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N Deguchi

Publications and source records attributed to N Deguchi.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Experience of 143 cases of laparoscopic surgery in urology--clinical outcome in comparison to open surgery].

(BACKGROUND). The clinical outcome of laparoscopic surgery performed in 143 patients, including laparoscopic adrenalecotmy, nephrectomy, pelvic lymph node dissection (PLND) and varicocele ligation is reported. (METHODS). In patients who underwent laparoscopic adrenalectomy (32 cases), laparoscopic nephrectomy (7) or PLND (44), the following parameters were evaluated and compared to those obtained in patients undergoing the same surgeries but by conventional open procedure; operation time, hospital stay, pain killer doses and the time necessitated for ambulation. (RESULTS). The operation was successful in 95.8% (137/143). Open laparotomy was necessitated in 4 patients to control bleeding (two in adrenalectomy and two for PLND) and in one nephrectomy case due to massive adhesion with the descending colon. The major complication occurred in 4.2% of the cases, but without mortality. The laparoscopic adrenalectomy, nephrectomy and PLND had an average operating time of 260, 304 and 139 minutes, respectively, while the open surgery for each procedure required 251, 212 and 128 minutes, respectively (p = 0. 24 approximately 0.82). Likewise, the total dose of pain killer was 0.8, 1.8 and 0.9 for the former, whereas it was 3.2, 6.0 and 3.9 for the latter, respectively (p < 0.01). The average hospital stay for laparoscopic surgery was 4.9, 6.4 and 4.7 days in the same order, whereas open adrenalectomy or nephrectomy required about 14 days (p < 0.001). Convalescence was completed within significantly shorter term in patients with laparoscopic surgery. Potential complications of laparoscopic surgery included not only those unique to pneumoperitoneum (8.1%), but also those which may be encountered during any endoscopic operation such as compartment syndrome in the lower extremities. The physiologic changes accompanying increased intra-abdominal pressure affected renal function, characterized by a significant decrease in urinary output (p < 0.02), which, however, resumed to normal range within several hours after the operation without causing permanent renal dysfunction. (CONCLUSION). These results suggest that the laparoscopic surgery in certain area in urology has less morbidity and equal accuracy compared with conventional open surgery.

Adolescent↗
PubMed1995

Laparoscopic adrenalectomy: clinical results in 25 patients.

Adrenal tumors would be eminently suitable for laparoscopic surgery because of their size and location. We have performed 25 cases of laparoscopic adrenalectomy, and the purpose of this study was to evaluate the clinical results. Since November 1992, 12 men and 13 women with a mean age of 47.3 (range 29-71) years underwent laparoscopic adrenalectomy. Fifteen lesions were on the left side, and ten lesions were on the right side. The clinical diagnosis was primary aldosteronism in eight patients, Cushing's syndrome in seven, and a nonfunctioning adrenal tumor in ten. The mean operating time was 254 +/- 72 minutes (range 155-412 minutes), but the time on the last 10 cases was 216 +/- 40 minutes, which was equal to the mean operating time of the 15 open adrenalectomy cases (190 +/- 66 minutes). There was no difference in the operating time by clinical diagnosis. The time to first oral intake after the operation was shorter in the laparoscopic group, the need for analgesics was less, and the hospital stay and the time until return to preoperative activity were shorter than after open surgery. The laparoscopic cases had no significant complications, and every operation was performed completely. Although there was the learning curve for the performance of laparoscopic adrenalectomy, its operating time was equal to that of open surgery, and the postoperative recovery was significantly faster. Therefore, laparoscopic adrenalectomy would be useful compared with open surgery on the basis of invasiveness and cost.

Adrenal Gland Neoplasms↗
PubMed1995

[Clinical efficacy of methotrexate, vinblastine, doxorubicin and cisplatin adjuvant chemotherapy following radical surgery for locally invasive urothelial cancers: long-term results].

Determined were long-term results of methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) adjuvant chemotherapy following radical surgery for locally invasive urothelial cancers. All cases at least histologically exhibited one of the following findings, a stage beyond pT3b (bladder cancer) or pT3 (upper tract urothelial cancer), lymph duct tumor involvement (ly +), venous involvement (V +), and/or regional lymph node involvement (N1) without any evidence of distant metastasis and/or residual tumors. Two cycles of M-VAC chemotherapy were given after radical surgery for each case. A total of 33 cases comprising 21 bladder cancers and 12 upper tract urothelial cancers following cystectomy and/or nephroureterectomy with partial cystectomy who had a mean follow-up period of 56.7 +/- 9.2 months could be analyzed. Overall actuarial survival rates of three- and five-years estimated by Kaplan-Meier method were respectively 41.9% and 31.6%. These results indicate that the postoperative outcome was extremely poor in patients with locally advanced urothelial cancer even after extensive adjuvant chemotherapy. Therefore, more effective modalities including optimal dose and scheduling of chemotherapy are needed to assure therapeutic improvement of locally invasive urothelial cancers.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Magnetic resonance imaging following microwave thermotherapy, laser ablation and transurethral resection in patients with BPH.

