The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
Volume 86 , Issue 7
Showing 1-16 articles out of 16 articles from the selected issue
  • Osamu Yamaguchi
    1995 Volume 86 Issue 7 Pages 1193-1207
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
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  • Jiro Miyazaki, Masato Fujisawa, Soichi Arakawa, Sadao Kamidono
    1995 Volume 86 Issue 7 Pages 1208-1215
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We examined immunohistochemically the expression of E-cadherin which is Ca2+ dependent intercellular adhesion molecules in bladder carcinoma and investigated the correlation among the expression of E-cadherin, pathological examination, clinical findings and course. Fifty cases of bladder carcinoma were examined except one squamous cell carcinoma. The pattern of the immunohistochemical staining by E-cadherin antibody were classified into 4 groups as follows. The tumor, over 75% of which cells were stained like normal epithelium, was regarded as (2+). When from 50% to 75% of the carcinoma cells were stained, it was (+). When from 25% to 50% of the carcinoma cells were stained, it was (±). The tumor showing that under 25% of the cells were stained or lack of staining was regarded as (-), It was demonstrated that the percentage of positive staining was significantly lower in cases of high grade or high stage tumors compared with those of low grade or low stage. As the pattern of invasion, 88% of the cases showing INFα was observed as (2+) or (+), while all cases with INFγ showed (±) or (-), The patients with superficial tumors showing (±) or (-) tended to have the higher local recurrence rate of the carcinoma compared with those showing (2+) or (+) staining. Immunoblotting analysis demonstrated no evidence of gross alteration of E-cardherin molecules between normal and carcinoma cells of the bladder.
    In conclusion, the decrease of E-cadherin expression may contribute to the tumor grade and invasiveness of bladder carcinoma.
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  • Hiro-omi Kanayama, Seiichi Naruo, Hiroshi Takigawa, Susumu Kagawa, Kei ...
    1995 Volume 86 Issue 7 Pages 1216-1220
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We analyzed germline mutations of the von Hippel-Lindau (VHL) gene located at chromosome 3p25 in a family of VHL disease by using single strand conformational polymorphism (SSCP) and Southern blot analyses. In 10 individuals including 2 patients with multiple renal cell carcinomas, multiple pancreatic cysts and cerebellar hemangioblastoma, there are no positive results in SSCP analysis. However, in 2 patients and one kindred, same abnormal band was observed in Southern blot analysis. Moreover, in this one kindred of 17 years old girl, multiple pancreatic cysts were found by computerized tomography (CT). These results shows the alteration in the VHL gene is a major rearrangement but not a small mutation and this alteration caused VHL disease in this family. Furthermore, presymptomatic diagnosis by direct mutation analysis seems to be very useful for early detection of this disease.
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  • Akihito Nambu, Yoshiaki Kumamoto
    1995 Volume 86 Issue 7 Pages 1221-1230
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    To investigate the mechanisms responsible for and recovery process of spermatogenic damage induced by anti-cancer agent and anti-androgen agents, we experimented with rats injected with those agents.
    Cis-diamminedichloroplatinum (CDDP) was selected as the anti-cancer agent causing spermatogenic damage. Flutamide and cyproterone acetate were selected as anti-androgen agents.
    Both of these agents induced histopathological spermatogenic damage. The influences of CDDP on spermatogonia and spermatocytes were remakable, compared with cyproterone acette and flutamide, which damaged mainly spermatids. CDDP had severely damaging effects on the DNA-synthesizing activity of spermatogenesis, based on findings using monoclonal antibody proliferating cell nuclear antigen (PCNA), compared with anti-androgen agents.
    We also studied Sertoli cell function of drug-induced spermatogenic damage in rat testes. Measuring the contents of transferrin in rat testes indicated the damage to Sertoli cell function. High doses of CDDP (8mg/kg) affected testicular transferrin concentration, but 4mg/kg and 2mg/kg of CDDP had no significant effect on Sertoli cell function. Cyproterone acetate and flutamide had severely damaging effects on Sertoli cell function not only at a high dose (30mg/kg) but at low doses of 15mg/kg and 7.5mg/kg.
    These results showed that an anti-cancer agent primarily affects the DNA synthesizing activity of spermatogonia and spermatocytes, but high doses of these agents also have damaging effect on Sertoli cells, and anti-androgen agents mainly affect Sertoli cells.
