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Mutsushi Kawakita

Publications and source records attributed to Mutsushi Kawakita.

At least 19 recordsLinked to original sources
PubMed2006

Significance of elevated preoperative alpha-fetoprotein in postchemotherapy residual tumor resection for the disseminated germ cell tumors.

BACKGROUND AND OBJECTIVES: The purpose of the study is to determine the significance of elevated serum alpha-fetoprotein (AFP) in the setting prior to residual tumor resection (RTR) following chemotherapy for metastatic germ cell tumor in terms of the prediction of histology of the specimen and postoperative survival. METHODS: We conducted a retrospective review of 68 patients undergoing RTR for metastatic nonseminomatous germ cell tumor or extragonadal germ cell tumor after at least a first-line chemotherapy. Pretreatment and postchemotherapy serum markers were evaluated in association with other clinical findings including results of pathological examination of RTR specimen and surgical outcome. RESULTS: Of the 68 study patients, 54 (79%) and 45 (66%) had positive AFP and beta-human chorionic gonadotropin (beta-HCG) in pretreatment settings. Rates of presence of residual malignant cell in RTR specimen were similar between patients with normal AFP (7/28 or 25%) and with mildly elevated (10-30 ng/ml) AFP (3/11 or 27%). In 26 patients who had residual viable malignancy in RTR specimen, patients with preoperative positive AFP had significantly better survival (P = 0.02) compared to those with preoperative positive beta-HCG. CONCLUSIONS: Sole and mild elevation of AFP is not always associated with postoperative poor prognosis. It should be carefully considered individually whether a mild elevation of AFP after chemotherapy represents residual malignancy or benign pathogenesis.

Adolescent↗
PubMed2006

Two cases of chyloretroperitoneum following retroperitoneoscopic nephroureterectomy.

Post-operative chyloretroperitoneum is a rare complication in urological surgery. We experienced two cases of post-operative chyloretroperitoneum following retroperitoneoscopic left nephroureterectomy. Both cases were treated successfully with drainage, low fat diet, total parenteral nutrition (case 1 only), sclerotherapy and somatostatin analog. Laparoscopic procedures are supposed to have a higher risk of chylous complications, as CO2 pressure appears to make the operator overlook suppressing the lymphatic leakage from the resected lymphatic channels.

Aged↗
PubMed2006

[Squamous cell carcinoma of the bladder presenting with bladder rupture: a case report].

A 71-year-old woman with pan-peritonitis was transferred to our hospital. Imaging studies showed the extravasation of contrast medium from the bladder to the intraperitoneal cavity, the right non-visualizing kidney and the left hydronephrosis. Cystoscopy revealed bladder stones and a fistula at the posterior wall of the bladder. A histological examination of specimen around the fistula revealed squamous cell carcinoma(SCC) with stromal invasion. Symptoms of peritonitis subsided following the placement of bilateral ureteral catheters and a urethral catheter. Because a laparotomy revealed peritonitis-carcinomatosa, she underwent bilateral ureterocutaneostomies, the removal of the bladder stones and the primary closure of the fistula. She died on the 42nd day after surgery.

Aged↗
PubMed2006

[Clinical review of conservative management of upper urinary tract transitional cell carcinoma].

We reviewed 18 patients with transitional cell carcinoma of the renal pelvis and ureter undergoing nephron-sparing surgery between April 1990 and Febrary 2003. The mean age of the patients, 17 males and one female, was 69 years (range 33-88 years). The tumor site was the renal pelvis in 2, ureter in 13 and ureteral orfice in 2. Six of them were imperative cases and 12 were elective. Eight patients underwent endourological treatment and 10 patients open surgery including partial ureterectomy performed on 8 patient. The follow up period was 3 to 104 months (mean 37 months). Among those defined as imperative, the histopathological stage was pT1 in one, pT2 in one, pT3 in 3 and one in pT4. Among the elective cases, the histopathological stage was pTa in 7, pT1 in 2, pT2 in one, pT3 in 2 patients. Of the three defired as elective with tumors cT2 or higher, two died of disease. The 5-year survival rate was 50% and 68% in the imperative and elective cases, respectively. In the patients with tumors pT2 or higher and/or grade 3, the prognosis was poor which suggests the need for intensive therapy including lymph node dissection and/or adjuvant chemotherapy. It is necessary to consider the possibility of selecting nephron-sparing surgery for locally advanced tumors.

