Search PubMed⌕ Search

Biomedical subjects

T Kinukawa

Publications and source records attributed to T Kinukawa.

At least 55 records · Page 3Linked to original sources
PubMed1994

Laparoscopic nephrectomy, radical nephrectomy and adrenalectomy: Nagoya experience.

A total of 37 patients with various renal and adrenal diseases underwent laparoscopic nephrectomy, radical nephrectomy and adrenalectomy since July 1991. The underlying diseases included renal calculi, vesicoureteral reflux, ureteropelvic junction obstruction, ureteral stenosis, ectopic ureter, vascular disease, renal cell carcinoma and adrenal tumors. Twenty-nine kidneys (including 5 with renal cell carcinoma) and 5 adrenal glands were removed successfully. Three cases failed because of dense adhesion to the surrounding structures, hemorrhage from the renal vein and hemorrhage from the vena cava, respectively. Of the remaining 34 patients 3 required additional open laparotomy to control bleeding or remove lost calculi. Mean operating time was 265 minutes for nephrectomy, 383 minutes for radical nephrectomy and 199 minutes for adrenalectomy, and mean estimated blood loss was 455 ml., 430 ml. and 80 ml., respectively. Average hospital stay was 10 days for the 31 patients without open laparotomy and convalescence was completed by postoperative day 21. These results indicate that laparoscopic surgery for renal and adrenal disease is a feasible, minimally invasive procedure. In the case of laparoscopic radical nephrectomy, however, longterm followup is necessary to confirm the efficacy.

Adolescent↗
PubMed1994

Laparoscopic radical nephrectomy for renal cell carcinoma: early experience.

We developed a laparoscopic radical nephrectomy for malignant disease of the kidney and successfully performed the operation in six patients between July 1992 and October 1993. This procedure is basically derived from that of Clayman and associates. A CO2 pneumoperitoneum is induced, and five trocars are introduced into the abdominal cavity through the lateral abdominal wall. The kidney is removed en bloc together with the adrenal gland, perirenal fatty tissue, and Gerota's fascia. The free kidney is put into a laparoscopy sack, and the sack is pulled out through a 5- to 6-cm incision in the abdominal wall without morcellation to allow complete pathologic examination. By this procedure, right nephrectomy was performed in four patients and left nephrectomy in two patients. The mean operative time was 6 hours and 13 minutes, and the mean blood loss was 430 mL. There were no severe complications. The average hospital stay was 11 days, and the average time to full convalescence was 21 days. Pathologic examination revealed renal cell carcinoma in five patients and nephroblastoma in one. Of the patients with renal cell carcinoma, the stage was pT1pN0pM0 in three patients and pT2pN0pM0 in two. There has been no recurrent disease in these six patients with a mean follow-up period of 9.5 months.

Adult↗
PubMed1994

[Laparoscopic pelvic lymphadenectomy in prostate cancer].

We described the clinical results and efficacy of laparoscopic pelvic lymphadenectomy for localized prostate cancer. This procedure was followed by radical prostatectomy, if metastasis was not found in frozen section. In the presence of positive nodes, optional treatment, such as TUR or castration, other than radical prostatectomy was performed. We performed laparoscopic lymphadenectomy on twenty seven patients between April 1992 and September 1993. They range from 52 to 78 years in age and consist of 4 patients with stage A2, 17 with stage B, and 6 with stage C. We dissected the obturator lymph nodes on bilateral sides. The average operating time was 162 minutes (range 86 to 320 minutes). The average number of nodes removed from the right side was 7.1 +/- 5.9 and 6.1 +/- 4.5 from the left side, which was comparable to the number of lymph nodes obtained by open dissection. Colon injury occurred in one patient, which was managed by laparotomy procedure. Nodal metastases were found in 6 patients by frozen section, and in 10 patients by permanent section. This discrepancy suggested that two-staged operation might be preferable for the localized prostate cancer. Six patients were given suitable therapies besides radical prostatectomy. Laparoscopic pelvic lymphadenectomy is a safe and useful procedure for prostate cancer, especially for the patients who are likely to have nodal metastasis.

Aged↗
PubMed1994

[A case of recurrent yolk sac tumor of testis in a 3-year-old child successfully treated by VAC (vincristine, actinomycin-D, cyclophosphamide) therapy].

A case of recurrent yolk sac tumor in a three-year-and five-month old child is reported. Left high orchiectomy was performed two years earlier at which time no evidence of metastatic disease was demonstrated. Twenty-four months postoperatively, serum alpha-fetoprotein (alpha-FP) was elevated and recurrent mass appeared in the left para aortic region. Treatment by VAC regimen consisting of vincristine, actinomycin D and cyclophosphamide was performed. Complete response was obtained after two courses of this therapy, which was confirmed by retroperitoneal lymphadenectomy. We believe that this chemotherapy is effective and safe for the treatment of yolk sac tumor of infantile testis.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Magnetic resonance images of hematospermia.

