The usefulness of ureterorenoscopic examination in evaluation of upper tract disease

AIM: The objective of the present study was to clarify the indications, usefulness and limitations of ureterorenoscopy. MATERIAL AND METHODS: From January 1998 to June 2004, 72 consecutive patients (48 men and 24 women) with a mean age of 66 years (range, 27-83 years) underwent ureterorenoscopy to diagnose upper urinary tract tumors (UUT). Median follow-up was 24 months (range, 1-73 months). Patients were divided into four subgroups by voided urine cytology and preoperative radiographic findings. Group A (n=11, 15.3%), positive voided urine cytology and positive preoperative radiographic findings; group B (n=5, 6.9%), positive cytology and negative radiographic findings; group C (n=48, 66.7%), negative cytology and positive radiographic findings and group D (n=8, 11.1%), frank hematuria originating from the UUT but negative cytology and negative radiographic findings. We compared the findings of ureterorenoscopic examination and biopsy with the results of retrograde pyelography and cytology of upper tract urine. For each examination, the following diagnostic indices were assessed: sensitivity, specificity, positive-predictive-value (PPV) and negative-predictive-value (NPV) and accuracy. Statistical analysis was performed using McNemar's test. RESULTS: For ureterorenoscopy, sensitivity was 94%, specificity 59%, PPV 72%, NPV 92% and accuracy 76%. For biopsy, sensitivity was 77%, specificity 100%, PPV 100%, NPV 80% and accuracy 88%. Accuracy of ureterorenoscopy tended to be superior to that of retrograde pyelography. Ureterorenoscopy was most useful in the group which consisted of 48 patients (66.7%) with negative voided urine cytology and positive preoperative radiographic findings. This group was the only group in which accuracy of ureterorenoscopic biopsy was superior to that of urine cytology, significantly (P=0.03). CONCLUSION: Results indicated that ureterorenoscopy is most suitable and gives superior accuracy in patients with positive radiographic findings and negative voiding cytology. Ureterorenoscopic biopsy of the upper urinary tract would provide useful information when considering therapeutic strategies, such as nephron-sparing management.     

Serum calcitonin gene-related peptide levels in untreated prostate cancer patients

BACKGROUND: The role of calcitonin gene-related peptide (CGRP) in prostate cancer has not been fully understood. Moreover, the serum CGRP level in prostate cancer patients has never been reported. We measured the serum CGRP levels in untreated prostate cancer patients to elucidate its clinical significance. MATERIALS AND METHODS: We used 36 serum samples from prostate cancer patients. All patients had never received any treatment. Serum CGRP was measured by immunoradiometric assay, and we analysed the association between serum CGRP level and clinicopathological factors. RESULTS: Serum CGRP levels in the patients with higher clinical stages and histological grade were significantly higher than in those with lower stages and grade, respectively. But the levels did not correlate with the patient's age, liver or renal functions, serum prostate-specific antigen levels. CONCLUSION: Serum CGRP levels were significantly elevated in the patients with high grade or high stage untreated prostate cancer patients. Measurement of the serum CGRP may be a useful predictor of staging or grading of prostate cancer in the untreated prostate cancer patients.     

Significance of plasma glutathione determination in patients with alcoholic and non-alcoholic liver disease

Plasma glutathione levels were determined in 79 patients with various types of liver disease and 18 healthy controls in order to study their significance in the course of liver disease. Plasma was taken at the time of needle liver biopsy. A positive linear correlation was found between plasma and hepatic glutathione concentrations, as has been suggested in experimental animals. In patients with acute viral hepatitis, chronic hepatitis, non-alcoholic liver cirrhosis and alcoholic liver disease, plasma glutathione levels were significantly decreased compared with those in controls. Of importance is the fact that the plasma levels increased after recovery in patients with acute viral hepatitis and after abstinence from alcohol intake in patients with alcoholic liver disease. Determination of plasma glutathione may be valuable in the evaluation of liver disease, particularly in acute viral hepatitis and alcoholic liver disease in which the hepatic content of glutathione is suggested to be decreased. Such patients may be susceptible to oxidative stress and radical-related hepatic injury.     

