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To examine the exchangeability of 137Cs and K in soils of agricultural fields after decontamination, 173 soil samples were collected in 2016 from the plowed layer (0–15 cm depth) of decontaminated agricultural fields in Tomioka town, Fukushima prefecture, Japan. We investigated total 137Cs, exchangeable 137Cs, exchangeable K, and nonexchangeable K content for these soils. The total 137Cs content in soils was, on average, 1,200 Bq kg−1 (value range: 20–4,400 Bq kg−1), which was an 80% decrease from the values determined before the decontamination. This result indicated that the decontamination process considerably reduced the total 137Cs content in the plowed layer. The exchangeable K content in soils was on average 172 mg kg−1 (value range: 27.9 – 743 mg kg−1). More than 80% of soils showed the exchangeable K content lower than the recommended threshold value for paddy soils needed in order to reduce the 137Cs transfer from soil to plant (i.e. 200 mg kg−1). The nonexchangeable K content showed a w...

Phytoavailable K in soil is a key to control the transfer factor of radiocesium from soil to brown rice. The transfer factors were determined for paddy fields cultivated in 2017 and 2018 under different K fertilization regimes in Fukushima Prefecture, Japan. Two phytoavailable forms of K, the exchangeable and nonexchangeable K contents were investigated for the surface soil sampled after the transplanting and fertilization as well as after harvest of rice in the same paddy fields. The exchangeable K content largely decreased from after transplanting and fertilization to after harvest, and the exchangeable K of the soil after harvest was negatively correlated with the transfer factor (rs = −0.70, p 50 mg K2O 100 g−1 indicated a considerably low transfer factor, even if exchangeable K deficient. Thus, via our field-scale experiments, we concluded that the criterion nonexchangeable K > 50 mg K2O 100 g−1 can be used as another threshold for use along with that of exchangeable K to differentiate soil with a low radiocesium transfer rate from exchangeable K deficient soil.

Bartter症候群では一般的に腎不全に進行することは少ない. 今回われわれは腎不全を呈した小児Bartter症候群type IV症例に対して生体腎移植を施行した1例を経験したので報告する. 患者は15歳男児で, 新生児期より哺乳不良, 体重増加不良であり, 10か月時多飲多尿が出現した. 1歳9か月時の精査にて血漿レニン活性の高値, 低カリウム血症, 難聴などを認めたことからBartter症候群type IVと診断されインドメタシン, スピロノラクトン, 塩化カリウムの投与が開始された. 腎機能に関しては, 乳児期より低下していたが思春期になりさらに低下し, 生体腎移植目的に2004年4月に当科紹介受診となった. 2004年11月中旬に移植予定であったが, 10月中旬にBUN 156mg/dL, Cr 17.2mg/dLと腎機能の悪化を認めたため, 腎移植前のコンディショニングとして血液透析を開始し, 11月中旬に40歳の母親をドナーとして生体腎移植を施行した. Bartter症候群の腎移植症例として, 術前にRAA系の亢進は認めていなかったがマレイン酸エナラプリルとロサルタンカリウムを移植前より投与した. 腎移植後, 腎機能は改善しRAA系の亢進も認めていない. Bartter症候群では一般的に腎不全に進行することはまれであり, 腎不全の因子としてはBartter症候群の病態だけでなく, Bartter症候群の治療に用いられるNSAIDsもその因子のうちの一つである. またこれまでの報告を含め, 腎不全を呈したBartter症候群に対しては, 腎移植後に腎不全だけでなくBartter症候群による内分泌学的異常も改善し, 腎移植が有用な治療であると考えられた.

Objective: The reported rate of erectile dysfunction after nerve-sparing prostatectomy varies according to physicians. Because exact preservation of the neurovascular bundle (NVB) solely depends on the judgment of the physician, he or she should try to correctly identify the NVB and also avoid neurophysiologic injury of the NVB during the procedure. The purpose of the present study is to assess the status of the NVB preservation by physician’s judgment at the operation, the changes in intracavernous pressure related to intraoperative electrical stimulation and postoperative histopathological examination. Patients and Methods: Thirty-eight patients who underwent nerve-sparing radical prostatectomy judged by intraoperative electrical stimulation of the NVB were included in this study. Bilateral, unilateral and non-nerve-sparing procedures were performed in 18, 17, and 3 cases, respectively. The NVB preservation evaluated by intraoperative physician’s judgment was compared to that evaluated by postoperative histopathological examination. Furthermore, the NVB preservation evaluated by intraoperative electrical stimulation was compared to that by physician’s judgment and postoperative histopathological examination. Results: For 68 of 76 NVB (89.5%), intraoperative subjective judgment and histopathological assessment were identical. For 66 of 76 NVB (86.8%), electrical stimulation findings and the physician’s judgments were identical, and for 70 of 76 NVB (92.1%), electrical stimulation findings and histopathological findings were identical. Conclusion: Even if physicians are convinced of a successful nerve-sparing procedure, there are some cases in which the NVB is not preserved accurately or neurophysiological damage is suffered. Therefore, intraoperative electrical stimulation of the NVB as well as the cavernosal nerve is very useful in evaluation of NVB preservation.

