Biomedical subjects

Osamu Kamihira

Publications and source records attributed to Osamu Kamihira.

18 recordsLinked to original sources

PubMed2007

Folic acid prevents neural tube defects: international comparison of awareness among obstetricians/gynecologists and urologists.

AIM: It has been suggested that periconceptional intake of folic acid prevents risks of having fetuses afflicted with neural tube defects. We aim to internationally investigate knowledge of the role of folic acid and attitudes toward the life-style of young women of child-bearing age among obstetricians/gynecologists and urologists. METHODS: A questionnaire was sent to obstetricians/gynecologists and urologists residing in Japan, South Korea, Taiwan, North America, Europe, Australia and New Zealand by post or e-mail. The investigation was conducted between December 2002 and November 2004. RESULTS: A mean of 91% of obstetricians/gynecologists and 56% of urologists are aware of the role of folic acid, where Asian urologists knew less compared to those of North America, Europe, Australia and New Zealand. A majority of doctors always, or occasionally, recommend folic acid supplements or multivitamins, well-balanced meals, and the cessation of smoking and drinking. An average of 85% of doctors believes information on folic acid should be disseminated to young women. CONCLUSIONS: A majority of obstetricians/gynecologists and urologists know the importance of periconceptional folic acid in reducing the risk of neural tube defects and have been advising young women to improve their lifestyle.

Awareness↗

PubMed2006

Laparoscopic nephroureterectomy for transitional cell carcinoma of renal pelvis and ureter: Nagoya experience.

OBJECTIVES: To evaluate the efficacy of retroperitoneoscopic nephroureterectomy for transitional cell carcinoma of the renal pelvis and ureter, we analyzed the clinical outcomes and long-term cancer control of 89 patients. METHODS: In 36 patients, the kidney was retroperitoneoscopically dissected and the ureteral end was resected with open procedure (combined laparoscopy group). In 53 patients, the ureteral end with a bladder cuff was transected using an endoscopic stapler (pure laparoscopy group). Sixty patients underwent open nephroureterectomy (open group). The median follow-up period was 35, 31, and 17 months in the open, combined, and pure laparoscopy groups, respectively. RESULTS: The average operative time and bleeding volume was 5.4 hours and 665 mL in the open group, 5.1 hours and 580 mL in the combined laparoscopy group, and 4.3 hours and 354 mL in the pure laparoscopy group, respectively. The cause-specific patient survival rate at 3 years was 81% in the open group, 86% in the combined laparoscopy group, and 80% in the pure laparoscopy group. The bladder recurrence-free rate at 3 years was 51% in the open group, 65% in the combined laparoscopy group, and 45% in the pure laparoscopy group. The extravesical recurrence-free rate at 3 years was 71% in the open surgery group, 76% in the combined laparoscopy group, and 71% in the pure laparoscopy group. No statistically significant difference was seen in patient survival, bladder recurrence, or extravesical recurrence rates among the three groups. CONCLUSIONS: Our retroperitoneal laparoscopic nephroureterectomy is less invasive than open surgery and is a safe and effective alternative.

Aged↗

PubMed2006

Efficacy, safety and hospital costs of tension-free vaginal tape and pubovaginal sling in the surgical treatment of stress incontinence.

AIM: The efficacy, safety and hospital costs of the tension-free vaginal tape procedure were compared with the pubovaginal sling operation. METHODS: A total of 60 women urodynamically diagnosed as having stress or mixed urinary incontinence were operated on using either the tension-free vaginal tape or pubovaginal sling operation in a prospective manner. Preoperative characteristics of the women were not significantly different for the groups. The women were followed for up to 24 months. RESULTS: In the tension-free vaginal tape group, the operation time was shorter, numbers of analgesics postoperatively required were less and hospital charges were less expensive compared to those in the pubovaginal sling operation (P < 0.01). Kaplan-Meier survival analysis showed a marginal significant difference (P = 0.059) in the objective cumulative cure rates at 24 months between the groups receiving the former (70.3%) and latter (48.3%) procedures. Subjective cure rates were not significantly different (P = 0.101). In both groups, an improvement in quality of life was significant and surgical complications were identical. De novo urge incontinence developed in 6% and 10% in the former and latter, respectively. CONCLUSIONS: The tension-free tape was significantly superior to the pubovaginal sling in terms of operation time, postoperative pain, and hospital charges, but not in cure rates. A longer follow up with a larger sample size is necessary to draw definite conclusions.