Health-related quality of life after radical prostatectomy in Japanese men with localized prostate cancer

PURPOSE: We evaluated retrospectively health-related quality of life (HRQOL) after radical prostatectomy (RP) in Japanese men with localized prostate cancer. METHODS: The study was based on self-reported HRQOL of 280 patients. Patients were divided into seven groups: time 0 (T0), baseline before operation; T1, 1-3 months after RP; T2, 4-6 months after RP; T3, 7-12 months after RP; T4, 13-24 months after RP; T5, 25-36 months after RP; and T6, more than 36 months after RP. We measured the general and disease-specific HRQOL using the RAND 36-item Health Survey 1.0 (SF-36) and the University of California, Los Angeles Prostate Cancer Index (UCLA PCI). RESULTS: The general HRQOL of the postoperative groups was assessed by SF-36. The postoperative groups showed almost the same or higher scores than those of the baseline group. Urinary function scores decreased substantially after surgery. In contrast, there was no difference in urinary bother between the baseline and postoperative groups. Sexual function deteriorated substantially in all postoperative groups. Similarly, the sexual bother score significantly deteriorated after RP. The sexual bother score of men aged 65-years or younger was significantly worse than that of their counterparts in the T1-2 groups. CONCLUSION: Despite reports of problems with sexual activity and urinary continence, general HRQOL was mostly unaffected by RP. Although there was a substantial decrease in urinary function, recovery from urinary bother was rapid. Since the deterioration of sexual function was marked through the postoperative period, careful attention should be paid to this issue during preoperative counseling, especially for younger patients.     

Echographic Detection of Latent Severe Thrombotic Stenosis of the Superior Vena Cava and Innominate Vein in Patients with a Pacemaker: Integrated Diagnosis Using Sonography, Pulse Doppler, and Color Flow

Thrombosis of the innominate vein and SVC is a serious complication in patients with pacemakers, inducing puhnonary embolism or SVC syndrome. Venography is the definitive method for its diagnosis; however, it is too invasive for related studies. The purpose of this study was to validate sonography, pulse Doppler, and color flow in detecting noninvasively innominate vein or SVC thrombosis in patients with pacemakers. In 53 patients with pacemakers, the 1 severe SVC stenosis and 18 severe innominate vein stenoses due to thrombosis were diagnosed by digital subtraction angiography. Sonography accurately showed the severe SVC stenosis due to thrombosis, but had limitations on the innominate vein thrombosis. Color flow demonstrated mosaic flow, indicating poststenotic turbulence due to stenosis of the innominate vein and SVC caused by thrombosis in 15 of 16 patients, and pulse Doppler disclosed absence of flow due to complete occlusion of the innominate vein in 2 of 2 patients. Sensitivity and specificity for detecting severe innominate vein stenosis due to thrombosis using combined color flow and pulse Doppler was 94% and 100%, respectively. In conclusion, sonography, pulse Doppler, and color flow allow accurate detection of severe innominate vein or SVC stenosis due to thrombosis, and are therefore useful for the follow-up of patients with a pacemaker.     

Endoscopic and Histopathological Study about 25 Cases of Minute Superficial Depressed Neoplastic Lesions in the Large Intestine

Abstract: We studied 25 cases of minute (less than 5 mm in a diameter) superficial depressed neoplastic lesions during the period of March 1990 to September 1991. These depressed neoplastic lesions were recognized by colonoscopy as asteroid redness with surrounding elevation. The thickness and height of the surrounding elevations were modified by air volume. Occasionally, they seemed according to the air volume to be elevated lesions, though their fundamental form was confirmed as being superficial depressed lesions from observations of histopathological sections and using a dissecting microscope. The endoscopic figures were emphasized by sprinkling them with Methylene Blue. All of the minute depressed neoplastic lesions were histopathologically diagnosed as being tubular adenoma. For the purpose of confirming the histopathological character of the depressed neoplastic lesions (n = 25) and distinguishing them from conventional elevated adenomas (n = 71) of the same diameter, we compared the incidences of glandular crowding, nuclear stratification, nuclear pleomorphism and loss of nuclear polarity in two groups. Glandular crowding and nuclear pleomorphism were recognized significantly more often in the depressed neoplastic lesions than in the elevated adenomas. Although most of the minute depressed neoplastic lesions were fundamentally adenomas, because of their unique histopathologic character, they could give new insight into the development of colon cancer.     

