(Purpose) I analyzed mentions of treatment in the Hippocratic Collection. (Materials and Methods) I examined quantitatively mentions of treatments in the Hippocratic Collection (Roeb edition, Otsuki edition, and Kon edition) to compare preferences for therapy between the Kos and Knidos schools. (Results) Treatments, mentioned in 2, 687 passages, were medical in 2, 319 (86%), and surgical in 368 (14%). These 2, 687 descriptions included 1, 023 (38%) from the Kos, 1, 261 (47%) from the Knidos school, and 403 (15%) from unspecified schools. 0f the 2, 319 descriptions of medical treatment, 560 (24%) referred to medicines and 466 (20%) to diet, followed by baths, vapor baths, exercise, running, walking, warm applications, and others. The 368 surgical descriptions involved traction and adjustment for treating fractures of bones of dislocation of joints in 166 (45%) and surgery using knife or fire in 202 (55%). Of the latter 202 mentions, 87 (43%) referred to incision with knife, 74 (37%) to cauterization and 73 (37%) to bloodletting. Diet exercises, running, walks, traction, adjustment and bloodletting were mentioned more frequently by the Kos school than the Knidos school, while medicines, baths, vapor baths (for gynecological diseases) and incision were mentioned more frequently by the Knidos school (chi-squared test, p<0.01). Medicines, diet, baths, warm applications, and incision over the kidney were mentioned among treatments for urinary stones, but cystolithotomy was not. Hippocates stated in “Aphorisms” that diseases that medicines do not cure can be cured by the knife. He also, stressed that any one intending to practice surgery for wounds arising in military service must serve in the army. (Conclusions) A large number of medical treatments were mentioned in Hippocratic Collection, while surgical treatments also were emphasized. Hippocrates warned beginning doctors not to used unproven treatments for urinary stone in the introduction to the “Oath”, but did not forbid surgical treatments.
(Purpose) To assess a value of decompression operation for a unilateral ureterocele with a complete duplex system as an initial procedure. (Methods) We reviewed records of 33 pediatric patients with a unilateral ureterocele in a complete duplex system who underwent decompression operation between 1987 and 2000. We checked the patient operative age, followup period, position of the ureterocele, type of decompression operation, and additional operation. Furthermore we also checked postoperative vesicoureteral reflux (VUR) in patients who underwent transurethral incision (TUI). (Results) Mean operative age and followup period were 6 months old and 82 months. Of the patients, 22 underwent TUI and 11 underwent upper moiety operation (UMO). In the TUI group, 14 (63.6%) had postoperative VUR and 13 (59.0%) underwent additional operations. These rates were higher in the patients with ectopic ureteroceles than with intravesical ureteroceles. Most additional operations were undergone for the patients with postoperative VUR in TUI group by lower complete reconstructions without UMO. All patients with non-functioning upper moiety underwent heminephrectomy at the additional operations. In the other hand, in the UMO group, 3 (27.3%) had additional operation because of persistent VUR which was found preoperatively in lower moiety or contralateral renal unit. (Conclusion) TUI was useful approach as an initial procedure for intravesical ureteroceles because of low additional operation rate. For ectopic ureteroceles with functioning upper moiety, TUI was high additional operation rate, but it was more useful initial operation of two-staged operation than UMO because of avoiding UMO, like heminephrectomy, at additional operation. UMO was low additional operation rate for ectopic ureteroceles without preoperative VUR of renal unit excluding upper moiety. Especially heminephrectomy was a useful approach as an initial procedure if upper moiety was non-functioning.
