Biomedical subjects

Shintaro Narita

Publications and source records attributed to Shintaro Narita.

14 recordsLinked to original sources

PubMed2006

Radical nephroureterectomy as initial treatment for carcinoma in situ of upper urinary tract.

OBJECTIVES: Transitional cell carcinoma in situ (CIS) of the upper urinary tract is a relatively rare disease, and treatment guidelines remain to be defined. In this study, we evaluated the outcomes after radical nephroureterectomy as the initial therapy for upper urinary tract CIS. METHODS: Eight patients treated with radical nephroureterectomy after the diagnosis of upper urinary tract CIS from December 1999 to May 2004 were entered in this study. The diagnosis criteria included positive voided urinary cytology; negative multiple random biopsies of the bladder; negative radiographic studies, including retrograde pyelography and computed tomography; and serial positive cytology results in selective ipsilateral urine samples. RESULTS: The median follow-up period was 56 months. The presence of CIS was confirmed pathologically in all patients. Two patients had more invasive lesions (pT1 and pT2), although retrospective evaluation revealed no infiltrative lesions. Intravesical recurrence was found in 5 patients, whose median recurrence-free period was 16 months. These heterotopic urothelial recurrences did not affect patient survival, and all 8 patients were alive without disease at last follow-up. CONCLUSIONS: Although radical nephroureterectomy may be overtreatment for some patients with upper urinary tract CIS, excellent survival outcomes can be accomplished. In addition, the presence of concomitant invasive lesions, which cannot be identified on pretreatment examination in a substantial subset of patients with CIS, should be taken into account. Although the number of patients in this study was small, the results support the view that nephroureterectomy should remain a standard option for the initial treatment of this disease.

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PubMed2006

Impact of IGF-I and CYP19 gene polymorphisms on the survival of patients with metastatic prostate cancer.

PURPOSE: The prognosis of metastatic prostate cancer significantly differs among individuals. While various clinical and biochemical prognostic factors for survival have been suggested, the progression and response to treatment of those patients may also be defined by host genetic factors. In this study, we evaluated genetic polymorphisms as prognostic predictors of metastatic prostate cancer. PATIENTS AND METHODS: One hundred eleven prostate cancer patients with bone metastasis at the diagnosis were enrolled in this study. Thirteen genetic polymorphisms were genotyped using polymerase chain reaction-restriction fragment length polymorphism or an automated sequencer with a genotyping software. RESULTS: Among the polymorphisms, the long allele (over 18 [CA] repeats) of insulin-like growth factor-I (IGF-I) and the long allele (over seven [TTTA] repeats) of cytochrome P450 (CYP) 19 were significantly associated with a worse cancer-specific survival (P = .016 and .025 by logrank test, respectively). The presence of the long allele of either the IGF-I or CYP19 polymorphisms was an independent risk factor for death (P = .019 or .026, respectively). Furthermore, the presence of the long allele of both the IGF-I and CYP19 polymorphisms was a stronger predictor for survival (P = .001). CONCLUSION: The prognosis of metastatic prostate cancer patients is suggested to be influenced by intrinsic genetic factors. The IGF-I (CA) repeat and CYP19 (TTTA) repeat polymorphisms may be novel predictors in prostate cancer patients with bone metastasis at the diagnosis.

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PubMed2006

Outcome of right hand-assisted retroperitoneoscopic living donor nephrectomy.

OBJECTIVES: To compare the results of right and left hand-assisted retroperitoneoscopic living donor nephrectomy (HARDN) and assess the usefulness and feasibility of right HARDN. METHODS: A total of 68 HARDNs performed from July 2001 to February 2005 in Akita University Medical Center were entered into this study. Of these, 12 cases were right-sided HARDN. The reasons for selecting right HARDN were wandering right kidney in 4, multiple left renal arteries in 3, lower glomerular function presenting in the right kidney in 2 patients, and left renal stone, right renal cyst, and right renal aneurysm in 1 patient each. We compared the perioperative and postoperative results of the 12 right-sided HARDNs with those of the 56 left HARDNs. RESULTS: No significant differences were found between the two groups in the demographic data (ie, age, sex, number of renal arteries), except for the body mass index. None of the right HARDNs resulted in major complications or open conversion, but two left HARDNs required conversion to open surgery. No difference was found between the two groups regarding estimated blood loss, warm ischemia time, or time to oral intake, although the right HARDN group had a longer mean operative time. No significant differences were found in the recipient's postoperative graft function or in the frequency of delayed graft function. CONCLUSIONS: Right HARDN provided almost similar perioperative and postoperative outcomes compared with those of left HARDN. Our results indicate that right HARDN is a choice for living donor nephrectomy because of its technical feasibility, safety, and minimal invasiveness, which are comparable to those of left HARDN.

