[show abstract][hide abstract] ABSTRACT: Adrenocorticotropic hormone-independent macronodular adrenal hyperplasia, characterized by bilateral macronodular adrenal hypertrophy and autonomous cortisol production, is a rare cause of Cushing's syndrome. Bilateral adrenalectomy is considered the standard treatment for adrenocorticotropic hormone-independent macronodular adrenal hyperplasia but obliges the patient to receive lifetime steroid replacement therapy subsequently, and may increase the patient's risk of adrenal insufficiency. These circumstances require surgeons to carefully consider operative strategies on an individual basis.
We performed successful laparoscopic adrenalectomy on four patients with adrenocorticotropic hormone-independent macronodular adrenal hyperplasia. Computed tomography scans showed bilateral adrenal enlargement in all patients. Case 1: a 56-year-old Japanese woman presented with obvious Cushing's symptoms during treatment for diabetes mellitus and hypertension. Case 2: a 37-year-old Japanese man also presented with Cushing's symptoms during treatment for diabetes mellitus and hypertension. These patients were diagnosed as Cushing's syndrome caused by adrenocorticotropic hormone-independent macronodular adrenal hyperplasia based on endocrinologic testing, and underwent bilateral laparoscopic adrenalectomy. Case 3: an 80-year-old Japanese woman was hospitalized due to unusual weight gain and heightened general fatigue, and was diagnosed as Cushing's syndrome caused by adrenocorticotropic hormone-independent macronodular adrenal hyperplasia. She underwent unilateral laparoscopic adrenalectomy due to high operative risk. Case 4: a 66-year-old Japanese man was discovered to have bilateral adrenal tumors on medical examination. He did not have Cushing's symptoms and was diagnosed as subclinical Cushing's syndrome due to suppressed adrenocorticotropic hormone serum levels and loss of cortisol circadian rhythm without abnormal levels of serum cortisol. He underwent unilateral laparoscopic adrenalectomy. During follow-up, serum cortisol levels were within the normal range in all cases, and serum adrenocorticotropic hormone levels were not suppressed. Further, cases with Cushing's syndrome experienced clinical improvement.
We were able to effectively treat adrenocorticotropic hormone-independent macronodular adrenal hyperplasia in patients with obvious Cushing's symptoms by laparoscopic bilateral adrenalectomy, which promptly improved symptoms. Further, unilateral adrenalectomy was effective for treating an older patient at high operative risk and a patient with subclinical Cushing's syndrome.
Journal of Medical Case Reports 09/2012; 6(1):312.
[show abstract][hide abstract] ABSTRACT: To review the medical records of patients with BK virus nephropathy (BKVN) following kidney transplantation in our institution.
We screened patients for decoy cells using urine cytology, assessed serum creatinine levels, and conducted a graft biopsy, as well as assessed the presence of plasma BK virus DNA by quantitative real-time polymerase chain reaction. The treatment of BKVN was based on the decreased use of immunosuppressants.
Overall, six male patients were studied (mean age 40.8 years, range 18-58; mean donor age 45.2 years, range 15-67). A positive urine cytology screen led to the subsequent detection of plasma BK virus DNA in the five patients with urine cytology results positive for decoy cells. In the four patients in whom plasma BK virus DNA was detected, a maximum value of DNA of > or = 10 000 copies/mL was observed. Time elapsed from transplantation to BKVN diagnosis ranged from 3 to 62 months. Although the two cadaver grafts were lost, the loss was not due to any effects directly associated with BKVN. The other four grafts are still functioning with a mean creatinine level of 1.8 mg/dL. Most of the patients with BKVN were regarded as being in a state of heightened immunosuppression. BK virus transition to blood was prevented in one patient.
Early diagnosis of BKV infection with reduction of immunosuppression may potentially counter BK viremia and retard progression of BKV nephropathy. Decoy cell screening by urine cytology as well as plasma BK virus DNA screening should be considered in addition to the required graft biopsy in kidney transplant recipients, particularly in those with impaired graft function.
