Biomedical subjects
Publications and source records attributed to E Nishikawa.
Baroreceptor sensitivity and carotid sinus distensibility were lower in patients with angina associated with significant coronary artery disease than in patients with vasospastic angina. Baroreceptor sensitivity was significantly correlated with carotid sinus distensibility in both groups of patients.
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 (> or = 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 10.8 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 150 ng/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 cancer patients.
The effectiveness of exercise training in patients with silent myocardial ischemia was examined. Forty patients with coronary heart disease (mean age 55 +/- 8 years) were recruited for a 12-week exercise training program. All patients underwent treadmill exercise stress testing, exercise thallium-201 single photon emission computed tomography and left heart catheterization. They were divided into three groups based on the symptoms and the results of exercise thallium scintigraphy, i.e., painful myocardial ischemia (PMI group), silent myocardial ischemia (SMI group), and non-myocardial ischemia (NMI group). Normalized treadmill time was longer in the SMI group (108 +/- 24%) than in the PMI group (86 +/- 14%, p < 0.05). All 40 patients, 14 from the PMI group, 16 from the SMI group and 10 from the NMI group, completed the whole exercise training program. A significant prolongation of treadmill time was attained in all three groups after exercise training [PMI group: from 494 +/- 105 to 632 +/- 78 sec (p < 0.05), SMI group: from 609 +/- 147 to 746 +/- 137 sec (p < 0.05), NMI group: from 572 +/- 112 to 739 +/- 13 sec (p < 0.05)]. The improvement of myocardial ischemia following exercise training was similar in the SMI and PMI groups. No adverse effects were detected throughout the program. The exercise training program adopted in this study proved safe and effective in patients with silent myocardial ischemia.
The blood flow in tumors of three patients with lung cancer, cancer in oral cavity and metastatic lymphnode was respectively evaluated before and after irradiation with color Doppler flow imaging. The arterial pulsating flow in lung cancer disappeared after 30 Gy irradiation and that in cancer of oral cavity disappeared after 15 Gy irradiation with intraarterial infusion chemotherapy. But the arterial pulsating flow in metastatic lymphnode was detected during irradiation and disappeared after 40 days post- irradiation. Therefore color Doppler flow imaging seemed to be useful for evaluation of the blood flow in tumors before and after irradiation.
Experimental and clinical studies were done on intracavitary and interstitial hyperthermia with a 2 mm diameter applicator with a 7 cm tip (Aloka, Co., Ltd.). Microwave energy at 2450 MHz was used to heat tumors. An outer cannula of 16G Medicut was implanted in the tumor. When a rabbit VX-2 tumor was heated, the temperature reached over 40 degrees C at 15 watts. We applied the same method to two patients, one with recurrent oropharyngeal tumor and the other with recurrent pelvic tumor. This applicator looks promising.
A Dornier MFL 5000, a new generation extracorporeal shock wave lithotripter, was installed in our hospital and the first Japanese clinical experience has been collected between July and November in 1989. We report our experience with the first 35 patients with 45 stones who were treated in 42 treatments using ESWL. We followed up 3 weeks. No invasive anesthesia was performed except 2 cases of epidural anesthesia. A double J catheter was installed in 2 patients, a ureteral catheter in 4 patients, and PNL was performed in 2 patients before ESWL. We did not use a PNL or a TUL in the postoperative treatment. In the 3 week followed up period, 29 patients (82.9%) were completely free from stone fragments. No serious complications were observed after ESWL. We conclude that the DORNIER MFL 5000 is effective for renal and ureteral stones without serious complications.
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A total of 518 bacterial strains isolated from the urine of patients with various urological diseases in our Urological Department between November, 1987 and February, 1989 were studied for their beta-lactamase production and susceptibility to various antimicrobial agents was determined. beta-lactamase activity was determined by the acidometry disc method. There were 241 gram-positive cocci, 276 of gram-negative rods and 1 Neisseria gonorrhoeae. Thirty-four percent of the gram positive and 76.3% of gram negative rods produced beta-lactamase. S. aureus (81.3%), S. epidermidis (65.1%) in gram-positive cocci, E. cloacae (100%), S. marcescens (100%), C. freundii (100%), P. aeruginosa (97.2%), P. Rettgeri (88.9%), E. gergoviae (85.7%), K. oxytoca (84.6%), M. morganii (81.8%) and E. coli (69.0%) in gram-negative rods produced beta-lactamase at a higher rate. beta-lactamase produced by gram-positive cocci was entirely penicillinase, and that produced by gram-negative rods only penicillinase in 4.0%, only cephalosporinase in 44.2% and both in 25.4%. In S. aureus and S. epidermidis, the isolated rate of strains resistant to ampicillin (p less than 0.01) and piperacillin (p less than 0.05) in the beta-lactamase producing strains was significantly higher than that in the beta-lactamase non-producing strains. In E. coli, the isolation rate of strains resistant to ampicillin and piperacillin in the penicillinase-producing strains was significantly higher than in the penicillinase non-producing strains (p less than 0.01). But both cephalosporinase-producing strains and beta-lactamase non-producing strains showed high susceptibility to cephalothin. These results suggest that the penicillinase might present a clinical problem in the treatment of urinary tract infections by S. aureus, S. epidermidis and E. coli.
