1
|
Kato K, Sasazawa S, Hazama T, Ishimura K, Tanimura K, Shinozaki H, Tsukamoto R, Tobe T. Transrenal Ureter Embolization for Refractory Urine Leaks from Iatrogenic Ureteric Injury Following Colorectal Surgery. INTERVENTIONAL RADIOLOGY 2022; 7:21-25. [PMID: 35911874 PMCID: PMC9327325 DOI: 10.22575/interventionalradiology.2021-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022]
Abstract
We present the cases of two patients who underwent ureteral occlusion using coils and/or Amplatzer Vascular Plug with N-butyl cyanoacrylate glue after extensive advanced rectal surgery. Both patients had complex urine leaks unresponsive to urinary diversion. In view of the progress of the disease and the history of polysurgery, reconstructive surgery or anterograde ureteral stent insertion was not chosen. All patients had immediate resolution of urinary leakage after ureteral embolization, resulting in symptom relief throughout the follow-up period. There were no procedure-related complications or side effects.
Collapse
|
2
|
Suzuki H, Jinnouchi S, Kaji Y, Kishida T, Kinoshita H, Yamaguchi S, Tobe T, Okamura T, Kawakita M, Furukawa J, Otaka A, Kakehi Y. Diagnostic performance of 18F-fluciclovine PET/CT for regional lymph node metastases in patients with primary prostate cancer: a multicenter phase II clinical trial. Jpn J Clin Oncol 2019; 49:803-811. [PMID: 31095314 DOI: 10.1093/jjco/hyz072] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/25/2019] [Accepted: 04/25/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This multicenter, phase II clinical trial evaluated the diagnostic performance of 18F-fluciclovine, a novel amino acid for positron-emission tomography (PET), for detection of small lymph node metastases with short-axis diameters of 5-10 mm in patients with prostate cancer. METHODS Patients with prostate cancer were eligible after screening of laboratory tests and pelvic contrast-enhanced computed tomography (CT). Pelvic region 18F-fluciclovine PET/CT was then acquired within 28 days and dissection of regional lymph nodes was performed within 60 days of pelvic contrast-enhanced CT. Diagnostic performance of 18F-fluciclovine-PET/CT was evaluated by comparison with standard histopathology of lymph nodes. RESULTS In a total of 28 patients, 40 regional lymph nodes with short-axis diameters of 5-10 mm were eligible for efficacy evaluation; seven of these showed metastases confirmed by histopathology. The sensitivity of 18F-fluciclovine PET/CT was 57.1% (4/7). All four true positive lymph nodes detected by 18F-fluciclovine PET/CT had a metastatic lesion with a long-axis diameter of ≥7 mm and a high proportion of cancer volume (60-100%) according to pathology evaluation. The specificity, diagnostic accuracy, positive predictive value, and negative predictive value of 18F-fluciclovine PET/CT in lymph node-based analysis were 84.8% (28/33), 80.0% (32/40), 44.4% (4/9), and 90.3% (28/31), respectively. No clinically significant adverse events occurred. CONCLUSIONS 18F-fluciclovine PET/CT detected small lymph node metastases; however it also showed positive findings in benign lymph nodes. Refinement of the image assessment criteria may improve the diagnostic performance of 18F-fluciclovine PET/CT for small lymph node metastases in patients with prostate cancer.
Collapse
|
3
|
Komiya A, Endo T, Kobayashi M, Kim W, Araki K, Naya Y, Suzuki H, Tobe T, Ichikawa T, Fuse H. Oral analgesia by non-steroidal anti-inflammatory drug zaltoprofen to manage cystoscopy-related pain: A prospective study. Int J Urol 2009; 16:874-80. [DOI: 10.1111/j.1442-2042.2009.02384.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
4
|
Sekiyama K, Yamanishi T, Yoshida K, Tobe T, Kaibuchi T, Mori I. MP-12.12: A Randomized, Controlled Trial Comparing the Efficacies of Alarm Treatment and Behavioural Modification in Enuresis. Urology 2009. [DOI: 10.1016/j.urology.2009.07.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
5
|
Taniyama M, Kusano S, Miyoshi Y, Nakamura H, Kaihara M, Tobe T, Tomita M, Katagiri T, Ban Y. Mild resistance to thyroid hormone with a truncated thyroid hormone receptor beta. Exp Clin Endocrinol Diabetes 2009; 104:339-43. [PMID: 8886752 DOI: 10.1055/s-0029-1211464] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recent studies have revealed mutations in the thyroid hormone receptor beta (TR beta) gene as a cause of the most cases of the thyroid hormone resistance syndrome. We have identified a novel nonsense mutation in codon 449 in the 3' end of exon 10 in the TR beta gene in a 16-year-old male patient with generalized resistance to thyroid hormone who also had familial thyroxine binding globulin deficiency. Receptor protein generated from this gene is thought to be 13 amino acid deficient at carboxy-terminus. Resistance to thyroid hormone was mild at least when the patient was evaluated. The patient was eumetabolic in the presence of elevated plasma-free thyroid hormone levels, and both thyrotrope and peripheral tissues responded to triiodothyronine (T3) administration. This mildness of resistance is in contrast to severe resistance to thyroid hormone in two previously reported cases with truncated receptors in which 16 amino acids or 11 amino acids were deficient at C-terminus. Thus, truncation of C-terminus of thyroid hormone receptor beta does not uniformly produce sever resistance.
