ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00569.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:Renal artery aneurysms (RAAs), once considered rare, are being recognized with increasing frequency. The treatment of aneurysms of the first ramification of the main renal artery is still controversial.Methods:From November 1984 to May 1992, we treated 8 patients with RAA at the first ramification. All the patients were treated with an ex vivo technique and autotransplantation.Results:The results, evaluated with intravenous pyelogram and arteriography were satisfactory. No operative deaths and no complications were noted.Conclusion:We concluded that surgery with an ex vivo technique and autotransplantation is an excellent method of treating this type of lesion.

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00570.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:To determine the immunosuppressive effect of surgery for urologic cancers, multiple variables of immune function were measured serially before and after operation in patients with urologic cancer.Methods:Peripheral blood was obtained before operation and at postoperative day 7 and 14 from 20 patients with bladder cancer, renal pelvic, or ureteral cancer, or renal cell carcinoma.Results:In patients with bladder cancer who were undergoing radical cystectomy with use of intestine for urinary diversion, the serum level of immunosuppressive acidic protein (IAP) increased, and serum levels of immunoglobulin (Ig)A, IgG, and IgM decreased after operation. In contrast, the number of CD25+ lymphocytes significantly increased. Transurethral resection of bladder cancer also resulted in an increase in serum IAP level, however, the number of CD4+ and human leukocyte‐associated HLA‐DR+ lymphocytes increased. In patients with renal pelvic or ureteral cancer undergoing nephroureterectomy with cuff, the level of serum IAP increased and serum IgG level decreased after operation. By contrast, the number of CD3+ lymphocytes increased. In patients with renal cell carcinoma, radical nephrectomy led to a significant increase in the number of CD8+ lymphocytes.Conclusions:These findings suggest that surgical stress in patients with urologic cancer may result in both suppression and stimulation of host immun

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00571.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:Because of the high cost, low overall response rate (10% to 20%), and poor quality of life during interferon therapy for advanced renal cell carcinoma, it is important to distinguish patients likely to respond to treatment. The expression of human leukocyte antigens (HLA) may serve as a clinical marker for response to interferon treatment in patients with renal cell carcinoma.Methods:We compared HLA phenotype frequency in 37 Japanese patients with advanced renal cell Carcinoma who showed a favorable response to interferon‐α, in 93 similar patients, before treatment, who did not receive interferon‐α, and in 939 healthy Japanese volunteers (historical control data).Results:Six HLA antigens, B35, Bw48, Bw60, DRw6, DRw8, and DR9, were expressed at a significantly lower rate in the 93 pretreatment patients with renal cell carcinoma, compared with the control subjects. Three HLA antigens, excluding Bw60, DRw6, and DRw8, were expressed at a significantly higher rate in the patients who responded to interferon‐α, compared with the pretreatment patients with renal cell carcinoma and control subjects.Conclusion:Three HLA antigens, B35, Bw48, and DR9, were expressed at a significantly higher rate in patients with renal cell carcinoma who showed a sensitivity to interferon‐α, and could be important markers for clinical response to this antitu

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00572.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:We correlated cystometric findings to the clinical features of benign prostatic hyperplasia (BPH) and compared them in terms of outcome after prostatectomy.Methods:Cystometric findings obtained from 78 patients who underwent prostatectomy were correlated with clinical features in BPH patients. In 41 consecutive patients of this group, prospective periodical cystometry was also performed.Results:Low bladder compliance correlated significantly with an increase in age and prostate volume, detrusor instability and impaired contractility. Low compliance also correlated with irritative symptoms, decreased maximum flow rate, increased post‐void residual urine and an increase in the American Urological Association symptom score. Postoperative persistent incontinence was associated with low bladder compliance and detrusor instability. In a prospective study, bladder dysfunction was not completely restored in 53% of patients examined at a mean interval of7.7months after prostatectomy.Conclusions:Among the cystometric parameters investigated, low compliance was the most relevant to the clinical features of BPH and had some predictive value for the outcome after prostatectomy. In about half of the BPH patients with bladder dysfunction preoperatively, this condition was irreversible for a significant period of time after prostatectomy, in spite of surgical relief of the infravesical obstructio

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00573.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:This study evaluated the long‐term efficacy of transurethral microwave thermotherapy (TUMT) in the treatment of benign prostatic hyperplasia (BPH), and determined whether the indices obtained with transrectal ultrasonography (TRUS) can predict the clinical response to TUMT.Method: Between November 1991 and June 1992, 43 patients with symptomatic BPH were treated with TUMT using the Prostcare device. The therapy consisted of a 1 ‐hour treatment under topical anesthesia. The findings of uroflowmetry and AUA symptom score before treatment were compared with those obtained dt each visit after the therapy. As the indices, the transition zone (TZ) volume, transition zone ratio (TZ ratio = TZ volume/total prostate volume), total prostate volume, and presumed circle area ratio (PCAR) were calculated.Results:There was a significant correlation between pretreatment TZ ratio and residual urine volume (r= 0.472,P= 0.0022). The efficacy rates calculated by response criteria on the 3 point scale at 2 months, 12 months, and 30 months were 44.2%, 30.2%, and 25%, respectively. The significant prognostic factors that predicted the clinical effect 1 year after treatment were the TZ ratio and intraprostatic temperature. After controlling for the treatment temperature, the multivariate logistic regression model demonstrated that the TZ ratio was the significant predictor (p= 0.049) of 1 year efficacy of treatment.Conclusion: The present study showed that the efficacy rate of TUMT at 30 months was 25%, and that TKUS provides a simple parameter, the TZ ratio, which predicts the efficacy of T