An 81-year-old woman was admitted to our clinic due to gross hematuria. A large bulky pedunculated mass was found in the bladder by cystoscopic examination. Subtotal cystectomy and bilateral cutaneostomy was performed on January 12, 1987. Histologically the tumor was composed of carcinomatous and sarcomatous elements. The carcinomatous element was composed fundamentally of grade 2, transitional cell carcinoma with numerous foci of squamous metaplasia. The sarcomatous element was composed of myxosarcomatous, chondro-sarcomatous pattern and non-differentiated malignant spindle cell component. Immunohistochemical examination demonstrated the presence of cytokeratin and epithelial membrane antigen in the spindle cell and more obvious carcinomatous regions, using the avidin-biotin conjugated immunoperoxidase technique. The patient died 3 months after operation. Autopsy findings showed multiple organ metastasis which were composed of carcinomatous and sarcomatous elements.
ABH-isoantigen (ABH-Ag) and Thomsen-Friedenreich antigen (T-Ag) were investigated by the Avidin-Biotin-Peroxidase Complex (ABC) method on 47 patients with epithelial tumor of the upper urinary tract (all patients underwent nephroureterectomy including the cuff of the bladder; 30 patients were diagnosed as transitional cell carcinoma of renal pelvis and 17 ureteral organs). The correlations between ABC expression for ABH-Ag and T-Ag with histological grade, stage and prognosis (5 year survival rate) were studied. A correlation was observed between grade (p less than 0.05) and deletion of the antigenicity of ABH-Ag, but no correlation was evident with stage and prognosis. A high correlation was evident, however, between grade (p less than 0.01), stage (p less than 0.01) and prognosis (p less than 0.01) and deletion of the antigenicity of T-Ag. The analysis of ABC expression for ABH-Ag and T-Ag may therefore be valuable for predicting the malignant potential in transitional cell carcinoma of the upper urinary tract. T-Ag determination in particular may provide a useful prognostic probe should it find clinical application.
Statistical studies were performed on bacterial strains isolated from the urine of patients with various urological disease in our Urological Department between January, 1983 and December, 1987. In 1987, sensitivity tests of antibiotics to various pathogens were carried out. From the outpatients, 5,725 bacterial strains were isolated. S. epidermidis was isolated most frequently (23.8%), followed by Enterococcus species (16.5%), E. coli (14.7%), Streptococcus species (12.6%), Proteus species (5.3%), other GNR (4.6%), P, aeruginosa (4.5%), Klebsiella species (4.4%), and others. From the inpatients, 4,747 bacterial strains were isolated. Enterococcus species was isolated most frequently (23.1%), followed by S. epidermidis (18.7%), Fungi (12.9%), P. aeruginosa (8.0%), other GNR (6.8%), Streptococcus species (5.4%), Enterobacter species (4.8%), E. coli (4.1%), S. aureus (4.1%) and others. Annual change of distribution of organisms indicated that S. aureus from outpatients had a tendency to increase and Streptococcus species had a tendency to decrease. Whereas from inpatients, E. coli, other GNR, Pseudomonas species and Enterobacter species had a tendency to increase, and Streptococcus species, P. aeruginosa, Proteus species and Klebsiella species had a tendency to decrease. S. epidermidis showed a high sensitivity to minocycline and cephalothin, and Enterococcus showed a high sensitivity to ampicillin and minocycline, but did not show good sensitivity to cefoperazone and latamoxef. E. coli showed a high sensitivity to all drug we tested. P. aeruginosa showed a high sensitivity to gentamycin and norflaxacin, but did not show good sensitivity to other many drugs we tested.
A case of long ureteral polyp is presented. The patient was a 62-year-old woman complaining of asymptomatic macrohematuria. Radiological examinations revealed ureteral tumor. A tumor was found with cystoendoscopy, and by transurethral biopsy in bladder the tumor was not malignant. Polypectomy was performed. The tumor removed was fibrous polyp measuring about 8 cm in length.
Thomsen Friedenreich antigen (T-ag), ABH isoantigen (ABH-ag) in 106 cases with bladder tumor (all transitional cell carcinoma) of various histological grades and stages were investigated by the Avidin-Biotin-Peroxidase Complex (ABC) method. There was a correlation between histological grade, stage and deletion of the antigenicity (T-ag and ABH-ag). In a follow-up study of 45 patients with low grade and low stage tumor, the recurrence rate after surgery of the cases with abnormal antigenicity (T-ag and ABH-ag) was significantly higher than that of the cases with the normal antigenicity. Combination of two markers (T-ag and ABH-ag) was significantly more effective than the single marker.
