Biomedical subjects

Akihiro Kawauchi

Publications and source records attributed to Akihiro Kawauchi.

At least 19 recordsLinked to original sources

PubMed2006

The significance of the expression of dihydropyrimidine dehydrogenase in prostate cancer.

OBJECTIVE: To measure dihydropyrimidine dehydrogenase (DPD), an enzyme involved in the metabolism of 5-fluorouracil (5-FU), expression in prostate cancer and determine whether 5-chloro-2,4-dihydroxypyridine (CDHP), a potent inhibitor of DPD, enhances the antitumoral activity of 5-FU against prostate cancer. PATIENTS, MATERIALS AND METHODS: In all, 44 prostate tissue specimens were obtained from men who had a radical prostatectomy alone for prostate cancer, and 38 specimens from men who had had neoadjuvant hormonal therapy. We analysed the cancerous tissue and normal prostate tissue for DPD expression using immunohistochemistry, and determined its prognostic significance. In cultured human prostate cancer lines (DU145 and LNCaP), we compared the cytotoxicity of 5-FU/CDHP with that of 5-FU alone. Finally, in experiments on immunodeficient mice, we studied the effect of oral administration of tegafur, a pro-drug for 5-FU, with or without CDHP on the growth of tumours introduced by injection of DU145 cells. RESULTS: The expression of DPD was significantly higher in cancerous than normal prostate tissue; 36 of 44 (82%) specimens of prostate cancer expressed DPD, whereas only 25 of 44 (57%) specimens of normal prostate tissue expressed DPD. For men with prostate cancer who had radical prostatectomy alone, men with negative DPD expression tended to have a longer recurrence-free survival than those with positive expression; there were no recurrences in men with prostate cancer and negative DPD expression in the 5-year follow-up. DPD expression was significantly lower in men with prostate cancer who received neoadjuvant hormonal therapy. In vitro treatment of human prostate cancer cell lines with 5-FU/CDHP showed more cytotoxicity than with 5-FU treatment alone. Finally, DU145 tumours in mice treated with tegafur and CDHP were significantly smaller than in mice given tegafur alone. CONCLUSION: The present study showed that DPD expression is elevated in prostate cancer, and indicate that DPD inhibitors might enhance the antitumour activity of 5-FU against prostate cancer.

Aged↗

PubMed2006

[Sexual precocity].

Explore the source record for details and available documents.

Androgen Antagonists↗

PubMed2006

Visual analog scale questionnaire to assess quality of life specific to each symptom of the International Prostate Symptom Score.

PURPOSE: We assessed patient quality of life specific to each of the 7 items on the International Prostate Symptom Score, as evaluated with a novel visual analog scale questionnaire. MATERIALS AND METHODS: A total of 246 male patients with a chief complaint of lower urinary tract symptom were asked to complete the International Prostate Symptom Score and visual analog scale questionnaires to assess bother or satisfaction regarding patient quality of life specific to each of the 7 items on the International Prostate Symptom Score. RESULTS: An item with the maximum visual analog scale measure matched the chief complaint in 169 patients (69%). In contrast, the chief complaint failed to match to an item with the most severe International Prostate Symptom Score in 104 patients (42%) (p = 0.012). Multiple regression analysis to define the best predictor of International Prostate Symptom Score quality of life score of the 14 items, including International Prostate Symptom Score and visual analog scale, revealed that the best predictor was the visual analog scale measure for nocturia (p = 0.0003), followed by visual analog scale measures for frequency (p = 0.0004) and incomplete emptying (p = 0.01). After alpha-blocker treatment improvement in the visual analog scale measure for the chief complaint correlated better with improvement in the International Prostate Symptom Score quality of life score than the change in International Prostate Symptom Score. The overall test-retest correlation for the visual analog scale questionnaire in 55 healthy elderly men and 44 patients with lower urinary tract symptoms was 0.772 and 0.742, respectively (p <0.00001). CONCLUSIONS: The novel visual analog scale measure of quality of life specific to each of the 7 items on the International Prostate Symptom Score has a significant impact on identifying the patient chief complaint as well as on patient specific quality of life. Our study supports the concomitant use of the International Prostate Symptom Score and visual analog scale questionnaires.

