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ABSTRACT: We report a case of hyperuricemia and acute kidney injury associated with mizoribine (MZR). A 15- year-old male with congenital renal hypoplasia underwent kidney transplantation. We used tacrolimus extended release (0.15 mg/kg/day), mizoribine (MZR) (12 mg/kg/day), prednisolone and basiliximab as immunosuppressants. On the 35th post operative day, he complained of acute right chest pain, right inguinal pain and dyspnea. Serum uric acid and creatinine were elevated. Accordingly, we changed MZR to mycophenolate mofetil, and added allopurinol and potassium citrate. Gradually, the symptoms disappeared and renal function was improved. In this case, prolonged MZR metabolism, hyperuricemia and progressive renal dysfunction may have formed a vicious cycle. In conclusion, monitoring of serum uric acid level is necessary, especially when using a high dose MZR.
Hinyokika kiyo. Acta urologica Japonica 02/2013; 59(2):103-6.
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ABSTRACT: We report a case of urothelial carcinoma (UC) in a 69-year-old man that occurred after renal transplantation. He had started receiving hemodialysis therapy in 2004 due to diabetic nephropathy and underwent living related renal transplantation from his brother in 2005. He was referred to our hospital in May 2009 with asymptomatic microscopic hematuria. Cystoscopy findings revealed multiple bladder tumors, and transurethral resection of bladder tumor (TUR-BT) followed by intravesical instillation of pirarubicin was performed. Histopathological findings revealed UC (G1>G2, pTa). Cytology findings after the operation did not become negative; urine specimen from the native right ureter was positive, and abdominal computed tomography (CT) demonstrated a right pelvic tumor. In January 2010, a laparoscopic right nephroureterectomy was performed and pathological examination findings revealed UC in the right pelvis (G3>G2, INFβ, pT3). In March 2010, recurrence of the bladder tumor was demonstrated as carcinoma in situ (CIS) of the bladder and left native ureter. In June 2010, a radical cystectomy with left nephroureterectomy and ileal conduit diversion were performed. One week after that operation, laboratory results revealed abnormal hepatic function and CT showed multiple liver metastases. The patient died in August 2010, 2 months after surgery.
Hinyokika kiyo. Acta urologica Japonica 02/2013; 59(2):117-20.
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ABSTRACT: A 55-year-old woman who presented with a retroperitoneal tumor was referred to our department. At the age of 51, she underwent a total gastrectomy for gastric cancer. Postoperatively, TS-1 administration was given for Virchow lymph node metastasis, which disappeared within 2 years and TS-1 was stopped. However, computed tomography revealed a retroperitoneal tumor adjacent to the inferior vena cava, which gradually increased and began to compress the inferior vena cava. Under a diagnosis of retroperitoneal tumor, laparoscopic resection was performed. Pathological findings led to a diagnosis of lymph node metastasis from an adenocarcinoma of the stomach.
Hinyokika kiyo. Acta urologica Japonica 12/2012; 58(12):683-686.
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ABSTRACT: OBJECTIVES: To assess the impact of preoperative serum sodium concentration on the prognosis of patients with upper urinary tract urothelial carcinoma treated by nephroureterectomy. METHODS: The clinical records of 139 patients treated for upper urinary tract urothelial carcinoma by nephroureterectomy were retrospectively reviewed. Recurrence-free and cancer-specific survival curves were calculated using the Kaplan-Meier method, with the difference between curves evaluated using the log-rank test. A multivariate analysis was carried out by Cox's proportional hazard model to identify prognostic factors. RESULTS: The median (range) follow-up time was 27 (1-139) months. The median (range) preoperative serum sodium was 141 (134-147) mEq/L. Five-year cancer-specific survival estimates for patients above and below the median preoperative serum sodium were 81.7% (95% confidence interval: 68.7-89.7) and 50.6% (95% confidence interval: 30.3-67.8), respectively. In the multivariate analysis, preoperative sodium concentration, pathological T stage, and lymphovascular invasion were independent and significant prognostic factors for cancer-specific survival. A prognostic model of risk classification for cancer-specific survival involving these parameters was developed, and 5-year cancer-specific survival estimates were 29.9% (95% confidence interval: 14.5-47.0) for the poor risk group (hazard ratio 19.95 [95% confidence interval: 8.5-46.6]; P < 0.001), 81.6% (95% confidence interval: 55.2-93.3) for the intermediate risk group (hazard ratio 5.70 [95% confidence interval: 1.27-25.5]; P = 0.022) and 97.9% (95% confidence interval 85.9-99.7) for the favorable risk group. CONCLUSION: These findings suggest for the first time that a low preoperative sodium level predicts a poor survival in upper urinary tract urothelial carcinoma patients treated by nephroureterectomy.
