Biomedical subjects
O Yoshida
Publications and source records attributed to O Yoshida.
[Renal or perirenal malignant lymphoma: report of three cases].
We report three cases of renal or perirenal malignant lymphoma. The patients were a 69-year-old woman presenting with lumbago, a 43-year-old man with fever and erythema, and a 69-year-old woman with general malaise. In each case, renal or perirenal tumor was discovered by abdominal ultrasound. Biopsy and microscopic examination revealed the diagnosis of non-Hodgkin's malignant lymphoma. The computerized tomography patterns of the cases were different from each other; "direct invasion" in the first case, "solitary nodule" in the second case, and "engulfment" in the third case. Chemotherapy and/or radiation therapy were performed. Only the third case is still alive at present. The computerized tomography pattern of renal or perirenal malignant lymphoma was classified into five groups; I) multiple nodules, II) solitary nodule, III) engulfment, IV) direct invasion, V) diffuse infiltration. This classification should be useful in making an accurate and early diagnosis.
Role of phosphate in experimental uraemia.
Serum, corpuscular and renal tissue phosphate (Pi) concentrations in normal and chronic renal failure rats were examined. A significant correlation was found between Pi levels and indications of renal function. In addition, there were significant relationships between phosphate levels and RBC, Hb, Hct, serum Fe, serum Al, serum Si concentrations, as well as between Pi levels, Ca levels and calcium phosphate products. These results show that Pi may be used as an indicator of renal function in uraemia, anaemia and renal calcification in uraemic state. Studies in humans to confirm these relationships would be appropriate.
Laparoscopic varicocelectomy.
Laparoscopic procedures are useful techniques for minimally invasive surgery in Urology. Varicocelectomy is also performed laparoscopically with less postoperative pain and shorter convalescence when compared to the open retroperitoneal approach. Details of the technique of laparoscopic varicocelectomy are presented and the advantages and disadvantages of the procedures are discussed. From the variety of treatment modalities, the most effective and the least invasive technique should be selected to treat varicocele testis.
[Hormonotherapy for prostate cancer].
Since the report by Dr. Huggins, the Nobel prize winner, hormonotherapy has been a predominant treatment modality for prostate cancer for decades around the world because of its anti-cancer effect and simplicity. In the 1960's, the Veterans Administration Co-operative Urological Research Group (VA CURG) in the U.S.A. claimed that synthetic estrogen had significant adverse effects such as cardio-vascular complications, which dissipated the merits of estrogen. They reported that a group of prostate cancer patients who underwent estrogen therapy showed the same survival as a no treatment group. The normal prostate gland is dependent on androgen for its development, growth and function as well as prostate cancer. Ninety to 95% of androgens are synthesized in testicular Leydig cells under the control of the pituitary-gonadal axis, and the remaining androgens come from the adrenal glands. At any point along the axis from the hypothalamus to the prostate cell nuclei, androgen action on the prostate gland can be inhibited. Castration eliminates Leydig cells and estrogen reduces the serum testosterone level by negative feedback to the pituitary gland. Because of the significant side effects of estrogen and the mental injury brought about by castration, LH-RH analogue could have received great popularity. But impotence is still a major consequence of this drug. For less invasive and more economical treatment modalities for prostate cancer, effective anti-androgenic drugs which do not cause impotence must be developed. And the mechanism of androgen independence must be elucidated to obtain a more effective and complete hormonotherapy for prostate cancer.
[Ureteral obstruction caused by aneurysm of iliac artery].
A 76-year-old man was referred to our hospital because of right hydronephrosis. A retrograde pyelogram showed obstruction of the right ureter at the level where it was crossed by the common iliac artery. A computerized tomography scan demonstrated an encased right ureter and aneurysm of right common iliac artery. Arteriography revealed aneurysm of right common iliac artery. An aorto-iliac graft bypass and ureterolysis were performed with intra-peritoneal displacement of the right ureter. The diagnostic procedures and treatment modalities for ureteral obstruction caused by aneurysm are discussed.
[Treatments of staghorn calculi].
