(Objective) To study the mechanism of thermotherapy on benign prostatic hyperplasia, we examined thermal effects on α1-adrenoceptors in the guinea-pig vas deferens. The histological changes in the muscle cells after thermal exposure were also examined by electron microscopy. (Methods) The guinea-pig vasa deferentia were pretreated at 4°C (control group), 43°C, 50°C, and 55°C (heated group) for 1 hour and returned to 37°C for 1 hour or 2 hours. Radioligand binding assay for α1-adrenoceptors was performed by an incubation of [3H]prazosin with the crude membrane fraction from vasa deferentia. The dissociation constant (Kd) and the number of binding sites (NBS) of α1-adrenoceptors were calculated from Scatchard analysis. The histological changes in the muscle cells were also examined at 4°C, 40°C, 50°C, and 55°C for 1 hour by electron microscopy. (Results) Kd and NBS did not change at 43°C, but declined significantly above 50°C for 1 hour. The changes in Kd and NBS above 50°C for 1 hour did not recover after returning to 37°C for 1 hour or 2 hours. Electron microscopic observations revealed a loss of myofilaments and dark staining of nuclear chromatin of the smooth muscle cells after thermal exposure above 50°C. (Conclusion) The binding ability of [3H]prazosin to α1-adrenoceptors declined after thermal exposure above 50°C. Also, the muscular damages were observed histologically after thermal exposure above 50°C. These results indicated that the irreversible decrease in NBS and the disruption of smooth muscle fibers were associated with the thermotherapy.
(Background and Purpose) Diethylenetriamine penta acetic acid (99mTc-DTPA), a substance which indicates glomerular filtration, is distributed equally in blood and tissue after a bolus intravenously injection. Ambulatory Renal Monitor (ARM) is a portable and non invasive device which monitors extracorporeally the clearance of intravenously injected 99mTc-DTPA. We examined correlation between half-time of clearance estimated by ARM and glomerular filtration rare, and clinical usefullness of ARM for a renal function monitoring. (Materials and Methods) The purposes of this paper are to describe the results obtained through basic analysis experiments and reproducibility in normal control, and its clinical application for 9 renal transplant patients, three drug-induced renal damage, one acute renal failure, one hemolytic uremic syndrome (HUS), two chronic nephritis, one donor of renal transplantation, one ureteral tumor, three renal tumors, two ureteral stones, one bilateral hydronephrosis and two normal controls. The half time of clearance of the tracer measured by an ARM. (ARM-HTC) is compared with the half time of clearance of the tracer measured by repeated blood sampling (Sampling-HTC) as a golden standard, serum creatinine and creatinine clearance. (Results) A significant correlation (linear) was detected when ARM-HTC was compared with Sampling-HTC (r=0.91), 1/serum creatinine (r=0.85) or creatinine clearance (r=0.82), although ARM-HTC showed a delay compared with Sampling-HTC. (Conclusions) The reason of this delay may be due to a difference in half-time when the tracer distributed in the blood and tissue. The results indicate that the estimation of 99mTc-DTPA clearance by ARM is valuable for renal function evaluation in wide ranges of renal function and in different origins of renal dysfunction such as in renal transplantation.
