Biomedical subjects

Kazunari Sato

Publications and source records attributed to Kazunari Sato.

At least 19 recordsLinked to original sources

PubMed2005

CA repeat polymorphism in the insulin-like growth factor-I gene is associated with increased risk of prostate cancer and benign prostatic hyperplasia.

Insulin-like growth factor-I (IGF-I) plays an important role in prostate growth, hyperplasia, and carcinogenesis. Circulating IGF-I levels may be modulated by a genetic cytosine-adenine (CA) repeat polymorphism in the promoter region of IGF-I. The association of the polymorphism with the risk of prostate cancer and benign prostatic hyperplasia (BPH) was explored in 303 patients with prostate cancer, 219 patients with BPH and 262 controls. The number of CA repeats ranged from 15 to 22 in case and control subjects. The 19-CA-repeat allele (19-allele) was more frequently observed in both the prostate cancer and BPH patients compared with the controls (prostate cancer versus control: P<0.001; BPH versus control: P=0.001). Compared with non-carriers of the 19-allele, men homo-zygous for the 19-allele had a significantly increased risk of prostate cancer [age-adjusted odds ratio (aOR) = 3.36, 95% confidence intervals (CI) = 1.30-8.67, P=0.012] or BPH (aOR = 3.53, 95% CI = 1.32-9.46, P=0.012), and those heterozygous for the 19-allele also had an intermediate increased risk of prostate cancer (aOR = 1.78, 95% CI = 1.25-2.53, P=0.001) or BPH (aOR = 1.66, 95% CI = 1.14-2.43, P=0.009). A gene dosage effect for the aORs was found with an increasing number for the 19-allele (P<0.001 in prostate cancer and P=0.001 in BPH). No significant association was found between the presence of the 19-allele and the tumor stage and grade at the time of diagnosis. In conclusion, the 19-allele of IGF-I appears to increase the risk of prostate cancer and BPH with a gene dosage effect in the Japanese population.

Alleles↗

PubMed2004

Association of lipoprotein lipase gene polymorphism with risk of prostate cancer in a Japanese population.

A high fat intake has been associated with prostate cancer risk, and gene polymorphisms of lipoprotein lipase (LPL) play an important role in plasma lipoprotein metabolism. We herein analyzed the association of LPL gene polymorphisms with the risk of prostate cancer in a Japanese population. Three single nucleotide polymorphisms (SNPs) of LPL designated as Ser447stop, HindIII and PvuII were genotyped by the polymerase chain reaction-restriction fragment length polymorphism method in 273 prostate cancer patients, 205 benign prostatic hyperplasia (BPH) patients and 230 male controls. The men with the CG + GG genotypes of the Ser447stop polymorphism had an increased risk of prostate cancer compared to those with the CC genotype [age-adjusted odds ratio (aOR) = 1.625; 95% CI = 1.068-2.471; p = 0.023]. Furthermore, the increased risk associated with the CG + GG genotypes was more strongly observed in patients with high-grade cancers (aOR = 2.843; 95% CI = 1.252-6.458; p = 0.039) or metastatic diseases (aOR = 2.300; 95% CI = 1.042-5.074; p = 0.013), whereas the risk was not significant in those with low- to intermediate-grade cancers or nonmetastatic diseases. In the HindIII and PvuII polymorphisms, there was no significant difference between the prostate cancer patients and the controls, and no significant results as for tumor grade and stage. None of the 3 polymorphisms showed any association with the risk of BPH. Our results suggest that the LPL Ser447stop polymorphism is a common genetic modifier for the development of prostate cancer, particularly that of high-grade and/or high-stage, in a Japanese population.

Aged↗

PubMed2004

Influence of CYP3A5 and MDR1 (ABCB1) polymorphisms on the pharmacokinetics of tacrolimus in renal transplant recipients.