International Journal of Urology 10/2009; 16(12):924-8. · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: We report on a BK virus-associated nephropathy in a 28-year-old man. His symptoms occurred 5 years after he had received a kidney transplantation. He was treated with tacrolimus, azathioprine, and prednisolone. The progress of the disease was monitored by quantitative real-time polymerase chain reactions for BK virus DNA. An analysis of viral DNA showed that the BK virus in the patient's plasma belonged to genotype IV.
Clinical and Experimental Nephrology 04/2007; 11(1):102-6. · 1.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: A 57-year-old woman was hospitalized with a left renal artery aneurysm (RAA). The aneurysm measured 35 mm in diameter and was located at the renal artery bifurcation. We performed a laparoscopic nephrectomy using a retroperitoneal approach and performed an ex vivo repair of the renal artery. The reconstructed kidney was then autotransplanted at the left iliac fossa. The patient's postoperative course was uneventful. A laparoscopic nephrectomy and ex vivo repair are both considered to be effective for treating complex RAA.
Surgery Today 02/2007; 37(2):169-72. · 0.96 Impact Factor
[show abstract][hide abstract] ABSTRACT: Laparoscopic adrenalectomy is currently recognized as the gold standard for the treatment of adrenal tumors. In order to assess the current status of laparoscopic adrenalectomy, we reviewed the literature focusing on the indications and contraindications, surgical techniques, complications and new methods. We also reviewed the results separately for aldosteronoma, pheochromocytoma, Cushing's syndrome, and primary or metastatic adrenal cancer.Laparoscopic adrenalectomy is a safe and effective treatment for adrenal disorders, excluding primary adrenal cancer. There are no differences of the various operative parameters between the transperitoneal and retroperitoneal approaches, so the choice of approach should depend on the surgeon's preference or the patient's circumstances. It is important for the surgeon to remove the tumor and the surrounding fat en bloc, especially in the case of large or irregular tumors because of the potential for malignancy. The surgeon must also immediately switch to an open procedure if the laparoscopic operation becomes difficult.We conclude that use of laparoscopic adrenalectomy allows the performance of minimally invasive surgery with the advantages of more rapid recovery and a shorter hospital stay than open adrenalectomy.
Journal of Minimal Access Surgery 10/2005; 1(4):165-72.
[show abstract][hide abstract] ABSTRACT: Laparoscopic adrenalectomy remains a controversial procedure for large tumors. We examined the outcome and complications of laparoscopic adrenalectomy for such lesions.
A total of 178 patients underwent laparoscopic adrenalectomy, of whom 29 patients had large (>or =5 cm) tumors. Their mean age was 47.9 years (range 21-72 years), and the mean tumor size was 6.5 cm (range 5.0-11.0 cm). They were compared with patients whose adrenal tumors were <5 cm.
The large-tumor group had a mean operating time of 176 +/- 48 minutes (range 84-278 minutes) and a mean blood loss of 136.6 mL (range 10-800 mL) and required a mean of 1.8 days before starting oral intake. None of these values is significantly different from the results in the control group (P > 0.05). The length of recovery was significantly longer in the large-tumor group (5.4 v 4.5 days; P < 0.05), but this was not true if a patient with a 23-day postoperative stay is excluded. The overall incidence of complications was 12% in the large-tumor group, which was not significantly different from that in the control group (P > 0.05).
The operating time, blood loss, and incidence of complications after laparoscopic adrenalectomy did not differ between the patients with large and small adrenal tumors, indicating that experienced surgeons can safely and effectively use laparoscopy for larger tumors. However, it is necessary to consider carefully whether laparoscopic surgery is indicated for tumors that show infiltration on preoperative imaging or for patients who have undergone previous upper-retroperitoneal surgery.
Journal of Endourology 06/2005; 19(5):537-40. · 2.07 Impact Factor
[show abstract][hide abstract] ABSTRACT: Using power Doppler ultrasonography (PDUS), we investigate the change of resistance index (RI) before and after transurethral vaporization of the prostate (TUVP) in benign prostatic hyperplasia (BPH) patients.