The treatment of staghorn calculi is still difficult even though urolithiasis treatment can now be performed by endourology and extracorporeal shock-wave lithotripsy (ESWL) without open surgery. Because of the variety in volume and pattern of the staghorn calculi, especially with or without dilated renal pelvis and calyces, selection of treatment methods is important. The combined method of percutaneous nephrolithotomy (PNL) and ESWL has been highly effective in the complete removal of most staghorn calculi. Developments of the ESWL instrument and tools have increased the success of less invasive ESWL monotherapy with placing of stent or percutaneous nephrostomy for staghorn calculi with nondilated calyces. Also the treatment methods should be selected depending upon the components of the staghorn calculi. Dissolution and solidity, which are affected by the components, are also important factors. Complete removal of staghorn calculi is very difficult, and almost impossible to be performed in only one occasion including other surgical procedures as a series and this is the existing insurance provision. Therefore, we await the creation of a new insurance provision for the treatment of staghorn calculi.
[Treatment of staghorn calculi on the basis of composition and structure].
Most staghorn calculi are infection stones composed of struvite and/or carbonate apatite. Sometimes, cystine, uric acid, whewellite and brushite stones also assume a staghorn configuration when located in the kidney. It is very important in stone crushing to know the composition and architecture of the stones. Struvite stones show a concentric laminal structure and are fragile because of wide interstices of crystals and rich organic matrix. These stones usually contain many bacterial colonies in the interstices of crystals and bacteria break out of the stones when they are crushed. Therefore, perioperative administration of antibiotics is necessary for prevention of bacteremia and sepsis. Whewellite stones and uric acid stones have a smooth surface and reveal compact radial and laminal structure especially in the peripheral layer. They are very hard and are refractory to crushing, and the fragments are large. Cystine stones show a compact radial monomineral texture and are very hard. The fragments made by crushing are large. Therefore, combination therapy of stone crushing and irrigation of alkali solution may be useful for treatment of cystine stones as well as uric acid stones. Calcium phosphate stones, hydroxyapatite or brushite stones, are rare and are formed in hyperparathyroidism, Cushing syndrome and renal tubular acidosis. Hydroxyapatite stones are rich in matrix and fragile. Brushite stones reveal radiate structure and are hard. There is no general method of treatment for staghorn calculi but we should select the most reasonable method including open surgery for each case taking into consideration the stone composition, predisposing factors and possibility of stone residue and recurrence.
[Combination therapy of ESWL and PNL for the staghorn calculi].
We have been engaged in the treatment of urinary tract calculi using extracorporeal shockwave lithotripsy (ESWL) and endourology techniques for more than 8 years. In the treatment of thin staghorn calculi, ESWL monotherapy is the first choice. On the other hand, combination of percutaneous nephrolithotomy (PNL) and ESWL is important for the treatment of thick staghorn calculi in order to avoid the stone street and side effects of shock waves. When the stone is made of hard components such as calcium oxalate monohydrate and cystine, combination of both methods is also useful. In the case of complicated staghorn calculi with isolated branches, open surgery such as nephrolithotomy or partial nephrectomy might be the choice.
[Cancer immunotherapy by murine bladder cancer cells transfected with mouse interferon-gamma gene].
We established constitutively an interferon-gamma (IFN-gamma) producing cell line (MBT2/gamma) from a mouse bladder cancer cell line (MBT2) by retroviral transfer of a mouse IFN-gamma cDNA. Although the in vitro cell growth of these cells was unaffected by the IFN-gamma production, their subcutaneous tumor growth in syngeneic C3H/He mice was different; MBT2/gamma tumor growth was more strongly suppressed (3/20) than that of MBT2 (10/10). MBT2/gamma tumor growth was observed in nude mice (6/6). The mice immunized with MBT2/gamma were resistant to tumor growth of the parental cells (7/9; 77%), but permitted the growth of another kind of C3H/He tumor line. These findings indicate that the reduced tumorigenicity of the IFN-gamma producing line was due to the augmented specific antitumor immunity, probably as a result of the immunomodulatory effects of the IFN-gamma derived from the tumor.
[Circumvention of the multidrug-resistance in renal cancer by bisbenzylisoquinoline].
A bisbenzylisoquinoline alkaloid, cepharanthine, significantly enhanced vinblastine, adriamycin and etoposide sensitivities in P-glycoprotein positive renal cancer cells. However, it did not show any enhancing effect on cisplatin sensitivity. Four patients with metastatic renal cell carcinomas were treated with intraarterial chemotherapy using vinblastine and/or adriamycin in combination with cepharanthine for their metastatic lesions (3 bone and 1 contralateral kidney metastases). A partial response was observed in 1 patient with femoral bone metastasis and a minor response in 1 patient with lumbar bone metastasis, although they were also treated with interferons. No adverse effects associated with cepharanthine were seen except in one patient complaining of redness and burning sense of the skin probably due to its vaso-dilatation effect.
