Biomedical subjects

Kentaro Ichioka

Publications and source records attributed to Kentaro Ichioka.

At least 19 recordsLinked to original sources

PubMed2006

Adult onset of declining spermatogenesis in a man with nonmosaic Klinefelter's syndrome.

OBJECTIVE: To examine an unusual case of Klinefelter's syndrome. DESIGN: Case report. SETTING: An infertility clinic at a private hospital. PATIENT(S): A patient with nonmosaic Klinefelter's syndrome who had had a child with his ex-wife without artificial reproductive technologies. INTERVENTION(S): Karyotyping with peripheral blood lymphocytes, microdissection testicular sperm extraction, and intracytoplasmic sperm injection (ICSI). MAIN OUTCOME MEASURE(S): Sperm count and testicular histopathology. RESULT(S): Semen analysis revealed severe oligoasthenozoospermia. Intracytoplasmic sperm injection using ejaculated spermatozoa was performed, and successful pregnancy and delivery were achieved. Two years later, multiple semen analyses revealed azoospermia. Microdissection testicular sperm extraction was performed, and motile sperm were successfully retrieved. Unfortunately, the first cycle of ICSI using testicular sperm failed. Testicular histopathology was compatible with decreased spermatogenesis. CONCLUSION(S): This is a case of a man with nonmosaic Klinefelter's syndrome who exhibited progressive decline of spermatogenesis. This case suggests the merit of early sperm retrieval and cryopreservation for future management of infertility in Klinefelter's syndrome.

Adult↗

PubMed2006

Testosterone-induced priapism in Klinefelter syndrome.

We present the case of a patient with Klinefelter syndrome and priapism after testosterone administration. The patient underwent testicular sperm extraction for interventional fertilization, but no sperm were found. Because he had given up trying to father a child and his testosterone level had been low, testosterone replacement therapy was started with testosterone enanthate. After the third injection, he presented with low-flow priapism. Conservative management was successful, and no recurrence developed during the next 15 months. Testosterone replacement therapy carries some risk of priapism even for patients with Klinefelter syndrome.

Adult↗

PubMed2006

Aging Males' Symptoms scale in Japanese men attending a multiphasic health screening clinic.

OBJECTIVES: The Aging Males' Symptoms (AMS) scale is a health-related quality-of-life scale. The AMS scale has been used worldwide for the evaluation of andropause symptoms, but its standardized values have only been published for Germany. We sought to evaluate the prevalence of andropause symptoms in the male Japanese population using the AMS scale. METHODS: Of a consecutive series of 2833 men who underwent multiphasic health screening at Kurashiki Central Hospital, we analyzed the results for 2211 men who responded to all questions on the AMS scale. RESULTS: The severity of the total score and the sexual subscore of the AMS scale increased significantly with age, but no significant age relationships were observed in the psychological and somatic subscores. Approximately 50% of men in their 40s had moderate or severe symptoms in the sexual subscore. The total scores and all subscores for the Japanese population were significantly greater than those for the German population. CONCLUSIONS: A decline in sexual function with age was demonstrated in healthy Japanese men, but the somatic and psychological subscores were not influenced by age. The present study has provided standardized values for the AMS scale for the Japanese population.

Adult↗

PubMed2006

Dynamic contrast-enhanced subtraction magnetic resonance imaging in diagnostics of testicular torsion.

