Biomedical subjects

O Yoshida

Publications and source records attributed to O Yoshida.

At least 145 records · Page 8Linked to original sources

PubMed1996

Bulky transitional cell carcinoma of bladder with inverted proliferation.

Two women, aged 51 and 62 years, had unusual transitional cell carcinomas of the urinary bladder which were > 5 cm and had a structural resemblance to inverted papilloma or Brunn's nest. They were treated by bladder-preserving surgery with no evidence of recurrence after 30 and 103 months follow-up, respectively. Our cases show some hitherto unrecognized aspects of transitional cell carcinoma with inverted proliferation because the tumors are usually found in males and tend to be aggressive.

Carcinoma, Transitional Cell↗

PubMed1996

Management of late complications of continent urinary diversion using the Kock pouch and the Indiana pouch procedures.

BACKGROUND: Continent urinary diversion (CUD) is performed on patients after total cystourethrectomy due to invasive bladder cancer or other diseases requiring urinary diversion. Since 1984, we have performed CUD using either the Kock pouch procedure or a modified Indiana pouch method. During the long-term follow-up, increasing numbers of late complications occurred, especially after the Kock pouch procedure. We summarized the frequency of postoperative complications, their management, and outcome of CUD using these 2 methods. METHODS: Between 1984 and 1995, CUD using the Kock pouch method was performed on 102 patients, and on 61 patients using the Indiana pouch method, with a mean follow-up period of 83 and 50 months, respectively. The patients were between 24 and 82 years old, with a mean age of 59 years. In most patients, the Kock pouch was constructed according to the original method, except for the use of a Dacron fabric collar, and the Indiana pouch was made using the ileal patch method. RESULTS: Of 95 patients followed up for more than 3 months after CUD using the Kock pouch method, efferent and afferent nipple valve malfunction occurred in 21 (22%) and 26 (27%) patients, respectively. Efferent complications occurred during the first year after surgery, whereas afferent complications occurred several years after surgery. Open repair surgery (excluding ileus) was necessary for 36 (38%) patients. Of 59 patients followed for more than 3 months after CUD using the Indiana pouch method, 7 patients with stomal stenosis, 2 patients with stomal prolapse, and 1 patient with stricture at the ureterocolonic anastomosis were treated surgically. An hourglass-like deformity of the pouch was seen in 2 patients, on whom the original Indiana pouch method was performed. As a whole, 13 patients (22%) were retreated with open surgery. Urinary calculi occurred in 42 (44%) patients after CUD using the Kock pouch method and in 11 patients (19%) using the Indiana pouch method. The outcome was excellent, good, fair, and poor in 31, 37, 24, and 8% of the patients after CUD using the Kock pouch method, and in 36, 17, 42, and 5% of the patients after CUD using the Indiana pouch method. CONCLUSIONS: We performed CUD using either the Kock pouch or the Indiana pouch method with a success rate of approximately 90%. The rates of revision, reoperation and stone formation were higher with the Kock pouch procedure than with the Indiana pouch procedure, while varying degrees of incomplete incontinence and difficulty in catheterization were seen more often in the latter.

Adult↗

PubMed1996

Radical prostatectomy for clinically localized prostate cancer: local tumor extension and prognosis.

BACKGROUND: This study was performed to evaluate the frequency of local tumor extension and its effect on disease progression after radical prostatectomy. METHODS: The study consisted of 66 consecutive men who underwent radical prostatectomy for clinically localized prostate cancer without any prior hormonal therapy. Cases were stratified according to pathologic findings. Sites of capsular penetration were also evaluated. RESULTS: The overall incidences of lymph node metastases, seminal vesicle invasion, capsular penetration, and positive surgical margin were, respectively, 23%, 32%, 55% and 35%. The disease progression rate in patients with positive lymph nodes differed significantly from that in those without nodal metastases (P < 0.0001). Although seminal vesicle invasion, capsular penetration, or positive surgical margin had an adverse effect on prognosis, the difference in progression missed statistical significance, when patients with positive lymph node metastases were excluded. The most common site of capsular penetration was posterolateral, in the area of the neurovascular bundle. CONCLUSIONS: Extraglandular tumor extension and positive surgical margins are common features of radical prostatectomy specimens. A nerve-sparing operation should be performed selectively and with great caution. The markedly adverse effect of lymph node involvement on progression must be accounted for when evaluating other variables relating to progression.