International Journal of Urology 11/2012; · 1.75 Impact Factor
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ABSTRACT: Objectives: Hyponatremia is reported to be associated with poor survival in localized renal cell carcinoma and metastatic renal cell carcinoma treated with immunotherapy. However, there are no reports on the relationship between hyponatremia and prognosis of metastatic renal cell carcinoma treated with molecular targeted therapy. We evaluated the prognostic significance of hyponatremia in metastatic renal cell carcinoma treated with molecular targeted therapy as first-line therapy. Methods: We retrospectively analyzed a database comprising 87 patients treated from April 2008 to July 2011 with sorafenib or sunitinib as first-line therapy for metastatic renal cell carcinoma. Patients were divided into three groups according to serum sodium level: severe hyponatremia (≤134 mEq/L), mild hyponatremia (135-137 mEq/L) and normal natremia (≥138 mEq/L). Results: Median cancer-specific survival time was 8.8 months in the patients with severe and mild hyponatremia, and 32.6 months in the patients with normal natremia (P < 0.001). Multivariate analysis showed severe and mild hyponatremia to be significantly associated with cancer-specific survival (hazard ratio 6.228; 95% confidence interval 2.161-17.947, P = 0.001; hazard ratio 3.374; 95% confidence interval 1.294-8.798, P = 0.013), respectively. Neutrophilia and high C-reactive protein level (C-reactive protein ≥1.0 mg/dL) were significant prognostic factors to predict inferior cancer-specific survival. In Harrell's concordance index calculation, hyponatremia could significantly improve the predictive accuracy for estimation of survival probability (P = 0.028). Conclusions: Hyponatremia (<138 mEq/L), neutrophilia and high C-reactive protein levels seem to represent significant predictive factors for cancer-specific survival in metastatic renal cell carcinoma patients treated with molecular targeted therapy as first line therapy. Furthermore, hyponatremia might be significantly associated with chronic inflammation and tumor aggressiveness.
International Journal of Urology 08/2012; · 1.75 Impact Factor
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ABSTRACT: A 42-year-old woman presented with left renal tumor. Computed tomography showed a left renal tumor (6 cm in diameter) and a tumor thrombus at the left renal vein, which had equal density to fat tissue. She was diagnosed with malignant tumor, and underwent radical left nephrectomy and resection of thrombus. Pathological diagnosis was angiomyolipoma with no findings of malignancy. No signs of recurrence or metastasis have been observed for 8 months after the operation.
Hinyokika kiyo. Acta urologica Japonica 05/2012; 58(5):227-9.
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Atsunari Kawashima,
Akira Tsujimura,
Hitoshi Takayama,
Yasuyuki Arai,
Mikio Nin, Go Tanigawa,
Yutaka Yasunaga,
Masatoshi Mukai,
Motohide Uemura,
Yasutomo Nakai,
Kazuo Nishimura,
Norio Nonomura
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ABSTRACT: Sunitinib is a multikinase inhibitor used as first- and second-line treatment of metastatic renal cell carcinoma. However, there are few reports on the necessary doses of sunitinib to get better clinical outcome in general practice with Japanese patients. We examined the relationship between the efficacy and the necessary doses of sunitinib therapy in a multi-institutional retrospective study. A study population of 94 metastatic renal cell carcinoma patients was eligible for this investigation. The most frequent grade 3/4 laboratory adverse events were decreased platelet (31.9 %) and white blood cell (21.3 %) counts. Treatment was discontinued in 18 patients (31.0 %) initially receiving a 50-mg/day dose within only one course, and median 1-month relative dose intensity was 74.3 %. Median progression-free survival time was 2.3 months in patients treated for only one course and 10.8 months in patients treated for more than one course (P < 0.001). Multivariate analysis showed that only one course of treatment and 60 % and less of 1-month relative dose intensity were significantly associated with inferior progression-free survival (P < 0.001 and P = 0.027, respectively). Moreover, modified Memorial Sloan-Kettering Cancer Center poor risk was significantly associated with progression-free survival time. It is difficult for Japanese patients to continue an initial dose of sunitinib therapy without drug withdrawal. Continuing therapy for more than one course and maintaining more than 60 % of 1-month relative dose intensity were very important in the prolongation of progression-free survival time regardless of the initial treatment doses.