OBJECTIVES: To retrospectively correlate the magnetic resonance imaging (MRI) diagnosis with the surgical findings and/or clinical outcomes in patients presenting with an acute scrotum. METHODS: From January 1997 to June 2004, 39 selected patients presenting with an acute scrotum underwent dynamic contrast-enhanced subtraction MRI as a 24-hour stand-by examination. The MRI diagnosis was based solely on the presence or absence of testicular contrast enhancement, without respect to the clinical history or physical examination findings. RESULTS: Contrast enhancement of the affected and normal testes could be accurately compared in all cases. The MRI diagnosis was testicular torsion (no testicular contrast enhancement, n = 13), nonspecific (reduced to normal enhancement, n = 10), appendiceal torsion (n = 3), and epididymitis (n = 13). The surgical findings and/or subsequent clinical outcomes showed that MRI diagnosis of testicular torsion was accurate in all 13 cases. Furthermore, exploration revealed testicular torsion in 1 case with very little enhancement. The sensitivity and specificity of MRI in the diagnosis of testicular torsion was 93% (13 of 14) and 100% (25 of 25), respectively. Although MRI detected testicular perfusion, 5 of the 6 patients with clinical suspicion of intermittent torsion underwent surgical exploration. CONCLUSIONS: MRI is a highly accurate imaging modality for the diagnosis of testicular torsion. However, it could not be used to rule out intermittent torsion and the clinical use of negative findings for an MRI torsion test was less than 100% specificity. Because this was a preliminary retrospective study, the true clinical value of MRI should be evaluated by prospective studies.

Adolescent↗

PubMed2006

Obstructive azoospermia associated with chronic sinopulmonary infection and situs inversus totalis.

We describe 2 cases of obstructive azoospermia associated with situs inversus and sinopulmonary infection due to ciliary defects. Electron microscopy of testicular sperm flagella demonstrated normal morphology with nine peripheral doublets surrounding a central pair and complete sets of inner and outer dynein arms. Electron microscopy of the nasal mucosa revealed partial defects of the dynein arms of cilia, although the "9+2" morphology was preserved. Our cases were considered unique variants of Young's syndrome but also had characteristic features of Kartagener syndrome, and thus support the hypothesis that Young's syndrome has a genetic etiology similar to that of Kartagener syndrome.

Adult↗

PubMed2006

Antibiotic prophylaxis in radical prostatectomy: 1-day versus 4-day treatments.

OBJECTIVE: The standard protocol of antibiotic prophylaxis in radical prostatectomy remains to be established. We retrospectively compared the occurrence of perioperative infections following radical prostatectomy between two different protocols of antibiotic prophylaxis. METHODS: This study included 106 cases of radical retropubic prostatectomy managed on the clinical pathways. Two different protocols of antibiotic prophylaxis were used in otherwise identical pathways. Between January and December 2004, 50 patients received a second generation cephem, cefotiam, for 4 days, beginning 30 min before surgery (4-day group), whilst between December 2004 and July 2005, only two doses of cefotiam were given on the day of operation in 56 patients (1-day group). The incidence of surgical site infection (SSI) and remote infection (RI) was retrospectively investigated. RESULTS: Superficial incisional SSI occurred in one (1.8%) patient in the 1-day group, whereas no patient in the 4-day group developed SSI. No RI was observed in either the 1-day or 4-day group. Intravenous antibiotics were administered besides the pathway in a patient in the 1-day group because unexplained fever more than 38 degrees C continued postoperative day (POD) 2 through POD 4 without signs of SSI or RI. Excluding this case, postoperative more than 38 degrees C was rare and transient after POD 2. CONCLUSION: The incidence of SSI and RI was low and not significantly different between the 1-day and 4-day groups. Therefore, the 1-day protocol of prophylactic antibiotic treatment seems adequate for preventing perioperative infections in radical prostatectomy.

Aged↗

PubMed2006

[The Aging Male's Symptoms (AMS) scale in Japanese men attending an infertility clinic].

There is a gradual decline in testosterone and free testosterone with age. Physical and psychological changes can occur due to this decline of androgens--a syndrome known as "partial androgen decline in the aging male" (PADAM). Male infertility and erectile dysfunction (ED) can also be caused by androgen deficiency. Thus, male infertility, ED and PADAM are interrelated. We evaluated the prevalence of PADAM symptoms in 215 infertile patients in an infertility clinic using the Aging Males Symptom (AMS) scale. Results of the evaluation of 301 men, (30-39 years old) using the same scale, who were part of a multiphasic health screening program, served as controls. The total score of the infertile patients was lower than that of the controls. Especially, the scores of the psychological and somatic subscales were significantly lower in infertile patients (P=0.009, P=0.012, respectively). Thirty three (15.3%) of the 215 infertile patients had ED. Although the score of sexual subscale was higher in the ED patients than in the controls, the scores of the psychological and somatic subscales were not significantly different from those in the controls. In conclusion, PADAM symptoms in Japanese infertile patients were not severe. Moreover, general function was better preserved in the infertile patients than in the controls. The psychological and somatic functions of ED patients were also well preserved.