BACKGROUND: A body-weight-based dose of tacrolimus often results in marked individual diversity of blood drug concentration. Tacrolimus is a substrate for cytochrome P450 (CYP) 3A5 and p-glycoprotein encoded by CYP3A5 and MDR1 (ABCB1), respectively, having multiple single nucleotide polymorphisms. In this study, we genotyped CYP3A5 A6986G, MDR1 G2677(A/T), and C3435T polymorphisms and investigated the association between these polymorphisms and the pharmacokinetics of tacrolimus in renal transplant recipients. METHODS: Thirty consecutive recipients were enrolled in this study. The pharmacokinetics of tacrolimus was analyzed on day 28 after transplant, when the daily dose was adjusted to the target trough level of 10-15 ng/mL. The polymerase chain reaction-restriction fragment length polymorphism and direct sequence method were used for genotyping the CYP3A5 and MDR1 polymorphisms, respectively. RESULTS: The single tacrolimus dose per body weight was significantly higher in CYP3A5 *1 carriers than CYP3A5 *3/*3 carriers (0.143+/-0.050 vs. 0.078+/-0.031 mg/kg, P<0.001). The dose-adjusted trough level and the area under the concentration-time curve (AUC0-12) were significantly lower in CYP3A5 *1 carriers than CYP3A5 *3/*3 carriers (0.040+/-0.014 vs. 0.057+/-0.024 ng/mL/mg/kg, P=0.015 and 0.583+/-0.162 vs. 0.899+/-0.319 ng.hr/mL/mg/kg, P=0.004), respectively. The MDR1 polymorphism was not associated with any pharmacokinetic parameters. CONCLUSIONS: Kidney transplant recipients with the CYP3A5 *1 allele required a higher daily tacrolimus dose compared with those with the CYP3A5 *3/*3 genotype to maintain both the target trough level and AUC0-12, suggesting that this polymorphism is useful for determining the appropriate dose of tacrolimus.

Adult↗

PubMed2004

Microsatellite polymorphism of steroid hormone synthesis gene CYP11A1 is associated with advanced prostate cancer.

It is widely recognized that androgen biosynthesis and metabolism are associated with the development and progression of prostate cancer. The human CYP11A1 gene (CYP11A1) encodes the P450scc enzyme, which mediates the first step in sex steroid hormone synthesis. The gene contains a (tttta)n-5 bp tandem repeat microsatellite polymorphism located at 528 bp upstream of the translation initiation site and the CYP11A1 mRNA level may be modulated by the polymorphism. Recent studies suggested that the absence of the shortest (tttta)4 allele of the CYP11A1 polymorphism was associated with a risk of polycystic ovary syndrome and with a hyperandrogenic state in polycystic ovary syndrome patients. In our study which included 278 prostate cancer patients, 213 benign prostatic hyperplasia (BPH) patients and 299 male controls, we explored the association between the CYP11A1 polymorphism and prostate cancer on the hypothesis that the presence of the (tttta)4 allele may increase the risk of the development or progression of prostate cancer. In addition, we measured the serum levels of 6 steroid hormones or their metabolite (i.e., testosterone, free-testosterone, estrone, estradiol, dehydroepiandrosterone and androstendione) in 156 control males subjects and compared those with and without the (tttta)4 allele. The polymorphism was evaluated by PCR amplification of a 145-170 bp fragment followed by polyacrylamid gel electrophoresis. The CYP11A1 allele consisted of 4, 6, 7, 8 and 9 (tttta)-5 bp repeats. There was no significant difference in the genotype frequency as for the presence of the (tttta)4 allele between prostate cancer patients and male controls, and between prostate cancer patients and BPH patients. However, there was a significant difference in the genotype frequency in relation to the disease status. Prostate cancer patients without the (tttta)4 allele had an increased risk of metastatic disease (stage D) compared to those with the (tttta)4 allele [adjusted odds ratio (aOR)=1.76, 95% confidence interval (Cl)=1.07-2.90 and p =0.026]. Patients without the (tttta)4 allele had an increased risk of high grade prostate cancer (Gleason score 8 or more, or poorly differentiated cancer) compared to those with the (tttta)4 allele (aOR=1.79, 95% Cl=1.08-2.97 and p =0.025). No significant difference in the serum levels of 6 steroid hormones or their metabolites was found in the presence or absence of the (tttta)4 allele. Our results suggest that the CYP11A1 polymorphism may have a significant influence on the development of advanced and/or high grade prostate cancer and the absence of the CYP11A1 (tttta)4 allele, i.e., the homozygosity for the (tttta)6 or longer allele, could be a useful marker for the prediction of disease progression of prostate cancer.

