Biomedical subjects
Publications and source records attributed to S Fukuzawa.
Female urethral diverticulum is not an uncommon disease. We report a case of female urethral diverticulum which caused severe urethral pain, but for which the diagnosis had not been obtained at many hospitals for many years. Transurethral electrocauterization of the diverticulum was very effective in this case.
BACKGROUND: Primary invasive adenocarcinoma of the urinary bladder was diagnosed in a 59-year-old man with a 6-month history of macrohematuria. METHODS: He was treated with intra-arterial infusion of 5-fluorouracil, leucovorin and cisplatin and underwent radical cystectomy and construction of ileal conduit. RESULTS: The pathologic examination of the specimen revealed no viable malignant cells. CONCLUSION: 5-Fluorouracil combined with leucovorin and/or cisplatin has been used in the treatment of gastrointestinal adenocarcinoma and may be useful in primary adenocarcinoma of the bladder.
Tuberculosis of the prostate is uncommon. However, the number of patients with tuberculosis has once again recently been gradually increasing in Japan. The number of immunocompromised hosts, such as those with AIDS, is also increasing, suggesting that this rare infectious disease may increase in frequency in the near future. We present a case of tuberculosis of the prostate.
This study evaluated the long-term prognosis of optimal 'stent-like' results, suboptimal results and failure of balloon angioplasty. The clinical data of 108 patients were examined during 8 years following balloon angioplasty. Based on the angiographic results, the patients were divided into 3 groups: Group A (n=59), <25% residual stenosis (ie, optimal stent-like result); Group B (n=43), 26-50% residual stenosis or large dissection (ie, suboptimal result); and Group C (n=6), >50% residual stenosis or stenosis could not be crossed (ie, failed angioplasty). Restenosis occurred in 20 of 43 patients (46.5%) in Group B, but only in 18 of 59 patients (30.4%) in Group A. Achieving stent-like results following balloon angioplasty significantly reduced the incidence of restenosis. Kaplan-Meier curves at 8 years demonstrated a survival rate without serious cardiac events of 83% in patients with stent-like results compared with 58% in those with suboptimal results and 17% in those with failed balloon angioplasty. In conclusion, the major finding of this study is that achieving stent-like results following balloon angioplasty reduces the incidence of restenosis, and 8-year survival without serious cardiac events after balloon angioplasty is significantly better in patients who have a stent-like result.
OBJECT: To assess the value of secondary prevention with lipid lowering therapy following either balloon angioplasty (PTCA) or bypass surgery (CABG) in familial hypercholesterolemia patients, the correlation of the new evolution of stenotic lesions and therapeutically achieved cholesterol levels was studied in 50 patients. METHODS: All surviving patients were followed angiographically after 5 years, and findings were correlated with the annually determined total serum cholesterol (TC) levels. RESULTS: New coronary atherosclerotic plaques were not observed in 18 patients in whom the TC was controlled to <220 mg/dl but in 19 of 32 patients in whom the TC was >220 mg/dl, a new evolution of stenotic lesions was observed angiographically. CONCLUSION: The new evolution of stenotic lesions following revascularization in patients with FH can be controlled significantly by lipid lowering therapy to maintain a TC level of <220 mg/dl, and if diet alone can not achieve it, aggressive medication and even LDL apheresis might be justified.
A 19-year-old male consulted our department, complaining of a painful scrotal mass. On palpation, the mass was discriminated from testis, epididymis, and spermatic cord in the left scrotum. He underwent total excision of the mass. Pathologic examination revealed cavernous hemangioma. Scrotal hemangioma is a relatively rare lesion and this is the 37th case reported in Japan.
