Biomedical subjects

Toshiro Terachi

Publications and source records attributed to Toshiro Terachi.

At least 19 recordsLinked to original sources

PubMed2007

Long-term results of first-line sequential high-dose carboplatin, etoposide and ifosfamide chemotherapy with peripheral blood stem cell support for patients with advanced testicular germ cell tumor.

OBJECTIVE: Standard chemotherapy shows relatively low long-term survival in patients with poor-risk testicular germ cell tumor (GCT). First-line high-dose chemotherapy (HD-CT) may improve the result. High-dose carboplatin, etoposide, ifosfamide chemotherapy followed by autologous peripheral blood stem cell transplantation (PBSCT) was investigated as first-line chemotherapy in patients with advanced testicular GCT. METHODS: Fifty-five previously untreated testicular GCT patients with Indiana 'advanced disease' criteria received three cycles of bleomycin, etoposide and cisplatin (BEP) followed by one cycle of HD-CT plus PBSCT, if elevated serum tumor markers were observed after three cycles of the BEP regimen. RESULTS: Thirty patients were treated with BEP alone, because the tumor marker(s) declined to normal range. Twenty-five patients received BEP and HD-CT. One patient died of rhabdomyolysis due to HD-CT. Three and six (13% and 25%) out of 24 patients treated with BEP and HD-CT achieved marker-negative and marker-positive partial responses, respectively. The other patients achieved no change. Fifteen (63%) are alive and 14 (58%) are free of disease at a median follow-up time of 54 months. Severe toxicity included treatment-related death (4%). CONCLUSIONS: HD-CT with peripheral stem cell support can be successfully applied in a multicenter setting. HD-CT demonstrated modest anticancer activity for Japanese patients with advanced testicular GCT and was well tolerated. This regimen might be examined for further investigation in randomized trials in first-line chemotherapy for patients with poor-risk testicular GCT.

Adolescent↗

PubMed2006

Significance of elevated preoperative alpha-fetoprotein in postchemotherapy residual tumor resection for the disseminated germ cell tumors.

BACKGROUND AND OBJECTIVES: The purpose of the study is to determine the significance of elevated serum alpha-fetoprotein (AFP) in the setting prior to residual tumor resection (RTR) following chemotherapy for metastatic germ cell tumor in terms of the prediction of histology of the specimen and postoperative survival. METHODS: We conducted a retrospective review of 68 patients undergoing RTR for metastatic nonseminomatous germ cell tumor or extragonadal germ cell tumor after at least a first-line chemotherapy. Pretreatment and postchemotherapy serum markers were evaluated in association with other clinical findings including results of pathological examination of RTR specimen and surgical outcome. RESULTS: Of the 68 study patients, 54 (79%) and 45 (66%) had positive AFP and beta-human chorionic gonadotropin (beta-HCG) in pretreatment settings. Rates of presence of residual malignant cell in RTR specimen were similar between patients with normal AFP (7/28 or 25%) and with mildly elevated (10-30 ng/ml) AFP (3/11 or 27%). In 26 patients who had residual viable malignancy in RTR specimen, patients with preoperative positive AFP had significantly better survival (P = 0.02) compared to those with preoperative positive beta-HCG. CONCLUSIONS: Sole and mild elevation of AFP is not always associated with postoperative poor prognosis. It should be carefully considered individually whether a mild elevation of AFP after chemotherapy represents residual malignancy or benign pathogenesis.

Adolescent↗

PubMed2006

Variation of alpha-methylacyl-CoA racemase expression in prostate adenocarcinoma cases receiving hormonal therapy.

alpha-methylacyl-CoA racemase (AMACR) is widely used as a diagnostic marker of prostate adenocarcinoma. It is also used to identify residual adenocarcinoma cells in posthormonal therapy cases. However, there have been very few studies on the relationship between hormonal therapy, which is also called androgen withdrawal therapy and AMACR expression. Here, we carried out a study on AMACR expression in paired pre- and posthormonal therapy prostate adenocarcinoma cases using an immunohistochemical method and a digital imaging system to elucidate the relationship between AMACR expression and hormonal therapy. This study showed that AMACR expression was decreased in 65 of 98 paired cases after hormonal therapy (Mann-Whitney U test, P < .05). Wilcoxon analysis also demonstrated a difference in the AMACR digital average expression in all 98 cases (P < .0001). However, this variation in AMACR expression did not seem to have any relevance to the response to hormonal therapy (P = .5386). We propose that AMACR, as a diagnostic marker, should be carefully used in posthormonal therapy cases. Further investigation of the relationship between AMACR expression and androgen or androgen receptors may provide new insight into novel preventive and curative medicine for prostate adenocarcinoma.