Adult↗
PubMed2006

[Holmium laser enucleation of the prostate: the Kobe City General Hospital experience].

Between October 2004 and August 2005, 43 patients with the mean age of 70.9 (ranging 57-83) years, who had lower urinary tract symptoms underwent holmium laser enucleation of the prostate (HoLEP) at our hospital. The mean operative time, change in hemoglobin and resected tissue weight were 193 (83-390) minutes, -2.1 (-5.3 -/+ 1.3) g/dl and 40.2 (6.3-90.9) g, respectively. The mean postoperative urethral catheter time and postoperative hospital stay were 1.7 and 5.5 days, respectively. Minor prostatic capsular perforation and bladder mucosal injuries in 18 cases without need of additional interventions or treatments. Blood transfusion for preoperative anemia was needed in one case. Postoperatively, high fever occurred in 6 cases including sepsis in one case, while recatheterization was needed in 2 cases because of urination difficulty. After discharge, meatal stenosis was found in 7 cases, urethral stenosis in 3 cases including 2 cases with preoperative urethral stenosis. Scrotal abscess developed after acute epididymitis in one case. Transient urinary incontinence reported in 12 cases, which requires medication or more than 1 pad per day. HoLEP improved international prostate symptom score, quality of life score, peak urinary flow rates and postvoiding residual urine volumes immediately and significantly. HoLEP is a feasible and effective procedure to relieve lower urinary tract symptoms, although technical and instrumental advances are required to reduce the operative time and complications.

Aged↗
PubMed2005

Colonic adenocarcinoma and stones in an Indiana pouch.

We report on a 63-year-old woman with adenocarcinoma and stones in an Indiana pouch. Adenocarcinoma of an Indiana pouch is extremely rare. To our knowledge, only four cases with adenocarcinoma in an Indiana pouch have been reported.

Adenocarcinoma↗
PubMed2005

Renal artery pseudoaneurysm after laparoscopic partial nephrectomy for renal cell carcinoma in a solitary kidney.

Renal artery pseudoaneurysms are a well-documented complication following trauma or percutaneous urological procedures, but are rare after partial nephrectomy. We present the case of a 34-year-old woman who, after undergoing a left nephrectomy in childhood due to Wilms' tumor, had a pseudoaneurysm in a solitary kidney after laparoscopic right partial nephrectomy with extraperitoneal approach for a renal cell carcinoma. The segmental renal artery feeding the pseudoaneurysm was embolized with coils without significant loss of residual renal function.

Adult↗
PubMed2005

Intravesical tape erosion following the tension-free vaginal tape procedure for stress urinary incontinence.

We report a case of intravesical tape erosion which occurred 6 months after the tension-free vaginal tape (TVT) procedure, which was successfully treated by partial tape removal. A 75-year-old woman, who had complained of recurrent cystitis after TVT procedure, was referred to Kobe City General Hospital in August 2003. The intravesical tape erosion was revealed by cystoscopy and computed tomography, and the tape was removed with a retropubic approach. The recurrent cystitis has been cured and the stress urinary incontinence has not recurred. The intravesical tape erosion was rare, with only seven reported cases including the present case.

Aged↗
PubMed2005

Constitutive activation of the 41- and 43-kDa mitogen-activated protein (MAP) kinases in the progression of prostate cancer to an androgen-independent state.