Aged↗

PubMed2006

[Retroperitoneal liposarcoma: a case report].

We report a case of retroperitoneal liposarcoma. A 66-year-old male was referred to our hospital for a retroperitoneal tumor that was detected during gallbladder stone examination. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed an extrarenal lipomatous tumor, 20 x 14 x 8 cm in size, in the right retroperitoneal space. He underwent surgical excision of the tumor with concomitant resection of the right kidney and adrenal gland. The resected tissue weighed 730 g. Histological examination revealed a well differentiated liposarcoma. He received no adjuvant therapy.

Adrenalectomy↗

PubMed2006

[Giant condyloma with malignant degeneration: a case report].

We report a case of giant condyloma with malignant degeneration. A 56-year-old male was referred to our hospital due to a penile infection that was resistant to antibiotic therapy for more than a year. The swelling appeared to be a penile cancer. We suspected malignancy and performed penile biopsies twice; however, the histopathological diagnosis was condyloma acuminatum and malignant findings were absent. We continued the antibiotic therapy for 3 months; however, no improvement was achieved. Therefore, total penectomy and urinary diversion were performed. The pathological diagnosis of the resected tissues was not only condyloma but also squamous cell carcinoma, and cancer cells appeared on the cut surface of the specimens. We added radiation therapy. There was no evidence of recurrence or metastasis at 18 months after surgery.

Carcinoma, Squamous Cell↗

PubMed2005

Laparoscopic radical nephrectomy for renal cell carcinoma: the standard of care already?

PURPOSE OF REVIEW: Laparoscopic radical nephrectomy has been developed and applied for patients with renal cell carcinoma since 1992. The number of patients undergoing laparoscopic radical nephrectomy has increased explosively worldwide in recent years, and laparoscopy is now extended to patients with advanced disease. It is very important to clarify the present status of laparoscopic radical nephrectomy among the treatment modalities for patients with renal cell carcinoma. RECENT FINDINGS: Laparoscopic radical nephrectomy has a minimally invasive nature as well as comparable long-term cancer control in patients with pT1-3a renal cell carcinoma to open surgery. It is technically applicable for N1-2 disease and T3b disease if the tumor thrombus is within the renal vein. Also, it is feasible as a cytoreductive surgery for patients with M1 disease. SUMMARY: Laparoscopic radical nephrectomy is a standard treatment modality for T1-3a renal cell carcinoma patients. It is also available for treating patients with N1-2 disease, and for patients with M1 disease as a cytoreductive surgery.

Carcinoma, Renal Cell↗

PubMed2005

Awareness of the role of folic acid, dietary folate intake and plasma folate concentration in Japan.

AIM: To investigate awareness of the role of folic acid in the prevention of neural tube defects, dietary intake of folate, and plasma folate concentration. METHODS: Postal questionnaires were collected from 1190 lay female subjects in three different groups and from seven groups of 3067 health-care providers. Dietary folate was investigated by assessing food frequency charts that were kept for 3 days by 245 women, and plasma folate was assessed by analyzing the blood serum of 194 women. RESULTS: Less than 15% of citizens and mothers who had live births knew that there was a link between folic acid and neural tube defects. The exception was with myelodysplastic families, in which awareness was 92%. Awareness among health-care professionals was generally low. The highest level was found in obstetricians-gynecologists (76%) and the lowest in nurses (12%). Dietary folate intake and plasma concentration were highest in pregnant women (356 microg/day and 11.9 ng/mL) and the lowest in student nurses (217 microg/day and 6.8 ng/mL). When the recommended dietary allowance of folate in Japan is taken into consideration, 22% of the non-pregnant women and 71% of the pregnant women did not fulfill the recommended dietary allowance. CONCLUSIONS: Information on the role of periconceptional intake of folic acid is not sufficiently disseminated to young women and health-care professionals alike. Pregnant women should be repeatedly recommended to take folic acid supplements of 400 microg/day.

Adult↗

PubMed2005

The long-term outcome of tacrolimus in cadaveric kidney transplantation from non-heart beating donors.

Tacrolimus (Tac), developed in 1990, has been applied as an immunosuppressive agent for liver, heart, and kidney transplantation and is known to have more powerful immunosuppressive effects than cyclosporine (CyA). To evaluate the efficacy of Tac in cadaveric kidney transplants from non-heart beating donors, we present the long-term outcome of patients receiving kidneys with ischemic damage, and compared it with that of CyA. Between July 1990 and December 2000, 55 patients with end-stage renal disease received kidneys from non-heart beating donors (Maastrichy category 3) and were treated with Tac and steroid immunosuppressive therapy. During the same period, we also performed 137 non-heart beating cadaveric renal transplants treated with CyA-based immunosuppressive therapy. The patient survival rate was 98% at 1 yr and 96% at 3-10 yr in the Tac group, and 97% at 1-3 yr, 93% at 5 yr and 85% at 10 yr in the CyA group. The graft survival rate was 91% at 1 yr, 80% at 3 yr, 63% at 5 yr and 34% at 10 yr in the Tac group, and 88% at 1 yr, 75% at 3 yr, 63% at 5 yr and 49% at 10 yr in the CyA group. There was no significant difference in either patient or graft survival rates between the two groups. Acute early rejection in the Tac group was less than that in the CyA group but acute tubular necrosis was the same in both groups. This indicates that Tac is available for cadaveric kidney transplants from non-heart beating donors. In conclusion, Tac is available as an immunosuppressive agent even for kidney transplants from non-heart beating donors.

Adult↗

PubMed2005

Determination of the relative probability for prostate cancer to avoid unnecessary biopsy.

BACKGROUND: To investigate whether using a new concept of relative probability for prostate cancer (RPpca) can increase sensitivity and specificity in detecting prostate cancer. METHODS: For 217 patients with total prostate-specific antigen (PSA) level of 4-20 ng/mL, prostate volume and free to total PSA (F/T) ratio were measured. From the fitted curves between positive predictive values for prostate cancer and age, prostate volume, total PSA or the F/T ratio, each function predicting prostate cancer was determined. RPpca defined by the combined functions of age, prostate volume, total PSA and F/T ratio was calculated for each individual patient. The probability of prostate cancer was also calculated, using logistic regression analysis (LRPpca). Receiver-operating characteristic analysis was performed to elucidate the areas under the curve (AUC), sensitivities and specificities and cutoff values of the conventional and new parameters. Finally, we investigated the applicability of the above parameters in the other patient group using a different PSA assay kit (AxSYM). RESULTS: Although RPpca had the largest AUC in the total PSA range of 4-20 ng/mL, it did not reach statistical significance between RPpca and F/T ratio or LRPpca. The cutoff values of F/T ratio, LRPpca and RPpca were determined as 0.15, 0.12 and 0.20, respectively. Using these cutoff values in AxSYM data, RPpca had the highest sensitivity (91%) and specificity (57%). CONCLUSIONS: RPpca can provide more precise information to avoid unnecessary biopsy than LRPpca or F/T ratio. RPpca could be valuable to decide whether to perform prostate biopsy when using various PSA kits.

Adult↗

PubMed2005

Comparison of tamsulosin and naftopidil for efficacy and safety in the treatment of benign prostatic hyperplasia: a randomized controlled trial.

OBJECTIVES: To compare the efficacy and safety of two alpha1a/alpha1d adrenoceptor (AR) antagonists with different affinity for the alpha1AR subtypes, tamsulosin and naftopidil, in the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Patients with BPH were randomized to receive either tamsulosin or naftopidil. The primary efficacy variables were the changes in the total International Prostate Symptom Score (IPSS), maximum flow rate on free uroflowmetry, and residual urine volume. The secondary efficacy variables were average flow rate, changes in the IPSS storage score, IPSS voiding score, and quality-of-life (QoL) Index score, from baseline to endpoint (12 weeks). Data on all randomized patients were included in the safety analyses for adverse effects and changes in blood pressure. RESULTS: Of the 185 patients enrolled data for 144 who were eligible for inclusion in the efficacy analysis were analysed (75 from the tamsulosin and 69 from the naftopidil group). There was no significant difference in any variable at baseline between the groups. There were statistically significant improvements for all primary and secondary variables in both groups, except for residual urine in the tamsulosin group. However, there was no significant intergroup difference in the improvement of any efficacy variable between the groups. The adverse effects were comparable, with no significant differences in systolic and diastolic blood pressure after treatment in both groups. CONCLUSIONS: This study suggests that naftopidil is as effective and safe as tamsulosin. Both drugs were effective in improving storage and voiding symptoms. However, there was no difference in clinical efficacy or adverse effects between the alpha1 AR antagonists with different affinity to alpha1 subtypes, alpha1a and alpha1d.