Adenocarcinoma↗

PubMed2006

[Orchitis].

Explore the source record for details and available documents.

Anti-Bacterial Agents↗

PubMed2006

Changes in quality of life in first year after radical prostatectomy by retropubic, laparoscopic, and perineal approach: Multi-institutional longitudinal study in Japan.

OBJECTIVES: To investigate the health-related quality of life of patients who underwent radical prostatectomy performed using retropubic, laparoscopic, and perineal approaches. METHODS: A total of 218 men who underwent retropubic prostatectomy, 65 who underwent laparoscopic prostatectomy, and 66 who underwent perineal prostatectomy were enrolled in our survey. A baseline interview was conducted before treatment. Follow-up interviews were conducted in person at scheduled study visits 1, 3, 6, and 12 months after surgery. We measured two validated questionnaires that assessed the general and disease-specific health-related quality of life. RESULTS: The retropubic group reported substantial deterioration in physical limitations, emotional limitations, social function, and bodily pain at 1 month. The perineal group reported less bodily pain just after surgery than the retropubic and laparoscopic groups. After 6 months, however, no significant differences were found among the three groups. Postoperative urinary function remained substantially lower than the baseline level in every treatment group. Each approach with a nerve-sparing procedure showed a similar recovery profile of urinary function postoperatively. The perineal group reported no significant difference in bowel function compared with the other two groups. All of the groups continued to have decrements in sexual function. CONCLUSIONS: The results of this study have demonstrated that retropubic, laparoscopic, and perineal prostatectomy have differences in the recovery of general and disease-specific quality of life in the early postoperative period. When performed by an experienced surgeon, the retropubic, laparoscopic, and perineal approaches appear to be equivalent in terms of health-related quality of life.

Aged↗

PubMed2006

The endoscopic surgical skill qualification system in urological laparoscopy: a novel system in Japan.

PURPOSE: The Japanese Urological Association, and Japanese Society of Endourology and ESWL have established the Endoscopic Surgical Skill Qualification System in urological laparoscopy. The system consists of a urological section as well as gynecology and general surgery sections. We present details of the Endoscopic Surgical Skill Qualification System and year 1 results. MATERIALS AND METHODS: Endoscopic Surgical Skill Qualification System requirements test the ability to complete common laparoscopic surgeries in each field. In urology applicants are required to complete adrenalectomies or nephrectomies appropriately and safely. Applicants should have 2 years of experience with laparoscopic practice, in addition to having completed a 6-year formal urological training program. Also, each surgeon must have performed more than 20 laparoscopic surgeries. According to assessment guidelines applicant skills are assessed by 2 referees who view unedited videotapes showing the entire laparoscopic procedure. To establish these referees 6 expert referees were first selected and 23 were then chosen from 36 referee applicants. Each referee had completed more than 100 laparoscopic surgeries and was chosen after video assessments by the 6 initial expert referees. RESULTS: Of 5,600 certified urologists in Japan 205 applied to this system in its first year, including 6 expert referees and 36 referee applicants. After video assessments by the referees 136 applicants were certified as having appropriate skills, resulting in a 66% pass rate. CONCLUSIONS: The Endoscopic Surgical Skill Qualification System has just started but it has drawn a lot of attention from the public. We hope that this qualification system will help prevent complications of urological laparoscopic surgeries and promote safer surgical procedures.

Clinical Competence↗

PubMed2006

Evaluation of renal function after laparoscopic partial nephrectomy with renal scintigraphy using 99mtechnetium-mercaptoacetyltriglycine.