ABH isoantigens in 82 cases with bladder tumor of various grades and stages were investigated by the avidin-biotin-peroxidase complex (ABC) method. Correlation of ABC expression for isoantigens with pathological findings on the grading and staging system of the bladder tumors were as follow: Of 60 cases of low grade tumors, 34 (56.7%) were positive and of 22 cases of high grade tumors, 21 (95.5%) were negative. Of 63 cases of low stage tumors, 35 (55.6%) were positive and all 19 cases of high stage tumors, (100%) were negative. The isoantigens in the tissue of the bladder tumors tended to disappear as the histologic anaplasia of the tumor progressed. There was a high correlation between the histological grade, stage and ABC expression (p less than 0.01). In a follow-up study of 38 patients with low grade, low stage, initial transitional cell carcinoma, 9 of the 24 patients positive for ABC expression (37.5%) showed recurrence during the 1 to 6 year follow-up period, whereas 10 of the 14 patients negative for ABC expression 10 (71.4%) did. There was a high correlation between the recurrence rate and ABC expression (p less than 0.05). Therefore, the analysis in the bladder tumors may be valuable for prediction of malignant potential, especially for the low grade, low stage tumors.
The tumor line in nude mice is one of the most important experimental animal models for oncodevelopmental studies. We implanted a human ureteral tumor into nude mice, established the tumor line, AM-UT-1, and maintained it by serial transplantation. The characteristics of this tumor line in nude mice are reported. Histologically, the original tumor was a transitional cell carcinoma (grade II, stage B). The transplanted tumor grew locally and had a constant growth pattern during serial passage until the 13th passage in nude recipients and maintained the basic histological, immunohistochemical findings of the original tumor. Both original tumor and serial transplanted tumor had carcinoembryonic antigen (CEA)-producing activity. A high level of serum CEA was also recognized in nude mice.
In this study, the clinical efficacy of fosfomycin (FOM) for various types of orofacial infections was evaluated in 40 patients, 27 males and 13 females, ranging in age from 16 to 71 years. All but 1 patients were treated orally with FOM at 500 mg 4 times daily. The total duration of treatment varied from 3 to 31 days. Basically, clinical effectiveness was determined by the criteria of Japanese Society of Oral and Maxillofacial Surgeons. Two cases, in which the final therapeutic evaluation could not be obtained because of side effects, were excluded from the analysis. The results were rated as excellent in 7, good in 26 and poor in 5 out of 38 evaluable cases, with an efficacy rate reaching 86.8%. From the clinical standpoint, the differences of efficacy were further discussed in terms of phase, type and intensity of infections respectively. In 9 (10 times) of 40 cases, the bacteriological analyses could be made. The identification of organisms obtained from abscess in each case demonstrated mixed infections caused by both aerobic and anaerobic organisms in more than half cases. From their sensitivity tests, it should be pointed out that FOM was efficiently active against aerobic and anaerobic Gram-positive organisms, while it was ineffective for the anaerobic Gram-negative organism, Bacteroides, although the role of the latter generally remained still obscure in orofacial infection. No serious side effects were observed except for mild diarrhea in 3 patients and a slight elevation of serum glutamic oxaloacetic transaminase (GOT) level in 1 patient. This study conclusively demonstrated that FOM was a useful and safe antibiotic in the treatment of patients with various orofacial infections.
The 19 cases of testicular tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The incidence of testicular tumors among the male outpatients in our urologic clinic was 0.31%. The patients ranged in age from 1 to 76 years old (average: 27.8 years old). The affected side was the left side in 11 and the right side in 8 cases. The most frequent symptom was a painless mass of the testis. Histopathological diagnosis according to the classification by Dixon and Moore was type I in 9 cases, type II in 4 cases, type II in 1 case, type IV in 4 cases. Thus germinal tumors accounted for 18 (94.7%) of the cases. One case (5.3%) of malignant lymphoma was non-germinal. As for the age distribution, two peaks were noted in testicular tumors, especially in cases with potential embryonal carcinoma, between 1 and 2 years and between 19 and 32 years. On the other hand, the cases with potential seminoma showed one peak between 25 and 44 years. The treatment consisted of high orchiectomy alone, orchiectomy with radiation, orchiectomy with chemotherapy or orchiectomy with radiation and chemotherapy. Retroperitoneal lymphadenectomy was not done in any case. The over-all 3-year and 5-year actual survival rates were both 92%.
The changes in NAG and BMG concentration in the urine during sudden exposure to a simulated 6,000 m altitude (354 mmHg) were studied. Subjects were 5 healthy male volunteers before a mountain climbing expedition (20-25 years old). Decompression was commenced at 11:00 and terminated at 17:00 (2-h ascent, 2-h sojourn, 2-h return) for 5 successive days. Urine was discarded at 9:00 and thereafter collected at 11:00 (group I), 14:00 (group II) 17:00 (group III), and 9:00 the next day (group IV) and urinary NAG and BMG was measured. The rate of NAG indicated elevation above 5.0 U/L in 2 cases in group III and elevation which was significantly different from that of the other 3 groups. In the other 3 cases, significant elevation was not observed, but for group III as a whole NAG excretion was significantly elevated compared of the other 3 groups. However, increased excretion of NAG was not observed on all 5 successive days. The change in BMG values was smaller than that of the NAG values and no significant elevation was observed in any of the 4 groups. Increasing urinary excretion of NAG by sudden exposure to a high altitude indicated excessive destroy of epithelium in the proximal tubules, but this change was reversible.