Medical Oncology 04/2012; · 2.14 Impact Factor
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ABSTRACT: Neurofibromatosis type 1 (NF1) is an autosomal dominant disease with multiple neurofibroma and café-au-lait spots. We report a case of plexiform neurofibroma of the bladder associated with NF1. A 34-year-old female was referred to our hospital for thickness of the bladder wall. Multiple café-au-lait spots and neurofibroma was found on her skin,and she was diagnosed with neurofibromatosis type 1. Ultrasound examination demonstrated bladder wall thickening,and cystoscopy revealed an irregular and erythematous mucosa. Transurethral biopsy of the bladder wall was performed. Histopathological diagnosis was plexiform neurofibroma of the bladder.
Hinyokika kiyo. Acta urologica Japonica 04/2012; 58(4):215-8.
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ABSTRACT: Acute pyelonephritis (APN) is a common complication of ureteral obstruction caused by urolithiasis, and it can be lethal if it progresses to septic shock. We investigated the clinical characteristics of patients undergoing emergency drainage and assessed risk factors for septic shock.
A retrospective study was performed of 98 patients (101 events) requiring emergency drainage at our urology department for obstructive APN associated with upper urinary tract calculi from January 2003 to January 2011. Clinical characteristics were summarized, and risk factors for septic shock were assessed by logistic regression analysis.
Objective evidence of sepsis was found in 64 (63.4%) events, and 21 events (20.8%) were categorized as septic shock. Ninety-six patients recovered, but 2 patients died of septic shock. Multivariate analysis revealed that age and the presence of paralysis were independent risk factors for septic shock.
APN associated with upper urinary tract calculi is a severe disease that should be treated with caution, particularly when risk factors are present.
BMC Urology 03/2012; 12:4. · 1.45 Impact Factor
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Atsunari Kawashima,
Yasutomo Nakai,
Masashi Nakayama,
Takeshi Ujike, Go Tanigawa,
Yutaka Ono,
Akihito Kamoto,
Tsuyosi Takada,
Yuichiro Yamaguchi,
Hitoshi Takayama,
Kazuo Nishimura,
Norio Nonomura,
Akira Tsujimura
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ABSTRACT: PURPOSE: To determine through the analysis of our multi-institutional database whether postoperative adjuvant chemotherapy for upper urinary tract carcinoma with localized invasive upper urinary tract carcinoma (UUTC) is beneficial. METHODS: A study population of 93 patients with pT3N0/xM0 UUTC was eligible for this study. Clinical features evaluated were sex, tumor location, adjuvant chemotherapy status, tumor pathology (histology, grade, infiltrating growth, lymphovascular invasion (LVI)), and cause of death. Cancer-specific survival (CSS) was estimated by Kaplan-Meier method. Prognostic factors related to CSS were analyzed by Cox proportional hazards regression model for multivariate analysis. RESULTS: In pT3 patients, overall 5-year CSS rate was 68.4% and median CSS time was 31 months (range 3-114 months). In the adjuvant chemotherapy group, 5-year CSS rate was 80.8%, whereas 5-year CSS rate was 64.4% in the non-adjuvant chemotherapy group. By multivariate analysis, adjuvant chemotherapy status was significantly associated with CSS (P = 0.008) were sex, tumor grade, tumor histology, and LVI presence. CONCLUSIONS: This study, although it was retrospective study, revealed that adjuvant chemotherapy after RNU may be beneficial in pT3N0/X patients by multivariate analysis. Prospective studies evaluating adjuvant therapy regimens for UTTC are required.
