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Biomedical subjects

N Goya

Publications and source records attributed to N Goya.

At least 19 recordsLinked to original sources
PubMed2000

Comparison of the depth of the desiccated zone with selected vaporizing-cutting electrodes: a basic study in animals.

OBJECTIVE: To evaluate in an animal model the haemostatic efficacy of vaporizing-cutting (VC) electrodes recently developed for use in high-energy transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Four VC electrodes were assessed for their haemostatic efficacy in the muscle and liver of pigs (in vitro) and dogs (in vivo). The devices tested were the roller-cutting and Vapor Cut (Karl Storz GmbH, Germany); the Wedge (Boston Scientific Corp., Boston, USA); and the Uroloop (Endocare Inc., Irvine, CA). In each the depth of the desiccated zone was compared with that produced by a standard cutting loop electrode. Each electrode was attached to a scanning system (developed previously) that allowed the electrode pressure on the tissue surface (in 3% sorbitol solution) and the running speed to be adjusted. The same generator was used with all devices. The tissue (muscle or liver) was cut by running the electrode over the surface at 200, 250 or 300 W, with the loop electrode used as the reference. After completing the procedure, the surgical wound and the surrounding tissue were dissected out and the depth of the heat-affected zone (HAZ, defined as the desiccated zone) measured. RESULTS: In pig muscle (stroke speed 5 mm/s) there was no significant difference in the depth of the HAZ between the four VC electrodes and the loop, or among the VC electrodes at any of the power levels tested. In pig liver (stroke speed 5 mm/s), the roller cutting and Vapor Cut electrodes produced a thicker HAZ than the loop at all power levels tested (P < 0.01). The Wedge electrode produced a significantly thicker HAZ than the loop at 200 and 300 W (P < 0.01). There were no significant differences in HAZ among the VC electrodes at any power level. In dog muscle in vivo (stroke speed 10 mm/s), the roller cutting, Vapor Cut and Wedge electrodes produced a significantly thicker HAZ at 250 W than the loop at 150 W (the usual power for TURP) (P < 0.01). There was no significant difference among the VC electrodes. In dog liver in vivo (stroke speed 10 mm/s), the roller cutting electrode produced a significantly thicker HAZ at 250 W than the loop at 150 W (P < 0.01). CONCLUSIONS: The present VC electrodes produced a thicker desiccation zone at higher powers (200-300 W) than the standard loop at the usual power (150 W). The four VC electrodes produced a similar desiccation zone. With pig muscle and liver in vitro, regular loops used at a higher power created a desiccation zone that was 70-80% of the depth created by the VC electrodes.

Animals↗
PubMed1999

Metabolic characteristics of the elderly with recurrent calcium oxalate stones.

OBJECTIVE: To determine the metabolic characteristics of elderly patients with recurrent calcium oxalate stones. PATIENTS AND METHODS: Metabolic abnormalities were investigated in 88 patients with recurrent calcium oxalate stones, including 70 aged <60 years and 18 aged >/=60 years. The frequency of each metabolic abnormality and the value of each urinary constituent were compared among subgroups of age and gender. RESULTS: Hyperoxaluria was the most common abnormality, present in 56% and 67% of patients aged <60 and >/=60 years, respectively. Hyperuricosuria was significantly more common in older than in younger patients. There were no significant differences in the frequencies of hypercalciuria and hypocitraturia between the age groups. The urinary excretion of oxalate and the ratio of oxalate to creatinine were significantly greater in older than in younger men. The frequency of low urine volume was lower in older than in younger patients and the mean urinary volume was also greater in the older group. CONCLUSIONS: Hyperuricosuria and hyperoxaluria seem to be essential risk factors for calcium oxalate stone formation in elderly patients. Urinary oxalate excretion is significantly greater in older than in younger stone formers and is more prominent in men.

Adult↗
PubMed1999

[Renal angiomyolipoma with a tumor thrombus extending into the right atrium--a case report].

