Prostate-specific antigen adjusted for total prostatic tumor volume as a predictor for outcome after radical prostatectomy.

The aim of this study was to investigate the potential prognostic value of preoperative serum prostate-specific antigen levels adjusted for total tumor volume (PSA-TTV density) for outcome following radical prostatectomy for prostate cancer by retrospective review in 268 patients. Lower PSA-TTV density was not only associated with a significantly higher risk for biological failure (bF), systemic failure and cancer death but also an independent predictor for bF (hazard ratio, 6.3). Therefore, these data suggest that there are subsets of prostate cancer with lower PSA secretion levels, and this phenotype is associated with a higher risk of failure after surgery.

Prevention of testicular damage by free-radical scavengers.

OBJECTIVES: The role of free radicals as mediators of ischemic injury to the testicle has been the subject of much investigation. We studied whether the testicular damage induced in the rat by cadmium chloride (CdCl2) can be prevented by administration of free-radical scavengers. METHODS: Sprague-Dawley rats (n = 45) were divided into 9 groups as follows: a negative control group; two positive control groups, one of which received injection of 1 mg/kg body weight of CdCl2 and the other 4 mg/kg body weight; and six cotreatment groups, each of which underwent one of these three procedures but was concurrently treated with heparin, oxypurinol, or superoxide dismutase (SOD). The damage was assessed by measurement of testicular weight, lactate dehydrogenase-X (LDH-X) activity, and histology. RESULTS: Testicular weight decreased significantly in the positive control groups (P < 0.05) compared to the negative control group, whereas testicular weight in oxypurinol or SOD cotreatment groups did not decrease significantly with the exception of those rats given the higher dose of CdCl2. The results were similar with regard to testicular LDH-X activity and histology. CONCLUSIONS: These findings suggest that CdCl2 induces impairment of testicular function and causes a marked reduction in testicular LDH-X activity; that LDH-X activity is a biological marker of testicular damage; and that, except at high doses of CdCl2, this damage can be prevented by oxypurinol or SOD.

Reactive oxygen species generation by seminal cells during cryopreservation.

OBJECTIVES: To test the hypothesis that conventionally used procedures for semen cryopreservation may cause an increase in the production of reactive oxygen species (ROS) by sperm or by seminal leukocytes, which may contribute to poor sperm function following cryopreservation. METHODS: Eighteen semen specimens with normal parameters from healthy male donors 22 to 40 years of age were each divided into two portions. The first portion was combined 1:1 with Test Yolk Buffer-Glycerol Freezing Medium and was frozen by gradual cooling into liquid nitrogen (-196 degrees C). The second portion was washed and the cells were resuspended in Sperm Washing Medium (SWM) and incubated at room temperature to serve as controls. After a period of treatment, frozen samples were thawed and semen cells were washed and resuspended in SWM. ROS generation by semen cells from each treatment group was measured on a luminometer. Sperm motility, sperm viability, and sperm membrane integrity were also measured in both control and freeze-thaw samples. To further assess ROS generation by semen cells during the cooling process, aliquots of washed semen cells and purified polymorphonuclear leukocytes (PMNs) were incubated separately at different temperature conditions (37 degrees C, 22 degrees C, 4 degrees C, and -20 degrees C). ROS activity in each treatment group was measured and compared with each other. RESULTS: In both semen cells and PMNs, ROS activity increased significantly during the cooling process. The highest ROS levels were recorded in both groups when cooled to 4 degrees C. The ROS levels were extremely low in samples cooled to -20 degrees C and in freeze-thaw samples, probably due to marked loss of cell viability. CONCLUSIONS: Gradual reduction of temperature during the process of semen cryopreservation can cause a significant ROS generation by semen cells. ROS is particularly elevated during cooling if the semen sample is contaminated by more than 0.5 x 10(6) leukocytes. Removal of leukocytes from semen samples or treatment with antioxidants prior to cryopreservation may improve sperm viability and function.

