Biomedical subjects
Publications and source records attributed to Y Kawada.
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Prostate specific antigen (PSA) levels after total prostatectomy or radiation therapy to localized prostate cancer and also during endocrine therapy are within normal range. Therefore, it is necessary to use hyper sensitive PSA assay kits for early detection of relapse. The present study was undertaken to evaluate two hyper sensitive assay kits (Delfia kit, lower limit 0.1 ng/ml, Kabi Pharmacia Diagnostics Co. and Markit M kit, 0.5 ng/ml, Dainippon Pharmaceutical Co.) and to compare them with conventional PSA kit (Eiken Chemical Co., 1.0 ng/ml). Total of 291 sera were examined: patients consisted of 10 total prostatectomy+endocrine therapy, 9 radiation therapy+endocrine therapy, 5 radiation therapy alone and 44 endocrine therapy alone. Values of endocrine therapy alone were divided into two groups according to duration after start of treatment; more or less than 5 years. The following results were obtained. 1. In non-relapse patients after total prostatectomy+endocrine therapy and radiation+endocrine therapy, PSA showed under lower limit with hyper sensitive kit. On the contrary, conventional kit indicated more than 1.0 ng/ml. 2. Radiation therapy alone kept PSA in detectable range with hyper sensitive kit in spite of no sign of relapse. 3. In non-relapsed patients under endocrine therapy alone, long duration (more than 5 years after start of treatment) decreased PSA in non detectable values with hyper sensitive kits. In this case, conventional kit still showed PSA as more than 1 ng/ml. 4. Doubling time at relapse was estimated similar with Delfia kit and Markit M kit, and much longer with conventional kit. It is concluded that hyper sensitive kit is more useful to manage patients after therapy than conventional kit.
Clinical evaluation of TANDEM PSA which is the most frequently used prostate specific antigen (PSA) assay method in the world and a comparison with other methods were performed in Japanese cases in a cooperative research fashion. The minimum detectable level of the method was found to be 0.50 ng of PSA in one ml of serum and 1.9 ng/ml was regarded as the upper normal value in Japanese males. The distribution of serum PSA showed a significant difference between the benign prostate hypertrophy (BPH) cases and patients with stage C or D prostate cancer. The sero-diagnosis prostate cancer at an early stage with the TANDEM PSA was difficult. The correlation to other methods of PSA detection was very high. Furthermore, the clinical use of the method in following-up the clinical course of prostate cancer patients was very useful. These findings suggested that the PSA detection using TANDEM PSA is applicable even in Japanese cases although the upper cut-off level is decreased.
A 73-year-old male with low abdominal pain on urination and frequent urination was diagnosed as poorly differentiated adenocarcinoma of prostate. He received endocrine therapy with DESD and bilateral orchiectomy. This treatment was not effective, so he was given intra-arterial infusion chemotherapy with MTX, ADM and CDDP using the reservoir system. After 2 courses of this chemotherapy the regression rate was 75%, and the pathological examination after the chemotherapy revealed no cancer cells. There is no established chemotherapy for prostate cancer at present. Thus this case is very suggestive for the treatment of prostate cancer.
OBJECTIVE: To determine the anthropometric indices linked to the biochemical risk factors for atherosclerosis in Japanese obese elementary school children, ages ranging from 6 to 12 years. DESIGN: Cross-sectional study of obese children based on fasting blood samples. SETTING: Outpatient clinic of University Hospital. SUBJECTS: 65 consecutive patients with simple obesity (38 boys and 27 girls), and age-matched controls, 184 boys and 205 girls. MAIN OUTCOME MEASURES: Percent obesity and body mass index as indices of being overweight; percent body fat and the sum of four skinfold thicknesses as indices of adiposity; waist-to-hip circumference ratio and waist-to-thigh circumference ratio as indices of body fat distribution. The anthropometric indices were standardized by calculating standard deviation scores based on data from control children. RESULTS: In the obese boys, all six anthropometric indices studied correlated closely with serum biochemical indices, and strong correlations were observed among the indices of overweight, adiposity and body fat distribution. In contrast, only the indices of body fat distribution, not those of overweight or of adiposity, were correlated with serum biochemical indices in the obese girls. No relationship was found between the indices of body fat distribution and the other anthropometric indices in the obese girls. Thus, the profile of the obese girls differed from that of their male counterparts. CONCLUSION: The results suggest that body fat distribution is related to certain biochemical complications of childhood obesity, and that androgyny in fat patterns induces metabolic derangements in children.