In all, 49 patients underwent transrectal PDUS before receiving TUVP, three were excluded because of cancer and three could not be followed up. The remaining 43 were enrolled in the present study. Patients were assessed before and 1, 3 and 6 months after surgery, giving a mean duration of follow-up of 9.1 months. International prostate symptom scores (IPSS), quality of life (QOL) scores, postvoiding residual urine volumes (PVR) and maximum urinary flow rates (Qmax) were evaluated and total prostatic volume (TPV) and RI were measured using PDUS.
Resistance index ranged from 0.64 to 0.91. The postoperative parameters except for RI, such as TPV, PVR, IPSS and QOL scores improved significantly at the follow-up assessment after surgery. The elevated RI decreased significantly 1, 3 and 6 months after the treatment. Resistance index significantly decreased after TUVP and IPSS and other urodymamics parameters improved.
The present study suggested that RI could evaluate the severity of BPH and the degree of intraprostatic pressure or bladder outlet obstruction.
International Journal of Urology 04/2005; 12(3):264-9. · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: The BK polyomavirus (BKV) infects most of the human population, but clinically relevant infections are usually limited to individuals who are in an immunosuppressed state. The significance of BKV infection was investigated in a 50-year-old man who underwent cadaveric kidney transplantation and was treated with tacrolimus, mycophenolate mofetil and prednisolone. By staining renal biopsy specimens with a monoclonal antibody against BK large T antigen, we were able to observe the relationship between the appearance of the BKV antigen and the extent of immunosuppression in this patient. We also determined that BKV belonged to genotype I by analysis of viral DNA from the patient's urine.
International Journal of Urology 09/2004; 11(8):656-62. · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: We report two cases of chromophobe cell renal carcinoma. Case 1 was in a 62-year-old man with the chief complaint of hematospermia. Ultrasound incidentally detected a left renal mass. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a relatively homogeneous, hypovascular tumor of the left kidney. We performed radical nephrectomy after making a clinical diagnosis of possible renal carcinoma. Case 2 was in a 66-year-old woman who was admitted to our hospital after a left renal mass was incidentally found by ultrasonography during a health check. We performed laparoscopic radical nephrectomy after making a diagnosis of renal cell carcinoma by CT and MRI. Both of the tumors were shown to be chromophobe cell carcinoma by microscopic examination after H & E staining and immunohistochemistry using Hale's colloidal iron stain. Chromophobe cell carcinoma is an uncommon type of renal cell carcinoma and the number of reported cases is limited in Japan. The clinical features and management of this rare tumor are discussed.
[show abstract][hide abstract] ABSTRACT: Serine:pyruvate/alanine:glyoxylate aminotransferase (SPT/AGT) is largely located in mitochondria in carnivores, whereas it is entirely found within peroxisomes in herbivores and humans. In rat liver, SPT/AGT is found in both of these organelles, and only the mitochondrial enzyme is markedly induced by glucagon. Although SPT/AGT is a bifunctional enzyme involved in the metabolism of both L-serine and glyoxylate, its contribution to L-serine metabolism is independent of mitochondrial or peroxisomal localization (Xue HH et al., J Biol Chem 274: 16028-16033, 1999). Therefore, the species-specific and food habit-dependent organelle distribution might be required for proper metabolism of glyoxylate at the subcellular site of its formation. Glyoxylate formation from glycolate and that from L-hydroxyproline have been shown to occur in peroxisomes and mitochondria, respectively. The present study found that urinary excretion of oxalate was markedly increased when a large dose of L-hydroxyproline or glycolate was administered to rats. Oxalate formation from L-hydroxyproline but not that from glycolate was significantly reduced when mitochondrial SPT/AGT had been induced by glucagon. The hydroxyproline content of collagen is 10 to 13%, and collagen accounts for about 30% of total animal protein; therefore, these results suggest that an important role of mitochondrial SPT/AGT in carnivores is to convert L-hydroxyproline-derived glyoxylate into glycine in situ, preventing undesirable overflow into the production of oxalate.