Aged↗

PubMed2004

Hand-assisted retroperitoneoscopic nephrectomy for living kidney transplantation: initial 44 cases.

OBJECTIVES: To report our technique and early results of hand-assisted retroperitoneoscopic nephrectomy (HARN) for living donor transplantation and to assess its feasibility. METHODS: HARN was effectively and safely performed on 44 donors from July 2001 to September 2003 at Akita University Medical Center. We describe our techniques and experiences with HARN and compare the early results with those of 27 cases of open donor nephrectomy at our institution. RESULTS: The mean operating time was 260 minutes (range 173 to 445), the mean estimated blood loss was 249 mL (range 15 to 967), and the mean warm ischemia time was 2.2 minutes (range 0.8 to 6.4). These parameters were similar to those of open donor nephrectomy. Intraoperative and postoperative complications occurred in 1 (2.3%) and 2 (4.6%) cases, respectively, but they were all minor. HARN was converted to open nephrectomy in 1 case (2.3%) because of uncontrollable bleeding. All HARN donors were ambulant within 2 days postoperatively and could initiate oral intake on the first postoperative day. Regarding graft function, 41 recipients (93.2%) had an immediate onset of diuresis and 3 (6.8%) had delayed renal function. The serum creatinine 7 days and 1 month postoperatively was not significantly different between the HARN group and the open nephrectomy group. CONCLUSIONS: HARN for living donors is one excellent option for donor nephrectomy because the procedure does not require intraperitoneal manipulation, thus reducing the risk of abdominal visceral injury, and also because of the minimal warm ischemia time owing to rapid extraction of the kidney with hand assistance.

Adult↗

PubMed2004

Numeric aberrations of HER-2 and chromosome 17 detected by fluorescence in situ hybridization in urine-exfoliated cells from patients with urothelial carcinoma.

OBJECTIVES: To elucidate the clinical significance of the HER-2 gene alterations in urine-exfoliated cells detected by fluorescence in situ hybridization (FISH) in patients with urothelial transitional cell carcinoma. METHODS: The relative increase of HER-2 (RI-HER2) and gain of chromosome 17 (G-17) in urine-exfoliated cells were examined using DNA probes for HER-2 and the chromosome 17 centromere in 103 patients. In addition, FISH analysis was performed using corresponding paraffin-embedded tissue sections from 45 cases to compare the results obtained using urine-exfoliated cells and those obtained using paraffin-embedded tissue. RESULTS: RI-HER2 and G-17 was found in 23 (22.3%) and 46 (44.6%) of 103 patients, respectively. RI-HER2 was significantly more frequent in tumors with two or more recurrences (40.7% versus 15.8%, P = 0.010) and in those with carcinoma in situ (CIS) (35.4% versus 15.9%, P = 0.029). G-17 was more frequent in high-grade tumors (69.1% versus 16.7%, P = 0.032), invasive tumors (63.6% versus 14.3%, P < 0.001), and in patients with CIS (77.1% versus 29.0%, P < 0.001). The positive rate for FISH (presence of RI-HER2 and/or presence of G-17) tended to be more frequent in FISH than in cytology. A comparison of the analyses using urine-exfoliated cells and paraffin-embedded tissue showed identical results in 36 (80.0%) of 45 cases. CONCLUSIONS: Numeric alterations of the chromosome 17 centromere in urine-exfoliated cells detected by FISH may reflect the malignant potential of urothelial carcinoma. In addition, a relative increase in HER-2 was associated with the number of recurrences and the presence of CIS.

Aged↗

PubMed2004

Radical cystectomy for invasive bladder cancer: results of multi-institutional pooled analysis.

