Approach to the neoaortic valve for replacement after the arterial switch procedure in patients with complete transposition

We report our experience of aortic valvar replacement subsequent to the arterial switch procedure, incorporating the Lecompte maneuver, in patients with complete transposition. The anterior wall of the neoaorta was incised in continuity with the posterior wall of the pulmonary trunk. The aortic root was reconstructed with or without augmentation using a patch after the operative procedures to the aortic valve. With this approach, the neoaortic root could readily be exposed without extensive dissection, and valvar replacement was safely achieved. These patients experienced no postoperative complications.

Extended unroofing procedure for creation of a new ostium for anomalous left coronary artery

A modified procedure to create an alternative ostium for the left coronary artery was successfully carried out in a patient having anomalous origin of the left coronary artery from the right coronary sinus of the aorta. The proximal portion of the artery had an intramural course. The newly constructed orifice was widely patent and functioning well 44 months later, without episodes of myocardial ischemia or aortic regurgitation.

[The role of MN/CA IX antigen in carcinogenesis and metastasis of renal cell carcinoma]

MN/CA IX is a carbonic anhydrase (CA) isoenzyme expressed in normal alimentary tract in a tissue-specific manner. This antigen is activated in the majority of renal cell carcinomas (RCC) but not in normal kidney tissues. Although the exact role of CA activity in carcinogenesis and metastasis has not been established, MN/CA9 has been suggested to be implicated in acidification of extracellular milieu surrounding the cancer cells and thus create a microenvironment conductive to tumor growth and spread. Mutations in the von Hippel-Lindau (VHL) gene cause the familial syndrome and are also found in the majority of sporadic RCC. Wild-type VHL was recently described to down-regulate MN/CA9 in RCC cell lines, and the molecular mechanism of MN/CA9 and VHL in renal carcinogenesis is of interest. To investigate the mechanism of MN/CA9 activation in RCC, we examined the methylation status of this gene in RCC cell lines and human tissue samples and found that hypomethylation in the promoter region may play an important role in the expression of MN/CA9. RT-PCR analysis of blood samples from RCC patients revealed the presence of circulating MN-positive cells in the blood. This antigen may be a potential therapeutic target as well as diagnostic marker for RCC. Therefore, we are currently investigating whether or not MN/CA IX peptide could be an appropriate molecule for use antigen specific immunotherapy on RCC patients.

Effect of synchronized intermittent mandatory ventilation on respiratory workload in infants after cardiac surgery

BACKGROUND

Synchronized intermittent mandatory ventilation (SIMV) is commonly used in infants and adults. However, few investigations have examined how SIMV reduces respiratory workload in infants. The authors evaluated how infants' changing respiratory patterns when reducing SIMV rate increased respiratory load. The authors also investigated whether SIMV reduces infant respiratory workload in proportion to the rate of mandatory breaths and which rate of SIMV provides respiratory workloads similar to those after tracheal extubation.

METHODS

When 11 post-cardiac surgery infants aged 2-11 months were to be weaned with SIMV, the authors randomly applied five levels of mandatory breathing: 0, 5, 10, 15, and 20 breaths/min. All patients underwent ventilation with SIMV mode: pressure control ventilation, 16 cm H2O; inspiratory time, 0.8 s; triggering sensitivity, 0.6 l/min; and positive endexpiratory pressure, 3 cm H2O. After establishing steady-state conditions at each SIMV rate, arterial blood gases were analyzed, and esophageal pressure, airway pressure, and airflow were measured. Inspiratory work of breathing, pressure-time products, and the negative deflection of esophageal pressure were calculated separately for assisted breaths, for spontaneous breaths, and for total breaths per minute. Measurements were repeated after extubation.

RESULTS

As the SIMV rate decreased, although minute ventilation and arterial carbon dioxide tension were maintained at constant values, spontaneous breathing rate and tidal volume increased. Work of breathing, pressure-time products, and negative deflection of esophageal pressure increased as the SIMV rate decreased. Work of breathing and pressure-time products after extubation were intermediate between those at a SIMV rate of 5 breaths/min and those at 0 breaths/min.

CONCLUSION

When the load to breathing was increased progressively by decreasing the SIMV rate in post-cardiac surgery infants, tidal volume and spontaneous respiratory rate both increased. In addition, work of breathing and pressure-time products were increased depending on the SIMV rate.