Morphologic changes in hyperplastic prostate tissue following three different treatments were analysed by MRI using an endorectal surface coil. In cases treated by TUMT, the MRI findings of the prostate showed hemorrhagic necrosis, which was absorbed in 12 weeks, and a widened prostatic urethra. In cases treated by laser ablation, the thermal effect went deep, causing necrotic changes, and it took more than 8 weeks for the tissue to be shed and re-epithelization completed. In TURP, degenerative changes were seen only near the surface following mass reduction of the hyperplastic tissue, and the capsule shrinkage resulted in normalization of the prostatic urethra. It is suggested that improvement of the other parameters, such as IPSS and peak flow, in patients with obstructive BPH basically depends on these morphologic changes shown by MRI.

Aged↗
PubMed1994

Flow cytometric bromodeoxyuridine/deoxyribonucleic acid bivariate analysis for predicting tumor invasiveness of upper tract urothelial cancer.

We previously reported that flow cytometric bromodeoxyuridine/deoxyribonucleic acid (DNA) bivariate analysis can provide important information on the malignant potential of bladder cancer. Therefore, in the current study we further evaluated upper tract urothelial tumors to clarify whether DNA/bromodeoxyuridine bivariate analysis can provide additional prognostic information on patients with upper tract urothelial tumor. A total of 43 upper tract urothelial tumors that were resected by nephroureterectomy was analyzed. Flow cytometric DNA ploidy and bromodeoxyuridine labeling were determined by an in vitro bromodeoxyuridine labeling method. DNA diploid tumors were associated with an 85.9% 3-year survival rate compared to 36.5% for DNA aneuploid tumors. On the other hand, 11 high bromodeoxyuridine labeled tumors demonstrated a 16.4% 3-year survival rate compared to 82.4% for those with low bromodeoxyuridine labeled tumors. Multivariate survival analysis using the Cox proportional regression model was performed to identify the most informative factors for prognosis, with the single most important factor being histological tumor stage. Nearly as important and the next factor to be chosen was tumor grade, followed by bromodeoxyuridine labeling index status. DNA ploidy status did not influence clinical outcome. Thereafter, when actuarial 3-year survival rates according to the bromodeoxyuridine labeling index status in grade 3 tumors were estimated, 68.4% and 16.7% 3-year survival rates were observed in cases of low and high bromodeoxyuridine labeling index tumors, respectively. These results indicate that flow cytometric bromodeoxyuridine/DNA bivariate analysis may be useful in dividing patients with grade 3 upper tract urothelial carcinoma into 2 different prognosis groups.

Bromodeoxyuridine↗
PubMed1994

Laparoscopic surgical correction of circumcaval ureter.

Laparoscopic transposition and reanastomosis of a circumcaval ureter were performed in a 52-year-old man with right flank pain. A preoperative perfusion pressure study revealed abnormally high intrapelvic pressure. Under laparoscopy, the renal pelvis was divided above the ureteropelvic junction and the ureter was relocated from behind the vena cava. A 5 cm segment of redundant ureter containing the postcaval segment was resected and the ureteral end and renal pelvis were reapproximated with interrupted sutures by intracorporeal knot typing. The postoperative convalescence was uneventful, not necessitating the administration of analgesics. The patient resumed full activities 3 weeks later. The intravenous urogram and renogram obtained 2 months after the operation revealed remarkable improvement in the ureteral obstruction.

Abnormalities, Multiple↗
PubMed1994

A new scoring system based on the histological behavior and proliferative activity of tumor cells for grading the malignant potential of bladder cancers.

