RESPONSE CRITERIA FOR THE THERAPEUTIC EFFICACY OF TREATMENT FOR BENIGN PROSTATIC HYPERPLASIA

Response criteria for the therapeutic efficacy of treatments for benign prostatic hyperplasia (BPH) were proposed following the International Consultation on BPH held in 1993. In the present study, we validated the criteria and proposed a simplified form, which consists of the responses of three parameters: symptom score and quality of life assessed by the international prostate symptom score and the maximum flow rate. Each of the three individual parameters is evaluated as one of four response grades: excellent, good, fair or poor, and the number of response grade of the three parameters determines the overall response. Excellent and Good responses are regarded as effective, and fair and poor are regarded as not effective. The validity of the response criteria was assessed by comparing the responses determined by these criteria with those made by physicians in charge using a group of 225 patients receiving various treatments. The agreement rates on effectiveness of overall responses between the response criteria and physicians were 77% for a multicenter trial of medical treatment (n = 94), 100% for TURP (n = 23), 92% for laser treatment (n = 47), 80% for thermal treatment (n = 26) and 78% for α-blockers (n = 35), respectively. Altogether, 88% (198 of 225 cases) were evaluated accurately regarding effectiveness. Addition of prostate volume to the battery of response parameters made little contribution to diagnostic accuracy. Deletion of any of the other three parameters, however, significantly compromised the quality of assessment. These results suggest that the proposed criteria may be useful as the standard method for the assessment of the clinical efficacy of BPH treatment.     

Relationship of HBsAg Subtypes with HBeAg/anti-HBe Status and Chronic Liver Disease. Part II: Evaluation of Epidemiological Factors and Suspected Risk Factors of Liver Dysfunction

In this study, we examined a possibility that epidemiological factors or suspected risk factors of liver dysfunction could account for the different HBeAg/anti-HBe status or the different prevalence of liver dysfunction between the adr and adw carriers. A total of 428 HBsAg carriers were surveyed of their age, sex, racial background, socioeconomic status, place of residence, birthplace, alcohol consumption, smoking habit, and history of blood transfusion as epidemiological factors or suspected risk factors of liver dysfunction. Adjustment for those variables using multivariate analyses did not substantially affect the association of the HBsAg subtypes with either prevalence of liver dysfunction or HBeAg/anti-HBe status. HBsAg subtypes seem to directly affect HBeAg/anti-HBe status and consequently influence development of chronic liver disease.     

Diagnosis of malignancy in the urinary tract and prostate gland from the aspect of hematuria

During the 10 years from 1979 to 1988, 245 patients with urinary tract or prostate gland malignancy were diagnosed and treated at our Department. 245 malignancies were composed of 5 groups, i.e., 50 renal cell carcinomas (RCC), 17 renal pelvic and ureteral tumors (RPUT), 117 bladder tumors (BLT), 59 prostate carcinomas (PRC) and 2 urethral carcinomas (URC). On the basis of chief complaint or reason leading to diagnosis, and of grade of hematuria, evaluation was performed in 4 groups except for group URC. With regard to the chief complaint or reason leading to diagnosis, asymptomatic gross hematuria was most frequently seen at 40%, 59% and 74% in groups RCC, RPUT and BLT, respectively. In group PRC, asymptomatic gross hematuria was seen at 8%, although dysuria and urinary retention were the most popular. Regarding grade of hematuria at the first visit, urine without any RBC (55%) and microscopic hematuria (39%) were the commonest in group RCC, while moderate degree of microscopic hematuria (5-20/hpf) was most frequently seen in group RPUT (44%). On the contrary, gross hematuria (38%) was the commonest in group BLT. Patients in group PRC showed gross and microscopic hematuria at 25%, though it was not the commonest one. In conclusion, it should be noted that no RBC may be seen on the first visit even if the chief complaint was gross hematuria in patients with urinary tract malignancy.     

[13C]methacetin breath test for evaluation of liver damage

Methacetin undergoes rapid O-dealkylation by hepatic microsomal enzyme systems, and the resultant CO2 is present in the expired air. The rate of O-dealkylation of methacetin was assessed by the [13C]methacetin breath test in seven healthy volunteers and 30 patients with histologically proven chronic liver diseases. The 30-min recovery of orally administered [13C]methacetin as 13CO2 in the exhaled air was significantly reduced in patients with chronic aggressive hepatitis and in those with liver cirrhosis but not in patients with chronic persistent hepatitis or healthy controls. Patients with either advanced cirrhosis or hepatocellular carcinoma showed significantly lower values than those with well-compensated cirrhosis. The levels in two patients with late primary biliary cirrhosis were reduced. These results show that the severity of liver damage can be effectively evaluated by [13C]methacetin breath test. In addition, this test is simple, safe, and time efficient.     

3-Year Study for the Prevention of Perinatal HBV Infection Under the Standard Method of the Ministry of Health and Welfare, Japan

We present the first report on a 3-year study for the prevention of HB virus infection under the standard method of the Ministry of Health and Welfare, Japan. We observed 50 children for three years, and obtained the following results: 1) Many children (57%) born to HBeAg-positive mothers maintained HBs-antibody titers higher than 10, expressed by the cut-off index based on the RIA system; 2) No case became an HB virus carrier after one year; 3) Six children born to Hkantibody positive mothers had HBs-antibody titers below 5. Children born to HBe-antigen positive mothers were mostly affected by the HB virus, so that their HBs-antibody titers were maintained at high levels. In contrast, HBs-antibody titers of children born to HBe-antibody positive mothers decreased, probably because of lack of exposure to the HB virus.     

Inorganic alkalizers and acidifiers under conditions of high urinary Na+ or K+ on cell proliferation and two-stage carcinogenesis in the rat bladder.

Effects of alkalizers and acidifiers on bladder cell proliferation and two-stage carcinogenesis were investigated under conditions of high urinary Na+ or K+. Animals were given 0.05% N-butyl-N-(4-hydroxybutyl)nitrosamine in their drinking water for 4 weeks and then received Na3PO4, NaH2PO4, NaCl, NaH2PO4 + NaCl, K3PO4, KH2PO4, KCl, KH2PO4 + KCl or no chemical supplement in the diet from weeks 5 to 8 and from weeks 12 to 20. During weeks 9 to 11, the rats were fed 3% uracil in their diet for acceleration of promotion. Na3PO4 or K3PO4 induced marked natriuresis or kaluresis and alkalinuria associated with strong promoting potential for bladder carcinogenesis. NaH2PO4 induced moderate natriuresis and aciduria and exhibited weak promoting activity. NaH2PO4 + NaCl or KH2PO4 + KCl caused marked increase in the respective cation levels and aciduria with elevation of promotion as compared to NaH2PO4 or KH2PO4 alone. NaCl or KCl induced moderate natriuresis or kaluresis and did not alter urinary pH. NaCl but not KCl also exerted weak promoting activity for bladder carcinogenesis. Increased DNA synthesis after test chemical exposure for 8 weeks and morphological alterations observed by scanning electron microscopy in the bladder epithelium were only quantitatively linked with promoting activity in the Na3PO4 case. With the other treatments no clear correlation between early cell proliferation and promotion potential was apparent. The present results suggest that although elevation in urinary Na+ or K+ level may be an essential factor for promotion of rat bladder carcinogenesis, the action of these cations may depend strongly on urinary alkalinity.