AIM: We evaluated the functions of an affected kidney after laparoscopic partial nephrectomy (LPN) using renal scintigraphy with (99m)technetium-mercaptoacetyltriglycine ((99m)Tc-MAG3). METHODS: Split renal function of 10 patients who underwent LPN for renal tumors was assessed using renal scintigraphy with (99m)Tc-MAG3 before surgery, and 1 week and 3 months post-surgery. RESULTS: Median operating time was 196.5 min, median tumor diameter was 2.3 cm, mean blood loss was 64 mL and mean ischemic time was 38.5 min. Median change in serum creatinine level pre- to post-surgery was 0.15 mg/dL. Median contribution of the affected kidney to total renal function (calculated using (99m)Tc-MAG3) was 50.0%, 41.7% and 36.1% before surgery, 1 week and 3 months after LPN, respectively. In one patient, the tumor was resected after cooling of the affected kidney with ice slush for 15 min, and the split renal function ratio remained as high as 50% at 3 months post-operatively despite a total ischemic time of 61 min. CONCLUSIONS: This paper evaluated renal function on the affected side before and after surgery by measuring split renal function with renal scintigraphy using (99m)Tc-MAG3. Risk factors for renal dysfunction in the affected kidney after LPN include age over 70 years with more than 30 min warm ischemic time, re-clamping of the renal artery procedure, and a warm ischemic time greater than 60 min. We believe that renal cooling with slush ice prevents renal dysfunction of the affected kidney after LPN with longer warm ischemic times. However, an easier renal cooling technique should be sought for regular use of cooling procedures in LPN.

Adult↗

PubMed2006

[A case report: simultaneous bilateral testicular tumors with different cell types--complete response after combination chemotherapy of cisplatin and irrinotecan hydrochloride--].

A 38-year-old man was admitted to our hospital complaining of bilateral scrotal swelling. On examination, the patient was found to have bilateral testicular tumors with jugular chain lymph node and para-aortic lymph node metastasis. He underwent bilateral inguinal orchiectomy. Histopathological examination of the excised tumors revealed seminoma, embryonal carcinoma, yolk sac tumor and immature teratoma in the right testis and seminoma in the left testis. The patient was treated postoperatively with two courses of BEP (bleomycin, etoposide, cisplatin) therapy and two courses of EP (etoposide, cisplatinum) therapy. The patient had lung metastasis during the follow-up period and we treated him with salvage combination chemotherapy of cisplatin and irinotecan hydrochloride (CPT-11). After the third course of cisplatin and CPT-11 chemotherapy the lung metastasis disappeared and we performed retroperitoneal lymph node dissection. The patient has remained free of disease 11 months after discharge.

Adult↗

PubMed2006

[Sepsis following transrectal prostate biopsy: a report of 2 cases and reviewed similar cases in Japan].

We report two cases of sepsis and disseminated intravascular coagulation (DIC), potentially fatal complications, following transrectal prostate biopsy. We also review similar cases reported in Japan. Case 1: A 63-year-old man received a cathartic and levofloxacin (LVFX) for prophylaxis. After transrectal prostate biopsy, he presented with fever and chills. Blood cultures grew Escherichia coli resistant to LVFX. Under a diagnosis of sepsis, he received intensive management that included endotoxin removal therapy. The patient was hospitalized for 27 days. Case 2: A 64-year-old man received a cathartic and cefazolin (CEZ) for prophylaxis. He presented with fever and chills after biopsy, and was admitted to hospital. Blood cultures grew E. coli resistant to CEZ. Under a diagnosis of sepsis, he received intravenous antibiotics, transfusion, and anti-DIC drugs. The patient was hospitalized for 11 days.

Biopsy↗

PubMed2006

Acute myocardial infarction during combined chemotherapy with bleomycin, etoposide and cisplatin for testicular cancer.

We report a case of acute myocardial infarction during combined chemotherapy with bleomycin, etoposide and cisplatin for testicular cancer. A 30-year-old smoker without any history of ischemic heart disease complained of sudden chest pain on the ninth day of his third course of chemotherapy. An electrocardiogram showed ST segment elevation in II, III and aVF. Emergency coronary angiography revealed total occlusion of the right coronary artery by a thrombus, which was removed by coronary atherectomy.

Adult↗

PubMed2005

Recovery of quality of life in year after laparoscopic or retropubic radical prostatectomy: a multi-institutional longitudinal study.

