Clinical effects of oxybutynin hydrochloride (Pollakis)--especially in the treatment of pollakisuria, urgency and urinary incontinence

The effects and the safety of oxybutynin hydrochloride were investigated in 52 patients, 17 male and 35 female, with the chief complaints of pollakisuria, urgency and urinary incontinence. Clinical responses to the drug were assessed mainly by the subjective symptoms of the patients. The diagnoses of these patients were neurogenic bladder in 17, unstable bladder in 16 and others in 19 patients. The average administration period was 66.8 days. The rate of global improvement (excellent and good) was 55% in the 2 mg dose given 3 times daily group, 68.2% in the 3 mg dose given 3 times daily group. Side effects, such as dry mouth, were observed in 2 of the 52 patients (3.8%), but no serious side effects were observed. The rate of global utility (remarkable and moderate) was 67.3%. These data indicate that oxybutynin hydrochloride seems to be useful and safe for the treatment of pollakisuria, urgency and urinary incontinence.     

Early and midterm results of the arterial switch operation for transposition of the great arteries in Japan

A total of 267 infants and children who underwent the arterial switch operation for transposition of the great arteries in the 6 years before Jan. 1, 1988 in six main Japanese institutions were entered into this review. The current status of patients surviving more than 1 year after the operation were evaluated along with early operative results. One hundred forty-six patients had an intact ventricular septum, 103 had a significant ventricular septal defect, and 18 had so-called Taussig-Bing anomaly of the transposition type. Eighteen patients were less than 28 days of age, 73 were 1 to 5 months of age, and 176 were older than 6 months of age at the time of operation. The overall mortality rate was 35% in the first 3 years and 12% in the more recent 3 years. There was a significant difference between the overall mortality rate of primary and two-stage repair (22% versus 10%, p = 0.047) in patients with intact ventricular septum. The overall mortality rate in patients with type B or C coronary arteries of Yacoub, and Radley-Smith's classification was significantly higher than that of other types of arteries (86% versus 18%, p = 0.0001). A total of 156 patients survived more than 1 year after the operation, and 44 children (28%) were noted to have supravalvular pulmonary stenosis (greater than 20 mm Hg). This complication was more common in patients operated on in the newborn period. Trivial or mild aortic regurgitation was noted in 29 patients (19%) and was more common in patients with two-stage than with primary repair (24% versus 14%). Aortic regurgitation was significantly more prevalent in patients in whom coronary arteries were implanted into slits or U-shaped defects than in those whose arteries were implanted into punched-out holes made on the pulmonary root (28% versus 8%, p = 0.049). Normal sinus rhythm was present in 97% of 154 patients and left ventricular ejection fraction was within the normal range in 97% of 115 patients at catheterization 1 to 5 months after the operation.     

Prevalence and risk factors for knee osteoarthritis in elderly Japanese men and women

BACKGROUND: The aims of the present study were to examine the prevalence and risk factors for knee osteoarthritis in elderly Japanese men and women. METHODS: We examined 598 of the 1513 inhabitants of Miyagawa village aged > or = 65 years (393 women, 205 men). Baseline data, obtained with standard questionnaires, included information on age, past history, sports activity, working, knee pain, smoking, and intakes of alcohol and milk. Bone mineral density of the forearm was measured using dual energy X-ray absorptiometry. Anteroposterior radiographs of both knees were graded for osteoarthritis using the Kellgren-Lawrence grading system. Definite osteoarthritis was defined as a grade of 2 or higher. We used logistic regression analysis by the stepwise method to determine the risk factors for radiographic knee osteoarthritis. RESULTS: The prevalence of definite radiographic knee osteoarthritis was 30.0% overall: 17.7% in men and 36.5% in women. The prevalence of symptomatic knee osteoarthritis was 21.2% overall: 10.7% in men and 26.7% in women. There were significant differences in the risk of radiographic knee osteoarthritis with body mass index (BMI), sex, age, and bone mineral density (BMD). CONCLUSIONS: The prevalence of definite radiographic knee osteoarthritis was 30.0% and that of symptomatic knee osteoarthritis was 21.2%. We found that higher BMI, female sex, older age, and higher BMD were significantly associated with an increased risk for radiographic knee osteoarthritis.     