[Clinical statistics on inpatients and operations in the urological department of the Omori Red Cross Hospital (January, 1981 to December, 1985].

The statistics obtained for the 716 inpatients and 550 operations at our clinic between January 1981 and December 1985 were reviewed. The patients were most frequently in their sixties, and there was a predominance in males. The most frequent diseases of the inpatients were benign prostatic hypertrophies and bladder tumors. The most performed operations were also those for urological tumors.

[A case of complete remission of distant metastases of a renal pelvic tumor by combination chemotherapy with mitomycin, cyclophosphamide and 5-fluorouracil].

A 48-year-old woman was admitted to our hospital with the complaint of gross hematuria in March, 1982. The diagnosis of left renal pelvic tumor and bilateral neck lymph-node metastasis was made. Left nephroureterestomy and partial cystectomy were carried out in April, 1982. After the operation, combination chemotherapy with mitomycin, cyclophosphamide and 5-fluorouracil was carried out. The neck lymph-node disappeared completely in May, 1982. No recurrence or metastasis has been detected up to April 1985.

[Clinical profiles of prostate cancer in our hospital: association between primary symptoms and clinical stage].

We analyzed the primary symptoms and clinical stage before and after 1988 when the prostate specific antigen (PSA) measurement was introduced in 491 patients with prostate cancer diagnosed in our hospital between 1976 and 1996. Most primary symptoms were related to problems with urination both before and after 1988. However, after PSA measurement became available, the number of patients referred to our hospital by non-urologists increased significantly. In contrast, the frequency of patients with stage D2 disease decreased significantly and the frequency of patients with early prostate cancer (stage A and B) did not increase. Few patients with prostate cancer had PSA levels of 4 to 10 ng/ml. We suggest that general use of PSA for prostate cancer screening by non-urologists does not contribute to the early detection of prostate cancer, most likely because few patients with prostate cancer have low PSA levels.

[A case of Sipple syndrome whose bilateral pheochromocytomas were resected separately after a 3-year interval].

A 23-year-old woman who had undergone total thyroidectomy and parabronchial lymphadenectomy at the Department of Otolaryngology in our hospital was suspected to have a thyroid carcinoma. Histological examination revealed a medullary carcinoma of the thyroid and normal parathyroid glands. Because a computed tomographic scan after surgery revealed a tumor of the left adrenal gland, the patient was examined at our department two months after the thyroidectomy, 1994. Endocrinic examinations and 123I-MIBG scintigraphy revealed a left adrenal pheochromocytoma of Sipple syndrome. She then underwent left adrenalectomy. Histological diagnosis was pheochromocytoma of the left adrenal gland. Three years after the surgery, a right adrenal tumor was detected by computed tomography. Although results of endocrine examinations were normal, 131I-MIBG scintigraphy showed a hot spot in the right adrenal gland. Right adrenal pheochromocytoma was diagnosed 3 years after surgery for a contralateral adrenal pheochromocytoma. Although surgery was recommended, the patient consented to right adrenalectomy, 1 year later after marriage and before becoming pregnant. Histological examination of the resected specimen revealed pheochromocytoma of the right adrenal gland.

[Four cases of parapelvic cyst].

Four cases of parapelvic cyst are reported, and 27 clinical cases reported in Japan are reviewed. Three of our four cases were male; two of the three cases were benign prostatic hypertrophy, and one was cholelithiasis. For routine urinary tract examination and for differential diagnosis, excretory urograms were made first. The excretory urograms suggested the presence of these parapelvic cysts. Computed tomography performed immediately, gave clear images of the parapelvic cyst in the kidney. The fourth case was a female patient preoperatively suspected as having a renal malignant tumor associated with hemorrhage, however, this case was postoperatively diagnosed as a parapelvic cyst of the kidney associated with hemorrhage in the cyst. Computed tomography should be considered as one of the most useful methods for the diagnosis of parapelvic cysts.