We treated a case of ACTH-independent bilateral adrenocortical macronodular hyperplasia (AIMAH), a rare disease. The patient was a 49 year-old man having chief complaints of facial edema, muscle wasting and typical Cushing's syndrome symptoms. He was diagnosed with AIMAH by specific hormonal tests for Cushing's syndrome and CT scan. Bilateral total adrenalectomy was performed in a two-stage operation for bilateral macronodular adrenocortical hyperplasia. The resected adrenal tumor weighed 57 g on the right side and 78 g on the left, and both had a yellowish nodular surface. The histological appearance was typical AIMAH. A total of 23 AIMAH reported cases was reviewed.
A 69-year-old woman visited our hospital with complaints of low grade fever and general fatigue in October 1990. Computed tomography (CT), ultrasonogram, and renal arteriography showed left renal tumor and she was diagnosed with renal cell carcinoma (T2M0N0). Left radical nephrectomy was performed in December 12, 1990. After operation, 3 x 10(6) unit per day of IFN-alpha were administered three times per week. She complained of low grade fever and general fatigue in June, 1991. CT showed left lung metastasis (phi 3 cm). She was given combined chemotherapy (MVP: methotrexate, vinblastine, pepleomycin). After 2 courses, lung metastasis decreased and after 4 courses, lung metastasis was not shown by CT in December, 1992. No evidence of relapse was shown by CT in June, 1994.
A 76-year-old Japanese male consulted our hospital complaining of dysphagia. He also complained of dyspnea, and a cardiovascular disorder was detected. Otolaryngological examination revealed dysphagia due to pharyngeal tumor. Further examination detected left renal cell carcinoma with multiple pulmonary metastasis, and selective angiography revealed arteriovenous fistula in the primary tumor. After resection of the pharyngeal tumor and left nephrectomy, pharyngeal tumor was pathologically confirmed as metastasis of renal cell carcinoma. Furthermore, after left nephrectomy, the cardiovascular disorder gradually improved. Thus, the cardiovascular disorder was considered to have developed based upon the arteriovenous fistulae. Pharyngeal metastasis of renal cell carcinoma is extremely rare, and the cardiovascular disorder in this case was also an extrarenal manifestation.
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A case of soft renal calculi with xanthogranulomatous change is reported. A 37-year-old female visited our hospital on February 4, 1992 complaining of frequency of urination and right lower abdominal pain. Under the clinical diagnosis of right renal calculi, extracorporeal shock wave lithotripsy was attempted, but no sign of destruction was observed. Right pyelolithotomy was performed on June 8, 1992. Several soft calculi were removed from the right renal pelvis. Microscopic examination showed that the calculi were surrounded by a cell layer including foam cells and giant cells. In addition, the calculi revealed positive reaction by several stainings (alcian-blue, PAS and muticarmin), which showed that the calculi were mainly composed of mucopolysaccharides. We discussed this disease in terms of symptoms, diagnosis, treatment and mechanism in comparison with previous reports.
Whether or not chronic L-dopa treatment (100 mg/kg, intraperitoneally (i.p.), twice daily for 4 weeks) alters lipid peroxidation in the brain as an indicator of neuronal damage was examined in normal mice and mice in which catecholamine (CA) neurons had been injured previously by the administration of 6-hydroxydopamine (6-OHDA), followed by recovery. In normal mice, chronic L-dopa treatment reduced the thiobarbituric acid reacting substances (TBARS) level, an indicator of lipid peroxidation, in the cerebral cortex. In contrast, in mice with CA neuronal injury induced by pretreatment with 6-OHDA, the chronic L-dopa treatment markedly increased the TBARS in the striatum and frontal cortex, despite recovery of the striatal dopamine levels similar to those in the control mice. These findings suggest that the long-term high-dose administration of L-dopa enhances the progression of neuronal damage in patients with injured CA neurons such as those with Parkinson's disease.
