The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
Volume 84 , Issue 2
Showing 1-22 articles out of 22 articles from the selected issue
  • Masanori Yamamoto
    1993 Volume 84 Issue 2 Pages 229-243
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
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  • Manabu Kuriyama, Nana Esaki, Ikuo Shinoda, Shin-ichi Ito, Shin-ichiro ...
    1993 Volume 84 Issue 2 Pages 244-250
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Serum prostate-specific antigen (PA) values detected by a newly developed enzyme immunoassay (EIA, MARKIT-M PA) as a successor of MARKIT-F PA, which has been a leading kit in Japan, were evaluated for its role in the diagnosis of cancer of the prostate and follow-up of the patients afflineted with the disease. The system is one-step sandwich type EIA using hourseradish peroxidase as a tracer and has 0.50-100ng/ml of detectable range with small amount of sample volume (25μl) and reliable quality control data. Furthermore, serum PA values detected by the assay were almost equivocal to those detected by MARKIT-F PA. Serum PA values in prostate cancer patients (n=122) were statistically higher than those in normal males (n=90), urological malignancies other than prostate cancer (n=48) or benign prostatic hypertrophy (BPH, n=73). Even in the patients with stage A and B prostate cancer, serum PA values were observed to be statistically higher than those in BPH cases. If 3.6ng/ml was used, which is normal value in MARKIT-F PA, as a cut-off value and BPH cases as a control, the sensitivity, specificity and efficacy for diagnosis of prostate cancer were 77.9, 91.8 and 83.1%, respectively, which showed the best results during the range examined. Serially determined serum PA values in following up the patients with prostate cancer were confirmed to be highly effective to evaluate treatment responses. These results suggest that MARKIT-M PA is thought to be one of the best tool for determination of serum PA values.
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  • Mitsuko Yasuda, Motoyuki Masai, Jun Shimazaki
    1993 Volume 84 Issue 2 Pages 251-257
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Incidence of simple renal cysts was calculated in 30, 316 patients receiving routine ultrasound examination in one hospital, and 170 cases visiting Chiba University Hospital were further analyzed in terms of their clinical features. Incidence of simple renal cyst was 14% in all populations and ratio of male to female was 1.6:1. Patients age ranged from 8 to 92 years (average age 58.6 years) and number of a renal cyst was increased after fifth decade in both sexes. Patients of Chiba University Hospital were examined on symptoms and clinical courses with maximal follow up to 132 months (average 18 months). Symptoms associated with simple renal cysts were: none (75.3%) pain (14.7%) and gross hematuria (6.4%). Uninalysis of patients without associated urinary diseases, showed microhematuria in 40% and proteinuria in 12%, however, grade of microhematuria and proteinuria was not correlated with size of cysts. Number of cysts tended to increase with age. Size of cysts and rate of enlargement were increasing along with age. In any cases, renal function was not and affected nor occurred malignant tumor during follow-up period. Cyst punctures with screlosing agent were performed in 16 patients, and most of the cysts remained the seme as or exceeded their original size. It is concluded that routine follow-up is sufficient in most cases without symptoms, since simple renal cysts increase slowly, and impairment of renal function and progression to malignant tumors do not occur.
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  • Takamasa Hamada
    1993 Volume 84 Issue 2 Pages 258-264
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    For investigation of function of the male posterior urethra, morphological study was performed in terms of the muscle architecture including sphincter muscle of the posterior urethra. The muscle localization was demonstrated by microdissection in eight male cadavers. Histological examination was also employed with HE staining and immunohistochemical method to detect the nature of these muscles.
    At the dorsal side, the muscle fibers of the deep trigone were located from the interureteral ridge beyond the bladder neck to the vermontanum surrounding the posterior urethra. They were regarded as the internal urethral sphincter muscles.
    At the ventral side, the muscle fibers were also found just outside the ventral prostate running from the base to the apex of the prostate. Then, they were circularly located around the, membranous urethra. These saddle shaped muscles were proved to be striated muscle by the immunohistochemical examination using anti-Desmin and anti-Myoglobin antibody. Therefore, the external urethral sphincter muscle would consist of the pelvic floor muscles and the urethral sphincter muscles.