[The therapy of renal cell carcinoma with human lymphoblastoid interferon].

We employed human lymphoblastoid interferon (HLBI) in the treatment of 4 cases of renal carcinoma with pulmonary metastases. All of the cases were males aged 58 to 62. On initial examination, it was revealed that all 4 cases already had multiple metastatic lesions in the lung as well as in other organs such as brain and bone. HLBI was injected i.m. daily at a dosage of 6 X 10(6) units. Treatment was continued for 33 to 119 days, with the total dose being 198 X 10(6) units to 714 X 10(6) units. As to tumor response, minor response was obtained in 1 case, no change in 2 cases, and progressive disease in 1 case. In the case in which minor response was obtained, the size of the pulmonary metastases had reduced by 30% after 8 weeks of treatment with HLBI. As side effects, we observed fever in all cases, and also, anorexia, general malaise, asthenia, and myelosuppression. However, none of these symptoms were serious enough to require discontinuation of HLBI medication. From the results obtained in our own cases, we believe that HLBI may become a new antitumor agent effective for renal cell carcinoma.

[Unexpected renal cell carcinomas found during the operation in renal calculus: report of two cases].

Case 1: A 58-year-old man was seen with dull pain over the left flank. The X-ray examination revealed a renal stone in the left kidney. On operation, a globular hard mass was found in the lower portion of the posterior aspect of the kidney from which a biopsy specimen was obtained. A frozen section study showed renal cell carcinoma, and nephrectomy was performed. The patient is well four years after the operation without recurrence or metastasis. Case 2: A 50-year-old man consulted with microhematuria pointed out in a physical examination. At the operation for renal stone, we found the mass in the lower portion of the kidney. A frozen section study of the mass revealed renal cell carcinoma. We performed nephrectomy and lymphadenectomy on the renal pedicle. The patient is well three years after the operation. We reviewed the cases of renal cell carcinoma associated with renal calculi reported in Japan and discussed how the nephrectomy should be performed according to the frozen section study.

[Clinical evaluation of serum prostatic acid phosphatase assay based on the immunoenzymatic method (TZR-516)].

The usefulness of a newly developed prostatic acid phosphatase assay based on the immunoenzymatic method (PAP-IEA) was studied. Serum samples were obtained from 22 untreated prostatic carcinoma patients, 34 benign prostatic hyperplasia patients, 32 prostatic disease-free patients and 27 normal volunteers. Mean +/- S.D. of PAP-IEA in prostatic disease-free group and normal volunteer group was 0.46 +/- 0.27 ng/ml. So, the upper limit of PAP-IEA for clinical normal range was set to 1 ng/ml (= Mean + 2S.D.). Thus, the false positive rate of benign prostatic hyperplasia was estimated at 9% and false negative rate of untreated prostatic carcinoma at 27%. Meanwhile, PAP-IEA values measured in this study were correlated well to PAP-RIA values measured in the same samples (r = 0.994).

[A case of allergic granulomatous prostatitis].

This is a case report of allergic granulomatous prostatitis and its systemic dissemination. A 45-year-old male visited our hospital with initial symptoms of dysuria, pollakiuria and fever on February 19, 1980. Thereafter, a painless abscess in his left cheek and hard swelling of his right parotid gland appeared. He was hospitalized on March 11 because of hearing difficulties and congestion in the conjunctiva. Physical examination revealed no abnormalities in the chest or abdomen, but a proctological examination showed stone-like hardness of the prostate gland which was the size of a hen's egg. Laboratory findings indicated peripheral eosinophilia and immunoglobulinemia. X-rays showed multiple coin lesions in the chest and multiple cystic changes in the spleen. Biopsies of the cheek lesion and prostate showed eosinophilic granulation accompanied by fibrinoid necrosis and vasculitis. When steroid administration was started, his symptoms and signs showed dramatic but temporary improvement. The allergic lesions then gradually progressed and resisted the steroid therapy. He died on March 13, 1982. In 1972, Towfighi et al. presented 31 cases of nonspecific granulomatous prostatitis with a comprehensive review of the literature. They stated that eosinophilic granulomatous prostatitis with both fibrinoid necrosis and vasculitis caused systemic disease with a poor prognosis. Since the pathological findings in our case showed eosinophilic granulation with fibrinoid necrosis and vasculitis, it was a very rare case of the systemic type of eosinophilic granulomatous prostatitis experienced by Towfighi et al.