Isolation of a Candida glabrata homologue of RAP1, a regulator of transcription and telomere function in Saccharomyces cerevisiae

To study the function of RAP1, an essential gene involved in the regulation of transcriptional activation, silencing and the telomere function in Saccharomyces cerevisiae, we isolated a Candida glabrata gene that complements the growth defect of a S. cerevisiae rap1 conditional mutant. The DNA sequence of the cloned gene, which we designated CgRAP1, predicted a 2064 bp open reading frame encoding a 687 amino acid protein with an overall identity of 65% and a similarity of 78% to Rap1p from S. cerevisiae.

Continuous systemic perfusion improves outcome in one stage repair of obstructed aortic arch and associated cardiac malformation

OBJECTIVE

To determine whether continuous systemic perfusion is of effective use when establishing primary repair of the aortic obstruction and associated cardiac malformations.

METHODS

Since 1991, 56 infants have undergone reconstruction of interrupted (in 28) or coarctated (in 28) aorta, concomitantly with closure of ventricular septal defects in 37, and repair of other malformations in the remaining 19. Of these, total circulatory arrest (30+/-11 min) was employed in 23. In another 21 patients, perfusion was maintained for the carotid arteries with the descending aorta cross-clamped (31+/-15 min). The bodily organs were perfused throughout the operative procedures by placing dual aortic cannulae in the remaining 12 patients.

RESULTS

The postoperative courses were less eventful in the non-circulatory arrest group than other groups of patients undergoing total or partial circulatory arrest, although these groups were operated in different time periods, and consequently, a general progress might be one reason for improvements in the surgical outcomes. All patients undergoing no circulatory arrest survived the primary repair, could have the sternum primarily closed, and had no episodes of cerebral bleeding. Prolonged tracheal intubation was needed just in one patient of this group. The amount of urine output during cardiopulmonary bypass was significantly greater in the non-circulatory arrest group than in the others. The maximal concentrations of urinary beta-microglobulin, serous creatinine, creatine phosphokinase, and glutamic oxaloacetic transaminase were lower in this setting.

CONCLUSIONS

Continuous systemic perfusion was considered less invasive when concomitantly repairing the obstructed aorta and intracardiac malformations.

[A case of prostate cancer with cyst formation]

A 73-year-old man with the complaint of dysuria of 2 years' standing was admitted to our hospital for further examination of an intrapelvic cystic mass, 8.6 cm in diameter, detected incidentally by abdominal ultrasonography. The serum concentration of prostate specific antigen (PSA) was elevated to 44.9 ng/ml. Pelvic computed tomography (CT) and magnetic resonance imaging (MRI) revealed a cystic mass with an irregular thick cyst wall posterior to the urinary bladder originating from the prostate. Transrectal needle biopsy presented a moderately differentiated adenocarcinoma of the prostate. The bloody fluid of the cyst obtained by transperineal aspiration contained a significantly increased level of PSA, but no cancer cells were detected by cytological examination. Total prostatectomy was performed under the diagnosis of clinical stage C (cT3N0M0) prostate cancer. Pathological diagnosis was that cancer cells were present in the prostate tissue and had partly infiltrated the cyst wall. These results suggest that the present cyst was associated with the development of prostate cancer as a pseudocyst without an epithelial lining. The patient has remained free from the disease for over ten months. We review 56 cases of this rare condition that have been reported in Japan.

Hypomethylation of the MN/CA9 promoter and upregulated MN/CA9 expression in human renal cell carcinoma

MN/CA9 is a cancer-related gene, frequently activated in human renal cell carcinomas (RCCs). To reveal the activation mechanism, we investigated the relationship between methylation status of the MN/CA9 promoter region and gene expression using 13 human RCCs, and examined the effect of in vitro CpG methylation on the MN/CA9 promoter activity using a human RCC cell line (SK-RC-44), expressing MN/CA9. MN/CA9 expression was evaluated by RT-PCR and observed in 10 of 13 RCCs (77%). A total of 9 out of 10 MN/CA9 -positive RCCs (90%) contained clear cell components. Methylation status of 6 CpGs in the MN/CA9 promoter region was decided by using the bisulfite genomic sequencing protocol. Out of 13 RCCs 9 (69%) showed partial hypomethylation of the CpG at -74 bp, while the other 4 RCCs and 3 normal kidney tissue samples showed complete methylation. Hypomethylation of the CpG at -74 bp was strongly correlated with MN/CA9 expression. Luciferase assay revealed that the MN/CA9 promoter activity was strongly suppressed by methylation of the CpG at -74 bp. These findings suggest that hypomethylation of the CpG at -74 bp in the MN/CA9 promoter region might play an important role in this gene activation of human RCC.