Adrenergic alpha-Antagonists↗

PubMed2004

[Awareness of periconceptional consumption of folic acid among urologists and a group of laymen].

OBJECTIVE: The Ministry of Health, Labour and Welfare announced that periconceptional consumption of folic acid will reduce risks of having babies afflicted with Neural Tube Defects (NTDs) in the year of 2000. We assessed awareness of the role of folic acid among urologists and a patient group, how urologists give advices on lifestyle to young women, and what lifestyle the patient group currently maintains. MATERIALS AND METHODS: A postal questionnaire survey was conducted involving 400 urologists randomly selected and a group of 250 female patients afflicted with NTDS and 250 mothers who had given birth to babies having NTDs during the past 7 years. Eighty-four percent of urologists aged 40 years and over and 76% of the patient group aged in their 20s and 30s. Response rates were 56% in the former and 52% in the later. RESULTS: Twenty-six percent of urologists and 92% of the patient group knew an important role folic acid played in prevention of neural tube defects. While 10% of urologists advised to consume multi-vitamins containing folic acid or folic acid supplements, 25% of myelodysplastics and the mothers took them. Sixty-eight percent of doctors advised to take well-balanced food and 82% of the patent group answered that they do. Over 80% of the doctors and the patient group believed that a folic acid campaign is to be organized to inform young women of childbearing age of possible reduction of the risk. CONCLUSION: It is found that proportion of urologists who are aware of a role of periconceptional consumption of folic acid is significantly lower than that of the group of patients (p < 0.0001). Urologists are expected to recognize specific benefits of folic acid in the prevention of NTDs, to advise young women of childbearing age to take well-balanced meals, and to recommend those who wish to be pregnant to consume 400 micrograms of folic acid supplements from 4 weeks before to 12 weeks after conception.

Adult↗

PubMed2004

[Primary undifferentiated carcinoma of the ureteral stump; a case report].

A 72-year-old man referred our hospital with the chief complaint of macroscopic hematuria. He had undergone simple left nephrectomy for left renal stone when he was 27-years-old. His urine cytology showed class IIIb. They were 4 times. We performed random biopsy of the bladder and retrograde pyelography of the right But they were no positive findings for the cause of hematuria and for the existence of malignancy. After 2 months, he had macroscopic hematuria again. Cystoscopic re-examination revealed a fibrin out of the residual left ureteral orifice. Computed tomographic scan showed a perivesical mass. The diagnosis was the carcinoma of the ureteral stump. We performed ureterectomy. The pathological study revealed the undifferentiated carcinoma. This case is the first report of the undifferentiated carcinoma occurred on the residual ureteral stump in the Japanese literature.

Aged↗

PubMed2003

Long-term outcome of laparoscopic radical nephrectomy for pathologic T1 renal cell carcinoma.

OBJECTIVES: To evaluate the oncologic adequacy of laparoscopic radical nephrectomy in patients with pathologic Stage T1 renal cell carcinoma, we analyzed the long-term results in those treated with laparoscopy and those undergoing open surgery. METHODS: The renal tumor of 263 patients was confirmed to be Stage T1 by pathologic examination of the radical nephrectomy specimen between January 1992 and June 2002. Of the 263 patients, 195 were treated laparoscopically and the remaining 68 by open surgery. The patient follow-up lasted until July 31, 2002. RESULTS: The follow-up period of the laparoscopy group was 2 to 121 months (median 40). A total of 183 patients survived, 5 died of renal cancer, 7 died without any recurrent disease, and 7 were lost to follow-up. Seeding of the port sites did not develop in any of the patients. Ten patients had metastatic or recurrent disease within 3 to 110 months, and 5 of these patients died of cancer within 12 to 86 months. The 5-year disease-free and patient survival rate was 91%, and 94%, respectively. The 68 patients who underwent open surgery were followed up for 11 to 126 months (median 65). Of the 68 patients, 56 survived without any recurrent disease, 4 survived with metastasis, 6 died of metastatic disease within 8 to 49 months, and 6 were lost to follow-up. The 5-year disease-free and patient survival rate was 87% and 94%, respectively. CONCLUSIONS: Laparoscopic radical nephrectomy is an alternative technique with comparable oncologic results to open nephrectomy in patients with localized pathologic Stage T1 renal cell carcinoma.