Collapse
|
6
|
Sakakibara R, Awa Y, Naya Y, Tobe T, Uchiyama T, Hattori T. Neobladder overactivity; an equivalent to spontaneous rectal contraction. Int J Urol 2007; 14:1054-6. [PMID: 17956538 DOI: 10.1111/j.1442-2042.2007.01885.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 76-year-old man had transitional cell carcinoma of the bladder and underwent orthotopic ileal neobladder, and developed severe nocturnal enuresis. We performed videomanometry in the ileal neobladder and the rectum of the patient. Slow filling of the ileal neobladder showed overactivity (the amplitudes up to 50 cmH2O), which was similar to that normally seen in the rectum (the amplitudes up to 20 cmH2O). In contrast to the normal rectal sensation, neobladder sensation was markedly decreased. During urination, the patient voided with strain and overactivity, both of which were similar to that seen in the rectum. Urethral sphincter function was preserved in the patient. In conclusion, both decreased sensation and neobladder overactivity, an equivalent to spontaneous phasic contraction of the rectum, contributed to nocturnal enuresis in our patient. Bowel-targeted management may be necessary to minimize nocturnal enuresis in bladder-substituted patients.
Collapse
|
7
|
Suzuki H, Komiya A, Kojima S, Tobe T, Ueda T, Ichikawa T. [The clinical efficacy of SNRI milnacipran in the treatment of hot flushes with prostate cancer hormonally treated]. HINYOKIKA KIYO. ACTA UROLOGICA JAPONICA 2007; 53:375-9. [PMID: 17628934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
We investigated the clinical efficacy of milnacipran (Serotonin-Noradrenalin Reuptake Inhibitor: SNRI) in prostate cancer patients who suffer from hot flushes. Our study included 12 patients who had taken hormone therapy for at least 3 months prior to the trial entry. All patients had severe hot flushes at least 3 times daily. Among 12 patients, 7 subjects received milnacipran 25 mg orally once a day and 5 subjects received 50mg once a day. The questionnaire was used to measure the frequency and severity of hot flushes at baseline, and at 6 and 12 weeks. At 12 weeks, 9 patients were available for the evaluation. Four patients received 50 mg per day and 5 patients received 25 mg per day. The patients with > or =50% decrease in baseline hot flash score were observed in 3 out of 4 who received 50 mg and 2 out of 5 who received 25 mg per day. The frequency of hot flushes had significantly decreased at the 12 weeks period than the baseline in the milnacipran 50 mg per day treatment group (p < 0.05, paired t-test). Adverse events were observed in 3 patients: 2 cases of nausea and 1 case of constipation. However, all of them were mild to moderate. These results indicated that milnacipran 50 mg per day therapy is effective in the treatment of hot flushes, which is the side effect of hormone therapy for prostate cancer.
Collapse
|
8
|
Orihara K, Narita M, Tobe T, Akasawa A, Ohya Y, Matsumoto K, Saito H. Circulating Foxp3+CD4+ regulates both Th1 and Th2 responses in vivo. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
9
|
Kobayashi M, Kojima S, Suyama T, Fujimura M, Awa Y, Naya Y, Suzuki H, Tobe T, Ichikawa T. [Retroperitoneal inflammatory fibrosarcoma; a case report]. Nihon Hinyokika Gakkai Zasshi 2006; 97:848-51. [PMID: 17154029 DOI: 10.5980/jpnjurol1989.97.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 62-year-old man was admitted to our hospital complaining of lower abdominal mass and weight loss. Computed tomography and magnetic resonance imaging studies revealed a large tumor occupying the pelvis and expanding into inferior vena cava, which reached to the renal pedicle. Open biopsy was undergone under general anesthesia. Histopathological diagnosis was inflammatory fibrosarcoma. Five courses of chemotherapy including vincristine, actinomycin-D and cyclophosphamide (VAC) resulted in 35% reduction of the tumor volume in one direction, indicating that VAC could be an alternative effective therapy for inoperable inflammatory fibrosarcoma.