We estimated the risk of a rapid prostate specific antigen (PSA) increase in men with a low baseline PSA range of 0.0 to 2.0 ng/ml to investigate the validity of setting a re-screening interval of more than 1 year.Between 1988 and 1999, 6,252 men with baseline PSA 2.0 ng/ml or less without suspicious findings on digital rectal examination (DRE) and 7,304 with the same baseline PSA who did not undergo DRE at the time of baseline PSA measurement were re-screened. The risks of a PSA increase to 4.1 to 10.0, 10.1 to 20.0 and greater than 20.0 ng/ml were investigated and stratified by re-screening interval, baseline DRE status, and subdivided baseline PSA ranges of 0.0 to 1.0 and 1.1 to 2.0 ng/ml.A total of 28 cases (0.2% of 13,556) of prostate cancer were detected after an average re-screening interval of 3.6 years. High PSA above 10 ng/ml at diagnosis was noted in 5 patients (18%), including 2 with a great PSA increase to 1,928 and 298 ng/ml at re-screening intervals of 4 and 6 years, respectively.Setting 4 to 5-year re-screening intervals for PSA measurements in men with PSA 1.0 ng/ml or less can decrease the cost of PSA tests without lowering sensitivity. A re-screening interval for PSA measurement should be set annually for men with PSA 1.1 to 2.0 ng/ml to minimize the risk of missing aggressive cancer.

Background & Aims : To assess the effectiveness of CT during arteriography (CTA) in superselective transarterial chemoembolization (TACE) for invasive bladder cancer, and to report preliminary results of superselective TACE. Methods : Angiography was performed in 20 patients with invasive bladder cancer, using a combined CT-Angiography system. Of the 20 tumors, 19 were T3, one was T2. The vesical arteries were selected using a 3F microcatheter, and perfusion was confirmed using CTA. TACE was performed after administrating 40 to 100 mg of cisplatin, with and without gelatin sponge particles. The effects of TACE were assessed by surgery or a combination of cystoscopy and CT in 15 cases. Results : The vesical arteries were successfully selected in 18 of 20 patients. In 16 small tumors, the tumor stain was clearly depicted on CTA. In two large tumors, the vascular supply was identified as involving multiple arteries. One case showed complete remission, six showed partial remission, and eight showed no change. Complications included mild local pain around the perineum during TACE, and transient nausea in some patients. Conclusion : CTA may be useful in superselective TACE for invasive bladder cancer, and may contribute to effective treatment of bladder tumors.

Routine screening for prostate cancer remains controversial. However, it is very important to show how the optimal rescreening interval should be set for men who want to be screened after informed consent. To solve this issue, the risk of prostate-specific antigen (PSA) increase above 4.0 ng/ml relative to baseline PSA levels and age was investigated. Between 1988 and 2000, 7,757 subjects screened twice or more and also with baseline PSA levels of 4.0 ng/ml or lower were enrolled in our study. All serum PSA levels were measured by E-test Tosoh II PA assay at one center. Interval PSA levels for men undergoing screening with a greater than 1 year interval were calculated on the assumption that PSA levels changed over time in a simple exponential fashion. Then, the cumulative rate of freedom from PSA increase above 4.0 ng/ml was estimated using the Kaplan-Meier technique stratified by baseline PSA ranges of 0.0 to 1.0, 1.1 to 2.0, 2.1 to 3.0 and 3.1 to 4.0 ng/ml and every 10 years of age ranges. Of the 7,757 subjects, 559 (7.2%) were expected to have had PSA levels increase above 4.0 ng/ml within 5 years after the baseline PSA measurements. The cumulative rate of freedom from the PSA increase above 4.0 ng/ml at 5 years was 98.7%, 92.9%, 70.3% and 38.5% in cases of baseline PSA levels of 1.0 ng/ml or lower, 1.1 to 2.0 ng/ml, 2.1 to 3.0 ng/ml and 3.1 to 4.0 ng/ml, respectively. The cumulative rates of freedom from the PSA increase were significantly decreased with the baseline PSA ranges being higher regardless of age range. Re-screening interval should be set stratified by baseline PSA levels, regardless of age and race. Rescreening interval should be set at 1, 1 to 2 and 3 to 5 years for men with baseline PSA ranges of 2.1 to 4.0 ng/ml, 1.1 to 2.0 ng/ml and 0.0 to 1.0 ng/ml, respectively, in individual-based screening. In mass screening system using PSA alone, rescreening interval should be set in the same manner as in individual-based screening, except for men with baseline PSA levels of 1.1 to 2.0 ng/ml, which should be set at 1 year to avoid developing incurable prostate cancer. © 2004 Wiley-Liss, Inc.

In order to clarify the incidence of bladder cancer with and without prostate cancer, we investigated bladder cancer discovered incidentally by urethrocystoscopy at prostate biopsy. Between April 1997 and December 2003, 498 patients who were suspected prostate cancer were performed prostate biopsy and urethrocystoscopy simultaneously. We investigate possible invasion of prostate cancer into the urethra or bladder mucosa as well as bladder cancer, including other benign lesions of the bladder by urethrocystoscopy. Prostate cancer was confirmed in 175 (35.1%) of the 498 patients histologically, and bladder cancer was discovered incidentally in 12 patients (2.4 %). The incidence of bladder cancer in patients with prostate cancer of 2.3% (4/175) was not significantly different from that in patients without prostate cancer, which was 2.5% (8/323). Superficial and those with a size less than 1 cm were noted in 11 patients (92%) and 10 patients (83%) respectively. High incidence rate of bladder cancer with prostate cancer was reported previously, however, there was no study to compare the incidence rate of bladder cancer between cases with and without prostate cancer. The present study suggests that asymptomatic tiny bladder cancer may be present at an unexpectedly high incidence rate in elderly males.