We present a case of spontaneous rupture of renal angiomyolipoma with a tumor thrombus extending from the right renal vein and inferior vena cava to the right atrium. A 41-year-old woman, previously in good health, was referred to our hospital with right flank pain. Computed tomography showed fat densities in both tumor and thrombus. Other imaging examinations also demonstrated a large right renal mass (18 cm in diameter), a long tumor thrombus (13 cm in length) and a small left renal tumor (1.5 cm in diameter). Right nephrectomy and en-bloc removal of the intra caval and intracardiac tumor thrombus were performed on cardiopulmonary bypass. It was pathologically diagnosed as an angiomyolipoma without tuberous sclerosis. At present, three years after surgery the patient is doing well, showing neither metastasis nor increase of the left renal angiomyolipoma. To our knowledge, our case seems to be the 3rd case report of renal angiomyolipoma with a tumor thrombus extending to the right atrium. We conclude that renal angiomyolipoma even with an intra cardiac tumor thrombus can be resected safely and successfully.

Adult↗
PubMed1999

[A case of sudden death by pulmonary embolism after angio-embolization of renal cell carcinoma extending into the inferior vena cava].

We report a 42-year-old renal-transplanted man with renal cell carcinoma (RCC) in the native kidney. He was admitted with gross hematuria and general fatigue as the chief complaint. Ultrasonography, computed tomography, magnetic resonance imaging and angiography, revealed a right RCC with intracaval tumor thrombus extending to the level of hepatic veins. Since selective renal angiography demonstrated a hypervascular tumor, angio-embolization was performed preoperatively. However, he died suddenly the next morning despite aggressive resuscitative measures. Autopsy revealed bilateral pulmonary arteries obstructed by the tumor thrombus. Renal arterial embolization is useful for advanced RCC, and side effects are mostly transient and well tolerated by the patients. However, indications for angio-embolization should be selected carefully with such a fatal case as this patient kept in mind.

Carcinoma, Renal Cell↗
PubMed1999

Ethanol injection therapy of the prostate for benign prostatic hyperplasia: preliminary report on application of a new technique.

PURPOSE: We evaluate the efficacy of a new technique of minimally invasive treatment for benign prostatic hyperplasia involving direct injection of dehydrated ethanol. MATERIALS AND METHODS: Dehydrated ethanol was injected transurethrally with lumbar or sacral and urethral anesthesia in 10 patients with prostatic hyperplasia. Endoscopic injection was performed at 4 to 8 sites in the prostate and 3.5 to 12.0 ml. ethanol were used. RESULTS: There were no intraoperative complications but postoperative urinary retention occurred transiently in all patients which required catheterization for a mean of 8.8 days. Mean symptom score plus or minus standard deviation was 12.2+/-5.8 at 3 months postoperatively, which was significantly improved from 23.1+/-7.0 preoperatively (p<0.01). Mean quality of life score also improved significantly from 5.1+/-0.6 preoperatively to 3.2+/-1.5 at 3 months postoperatively (p<0.01), mean peak urinary flow rate increased from 8.0+/-2.2 (9 patients) to 13.1+/-3.6 ml. per second (p<0.05) and mean residual urine volume decreased from 129.1+/-55.3 (9 patients) to 49.3+/-34.7 ml. (p<0.05). There was no significant change in prostate volume. Acute epididymitis and chronic prostatitis occurred in 1 patient each. CONCLUSIONS: This technique can be performed as an outpatient procedure and appears to be safe and cost-effective. Retrograde ejaculation can be avoided.

Aged↗
PubMed1998

Long-term results of ABO-incompatible living kidney transplantation: a single-center experience.

BACKGROUND: Despite great efforts to promote the donation of cadaveric organs, the number of organ transplantations in Japan is not increasing and a serious shortage of cadaveric organs exists. These circumstances have forced a widening of indications for kidney transplantation. For this purpose, ABO-incompatible living kidney transplantations (LKTs) have been performed. Although we have already reported the short-term results of ABO-incompatible LKT, there is no report of long-term results in such cases; anti-A and anti-B antibodies could cause antibody-induced chronic rejection and result in poor long-term graft survival. In this study, we have reviewed the long-term results of ABO-incompatible LKT and tried to identify the most important factors for long-term renal function in ABO-incompatible LKT. METHODS: Sixty-seven patients with end-stage renal failure underwent ABO-incompatible living kidney transplantation at our institute between January, 1989, and December, 1995. The mean age was 34.9 years (range, 8-58 years), with 38 males and 29 females. Incompatibility in ABO blood group antigens was as follows: A1-->O, 23 patients; B-->O, 19 patients; A1B-->A1, 7 patients; B-->A1, 8 patients; A1-->B; 4 patients; A1B-->B, 4 patients; A1B-->O, 2 patients. The number of HLA-AB, and -DR mismatches were 1.6+/-1.1 and 0.76+/-0.6, respectively. Plasmapheresis and immunoadsorption were carried out to remove the anti-AB antibodies before the kidney transplantation. In the induction phase, methylprednisolone, cyclosporine, azathioprine, antilymphocyte globulin, and deoxyspergualin were used for immunosuppression. Local irradiation of the graft was performed at a dose of 150 rad, on the first, third, and fifth days after transplantation. Splenectomy was done at the time of kidney transplantation in all cases. RESULTS: Patient survival was 93% at 1 year and 91% at 8 years. Graft survival was 79% at 1, 2, 3, and 4 years, 75% at 5 and 6 years, and 73% at 7 and 8 years. Patient survival was not significantly different from that of ABO-compatible patients. However, graft survival was significantly different between ABO-incompatible grafts and ABO-compatible grafts. Specifically, ABO-incompatible transplant recipients experienced a significantly higher rate of early graft loss up to 3 years but showed an equivalent graft loss by year 4. Among 67 patients, 16 grafts were lost during the observation period. Loss was due to acute rejection in 5 patients, followed by chronic rejection in 5 patients and death with function in 3 patients, whereas immunosuppression was withdrawn in 3 patients due to nonimmunological reasons. Of 16 grafts lost, 15 were lost within 1 year after transplantation. Of the 67 patients, 5 died during observation. Three patients with functioning grafts died of uncontrolled bleeding due to duodenal ulcer, malignant lymphoma, and cerebral hemorrhage (one patient each). One patient died of ischemic colitis due to secondary amyloidosis and one patient of cerebral hemorrhage after graft loss due to humoral rejection. There was no fatal infectious complication, whereas 10 patients had non-tissue-invasive cytomegalovirus infection. The stepwise logistic regression model was employed to identify the most important factors for long-term renal function. Patients were subdivided into those with serum creatinine of less than 2.0 mg/dl (group 1, n=39) versus those with serum creatinine of more than 2.0 mg/dl (group 2, n=22) at one year after renal transplantation. Six patients were excluded because of death with functioning graft (three patients) and withdrawal of immunosuppression (three patients). Rejection episodes within 6 months were significantly frequent in group 2 compared with group 1 (P=0.0008). Odds ratio was 112-fold in the rejection episodes. Obviously, the high incidence of early humoral rejection is caused by ABO incompatibility, because ABO-incompatible grafts experience a higher rate of early rejection and graft loss compa

ABO Blood-Group System↗
PubMed1998

Autotransfusion supported by erythropoietin therapy in transurethral resection of the prostate.

We investigated the collection and transfusion of autologous blood after treatment with EPO in 68 BPH patients (including 10 controls) who were scheduled to undergo TUR-P. All patients received oral and/or intravenous iron supplements. Assessments were made based on the preoperative increase in blood hemoglobin levels including autologous blood predonation (deltaHb). The deltaHb in patients undergoing collection of 600 ml of blood were as follows: control group: -0.36 +/- 0.57 g/dl; EPO group, 9 x 3000 units intravenously: 1.15 +/- 0.83 g/dl; EPO group, 6 x 6000 units intravenously: 0.79 +/- 0.80 g/dl; EPO group, 3 x 12,000 units subcutaneously: 1.47 +/- 0.62 g/dl. In patients undergoing collection of 800 ml of blood, the results were as follows: EPO group, 3 x 12,000 units subcutaneously: 1.80 +/- 0.69 g/dl; EPO group, 3 x 24,000 units subcutaneously: 2.03 +/- 0.77 g/dl. All EPO-treated patients successfully underwent surgery using their own blood, and none of them required homologous transfusion. The increase of Hb was greater in the patients treated with EPO than in controls, allowing safe preoperative blood collection even in elderly patients. In patients with relatively severe BPH, homologous transfusion could be avoided and surgery was performed safely.

Aged↗
PubMed1998

Detection and quantification of soluble intercellular adhesion molecule-1 (sICAM-1) in the serum and urine of patients with bladder cancer.

BACKGROUND: A possible role for intercellular adhesion molecules in tumor progression and metastasis has been strongly suggested. To investigate the effect of soluble intercellular adhesion molecule-1 (sICAM-1) on bladder cancer, sICAM-1 serum and urinary concentrations were measured in patients with superficial or invasive bladder cancer and in patients with prostatic hypertrophy. METHODS: Serum and urine samples were obtained from 26 patients with transitional cell carcinoma of the bladder (mean age, 66.8 years) and 14 patients with benign prostatic hypertrophy (BPH; mean age, 70.5 years). Fifteen healthy volunteers served as control patients. Samples were collected before surgery and 5 days after surgery. The serum and urinary slCAM-1 levels were measured by an ELISA. RESULTS: The preoperative serum concentration of sICAM-1 was significantly higher in patients with invasive bladder cancer (351.8+/-158.0 ng/mL) than in the healthy controls (233.1+/-96.1 ng/mL; P< 0.05) or BPH patients (224.7+/-80.5 ng/mL; P< 0.05). In addition, serum sICAM-1 levels were significantly higher in patients with tumors greater than 3 cm in size (412.7+/-147.6 ng/mL) than in patients with smaller tumors (246.6+/-101.2 ng/mL; P<0.05). Urinary sICAM-1 levels in patients with invasive bladder cancer were also significantly higher than in the patients with superficial cancer prior to surgery. CONCLUSION: Our results suggested that sICAM-1 may play an important role in the progression of bladder cancer, and that elevated serum sICAM-1 levels may be related to tumor size.

Adolescent↗
PubMed1998

[Study on urinary levels of interleukin-1 beta, interleukin-6 and tumor necrosis factor-alpha in patients with renal cell carcinoma].

We examined the preoperative and postoperative, urinary levels of the cytokines, interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) in 14 patients with renal cell carcinoma (RCC), and 9 patients who underwent nephrectomy as donors (controls). Although urinary IL-1 beta was measurable in every subject, both IL-6 and TNF-alpha were undetectable in 12 of the 14 patients. None of the urinary cytokines showed levels significantly different from the controls preoperatively. Urinary levels of IL-1 beta showed no correlation with clinical stage or histological grade. Only urinary IL-1 beta was significantly elevated after nephrectomy, when compared with the controls (P < 0.05). However, urinary IL-1 beta showed no correlation with operative blood loss or postoperative infection. These findings suggest that measurement of urinary cytokines is not useful for diagnosis or monitoring of therapy in RCC patients.

Adult↗
PubMed1997

Long-term outcome of renal transplantation in hepatitis B surface antigen-positive patients in cyclosporin era.

The impact of hepatitis B virus (HBV) infection on the outcome of renal transplantation (Tx) has been controversial. To determine the indication of renal Tx in patients infected by HBV, we investigated the long-term outcome of renal transplant patients with hepatitis B surface antigen (HBsAg). We analyzed 980 patients, including 18 HBsAg carriers, who underwent renal Tx and were immunosuppressed with cyclosporin in our institute. Fourteen out of 18 patients (77.8%) showed hepatic dysfunction after an average period of 17.8 months (range 1-65) after Tx. Four out of 14 patients (28.5%) with hepatic dysfunction died of liver failure due to fulminant hepatitis with functioning grafts between 15 and 71 months after Tx. The remaining 10 patients with hepatic dysfunction are alive up to the time of last follow-up; however, 5 of them lost their grafts because of rejection between 44 and 92 months after Tx. Their liver function improved after withdrawal of cyclosporin. Only 4 patients did not develop chronic liver disease and have had functioning grafts for between 44 and 147 months. One patient died of subarachnoid hemorrhage 22 months after Tx. HBe antigen, antibody and HCV antibody status were not related to the occurrence of liver dysfunction after Tx. Four HBV-DNA-positive patients showed deteriorated liver function. Three patients with chronic active hepatitis confirmed by the biopsy were treated with interferon. Interferon improved liver function in 2 patients, however, 1 patient died of liver failure despite interferon therapy. Our data suggested that the presence of HBsAg is often associated with chronic liver disease leading to liver failure regardless of HBe and HCV status after Tx. The indication of renal Tx in patients with HBsAg should be determined carefully giving consideration to these results.

Adolescent↗
PubMed1997

[A preliminary study on transurethral electrovaporization of the prostate (TVP) using VaporTrode].

