Biomedical subjects
Publications and source records attributed to R Yasumoto.
A retrocaval ureter was treated laparoscopically with good success. The retrocaval segment of the ureter was easily separated and the ureter was reanastomosed using a laparoscopic suturing technique. Laparoscopic surgery is useful for the treatment of a retrocaval ureter with minimal postoperative pain and a short convalescence.
BACKGROUND: Sixteen patients with invasive bladder cancer were received neoadjuvant methotrexate, vinblastine, pirarubicin and cisplatin chemotherapy on our planning protocol. METHODS: The tumor was evaluated after 1 course of chemotherapy by radiographic examination, urine cytology, cystoscopy and random biopsy. If the response is CR or PR, one more course of chemotherapy was performed, and cystectomy was carried out. If the response is NC or PD, cystectomy was immediately carried out. Twelve of them were underwent cystectomy and four were preserved bladder. Clinical response was evaluated by echo, CT, MRI, urinary cytology, cystoscopy and random biopsy. RESULTS: Clinical CR was observed in 25% and PR was 37.5%. Pathological CR was observed in 31.3% and PR was 37.5%. The different rate between clinical and pathological evaluations was 31.3% and the result suggests that we should find the method of more accurate staging evaluation. Four patients who were evaluated clinical CR were selected bladder-preserving. However, two of them (50%) had recurred; one had grade 3 tumor was treated by total cystectomy and the other had multiple tumors was treated by one course of M-VAC and TUR-Bt. CONCLUSION: We should consider which cases are possible to preserve bladder by investigating the tumor characteristics.
In 43 men who required further examination of erectile function, we analyzed the relationship between the various factors including hormone levels, penile blood pressure index (PBPI), shape of the arterial wave, erection period after prostaglandin E1 injection and dynamic cavernosography/metry, as well as the patterns of nocturnal penile tumescence (NPT) with rigidity. Normal, dissociation, short episode, low amplitude and flat trace patterns, which were classified by Kaneko, were observed in 11, 8, 11, 2 and 11 men, respectively. Uncoupling was not observed in any men. There were no differences in the levels of prolactin and LH among the 6 patterns. A high FSH level was seen in men with a flat trace pattern; a low level of free testosterone ( < 12.2 pg/ml) was seen in men with dissociation, low amplitude and flat trace patterns, and low PBPI ( < 0.75) in men with flat trace pattern; and an arteriosclerotic shape of the arterial wave was seen in men with short episode and flat trace patterns. Each erection period immediately after prostaglandin E1 injection in men with dissociation, short episode, low amplitude and flat trace was shorter compared with cases with a normal pattern. Venoocclusive dysfunction was observed in 5 men with a dissociation pattern and 6 men with a flat trace pattern. In conclusion, an integral analysis of pattern of NPT with rigidity and other examinations are useful for differentiating organic impotence from psychogenic impotence and for accurately diagnosing pathophysiological disorders of organic impotence and underlying diseases.
We present an infertility male with prolactin level of 37.5 ng/ml. The patient had pituitary microadenoma detected by Gd-DTPA enhanced magnetic resonance imaging (MRI). After bromocriptine was administrated for 4 months, the size of microadenoma decreased, and sperm density and mortality improved. His wife became pregnant after 6 months. Dynamic MRI is a useful modality for detection of pituitary microadenoma, and bromocriptine is also useful for treatment of oligospermic patients with marginal hyperprolactinemia.
1. The thermolysin digest of dried bonito, Katsuo-bushi, showed inhibitory activity (IC50 = 29 mu g/mL) for angiotensin I-converting enzyme (ACE) and an antihypertensive effect after a single oral administration in SHR at a dose of 500 mg/kg. In a long-term feeding experiment, in which 3 week old SHR were fed a standard chow supplemented with the digest for 7 weeks, elevation of the systolic blood pressure was significantly suppressed by 15 mg/kg per day of the digest. 2. A digest of dried bonito by gastrointestinal proteases (pepsin-trypsin-chymotrypsin) failed to lower the blood pressure after a single oral administration (1000 mg/kg) in spite of a fairly strong ACEI activity (IC50 = 41 mu g/mL). 3. The ACEI activity of the thermolysin digest did not change after preincubation with gastrointestinal proteases or ACE. However, that of the pepsin-trypsin-chymotrypsin digest was reduced after the preincubation with ACE suggesting that the apparent inhibitory activity was due to ACE substrate peptides. 4. Eight ACEI peptides were isolated from the thermolysin digest. Most of them were true inhibitors or precursors that are converted into true inhibitors by ACE or gastrointestinal proteases in vivo. The precursor type peptides required a longer time than true inhibitors to show maximal antihypertensive effect after a single oral administration in SHR. Thus, the thermolysin digest of dried bonito is a mixture of a true inhibitor and precursor peptides differing from each other in maximally effective times.