Seminal vesicles and their adjacent structures were studied using magnetic resonance imaging (MRI) in 7 normal volunteers and 15 patients with hematospermia. Normal seminal vesicles are depicted on T2-weighted images either as a mixture of high- and low-signal granules or as a convolution of tubules with a diameter of less than 0.5 cm. Fourteen of the 15 patients with hematospermia exhibited abnormalities on MRI. Dilatation or cyst formation in the seminal vesicle was observed in 13 patients, and a dilatation of the midline structure was seen in 3 patients. Abnormal signal intensity of the seminal vesicles was seen in 11 patients and was thought to be due to subacute hemorrhage.

Adult↗
PubMed1993

Increased levels of calbindin-D in serum and urine from patients treated by extracorporeal shock wave lithotripsy.

Calbindin-D 28 kDa. is a vitamin D-dependent calcium binding protein that is found mainly in the distal renal tubules and central nervous tissue in humans. Calbindin-D was measured in the serum and urine before, and immediately, 2 hours or 24 hours after extracorporeal shock wave lithotripsy (ESWL*) in 83 consecutive patients. ESWL was performed with the Siemens Lithostar device in 61 patients and with the Dornier MPL9000 lithotriptor in 22. The serum 28 kDa. calbindin-D level was undetectable (less than 20 pg./ml.) in many samples, whereas urinary 28 kDa. calbindin-D could be detected in every sample. The serum 28 kDa. calbindin-D level was usually elevated after ESWL and the concentration in patients treated with the MPL9000 device was greater than in those treated with the Lithostar instrument. Urinary 28 kDa. calbindin-D levels were elevated significantly immediately and at 2 hours after ESWL, and they decreased to the baseline level within 24 hours after ESWL in the Lithostar group but remained consistently significantly elevated after ESWL in the MPL9000 group. This fact may be because the MPL9000 lithotriptor produces a stronger shock wave than does the Lithostar device during ESWL. These results suggest that 28 kDa. calbindin-D is released from damaged distal renal tubule cells into the serum and urine during ESWL and that 28 kDa. calbindin-D is a specific marker for renal damage by ESWL. To our knowledge this is the first clinical study using a sensitive enzyme immunoassay for human 28 kDa. calbindin-D to estimate renal damage during ESWL.

Adult↗
PubMed1993

[Laparoscopic nephrectomy; results of initial 14 cases and procedure for renal cell carcinoma].

Since July 1991, we have performed laparoscopic nephrectomy for removal of damaged kidneys in thirteen patients. In addition, we recently developed a new procedure of laparoscopic nephrectomy for renal cell carcinoma and successfully removed the kidney with renal cell carcinoma. Patients' age ranged from 18 to 80 years with the average being 50 years. There were 8 male and 6 female patients. Original disease was calculous disease in 5 patients, vesicoureteral reflux in 4, renovascular disease in 2, ureteropelvic junction obstruction in 1, ectopic ureter in 1 and renal cell carcinoma in 1. The mean size of the diseased kidney was 9 x 5 x 4 cm in the initial 13 cases and 13 x 7 x 6 cm in the case with renal cell carcinoma. The size of the tumor was 2.5 x 2 x 2 cm. In the first 13 patients, nephrectomy was performed as described previously. In the patient with renal cell carcinoma, a new procedure was applied. In the new procedure, five trocars were introduced into the abdominal cavity through the lateral abdominal wall. The kidney was removed en bloc together with the adrenal gland, perirenal fat and Gerota's fascia in the same fashion as traditional radical nephrectomy. Thirteen kidneys were successfully removed, but one failed because of dense adhesion to the surrounding tissue. Three of the 13 patients required additional laparotomies to control bleeding or to remove missed stone.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[The effects of the treatment for acute rejection with OKT3 monoclonal antibody treatment on the long-term results of cadaveric kidney transplantation].

Although the efficacy of OKT3 monoclonal antibody (OKT3) upon the steroid resistant rejection is well known, its beneficial effect on long-term result of kidney transplantation has not yet been well examined in Japan. A retrospective group study was performed to analyze the effect of OKT3 on the cadaver kidney allograft. Between September 1987 and October 1990, a total of 77 patients from four different hospitals were classified into 2 groups. Thirty-four patients from 2 hospitals were entered OKT3 therapy group and 43 patients from the other hospitals were entered steroid therapy group. Initial immunosuppression comprised low-dose cyclosporine (6 mg/kg), steroid and antilymphocyte globulin in both groups. In OKT3 therapy group, acute rejection episodes those were considered steroid resistant were observed in 7 patients. They were treated with OKT3 monoclonal antibody. Of the seven patients, six recovered normal renal function. The mild rejection in OKT3 therapy group was treated with high-dose steroid. Minimal follow-up was 2 years. The 2-year graft survival was 82.4% in OKT3 therapy group and 74.4% in steroid therapy group. Although the improvement on the 2 year graft survival with OKT3 treatment was 8%, the difference between two groups was not statistically significant.

Adolescent↗
PubMed1993

[A case of renal cell carcinoma treated by ex vivo partial nephrectomy and autotransplantation].