BACKGROUND: We report the outcome of radical cystectomy for patients with invasive bladder cancer, who did not have regional lymph node or distant metastases, at 21 hospitals. METHODS: Retrospective, non-randomized, multi-institutional pooled data were analyzed to evaluate outcomes of patients who received radical cystectomy. Between 1991 and 1995, 518 patients with invasive bladder cancer were treated with radical cystectomy at 21 hospitals. Of these, 250 patients (48.3%) received some type of neoadjuvant and/or adjuvant therapy depending on the treatment policy of each hospital. RESULTS: The median follow-up period was 4.4 years, ranging from 0.1 to 11.4 years. The 5-year overall survival rate was 58% for all 518 patients. The 5-year overall survival rates for patients with clinical T2N0M0, T3N0M0 and T4N0M0 were 67%, 52% and 38%, respectively. The patients with pT1 or lower stage, pT2, pT3 and pT4 disease without lymph node metastasis had 5-year overall survivals of 81%, 74%, 47% and 38%, respectively. The patients who were node positive had the worst prognosis, with a 30% overall survival rate at 5 years. Neoadjuvant or adjuvant chemotherapy did not provide a significant survival advantage, although adjuvant chemotherapy improved the 5-year overall survival in patients with pathologically proven lymph node metastasis. CONCLUSIONS: The current retrospective study showed that radical cystectomy provided an overall survival equivalent to studies reported previously, but surgery alone had no more potential to prolong survival of patients with invasive cancer. Therefore, a large-scale randomized study on adjuvant treatment as well as development of new strategies will be needed to improve the outcome for patients with invasive bladder cancer.

Adult↗

PubMed2004

Increased risk of bladder cancer associated with a glutathione peroxidase 1 codon 198 variant.

PURPOSE: The glutathione peroxidase 1 gene (GPX1) and the manganese superoxide dismutase gene (MnSOD) encode the main antioxidant enzymes that detoxify endogenous reactive oxygen species involved in carcinogenesis. Polymorphisms of GPX1 and MnSOD genes, and the risk of transitional cell cancer of the bladder were tested. MATERIALS AND METHODS: Genotypes of the leucine (Leu) to proline (Pro) polymorphism at codon 198 of GPX1, the alanine (Ala) to Valine (Val) polymorphism in exon 2 and the isoleucine to threonine polymorphism at codon 56 of MnSOD were determined by a polymerase chain reaction-restriction fragment length polymorphism technique in 213 patients and 209 normal controls. RESULTS: There was a significant difference in GPX1 genotype frequency between the case and control groups (p = 0.001). The adjusted OR for bladder cancer was 2.63 for the Pro/Leu genotype compared with the Pro/Pro genotype (95% CI 1.45 to 4.75, p = 0.001). Compared with the Pro/Pro genotype the Pro/Leu genotype was significantly associated with advanced tumor stage (Ta-1 vs T2-4, OR 2.58, 95% CI 1.07 to 6.18, p = 0.034) but not with tumor grade. Analysis of the MnSOD polymorphism provided no significant results. However, in men with at least 1 Ala MnSOD allele the risk associated with the Pro/Leu GPX1 genotype increased up to 6.31 (95% CI 1.28 to 31.24, p = 0.024). CONCLUSIONS: The GPX1 Pro/Leu genotype may significantly increase the risk of bladder cancer and the increased risk may be modified by the Ala-9Val MnSOD polymorphism. The GPX1 genotype may further affect the disease status of bladder cancer.

Aged↗

PubMed2004

Rectosigmoidal bladder utilizing intussuscepted ileal segment: a surgical technique for urinary diversion and experiences in 30 patients.

BACKGROUND: We previously reported that the ileocecal rectal bladder consists of interposition of an intussuscepted ileocecal segment between the ureters and the rectum for those in whom the urethra is not available. Although the ileocecal rectal bladder has been well accepted by most patients, it requires an extensive preparation along the ascending colon. We present a modified operation technique (rectosigmoidal bladder) by using the ileal segment alone as an interposing antireflux component and by using the sigmoidal segment to augment the rectal capacity. METHODS: From February 1993 to July 2002, 30 patients with a median age of 64 years underwent construction of a rectosigmoidal bladder. Median follow-up period was 26 months (range, 13-125). The follow up was carried out using clinical and functional assessments such as evacuation status, serum chemistry and radiographic evaluation of the upper urinary tracts and rectosigmoidal pouch. To assess the postoperative health-related quality of life, we carried out a survey comparison of the ileocecal rectal bladder patients and the rectosigmoidal bladder patients. RESULTS: No operative or urinary diversion-related postoperative mortality was encountered. All rectosigmoidal bladders had sufficient capacity, with no evidence of urinary reflux or daytime incontinence. When compared with our previous procedure, the ileocecal rectal bladder, the present procedure had advantages with respect to complications with urine-fecal leak and acidosis. There were no differences in mean operation time, or in the health-related quality of life survey, between the two procedures. CONCLUSIONS: Our experience showed that this technique should be considered for those in whom the urethra is not available.