Cellular and Structural Atypia of the Early Colorectal Cancers

Cellular and structural gland atypia in lesions of early colorectal cancer removed by endoscopic polypectomy in 101 patients were histopathologically studied. The following results were observed. Cellular atypia was frequently found in lesions with a high rate of nuclear polarity loss and multiple nuclear mitoses (99. 0%). The most frequent findings in the glands with structural atypia was intraglandular glands and crowding of neoplastic glands (85. 1%). Most of the appearances of the cellular and structural atypias showed no marked relationship with the sizes of the lesions, depth of invasion and association of adenoma components. Early cancer had both cellular and structural atypia in 95% of the patients and could be diagnosed by conventional histopathological criteria. However five patients with early cancer showed no structural atypia and were diagnosed as having cellular atypia. These cancers were early intramucosal cancer and four lesions were associated with adenoma components 20 mm or less in size. The loss of nuclear polarity and nuclear pleomorphism may be considered more important than nuclear stratification and mitoses in the diagnosis of early cancer.     

A case of sub wakefulness syndrome

Abstract We report a patient, a 30-year-old male Japanese-Brazilian migrant construction worker, suffering from excessive daytime sleepiness for at least 6 months. Electroencephalogram recordings during his waking states showed that 10-Hz and 60-µV alpha activity was present prominently in the occipital regions. From the multiple sleep latency test, it was found that stages 1–2 NREM sleep episodes appeared repetitively without any REM episodes, and that the mean sleep latency was 10.2 min. These findings support the diagnosis that this patient suffers from subwakefulness syndrome.     

Relation between serum hepatitis C virus-RNA levels and efficacy of interferon-β therapy

We performed two courses of interferon-β (IFN-β) to a child with chronic hepatitis C. A complete response was not obtained by the first interferon treatment, however, the results of the second treatment differed from those of the first. Hepatitis C virus (HCV)-RNA remained negative and both aspartate aminotransferase and alanine aminotransferase levels remained normal after completion of the second course. From these results we estimated that HCV-RNA levels before IFN therapy could be significantly associated with the efficacy of this treatment. The serum level of HCV-RNA was 10⁶ copies/50 μL before the first treatment, but was 10³ copies/50 μL before the second course. We conclude that IFN therapy to children with hepatitis C should always be directed at providing a cure. Even if the clinical effects of the first course are minimal decreasing quantities of HCV-RNA still offer hope for cure by subsequent readministration.     

Is the Histogenesis of 6-10 mm Early Colorectal Cancer Different from that of Larger Cancers?

Abstract: Out of a total of 466 cases of early colorectal cancer, we analyzed 139 cases with submucosal invasion (sm cancer) according to tumor size, gross appearance, depth and degree of invasion, and the presence of adenoma components. Early colorectal cancers 11 -20 mm in diameter were the most common lesion in this group, and the percentage with sm cancer increased with tumor size. More than 70% of relatively small sm cancers, 6-10 mm in diameter, had moderate or massive submucosal invasion similar to that found in large sm cancers. Only 35% of 6-10 mm cancers had an adenoma component; the majority (65%) had no adenoma component. In marked contrast, 63% of sm cancers 11 -20 mm in diameter had an adenoma component and in sm cancer the percentage of tumors composed solely of cancerous tissue without an adenoma component was low. Similar results were obtained when only protruding type sm cancers, which accounted for the majority of sm cancer cases, were included in the analysis. Therefore, we believe that the protruding type sm cancer 6-10 mm in diameter is at a stage close to advanced cancer. It is possible that many 6-10 mm sm cancers have a histogenesis different from that of large sm cancers.