Collapse
|
10
|
Naya Y, Tobe T, Suyama T, Araki K, Komiya A, Suzuki H, Igarashi T, Ichikawa T. The efficacy and safety of laparoscopic nephrectomy in patients with three or more comorbidities. Int J Urol 2006; 14:17-20. [PMID: 17199854 DOI: 10.1111/j.1442-2042.2006.01663.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Laparoscopic surgery for kidney treatment is a common procedure. However, the efficacy of this procedure in patients with several comorbidities has not been well investigated. We conducted a retrospective comparison of results of laparoscopic surgery between patients with several comorbidities and patients with no comorbidity to access the efficacy and safety of this procedure. METHODS The subjects were 20 patients with three or more comorbidities (group A) and 46 patients with less than three comorbidities (group B). These 66 patients were 48 men and 18 women with a mean age of 62.3 years (age range, 24-83 years). The data from these two groups were compared for American Society of Anesthesiology (ASA) physical status score, previous surgical history, duration of surgery, estimated blood loss, tumor size, complications during and after surgery, conversion rates, time to oral intake, and length of hospital stay. RESULTS The initial ASA score and age were significantly higher for the patients with comorbidities (P < 0.0001, P = 0.0008, respectively). All other variables before, during, and after surgery were similar for both laparoscopic groups. However, the incidence of atelectasis of laparoscopy was higher than that of open surgery. CONCLUSIONS Laparoscopic nephrectomy for patients with comorbidities is safe and minimally invasive. Further investigation to prevent atelectasis is necessary.
Collapse
|
11
|
Araki K, Igarashi T, Tobe T, Mizoguchi K, Suzuki H, Furuya Y, Ichikawa T, Nakatsu HO, Ito H. Serum immunosuppressive acidic protein doubling time as a prognostic factor for recurrent renal cell carcinoma after nephrectomy. Urology 2006; 68:1178-82. [PMID: 17141843 DOI: 10.1016/j.urology.2006.08.1071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 05/29/2006] [Accepted: 08/14/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify the prognostic factors in patients with recurrent renal cell carcinoma after nephrectomy, various factors were assessed, with special attention to serum immunosuppressive acidic protein (IAP) and its doubling time. METHODS Age, sex, stage, grade, histopathologic type, primary tumor size, site and number of metastatic organs, time to recurrence, IAP levels before nephrectomy and at the diagnosis of recurrence, and IAP doubling time just before recurrence were analyzed in 125 patients with recurrent renal cell carcinoma after nephrectomy. RESULTS Univariate analysis identified stage, grade, histopathologic type, primary tumor size, time to recurrence, IAP level at the diagnosis of recurrence, and IAP doubling time as significant prognostic factors. After exclusion of confounding factors, multivariate analysis showed that IAP doubling time was the most potent independent prognostic factor. Patient survival rates dichotomized according to IAP doubling time were compared at 100-day intervals from 100 to 700 days and 1000 and 2000 days. The maximal difference in survival rate was found when the cutoff level in the IAP doubling time was set at 200 days. CONCLUSIONS The results of our study have shown that the IAP doubling time is a potent prognostic factor in patients with recurrent renal cell carcinoma. Periodic checkups with serum IAP level monitoring are recommended to predict prognosis after recurrence.
Collapse
|
12
|
Onishi T, Igarashi T, Tobe T, Ichikawa T. [A case report of chromophobe cell renal carcinoma arising from atrophic kidney during long-term haemodialysis]. HINYOKIKA KIYO. ACTA UROLOGICA JAPONICA 2006; 52:919-21. [PMID: 17252973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A 60-year-old woman with chromophobe cell renal carcinoma arising from the atophic right kidney during long-term haemodialysis was reported. The right renal tumour was detected incidentally by abdominal ultrasound examination. She received right nephrectomy through flank incision, and the pathological diagnosis was an eosinophilic variant of chromophobe cell renal carcinoma. Chromophobe cell renal carcinoma is a relatively rare subtype of renal cell carcinoma (5%), and the rate of this subtype on a long-term haemodialysis was quite low (0.6-0.7%), and almost all these patients had acquired cystic disease accompanied with haemodialysis. By contrast, our case occurred in the atrophic kidney (non-cystic kidney), and this might be the first case report of chromophobe cell renal carcinoma arising from an atrophic kidney in a patient on long-term haemodialysis.
