Effectiveness of percent free prostate specific antigen as a predictor of prostate cancer detection on repeat biopsy

BACKGROUND: The aim of this study was to identify predictors that can increase the accuracy of detecting prostate cancer on subsequent biopsies. METHODS: Between 1998 and 2003, a total of 235 men with prostate specific antigen (PSA) levels between 4.0 and 20 ng/mL underwent one or more systematic needle biopsies of the prostate. Of these men, 73 (31.1%) underwent one repeat biopsy and 26 (11.1%) underwent two or more repeat biopsies. We evaluated the results of prostate biopsies in relation to the morbidity of prostate cancer detected on repeat biopsies. RESULTS: Of the 73 men who underwent repeat biopsy, 16 (21.9%) had prostate cancer. Twenty-six men with one negative re-biopsy underwent two or more repeat biopsies, and five of these patients were found to have early stage prostate cancer. On repeat biopsy, there was a significant difference in percent free PSA between the cancer-detected group and the no-cancer-detected group (P < 0.01). A receiver operating characteristics (ROC) curve gave an optimal cut-off value for percent free PSA of 11%, demonstrating a significant difference in the cancer detection rate on repeat biopsy (P = 0.0009). Analysis of the data for re-biopsies showed that cancer-detected cases showed a raised PSA value and a simultaneously reduced percent free PSA (these differences were statistically significant). CONCLUSIONS: A low percent free PSA level increased the probability of a positive result in repeat biopsy. An increase in the accuracy of detecting cancer, especially on repeat biopsy, will promote the detection of more early stage prostate cancer.     

Usefulness of ultrasensitive prostate-specific antigen assay for early detection of biochemical failure after radical prostatectomy

BACKGROUND: In order to assess whether the prostate-specific antigen (PSA) nadir obtained with an ultrasensitive PSA assay can be used as a prognostic indicator for patients undergoing radical prostatectomy, we investigated it retrospectively. METHODS: Between October 1997 and July 2003, 46 patients underwent radical prostatectomy for prostate cancer at our institution. None of them received preoperative treatment. Levels of PSA were measured with an ultrasensitive PSA assay every 1-3 months after prostatectomy. Biochemical recurrence was defined as a PSA level of 0.2 ng/mL or higher. RESULTS: There was a significant difference in PSA nadir between the biochemical recurrence group and the no recurrence group (P < 0.001). The receiver operating characteristics (ROC) curve gave an optimal cut-off value for PSA nadir of 0.01 ng/mL, demonstrating a significant difference in biochemical recurrence after radical prostatectomy. No patient with a PSA nadir level <0.01 ng/mL showed biochemical failure, while 15 out of 22 patients with PSA nadir levels >or=0.01 ng/mL showed biochemical failure. CONCLUSION: The PSA nadir level obtained using an ultrasensitive PSA assay is an excellent predictor of biochemical recurrence after radical prostatectomy. Early detection of recurrence offers the possibility of early salvage therapy.     

Home Orthostatic Self-Training in Neurocardiogenic Syncope

We assessed the efficacy of daily sessions of home orthostatic self-training (30 minutes per session standing against the wall without moving) in the prevention of neurocardiogenic syncope in 37 patients. Of these, 10 patients were instructed to perform two sessions per day, 14 were instructed to perform a single session per day, and the remaining 13 were instructed to perform one session every other day. The patients who performed one to two sessions of training per day continued to do so over a 6-month follow-up period, during that time none of them experienced spontaneous syncope. Only 5 of 13 patients who were instructed to train once every two days were able to continue doing so over the 6-month follow-up period; however, no spontaneous syncope was observed in these five patients. The remaining 8 of 13 patients could not continue their home training, and syncope or presyncope recurred in three of them during follow-up. We conclude that one session per day of home orthostatic self-training should be prescribed for the prevention of neurocardiogenic syncope.     

Ureteral obstruction associated with pelvic inflammatory disease in a long-term intrauterine contraceptive device user

We report herein a case of ureteral obstruction associated with pelvic inflammatory disease in a long-term intrauterine contraceptive device (IUD) user. A 62-year-old woman presented with a 2-week history of left flank pain and high fever, but no abdominal pain. She had forgotten the use of an IUD. Retrograde pyelography showed a stricture in the lower third of the left ureter. Magnetic resonance showed swelling of the uterus wall and left parametria, but did not reveal the presence of an IUD. Subtotal hysterectomy, bilateral salpingo-oophorectomy and left nephronureterectomy was performed. The IUD was then found in the uterine cavity. The results of pathological and bacteriological findings for Actinomyces infection were negative. Therefore we diagnosed this case as ureteral obstruction associated with pelvic inflammatory disease. Ureteral obstruction associated with pelvic inflammatory disease in a long-term IUD user is extremely rare.     