Adult↗

PubMed2005

Intraoperative electrophysiological confirmation of neurovascular bundle preservation during radical prostatectomy: long-term assessment of urinary and sexual function.

OBJECTIVE: We investigated the longitudinal recovery of urinary and sexual function after radical retropubic prostatectomy (RP) using an intraoperative electrophysiological test to confirm the functional preservation of the neurovascular bundle (NVB). METHODS: A total of 70 patients who underwent RP for localized prostate cancer were prospectively enrolled in our survey. During RP, electrophysiological testing was performed to confirm the NVB preservation. The NVB was electrostimulated and the responses were observed by monitoring the intracavernous or intraurethral pressure changes. All patients were classified into three groups according to the degree of nerve-sparing [a bilateral nerve-sparing group (BNS), a unilateral nerve-sparing group (UNS) and a non-nerve-sparing group (NNS)] based on the macroanatomical as well as the electrophysiological assessment. Both urinary and sexual function were measured before and 3, 6, 12 and 24 months after RP by a self-administered questionnaire. RESULTS: The concordance rate of nerve-sparing or non-nerve-sparing between the electrophysiological and macroanatomical assessment was 80%. According to the electrophysiological data, the BNS maintained significantly better urinary function at 3 months after RP than the NNS and UNS. After 6 months, each group had almost recovered continence. When considering sexual function, the BNS showed better sexual function scores than the NNS throughout the post-operative periods and the UNS at 2 years. According to the macroanatomical assessment, however, these differences were significant. CONCLUSIONS: Nerve-sparing RP as confirmed by intraoperative electrophysiological test may contribute significantly to the early recovery of continence and greater rate of sexual function after RP.

Aged↗

PubMed2005

Quality of life after radical prostatectomy in Japanese men: 2 year longitudinal study.

OBJECTIVE: We performed a 2 year longitudinal survey of health-related quality of life (HRQOL) after radical retropubic prostatectomy (RP) in Japanese men with localized prostate cancer. PATIENTS AND METHODS: We measured 112 patients who underwent RP with SF-36 and University of California, Los Angeles Prostate Cancer Index before and 3, 6, 12, 18 and 24 months after surgery. RESULTS: Patients who underwent RP showed problems in some domains of general HRQOL, but these problems diminished over time. Mental health significantly improved throughout the follow-up period. The urinary function substantially declined at 3 months and continued to recover gradually but never returned to the baseline. Urinary bother at 3 months showed a significant decrease, but at 6 months it returned to baseline. The data of sexual function and bother showed a substantially lower score after RP. Patients lost their sexual desire significantly throughout the post-operative period. After 12 months, the nerve sparing group had significantly better improvement in sexual function than the non-nerve sparing group and this improvement continued up to 2 years after operation. CONCLUSION: Despite reports of problems with sexuality and urinary continence, general HRQOL was mostly unaffected by RP after 6 months. RP had a favorable impact on mental health. Although urinary function did not completely return to the baseline level even at 2 years after RP, recovery from urinary bother was rapid. RP had serious consequences on libido, erectile function and sexual activity. In the second year, the sexual function of those who underwent RP with bilateral nerve sparing procedure continued to improve.

Aged↗

PubMed2005

Risk stratification after radical prostatectomy in men with pathologically organ-confined prostate cancer using volume-weighted mean nuclear volume.