[A renal adenoma: a case report and review of diagnostic imaging].

Renal adenoma indistinguishable from renal cell carcinoma preoperatively in a 34-year-old male is reported. The tumor found by CT-scan was located in the middle portion of the left kidney. Renal cell carcinoma was diagnosed preoperatively by total diagnostic imaging. Simple nephrectomy was conducted, and the pathological specimen was a renal adenoma.

[Simultaneously detected double malignancies on a duplicated kidney associated with atrophied counterpart: a case report].

A case of simultaneous double malignant tumor in the same kidney, associating renal cell carcinoma with renal pelvic transitional cell carcinoma, in a 70 year-old-male was reported. On January 6, 2000 he presented with macroscopic hematuria. There were no remarkable findings on cystoscopic examination. Drip infusion pyelography and multidetector-row computed tomography demonstrated a tumor mass on the upper pole of the left kidney and atrophic right kidney. Systemic chemotherapy with CDDP, MTX and ADR was performed preoperatively. Then, hemi-left nephrectomy underwent with the diagnosis of renal pelvic tumor and renal tumor. The surgical specimen was pathologically diagnosed as transitional cell carcinoma of the renal pelvis and renal cell carcinoma of its upper pole. This is the 32nd case of simultaneous occurrence of renal cell carcinoma and transitional cell carcinoma in the same kidney in the Japanese literature.

[Two cases of replacement lipomatosis of the kidney].

Two cases of replacement lipomatosis of the kidney are reported. One patient was a 64-year-old woman who presented with pain caused by a subcutaneous abscess in the back as the chief complaint. Replacement lipomatosis of the kidney associated with staghorn calculi was diagnosed by computerized tomography (CT) and magnetic resonance imaging (MRI), and nephrectomy was performed. The other patient was a 71-year-old woman whose chief complaint was repeated episodes of pyelonephritis. Staghorn calculi and severe renal dysfunction were diagnosed, and nephrectomy was performed. In both patients, pathological examination revealed marked hyperplasia of adipose tissue in the renal sinus which consisted of mature fat cells, and replacement lipomatosis of the kidney was diagnosed. CT is useful in the diagnosis of this disease, and MRI provides further confirmation.

[A randomized comparative study assessing once versus twice a day treatment of benign prostatic hyperplasia with terazosin].

We compared the efficacy of once a day administration of terazosin hydrochloride with that of twice a day administration for benign prostatic hyperplasia (BPH) patients. Forty-two patients with BPH were randomly assigned to receive a maximum dose of 2 mg terazosin either once (n = 21) or twice (n = 21) a day. International prostate symptom score (IPSS), uroflowmetry and side effect profile were determined before and 4 weeks after randomization. Both groups were similar with respect to patient age, baseline IPSS and prostate volume. After 4 weeks of treatment with terazosin, significant improvement in IPSS, maximum flow rate and mean flow rate were observed in both groups. However, these improvements did not differ significantly between them. In addition, there were no differences in side effects between the groups. In conclusion, once a day administration of terazosin hydrochloride is as effective and safe as twice a day administration in patients with BPH.

[A case of primary renal carcinoid tumor].

