Biomedical subjects

T Kotake

Publications and source records attributed to T Kotake.

At least 163 records · Page 9Linked to original sources

PubMed1991

[Incontinent urinary diversion].

We analyzed 237 patients who underwent total cystectomy with ileal conduit urinary diversion or cutaneous ureterostomy at the Center for Adult Diseases, Osaka. One-hundred and eighty-eight patients underwent ileal conduit diversion and 49 patients underwent cutaneous ureterostomy. No patient died within 30 days after the operation, but two patients who underwent ileal conduit diversion died of postoperative complications within 2 months. Early complications occurred in 94 patients (50%) in the ileal conduit group and in 18 patients (37%) in the ureterostomy group. Late complications occurred in 85 patients (45%) in the ileal conduit group and in 23 patients (47%) in the ureterostomy group. Frequent early complications in the ileal conduit group were wound infection (29%), and intestinal complications (13%) which included ileus and upper urinary tract complications (12%). The most frequent late complications were stomal complications (26%) which included peristomal dermatitis stomal stenosis, parastomal hernia, and stomal prolapse, and upper urinary tract complications which were noted in 27 patients (14%).

Aged↗

PubMed1991

[Chemotherapy of invasive bladder cancer].

This article is a review of the results of systemic chemotherapy for invasive bladder cancer. Transitional cell carcinoma of the urinary tract including the urinary bladder, renal pelvis and ureter has been moderately responsive to chemotherapy. Many chemotherapeutic agents have been studied singly or in combination. Until about 10 years ago, adriamycin (ADM) was the most studied agent for treatment of invasive bladder cancer. However, the results of single agents and combination with ADM have been disappointing; the overall response rate was approximately 20%. With the introduction of cisplatin (CDDP), the efficacy of chemotherapy for invasive bladder cancer has improved significantly. As single agents, CDDP has a response rate of 30 % in 320 cases, methotrexate (MTX), 29% in 236 cases, ADM, 17% in 248 cases, vinblastine (VBL), 16% in 38 cases, and mitomycin C, 13% in 42 cases. Presently the most important agents in the treatment of this disease are CDDP and MTX, and the next most useful agents are ADM and VBL. Recent data from limited trials in patients with advanced bladder cancer suggest that combination chemotherapy regimens with these agents induces a high percentage of complete remissions (CR), an overall response rate between 50% and 70%, and a median response duration of longer than 6 months. Most active combination regimens are M-VAC (CDDP + MTX + ADM + VBL), CMV (CDDP + MTX + VBL), CM (CDDP + MTX) and CISCA (CDDP + ADM + cyclophosphamide). These combination regimens with M-VAC, CMV, CM and CISCA show a response rate of 57%, 57%, 46% and 46%, respectively. However, these drugs have a substantial toxicity and their combination has still been regarded as too hazardous. The attainment of CR in 20% to 40% of cases given these combination regimens has led to adjuvant and neoadjuvant chemotherapy.

Antineoplastic Agents↗

PubMed1991

[Management of prostate cancer--current status and hazards].

Recently the deaths from prostatic cancer deaths outnumber the deaths from bladder cancer which used to be the most frequent cause of death in urologic cancer. The management of prostate cancer will become more important in the future society with increase in the elderly population size, though there still remain several hazards to be solved. The present paper is a summary of 8 articles presented at the symposium on "Management of Prostate Cancer--Current Status and Hazards", 39th Annual Meeting of Central Section of Japanese Urological Association held in November, 1989. Mass screening in function with early detection, radical surgery, radiation therapy and endocrine therapy and/or chemotherapy of carcinoma of the prostate were discussed.

Combined Modality Therapy↗

PubMed1991

[Clinical results of total prostatectomy].

Radical surgery was administered to 63 patients with prostatic carcinoma, of whom 48 were put under total prostatectomy, 13 under cystoprostatectomy and 2 under pelvic exenteration. Adjuvant therapy was given in three forms: pretreatment to 31 patients, castration to 44 patients and pelvic lymphadenectomy to 39 patients. The 7 patients in stage A survived without carcinoma. Of the 25 patients in stage B, recurrence was seen in 7 patients but there were no deaths and the 5- and 10-year cumulative survival rates were both 86%. Of the 24 stage C patients, 8 developed recurrence, 4 died with the disease, and the 5 and 10 year cumulative survival rates were 82% and 55% respectively. There were 7 stage D patients, of whom 3 developed recurrence and 2 died, and these patients had a 5 year cumulative survival rate of 86%. The results demonstrated that total prostatectomy with suitable adjuvant therapy is useful for advanced carcinoma as well as clinically early stage carcinoma.

