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ABSTRACT: Purpose: To demonstrate the change in the expression of angiotensin II type 1 receptor (AT1) in the rat bladder with partial bladder outlet obstruction (P-BOO). Materials and Methods: Bladder specimens were obtained from 12-week-old Wistar female rats that were divided into two groups, a P-BOO group and a control group. The rats of the P-BOO group were divided into six groups: a sham-operated control group, 1 day postoperatively, 2 days postoperatively, 4 days postoperatively, 7 days postoperatively and 14 days postoperatively. The cystometric findings and immunohistochemical staining of the detrusor muscle with the AT1 antibody were compared in each group. Results: AT1 localized on the cell membrane of the detrusor smooth muscle and in cytoplasm of suburothelial myofibroblasts in the control rats. The expression of AT1 disappeared in the detrusor muscle and suburothelial myofibroblasts in P-BOO, but AT1 was highly expressed in urothelial cells 1 day after surgery. The expression of AT1 in urothelial cells gradually decreased with time after surgery. AT1 completely disappeared in urothelial cells 14 days after surgery. Conclusions: The present study demonstrated that the site of AT1 expression changes in response to the mechanical stress caused by P-BOO, and finally there was no expression of AT1 in rat bladder tissue following P-BOO. These data suggest the change in AT1 expression may play a role in bladder function.
Urologia Internationalis 07/2012; 89:241-5. · 0.99 Impact Factor
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ABSTRACT: Objectives. To investigate whether procalcitonin (PCT) could be useful for detecting bacterial infections in patients on hemodialysis (HD) and with increased calcitonin (CT). Methods. This prospective study included 42 males and 34 females on HD. The infection group consisted of 15 patients with proven bacterial infections; the other 61 patients were designated as the noninfection group. Serum C-reactive protein (CRP), interleukin (IL)-6, white blood cell (WBC) count, immature and total neutrophil (I/T) ratio, and CT were measured at the beginning of HD, and serum PCT levels at the beginning of HD and after HD. Results. The mean CT level in the both groups was apparently higher than that of nonchronic kidney disease. Significantly higher values between the infection and noninfection groups were seen for CRP, IL-6, WBC, I/T ratio, PCT, and CT. The PCT value of the area under the receiver operating characteristic curve was 0.921, which was significantly higher than the values for CRP (0.853; P < 0.01), IL-6 (0.739; P < 0.01), WBC (0.692; P < 0.01), and I/T ratio (0.584; P < 0.01). Conclusions. PCT was useful marker of bacterial infection in patients on HD and with increased CT. PCT levels should be determined before HD.
ISRN urology. 01/2012; 2012:431859.
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Tatsuro Kondoh,
Atsushi Kanno,
Hiroshi Itoh,
Mikiro Nakashima,
Ryoko Honda,
Michio Kojima, Mitsuru Noguchi,
Hideyuki Nakane,
Hidetsugu Nozaki,
Hitoshi Sasaki,
Toshiro Nagai,
Rika Kosaki,
Naoko Kakee,
Torayuki Okuyama,
Masafumi Fukuda,
Masayuki Ikeda,
Yoshisada Shibata,
Hiroyuki Moriuchi
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ABSTRACT: Down syndrome (DS) patients share certain neuropathological features with Alzheimer disease patients. A randomized, double-blind, placebo-controlled study was performed to investigate the efficacy and safety of donepezil, an Alzheimer disease drug, for DS patients.
Twenty-one DS patients with severe cognitive impairment were assigned to take donepezil (3 mg daily) or a placebo for 24 weeks, and evaluated for activities in daily lives by concisely modified International Classification of Functioning, Disability and Health (ICF) scaling system.
ICF scores significantly increased without any adverse effects in the donepezil group in comparison to those in the placebo control. Among the individual functions tested, there was a dramatic improvement in the global mental functions and in specific mental functions.
Donepezil may effectively and safely improve overall functioning of DS patients with severe cognitive impairment.
