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Biomedical subjects

Masatsugu Iwamura

Publications and source records attributed to Masatsugu Iwamura.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic radical cystectomy and bilateral ureteric ligation for muscle-invasive bladder cancer in a patient on hemodialysis.

Laparoscopic cystectomy and bilateral ureteric ligation were performed on a 52-year-old woman with end-stage renal disease on hemodialysis (HD) for muscle-invasive bladder cancer. Her volume of urine production was approximately 100 mL/day. Excisions of the bladder and uterus with ligation of the bilateral ureter were conducted completely laparoscopically. Total operative time was 280 min and the amount of blood loss was 60 mL. No complications were seen perioperatively and no adverse events regarding ureteric ligation arose. HD was performed on the second postoperative day. At a 12-month follow-up, the patient showed no evidence of disease.

Cystectomy↗
PubMed2006

[8-month neoadjuvant hormonal therapy before radical prostatectomy for high-risk prostate cancer].

PURPOSE: To evaluate the clinicopathological outcomes of 8 months of neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy for high-risk prostate cancer. PATIENTS AND METHODS: A multi-institutional prospective trial was performed between July 2000 and May 2003 involving high-risk prostate cancer patients without metastasis, including 21 who received 8 months of NHT before radical prostatectomy. High-risk group was defined as clinical stage > or =T2c and/or prostate-specific antigen (PSA) >20 ng/ml and/or Gleason score > or =8. PSA values were considered elevated (biochemical failure) if values of 0.1 ng/ml or greater were obtained. RESULTS: Median of initial PSA levels before prostate biopsy was 27.6 ng/ml (8.5-80.7 ng/ml), and median of pre-operative PSA levels after NHT was 0.28 ng/ml (0.02-4.2 ng/ml). There were 5 patients (23.8%) with lower limit of PSA detection (less than 0.02 ng/ml) in 8 months after NHT. The clinical T stage was T1c in 9 patients (42.9%), T2a-b in 8 patients (38.1%), T2c in 3 patients (14.3%), and T3a in 1 patient (4.8%). The median follow-up was 25 months (range 4 to 37). There were 2 patients (9.5%) in pT0, 5 patients (23.8%) with positive surgical margin, 5 patients (23.8%) with extracapsular extension (ECE) and 3 patients (14.3%) with seminal vesicle involvement (SVI). Biochemical failure was occurred in 9 of 21 (42.9%) including of one pT0. Range of time to postoperative biochemical failure was 2 to 25 months (median 6 months) and most of biochemical failure was found within 12 months after surgery. Biochemical failure rate was significantly higher in patient with positive SVI (p = 0.0308) and higher in patients with pre-operative PSA levels of more than 0.1 ng/ml (p = 0.0836), positive ECE (p = 0.0545) and positive surgical margin (p = 0.0545). CONCLUSION: Biochemical failure was frequent after this combined treatment, even in a pT0 case. Long-term follow-up of patients is needed to assess the impact of this therapy on mortality.

Aged↗
PubMed2006

[Cranial nerve palsies due to skull base metastases in patients with prostate cancer: a report of two cases].

Two patients with prostate cancer showed cranial nerve palsies due to skull base metastases. Case 1: A 64-year-old man had prostate cancer (T4 N0 M1, Gleason score 7, prostate-specific antigen [PSA] level 372 ng/mL) with multiple bone metastases. Seventy-seven months after initiation of therapy, he had an articulation disorder and palsy of the left side of the tongue, with 12th cranial nerve palsy. Case 2: A 75-year-old man had a prostate cancer (T3b N0 M1, Gleason score 7, PSA level 177 ng/mL) with multiple bone metastases. Sixty-six months after initiation of therapy, he had hearing loss, noise in the right ear, and dizziness, with 8th cranial nerve deficits. Magnetic resonance imaging showed low intensity in the clivus in both cases, and all over the skull in case 2. The first patient was treated with radiation therapy and intravenous steroids at an early date. His symptoms improved.

Adenocarcinoma↗
PubMed2006

[Late-onset urethrorectal fistula after laparoscopic radical prostatectomy: report of a case].

Urethrorectal fistula is a relatively rare disease. The most frequent cause of acquired urethrorectal fistulas is known to be iatrogenic complications, such as rectal injuries during the prostate operations. Rectal injuries are usually noticed during the operation and the majority can be repaired in situ. We report a case of late-onset urethrorectal fistula that lacked obvious rectal injury during the operation. Ischemic change or heat denaturation of rectal wall may be the potential cause of the present urethrorectal fistula.