Aged↗

PubMed1996

Pyogenic vertebral osteomyelitis after acute bacterial prostatitis: a case report.

A case of pyogenic vertebral osteomyelitis after acute bacterial prostatitis in a 78-year-old man is reported. The rarity and subtle clinical presentation of this condition, and the delayed appearance of radiologic signs of progression to destructive osteomyelitis, contributed to a significant delay in diagnosis. An arterial blood culture positive for bacterial growth during the episode of acute prostatitis suggested that bacteremia might result from hematogenous spread of the infection to the vertebral column via the venous system. Since intensive antimicrobial therapy proved ineffective, debridement of the first and second lumbar vertebral bodies, and anterior spinal fusion from the twelfth thoracic to the third lumbar vertebrae were performed. The patient's high fever and severe lumbago subsided immediately after the surgery. The possibility of development to pyogenic vertebral osteomyelitis should be kept in mind when treating a serious genitourinary tract infection.

Acute Disease↗

PubMed1996

Effect of surgical stress on immune function in patients with urologic cancer.

BACKGROUND: To determine the immunosuppressive effect of surgery for urologic cancers, multiple variables of immune function were measured serially before and after operation in patients with urologic cancer. METHODS: Peripheral blood was obtained before operation and at postoperative day 7 and 14 from 20 patients with bladder cancer, renal pelvic, or ureteral cancer, or renal cell carcinoma. RESULTS: In patients with bladder cancer who were undergoing radical cystectomy with use of intestine for urinary diversion, the serum level of immunosuppressive acidic protein (IAP) increased, and serum levels of immunoglobulin (Ig)A, IgG, and IgM decreased after operation. In contrast, the number of CD25+ lymphocytes significantly increased. Transurethral resection of bladder cancer also resulted in an increase in serum IAP level, however, the number of CD4+ and human leukocyte-associated HLA-DR+ lymphocytes increased. In patients with renal pelvic or ureteral cancer undergoing nephroureterectomy with cuff, the level of serum IAP increased and serum IgG level decreased after operation. By contrast, the number of CD3+ lymphocytes increased. In patients with renal cell carcinoma, radical nephrectomy led to a significant increase in the number of CD8+ lymphocytes. CONCLUSIONS: These findings suggest that surgical stress in patients with urologic cancer may result in both suppression and stimulation of host immunity.

Adult↗

PubMed1996

Pros-Eight transurethral radiofrequency thermotherapy for benign prostatic hyperplasia: preliminary clinical results.

BACKGROUND: We have developed a new transurethral thermotherapy device using 8MHz radiofrequency (RF) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH). We report the safety and effectiveness of the initial clinical experience with this device. METHODS: Sixty patients with symptomatic BPH were subjected to a single 1-hour treatment under local anesthesia. The treatment device uses extracorporeal RF capacitive heating in combination with radiative heating and conductive cooling of the urethra. RESULTS: In the 49 patients evaluable at 3 months, the mean International Prostate Symptom Score decreased from 17.8 to 13.1 (P < 0.0001) and the Quality of Life score decreased from 4.4 to 3.4 (P < 0.0005). Maximum flow rate increased from 8.1 to 9.7 mL/s (P < 0.05) at 3 months. Overall effectiveness by Homma's response criteria was as follows; excellent 4.1%, good 10.2%, fair 38.8% and poor 46.9%. Side effects were minimal. Gross hematuria was seen in 3 patients and erosion of the external urethral meatus was seen in 2 patients, but none had urinary retention. CONCLUSIONS: In this initial clinical trial, transurethral RF thermotherapy was safe and resulted in modest symptomatic improvement. Further investigations for optimizing the treatment protocol seem warranted.

Aged↗

PubMed1996

Persistent bacteriuria caused by uropathogenic Escherichia coli.