BACKGROUND: In an attempt to determine the biological significance of nuclear morphometric findings, measurements of mean nuclear volume (MNV) and nuclear roundness factor (NRF) were compared to the immunoreactivity of p53 expression and proliferating cell nuclear antigen (PCNA) in human bladder cancer. METHODS: MNV and NRF were measured using stereological methods. Expression of p53 and PCNA were determined by immunohistochemical staining. Specimens from 111 patients with previously untreated bladder cancer were analyzed. RESULTS: The mean MNV was 235.8 +/- 133.6 microm3 for the 81 patients with p53-labeling index (LI) less than 10% and 337.2 +/- 141.0 microm3 for the 30 patients with p53 LI greater than 10% (P = 0.008). There was no significant correlation between NRF and expression of p53. The mean MNV was 220.1 +/- 120.5 microm3 for the 67 patients with PCNA LI less than 28% (the mean value of PCNA LI) and 328.9 +/- 149.2 microm3 in 44 patients with PCNA LI greater than 28% (P = 0.0001). The mean NRF was 80.7 +/- 4.2 for the 67 patients with PCNA LI less than 28%, and 82.3 +/- 3.4 for the 44 patients with PCNA LI more than 28% (P = 0.04). CONCLUSION: Nuclear morphometric findings may reflect the proliferative potential of cancer cells of the bladder, as indicated by findings of immunostaining for p53 and PCNA.
In patients with coronary artery disease (CAD), differentiation between severely ischemic but potentially viable myocardium and irreversibly infarcted tissue is clinically important, particularly when revascularization procedures are considered. Although thallium (TI) cardiac imaging has been shown to be a good tool for investigating myocardial viability in CAD, this tracer shows physical limitations, such as a low photon energy and long half-life. We assessed the results of a rest TI-201/stress Tc-99m tetrofosmin protocol in subjects with prior anterior myocardial infarction. All of the patients had an akinetic or dyskinetic area and more than 75% stenosis in the left anterior descending artery. All of the patients underwent revascularization after the examination. We evaluated the improvement in wall motion after revascularization using the centerline method with contrast left ventricular angiography. Fourteen patients showed reversible defects with the rest TI-201/stress Tc-99m tetrofosmin protocol or in additional TI-201 24 h redistribution images. All 14 patients showed a significant improvement in wall motion after revascularization. Dual-isotope rest TI-201/stress Tc-99m tetrofosmin single photon emission tomography data, acquired separately, may give fast and complete information about myocardial perfusion during stress and at rest, and on about myocardial viability.
We report a case of uretero-aortic fistula. A 69-year-old man with rectal cancer underwent a pelvic exenteration and a double--barreled cutaneous ureterostomy in the right lower abdomen. Stomal stenosis necessitated continuous indwelling of double J stents in the two ureters. Two years postoperatively, massive bleeding occurred during exchange of double J catheters. Occlusive ureterogram demonstrated a uretero-aortic fistula at the crosspoint between the left ureter and the aorta. The surgical repair consisted of closure of the aortic fistula, ligation of the left ureter proximal to the fistula and percutaneous left nephrostomy.
The effectiveness of transurethral microwave thermotherapy (TUMT) for BPH has been confirmed. To identify the characteristics of the ideal candidate, retrospective analysis and morphometric study of prostatic tissue were performed. Forty-two patients with symptomatic BPH were included in the study; these comprised 10 patients treated for more than 3 months with anti-androgen pre-TUMT (group A) and 32 fresh cases (group B). Subjective and objective responses were evaluated at 2 months post TUMT. In 12 fresh cases who underwent pre-TUMT biopsy of the prostate, the stromal-to-epithelial ratio was determined via quantitative image analysis on a computer-assisted morphometry system. No significant differences in baseline patient characteristics were found between the two groups: age, prostate volume, peak flow rate (PFR), or International Prostate Symptom Score (I-PSS). However, significant differences in treatment outcome were found between the two groups (group A vs. group B, respectively): total energy delivered to the prostate: 96 kJ vs. 125 kJ: I-PSS decrease from baseline: 5.9 vs. 11.6; PFR increase from baseline: 1.1 vs. 4.7 ml/sec. There was a positive correlation between the I-PSS change from baseline and the stromal-to-epithelial ratio of the prostatic tissue (r = 0.4857). The results suggest that microwave interacts poorly with the prostate due to the artificially created "lack" of glandular tissue. The morphometric study also supports the contention that the histological composition of the prostatic tissue plays an important role in terms of microwave thermal interactions and treatment outcome.