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  • Hiromi Kumon, Noriaki Ono, Satoshi Uno, Toshihide Hayashi, Kazuhiro Ha ...
    1993 Volume 84 Issue 2 Pages 265-271
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A total of 36 cases with chronic non-bacterial and non-chlamydial prostatitis or prostatodynia underwent 5 weekly, 1-hour sessions of transrectal microwave hyperthermia (43°C) to the prostate.
    All patients had a long history of the condition and failed to respond to a variety of conventional treatments. The efficacy of the treatment was evaluated by the effects on subjective symptoms and/or on white blood cells in expressed prostatic secretions. Concerning the overall clinical efficacy, excellent results were obtained in 11 (30.6%), good in 8 (22.2%), fair in 8 (22.2%) and poor in 9 (25.2%). Although minor complications were noted in 5 cases (anal pain; 2, hematospermia; 1, hematuria; 1), all cases received full sesseions. These results indicated the usefulness of the hyperthermia for this benign condition, which has so far responded poorly to the conventional therapy.
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  • Yukio Homma, Chieko Imajo, Satoru Takahashi, Yoshio Aso
    1993 Volume 84 Issue 2 Pages 272-279
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The grading of severity of benign prostatic hyperplasia (BPH) was attempted by scoring clinical manifestations associated with the disease. The total score (0 to 100 points) is the sum total of subjective and objective one, each of which is 50 points at its maximum. Subjective score is composed of symptom score (0 to 25 points) evaluating 5 each obstructive and irritative symptoms and quality of life (QOL) score (0 to 25 points). Objective score consists of functional and anatomical scores. Functional score (0 to 25 points) is calculated by scoring maximum flow rate and residual urine. Anatomical score (0 to 25 points) is calculated by the score of prostatic volume. Seventy-seven BPH patients have been evaluated by this scoring system. The mean values of 4 kinds of scores (symptom, QOL, functional and anatomical scores) were about 8-9 points and thus comparable each other. The total score was 35.4±12.3 in the average and divided into 6 grades: Grade 0;<10, Grade 1;≥10, Grade 2;≥20, Grade 3;≥30, Grade 4;≥40, Grade 5;≥50. The present scoring and grading.systems appear to be appropriately formulated to estimate the global severity of BPH patients. Further studies to apply the system to evaluation of therapeutic responses would be mandatory to examine its validity.
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  • Keiichi Miyakoda, Kousuke Watanabe
    1993 Volume 84 Issue 2 Pages 280-290
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    In 45 patients (38 males and 7 females; average age: 78 years) with brain bladder, who did not have any peripheral neuropathies and spinal disturbances, cerebral findings of MRI (1.5T) T2 enhanced image were analyzed in comparison with those of 7 control patients with normal urination after BPH operations. Patients with neurogenic bladder were divided into three groups as follows: 33 patients with a chief complaint of urinary disturbance (Group I), 9 patients with urinary incontinence (Group II) and 3 patients with balanced bladder (Group III). High frequency of lacune (24%) of the globus pallidus and low signalling of the corpus striatum (30%) was found in Group I patients, but low frequency in other Group patients and control patients. Further-more, pathologic changes with various grade in the globus pallidus were observed in 91% of Group I patients.
    In the treatment of urinary disturbance, a high improvement rate of micturition disorder (77%) was obtained in patients treated with a combination of dantrolen and TURp (TUIbn for females). However, patients which had clear lacune of the globus pallidus showed the low improvement rate. It should be possible that the globus pallidus contributes to control the movement of the external sphincter and the pelvic base muscles as well as other striated muscles.
    Moreover, lacune was rarely found in the urination center of the brain-stem on MRI.
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  • Teruo Mishina
    1993 Volume 84 Issue 2 Pages 291-296
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The prostatic weight was evaluated in 264 patients with benign prostatic hyperplasia before transurethral resection of the prostate (TUR-P) by transrectal ultrasonotomography. In the first group of 121 among 132 patients, the weight of both the total prostate (EPWt) and the internal prostatic gland (EPWi) was estimated and compared to the actual weight of resected specimens (RPW). In the remaining 11 patients, EPWt was obtained but not EPWi because their prostatic gland echograms were obscure.