De novo autoimmune hepatitis following living-donor liver transplantation for primary biliary cirrhosis

Abstract:  Since first being described in 1998, de novo autoimmune hepatitis (AIH) after liver transplantation has been reported in several cases suffering from non-autoimmune liver diseases and primary biliary cirrhosis (PBC). Glutathione S-transferase (GST) T1 genotype mismatches between donor and recipient have also been suggested to constitute a risk factor for de novo AIH. Here, we report a 33-yr-old woman who presented complaining of marked fatigue and jaundice four yr after living-donor liver transplantation for PBC. On examination, transaminase levels were highly elevated and ANA and antimitochondrial antibody M2 were positive. Histological findings showed zonal necrosis with lymphoplasmacytic infiltration closely resembling AIH. She had pretreatment AIH score of 16 and 19 points after relapse of de novo AIH. Two color fluorescence in situ hybridization with X and Y chromosome-specific probes clearly revealed that the hepatocytes were of donor origin and lymphocytes were of patient origin. The GSTT1 genotype of the patient and the donor were the same null type, suggesting that mechanisms other than GSTT1 mismatches may exist in de novo AIH development. In conclusion, recipient immune cells attacked the allogeneic transplanted liver of the patient via de novo AIH, although the exact participation of autoimmune mechanisms is unclear.     

Fit and fill analysis of a newly designed femoral stem in cementless total hip arthroplasty for patients with secondary osteoarthritis

The fit and fill of the femoral canal are critical to the success of cementless femoral stems in total hip arthroplasty. It is difficult for conventional stems to provide a good fit and fill for the femora of patients with secondary osteoarthritis. Based on measurements of 100 femora of these patients, we designed two types of Fukui Medical School (FMS) stems with a proximal lateral flare that differed in the medial radius. We compared the fit and fill of the FMS stems with those of four conventional stems, using computer simulation. The mean proximal fit and total fit of the FMS stems were 46% and 53% respectively, a significant improvement compared with the other stems examined. The mean fill of FMS stems was 82% at the lower end of the lesser trochanter and 84% at the upper end of the isthmus, values that were significantly higher than those of the other stems. Since September 1995, we have implanted FMS stems in 15 hips with secondary osteoarthritis. Radiographic evaluations showed that the canal fill of the FMS stems was significantly greater in the proximal femur compared with other stems previously inserted at our department. A summary of this paper was presented at the 9th Symposium on Computer-Assisted Radiology; June 1995, Berlin, and at the 8th International Symposium on Technology in Arthroplasty; September 1995, Puerto Rico.     

Usefulness of transpapillary cytology and biopsy in diagnosing cholangiocarcinoma that mimics primary sclerosing cholangitis

Two patients with a sclerosing type of cholangiocarcinoma are reported. One, a 68-year-old male, presented with jaundice and mild right upper abdominal pain. Endoscopic retrograde cholangiography showed diffuse narrowing and irregularity of the intra- and extrahepatic bile ducts, suggestive of primary sclerosing cholangitis. The other patient was a 72-year-old female who complained of slight right upper abdominal pain, lassitude, and anorexia. Both ultrasonography and computed axial tomography demonstrated slight dilatation of the anterior branch of the right hepatic duct, but no mass. Endoscopic cholangiography revealed stenosis of that duct and diffuse irregularity of the other intrahepatic ducts, also suggestive of primary sclerosing cholangitis. In both patients, however, transpapillary cytology of bile demonstrated malignant cells, and biopsy from within the bile duct showed cholangiocarcinoma. Both transpapillary cytology and biopsy, especially the latter, are useful procedures for the diagnosis of this unique clinical entity.     

The presence of donor-reactive CD4 T cells in early-phase liver-induced tolerance in rats: analysis using donor passenger leukocytes from the recipient

In previous studies, we showed that the recipient spleen 12 h after liver transplantation included highly immunogenic donor passenger leukocytes (PLs) in the non-rejector rat strain combination (Lewis: LEW-->Wistar Furth: WF). Furthermore, we noted that giving anti-CD4 mAb to WF recipients at the time of liver grafting prolonged the liver damage due to primary rejection reaction, suggesting that CD4 T-cell regulation but not the deletional mechanism played a dominant role during the induction phase of tolerance in this combination. We proposed that in vitro CD4 T-cell response to the donor PLs from the recipient lymphoid organ may be observed in the early phase of tolerance induction. We initially observed donor-specific acceptance by 10 days after liver transplantation from the result of secondary heart transplantation, and showed that donor (LEW) PLs in recipient WF spleen 12 h after grafting were able to prime cytotoxic CD8 T cells in vivo. We then isolated functional donor PLs from the recipient WF spleen and established in vitro proliferation assay. When the enriched donor PLs were used as stimulator cells in the proliferation assay, a powerful alloimmunostimulatory ability was observed. Moreover, a potent response of recipient splenocytes to the PLs was observed on postoperative day 14. From these observations, we confirmed that clonal deletion of donor-reactive CD4 T cells did not participate in early phase of tolerance induction in this setting.     