Aged↗

PubMed2003

Retroperitoneoscopic nephroureterectomy for transitional cell carcinoma of the renal pelvis and ureter: Nagoya experience.

OBJECTIVES: To evaluate the efficacy of our new retroperitoneoscopic nephroureterectomy for patients with transitional cell carcinoma of the renal pelvis and ureter, we present the operative procedure and analysis of the clinical outcome of retroperitoneoscopy in 23 patients. METHODS: Twenty-three patients with transitional cell carcinoma of the upper urinary tract underwent retroperitoneal laparoscopic nephroureterectomy between February 2000 and February 2002. Patient age ranged from 44 to 83 years (mean 66.7). Each kidney was retroperitoneoscopically dissected en bloc, together with the perirenal fatty tissue, lymph nodes, and/or adrenal gland, without transecting the ureter. The lower ureter was resected with the bladder cuff transected using an ultrasonic scalpel and an endoscopic gastrointestinal automatic stapler. The dissected specimen was removed intact through a 6-cm-long original incision. RESULTS: The mean operating time was 4.8 hours, including 0.7 hours for complete removal of the ureteral end with the bladder cuff. The mean estimated blood loss was 304 mL. The mean time to recovery to normal activity was 18 days. In the mean follow-up period of 15 months, 2 patients died of cancer progression in the sixth postoperative month, 2 died of other causes, and 4 had recurrent transitional cell carcinoma of the bladder after surgery. CONCLUSIONS: Our retroperitoneal laparoscopic nephroureterectomy using an endoscopic gastrointestinal automatic stapler is a fast, low-risk, and minimally invasive procedure and might be an alternative to other laparoscopic techniques and open nephroureterectomy. However, long-term follow-up is necessary to confirm the efficacy for patients with transitional cell carcinoma of the renal pelvis and ureter.

Adult↗

PubMed2003

Focal segmental sclerotic lesions of the glomerulus in transplanted kidneys assessed using computerized image analysis.

Mechanisms responsible for the development of focal segmental sclerotic lesions of the glomerulus (FSGS lesions) in transplanted kidneys were investigated by morphometric analysis. The mean glomerular area and the interstitial area were measured using computerized image analysis to compare implantation biopsies (so-called 1-h biopsies; 1Bx) with later biopsies (episode Bx; EBx) that had been taken for diagnostic purposes to identify the cause of deteriorating renal function. Groups of patients with (group A, n = 15) or without (group B, n = 10) FSGS lesions were compared. Twelve of 15 in group A and all in group B had lost graft function due to chronic allograft nephropathy. It was found that neither the mean glomerular area nor the interstitial area differed significantly between the two groups in either 1Bx or EBx. The interstitial area was significantly increased (P = 0.007) and the mean glomerular area tended to be increased (P = 0.085) in EBx compared with 1Bx in group A but not in group B. The serum creatinine level at the time of EBx in group A correlated with the interstitial area (P = 0.031) but not the mean glomerular area. However, there was no similar correlation in group B. In conclusion, factors for the development of FSGS lesions in transplanted kidneys may be the increase in interstitial area and possible glomerular hypertrophy following transplantation, rather than pre-existing reduced renal mass of the donor kidneys.

Adult↗

PubMed2003

[Urolithiasis in those patients with myelodysplasia].

