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Biomedical subjects

K Nakauchi

Publications and source records attributed to K Nakauchi.

At least 19 recordsLinked to original sources
PubMed1995

Influence of minor trauma to the neck on the neurological outcome in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.

The influence of minor trauma to the neck on the neurological outcome in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine was evaluated retrospectively. Out of 118 patients treated in our clinic for cervical OPLL between 1976 and 1992, 27 had sustained minor trauma to the cervical spine. Of these 27 patients, 13 developed myelopathy, seven showed deterioration of preexisting myelopathy, and no neurological change was observed in seven patients. Regarding the relationship between the diameter of the residual spinal canal and the neurological outcome in these 27 patients, 18 out of the 19 patients with a narrow residual spinal canal (< 10 mm) developed neurological deterioration, whereas that occurred in only two of the eight patients with a wider spinal canal (> or = 10 mm). Although the severity of myelopathy and the transverse area of the spinal cord measured from T1-weighted magnetic resonance images, in patients who had sustained minor trauma was not statistically different from patients without trauma, neurological recovery after surgical treatment was poorer in the former group than in the latter. These results indicate that even indirect minor trauma to the neck can cause irreversible changes in the spinal cord if there is marked stenosis of the cervical spinal canal; such patients who are at risk, must be educated, and should be told to avoid even minor injuries at any cost.

Adult↗
PubMed1995

[An analysis of 41 elderly patients with urosepsis].

We performed a clinical evaluation in 41 patients with urosepsis at Tokyo Metropolitan Geriatric Hospital from July 1992 through March 1993. The most common organism isolated from the patients was Escherichia coli (46.3%), followed by Pseudomonas aeruginosa (9.8%), Methicillin-resistant staphylococcus aureus (7.3%), and mycetes (7.3%). The most frequent underlying disease was cerebrovascular disease (34.1%) and malignancies were observed 29.2% of all cases. Twenty-six patients (63.4%) had indwelling urethral catheters. Indwelling catheters were suspected to be related to the onset of urosepsis in 16 cases. Total mortality of urosepsis was 4.9% (2/41) in this study. We speculate that the main cause of urosepsis is a long-term use of urethral catheterization, especially in elderly patients with severe complications who are vulnerable to infections. It is important to assess and correct the conditions of dysuria of individual patients before placing indwelling urethral catheters.

Aged↗
PubMed1992

[Small cell carcinoma of urinary bladder. A case report].

A 57-year-old male patient was admitted because of a severe lumbar pain and gross hematuria. The rectal examination revealed a fist-sized soft tissue mass in the small pelvic space. A huge non-papillary tumor, which occupied the intravesical space, was found on cystoscopic examination. CEA IAP, TPA, CA19-9 and NSE were abnormally elevated in the serum. The pelvic CT scan shown an enormous polypoid tumor arising from the anterior vesical wall, while no abnormal lesion was found in the head, neck, chest and abdominal CT scans. The bone scintigraphy revealed multiple abnormal accumulations. The transurethral biopsy of the tumor was carried out. The pathological examination revealed homogeneous and small tumor cells arranged in sheet and solid patterns, which were positive for the anti-NSE stain and anti-NF stain, but negative for Grimelius stain. The final diagnosis was small cell undifferentiated carcinoma of the urinary bladder. The patient died of cancer five months after diagnosis.

Carcinoma, Small Cell↗
PubMed1991

[A clinical study of associated bladder cancer in patients with renal pelvic and ureteral cancer].

Retrospective study on the frequency of associated bladder cancer and the influence on the prognosis was carried out in 170 cases of renal pelvic and ureteral cancer. The number of cases of associated bladder cancer coexistent with renal pelvic and ureteral cancer was 31 (18.2%), and the number of subsequent cases 3 (19.4%). The frequency of occurrence of the primary tumor site was 27.2% in the renal pelvis, 45.6% in the ureter and 58.3% in both renal pelvis and ureter. Multiple tumors occurring in the renal pelvis and ureter occupy a high percentage. As for the degree of differentiation, many cases were subsequent to G1. As for the stage, a few cases with bladder cancer were subsequent to T4, but there was no definite tendency in the occurrence of bladder cancer. The prognosis of renal pelvic and ureteral cancer: the 10-year survival rate was 93.3% for G1, 66.6% for G2 and 12.4% for G3. As can be seen, there was good correlation with the pathological gradings. It must be remembered, however, that 5-year survival rates in cases of associated bladder cancer of coexistent type, in cases of subsequent type and in cases without associated bladder cancer were 56.2%, 72.7% and 64.8%, respectively: there was no significant difference. Bladder cancer associated with renal pelvic and ureteral cancer makes the therapy troublesome, but no influence on the prognosis was observed. Therapy in conformity with the pathological grading and stage is regarded as particularly important in cases of associated bladder cancer.

