The ADVIA2120i parameter Revised %MICRO is a surrogate marker of schistocyte formation after hematopoietic stem cell transplantation.

Objectives : Hematopoietic stem cell transplantation (HSCT)-associated thrombotic microangiopathy (TA-TMA) is an important early post-treatment condition. This study evaluated the Revised %MICRO, a parameter obtained from the ADVIA 2120i automated blood cell counter, as a surrogate marker of the schistocyte ratio. We hypothesized that individual differences between the %MICRO value and schistocyte ratio would remain constant. Design and Methods: EDTA-2K-treated peripheral blood samples were collected from 19 patients who underwent allogeneic HSCT from April 2014 to September 2018. First, the baseline difference, X, was calculated using a sample from the first day after HSCT as X = %MICRO (first day) - schistocyte ratio (first day). Next, the Revised %MICRO for each subsequent day was calculated as Revised %MICRO = %MICRO - X. We evaluated correlations of the schistocyte ratio with the calculated %MICRO and Revised %MICRO and the RBC fragment, RBC distribution width, %MICRO and Revised %MICRO data obtained from the ADVIA 2120i. Results : The mean schistocyte percentage and Revised %MICRO were both 0.4% ±â€…0.6. RBC fragments correlated weakly with the %MICRO and schistocyte ratio, respectively (r = 0.162 and r = 0.771, respectively), whereas the Revised %MICRO correlated strongly with the schistocyte ratio (r = 0.893). Conclusion : The Revised %MICRO appears to be a good surrogate of the schistocyte ratio in a clinical setting. J. Med. Invest. 67 : 250-254, August, 2020.

The effect of patient age and other factors on the maintenance of permanent hemodialysis vascular access.

The objective of the present study was to investigate whether patient age is associated with vascular access failure during maintenance hemodialysis. Thus, patients who had a successful permanent hemodialysis vascular access installed (Group N: 314 cases), and those who required vascular access revision (Group R: 108 patients) were studied. To assess the association between patient age and the risk of vascular access failure, Cox proportional hazards regression was used to determine hazard ratios (HR) and 95% confidence intervals (CI). We found that in Group N, the significant risk factors were age, gender, and diabetes mellitus (95% CI: 1.004-1.013, 0.380-0.827, 1.279-2.859). Using a univariate analysis model, significant hazard ratios (HR) were found with ages of 60 (CI: 1.062-2.302), 65 (CI: 1.052-2.280), and 70 (CI: 1.082-2.537) years, with the largest HR at 70 years of age (HR: 1.657). In contrast, in Group R, multivariate analysis using Cox proportional hazards identified only one prognostic variable, the location of the vascular access. In Group R, univariate analysis models showed that age was not a significant factor. We conclude that our data show that age is a risk factor for the successful maintenance of initial permanent hemodialysis vascular access. Other risk factors include gender and diabetes mellitus. However, these factors were not related to the successful maintenance of revised vascular access.

Urethral reconstruction using buccal mucosa urethroplasty in the treatment of urethral injury.

A 52-year-old Japanese man was referred to us with a urethral injury caused by masturbation. His penis was swollen and about one and a half times its size due to urine extravasation and infection. Foreign bodies were surgically removed, and debridement and excision of necrotic tissue were performed. After confirming that the infection was under control, we planned the reconstruction of the urethra and penis, following endoscopic urethrotomy for the bulbous urethra stricture. A free graft from the buccal mucosa was harvested, placed over the defect and fixed with interrupted suture as ventral onlay. The patient could achieve satisfactory voiding and no complication was seen during the 18-month follow up. In our experience, buccal mucosa is a useful source of urethral grafting material and excellent results can be expected in case of urethral injury.

Cadmium-induced testicular damage in a rat model of subchronic intoxication.