Adenocarcinoma↗
PubMed2006

[A case report: Bilharzial schistosomiasis in the urinary bladder presented with gross hematuria].

A 31-year-old Japanese man who had been in Africa for two years presented with gross hematuria. He had been swimming in Lake Malawi during this period. Urinary specimen consisted of hematuria and pyuria. Cystoscopy showed tumors resembling Bilharzial tubercles located in the trigone, left lateral and posterior wall and dome. Further urine examination demonstrated eggs of schistosome haematobium. The patient was highly suspected of having Bilharzial schistosomiasis in the urinary bladder. Transurethral resection of bladder tumors was performed for diagnosis. Pathological examination revealed granuloma with many eggs of schistosome haematobium. He was diagnosed with Bilharzial schistosomiasis and was treated with 3,600 mg of praziquantel daily for two days. There have been no signs of recurrence during the one-year follow up except for excretion of degenerated eggs of schistosome haematobium in the urine specimens.

Adult↗
PubMed2006

[A case report: small cell carcinoma transformed from transitional cell carcinoma of the urinary bladder].

A 72-year-old man presented with gross hematuria. Cystoscopy showed a non-papillary tumor at the right side of the posterior wall. Transurethral resection of the bladder tumor (TURBT) was performed. Pathologic findings demonstrated superficial transitional cell carcinoma (TCC). However, recurrent tumors were detected at the same location after 69 months' follow up. TURBT was done for the biopsy and pathologic examination showed muscle-invasive TCC. After two courses of neoadjuvant chemotherapy (MVAC), we performed radical cystectomy with Hautmann's continent reservoir. Pathologic findings revealed small cell carcinoma without any TCC features. Immunohistochemical staining using chromogranin A and synaptophysin was positive in the latest TURBT and the radical cystectomy specimens. We report a case of primary small cell carcinoma transformed from TCC of the urinary bladder.

Aged↗
PubMed2005

[Sudden death after 125I brachytherapy in prostate cancer patient: a case report].

A management of 125I isotope is defined by medical guideline from Ministry of Health, Labour and Welfare in Japan. According to this, when the patient died within one year after 125I interstitial permanent prostate brachytherapy, we have to do autopsy and collect all implanted isotopes as soon as possible. We report here, a 70-year-old man who underwent 125I interstitial permanent prostate brachytherapy for localized prostate cancer and one month after brachytherapy the patient died of acute cerebral hemorrhage, which was unrelated to the 125I brachytherapy. Autopsy was performed and collection of migrated isotopes was extremely difficult in technically. In addition, the cost of autopsy and distance from our hospital were also problems in this case. Treatment of prostate cancer with brachytherapy has increased in Japan, and we should establish management manual for sudden death case after 125I brachytherapy.

Adenocarcinoma↗
PubMed2005

[Laparoscopic unroofing of peripelvic cyst].

Laparoscopic unroofing of renal cyst has replaced open surgical intervention in recent years. We report our experience with this procedure on 6 patients with hydronephrosis due to peripelvic cyst. Four male and two female patients, ranging from 51 to 67 years, underwent laparoscopic unroofing of peripelvic cyst. All patients had various degrees of hydronephrosis. Two patients had lumbago and hematuria. The cause of this hematuria was probably due to the renal pelvic stone. Surgical approaches i.e., retro- or transperitoneal were selected depending on the location of cyst. The operative time ranged from 80 to 235 minutes (mean 167 minutes). The length of postoperative hospital stay ranged from 3 to 7 days (mean 4.6 days). Intraoperative blood loss ranged from 20 to 26 cc (mean 21 cc). Four weeks after the operation, all patients showed improvement of hydronephrosis. Laparoscopic unroofing of peripelvic cyst is a safe and efficacious procedure, and could be an' attractive alternative for management of peripelvic renal cysts.

Aged↗
PubMed2004

Laparoscopic pyeloplasty for ureteropelvic junction obstruction: outcome of initial 12 procedures.

