Clinical efficacy of an α1A/D-adrenoceptor blocker (naftopidil) on overactive bladder symptoms in patients with benign prostatic hyperplasia

AIM: We evaluated the efficacy of an alpha1a/d blocker, naftopidil, on storage symptoms in patients with benign prostatic hyperplasia (BPH), using frequency/volume charts (FVC). METHODS: A total of 81 patients with BPH (52-91 years, mean age 69.0 years) were studied. The inclusion criteria were: (i) one or more episode(s) of urinary urgency/day; (ii) a score of eight or more points on the International Prostate Symptom Score (I-PSS); and (iii) three or more points in any of the scores for three items (frequency, nocturia, and urgency) of the I-PSS. The patients received 50-75 mg/day of naftopidil for 6 weeks. All the patients were examined for 2-day FVC before and after the administration of naftopidil. I-PSS, quality of life index, and uroflowmetry were also evaluated. RESULTS: Total I-PSS decreased from 19.1 to 10.5 points (P < 0.0001), with significant improvement of both storage and voiding symptom scores (P < 0.0001, both). The score for urgency decreased from 3.1 to 1.4 (P < 0.0001). Daytime and night-time frequency decreased from 9.3 to 8.0 (P < 0.0001) and from 2.7 to 2.0 (P = 0.0009), respectively. Mean volume/void increased from 174.0 to 188.6 mL (P = 0.0453). Nocturia decreased from 3.2 to 2.3 (P < 0.0001) in 40 patients who suffered from nocturia two times or more. Notably, significant improvement of nocturia was observed in the patients both with and without nocturnal polyuria (P = 0.0006 and 0.0135, respectively). CONCLUSION: The alpha1a/d blocker naftopidil improves not only voiding symptoms but also storage symptoms, and is effective for nocturia in patients with BPH regardless of the existence of nocturnal polyuria.     

Three‐Dimensional Reconstruction of the Mucosa from Sequential Sections of Biopsy Specimens for Understanding Disease Progress in Ulcerative Colitis

Background: This paper describes the creation of 3‐D computer graphic images of the mucosal crypt of ulcerative colitis (UC) and the resulting observations, which may have great significance to our understanding of the mechanisms involved in the progress of this disease. Methods: Endoscopic biopsy specimens of normal, diseased and transitional (the border area between normal and diseased) zones of the mucosa were taken from five different patients of various ages and at various periods in the progress of their diseases. Three‐dimensional reconstruction of these specimens was perfomed using TRI for Windows (RATOC System Tokyo, Japan) as software. Results: Clear stereographic images exhibiting the structures of crypts, the effects and the progress of UC were obtained. It was seen that, (i) moving from normal to transitional and to diseased zones, the value for crypt volume and crypt surface area increased, but at a far lower rate than those representing the lumen volume and surface area, (ii) the numbers of crypts and crypt lumina decreased as inflammation became more severe and (iii) it is likely that there is a specific point (the intermediate portion of the crypt) which is attacked by inflammation in ulcerative colitis. Conclusion: This method, of stereographic analysis by computer, has opened a new door to the study of a whole range of inflammatory bowel diseases.     

Analysis of urgent colonoscopy for acute lower intestinal bleeding

Background: Urgent colonoscopy is often performed to diagnose and stop acute lower intestinal bleeding, but its usefulness has yet to be clarified. The aim of this study was to clarify the present role of urgent colonoscopy for this purpose. Methods Urgent colonoscopy was defined as colonoscopy performed within 48 h of the occurrence of hematochezia. All patients investigated by urgent colonoscopy from September 1996 to March 2000 who were hospitalized in Shimane Medical University Hospital or Shimane Prefectural Central Hospital, Japan, were enrolled in this study. The endoscopic data and medical records of all the investigated patients were reviewed retrospectively to clarify the role of urgent colonoscopy for diagnosing and treating patients with hematochezia. Results A total of 152 patients were enrolled and 137 (90.1%) were successfully diagnosed endoscopically. Ischemic colitis was the most frequent disease found (32.9%), followed by postpolypectomy hemorrhage (9.2%), hemorrhoids (8.6%) and rectal ulcer (7.2%). Endoscopic hemostasis was employed to treat postpolypectomy hemorrhage and bleeding rectal ulcers with favorable results. Conclusions Urgent colonoscopy is useful for the diagnosis of hematochezia. Endoscopic hemostasis is frequently required to treat postpolypectomy hemorrhage and bleeding rectal ulcers.     

Clinicopathological factors predicting recurrence of N0M0 renal cell carcinoma: A case series analysis of one facility

BACKGROUND: Although many factors have been reported as predictors of the recurrence of renal cell carcinoma (RCC), none of the factors are consistent among different studies. In the study presented here, the potential clinicopathological predictors of the recurrence of N0M0 RCC were examined. METHODS: A total of 201 patients who underwent nephrectomy for N0M0 RCC were examined to determine the pathological tumor stage (pT stage), pathological tumor grade of malignancy (tumor grade), symptoms, and tumor size. RESULTS: RCC recurred in 29 patients (14.4%), 50% of whom developed new tumors within 24 months after nephrectomy. The disease-free 3- and 10-year survival rates declined as the pT stage and tumor grade increased: these rates were, respectively, 98.6% and 86.5% for pT1a; 93.7% and 87.9% for pT1b; 100% and 100% for pT2; 78.6% and 58.0% for pT3a; and 88.9% and 16.7% for pT3b. Significant differences in the recurrence rate were noted between pT3 and pT1 or pT2, as well as between grade 3 disease and grade 1 or grade 2 tumors. Multivariate analysis showed that a combination of the pT stage, grade, and presence of symptoms was useful for predicting the recurrence of RCC. CONCLUSION: The present study showed that patients undergoing nephrectomy for N0M0 RCC should be followed-up carefully for 2 years postoperatively with special attention to high pT stage, high grade, and the development of symptoms.     

Significance of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for detection of renal cell carcinoma and immunohistochemical glucose transporter 1 (GLUT-1) expression in the cancer

OBJECTIVE: Positron emission tomography (PET) is now primarily used in oncological indication owing to the successful application of fluorine-18 fluorodeoxyglucose (FDG) in an increasing number of clinical indications. Glucose transporter 1 (GLUT-1) is recognized as a major early marker of cellular malignant transformation. The aims of this study were to assess whether FDG-PET is a useful diagnostic tool for renal cell carcinoma and to compare the pathologic characteristics. METHODS: Nineteen consecutive patients who had renal cell carcinoma were examined using FDG-PET preoperatively. The results of PET were then compared to the histology obtained after radical surgery and the immunoreactivity of GLUT-1 was also studied. RESULTS: Pathologic examination confirmed that all 19 patients suffered from renal cell carcinoma. Increased FDG uptake was found in six of the 19 patients (31.5%). The immunohistochemical examination of GLUT-1 in renal cell carcinoma produced different results in each patient. There was no correlation with GLUT-1 immunoreactivity and FDG-PET positivity. CONCLUSION: These results suggest that FDG-PET may not be a useful diagnostic tool for renal cell carcinoma.