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  • Akihito Nambu, Yoshiaki Kumamoto
    1995 Volume 86 Issue 7 Pages 1231-1239
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We investigated spermatogenic damage induced by anti-cancer agents in previous studies. The results showed that the damage to spermatogenesis induced by anti-cancer agents could be due to not only direct damaging effects on DNA synthesis but also a direct effect on Sertoli cell function. Thus, stimulating Sertoli cell function could protect against the damaging effects of anti-cancer agents on spermatogenesis, or stimulate recovery from impair spermatogenesis.
    We experimented with rats injected with the anti-cancer agents cis-diamminedichloroplatinum (CDDP) and adriamycin, which impair spermatogenesis, in order to examine this hypothesis. Follicle-stimulating hormone (FSH), which should stimulate Sertoli cell function in vivo, was selected, and the effects of FSH in protecting against damage or stimulating recovery from damage were investigated.
    The injection of FSH resulted in no significant differences in the histopathological findings of spermatogenic damage induced by anti-cancer agents or testicular transferrin concentration as compared to those observed without FSH injection.
    But, in the protocol of the experiments on acceleration of recovery from spermatogenic damage induced by anti-cancer agents, the spermatid index without FSH was 1.02±0.24, that with FHS 75IU/kg was 1.50±0.15, and that with FSH 150IU/kg was 1.62±0.39, a significant difference (p<0.05). Also, the PCNA labeling index and testicular transferrin concentration were significantly different with FSH from those without FSH.
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  • Hiromitsu Fujii, Sohei Tokunaka, Sunao Yachiku
    1995 Volume 86 Issue 7 Pages 1240-1248
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The present study investigates the effects of chronic low-frequency electrical stimulation on the external urethral sphincter (EUS) of rabbits through the biochemical analysis of the isoforms of myosin light and heavy chains. Twenty-eight adult male rabbits were used in the test. Of these, the EUS of 14 rabbits were continuously stimulated directly at 1.8Hz, 0.8msec, 5.0V with an implantable electrical cardiac pacemaker for more than 10 weeks. The other 14 rabbits were used as the control group and were nurtured under the same conditions as the stimulated group but without the electrical stimulation. Upon conclusion of the stimulation program, the urethra was removed from all 28 rabbits. The portion of the urethra containing the EUS (from the middle of the prostate to the pelvic diaphragm) was cut transversely into thin serial sections and glycerinated. The glycerinated muscle fibers were then isolated under a stereomicroscope and samples for electrophoretic analysis were prepared. Two-dimensional electrophoresis according to the procedure of O'Farrell for myosin light chains and SDS-PAGE containing 40% glycerol for myosin heavy chains were carried out. The molar ratio of myosin subunits was determined by quantification through the dye elution process. The average percentages of slow myosin light chain molecules in 8 unstimulated and 8 stimulated EUS were 33.4±8.9% (mean±SD) and 70.1±12.8%, respectively. The average percentages of slow myosin heavy chain molecules in 6 unstimulated and 6 stimulated EUS were 17.6±5.7% and 40.2±7.1%, respectively. The percentages of the slow myosin isoforms from stimulated EUS were significantly higher than those from unstimulated EUS in both the light and heavy chain analyses, indicating that chronic low-frequency electrical stimulation on EUS causes a partial transformation of fast muscle fibers into slow muscle fibers in EUS. EUS seems to possess plasticity of phenotypic properties, the same as ordinary striated musculature.
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  • Osamu Kamihira, Yoshinari Ono, Norio Katoh, Shin Yamada, Kazuo Mizutan ...
    1995 Volume 86 Issue 7 Pages 1249-1254
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    During ESWL monotherapy for staghorn calculi, the formation of a stone street in the ureter is often encountered, and can be a troublesome problem. At the Komaki Shimin Hospital, 75 patients with staghorn calculi were treated with ESWL monotherapy using a Dornier HM-3 lithotriptor between October 1987 and August 1992. Among them, three patients had involvement of both collecting systems. An indwelling double J catheter was always inserted during treatment.
    Our strategy for the treatment of stone street was as follows; observation was initially performed for one month after ESWL, as long as pyelonephritis and/or complete obstruction did not occur. In the patients without any improvement of the stone street, TUL or ESWL was then performed for removal.
    A stone street (stone fragments extending ≥4cm) was formed in 38 of 78 renal units (49%). In 14 cases (37%), it disappeared spontaneously. TUL was required in 14 unit (37%), ESWL in eight units (21%), and both procedures in two units (5%). In one unit (3%), renal function was severely damaged. In another unit, ureteric perforation occured during the TUL procedure, and caused stone loss outside the ureter. To clarify the factors causing stone street, we compared the number of shock waves, the size of the stones, the severity of hydronephrosis and renal function in stone street formers and non-formers. However there were no significant differences among these factors.