Journal of the American Society of Nephrology 05/2003; 14(4):939-46. · 8.99 Impact Factor
[show abstract][hide abstract] ABSTRACT: Thymidine phosphorylase (TdR-Pase) and dihydropyrimidine dehydrogenase (DPD) are thought to be key enzymes in the metabolic pathways of 5-fluorouracil (5-FU). Theoretically, tumors which have low DPD and/or high TdR-Pase expression should be 5-FU-sensitive. TdR-Pase also has angiogenic expression which aids tumor progression and metastasis. However, little is known concerning the relationship between DPD expression and clinical malignant potential, especially in urological cancer.
Transitional cell cancer (TCC) tissues were obtained from 50 patients, and TdR-Pase and DPD expression was measured by ELISA and radioenzyme assay, respectively. The sensitivity of 23 of the 50 specimens to 5-FU was assessed in a histoculture drug response assay (HDRA), an in vitro chemosensitivity test.
TdR-Pase and DPD expression in TCC tissues was higher than in normal urothelial tissues. The expression of both TdR-Pase and DPD in TCC increased with histological grade and stage. Superficial bladder cancer patients who had undergone transurethral resection were divided into two groups, a recurrent and a nonrecurrent group. The expression of TdR-Pase and DPD was higher in the recurrent group than in the nonrecurrent group, but the differences were not significant. There was a significant inverse correlation between DPD expression and 5-FU sensitivity. However, TdR-Pase exhibited no correlation with 5-FU sensitivity.
The expressions of both enzymes may be a good indicator of the malignant potential of TCC. Although DPD may be a good indicator of sensitivity of TCC to 5-FU, TdR-Pase appeared not to regulate the sensitivity of TCC to 5-FU.
Cancer Chemotherapy and Pharmacology 02/2003; 51(1):29-35. · 2.80 Impact Factor
[show abstract][hide abstract] ABSTRACT: Thymidine phosphorylase (TdR-Pase) and dihydropyrimidine dehydrogenase (DPD) are thought to be key enzymes in the metabolic pathway of 5-fluorouracil (5-FU). Theoretically, cancer cells which have high TdR-Pase activity and/or low DPD activity should be sensitive to 5-FU. TdR-Pase is also known to have angiogenic activity which helps tumor progression and metastasis. On the other hand, little is known concerning the relationship of DPD activity with clinical malignant potential in renal cell carcinoma (RCC). In this study, we measured both TdR-Pase and DPD activities in surgically obtained RCC tissues and examined the relationship between these enzymatic activities and histological parameters. In addition, the results of in vitro chemosensitivity testing were also analyzed to determine whether TdR-Pase and/or DPD activity in carcinoma cells can predict the efficacy of 5-FU.
RCC tissues from 53 patients were obtained. TdR-Pase and DPD activities were measured by ELISA and radioenzyme assay, respectively. Sensitivity to 5-FU was assessed by histoculture drug response assay (HDRA), an in vitro chemosensitivity test, for 20 of the 53 specimens.
Both TdR-Pase and DPD activities of RCC increased with histological grade. There was a significant positive correlation between the TdR-Pase activity and 5-FU sensitivity. In addition, a stronger positive correlation was found between TdR-Pase / DPD ratio and 5-FU sensitivity. DPD exhibited no correlation with 5-FU sensitivity.
The activity of both enzymes increased with malignant potential of RCC. TdR-Pase appeared to be the enzyme regulating activation of 5-FU in RCC.
European Urology 02/2003; 43(1):45-51; discussion 51-2. · 10.48 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of the present study was to assess the resistive index in patients with benign prostatic hypertrophy (BPH) and the role of power Doppler ultrasonography.
From April 1996 to December 1997, a total of 214 men aged 48-86 years with symptoms of BPH were prospectively enrolled to participate in our study. All patients presented to our clinic with lower urinary tract symptoms. Transrectal ultrasonography was used to calculate the total prostate volume (TPV), transition zone (TZ) volume, transition zone index (TZI = TZ volume/TPV) and presumed circle area ratio (PCAR). Power Doppler imaging was used to identify the capsular and urethral arteries of the prostate and measure its resistive index (RI) value.