Double inlet right ventricle versus other types of double or common inlet ventricle: its clinical characteristics with reference to the Fontan procedure

OBJECTIVE

To determine the clinical features in patients with double inlet right ventricle (DIRV) and separate atrioventricular (AV) valves in terms of the Fontan procedure.

METHODS

Surgical procedures were carried out in 31 patients with this rare malformation. Their clinical characteristics were compared with similar features in 45 patients with double inlet left ventricle (DILV), 93 with common inlet right ventricle (CIRV), and 20 with common inlet left ventricle (CILV).

RESULTS

Pulmonary atresia with the right and the left pulmonary arteries being confluent was seen in 58% of patients with DIRV, and pulmonary atresia with non-confluent pulmonary arteries in 15% (P=0.0001). The incidence of these findings was significantly higher when compared with DILV (P=0.0001). Reflecting these morphologic features, constructions of systemic-to-pulmonary shunts and extensive plasty to the pulmonary arteries were more frequently needed in patients with DIRV than in the others (P=0.04, 0.0001). The AV valves have become moderately or severely regurgitant in three with DIRV (10%). The Fontan procedure has thus been employed in 21 with DIRV (64%), this incidence being significantly higher than that seen in the CIRV (37%) group (P=0.01). Survival rate of 95% at 10 years in this group was as excellent as that in the DILV group, and obviously better than that in either CIRV or CILV (P=0.002).

CONCLUSIONS

Although multiple palliative procedures might be frequently needed to maintain pulmonary perfusion, the Fontan circulation can be justifiably established in patients with DIRV, and regurgitation across the AV valves was not very common.

Fluorescence in situ hybridization evaluation of c-erbB-2 gene amplification and chromosomal anomalies in bladder cancer

Oncogene amplification and chromosomal anomalies are found in many solid tumors and are often associated with aggressiveness of cancer. We evaluated the frequency and the role of c-erbB-2 gene amplification, relative increase in c-erbB-2 gene copy number, and gain of chromosome 17 in bladder cancer. A total of 29 bladder cancer specimens were examined using fluorescence in situ hybridization (FISH). Dual labeling hybridization with a directly labeled centromere probe for chromosome 17 together with a probe for the c-erbB-2 locus was performed. c-erbB-2 gene amplification was found in 3.4% (1 of 29) of specimens. Relative increase in c-erbB-2 gene copy number was found in 41.4% (12 of 29) of specimens and was significantly associated with tumor grade (P = 0.044 by Fisher's exact test). Gain of chromosome 17 was identified in 65.5% (19 of 29) of specimens and was significantly associated with tumor grade (P = 0.002 by Fisher's exact test) and tumor stage (P = 0.003 by Fisher's exact test). Our results suggest that c-erbB-2 gene amplification, relative increase in c-erbB-2 gene copy number, and gain of chromosome 17 may play important roles in the development and progression of bladder cancers. Moreover, the use of c-erbB-2 amplification, relative increase in c-erbB-2 gene copy number, and gain of chromosome 17 using FISH, together with tumor grade and stage, may provide a more useful clinical indicator in bladder cancer.

Repair of double outlet right ventricle with doubly-committed ventricular septal defect

OBJECTIVE

To investigate our surgical results of intraventricular rerouting in patients having double outlet right ventricle with doubly-committed ventricular septal defect.

METHODS

We undertook repair in 8 patients with this particular feature. Of these, 2 patients had pulmonary stenosis, and another had interruption of the aortic arch. The subarterial defect was unequivocally related to both the aortic and the-pulmonary orifices in all, albeit slightly deviated towards the aortic orifice in one, and towards the pulmonary orifice in another. Intraventricular rerouting was carried out via incisions to the right atrium and the pulmonary trunk. To ensure reconstruction of an unobstructed pulmonary pathway, a limited right ventriculotomy was made in 5.

RESULTS

All patients survived the procedure, and are currently doing well, with follow-up of 25 to 194 months, with a mean of 117+/-68 months. Catheterization carried out 16+/-6 months after repair demonstrated excellent ventricular parameters. Mean pulmonary arterial pressure was 16+/-7 mmHg, being higher than 20 mmHg in 2 patients. No significant obstruction was found between the right ventricle and the pulmonary arteries. A pressure gradient across the left ventricular outflow tract became significant in one patient in whom a small outlet septum was present, and a heart-shaped baffle had been used for intraventricular rerouting. Reoperation was eventually needed in this patient for treatment of the obstruction, which proved to be progressive.