Aged↗

PubMed1991

[Clinical study of incidental prostatic carcinoma].

At the Center for Adult Diseases, Osaka, between 1961 and 1987, 28 cases (1.8%) of incidental prostatic adenocarcinoma were detected by transurethral or subcapsular prostatectomy for clinically benign prostatic hypertrophy (1388 cases) and cysto-prostatectomy for urinary bladder carcinoma (156). Nine (32%) and 19 (68%) cases were in stages A1 and A2, respectively. Of the 19 A2 cases, 9 were well, 9 were moderately and 1 was poorly differentiated adenocarcinoma. Five of the A2 and 1 of the A1 progressed into clinical carcinoma, but none of these patients died of the cancer. Four of these 5 A2 patients had received no treatment postoperatively and one received castration. The intervals from diagnosis to progression ranged from 11 to 78 months. The survival rates at 5 and 10 years with A1 were 75% and 75%, and those with A2 were 80% and 37%. We conclude that the patients in stage A2 should be treated because stage A2 tumors, especially those with no treatment, progress at a higher frequency than stage A1 tumors.

Adenocarcinoma↗

PubMed1991

Treatment of metastatic renal cell carcinoma with a combination of human lymphoblastoid interferon-alpha and cimetidine.

Human lymphoblastoid interferon-alpha was administered intramuscularly at a dose of 5 x 10(6) units/day to 20 metastatic renal cell carcinoma patients. For potentiating the antitumor effect of interferon, cimetidine was also given to them orally at a dose of 800 mg/day. The combination therapy obtained a complete response in three patients (15%) and a partial response in three (15%). Nine patients (45%) had stable disease and five (25%), progressive disease. All six patients who responded to the combination therapy had been nephrectomized and had pulmonary metastases. Two of them also had metastases to other sites (mediastinal lymph nodes and bone). The pulmonary metastases were significantly more receptive to interferon therapy than those at the other sites. The average times before a response was obtained were 2.2 months for a minor response, 2.7 months for a partial response and 3.0 months for a complete response, and the average duration of response was 26 months. The six patients who responded survived for a significantly longer period than the 14 non-responding patients treated with interferon in combination with cimetidine. The major toxicities encountered were fever, fatigue and anorexia due to interferon, and the combination therapy was well tolerated except in three patients. The results suggest that interferon-alpha and cimetidine combination therapy may be of use in the management of patients with metastatic renal cell carcinoma.

Administration, Oral↗

PubMed1991

[Rectal metastasis of prostatic cancer causing annular stricture: a case report].

A 61-year-old man diagnosed with poorly differentiated adenocarcinoma of the prostate (T4 NxM0, stage C) underwent endocrine therapy. The reduction of the tumor was recognized but soon annular rectal stricture appeared. In spite of the subsequent chemotherapy, symptoms aggravated. Then total pelvic exenteration and colostomy were performed. Prostate was easily separated from the rectal wall and the tumor continuity was not proved. Immunohistochemical inspection indicated that the origin of the tumor cells of the rectum was the prostate. Histopathological examination of the rectum using the step section method showed no trace of cancer invasion but many cancer cells in the intramural lymphatic duct. We concluded that adenocarcinoma of the prostate metastasized to the rectum by way of lymphatic flow and caused the annular stricture of the rectum.

Adenocarcinoma↗

PubMed1990

[Radiation therapy for prostatic cancer].

From February 1979 through May 1988, a total of 26 patients with adenocarcinoma of the prostate were treated with radiation therapy for the primary site. The actuarial 5-year survival rate was 59% for 14 patients with Stage C or less disease (A; 1 case, B; 2 cases, and C; 11 cases), and 10% for 12 patients with Stage D. The logrank test showed significant difference between these two groups (p less than 0.007). Rectal radiation injuries occurred in 2 cases (8%) at 7 months (grade I) and 6 months (grade II), respectively. From the analysis of local control and complication, optimum radiation dose ranged from 64.8 Gy to 68.4 Gy (TDF 100-106). In addition, optimum boost radiation field size with rotation technique (after whole pelvic irradiation of 40-45 Gy with anteroposterior opposing fields) ranged from 30 to 48 cm2.

Adenocarcinoma↗

PubMed1990

Combination salvage chemotherapy using cisplatin and teniposide for patients with refractory germinal testicular tumors.

