Effect of SARS-CoV-2 BNT162b2 mRNA vaccine on thyroid autoimmunity: A twelve-month follow-up study

Objectives

Graves' disease (GD) has been highlighted as a possible adverse effect of the respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine. However, it is unknown if the SARS-CoV-2 vaccine disrupts thyroid autoimmunity. We aimed to present long-term follow-up of thyroid autoimmunity after the SARS-CoV-2 BNT162b2 mRNA vaccine.

Methods

Serum samples collected from seventy Japanese healthcare workers at baseline, 32 weeks after the second dose (pre-third dose), and 4 weeks after the third dose of the vaccine were analyzed. The time courses of anti-SARS-CoV-2 spike immunoglobulin G (IgG) antibody, thyroid-stimulating hormone receptor antibody (TRAb), and thyroid function were evaluated. Anti-thyroglobulin antibodies (TgAb) and anti-thyroid peroxidase antibodies (TPOAb) were additionally evaluated in thirty-three participants.

Results

The median age was 50 (IQR, 38-54) years and 69% were female. The median anti-spike IgG antibody titer was 17627 (IQR, 10898-24175) U/mL 4 weeks after the third dose. The mean TRAb was significantly increased from 0.81 (SD, 0.05) IU/L at baseline to 0.97 (SD, 0.30) IU/L 4 weeks after the third dose without functional changes. An increase in TRAb was positively associated with female sex (β = 0.32, P = 0.008) and low basal FT4 (β = -0.29, P = 0.02) and FT3 (β = -0.33, P = 0.004). TgAb was increased by the third dose. Increase in TgAb was associated with history of the thyroid diseases (β = 0.55, P <0.001).

Conclusions

SARS-CoV-2 BNT162b2 mRNA vaccine can disrupt thyroid autoimmunity. Clinicians should consider the possibility that the SARS-CoV-2 vaccine may disrupt thyroid autoimmunity.

[Clinical results of interstitial laser coagulation for benign prostatic hyperplasia using diode laser]

Interstitial laser coagulation (ILCP) is currently considered to be one of the avenues for treatment of benign prostatic hyperplasia (BPH). The efficacy and effectiveness of the treatment, however, have not been well clarified. Here we report the outcome of treatment in benign prostatic hyperplasia using ILCP. Twenty patients with BPH who underwent interstitial laser coagulation using a diode laser between March and December 1998 were investigated. Our results showed that there are significant improvements in prostate symptom score and quality of life index after the treatment. According to the efficacy criteria, 70% of the patients showed clinical improvement of both scores at 1 month, and more than 90% of the patients at 3 months. The reduction of prostate volume was observed after 1 month of treatment and continued for 6 months. The improvement on peak flow rate was observed in 50% of the patients at 3 months and in 73.3% of the patients at 6 months. The overall efficacy rates were 62.5%, 85.0% and 100% of the patients at 1, 3 and 6 months, respectively. In all 20 patients the complications were minimal. No blood transfusion was required in any patients. However, one patient experienced both epididymitis and prostatic abscess and was treated with conservative therapy. In conclusion, interstitial laser coagulation using a diode laser is a very effective means for the treatment of benign prostatic hyperplasia. Because of its less invasive nature, we strongly recommend that ILCP be the major way of treatment for benign prostatic hyperplasia.

Orthotopic ileal neobladder in male patients: functional outcomes of 66 cases

BACKGROUND

Orthotopic urinary diversion has become the preferred form of bladder reconstruction after cystectomy. We report on our experience with 66 male patients undergoing this procedure from November 1990 to February 1998.

METHODS

A neobladder was constructed using an ileal segment with a Hautmann type bladder. Complications were assessed and subdivided into early and late types. Voiding function was evaluated in terms of voiding pattern and continence. Median follow up was 19.5 (range 3.5-87.7) months.

RESULTS

There was one (1.5%) perioperative death. The most frequent pouch-related and unrelated early complications were persistent urine leak (7.6%) and prolonged ileus (16.7%), respectively, the majority of cases of which were managed conservatively. Analysis of late complications revealed 6.2% ureteroileal stenosis and 1.5% urethrointestinal stenosis rates, but no case of bladder stone formation. Of the 61 patients in whom voiding function was evaluable, 95.1% achieved excellent daytime continence, while only 67.2% had night-time continence. With regard to posture at voiding, 23 (37.7%) voided in a sitting position. Three of the patients (4.9%) were unable to void and required regular intermittent catheterization.