The reliability of two methods for the detection of pyuria was studied in a total of 106 urine samples obtained from patients with identifiable underlying urinary tract disease. The coefficient of variation (CV) was significantly higher in the microscopic than in the counting chamber method. The CV obtained with the use of the KOVA slide 10 grid, a disposable and less expensive counting chamber, was identical to that obtained with the Bürker-Türk counting chamber. Only 50% of the patients who were proven to have pyuria of > or = 5 WBCs/HPF by the microscopic method had significant bacteriuria of > or = 10(4) bacteria per ml of urine. On the other hand, 95% and 90% of the patients who were proven to have pyuria of > or = 10 WBCs/mm3 with the Bürker-Türk and Fuchs-Rosenthal counting chambers had significant bacteriuria. It was concluded that the counting chamber provides a reliable method for the detection of pyuria and is highly predictive for the presence of significant bacteriuria. The KOVA slide 10 grid is an acceptable alternative to the regular counting chamber.
Whether or not the efficacy of antimicrobial agents in complicated urinary tract infection (UTI) in men and women can be evaluated with the same protocol was studied in a total of 416 male and 387 female patients. Clinical and bacteriological efficacies achieved in male patients were significantly lower than those achieved in female patients. The most important reason for the difference in clinical and bacteriological efficacies was due to the difference of infecting organisms between male and female patients. It was concluded that complicated UTI in men and women can alternatively be studied with the same protocol in so far as the results were stratified according to sex and infecting organism.
Mycoplasma genitalium causes urethritis in non-human primates, but studies on its pathogenicity in man have been hampered by the difficulty in isolating this oragnism in culture. We have used a specific polymerase chain reaction to examine the role of M. genitalium in non-gonococcal urethritis (NGU). Oligonucleotide primers were used to amplify a 281 bp of 140-KDa adhesin gene of M. genitalium. A characteristic PCR product was amplified, when M. genitalium DNA was template for the PCR. No amplified product was detected in Mycoplasma pneumoniae DNA, Mycoplasma hominis DNA or other bacterial DNAs. M. genitalium DNA was detected in urethral swabs from 17 (14.9%) of 114 men with NGU. Three (9.1%) of the 33 men with Chlamydia-positive NGU and 14 (17.3%) of the 81 with Chlamydia-negative NGU were positive for M. genitalium DNA, but 29 men without urethritis were negative. The prevalence of M. genitalium in NGU and in Chlamydia-negative NGU was significantly higher than that in the normal control. These findings suggest that M. genitalium would be a cause of NGU.
We report a case of metachronous bilateral malignant lymphoma of the testis. A 67-year-old man was admitted to our hospital with complaints of left scrotal swelling with swelling of the left inguinal lymph node. Left high orchiectomy and dissection of the left inguinal lymph node were done under the diagnosis of the testicular tumor. Histopathological diagnosis was non-Hodgkin's lymphoma of diffuse, medium-sized cells of the B cell type. Several examinations revealed no apparent additional involvement. Chemotherapy was initiated with cyclophosphamide, adriamycin, vincristine and prednisolone (VEPA). One year and 10 months later, contralateral right scrotal swelling with swelling of the right inguinal lymph node occurred. Histopathological findings were similar to those of the resected left testis. We discussed malignant lymphoma of the testis, especially bilateral cases.