CONCLUSION

Precise recognition of the morphologic features is of paramount importance when choosing the optimal options for biventricular repair in patients with double outlet right ventricle and doubly-committed interventricular communication.

[Reconstruction of the right ventricular outflow tract in patients undergoing the Ross procedure]

Since 1992, 46 patients have undergone the Ross procedure. Of these, a pulmonary homograft was used for reconstruction of the RVOT in 16, and a tailored heterologous or autologous pericardial roll tube in 9. In the remaining 21, the autologous tissues were used as a posterior wall of the channel, placing another patch (bearing a monocusp in 14) anteriorly. All the patients survived the procedure. Reoperation has been needed thus far in one for infection of the prosthetic patch placed at the right ventricular outflow tract, and catheter intervention in 2 for mild obstruction across the channel. On the basis of postoperative catheterization, presence or absence of a valvar structure across the right ventricular outflow tract did not affect ejection fraction of the right ventricle and right atrial pressure. In contrast, right ventricular end diastolic volume was smaller, as well as diastolic pulmonary arterial pressure was higher, when a competent trifoliate valve was provided at the right ventricular outflow tract. An incision to the ventricular septum for subaortic stenosis, coronary arterial obstruction preoperatively present, and age at operation younger than 2 years old, were unfavourable factors affecting right ventricular performance. We conclude that, in the majority of our patients, right ventricular performance was unlikely impaired even without a competent pulmonary valve. Use of a homograft, however, could be preferred in a selected group of patients with deleterious circumstances on the postoperative circulation.

Long and accurate PCR with a mixture of KOD DNA polymerase and its exonuclease deficient mutant enzyme

DNA polymerase from Thermococcus kodakaraensis KOD1 (previously Pyrococcus sp. KOD1) is one of the most efficient thermostable PCR enzymes exhibiting higher accuracy and elongation velocity than any other commercially available DNA polymerase [M. Takagi et al. (1997) Appl. Environ. Microbiol. 63, 4504-4510]. However, when long distance PCR (>5 kbp) was performed with KOD DNA polymerase, amplification efficiency (product yield) becomes lower because of its strong 3'-5' exonuclease activity for proof-reading. In order to improve a target length limitation in PCR, mutant DNA polymerases with decreased 3'-5' exonuclease activity were designed by substituting amino acid residues in conserved exonuclease motifs, Exo I (Asp141-Xaa-Glu), Exo II (Asn210-Xaa-Xaa-Xaa-Phe-Asp), and Exo III (Tyr311-Xaa-Xaa-Xaa-Asp). Exonuclease activity and amplification fidelity (error rate) of the DNA polymerases were altered by mutagenesis. However, long and accurate PCR by a single-type of mutant DNA polymerase was very difficult. The wild-type DNA polymerase (WT) and its exonuclease deficient mutant (N210D) were mixed in different ratio and their characteristics in PCR were examined. When the mixed enzyme (WT and N210D) was made at the ratio of 1:40, long PCR (15 kbp) at lower mutation frequency could be efficiently achieved.

Congenital diverticulum of the left ventricle

We present a case of a congenital left ventricular diverticulum of fibrous type that was surgically repaired. Considering the potential risks such as rupture, systemic thromboembolism, and arrhythmia, an early surgical intervention should be employed for this rare abnormality even in a child without clinical symptoms.

Isolation of GCR1, a major transcription factor of glycolytic genes in Saccharomyces cerevisiae, from Kluyveromyces lactis

To study the function of GCR1, a gene involved in the expression of glycolytic genes in Saccharomyces cerevisiae, a Kluyveromyces lactis gene that complements the growth defect of a S. cerevisiae Deltagcr1 mutant was isolated. Introduction of this gene into the Deltagcr1 mutant also restored the activities of glycolytic enzymes. DNA sequencing of KlGCR1 predicted an open reading frame of a 767 amino acid protein with an overall identity of 33% and similarity of 48% to Gcr1p from S. cerevisiae. Its DDBJ/EMBL/GenBank Accession No. is AB046391.