Objectives To investigate the natural history of prostate-specific antigen (PSA) increase in men with and without prostate cancer to clarify the probability of cancer-related PSA increase. Methods Between 1986 and 2001, 504 men aged 79 years or younger with baseline PSA levels of 4.0 ng/mL or less and a PSA increase greater than 4.0 ng/mL on consecutive screening were enrolled in this study. The types of PSA increase were classified as “non-cancer-related PSA increase,” “suspicious cancer-related PSA increase,” and “cancer-related PSA increase.” The probability of a “cancer-related PSA increase” was investigated and stratified by baseline PSA levels and elapsed years until the PSA level increased to greater than 4.0 ng/mL. Results The probability of a “non-cancer-related increase,” “suspicious cancer-related PSA increase,” and “cancer-related PSA increase” was 57%, 15%, and 28%, respectively. The PSA velocity before the PSA increase was not significantly different between those with and without prostate cancer. A “non-cancer-related PSA increase” was observed in 92% of those with a PSA increase within 2 years of baseline PSA ranges of 2.0 ng/mL or less. Regardless of elapsed years until a PSA increase to greater than 4.0 ng/mL, a “suspicious cancer-related PSA increase” or “cancer-related PSA increase” was observed in almost one half of those with baseline PSA levels of 2.1 to 4.0 ng/mL. Conclusions Intensive serial observations should be recommended before undergoing biopsy for those with a PSA increase within 2 years of a baseline PSA range of 0.0 to 2.0 ng/mL. It may be difficult to distinguish between those with and without cancer using only subsequent total PSA measurements for the remaining cases, and prostate biopsy should be recommended at present.

Aim: Vitamin D acts as an antiproliferative agent against prostate cells. Epidemiological study has shown that a low level of serum vitamin D concentration is a risk factor for prostate cancer. Vitamin D acts via vitamin D receptor (VDR), and an association of genetic polymorphisms of the VDR gene has been reported. In the current study, we examined the association of VDR gene polymorphisms with familial prostate cancer in a Japanese population. Methods: We performed a case–control study consisting of 81 familial prostate cancer cases and 105 normal control subjects. Three genetic polymorphisms (BsmI, ApaI and TaqI) in the VDR gene were examined by the restriction fragment restriction length polymorphism method. Results: Overall, there was no significant association of the VDR gene polymorphisms with familial prostate cancer risk in the cases and control subjects. However, a weak association between BsmI or TaqI genotypes and cancer risk was observed in subjects under 70 years of age. Stratification of cases by clinical stage or pathological grade did not show significant association between the VDR gene polymorphisms and prostate cancer risk. Conclusion: In the present study, we could not confirm any significant association between VDR gene polymorphisms with familial prostate cancer risk in a Japanese population. Further large-scale case–control studies are warranted to confirm the importance of VDR gene polymorphisms in familial prostate cancer.

Objectives To evaluate the usefulness of measuring the free/total prostate-specific antigen (PSA) ratio (%fPSA) in men with initial PSA levels of 4.1 to 10.0 ng/mL as a predictor of the future risk of developing prostate cancer. Methods Between 1989 and 2001, 201 subjects with an initial PSA level of 4.1 to 10.0 ng/mL, who had free PSA measured at initial screening using frozen serum and underwent consecutive screening at least once, were enrolled in this study. All participants were followed up by consecutive PSA measurements. Biopsies were performed for those with PSA levels greater than 10.0 ng/mL or with a PSA velocity of 1.0 ng/mL or greater in consecutive screening. The follow-up period was 1 to 12 years, and the mean number of screenings was 3.8. The usefulness of %fPSA, age, and total PSA as predictive factors of future prostate cancer morbidity was investigated. The cumulative non-prostate cancer rate was evaluated using Kaplan-Meier analysis relative to various %fPSA cutoffs. Results A total of 142 patients (71%) underwent prostate biopsy at least once during observation according to the biopsy criteria. The detection rate of prostate cancer was 26% (53 of 201) in consecutive screening. The most recent PSA velocity and serum PSA levels at last follow-up in patients with prostate cancer were significantly higher than in those without prostate cancer. The cumulative non-prostate cancer rate was significantly greater in subjects with %fPSA less than the cutoff than in those with %fPSA at the cutoff point or greater in the %fPSA cutoffs of 16% to 25%. Conclusions Men with PSA levels of 4.1 to 10 ng/mL who are not suspected of having prostate cancer by whatever means should undergo %fPSA measurement and be carefully monitored at short intervals over the long-term if they have lower %fPSA levels.