BACKGROUND: Open pyeloplasty has been the gold standard for surgical treatment of ureteropelvic junction (UPJ) obstruction, enjoying a long-term success rate exceeding 90%. Unfortunately, this procedure requires a muscle incision that entails some degree of morbidity. We have, therefore, investigated the feasibility of laparoscopic pyeloplasty for UPJ obstruction and report here the outcomes of our early cases. The median follow up is 25 months (range, 12-42 months). METHODS: Between March 1999 and September 2001 we performed laparoscopic pyeloplasty on 12 ureters in 11 patients presenting with symptomatic hydronephrosis, secondary to a short stenosis of the UPJ or to ventrally crossing vessels; bilateral pyeloplasty was performed as a single procedure in one patient. We performed dismembered Anderson-Hynes pyeloplasty, Fenger plasty and Y-V plasty in eight, two and two ureters, respectively. All procedures were carried out transperitoneally. RESULTS: The procedure was completed successfully in all cases. Crossing vessels were noted in six of 12 ureters (50.0%). Mean operative time and blood loss in 11 patients (including one bilateral case) were 272.8 min (range, 175-480 min) and 96.4 mL (range, 20-340 mL), respectively. Postoperative complications were noted in two patients (18.2%): one instance of prolonged urine leakage and one anastomotic re-stricture. Eleven of 12 ureters (91.6%) demonstrated a patent UPJ on excretory urography and/or improvement of renal function on diuretic renography at a minimum follow up of 12 months. CONCLUSION: Although the procedure requires advanced laparoscopic skills, it can be safely and successfully completed as frequently as the conventional open procedure. Laparoscopic pyeloplasty seems to be a valuable alternative to open pyeloplasty for UPJ obstruction.

Adolescent↗
PubMed2004

[Arthritis following intravesical instillation of BCG for urothelial cancers].

BACKGROUND: Intravesical instillation of bacillus Calmette-Guerin (BCG) is efficient for prophylaxis of superficial bladder cancer and treatment for carcinoma in situ (CIS) of the upper urethelial cancer. However, the incidence of adverse effects is relatively high, and those include reactive arthritis. We retrospectively evaluated the incidence and the outcome of reactive arthritis following intravesical BCG therapy for urothelial cancers. PATIENTS AND METHODS: Intravesical instillations of BCC were performed in 192 cases (218 courses) between January 1998 and January 2002. BCG was instilled for prophylaxis of superficial bladder cancer recurrence in 170 (195 courses), treatment for CIS in 7 (8 course), and treatment for CIS in 7 (8 courses), and treatment for CIS in upper urinary tract in 15 (15 courses). RESULTS: Arthritis was recognized in 8 cases (3.7%, 8/218 courses), and 7 of them were identical to reactive arthritis following BCG therapy. Remaining 1 patient was diagnosed as rheumatoid arthritis (RA), and the relation between arthritis and intravesical BCG instillation was unclear. Mean number of BCG instillation was 5.6 (3-8 times). All reactive arthritis were occurred within 4 weeks after the last BCG instillation, i.e., BCG induced urinary tract infection, and 6 of them were polyarthritis. Concurrence of conjunctivitis was seen in one patient. HLA-B27 was negative in 4 examined patients. A nonsteroidal anti-inflammatory drug (NSAID) was used in all 8 patients, anti-tuberculous agents were used in 3, and prednisolone was added in 3, Arthritis was improved within 2 months in patients received prednisolone, however, it persisted longer than 3 months in patients without prednisolone. CONCLUSION: Arthritis was recognized in higher incidence than previous reports following intravesical instillation of BCG. All cases except one, diagnosed as RA, were diagnosed as reactive arthritis (Reiter's syndrome). However, correlation between HLA-B27 and arthritis was not clear in this study. Administration of steroidal drug was thought to improve arthritis in shorter duration.

Administration, Intravesical↗
PubMed2004

[Questionnaire survey on the theory of antimicrobial prophylaxis in urologic surgery].

In order to establish an acceptable guideline for prevention of perioperative infection following urologic surgery, a questionnaire survey on the theory of antimicrobial prophylaxis (AMP) was conducted among urologists in Japan in February 2004. A reply was obtained from 149 urologists working for institutes located all over Japan from Hokkaido to Kyushu areas. Ninety-two percent of the urologists agreed that AMP should be administered 30 min before an incision, and 44% replied that an additional dose of AMP is required in the case of prolonged intervention. Penicillins or the 1st or 2nd generation cephems were used by 89 to 93% of the urologists in operations not including bowel segments, while 78% preferred such AMP agents in the procedures including bowel segments. AMP was terminated within 3 days in 87% for genital operations, in 70 to 76% for laparoscopic operations, in 54 to 65% for other clean or clean-contaminated operations, and in 24% for operations without the bowel segments. Especially, 58% of the urologists continued AMP for more than 5 days after operations with urinary diversion using the intestine. When compared with the previous questionnaire survey by Shinagawa et al, our survey demonstrated that standard consensus of AMP has spread widely among urologists in Japan, although the recommendations published in Europe and United States are still controversial in Japan. Thus, further well-designed clinical trials are required to establish original guidelines in Japan.