[A case of müellerian duct cyst with prostate cancer].
A case of müellerian duct cyst with prostate cancer is reported. The patient was a 64-year-old male, complaining of hemospermia. Prostate cancer was suspected by rectal examination and a cystic mass was detected between the ejaculatory ducts by computed tomography and magnetic resonance imaging. He underwent a transperineal needle aspiration of the cyst. The fluid did not contain spermatozoa. A adenocarcinoma was detected from the prostate by needle biopsy. Therefore, a radical prostatectomy with the resection of the cyst was performed. This is the first report about the resection of müellerian duct cyst with the organs around it in Japan.
[Anomalies of the upper urinary tract].
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[Statistical review of prostatic cancer].
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[Statistical review of testicular tumor].
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[Side effects of estrogen administration to prostatic cancer patients: clinical and statistical survey of 109 prostatic cancer cases of Kyoto University Hospital].
Since the introduction of hormonal treatment for prostatic cancer by Huggins and Hodges in 1941, severe side effects of synthetic estrogen, which have overcome its benefit, have been reported in the U.S.A. and in European countries. However, in Japan the adverse effects of estrogen have been reported to be milder than in western countries, and estrogen still has an important role in the treatment of prostatic cancer in Japan. In this communication, the side-effects of synthetic estrogen administered to 109 prostatic cancer patients, who were admitted to Kyoto University Hospital between 1980-1990 are reported. Fifty-three (48.6%) of the 109 patients suffered adverse side effects of the estrogen, specifically cardiac disease (20.2%), fluid retention (14.7%) and hypertension (13.8%). Five of these patients died. Among the risk factors analyzed, daily dose, past history of cardio-vascular disease and ECG abnormalities were significantly correlated with the appearance of adverse effects. The reasons why the frequency of lethal side-effects is lower in our cases compared to findings reported by the Veterans Administration group may be the lower daily dose and cessation of estrogen administration when mild adverse effects appear and some other unknown factors, although the background of the patients and method of analysis are not comparable among them. The overall frequency of side-effects in prostatic cancer patients administered estrogen in our cases is not necessarily lower than in western countries, but the severity of the side effects was milder in our cases. We must be a ware of the potential adverse effects of estrogen.
[Quality of life of the patients with continent urinary reservoir].
To improve the quality of life (QOL) of patients requiring urinary diversion, various surgical techniques including those employing a continent urinary reservoir (CUR), such as Kock pouch or Indiana pouch, and those using the conventional ileal conduit have been advocated. In this study we asked patients who had undergone a CUR operation to complete a questionnaire, consisting of 106 questions relating to the QOL during the disease-free period. A total of 81 questionnaires were sent out, and 60 (74.1%) CUR patients responded. The average age was 61 and the male to female ratio was 49 to 11. The time elapsed from the operation was 42 months. Twenty-nine questions addressed the patients physical condition and on the whole it was kept in good quality. Because they were unwilling to show their stoma, they were reluctant to bathe together with family members. However, 59% of them went to a public bathhouse (common in Japan). Other physical abilities related to exercise were not significantly hampered by this operation. Eighty per-cent of them were not bothered by having a stoma. Twenty four questions were related to social life. The operation had a bad influence in 20-30% of them concerning their interaction with friends and hobbies. Twenty two percent of the patients who had a job prior to the operation stopped working. Only a few patients abandoned travelling. Concerning their sex life (7 questions), males suffered impotence at a very high rate, but only 26% of the patients lost interest in sex. Symptoms related to the operation (41 questions) were mild. Overall, 94% of the patients would choose the same operation again if it were required.(ABSTRACT TRUNCATED AT 250 WORDS)
[Multifocal renal oncocytoma: a case report].
A case of multifocal renal oncocytoma in a 55-year-old man admitted for further examination following the detection of left renal tumors, is reported. Computerized tomographic (CT) scanning and magnetic resonance imaging (MRI) revealed 2 masses in the left kidney. A left radical nephrectomy was performed and two tumors were found. Both tumors were confirmed to be renal oncocytomas by light and electron microscopic examination. Including this patient, 42 cases of bilateral and multifocal renal oncocytoma have been reported in the literature to date. The clinical features of bilateral and multifocal renal oncocytomas are discussed accordingly.