Ten patients with refractory germ-cell tumors were treated with a chemotherapy regimen consisting of teniposide and cisplatin (VM-26 and CDDP; P-VM therapy). Three patients (30%) achieved a complete remission (CR) after chemotherapy alone, and another three subjects (30%) attained a CR following chemotherapy and radiation therapy. Three of the six complete responders relapsed but were rendered disease-free by re-salvage therapy. Among the responders, six patients (60%) are alive and remain disease-free after follow-up periods ranging from 18 to 84 months (median, 48 months). However, the toxicity of P-VM therapy was high, with severe myelosuppression being observed in nine patients; nevertheless, all side effects were reversible. We concluded that the P-VM regimen seems to be effective in the treatment of refractory testicular cancers.

Adult↗

PubMed1990

Solitary neurofibroma of scrotum.

We report a case of solitary neurofibroma of the scrotum. These tumors, which arise from perineural and Schwann cells, commonly occur throughout the body but they rarely have been reported to originate in the scrotum. No stigmata of von Recklinghausen's disease were identified.

Adult↗

PubMed1990

Cooperative study of pirarubicin against urological cancers and future direction of its combination use. The Clinical Study Group of THP for Urological Malignant Tumors.

In the urological field, one of the most effective drugs is doxorubicin. A cooperative phase II study on pirarubicin (THP), a new anthracycline with less cardiotoxicity than doxorubicin, was performed in 14 institutions for treating urological tumors. THP was administered intravenously 3 or more times (as one course, 30-40 mg/m2 once a week, every 3 weeks or 20 mg/m2 2 consecutive days a week every 3 weeks). Fifty-four of the 63 patients included in this study were evaluable. An overall efficacy rate was 18.5% (10/54), consisting of transitional cell carcinoma 24.3% (9/37; bladder cancer 6/27 (22.2%), tumors of the renal pelvis and ureter 3/10 (30.0%), and prostatic cancer 1/15 (6.7%). Adverse effects were mostly slight especially alopecia (15.9%, WHO grade 1:7 patients and grade 2:3 patients), and there was no problem attributable to cardiotoxicity of THP. Leukocytopenia was seen for 65.1% (grade 1:14 patients, grade 2:13 patients, grade 3:13 patients, and grade 4:1 patients). The nadir was observed about 2 weeks later and it took about 2 weeks for the recovery. Thus, it can be concluded that the usefulness of THP in treating urological tumors is comparable to or better than that reported for doxorubicin. Based on the above results, a combination regimen including THP has been investigated in Japan.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1990

Point mutations of c-ras genes in human bladder cancer and kidney cancer.

Point mutations of c-ras genes at codons 12, 13 and 61 were analyzed in 26 cases of bladder cancer and 16 cases of kidney cancer. DNA prepared from either frozen tissues or 10% formalin-fixed, paraffin-embedded tissues were amplified by means of polymerase chain reaction methods, and mutations were analyzed by dot blot hybridization assays with oligonucleotide probes. In three cases of bladder cancer c-ras mutations were found, at codons 13 and 61 of c-Ha-ras and at codon 61 of c-Ki-ras, while no mutation was found in kidney cancer. No mutation was found in normal bladder epithelial tissues from the same patients. Our findings, taken together, may indicate relative scarcity of c-ras mutations in these types of human cancer. The results of dot blot hybridization assays and DNA sequencing showed a G-to-C transition of the first nucleotide at codon 13 c-Ha-ras. This is the first time that such a point mutation has been detected in human cancer tissues.

Aged↗

PubMed1990

Detection of the c-myc gene product in urinary bladder cancer.

Expression of the c-myc gene product in urinary bladder cancer was investigated by immunohistochemical staining with anti-c-myc monoclonal antibody (mAb) MYC-1. Positive staining was observed in the cytoplasm, but not in the nucleus in tissues fixed with 10% formalin. On the other hand, positive staining was localized in the nucleus in cryopreserved tissues. Of 34 cryopreserved specimens examined, positive staining with MYC-1 mAb was observed in 1 of 12 (8.3%) of grade 1 (G1), 12 of 15 (80%) of G2 and 6 of 7 (86%) of G3. Positive staining with Ki-67 mAb was observed in 2 of 12 (17%) of G1, 12 of 15 (80%) of G2, and 6 of 7 (86%) of G3. These results suggest that tumors with higher nuclear pleomorphism contain more proliferating cells.

Carcinoma, Transitional Cell↗

PubMed1990

Leuprorelin acetate depot: results of a multicentre Japanese trial. TAP-144-SR Study Group.