CONCLUSIONS

An orthotopic neobladder can be constructed with acceptable morbidity and excellent functional results. We believe that orthotopic urinary diversion offers an attractive alternative to a bladder substitute when cystectomy is required.

Voiding function of orthotopic ileal neobladder in women

OBJECTIVES

Although the advent of orthotopic lower urinary reconstruction in women is a major achievement in the evolution of urinary diversion, the mechanism of voiding dysfunction remains incompletely understood. We report on the voiding function of ileal neobladder in 12 female patients.

METHODS

A neobladder was constructed using an ileal segment. Voiding function was evaluated in terms of voiding pattern and continence. Chain cystography was performed postoperatively to detect the existence of urethral angulation. Median follow-up was 33.2 months (range 8.4 to 77.4).

RESULTS

Of the 1 2 patients, 10 (83.3%) achieved excellent daytime continence, and 6 (50%) had nighttime incontinence despite regular voiding during the night. Three patients (25%) sometimes or often performed self-catheterization because of difficulty in urinating. One patient (8.3%) was unable to void and required regular intermittent catheterization. Chain cystogram revealed urethral angulation in the 3 patients with difficulty in urinating or hypercontinence.

CONCLUSIONS

An orthotopic neobladder can be constructed in women with excellent functional results. Urethral angulation appears to be one of the main mechanisms for voiding dysfunction, and further studies on the functional anatomy of the female urethra are needed to improve the voiding function of the orthotopic neobladder in women.

[Prophylactic effect of UFT in combination with intravesical chemotherapy on the recurrence of superficial bladder tumor]

The influence of N1-(2-tetrahydrofuryl)-5-fluorouracil plus uracil (UFT) on the recurrence of superficial bladder tumors was evaluated in a randomized clinical study. Group A (n = 196) underwent transurethral resection (TUR) and the intravesical chemoprophylaxis, while group B (n = 193) received 400 mg per a day of UFT orally for 6 months in addition to the instillation therapy. These adjuvant therapy was started one week after TUR. Consequently, 30 patients in group B showed UFT-related toxicity and administration of UFT was discontinued in 10 of them. In addition, 87 patients in group B did not complete the 6-month course of UFT administration. Comparison of 2-year actuarial non-recurrence curves revealed no significant difference between groups A and B. However, UFT seemed to have a favorable prophylactic effect when recurrence rates were compared among those patients with recurrent tumors (generalized Wilcoxon: p = 0.1277), and those with recurrent multiple tumors (p = 0.0847).

A case large protruding cystitis glandularis: clinical, histological and mucin-histochemical study

A case of large protruding cystitis glandularis is reported. A 36-year-old man was admitted to our hospital due to acute cholecystitis, and large protruding masses were incidentally found in the urinary bladder by abdominal ultrasonography. The histological study revealed that they consisted of a large number of Brunn's nests with or without cysts which were often accompanied with columnar epithelial metaplasia, and of glandular structures closely resembling the colonic crypts. The mucin-histochemical study demonstrated glandular lesions in the bladder secreted colonic type mucin, and endocrine cells positive with Grimelius' staining. A review of literature disclosed 19 clinical cases of cystitis glandularis, since 1970, in Japan, but such a large protruding lesion as this case is rare. We first performed detailed histological and mucin-histochemical studies for this clinical case.

[Clinical and pathological studies of the urothelial tumors with inverted proliferation]

We reported a case of inverted papilloma of the bladder, and six cases (two of ureteral cancer and four of bladder cancer) of transitional cell carcinoma with inverted proliferation. These tumors were superficial and pedunculated as well as transitional papilloma or ordinary papillary transitional cell carcinoma though they showed a non-papillary and polyp-like configuration. Moreover, these urothelial cancers with inverted proliferation were thought to be similar to papillary cancer with regard to grading, multiplicity, invasiveness and recurrence. Therefore, transurethral resection or segmental ureterectomy may be recommended for the tumor of low grade malignancy and radical treatment including systemic chemotherapy may be recommended for the tumor of high grade malignancy.

[Diagnosis of the upper urothelial tumor using a rigid ureteroscope]

We preoperatively diagnosed four cases suspected as malignant urothelial tumor of upper urinary tract using a rigid ureteroscope. In three cases of ureter tumor, biopsy was successful and showed low grade malignancy. Nephroureterectomy was performed in two cases with upper ureteral tumor. The tumor was fulgurated ureteroscopically in a case of lower ureteral tumor. In one case of renal pelvic tumor, biopsy was unsuccessful though the tumor was observed as a papillary configuration. Successively, biopsy using a flexible ureteroscope was performed and the tumor was treated by fulguration. Ureteroscopy is very useful for preoperative diagnosis of ureteral tumor and selection of treatment.