Urothelial cancer can be considered to consist of a spectrum of diseases with diverse natural histories and the conventional morphological classifications provided by classical histology remain the basis for any decision-making process. The proliferative rate of the tumor cells may be significant since the rate of DNA synthesis is directly related to the rate of tumor growth or tumor involvement. We have previously reported that flow cytometric deoxyribonucleic acid (DNA)/bromodeoxyuridine (BrdU) bivariate analysis can provide important information about the malignant potential of bladder cancer. In the present study, we have formulated a new system based on the histological grade and tumor proliferative activity determined by the BrdU labeling index. An attempt has been made, moreover, to investigate whether this grading system can be used to determine the malignant potential of bladder cancers. A total of 86 patients with bladder tumors, histologically proven to be transitional cell carcinomas, were analyzed. Immediately after removal of tumor specimens, in vitro BrdU labeling was performed. Multivariate survival analysis was conducted using Cox's regression model, followed by estimation of the risk ratio for survival. Based on the risk ratio of the histological grade and the BrdU labeling index, a score ranging from 1 to 52 was assigned to each tumor. Forty-four patients with a score of 1 had a 100% survival rate at 3 years, compared with 42.9% for patients having a score greater than 1. Conversely, 26 patients with the highest score, 52 exhibited a survival rate of only 17.3% at 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Bromodeoxyuridine↗
PubMed1994

Acquired idiopathic pure red cell aplasia in a hemodialyzed patient with inactive systemic lupus erythematosus.

A male patient suffered chronic renal failure due to lupus nephritis and was undergoing hemodialysis. Six years after beginning hemodialysis, anemia developed, which improved by erythropoietin. Unresponsiveness to erythropoietin gradually appeared, and with a suspicion of pure red cell aplasia, he was treated with a high-dose corticosteroid but the unresponsiveness did not improve. Neither his serum nor lymphocytes inhibited erythropoiesis of either normal bone marrow stem cells or his own in vitro. These observations suggest an impaired hematopoietic microenvironment in his bone marrow.

Adrenal Cortex Hormones↗
PubMed1994

[A case of immature teratoma and yolk sac tumor of the testis associated with pulmonary metastases of 2 distinct histological types].

A 24-year-old man presented with right scrotal swelling and was diagnosed as having a testicular cancer. A high inguinal orchiectomy was carried out. Histological examination revealed immature teratoma and yolk sac tumor of the testis. Eight months later, 2 separate metastatic lesions appeared in the lungs, both of which were removed by operation after a course of combination chemotherapy with Etoposide and Cisplatin. The histology showed one to be composed of immature teratoma, and the another of yolk sac tumor.

Adult↗
PubMed1994

[Clinical study of the advanced testicular tumor non-achieved complete response by primary chemotherapy and relapse cases. The East Japan Testicular Tumor Study Group].

The East Japan Testicular Tumor Study group has studied advanced testicular tumors. Treatment and prognosis of the patients who did not achieved complete response on the primary chemotherapy were discussed in this paper. Also 8 patients who had once reached complete response by primary treatments and relapsed later have been clinically analyzed. 1. Concerning the patients non-achieving complete response on the primary chemotherapy: Two cases who had resection of the residual tumors and 4 cases who had radiation therapy had reached NED in 7 cases of seminoma stage II. Nine of 10 cases in non-seminoma stage II reached NED on resection of the residuals. Moreover, 10 out of 17 cases in stage III showed NED on excision of the residuals. On the other hand, recuperating was very difficult in the cases who could not have excision of residual tumor. The histological findings of the residual tumors after chemotherapy were necrosis and fibrosis in 13 cases, viable cells in 4 cases, teratoma in 6 cases and other 2 cases were not clear. Five out of 15 who had teratoma in the primary lesion had teratoma in the resected residuals on metastatic lesion. On the other hand 5 patients who did not have teratoma originally had no any teratoma elements in the residuals. 2. Concerning the relapse cases by primary treatments: Although relapses were possible in any stages, they were more common with stage IIIB and IIIC cases. Those who achieved complete response after chemotherapy alone fewer relapse than those who had partial response after chemotherapy and there after had excision of residual tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1993

Prognostic significance of bromodeoxyuridine high labeled bladder cancer measured by flow cytometry: does flow cytometric determination predict the prognosis of patients with transitional cell carcinoma of the bladder.