Background: It is important to preserve the neurovascular bundle (NVB) during nerve-sparing surgery. This article presents the preliminary results of our monitoring system for the postoperative preservation of erectile function. Methods: In 15 patients undergoing radical prostatectomy and 20 patients undergoing radical cystoprostatectomy, intraoperative electrical stimulation along the NVB was performed to measure changes in intracavernous pressure before and after prostate removal. Seven of the radical prostatectomy patients and eight of the radical cystoprostatectomy patients underwent nerve-sparing surgery. Postoperative erectile function was evaluated in 25 patients not receiving adjuvant hormonal therapy. Results: The NVB was judged to be preserved at least on one side electrophysiologically in 14 of 15 patients. Pathologically, three patients had pT3 cancer. Postoperatively, sufficient erectile function was demonstrated using the International Index of Erectile Function 5 in three patients, nocturnal penile tumescence in three patients, and a questionnaire or an interview in three patients. The other patients were incompletely erectile. None of the 11 patients not receiving adjuvant hormonal therapy, in whom NVB was not preserved, were erectile. Conclusion: If the successful criterion of nerve-sparing surgery is defined as a change in intracavernous pressure of 4 cm H2O or more being observed at least unilaterally, and the successful criteria of erectile function preservation includes being sufficiently erectile as revealed by an interview, the sensitivity of our system was 69.2% (9/13) and the specificity was 100% (12/12). Neither adverse reactions to the measurement, nor inadequacy of cancer excision accompanying NVB sparing, were observed. These results suggest that our system can predict postoperative erectile function fairly accurately.

The purpose of this study was to clarify the androgen-ablation-induced morphological changes in the capillaries and stroma near the epithelial cells in prostate and seminal vesicles (SV) using transmission electron microscopy (TEM). In ventral prostate (VP) and SV of immature male rats, the luminal areas of subepithelial capillaries and the width of the stromal layers between endothelia and epithelia were measured quantitatively after castration using TEM and a computed image analyzer. The luminal areas of the capillaries were significantly reduced in VP and SV in the short-term after castration. In the stromal layer, the width of the collagen layer surrounding the capillary significantly increased in VP and SV in the long-term after castration. These data suggest that the reduction of the capillaries and the thickening of collagen surrounding them are related to the involution of glandular epithelial cells in VP and SV after castration.

Background and Aims : To investigate the usefulness of intraarterial chemotherapy (IAC) with CDDP powder and lipiodol suspension (LCS) for invasive bladder cancer as a dose escalation modality of conventional IAC, we administered LCS into the internal iliac artery of dogs and evaluated pharmacokinetics of CDDP. Methods : An angiographic catheter was inserted to the internal iliac artery of an anesthetized dog under fluoroscopic guidance. CDDP solution, LCS, or a combination of CDDP solution and LCS were intra-arterially infused. For comparison, CDDP solution was also intravenously infused. The dose of CDDP ranged from 1 to 3 mg/kg. For combination study, the dose of CDDP ranged from 3 to 5 mg/kg. In all groups, blood samples were collected 5, 15, 30, 60, 120, and 180 minutes after administration, and serum Pt levels were measured. Results : In the LCS group, the serum Pt level was lower than those after intravenous or intraarterial infusion of CDDP solution. In the combination therapy group, the serum Pt level increased with the total dose of CDDP. Conclusions : Intraarterial infusion of LCS showed a lower systemic CDDP level. This method may reduce the incidence of side effects, suggesting the usefulness of intraarterial infusion therapy with LCS for invasive bladder cancer.

We attempted to identify factors that predict the outcomes of salvage external beam radiotherapy (sEBRT) in patients who showed local recurrence without systemic progression or isolated prostate specific antigen (PSA) recurrence after initial hormonal therapy.The subjects were 33 patients who were diagnosed as having local recurrence without systemic progression (30 cases) or isolated PSA recurrence (three cases). Of these patients, those with continuously decreasing PSA levels, which were 1.0 ng/ml or less 1-1.5 years after sEBRT, were regarded as good responders (GR) whereas the remaining patients were regarded as poor responders (nGR). Survival rates in these patients and factors that distinguish GR from nGR were evaluated retrospectively.The cancer-specific 10-year survival rate was 82.4% in the 33 patients, 100% in the 21 GR patients and 55% in the 12 nGR patients (P0.0001). Stepwise variable selection to discriminate between GR and nGR revealed that the time from sEBRT initiation to the nadir PSA was the most significant factor (P = 0.000097). Before sEBRT, GR can be predicted in patients with pre-sEBRT PSA30.0 ng/ml and PSA doubling time (PSADT)7.0 months, with a sensitivity of 95.2% (20/21), a specificity of 100% and an accuracy of 97.0%.Good responses to sEBRT can be expected in patients with local recurrence without systemic progression or isolated PSA recurrence after initial hormonal therapy when the patients show both pre-sEBRT PSA30.0 ng/ml and PSADT7.0 months.