AIM: The 41- and 43-kDa mitogen-activated protein kinases (MAPK; ERK2 and ERK1, respectively) play pivotal roles in the mitogenic signal transduction pathway. We previously demonstrated that constitutive activation of the MAPK cascade was related to the carcinogenesis of human tumors. In this study, we examined whether constitutive activation of MAPK was related to the progression to androgen independence of prostate cancer. METHODS: MAPK activation was examined by the appearance of phosphorylated forms and an in vitro kinase assay in four human (androgen-dependent and independent) prostate cancer cell lines and rat prostate cancer cell line Dunning (androgen-sensitive G line, and androgen-independent AT-3, AT-6 sublines). In addition, when androgen-dependent mouse Shionogi Carcinoma 115 (SC115) cells were serially cultured without androgen to obtain androgen-independent cells, the time and degree of MAPK activation were examined. RESULTS: One of three human androgen-independent cell lines (DU145) showed constitutive activation of MAPK, while an androgen-dependent cell line (LNCaP) did not show MAPK activation. While MAPK were not activated in an androgen-sensitive Dunning G cell line, MAPK were activated in androgen-independent sublines (AT-3 and AT-6) derived from a G cell line. In addition, when SC115 cells were serially cultured without androgen, the cells 16-24 weeks after androgen removal showed MAPK activation. Furthermore, in subcloned cells, MAPK activation was observed even in the cells maintained for 9 weeks in medium without testosterone. CONCLUSIONS: The present fi ndings suggest that constitutive activation of MAPK may be associated with the acquisition of hormone independence in prostate cancer and that clonal selection after androgen removal and hormone-independent growth through the MAPK signal transduction pathway could begin at a relatively early period in the individual cells.

Adenocarcinoma↗
PubMed2005

[Retroperitoneoscopic partial nephrectomy for renal cell carcinoma: our initial experience and review of the literature].

PURPOSE: We report our initial experiences of retroperitoneoscopic partial nephrectomy for renal cell carcinoma. MATERIALS AND METHODS: From April 2002 to October 2003, we performed 11 retroperitoneoscopic partial nephrectomy for renal cell carcinoma. Our indication was T1N0M0 renal tumors which sizes were about 4 cm or less and were exophytic and were not situated at the renal hilum. First we inserted single J catheter to the renal pelvis cystoscopically. under fluoroscopic guidance. Next 4 trocars were set at pneumoretroperitoneum and the renal artery and vein were clamped individually after cold saline was circulated from the single J catheter. Renal parenchyma was sharply cut with scissors and vessels were coagulated with bipolar coagulator. When renal collecting system was opened, cariceal suture repair was performed. We used the microwave tissue coagulator without clamping the renal pedicle when the tumor was 2 cm or less in diameter and the distance from the tumor edge to the renal collecting system was more than 1cm. RESULTS: In 9 cases renal pedicles were clamped and in 2 cases were not. Mean tumor size was 27.5 +/- 8.9 mm and mean operative time was 350 +/- 92 minutes and mean estimated blood loss was 743 +/- 998 ml, and mean warm ischemic time was 70 +/- 30 minutes. In one case bleeding from cut surface was uncontrollable, so open conversion was needed. In this case the renal artery and vein were clamed but another artery exited. The surgical margins were all negative, and no other complications were happened. Post operative serum creatinine raised soon after the operation but finally downed, and the mean up level was 0.07 ng/ml only. But RI examination revealed the residual renal damages were in proportioned to the warm ischemic times. During a mean followup of 8 months no patients has had local recurrence or metastatic disease. CONCLUSIONS: Retroperitoneoscopic partial nephrectomy for renal cell carcinoma is effective for select patients. But better cooling method and earlier suture technique and more long follow-up periods will be necessary for establishment.

Aged↗
PubMed2005

[Laparoscopic radical nephrectomy for renal cell carcinoma at Kobe City General Hospital].