BACKGROUND: Surgical therapy for Benign Prostatic Hypertrophy (B.P.H.) has mainly depended upon Transurethral Resection of the Prostate (TUR-P) using a cutting loop electrode. Recently, a new technique TVP was reported using the VaporTrode apparatus. We assessed the safety and efficacy of the VaporTrode in a preliminary study. METHODS: Histological changes of the muscle and liver of pigs were examined after vaporization using the VaporTrode and a cutting loop electrode. First, histological changes were investigated following vaporization after one stroke at a slow hand speed. Next, histological changes were assessed following vaporization at fixed stroke speed in an experimental model. RESULTS: At an electrical output of less than 275 W, the depth of the vaporized layer increased as the stroke speed became slower (4.0 cm/s-2.5 cm/s). When the electrical output was 300 W, the depth of vaporized layer increased even at a faster stroke speed (2.5 cm/s-3.0 cm/s.) The depth of the desiccated layer increased as the stroke speed became slower at any electrical output. However, when the stroke speed was 4.0 cm/s, the depth of this layer was less than 2.0 mm. With the cutting loop electrode, the depth of the desiccated layer increased at a higher electrical power, but the change was very small. CONCLUSION: To achieve deep enough vaporized and desiccated layers safely, the VaporTrode should be used at a stroke speed slower than 3.0 cm/s and a high electrical power of about 275 W.

Animals↗
PubMed1997

[Utility of prostate specific antigen (PSA) density in detecting prostate cancer in men showing gray zone serum PSA levels].

The efficacy of prostate specific antigen density (PSAD) in diagnosing prostate cancer was assessed in 98 patients with serum prostate specific antigen (PSA) levels between 2 and 10 ng/ml who had a pathological diagnosis made by prostate biopsy or transurethral resection of the prostate. Of the 98 patients, 22 (22%) had prostate cancer. The PSA (based on a cut-off value of 4.5 ng/ml) had a sensitivity and positive predictive value (PPV) of 82% and 38%, respectively, for diagnosing prostate cancer, while the results for PSAD (based on a cut-off value of 0.13) were 91% and 61%. The PSAD was more efficient than the PSA levels and was also superior to digital rectal examination (DRE) combined with transrectal ultrasonography (TRUS), for which the sensitivity and PPV were 73% and 39%, respectively. Six (11%) out of 57 patients who were normal on DRE and TRUS had prostate cancer. In these 57 patients, the PSA (cut-off value: 4.5 ng/ml) had a sensitivity of 50% and PPV while the values for PSAD (cut-off value: 0.13) were 83% and 36% respectively. The PSAD could effectively detect even impalpable prostate cancer not visible on TRUS.

Aged↗
PubMed1997

[Bladder carcinoma presenting with hypercalcemia: a case report].

A 47-year old woman was referred to our hospital with nausea, vomiting and the loss of body weight. Pelvic computed tomography and magnetic resonance imaging revealed an invasive bladder tumor on the left lateral wall, accompanied with calcification. Laboratory examination revealed marked hypercalcemia (20.6 mg/dl) and elevated serum parathyroid hormone-related protein-intact (29.9 pmol/l), which was apparently produced by the tumor. Treatment with pamidronate and colloid infusion resulted in normocalcemia. Anterior pelvic exenteration was performed. Histopathological diagnosis was transitional cell carcinoma > adenocarcinoma, G3, pT4pN2M0, stage IV. She died of cancer 7 months postoperatively.

Carcinoma, Transitional Cell↗
PubMed1997

[A case of xanthogranuloma of the urinary bladder].

A case of xanthogranuloma of the urinary bladder is reported. A 68-year-old man was referred to our hospital for the evaluation of microscopic hematuria. At that time, he did not have an abdominal tumor and ultrasonography showed no abnormality of the kidneys and the bladder wall. Two months later, he was admitted with the chief complaints of perineal discomfort and non tender fist size mass was palpable in the lower abdomen. Ultrasonography, computed tomographic scan and magnetic resonance imaging MRI demonstrated a supravesical mass which was strongly suspected as urachal tumor. Total cystectomy with urachal resection was performed. The histological diagnosis was xanthogranuloma. The patient has been in good health without recurrence, 4 years after surgery. We discuss xanthogranuloma of the urinary bladder in the literature.

Aged↗