    In conclusion, since it is impossible to predict stone street formation after ESWL monotherapy for staghorn calculi, patency of the indwelling double J catheter should be maintained and stone removal should be attempted after one month if necessary.
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  • Hiroshi Etoh, Kouichi Ueno, Hideaki Miyake, Takeki Sugiyama, Yasuhiko ...
    1995 Volume 86 Issue 7 Pages 1255-1260
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    (Purpose) The objective of this study is to evaluate the efficacy of nephron sparing surgery for renal cell carcinoma in patients with a solitary kidney or bilateral tumors.
    (Patients and methods) From 1982 to 1994, a total of 12 patients with a solitary kidney or bilateral tumors underwent nephron sparing surgery. The survival and complications were examined.
    (Results) The patients were 11 males and 1 female. Three patients were in stage 1, 6 in stage 2, 2 in stage 3, and 1 in stage 4, and the mean tumor size was 3.4cm (0.8-6.5). The complications were post-operative bleeding in one patient and slight transient renal dysfunction which didn't requrie hemodialysis in 3 patients. The local recurrence was observed in 1 patient (8.3%), metastasis in 3 (25%), no evidence of disease in 8 (66.7%), alive with cancer in 1 (8.3%), death due to cancer in 2 (16.7%), death due to other disease in 1 (8.3%), and the 5 year survival of all patients was 62.5%, that was almost the same as the result of 141 renal cell carcinoma patients treated with nephrectpmy in our hospital. The disease free survival rate of the patients in stage 1 and 2 seems to be higher than in stage 3 and 4 with no significant difference (p=0.0956).
    (Conclusion) These results suggest that nephron sparing surgery for renal cell carcinoma in patients with a solitary kidney or bilateral tumors is a useful therapy.
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  • Yasuhisa Fujii, Yotsuo Higashi, Fumio Owada, Tetsuo Okuno, Akira Noro, ...
    1995 Volume 86 Issue 7 Pages 1261-1265
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The response of bone metastatic lesions to endocrine therapy was assessed by reperated magnetic resonance imaging (MRI) and an isotope bone scan after an average period of 7.0 months (2-10 months) in 12 patients with prostate cancer. MRI used both T1-weighted spin echo technique and short TI IR (STIR) sequence. Of 7 patients with hormone-dependent cancer, the bone metastatic lesions resolved or became vague in all patients on STIR image, while in only 4 and 3 on T1-weighted image and bone scan, respectively. Of 5 patients with hormone-refractory cancer, the lesions progressed on both MRI and bone scan in all patients except one who had initially had diffusely metastatic lesions of systemic bone.
    The results indicate that STIR image of MRI is helpful for the therapeutic evaluation of bone lesions.
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  • Takeshi Ueda, Hiroomi Nakatsu, Shigeo Isaka, Jun Shimazaki
    1995 Volume 86 Issue 7 Pages 1266-1271
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Radical prostatectomy is the effective treatment for clinical T2 prostatic cancer. However, clinical T2 stage is often understaged preoperatively. The objective of neoadjuvant therapy is to increase the curability of surgery to understaged patients. The present study was based on patients who had had neoadjuvant endocrine therapy (LH-RH agonist) prior to radical nerve-sparing prostatectomy for T2 prostatic cancer. Sexual function were estimated before and after surgery.
    Ten patients with a mean age of 64.6 years (range 57-71 years) and biopsy-proven cancer received this treatment modality. No patients had evidence of lymph node metastasis by the pelvic computerized tomography and their bone scan was negative for metastasis.
    Clinical stage was T2a in 3 patients and T2b in 7. The grade of these tumors as assessed on prostatic biopsy before neoadjuvant endocrine treatment was well differentiated in 3 and moderately differentiated in 7.
    The duration of neoadjuvant endocrine therapy was 3.6 months (range 2-5 months) in average. Serum levels of prostatic specific antigen (PSA) were examinated monthly and prostate volume was measured by transrectal ultrasonography before and after neoadjuvant treatment. Decrease in serum PSA values was observed from an average level of 8.6ng/ml (range 3.1-17.5ng/ml) determined prior to neoadjuvant treatment to an average of 1.1ng/ml (range 0.6-3.3ng/ml) determined after neoadjuvant treatment.