The clinical efficacy and safety of 3.75 or 7.5 mg leuprorelin acetate depot given subcutaneously once every 4 weeks was evaluated in a collaborative study of 81 patients with untreated prostatic cancer. Efficacy of treatment was assessed using criteria based on a meeting of the Prostatic Cancer Study Group funded by the Japanese Ministry of Health and Welfare and using National Prostatic Cancer Project criteria. Japanese criteria enabled evaluation of individual parameters, unlike the National Prostatic Cancer Project system which classified a patient as unevaluable if one evaluation parameter was unavailable. Leuprorelin acetate depot suppressed serum luteinizing hormone, follicle stimulating hormone and testosterone concentrations. Objective response rates of the prostate, bone metastases, serum prostatic acid phosphatase and soft tissue metastases, and subjective dysuria and pain responses were comparable to those found with conventional hormone therapy. Leuprorelin acetate depot was well tolerated, with no significant differences in response to the two doses.

Adult↗

PubMed1990

[Upper urinary tract tumors following bladder cancer].

We treated in total 795 patients with primary transitional cell carcinoma of the urinary bladder between April, 1964 and December, 1988. Eighteen patients of them had upper urothelial cancer during the follow-up period. Thirteen of the 18 patients had received transurethral resection for the initial bladder cancer, while 3 total cystectomy and 2 segmental resection. The over-all incidence of bladder cancer patients who subsequently developed upper urinary tract tumors was 2.3 per cent. The interval between initial treatment of the bladder cancer and treatment for the upper urinary tract tumor ranged from 2 to 74 months (median 20 months). The five-year survival rate after treatment for the upper urinary tract tumor was 31.7 per cent. We conclude that the following are high risk patients for development of upper urinary tract recurrences: 1) patients with bladder cancer near orifices, 2) patients with recurrent bladder cancer under bladder preserving treatment for a long time, 3) patients with G2 multifocal bladder cancer.

Aged↗

PubMed1990

[Role of pulse volume recording in the evaluation of penile blood flow].

Pulse volume recordings were obtained in 53 patients who were hospitalized with urological disorders other than impotence. This method seems to record the total blood volume changes in the penis. Pulse volume recordings also were found to correlate with the value of Penile Brachial pressure Index (PBI). Therefore, it proved to be valuable for estimating penile perfusion. Pulse volume recording is a simple, reliable and adaptable screening method for abnormal penile blood flow. Further investigation is necessary to determine the precision with which the method can detect abnormality of penile blood flow in patients with abnormal venous return.

Adult↗

PubMed1990

[Production of monoclonal antibodies against human bladder cancer cells and application to immunohistochemical analysis of bladder cancer].

Two hybridomas secreting two monoclonal antibodies IgG1 B1.4 and IgG2a B1.6 were obtained by immunizing BALB/c mice with human bladder cancer cell line EJ-1. In immunohistochemical staining of cryopreserved tissues, B1.4 reacted with 0 of 9 grade 1 TCC, 6 of 11 grade 2, all of 6 grade 3 and five metastatic specimens. The antigen recognized by B1.4 was not expressed by normal urothelial cells but were expressed by vascular endothelial cells and muscle of tunica media. The target antigen of B1.6 was expressed by normal urothelial cells and all grade of TCC. In this study, it was demonstrated that poorly differentiated bladder cancer and metastatic specimens of bladder cancer express a vascular carbohydrate antigen. Taking the escape mechanism of immune surveillance, into consideration, it is possible that the antigen recognized by B1.4 is an indicator of metastatic potential of bladder cancer.

Animals↗

PubMed1990

[Results of surgical treatment of proximal hypospadias].

Eighteen patients of proximal hypospadia underwent operations by our two-stage method. First stage operation was done by exaggerated Nesbit's method. The foreskin was transposed to the ventral surface of the penis as a flap that is long enough to be brought to the top of the glans. The second-stage procedure was done after a minimum of 6 months. The urethral tube was formed around the Foley catheter with a flap, its peripheral end being one to two centimeters proximal to the sulcus. For one to two centimeters the distal flap was freed. The tubularization was done by a continuous 4-0 nylon suture, which was removed after ten days. The tube was passed to the top of the glans through the tunnel and sutured to the glans with 5-0 nylon. Urinary diversion was not performed. In one case the new urethral orifice receded and reoperation was done. The operations in the other 17 cases were successful without stricture or fistula formation.

Adult↗