(Background) Cystinuria is an autosomal recessive disorder, and primary manifestation is the repeated formation of cystine calculi. Little information is available regarding clinical course of pediatric cystinuria having followed into adulthood. We report our experience with the management and the clinical course on cystinuria in children, who have been followed up for relatively long time. (Materials and Methods) We retrospectively reviewed the records of all pediatric patients with cystinuria in whom urolithiasis was treated from 1970 to 1996. (Results)A total of 15 pediatric patients with cystine calculi (9 boys, 6 girls) were treated in our hospital. Average age at diagnosis was 3 years 4 months old. Mean follow-up was 104 months. Stone location was upper urinary tract in 11 cases, bladder in 3 cases and both upper urinary tract and bladder in 1 case. Medical treatments including hydration, urine alkalization and dissolution therapy were performed in all patients. In three cases whose urinary cystine level ranged from 138 to 326mg/gCr, cystine calculi were disappeared by medical therapy alone. In one of 3 cases vesicoureteral reflux was identified. Side effects were noticed in 30.0% of patients with tiopronin and in 85.7% of those with D-penicillamine, especially in 1 case with tiopronin nephrotic syndrome being noticed. Surgical procedures were performed in 13 patients (lithotomy: 17 calculi, endourology: 7 calculi and ESWL: 7 calculi). The stone free rate was 100% with lithotomy, 80 to 100% with endourology and 43% with ESWL at an average of 5.9 procedures. No complications were recognized after the surgical treatments. The stone events of 15 patients ranged from 0 to 1.5 (average 0.55). In all six patients followed up over the age of 20 years, stone recurrences were observed exclusively between 17 and 20 years of age. (Conclusion) Dissolution therapy is more effective for cystinuric patients in whom urinary cystine excretion is less than 330mg/gCr. For those cases with low urinary cystine level it is necessary to evaluate structural abnormalities of the urinary tract to avoid stone recurrence. ESWL and endourology should be tried for pediatric cystinuria except for neonates and infants, considering its safety. The patients and thier parents must have adequate knowledge about the disease itself and its management. Prevention of cystine calculi recurrences depends on patient compliance to the therapeutic regimens necessitating close follow up according to the clinical conditions, especially for those in pubertic or postpubertic age.
(Purpose) This report focuses on the prognostic factors of the renal pelvic and ureteral cancer and on the treatment for advanced and/or recurrent cases. (Methods) We reviewed the forty-nine patients with transitional cell carcinoma of the renal pelvis and/or ureter who underwent surgery at the Department of Urology, Osaka National Hospital from April, 1986 to October, 1996. Univariate and multivariate analysis was done on the pathological features from these patients. (Results) The patients consisted of 34 males and 15 females and the mean age was 64.9, ranging from 27 to 83. Overall the 1, 3 and 5-year disease specific survival rates were 93.5%, 70. 2% and 61.3% respectively by the Kaplan-Meier's method. The prognostic significance of the 6 pathological factors (pT, Grade, INF, pL, pV and pR) were evaluated statistically in terms of generalized Wilcoxon test and/or Cox-Mantel test. All the 6 factors effected on survival rates significantly. However, the grade, INF, pL, pV and pR factors were closely related to the pT factor. Moreover the pT factor was confirmed to be the most important and independent factor according to a multivariate analysis by the Cox's proportional hazard model. And the grade 3 factor with pT2 or higher stage was a high risk factor in recurrences significantly, in spite of curatively operated cases. Thirteen patients with high stage, metastasis or recurrences were treated after operation with the M-VAC or modified M-VAC regimen as preventive, adjuvant and/or salvage chemotherapy. The overall response rate was 72.7% in eleven cases with evaluable lesions, while these regimens could not be expected to improve long-term survival rate. The response rate of combined chemoradiation therapy was 66.7% for six cases with the localized recurrent cancer. (Conclusions) The pT factor was the independent predictor of disease-specific survival. Adjuvant chemotherapy for prevention of cancer recurrence should be considered in the case of pT2 or higher stage plus grade 3 factor, even if curatively operated cases. The M-VAC or modified M-VAC regimen was reconfirmed to be useful as first line chemotherapy of advanced renal pelvic and ureteral cancer. Combined chemoradiation therapy was useful for the localized cancer recurrences, especially as a second line therapy for relapsed cases after M-VAC chemotherapy in this series.
(Background) Nuclear matrix protein 22 (NMP22) is a paramater of cell death including apoptosis. To evaluate the clinical efficacy of NMP22 as a marker for rejection after renal transplantation, we measured serum and urinary NMP22. (Patients and Methods) We measured the concentrations of serum NMP22 by Konica-Matritech NMP22 kit, and CD3, 4, 8 which are surface markers of lymphocyte, in 11 patients with renal transplantation. The patients consisted of 10 males and 1 females whose serum creatinine ranged 1.0 to 2.7mg/dl. Additionally, 9 healthy adults were employed as control subjects. And serum and urinary NMP22 were measured after transplantation sequentially in 5 of the patients. (Results) 1) In the patients, serum NMP22 values were higher than those in control subjects, statistically (p<0.01). 2) There were not significant correlations between serum NMP22 and CD3, 4, 8. 3) At the periods of acute tubular necrosis and acute rejection, serum NMP22 values were higher than those at the stable periods. (Conclusions) These results suggest that serum NMP22 is useful parameter of rejection in renal transplantation patients.