Adult↗

PubMed2004

Influence of pretransplant dialysis modality on the change of lymphocyte subset populations and acute rejection rates after renal transplantation.

BACKGROUND: The influence of dialysis modality on the acute rejection (AR) rate after renal transplantation is controversial. We investigated whether the pretransplant dialysis modality correlated with the lymphocyte subset populations and the incidence of AR after renal transplantation. METHODS: Thirty-eight first living renal transplant recipients, consisting of 22 patients on pretransplant hemodialysis (HD) and 16 patients on pretransplant peritoneal dialysis (PD), were studied. Peripheral blood samples were taken on days -1 through 28 after transplantation, and the lymphocyte fractions were exposed to the monoclonal antibodies anti-CD3, CD19, CD4, CD8 and CD28 for a flow cytometer analysis. Biopsy specimens were obtained at the time of presumed AR episodes and on day 28 after transplantation. RESULTS: The PD patients had a higher frequency of AR (37.5% in PD vs 9.1% in HD patients, P = 0.034). In contrast, two HD patients showed graft loss at 18 and 30 months after transplantation. The increases of CD3, CD19, CD4 and CD4+ CD28+ cells in the PD patients occurred earlier than in the HD patients and the numbers of these cells in the PD group were higher than those in the HD between days 3-28 after transplantation, most significantly on day 7. CONCLUSIONS: These findings suggest that the PD patients with similar clinical characteristics could potentially have a higher immunocompetence and immune responsiveness associated with a higher rate of AR in the early stage of renal transplantation when compared with the HD patients.

Acute Disease↗

PubMed2004

Early and large-dose intravesical instillation of epirubicin to prevent superficial bladder carcinoma recurrence after transurethral resection.

OBJECTIVE: To prospectively compare the prevention of tumour recurrence by four intravesical adjuvant administration protocols, and thus elucidate the efficacy of early and high total dose instillations of epirubicin to prevent superficial bladder tumour recurrence after transurethral resection of bladder tumour (TURBT). PATIENTS AND METHODS: In all, 69 patients with Ta/T1 bladder cancer were randomly assigned to four intravesical administration protocols: A, delayed instillation (first instillation 7 days after TURBT) and low-dose (30 mg once every 2 weeks, six times): B, early instillation (three instillations before 7 days after TURBT) and low-dose; C, delayed and high-dose (30 mg once weekly 12 times) instillation; D, early and high-dose. The influence of the instillation protocols and tumour characteristics on the probability of recurrence-free survival was examined using Kaplan-Meier analysis and a Cox regression hazard model. RESULTS: The early-instillation and high-dose groups had relatively lower recurrence rates after 6 months (A, 30%; B, 25%; C, one of 12; and D, none) and 1 year (50%, 35%, four of nine and one of eight, respectively). Patients who received 360 mg epirubicin (C and D) had a significantly better recurrence-free survival than those receiving 180 mg (A and B; P = 0.012). Preoperative urine cytology and tumour multiplicity were significantly associated with recurrence. However, multivariate analysis of the risk of recurrence using a Cox proportional hazard model showed that urine cytology (hazard ratio 3.11, 95% confidence interval 1.08-8.94, P = 0.04) and total dose (0.32, 0.11-0.92, P = 0.03) were independent prognostic factors for recurrence. CONCLUSION: Patients who received a high-dose epirubicin instillation had a significantly lower recurrence rate but the benefit of early instillation was not confirmed, as the study group was too small.

Administration, Intravesical↗

PubMed2004

A novel antireflux technique using an intussuscepted ileal segment.