Tc-99m tetrofosmin is a lipophilic, cationic perfusion imaging agent that changes to Tl-201 in detecting coronary artery disease during exercise testing. The purpose of this study is to evaluate the usefulness of Tc-99m tetrofosmin dipyridamole stress imaging combined with low level exercise for the detection of coronary artery disease. We examined 42 patients and 10 normal volunteers who also underwent coronary angiography. A one-day protocol was used: in the stress study, 296 MBq of tetrofosmin was injected and in the rest study 888 MBq was injected. After intravenous administration of dipyridamole (0.142 mg/kg/min for 4 minutes), the patient was exercised on a bicycle ergometer for 3 min (25 Watts). Tetrofosmin was injected 2 minutes after dipyridamole infusion during the exercise. Single photon emission computed tomographic images were obtained 30 minutes after the tracer injection. Images were interpreted as abnormal in 36 of 42 patients with coronary artery disease, and normal in all of 10 normal volunteers. The overall sensitivity of detection of coronary artery disease was 83.3% and the normalcy rate was 100%. The diagnostic values for the detection of significant stenosis in the three major arteries were: LAD sensitivity 83%, specificity 92%; LCX sensitivity 47%, specificity 91%; RCA sensitivity 75%, specificity 83%. Of the 66 arteries with more than 50% stenosis, 48 arteries were correctly identified. Of the 36 with more than 70% stenosis, 31 were identified. Scintigraphic evidence of multivessel disease was found in only 9 patients (50%). A protocol of Tc-99m tetrofosmin SPECT combined with low level exercise after dipyridamole is therefore useful for the detection of the coronary artery disease.
Radiolabeled fatty acids such as iodine-123-betamethyl-p-iodophenyl-pentadecanoic acid (BMIPP) have unique metabolic properties suggesting potential use as myocardial perfusion tracers. The uptakes of BMIPP and thallium 201 were compared using single photon emission computed tomography (SPECT) in 24 patients displaying unstable angina with multivessel disease at a mean of 3.4 days after admission. Coronary angiography was performed within a week. Uptake was considered normal if the activity was greater than 80% of the normal area, mildly reduced if 50% to 79%, and severely reduced if less than 50%. The regional activities in four quardrants in short-axis slices were measured from basal, mid and apical sets. We attempted to identify the causative lesion on dual SPECT imaging. We planned the following management of each patient based on the results of the dual SPECT study. BMIPP activity imaging found 4 segments (1.4%) with severe decrease, 70 (24.3%) with mild decrease, and 214 (74.3%) with normal uptake. In contrast, T1 activity imaging showed normal uptake in 68 of 74 abnormal BMIPP activity segments. Furthermore, all segments with abnormal BMIPP uptake were matched with locations of coronary artery stenosis by coronary angiography. Accordingly, coronary revascularization (percutaneous transluminal coronary angioplasty, coronary artery bypass grafting) was performed based on BMIPP SPECT. Reductions in BMIPP activity were common in patients with unstable angina with multivessel disease. BMIPP SPECT is an excellent tool for detecting the causative lesion in unstable angina. The subsequent intervention could be performed with less risk based on the strategy of dilating the only causative lesion which was detected by the BMIPP SPECT in patients with multivessel disease displaying unstable angina.