Ampicillin↗
PubMed2003

Combined effect of clarithromycin and imipenem/cilastatin against urinary biofilm infection after pyeloplasty.

The present report concerns a 38-year-old man, who had been treated with pyeloplasty and lithotomy for the improvement of urinary excretion and resolution of a kidney stone. The patient developed a biofilm infection involving Pseudomonas aeruginosa and Staphylococcus epidermidis, and had been suffering from recurrent acute pyelonephritis for one year. Combination therapy with clarithromycin (CAM) and imipenem/cilastatin (IMP/CS) consisted of administration of CAM at a dose of 400 mg/day for 1 week, followed by 500 mg/day of IMP by intravenous infusion combined with CAM (400 mg/day) for 5 days. This therapy produced an immediate antimicrobial effect and no further signs of pyuria have been seen during one year of follow-up in this patient.

Adult↗
PubMed2003

Delayed recovery of urinary continence after laparoscopic radical prostatectomy.

AIM: To study the rate at which patients regained urinary continence during our institution's early experience with laparoscopic radical prostatectomy. METHODS: The urinary continence of 34 patients was recorded at various intervals following laparoscopic radical prostatectomy. These data were compared with those from 49 patients who had undergone radical retropubic prostatectomy. RESULTS: For laparoscopic prostatectomy patients, 2.9% had regained urinary continence at 1 month, 29.4% at 3 months, 46.9% at 6 months, 56.0% at 9 months and 60.0% at 12 months. For retropubic prostatectomy patients, the corresponding rates were 22.4% at 1 month, 63.3% at 3 months, 84.1% at 6 months, 92.9% at 9 months and 92.9% at 12 months. Backward stepwise logistic regression analysis indicated that laparoscopic surgery itself significantly predicted urinary incontinence at every interval from 1 to 9 months following surgery (P < 0.05). CONCLUSION: Patients' postoperative recovery of urinary continence was not satisfactory in our early experience with laparoscopic radical prostatectomy. Further efforts to elucidate the reason for this poor functional outcome are mandatory before the procedure is accepted as part of standard practice.

Aged↗
PubMed2003

Sufficient prophylactic efficacy with minor adverse effects by intravesical instillation of low-dose bacillus Calmette-Guérin for superficial bladder cancer recurrence.

BACKGROUND: Intravesical instillation of bacillus Calmette-Guérin (BCG) is the most efficient strategy for prophylaxis of superficial bladder cancer recurrence. Adverse effects of BCG are major obstacles, but the reduction of BCG dose could minimize these effects. The efficacy and adverse effects of half-dose (40 mg) BCG, Tokyo 172 strain, were prospectively evaluated. METHODS: A total of 93 patients with superficial bladder cancer (pTa or pT1) were sequentially assigned to receive either 40 or 80 mg of BCG after transurethral resection. BCG was administered weekly for 6 weeks postoperatively. Eighty patients observed longer than 12 months after BCG therapy (41, 40 mg group; 39, 80 mg group) were analyzed. RESULTS: BCG therapy course was completed in 71 patients. Tumor recurrence was recognized in 11 of 40 patients in the 40 mg group and in 5 of 31 patients in the 80 mg group. There was no significant difference in tumor recurrence rate between the two groups (P = 0.547). BCG therapy was withdrawn in 1 patient in the 40 mg group and in 8 patients in the 80 mg-group because of BCG-related adverse effects. The morbidity of BCG-related toxicity was significantly higher in the 80 mg group. CONCLUSION: Half-dose of BCG Tokyo 172 strain had a similar efficacy and its toxicity was significantly lower compared to the standard dose. Thus, half-dose of this strain might be suitable, at least for initial BCG therapy, for the prophylaxis of bladder cancer recurrence. Further study would be necessary to clarify the efficacy of low-dose instillation in high-risk patients.