(Background) During the past decade, studies of human cancer have begun to yield molecular information on the identify of the multiple genetic changes in the development and progression of tumorigenesis. We investigated alterations of p53 and genomic instability in testicular tumors. (Materials and Methods) Polymerase chain reaction (PCR) single-strand conformation polymorphism was performed for analysis from exons 5 to 8 of p53 gene in 22 cases and PCR-microsatellite instability analysis using 8 microsatellite markers were conducted in 19 cases of testicular tumor. (Results) No mutations were noted for exons 5 to 8 of the p53 gene. Differences in unrelated microsatellites for tumor and corresponding normal DNA were detected in 5 of 19 (26.3%) cases examined. Alterations noted in more than 2 microsatelltes were observed in 3 of 19 (15.8%) and categorized as replication error (RER) phenotype. Two of 7 (28.6%) seminomatous and 1 of 12 (8.3%) non-seminomatous testicular tumors patiens showed RER. Two of 16 (12.5%) stage T1-3N0M0 and 1 of 3 (33.3%) stage T1-3N1-3M0-1 showed RER. (Conclusions) Alterations in microsatellite instability may be involved in the develpment of testicular tumor.
A 44-year-old man suspected of having transitional cell carcinoma (TCC) of the prostate was referred to our hospital. He had a painful semi-erect penis at his first visit. Then needle biopsy of the corpus cavernosum histologically revealed metastatic TCC. CT of the pelvis showed bilateral ureteral obstruction caused by the advanced tumor but no lymphonode swelling was found. Under the diagnosis of prostatic TCC with penile metastasis, bilateral percutaneous nephrostomy followed by two courses of combination chemotherapy (IFEP regimen) was carried out, which resulted in the disappearance of priapism. Radical cystectomy with total penectomy was performed. The final pathological diagnosis was corrected to TCC of the urinary bladder with invasion to the prostate and metastasis of the corpus cavernosum and the right obturator lymph node. Enlargement of the prostate proved to be caused by glandular hyperplasia with atypical hyperplasia of the prostate gland. Three courses of adjvent IFEP chemotherapy was given post-operatively and he has been alive with no evidence of the disease for 10 months.
In a case histologically proven prostatic ductal adenocarcinoma with endometrioid features associated with rectal invasion and multiple liver metastases the expression of prostate specific antigen (PSA) and carcinoembryonic antigen (CEA) was studied immunohistochemically on paraffin sections to clarify markedly elevated PSA and relatively elevated CEA in sera. All of prostatic ductal adenocarcinoma with endometrioid features, rectal invasion and liver metastases gave positive staining for PSA. Although rectal invasion and liver metastases gave positive staining for CEA, the primary tumor was never stained for CEA. Further study is necessary to clarify any significance of CEA within the cancer cell.
We report a case of renal cell carcinoma in whom preoperative interferon-α therapy was successful in reducing the primary lesion and the tumor thrombus extending into the inferior vena cava. A 67-year-old man was referred to our hospital because of his right renal mass. We made a diagnosis of a right renal tumor with tumor thrombus by imaging examinations. Because his performance status was 3, a radical operation was considered risky. So we started interferon-α therapy. Four months after the start of interferon-α thrapy, the primary lesion and the tumor thrombus reduced in their size, and the clinical response was evaluated as partial response by the response criteria for urological cancer treatment. Because of improoving the performance status and reducing the tumor size, radical nephrectomy and tumor thrombectomy could be performed. Pathological examinations revealed that viable renal cell carcinomas were found only in some small parts of the primary lesion, but not in the tumor thrombus. Postoperatively, no reccurence and metastasis of renal cell carcinoma of the patient have been detected in these two and a half years.