Treatment of Advanced Atrioventricular Block with Beta-Adrenergic Blockade Therapy

A 26-year old woman, who experienced syncope associated with advanced AV block, was referred for further evaluation. Electrophysiological study showed normal SA and AV node physiology. Syncope associated with advanced AV block on the electrocardiogram was induced by head-up tilt test. Oral propranolol therapy completely prevented the AV block and syncope induced by head-up tilt. The physician should be aware of advanced AV block associated with neurocardiogenic syncope, especially before permanent - pacemaker therapy is considered. The head-up tilt test is a useful diagnostic tool for an etiology of paroxysmal AV block.     

Preliminary Phase II Study of Aclacinomycin A in Patients With Adult Acute Leukemia

Seventeen patients with adult acute leukemia in relapse weretreated with aclacinomycin A in 5-day courses given at a doseof 90 to 210 mg/m²/5 days as a daily bolus injection. Completeremission was achieved in patients treated with 130 or moremg/m²/5 days. Three out of seven patients with acute nonlymphocyticleukemia achieved complete remission lasting 15 mo, 14+ mo,and 2 mo. Of seven patients with acute lymphocytic leukemia,one achieved complete remission which lasted more than 11 mo.One patient with refractory anemia with an excess of blast cellsalso achieved complete remission. Neutropenia and thrombocytopeniaoccurred in all patients. The dose-limiting factors were gastrointestinalsymptoms and stomatitis, the latter occurring in three of theseven patients who received 200–210 mg/m²/5 days. Hyperbilirubinemiaassociated with antibiotic therapy was seen in four patients.Since aclacinomycin A has significant activity in acute nonlymphocyticleukemia, consideration should be given to exploring its usein combination with other active drugs.     

Radiofrequency Catheter Ablation of an Accessory Pathway in Dextrocardia

A 60-year-old woman with situs inversus and paroxysmal supraventricular tachycardias utilizing an AV accessory pathway underwent successful, uncomplicated RF ablation. Using biplane fluoroscopy, accessory pathway catheter ablation in dextrocardia is as safe, easy, and useful as that for normal heart structure cases, and does not require a lengthy procedure.     

Neurohumoral and Hemodynamic Mechanisms of Diuresis During Atrioventricular Nodal Reentrant Tachycardia

Thirty-two consecutive patients with paroxysmal supraventricular tachycardias, with previously defined mechanisms of the tachycardias, were interviewed by noninvestigators about whether they experienced symptoms of diuresis during or at the termination of the tachycardias, to test the hypothesis that patients with AV nodal reentrant tachycardia would have a feeling of diuresis, polyuria, or both during or at the termination of the tachycardia. Twelve of the 13 patients with AV nodal reentrant tachycardia (92%), two of the 15 patients with AV reentrant tachycardia (13%), and one of the 4 patients with atrial flutter associated with 2:1 AV conduction (25%) felt diuresis during or at the termination of the tachycardias (AV nodal reentrant tachycardia vs other forms of tachycardia; P < 0.001). In 14 of the 32 patients, the right atrial pressure and plasma atrial natriuretic peptide (ANP) concentration were measured during both the tachycardias and sinus rhythm. The mean right atrial pressure during AV nodal reentrant tachycardia was significantly elevated compared to that during other forms of tachycardia (P < 0.01). The plasma ANP concentration during AV nodal reentrant tachycardia was also elevated significantly compared to that during other forms of tachycardias (P < O.OO1). There were no significant differences in the cycle lengths of the tachycardias, age, left atrial dimensions, or the left ventricular ejection fraction between the AV nodal reentrant tachycardia and the other forms of tachycardia. We concluded that the feeling of diuresis during or at the termination of tachycardia was a more common symptom in patients with AV nodal reentrant tachycardia. The higher secretion of plasma ANP from the right atrium might be involved in the mechanism of this symptom.     

Situational analysis of maternal and child health services for foreign residents in Japan

BACKGROUND: Since the 1980s, the number of foreign residents in Japan has continuously been on the rise. In order to improve the foreign resident support services infrastructure and effectiveness, a survey was conducted at a national level from February to August 2002. The survey was done via a mailed questionnaire to all municipalities in Japan. METHODS: For the purpose of the study, municipalities were divided into four groups based on level of urbanization and numbers of foreign residents in the area. The situation of the foreign maternal and child support programs were compared and the municipal administrations were evaluated. In addition, the attribution analysis and evaluation of the foreigner support program was conducted in each municipality group. RESULTS: The evaluation of the current service support program for foreigner was not judged positively in the majority (95%) of the municipalities. In the non-urbanized municipalities with a low composition of foreigners, the foreigner mother and child support program were not functional compared with other regions. Additionally, various factors were highlighted based on attribution analysis among each group. Although most of the municipalities recognized the importance of the foreign resident support program, the evaluations showed a wide gap between intention and reality. CONCLUSION: It is recommended that the barriers as identified in the research results are rectified, and the current situation improved based on municipality characteristics, local demands and the needs of the population. The efficient use of limited fiscal and human resources is also advocated by strengthening of cooperation with other official bodies and also employing foreign residents to work in public offices for facilitating the foreign residents support programs.