Two cases of main trunk artery occlusion associated with multiple cerebral aneurysms

We report 2 cases of multiple aneurysms (AN) associated with main trunk artery occlusion. CASE 1: A 52-year-old male was admitted to our hospital with dysarthria and weakness of the right side of the body. Computed tomography (CT) showed cerebral infarction in the left corona radiata. MR angiography and conventional angiography showed occlusion of the left middle cerebral artery (MCA) and saccular aneurysms (ANs) at the origin of the anterior communicating artery (A-com) and bifurcation of the right MCA. Subsequent 123I-IMP-single photon emission tomography (SPECT) revealed marked reduction of cerebral blood flow and disturbed reactivity to acetazolamide in the left cerebral hemisphere. Superficial temporal artery (STA)-MCA anastomosis was performed to improve cerebral blood flow and reduce hemodynamic stress for AN of the A-com and right MCA. At 5 months after the first operation, neck clipping was performed successfully for the non-ruptured A-com AN and right MCA AN. CASE 2: A 65-year-old male was admitted to our hospital. CT revealed subarachnoid hemorrhage (SAH), and 3D-computed tomographic angiography (CTA) and cerebral angiography showed basilar top AN, A-com AN and right MCA AN associated with right internal carotid artery occlusion. Right ACA and MCA territories were visualized from the A-com artery and posterior cerebral artery. STA-MCA anastomosis was performed to improve cerebral blood flow and reduce hemodynamic stress for ANs. In the same operation, successful neck clipping was performed for BA top AN and right MCA AN. In such cases as these, particularly in ischemic cases associated with main trunk artery occlusion, it was important to consider surgery for AN after STA-MCA anastomosis in anticipation of improved cerebral blood flow and reduce hemodynamic stress for AN.     

Risk group stratification to predict recurrence after transurethral resection in Japanese patients with stage Ta and T1 bladder tumours: validation study on the European Association of Urology guidelines

Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? EAU guidelines on non‐muscle‐invasive bladder tumours have been widely used for the prediction of recurrence after TUR. However, there are substantial differences in bladder cancer incidence and mortality rates between European countries and Japan. This study provides useful factors for predicting recurrence and validation of EAU guidelines on the risk group stratification to predict recurrence in Japanese patients with stage Ta and T1 bladder tumours.

OBJECTIVE

• ? To validate the European Association of Urology (EAU) guidelines on risk group stratification to predict recurrence in Japanese patients with stage Ta and T1 bladder tumours.

PATIENTS AND METHODS

• ? A cohort of 592 Japanese patients who were treated with transurethral resection (TUR) and histopathologically diagnosed with Ta and T1 urothelial carcinoma of the bladder were enrolled in this retrospective study.
• ? The primary endpoint of the present study was recurrence‐free survival, and the median follow‐up duration was 37 months in recurrence‐free survivors.

RESULTS

• ? Multivariate Cox proportional hazards regression analysis showed that the Eastern Cooperative Oncology Group performance status (ECOG PS), prior recurrence rate, number of tumours and T category were independent predictors of time to recurrence (P < 0.05). According to the EAU guidelines for predicting recurrence, the vast majority of Japanese patients were classified into intermediate risk.
• ? The intermediate‐risk patients were further divided into intermediate‐low‐risk and intermediate‐high‐risk subgroups based on the European Organization for Research and Treatment of Cancer risk table, and a significant difference in the recurrence‐free survival rates was found between these subgroups (P < 0.001).
• ? It was also found that patients with high risk combined with intermediate‐high risk had significantly poorer recurrence‐free survival rates than those with low risk combined with intermediate‐low risk (P < 0.001).

CONCLUSIONS

• ? This is the first report on the ECOG PS as a potentially useful predictor for bladder tumour recurrence.
• ? The risk group stratification of the EAU guidelines for recurrence might not be applicable to Japanese patients with Ta and T1 bladder tumours, but the subgroup classification of intermediate risk could be appropriate.