Lobulated polypoid tumor of the ureter showing histologically high grade malignancy: report of a case

A case of a lobulated polypoid tumor of the ureter showing histologically high grade malignancy is reported. Such a tumor is rare in the bladder, and to date none have been documented in the ureter. This tumor is probably the most malignant urothelial tumor of the inverted type in the urinary tract, including inverted papilloma.

[Urachal carcinoma producing carcinoembryonic antigen: a case report]

We report a case of urachal carcinoma with elevated serum carcinoembryonic antigen (CEA) level in a 36-year-old man. En bloc resection was performed. The production of CEA was proved histologically. The level of serum CEA returned to the normal value after operation. Seventeen postoperative months the level of serum CEA was noted to be elevated again, and 2 months later symptoms appeared and tumor recurrence was revealed on computer tomographic scan. Radiotherapy and chemotherapy were done without any noticeable response. He died of tumor progression. In our case, serum CEA gave useful information as a tumor marker. It showed specificity for the tumor and helped evaluation of tumor resection as well as detection of tumor recurrence.

[Sequential combination chemotherapy consisting of vincristine, peplomycin, methotrexate, cis-diamminedichloroplatinum (II) and adriamycin in urothelial cancer]

The VPM-CisA (vincristine (VCR), peplomycin (PLM), methotrexate (MTX), cisplatin (CDDP) and doxorubicin (ADM), regimen was used to treat 33 patients with urothelial tract tumors. Twenty-two patients had bi-dimensionally measurable disease parameters and 11 patients with locally advanced tumors were given postoperative adjuvant chemotherapy. The protocol consisted of 0.6 mg/m2 VCR on days 1 and 3, 3 mg/m2 PLM on days 1 to 4, 3 mg/m2 MTX on days 2 and 4, 35 mg/m2 CDDP on day 4, and 20 mg/m2 ADM on day 5. These doses were adjusted for each case: the above mentioned dose x [(80/(40+Age]2 +[(Karnofsky's performance status/100)2]. Of these patients, 28 (86 percent) were treated adequately, including 8 (36 per cent) who achieved a complete (2) or partial (6) remission. The mean duration of survival was 65.2 weeks for complete and partial responders, and 48.8 weeks for non-responders, which was not a statistically significant difference. Of 11, who were given post-operative adjuvant chemotherapy (mean observation period: 83.5 weeks) 9 were alive without evidence of disease, 1 had a recurrence 8 months after first chemotherapy, 1 died due to pulmonary and liver metastasis 2 years after the chemotherapy. Toxicity included mild myelosupression, moderate anorexia, vomiting, and severe gastric ulcer, pulmonary fibrosis.

Female wide urethra masquerading as a urethral diverticulum in association with ectopic ureterocele

A rare case of wide urethra in a female infant mimicking as a urethral diverticulum in association with ectopic ureterocele is reported. The ureterocele terminated just below the bladder neck, but the diverticulum-like structure everted from the wide urethra, protruding towards the ureterocele. Weakness of the urethral wall, distal to the actual ureterocele may produce such an abnormal radiologic finding. The pertinent literature is reviewed.

[Surgical treatment for metastatic lesions from renal cell carcinoma]

We report our experience on operations for solitary metastasis from renal cell carcinoma. Two cases had bone metastasis, and 2 cases brain metastasis. In 3 cases, the symptoms from the metastasis had remained absent for several months after the operation. One case was cancer-free for 2 years. Surgical treatment was useful for the solitary metastasis from the renal cell carcinoma. We examined both the primary lesion and metastatic lesion histopathologically. Pathological findings revealed grade-up and change of cell subtype in metastasis.

[Experimental study of chemotherapy of renal cell carcinoma. 1. Combination effect through the use of cell kinetics-directed treatment schedules]