    An average reduction of prostatic volume was 25.3% (range 7.4-56.7%) after neoadjuvant therapy. Pathological effects of the neoadjuvant therapy by the criteria proposed by Japanese Urological Association were Grade (G) 0a in 3 patients, G0b in 4, G1 in 2 and G2 in 1. Of patients who had 10 stage T2 cancer before treatment, 4 had pT2 and 6 pT3. Of six patients who had pT3 cancer, 5 had capsular invasion, 2 positive surgical margins, 2 seminal vescicle invasion and one positive lymph node.
    Data of the sexual function before (all cases) and after surgery (only pT2b patients) were obtained by a questionnaire regarding 8 questions. All 10 patients were potent preoperatively. Four patients with pT2 cancer did not receive anticancer therapy after surgery. Of the 4 patients, two patients were able to have sexual intercourse and one could obtain penile erection. One patient with pT3 relapsed after seven months, but the other nine patients were alive without disease.
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  • Kazuya Tashiro, Hiroshi Nakajo, Shinya Iwamuro, Akira Furuta, Shinya I ...
    1995 Volume 86 Issue 7 Pages 1272-1278
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A total of 205 patients with primary superficial bladder cancer (Ta, T1) followed more than 3 years were retrospectively aralyzed for factors related to reccurrence of tumors after transurethral resection. Patients age were 25 to 90 years old, average 61 years old, and there were 160 males and 45 females. Initial tumor grades were G0 in 4 patients, G1 in 48, G2 in 134 and G3 in 19. Seventy four patients had Ta tumor and 131 had T1. Initial treatments were transurethral resection (TUR) alone in 137 patients, TUR with intravesical chemotherapy in 64, with BCG therapy in 7 and others in 7. Factors examined included age, sex, chief complaint, shape, size, and number of tumors, tumor distribution (single area or multiple area), histological grade, stage and intravesical chemotherapy. Overall non-recurrent rate were 81.7% at 1 year, 60.7% at 3 year, 53. 8% at 5 year and 44.2% at 8 year. Five-year non-recurrent rate according tumor factors, showed significant difference regarding tumor size (<1cm or 1cm<:P=0.027), tumor number (single or multiple:P=0.004), tumor distribution (single area or multiple area:p=0.002), histological grade (<G1 or G2<:p=0.001) and stage (Ta or T1:p=0001). However, there were no significant difference regarding factors of age, sex, chief complaint, tumor figure and psesence or absence of intravesical chemotherapy. This results suggested that the tumor factors of size, number, tumor distribution, grade and stage were highly related to intravesical tumor recurrence of superficial bladder cancer.
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  • Sumio Noguchi, Taro Shuin, Yoshinobu Kubota, Mitsunobu Masuda, Masahir ...
    1995 Volume 86 Issue 7 Pages 1279-1286
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We examined various prognostic factors of metastatic renal cell carcinoma. Patients who had metastasis at nephrectomy (A group, 38 cases) and those who had metastasis as recurrent tumors after nephrectomy (B group, 38 cases) entered in this study. Five-year survival rate of total cases after confirmation of metastatic foci was 15% and there was no statistical significant difference between A and B groups.
    Several pathological factors were related to poorer prognosis and included large diameters of original tumors, positive lymph nodes, higher grade tumors and non-clear cell type tumors. Patients who have a solitary lung metastasis showed better prognosis compared to those with multiple lung metastases or metastases of other organs. Two factors related to treatment were shown to contribute to better prognosis. These were the response to interferon alfa (IFNα) and the possibility of total resection of visible metastatic tumors. Patients who belong to A group were shown to achieve markedly better therapeutic benefit from IFNα or IFNα plus anticancer drugs. Five-year survival rate for the responders was 40%, as compared to less than 5% for the non-respondes. Ten-year survival rate for patients with metastasis who had undergone complete resection of visible tumor was 50%, and the for patients belonging to B group Showed 80%.
    We concluded that these prognostic factors should be considered to decide how to select patients with metastatic renal cell cancer.
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  • Junji Yonese, Satoru Kawakami, Tomohiro Ueda, Masahiro Tsuzuki, Susumu ...