Adult↗

PubMed2006

Bladder acellular matrix grafting regenerates urinary bladder in the spinal cord injury rat.

OBJECTIVES: To assess the feasibility of bladder acellular matrix (BAM) grafting onto the bladder of rats with spinal cord injury (SCI). METHODS: Female Wistar rats, weighing 100 to 150 g, were divided into four groups: neurologically intact groups with sham operation or BAM grafting and SCI rats with or without BAM grafting (grafted groups, n = 15 each; nongrafted groups, n = 5 each). The BAM was prepared from other normal rat bladder tissue. During BAM surgery, the rats underwent partial cystectomy, followed by BAM grafting as a bladder augmentation. The SCI was created by compressing the spinal cord at the 10th thoracic level. BAM grafting in SCI rats was performed 2 to 3 weeks after SCI. At 2, 4, and 12 weeks after grafting, cystometry was performed with the rats under pentobarbital anesthesia, and the bladders were subsequently harvested and immunostained with anti-PGP9.5, uroplakin III, and alpha-smooth muscle actin antibodies (n = 5 each time). For comparison, similar examinations were performed in the nongrafted groups (n = 5 each). RESULTS: Regenerated urothelium, smooth muscles, and nerve fibers in the grafted BAM appeared at 2, 4, and 12 weeks, respectively, in both intact and SCI rats. Immunohistologic examination showed that these regenerated tissues inherited each characteristic of the host bladder tissue. The grafted BAM itself also showed the proper storage function of distensibility in the intact and SCI groups receiving BAM. CONCLUSIONS: Our data have indicated that BAM grafting is feasible, even in animals with spinal injury, suggesting that BAM may be one of the alternatives for patients with a neurogenic bladder who require augmentation enterocystoplasty in clinical situations.

Animals↗

PubMed2006

Hand assisted retroperitoneoscopic living donor nephrectomy in elderly donors.

PURPOSE: We assessed the influence of HARDN on residual donor kidney and allograft function, invasiveness and morbidity in elderly living donors. MATERIALS AND METHODS: A total of 89 living donors underwent nephrectomy before September 2004 at our institution. The 18 donors who were 65 years or older included 4 of 27 with ODN and 14 of 62 with HARDN. RESULTS: In older (65 years or older) donors mean operative time, mean blood loss and warm ischemia time in the HARDN group did not differ from those in the ODN group. None of the donors had major complications. Older donors with HARDN had a tendency toward a shorter hospital stay than those with ODN. Postoperative serum creatinine in older donors with HARDN was higher than that in younger donors with HARDN, while there was no difference in postoperative serum creatinine between older donors with HARDN and those with ODN. The frequency of allograft losses tended to be higher in older than in younger kidneys (4 of 18 vs 5 of 71, p = 0.054). However, most allograft losses did not seem to be related to surgical technique. CONCLUSIONS: Although further studies, especially with long-term followup, are necessary, HARDN is suggested to be safe and minimally invasive surgery even in elderly donors and to be comparable to open surgery in terms of morbidity, the residual donor kidney and allograft function.

Adult↗

PubMed2006

Association of XRCC1 gene polymorphisms with the susceptibility and chromosomal aberration of testicular germ cell tumors.

It is known that many genomic and genetic alterations caused by aging or environmental factors are responsible for cancer development and progression. XRCC1 is involved in the repair of DNA single-strand breaks formed by exposure to ionizing radiation and alkylating agents. The objective of this study was to investigate the association of genomic alterations and the susceptibility of testicular germ cell tumors with XRCC1 polymorphisms. Two polymorphisms of XRCC1, Arg194Trp and Arg399Gln, were genotyped in 83 patients with testicular germ cell tumors (TGCT) and 87 male controls. Allelic imbalances (AI) were evaluated using 4 microsatellite markers in a subgroup of 50 patients. Patients with at least one Gln allele of the Arg399Gln polymorphism had an increased risk of TGCT than those with the Arg/Arg genotype (aOR=1.775, 95% CI=1.045-3.016, P=0.034). Furthermore, the increased risk associated with the Gln allele against the Arg homozygote was more strongly observed in patients with pure seminoma (aOR=2.242, 95% CI=1.149-4.374, P=0.018) or with metastasis (aOR=2.481, 95% CI=1.267-4.862, P=0.008). In the Arg194Trp polymorphism, there was no significant difference in the genotype distribution between TGCT patients and the controls. In AI analysis, the frequency of AI was significantly higher in tumors with at least one Gln allele than those with the Arg/Arg genotype in D13S317 (P=0.010) and in a combination of 4 markers (0.51+/-0.32 vs 0.32+/-28, P=0.028). Our results suggest that the Gln allele of the XRCC1 Arg399Gln polymorphism may genetically modify the development and progression of TGCT through genomic instability.