BACKGROUND The authors evaluated a new age-adjusted and prostate volume-adjusted biopsy method for the detection of prostate carcinoma through the transperineal and the transrectal approaches in men with PSA levels of 4.1–10.0 ng/mL. METHODS The value of the adjusted biopsy method was calculated by using the following four factors: 1) life expectancy in Japanese men in 1998, 2) prostate volume estimated by transrectal ultrasonography, 3) tumor doubling time (4 years), and 4) tumor volume that influenced death (20 cc). The number of biopsy sites was set at 8–20. Between August, 1999 and December, 2001, 100 men age ≤ 79 years with prostate specific antigen (PSA) levels of 4.1–10.0 ng/mL underwent age-adjusted and volume-adjusted, systematic prostate biopsy. RESULTS The detection rate for the adjusted biopsy method was 46% (46 of 100 men). The clinical stage of prostate carcinoma was Stage II in 85% of patients and Stage III in 15% of patients. If routine six-sextant biopsy had been performed in all of the men who underwent adjusted systematic biopsy, then 15 of 46 patients (33%) with prostate carcinoma would have been missed. The detection rates of prostate carcinoma in men who underwent adjusted biopsies were relatively high, especially in men with PSA levels of 6.1–10.0 ng/mL, men age ≤ 64 years, men with prostate volumes ≥ 50 cc, and men with PSA density (PSAD) levels ≤ 0.15 ng/mL/cc compared with the detection rates from six-sextant and directed biopsies. The high detection rates were observed from biopsy sites at the posterior aspect of the lateral lobe through both the transperineal approach and the transrectal approach and at the anterior aspect of the transition zone through the transperineal approach. CONCLUSIONS The age-adjusted and prostate volume-adjusted prostate biopsy method was more useful for detecting clinically significant disease compared with the traditional six-sextant biopsy method. This adjusted biopsy method was especially useful in patients age ≤ 64 years, patients with large prostate volumes (≥ 50 cc), and patients with PSAD levels ≤ 0.15 ng/mL/cc. The authors recommend that patients undergo an additional transition zone biopsy at the anterior aspect through the transperineal approach. Cancer 2002;95:2112–9. © 2002 American Cancer Society. DOI 10.1002/cncr.10941

群馬大学医学部附属病院において1995年1月1日から2000年12月31日までの6年間にシャントと腹膜透析カテーテル関連手術以外の手術療法を受けた慢性維持透析患者延べ213名について, 手術内容, 基礎疾患などを検討し, 特に1999年と2000年の全身麻酔下手術症例に関しては手術前検査値, 手術後合併症なども検討した.各年ともに眼科系手術が約50%を占めていたが, 各科にわたりmajor surgeryが積極的に施行され, 心, 血管系手術は毎年施行されていた. 眼科系手術症例は糖尿病を基礎疾患として透析導入後比較的早い時期に手術が施行されていた.1999年 (16例) と2000年 (14例) の全身麻酔下手術症例の検討では, 2000年症例の方が手術時平均年齢の高齢化傾向や平均維持透析期間の長期化傾向を認めた. また, Hct, Hb, TP, BUN, 血清クレアチニン値などの手術前検査値が改善していた. 手術後合併症は感染症 (手術創移開, 肺炎) が最も多く, 次に出血 (消化管出血や脳出血) が続いた. 手術後合併症出現症例の基礎疾患は糖尿病と悪性腫瘍が多くを占めた.維持透析患者の周術期管理方法の改善により維持透析患者の手術適応は拡大し積極的に手術が施行されている. しかし, 基礎疾患に糖尿病と悪性腫瘍を持つ維持透析患者に関しては, 手術後合併症予防管理方法にまだ課題が残っている.

症例は51歳男性, 排尿時痛を主訴に当科を初診した.膀胱内視鏡にて膀胱頂部に非乳頭状広基性腫瘍を認めた.CT, MRIにて長径3cmの浸潤型膀胱腫瘍を認め, 遠隔転移は認めなかった.膀胱生検を施行したところ平滑筋肉腫が疑われた.局所進展の制御目的に両側上膀胱動脈からシスプラチン注入療法と動脈塞栓療法を施行した後, 根治的膀胱全摘除術及び自排尿型代用膀胱造設術を行った.術後診断は膀胱原発平滑筋肉腫pT2, pNO, MOであった.術後経過は良好で12ヶ月後の現在, 再発転移の所見を認めていない.平滑筋肉腫は膀胱腫瘍では比較的稀な組織型であり本邦報告例を集計し検討した.

The patient was a 47-year-old male, who visited Hidaka Hospital with a chief complaint of swelling in the right inguinal region and the scrotum. With a diagnosis of a right spermatic cord tumor, right high orchiectomy was performed. Since an inflammatory type of malignant fibrous histiocytoma (MFH) was diagnosed from histopathological findings, chemotherapy and radiation therapy were performed as postoperative treatment. Malignant fibrous histiocytoma with the primary focus of the spermatic cords is a rare disease. To our knowledge, this is the 20th case of MFH of the spermatic cord in Japan (the 42nd in the world) and it is the second case of inflammatory type of MFH in Japan.

Androgen insensitivity syndrome (AIS) is an X-linked recessive disorder. The molecular mechanism of AIS is reduction or absence of androgen signalling caused by androgen receptor (AR) malfunction or absence. The phenotype of AIS varies from a complete female phenotype (complete AIS, CAIS) to male genitalia with mild hypospadias (partial AIS, PAIS). In the current study, we characterize a novel point mutation in the ligand binding domain of the AR gene in a 50-year-old Japanese CAIS patient. Sequence analysis showed a single point mutation at nucleotide 3359 (Genbank, NM 000044), T to C, in exon E in the AR gene. This mutation led to the conversion of codon 739 tyrosine into aspartic acid in the ligand binding domain. No specific androgen binding was detected in genital fibroblasts isolated from the patient. Transcriptional activating activity of the mutant AR was examined by transient DNA transfection into COS-1 cells. Wild-type AR successfully activated androgen inducible MMTV promoter dose-dependently. In contrast, the mutant AR did not activate MMTV promoter. Thus, we demonstrated the molecular characteristics of the novel point mutation in the ligand binding domain of the AR gene associated with CAIS. This information will provide a further understanding of the structure and function of the AR gene.