    1995 Volume 86 Issue 7 Pages 1287-1293
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Of 130 cases with renal cell carcinoma treated at Cancer Institute Hospital from January, 1981 to December, 1992, 14 (10.6%) developed brain metastasis, 12 of whom had had preceding pulmonary metastasis. Interval between the initial treatment of the primary lesion (nephrectomy in 13, embolization in 1) and the diagnosis of brain metastasis ranged 0 to 57 months with a median of 11 months. Twelve patients had clinical symnptoms such as headache, vomiting, paralysis or disturbance of consciousness. Eleven patients were treated with external beam irradiation (30-60Gy linear accelerator). Only 3 (30%) of 10 patients with measurable lesion on CT scan achieved PR but 6 (66.7%) of 9 had symptomatic improvement. Especially, chronic intracranial hypertension such as headache and vomiting disappeared in 5 (83.3%) of 6. Average survival period and one year survival after the diagnosis of brain metastasis were 5 months and 14.3%. Although most of the patients with brain metastasis died of the progression of other organ metastasis, radiation therapy for brain metastasis was useful to palliate the agonizing symptoms.
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  • Hiroshi Terada, Yasuzoh Yamaguchi, Tomomi Ushiyama, Kazuo Suzuki, Atsu ...
    1995 Volume 86 Issue 7 Pages 1294-1297
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A 28-year-old man visited our hospital with a complaint of male infertility. His development was normal with body size of 169.5cm in height and muscular type. His beard and axillary and pubic hairs were male type. The penis and scrotum were also normal, but testes were small (8ml, bilateral).
    Semen analysis reveled azoospermia. Serum luteinizing hormone (LH) and testosterone levels are within normal range but follicle stimulating hormone (FSH) was moderately elevated.
    Testicular biopsy specimen showed severely hyalinized seminiferous tubuli, incarceration of basement membrane and hyperplasia of Leydig cells. Johnsen's score count was two. Chromosomal analysis reveled a mosaic type of 45, X/46, X+mar. We tried to confirm the existence of sex-determining region of the Y chromosome (SRY) by the DNA analysis. It was shown that SRY on genomic DNA fragment. This marker chromosome may be translocated to a fragment of the short arm of Y chromosome.
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  • Nobuaki Ohtake, Akihiko Shiono, Kazuhiko Okabe, Yutaka Takezawa, Hidet ...
    1995 Volume 86 Issue 7 Pages 1298-1301
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A 6-year-old boy who had been diagnosed as having Wilms tumor at the prior hospital was admitted to our hospital for investigation of a right flank mass and macrohematuria in October 1990. Magnetic resonance imaging showed Wilms tumor of the right kidney extending into the inferior vena cava. Right radical nephrectomy, lymphadenectomy and thrombectomy were done on October 30th, 1990. Pathological findings indicated clear cell sarcoma of the kidney. One week after the operation, radiotherapy and chemotherapy with actinomycin D (ACTD), vincristine sulfate (VCR), doxorubicin hydrochloride (DXR) and cyclophosphamide (CPM) were started according to the protocol by National Wilms Tumor Study (NWTS) III. However, he died of bone metastases and pneumomycosis on October 13th, 1992. Clear cell sarcoma of the kidney (CCSK) is a rare tumor accounting for about 4-5% of Wilms tumors. This is the first report on CCSK with tumor thormbus in Japan.
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  • Masamichi Hayakawa, Fumio Nakajima, Isao Higa, Yuzou Koyama, Tadashi H ...
    1995 Volume 86 Issue 7 Pages 1302-1305
    Published: July 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Significance of surgical extirpation of a massive tumor involving adjacent viscera is still controversial, because this sort of extensive resection is unusual and its results are poor in terms of a short survival time. Here, we summarize the clinical courses of 7 patients who had been diagnosed as invasive renal cell carcinoma (RCC) and undergone extensive resection of the bowel and/or other adjacent visceras. In addition, a percentage of patients who had direct invasion and/or metastasis to adjacent viscera in routine autopsies was looked up in the Annual Report of the Pathological Autopsy Cases in Japan.
    Pathological diagnosis indicated that direct invasion was confirmed in 4 out of 7 patients. One patient was relieved from septic shock due to pelvicocolic fistula caused by a direct invasion of RCC. New metastases developed in all patients after the radical operation (2-30mos), and 3 of them further underwent resection of the metastastic lesion(s). Although 5 patients ultimately died of cancer or its related diseases (mean survival time: 14.2±10.7mos), other 2 (pT4 and pT3) who underwent resection of lung metastasis have survived for 19 and 72 months. Either an early occurence of metastasis after local resection or a tumor predominantly composing of spindle cells might indicate a poor prognosis.
    Surgical extirpation should not be precluded when the patient is having severe symptoms related to extensive involvement of the adjacent visceras. We believe that it is appropriate to individualize in case of choosing patients for such extended radical surgery.
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