(Objectives) We conducted a preliminary study to examine the validity of assessment criteria of lower urinary tract symptoms (LUTS) severity for general practitioners (GPs). (Materials and Methods) This study included 194 patients with LUTS, who visited the urology clinics in three hospitals. In 177 who completed International Prostate Symptom Score (I-PSS), International Consultation on Incontinence Questionnaire: Short-Form (ICIQ-SF), frequency-volume chart, uroflowmetry and post-void residual urine measurement, three overall grades (mild, moderate and severe) of LUTS were determined using the newly-developed assessment criteria for GPs. The relationship between diagnoses and treatments by the urologists, and overall LUTS grades were examined. (Results) All of the 70 patients with “severe” grade and 68 (94%) of 72 with “moderate” grade were diagnosed as having urination problems. Sixty-eight (97%) with “severe” grade and 64 (89%) with “moderate” grade were treated with fluid restriction, behavioral therapy, and/or drug therapy. Of 35 with “mild” grade, 17 (49%) were diagnosed as having normal urination. In this grade, eight patients (23%) were treated with fluid restriction and 15 (43%) with drug therapy. (Conclusions) This preliminary study revealed that our criteria of LUTS severity for GPs were useful to determine whether the elderly patients should be treated or not. It is necessary to examine the validity of the criteria in a model in which GPs participate.
(Purpose) The 2nd generation transurethral microwave thermotherapy (TUMT), equipped with high energy microwave generator and urethral cooling device is widely accepted as an less invasive effective modality to treat benign prostatic hyperplasia. For prostatic cancer, however, it is generally estimated as insufficient because of limitation in penetration of microwave into deep prostatic tissue. In this study, we examined histopathologic changes after androgen deprivation theraphy (ADT) and TUMT. (Patients and Methods) Ten patients with localized prostate cancer underwent ADT for 3 months, and then TUMT was proceeded using Urowave (Dornier MedTech GmbH). Additionl 3 months after TUMT and continued ADT, TURP in radical fashion was performed in all the patients, and all the resected chips were submitted for pathological study. (Results) Significant reduction in prostate volume was noted after NHT for 3 months from 37.4±9.6ml to 22.0±5.6ml. The pathological study of resected chips revealed progressive fibrotic changes without viable cancer cells in 9 of 10 patients. In 1 patient, however, some remnant of carcinomatous foci were noted in a resected chip from the middle lobe of the prostate. (Conclusion) Although the number of patient is limited and longer follow-up is needed, the results in present series was interested and worth considering.
(Purpose) We report a technique and outcome of endoscopic trigonoplasty II (ET II), antireflux surgery via a transvesicostomy transurethral approach and discuss its usefulness. (Materials and methods) Fifteen female patients, aged 5 to 64, with 23 refluxing ureters (grade I:5, II:2, III:14, IV:2) underwent the ET II. The principle of this surgery is tightening the muscular backing and elongating the intramural ureter. The operation consists of three steps: 1) two 5mm locking trocars are placed into the bladder, 2) irrigating with 3% D-sorbitol solution, the bladder wall is incised upward along each side of the ureter using a resectoscope, to make a 2 to 3cm U-shaped bladder flap including the ureter, 3) under a pneumobladder, the incised wall is sutured to make a muscular bed with a needle-holder via the urethra and forceps via the abdominal trocar. The U-shaped flap is fixed with two distal anchor sutures and four additional mucosal sutures. Urethral catheter is indwelled and the operation is finished. In recent four cases, we closed the tracts endoscopically. (Results) The average operative time was 144 minutes per ureter. In one patient with unilateral reflux, we switched to open surgery because of bleeding. Of 22 refluxing ureters, the reflux disappeared in 18 ureters (82%) and improved grade III to I in 1 ureter (5%) after 3 months and disappeared in 19 ureters (86%) after 12 months postoperatively. Ureteral injury was occurred in 3 patients during the transurethral incision of the bladder. Though we repaired it by placing a double-J stent in the 2 patients, reflex recurred in 12 months postoperatively in one of them. In the other patient cystoscopy revealed a vesicoureteral fistula in the injured portion. She subsequently underwent successful open Politano-Leadbetter ureteroneocystostomy. The average duration of indwelling catheter was shortened from 4.3 to 3.0 days by closing the tracts endoscopically. (Conclusions) The overall cessation rate of the ET II was inferior to those of open anti-reflux surgeries or laparoscopic extravesical ureteral reimplantation. We do not recommend ET II for vesicoureteral reflux.