Background: Cadmium (Cd)-induced testicular damage in relation to spermatogenesis has not been well studied. We studied the mechanism of Cd-induced testicular damage in a rat model of subchronic intoxication. Methods: Male Sprague-Dawley rats were subcutaneously injected with 0.6 mg Cd/kg per day for 6 weeks. The concentration of Cd in urine, serum and testes was measured by using atomic absorption spectrophotometry. Testicular damage was evaluated by counting the spermatogonia (SG) and spermatocytes (SC) on one cut-surface of five seminiferous tubules in stages VII or VIII of spermatogenesis every week. The location of intratesticular cadmium was determined by using oxine-fluorescent cytochemistry. Results: There were no differences in the testes/bodyweight ratio between the study and control groups. The concentration of Cd in the testes increased more than 100-fold that in serum after week 2, suggesting active testicular Cd accumulation (1-3 mg/g tissue). Cadmium accumulation was detected in SG and SC. The number of SG and SC diminished significantly in the study group (week 2: SG 74%, SC 90%; week 4: SG 47%, SC 75%; week 6: SG 30%, SC 54% of the control, respectively). Conclusions: Cadmium accumulated in SG and SC, consequently reduced the number of these cells, and disturbed the spermatogenesis in this rat model of subchronic Cd intoxication. Therefore, the number of SG decreased in this rat model of subchronic Cd intoxication. (Reprod Med Biol 2002; 1: 59-63).

Comparison of Gas-less laparoscopy-assisted surgery, hand-assisted laparoscopic surgery and pure laparoscopic surgery for radical nephrectomy.

BACKGROUND: We report our experience with Gas-less laparoscopy-assisted surgery (Gas-less LAS), hand-assisted laparoscopic surgery (HALS) and pure laparoscopic surgery (LS) for renal carcinoma and compare the characteristics and usefulness of these methods. METHODS: Seventeen, 14 and 16 patients were subjected to Gas-less LAS, HALS and LS, respectively. The study started with Gas-less LAS and then gradually shifted to HALS and LS. We evaluated the operative and postoperative parameters for each group. The learning curve effect was evaluated based on data from the first 10 cases of each group, which were operated on by the same surgeon and operation team. RESULTS: The learning curve of operation times in the LS group demonstrated that the operation time for this procedure is acceptable even in early-stage cases. Differences in mean operative time between the three surgical groups, excluding the conversion cases, were not statistically significant; however, there was a significant difference in blood loss volume between the groups (P

Short-term ureteral catheter stenting after uncomplicated transurethral uretero-lithotomy.

Short-term (1 or 2 post-operative days) ureteral catheter stenting after transurethral uretero-lithotomy (TUL) to avoid flank pain due to transient ureteral edema is described. Patients who underwent TUL for middle or distal ureteral stones with a rigid ureteroscope without complications during the procedures were the candidates for short-term ureteral stenting. An end-hole ureteral catheter, used to insert a guide wire during TUL, were used for stenting. The tip of the catheter was located near the renal pelvis and the other end was introduced outside through the urethra with a 14 F urethral catheter. The stent and catheter were removed on post-operative day 1 or 2. For the 18 patients treated using this method, the time of analgesic use after stent removal was 0.6+/-0.8, indicating a sufficient duration of stenting. Short-term ureteral catheter stenting is a cheap and easy way for post-operative management for uncomplicated TUL.

Cadmium nephrotoxicity and evacuation from the body in a rat modeled subchronic intoxication.

BACKGROUND: Cadmium (Cd) is an important industrial pollutant, although its mechanism of toxicity has not been completely clarified. We studied Cd-induced subchronic nephrotoxicity and the cadmium evacuation system in rats and cultured human renal tubular cells. METHODS: Male Sprague-Dawley rats were subcutaneously injected with 0.6 mg Cd/kg per day for periods of 3, 5 and 8 weeks. The concentration of Cd in urine, serum and kidneys was measured by atomic absorption spectrophotometry. Nephrotoxicity was evaluated based on the urinary concentration of beta2 microglobulin (B2MG) and histopathological findings. Apoptotic cells were detected by nick-end labeling and DNA laddering, and were based on the level of caspase-3 activity. Cadmium-induced toxicity was also studied in cultured human renal tubular cells. RESULTS: Nephrotoxicity was detected after 4 weeks of exposure to Cd, because Cd and B2MG appeared in urine. The tissue concentration of Cd increased linearly throughout the 8 weeks of exposure to Cd. The concentration of renal Cd did not change in the 3-week exposure group, but it decreased after withdrawal of Cd in the 5-week exposure group, suggesting an active Cd excretion mechanism started after the 4th week. The threshold Cd concentration for nephrotoxicity was 150 micrograms/gram wet tissue, at which concentration histological tubular damage started. Although the kidneys presented mainly necrosis, apoptosis was observed at weeks 4 and 5, before renal tubular necrosis occurred. In vitro DNA laddering was observed and peak caspase-3 activity was detected when the cells were exposed to the threshold concentration of Cd. CONCLUSION: Cadmium was effectively evacuated from the body by exfoliation of damaged renal tubular cells presenting focal tubular necrosis after the renal Cd concentration reached the threshold. Apoptosis may be involved in the regulation of Cd-induced nephrotoxicity.