We studied whether flow cytometric determination of proliferative cell activity estimated by the bromodeoxyuridine in vitro labeling technique provides significant prognosticators beyond the classical histological evaluation in the patient with bladder cancer. We evaluated 81 patients with transitional cell carcinoma of the bladder using fresh bladder specimens. Clinical followup of at least more than 24 months was requested, with the mean followup being 37.9 +/- 10.5 months. Tumor grade and stage were the histological prognostic parameters. Flow cytometric bivariate measurements of deoxyribonucleic acid (DNA) ploidy and bromodeoxyuridine labeled cell index were evaluated. Tumors with a bromodeoxyuridine labeled cell index of more than 10.7%, which was the value of the mean plus 2 times the standard deviation obtained in grade 1 bladder tumors, were designated as high bromodeoxyuridine labeled cell index tumors. A total of 51 patients with low bromodeoxyuridine labeled cell index tumors demonstrated a 98.0% 3-year actuarial survival rate estimated by the Kaplan-Meier method, compared to 42.9% for those with high index tumors. Multivariate survival analysis was performed with Cox's proportional regression model to study statistical individual prognostic values of histological and flow cytometric parameters. Histological tumor grade was the single most important prognostic factor (risk ratio 13.2, p < 0.05), with tumor stage being the second most important (risk ratio 9.2, p < 0.05), followed by bromodeoxyuridine labeled cell index status (risk ratio 6.9, p < 0.05). DNA ploidy status did not influence the clinical outcome. When grade 3 tumors were classified as low and/or high bromodeoxyuridine labeled cell index tumors, 3-year actuarial survival rates were 85.7% and 27.3%, respectively. These results indicate that DNA/bromodeoxyuridine bivariate analysis can be used as an effective adjunct to histological examination for prognostication and decision-making in treatment of bladder cancer patients.

Actuarial Analysis↗
PubMed1993

[Long-term results and risk factors of tumor recurrence in patients with superficial bladder cancer who were treated by intravesical bacillus Calmette-Guerin (BCG) instillation].

An evaluation was made of the long-term results and risk factors of tumor recurrence in patients with superficial bladder cancer who were treated with intravesical bacillus Calmette-Guerin (BCG) and who had a mean follow-up period of 57 months. Eligible for the study were a total of 102 patients who were treated by transurethral resection of tumors and were considered to be free from tumor from 1984 to 1989. A suspension containing 80 mg Tokyo 172 strain BCG in 50 ml normal saline was given intravesically to 50 patients once a week for six weeks without further maintenance instillation. To the other 52 patients was additionally given monthly intravesical BCG instillation for 12 months. The actuarial nonrecurrent rates according to sex, different BCG treatment protocol, tumor grade, tumor status including primary or recurrent tumors, and solitary or multiple tumors were estimated by Kaplan-Meier method. The estimated three-, five- and seven-year actuarial nonrecurrent rates in all 102 cases were 77.3%, 68.5% and 60.6%, respectively. When nonrecurrent rates were compared to tumor characteristics, no statistically significant differences were observed between primary and recurrent tumors or between solitary and multiple tumors estimated by generalized Wilcoxon method. On the other hand, when nonrecurrent rates were compared with tumor grades, grade 3 tumor showed a 40.0% three-year nonrecurrent rate. The differences between grade 3 and grade 1 and between grade 3 and grade 2 were statistically significant (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intravesical↗
PubMed1992

[Percutaneous transluminal angioplasty for stenotic dialysis arterio-venous fistulas].

From December 1982 to January 1991, we performed fistulography on 40 patients who complained functional failure of arterio-venous dialysis fistula. And percutaneous transluminal angioplasty (PTA) was attempted on 15 patients (19 times) who revealed marked fistula stenosis. Initial successful rate was 78.9% and patency rate was 56.2% in the first 6 months. (75% in the first 6 months when angioplasty was initially successful). We describe the method of fistulography and PTA for stenotic dialysis fistulas, and evaluate the usefulness of PTA. And also we introduce our attempts for improving the initial successful rate and patency rate. In conclusion, when dialysis arterio-venous fistula is stenotic but not occlusive, PTA should be considered first before surgical treatment is done.

Adult↗
PubMed1992

Immunohistological analysis of tumour infiltrating lymphocytes in seminoma using monoclonal antibodies.

Immunological characterization of tumour infiltrating lymphocytes (TIL) by immunohistological techniques was carried out in 20 cases of stage I seminoma. Routine pathological examination of these surgical specimens showed typical seminoma in 20 cases. Eighteen cases showed obvious TIL and immunohistological staining on frozen specimens was performed in 12. TIL in seminomas were predominantly T-cells but B-cells were also identified. T-cells were distributed diffusely with predominance of the CD8+ phenotype judged semiquantitatively. In contrast to the distribution of T-cells, B-cells tended to accumulate and occasionally formed lymphoid follicles. In such follicles the phenotypic pattern of B-cell antigens was comparable with secondary lymphoid follicles in lymphoid organs. There is an immunologically complex response to seminoma by the host with a predominant infiltration of cytotoxic/suppressor T-cells and functional maturation of B-cells.

Adult↗
PubMed1992

Enhancement of lymphokine-activated killer activity induction in vitro by interleukin-1 administered in patients with urological malignancies.