    The correlations between RPW and EPWi, and between RPW and EPWt in 121 patients were proved to be RPW=0.999 EPWi-0.586 (r=0.851), RPW=0.537 EPWt-1.914 (r=0.766), respectively.
    In the second group of 132 patients, the weight of the prostatic adenoma to be resected was estimated preoperatively by the measurement of EPWt and the application of the latter formula (CRPW). The correlation between RPW and CRPW was proved to be RPW=0.930 CRPW -1.570 (r=0.824).
    It is presumed f rom this study that preoperative estimation of EPWi or EPWt may be useful not only for selection of the treatment modality for BPH, namely TUR-P or open surgery, but also for prediction of an operation time in TUR-P.
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  • Takashi Kaneda, Ryuichiro Konda, Seiichi Orikasa, Kiyohide Sakai, Shoz ...
    1993 Volume 84 Issue 2 Pages 297-302
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The effects of partial or total removal of the kidney with ectopic ureter on the contralateral kidney were evaluated using DMSA renal uptake rate on 8 patients.
    After partial nephrectomy on 6 cases, the affected residual kidneys showed significant decrease in DMSA renal uptake rate in 2 cases in which the extirpated kidneys had normal renal tissue in part but did not show significant change in DMSA uptake rate in 4 cases in which the extirpated kidneys were dominated mainly with dysplasia.
    Post-operative increase in DMSA uptake rate of the contralateral kidneys were significant in 3 of 4 patients who had the operation before they became 2 years old. In 2 of these 3 cases, pre-operative scintigram showed extremely low rate of DMSA renal uptake. Four cases aged 2 years old and over did not show post-operative increase in the uptake rate. As we have previously reported on the cases with hydronephrosis, these results suggest that 1) existence of obstruction casued by ectopic ureter inhibit the development of the contralateral kidney and 2) the growth of the kidney can resume the release of that obstruction, if the release is made while the kidneys are still in developing stage.
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  • Shinya Kudo, Tadashi Suzuki, Hidekazu Inazumi
    1993 Volume 84 Issue 2 Pages 303-312
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Antitumor activity of BCG for transitional cell carcinoma of the urinary bladder was evaluated in 103 patients from October, 1983 to October, 1989 at Hirosaki University Hospital. At the same time, the role of various inflammatory cells infiltrating in the bladder wall after intravesical BCG instillation as mechanism of action of BCG was studied.
    Of 72 patients with superficial bladder cancer, 19 showed a complete response and 28 showed a partial response. The effective rate was 65.3 percent. Significant efficacy was obtained in patients received more than 5 times instillation of BCG.
    Before intravesical BCG instillation, a small number of lymphocytes or plasma cells infiltrated in the stroma of the tumor. But histiocytes, neutrophils or eosinophils were hardly found. After BCG instillation, the degree of infiltration of each of them tended to increase.
    The mean degree of infiltration of those inflammatory cells almost all significantly increased in the stroma of the tumor, while only lymphocyte and histiocyte counts significantly increased in both the basal areas of the advancing margin of tumor cells and the tumor free submucosa after BCG instillation.
    Epithelioid granulomas were recognized almost in the basal areas of the advancing margin of tumor cells and the tumor free submucosa after BCG therapy. Langhans' giant cells were occasionally found within these lesions. In 2 patients marked central necrosis (caseation) was noticed in epithelioid granulomas.
    In BCG effective cases with superficial bladder cancer lymphocytes and histiocytes increased significantly in all of the stroma of the tumor, the basal areas of the advancing margin of tumor cells and the tumor free submucosa. On the other hand, in BCG noneffective cases they increased significantly only in the stroma of the tumor.
    Subsets of lymphocytes which increased after intravesical BCG instillation were mainly T pan cells with the predominance of T helper/inducer cells (Th/Ts ratio always>1).
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  • Yasushi Saiko, Shigeru Minowada, Misturu Shinohara, Kikuo Nutahara, Yu ...
    1993 Volume 84 Issue 2 Pages 313-321
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Adrenalectomy for Cushing's syndrome due to adrenocortical adenoma was performed on 40 patients at Tokyo University Hospital between 1960 and 1990. There were 32 women and 8 men aged 2 to 59 (mean 35.7) years. Three different operative approaches to the adrenal gland were emploied: lumbar approach in 24 cases, dorsal in 8, and transabdominal in 8 of whom 7 patients were operated before 1970 without definite preoperative localization of the lesions.
    Postoperative administration of cortisone and hydrocortisone as a steroid replacement has been reduced in duration and dosage in recent 10 years.
    Average treatment period was 3 years and 1 month in the 1970's, and 9.5 months in the 1980's, respectively. The mean daily dosage of steroid hormone was 517.5mg (mean) on the operative day and 43.1mg after three weeks in the 1970's, while 187.5mg and 18.4mg in the recent five years, respectively. Nonetheless, even in the recent 6 patients, metabolic alkalosis and hypopotassemia because of steroid excess were observed in a few days after the surgery.
    These observations indicate that period and dosage of steroid replacement have been reduced in these years and could be further shortend by means of rapid tapering in the early postoperative phase.
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  • Kaname Ameda, Masami Nantani, Kotaro Taniguchi, Tadashi Matsuno, Tomoh ...
    1993 Volume 84 Issue 2 Pages 322-329
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Four hundred and thirty-seven patients with benign prostatic hyperplasia selected for elective prostatectomy underwent preoperative cystometry. Of these patients 263 (60.2%) had bladder instability, who tended to be more irritative and more obstructive in their preoperative objective assessment than the others. Forty-seven patients (12.5%) revealed vesical denervation supersensitivity, of these patients all but one had bladder instability. Significant correlation was found between occurrence of the bladder dysfunction and the severity of obstruction. The occurrence of both bladder dysfunction developed with age.
    Four hundred and fourteen patients (94.7%) had successful outcome in voiding postoperatively, but elderly patients with low bladder compliance and severe emptying failure tended to need several months in their recovery. Postoperative incontinence was found in 100 patients (22.9%) with high incidence of preoperative bladder instability in the early phase, but was reduced in most cases 6 months later. Eighteen prolonged incontinent cases showed high incidence of low bladder capacity and low compliance with instability at preoperative cystometry. In these cases, the incidence of elderly patients was higher than that of dry cases.
    It is concluded that most of these bladder dysfunction is secondary to the infravesical obstruction which depends upon severity and duration of the disease, but aging also appears to play a role in its appearance. We assume that detrusor instability represents a kind of compensation for infravesical obstruction, and that the development of denervation supersensitivity indicates that the bladder damage is severely progressing.
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  • Shunichi Takyu
    1993 Volume 84 Issue 2 Pages 330-338
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Effects of testosterone on the autonomic receptor-mediated function of the male rabbit urinary bladder and proximal urethra were examined. The alteration of α1-, α2-, β-adrenergic receptor and muscarinic cholinergic receptor densities in the urinary bladder and proximal urethra were determined by radioligand binding techniques after castration. The density of α1-adrenergic receptor in the proximal urethra decreased gradually after castration. This change was significant 8 weeks after castration. The α2-adrenergic receptor density in the proximal urethra slightly increased after castration, but it was not statistically significant. The β-adrenergic receptor density in the bladder dome did not change after castration. The density of muscarinic cholinergic receptor in the bladder dome significantly decreased in animals 2 weeks after castration. Additionaly, the density of autonomic receptors and the response of muscle strips to autonomic drugs were compared in three age-matched experimental groups: control group, castrated group and castrated and testosterone supplemented group. When the autonomic receptor densities in the castrated group were compared to those of the control, the changes similar to the result in the previous experiment were noted.
    Testosterone supplementation restored the densities of α1-adrenergic and muscarinic cholinergic receptors in castrated group to control levels. The responses of muscle strips to autonomic drugs closely paralleled the receptor densities. Castration decreased the α1-adrenergic and the muscarinic cholinergic receptor function, however, testosterone restored those function. These findings indicate that testosterone affects the autonomic receptor-mediated function in the smooth muscle of lower urinary tract.
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  • Shoichi Ebisuno, Kayo Miyata, Yasuo Kohjimoto, Tadashi Ohkawa
    1993 Volume 84 Issue 2 Pages 339-344
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We studied inhibitory activity of urinary macromolecule upon the calcium oxalate crystal aggregation using an aggregometer. We have developed an aggregometric assay method to measure the anti-aggregation ratio of calcium oxalate crystals in vitro. The macromolecular fraction of urine with a molecular weight above 5, 000 was isolated by PD-10 (Sephadex G-25M, Pharmacia) and made up to three-fold by Centriprep Concentrator (Amicon). The urinary macromolecular substances of recurrent calcium stone formers showed much less inhibitory activity than those of healthy controls. There were no significant relationships between the anti-aggregation activity and the concentration of urinary proteins and other parameters concerning with stone diseases. It was speculated that some proteins, molecular weight about 10, 000-30, 000, might inhibit the aggregation vigorously based on the result of gel filtration (Superrose 12HR, 20/50, Pharmacia) technique used in a healthy man's 24 hours urine.
    Thus, it supports that some urinary macromolecules are important during the phase of aggregation of calcium oxalate crystals, and that the feeble activity to present the aggregation may be one of the cause of calcium oxalate stone formation.
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  • Takeshi Kurozumi, Hiroo Yagi, Yasuhiro Koikawa, Ken Goto, Tetsuo Omoto ...
    1993 Volume 84 Issue 2 Pages 345-349
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The usefulness of transvascular embolization before radical nephrectomy using absolute ethanol was studied in thirty-two cases with renal cell carcinoma, among them, 30 cases received radical nephrectomy one day after transvascular embolization. And a nation wide questionnaire survey regarding the embolization was also reported.
    These results were as follows:
    1. The infarcted areas were very extensive and among 28 cases examined, 26 cases showed more than 75% of infarct in the whole area of the cortex.
    2. Among 32 cases, 22 cases complained of no pain after the embolization using absolute ethanol only by the preventive epidural administration of analgesics.
    3. The questionnaire survey showed that the embolization before radical nephrectomy was performed in 62% of the hospitals as a whole, including 81 hospitals (41%) in which the embolization was performed case by case. In the whole of hospitals, 21% performed the embolization principally by evaluating the significans of the embolization. On the other hand, 19% of the hospitals did not perform by the reason of no significans of the embolization on the treatment of renal cell carcinoma. As shown in this questionnaire survey, the signif icans of the embolization before radical nephrectomy was still debatable in our country.
    4. In 62% of the hospitals where the empolization is carried out, as a whole, the period from embolization to the nephrectomy was 3-7 days. And in 42% of the hospitals as a whole absolute ethanol was principlly used as an embolizing agent.
    In conclusion we believe that absolute ethanol was useful and should find further application as an embolizing agent before the radical nephrectomy.
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  • Hiroshi Okada, Akifumi Hayashi, Osamu Matsumoto, Sadao Kamidono
    1993 Volume 84 Issue 2 Pages 350-354
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    It is hard to differenciate leucocytes from immature germ cells among many round cells in ejaculated semen. Recently monoclonal antibodies (MoAbs) which recognize surface antigen of various subtypes of leucocytes are available. In this study we applied a panel of MoAbs for leucocyte subpopulations (granulocytes, T-lymphocytes, B-lymphocytes, Monocytes/Macrophages and panleucocytes). Semen smears from 64 mild oligozoospermic patients and 5 fertile volunteers were stained by immunohistological technique (avidin-biotin-immunoperoxidase method). We found highly varying total leucocyte numbers ranging from 1200 to 2.2×108 per ejaculate. When comparing semen from infertile patients with those from fertile donors, statistically significant higher medians of total leucocytes, total granulocytes and monocytes/macrophages were seen in infertile group. We compared a total number of leucocytes obtained from conventional Papanicolaou staining with that from immunohistochemical staining. Both were almost identical but the former gave a little bit higher value, because of the difficulty in differentiating leucocytes from immature germ cell by Papanicolaou staining. Moreover we performed an experiment to evaluate the applicability of flowcytometry (FCM) to count leucocytes in semen. Cells in the semen smears were stained with MoAbs recognizing the surface antigen shared by every leucocyte, and percentage of the leucocytes which were thus stained with MoAbs was compared with that determined by FCM. Results from FCM constantly gave lower value than these from immunostaining. This is probablly because FCM could not differentiate leucocytes from contaminated non cell substances (e. g. cell debris). From the present study it is not adequate to use FCM for the detection of leucocytes in semen as applied in haematology, Further techniques to remove non-cellular substances should be established for its application in semen analysis.