Collapse
|
13
|
Ishihara M, Suzuki H, Akakura K, Komiya A, Imamoto T, Tobe T, Ichikawa T. Baseline health-related quality of life in the management of prostate cancer. Int J Urol 2006; 13:920-5. [PMID: 16882056 DOI: 10.1111/j.1442-2042.2006.01441.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to clarify characteristics of baseline health-related quality of life (HRQOL) during the diagnostic process of prostate cancer. METHODS A prospective study was conducted to measure HRQOL in a cohort of 141 patients in whom prostate cancer was suspected and prostate biopsy was scheduled, using both generic and disease-specific HRQOL measures (SF-36, UCLA-Prostate Cancer Index) at two points: before prostate biopsy (prediagnosis) and after giving biopsy results (postdiagnosis). Seventy-three patients were diagnosed with prostate cancer and 68 were not. RESULTS Compared to age-gender adjusted population norms, patients demonstrated better physical function (PF) and worse mental health (MH). Characteristic age-related changes were found in PF and sexual function (SXF); however, disease stage exhibited no relevant effects in HRQOL. No significant difference was detected between pre- and postdiagnosis SF-36 and UCLA-PCI scores. CONCLUSION The present study discovered no relevant impact of the diagnostic process of prostate cancer on baseline HRQOL using SF-36 and UCLA-PCI. Combined with results of previous studies, it is supportive of regarding pretreatment levels of HRQOL as the baseline.
Collapse
|
14
|
Kato T, Suzuki H, Komiya A, Imamoto T, Naya Y, Tobe T, Ichikawa T. Clinical significance of urinary white blood cell count and serum C-reactive protein level for detection of non-palpable prostate cancer. Int J Urol 2006; 13:915-9. [PMID: 16882055 DOI: 10.1111/j.1442-2042.2006.01440.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The clinical significance of the urinary white blood cell (U-WBC) count and serum C-reactive protein (CRP) level was evaluated in an effort to improve the efficiency of prostate biopsies. METHODS We enrolled 228 consecutive patients with serum prostate-specific antigen (PSA) ranging from 3.0 to 20.0 ng/mL, normal digital rectal examination findings, and who underwent prostate biopsies between January 2001 and August 2004. Of these, 157 patients had histologically confirmed benign prostatic disease and the remaining 71 patients had prostate cancer. Patients with a pretreatment U-WBC count < or =3 or >3/high power field were defined as non-pyuria and pyuria, respectively. The patients were also separated into two groups based on the serum CRP level prior to biopsy. Several clinical factors were compared among these subgroups. RESULTS Inflammation was histologically detected at rates of 58.1% and 34.1% in the pyuria and non-pyuria groups, respectively (P = 0.0014). The rates of cancer detection were significantly lower in the pyuria, than in the non-pyuria group (P = 0.0384). The cancer detection rates did not significantly differ according to serum CRP levels prior to biopsy. CONCLUSION The U-WBC count appears to be a reliable indicator of minute prostatic inflammation. The serum PSA level was elevated in patients with asymptomatic prostatitis. Counting U-WBC is a simple, convenient and non-invasive method that should be valuable part of routine urological examinations.
