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Biomedical subjects

Shingo Yamamoto

Publications and source records attributed to Shingo Yamamoto.

At least 55 records · Page 3Linked to original sources
PubMed2004

Assessment of a protocol for prophylactic antibiotics to prevent perioperative infection in urological surgery: a preliminary study.

BACKGROUND: The aim of the present study was to assess the usability and efficacy of our new protocol of prophylactic antibiotic use to prevent perioperative infection in urological surgery. METHODS: We prospectively investigated 339 cases of typical urological surgery in our department between April 2001 and March 2002 (group I). We classified surgical procedures into four categories by invasiveness and contamination levels: category A, clean less invasive or endoscopic surgery; category B, clean invasive or clean contaminated surgery; category C, urinary tract diversion using the intestine; and category D, infected surgery. Antibiotics were administrated intravenously according to our protocol: category A, first or second generation cephems or penicillins during the operative day only; category B, first and second generation cephems or penicillins for 3 days; and category C, second or third generation cephems for 4 days. Category D was excluded from the analysis. To judge perioperative infections, the wound condition and general conditions were evaluated in terms of the surgical site infection (SSI) as well as remote infection (RI) up to postoperative day (POD) 14. We retrospectively reviewed 308 patients who underwent urological surgery between April 2000 and March 2001 (group II) as reference cases that were administered antibiotics without any restriction. RESULTS: Perioperative infection rates (SSI + RI) in group I and group II were 25 of 339 (7.4%) and 35 of 308 (11.4%), respectively. Surgical site infection rates of categories A, B, and C in group I were 1.8%, 7.6%, and 30.0%, respectively, while those in group II were 2.0%, 7.4%, and 46.2%, respectively. There was no significant difference in infection rates in terms of RI and SSI between group I and group II. The amounts, as well as the prices, for intravenously administrated antibiotics and oral antibiotics decreased to approximately half and one-fifth, respectively. CONCLUSION: Our protocol effectively decreased the amount of antibiotics used without increasing perioperative infection rates. Thus, our protocol of prophylactic antibiotic therapy would be recommended as an appropriate method for preventing perioperative infection in urological surgery.

Adolescent↗
PubMed2004

[A case of vaginal metastasis of transitional cell carcinoma].

A 74-year-old female with a complaint of genital bleeding was referred to our hospital. In her past history, 4 times of transurethral resection of bladder tumor (TUR-BT) for bladder cancers and right nephroureterectomy with cuff for right ureteral tumors were performed during these 17 years, followed by simple cystectomy 3 years before. A punch biopsy of anterior vaginal wall demonstrated metastases of transitional cell carcinoma. Although total histero-vaginectomy was performed, recurrence of disease was observed in bone, skin and inguinal lymph nodes 9 months after the operation. This case is the 13th report of vaginal metastases of transitional cell carcinoma in the world.

Aged↗
PubMed2004

[Transitional cell carcinoma in prostate after intravesical instillation of Bacillus Calmette-Guerin].

We report 3 cases of prostatic involvement of transitional cell carcinomas (TCCs). All cases presented positive urinary cytology after intravesical instillation of Bacillus Calmette-Guerin (BCG) and then random biopsy of bladder and transurethral resection (TUR)-biopsy of prostatic urethra were performed. TUR-biopsy demonstrated TCC in the prostate, although random biopsy failed to detect tumors in the bladder in all cases. Case 1 was treated with cystourethrectomy with ileal conduit, case 2 was treated with cystourethrectomy with bilateral ureterocutaneostomy and case 3 was treated with cystectomy with orthotopic ileal neobladder reconstruction. All cases are alive with no evidence of disease. TUR-biopsy of prostatic urethra should be perfomed when patients present positive urinary cytology after BCG instillation therapy, because prostatic involvement of TCC associated with bladder carcinoma in situ is not rare.

Administration, Intravesical↗
PubMed2004

[Right ectopic ureter with ipsilateral renal agenesis presenting with infertility: a case report].

A 30-year-old man was referred to our hospital with a complaint of male infertility, presenting abnormal semen analysis (semen volume 0.1 ml, sperm concentration 1.2 x 10(6)/ml, sperm motility 0%). Radiological examinations demonstrated right renal agenesis and a cystic mass extending from the prostate to the posterior of the bladder. Our final diagnosis was obstruction of the ejaculatory duct secondary to right ectopic ureter associated with ipsilateral renal agenesis. The patient was treated by transurethral unroofing of the cyst. Three months after the surgery, the cystic mass disappeared and the seminal findings showed marked improvement.