The predominant strain of Escherichia coli, the most frequently associated causative agent of urinary tract infections (UTI), in the rectal flora of patients with UTI has been reported to match the strain associated with the etiologic agent of UTI. Since acquisition of UTI may depend on the immediate surrounding flora of the patient, the chromosomal DNAs of strains of E. coli isolated from 3 patients suffering from recurrent cystitis and asymptomatic bacteriuria were examined by multiple polymerase chain reaction using 6 sets of primers for all the known urovirulence factors and by pulsed-filed gel electrophoresis. Genetically identical or similar strains were continuously isolated from these patients and each strain carried the identical urovirulence factors. The findings strongly supported the previous notion that the acquisition of UTI is dependent upon the occurrence of the strain carrying the urovirulence factors in patients or in the environment.

Adult↗

PubMed1996

A heterogeneous pattern of progression in endocrine-treated patients with prostate cancer.

Prostatic carcinoma often shows different behavior in the primary site than in the metastases after endocrine treatment. The pattern of disease progression was evaluated in prostate cancer patients. Two hundred and sixty consecutive patients were observed following the initiation of endocrine treatment (11 patients with stage T1 disease, 42 with stage T2 70 with stage T3, 11 with N + M0 and 126 with stage M1 disease). Of the 117 patients whose disease progressed, 100 could be evaluated in terms of the pattern of disease progression. Twenty-two (64.7%) of the 34 patients with stage T1-3N0M0 showed a pattern of local progression. On the other hand, 56 (84.8%) of the 66 patients with stage N + or M1 experienced a pattern of distant progression. Patients with only distant progression numbered 36 cases and patients with local progression and distant progression numbered 20 cases. Most of the distant progressions appeared in bone site. Local progression was observed in only 30 (45.5%) patients with stage N + or M1 disease. In patients with localized disease (T1-3N0M0), both the interval to disease progression and the time to cancer death from the start of disease progression were significantly longer than those of patients with stage N + or M1. However, once bone metastasis occurred, the disease tended to progress rapidly. There was no significant difference between the interval to cancer death after the appearance of bone metastasis in patients with initially localized stages (T1-3N0M0) and the time to cancer death after disease progression in patients with metastatic disease (N + or M1). The study shows a heterogenous behavior of the prostatic tumor after endocrine treatment. This suggests that metastases and primary tumor have different clonal compositions. The study also supports the idea that there is a preferential environment for the growth of prostatic carcinoma cells in bone sites.

Aged↗

PubMed1996

Urinary calculi as a late complication of the Indiana continent urinary diversion: comparison with the Kock pouch procedure.

PURPOSE: Although urinary calculi have been frequent late complications of the Kock continent urinary diversion, they have not been regarded as significant problems in patients with the Indiana pouch because of the lack of foreign material present. However, stones developed in a significant percentage of our patients with an Indiana pouch. We investigated the characteristics of stone formation in patients with the Indiana pouch and compared them to those with a Kock pouch. MATERIALS AND METHODS: Detailed clinical courses regarding stone formation were reviewed in 72 patients with a Kock pouch and 54 with an Indiana pouch who had a minimum followup of 12 months. RESULTS: Stones developed in 7 of 54 patients (12.9%) with an Indiana pouch compared to 31 of 72 (43.1%) with a Kock pouch. The incidence gradually increased with longer followup but it was lower in the Indiana than in the Kock pouch group (5-year stone-free rate 84% versus 66%, respectively). Although the stones consisted principally of a mixture of struvite, carbonate apatite and ammonium hydrogen urate, variable amounts of calcium oxalate were identified in 50% of the Indiana pouch calculi. CONCLUSIONS: Not only urinary infections but also metabolic factors were considered to be involved in stone formation within the Indiana pouch. However, the substantially higher rate of stone formation in our Kock and Indiana pouch groups than has been reported in the United States suggested that no or infrequent pouch irrigations in our patients were important risk factors for urinary calculi.

Case-Control Studies↗

PubMed1996

Long-term followup of patients with tumor thrombi from renal cell carcinoma and total replacement of the inferior vena cava using an expanded polytetrafluoroethylene tubular graft.

