PubMed Health⌕ Search

Biomedical subjects

K Koshiba

Publications and source records attributed to K Koshiba.

At least 19 recordsLinked to original sources
PubMed1997

The ratio of free to total serum prostate specific antigen and its use in differential diagnosis of prostate carcinoma in Japan.

BACKGROUND: To improve the clinical usefulness of prostate specific antigen (PSA), unique methods have been proposed. The percentage of free PSA in serum facilitates the distinction between benign histologic conditions and prostate carcinoma while retaining high sensitivity. METHODS: Using monoclonal antibodies, an AIA total PSA assay system was established that recognized PSA equally in free or complex form. The clinical usefulness of the ratio of two different molecular forms of PSA was investigated using 268 archival serum samples. RESULTS: Men with prostate carcinoma had significantly lower ratios of free to total PSA than those with benign prostatic hyperplasia (BPH) (P = 0.0001). At total PSA levels between 2.1 and 10 ng/mL, medians of total PSA were not significantly different between men with prostate carcinoma and men with BPH. Differences in median percentages of free PSA for these two groups were statistically significant (P = 0.0001). The ratio of free to total PSA was useful for identifying prostate carcinoma in palpably benign glands with total PSA of 2.1-10 ng/mL (P = 0.0001), whereas total PSA was not useful for such identification. When calculated for low total PSA levels between 2.1 and 4 ng/mL, sensitivity and specificity were 91.7% and 72.2%, respectively, with a cutoff value of 17%. This ratio of free to total PSA was as useful as PSA density in receiver-operating curve analysis. CONCLUSIONS: The use of the ratio of free to total PSA renders total PSA of greater use of distinguishing prostate carcinoma and is applicable to patients with low total PSA. Elderly men with a clinical diagnosis of BPH who are scheduled for surgery may benefit from the determination of this ratio.

Aged↗
PubMed1996

Microsatellite instability in transitional cell carcinoma of the urinary tract and its relationship to clinicopathological variables and smoking.

To determine whether microsatellite instability is involved in the development of transitional cell carcinoma (TCC) of the urinary tract, a microsatellite instability assay was carried out using PCR with 9 microsatellite loci. Thirty-eight TCC samples (30 patients with bladder cancer, 5 with renal pelvic tumors and 3 with ureteral tumors) and 1 lymph node with metastasis were examined. Microsatellite instability was found in 8 of 38 tumors examined, and 3 showed alterations in more than 2 microsatellite loci. All 8 tumors were beyond grade 2 and stage pT2 advanced tumors. Stages pT1-2 and pT3-4 patients differed significantly. Microsatellite instability was greater in smokers than non-smokers, but the differences were not significant. Microsatellite instability in TCC of the urinary tract is rare in superficial tumors but more common in invasive tumors. Microsatellite alterations would thus appear to occur, and possibly be importantly involved, in the tumorigenesis of urinary tract TCC.

Carcinoma, Transitional Cell↗
PubMed1996

Risk of progression and dying of clinically localized prostate cancer in Japan.

Study was made of the conservative management of 107 men with clinically localized prostate cancer. Distant metastasis developed more frequently in patients with poorly differentiated tumors than in those with well- and moderately differentiated counterparts (P < 0.01). Poorly differentiated histology was strongly associated with cancer-specific death (P < 0.01). The progression-free and cancer-specific survival of patients with stage T1a disease was significantly better than that of patients with stages T1b, T2a-b, and T2c tumors (P < 0.05). Available data clearly demonstrate that prostate cancer is a progressive disease when managed conservatively. Long-term follow-up data indicate the natural history of prostate cancer not to differ significantly according to race, despite noteworthy differences in prevalence and mortality. Patients with localized prostate cancer would be candidates for expectant therapy if they had lower-grade tumors and a life expectancy of 10 years or less. For patients with a 10-year or greater life expectancy and any grade of disease definitive therapy should be applicable.

Aged↗
PubMed1996

Deoxyribonucleic acid ploidy status as no basis for pathologic stage prediction in clinically resectable prostate cancer.

OBJECTIVES: Assessment of deoxyribonucleic acid (DNA) ploidy status of a tumor as a means for predicting pathologic stages in prostate cancer. METHODS: DNA ploidy of each focus of a cancer in 70 radical prostatectomy specimens was determined by nuclear image analysis. DNA ploidy was compared with the pathologic features of tumors. RESULTS: One hundred three individual cancers in 70 patients were used for DNA ploidy analysis. Of these, 39 (38%) were diploid and 64 (62%), nondiploid. DNA ploidy was weakly correlated with increase in tumor volume (P = 0.049) but not tumor grade. The relationship between DNA content and extraprostatic spread was not statistically significant. Increase in tumor volume and grade promoted extraprostatic spread more than nondiploidy, as shown by multivariate analysis. CONCLUSIONS: The incidence of a nondiploid cell population in a tumor focus in prostate cancer is essentially the same, at least for Americans and Japanese. DNA ploidy of a tumor cannot serve as a means of pathologic stage prediction in clinically resectable prostate cancers, contrary to many previous studies. Thus, DNA content analysis would be of no use for deciding on the treatment strategy of prostate cancer.