BACKGROUND: Histologic grade and clinical stage generally are used for estimating the prognosis of bladder carcinoma. However, both methods have been reported to have a rather low reproducibility and to be unsatisfactory for predicting the recurrence and progression of superficial bladder carcinoma. Recently, nuclear morphometry was used to quantitate the malignant potential of cancer cells in a more objective and reproducible manner. The authors quantitatively analyzed the malignant potential of bladder carcinoma at initial presentation using a combination of several nuclear morphometric variables. METHODS: The subjects were 156 patients with previously untreated bladder carcinoma. Three morphometric variables were measured in each subject: the mean nuclear volume (MNV), the nuclear roundness factor (NRF), and the variation of nuclear area (VNA). RESULTS: Univariate analysis showed that MNV and NRF were significant prognostic indicators for survival (MNV, P < 0.0001; NRF, P = 0.008). In addition, MNV was a prognostic indicator for tumor recurrence (P = 0.001), whereas MNV and NRF were prognostic indicators for invasive progression (MNV, P = 0.02; NRF, P = 0.009). For accurate prediction of the prognosis of patients with bladder carcinoma, a prognostic score, a recurrence score, and a progression score were designed using the coefficients of MNV and NRF in a proportional hazards model. The prognostic score clearly divided the patients into two different groups with 5-year survival rates of 88% and 64% (P = 0.0002). In addition, patients with superficial bladder carcinoma and a low recurrence score had a significantly higher 5-year recurrence free rate than those with a high recurrence score (40% vs. 23%, P = 0.0004), and the 5-year progression free rate of patients with a low progression score was significantly higher than that of those with a high progression score (98% vs. 73%, P = 0.0006). CONCLUSIONS: These findings suggest that nuclear morphometry is a reliable technique with which to identify prognostic indicators for human bladder carcinoma. A combination of several nuclear morphometric variables provides a more accurate indication of prognosis than any single parameter.
Follow-up angiography after percutaneous transluminal coronary angioplasty (PTCA) often demonstrates "moderate" angiographic restenosis, but the need for subsequent revascularization is difficult to determine. We examined the clinical outcome of patients with moderate angiographic restenosis after PTCA. Follow-up angiography performed in 96 patients within 4 months showed light restenosis (LR:stenosis < 40%) in 52 patients, moderate restenosis (MR:40-70%) in 21, and severe restenosis (SR: > 70%) in 23. One of 21 patients with MR underwent repeat PTCA after a positive exercise test. The remaining 20 patients with MR were compared with 52 with LR (follow-up: 12-18 months). Five patients with MR underwent repeat PTCA for recurrence of angina in the follow-up period. Log rank analysis of the Kaplan-Meier estimates for event-free survival (death, myocardial infarction CABG, re-PTCA) showed the outcome was significantly worse for MR patients. However, 14 MR patients who had no cardiac event demonstrated regression of stenosis at 1-year follow-up angiography (58.2% to 45.4%). Moderate restenosis at angiographic follow-up was observed in 30% of all PTCA patients. Moderate restenosis patients have a worse prognosis than light restenosis patients. Adequate follow-up management is mandatory for moderate restenosis patients.
In patients who received thrombolytic therapy for acute myocardial infarction (AMI), we observed 3 distinct patterns in gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced magnetic resonance (MR) imaging. To clarify the significance of these distribution patterns of Gd-DTPA, 20 consecutive patients underwent Gd-DTPA-enhanced MR imaging 7-10 days after AMI. All of the patients received intravenous recombinant tissue plasminogen activator (IVTPA) within 6 h of onset. Echocardiograms were obtained prior to and serially over 10 days, and interpreted for regional wall motion. Coronary angiograms were obtained the day before discharge. None of the 6 patients with a closed infarct-related artery, and 9 of the 14 patients with an open artery, demonstrated subendocardial enhancement (p < 0.05). All of these latter 9 patients demonstrated a significant improvement in wall motion between days 1 and 10 after AMI. In contrast, only 1 of the 7 patients with transmural enhancement and none of the 4 patients with non-homogeneous enhancement demonstrated improvement of wall motion on day 10 (p < 0.05). We concluded that subendocardial enhancement was a fair prognostic sign for restoration of regional cardiac function in patients who received IVTPA during AMI.
A 63-year-old male patient with multiple myeloma developed congestive heart failure due to streptococcus endocarditis prior to the initiation of chemotherapy. Doppler echocardiographical examination revealed the presence of a large vegetation on the anterior mitral leaflet as well as the association of severe mitral regurgitation. Surgical repair (mitral valve replacement) was urgently undertaken and the postoperative course resulted in uneventful recovery. In immunodeficient patients with such a streptococcus sepsis, the possibility of infectious endocarditis should be taken into consideration and proper management is mandatory in these circumstances.