The patient was a 44-year-old woman in whom a mass of the right kidney was found when she underwent abdominal ultrasonography in a physical checkup. The computed tomography of abdomen and the magnetic resonance imaging of abdomen revealed a 3 x 3 cm solid mass at the right kidney. Excretory urograms showed a deformity of the right collecting system due to a mass lesion. The specimen of the resected tumor showed a cellular arrangement specific to carcinoid tumor and positive reaction of Grimelius stain. Electron microscopy confirmed the presence of dense-core granules in the tumor cells. Gastrointestinal investigation after the operation revealed no particular findings suggesting a carcinoid syndrome. No evidence of metastasis or recurrence was noted for 5 months after the operation. This was a very rare case of primary renal carcinoid tumor, representing the 12th case in the literature in Japan.

[Risk factor of liver disorders caused by flutamide--statistical analysis using multivariate logistic regression analysis].

The antiandrogenic drug, flutamide (Odyne), is widely used in the treatment of carcinoma of prostate. It is well known that flutamide has adverse effects of liver disorders. To ascertain the risk of liver disorders before administering this drug, past history and lifestyle preferences were resurveyed in 123 patients who had been treated with flutamide. The results obtained were assessed in relation to the occurrence of liver disorders by multivariate logistic regression analysis. The incidence of liver disorders was 26% (33/123), with 64% of the disorders occurring within 9 months. The chi-square test for dependent variables revealed that three variables, i.e., body mass index, past history of liver disorders and elevated glutamic-pyruvic transaminase levels were significantly related to the incidence of liver disorders (p > 0.05). Multivariate analysis indicated that a history of liver disorders and elevated alanine aminotransferase (ALT) levels were related to a higher incidence of liver disorders. Elevated ALT levels were associated with a higher incidence of liver disorders and smoking was related to a lower incidence of the liver disorders.

[Clinical statistics on patients and operations during a 20-year period (1978-1997) at Department of Urology, Jikei University School of Medicine].

A statistical analysis was made of diseases, patients, and operations at our department in the four affiliated hospitals of Jikei University School of Medicine from 1978 through 1997. Our findings were as follows. Newly diagnosed urogenital malignancies, except testicular tumors, have been increasing in the last two decades among both outpatients and inpatients. Urogenital infections, including tuberculosis, have gradually been decreasing in the last two decades. The treatment of urinary stone diseases was markedly altered by the induction of extracorponeal shock wave lithotripsy.

[Mechanism of alcoholic testicular damage].

To observe the mechanism of alcoholic testicular damage, in a previous experiment we used weanling male SD rats aged 45 days, weighing about 200 g, and fed a liquid diet (Lieber's) containing 5% ethanol. The latter accounted for 36% of total caloric intake for 7 weeks, but did not result in testicular atrophy. In a later experiment, we used a liquid diet in which ethanol accounted for 46% of the total calorie count. It provided a high-fat, low-protein content which simulated the nutritional background of patients with alcoholic liver diseases. This diet resulted in testicular atrophy. Histological and biochemical changes accompanying this experimental testicular atrophy included the following: 1) The testes of alcohol-fed animals contained smaller seminiferous tubules with reduced numbers of total cells, but no degeneration was seen in the spermatids. 2) In the peritubular wall of the seminiferous tubules, we observed curvature, irregularities, infolding of the basement membrane, and lamellation of the lamina densa, as well as hyperplasia of collagen fibers in the tunica propria. 3) In the cytoplasm of the Sertoli cells, deposits of gigantic fat droplets and stratification of the mitochondria were observed. The permeability of the Sertoli cell tight junction was confirmed using the Lanthanum method. 4) Testosterone levels in both the serum and testes declined. 5) Lactate dehydrogenase-X (LDH-X) activity in the testes declined. 6) Low Km alcohol dehydrogenase (ADH) activity localized in the testicular interstitial tissue was increased. These results indicate that the composition of three major nutritional elements as well as alcohol concentration are important in the mechanism of alcoholic testicular damage, and this damage affects both the testicular interstitial cell and the seminiferous tubules, particularly the Sertoli cells and peritubular wall of the latter. In addition, the findings suggest that ADH is involved in alcohol metabolism in the interstitial cells of the testes.