Adult↗
PubMed1991

[A case of mesothelioma of perinephric space origin].

Cystic mesothelioma of perinephric retroperitoneum origin are very uncommon tumors and considered potentially malignant. We report one such case and discuss the clinical and pathological findings. A 70-year-old man was seen with complaint of discomfort in the right flank and hospitalized in May 1989. Computerized tomography revealed multiple cystic masses in the right retroperitoneal space which appeared to be infiltrating the kidney and the iliopsoas muscles. Magnetic resonance imaging showed deformation of the right kidney with many impressions in the parenchyma. The cystic lesions and the right kidney were extirpated on June 2, 1989. Grossly the specimen was 16 x 10 x 8 cm in size and 630 g in weight. The multiple cysts surrounding the kidney were each approximately 10 mm in diameter and had thin outer walls. The cyst fluid was clear and serous. The kidney had not been infiltrated but had only external impressions caused by the cystic lesions. Microscopically, the cysts were lined by a single layer of cuboidal cells accompanied by some hobnail-shaped cells, and no evidence of malignancy was found. The epithelium was focally positive for periodate acid Schiff and slightly positive for Alcian blue. It was strongly positive for cytokeratin and vimentin, and slightly positive for EMA but negative for lectins. The diagnosis was diffused benign multicystic mesothelioma. However, CT taken four months after the operation revealed local recurrence and radiotherapy (40 Gy) was instituted. Since the cystic mass tended to grow in size thereafter, the lesion appeared to be malignant clinically. We consider this is the first case of cystic mesothelioma of perinephric retroperitoneum origin reported in Japan.

Aged↗
PubMed1991

[A case of priapism successfully managed by local irradiation].

A 42-year-old man with priapism is reported. The condition did not improve by cavernous body irrigation with heparin, intravenous administration of anticoagulant, or various surgical shunt operations. However, the condition improved after local radiation therapy: a total dose of 6Gy, 1.5 Gy daily for 4 days, was given to a site 24 cm x 24 cm which covered the small pelvic cavity and the femoral area centering around the root of the penis. Improvement of the condition became evident from Day 3 of radiation therapy. For about 1 year since then the patient has been entirely free of recurrence.

Adult↗
PubMed1991

[A case of malignant pheochromocytoma of the urinary bladder].

A 31-year-old man was admitted to our hospital because of miction pain and gross hematuria in August, 1988. Cystoscopic examination revealed a solid mass in the bladder. The histological diagnosis was pheochromocytoma of urinary bladder by biopsy. He had a history of syncope on urination several times. Abnormal elevation of serum noradrenaline was observed in hormonal studies and abnormal accumulation was seen in the bladder by 131I-MIBG scintigraphy. Total cystectomy, lymphadenectomy and urinary diversion were performed in November, 1988. Pathological diagnosis was pheochromocytoma of the urinary bladder with metastasis to both iliac lymph nodes.

3-Iodobenzylguanidine↗
PubMed1991

[Urinary incontinence in the aged].

With increasing number of the elderly, the problem of urinary incontinence might become as serious as those of dementia and the bedridden. But strategy for urinary incontinence of the aged lay behind those for the other two. Not only does urinary incontinence significantly disturb the activity and social participation of patients it also increases the total cost of care and the number of long-stay patients in hospitals, causing enormous expenses. The relative and absolute decrease of the younger generation, coupled with the tendency towards nuclear families, makes the national policy of home-care system for the aged patients difficult. Now we must take new steps to cope with this situation. Since urinary incontinence is generally caused by some disease, medical care might cure it or simplify its management in many cases. However, considering the increase in the number of elderly urinary incontinent patients, the number of incontinence-care professionals is very small in our country. A help from general practitioners who are usually in contact with age patients, is indispensable. To assist them, we are now compiling a manual on how to assess and manage urinary incontinence in the elderly, based on the useful classification of Brocklehurst. The causal diseases of transient urinary incontinence are familiar to the general practitioners and may be treated by them relatively easily. For the treatment of the causal diseases of the established urinary incontinence the patients should be sent to specialists, after first aid if necessary. Some advice concerning to pharmaceutical therapy, based on my daily clinical experience, are added.

Aged↗
PubMed1990

[In vivo anti-tumour efficacy of tumour necrosis factor and interferon- alpha, -gamma on human renal cell carcinoma heterotransplanted in nude mice].

