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S Mugiya

Publications and source records attributed to S Mugiya.

At least 19 recordsLinked to original sources
PubMed2001

[A case of pheochromocytoma with von Recklinghausen's and review of 67 Japanese cases].

A 19-year-old woman with von Recklinghausen's disease was referred to our hospital because of right adrenal pheochromocytoma. The tumor was detected incidentally with the abdominal ultrasonography when she complained epigastralgia to the home doctor who treated her hypertension. Plasma and urinary catecholamines level were elevated. The tumor was removed by laparoscopy assisted adrenalectomy without pneumoperitoneum. The resected specimen was 35 x 60 x 75 mm in size and weighed 70 g. Pathological diagnosis was adrenomedullary pheochromocytoma. Postoperative course was uneventful. She has been well with no signs of recurrence after 7.5 years. We reviewed 67 Japanese patients previously reported as von Recklinghusen's disease with pheochromocytoma. Of the 60 patients whose details were described, 16.7% had metastases and pathological malignancy from pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed2001

[Local staging with magnetic resonance imaging after neoadjuvant hormonal therapy for prostate cancer].

We retrospectively studied the staging accuracy of magnetic resonance (MR) imaging after neoadjuvant hormonal therapy (NAH) for 21 localized prostate cancers. MR imaging was performed using a 1.5-Tesla magnetic resonance system with a pelvic phased array coil. T2-weighted MR images were obtained on axial and coronal planes, and T1-weighted MR images using the dynamic technique with Gd-DTPA bolus enhancement were obtained in axial planes for each patient. On T2-weighted imaging, the signal intensity of the normal tissue in the peripheral zone became lower after NAH. Therefore, it was more difficult to detect residual malignant lesions in many cases than before NAH. The accuracy of T staging for prostate cancer after NAH in MRI was 71%. The accuracy, sensitivity, and specificity of the extracapsular invasion was 76%, 0% and 94%, respectively, and those of the seminal vesicular invasion 85%, 0% and 100%, respectively. While 2 of the 4 patients judged as downstaged cases in MRI showed corresponding pathological findings, 5 of the 21 cases (23.8%) were underdiagnosed. Local staging with only MRI for prostate cancer after NAH seems to have limits in applicability.

Aged↗
PubMed2000

Complicating risk factors for pyelonephritis after extracorporeal shock wave lithotripsy.

PURPOSE: The score to predict the risk of post-extracorporeal shock wave lithotripsy (ESWL) pyelonephritis was evaluated. The score was based on the multivariate analysis of risk factors available pre-operatively. Stone size, pyuria, bacteriuria, previous pyelonephritis and other adjunctive procedures had been selected and scored. METHODS: Three-hundred and forty-eight adult patients without active urinary infection undergoing ESWL therapy were studied. One of three regimens were selected by either doctor or patient: (i) no antimicrobial treatment; (ii) one dose of levofloxacin; or (iii) 1 week course of levofloxacin. Who and why selected it were described. Post-ESWL fever over 38 degrees C was defined as the unfavorable event. RESULTS/CONCLUSION: With increasing score, doctors recommend taking an antimicrobial. There were 11 bacteriuric patients and post-ESWL pyelonephritis developed in one of them. Bacteria within the stone and post-ESWL ureteral obstruction caused by the stone fragments were considered to be important in developing pyelonephritis. However, multiple factors were related with it. Although their decision was not based simply on the score, the score was confirmed to be useful in identifying the high-risk patients and, therefore, to implement cost-effective antimicrobial use.

Adolescent↗
PubMed2000

[A clinical study of patients undergoing curative surgery for renal pelvic and ureteral cancers].

We retrospectively studied 30 patients who underwent curative surgery for renal pelvic and/or ureteral cancer between August 1987 and August 1998. Their clinicopathological features were classified by the criteria of the Japanese Urological Association. The 1-, 3-, and 5-year cause-specific survival rates were, respectively, 100, 95.5, and 85.1%, while the disease-free rates were 100, 78.9, and 78.9% by the Kaplan-Meier method. Prognostic factors were evaluated by the log-rank test. The significant prognostic factors were pT3 and pV1 for cause-specific survival (p = 0.0277, p = 0.0025), while pT2 (or higher), grade 3, and pV1 were significant for disease-free survival (p = 0.0271, p = 0.0327, and p = 0.0002). Nine patients who received adjuvant chemotherapy are alive, but 3 patients have relapsed. Chemotherapy did not have a significant effect on the cause-specific survival or disease-free survival.

Adult↗
PubMed2000

[Cystolithotripsy for bladder stones: comparison of holmium:YAG laser with Lithoclast as a lithotripsy device].

