present our experience with a new and unique device for performing intracorporeal lithotripsy known as the Swiss Lithoclast. This simple device uses compressed air to activate a solid probe in a manner of a jackhammer. This device was used to treat 20 patients with stones in the ureter (11), bladder (5) or a Kock pouch (4). The Lithoclast successfully fragmented 90% of the calculi independent of the composition and salvaged 2 failed ESWL treatments. At one month after the procedure, either alone or in combination of with ESWL, 17 of 20 patients became free of stones. There were no complications related to use of the device. We have found the Swiss Lithoclast to be a safe and effective means of performing intracorporeal lithotripsy for urinary calculi.
Adult↗
[Prenatally diagnosed bilateral multicystic dysplastic kidneys associated with multiple anomalies: a case report].
A case of bilateral multicystic dysplastic kidneys with multiple anomalies is reported. Prenatal ultrasonography showed oligohydramnios, atrial septal defect, bilateral multicystic kidneys, omphalocele, and bowel dilatation. A male baby died of respiratory insufficiency immediately after premature delivery. Autopsy showed multiple anomalies of face, fingers, lung, heart, bowels, and genitourinary tract. Seven more cases with urinary tract anomalies prenatally detected by ultrasonography are also reported. Ultrasonography is useful to diagnose anomalies of fetus.
Abnormalities, Multiple↗
[Management of voiding dysfunction in elderly patients: effectiveness of rehabilitation and familial care].
We examined whether the improvement of impaired mobility correlates with the success rate in achievement of catheter-free or diaper-free status of 260 hospitalized elderly patients whose activities in daily life (ADL) were impaired and urinary tract dysfunctions including urinary incontinence were managed by indwelling catheters or diapers. The contribution of physical rehabilitation and/or care given by family to the improvement of impaired mobility was also investigated. All 154 patients whose ADL improved during the course of the treatment acquired the catheter-free or diaper-free status. Of 106 patients whose ADL did not improve, 85 patients became free of catheters or diapers. All of the remaining 19 patients who continued to be dependent upon catheter or diapers had been bed-ridden during the course of the treatment. Among 201 patients who were bed-ridden before the treatment, the success rate in the improvement of impaired ADL in 84 patients who underwent physical rehabilitation and received care given by family, was 83%. The ADL improved in 71% of the 70 who received rehabilitation and 53% of 17 bed-ridden patients who received familial care. By contrast, only 2 out of 30 patients who received neither of them were free from the bed-ridden condition. The remaining 28 patients continued to be bed-ridden, and the 19 cases who were not free of indwelling catheters or diapers were a part of this population of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Activities of Daily Living↗
[Management of voiding dysfunction in elderly patients: prognosis 1 year after discharge from hospital].
We investigated how 293 elderly patients who had been successfully treated to be free of catheters or diapers managed to urinate one year after their discharge from our hospital. Of 192 patients who returned to their own home 154 (80%) had good activities in daily life (ADL), and of 101 who moved to a nursing home or other hospital only 7 (7%) had good ADL. Among the 192 in their own home, 151 (79%) remained free of catheters or diapers thanks to the home care services provided by trained nurses belonging to our hospital. However, among the 101 at other facilities 21 (21%) could avoid these appliances. Furthermore, those who stayed in their own home with poor ADL had a significantly higher rate of being independent of catheters or diapers (34%) compared to those who lived in facilities other than their home with poor ADL (13%). These findings indicate that the elderly patients who reside in their own home or have good ADL possess a better chance of avoiding catheters or diapers compared to those who live in other than their residence or have poor ADL, and that continued urological care coupled with the home-visiting services is effective and important in attaining these aims.
Activities of Daily Living↗
[Study on E-cadherin expression in relation to invasion and metastasis in urothelial cancer patients].
E-cadherin expression was investigated in 30 patients with urothelial cancer (bladder; 27, ureter; 2, urethra; 1) by an immunohistochemical method. Twelve out of 22 patients with strong and homogeneous expression of E-cadherin (preserved) had grade 1 tumors, while all 8 patients with heterogeneous, weak and homogeneous, or lost expression of E-cadherin (reduced) had grade 2 or grade 3 tumors. Only 2 out of 22 patients with preserved expression had invasive tumors (> or = pT2), whereas 6 out of 8 patients with reduced expression had invasive tumors (p = 0.002). Three out of 4 patients with metastasis had reduced expression and 2 of them died. These findings suggest that urothelial tumors with reduced expression of E-cadherin have high grade and high stage, and E-cadherin expression could be one of the prognostic factors.
Aged↗