The RI of capsular arteries significantly correlated with theTPV, TZ volume, TZI (r = 0.470; P < 0.0001) and PCAR (r = 0.334; P < 0.0001). Correlations were found between the RI of capsular arteries and the International Prostatic Symptom Score (IPSS) (r = 0.389; P < 0.0001), peak flow rate of uroflowmetry (r = -0.393; P < 0.0001).
We demonstrated that an increase of the RI of capsular arteries correlated with increases in the TZI and PCAR in BPH. The lower IPSS and peak flow rate correlated with the high RI of capsular arteries; however, no correlation between the RI of urethral arteries and prostatic parameters was found. The findings suggested that the RI of capsular arteries may become the index for measuring lower urinary obstruction in the future.
International Journal of Urology 08/2002; 9(8):427-30. · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Thymidine phosphorylase (TdR-Pase) is an essential enzyme in the metabolism of fluorouracil-related drugs and is also a potent angiogenic factor. We measured the TdR-Pase activity in human renal cell carcinomas (RCCs) to assess the relationship between TdR-Pase activity and the degree of tumor malignancy. We also investigated the relationship between TdR-Pase activity and chemosensitivity to fluorouracil-related drugs. A total of 61 RCC tissue specimens and 39 normal kidney tissue specimens were obtained. TdR-Pase activity was measured by enzyme-linked immunosorbent assay. The in vitro histoculture drug response assay was also performed to examine tumor sensitivity to 5-fluorouracil (5-FU) and doxifluridine (5'-DFUR). The TdR-Pase activity of RCCs was 13-fold that of the normal tissues. Activity increased with histological grade, and,was significantly higher in high-stage tumors (T3 or higher). TdR-Pase activity exhibited a significant positive correlation with sensitivity to 5-FU and 5'-DFUR. High TdR-Pase activity in human RCC was confirmed to predict high tumor grade and stage. RCCs with high TdR-Pase activity were also sensitive to FU-related drugs.
Urological Research 06/2002; 30(2):112-5. · 1.59 Impact Factor
[show abstract][hide abstract] ABSTRACT: A 65-year-old man presented with the complaint of gross hematuria. Cystoscopy revealed a sessile tumor on the left bladder wall. It was diagnosed as primary signet ring cell carcinoma of the bladder (T3bN0M0). The patient did not want surgical treatment. Therefore, three courses of arterial infusion of carboplatin were administered at 3-week intervals. Complete remission was obtained and has been maintained for 44 months. Our case appears to be the first report of successful treatment with chemotherapy alone of an infiltrating signet ring cell carcinoma of the bladder.
[show abstract][hide abstract] ABSTRACT: We successfully performed a laparoscopy-assisted radical nephrectomy for renal cell carcinoma in 2 patients on long-term hemodialysis. Both tumors were incidentally discovered on screening by abdominal CT scanning. There were no complications during the operation or in the postoperative period, and both patients resumed normal activities by the fifth postoperative day. A laparoscopic-assisted radical nephrectomy may be useful for the treatment of renal cell carcinoma in hemodialysis patients.
International Journal of Urology 10/1998; 5(6):601 - 603. · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background Tumor size is important when distinguishing T1 renal cell carcinoma (RCC) from T2 disease. However, further details of the
relationship between tumor size and TNM classifications have not been reported. In this study, we evaluated the correlation
between the size and TNM stage of RCC and compared it with correlations for tumor volume.
Methods We retrospectively studied 241 patients with RCC and obtained data on size and TNM stage from surgical records. To assess
the correlation of these variables with involvement of the renal capsule, lymph node metastasis, and distant metastasis, the
area under the corresponding receiver-operator characteristic (ROC) curve was calculated. The statistical significance of
differences between these ROC curves was also studied.