The International Journal of Psychiatry in Medicine 01/2011; 41(1):71-89. · 1.03 Impact Factor
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ABSTRACT: The mean age of Japanese patients requiring a dialysis induction is 67.7-year-old in 2007. Comparing with hemodialysis, peritoneal dialysis is fit for old patients because of a lesser degree of influence on cardiovascular system and a lesser degree of restriction on the issue of water and food. However, a home care system for patients with peritoneal dialysis has not been established. In Nagasaki city, "Nagasaki Home Doctor Net" supports the home care through many kinds of medical occupational linkage. By applying this system, we are trying to establish a supporting system for elderly patients with peritoneal dialysis. Furthermore, in each patient, we make the "Putit-mailing list" on Internet. It is a very effective tool for all medical care members to send and get the information about the patients on time and timely.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2009; 36 Suppl 1:11-3.
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ABSTRACT: In the treatment of pelvic tumors, pelvic floor defects owing to a wide excision tend to increase the occurrence of such morbidities as radiation injury. The reconstruction of these defects would minimize the risk of such morbidities. Authors introduce a new technique for repairing a pelvic floor defect using a tensor fascia lata flap.
Two boys, 4 years old and 10 months old, presenting with pelvic rhabdomyosarcoma underwent a tumor extirpation associated with a wide excision of the pelvic organs. After the removal of the tumor, a tensor fascia lata flap was designed on the right thigh. The pedicled rotation flap was subcutaneously elevated, guided to the intraperitoneal cavity, and was fixed to cover the superior aperture of the lesser pelvis.
The flaps functioned well, and postoperative radiation therapies consisting of 45 and 41.4 Gy to the lesser pelvic cavity were carried out without any complications. As a result, the necessary postoperative protocol combination therapies could be successfully performed in a timely manner.
The pedicled tensor fascia lata flap is considered to be an alternative option for the stable repair of pelvic floor defects to prevent radiation injury.
Journal of Pediatric Surgery 06/2008; 43(5):947-50. · 1.45 Impact Factor
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Takayuki Hamada,
Ryuichiro Hirose,
Taiichiro Kosaka,
Ken Taniguchi, Mitsuru Noguchi,
Toshiharu Kihara,
Masanori Egashira,
Masato Tagawa,
Kiyonori Miura,
Hideaki Masuzaki,
Yoshitsugu Tajima,
Tomayoshi Hayashi,
Takashi Kanematsu
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ABSTRACT: This report describes a case of giant cystic meconium peritonitis (GCMP) associated with a cloacal anomaly. Antenatal ultrasonography and magnetic resonance imaging demonstrated persistent fetal ascites, bilateral hydronephrosis, and 3 pelvic cystic structures. The baby girl showed duplicated hydrocolpos and a single orifice of the cloaca with a long common channel inducing a urinary outflow obstruction. After constructing a diversion colostomy, a cutaneous vesicostomy was necessary to prevent recurrent urinary tract infections. These findings are consistent with a prenatal diagnosis of cloacal anomalies, thus suggesting an association with severe obstruction of lower urinary tract and meconium peritonitis. Most of reported cases of meconium peritonitis associated with the cloaca show fibroadhesive types with scattered intraperitoneal calcifications and adhesions. However, the present case showed a rare GCMP suggesting continuous urinary influx via the fallopian tubes until the later stage of intrauterine life.
Journal of Pediatric Surgery 04/2008; 43(3):E21-3. · 1.45 Impact Factor
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ABSTRACT: Combined cisplatin-based intra-arterial chemotherapy and radiotherapy is an effective treatment for patients with locally invasive bladder carcinoma. We report long-term follow-up data regarding definitive treatment of locally invasive bladder carcinoma, regardless of whether bladder preservation was possible.
The follow-up data from 24 patients (18 males and six females; aged, 31-85 years; median, 73 years) with invasive bladder carcinoma, between 1993 and 2003, was examined. The clinical stages of the patients ranged T2-T4, all N0M0, and involved 13 patients at T2 (T2a, T2b), seven patients at T3 and four patients at T4. Combined cisplatin-based intra-arterial chemotherapy and radiotherapy was performed.