OBJECTIVE: To evaluate incidence and treatments of urolithiasis in myelodysplastic patients. PATIENTS AND METHODS: During the past 27 years 303 myelodysplastic patients, 160 men and 143 women, have been treated and 50 of them were operated on with bladder augmentation procedures. Their medical records were retrospectively reviewed. RESULTS: Urolithiasis occurred 20 times in 15 patients, 11 men and 4 women, where calculi developed 18 times in the bladder and twice in the kidney. Prevalence of urolithiasis was 20% (10/50) in those who had undergone bladder augmentation and 2% (5/253) in those who had not had this surgery, where the difference was statistically significant between the two groups (p < 0.01). Overall, 5% of all the patients suffered from stones in the urinary tract. Bladder calculi were endoscopically treated in 11 occasions or were resolved with suprapubic lithotomy in 4 cases. Small stones in the bladder were spontaneously delivered 3 times and extracorporeal shock wave lithotripsy (ESWL) was necessary for a renal calculus in one patient. The last patient having a renal stone has been put under care. Majority of stone compositions consisted of magnesium ammonium phosphate (MAP). CONCLUSION: It was found that urolithiasis was 10 times more prevalent in those patients operated on with enterocystoplasty than those without bladder augmentation and that intermittent clean catheterization and regular bladder irrigation were of necessity to prevent urolithiasis for those having enterocystoplasty.

Adolescent↗

PubMed2003

[Folic acid reduces risks of having fetus affected with neural tube defects: dietary food folate and plasma folate concentration].

OBJECTIVES: Risk of having fetus affected with neural tube defects can be reduced by maternal periconceptional folic acid supplementation. The purpose of the present study is to investigate how folate is taken from diets and to measure plasma folate concentrations. SUBJECTS AND METHODS: A total of 222 women comprising 5 groups, i.e., healthy women, mothers of myelodysplastic patients, pregnant women, myelodysplastic patients, nurse students, participated in our study. Food frequency questionnaires kept 3 days were analyzed based on the 5th standard table of food composition in Japan. Plasma folate concentrations were measured by means of chemiluminescent immunoassay method. Changes in plasma folate concentrations and possible adverse effects following the folic acid supplementation for 16 weeks were also investigated. RESULTS: The dietary intake of folate, plasma folate concentration and energy intake averaged 293 micrograms/day, 8.1 ng/ml and 1,857 Kcal, respectively, among the subjects. Pregnant women took the largest amount of folate from diets and demonstrated the highest plasma folate concentration among the groups. The dietary folate in myelodysplastic patients and nurse students was significantly lower compared to that of healthy women. The Recommended Dietary Allowance of folate was not fulfilled in 22% of non-pregnant adult women and 72% of pregnant women. The dietary folate was mainly taken from the 3rd food group but the 4th group of food was consumed most. Mean folate intake was significantly correlated with circulating concentrations of serum folate (p = 0.012 r = 0.186). The consecutive administration of 400 micrograms supplements for 16 weeks increased a baseline plasma value of 8.7 ng/ml to 32.6 but fell down rapidly to 17.3 24 hours later without any adverse effects. CONCLUSIONS: The dietary folate and serum folate concentrations averaged 293 micrograms/day and 8.1 ng/ml, respectively. The former is the first report based on the 5th standard table of food composition in Japan. Majority of pregnant women took less dietary folate than what recommended by the government. Those who are capable of becoming pregnant are recommended to consume much of the 3rd food group and those who are planning to become pregnant are recommended to take 400 micrograms of folic acid supplements from 4 weeks before to 12 weeks after conception.

Adolescent↗

PubMed2003

[A case in which severely irritable bladder following intravesical instillation of Bacillus Calmette Guerin was successfully treated by steroid therapy].

We report a patient whose irritable bladder symptoms following Bacillus Calmette Guerin (BCG) instillation were satisfactorily treated by steroid administration. A 59-year-old male had undergone transurethral resection for the bladder carcinoma recurred three times. The histopathological examination revealed the tumor as transitional cell carcinoma, G1 to G2, and pTa. Subsequently an instillation of 80 mg BCG into the bladder was planned 8 times every 7 days. After the 5th instillation he presented with gross hematuria, painful micturition, pollakisuria, urgency and reduced bladder capacity of 15 ml. The dose was reduced to 40 mg and another 3 instillations were accomplished. Since conventional treatments of anti-cholinergics, analgesics and epidural anesthesia were of little help for the subjective symptoms, he was put on the steroid pulse therapy 2 weeks after completion of the BCG regimen. The treatment gradually improved the subjective symptoms and increased the bladder capacity up to 160 ml. In conclusion, we believe that the steroid pulse therapy deserves considering in the early stage of irritable bladder symptoms following BCG instillation.

Administration, Intravesical↗