Influence of ventricular morphology on aerobic exercise capacity in patients after the Fontan operation

OBJECTIVES

This study investigated the influences of ventricular morphology, hemodynamics and clinical findings on exercise capacity in patients after the Fontan operation.

BACKGROUND

Determinants of exercise capacity after the Fontan operation remain unclear.

METHODS

Peak oxygen uptake (PVo2) was determined in 105 patients by exercise test and compared to hemodynamics and clinical findings. Patients were divided into three groups based on ventricular morphology: those with a right ventricle (group RV), a biventricle (group BV) and a left ventricle (group LV).

RESULTS

Ten patients with atrioventricular valve regurgitation (AVVR) or hypoxia exhibited a low PVo2. After excluding these patients, although PVo2 did not correlate with hemodynamics, except ventricular ejection fraction (p < 0.02), it correlated with age at the Fontan operation and exercise test (p < 0.002). The PVo2 was higher in group LV (63+/-9%) than in groups RV (55+/-9%) and BV (55+/-12%) (p < 0.01), while an inverse correlation between PVo2 and age at operation was demonstrated only in group RV (p < 0.05). Groups RV or BV and age at exercise test were associated with a lower PVo2, whereas group LV was an independent predictor of a higher PVo2 (p < 0.01). During 4.2 years of follow-up, a decrease in peak heart rate was related to a decrease in PVo2 (p < 0.05). The PVo2 decreased in group RV (p < 0.01).

CONCLUSIONS

In addition to AVVR, hypoxia, and heart rate response, ventricular morphology is related to exercise capacity. Early Fontan operation may be beneficial in terms of exercise capacity, especially in the group RV patients.

Staged unifocalization and anatomic repair in a patient with right isomerism

Anatomic biventricular repair was successfully achieved subsequent to bilateral unifocalizations of the pulmonary blood supply using heterologous pericardial rolls in a patient with isomeric right appendages and major aortopulmonary collateral arteries.

[Diagnosis of prostate capsular invasion by pelvic magnetic resonance imaging and serum level of prostate specific antigen]

Transrectal ultrasonography (TRUS), computed tomography (CT), and magnetic resonance imaging (MRI) are employed to diagnose the clinical stage of prostate cancer. However, several cases are diagnosed as pathological stage pT3 after total prostatectomy. We investigated the accuracy of the evaluation of pathologic capsular penetration by preoperative pelvic MRI and preoperative serum PSA level and capsular penetration. The diagnostic accuracy of capsular penetration by MRI was 63.3%. On the other hand, the diagnostic accuracy of capsular penetration by preoperative PSA was 89.7% when its cut off value was 17 ng/ml. We conclude that preoperative serum PSA level could be more useful to diagnose accurately stage of prostate cancer than pelvic MRI.

Characterization of a brain-related serine protease, neurosin (human kaillikrein 6), in human cerebrospinal fluid

Neurosin (also known as zyme or protease M) is a trypsin-like serine protease dominantly expressed in the human brain. According to the official nomenclature, this gene is now designated as human kallikrein 6 (KLK6) and the protein is designated hK6. To investigate the metabolism of neurosin in human brain, neurosin contained in the human cerebrospinal fluid (CSF) was analyzed. Neurosin was detected in the all CSFs tested by Western blot analysis using an anti-neurosin monoclonal antibody. We purified neurosin from CSF (CSF-neurosin) using an immunoaffinity chromatography and an anion-exchange chromatography. SDS-PAGE revealed that the purified protein has a relative mol. mass (Mr) of 25,000 Da. The observed sequence of the N-terminal amino acids, Glu-Glu-Gln-Asn-Lys, of the purified CSF-neurosin was identical to the sequence of N-terminal of the pro-enzyme form, which is presumed to have no enzyme activity. CSF-neurosin neither showed any enzyme activity to Boc-Phe-Ser-Arg-4-methylcoumaryl-7-amide, which is known to be degraded by the mature neurosin, nor cleaved gelatin. To confirm that the major portion of CSF-neurosin is present in the pro-enzyme form, Western blot analysis using antibodies specific to the pro- or mature enzyme was carried out. The antibody against the mature neurosin fragment did not react with CSF-neurosin. Only the antibody against the pro-enzyme fragment detected CSF-neurosin. Thus, our results suggest that neurosin is present as an inactive pro-enzyme in the human CSF.