The 5-year overall survival rate and cancer-specific survival rate for all patients were 81.6% and 85.6%, respectively. When the patients were divided into complete response (CR) of 10 patients and non-CR groups of 14 patients, the 5-year overall survival rate for the CR group was 87.5%, while that of the non-CR group was 78.6% (P = 0.58). The tumor grade of the CR group was significantly lower than that of the non-CR group (P = 0.01). When the non-CR group was divided into radical cystectomy and non-radical cystectomy groups, the 5-year overall survival rate for the radical cystectomy group (100%) was higher than that of the non-radical cystectomy group (70%).
This combined chemo-radiotherapy was effective for local invasive bladder carcinoma, leading to the possibility of bladder preservation using this therapy.
International Journal of Urology 08/2007; 14(7):591-4. · 1.75 Impact Factor
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ABSTRACT: We report two cases of primary non-functioning kidney from the same non-heart beating donor (NHBD). A 42-yr-old man received a renal transplant from a NHBD. The donor was a 38-yr-old male who died of neck spinal injury. The warm ischemic time was 61 min. One h after reperfusion, the graft became edematous and congested in the presence of normal and adequate vascular anastomosis and lack of renal vein thrombosis. The one-h biopsy specimen showed acute tubular necrosis and severe congestion with occasional platelet aggregates in glomerular capillaries. The graft was resected on post-transplantation day 6. Graftectomy specimen revealed renal cortical necrosis. The contralateral kidney of the same donor was transplanted into a 54-yr-old male. The one-h biopsy specimen showed tubular degeneration and neutrophil infiltration in peritubular capillaries, but no glomerular congestion or thrombus. The recipient died on post-transplantation day 4. Although the cause of death was unknown, necropsy of the renal graft showed renal cortical necrosis, similar to case 1. Ischemia/reperfusion injury was considered the cause of non-functioning kidney in both cases, because of long warm ischemic time. The biopsy specimens at zero-h from both grafts showed focal tubular degeneration only without distinct necrosis, indicating it is difficult to predict viability based on the pathological findings at zero-h or one-h biopsies. There is a need for further understanding of clinical and histological patterns in order to define the criteria of viability of kidney transplant.
Clinical Transplantation 06/2007; 21(s18):64 - 68. · 1.67 Impact Factor
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ABSTRACT: We report a case of intrarenal teratoma arising from a horseshoe kidney. A 6-day-old girl was admitted with an abdominal mass that had been noticed at 37 weeks gestation by routine ultrasonography. At 20 days of age, a tumorectomy with a right nephrectomy was performed. The pathological diagnosis was an immature teratoma. An intrarenal teratoma is extremely rare. In addition, we believe that this case represents the first case of an immature teratoma occurring in a horseshoe kidney. The diagnosis in this type of case is difficult, but we recommend that such tumors be included in the differential diagnosis.
Journal of Pediatric Surgery 08/2006; 41(7):1313-5. · 1.45 Impact Factor
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ABSTRACT: Accelerated atherosclerosis is a major complication in patients on haemodialysis (HD). Macrophage colony-stimulating factor (MCSF) is a representative regulator of activation of monocytes and macrophages, and plays important roles in the development of atherosclerosis in HD patients. However, the long-term predictive value of the serum MCSF level for the development of aortic calcification under HD conditions has not been reported.
Serum MCSF level was measured in 40 HD patients. The aortic calcification index (ACI) was also calculated on computed tomography once each year for 6 years. Predictive value was examined by logistic regression analysis.
At baseline, there was a significant correlation between serum MCSF and ACI (r = 0.43, P<0.01). A significant increase in ACI was first noted at 4 years post-baseline and the increase was maintained thereafter in the high MCSF group. No such changes were noted in the low MCSF group. Univariate analysis identified high levels of calcium x phosphorus product, triglyceride, C-reactive protein (CRP), MCSF and presence of diabetes mellitus as significant predictors for increased ACI at 6 years. However, among these five factors, high levels of CRP and MCSF were the only independent and significant predictors (odds ratio = 24.0, P = 0.03 and odds ratio = 22.8, P = 0.02, respectively).