Adult↗
PubMed2004

[A case of schwannoma in the renal hilum].

A 58-year-old female presented with a well-encapsulated tumor in the left renal hilum on computed tomography (CT). On magnetic resonance imaging (MRI), the tumor showed low intensity on the T1-weighted image, high intensity on the T2-weighted image. Laparoscopic radical nephrectomy was performed because we could not exclude the possibility of malignancy such as renal cell carcinoma. Histopathological examination revealed that the tumor was a benign Schwannoma. Although renal hilum is a common site of renal schwannoma, it is difficult to differentiate benign tumors from malignant ones, and then nephrectomy is usually performed.

Diagnosis, Differential↗
PubMed2004

[Clinical results of immunosuppressive triple therapies in living-related renal transplantation--a single center experience].

We reviewed the outcome of three methods employed for living-related renal transplantation (RTx) in our institution to assess triple immunosuppressive regimens. Between January 1989 and July 2003, a total of 35 living-related RTxs were performed at our institution. The immunosuppressive regimen given to 16 patients (group A) was cyclosporine (CsA), steroid and azathoprine (AZ) that given to 9 patients (group B) was tacrolimus (TAC), steroid and AZ and that given 9 patients (group C) was TAC, steroid and mycophenolate mofetil (MMF). Graft survival rate, serum creatinine, proteinuria, acute rejection, chronic allograft nephropathy (CAN), cytomegalovirus (CMV) infection and drug-induced nephropathy were investigated. There was no significant difference in graft survival rate among the three groups. Although serum creatinine levels (mg/dl) at 3 months post-transplant were 1.22+/-0.37 in group A, 1.43+/-0.14 in group B, 1.30+/-0.34 in group C, respectively (p<0.05; A vs. B), there was no significant difference at 1 year post-transplant. Frequency of proteinuria in groups A, B and C was 75.0, 50.0, 25.0%, respectively (p<0.05; A vs. C). The incidences of acute rejection and CAN within 1 year post-transplant were, respectively, 56.3% and 43.8% in group A, 37.5% and 37.5% in group B; and, 25.0% and 12.5% in group C (NS). The incidence of drug-induced nephrotoxicity was 12.5, 50.0% and 37.5% in groups A, B and C, respectively (p<0.05; A vs. B). The triple immunosuppressive therapy including calcineurin inhibitors, especially the regime of TAC, MMF, and steroids decreased the frequencies of proteinuria and rejections, which deteriorated the long-term outcome in living-related RTxs.

Adult↗
PubMed2004

[A multi-center prospective study for antibiotic prophylaxis to prevent perioperative infections in urologic surgery].

In order to assess the ability of our protocol for antibiotic prophylaxis to prevent perioperative infections in urologic surgery, 1,353 operations of open and laparoscopic urologic surgery conducted in 21 hospitals between September 2002 and August 2003 were subjected to analyses. We classified surgical procedures into four categories by invasiveness and contamination levels: Category A; clean less invasive surgery, Category B; clean invasive or clean-contaminated surgery, Category C; surgery with urinary tract diversion using the intestine. Prophylactic antibiotics were administrated intravenously according to our protocol, such as Category A; first or second generation cephems or penicillins on the operative day only, Category B; first and second generation cephems or penicillins for 3 days, and Category C; first, second or third generation cephems or penicillins for 4 days. The wound conditions and general conditions were evaluated in terms of the surgical site infection (SSI) as well as remote infection (RI) up to postoperative day (POD) 30. The SSI rate highest (23.3%) for surgery with intestinal urinary diversion, followed by 10.0% for surgery for lower urinary tract, 8.9% for nephroureterctomy, and 6.0% for radical prostatectomy. The SSI rates in clean surgery including open and laparoscopic nephrectomy/adrenalectomy were 0.7 and 1.4%, respectively. In SSIs, gram-positive cocci such as methicillin-resistant Staphylococcus aureus (58.8%) or Enterobacter faecalis (26.5%) were the most common pathogen. Similarly, the RI rate was the highest (35.2%) for surgery using intestinal urinary diversion, followed by 16.7% for surgery for lower urinary tract, 11.4% for nephroureterctomy, and 7.6% for radical prostatectomy, while RI rates for clean surgery were less than 5%. RIs most frequently reported were urinary tract infections (2.6%) where Pseudomonas aeruginosa (20.3%) and Enterobacter faecalis (15.3%) were the major causative microorganisms. Parameters such as age, obesity, nutritional status (low proteinemia), diabetes mellitus, lung disease, duration of operation, and blood loss volume were recognized as risk factors for SSI or RI in several operative procedures. Postoperative body temperatures, peripheral white blood counts, C reactive protein (CRP) levels in POD 3 were much higher than those in POD 2 in cases suffering from perioperative infections, especially suggesting that CRP could be a predictable marker for perioperative infections.