Chromosome Aberrations↗

PubMed2005

Association of BCL10 germ line polymorphisms on chromosome 1p with advanced stage testicular germ cell tumor patients.

The association between four BCL10 single nucleotide polymorphisms at codons 5, 8, 162, and intron 1 and the susceptibility or progression for germ cell tumors (GCTs) was investigated in 73 testicular GCT patients and 72 controls. GCT patients with metastatic disease were more likely to have a variant type allele of the polymorphisms at codon 5 (age-adjusted odds ratio (aOR)=6.25; 95% CI=1.09-35.83; P=0.040) and codon 8 (aOR=4.63; 95% CI=1.35-15.93; P=0.015) than those with the localized disease. Therefore, BCL10 polymorphisms at codons 5 and 8 may play a role in the progression to advanced stage GCTs.

Adaptor Proteins, Signal Transducing↗

PubMed2005

CYP3A5 gene polymorphism and risk of prostate cancer in a Japanese population.

The CYP3A5 gene (CYP3A5) encodes the cytochrome P450 3A5, which catalyzes the 6beta-hydroxylation of testosterone. We explored association between the CYP3A5 A6986G polymorphism and a risk of prostate cancer in 260 prostate cancer patients, 199 BPH patients and 212 male controls. The CYP3A5 gene polymorphism did not influence significantly a risk of developing of prostate cancer in general. However, compared with males with the GG genotype, those with the AA genotype had a 0.23-fold decreased risk of developing low-grade prostate cancer (P=0.023), and a 0.31-fold decreased risk of developing localized (stages A-C) prostate cancer (P=0.044). The CYP3A5 A6986G polymorphism may be specifically associated with a decreased risk of low-grade or early stage prostate cancer.

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PubMed2005

An A/G polymorphism of core 2 branching enzyme gene is associated with prostate cancer.

The expression of core 2 beta1,6-N-acetylglucosaminyltransferase-1 (C2GnT) is associated with development and progression of malignancy. Sequence analysis showed that the codon 152 of C2GnT has a polymorphism having GTT encoding valine or ATT encoding isoleucine. By examining the polymorphism in prostate cancer and benign prostatic hyperplasia patients, we found that the C2GnT G allele was more frequently observed in the prostate cancer group (p=0.015) than the control group. Men with the GG genotype had a 3.60-fold increased risk of prostate cancer, and men with the AG genotype had a 1.58-fold increased risk of prostate cancer compared with those with the AA genotype. The G allele was found to have a gene dosage effect for prostate cancer risk. No such risk was associated for benign prostatic hyperplasia. These results demonstrate that C2GnT A/G polymorphism is associated with the susceptibility to prostate cancer in a Japanese population.

1,4-alpha-Glucan Branching Enzyme↗

PubMed2005

Successful renal transplantation in the right iliac fossa 2 years after serious deep venous thrombosis in a patient with systemic lupus erythematosus.

Deep venous thrombosis (DVT) possibly occurs in the perioperative period, and induces serious complications such as a pulmonary embolism. On the other hand, allograft renal vein thrombosis leads to a high incidence of graft loss. We experienced a case in which a serious DVT occurred prior to renal transplantation; however, a successful renal transplantation in the right iliac fossa was performed after 2 years of anticoagulant therapy. It is suggested that the external iliac vein even after suffering from DVT can be anastomosed to an allograft vein successfully, when enough blood fl ow or a lower venous pressure is confirmed. However, one should be aware of the risk factors and the adequate management of thrombosis in renal transplantation because of the serious complications of DVT and the poor prognosis of allograft vein thrombosis.

Adult↗

PubMed2005

[Comparison of radical retropubic prostatectomy under combined lumbar spinal and epidural anesthesia with that under combined general and epidural anesthesia].