群馬大学医学部附属病院における1999年の外来初診患者の臨床統計を報告した.総数729名であり, 男性529名, 女性200名で男女比は2.65:1であった.紹介患者は61.5%(448名)で院外の紹介が48.0%(350名)を占めていた.悪性新生物は96例で, 前立腺癌38例, 腎癌18例, 膀胱腫瘍17例, 精巣腫瘍10例であった.良性新生物では前立腺肥大症が205例と大部分を占めていた.その他, 多い疾患として尿路結石59例, 血液透析51例, 膀胱炎46例と続いた.市中病院の報告に比し, 悪性腫瘍, 男性不妊, 透析関係は多く, 包茎, 外傷, STDは少ない傾向だった.

BACKGROUND Long term follow-up for subjects whose initial prostate specific antigen (PSA) levels were 4.0 ng/mL or lower was conducted to investigate the proper interval for PSA screening. METHODS Eight thousand five hundred ninety-five men aged 50 years or older with an initial PSA level of 4.0 ng/mL or lower were screened with tumor marker measurement and/or digital rectal examination (DRE) and/or transrectal ultrasonography as a first step in the mass screening, and a prostate biopsy was performed for individuals with abnormal findings. RESULTS Cancer was detected in 0.18% (8 of 4526), 1.0% (27 of 2724), and 3.6% (49 of 1345) of men whose initial PSA levels were lower than 1.0, 1.0–1.9, and 2.0–4.0 ng/mL, respectively. Among these prostate carcinoma cases, 25% (6 of 8), 56% (15 of 27), and 63% (31 of 49) were detected by abnormal PSA in patients with initial PSA levels lower than 1.0, 1.0–1.9, and 2.0–4.0 ng/mL, respectively. The detection rates of prostate carcinoma within 3 years after the initial visit were 0.07%, 0.24%, and 1.2% in cases with initial PSA levels lower than 1.0, 1.0–1.9, and 2.0–4.0 ng/mL, respectively. CONCLUSIONS It is recommended that DRE and PSA measurements should be performed once every 3 years in individuals with initial PSA levels of less than 1.0 ng/mL. The prostate carcinoma detection rate increased over time in individuals with initial PSA levels of 1.0 to 4.0 ng/mL, especially in cases with 2.0–4.0 ng/mL, and annual measurement of PSA was more useful than DRE. Therefore, it is recommended that PSA screening should be performed once every year for individuals with initial PSA levels of 1.0 to 4.0 ng/mL. Cancer 2001;91:744–51. © 2001 American Cancer Society.

1993年1月から1999年4月までの約6年間に群馬大学医学部附属病院泌尿器科において加療を行った精巣腫瘍77例に対して臨床的検討を行った.胚細胞性腫瘍が71例を占め, セミノーマが34例, 非セミノーマが37例であった.非胚細胞性腫瘍は悪性リンパ腫5例, Leydig cell tumorが1例であった.年齢は0歳から75歳に分布し, 30歳代が最も多かった.病理組織型別, 臨床病期別の生存率の比較を行ったが, それぞれセミノーマ, 早期症例で良好であったが有意差を認めなかった.再発症例は4例あり, そのうち2例が癌死した, また, 初回化学療法が奏功せずに進行症例2例が治療開始後1年以内に癌死した.治療上の課題として, 進行症例における化学療法の選択基準早期症例におけるsurveillance policy導入の是非などがあげられ, 今後なお検討を要すると考えられた.

八味地黄丸の膀胱機能に対する作用を検討した.実験は麻酔下イヌ生体位膀胱を用い, 八味地黄丸抽出エキス溶液を静注して行った.八味地黄丸10mg/kg投与では律動的膀胱収縮頻度を軽度増加させたが, 100mg/kg投与では収縮頻度を抑制した.八味地黄丸, 硫酸アトロピン共に収縮振幅を抑制した.膀胱内圧測定では八味地黄丸は最大膀胱容量と有効膀胱容量を有意に増加させた。硫酸アトロピン (0.1mg/kg) は最大膀胱収縮圧を低下させたが, 八味地黄丸では見られなかった.これらの所見より, 八味地黄丸が頻尿治療に有用な薬剤であることが示唆された.

群馬県の前立腺がん数は16年間で約7倍に増加し, 検診で発見されたがんの約60%は前立腺内に限局する早期がんである.診断精度も1992年以降の前立腺特異抗原 (PSA) の測定, 生検法の進歩により向上した.PSAは血中遊離型と結合型PSAを等モルに認識できるキットで測定されるべきで, われわれはさらに年齢階層別PSA, PSA density, 年隔差PSAなどを使い分けて診断に使用している.現在70%の市町村はPSA単独検診であるが, 重要な問題点としてPSA陰性がんの存在があげられる. PSA陰性がんは今までの他検査を併用した検診で発見された前立腺がん303例中43例 (14%) を占めるが, そのうち骨転移を有する症例は6例 (2%) のみであった. PSA単独検診は今までの直腸診や経直腸的超音波検査を取り入れた検診に比べ, 受診者の精神的負担が少なく, 受診者が増加し, 結果的には前立腺がんの発見数の増加につながると考えられる.