Antibiotic Prophylaxis↗
PubMed2004

[Questionnaire survey on the theory of antimicrobial prophylaxis in urologic surgery].

In order to establish an acceptable guideline for prevention of perioperative infection following urologic surgery, a questionnaire survey on the theory of antimicrobial prophylaxis (AMP) was conducted among urologists in Japan in February 2004. A reply was obtained from 149 urologists working for institutes located all over Japan from Hokkaido to Kyushu areas. Ninety-two percent of the urologists agreed that AMP should be administered 30 min before an incision, and 44% replied that an additional dose of AMP is required in the case of prolonged intervention. Penicillins or the 1st or 2nd generation cephems were used by 89 to 93% of the urologists in operations not including bowel segments, while 78% preferred such AMP agents in the procedures including bowel segments. AMP was terminated within 3 days in 87% for genital operations, in 70 to 76% for laparoscopic operations, in 54 to 65% for other clean or clean-contaminated operations, and in 24% for operations without the bowel segments. Especially, 58% of the urologists continued AMP for more than 5 days after operations with urinary diversion using the intestine. When compared with the previous questionnaire survey by Shinagawa et al, our survey demonstrated that standard consensus of AMP has spread widely among urologists in Japan, although the recommendations published in Europe and United States are still controversial in Japan. Thus, further well-designed clinical trials are required to establish original guidelines in Japan.

Ampicillin↗
PubMed2003

Low incidence of ipsilateral adrenal involvement and recurrences in patients with renal cell carcinoma undergoing radical nephrectomy: a retrospective analysis of 393 patients.

OBJECTIVES: To evaluate, in a retrospective analysis of the outcome of 393 consecutive patients undergoing radical nephrectomy, the advantages and disadvantages of concomitant ipsilateral adrenalectomy with this operation. METHODS: The medical records, pathologic specimens, and preoperative and postoperative computed tomography scans of 165 patients with, and 228 patients without, concomitant adrenalectomy were reviewed. The incidence of adrenal involvement in the former patients and ipsilateral adrenal recurrence in the latter patients was evaluated. The influence of adrenalectomy on the disease-specific survival was also assessed by both univariate and multivariate analyses. RESULTS: Of the 165 patients, only 5 (3.0%) had adrenal involvement. All of these cases were diagnosed as cT3 or greater preoperatively, and preoperative computed tomography detected 4 of these 5 cases. Of the 228 patients without adrenalectomy, no ipsilateral adrenal recurrence was observed at a mean follow-up of 65.2 months. Ipsilateral adrenalectomy did not confer a favorable prognosis on the patients. CONCLUSIONS: Our results indicate that the advantages of ipsilateral adrenalectomy in patients with normal findings on preoperative computed tomography are limited. Concomitant ipsilateral adrenalectomy is indicated in cases such as locally advanced tumors with uncertain preoperative imaging studies or those with apparent adhesion or inflammation around the adrenal gland at surgery, thus suggesting perinephric tumor involvement.

Adrenal Gland Neoplasms↗
PubMed2003

Living related renal transplantation for end-stage renal disease after liver transplantation from a brain-dead donor.

We report a case in which a living related renal transplantation was successfully performed for end-stage renal disease that had progressed after a liver transplantation from a brain-dead donor for liver cirrhosis associated with type C hepatitis. Because the transplanted liver function had been excellent with the use of tacrolimus and mycophenolate mofetil, the same immunosuppressive agents with prednisolone were employed for the renal transplantation. Both grafts are functioning well without recurrence of hepatitis at 10 months after the renal transplantation. From our experience, renal transplantation should not be contraindicated even if the patient has undergone liver transplantation or has hepatitis C viral infection.

Hepatitis C, Chronic↗
PubMed2003

Local delivery of matrix metalloproteinase gene prevents the onset of renal sclerosis in streptozotocin-induced diabetic mice.