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PubMed2006

Running suture for vesicourethral anastomosis in minilaparotomy radical retropubic prostatectomy.

INTRODUCTION: We used a running suture method for vesicourethral anastomosis in patients undergoing minilaparotomy radical retropubic prostatectomy. TECHNICAL CONSIDERATIONS: The vesicourethral anastomosis using a single knot at the 6:30-o'clock position is created with two steps of semicircular running suture. A total of 21 consecutive patients underwent this running suture method using the Endostitch in the hands of a single surgeon (T.M.) between March and November 2004. The running suture procedure was completed in 15 minutes on average. After surgery, no urinary leakage at the anastomotic site was found. Satisfactory continence was achieved in the short term in 100% (0 to 1 pad per day) of cases. However, dilation at the anastomosis using a metal dilator was required in 2 patients immediately after surgery. CONCLUSIONS: The running suture method is considered a feasible alternative in minilaparotomy radical retropubic prostatectomy.

Anastomosis, Surgical↗

PubMed2006

Complexed PSA improves prostate cancer detection: results from a multicenter Japanese clinical trial.

OBJECTIVES: To compare the distribution of total and complexed prostate-specific antigen (cPSA) in men with and without prostate cancer with another studied population and to ascertain whether cPSA could enhance the detection of prostate cancer in Japanese men. METHODS: A total of 760 men whose serum total PSA (tPSA) values ranged from 1.0 to 100 ng/mL were enrolled. Serum samples for tPSA and cPSA (ADVIA Centaur) were obtained in all cases. The area under the curve was calculated for comparison of the tPSA and cPSA values. We calculated the number of cancers missed and false-positive results at various cutoff values of cPSA compared with the conventional tPSA threshold of 4.0 ng/mL. RESULTS: Prostate cancer was detected in 268 (35.3%) of 760 patients. cPSA was greater than 8.3 ng/mL (equivalent to 10.0 ng/mL tPSA) in 46.6% of the men with cancer. The area under the curve for cPSA (0.741) was significantly better than that for tPSA (0.721, P <0.001). At a sensitivity of 85% to 95%, significant differences were found in the corresponding specificity between tPSA and cPSA. cPSA at a 3.0-ng/mL threshold detected an identical number of cancers as a tPSA cutoff of 4.0 ng/mL; however, it decreased the false-positive results by 28 cases. CONCLUSIONS: To our knowledge, this is the first report of the distribution of cPSA in Japanese men using a urologic referral population. cPSA can be an alternative to tPSA as the first screening test. A substantial number of men in Japan with prostate cancer are currently diagnosed with a tPSA value greater than 10.0 ng/mL.

Aged↗

PubMed2006

Partial androgen insensitivity syndrome with thermolability in the androgen receptor.

We report case of partial androgen insensitivity syndrome in a 12-year-old boy referred to our clinic complaining of bilateral gynecomastia and left undescended testicle. Laparoscopy for undescended testicle and bilateral mastectomy were performed, and the left testicle was absent. When skin fibroblasts of the scrotum obtained during surgery were cultured to analyse the androgen receptors, a slight thermolability was observed. Genomic examination of the androgen receptor gene could not detect any mutations.

Androgen-Insensitivity Syndrome↗

PubMed2006

Significant relationship of time-dependent uroflowmetric parameters to lower urinary tract symptoms as measured by the International Prostate Symptom Score.

AIMS: The aim of the present paper is to elucidate the possible involvement of time-dependent parameters as obtained by uroflowmetry in the manifestation of lower urinary tract symptoms (LUTS) in elderly patients. METHODS: Using simple and multiple regression analyses, the correlation of the International Prostate Symptom Score (IPSS) with objective parameters including age, postvoid residual, uroflowmetry and transrectal ultrasonic measurements of the prostate was analyzed in 206 male patients (average age of 68.0 +/- 7.4 years) who visited our outpatient clinic complaining of LUTS. RESULTS: In the 206 patients, the mean maximum flow rate was 12.2 mL/s (13.7 mL/s in mild, 11.9 mL/s in moderate, and 11.2 mL/s in severe IPSS total score) and average flow rate was 4.4 mL/s (5.4 mL/s in mild, 4.3 mL/s in moderate, and 3.5 mL/s in severe IPSS total score). Simple regression analyses demonstrated that age, voiding time, and average and maximum flow rates correlate significantly with symptom scores. In particular, relatively strong relationships were found between average flow rate and scores of intermittency, weak stream and total and voiding symptoms scores. Serum prostate specific antigen level, postvoid residual and prostatic ultrasonic measurements did not show a significant correlation with symptom scores. Multiple regression analyses revealed age and average flow rate to be independent determinants for symptom scores. These results suggest that the time-dependent function in micturition interferes in the manifestation of LUTS in elderly men who have borderline or pathologic maximum flow rate. When evaluating uro flowmetry in elderly male patients with LUTS, attention should be paid to time-dependent parameters such as voiding time and average flow rate.

Aged↗

PubMed2006

Gene therapy with TRAIL against renal cell carcinoma.

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) induces apoptosis in cancer cells. However, TRAIL is not toxic against most normal cells. We have accordingly examined by in vivo electroporation whether TRAIL induces apoptosis in renal cell carcinoma. In addition, combination treatment with TRAIL and 5-fluorouracil (5-FU) against renal cell carcinoma was also investigated. The NC65 renal cell carcinoma line was used as a target. pCAGGS TRAIL was injected into the NC65 tumors in the right flanks of severe combined immunodeficient mice. Tumors were pulsed with the CUY21 electroporator. Electroporation was done once on day 0 or thrice on days 0, 2, and 4. Apoptosis was determined by terminal deoxyribonucleotide transferase-mediated nick-end labeling assay. When TRAIL gene therapy using in vivo i.t. electroporation was done once only, the growth of NC65 tumors was not inhibited. However, when TRAIL gene therapy was done thrice, growth suppression of the NC65 tumors was observed. Transfection of the TRAIL gene by in vivo electroporation induced apoptosis in NC65 tumors. When NC65 cells were treated with TRAIL gene therapy in combination with 5-FU, stronger growth suppression was obtained. TRAIL gene therapy did not induce liver dysfunction in severe combined immunodeficient mice. This study shows that TRAIL gene therapy induced growth suppression and apoptosis in NC65 tumors without severe side effects, and that combination treatment of NC65 cells with TRAIL gene therapy and 5-FU resulted in higher antitumor activity. These findings suggest that TRAIL gene therapy and/or 5-FU may be effective against renal cell carcinoma without harmful toxic effects.

Animals↗

PubMed2006

[Progress in therapy for testicular tumors].

Approximately 80% of patients with metastatic testicular tumors are cured by cisplatin-containing chemotherapy and surgery. However, the remaining 20% of patients with advanced testicular tumors can not be cured at present. Thus, therapy for these testicular tumors infractory to treatment is the most important issue. Recently, chemotherapy for such tumors is developing, especially salvage chemotherapy using novel anticancer agents(paclitaxel, gemcitabine,irinotecan, docetaxel, oxaliplatin, etc) and high-dose anticancer drugs. Some of the new modalities are very attractive. In this article, we reviewed mainly these new forms of chemotherapy for testicular tumors.

Antineoplastic Agents↗

PubMed2006

[Salvage chemotherapy with paclitaxel, ifosphamide and nedaplatin for relapsed or refractory germ cell cancer].

PURPOSE: Only 20-30% of patients with cisplatin refractory or relapsed germ cell cancer will remain continuously disease free with salvage chemotherapy. Paclitaxel is a potent anticancer agent against a variety of solid cancers. The present study investigated the chemotherapy with paclitaxel in combination with nedaplatin, which is a derivative of cisplatin, and ifosphamide as salvage chemotherapy for cisplatin refractory germ cell cancer. MATERIAL AND METHODS: The combination chemotherapy consisted of paclitaxel 210 mg/m2 on day 1, nedaplatin 100 mg/m2 on day 2 and ifosphamide 1.2 g/m2 on day 2-day 6 every three weeks. Fourteen patients with cisplatin refractory germ cell cancer, ranging in age from 17 to 44 years were enrolled onto the study. RESULTS: Fourteen patients were evaluated for response and toxicity. Patients received 1-14 cycles of the combination chemotherapy. The median duration of follow-up was 34 months (10-64 months). Response rate was 57.1% (CR / PR(m-):8 cases, NC:5 cases, PD:1 cases). Seven patients remain alive without disease. However, 5 patients died of the disease. All patients had grade 3 or 4 hematological toxicity. CONCLUSION: This study demonstrates that the chemotherapy with paclitaxel in combination with nedaplatin and ifosphamide showed a significant anticancer activity for patients with cisplatin refractory or relapsed germ cell cancer. These findings suggest that the combination chemotherapy may be one of the options of salvage chemotherapy for cisplatin refractory or relapsed germ cell cancer.

Adolescent↗

PubMed2006

Four-dimensional ultrasonography for dynamic bladder shape visualization and analysis during voiding.

OBJECTIVE: The purpose of this study was to describe initial applications of 4-dimensional ultrasonography (4DUS) for visualizing dynamic change in 3-dimensional (3D) bladder shape as well as for analyzing intravesical volume and diameters during voiding. METHODS: In 15 healthy volunteers and 5 patients with lower urinary tract symptoms, 4DUS images of the bladder during voiding were obtained by transabdominal 4DUS and compared with the outcome of uroflowmetry. Changes of intravesical volume as well as diameters in axial, coronal, and sagittal planes were measured and analyzed in comparison with uroflow data. RESULTS: Dynamic 3D visualization of the bladder shape was feasible in all 20 men. Multiplanar display of 4DUS showed dynamic 3D images of the bladder during voiding to be simultaneously visualized in the axial, coronal, and sagittal planes. The change and decrease rate in intravesical volume calculated by 4DUS data had significant correlation with the average flow rate (P = .02) and the maximum flow rate (P = .04), respectively. Among the 3 diameters, the change of coronal diameter was significantly most correlated with change of the intravesical volume (P < .0001). The change in coronal diameter, which was observed in patients with urinary disturbance, had a significant difference compared with those observed in control subjects (P = .01). CONCLUSIONS: Monitoring of voiding with 4DUS was feasible in healthy men and patients with lower urinary tract symptoms. Four-dimensional ultrasonography has the potential to be a novel noninvasive urodynamic modality to visualize dynamically the lower urinary tract during voiding and to improve pathophysiologic understanding of voiding.

Adult↗

PubMed2006

[Epidemiological survey of sexually transmitted male urethritis in Kyoto Prefecture].

The data of sexually transmitted urethritis in males have been collected at 24 institutes in Kyoto Prefecture since October, 2002. The data collected from January to December in 2004 are summarized herein. A total of 1,275 patients were diagnosed with urethritis during this period. Microbiological examinations isolated Neisseria gonorrhoeae alone in 368 (29%), Chlamydia tracomatis alone in 336 (26%), both in 85 (7%), and others in 453 (36%). Male patients under 20 years old tended to have Chlamydial urethritis, alone or combined with gonococcal infection, and had a predominant infectious source, a non-commercial-sexual-worker female partner, suggesting a profound problem in sexual life of adolescents. The urologist preferred to use quinolones as the first therapeutic modality against male urethritis. However, drug resistance of N. gonorrhoeae, especially against quinolones, has rapidly progressed, which was also observed by a sensitivity examination test. Antibiotics should be used adequately against male urethrits according to the recent guidelines.

Adolescent↗

PubMed2005

Combination therapy with alarm and drugs for monosymptomatic nocturnal enuresis not superior to alarm monotherapy.

OBJECTIVES: To evaluate the effectiveness of alarm-based combination therapy using desmopressin and imipramine for primary monosymptomatic nocturnal enuresis. METHODS: Of the 105 patients, 37 were treated with alarm monotherapy (monotherapy group), 35 were treated with desmopressin combined with an alarm (desmopressin group), and 33 were treated with imipramine combined with an alarm (imipramine group). The therapeutic effects were evaluated at 3 and 6 months. The relapse rates and predictive factors of the therapies were also studied. RESULTS: No significant differences were found in the changes in the frequency of wet nights among the three groups, although the frequencies in all three groups decreased significantly with the therapeutic duration. Although the improvement rates at 3 months did not differ among the three groups, the improvement rate of 80% in the desmopressin group and 79% in the imipramine group at 6 months were greater than the 59% rate in the monotherapy group. After cure, no patients relapsed in the monotherapy group, and 3 (43%) each did so in the desmopressin and imipramine groups. In comparing the improved cases in each group, no significant differences were found in background factors. CONCLUSIONS: Desmopressin and imipramine combined with an alarm was no more effective than alarm monotherapy. As for alarm monotherapy, other therapeutic modalities should be considered if it has not proved effective after 3 months. In such a situation, combination therapy may be effective as a second choice. No predictive factors for the therapeutic effects in the three modalities were found.

Adolescent↗

PubMed2005

Laparoscopic pyeloplasty and isthmectomy for hydronephrosis of horseshoe kidney: a pediatric case.

A 4-year-old boy suffering from hydronephrosis of a horseshoe kidney underwent laparoscopic pyeloplasty with isthmectomy. Pyeloplasty was performed by the transposition of crossing vessels and the Anderson-Hynes method. In isthmectomy, Ligasure was used for transection of the isthmus. The surgery time was 310 minutes, the estimated blood loss was 10 mL, and the patient required no analgesia postoperatively. Convalescence was complete within 14 days. The follow-up diuretic renal scan showed prompt emptying of the radioisotope from the left collecting system, with a T1/2 of 12 minutes.

Anastomosis, Surgical↗

PubMed2005

Learning curve of hand-assisted retroperitoneoscopic nephrectomy in less-experienced laparoscopic surgeons.

AIM: To evaluate the learning curve of hand-assisted retroperitoneoscopic nephrectomy (HALS) performed by less-experienced surgeons. METHODS: The operative records of 166 patients, including 103 with renal tumors and 63 with renal pelvic or ureteral tumors, who underwent HALS performed by 18 less-experienced urologists were reviewed. RESULTS: The insufflation time in the first four cases was significantly longer than that in the sixteenth and later cases. The insufflation time in cases 5-10 was 14-24 min longer than that in the cases 16 onward, although the differences were not significant. The estimated blood loss did not differ in each group of cases. The complication rate in early cases, in which the operators' experience was five cases or less, was 6% (4/71), while that in later cases was also 7% (7/95). In the analysis of the learning curve of a single surgeon who performed 57 procedures, the insufflation time in cases 1-5 was significantly longer than in cases 41-57. The insufflation times in cases 5-10 were 45 min longer than those in cases 41-57, although the difference was not significant. The estimated blood loss did not differ in each group of cases. Complications did not seem related to operation experience. CONCLUSION: In HALS, 5-10 cases were necessary for less-experienced urologists to gain average operating skills for this procedure. It may be reasonable for less-experienced surgeons to begin standard laparoscopic procedures after experiencing 10 cases of the present procedure.

Adult↗

PubMed2005

Clinical characteristics of prostate cancer in Japanese men in the eras before and after serum prostate-specific antigen testing.

BACKGROUND: We retrospectively reviewed a large series of Japanese men with histologically proven prostate cancer to assess the clinical characteristics of the cancer in three different eras of prostate cancer management since prostate-specific antigen (PSA) testing started in 1988. METHODS: The medical records of 1125 patients treated between 1975 and 2002 were reviewed with respect to age, chief complaints, clinical stage, tumor grade, treatment options at each stage, and prognosis. We classified the patients as follows: those treated in the pre-PSA era between 1975 and 1988 (n=182), those treated in the PSA era between 1988 and 1997 (n=301; PSA era phase 1) and the PSA era between 1998 and 2002 (n=642; PSA era phase 2). RESULTS: Compared with the pre-PSA era, there were significant increases in the proportion of well-differentiated adenocarcinoma with respect to the biopsy tumor grade (24 vs 35%, P<0.01), in the proportion of linically organ-confined disease (21 vs 43%, P<0.001), and in the proportion of patients who underwent radical prostatectomy (13%vs 20%, P<0.01) after PSA testing was introduced. In addition, there was a significant difference in the proportion of subjects who were 70--79 years of age between the pre-PSA era (52%, 95/182) and the PSA era phase 2 (42%, 270/642, P<0.05). There was also a significant difference in the proportion of patients who underwent surgical castration between the pre-PSA era (78%) and PSA era phase 2 (10%, P<0.001). The proportion of patients participating in prostate cancer screening increased from 3% (pre-PSA era) to 11% (PSA era phase 1 and PSA era phase 2, P<0.05). In all clinical stages, there were significant differences between the pre- and post-PSA eras in cause-specific survival rates (5-year: 74 vs 94% in stages A and B, P<0.01; 54 vs 89% in stage C, P<0.001; 32 vs 53% in stage D, P<0.001). CONCLUSIONS: Migrations in the age of patients (toward younger patients), the stage of the cancer (towards earlier stages) and the histological findings (toward favorable findings), in addition to changes in treatment options, have contributed to the prolonged survival of Japanese men with prostate cancer after the PSA testing was introduced.

Aged↗

PubMed2005

Preoperative administration of chlormadinone acetate reduces blood loss associated with transurethral resection of the prostate: a prospective randomized study.

OBJECTIVES: To assess the effects of giving chlormadinone acetate (CMA) before surgery on blood loss associated with transurethral resection of the prostate (TURP), in a prospective randomized controlled study. PATIENTS AND METHODS: Candidates for TURP among patients with benign prostatic hyperplasia were randomized to either treatment with CMA (CMA+) or not (CMA-). In principle, CMA was started at least 28 days before TURP and continued until just before surgery. RESULTS: In all, 33 patients in the CMA+ (median duration of treatment 34.5 days) and 38 in the CMA- group were evaluable. The mean blood loss during TURP was less in the CMA+ (237.3 mL) than in the CMA- group (263.1 mL), but the difference was not significant. There was significantly less blood loss per gram of resected prostate tissue in the CMA+ (9.6 mL/g) than in the CMA- group (13.3 mL/g) (P < 0.05). Haematuria on the day of and the day after TURP was also significantly less severe in the CMA+ than in the CMA- group (P < 0.001 and P < 0.05, respectively). The mean microvessel density of resected prostate tissue was significantly less after CMA treatment (P < 0.001). CONCLUSIONS: CMA given for 1 month before TURP could reduce blood loss to some extent during and after TURP, and this may be related to a decrease in microvessel density.

Aged↗

PubMed2005

[Radio-frequency ablation of T1a renal cell carcinoma].

We report the efficacy of radio-frequency ablation (RFA) for T1a renal cell carcinoma (RCC). RFA was performed under epidural or local anesthesia by ultrasound or computed tomography (CT) guidance in seven patients with Tla RCC, who were at significant operative or anesthetic risk for invasive surgery. At a median follow-up of 17.5 months, 6 (86%) of the seven patients showed no tumor enhancement in follow-up CT scans or magnetic resonance images. Temporary macroscopic hematuria was observed in one case. RFA is an effective and safe minimally invasive therapeutic option for selected patients with RCC who have reason to avoid invasive surgery under general anesthesia.

Aged↗