To establish a useful combination chemotherapy of advanced renal cell carcinoma, I determined the optimal design of therapeutic schedules with an in vitro experimental model. At first, I determined the chemosensitivity of the NC-65 cell line established from human renal cell carcinoma. The method used is an original growth inhibition test which traces the cell growth in the same area by photography. This method can be completed in a short term and cell growth inhibition rate evaluated sequentially and precisely as well. Among 8 tested drugs, vincristine (VCR), adriamycin (ADM) and carboquone (CQ) were the most effective drugs. The effect of these three drugs on cell cycle traverse was estimated by flow cytometry. With all of these three drugs, at a concentration which inhibits cell growth less than 50%, an accumulation of cells in the S and G2-M phases was observed 12 hours after the exposure to the drugs. Although 24 hours later, the histogram showed the increase in cells of a G1 phase and decrease in G2-M cells, followed by the cell progression partially synchronized. The tendency was the most characteristic in VCR although it was not so significant in CQ. Effectiveness of the simultaneous or sequential combination of two-drugs was compared to the calculated expected effect using the t-test. At a low concentration which inhibits cell growth 32% (IC 32), most of the combination groups showed a weak effect. Sequential treatment at 12-hour intervals such as with VCR-ADM, CQ-VCR, CQ-ADM, were considered more effective than that of a 24-hour interval. In the medium concentration which inhibits cell growth 50% (IC 50), simultaneous administration of ADM and CQ showed a relatively high inhibition rate. Sequential treatment of CQ followed by VCR was the most cytotoxic. Comparison of sequential administration schedules, administration at 12-hour intervals showed a higher inhibition rate than that of a 24-hour interval, in the combination of VCR-ADM, CQ-ADM.

[Experimental study of chemotherapy of renal cell carcinoma. 2. Combination effect of interferon and antitumor agents based on cell kinetic analysis]

To establish a useful combination therapy of interferon (IFN) with antitumor agents, I investigated the antiproliferative effect and change of DNA histograms in vitro after the IFN exposure either alone or in combination with antitumor agents, simultaneously or sequentially, on NC-65 cells derived human renal cell carcinoma. The IFN used was recombinant interferon alpha-2a (IFN-alpha) and the antitumor agents selected were vincristine (VCR) and adriamycin (ADM). IFN-alpha suppressed the proliferation clearly in a dose dependent manner but not so apparently even after the 96-hour exposure. Six to 12 hours after the exposure of IFN-alpha, accumulation of the cells in the G1 phase was observed at the higher concentration, and then increase of S phase cells up to 72 hours, suggesting a G1-S block at a short period and then prolongation of S-phase. VCR combined with IFN-alpha suppressed NC-65 cell proliferation additively, whereas ADM combined with IFN-alpha suppressed it rather less than additively. The sequential exposure of IFN followed by VCR induced the enhancement at a higher concentration but that followed by ADM did not, suggesting that IFN-induced cell modification made the cells more sensitive to VCR. Dose dependent accumulation in the G1-S boundary phase was observed after the combined exposure of IFN-alpha and antitumor agents, especially by sequential exposure, and then accumulation in S and G2-M were observed. The delay of cell progression in the S phase was likely significant when IFN-alpha was used with antitumor agents, such as VCR and ADM.

[Studies on 5-FU concentration in serum and bladder tumor tissue after oral administration of UFT]

The concentration of 1-(2-tetrahydrofuryl)-5-fluorouracil (FT), 5-fluorouracil (5-FU) and uracil in blood, the bladder tumor tissue and the bladder mucosa after oral administration of 600 mg per day of UFT for 7 consecutive days was examined in 10 cases of bladder tumors. The concentration of FT and uracil in the tumor tissue did not significantly increase as compared with that in the blood and the bladder mucosa. However, the concentration of 5-FU in the tumor tissue remarkably increased and was 10.7 and 4 times as much as that in the blood and the bladder mucosa, respectively. These results show that administration of UFT meaningfully increases the 5-FU content in bladder tumors and enhances the antitumor activity.

[Transcatheter embolization in the management of pain from metastatic uroepithelial cancer]

Arterial embolization was performed for the relief of pain in 4 patients with symptomatic osseous metastases associated with extensive soft tissue tumors. Two patients had metastatic transitional cell carcinoma of the bladder and renal pelvis, and 2 had metastatic renal cell carcinoma. Three of the 4 patients experienced significant relief of pain and improved performance status. Decrease of tumor size or healing of osteolytic metastasis did not occur. Errant embolization occurred in one patient but did not become a serious problem. In 3 patients post-infarction pain occurred, but subsided within 36 hours. This therapeutic approach may be useful to control the pain associated with a massive advanced uroepithelial cancer.

[Spontaneous urinary extravasation due to chronic ureteral obstruction]

Spontaneous nontraumatic perirenal extravasation of urine is an unusual phenomenon, and the majority of the reported case were caused by acute obstruction with passage of a ureteric calculus. Extravasation due to obstruction of more gradual onset occurs less frequently. We report four cases, three caused by tumor obstruction of the ureter, and one thought to be obstructed by the stricture due to ureteral inflammation. We discuss the diagnosis and treatment of spontaneous urinary extravasation, especially due to chronic ureteral obstruction.