OBJECTIVES: To compare the general and disease-specific health-related quality of life (HRQOL) after laparoscopic radical prostatectomy (LRP) with that after retropubic radical prostatectomy (RRP). METHODS: A total of 45 patients who underwent LRP alone and 121 who underwent RRP alone were prospectively enrolled in an HRQOL survey. We measured the general and disease-specific HRQOL with the Medical Outcomes Study 36-Item Short Form and University of California, Los Angeles, Prostate Cancer Index, respectively. The participants were asked to complete the questionnaires before and 1, 3, 6, and 12 months after surgery. RESULTS: No significant differences were found in the preoperative characteristics of the two groups. Repeated measures of analyses of variance revealed significantly different patterns of alteration in the several general HRQOL domains between the RRP and LRP groups. The LRP group tended to have a more delayed recovery than the RRP group in the domain of urinary function and bother. The sexual function and bother of both groups showed a substantially lower score throughout the postoperative period. When the LRP group was divided into two groups according to the surgical period, an apparent improvement in HRQOL was observed in the most recent LRP series. CONCLUSIONS: The two approaches showed different patterns of alteration regarding general HRQOL for 1 year after surgery. The LRP group reported delayed recovery of urinary and sexual function, which seemed to affect their general HRQOL. LRP appears to be still an evolving procedure.

Aged↗

PubMed2005

New genetic causes of pheochromocytoma: current concepts and the clinical relevance.

Pheochromocytoma and paraganglioma are tumors of the autonomous nervous system mainly occurring in the adrenal medulla, but also in the extraadrenal paraganglias of the abdomen, thorax, neck and skull basis. The etiology comprises germline mutations of now 6 genes. About 10 years known are the RET gene susceptible for multiple endocrine neoplasia type 2, the VHL gene for von Hippel-Lindau Disease, and the NF 1 gene for neurofibromatosis Recklinghausen (neuro- fibromatosis type 1). Since 2000 the genes for succinatedehydrogenase subunits SDHB, SDHC, and SDHD have been identified for paraganglioma syndromes type 4, type 3, and type 1 respectively. Investigations of series of pheochromocytoma patients identified germline mutations in one of the genes SDHB, SDHD, VHL and RET in 24% to 50% of the patients. Multifocal tumors, young age and positive family history, known features associated with inheritence, have not been present in all patients. Therefore, analyses of blood DNA for mutations in these genes are recommended. Positive tests provide the patients and their relatives with essential platforms for clinical care. Experiences in this field of medicine have shown that optimal management of patients with pheochromocytoma-associated syndromes is a high challenge. National registries may be instrumental in order to provide with adequate facilities.

Adrenal Gland Neoplasms↗

PubMed2005

[Clinical outcomes and problems in laparoscopic radical prostatectomy].

We evaluated the clinical outcome and problem of laparoscopic radical prostatectomy (LRP) for 115 prostate cancer patients. Mean (+/- SD) operative time was 294 +/- 57.5 min. and mean blood loss was 409.5 +/- 336.4 g. Mean duration of urethral catheter indwelling was 4 +/- 4.9 days and mean postoperative hospital stay was 8 +/- 4.6 days. Fifty one and 83% of the patients recovered urinary continence one month and 3 months after surgery in the latest procedure, respectively. Positive surgical margin was seen in 18 patients (15.7%) in total, but in 6 patients (6.6%) with pT2 > or = disease. Chemical relapse was seen in 14 patients (14.4%). Although oncological results of LRP are compatible to those of RRP, delay of early recovery of urinary continence is still the problem.

Biomarkers, Tumor↗

PubMed2005

[Metastatic small intestinal tumor associated with transitional cell carcinoma: a report of 2 cases and review of cases in Japan].

Transitional cell carcinoma (TCC) frequently metastasizes to lymph nodes, liver, lungs and bone. However, metastasis to the gastrointestinal tract is rare. We report two cases of bladder tumor which metastasized to the ileum. According to the literature, these are the 7th and 8th cases in Japan. Case 1: A 87-year-old man had a history of bladder tumor (TCC, grade 3, pT2bN0M0) and has transurethral resection of bladder tumor (TUR-BT) three times. Two months after the last TUR-BT, he was admitted with ileus. As computed tomography (CT) showed abdominal free air, our diagnosis was perforation of gastrointestinal tract. The patient received an operation which resected partial ileum. We found the elastic hard tumor in the ileum on the perforated lesion, which showed metastatic TCC in the ileum pathologicaly. Case 2 : A 53-year-old man visited our hospital with gross hematuria. Cystoscopy showed a non-papillary broad based tumor in the right wall of the bladder. CT showed a bladder tumor invaded into the prostate (pT4aN1M0), we performed total cyctectomy and ileal conduit after neo-adjuvant chemotherapy. During the operation, we found the tumor (2 cm in diameter) in the small intestine which was metastasized of bladder tumor.