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  • Mitsutaka Ueda
    1993 Volume 84 Issue 2 Pages 355-363
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Cathepsin B is a lysosomal cysteine proteinase which is thought to regulate intracellular protein metabolism. In the present study, cathepsin B-like activity was determined in the urine of 53 patients with renal cell carcinoma, 22 patients with urothelial carcinoma and 41 control subjects. In addition, immunohistochemical study of cathepsin B was performed in specimens obtained from 20 patients with renal cell carcinoma, 59 patients with bladder carcinoma and 20 patients with renal pelvic and ureter carcinoma by using sheep anti-human liver cathepsin B antibody. Cathepsin B-like activity was higher in the urine from patients with renal cell carcinoma or urothelial carcinoma than in that from controls. Positive reactions for cathepsin B were found in 18 of 20 patients with renal cell carcinoma, in 37 of the 59 patients with bladder carcinoma and in 14 of the 20 patients with renal pelvic and ureter carcinoma. In patients with urothelial carcinoma high rates of positive reaction for cathepsin B were observed in patients with advanced stage tumors, with INFγ-type tumors and with metastatic lesions. In patients with renal cell carcinoma, there was no correlation between the rate of positive reaction and pathological findings. These results indicate that urinary cathepsin B-like activity is higher in patients with urological cancer and that a highly positive reaction for cathepsin B is a risk factor for tumor invasion, metastasis and poor prognosis in patients with urothelial carcinoma.
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  • Kiyohide Sakai, Ryuichiro Konda, Seiichi Orikasa, Satoru Kuji, Syozo O ...
    1993 Volume 84 Issue 2 Pages 364-373
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Measurements were performed on β2-microglobulin (β2-MG), α1-microglobulin (α1-MG), N-acetyl-β-D-glucosaminidase (NAG) as indices of renal tubular damage and microalbumin as an index of renal glomerular damage in 204 cases with primary vesicoureteral reflux (VUR). Invesigations were made on the relationship between each index and extent of renal cortical damage from the findings of 99mTc-dimercapto-succinic acid (DMSA) renoscintigraphy, and also on the changes of each index before and after antireflux operation.
    At the first examination, high values of urinary β2-MG, α1-MG, NAG and albumin were noted in 36%, 40%, 50% and 34% of cases with VUR respectively. Almost all the cases with high indices values before the operation showed improvement in those values accompanied with disappearance of VUR after the operation. These findings suggest that renal tubular and glomerular damage were induced by the sterile reflux itself.
    High values of urinary indices were confirmed in 16% (β2-MG), 40% (α1-MG), 27% (NAG) and 32% (albumin) cases after a lapse of 2 years or longer since antireflux operation or spontaneous disappearance of VUR. In some of these cases indices values showed some improvement but have not returned to normal levels, and in other cases indices were within normal limits preoperatively but turned out to be high levels during the observation period even after the disappearance of VUR. Most of these cases were accompanied with severe cortical damage of unilateral or bilateral kidneys on DMSA renoscintigraphy. Based on these findings, we suggest that overload to residual nephron, caused by reduced mass of functional nephron, is playing an important role on raising the values of various urinary indices.
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  • Shiro Oku, Teruo Kadowaki, Tadashi Uemura, Haku Nishioka
    1993 Volume 84 Issue 2 Pages 374-381
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Nineteen patients (mean age, 70 years; range, 58-80 years) undergoing elective transurethral resection of benign hypertrophy of the prostate (mean weight of resectate, 25g; range 10-59g; mean resection time, 61min; range 45-80min) under spinal anesthesia were studied for early detection of absorption of irrigating solution by means of expired breath alcohol analysis. The irrigating fluid used in all resections was tenfold diluted Urigal solution containing 1% ethanol. Expired breath was collected into a rubber bag every 10min during the surgery, and the concentration of ethanol was analyzed using a gas detector tube (GASTEC LTD.). Hemodynamic parameters including centrall venous pressure were routinely measured at the same intervals. The volumetric fluid balance was measured every 20min. Blood was collected preoperatively, at the same 20-min intervals during the resection, and 4-6 hours after the end of the operation. Serum electrolytes, hemoglobin and total plasma protein concentration were measured, and blood gas tension was analyzed. Mean arterial pressure, central venous pressure, blood gas tension showed no significant changes at these observed time intervals. Heart rate decreased 120min after the start of the operation. Ethanol was detected in the expired breath 10min after the start of the surgery, and showed progressive increase in concentration until the end of the surgery. Serum eletrolyte concentrations and hemoglobin content showed gradual decrease proportional to the increase in irrigating fluid volume. The ethanol concentration in the expired breath was significantly correlated with the change in serum sodium concentration. This method of monitoring alcohol in the expired breath to detect absorption of irrigating fluids presents practical advantages in terms of convenience and speed in comparison with other methods.