Between April 2002 and March 2004, 21 patients with clinical T1-T3a renal cell carcinoma underwent laparoscopic radical nephrectomy at the Kobe City General Hospital. A transperitoneal approach was chosen in 9 patients with clinical T2 stage, tumors more than 5 cm in diameter at the upper pole of the kidney, and posteriorly protruded tumors at the middle portion. Otherwise, a retroperitoneal approach was chosen in 12 patients. The mean (range) operative time for the transperitonal and retroperitoneal approaches was 355 (290-410) min and 342 (275-490) min, respectively. There were no major intraoperative complications. Postoperatively, one patient underwent emergency operation due to the perforation of duodenal ulcer. In the mean follow-up of 15.9 months, lung metastasis was seen in one patient under adjuvant immunotherapy. Significant differences between transperitoneal and retroperitoneal approaches were seen in mean time to renal artery clipping (170 versus 85 min, p < 0.01), mean blood loss (548 versus 281 ml, p < 0.05) and concurrent adrenalectomy (66.7 versus 16.7%, p < 0.05). Laparoscopic radical nephrectomy is a safe and feasible procedure when suitable approaches are chosen depending on tumor size and location.

Adult↗
PubMed2004

Diagnostic potential in bladder cancer of a panel of tumor markers (calreticulin, gamma -synuclein, and catechol-o-methyltransferase) identified by proteomic analysis.

Using proteomic analysis, we previously identified calreticulin (CRT) as a potentially useful urinary marker for bladder cancer. Now, we have also identified gamma -synuclein (SNCG) and a soluble isoform of catechol-o-methyltransferase (s-COMT) as novel candidates for tumor markers in bladder cancer, by means of proteomic analysis. In the process of establishing a superior tumor marker system, we investigated the diagnostic value of a combination assay of these three proteins. Voided urine samples were obtained from 112 bladder cancer and 230 control patients. Urinary CRT, SNCG, and s-COMT were measured as a combined marker by quantitative western blot analysis. Relative concentration of each protein was calculated and the diagnostic value of a concomitant examination of these markers was evaluated by receiver operator characteristic analysis. With the best diagnostic cutoff, the overall sensitivity of the combined markers was 76.8% (95% confidence interval, 69-81%) with a specificity of 77.4% (72-80%), while those of a single use of CRT were 71.4% and 77.8%, respectively. When evaluated in relation to tumor characteristics, such as grade, stage, size, and outcome of urinary cytology, the diagnostic capacity of the combined markers was equal to or better than that of CRT in all categories. Concomitant use of CRT, SNCG, and s-COMT had higher sensitivity for detection of bladder cancer than did single use of CRT. Our study suggests that use of this panel of markers will improve the diagnosis of bladder cancer and may allow the development of a protein microarray assay or multi-channel enzyme-linked immunosorbent assay.

Aged↗
PubMed2004

Micropapillary variant of transitional cell carcinoma of the bladder.

A 77-year-old man visited the Kobe City General Hospital complaining of macroscopic hematuria. A computed tomography scan found a bladder tumor with left iliac and para-aortic lymph node metastasis. Two courses of cisplatin, cyclophosphamide and doxorubicin chemotherapy resulted in a minimal response. Radical cystectomy and a retroperitoneal lymph node dissection with bilateral ureterocutaneostomy reconstruction were then performed. A pathological examination revealed a micropapillary variant of transitional cell carcinoma (Grade 3, pT1pN2M1). The patient died of pelvic recurrence 7 months after the initiation of chemotherapy. Peritonitis carcinomatosa and lung metastases were observed at autopsy.

Aged↗
PubMed2004

Traumatic renal artery thrombosis with renovascular hypertension.

A 15-year-old boy, who tumbled from a fourth-floor window, was transported to our hospital. Enhanced computed tomography (CT) 1.5 h after the injury showed a non-contrasted right kidney, and a repeat CT 6 h after the injury showed a growing retroperitoneal hematoma. The angiography showed complete obstruction of the right renal artery and bleeding from the subcapsular artery, which was successfully embolized. Renovascular hypertension developed on the second day after the injury; therefore, simple nephrectomy was performed.