Collapse
|
15
|
Matsumoto A, Tobe T, Kamijima S, Araki K, Naya Y, Igarashi T, Ichikawa T. The usefulness of ureterorenoscopic examination in evaluation of upper tract disease. Int J Urol 2006; 13:509-14. [PMID: 16771717 DOI: 10.1111/j.1442-2042.2006.01352.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The objective of the present study was to clarify the indications, usefulness and limitations of ureterorenoscopy. MATERIAL AND METHODS From January 1998 to June 2004, 72 consecutive patients (48 men and 24 women) with a mean age of 66 years (range, 27-83 years) underwent ureterorenoscopy to diagnose upper urinary tract tumors (UUT). Median follow-up was 24 months (range, 1-73 months). Patients were divided into four subgroups by voided urine cytology and preoperative radiographic findings. Group A (n=11, 15.3%), positive voided urine cytology and positive preoperative radiographic findings; group B (n=5, 6.9%), positive cytology and negative radiographic findings; group C (n=48, 66.7%), negative cytology and positive radiographic findings and group D (n=8, 11.1%), frank hematuria originating from the UUT but negative cytology and negative radiographic findings. We compared the findings of ureterorenoscopic examination and biopsy with the results of retrograde pyelography and cytology of upper tract urine. For each examination, the following diagnostic indices were assessed: sensitivity, specificity, positive-predictive-value (PPV) and negative-predictive-value (NPV) and accuracy. Statistical analysis was performed using McNemar's test. RESULTS For ureterorenoscopy, sensitivity was 94%, specificity 59%, PPV 72%, NPV 92% and accuracy 76%. For biopsy, sensitivity was 77%, specificity 100%, PPV 100%, NPV 80% and accuracy 88%. Accuracy of ureterorenoscopy tended to be superior to that of retrograde pyelography. Ureterorenoscopy was most useful in the group which consisted of 48 patients (66.7%) with negative voided urine cytology and positive preoperative radiographic findings. This group was the only group in which accuracy of ureterorenoscopic biopsy was superior to that of urine cytology, significantly (P=0.03). CONCLUSION Results indicated that ureterorenoscopy is most suitable and gives superior accuracy in patients with positive radiographic findings and negative voiding cytology. Ureterorenoscopic biopsy of the upper urinary tract would provide useful information when considering therapeutic strategies, such as nephron-sparing management.
Collapse
|
16
|
Kamijima S, Tobe T, Suyama T, Ueda T, Igarashi T, Ichikawa T, Ito H. The prognostic value of p53, Ki-67 and matrix metalloproteinases MMP-2 and MMP-9 in transitional cell carcinoma of the renal pelvis and ureter. Int J Urol 2005; 12:941-7. [PMID: 16351648 DOI: 10.1111/j.1442-2042.2005.01159.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate the prognostic and predictive relevance of p53 protein, Ki-67 antigen, MMP-2 and MMP-9 in patients with transitional cell carcinoma (TCC) of the upper urinary tract. METHODS The expression of p53 protein, Ki-67 antigen, MMP-2 and MMP-9 was examined by immunohistochemistry in 69 patients with TCC of the upper urinary tract. Correlation of p53, Ki-67, MMP-2 and MMP-9 over-expression with conventional pathological parameters and patient survival was examined. RESULTS p53 over-expression was significantly correlated with histological grade (P < 0.05), but not with pathological stage, vascular invasion, lymphatic invasion or lymph node metastasis. Ki-67 over-expression was significantly correlated with stage, grade, lymphatic invasion and vascular invasion (P < 0.05). In survival analyses, Ki-67 over-expression was a significant prognostic factor in the univariate analysis (P < 0.05), but it did not have a significant impact on survival in the multivariate analysis. Ki-67 labeling index was a significant prognostic factor in patients with a low p53 labeling index, but not in patients with a high p53 labeling index. CONCLUSION Ki-67 over-expression is of prognostic value in TCC of the upper urinary tract, while p53, MMP-2 and MMP-9 are of limited value.
Collapse
|
17
|
Naya Y, Suzuki H, Komiya A, Nagata M, Tobe T, Ueda T, Ichikawa T, Igarashi T, Yamaguchi K, Ito H. Laparoscopic adrenalectomy in patients with large adrenal tumors. Int J Urol 2005; 12:134-9. [PMID: 15733106 DOI: 10.1111/j.1442-2042.2005.01017.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The maximum size of adrenal tumors that should be removed by laparoscopic adrenalectomy is controversial. We conducted a retrospective comparison of the results of laparoscopic adrenalectomy between patients with adrenal tumors > or =6 cm ('large tumors') and patients with adrenal tumors <6 cm ('small tumors'). METHODS The participants in the study were 16 patients with large tumors and 111 patients with small tumors. The patients comprised 59 men and 68 women (mean age, 49.0 years; age range, 23-79) with varying diagnoses. Of the 16 patients with large tumors, five had Cushing's syndrome, four had pheochromocytomas, six had a non-functional tumor and one had malignant lymphoma. Adrenal tumors were confirmed by hormonal assays, biochemical tests and computed tomography. Of the 16 large tumors, five tumors were on the right and 11 were on the left. RESULTS We found no significant differences in general demographic parameters between patients with large and small tumors. The mean duration of surgery was not significantly different between two groups. (large tumors, 210 min; small tumors,175 min). The mean volume of blood loss was 212 mL for large tumors and 30 mL for small tumors (P < 0.001, significant difference). There was no significant difference in time until walking, duration of hospitalization or number of using analgesics used. The time to first oral intake of group 1 (<6 cm) was significantly shorter than group 2 (> or =6 cm). Tumor size (> or =7.5 cm) was an independent predictor of a longer operation and greater blood loss in large tumors. CONCLUSIONS Laparoscopic adrenalectomy for large tumors was safe and minimally invasive.