Arteriovenous graft featuring end-to-end anastomosis to a deep vein for hemodialysis.

We describe a new vascular access grafting technique featuring end-to-end anastomosis to a deep vein in the forearm, designed to create a functional arteriovenous fistula in the forearm of patients whose subcutaneous veins are not usable for this purpose because of occlusion or attenuation. This new technique offers a valuable option in this setting.

Kidney autotransplantation in a patient with renal pelvic and bladder carcinomas.

A 66-year-old Japanese woman, whose left kidney was non-functioning, was referred to us with a diagnosis of invasive bladder carcinoma and right renal pelvic carcinoma. The latter tumor was clearly packed in the renal calyx and was considered to be of low-grade malignancy. Nephron preserving surgery of the right kidney was performed, followed by radical cystectomy and construction of an ileal conduit. The postoperative course was good, without significant complications. Renal function was restored and a postoperative imaging study showed a well-functioning transplanted kidney. At present (20 months after surgery), the patient is doing well and has presented no signs of recurrence of the disease.

Metastatic malignant ameloblastoma of the kidneys.

Ameloblastoma is an uncommon disease in the urological field. The resulting tumors or cysts are of odontogenic epithelial origin, are usually benign in nature and rarely metastasize to distant organs. We describe a case of metastatic ameloblastic carcinoma in both kidneys of a 38-year-old Japanese man, who had a history of malignant ameloblastoma and was referred to us for evaluation because of gross hematuria and left flank pain. Computed tomography showed irregular cystic masses in both kidneys. After we confirmed that the primary lesion and the lung metastatic lesion had not recurred, we treated the patient surgically. Approximately 4 months postoperatively the patient suffered a local recurrence of tumors that was very invasive and aggressive. The patient died 2 months later and the autopsy showed local metastasis only, without any metastatic lesion in the lungs or other organs. The present case showed that malignant ameloblastoma is highly aggressive, and in the case of metastases the prognosis is usually extremely poor.

New method to create a vascular arteriovenous fistula in the arm with an endoscopic technique.

We describe a new technique in which the basilic vein is transposed subcutaneously with endoscopic surgery to create a vascular access in the arm. The vein was harvested with the Endoscopic Vascular Surgery System (Olympus Co, Tokyo, Japan). We could harvest a vessel about 25 cm long with endoscopy. After vessel transposition, an arteriovenous fistula was created in the usual manner. In all 10 patients, we created an effective blood access as scheduled before surgery. We could use the arteriovenous fistula 6 days after surgery and get blood flow in all cases.

Phase I/II clinical trials of carbon ion therapy for prostate cancer.

BACKGROUND: Heavy ion beams possess high linear energy transfer components and a prominent Bragg peak in the human body, resulting in higher relative biological effectiveness and improved dose distribution. To establish heavy ion therapy techniques for the treatment of prostate cancer, phase I/II clinical trials were initiated. METHODS: For 96 patients with T1b-T3 prostate cancer, three carbon ion beams were used to irradiate the prostate and seminal vesicles (20 times/5 weeks) with or without endocrine therapy. Radiation dose was expressed in GyE which was initially thought to be equivalent to photon dose. Total dose was gradually increased from 54 to 72 GyE. RESULTS: Carbon ion therapy was completed in 20 cases of T1b/T1c/T2aN0M0 as monotherapy, in 8 cases of T2b/T3pN0M0 with neoadjuvant endocrine therapy, and in 68 cases of T2b/T3N0/pN1M0 with neoadjuvant and adjuvant endocrine therapy. Median observation period was 47 months. Grade 3 late radiation morbidity of rectum and/or bladder/urethra developed in one and five cases who received 66 and 72 GyE of radiation, respectively. After these adverse effects were observed, total dose was decreased to 66 GyE and the radiation field was coned down during the treatment course. At 5 years, overall, cause-specific, clinical recurrence-free, and biochemical recurrence-free survival rates were 87.7, 94.9, 90.0, and 82.6%, respectively. Local control was achieved in all patients except one patient who received 54 GyE of radiation. CONCLUSIONS: The therapeutic techniques of carbon ion therapy have been established for patients with prostate cancer. Carbon ion therapy may exert excellent effect to the tissues of prostate cancer.