Using human renal cell carcinoma heterotransplanted in nude mice (JRC 11: anaplastic and alveolar pattern, grade IV), the in vivo anti-tumour efficacy of tumour necrosis factor (rHu-TNF-alpha: PT-050) and IFN-alpha (nHu-IFN-alpha: HLBI), IFN-gamma (nHu-IFN-gamma: OH-6000) were investigated. The dose of TNF was 1,000, 3,000, 10,000 J.R.U. (i.p., every day), that of IFN-alpha was 1 x 10(4) and 1 x 10(5) I. U. (s.c., every day) and that of IFN-gamma was 1 x 10(4) and 1 x 10(5) I.U. (s.c., every day). Mono-therapy of TNF, IFN-alpha and IFN-gamma was not effective with regard to tumour regression rates, histological degeneration rates and survival time of the host mice. Combination therapy of TNF and IFN-alpha, IFN-gamma were also not effective with regard to tumour regression rates, but when considering histological change, sporadic disappearance of endothelium of intra-tumoural vasculature, flow of tumour cells clustered in intra-vascular cavity, and extra-vascular bleeding were observed. With special reference to survival of host mice, prominent prolongation of survival time in combination treatment, especially in TNF combination therapy groups with the dosage of 10,000 J.R.U. was observed. Therefore we concluded that there is no synergistic reaction in combination therapy of TNF and IFN against JRC 11 tumour. But combined activity of TNF and IFN on the vasculature of renal cell carcinoma (JRC 11) and the suppression of cachexia related condition were detected.

Animals↗
PubMed1990

Influence of differences in tumor vascularity upon the effects of hyperthermia.

Utilizing two types of human renal carcinoma heterotransplanted in nude mice, we investigated the variations in hyperthermic effects (42.5 degrees C for 30 min) caused by differences in tumor type with special reference to variations in tumor vascularity. In the hypovascular JRC1 strain, sporadic vascular dilation was observed throughout the tumors after heating. Destruction of tumor cells was observed mainly in the region of dilation. In the hypervascular JRC11 strain, homogenous vascular dilation was observed immediately after heating, mainly at the periphery of tumors. There was a decrease in the viability of cells in the center of the tumor. Therefore, the hypervascular tumors showed greater destruction mainly at the center where blood circulation was reduced. The range of necrosis was also greatly affected by the extent of vascular dilation caused by heating in hypovascular tumors.

Animals↗
PubMed1990

[Urinary incontinence in the aged].

Following the recent increase in the aged population, an increase in the number of cases of urinary incontinence among aged people can be anticipated. Considering the relative decrease of care-givers such as cohabitating family and increase of the cost of incontinence care, a social and national economic problem might be arise in near future. Therefore rapid steps to cope with this situation are necessary. Urinary incontinence of the aged has been mainly considered to be the problem for management and have been avoided by medical professionals until recently. Urinary incontinence is not only a problem of only aging, but generally is caused by some disease, therefore medical care might cure the incontinence or make the management of it easier. However, considering the increase in the number of elderly aged urinary incontinence patients, the number of incontinence-care professionals is very small. Help from the general practitioners is indispensable. Therefore this speech was drafted with the wish that the audiences, manly medical and geriatric doctors who usually are in contact with aged patients, may understand and become familiar with urinary incontinence of the elderly. This paper covered the physiology of urination especially in relation to the nervous system, abnormal bladder and urethral function found in urodynamic tests of elderly apparently normal persons, pathophysiological mechanism of urinary incontinence of aged people, urinary incontinence evoked as a side effect of some drugs. In order to assess and manage elderly urinary incontinence better, we must be able to recognize often there are two or more simultaneous basic underlying causes and how combinations of these cause create multifactorial mixed types of urinary incontinence.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Early changes in serum alpha-fetoprotein after chemotherapy in advanced testicular tumors].

The serum levels of alpha-fetoprotein (AFP) are known to undergo acute changes (paradoxical elevation) after effective chemotherapies for testicular germ cell tumors. In order to understand the clinical significance, the changes of the serum AFP levels after PVB therapy for testicular germ cell tumors were analyzed, and their relationship to the treatment effects was investigated in this retrospective study. Thirty-one patients with testicular germ cell tumors (11 with stage I, 7 with stage II, and 13 with stage III) which had been treated by PVB therapy were evaluated. The measurement of the serum AFP levels was performed by radioimmunoassay on Day 1 (the initiation day of the PVB therapy), thereafter on Day 8 and Day 22. The half-life (t1/2) or doubling time (t2) of the serum AFP were calculated. In patients with stage I disease, the serum AFP levels declined nearly according to its biological half-life between Day 1 and Day 22 after termination of chemotherapy (t1/2 = 6.2 days). In patients with stage II or III disease, the changes of the serum AFP levels were not consistent with the treatment results between Day 1 and Day 8. Namely, complete responders revealed a prolonged decline of the serum AFP levels (t1/2 = 63.0 days), partial responders a transient rise of the serum AFP levels (t2 = 49.5 days) and non-responders a sudden rise of the serum AFP levels (t2 = 9.9 days). On the contrary, the serum AFP levels changed in accordance with the treatment effects between Day 8 and Day 22. Early changes of the serum AFP levels were seen in patients with stage II or III disease between Day 1 and Day 8 after chemotherapy. It was indicated that the measurements of the serum AFP levels during this period were not useful for the evaluation of the treatment effects in these patients. Furthermore, it was suggested that the early changes of the serum AFP levels possibly correlate with the poor response. The mechanism of the early changes of the serum AFP was also discussed.