Collapse
|
18
|
Kawamura K, Kamiya N, Suyama T, Shimbo M, Oosumi N, Suzuki H, Ueda T, Tobe T, Igarashi T, Ito H, Ishikura H. IN SITU
GELATINOLYTIC ACTIVITY CORRELATES WITH TUMOR PROGRESSION AND PROGNOSIS IN PATIENTS WITH BLADDER CANCER. J Urol 2004; 172:1480-4. [PMID: 15371875 DOI: 10.1097/01.ju.0000137749.99255.3e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Degradation of the extracellular matrix by malignant tumor cells has an essential role in the process of tumor invasion and metastasis. The 2 gelatinolytic matrix metalloproteinases (MMPs) MMP-2 and MMP-9 are believed to be key enzymes in this process. We investigated the possible relationship between in situ gelatinolytic activity of MMPs and clinicopathological factors in patients with bladder cancer to clarify whether these proteins would be critical for tumor advancement in this disease. MATERIALS AND METHODS We evaluated the intensity of gelatinolytic activity in 25 bladder cancer tissues by film in situ zymography (FIZ). To clarify the MMP(s) responsible for gelatinolytic activity in bladder cancer tissues we examined MMP-2 and MMP-9 expression in bladder tissues by gelatin zymography. MMP expression was also confirmed by reverse transcriptase-polymerase chain reaction and Western blotting. We then investigated the association between MMP expression detected by gelatin zymography and the intensity of gelatinolytic activity determined by FIZ. RESULTS FIZ demonstrated that all tumor tissues had in situ gelatinolytic activities. There was a statistically significant correlation between the intensity of gelatinolytic activity, and tumor grade, stage, vessel invasion and cause specific survival (p <0.05). Stronger in situ gelatinolytic patterns were documented in cases with higher pro and active MMP-2 expression. CONCLUSIONS FIZ enables the direct assessment of in situ gelatinolytic activity in bladder cancer tissues. The intensity of activity appears to affect the biology of carcinoma tissues. Our results indicate a major role for MMP-2 in in situ gelatinolysis in bladder cancer.
Collapse
|
19
|
Ueda T, Tobe T, Yamamoto S, Motoori K, Murakami Y, Igarashi T, Ito H. Selective intra-arterial 3-dimensional computed tomography angiography for preoperative evaluation of nephron-sparing surgery. J Comput Assist Tomogr 2004; 28:496-504. [PMID: 15232381 DOI: 10.1097/00004728-200407000-00010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate selective intra-arterial 3-dimensional computed tomography (3D-CT) angiography as a tool for the preoperative evaluation of nephron-sparing surgery (NSS). METHODS Twenty-three patients with renal cell carcinoma indicating NSS underwent selective intrarenal 3D-CT angiography. The time-lapse dual-phase technique was used for simultaneous vascular and urographic visualization. The 3D images were created by the shaded volume-rendering method. The CT attenuation of target structures was measured for quantitative evaluation. The 3D images were visually evaluated for the renal artery, vein, and collecting system using a grading system. Results were statistically analyzed. RESULTS The 3D-CT angiography depicted the intrarenal branches of the renal artery and vein and the whole collecting system in most patients. Visualization of the renal artery was significantly correlated to its CT attenuation. Visualization of the renal vein was correlated to its CT attenuation adjusted by the surrounding renal parenchyma. CONCLUSION Selective intra-arterial 3D-CT angiography allows the detailed visualization of intrarenal structures.