Adjuvants, Immunologic↗
PubMed2003

[The clinicopathological characteristics in renal cell carcinoma with end-stage renal disease].

OBJECTIVES: The influence and the interdependence of pathological and clinical factors on prognostic differences between renal cell carcinoma (RCC) with end-stage renal disease (ESRD) and RCC without ESRD after nephrectomy has remained unclear. We compare the clinicopathological features between RCC with and without ESRD. MATERIALS AND METHODS: From June 1993 to May 2000, 150 RCC patients who underwent nephrectomy were pathologically defined to have pT1 to pT3NXM0. The patients were followed for 1 to 84 months (median 30 months) after the surgery. Total of 16 patients with ESRD and 134 patients without ESRD were studied, and the differences of clinicopathological features between two groups were statistically compared. RESULTS: We compare the clinicopathological features between RCC with and without ESRD. Patients' age, tumor size, rate of incidental cancer, pathological T stage, and grade were not significantly different between two groups. The 5-year recurrence-free probability rate was significantly higher in patients without ESRD than in patients with ESRD (log-rank test: p = 0.04). The status of ESRD, patients age and pathological T stage were significant predictors of recurrence when analyzed by Cox proportional hazards analysis (p = 0.01, p = 0.03 and p = 0.02, respectively). CONCLUSIONS: This study demonstrated that the ESRD is an independent prognostic factor in RCC patients after surgery. These results reflect that the patients with ESRD have higher risk of tumor progression. Therefore, early detection of tumors is particularly important in these patients by regular abdominal ultrasound or CT screening.

Adult↗
PubMed2003

[Two cases of ganglioneuroma].

Ganglioneuroma is relatively rare, and difficult to distinguish from other tumors due to lack of image findings specific for ganglioneuromas. In this report, two cases of ganglioneuroma preoperatively diagnosed as non-functioning adrenal tumor and retroperitoneal tumor are reported. A 25-year-old male and a 29-year-old male visited our institute with chief complaints of upper abdominal pain and asymptomatic microscopic hematuria, respectively. Computed tomographic scan and magnetic resonance imaging showed a 7 x 6 x 5 cm solid tumor above the upper pole of the right kidney in the former case, 8 cm poorly enhanced tumor grown surrounding the left renal artery in the latter case. Surgical resection was performed in both cases. In the latder case, since intraoperative histological examination showed no malignant finding, renal vessels penetrating in the tumor were preserved by transecting the tumor. Postoperative histological examination revealed an adrenal ganglioneuroma and a retroperitoneal ganglioneuroma in the former and latter cases, respectively. A ganglioneuroma can be surgically dissected with favorable prognosis, but preoperative differential diagnosis is sometimes difficult due to few specific radiological and laboratory findings.

Adrenal Gland Neoplasms↗
PubMed2002

Intravesical instillation of bacille Calmette-Guérin for carcinoma in situ of the urothelium involving the upper urinary tract using vesicoureteral reflux created by a double-pigtail catheter.

OBJECTIVES: To evaluate the therapeutic efficacy of bacille Calmette-Guérin (BCG) for carcinoma in situ (CIS) of the urothelium involving the upper urinary tract when the vaccine was administered by way of the bladder using vesicoureteral reflux created by a double-pigtail (DP) catheter. METHODS: Thirteen upper urinary tracts of 9 patients with cytologically diagnosed CIS, with concomitant bladder CIS in 4, were treated by intravesical BCG instillation. A DP catheter was placed retrogradely, and the appearance of vesicoureteral reflux was confirmed by cystography. BCG (1 to 2 mg/mL) in a volume sufficient to fill the renal caliceal system was administered into the bladder weekly for 6 weeks. The mean follow-up was 36 months (range 8 to 97). RESULTS: The voided urine cytology turned negative in all 9 patients at a mean of 86 days after the first administration of BCG. The voided urine cytology returned positive afterward in 3 patients, and positive cytology in the upper urinary tract was confirmed in 1 of 13 treated urinary tracts, which were successfully treated by another course of BCG therapy with the DP catheter. Minor adverse effects related to BCG and the DP catheter were seen in 5 patients. CONCLUSIONS: BCG therapy for the CIS involving the upper urinary tract using a DP catheter might have the potential to be an effective procedure preserving renal units and could be adopted not only as an imperative, but also as an elective, treatment option.

Administration, Intravesical↗