[Clinical experience in renal transplantation]

In Shiga Prefecture, 378 chronic renal failure patients were registered at the end of 1981. In 1982, the Kidney Transplantation Group, composed of the department of Urology and the 1st division of Surgery, was organized in our hospital and 10 living related renal transplantations and 8 cadaver renal transplantations were performed between July 1982 and October 1984. As immunosuppressants, azathioprine, mizoribine, cyclosporine, prednisolone, methylprednisolone and ALG were used. Azathioprine was used mainly for living transplantation and cyclosporine mainly for cadaver transplantation. ALG was used only for the initial 3 living transplantations. Mizoribine was sometimes used in combination with azathioprine to reduce the dose of azathioprine and reduce its severe side effects. Seven episodes of acute rejection were experienced and all episodes were remitted by methylprednisolone pulse therapy. There were 20 major post-transplant complications in 13 recipients and among them 2 pulmonary infections were fetal (1 from aspergillus infection and 1 from cytomegalovirus infection). The 10 living related kidney transplantation recipients are all well and none have undergone hemodialysis. Three of the 8 cadaver renal transplantation are well without hemodialysis. One patient could not obtain diuresis. In addition to our experience of renal transplantation, the preoperative scheduled blood transfusion with combination of azathioprine administration, was briefly discussed.

[Clinical study of children with sterile vesicoureteral reflux]

A clinical study of 5 children (3 boys and 2 girls) with primary sterile vesicoureteral reflux is presented. Their ages ranged from 8 to 11 years old. During the same period, we saw 14 children (6 boys and 8 girls) with primary infected vesicoureteral reflux. Their ages ranged from 1 to 13 years old. There were several distinctions between these two reflux groups. Manifestations of the infected reflux group were mainly fever attacks, while those of the sterile reflux group were hypertension, proteinuria and enuresis. The duration from onset to diagnosis was longer in the sterile reflux group because their manifestations did not appear to be severe especially in cases of enuresis. The grade of reflux tended to be more advanced in sterile reflux group. The renal scarrings were identified in all involved kidneys in the sterile reflux, while in 65.2% in the infected reflux group. It is difficult to detect sterile reflux early because the manifestations are not related with urinary tract infection. Recently, reflux nephropathy is a subject of frequent discussion and end stage of reflux nephropathy has been sporadically reported. Therefore, an effort should be made for early detection of sterile reflux. Based on our experiences as well as review of the literature, possible clues to detect sterile reflux are abnormal voiding patterns, such as nocturnal enuresis, incontinence, frequency and so on.

[Prolapse of ureteral tumor]

We present three cases of prolapse of ureteral tumor. Prolapse of a ureteral tumor is usually associated with antegrade intussusception of the ureter, and is thought to be a sign of noninvasiveness. In such a case segmental ureterectomy may be justified.

[Rhabdomyosarcoma of the bladder in a child: report of a case]

A case of rhabdomyosarcoma of the urinary bladder in an 11-month-old boy is presented. The chief complaint was complete urinary retention and histological examination showed embryonal rhabdomyosarcoma of the bladder. Initially, he was treated with vincristine, actinomycin-D and radiation therapy. This therapy was not effective, and he was next treated with vincristine, bleomycin, and cis-DDP. This therapy was significantly effective, and the tumor became non-palpable on physical examination. After six courses he was discharged and maintenance chemotherapy was continued until the tumor relapsed 1 year later. Finally he died of dyspnea due to diffuse pulmonary metastases approximately 2 years after the first diagnosis. We herein discuss several points which affect the prognosis and the usefulness of chemotherapy, especially combination therapy with vincristine, bleomycin, and cis-DDP for recurrent cases.

[A study on urinary fungal infection]

We analyzed 20 cases of urinary fungal infection experienced at our Department, during the last 2 years. Candida albicans was the most prevalent of the fungi affecting the urinary tract. Torulopsis glabrata and Candida tropicalis were also prevalent. Antibiotics, indwelling catheter and obstructive uropathy were the most prevalent predisposing factors of the fungal infection. Of 20 cases of fungal infection, 5 cases were cured only by elimination of the predisposing factors, and 15 cases were treated and resolved by administration of sodium bicarbonate, 5-fluorocytosine and or irrigation with amphotericin B. But one case of bilateral renal torulopsiosis developed into renal failure, and 4 cases died of the primary disease.