Collapse
|
20
|
Kawai S, Hiroshima K, Tsukamoto Y, Tobe T, Suzuki H, Ito H, Ohwada H, Ito H. Small cell carcinoma of the prostate expressing prostate-specific antigen and showing syndrome of inappropriate secretion of antidiuretic hormone: an autopsy case report. Pathol Int 2004; 53:892-6. [PMID: 14629757 DOI: 10.1046/j.1440-1827.2003.01568.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An autopsy case of primary small cell carcinoma (SCC) of the prostate in a 68-year-old man is reported. The patient was admitted to hospital because of a bloody stool and suspected rectal cancer. However, a diagnosis of prostate cancer was made on the basis of a digital rectal examination, the serum level of prostate-specific antigen, and a needle biopsy of the prostate. The patient also experienced a syndrome of inappropriate secretion of antidiuretic hormone. He died 29 days after admission. At autopsy, the tumor had invaded the rectum, bladder and pelvic peritoneum. Metastases to the heart, vertebrae and lymph nodes were observed. Microscopically, the tumor was composed of small round cells that showed a solid growth pattern. Rosette formations were observed. Immunohistochemically, the tumor cells were positive for a prostatic epithelial marker and neuroendocrine markers. A high level of antidiuretic hormone was detected in the tumor tissue. To our knowledge, this is the first reported case of SCC of the prostate in which both a prostatic epithelial marker and neuroendocrine markers have been found in the same tumor. This finding supports the hypothesis that SCC of the prostate originates from a multipotential stem cell of the prostatic epithelium.
Collapse
|
21
|
Nagata M, Ueda T, Komiya A, Suzuki H, Akakura K, Ishihara M, Tobe T, Ichikawa T, Igarashi T, Ito H. Treatment and prognosis of patients with paraplegia or quadriplegia because of metastatic spinal cord compression in prostate cancer. Prostate Cancer Prostatic Dis 2004; 6:169-73. [PMID: 12806378 DOI: 10.1038/sj.pcan.4500641] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Metastatic spinal cord compression (MSCC) is a serious complication of metastatic prostate cancer (PCa). This study retrospectively evaluated patients who presented with paraplegia or quadriplegia because of MSCC of PCa. Of 847 patients with PCa who were treated between 1989 and 1998, 26 (3.1%) demonstrated paraplegia or quadriplegia because of MSCC. Characteristics, treatment efficacy, and prognosis of these patients were analyzed. In total, 15 cases became paraplegic despite androgen ablation therapy (Group I). Average time to paraplegia from initial hormonal treatment was 34 months. Out of nine cases who underwent radiation therapy (RT) to spinal lesions with/without chemotherapy, one patient became ambulatory. However, this patient subsequently had recurrent compression. Two cases had remission of paralysis. Two cases underwent laminectomy plus RT and in one case paralysis improved. MSCC was the first indication of PCa in 11 cases (Group II). Two cases underwent laminectomy plus hormone therapy and nine cases underwent hormone therapy alone. Four patients became ambulatory and two cases showed improved motor capacity. Average interval from paraplegia to death was 7.4 months in Group I and 27.1 months in Group II. However, there was no statistical difference in these two groups on disease-specific survival from the start of initial treatment. It is difficult to recover the ability to walk if paraplegia or quadriplegia occurs in PCa patients although decompression surgery plus hormone therapy seemed to impair the prognosis. Stage M1 patients with paraplegia had survival rates as good as stage M1 patients without paralysis. This should encourage an aggressive treatment approach. However, for patients with hormone-independent disease there seems to be no effective treatment and prognosis is poor.
Collapse
|
22
|
Matsuno Y, Komiyama M, Tobe T, Toyota N, Adachi T, Mori C. Association of testicular undescent induced by prenatal flutamide treatment with thickening of the cremaster muscle in rats. Reprod Med Biol 2003; 2:109-113. [PMID: 29699173 DOI: 10.1046/j.1445-5781.2003.00026.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and Aims: Previously, in cryptorchid rats, which were induced by prenatal exposure to flutamide, we found a thickening of the cremaster muscle. This study was undertaken to quantify the increase of the cremaster muscle thickness in the cryptorchid rats, and to examine its possible relationship with the proliferation of muscle cells. Methods: To obtain cryptorchid rats, pregnant Wistar rats were subcutaneously injected with flutamide (100 mg/kg per day) during gestational days 16-17. Serial sections of the scrotum, containing the testis and cremaster muscle, were prepared from the control and cryptorchid rats that were 2-6 weeks of age, and stained with hematoxylin-eosin for morphometry, or stained with antibody against the proliferating cell nuclear antigen (PCNA) to analyze the cell proliferation ability. Results: The thickened cremaster muscle was always associated with cryptorchid testis and, in the case of unilateral cryptorchidism, the cremaster muscle of the contralateral (descended testis) side exhibited normal thickness. The average thickness of the affected cremaster muscle was 0.80 and 1.89 mm at 4 and 6 weeks of age, respectively, although that of the normal muscle was 0.28 and 0.33 mm at the same time period, respectively. Conclusion: Our results showed that the cremaster muscle of the cryptorchid rats was significantly thicker than that of the control rats. The immunohistochemical analysis revealed that a thickened cremaster muscle contained many PCNA-positive nuclei even at 4 weeks of age, in contrast to the control, which had only a few positive nuclei. Our present study indicates that continuous proliferation of the muscle cells associated with cryptorchid testis increases the thickness of cremaster cells in rats exposed to flutamide prenatally. (Reprod Med Biol 2003; 2: 109-113).