A novel surgical technique of antireflux with an ileal conduit for urinary diversion is presented with our early results. The mid 8-cm portion of an isolated terminal ileum is intussuscepted. After skeletonization of the mesenterial vasculature, 3 rows of 4 mattress seromuscular silk sutures are placed on the ileum. By tying the sutures successively, the ileum is intussuscepted and the resultant nipple is secured simultaneously between its outer and inner layers. The outer nipple layer and the recipient ileal layer are further fixed as a whole by placing 3 rows of metal staples. The nipple base is secured by interrupted silk sutures and the mesenterial defect is closed. This technique was applied to 30 patients undergoing rectosigmoidal bladder procedure, a modified ileocecal rectal bladder, in which the antireflux conduit was interposed between the ureters and the rectosigmoidal pouch. Ureteral reflux was observed in none of the patients during a mean follow-up period of 29.9 months. Of the 60 renal units, 53 (88.3%) had normal pyelography and 7 (12.7%) showed mild hydronephrosis at 3-6 months postoperatively. This antireflux technique is simple and reliable, and can be applied to other urinary diversion/reconstruction surgeries, such as the continent reservoir, orthotopic neobladder, and/or bladder augmentation.

Adult↗

PubMed2004

[A case of organ sparing surgery for metachronous bilateral testicular tumor with maintaining testicular function].

A 28-year-old man, who had undergone right orchiectomy and prophylactic irradiation for stage I seminoma 6 years ago, developed left testicular tumor. Since the secondary tumor was localized in the lower pole of the testis, partial orchiectomy was performed with an attempt to preserve the testicular function. The pathological finding of the surgical specimen was a mixed type testicular tumor consisting of seminoma, embryonal carcinoma and teratoma elements. Postoperative chemotherapy with 3 courses of BEP regimen resulted in azoospermia, but the impaired spermatogenesis recovered to a normal range within 18 months with no evidence of tumor recurrence and his wife delivered a healthy baby 2 years later. For the synchronous or metachronous bilateral testicular tumors, the combination of organ sparing surgery and chemotherapy could be a treatment of choice.

Adult↗

PubMed2004

[Angioplasty for the intimal dissection of graft artery immediately after blood reflow: a successful case of renal transplantation].

A 58-year-old woman, who had been suffering from chronic renal failure on hemodialysis since 1999, underwent living renal transplantation on January 14, 2003. The donor was her husband, and his left kidney was resected by a hand-assisted retroperitoneoscopic technique. Vascular clamps were removed after vascular anastomoses, but the color of two-thirds of the graft back side was dark, and urine excretion was not observed for 1 hour. The intimal dissection of the graft artery developed false lumen that occluded the blood flow to the transplanted kidney. The graft was resected from the recipient, and an angioplasty was performed for the false lumen of the graft artery after the second cold preservation. The graft with repaired artery was re-transplanted, and urine excretion was observed immediately after operation. Total ischemia time was 5 hours. Clinicopathological acute rejection episode and stenosis of graft artery did not occur for 6 months after operation. The intimal dissection of graft artery might occur at the time of catheterization on the perfusion for cold preservation and/or vascular anastomosis.

Anastomosis, Surgical↗

PubMed2004

[Active chemotherapy with gemcitabine, carboplatin and docetaxel for three patients with MVAC-resistant liver metastasis of urothelial carcinoma].

We report three cases with methotrexate-vinblastin-adriamycin-cisplatin (MVAC) resistant multiple liver metastases of urothelial carcinoma that responded to combination chemotherapy consisting of gemcitabine plus carboplatin (GC) with additional docetaxel (GCD) as salvage chemotherapy. Case 1: A 55-year-old man underwent left nephroureterectomy for ureteral cancer (TCC, G3, pT3pN1M0). Three courses of GC followed by three courses of GCD were given via intra-hepatic arterial infusion for multiple liver metastases, which appeared after adjuvant high-dose MVAC therapy. Complete response was obtained and maintained for 11 months. Case 2: A 46-year-old man underwent radical cystectomy for locally advanced bladder cancer (TCC G3 + adenocarcinoma. pT3pN0M0). Two courses of GC followed by 2 courses of GCD systemic therapies were performed for multiple liver metastases, which appeared after adjuvant high-dose MVAC therapy. Partial response was obtained and maintained for six months. Case 3: A 66-year-old man received three courses of MVAC for multiple metastases of the bladder cancer (TCC, G3, > pT2), which resulted in disease progression. Eight courses of GC followed by six courses of GCD were administrated via intra-hepatic arterial infusion. Partial response was obtained and maintained for 12 months. Although the response duration was still short, GC and GCD may be promising salvage chemotherapeutic regimens for the patients with MVAC-resistant liver metastases of urothelial carcinoma.