PURPOSE: Inferior vena caval resection and its reconstruction are sometimes necessary when the inferior vena cava is extensively involved by a large and fixed tumor thrombus from renal cell carcinoma or other malignancies. We successfully replaced the inferior vena cava using tubular expanded polytetrafluoroethylene (Teflon) vascular grafts after en bloc removal of the tumor thrombus and inferior vena cava. We followed the patients long term and observed inferior vena caval patency. MATERIALS AND METHODS: The 3 men and 2 women ranged from 42 to 75 years old. The renal tumors were on the right side in 4 patients and asynchronously bilateral in 1. The suprarenal inferior vena cava was replaced in 3 patients and the infrarenal portion was replaced in 2. The expanded polytetrafluoroethylene tube grafts, 18 to 22 mm. in diameter and 5 to 12 cm. long, were externally stented in 3 patients and not stented in 2. RESULTS: Followup ranged from 6 to 96 months (mean 58). Long-term patency of the graft was maintained in all patients. Of the patients 3 had no evidence of disease at 6 months and 2 died of recurrent tumor at 6 and 84 months. CONCLUSIONS: Total replacement of the inferior vena cava using an expanded polytetrafluoroethylene tubular graft may offer a feasible method with good patency rates in the long term.

Adult↗

PubMed1996

Quantitative analysis of testicular histology in patients with vas deferens obstruction caused by childhood inguinal herniorrhaphy: comparison to vasectomized men.

PURPOSE: We investigated the effects on spermatogenesis of lifelong vas deferens obstruction caused by childhood inguinal herniorrhaphy. MATERIALS AND METHODS: Testicular histology was analyzed quantitatively in 15 post-herniorrhaphy patients with vasal obstruction for a mean of 28.5 years (group 1). The results were compared to those of 19 vasectomy patients with obstruction for a mean of 8.2 years (group 2). RESULTS: There were significantly fewer total germ cells per tubular cross section in group 1 than in group 2 (p < 0.05). There was a significant negative correlation between the duration of obstruction and total germ cells per tubule (r = -0.389, p < 0.03, 34 patients). The tubular diameter was significantly larger in group 2 than in group 1 (p < 0.01). CONCLUSIONS: Patients with vas deferens obstruction caused by childhood inguinal herniorrhaphy have decreased spermatogenesis compared to post-vasectomy patients, probably due to the longer obstruction period.

Adult↗

PubMed1996

Psychosocial aspects in long-term survivors of testicular cancer.

PURPOSE: We assessed the psychosocial well-being in cured testicular cancer patients who had undergone chemotherapy with or without retroperitoneal lymph node dissection, radiotherapy or surveillance therapy. MATERIALS AND METHODS: The sample consisted of 83 cured testicular cancer patients of whom 34 had undergone cisplatin-based combination chemotherapy with or without retroperitoneal lymph node dissection (chemotherapy group), 42 had received infradiaphragmatic radiotherapy (radiotherapy group) and 7 had received surveillance therapy (surveillance group). The questionnaire reported demographic data, psychosocial well-being, working ability, satisfaction with life, relationships, and general health and fitness. RESULTS: For questions dealing with psychological distress there were no differences among the groups. However, a significant number of patients in all groups reported greater feelings of anxiety about health and future since treatment. Working ability was significantly better in the chemotherapy and radiotherapy groups than in the surveillance group (p < 0.05 and p < 0.01, respectively). Interestingly, the patients who received the most extensive treatment (chemotherapy plus retroperitoneal lymph node dissection) reported the best working ability. Using the satisfaction with life scale, patients in the chemotherapy and radiotherapy groups showed significantly higher scores than those in the surveillance group (p < 0.05). The majority of the patients reported no significant change in long-term relationships with family, friends and spouse. CONCLUSIONS: The development of psychosocial problems during long-term adjustment seems to be low regardless of treatment received. Although a significant number of patients reported a higher incidence of anxiety and depression since the illness, the overall attitude was positive toward life. With regard to treatment type, patients in the chemotherapy and radiotherapy groups had better working ability and greater satisfaction with life than the surveillance group.

Adolescent↗

PubMed1996

Prognostic significance of circulating cytotoxic lymphocytes against autologous tumors in patients with bladder cancer.