World Journal of Urology 10/2011; · 2.41 Impact Factor
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Go Tanigawa,
Atsunari Kawashima,
Seiji Yamaguchi,
Kazuo Nishimura,
Susumu Miyoshi,
Jiro Kajikawa,
Norio Meguro,
Toshiaki Yosioka,
Toshitsugu Oka,
Tsuneo Hara,
Hitoshi Takayama,
Norio Nonomura
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ABSTRACT: Effects of sorafenib in general clinical practice, especially those with patients of Asian ethnicity, have been rarely investigated. We assessed efficacy, safety and prognostic factors for progression-free survival in Japanese patients receiving sorafenib for advanced renal cell carcinoma.
We performed a retrospective analysis of 159 Japanese patients with renal cell carcinoma. Progression-free survival was estimated by the Kaplan-Meier method. Objective response (per Response Evaluation Criteria in Solid Tumors) and safety were assessed. Cox proportional hazards model was used to identify independent prognostic factors for progression-free survival.
The median progression-free survival was 9.0 months (95% confidence interval, 7.5-10.6 months). In 142 patients with measurable lesions, the objective response rate was 21.8%, and disease control was achieved in 85 (59.9%) patients. Adverse events of any grade occurred in 152 patients (95.6%). Most common adverse events causing discontinuation or interruption of sorafenib were hand-foot skin reaction (22%), rash (10.7%) and liver dysfunction (10.7%). Dose reduction or therapy interruption due to adverse events was required in 128 patients (80.5%). Univariate and multivariate analysis revealed that favorable prognosis according to Memorial Sloan-Kettering Cancer Center prognostic factors and relative dose intensity during the first month of treatment of ≥50% were significant factors for predicting superior progression-free survival with sorafenib treatment.
Sorafenib was effective in Japanese patients with advanced renal cell carcinoma in general clinical practice and was tolerated although most patients required dose reduction or interruption of therapy. Future studies should establish new strategies for treatment without sacrificing both efficacy and patient quality of life.
Japanese Journal of Clinical Oncology 09/2011; 41(11):1265-70. · 1.78 Impact Factor
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ABSTRACT: We report two cases of the plasmacytoid variant of urothelial carcinoma of urinary bladder in which systemic chemotherapy was effective. In the first case, a 76-year-old man presented with dysphasia. Magnetic resonance imaging (MRI) and computed tomography revealed a brain tumor and a bladder tumor. Resection of the brain tumor and transurethral resection of the bladder tumor were performed. The pathological diagnosis was plasmacytoid variant of urothelial carcinoma of urinary bladder with brain metastasis (pT1N0M1). Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) chemotherapy were performed. He has no evidence of recurrence 96 months after resection of brain metastasis. In the second case, a 76-year-old man presented with hematuria. MRI revealed a bladder tumor with abdominal wall invasion, and a transurethral biopsy was performed. The pathological diagnosis was plasmacytoid variant of urothelial carcinoma of urinary bladder (cT4bN0M0). After three cycles of neoadjuvant GC (gemcitabine and cisplatin) chemotherapy, MRI demonstrated a complete response. Radical cystectomy was performed, and the pathological diagnosis was pT0pN0. Although there was no evidence of recurrence 9 months after radical cystectomy, he died from other causes. Our two cases suggest that systemic chemotherapy might be effective for the plasmacytoid variant of urothelial carcinoma.
International Journal of Clinical Oncology 07/2011; 16(6):759-62. · 1.41 Impact Factor
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Atsunari Kawashima,
Hitoshi Takayama,
Yasuyuki Arai, Go Tanigawa,
Mikio Nin,
Jiro Kajikawa,
Tetsuo Imazu,
Tatsuya Kinoshita,
Yutaka Yasunaga,
Hitoshi Inoue,
Kenji Nishimura,
Shingo Takada,
Kazuo Nishimura,
Akira Tsujimura,
Norio Nonomura
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ABSTRACT: Sorafenib is a multikinase inhibitor used as a second-line treatment for metastatic renal cell carcinoma (mRCC). However, it is very difficult to estimate sorafenib dosage because it is difficult to maintain stable administration and dosage intervals due to several side-effects. We examined the correlation between relative dose intensity (RDI) and clinical outcome of sorafenib therapy in a multi-institutional study.