The present study was undertaken to investigate whether matrix metalloproteinase (MMP) functions to prevent the occurrence of destructive fibrosis in progressive renal disease. As a sustained release carrier of plasmid DNA, biodegradable hydrogels and microspheres were formulated from cationized gelatin prepared through aminization. Plasmid DNA was released from the cationized gelatin hydrogels as a result of hydrogel degradation. A plasmid DNA including a cytomegalovirus promoter and human recombinant MMP-1 gene (pCMV-MMP) was constructed. Gelatin microspheres incorporating pCMV-MMP as well as phosphate-buffered saline (PBS) with or without pCMV-MMP were injected into the renal subcapsule of C57BL/6 mice, which were intraperitoneally injected with streptozotocin (STZ) to induce diabetes 7 days after operation. The mice were killed 4 weeks after STZ injection to sample their blood and kidneys for biochemical and histological examinations. An immunofluorescence study confirmed that MMP protein was expressed around the renal tissue injected with gelatin microspheres incorporating pCMV-MMP. When applied with cationized gelatin microspheres incorporating pCMV-MMP, the mice showed a level of blood urea nitrogen significantly lower than that of other groups. A reduced content of collagen in the kidneys of mice administered gelatin microspheres incorporating pCMV-MMP was histologically observed. Further, the hydroxyproline assay revealed a significantly decreased content of hydroxyproline in kidney. We conclude that sustained release of MMP-1 gene is a promising prophylactic trial for kidney fibrolysis and dysfunction in the STZ-induced diabetic mouse model.

Animals↗
PubMed2003

Distribution of afaE adhesins in Escherichia coli isolated from Japanese patients with urinary tract infection.

PURPOSE: Afimbrial adhesin is known to be one of the most prevalent virulence factors in uropathogenic Escherichia coli. A recent report showed that the new subtype afaE8 predominated in afa positive isolates from patients with pyelonephritis (55.6%), suggesting that this subtype may be an important factor in ascending urinary tract infections. MATERIALS AND METHODS: A total of 457 E. coli strains consisting, of 194, 76 and 107 isolates from patients with cystitis, pyelonephritis and prostatitis, respectively, and 80 isolates from the rectal flora of healthy individuals were subjected to polymerase chain reaction to determine the afa operon as well as afaE subtypes. RESULTS: We identified 32 afa positive isolates of 377 strains (8.5%) and 2 of 80 strains (2.5%) from urinary tract infection isolates and normal flora, respectively. When afaE subtypes were determined, the afaE3 subtype predominated in afa positive isolates from cystitis (64.7%), pyelonephritis (66.7%) and prostatitis (50%). However, the afaE8 subtype was absent from urinary tract infection isolates, while only 1 isolate from the stool of a healthy adult harbored this subtype. CONCLUSIONS: Our data show that the afaE3 subtype predominated in pyelonephritis as well as in other urinary tract infections, indicating that the afa gene may be important in urinary tract infection. However, the distribution of afaE subtypes may be diverse in different areas of the world.

Adhesins, Escherichia coli↗
PubMed2003

Bladder regeneration by bladder acellular matrix combined with sustained release of exogenous growth factor.

PURPOSE: We investigate the use of bladder acellular matrix (BAM) as a carrier of exogenous growth factor. MATERIALS AND METHODS: Basic fibroblast growth factor (bFGF) protein was loaded in a lyophilized BAM by rehydrating the matrix with the growth factor solution. In vitro and in vivo release of bFGF from BAM was traced by radiolabeled bFGF. To assess biological effect of the released bFGF, BAMs incorporating bFGF were implanted into back subcutis of mice and vascular endothelial growth factor levels in the local tissue were determined. Furthermore, bladder augmentation was performed in rats with BAM grafts containing various concentrations of bFGF. At 4 and 12 weeks the graft size at maximal cystometric capacity was evaluated, followed by histological and physiological evaluation. RESULTS: Sustained release of bFGF from BAM was observed in vitro and in vivo. In vivo biological activity of bFGF in BAM as determined by vascular endothelial growth factor levels was preserved for more than 3 weeks. In the bladder augmentation model angiogenesis into the matrix was promoted and graft shrinkage was significantly inhibited by incorporated bFGF in a dose dependent manner at 4 weeks. CONCLUSIONS: BAM can function as a platform for sustained release of exogenous bFGF. This delivery method of growth factor could be a useful tool for bladder reconstruction.