DNA, Neoplasm↗
PubMed1996

Significance of preoperative parameters for predicting tumor volume in nonpalpable prostate cancer.

Preoperative parameters were assessed for their usefulness in predicting tumor volume in 26 cases of nonpalpable prostate cancer. The number of positive biopsy cores was found to be the parameter which predicted most accurately tumor volume in surgical specimens. All 14 patients with multiple positive cores had an index tumor of 0.5 cm3 or more in radical prostatectomy specimens. Only six tumors with a single positive core were substantial. Three of the patients showed a serum level of prostate specific antigen (PSA) of 4.0 ng/ml or more. The pathological stage and prostatectomy Gleason sum could not be predicted accurately by this variable (P>0.05). To predict index tumor volumes of 1.0 cm3 or greater, stepwise logistic regression analysis was conducted, and on the basis of the results it was possible to single out multiple positive biopsies as the only significant variable. The number of positive biopsies appeared reliable for predicting tumor volume of surgical specimens in cases of nonpalpable disease. The presence of significant tumors despite "normal" levels of PSA warrants further investigation of variables that can predict such prostate cancers. An adequate model for predicting significant tumors in oriental male populations should be established using samples of larger size.

Biopsy, Needle↗
PubMed1996

Preoperative serum prostate-specific antigen, clinical stage and Gleason sum as basis for predicting final pathological stage in Japanese patients with prostate cancer.

By logistic regression analysis and log-likelihood ratio chi-square test, the usefulness of preoperative variables (prostate specific antigen [PSA], clinical stage and biopsy Gleason sum) for predicting the final pathological stage was assessed in 77 patients with clinically resectable prostate cancers. Pathologically, 32 (41.6%) had organ-confined disease. Extracapsular extension was found in 41 (53.2%), seminal vesicle involvement in 30 (39.0%), positive pelvic lymph nodes in 10 (13.0%) and a positive surgical margin in 27 (35.1%). Each preoperative variable was found to be significantly associated with the final pathological stage. Any combination of these variables was more predictive for extraprostatic disease, compared with each individual variable. Extraprostatic spread was found more frequently in patients with lower serum PSA in this Japanese elderly male population compared with North American males. These preoperative variables considered in combination may provide valuable information for management decisions related to prostate cancer. Serum PSA alone cannot reliably predict pathological stage on an individual basis except in patients with a PSA level of 20 ng/ml or greater. The high incidence of extraprostatic spread at intermediate PSA underscores the importance of selecting an ideal cutoff value for PSA-based screening in a Japanese male population.

Aged↗
PubMed1996

A non-randomized comparative study of visual laser ablation and transurethral resection of the prostate in benign prostatic hyperplasia.

BACKGROUND: Transurethral resection of the prostate (TURP) has been the preferred surgical treatment for benign prostatic hyperplasia (BPH) for the past 50 years. Alternative methods for treating BPH such as visual laser ablation (VLAP) have been established during the past decade. In order to assess the safety and efficacy of VLAP, this alternative method was performed using a Urolase fiber and neodymium: yttrium-aluminum-garnet laser, and compared to results obtained in patients treated with TURP for BPH. METHODS: In this non-randomized comparative study, 100 BPH patients were equally split between treatment with VLAP or TURP, and their cases compared. The efficacy was assessed using an International Prostate Symptom Score, urinary flow rates, post-void residual urinary volume and an estimated prostate volume. RESULTS: There was a clinically significant improvement in all parameters in both groups. In the VLAP and TURP groups, 92.0% and 81.6%, 90.2% and 86.2 and 93.1% and 100.0% were categorized as effectively-treated cases at 3, 6 and 12 months post-operatively, respectively. No severe side effect was seen in VLAP group. The total and post-operative lengths of hospitalization in the VLAP group were shorter, but the duration of post-operative bladder irrigation was longer in these patients. CONCLUSIONS: Although TURP remains the standard surgical treatment for BPH, VLAP is associated with less morbidity and the clinical outcome is similar compared to patients treated with TURP. VLAP in conjunction with TURP may result in less risk of postoperative urinary retention and vesical irritability.

Aged↗
PubMed1996

Injection of glutaraldehyde cross-linked collagen for urinary incontinence: two-year efficacy by self-assessment.