Analysis of microcystins in sediments using MMPB method

During the course of study on the detoxification of microcystins, the adsorption on sediments in the natural environment was investigated. Because it was very difficult to extract microcystins from sediments using conventional techniques, a physicochemical screening method, the MMPB (2-methyl-3-methoxy-4-phenylbutyric acid) method, including ozonolysis and mass spectrometric detection was developed. This method consisted of the following operations: lyophilized sediments were suspended in methanol and MMPB-d(3) as an internal standard was added to this suspension, which was cooled at -78 degrees C with vigorous stirring and then treated with a stream of ozone/oxygen. After centrifugation, an aliquot of the reaction solution was subjected to EI (electron ionization)-GC/MS analysis after methylation with 14% BF(3)-methanol and liquid-liquid extraction. The established method had a potential for the analysis of microcystins in sediments that are difficult to analyze using conventional methods. Finally, this method was applied to sediment samples collected in Japanese lakes and six of the eleven samples showed positive results. The obtained results clearly indicated that the adsorption on sediments contributes to the detoxification of microcystins under natural conditions.

Biventricular repair in a patient having double outlet right ventricle with unusual straddling of the mitral valve

The authors achieved biventricular repair in a 1-year-old boy having double outlet right ventricle and unusual straddling of the mitral valve. There was a substantial abnormal muscular bar present within the right ventricle, and some of the tendinous cords of the mitral valve were attached to this structure. Preoperative echocardiography was particularly informative in enabling the surgeon to arrange the optional operative procedures. The postoperative course was smooth and uneventful.

Use of a 0.052" Gianturco coil to embolize a persistent right superior vena cava following extracardiac total cavopulmonary connection

A persistent right superior vena following extracardiac total cavopulmonary connection was occluded using a 0.052" Gianturco coil combined with a 3 Fr biopsy forceps. Controlled delivery of a 0.052" Gianturco coil is a safe and effective procedure to occlude a large anomalous vessel other than a large persistent arterial duct.

Functional roles of cardiac and vascular ATP-sensitive potassium channels clarified by Kir6.2-knockout mice

-ATP-sensitive potassium (K(ATP)) channels were discovered in ventricular cells, but their roles in the heart remain mysterious. K(ATP) channels have also been found in numerous other tissues, including vascular smooth muscle. Two pore-forming subunits, Kir6.1 and Kir6.2, contribute to the diversity of K(ATP) channels. To determine which subunits are operative in the cardiovascular system and their functional roles, we characterized the effects of pharmacological K(+) channel openers (KCOs, ie, pinacidil, P-1075, and diazoxide) in Kir6.2-deficient mice. Sarcolemmal K(ATP) channels could be recorded electrophysiologically in ventricular cells from Kir6.2(+/+) (wild-type [WT]) but not from Kir6.2(-/-) (knockout [KO]) mice. In WT ventricular cells, pinacidil induced an outward current and action potential shortening, effects that were blocked by glibenclamide, a K(ATP) channel blocker. KO ventricular cells exhibited no response to KCOs, but gene transfer of Kir6.2 into neonatal ventricular cells rescued the electrophysiological response to P-1075. In terms of contractile function, pinacidil decreased force generation in WT but not KO hearts. Pinacidil and diazoxide produced concentration-dependent relaxation in both WT and KO aortas precontracted with norepinephrine. In addition, pinacidil induced a glibenclamide-sensitive current of similar magnitude in WT and KO aortic smooth muscle cells and comparable levels of hypotension in anesthetized WT and KO mice. In both WT and KO aortas, only Kir6.1 mRNA was expressed. These findings indicate that the Kir6.2 subunit mediates the depression of cardiac excitability and contractility induced by KCOs; in contrast, Kir6.2 plays no discernible role in the arterial tree.

[Clinical outcome and analysis of radical prostatectomy in clinical stage B and C prostate cancer]

Between 1989 and 1999, 40 patients treated with radical prostatectomy for clinical stage B and C prostate cancer were analyzed. Prostate-specific antigen (PSA) failure after radical prostatectomy occurred in four patients, and one of them died of clinical recurrence of prostate cancer. Cause-specific survival at 5 years was 91.7% and PSA failure-free rate at 5 years was 76.8%. Staging accuracy of CT and MRI image was not satisfactory. In 41.7% patients, extracapsular extension can not be determined. Preoperative serum PSA levels of pathologically organ-confined disease (OCD) patients were significantly lower than those of pathologically non-OCD patients. Further analysis indicated that preoperative serum PSA levels of greater than 20.1 ng/ml are useful predictors for pathologically non-OCD.