Aged↗

PubMed2005

Association of neuroendocrine differentiation with neoadjuvant hormone therapy effects in prostatic cancer.

Histological therapeutic effects of neoadjuvant hormone therapy (NHT) in prostatic cancer were examined, focusing on the association with neuroendocrine differentiation (NED), using 69 radical prostatectomy cases. The effects of NHT were classified into 3 grades based on the extent of tumor degeneration as observed with hematoxylin and eosin staining. NED cells in the cancer were semi-quantified into 4 grades (negative, 1+, 2+, and 3+) by immunohistochemical staining of chromogranin A (CgA). According to the therapeutic effects, the cases are divided as follows: good response in 26 patients, intermediate in 20, poor in 23. The histological therapeutic effects were significantly weaker in the CgA-positive group than the CgA-negative group (p=0.02). A close relationship between the extent of CgA expression and the histological response was also demonstrated (p=0.007). In the biopsy specimens before NHT, CgA was positive in 46% (32/69) and there was no significant difference in histological therapeutic effects between the positive and negative groups. However, the therapeutic effects were significantly weaker in 22 CgA-positive cases for both biopsy and prostatectomy specimens than in 18 CgA-negative cases for both specimens (p=0.001). In conclusion, although it seems difficult to predict the therapeutic effects of NHT using the biopsy specimens of prostatic cancer, we believe that NED is negatively associated with histological response of prostatic cancer to NHT.

Adenocarcinoma↗

PubMed2005

Screening program of prostate cancer at Tokai University Hospital: characterization of prostate-specific antigen measurement.

A total of 67,214 men participated in screening for prostate cancer (PC) using serum prostate-specific antigen (PSA) from April 1996 to March 2003 at Tokai University Hospital. In 3.5% (2330 / 67,214) of the men, an elevated PSA level (> 4.0 ng/ml) was found and 68.1% (1586/2330) of these subjects were examined at our Urological Outpatient Clinic. Re-testing of PSA showed that 8.4% (133/1586) had a normal level. Needle biopsy of the prostate was performed in 45.2% (633/1453) of the remaining men. As a result, 142 PCs were found and the detection rate was 0.2% (142 / 67,214). The age of the patients with PC was over 50 years. During this period, 135 individuals with voiding dysfunction were also diagnosed as having PC. Comparison of the patients detected by screening with those found at the outpatient clinic revealed significant differences of the age (64.8 vs. 71.9 years, p < 0.0001), serum PSA level (14.6 vs. 154.9 ng/ml, p < 0.0001), and clinical stage (p < 0.0001). In conclusion, a health screening program that includes serum PSA testing is useful for detection of PC at an earlier stage and in younger individuals. We recommend that all men aged 50 years or older undergo testing for PSA to detect PC at an early stage.

Aged↗

PubMed2005

Successful treatment of renal cell carcinoma with mediastinal lymph node metastasis by interleukin-2: a case report.

A 57-year-old woman presented to our hospital with macrohematuria. Renal cell carcinoma (RCC) of the left kidney with bilateral pulmonary and mediastinal lymph node metastases was diagnosed. Radical nephrectomy was performed. Pathological examination confirmed the diagnosis of RCC (pT2pN0M1), so immunotherapy was performed using interleukin-2 (IL-2). The mediastinal lymph node metastases disappeared completely after 5 months of immunotherapy. Investigation of immunological parameters showed an increase of CD8-positive T cells (CD8) and a decrease of CD14-positive cells (CD14), leading to a marked increase of the CD8/CD14 ratio. Although her pulmonary metastases are unchanged, the mediastinal metastases still show complete remission at 14 months postoperatively. The CD8/CD14 ratio may have potential as a new marker for monitoring the response of RCC to immunotherapy and selecting suitable patients for such therapy.

Carcinoma, Renal Cell↗

PubMed2005

[Schwannoma of the kidney with severe calcification: a case report].

Schwannoma arising from the kidney is a rare benign tumor, with only 20 cases reported in the English literature. We encountered a histopathologically typical Schwannoma of the kidney in a 39-year-old woman, which was characterized by marked calcification. Radical nephrectomy was performed under the diagnosis of renal cell carcinoma. The 21 reported cases of schwannoma of the kidney, including the present case, are reviewed in detail.

Adult↗