BACKGROUND Our aim was to assess the effect of dual inhibition of 5-alpha-reductase and aromatase on prostate glands. METHODS We investigated the morphological changes in the prostate gland and the changes in the hormonal environment after administration of finasteride and arimidex to intact canine specimens. The study consisted of four groups: a 5-alpha-reductase only group (5RI only, n = 5); a 5RI plus aromatase-inhibitor combination group (5RI + ARI combination, n = 5); a BPH control group (n = 3); and a castration control group (n = 3). Finasteride (1 mg/kg/day) and the same dose of arimidex were orally administered for 80 days. RESULTS In the 5RI group, a significant decrease in the serum dihydrotestosterone (DHT) level was found, and prostatic volume was significantly decreased. However, significant increases in serum testosterone (T) and DHT levels were observed, with a concomitant increase in prostatic volume in the 5RI + ARI combination group. Morphometric analysis showed that histopathological findings in the 5RI + ARI combination group were similar to those in the BPH control group. CONCLUSIONS Dual inhibition of 5-alpha-reductase and aromatase resulted in a significant increase in prostate volume, accompanied by a 3–10-fold increase in serum testosterone levels and a significant increase in testicular volume. Prostate 37:70–76, 1998. © 1998 Wiley-Liss, Inc.

群馬大学医学部附属病院泌尿器科における1996年の外来初診患者の臨床統計を報告した.総数878名であり, 男性629名, 女性249名で男女比は2.52 : 1であった.年齢は, 男女ともピークは60～69歳に認めた.紹介患者は68.2% (599名) で, 他医よりの紹介が43.1% (378名) を占めていた.悪性新生物は149例あり, 前立腺癌51例, 腎癌41例, 精巣腫瘍25例および膀胱腫瘍19例であった.良性新生物では前立腺肥大症が100例と大部分を占めていた.その他多い疾患として, 尿路結石が60例, 以下, 移植・透析関係54例, 膀胱炎35例であった.他報告に比し, 前立腺癌, 腎癌, 移植・透析関係, 精巣腫瘍が多く, 膀胱炎, 膀胱癌STD, 包茎, 亀頭包皮炎, 外傷などは少ない傾向だった.

1982年-1996年の15年間に群馬大学医学部附属病院で診断治療された膀胱癌314症例に対し臨床的検討を行った.男女別では男性229例, 女性85例で男性 : 女性は2.7 : 1であった.年齢は17歳から97歳で平均は68.2歳であった.表在性腫瘍, 浸潤性腫瘍の5年生存率はそれぞれ94.8%, 48.2%であった.腫瘍形態, 腫瘍茎性状, 腫瘍径, 腫瘍数組織学的異型度, 深達度等により生存率を比較したところ, 乳頭状, 有茎性, 1 cm未満, 単発, transitional cell carcinoma G1, pTa が有意に予後良好であった.膀胱全摘後の尿路変向は回腸導管造設術が多く施行されてきたが, 最近では蓄尿型尿路変向術や尿道温存尿路再建術 (新膀胱形成術) も行われるようになってきた.浸潤性腫瘍の治療については, 患者のQOLも考慮し, 更なる検討が必要であると考えられた.

To assess the limitation of standard cisplatin-based combination chemotherapy for metastatic germ cell tumor, clinical records of 37 patients with metastatic testicular cancer and extragonadal germ cell tumor treated with primary chemotherapy were reviewed. Thirteen patients of 37 had limitation of the treatment. We categorized the mode of treatment limitation into 5 criteria according to the response of tumor marker levels and radiographic findings, and recurrence. Tumor volume was strongly associated with the limitation of the treatment. Indiana University Staging System, not Royal Marsden Hospital's classification clearly discriminated the patient with limitation of standard cisplatin-based combination chemotherapy. High dose chemotherapy was effective for patients to whom the initial chemotherapy with standard cisplatin-based regimen was effective. It did not offer any benefit to patients with refractory tumor. We conclude that it is important to introduce more aggressive chemotherapy regimens as an initial chemotherapy to patients with large volume tumor.

症例は, 64歳, 男性.排尿障害を主訴に当科に紹介された.日本泌尿器科学会前立腺肥大症重症度判定基準では, 自覚所見重症, 他覚所見中等症であった.α1-ブロッカーによる治療を行ったが効果無く, 4ヶ月目に経尿道バルーンレーザー高温度治療 (TUBAL-T) を施行した.徐々に, 自覚他覚所見ともに改善が見られ, 14ヶ月後には前立腺体積の50%の減少が見られた.一般に高温度治療にては前立腺体積への影響は少ないと言われているが, 本症例では著明な前立腺縮小が得られたので, 若干の文献的考察を加え報告した.