From March 1995 to March 1999, endoscopic lithotripsy of bladder stones was done for 33 patients. We used Holmium:YAG laser for the initial 23 patients, and the Swiss Lithoclast for the recent 10 patients. We compared the safety and efficacy of the two modalities. Both lithotriptors were safe and effective to fragment the bladder stones. All the patients became stone-free at one session. However, we needed to use the Holmium:YAG laser in one patient to disintegrate the larger fragments after Lithoclast. For a big stone, Holmium:YAG laser is preferable.

Adult↗
PubMed2000

Endoscopic management of impacted ureteral stones using a small caliber ureteroscope and a laser lithotriptor.

PURPOSE: We reviewed our experience with retrograde endoscopy using a small caliber ureteroscope and a laser lithotriptor in 104 consecutive patients with impacted ureteral stones and also analyzed the associated endoscopic findings. MATERIALS AND METHODS: From July 1993 to October 1999 we performed retrograde endoscopic treatment in 104 patients with impacted ureteral stones. Average maximum stone diameter was 15.2 mm. (range 2 to 110), and 9 patients had stones larger than 3 cm. Mean duration of impaction was more than 14 months and the longest was 10 years. We used 6.9Fr rigid or 6.9 to 7.5Fr flexible ureteroscopes and a pulsed dye laser or holmium:YAG laser lithotriptor. RESULTS: Of the 104 ureteral stones 100 (96.2%) were completely fragmented by a single endoscopic procedure. Although 1 uric acid stone could not be disintegrated by either the pulsed dye laser or electrohydraulic lithotripsy early in this series, it was discharged spontaneously 2 weeks after the procedure. Additional extracorporeal shock wave lithotripsy (ESWL*) was required in 3 patients who initially had stones larger than 3 cm. A month after treatment no patient had evidence of residual stones. Using adjuvant ESWL a 100% success rate was attained with minimal morbidity. Endoscopic observation revealed inflammatory polyps of the ureter in 22 patients (21.2%), and stricture adjacent to the stone in 16 (15. 4%). There were no significant complications. CONCLUSIONS: Using a small caliber ureteroscope and a laser lithotriptor we could treat the target stone in all 104 patients with adjuvant ESWL in 3 cases. Endoscopic lithotripsy seems to be effective first line therapy for chronically impacted stones which are frequently associated with chronic inflammation, polyps and strictures, and avoids the futile repetition of ESWL and problems related to the prolonged passage of stone fragments.

Adult↗
PubMed1999

Endoscopic management of upper urinary tract disease using a 200-microm holmium laser fiber: initial experience in Japan.

OBJECTIVES: To study the clinical effectiveness of the 200-microm holmium laser fiber for endoscopic management of upper urinary tract lesions. METHODS: From January 1997 to March 1998, we performed retrograde endoscopic treatment in 25 patients with urinary tract lesions using a 200-microm holmium laser fiber. Nineteen patients had 20 stones (16 ureteral, 3 lower calyx, and 1 middle calyx), 4 had bleeding lesions in the lower calyx, 1 had transitional cell carcinoma involving the renal pelvis and upper calyx, and 1 had a ureteral stricture associated with an impacted ureteral stone. We used a 7.5F flexible ureterorenoscope for renal and upper ureteral lesions, and a 6.9F rigid ureteroscope for mid and lower ureteral lesions. For treatment, we used a holmium:yttriumaluminum-garnet laser generator and a 200-microm flexible quartz fiber. RESULTS: All stones were successfully fragmented, including three lower caliceal stones. Lower caliceal bleeding spots were successfully cauterized for hemostasis in all 4 patients, and the pelvic tumor was successfully vaporized and ablated. In 1 patient, we had previously failed to treat a ureteral stricture with a 365-microm fiber because of inadequate visualization, but it was successfully incised using the 200-microm fiber. There were no significant complications such as ureteral obstruction or stenosis. CONCLUSIONS: The improved flexibility of the new 200-microm holmium laser fiber facilitates treatment of stones, tumors, strictures, and lesions in the lower calyx, where access is difficult when using the previously available 365-microm fiber.

Adult↗
PubMed1999

Retroperitoneoscopic treatment of a retrocaval ureter.

BACKGROUND: Retroperitoneoscopic surgery was performed on a 41-year-old man with a retrocaval ureter. METHODS: The retrocaval segment of the ureter was retroperitoneoscopically separated and the ureter was reanastomosed using an automatic suture device. RESULTS/DISCUSSION: He returned to normal activities four days postoperatively. Postoperative excretory urography showed improvement of hydronephrosis and no residual stenosis.

Adult↗
PubMed1999

Complete disruption of the female urethra.