The detection of various cytokines; interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), was studied in patients with nonbacterial prostatitis (NBP), and the clinical efficacy of sparfloxacin was also reported. The seminal plasma of 11 normal men and 10 patients with NBP were examined for the cytokines. There was no IL-1 beta or IL-6 in the seminal plasma of normal men. TNF-alpha was detected in only one normal man. In the seminal plasma of the patients, IL-1 beta was detected in 2 out of 10, and IL-6 was also detected in 6. TNF-alpha was detected in 6 out of 10 patients with NBP. The rate of detection of IL-6 and TNF-alpha was significantly higher in the patients with NBP than in normal men. The average levels (range) of IL-1 beta, IL-6 and TNF-alpha were 28 pg/ml (27-29), 110 pg/ml (25-476) and 25 pg/ml (6-113), respectively. After treatment with sparfloxacin at a dose of 100 mg to 200 mg per day, their symptoms disappeared. The number of leukocytes in the seminal plasma decreased to the normal level and these cytokines were not detected. The favorable clinical effect was achieved in 13 of the 17 patients (76%). These findings suggested that the cytokines have an important role in the pathogenesis of prostatitis and that the level of the cytokines are useful indicators in patients with prostatitis, particularly with NBP.
Autourethrography (A-UG), a new method of retrograde urethrography was developed, in which the patient injects the contrast medium by himself under fluoroscopical observation by urologists out side of the room. For clinical study of A-UG, comparative study between A-UG and the conventional retrograde urethrography (C-UG) was performed on 20 patients with benign prostatic hypertrophy. The mean age was 68.8 years (range 49-85 years) in A-UG and 69.4 years (range 61-86 years) in C-UG. We evaluated complications of A-UG, compared with these of C-UG. Opacification of the posterior urethra was achieved in all but one in A-UG. None of these patients in A-UG experienced pain during the examination of A-UG. On the other hand, all patient experienced pain in C-UG. Urethral bleeding occurred in only one of 19 patients in A-UG, compared with eighteen of 20 patients in C-UG. Extravasation occurred in one of 19 patients in A-UG, compared with three patients of 20 patients in C-UG. A-UG left the urologists free from the radiological exposure. It is concluded that A-UG is highly useful examination for patients and urologists.
From December 1989 to September 1992, nine patients with impotence were instructed to perform intracavernous self-injection of vasoactive drugs. At first 40 mg of papaverine hydrochloride was used in all patients and the response on erection was evaluated. If the response did not show sufficiently functional erection, a mixture of 40 mg of papaverine hydrochloride and 1 mg of phentolamine mesylate or 20 mg of prostaglandin E1 was reinjected. Eight patients had achieved full erections and vaginal penetrations without noteworthy complications during the follow-up period. Out of eight patients, three patients were able to ejaculate and one patient showed recovery of erection. No major side effects were seen. In conclusion, intracavernous self-injection is a useful modality for impotence.
Transurethral hyperthermic treatment was performed on 30 patients with benign prostatic hypertrophy (BPH). Two patients had a urethral catheter because of urinary retention. The prostate was heated transurethrally. The treatment consisted of 3-8 sessions of 60 min. each. To evaluate this treatment, the following parameters were determined before and 1-5 weeks after the last hyperthermia session; subjective symptoms score, and as objective data residual urine volume and uroflowmetry. The symptoms score improved in 25 (83%) patients. Of 2 patients with a catheter, the catheter could be removed from 1 patient. Although there was no change in prostatic volume, significant decreases in residual urine volume, and increases of maximum flow rate and mean flow rate were observed. No adverse reactions were seen. Judging from the above results, this treatment is considered to be useful for patients with BPH.