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  • Ryou Otomo, Seiji Yamashiro, Osamu Nishizawa, Tadashi Harada, Kazunari ...
    1993 Volume 84 Issue 2 Pages 382-385
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A 60-year-old male with locally invasive bladder carcinoma (pT4 pNo Mo) had a remarkable leukocytosis of 64, 900/mm3 in the peripheral blood count without any findings of inflammatory disease. The grade 3 transitional cell carcinoma (TCC) measuring 60 by 58mm involved the prostate, but radiological examinations including abdominal CT scan and isotopic bone scan failed to prove distant metastasis. Serum calcium level was within normal level. Negative bone marrow finding for leukemia strongly suggested a leukemoid reaction by the bladder carcinoma.
    Preoperative arterial chemoembolization utilizing mitomycin C microcapsules and cisplatin infused into the tumor feeding arteries provided a normalization of leukocyte count (8, 200/mm3) in association with a substantial tumor reduction, and was followed by radical cystoprostatectomy. Although the leukocyte count maintained a normal range for 2 months postoperatively, leukocytosis recurred and rapidly progressed to a leukocyte count of 51, 300/mm3. CT scan revealed intrapelvic tumor recurrence, and serum analysis for granulocyte colony stimulating factor (G-CSF) demonstrated an elevated value of 130.9pg/ml (normal, less than 30pg/ml). The patient is now on systemic chemotherapy.
    The laboratory data and the response to the treatments would indicate that the leukocytosis in this patient is a leukemoid reaction due to the bladder carcinoma which may release G-CSF. Ten cases of bladder tumor representing leukemoid reaction have been reported in the literature.
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  • Hiromichi Iuchi, Sigeo Kaneko, Sohei Tokunaka, Sunao Yachiku, Makoto F ...
    1993 Volume 84 Issue 2 Pages 386-389
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We report a case of pelvic fibromatosis, which has been rarely found.
    A 36-year-old man refered to our hospital complaning of right abdominal pain and a swelling mass. Abdominal CT and transabdominal echogram revealed a tumor contacted to the bladder.
    A nonpapillary tumor (little finger sized) at the bladder dome was observed by cystoscopy, and the tumor was clinically considered as urachal tumor. Wide radical excision including the bladder and prostate was performed. Pathological diagnosis was pelvic fibromatosis arising from musculoaponeurotic structures in the pelvis: The fibromatosis is benign nonmetastatic tumor but the recurrence rate is considerably high. However, in the present case, 14 months after operation there is no recurrence yet.
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  • Takanori Yamate, Kenjiro Kohri, Masahiko Takada, Takeshi Matsuura, Yas ...
    1993 Volume 84 Issue 2 Pages 390-393
    Published: February 20, 1993
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Total parathyroidectomy and autotransplantation to treat secondary hyperparathyoidism (SHP) have been often performed on adult patients with a favor able result, but have rarely been reported in the pediatric literature.
    We performed the above operations on a 4-year-7-month girl who was treated by continuous amburatory peritoneal dialysis (CAPD). The postoperative levels of serum calcium remained low in spite of oral calcium and Vitamin D3 medication, and intravenous calcium administration. But an administration of calcium into CAPF fluid has been maintained the normal level of serum calcium. A calcium balance study conducted for 3 days starting the 24th postoperative day showed 391mg/day of calcium absorption.
    The girl obtained a relief from the bone pain approximately 2 weeks after the operation and was able to run easily one and a half month after the operation.
    Total parathyroidectomy and autotransplantation were considered to be an effective treatment for severe symptoms of osteodystrophy in infantile patients with chronic renal failure.
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