PURPOSE: Cell-mediated immunity is an important and central mechanism of host resistance to cancer. Many studies have used cultured tumor cell lines as targets for cell-mediated cytotoxicity. However, it is difficult to interpret the data generated from the cytotoxic activity against cultured tumor cell lines, since they may not represent the activity against fresh autologous tumor cells. We examined the prognostic significance of circulating antitumorigenic cytotoxic lymphocytes at operation. MATERIALS AND METHODS: Peripheral blood lymphocytes derived from 89 patients with a bladder tumor were tested at operation for cytotoxic activity against a natural killer sensitive myeloid leukemia line K562, a human bladder tumor cell line T24 and freshly isolated autologous tumor cells in a 12-hour 51chromium release assay. The levels of the cytotoxic activity were evaluated for potential prognostic significance. RESULTS: The mean cytotoxic activities of peripheral blood lymphocytes against K562 cells, T24 cells and autologous tumor cells were 37.2%, 19.8% and 9.7%, respectively, using an effector-to-target cell ratio of 40:1. Based on the analysis, patients with bladder tumors were divided into 2 groups of high (greater than the mean value) and low (less than the mean value) cytotoxic activity. The magnitude of the anti-K562 or anti-T24 cytotoxic activity did not correlate with the 5-year survival rate or the postoperative disease-free period. In contrast, bladder tumor patients with high anti-autologous cytotoxic activity had higher disease-specific survival rates and a longer postoperative tumor-free interval compared to those with low activity during the 5-year follow-up. In addition, similar analysis of the data at an effector-to-target cell ratio of 20:1 revealed that patients with high anti-autologous tumor cytotoxic activity also had a higher survival rate and a longer postoperative tumor-free period than those with low activity. No statistical differences were observed in patient age and sex, as well as the size, number, histological grade and stage of bladder tumors between patients with high and low anti-autologous tumor cytotoxic activity. The anti-autologous tumor cytotoxic activity was not paralleled with either anti-K562 or anti-T24 cytotoxic activity. CONCLUSIONS: These results suggest that anti-autologous tumor cytotoxic activity of peripheral blood lymphocytes might be a significant and independent prognostic indicator in patients with bladder tumors, and that the autologous tumor cell killing system might have an important role in the immune surveillance against bladder tumors.

Adult↗

PubMed1996

[Asynchronous metastases solely to the bilateral adrenal glands from bladder cancer: a case report].

We report a case of transitional cell carcinoma of the bladder metastasizing to bilateral adrenal glands without other metastasis. A 47-year-old male underwent total cystectomy due to bladder cancer (TCC, G2, pT2) in 1992. One year later, CT scan showed a large tumor in the right adrenal gland. Right adrenalectomy revealed metastatic transitional cell carcinoma. He underwent 3 courses of M-VAC postoperatively. However, one year after the second operation, left adrenal tumor was detected by CT. Because there was no apparent metastasis other than the adrenal gland, left adrenalectomy was performed and the tumor was transitional cell carcinoma of grade 3. He was discharged from the hospital after 2 courses of CISCA chemotherapy, and has been doing well without evidence of recurrence for two years, being supported by the adrenocortical steroids.

Adrenal Gland Neoplasms↗

PubMed1996

Effect of long-term administration of finasteride (MK-906), an inhibitor of 5 alpha-reductase, in patients with benign prostatic hyperplasia.

We evaluated the effect of long-term administration of finasteride (MK-906), a potent inhibitor of 5 alpha-reductase in patients with benign prostatic hyperplasia (BPH). The effect of an increase in dose was also assessed. Finasteride was administered to 61 patients with BPH at the dose of 1 mg/day for 48 weeks. Thirty three of these patients subsequently received finasteride at the dose of 5 mg/day for further 24 weeks in an open extension study. Urinary symptoms, urinary flow rate, residual urinary volume, prostatic volume and serum concentrations of dihydrotestosterone and prostate-specific antigen were examined periodically during the treatment. The size of the prostate and total urinary symptom scores decreased progressively during the first 16 weeks of treatment. The patients who received finasteride had a significant increase in the maximal urinary flow rate and a significant decrease in residual urinary volume. After 72 weeks of treatment, finasteride at an increased dose of 5 mg did not provide additional benefit to patients, although the effects of the drug at a dose of 1 mg were well maintained. Treatment with finasteride was well tolerated at both doses. In conclusion, the treatment of BPH with 1 mg of finasteride per day for 48 weeks results in a significant increase in maximal urinary flow rate, and a decrease in prostatic volume, symptoms of obstruction and residual urinary volume, with minimal toxicity.