Adolescent↗
PubMed1990

[Study of blood flow in hyperthermia using human renal cell carcinoma heterotransplanted in nude mice--differences in histological tumour pattern upon the effects of hyperthermia].

Utilizing two types of human renal cell carcinoma heterotransplanted in nude mice (JRC 1; papillary, avascular pattern, grade III, JRC 11; anaplastic and alveolar, hypervascular pattern, grade IV), we investigated the influence of tumor blood flow upon the effects of local hyperthermia (42.5 degrees C), induced by 915 MHz microwave. Blood flow was determined from the rate of thermal clearance by use of the bio-heat transfer equation. The rate of thermal clearance was measured at intervals of approximately 10 minutes throughout the treatment session after turning off the microwave for 50 seconds. With both strains it was necessary to increase the microwave power until the constant steady-state temperature of 42.5 degrees C was reached. The JRC 11 strain needed more power for the constant temperature than JRC 1, but it needed a greater decrease in power level during the heating session to maintain a constant steady-state temperature. This was an indication that the tumour blood flow decreased more markedly in the JRC 11 strain. In both tumours, a decrease of blood flow was observed during the heating session. In the case of the JRC 1 strain, it was observed that the mean value of blood flow was 1.87 times higher than that of JRC 11. This indicated a sharp reduction in blood flow in JRC 11 strain. This reduction was confirmed by the thermal clearance measurement at the end of the treatment session. A sharp reduction in blood flow in hypervascular tumour (JRC 11 strain) is caused by a stasis of intra-tumoural blood circulation during the heating.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

[Study on clinical characteristics in relation to size of renal cell carcinoma].

Four hundred and thirty-one patients with renal cell carcinoma treated at Jikei University and its related institutions from 1957 to 1988 were studied as to tumour size in relation to clinical characteristics (age, sex ratio, affected side, symptoms), prognostic factor (fever, weight loss, anaemia, elevation of erythrocyte sedimentation rate), pathological staging, pathological grading, and survival. The treated patients were divided into 4 groups on the basis of tumour size (group A; under 3.0 cm, group B; 3.1 to 5.9 cm, group C; 6.0 to 9.9 cm, group D; over 10 cm in diameter). At the time of operation, there were 22 cases (5.1%) in group A, 121 cases (28.1%) in group B, 209 cases (48.5%) in group C, and 79 cases (18.3%) in group D. In studying the clinical factors of age, sex ratio, and affected side, no relationship with size was detected. As for the symptoms, the larger the tumour, the more frequent the symptoms of urinary tract (haematuria, pain, and palpable mass). This tendency was especially marked in the cases of group D (over 10.0 cm in diameter). In addition, no relationships were observed between the rate of haematuria and the symptoms of extraurinary tract in each group. As for the prognostic factors (fever, weight loss, anaemia and the elevation of erythrocyte sedimentation rate), there was an obvious tendency for a positive reaction of these factors in the cases of groups C and D (over 6.0 cm in diameter). As for the distribution of stage and grade in each group, a higher stage and grade were observed with large sized tumours.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Renal Cell↗
PubMed1989

[A case of bullous cystitis].

A case of bullous cystitis with a right ureter stone seen in a 25-year-old male is described. Inflammatory tumorous cystitis was performed. One month after transurethral resection, there was inflammatory tumorous cystitis at the same position. Therefore, right ureterolithotomy and right ureterovesical neostomy were done. The patient is currently in good health 1 year and 5 months after the surgery.

Adult↗
PubMed1989

[Clinical study of renal cell carcinoma with bony metastasis: comparative study with lung metastasis].

For the purpose of clinical analysis of renal cell carcinoma with bony metastasis (59 cases) the cases with lung metastasis (146 cases) were selected for comparison. The analyzed items were the distribution of bony metastatic portions, the results of radiotherapy for bony metastasis, comparative study with lung metastasis on clinical background, comparative study with lung and bony metastasis on the survival rate, comparative study with solitary bony and lung metastasis on the survival rate, comparative study with bony and lung metastasis on the grade of primary lesion. The most frequent metastatic portion was lower extremities, spine, upper extremities and pelvic bone in this order. The survival rate of the cases with bony metastasis was better than that of lung, especially with solitary metastatic cases. The effects of radiotherapy for bony metastasis were not so good for prolonging the survival. The grade of kidney malignancy did not influence the survival of patients with bony metastasis, on the contrary, in patients with lung metastasis, there was a good prognostic factor for survival.

Adult↗