Our results demonstrated that MCSF is associated with the process of atherosclerosis in HD patients. Furthermore, the serum MCSF level is an independent long-term predictor of increased ACI. These results provide useful information for preventive strategies against atherosclerotic disease under HD conditions.
Nephrology Dialysis Transplantation 09/2005; 20(8):1647-52. · 3.40 Impact Factor
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ABSTRACT: To investigate alterations in gap junctional protein, connexin-43 (Cx-43), in the rat detrusor muscle with partial bladder outlet obstruction (P-BOO). Muscle cell actions, such as detrusor contractions, are thought to be synchronized by way of gap junctional intercellular communication. Gap junctions may play an important role in voiding, and P-BOO is a common medical problem.
A total of 33 female Wistar rats (12 weeks old) were divided into a P-BOO group and a sham-operated control group and were killed at 2, 4, and 8 weeks after surgery. Cystometric investigation, the alteration of gap junction, and Cx-43 protein expression, which compose the gap junction, were examined.
The number of gap junctions was decreased in the P-BOO rat bladder. Furthermore, decreased cellular membrane expression of Cx-43 proteins was detected in rat detrusor muscle cells more than 4 weeks after surgery. The gap junctions of the detrusor muscle cell membranes were significantly fewer in number in the P-BOO rats with no detrusor contractions.
These data suggest that the normal signals that contribute to voiding function could be transported directly through the gap junctions. Voiding dysfunction may be caused by the disruption of gap junctional intercellular communication.
Urology 07/2005; 65(6):1254-8. · 2.43 Impact Factor
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ABSTRACT: Erectile dysfunction (ED) is common in patients with diabetes mellitus (DM) as well as those undergoing hemodialysis (HD). The purpose of this study is to investigate the frequency and severity of ED in HD patients with DM and those without DM. In addition, we examined the relationship between erectile function and several risk factors, including presence of DM and hemoglobin A1c levels in HD patients.
This study involved 180 patients on HD, including 66 HD patients with DM (DM-HD) and 114 patients without DM (non-DM-HD). We evaluated erectile function using an abridged five-item version of the international index of erectile function (IIEF-5). Logistic regression analysis was used to investigate the relationship between presence of ED and several risk factors.
The total score of IIEF-5 in DM-HD patients (9.5 +/- 4.2) was significantly lower than in non-DM-HD patients (13.5 +/- 5.7). The prevalence of severe ED was 42.4% and 18.4% in DM-HD patients and non-DM-HD patients, respectively. Age, cardiovascular disease history, and DM were identified as independent risk factors for the presence of ED. Furthermore, age and elevated hemoglobin A1c levels were identified as independent risk factors for the presence of severe ED.
DM-HD patients are more likely to have ED, and particularly severe forms of ED, than non-DM-HD patients. DM and elevated hemoglobin A1c levels were associated with the presence of ED or severe ED, respectively. Aging was identified as an independent factor in both ED and severe ED.
International Journal of Urology 08/2004; 11(7):530-4. · 1.75 Impact Factor
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ABSTRACT: To report our experience with bacille Calmette-Guérin (BCG) perfusion therapy for transitional cell carcinoma in situ of the upper urinary tract. BCG perfusion therapy is widely used to treat transitional cell carcinoma in situ of the upper urinary tract. However, it has not yet been established as a standard treatment.
Ten patients diagnosed with transitional cell carcinoma in situ of the upper urinary tract were treated with BCG perfusion therapy from January 1990 to May 2002. BCG was instilled weekly for 6 weeks, with a median dose of 65 mg at 1.17 mg/mL (Tokyo 172 strain, dissolved in normal saline).
The mean follow-up period was 50.9 months (range 12 to 134). The initial response to therapy was excellent, and cytology became negative in all patients after one course of BCG perfusion. Five patients developed recurrence after 5, 11, 24, 26, and 45 months, and all died after 46, 12, 41, 134, and 79 months, respectively. The mortality rate was 50% and was 100% in those with recurrence. The mean recurrence-free period was 22.2 months (range 5 to 45). Complications included bladder irritation-related symptoms in all patients, fever greater than 38 degrees C (n = 9), hematuria (n = 2), hydronephrosis (n = 2), and lumbago (n = 1) but all were transient and did not affect long-term prognosis.