5-alpha Reductase Inhibitors↗

PubMed1996

[A case of localized amyloidosis of the ureter].

A case of localized amyloidosis of the ureter is reported. The patient was a 49-year-old female whose chief complaint was macrohematuria. Roentogenographic examination showed left hydronephrosis due to stenosis of left middle ureter. Left nephrouretectomy with cuff was performed with a diagnosis of the left ureteral tumor, and pathological examination revealed localized amyloidosis of the left ureter. Localized amyloidosis of the ureter is a rare lesion, and this is the twenty-first case reported in the Japanese literature. Review of the literature revealed that it is difficult to differentiate this lesion from other ureteral tumors by roentgenographic examination, and it is important to perform preoperative or intraoperative biopsy of ureteral tumors if benign diseases cannot be ruled out.

Amyloidosis↗

PubMed1996

[Phase I study of bicalutamide (Casodex), a nonsteroidal antiandrogen in patients with prostatic cancer].

A phase I study (open trial) of bicalutamide (Casodex), a non-steroidal antiandrogen, was conducted on 16 patients with prostatic cancer (stage C to D). The patients were given 10, 30, 50, 80 or 100 mg of bicalutamide orally daily for 12 weeks. Adverse reactions were observed in 8 out of 16 patients, but almost all were mild. Breast pain, gynecomastia and hot flushes were observed in 6 patients. Adverse reactions regarding liver function tests were observed in 3 patients. These were increased glutamic-oxalacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), alkaliphosphatase (AL-P) or gamma guanosine 5'-triphosphate (gamma-GTP). However, during or after the treatment period the elevated values were reversed to the pretreatment level. In terms of efficacy, anti-tumor effect was observed in 1 or 2 patients at each dose. Serum concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone and estradiol increased during treatment. Plasma concentrations of the R (-) enantiomer, which has antiandrogenic activity, reached the steady state 6-8 weeks after the initiation of treatment; its apparent plasma elimination half-life observed following repeated administration was 8.4 +/- 1.1 days. In conclusion, bicalutamide (10-100 mg od) is considered to be tolerated well enough to be administered to patients with prostatic cancer and has shown evidence of anti-tumor effect.

Administration, Oral↗

PubMed1996

[Clinical early phase II study of bicalutamide (Casodex) in patients with prostatic cancer].

To investigate the efficacy and safety of bicalutamide (Casodex) with its clinically recommended dose, the randomized early phase II study was performed in 124 patients with prostatic cancer (stage C, D). The patients were given 50, 80 or 100 mg of bicalutamide orally once a day in fixed doses for 12 weeks; 122 patients were eligible for evaluation. The overall response rate was 50.0% (20/40), 61.0% (25/41) and 53.7% (22/41) in the 50 mg, 80 mg and 100 mg groups, respectively. The response rate in prostate lesion, bone and lymph node metastases was slightly higher in the 80 mg group than in the 50 mg and 100 mg groups. The proportion of patients showing a response with regard to serum PSA (CR and PR) was 84.2, 92.7 and 97.6% in the 50, 80 and 100 mg groups, respectively. The incidence of adverse reactions was 65.0, 61.0 and 61.0% in the 50, 80 and 100 mg groups, respectively, and there was no significant difference in overall safety rating in the three groups. Frequent adverse reactions were gynecomastia and breast pain. Only one patient in the 80 mg group was withdrawn due to shortness of breath. Serum concentrations of LH, testosterone and estradiol increased significantly after treatment. Bicalutamide was concluded to be effective and well tolerated in patients with prostatic cancer, and its recommended dose was 80 mg once daily.

Administration, Oral↗