We have evaluated the synergistic effects of interleukin-1 (IL-1) and interleukin-2 (IL-2) on the induction of lymphokine-activated killer (LAK) activity. Subcutaneous injection of recombinant IL-1 beta at an initial dose of 1 x 10(4) U was given to nine patients (five with renal cell carcinoma, two with bladder carcinoma, one with renal pelvic tumor, one with testicular tumor) on days 1 and 2 weekly for 4 weeks. The dose was increased weekly up to 4 x 10(4) U, if it was well tolerated. Peripheral blood mononuclear cells (PBMC) were isolated from patients on day 3 in the 2nd and 4th weeks, and LAK activity of PBMC against Daudi cells was measured using a 4-h 51Cr-release assay at an effector:target cell ratio of 20:1, after incubation with 50 U/ml of recombinant IL-2 for 72 h. Proliferation of PBMC was measured by tritiated thymidine incorporation after incubation with IL-2 for 72 h. IL-2 receptor (IL-2R)-positive cells in PBMC were enumerated using monoclonal antibody and flow cytometry. Mean values of LAK activity induced by IL-2 were significantly augmented after administration of IL-1 beta (p less than 0.01). IL-1 beta, however, did not enhance proliferation of PBMC caused by IL-2, nor did it increase the number of IL-2R-positive cells in peripheral blood lymphocytes of the patients. Results suggest that combination of IL-1 and IL-2 has synergistic antitumor activity in treatment of malignant diseases.

Cell Division↗
PubMed1992

[Studies on the production of endogenous cytokines in patients with renal cell carcinoma].

This study was undertaken to determine the production of tumor necrosis factor (TNF) and interferon-gamma (IFN-gamma) by biological response modifier (BRM) in patients with renal cell carcinoma (RCC). Peripheral blood mononuclear cells (PBMC), which were donated from thirteen patients with RCC and five healthy controls, were cultured with streptococcal preparation, OK432, and/or macrophage-colony stimulating factor (M-CSF), and the TNF levels and IFN-gamma levels in the supernatant were evaluated. TNF activities were assayed by cytotoxicity to L929 cells and IFN-gamma activities were measured by inhibition of the cytopathic effects of sindbis virus on FL cells. The highest levels of TNF in the supernatant were 235.4 +/- 96.0 U/ml/1 x 10(4) cells in patients with renal cell carcinoma and 251.6 +/- 71.8 U/ml/1 x 10(4) cells in healthy controls, which were noted at 12 hours of incubation with the concentration of OK432 adjusted to 0.05 KE/ml. There was no statistically significant difference between the TNF activities induced by in vitro culture of PBMC obtained from patients with renal cell carcinoma and those from healthy controls. The production of TNF by in vitro culture of PBMC with OK432 of 0.05 KE/ml was augmented by adding 100 U/ml M-CSF especially at 48 and 72 hours of incubation, whereas M-CSF alone did not stimulated TNF production. The medium levels of IFN-gamma in six different cultures of PBMC with 0.05 KE/ml OK432 at 12, 24 and 48 hours of incubation were 1.15 +/- 0.34 U/ml/l x 10(4) cells, 2.23 +/- 0.93 U/ml/l x 10(4) cells, and 7.83 +/- 4.00 U/ml/l x 10(4) cells, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Analysis of early and late complications and their origins in Kock continent urinary reservoir following technical modification].

Kock and associates have made a major contribution to the ideal continent urinary diversion by developing a method for creating a continent internal reservoir for urine using the ileum. However, substantial problems have unfortunately resulted due to early and late postoperative complications. In an effort to further elucidate this problem, we herein summarize the incidence of early and late postoperative complications following a series of technical modifications made in patients who underwent Kock continent ileal reservoir construction from our ongoing experience to develop more suitable modifications of this procedure. From January 1985 through December 1991, 47 patients have undergone Kock pouch construction for continent urinary diversion. Our basic technique utilized in this study was slightly modified from that described by Skinner et al. Based on our earlier experience, several changes in the technique were made. One major change is that one row of surgical staples fixes the created nipple to the back wall of the reservoir for the efferent limb, and a further 3-cm longitudinal mucosal incision is made through the outer layer of the intussuscepted ileal nipple and the opposite wall of the reservoir which are sewn to the reservoir edge. A total of eleven patients (11/47) suffered one or more early surgical complications. A 31.8% (7/22) morbidity with an operative mortality rate of 4.3% (2/47) and a 16.0 (4/25) morbidity were observed in the early phase and late phase, respectively. Prolonged urinary leakage from the ileal reservoir and/or through a pin hole in the afferent limb made by surgical staples was observed in six patients (27.3%) in the early phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