(Objectives) Treatment outcomes for prostate cancer in our hospital were reported. (Materials and Methods) We analyzed 1, 009 patients with prostate cancer treated at Niigata Cancer Hospital between 1983 and 2003. (Results) As for the clinical stage, 20 cases belonged to Stage I, 367 cases to Stage II, 269 cases to Stage III and 353 cases to Stage IV. The overall 5-year survival rate of the all 1, 009 cases was 59.0%, comprising 78.2% for stage I, 82.0% for Stage II, 76.0% for Stage III and 30.0% for Stage IV cases. Disease-specific 5-year survival rates for Stage I, II, III and IV were 100%, 96.8%, 89.3% and 41.1% respectively. In Stage III patients, the radiotherapy (with endocrine therapy) group showed longer cause-specific survival than the endocrine therapy group (p=0.0056). (Conclusions) Our result suggest that the radiotherapy with endocrine therapy is useful for Stage III prostate cancer.
We report a case of advanced renal cancer that showed different responses to the alteration of therapeutic cytokines. A 73-year-old man presented with asymptomatic macrohematuria, and was diagnosed as right renal cancer (11×9×9cm in diameter) with metastases to abdominal and mediastinal lymph nodes (cT3bN2M1, stage IV). Transluminal embolization of the right renal artery was performed, and then he was treated by intramuscular administration of natural human interferon (IFN)-α (Sumiferon®; 6×106 units) three times a week. Four months later, lymph node metastases enlarged, and human interleukin-2 therapy (intravenous administration; 1.4×106 units) was initiated instead of IFN-α. However, lymph node metastases further enlarged and multiple lung metastases newly appeared in 5 weeks after the alteration of the therapy. Then, the treatment was switched to intramuscular administration of another natural human IFN-α (OIF®; 5×106 units) three times a week. In 3 months after OIF® administration, all lung metastases disappeared. Lymph node metastases have shown no progression for 9 months after the switch to OIF®. Different responses to the two types of IFN-α in this case may be caused by the difference in the composition of IFN-α subtypes. Alteration of therapeutic cytokines, especially a switch from one type to another IFN-α may be one of worth attempts even if other cytokines are not effective.
A 31-year-old man was referred to our department for investigation and treatment of a rapidlygrowing mass in the perineal region. MRI showed a periurethral tumor in the perineal region measuring 3.5cm in maximum diameter and bilateral inguinal lymph nodes enlargement. Therefore, the tumor was extirpated immediately with bilateral inguinal lymphadenectomy. The pathological examination with immunohistochemistry revealed that the tumor was proximal-type epithelioid sarcoma. Multidisciplinary therapy with irradiation, chemotherapy, and tumor ablation with a microwave tissue coagulator, was not effective for local recurrence and metastasis, and finally he died of progressive disease 14 months after the operation. Epithelioid sarcoma originating from the thigh or trunk is classified into the proximal-type, which shows significantly poorer prognosis than the distal-type that develops in the distal extremities. The proximal-type epithelioid sarcoma of the perineum is rare and, to our knowledge, the present report is the fourth case in the Japanese literatures.
In September 2003, a 58-year-old woman complained of bladder irritation and urinary frequency. She was admitted to a nearby hospital, and an evaluation was performed. Urine cytology revealed a class V, and a tumor was detected in the lower left ureter with mild hydroneprhosis of the left kidney. We performed a left ureteronephrectomy with partial cystectomy in April 2004. The pathological diagnosis was clear cell carcinoma with small foci of conventional urothelial carcinoma of the left ureter (pT3pN0, G3>G2, INFγ). And now she lives well without recurrence in August 2005. This is the first case report of clear cell carcinoma of the ureter in Japan.