Between May 1990 and August 1992, 5 patients with advanced seminoma were treated with single agent carboplatin at Kyoto University. The mean follow-up period of all patients was 23 months. The clinical stage was IIA: 1, IIB: 1, IIIA: 2, IIIB1: 1. Three to 4 courses of carboplatin at 400 mg/m2, were administered intravenously over 1 hour without hydration every 3 to 4 weeks. One patient achieved complete response (CR). Four patients with a residual mass were observed, in two of them the mass disappeared and they remained free of disease. Two of the 4 patients with a residual mass relapsed 11 and 19 months after the start of treatment, and were successfully salvaged with surgery and adjuvant EP (etoposide and cisplatin) therapy. Subsequently, the overall CR rate was 60% and overall survival rate was 100%. The side effects of carboplatin were compared with those of VAB6 (vinblastine, actinomycin-D, bleomycin, cisplatin and cyclophosphamide), with which another 5 patients were previously treated at our hospital. Leukopenia and alopecia were observed in the VAB6 group with a significant difference (p < 0.05). Severe thrombocytopenia, dyspnea, skin rash, tinnitus and numbness were observed in 4 patients in the VAB6 group. However, no other symptoms but nausea and vomiting were observed in the carboplatin group. It was concluded that single agent carboplatin therapy for advanced seminoma was effective and less toxic, and it would be beneficial for the quality of life of patients, but the residual mass should be treated with surgery, cisplatin-based chemotherapy, or radiotherapy because it possibly has a recurrent potential; otherwise it should be carefully observed.
BACKGROUND: Histopathologic, prognosis-related grading of malignancy by means of morphologic examination in transitional cell carcinomas of the urinary bladder (TCC) may be subject to observer variation, resulting in a reduced level of reproducibility. This may confound comparisons of treatment results. Using objective, unbiased stereologic techniques and ordinary histomorphometry, such problems may be solved. EXPERIMENTAL DESIGN: A study of 110 patients with papillary or solid transitional cell carcinomas of the urinary bladder in stage Ta through T4 was carried out, addressing reproducibility of both qualitative and quantitative grading methods. Grading of malignancy was performed by one observer in Japan (using the World Health Organization scheme), and by two observers in Denmark (using the Bergkvist system). A "translation" between the systems, grade for grade, and kappa statistics were used in evaluating the reproducibility. Unbiased estimates of nuclear mean volume, nuclear mean profile area, nuclear volume fraction, nuclear profile density index, and mitotic profile density index were obtained twice in 55 of the studied cases by one observer in Japan and one in Denmark, using a random, systematic sampling scheme. RESULTS: The results were compared by bivariate correlation analyses and Kendall's tau. The international interobserver reproducibility of qualitative gradings was rather poor (kappa = 0.51), especially for grade 2 tumors (kappa = 0.28). Likewise, the interobserver agreement on the Bergkvist scheme was poor (kappa = 0.43). On the other hand was the interobserver agreement on invasion high (kappa = 0.75). The intraobserver reproducibility of the quantitative histopathologic variables was excellent in both Japan and Denmark for estimates of nuclear mean volume (r = 0.93), for nuclear mean profile area (0.78 < r < 0.83), and for nuclear profile density index (0.85 < r < 0.89), whereas the reproducibility for nuclear volume fraction was somewhat poorer (0.68 < r < 0.64). The slopes of the correlation lines were not significantly different from unity. Estimates of mitotic profile density index also showed acceptable intraobserver reproducibility (Kendall's tau > 0.53). CONCLUSIONS: The international, interobserver reproducibility of the quantitative estimators yielded similar results for all histopathologic variables investigated, except for nuclear volume fraction (r = 0.54). This can probably be related to the manual design of the sampling scheme and may be solved by introducing a motorized object stage in the systematic selection of fields of vision for quantitative measurements. However, the nuclear mean size estimators are unaffected by such sampling variability. The results obtained in this study stress the need for objective, quantitative histopathologic techniques substituting qualitative, subjective methods in prognosis-related grading of malignancy.