Collapse
|
23
|
Igarashi T, Takahashi H, Tobe T, Suzuki H, Mizoguchi K, Nakatsu HO, Ito H. Effect of tumor-infiltrating lymphocyte subsets on prognosis and susceptibility to interferon therapy in patients with renal cell carcinoma. Urol Int 2003; 69:51-6. [PMID: 12119440 DOI: 10.1159/000064361] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Immunotherapy effectively treats advanced renal cell carcinoma in only a limited number of patients. However, the predicted prognosis for each patient in relation to immune status and response to immunotherapy remains problematic. We analyzed tumor-infiltrating lymphocyte (TIL) subsets to determine whether these correlated with the prognoses for the patients and the response to alpha-interferon therapy. MATERIALS AND METHODS TIL subsets from resected specimens of 79 patients were analyzed by two-color flow cytometry and then compared with the patients' long-term clinical courses and responses to interferon therapy. RESULTS In patients with stages III and IV, an increased infiltration of CD4+ cells and decreased CD8+ cells constituted a fair prognostic factor. In 17 patients with metastatic lesions, 8 of 10 patients who had disease progression after interferon therapy showed an increase in CD8+ cells above 25%, whereas 2 responders and 5 patients who had stable disease showed infiltration of CD8+ cells below 25%. CONCLUSIONS The TIL subset is a prognostic factor for advanced renal cell carcinoma, and its analysis provides a method to predict the susceptibility to interferon therapy.
Collapse
|
24
|
Sakamoto S, Igarashi T, Osumi N, Imamoto T, Tobe T, Kamiya M, Ito H. Erythropoietin-producing renal cell carcinoma in chronic hemodialysis patients: a report of two cases. Int J Urol 2003; 10:49-51. [PMID: 12534927 DOI: 10.1046/j.1442-2042.2003.00568.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Erythropoietin (EPO)-producing renal cell carcinomas in two hemodialysis patients are reported. Despite deteriorated kidney function, these patients did not manifest anemia at diagnosis and their elevated serum EPO levels rapidly returned to within the normal range after nephrectomy. Immunohistochemical staining of the resected specimens showed production of erythropoietin in the tumor cells in one case and in the lining cells of the cyst wall in the other case. Renal cell carcinoma could cause an increase of blood hematocrit level in dialysis patients.
Collapse
|
25
|
Sekiyama K, Akakura K, Mikami K, Mizoguchi KI, Tobe T, Nakano K, Numata T, Konno A, Ito H. Usefulness of diagnostic imaging in primary hyperparathyroidism. Int J Urol 2003; 10:7-11; discussion 12. [PMID: 12534918 DOI: 10.1046/j.1442-2042.2003.00564.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In patients with primary hyperparathyroidism, prevention of urinary stone recurrence can be achieved by surgical removal of the enlarged parathyroid gland. To ensure the efficacy of surgery for primary hyperparathyroidism, preoperative localization of the enlarged gland is important. In the present study, usefulness of diagnostic imaging for localization of the enlarged gland was investigated in primary hyperparathyroidism. METHODS We retrospectively examined the findings of imaging studies and clinical records in 79 patients (97 glands) who underwent surgical treatment for primary hyperparathyroidism at Chiba University Hospital between 1976 and 2000. The detection rates of accurate localization were investigated for imaging techniques, such as ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), thallium-201 and technetium-99m pertechnetate (Tl-Tc) subtraction scintigraphy and 99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy, and analysed in relation to the size and weight of the gland and pathological diagnosis. RESULTS The detection rates by US, CT, MRI, Tl-Tc subtraction scintigraphy and MIBI scintigraphy were 70%, 67%, 73%, 38% and 78%, respectively. The overall detection rate changed from 50% to 88% before and after 1987. The detection rate of MIBI scintigraphy was superior to Tl-Tc subtraction scintigraphy. CONCLUSION In primary hyperparathyroidism, improvement of accurate localization of an enlarged parathyroid gland was demonstrated along with recent advances in imaging techniques including MIBI scintigraphy.
Collapse
|