PURPOSE: We report a rare condition of complete rupture of the bladder neck with an anterior vaginal laceration secondary to blunt pelvic trauma in a 19-year-old woman. METHODS: Management consisted of a suprapubic cystostomy, followed by end-to-end anastomosis 3 days later. RESULTS/CONCLUSIONS: After 6 months, the patient is continent without any urinary disturbances.

Adult↗
PubMed1999

Unilateral laparoscopic adrenalectomy followed by contralateral retroperitoneoscopic partial adrenalectomy in a patient with multiple endocrine neoplasia type 2a syndrome.

We report the first patient who had bilateral pheochromocytoma associated with multiple endocrine neoplasia type 2a syndrome (MEN 2a) and underwent unilateral laparoscopic adrenalectomy followed by contralateral retroperitoneoscopic partial adrenalectomy 2 years later. The postoperative course was uneventful both times, and the patient was cured of hypertension without any need for steroid replacement. Endoscopic partial adrenalectomy is a minimally invasive procedure for pheochromocytoma with mild symptoms. We believe that this procedure has considerable potential for treating bilateral pheochromocytoma, which is frequently observed in patients with MEN 2a.

Adrenal Gland Neoplasms↗
PubMed1999

Complications of laparoscopic adrenalectomy in 75 patients treated by the same surgeon.

OBJECTIVE: We analyzed the complications of endoscopic adrenalectomy. METHODS: We retrospectively reviewed the operative and postoperative complications among 75 patients with adrenal tumors who underwent endoscopic adrenalectomy by the same surgeon. RESULTS: Five patients (6.7%) were converted to open surgery. Of these, there were 2 with metastatic adrenal carcinoma, and 1 with adrenal tuberculosis. A total of 21 patients (28%) had 24 complications (32%). There was no mortality. As for access and pneumoperitoneum-related complications, 5 cases of subcutaneous emphysema and 3 of radiating shoulder pain occurred. Intraoperative complications included 2 cases of vascular injury, 2 of organ injury, and 4 of massive bleeding (>500 ml). Postoperative complications included 2 cases of mild paralytic ileus, 2 asthma, and 1 each of angina, wound infection, retroperitoneal hematoma, and contralateral atelectasis. Except for the patients with adrenal malignancy and adrenal tuberculosis, 71% of the complications occurred among the initial 25 patients with laparoscopic adrenalectomy and 80% occurred in the initial 10 retroperitoneoscopic patients. CONCLUSION: Although endoscopic adrenalectomy is a valuable alternative to open surgery, it should be done by a skilled laparoscopist in patients with adrenal inflammatory lesions or malignancy. Careful patient selection and correct choice of surgical approach according to the tumor size and the patient's condition are the most important points for avoiding the complications of laparoscopic adrenalectomy.

Adrenal Gland Diseases↗
PubMed1998

Genotype-phenotype correlation of patients with multiple endocrine neoplasia type 2 in Japan.

BACKGROUND: Multiple endocrine neoplasia type 2 (MEN 2) is a hereditary syndrome characterized by medullary thyroid carcinoma (MTC), pheochromocytoma and hyperparathyroidism. MEN 2 is caused predominantly by germ-line mutations of the RET proto-oncogene. This study aimed to clarify the genotype-phenotype correlation in MEN 2 patients in Japan in order to modify the clinical management according to the genotype. METHODS: Constitutive DNA of 64 MEN 2 patients (48 kindreds) were searched for mutations at exons 10, 11, 13, 14 and 16 of the RET proto-oncogene using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP), direct sequencing and restriction enzyme digestion. The clinical characteristics of the patients were obtained from a previous nationwide questionnaire survey. RESULTS: Overall, 62 (96.9%) out of 64 patients had a germ-line point mutation at the hot spots. MTC and pheochromocytoma occurred equally in every genotype except C630S. Specific genotype had a correlation between tumor size and age at the operation for MTC or extent of MTC, i.e. C618S developed late onset type of MTC as compared with that of C634R, C634Y and M918T. Small MTC in C634R may be less aggressive than those in C634Y and M918T. CONCLUSIONS: DNA testing has good clinical implications for the management of patients with MEN 2 and the timing and operative procedures of thyroidectomy can be modified according to the genotype.

Adrenal Gland Neoplasms↗
PubMed1998

Combined treatment of staghorn calculi by fiberoptic transurethral nephrolithotripsy and extracorporeal shock wave lithotripsy.