BACKGROUND: Glutaraldehyde cross-linked (GAX) collagen has recently become available as injection material for treatment of urinary incontinence and should be evaluated for its long-term efficacy. METHODS: The subjects included 78 females with genuine stress incontinence (GSI) and 19 male or female patients with intrinsic sphincter deficiency (ISD: urinary incontinence due to urethral sphincter damage). GAX collagen was injected transperineally or transurethrally through an injection needle under direct endoscopic observation. The efficacy was evaluated by the patients' overall assessment at two years post-treatment. RESULTS: Under local or regional anesthesia, GAX collagen was injected 1.9 times on average (total injection volume: 23.5 mL) in GSI patients and 2.2 times (40.1 mL) in ISD patients. Improvement at two years post-treatment by patients' assessment was observed in 71.7% of GSI patients and 53.3% in ISD patients. Side effects were urinary retention and difficulty in voiding after 48 of the total of 188 injections (25.5%), a large amount of residual urine in four (2.1%) and miscellaneous in 19 (10.1%), for a short period after injection and were not serious. CONCLUSION: Our study indicates that GAX collagen injection is an effective, safe and easy non-medical treatment for urinary incontinent patients.

Aged↗
PubMed1996

Giant retroperitoneal cyst in an adult male.

This paper presents a case of a symptomatic giant retroperitoneal cyst in an adult male. The unilocular cyst was excised successfully with resolution of the attendant symptoms. Histological findings of the cyst wall suggested a lymphangiomatous etiology. Any good risk patient found to harbor such a cyst should undergo complete excision in view of the potential for the development of symptoms and complications.

Cysts↗
PubMed1996

[Renal cell carcinoma associated with circumferential "ring-like" calcification].

A 37-year-old man was found to have large calcification in the left kidney in a health check. This calcification has not changed in size during 3 years with computerized tomographic (CT) studies. However, a suspicious lesion for a malignant tumor with the calcification was suggested by a magnetic resonance image (MRI) study. Thus, the patient underwent tumor enucleation and the histology showed the mixed typed renal cell carcinoma. Although it remains controversial, partial nephrectomy or tumor enucleation would be considered in a case of renal cell carcinoma with calcification, which is usually considered to have a favorable prognosis compared to that of a tumor without a calcification.

Adult↗
PubMed1996

[A case of solitary metastasis from renal cell carcinoma to the thyroid gland].

A case of solitary metastasis with renal cell carcinoma to the thyroid gland is presented. The patient was a 54-year-old man found to have an abnormal mass in the neck. He had a past history of radical nephrectomy orignating from the right renal cell carcinoma 5 years earlier (pT2N0M0, G2 > 3, alveolar type, clear cell subtype). Ultrasonography revealed a tumor mass in the right hemithyroid gland. Right hemithyroidectomy was performed on April 19, 1995. Histopathologically, the removed thyroid tumor showed clear cell carcinoma. The possibility of a primary thyroid tumor was ruled out by immunohistochemical thyroglobulin staining, and the present case was thus diagnosed as of metastatic thyroid tumor of renal cell carcinoma. The present case is the 12th case of thyroid solitary metastasis of renal cell carcinoma reported in Japan to date.

Carcinoma, Renal Cell↗
PubMed1996

[Renal cell carcinoma in childhood: a case report].

A case of renal cell carcinoma (RCC) in a teenage patient is reported. A 13-year-old girl visited our hospital with the complaint of dyspnea and right abdominal mass. CT scan and chest X-P revealed a right renal tumor with multiple lung metastasis. Wilms' tumor was suspected and a combination chemotherapy consisting of actinomycin D and vincristin was performed. Since the tumor was insensitive to these agents, open biopsy was done. The pathological findings showed clear cell renal cell carcinoma. Despite the administration of alpha interferon, 5-FU and cimetidine, the disease was progressive and the patient died 5 months after diagnosis. It is important to consider the possibility of renal cell carcinoma in teenage patients with a renal mass, since more than 40% of the renal tumors in this age group are renal cell carcinomas.

Adolescent↗
PubMed1996

[A case of spontaneous rupture of renal leiomyosarcoma].

A 53-year-old female visited our out-patient department complaining of right flank pain. Ultrasonography revealed a solid mass lesion in the lower pole of the right kidney and further evaluation was scheduled. A few days later, she suddenly felt pain at the abdominal enlarged mass. Computed tomographic (CT) scan revealed a huge retroperitoneal mass with heterogenous density. Spontaneous rupture of renal tumor was suspected and emergency nephrectomy was performed. The ruptured tumor was pale, elastic firm and invaded directly to the duodenum. Histopathological findings revealed fibrous cells with frequent nuclear mitosis. Smooth muscle actin was identified immunohistochemically. Therefore, the tumor was diagnosed as leiomyosarcoma. The patient died 2 months after operation due to perforation of the intestine.

Actins↗
PubMed1996

[A case of congenital penile curvature].

A case of congenital penile curvature is reported. A 21-year-old man was admitted because of penile pain curvature to the left at the erection and the difficulty of intercourse. He had no signs of Peyronie's disease and no history of penile fracture so that he was considered to have congenital penile curvature. By Nesbit's method the curvature of the penis was appropriately corrected. There were no signs of recurrence at either 1 or 5 months after the operation.

Adult↗