The effect of TZP-4238, an antiandrogen drug, on renal function was examined. Single administration test: Patients with prostatic hypertrophy were divided according to creatinine clearance (CCr) into group A (CCr < 50 ml/min) and group B (CCr > or = 50 ml/min), and hemodynamics after a single administration of TZP-4238 were compared between the two groups. Groups A and B showed similar TZP-4238 hemodynamics, and there was no significant difference in pharmacokinetic parameters or the rate of serum protein binding between them. There was no difference in the hemodynamics of a major metabolite, 15-OH body, between the two groups. Neither was there any significant difference in the urinary excretion rate of TZP-4238 or 15-OH body. There were no findings of adverse clinical significance, and there were no problems with safety. Consecutive administration test: A 16-week consecutive administration study was performed on patients with prostatic hypertrophy associated with relative renal hypofunction. The blood levels determined in 5 patients were in good accordance with the simulation curve drawn from the results of group A. The rates of efficacy, safety and usefulness were 71.4%, 90% and 71.4%, respectively. Mild side effects were observed in one patient, but the 16-week administration was completed in all patients, and no adverse effects on renal function were observed. Favorable blood levels of TZP-4238 were obtained even in patients with prostatic hypertrophy associated with renal hypofunction, and adequate efficacy and safety were achieved even with consecutive administration. Furthermore, the drug had no apparent adverse effect on renal function.
We assessed the nephrotoxicity of a non-ionic contrast medium, Iohexol, in 18 elderly patients. They were divided into two groups. Group 1 consisted of 12 patients with glomerular flow rate (GFR) above 60 ml/min/1.73 m2 (range 69-136; average 96) and group 2 consisted of 6 patients with GFR below 60 ml/min/1.73 m2 (range 38-59; average 49). Urine samples, collected before, immediately after, and on the third and sixth days after drip infused pyeloureterography (DIP) were analyzed for gamma-glutamyl transpeptidase (gamma-GTP), N-acetyl-beta-D-glucosaminidase (NAG), beta 2-microglobulin (beta 2-MG) and albumin. In group 1, immediately after DIP, the urinary excretion of albumin, gamma-GTP and NAG were significantly increased (p < 0.01, p < 0.01, p < 0.01). In group 2, immediately after DIP, the urinary excretion of gamma-GTP and beta 2-MG were significantly increased (p < 0.01, p < 0.1). The gamma-GTP and NAG values in both groups suggest that the damage of proximal tubules cells will not continue for more than 4 days. However, as for the reabsorption of beta 2-MG on proximal tubules, in group 2 the value did not return to the pre DIP level until 6 days after DIP. We believe it is important to postpone injection of non-ionic contrast medium within 6 days of its last usage.
Case 1. A 55-year-old male visited our hospital complaining of dysuria and two-staged micturition. Physical examination revealed a fist sized, elastic soft mass in the left inguinal region. Upright drip infusion pyelography (DIP) showed left inguinal hernia of the bladder. Retrograde urethrography showed bladder neck contracture and a diverticulum. Cystoscopy revealed a indentation in the left bladder wall. Urodynamic studies demonstrated organic obstruction in the lower urinary tract. From these findings, diagnosis was made as bladder hernia and bladder neck contracture. Resection of thin portion of the bladder wall and hernia repair, accompanied by prostatectomy, was performed. Case 2. A 37-year-old male visited our hospital with the history of ureteral stone and chronic prostatitis. Upright DIP incidentally revealed the small right inguinal bladder hernia. Because he had no complaint of dysuria and two-staged micturition, he was observed without surgical treatment.