We report on a case of renal cell carcinoma in a functionally solitary kidney, treated by ex vivo partial nephrectomy and autotransplantation. A 62-year-old woman was admitted for examination of a left renal mass and right hydronephrosis, incidentally detected on echography and CT scan. The right hydronephrosis was caused by congenital ureteropelvic junction obstruction, associated with severely impaired renal function. A solid tumor was found in the left kidney, located in the upper pole and extending to the hilus, and was suspected to be renal cell carcinoma. The patient was treated by ex vivo partial nephrectomy of the left kidney followed by autotransplantation. The tumor was 35 x 55 x 40 mm in size and diagnosed histologically to be renal cell carcinoma. Hemodialysis was unnecessary since good urine output was obtained postoperatively from the transplanted kidney. The patient was discharged 3 months after surgery, following interferon-alpha therapy, with serum creatinine level of 1.4 mg/dl.

Carcinoma, Renal Cell↗
PubMed1993

[Clinical results in the treatment for primary carcinoma of the renal pelvis and ureter].

One hundred and five patients with renal pelvic and ureteral tumor entered our treatment program between 1982 and 1991. Of 105 patients, 81 had resectable transitional cell carcinoma and were treated with radical or total nephroureterectomy (57 vs. 24) and/or lymph node dissection (66). Adjuvant chemotherapy was added in 26 patients with high stage disease and with lymph node disease. There were 61 male and 20 female patients. Their ages ranged from 36 to 86 years, with a mean of 62 years. The follow-up period was 3 to 114 months, with a mean of 31 months. The estimated 5-year survival was 67% in all 81 patients. Classified according to the pathological stage, 5-year survival was 70% in pTis + pTa disease group, 91% in pT1 group, 88% in pT2 group, 53% in pT3 group, and 27% in pT4 group. Under the grading system, 5-year survival was 100% in grade 1 disease, 74% in grade 2, and 26% in grade 3. It was 78% in 52 patients with negative node disease and 26% in 15 with positive node disease. There were 51 patients (61%) with no recurrent disease. Seventeen patients (21%) had recurrence in the bladder after a median latent period of 8-month, and 15 (19%) patients had recurrence in the retroperitoneum, liver, lung and (or) other site after a median latent period of 8 months. The results of this series were quite similar to those of previous reports. The efficacy of lymph node dissection and adjuvant chemotherapy could not be confirmed.

Adult↗
PubMed1993

[Antibiotic prophylaxis for transurethral resection of the prostate--comparison of oral administration therapy with intravenous administration therapy].

To compare the prophylactic effect of oral and intravenous antibiotics against postoperative fever and urinary tract infection (UTI) after transurethral resection of the prostate (TUR-P), we conducted a multi-center prospective randomized study. The incidence of pyrexia over 38 degrees C was defined as the primary endpoint. One hundred and fifty patients with sterile urine before TUR-P were entered into this study. The patients were allocated randomly into the two arms; arm A cefotiam 4 g a day for 7 days, arm B tosufloxacin 300 mg a day for 7 days, based on the stratification into the 4 groups determined with/without preoperative indwelling catheters and with/without the history of preoperative UTI. Of these patients, 143 were eligible. We divided 124 patients without preoperative UTI and without indwelling catheters as the "low risk group", and the other 19 patients with preoperative UTI and/or with indwelling catheters as the "high risk group". In the low risk group, 9 patients out of 63 (14.3%) in arm A and 6 out of 61 (9.8%) in arm B had pyrexia during 7 postoperative days. The incidence of fever in arm B was 4.4% less than that in arm A and the 95% confidence limit was from -7% to 16%. In the high risk group, 4 out of 11 (36.4%) patients in arm A and none of 8 in arm B had fever but the difference was not significant. The incidence of post operative UTI in the low risk group on the 4 to 5, 9 to 12, 23 to 26 and 37 to 40 postoperative days was 8.3, 16.4, 25.0 and 23.9% in arm A and 6.7, 16.7, 29.6 and 36.7% in arm B, respectively. The prophylactic effect of oral administration of tosufloxacin is equivalent to that of the intravenous administration of cefotiam. The use of oral antibiotics is beneficial to reducing the cost of medication.

Administration, Oral↗
PubMed1992

Endopyeloureterotomy via a transpelvic extraureteral approach.

Endopyeloureterotomy has been accepted as a procedure to relieve obstruction of the ureteropelvic junction and upper ureteral stenosis. However, in patients with a long stenotic segment poor results are often obtained with the conventional technique. To resolve this problem we developed a new technique using a 22F urethrotome and a transpelvic extraureteral approach. In this technique the renal pelvis was incised for 1 to 1.5 cm. from the ureteropelvic junction in the direction of the parenchyma using the cold knife of the urethrotome under direct vision. For upper ureteral stenosis the dilated pelvic and ureteral posterolateral walls were incised 1 to 1.5 cm. from the stenotic segment toward the ureteropelvic junction. Then, the stenotic segment was treated with the urethrotome after it was advanced into the retroperitoneal space through the incision in the renal pelvis. We treated 21 patients with the new technique between August 1988 and August 1990. Our series included 3 patients with the high insertion type of ureteropelvic junction obstruction and 4 with a long stenotic segment. The success rate was 95% without any severe complication. These results indicate that our new technique could become a useful procedure for endopyeloureterotomy.

Adolescent↗