A study population of 70 first-line therapy-refractory patients with pathologically confirmed RCC was eligible for this investigation. Clinical outcomes were evaluated according to clinicopathological features and RDI for 1 month (1M-RDI).
There was significant difference in progression-free survival (PFS) time but not overall survival (OS) time when the 1M-RDI cut-off value was ≥ 50%. In 15 patients (21.4%) with 1M-RDI of <50%, median PFS time was 4.1 months (95% I collagen (95% CI): 2.0-6.2), whereas it was 10.5 months (95% CI: 7.6-13.4) in the patients with 1M-RDI of ⩾50% (P=0.022). Multivariate analysis showed 1M-RDI status to be significantly associated with PFS (HR: 3.838, 95% CI: 1.658-8.883, P=0.002) but not OS (P=0.328).
Although this study was retrospective, a 1M-RDI cut-off value of ≥ 50% for sorafenib may be the first factor to predict PFS but not OS in cytokine pretreated mRCC patients. The data indicate that a dose of 400mg/day of sorafenib administered successively for the first one month was necessary to prolong disease stabilisation and could be tolerated by Japanese patients.
European journal of cancer (Oxford, England: 1990) 07/2011; 47(10):1521-6. · 4.12 Impact Factor
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ABSTRACT: A 31-year-old man visited our hospital complaining of swelling in the left scrotum. Five days previously, he had felt sudden pain in the left lower abdomen and noticed swelling in the left scrotum. He had been suffering from intermittent gross hematuria and left flank pain for 1 year. An elastic hard mass was palpable in the left scrotum. Scrotal hematoma and marked dilation of left renal vein and left gonadal vein were revealed by computed tomography. A diagnosis of varicocele rupture secondary to nutcracker phenomenon was made. One month later, he underwent retroperitoneal laparoscopic donor nephrectomy and subsequent renal autotransplantation into the left iliac fossa. The post-operative course was uneventful. Gross hematuria was resolved 3 days after the operation, and swelling in the left scrotum was resolved within 6 months of the operation. Surgical intervention to treat nutcracker phenomenon is considered controversial. We believe that our procedure is a reliable option for surgical treatment for nutcracker phenomenon.
Hinyokika kiyo. Acta urologica Japonica 04/2011; 57(4):213-6.
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ABSTRACT: Asymptomatic prostatic inflammation may cause increased prostate specific antigen in some men, leading to unnecessary repeat prostate biopsy. We determined whether histological findings of inflammation in initial biopsy specimens and/or clinical indicators of inflammation could predict the outcome of subsequent biopsy in men with a negative initial biopsy.
A total of 105 Japanese men with increased prostate specific antigen underwent repeat prostate biopsy after initial biopsy revealed no evidence of carcinoma. Of the cases 45 (42.8%) were positive for prostate cancer at repeat biopsy. We evaluated initial biopsy specimens for evidence of inflammation by mononuclear and polymorphonuclear leukocytes, serum and urinary white blood count, and C-reactive protein.
Polymorphonuclear leukocyte infiltrates, urinary white blood count, patient age, prostate specific antigen at repeat biopsy, prostate volume, prostate specific antigen velocity and prostate specific antigen density were associated with the repeat biopsy outcome (p <0.05). Multivariate analysis revealed that age, prostate specific antigen density and urinary white blood count were independent predictors of outcome. On subgroup analysis of 63 men with serum prostate specific antigen less than 10 ng/ml before initial biopsy polymorphonuclear and mononuclear leukocyte inflammation, age, prostate specific antigen at repeat biopsy, prostate volume, prostate specific antigen velocity and prostate specific antigen density were associated with the outcome of repeat biopsy (p <0.05). Multivariate analysis showed that polymorphonuclear leukocyte infiltrate, prostate specific antigen density and age were independent predictors.