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00574.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:We have developed a new transurethral thermotherapy device using 8MHz radiofrequency (RF) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH). We report the safety and effectiveness of the initial clinical experience with this deviceMethods:Sixty patients with symptomatic BPH were subjected to a single 1‐hour treatment under local anesthesia. The treatment device uses extracorporeal RF capacitive heating in combination with radiative heating and conductive cooling of the urethra.Results:In the 49 patients evaluahle at 3 months, the mean International Prostate Symptom Score decreased from 17.8 to 13.1 (P<0.0001) and the Quality of Life score decreased from 4.4 to 3.4 (P<0.0005). Maximum flow rate increased from 8.1 to 9.7mL/s (P<0.05) at 3 months. Overall effectiveness by Homma's response criteria was as follows; excellent 4.1%, good 10.2%, fair 38.8% and poor 46.9%. Side effects were minimal. Gross hematuria was seen in 3 patients and erosion of the external urethral meatus was seen in 2 patients, but none had urinary retention.Conclusions:In this initial clinical trial, transurethral RF thermotherapy was safe and resulted in modest symptomatic improvement. Further investigations for optimizing the treatment protocol seem warrante

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00575.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:We compared preoperative tumor location, as identified by transrectal ultrasonography (TRUS), and TRUS‐guided core biopsies with the final histopathological examination of radical prostatectomy specimens.Methods:Thirty patients who had radical retropubic prostatectomy after evaluation with TRUS are included in the study. Diagnosis of prostate cancer was established with TRUS‐guided systematic (3 cores from base, mid and apex of the peripheral zone, and 1 core from the transition zone of each side of the prostate) and lesion‐directed core biopsies in all cases. Each prostate gland was halved for histopathological examination and results are reported in terms of “sides”.Results:Histopathological examination of the prostatectomy specimens revealed prostate cancer bilaterally in 29 glands (58 sides) and unilaterally in 1 gland. Preprostatectomy TRUS examinations missed cancer in 29 sides, and core biopsies were negative for cancer in 14 sides.Conclusion:This study revealed that 49% of prostate cancer lesions (n=29 sides) were not recognized on TRUS and 52% of those (n = 15 sides) were diagnosed only by additional systematic biopsies. Furthermore, even with TRUS‐guided systematic core biopsies, failure to detect the prostate cancer lesions may be as high as 24% (n

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00576.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:The clinical significance of pretreatment serum prostate‐specific antigen (PSA) values was studied to determine the ability to predict clinical stage and prognosis using a relatively large number of patients with prostate cancer.Methods:Serum PSA values at diagnosis were analyzed from 749 patients with newly‐diagnosed prostate cancer and registered in the Tokai Urological Cancer Registry. Correlations between the PSA value, the clinical stage and prognosis of the patients were evaluated.Results:Serum PSA values at each stage of diagnosis showed positivity (≥ 3.6 ng/mL) in 23% (stage A1) to 91.2% (stage D2) of patients, and it was possible to obtain statistical differences between the stages, even between A1 and A2. Based on a cumulative study of PSA distribution, stages greater than A2 could be diagnosed using a cut‐off of 7.2 ng/mL, with a 99.2% positive predictive value (PPV), and a 16.2% negative predictive value (NPV). At a PSA level of 1 0.8 ng/mL, stages greater than B2 could be predicted with a PPV of 95.3% but an NPV of 40.3%. Pretreatment PSA values were a significant prognostic indicator in stage D2 patients using 100 to 150ng/mL as the cut‐off values. These differences were primarily found in the poorly differentiated group, which showed a statistical difference using cut‐off PSA values from 75 to 150 ng/mL.Conclusions:Serum PSA levels from a large number of patients can be used to predict the stage and prognosis of prostate canc

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00577.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:In a recent study by the Casodex Combination Study Group, USA, patients in a flutamide (750mg/day) plus LH‐RH agonist group showed a high treatment failure rate, mainly due to flutamide‐induced diarrhea and hepatotoxicity. Our current study was conducted to determine the optimal dose of flutamide for use in this type of Combination therapy.Methods:In a randomized, multicenter study, 30 patients (hormone untreated; stage C or D) were divided into 2 groups: flutamide 250mg (125mg × 2; 14 patients) and flutamide 375mg (125mg × 3; 16 patients), and each dose combined with either goserelin acetate (3.6 mg every 4 weeks) or leuprolide acetate (3.75 mg every 4 weeks). Goserelin and leuprolide were administered to patients in a 1:1 ratio. Flutamide monotherapy at a daily dose of 375 mg was determined to be the optimal dose in Japan in our previous phase II study. The endpoints of this pilot study were the objective response and adverse events during the 12‐week treatment.Results:The objective response rate was 83.3% in the flutamide 250mg group and 85.7% in the flutamide 375 mg group according to the Japanese response criteria for prostate cancer. Elevated PSA levels fell to within the normal range in 83.3% of the patients in the former group and in 93.3% of the patients in the latter group. One patient administered 250 mg of flutamide experienced diarrhea, while the serum GOT and/or GPT were elevated in 3 patients administered 250 mg of flutamide and 4 patients administered 375 mg of flutamide.Conclusions:Based on the findings of this pilot study of maximal androgen‐depletion therapy for advanced prostate cancer, 375mg/day of flutamide is recommended in combination with an LH‐RH agonist. Assessment of the effects of our recommended regimen on longer term survival, quality of life and antiandrogen withdrawal syndrome of patients treated requires additional patients and time fo

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00578.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY