Biomedical subjects

Akira Fujito

Publications and source records attributed to Akira Fujito.

12 recordsLinked to original sources

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

[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↗

PubMed2004

Hand-assisted retroperitoneoscopic radical nephrectomy and nephroureterectomy.

In laparoscopic operations for renal tumor and upper urinary-tract transitional-cell carcinoma (TCC), three approaches - the transperitoneal, retroperitoneal, and transperitoneal hand-assisted - have been reported. We have performed hand-assisted retroperitoneoscopic radical nephrectomy (RN) since 1999 and nephroureterectomy (NU) since 2000. The surgical techniques and the operative results of 95 cases of RN and 54 cases of NU are described and analyzed. These procedures were effective and safe for renal tumors and upper urinary-tract TCC.

Carcinoma, Transitional Cell↗

PubMed2004

Retroperitoneoscopic heminephroureterectomy for children with duplex anomaly: Initial experience.

OBJECTIVES: To evaluate the feasibility of retroperitoneoscopic heminephroureterectomy for children with duplex anomaly. METHODS: Retroperitoneoscopic heminephroureterectomy was performed in five children (four girls and one boy) with complete duplication of the ureter, of whom four (age range 1-5 years; mean age 3.3 years) had upper pole ectopic megaureters and one (3 years old) had an upper pole megaureter with ureterocele. In the patient with ureterocele, distal ureterectomy and ureterocelectomy were performed by Pfannenstiel incision. RESULTS: The mean operation time was 346 min (range 270-450 min) in the four patients with ectopic megaureter and 420 min (330 min for heminephroureterectomy) in the patient with ureterocele. The mean estimated blood loss was 43 mL (range 5-100 mL) in the four patients with ectopic megaureter and 40 mL in the patient with ureterocele. No postoperative complications were observed. Postoperative intravenous pyelography showed normal pyelogram and renal function of the preserved lower pole in all cases. CONCLUSIONS: Retroperitoneoscopic heminephroureterectomy for children is feasible, safe and has good postoperative results, including cosmetic results. However, the operation time needs to be reduced.

Child, Preschool↗

PubMed2004

Radio-frequency ablation of renal cell carcinoma in patients who were at significant risk.

OBJECTIVE: Although radio-frequency ablation (RFA) has been recently applied as a minimally invasive treatment option for renal cell carcinoma (RCC), indication of this modality remains a critical issue due to the lack of complete tumor destruction as well as the uncertainty of its long-term efficacy. We report the efficacy of RFA for nine carefully selected patients with RCC who had significant reason to avoid invasive surgical treatment under general anesthesia. METHODS: Radio-frequency ablation was performed under epidural or local anesthesia by ultrasound or computed tomography (CT) guidance in nine patients with biopsy proven RCC (mean diameter, 38 mm; range, 20-53 mm), who were at significant operative or anesthetic risk for invasive surgery. Follow-up enhanced CT scans or magnetic resonance images were evaluated every 3-6 months and an evaluation of metastasis was performed every 6 months. RESULTS: At a mean follow-up of 17 months, seven (78%) of the nine patients with renal tumor showed no tumor enhancement. The renal function of all patients was well preserved. All patients were able to continue undergoing their respective treatments for active diseases in other organs in parallel to the RFA treatment. No distant metastasis, urine leakage were reported and one case of temporary hematuria and one case of peri-renal hemorrhage not requiring blood transfusion were encountered. Intra-operative ultrasonography was useful in the real-time monitoring of the minimally excessive extension of ablation into the normal parenchyma. CONCLUSION: Radio-frequency ablation appears to be an effective and safe minimally invasive therapeutic option for selected patients with RCC who have reason to avoid invasive surgery under general anesthesia.

Aged↗

PubMed2003

Preliminary report of association of chronic diseases and erectile dysfunction in middle-aged men in Japan.

OBJECTIVES: To investigate the effect of chronic diseases on erectile dysfunction (ED) in Japanese middle-aged men using the International Index of Erectile Function, 5-item version (IIEF-5). METHODS: The subjects consisted of 640 healthy men and 396 men with chronic disease who responded to the IIEF-5 questionnaire (mean age 43.6 +/- 8.3 years, range 30 to 59). The incidence and severity of ED were calculated in three age groups (30 to 39, 40 to 49, and 50 to 59 years). RESULTS: The incidence of hypertension, cardiac disease, diabetes mellitus, and chronic renal failure was associated with the incidence and severity of ED, as was age. In stepwise multivariate logistic regression analysis, cardiac disease was the strongest independent risk factor (odds ratio [OR] 6.5), followed by diabetes mellitus (OR 5.9), chronic renal failure (OR 3.9), hypertension (OR 2.0), and age (OR 1.8). CONCLUSIONS: The results of this study demonstrated that the risk of ED increases with the presence of cardiac disease, diabetes mellitus, chronic renal failure, and hypertension in middle-aged men in Japan.

Adult↗

PubMed2003

Significant antitumor effect of intratumoral ethanol injection on renal cell carcinoma.

OBJECTIVE: The effects of intratumoral ethanol injection on renal cell carcinoma (RCC) heterotransplanted in nude rats were evaluated. MATERIALS AND METHODS: The OUR95AF human RCC cell line was inoculated subcutaneously into the backs of nude rats. Four weeks after transplantation, the size of tumors became 1.5-2.0 cm in maximal length, and 95% ethanol was injected intratumorally once a week for five weeks. The effectiveness of this treatment was evaluated by measurement of tumor volume, magnetic resonance (MR) imaging using Gadopentetate-diethylenetriaminepentaacetic acid (Gd-DTPA) and histological examinations. RESULTS: In the ethanol injected group, no increase in tumor volume was recognized. The growth of the tumors was significantly suppressed after the third injection. Non-enhanced parts in MR imaging were observed in the central region of the tumors at the second injection, and increased at the third injection. After the fifth injection, only small parts of non-enhanced regions remained. Degenerative necrosis was histologically found in the non-enhanced parts of the MR image. The signal to noise ratio (SNR) and the contrast to noise ratio (CNR) calculated from T1 weighted imaging using Gd-DTPA, and relative enhancement (RE) were thought to be good parameters for evaluating the effect of ethanol injections. CONCLUSION: Intratumoral ethanol injection was very effective against RCC. Five weekly injections of ethanol induced necrosis of the tumor. MR imaging using Gd-DTPA may be a useful method for evaluating the effect of ethanol injection.

Animals↗

PubMed2003

Laparoscopic correction of vesicoureteral reflux using the Lich-Gregoir technique: initial experience and technical aspects.

We report two female cases with vesicoureteral reflux (VUR) who underwent laparoscopic correction of VUR by the Lich-Gregoir technique. One patient was 10 years of age, with international grade III reflux of the left ureter; the other was 27 years of age, with grade II reflux of the right ureter. The respective operating times were 6 h 40 min and 6 h 10 min. There were no complications during surgery. Although post-surgical ultrasonography revealed mild hydronephrosis in the adult patient, the condition resolved spontaneously 2 months after surgery. The disappearance of reflux was confirmed in both cases by voiding cystography 6 months after surgery.

Adult↗

PubMed2003

Hand assisted retroperitoneoscopic nephroureterectomy: comparison with the open procedure.

PURPOSE: We report our initial experience with hand assisted retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma and compared our results to those of a contemporary series of open nephroureterectomy. MATERIALS AND METHODS: Clinical data on 34 consecutive patients who underwent hand assisted retroperitoneoscopic nephroureterectomy were reviewed and compared with those on 34 who underwent open nephroureterectomy. All specimens were extracted intact. RESULTS: Total operative time was similar in the 2 groups (233 versus 236 minutes). Estimated blood loss was significantly less in the hand assisted laparoscopy group (236 versus 427 ml.). During convalescence the frequency of parenteral analgesia postoperatively was significantly lower in the laparoscopy group than in the open surgery group. The former patients had a significantly shorter interval to oral intake and ambulation as well as a shorter hospital stay and convalescence compared with those who underwent open surgery. In each group the complication rate was 12% (4 of 34 cases). In the hand assisted laparoscopy group 1 conversion to an open procedure was due to bleeding. There was recurrence in 4 of the 34 patients (12%) in the laparoscopy group, including 2 with bladder recurrence and 2 with metastases, at an average followup of 13.1 months. CONCLUSIONS: Hand assisted retroperitoneoscopic nephroureterectomy is an effective and safe alternative to open nephroureterectomy for upper urinary tract transitional cell carcinoma.

Adult↗

PubMed2002

Clinical utility of ursodeoxycholic acid in preventing flutamide-induced hepatopathy in patients with prostate cancer: a preliminary study.

BACKGROUND: The present study was designed to ascertain retrospectively the validity of ursodeoxycholic acid (UDCA) in the treatment of prostate cancer in terms of prophylactic effects on the occurrence of flutamide-induced hepatopathy in a large number of patients surveyed in a multi-center cooperative study. METHODS: One hundred and eighty-one patients (74.1 +/- 4.9 years) with prostate cancer treated with flutamide with (n = 70) or without (n = 111) UDCA were retrospectively evaluated and the occurrence of hepatopathy was compared between these two patient groups. RESULTS: Between patients treated with UDCA and those without it, no significant differences were noted in age, clinical stage, grade, duration of flutamide administration and serum prostate-specific antigen (PSA) levels before treatment. However, there were significant differences in the presence or absence of previous treatments and treatments used together with flutamide. The incidence of hepatopathy was 11.4% (8/70) in patients with UDCA and 32.4% (36/111) in those without it, showing a statistically significant difference (P < 0.05). The hepatopathy-free rate obtained by the Kaplan-Meier method was also significantly higher in patients with UDCA (88.4% 1 year following flutamide administration) than that in those without it (59.6%) (P < 0.005). CONCLUSION: These results suggest that UDCA has a prophylactic effect against flutamide-induced hepatopathy in patients with prostate cancer.

Aged↗

PubMed2002

Hand-assisted retroperitoneoscopic radical nephrectomy: initial experience.

OBJECTIVES: To report our initial experience of hand-assisted retroperitoneoscopic radical nephrectomy for stage T1 renal tumors. METHODS: The clinical data on 22 consecutive patients who had undergone hand-assisted retroperitoneoscopic radical nephrectomy and 22 who had undergone open radical nephrectomy were reviewed. The operation was performed with a hand placed retroperitoneally through a pararectal longitudal 7-7.5 cm incision using a LAP DISC. RESULTS: The total operating time was between 2.3 and 5.8 h (mean: 3.4 h). The estimated blood loss was between 15 and 650 mL (mean: 170 mL). The complication rate was 9% (2/22). No conversions to open procedure occurred. In comparison to open radical nephrectomy, the operating time was similar (3.4 vs 3.9 h) whereas the estimated blood loss was significantly less in this procedure (170 vs 495 mL). During the convalescence period the patients revealed significantly less postoperative pain, shorter intervals to resuming oral intake and more rapid return to normal activities compared to the open radical nephrectomy patients. CONCLUSION: Hand-assisted retroperitoneoscopic radical nephrectomy is an effective and safe procedure for T1 renal tumors.

Adult↗