Age, prostate specific antigen density, polymorphonuclear leukocyte inflammation in initial biopsy specimens and urinary pyuria are indicators of benign repeat biopsy. They help avoid unnecessary repeat biopsy in men with increased prostate specific antigen.
The Journal of urology 03/2011; 185(5):1722-7. · 4.02 Impact Factor
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ABSTRACT: Late side effects of ileal conduit are uncommon. Here we report a case of ileal conduit hemorrhage in a 78-year-old woman 8 years after radical cystectomy and ileal conduit diversion. The patient presented with gross hematuria and abdominal dynamic computed tomography showed extravasation of contrasts in ileal conduit and the patient was diagnosed with ileal conduit hemorrhage. Clipping hemostasis was performed under gastrointestinal endoscope and revealed that Dieulafoy's ulcer was the cause of ileal conduit hemorrhage. This is the first case of Dieulafoy's ulcer occurred in ileal conduit. Hemorrhage from ileal conduit is an important late side effect.
Hinyokika kiyo. Acta urologica Japonica 01/2011; 57(1):29-31.
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ABSTRACT: A 35-year-old male patient with Down' s syndrome received radical inguinal orchitectomy for left testicular tumor in 2006. Histological examination revealed a typical seminoma. 18 months after the operation, we found a metastasis in the right retroperitoneum lymph node. He received adjuvant chemotherapy (bleomycin, etoposide, and cisplatin : BEP). After 3 cycles of chemotherapy, the tumor disappeared. There is no obvious re-occurrence sign and general condition is good after chemotherapy. As we treated a relapse of seminoma in Down's syndrome successfully, we report this case and review 41 cases in Japanese literatures.
Hinyokika kiyo. Acta urologica Japonica 07/2010; 56(7):397-401.
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ABSTRACT: A retrospective clinicopathological study of 82 patients with invasive urothelial carcinoma treated with radical cystectomy was performed. There were 62 men and 20 women, median age at operation was 68-years-old and the 5-year overall cancer-specific survival rate was 82.5%. Univariate analyses demonstrated that female patients had poor prognosis, and that lymphovascular invasion was a predictor of recurrence. Multivariate Cox regression analyses including age, grade, and vascular invasion, showed that vascular invasion was an independent predictor of recurrence (HR4.46, P=0.008).
Hinyokika kiyo. Acta urologica Japonica 11/2009; 55(11):665-9.
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ABSTRACT: A 52-year-old male presented with left intermittent abdominal pain, and was subsequently diagnosed with a tumor in the hilum of the left kidney based on computed tomography (CT) and magnetic resonance imaging (MRI) findings. Under suspicion of left renal cancer, we performed a retroperitoneoscopic left nephrectomy. Histopathological features of the resected specimen were compatible with leiomyosarcoma originating from the left renal vein. Immunohistologically, the tumor cells were spindle-shaped, arranged in bundles, and stained positive for a-smooth muscle actin and desmin. The patient was free from recurrence 2 years after surgery. The prognosis of leiomyosarcoma arising from the renal vein has been considered poor. Herein, we provide details of our case and also review 16 cases of leiomyosarcoma of the renal vein in Japan. We conclude that radical tumor resection is necessary for long-term survial.
Hinyokika kiyo. Acta urologica Japonica 10/2009; 55(10):607-10.
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ABSTRACT: We report a case of giant left renal arteriovenous fistula (AVF). A 36-year-old man was diagnosed with chronic glomerulonephritis (CGN) by biopsy on the left kidney 11 years ago. He had been receiving hemodialysis for end-stage kidney disease from CGN since 10 years ago. A left renal cystic lesion was found and he was referred to our department for examination and treatment. He was diagnosed as having left AVF using imaging techniques (computed tomography, magnetic resonance imaging and Color Doppler ultra sonography). He underwent embolization of left renal artery using microcoils. After the surgery, there were no major complications, and there were no signs reccurence. AVF in a long-term dialysis patient is rare. We report this case and summarize the cases reported in Japan.
Hinyokika kiyo. Acta urologica Japonica 09/2009; 55(9):559-62.