Results With respect to involvement of the renal capsule, the areas under the ROC curves for tumor size and volume were 0.796 and
0.800, respectively. There was no significant difference between tumor size and tumor volume. With lymph node metastasis,
the areas for tumor size and volume were 0.751 and 0.757, respectively. With distant metastasis they were 0.693 and 0.722,
respectively. The areas for tumor volume were larger than those for tumor size, but there were no significant differences
between these 2 variables. By using a cutoff value of 5 cm for tumor size and 65 mL for tumor volume, we obtained a high sensitivity
and specificity in detecting renal capsular invasion.
Conclusion Tumor size and volume are both sensitive and specific indices of renal capsular invasion. These variables, obtained before
surgery by imaging modalities, could be useful for preoperative staging of RCC, especially for T staging.
International Journal of Clinical Oncology 01/1998; 3(3):134-137. · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background
Cyclosporine is a potent immunosuppressant with nephrotoxic effects. The decreased effective renal blood flow caused by vasoconstriction of afferent arterioles is now considered the main mechanism of cyclosporine-induced nephrotoxicity. It has been suggested that endothelin (ET) receptor antagonists might have beneficial effects against cyclosporine-induced vasoconstriction. We studied the acute effect of a nonpeptide selective ET-A receptor antagonist, S-0139, against cyclosporine-induced reduction of renal cortical blood flow (RCBF).
Male Wistar rats were divided into 3 groups (10 rats each). Both cyclosporine and S-0139 were dissolved in normal saline solution and infused into the femoral vein. Group 1 received cyclosporine at a dose of 0.1 mg/kg per minute. Group 2 received cyclosporine at the same dose and S-0139 at 0.2 mg/kg per minute. Group 3 received the medium as a control. RCBF was measured every 30 minutes for 4 hours by the hydrogen gas clearance method under urethane anesthesia. Serum creatinine, serum potassium, plasma endothelin 1 (ET1) concentrations and plasma renin activity were then measured.
Group 1 showed a significant decrease in RCBF, while groups 2 and 3 showed no change. Serum creatinine and serum potassium were significantly higher in group 1 than in groups 2 and 3. Plasma ET1 levels were both significantly higher in groups 1 and 2 than in group 3. There were no significant differences among the 3 groups in plasma renin activity.
We conclude that S-0139 has an acute preventive effect against cyclosporine-induced RCBF reduction.
Clinical and Experimental Nephrology 11/1997; 1(4). · 1.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: BackgroundThe well-known, classical symptoms of renal cell carcinoma (RCC) are abdominal or flank pain, a palpable mass, and hematuria.
However, the number of patients with this classical triad has been decreasing recently. This is especially true in Japan where
health screening programs detect many incidental renal cell carcinomas. This study reevaluated the presenting symptoms of
RCC as prognostic factors. It also showed that patients found to have RCC by health screening had a significantly low hazard
ratio and a good prognosis.
Patients and MethodsTo evaluate the presenting symptoms as prognostic factors for survival, we retrospectively studied 320 patients with renal
cell carcinoma between 1978 and 1995. The following symptoms were evaluated as prognostic factors: large amount of hematuria,
any hematuria (including microscopic and macroscopic), flank and/or abdominal pain, a palpable mass, malaise, weight loss,
pyrexia, and the reason for examining the kidneys. Survival curves were calculated by the Kaplan-Meier method, and univariate
analysis was performed using the log-rank test and Cox's proportional hazard model. Significant factors were then chosen for
Cox's multivariate proportional hazard test to evaluate their relative prognostic value.
ResultsThe median follow-up period was 29 months. The overall survival rate at 1, 5, and 10 years was 90.0%, 77.6%, and 69.9%, respectively.
The chi-square test revealed a close relationship between flank and/or abdominal pain and local tumor extent; pyrexia and
lymph node and distant metastasis; and incidental detection by health screening with no local invasion or distant metastasis.
ConclusionOf the 8 prognostic factors evaluated, univariate and multivariate analysis showed that flank and/or abdominal pain and pyrexia
were poor prognostic factors, while patients with tumors found by routine health screening or during workup of other diseases
showed a good outcome.
International Journal of Clinical Oncology 01/1997; 2(1):6-9. · 1.73 Impact Factor