Animals↗
PubMed2003

Distribution and genetic association of putative uropathogenic virulence factors iroN, iha, kpsMT, ompT and usp in Escherichia coli isolated from urinary tract infections in Japan.

PURPOSE: Many virulence factors (VFs) have been reported in uropathogenic Escherichia coli. Recently we found a putative uropathogenic island including a gene encoding uropathogenic specific protein (USP). We have described the association between usp and other VFs reported previously. In the current study we examined epidemiological associations among 5 putative uropathogenic VFs. MATERIALS AND METHODS: In 427 E. coli strains, including 194, 76 and 107 isolates from patients with cystitis, pyelonephritis and prostatitis, respectively, and 50 isolates from the stool of healthy adults, we detected catecholate siderophore receptor (iroN), iron regulated gene A homologue adhesin (iha), group II capsule (kpsMT) and outer membrane protease T (ompT) by polymerase chain reaction assays. We analyzed their distribution and genetic association. RESULTS: Relative prevalence ratios of iroN, iha, kpsMT, ompT and usp were 2.0 to 4.3 times more frequently in urinary tract infection isolates than in fecal isolates. Isolates from prostatitis were frequently associated with iroN, ompT and usp, whereas isolates from pyelonephritis frequently harbored usp. Together with iroN and iha we noted S-/F-fimbriae and iucD aerobactin (OR 95.9 and 187.2), while usp showed a close association with kpsMT and ompT (OR 38.3 and 38.4, respectively). CONCLUSIONS: Of the putative uropathogenic VFs examined iroN, iha, kpsMT, ompT and usp were frequently associated with urinary tract infection. Especially iroN and usp were most frequently associated with prostatitis. Some VFs were closely associated with a specific anatomical site of infection. Strong associations among several VFs might indicate not only well-known genetic linkages, but also unknown functional linkages among these VFs.

Adult↗
PubMed2003

Distribution of the usp gene in uropathogenic Escherichia coli isolated from companion animals and correlation with serotypes and size-variations of the pathogenicity island.

Uncomplicated urinary tract infection (UTI) caused by uropathogenic Escherichia coli(UPEC) is a serious problem not only among humans but also in companion animals such as dogs and cats. The uropathogenic specific protein gene (usp ) is preferentially distributed in UPEC isolates from dogs and cats compared with the distribution of usp in E. coli strains from feces of healthy dogs and cats and this pattern of distribution resembles that observed in human UPEC strains. The UPEC strains from companion animals share common O serotypes like O1, O2, O4, O6, O16, O18, O22, O25 and O75 as those reported for human UPEC. The size variation of the pathogenicity island that includes usp in UPEC from dogs and cats was almost similar to those seen in human UPEC. We propose that dogs and cats are the alternative reservoirs for UPEC strains that are associated with human UTI.

Animals↗
PubMed2003

[Marked improvement of cardiac function following renal transplantation: a case report].

The recipient, a 31-year-old man, was diagnosed with severe diffuse hypokinesis of left ventricle and diastolic dysfunction by echocardiography before the renal transplantation. His left ventricular ejection fraction (LVEF) was 29%. Therefore we had to postpone the operation and tried to improve his cardiac function. We controlled his dry weight more strictly with hemodialysis and limited in take of salt and water to reduce preload of his heart and administered erythropoietin to improve his anemic condition. We administered angiotensin-converting enzyme inhibitors (ACEI) to control his blood pressure and reduce afterload of his heart. Two months later, his cardiac function was marked improved (LVEF, 29% to 47%), and he underwent renal transplantation. Five months after the operation, improvement of his cardiac function kept on being observed in spite of the cessation of treatment for his heart (LVEF, 47% to 68%). Successful renal transplantation can significantly improve the cardiac function of patients on maintenance dialysis.

Adult↗
PubMed2003

[A case report of a young patient with invasive bladder cancer].

A 29-year-old male with bladder cancer was referred to our hospital. Histological examination of transurethral biopsy showed transitional cell carcinoma with invasion into prostate (T4aN0M0, grade 3). Nerve-sparing radical cystectomy with ileal neobladder reconstruction was performed after 3 courses of neoadjuvant chemotherapy with Methotrexate, Epirubicin and Cisplatin. Continence and erectile function were preserved and no recurrence has been observed for 18 months after the operation. This is the sixth case of an invasive bladder cancer in Japanese patients under 30 years old.

Adult↗