PURPOSE: To evaluate the efficacy of combined lumbar spinal and epidural (CLSE) anesthesia in retropubic radical prostatectomy. MATERIALS AND METHODS: Twenty consecutive patients who underwent radical retropubic prostatectomy by a single surgeon (H.K.) under CLSE anesthesia from July of 2003 to February of 2004 were selected as subjects. They were compared with 20 consecutive patients who underwent radical retropubic prostatectomy performed by the same surgeon under combined general and epidural (CGE) anesthesia from April to December of 2002. Both periods were carefully selected to exclude radical prostatectomies with intraoperative complications to evaluate genuine effects of anesthesia. For lumbar spinal anesthesia, 0.5% hyperbaric bupivacaine hydrochloride or 0.5% hyperbaric tetracaine hydrochloride (dissolved in a 10% glucose solution) was used. An epidural tube was inserted for both lumbar spinal anesthesia and general anesthesia mainly for the purpose of controlling a pain after operation. RESULTS: Intraoperative blood loss was significantly less in the CLSE anesthesia group compared with CGE anesthesia group (p = 0.024). Postoperative water drinking was started at 0.4 days (average) for CLSE anesthesia and at 1.1 days (average) for CGE anesthesia (p < 0.0001). Postoperative diet was begun at 0.7 days (average) for CLSE anesthesia and at 1.5 days (average) for CGE anesthesia (p < 0.0001). Compared with the CLSE anesthesia group, the mean of the highest intraoperative mean blood pressure was significantly higher in the CGE anesthesia group (p = 0.002). CONCLUSION: Intraoperative blood loss was less, intraoperative change in blood pressure was less and recovery of postoperative intestinal peristalsis was earlier in patients who underwent prostatectomy under CLSE anesthesia than in patients who underwent prostatectomy under CGE anesthesia. We believe that prostatectomy under CLSE anesthesia is more advantageous than prostatectomy under CGE anesthesia.

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PubMed2005

[Outcome of treatment with surgical resection of the remaining tumor after modified M-VAC treatment for advanced urothelial carcinoma].

We retrospectively evaluated the effect of the surgical resection of the remaining tumor after modified M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) (m-M-VAC) treatment for locally advanced or metastatic urothelial carcinoma. In m-M-VAC therapy, methotrexate and vinblastine on 15 and 22 days were omitted from the classical M-VAC to avoid the discontinuation and the dose reduction, and duration of 1 course was shortened to 21 days from 28 days of the classical M-VAC. Seven patients with locally invasive or metastatic carcinoma of the renal pelvis, ureter, and bladder, 6 males and 1 female, with a median age 64.1 years, ranging from 49 to 77 years received m-M-VAC chemotherapy without severe side effects. In all patients, the residual viable carcinoma was completely resected and they achieved complete remission. The median survival time was 20 months (range, 7 to 61). Five of these 7 patients were still alive. Two patients had no recurrence and achieved long-term survival (survival duration; 61 and 39 months). Although further studies and long-term follow up are required, these results suggest that patients who present with locally advanced or metastatic urothelial carcinoma may benefit from surgical resection after m-M-VAC.

Aged↗

PubMed2004

Association of lipoprotein lipase gene polymorphism with risk of prostate cancer in a Japanese population.

A high fat intake has been associated with prostate cancer risk, and gene polymorphisms of lipoprotein lipase (LPL) play an important role in plasma lipoprotein metabolism. We herein analyzed the association of LPL gene polymorphisms with the risk of prostate cancer in a Japanese population. Three single nucleotide polymorphisms (SNPs) of LPL designated as Ser447stop, HindIII and PvuII were genotyped by the polymerase chain reaction-restriction fragment length polymorphism method in 273 prostate cancer patients, 205 benign prostatic hyperplasia (BPH) patients and 230 male controls. The men with the CG + GG genotypes of the Ser447stop polymorphism had an increased risk of prostate cancer compared to those with the CC genotype [age-adjusted odds ratio (aOR) = 1.625; 95% CI = 1.068-2.471; p = 0.023]. Furthermore, the increased risk associated with the CG + GG genotypes was more strongly observed in patients with high-grade cancers (aOR = 2.843; 95% CI = 1.252-6.458; p = 0.039) or metastatic diseases (aOR = 2.300; 95% CI = 1.042-5.074; p = 0.013), whereas the risk was not significant in those with low- to intermediate-grade cancers or nonmetastatic diseases. In the HindIII and PvuII polymorphisms, there was no significant difference between the prostate cancer patients and the controls, and no significant results as for tumor grade and stage. None of the 3 polymorphisms showed any association with the risk of BPH. Our results suggest that the LPL Ser447stop polymorphism is a common genetic modifier for the development of prostate cancer, particularly that of high-grade and/or high-stage, in a Japanese population.

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PubMed2003

Transitional cell carcinoma in an ectopic ureter.

We experienced an 82-year-old man with transitional cell carcinoma in an ectopic ureter draining into the prostatic urethra. Carcinoma arising from an ectopic ureter is very rare and a differential diagnosis is difficult. To our knowledge, our case is the third male case reported in the literature.

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