The clinical efficacy of temafloxacin (TMFX) was evaluated in the patients with acute prostatitis (AP: 31 cases) and chronic prostatitis (CP: 75 cases), and the criteria for clinical evaluation on bacterial prostatitis by the Japanese UTI Committee were re-examined. The clinical efficacy of TMFX on prostatitis was examined. The number of the evaluable cases by doctors in charge were 30 and 68 for AP and CP, respectively. The efficacy rates were as high as 96.7% for AP and 80.9% for CP. In the patients whose efficacy could be evaluated by the Committee, the efficacy rates were as high as 100% (15/15) for acute bacterial prostatitis (ABP) and 66.7% (18/27) for chronic bacterial prostatitis (CBP). The bacteriological eradication rates were 100% (15/15) for ABP and 81.5% (22/27) for CBP. Adverse drug reactions were observed in 8 of 100 cases (total evaluable cases) but they clinically did not consist any problems. Abnormal laboratory test findings were observed in 9 of 71 cases (total evaluable cases), whose changes were all slight and did not clinically cause any problem. Therefore, TMFX was concluded to be highly useful in the treatment of ABP and CBP. The criteria for clinical evaluation on bacterial prostatitis were re-examined. Concerning the treatment period, comparison of the evaluation at Day 7 with that at Day 14 in ABP revealed that the efficacy was evaluable at Day 7. In the same way, comparison of the evaluation at Day 14 with that at Day 28 in CBP revealed that the efficacy was evaluable at Day 14. Concerning the pathogens, in ABP, the major pathogens were considered to be GNR as well as E. coli. On the other hand, in CBP, GNR and E. faecalis, that were generally authorized to be pathogens, were detected in less than half of the patients, and CNS were detected in the other patients. Among the CNS cases, there were some cases that showed no relationship between improvement of clinical symptoms and bacterial response. Therefore, it is necessary to perform further studies on this matter. In conclusion, regarding the criteria for clinical evaluation on bacterial prostatitis proposed by the Japanese UTI committee, the treatment period for evaluation of efficacy was appropriate, and it is necessary to perform further studies in order to determine the pathogens in bacterial prostatitis.
To examine the frequency and the type of infection during cancer chemotherapy in the urological field, we studied the causes of fever in 67 patients with genitourinary cancer. Twenty-six patients had developed a fever of higher than 38 degrees C. Although fever without proven infection was seen in 11 patients (42.3%), fever caused by pyelonephritis was the most common infection. There was a relationship between fever and the presence of hydronephrosis. Fever was observed more often in patients with a leucocyte count of less than 2,000 white blood cell/mm3. In conclusion, we recommend the interruption of cancer chemotherapy or the use of granulocyte colony-stimulating factor for the prevention of infection, when the leukocyte count is less than 2,000 cell/mm3, especially in patients with hydronephrosis.
OBJECTIVE: To investigate the effectiveness of administering relatively high doses of r-HuEPO subcutaneously once a week or once every 2 weeks in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). DESIGN: Multicenter prospective analysis. The trial was divided into two phases: an initial 8-week phase (once a week dosing) followed by a 12-week maintenance phase (once every 2 weeks dosing). A response was defined as a change in hematocrit (Ht) of 3% or more. Results were analyzed using Sheffe's test, Mantel-Haenszel's test, and Dunnett's test. SETTING: Eleven renal units in Japan providing a CAPD program. PATIENTS: Forty-one CAPD patients with a Ht of 28% or less. RESULTS: After the initial 8 weeks, 13 (81.3%) of 16 patients showed a response to 6000 U (106.9 +/- 20.0 U/kg) subcutaneously (sc), once a week. Eleven (84.6%) of 13 in the 9000 U (166.5 +/- 27.7 U/kg) group and all 12 (100%) in the 12,000 U (210.7 +/- 42.1% U/kg) group also showed responses. At the end of both phases, that is, at 20 weeks, 7 (53.8%) of 13 patients in the 6000 U group with once every 2 weeks dosing, 7 (63.6%) of 11 in the 9000 U group, and 10 (90.9%) of 11 in the 12,000 U group maintained responses with the same dosing interval. There were no significant changes in mean blood pressure during the study period, and only 2 patients developed treatable hypertension with mild headache. CONCLUSION: Administration of relatively high doses of r-HuEPO to CAPD patients once a week or once every 2 weeks is safe and potentially an effective regimen for the correction of renal anemia.