OBJECTIVE: We examined the impact of volume-weighted mean nuclear volume (MNV) on biochemical failure after radical prostatectomy (RP) in pathologically organ-confined prostate cancer (PC) and developed a prognostic factor-based stratification model for these patients. PATIENTS AND METHODS: We analyzed 141 patients with pathologically organ-confined PC treated solely with RP. Unbiased estimates of MNV were calculated from biopsy specimens based on a stereological method, and compared with other clinical and pathologic findings including patient age, pre-treatment PSA, biopsy and RP specimen Gleason score, pathologic stage, total cancer volume, index cancer volume, tumor differentiation, number of tumor foci, main tumor location, and surgical margin status, with regard to prediction of disease outcome after RP using Cox proportional hazard models. RESULTS: The median follow-up was 38.6 months (range 4--119 months). Twenty patients (14.2%) experienced biochemical failure. On multivariate analysis, MNV was demonstrated to be an independent prognostic factor, along with pre-treatment PSA and total cancer volume (P=0.0004, 0.0184, and 0.0285, respectively). All patients were stratified into three groups according to their prognostic scores developed on the basis of multivariate analysis, with statistically significant prognostic differences revealed for each of the between-group comparisons. CONCLUSION: The results demonstrated that estimates of MNV contribute most significantly to the prediction of biochemical control of pathologically organ-confined PC. The combination of MNV with other independent predictors such as pre-treatment PSA and total cancer volume provided a statistically verifiable basis for risk stratification, facilitating more accurate prediction of disease outcome.

Aged↗

PubMed2005

Use of complementary and alternative medicine by patients with urologic cancer: a prospective study at a single Japanese institution.

OBJECTIVES: We prospectively evaluated the prevalence and predictors of complementary medicine (CAM) use among Japanese patients with urologic cancer 1 year after diagnosis. PATIENTS AND METHODS: A total of 349 patients with newly diagnosed urologic cancer answered a self-administered questionnaire on CAM use 1 year after diagnosis. General-health-related quality of life (GHQL) of the patients was also assessed at diagnosis and 1 year after diagnosis using the Medical Outcome Study Short Form-36 (SF-36). The overall prevalence, types of CAM used, and costs of CAM were assessed. The effects of several variables including GHQL at baseline and 1 year after treatment on the prevalence of use of CAM were evaluated. RESULTS: A total of 164 respondents (47%) admitted using some type of CAM, of which 73 (45%) had used multiple types. "Health food," in particular extract from Agaricus blazei, was the most common type of CAM used. CAM users had significantly lower scores for social function, general health perception, and vitality domains than CAM non-users 1 year after diagnosis. This tendency was more marked in users of multiple types of CAM. CONCLUSIONS: "Health food," including extract from A. blazei, was the most commonly used CAM in Japan. The prevalence of CAM use did not differ between patients with prostate cancer and those with urologic cancer other than prostate cancer. CAM users, especially those who used multiple types of CAM, had lower GHQL scores than non-users of CAM.

Adult↗

PubMed2005

Paracentric inversion of chromosome 7(q22-31) associated with nonobstructive azoospermia.

OBJECTIVE: To examine an unusual paracentric inversion of chromosome 7 found in an azoospermic man. DESIGN: Case report. SETTING: Infertility clinic at a private hospital. PATIENT(S): An azoospermic but otherwise apparently healthy man. INTERVENTION(S): Karyotyping with peripheral blood lymphocytes, microdissection testicular sperm extraction (TESE), and intracytoplasmic sperm injection (ICSI). MAIN OUTCOME MEASURE(S): Sperm count and GBG banding. RESULTS: A karyogram revealed paracentric inversion of chromosome 7 with breakpoints at 7q22 and 7q31. Testicular histopathology confirmed the Sertoli cell-only syndrome. Successful pregnancy and delivery were achieved with microdissection TESE and ICSI. CONCLUSION(S): Paracentric inversion of chromosome 7(q22-31) associated with nonobstructive azoospermia is rare. Chromosome 7q22-31 may be responsible for impaired spermatogenesis.

Adult↗

PubMed2005

Risk factors for subsequent development of bladder cancer after primary transitional cell carcinoma of the upper urinary tract.