BCG perfusion therapy for carcinoma in situ of the upper urinary tract is safe, and the short-term response is excellent. However, the long-term results were not satisfactory. Therefore, this therapy should be considered experimental, although it may have potential benefits in delaying progression and possibly providing local control for patients in poor condition. Long-term studies are required for additional evaluation of BCG therapy.
Urology 07/2004; 63(6):1084-8. · 2.43 Impact Factor
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ABSTRACT: A 71-year-old man presented complaining of severe left flank pain. A computed tomography scan of the abdomen disclosed a left peripelvic extravasation of urine and a 4.0-cm abdominal aortic aneurysm with a significant amount of perianeurysmal thickening and prominent left hydroureter. The patient was diagnosed as having an inflammatory aneurysm of the abdominal aorta (IAAA) with peripelvic extravasations of urine. We report the results of a patient with IAAA with ureteral obstruction successfully treated with steroid therapy and a ureteral stent.
International Journal of Urology 07/2004; 11(6):419-20. · 1.75 Impact Factor
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ABSTRACT: Patients with human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) frequently experience voiding dysfunction. In patients with HAM/TSP, the major symptoms are gait disturbance and voiding dysfunction. However, the detailed natural course of voiding function and the management of their urination has not previously been investigated. We examined the correlation between voiding function and clinical features and evaluated the management of urination, in the patients with HAM/TSP.
The voiding function of 47 patients (7 males, 40 females, aged 29-89 years, mean: 60.9 years) with HAM/TSP was analyzed retrospectively. All HAM/TSP patients are positive for HTLV-1. Patients were referred to a neurologist for analysis of bladder function. In the present study, we analyzed their clinical details, age at disease onset, voiding function and alterations in the management of their urination. Furthermore, we investigated the relationship between urological management and the clinical features of HAM/TSP.
Of the 47 patients, 20 (42.5%) were able to void with or without drug therapy. Thirty-four (72.3%) experienced clean intermittent self-catheterization (CIC), with 25 of these 34 continuing CIC, 7 changing to voiding and 2 changing to management with the Foley catheter. No relationship was noted between disruption of voiding function and either age or gender. However, significant inverse correlation was observed between the age at disease onset and the time to CIC (r=-0.77, P=0.00001).
These data suggest that the younger a patients is at HAM/TSP onset, the longer voiding function will be maintained.
Journal of the Neurological Sciences 02/2004; 217(1):3-6. · 2.35 Impact Factor
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ABSTRACT: Patients with sarcomatoid renal cell carcinoma are rare and have poor survival. We evaluated 14 patients who had renal cell carcinoma with a sarcomatoid component between 1982 and 2000. There were 9 men and 5 women with a median age of 59.5 years (range 32 to 77). Seven patients had a tumor on the right side and 7 on the left side. Thirteen patients had some symptoms and 11 had metastases at the initial visit. Most of them were stage T4 and high nuclear grade cancer and showed elevated acute phase reactants. There were 7 patients followed by interferon therapy, and the cause-specific 5-year survival rate was less than 10%. We confirmed that renal cell carcinoma with a sarcomatoid component often showed local invasion, distant metastasis and poor prognosis.
Hinyokika kiyo. Acta urologica Japonica 04/2003; 49(3):131-3.
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ABSTRACT: We report a case of renal cell carcinoma with solitary metachronous metastasis to the urinary bladder occurring 6 years after radical nephrectomy. The patient was treated with partial cystectomy and survived for 60 months. Other cases like this one were reviewed in published reports, and the 3-year survival rate for patients with this type of cancer with solitary metastasis to the urinary bladder was found to be 80%. The follow-up duration of our case was the longest in the published studies. We suggest that urinary bladder metastasis of renal cell carcinoma should be resected because no effective treatment for metastatic renal cell carcinoma is available. A good prognosis may be expected, especially in patients with solitary metastasis to the urinary bladder.