Aged↗

PubMed2004

[Retroperitoneoscopic partial nephrectomy by using microwave tissue coagulation].

Partial nephrectomy is widely accepted as a treatment for small renal cell carcinoma. However, the laparoscopic approach has not yet been considered as a standard procedure. We reviewed our 13 retroperitoneoscopic partial nephrectomies and 11 conventional open partial nephrectomies. We have used microwave tissue coagulation for retroperitoneoscopic surgery without renal pedicle clamping between December 1999 and May 2003. The mean operating time for the retroperitoneoscopic group was not significantly longer than that for conventional open surgery group (183 minutes vs 194 minutes). However, the mean blood loss for the retroperitoneoscopic group was less than that for the open group (143 ml vs 512 ml). Histologic evaluation revealed renal cell carcinoma in 10 patients, angiomyolipoma in 2 patients, and lymphoangiomyomatosis in one patient for retroperitoneoscopic group and renal cell carcinoma in 11 patients for the conventional open surgery group. In addition, when compared with the historical control that had undergone conventional partial nephrectomy, laparoscopic cases had significantly shorter postoperative times to oral intake, ambulance, and discharge from hospital. Bowel injury, massive bleeding, urine leakage, and atelectasis occurred in one case each in retroperitoneoscopic surgery. Retroperitoneoscopic surgery in the case of massive bleeding was converted to open surgery. On the other hand, urine leakage and postoperative hemorrhage occurred in one case each in conventional open surgery. Retroperitoneoscopic partial nephrectomy by using microwave tissue coagulation is a useful and less invasive method, whereas this procedure is more challenging than open partial nephrectomy in terms of complications.

Adult↗

PubMed2004

[Laparoscopic adrenalectomy: Akita University experience].

We performed 52 laparoscopic adrenalectomies between January 1997 and March 2003. In 51 patients, adrenal tumors were successfully removed laparoscopically. In one patient, the laparoscopic procedure was converted to open surgery because of insufflator's trouble and hemorrhage. Perioperative blood transfusion was required in two patients; one for intraoperative and another for postoperative bleeding. We compared laparoscopic adrenalectomy with conventional open surgery which had been performed in our clinic before the laparoscopic adrenalectomy era. The mean operative time of the laparoscopic adrenalectomy (187 +/- 59 min) was not significantly longer than that of the open surgery (193 +/- 49 min). The mean estimated blood loss of laparoscopic adrenalectomy (75 +/- 145 g) was significantly less than that of the open surgery (438 +/- 447 g). Time to oral intake and ambulation for laparoscopic adrenalectomy were significantly earlier than those of the open surgery. Operation time was significantly shortened as the experience of this surgery was accumulated. The results of our experience support the concept that laparoscopic adrenalectomy is safe and is a standard treatment for surgical treatment of adrenal tumors.

Adrenal Gland Diseases↗

PubMed2003

Polymorphisms in prostate-specific antigen (PSA) gene, risk of prostate cancer, and serum PSA levels in Japanese population.

Recent studies have indicated that the prostate-specific antigen (PSA) gene polymorphisms may be associated with the risk of prostate cancer in Caucasian populations. To verify the association, we examined the PSA polymorphisms at positions -158 and -252 in 300 prostate cancer cases, 216 benign prostatic hyperplasia (BPH) cases, and 266 controls by the PCR-restriction fragment length polymorphism analysis. Regarding the PSA polymorphism at position -158, the A allele was less common in the Japanese population (A 0.22, G 0.78) than that in other ethnic populations (A 0.37-0.52, G 0.48-0.63). No significant associations were found between the polymorphism and the risks of prostate cancer (P=0.530) and BPH (P=0.740) and between the polymorphism and the serum PSA level (P=0.626). As for the polymorphism at position -252, no significant results were also found. In conclusion, the PSA polymorphisms may not be associated with the risk of prostate cancer development and its disease progression and the risk of BPH in Japanese men, and may also be not related to the serum PSA level in Japanese men with prostate cancer.

Aged↗