OBJECTIVES: To determine the independent risk factors for intravesical tumor recurrence in patients with primary transitional cell carcinoma of the upper urinary tract, and to develop a risk-stratification model to allow more accurate prediction of recurrence risk. METHODS: Of 141 patients who underwent total nephroureterectomy for clinically localized transitional cell carcinoma of the upper urinary tract, the data from 89 patients were retrospectively reviewed. Patients with a previous history or concomitance of bladder cancer and/or a follow-up period of less than 1 year were excluded from this study. Multivariate analysis by Cox's proportional hazards model was used to determine independent risk factors for intravesical tumor recurrence. RESULTS: Of 89 patients, 37 (41.6%) experienced subsequent intravesical tumor recurrence during a median follow-up period of 39.7 months (range 12.0 to 186.6). On multivariate analysis, tumor multiplicity, pathologic stage, tumor size, and surgical modality had a statistically significant impact on the risk of intravesical tumor recurrence (P = 0.0075, P = 0.0221, P = 0.0377, and P = 0.0413, respectively). Pathologic stage and tumor size were inversely correlated to the risk. A scoring system for the risk of intravesical recurrence was developed from the proposed prognostic factors, and the patients were stratified into three groups according to their scores, with statistically significant prognostic differences between them (P = 0.0018). CONCLUSIONS: Tumor multiplicity, pathologic stage, tumor size, and surgical modality all had a significant impact on the incidence of intravesical tumor recurrence. A risk stratification model constructed from tumor biologic factors may be useful in the follow-up of patients with transitional cell carcinoma of the upper urinary tract.

Aged↗

PubMed2005

Impact of superficial bladder cancer and transurethral resection on general health-related quality of life: an SF-36 survey.

OBJECTIVES: To assess the general health-related quality of life (GHQOL) of patients with superficial bladder cancer who underwent transurethral resection (TUR). METHODS: We assessed the GHQOL a total of 178 times for 133 patients with superficial bladder cancer before multiple TURs. The GHQOL was assessed using the Medical Outcome Study Short-Form 36-item survey (SF-36). Ninety-three patients answered the questionnaire at the first TUR, 34 at the second TUR, 17 at the third TUR, and 34 at the fourth or later TUR. RESULTS: Compared with age-matched and sex-matched Japanese norms, the general health perception was severely impaired in patients with superficial bladder cancer. Their mental health was also severely impaired at the first TUR, but gradually returned to normal as TUR was repeated. The scores of physical functioning, social functioning, and role-emotional demonstrated a nadir at the second or third TUR, and increased thereafter if TUR was repeated four or more times. Intravesical treatment for prevention of recurrence increased the score of bodily pain. CONCLUSIONS: Although superficial bladder cancer is not frequently lethal, patients with this disease believed their general health was much impaired. Only two domains of bodily pain and vitality had no negative impact from this disease. As urologists, we should notice the considerable affect of superficial bladder cancer on the GHQOL of patients.

Aged↗

PubMed2005

Use of acute normovolemic hemodilution in patients undergoing radical prostatectomy.

OBJECTIVES: To evaluate the efficacy and safety of acute normovolemic hemodilution (ANH) in patients undergoing radical prostatectomy. Preoperative autologous blood donation (PAD) is widely accepted as a means of reducing the need for allogeneic blood transfusion in radical prostatectomy. ANH is an alternative method for obtaining autologous blood. METHODS: On the basis of our previous report that showed the equivalence of PAD and ANH, we prospectively replaced PAD with ANH as a standard practice for radical prostatectomy after September 1999. Of 174 radical prostatectomy patients between September 1999 and June 2004, 153 underwent ANH alone, 15 chose to receive both PAD and ANH, and ANH was contraindicated in 15 because of comorbidities. RESULTS: For the 153 patients undergoing ANH alone, 1032 +/- 201 mL of autologous blood was collected. With an intraoperative blood loss of 1602 +/- 926 mL, 14 patients (9.2%) received allogeneic blood transfusion. The preoperative, intraoperative nadir, and postoperative hematocrit value was 43.6% +/- 3.4%, 25.8% +/- 3.8%, and 31.9% +/- 4.3%, respectively. No patient experienced a perioperative adverse event related to hemodilution or blood transfusion. CONCLUSIONS: Our continued experience has shown that ANH is a safe and effective means of autologous blood procurement. Given its advantages, including lower cost, lower risk, and simplicity, we conclude that ANH can replace conventional PAD for use in radical prostatectomy, although the true value of ANH should be determined by future randomized studies including a no-treatment control group.