BACKGROUND: Although various strategies have been proposed, the treatment of staghorn calculi is still controversial. We report on the treatment of 27 staghorn calculi using fiberoptic transurethral nephrolithotripsy (f-TUL) combined with extracorporeal shock wave lithotripsy (ESWL). METHODS: Stones were initially disintegrated by f-TUL as an inpatient procedure. For stone fragmentation, we originally used an electrohydraulic lithotriptor (EHL) but changed to a pulsed-dye laser in 1993. After the stones were disintegrated as much as possible, a double-J ureteral stent was inserted and the patient was discharged. ESWL for the residual fragments was begun on an outpatient basis at 1 or 2 weeks after f-TUL and repeated until the residual fragments were smaller than 4 mm. RESULTS: Since 1989, 27 staghorn calculi in 26 patients have been treated. Among them, 21 were successfully fragmented using this combined treatment regimen. From 3 to 26 ESWL sessions (mean, 8.4 sessions) were required to disintegrate the staghorn calculi. Auxiliary percutaneous endourological procedures were necessary in 2 cases due to ureteral obstruction. The other 4 patients are still receiving ESWL for residual fragments. Urinary tract injury occurred in 2 patients early in this series when an EHL was used, but was managed without any surgical procedures. A fever greater than 38 degrees C developed in 9 patients. CONCLUSION: Combining f-TUL with ESWL provides an alternative treatment option for staghorn calculi. The use of a small caliber fiberscope (2.6 mm in diameter) and a laser for fragmentation decreased the risk of complications.

Adult↗
PubMed1998

Laparoscopic nephrectomy in children: two case reports.

We successfully performed a laparoscopic nephrectomy on 2 young girls in March 1994 and August 1994. The first patient was a 9-year-old girl with a hypoplastic kidney associated with an ectopic ureterocele, and the other was a 3-year-old girl with a nonfunctioning hydronephrotic kidney caused by stricture of the pyeloureteral junction. The operating times were 153 and 183 minutes, respectively. No complications occurred intraoperatively or postoperatively in either patient. The 9-year-old girl resumed normal daily activities by postoperative day 2, and the 3-year-old girl by postoperative day 3. Both girls were discharged on day 4.

Child↗
PubMed1998

Significant prognostic factors for 5-year survival after curative resection of renal cell carcinoma.

BACKGROUND: Renal cell carcinoma (RCC) patients occasionally die of RCC even after curative resection. In this study, we investigated prognostic factors between survivors for more than 5 years and patients who died within 5 years after curative resection. METHODS: We retrospectively studied 111 patients who underwent RCC curative resection and were followed for more than 5 years. Patient survival at 5 years after curative resection was regarded as the end-point of this analysis. Statistical differences of 19 prognostic factors between surviving and deceased patients were determined using logistic regression analysis. RESULTS: Eighteen of the 111 patients died of RCC during the 5-year follow-up period. Of the 19 prognostic factors evaluated, univariate analysis showed significant differences in the body temperature, hemoglobin, erythrocyte sedimentation rate (ESR), alpha2-globulin, C-reactive protein (CRP), fibrinogen, tumor size, Robson's stage, T classification (renal capsular involvement), pathological grade, and mode of tumor infiltration. Five significant variables (body temperature, ESR, alpha2-globulin, fibrinogen, and tumor size) were excluded from multivariate analysis because greater than 10% of the data was missing. The TNM staging system was selected as the representative variable for stage for multivariate analysis. Using the remaining 5 significant variables (hemoglobin, CRP, T stage, pathological grade, and mode of tumor infiltration), multivariate analysis showed that CRP (P = 0.0126) and T stage (P = 0.0490) were the most important prognostic factors. CONCLUSION: From this analysis, CRP and renal capsular involvement were the most important factors predicting survival for greater than 5 years after curative resection of RCC.

Adult↗
PubMed1998

[Clinical experience of extracorporeal shock wave lithotripsy with lithodiagnost M for upper urinary tract stones].

Between August 1995 and March 1997, 197 patients underwent 257 treatments for 217 stones by extracorporeal shock wave lithotripsy (ESWL) using a Lithodiagnost M (Philips, Holland). There were 149 males and 48 females with an average age of 50.6 years, ranging from 15 to 85 years. There were 53 stones located in the renal pelvis and calices (R2), 20 stones at the pelvi-ureteric junction (PUJ) (R3), 101 stones in the upper ureter (U1), 15 stones in the middle ureter (U2) and 28 stones in the lower ureter (U3). The average number of sessions was 1.18 and the average number of shock waves per stone was 3,546. Efficacy was evaluated 3 months after the final ESWL. The success rate was 95.4% (207/217), with complete disappearance of stones in 71.4% (155/217) and residual stones of less than 4 mm diameter in 24% (52/217). No severe complications, except for subcapsular renal hematoma in one patient, were observed. These results indicate that almost all upper urinary tract stones can be successfully treated by ESWL monotherapy.

Adolescent↗