A clinical study was conducted to evaluate the efficacy of combination therapy with interferon (IFN) alpha and gamma in 16 patients with advanced renal cell carcinoma whom we observed between August 1986 and June 1992. Eight patients had already had stage IV disease when they were seen first and five of them underwent nephrectomy. The other eight patients developed metastases after nephrectomy. The time to occurrence of the metastasis was 4-110 months. The dosage of the regimen was IFN alpha, 3 x 10(6) U, intramuscularly for 7 consecutive days at weeks 1, 3, 5 and 7 and IFN gamma, 6 x 10(6) JRU by intravenous drip on days 2, 4 and 6 of weeks 2, 4, 6 and 8. At and after week 9, the combined use of IFN alpha, 3 x 10(6) U, and IFN gamma, 1-6 x 10(6) JRU, was continued at least on a once-a-week basis as maintenance therapy as long as possible. The effect was evaluated as PR in 2 patients, MR in 2, NC in 3 and PD in 9. The response rate was 12.5% and the efficacy rate including MR was 25%. The time to onset of the effect was 8-24 weeks. Of the four patients showing MR or better responses, three had stage IV disease and one had metastatic disease after the operation. The duration of effect was 2-8 months. Side effects were fever, general malaise, anorexia, leukocytopenia and impaired liver function, and were noted frequently.(ABSTRACT TRUNCATED AT 250 WORDS)
We herein report three cases of primary carcinoma in situ (CIS) of the upper urinary tract. The significance of urinary cytology and pathological study by means of mapping of isolated specimens was investigated in cases reported in Japan, including our cases. 1. The most common clinical symptom of CIS of the upper urinary tract was hematuria. Particularly, gross hematuria showed a high incidence. 2. In cases of CIS involving the ureter, hydronephrosis frequently resulted from ureteral stenosis and obstruction. 3. Urinary cytology was a useful diagnostic examination, in particular, the cytology of catheterized urine or washings increased the diagnostic accuracy. It appeared that for definite diagnosis, positive urinary cytology should be obtained repeatedly. 4. The mapping analysis of isolated specimens revealed that it was characterized that CIS was multiple and coexistent with dysplasia. 5. Total nephroureterectomy is the treatment of first choice. An investigation of the distribution of CIS and dysplasia by mapping and grading of CIS seemed to be useful for following up the postoperative course.
We report a case of milk of calcium renal stone within a calyceal diverticulum in the patient with left ureteral tumor. The patient was a 77-year-old-man with the chief complaint of asymptomatic microscopic hematuria. A plain film revealed round opaque calcific densities in the left kidney in the supine position and a dense crescent-shaped shadow with a horizontal border in the upright position. An intravenous pyelography showed left hydronephrosis and calculi within a calyceal diverticulum. Computed tomography in the supine position revealed layering of the calcifications in cystic lesion of the left kidney accompanied by left hydronephrosis due to a soft mass in the left ureter and a right renal cyst. Retrograde pyelography revealed a filling defect of the middle portion of the left ureter. Under the diagnosis of milk of calcium renal stone and left ureteral tumor, left total nephroureterectomy and partial cystectomy was performed. Pathological findings indicated transitional epithelium of the diverticulum wall and grade 1 transitional cell carcinoma of the left ureteral tumor.
We evaluated retrospectively 107 patients with staghorn calculi who underwent extracorporeal shock wave lithotripsy (ESWL) monotherapy from 1985 to 1990. The 107 patients consisted of 65 complete staghorn calculi and 55 partial staghorn calculi. Staghorn calculi required an average of 4.3 treatment sessions. Using a Dornier HM3 lithotriptor, the stone-free rate was 33% in patients with complete staghorn calculi, and 35% in patients with partial calculi. For stone evacuation following ESWL procedure, ureteral stenting, nephrostomy and transurethral lithotripsy were necessary. Four of the 21 patients who underwent ESWL monotherapy and were available for long-term followup showed stone growth, while all of the 10 patients who underwent open surgery during the previous 5 years became stone free. The average period of hospitalization and cost were 38.3 days and 700,000 yen in patients who had received open surgery, and 25.8 and 1,720,000 yen in patients receiving ESWL monotherapy. In conclusion, ESWL monotherapy is useful, and if patients require complete removal of all stone fragments, a percutaneous lithotripsy should be performed following ESWL monotherapy.
The patient was a 70-year-old male with invasive bladder cancer. We performed intermittent arterial infusion (ITI) combined with alteration of blood flow in the bladder wall using the contralateral arterial embolization. As for anti-tumor agents, cisplatin (CDDP) 10mg and pirarubic in (THP) 10 mg were selected, and were injected every week for 11 times. Complete response (CR) was noted by cystoscopy and biopsied specimen. In our conclusion. ITI was useful for the treatment of bladder cancer.
A 30-year-old male patient without diabetes mellitus and tuberculosis was referred to our outpatient department for the purpose of further examinations of azoospermia. Transrectal ultrasonography revealed the bilateral calcifications of vas deferens. Kidney-ureter-bladder X-ray and computerized tomography revealed also the same findings. Seminal vesiculography revealed no obstructive sign of vas deferens. Histopathology of testes showed hypoplasia. Judging from these findings, we diagnosed the case as calcification of vas deferens associated with spermatogenic disturbance. Review of the 31 cases reported in the Japanese literature including our case was performed.