Aged↗

PubMed2005

Lymphoepithelioma-like carcinoma of the ureter.

Lymphoepithelioma-like carcinoma is an undifferentiated epithelial tumor with a prominent lymphocytic infiltrate and is rarely seen in the upper urinary tract. Only 3 and 2 cases involving the ureter and renal pelvis, respectively, have been reported. We report the fourth documented case of lymphoepithelioma-like carcinoma of the ureter. Tumor cells were immunoreactive to cytokeratin and negative for Epstein-Barr virus. Our patient was disease free 30 months after nephroureterectomy. The prognosis is favorable for pure lymphoepithelioma-like carcinoma of the upper urinary tract.

Aged↗

PubMed2005

Emergency drainage for urosepsis associated with upper urinary tract calculi.

PURPOSE: We examined the characteristics of patients with urosepsis associated with upper urinary tract calculi requiring emergency drainage. MATERIALS AND METHODS: From January 1994 to December 2003, 424 patients were admitted to our urological department a total of 473 times for treatment of upper urinary tract calculi, of whom 53 required a total of 59 emergency drainage procedures for urosepsis. We summarized the characteristics of these patients and events, and determined risk factors for emergency drainage using logistic regression analysis. RESULTS: In 14 events (24%) intensive management, such as the use of vasopressors and anticoagulants, was performed. Transient thrombocytopenia less than 100,000/mm occurred in 18 events (31%). Hyperbilirubinemia occurred in 8 of 38 events (16%) without prior antibiotic therapy. One patient (2%) died of urosepsis. Patients with calculi who underwent emergency drainage required a longer hospital stay than those without emergency drainage (25.2 vs 14.8 days, p <0.001). Of the variables analyzed poor performance status (Karnofsky performance status 70% or less, OR 2.9, p = 0.003), age 75 years or older (OR 2.1, p = 0.038) and female sex (OR 1.8, p = 0.046) were risk factors on multivariate analysis. CONCLUSIONS: Our findings suggest that the frequency of emergency drainage in elderly patients with poor performance status has increased in recent years, at least in our rural area of Japan. Preventing calculous formation and urinary tract infection in individuals with poor performance status will be of considerable importance in the future.

Aged↗

PubMed2005

Alteration of body configuration after retroperitoneoscopic nephrectomy and nephroureterectomy.

OBJECTIVE: To evaluate objective alterations of body configuration in patients who treated with retroperitoneoscopic nephrectomy (RN) and retroperitoneoscopy-assisted nephroureterectomy (RAN). PATIENTS AND METHODS: Twenty-six patients who had RN and 23 RAN were eligible for the study. Abdominal computed tomography films before and after surgery were evaluated. The intra-abdominal content surrounded by the vertebral bones and the muscles forming the trunk of the body were divided into four subspaces. The areas of these four portions were measured, and the ratio of occupation of each portion calculated before compared with that obtained after surgery. RESULTS: While RAN had little impact on body configuration, RN significantly affected it; after RN the total area and area of ventral subspaces decreased homogeneously throughout the L2-L4 levels. The ipsilatero-dorsal subspace had a marked cranial decrease in area and no caudal alteration. CONCLUSIONS: While RAN has little effect on body configuration, RN has a significant effect, as measured objectively. Continuing the skin incision between ports and muscle splitting to extract the specimen is probably responsible for the difference between the findings of RAN and RN.

Abdomen↗