Adolescent↗
PubMed2004

[Preputial development in Japanese boys].

The natural course of preputial development is still not clearly understood. The preputial retractability was evaluated in 242 Japanese boys. The incidence of having a retractable prepuce gradually increased with age from 0% at age 1 year to 77% by the age of 11 to 15 years. In 48 boys, preputial development was followed up for 2 to 10 years with the self-retract maneuver. Non-retractable prepuce was found in 9 boys, which then became retractable within 2-7 years. The prepuce became retractable in most of the boys with balanoposthitis. In conclusion, forced retraction or circumcision is unnecessary for phimosis in boys with or without balanoposthitis.

Adolescent↗
PubMed2003

Surgical outcome of laparoscopic radical prostatectomy: summary of early multiinstitutional experience in Japan.

BACKGROUND: Because laparoscopic radical prostatectomy requires significant laparoscopic expertise, it needs to be evaluated critically before being accepted as a standard therapeutic option for localized prostate cancer. METHODS: A total of 148 men diagnosed as having clinically resectable prostate cancer underwent laparoscopic radical prostatectomy at seven different institutions in Japan. Early biochemical and oncological outcomes were investigated. RESULTS: Policies underlying the selection of laparoscopic radical prostatectomy did not appear to be consistent among the participating institutions. Pathologically organ-confined disease was found in 64.0% of the patients who had undergone neoadjuvant therapy and in 77.2% of those who had not. Positive surgical margins were found in 36.0% and 34.1%, respectively, of the specimens. The most common site was the apex, which accounted for 77.8% of positive margins in patients who had undergone neoadjuvant therapy and 50.0% in those who had not. Seven patients have experienced biochemical failure at a median follow-up of 9.0 months. No clinical progression has been reported. CONCLUSIONS: Continuing improvements in each step of laparoscopic radical prostatectomy, especially apical dissection, should be sought as we pursue the goal of still better oncological outcomes. A systematic approach and therapeutic guidelines should help to reduce the learning curve for competent performance of this procedure.

Aged↗
PubMed2003

Morbidity of laparoscopic radical prostatectomy: summary of early multi-institutional experience in Japan.

AIM: Laparoscopic radical prostatectomy is being evaluated throughout the world. The aim of the present study is to report early multi-institutional experience of the procedure in Japan. METHODS: A total of 148 men who were diagnosed with clinically localized prostate cancer underwent laparoscopic radical prostatectomy at seven different institutions in Japan. Early complications (within 30 days postoperatively) and postoperative convalescence were reviewed retrospectively. The median age of patients was 68.0 years (range, 51-80). RESULTS: The median operative time was 403 minutes (range, 167-925; average, 427). Blood loss ranged from 50 to 5000 mL (median, 540; average, 856). A total of 66 complications were reported in 55 patients (37.2%). Intraoperative complications were noted in 25 of 148 patients (16.9%): 10 rectal injuries (6.8%); five bladder injuries (3.4%); five cases of subcutaneous emphysema (3.4%); two intestinal injuries (1.4%); one major vessel injury (0.7%); one ureteral injury (0.7%); and one obturator nerve injury (0.7%). Overall, 16 of 148 patients (10.8%) required open conversion or postoperative open surgical repair. The most common postoperative complications were anastomotic leakage (6.8%), wound-related complications (4.7%) and perineal pain (4.7%). The bladder catheter was removed on day 7 or earlier in 73 cases (49.3%). The median time to ambulation was 1 day (mean 1.4, range 1-5). Oral intake was started on postoperative day 1 in 67 patients (45.2%) and on postoperative day 2 in 65 (43.9%). CONCLUSION: Although laparoscopic radical prostatectomy is technically demanding, reduced blood loss and shorter convalescence periods can be expected from the procedure. Surgeons should be aware of the disturbingly high morbidity rate related to early experience. By mastering laparoscopic skills and sharing knowledge, surgeons could reduce the impact of the learning curve required to complete this procedure competently.

Aged↗