[Clinical Significance of Neutrophil-to-Lymphocyte Ratio in Patients with Prostate Cancer].

Neutrophil-to-lymphocyte ratio (NLR), a simple marker of systemic inflammatory response, has clinical and prognostic value in patients with cancer. We evaluated the role of NLR prior to biopsy in patients suspected of having cancer prostate cancer. In this retrospective study, we reviewed the records of 204 patients who underwent prostate biopsy in Mizushima Kyodo Hospital between August 2002 and June 2015 and collected the following data : age, C-reactive protein (CRP), prostate volume (PV), clinical cancer staging, prostate-specific antigen (PSA) prior to biopsy , Gleason score (GS), NLR. NLR was calculated by prebiopsy neutrophil and lymphocyte counts. We divided the 83 of 204 patients found to have prostate cancer (PCa) into two or three groups by the results of biopsy, PSA, clinical cancer staging, GS, and D'Amico risk classification. Mann-Whitney U-test and Kruskal-Wallis H-test were used to compare NLR in each group. Significant differences were recognized in NLR between the groups : PSA≧10 ng/ml VS ＜ 10 ng/ml in all patients and in patients with cancer, cT2b≧ VS cT2c≦, GS 6 VS GS 7 VS GS 8≦ in patients with cancer and low risk VS intermediate risk VS high risk in patients with cancer without metastasis. Also we investigated the correlated factor with NLR in patients with cancer without metastasis. On multiple regression analysis including age, CRP, PV, PSA, clinical tumor stage and GS, PSA and GS had a significant association with NLR.

[An ileal neobladder-enteric fistula 10 years after a radical cystectomy with ileal neobladder construction].

A 67-year-old male underwent a radical cystectomy and ileal neobladder construction in September 2002. He developed adhesive ileus postoperatively and underwent an intestine-ascending colon bypass operation with a side-to-side anastomosis in December of 2002. Subsequently, the patient developed ileus frequently, which improved with conservative management. In February 2013, he had fecaluria and was diagnosed with an ileal neobladder-enteric fistula based on computed tomography 2 hours after contrast medium injection. He underwent closure of the intestinal anal side of the anastomosis between the intestine and ascending colon. The fecaluria disappeared and he is making steady progress. An ileal neobladderenteric fistula as a long-term postoperative complication of ileal neobladder construction is extremely rare, with no other reports to our knowledge. Here, we discuss its cause, diagnosis and treatment, with reference to previous reports.

Cavernous nerve reconstruction during radical prostatectomy by sural nerve grafting: surgical technique in nerve harvesting and grafting.

The authors performed cavernous nerve reconstruction by nerve grafting in 22 patients (unilateral-16, bilateral-6) between August 2001 and June 2004. Harvesting of the sural nerve was unexpectedly more difficult than nerve grafting in the extremities or the head and neck, because a knee and lumbar bending position was impossible due to the pelvic surgical field. Suture of the grafted nerve on the distal side required great effort, because there was only sufficient space for one hand at the maximum in a deep region of the pelvic cavity, and the nerve ends easily become invisible by inflow of even a small amount of urine or blood. The mean time of the nerve harvesting and grafting was 1 hr 50 min for unilateral grafting and 2 hr 40 min for bilateral grafting. Recovery of erectile function was observed in about half the patients who had undergone surgery nearly 1 year before. Since harvesting of the sural nerve and nerve grafting were more difficult than expected, modification and improvement of many surgical elements, such as improvement of surgical devices and application of endoscopic techniques, are necessary.

[Three dimensional conformal radiotherapy (3D-CRT) for localized prostate cancer under field adjustment with implanted gold markers: early clinical outcome].

Three dimensional conformal radiotherapy (3D-CRT) for localized prostate cancer under field adjustment with gold marker implantation was performed according to the treatment strategy based on the clinical risk factors to the patients who chose external beam radiotherapy. The treatment strategy contains indications for laparoscopic staging lymphadenectomy and neoadjuvant combined androgen blockade (CAB). This protocol was applied to 19 patients at Kagawa University Hospital from July 2001 to December 2003. The patients were divided into high-risk group (n=14): T3-4N0M0 or PSA > or = 20 ng/ml or Gleason sum > or = 8 or suspicious node, and low-risk group (n=5): T1c-2bN0M0 and PSA < 20 ng/ml and Gleason sum < or = 7 and no suspicious nodes. Basically, high-risk patients underwent laparoscopic staging lymphadenectomy prior to radiotherapy. One of the 14 patients had a positive node and underwent endocrine therapy. The high-risk group received neoadjuvant CAB for 3 to 4 months, followed by gold marker implantation. One patient chose endocrine therapy at this point. Low-risk patients underwent marker implantation without endocrine therapy. Every patient successfully completed planned irradiation. The changes of prostate volume and serum PSA after neoadjuvant CAB were significant [28.7 ml to 15.7 ml (p=0.004) and 53.9 ng/ml to 1.4 ng/ml (p=0.023), respectively]. Only one patient in the high-risk group had biochemical failure. No grade 3 or 4 adverse events occurred in NCI-CTC grading. The analysis of gravity center migration of the implanted gold markers in the first 8 patients showed that the planned safety margin might not be wide enough to avoid neighboring organ irradiation. These results suggested that 3D-CRT under field adjustment with implanted gold markers contributes to both higher efficacy and lower morbidity.

Transitional cell carcinoma of the ureteral stump eight years after nephrectomy for benign disease.

A case of primary carcinoma of the ureteral stump is reported. A 68-year-old man presented with asymptomatic gross hematuria. He had undergone a right nephrectomy for a benign disease previously. Cystoscopy and left ureteroscopy showed no abnormalities. A computed tomography showed a solid mass on the region of the right ureteral stump. He underwent a right ureterectomy and bladder cuff resection. A pathological examination showed transitional cell carcinoma.

High molecular weight calmodulin-binding protein is phosphorylated by calmodulin-dependent protein kinase VI from bovine cardiac muscle

A high molecular weight calmodulin-binding protein (HMW CaMBP) from bovine heart cystosolic fraction was purified to apparent homogeneity. A novel CaM-dependent protein kinase was originally discovered when the total CaM-binding protein fraction from cardiac muscle was loaded on a gel filtration column. The CaM-dependent protein kinase has been highly purified by sequential chromatography on DEAE-Sepharose CI 6B (to remove calmodulin), CaM-Sepharose 4B, phosphocellulose, Sepharose 6B gel filtration and Mono S column chromatographies. The highly purified protein kinase stoichiometrically phosphorylated the HMW CaMBP in a Ca2+/CaM-dependent manner. The phosphorylation resulted in the maximal incorporation of 1 mol of phosphate/mol of the HMW CaMBP. The distinct substrate specificity of this protein kinase indicates that it is not related to the known protein kinases (I, II, III, IV and V) that have been already characterized, therefore we would like to designate this novel kinase as a CaM-dependent protein kinase VI (AU)