Urology 12/2002; 60(5):911-2. · 2.43 Impact Factor
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ABSTRACT: To examine gap junction expression during compensatory renal growth. Compensatory renal growth is a normal response to the removal of renal cells. Gap junctional intercellular communication plays important roles in homeostatic regulation, differentiation, and synchronization of cellular electronic and metabolic functions.
The right ureters of 5-week-old ddy mice were dorsally incised and unilaterally obstructed, and the animals were killed at varying intervals. The control group underwent a sham operation. Freeze-fractured kidney tissue samples were studied using electron microscopy. The amount of proliferative cell nuclear antigen-positive cells and connexin 43 (Cx43) protein was studied by immunohistochemistry and Western blotting, respectively.
Proliferative cell nuclear antigen-positive cells in the renal tubules increased on days 1 and 2 after surgery that obstructed the ureter, and decreased to normal levels by day 14. The number of gap junctions significantly decreased on days 1 and 2, and then gradually increased to normal levels from days 3 to 14 after surgery. The amount of Cx43 protein in the renal tubules decreased until day 2 and recovered to the same level as that of the control by day 14 after surgery. Significantly, a hyperphosphorylated band of Cx43 in the control kidney was not detected in the operated kidney.
These data suggest that the gap junctional intercellular communication of renal tubular cells during compensatory renal growth after unilateral ureteral obstruction could be temporarily reduced concomitant with a decrease of the expression of a phosphorylated Cx43 protein in renal cortical tubular cells after unilateral ureteral obstruction of the contralateral kidney.
Urology 11/2002; 60(4):726-30. · 2.43 Impact Factor
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ABSTRACT: Intravesical instillation of epirubicin (EPI) is one of the most effective adjuvant therapies for non-muscle-invasive bladder cancer after transurethral resection. We evaluated the optimal duration of EPI instillation in a multi-institution prospective randomized clinical study.
Between June 1995 and May 1998, a total of 125 patients with superficial bladder cancer (transitional cell carcinoma grade 1 or 2) were enrolled in this study, and 102 patients were fully evaluated for recurrence. Two protocols for intravesical therapy (arm A - 30 mg EPI/30 ml saline 19 times over 1 year; arm B - 30 mg EPI/30 ml 12 times over 5 months) were established. Instillations were given every week for 4 weeks and then every 2 weeks for 4 months in arm B. After 5 months of treatment, maintenance was performed with seven further instillations (one every month for 7 months) in arm A. The analyzed background factors were the therapeutic method, gender, history (primary or recurrent tumor), stage (T classification), grade, number of tumors, and tumor size.
There were no significant differences in the analyzed background factors between the two arms, and there were no serious side effects in the study. In an intent-to-treat analysis, the overall 3-year recurrence-free survival rates were 48.5% in arm A and 55.1% in arm B. The difference between the two groups was not significant.
This analysis indicated that extended prophylactic maintenance instillation of EPI was not significantly effective in reducing bladder cancer recurrence.
Cancer Chemotherapy and Pharmacology 11/2002; 50(4):266-70. · 2.83 Impact Factor
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ABSTRACT: The patient was a 54-year-old woman with recurrent urinary tract cancer. A CT of the lung showed multiple nodules after bil-nephroureterectomy, cystectomy and combination chemotherapy with cisplatin (CDDP) and epirubicin (EPI). As second line chemotherapy for the patient, TXL was administered. She was hemodialized after operation, and there are few reports about paclitaxel (TXL) therapy for hemodialysis (HD) patients. Peak blood TXL concentration, about 1,200 ng/ml, was achieved 6 hours after the administration of TXL. The blood TXL concentration was 41 ng/ml 24 h after the administration of TXL. However, the TXL therapy was not repeated because of unacceptable neurological side effects. An almost 40% shrinkage in the size of the metastatic lung nodule was obtained after 1 cycle of treatment.
Gan to kagaku ryoho. Cancer & chemotherapy 08/2002; 29(7):1247-50.