Background: Transurethral balloon laser thermotherapy (TUBAL-T) improves objective, but not subjective, symptoms of benign prostatic hyperplasia (BPH). We studied whether or not an Nd:YAG laser beam with a shielded balloon could successfully irradiate the prostate during TUBAL-T in a selective manner, to improve the subjective symptoms. Methods: TUBAL-T was performed on canine prostates using the balloon with a laser probe, which was shielded anteriorly at 90 degrees (from the center of the balloon) and posteriorly at 90 degrees. Results: At 20 watts laser power, the relative power density in the bilateral non-shielded areas was 17.4 and 17.8, and in the shielded area it was 1.0. Observation by thermography revealed that the temperature after laser radiation in a non-shielded area of a fish cake phantom was higher than in a shielded area. Following transurethral thermotherapy using a shielded balloon in dogs, a cavity was formed bilaterally around the urethra, and the tissues at the anteroposterior sides and the urethra were preserved. Conclusions: TUBAL-T, which has been performed in clinical cases of benign prostatic hyperplasia, might be useful in selective irradiation of adenoma if a shielded balloon is used.

Five patients with chronic non-bacterial prostatitis, which was resistant to conventional treatments, underwent transurethral balloon laser hyperthermia (TUBAL-H), and were followed for more than one year. In regard to the chief complaints, the symptoms were resolved in 1 patient and improved in 4 at three months after treatment, and improved in 2 and persisted in 1 at one year after treatment. According to I-PSS scores, the symptoms were improved in 4 patients and persisted in 1 at three months, and improved in 2 and persisted in 1 at one year. White blood cells in expressed prostatic secretions were absent in 4 patients and decreased in 1 at three months, and absent in all cases between six months and one year. TUBAL-H was thought to be useful for treating chronic non-bacterial prostatitis.

To evaluate the impact of radical prostatectomy on the quality of life (QOL) in patients with prostate cancer, we assessed the responses of 12 patients to a self-administered questionnaire 6-95 months (median 36 months) postoperatively. The QOL assessment focused on urinary disturbance, urinary incontinence and sexual function, which seem to be the major issues in deciding whether to perform radical prostatectomy.IPSS (International Prostate Symptom Score) for urinary disturbance was 3 points and a satisfactory grade was 2 points. Items reflecting irritative symptom were predominant, but no replies were very severe. Postoperative urination was good on the whole.In regard to incontinence, 58% reported some problem with wetness. Judging from the number of incidents of incontinence per day, the frequency of pad changes and impression of present status, the condition of two patients seemed to be serious, but their daily activities were not restricted. We therefore concluded that QOL about continence were not disturbed as a whole.As for sexual function, since many patients were on adjuvant hormonal treatment, we could not evaluate sexual function in detail. But 57% of all were dissatisfied with their postoperative sexual function, so our results were concluded not to be sufficient.

A 26-year-old man with testicular cancer was treated with combination chemotherapy (cisplatin, etoposide and bleomycin). He underwent salvage surgery after four courses of treatment. Postoperatively, he suffered pneumonia caused by methicillin-resistant staphylococcus aureus (MRSA) leading to septic shock. In spite of an inflammatory response, his peripheral leukocyte blood cell count was rather low due to post chemotherapy myelosuppression. We administered granulocyte-colony stimulating factor concomitant with antibiotics, such as vancomycin. Immunocompromised status caused by myelosuppression after chemotherapy and the stress of major surgery were considered worsening factors for MRSA infection. In patients with metastatic testicular cancer, in which major surgery is performed after chemotherapy, preoperative MRSA surveillance and careful postoperative careful management are important.

Transurethral balloon laser-enhanced thermotherapy (TUBAL-ET) using ultrafine carbon particles was performed, and the temperature distribution in a phantom was determined by using a thermograph. Carbon particles 0.1ml were injected into a fishcake phantom 5mm from a shielded balloon surface, and TUBAL-ET was performed at a laser power of 30, 40 or 50 watts. Three minutes after treatment, the temperature was highest 5mm below the balloon surface and the distribution pattern was ellipsoidal. Injection of carbon particles to the phantom raised the temperature to between 14°C and 21°C higer than on the contra-lateral side with continuous irradiation at 30 watts, between 15°C and 26.2°C at 40 watts, and 21°C and 33.6°C at 50 watts. Intermittent irradiation raised the temperature 11°C higher at 30 watts, 13°C higher at 40 watts, and 16°C higher at 50 watts. These findimgs suggest that TUBAL-ET could be performed by using a agent which absorbs Nd : YAG laser energy.

Transurethral balloon laser thermotherapy (TUBAL-T) was performed in 30 patients with benign prostatic hyperplasia (BPH), and the mechanism of TUBAL-T was assessed by a pathological study. The urethra was cooled by a urethral cooling system during the treatment, and the prostatic tissue at 5 to 10mm depth from the urethral surface was heated to more than 45 degrees C. The depth of tissue damages ranged from 10 to 20mm from the urethral surface by CT or MRI. Pathological studies immediately after the treatment indicated the detachment of prostatic epithelia from the basement membrane, nuclear degeneration and coagulonecrosis of the smooth muscle cells, swollen endothelial cells, and stasis of leukocytes in the vessels. The mechanism of TUBAL-T was thought to be an effect of the direct heat to BPH tissues and circulatory disturbances which may accelerate tissue damage.

Retroperitoneal lymphnode dissection after chemotherapy is a definite strategy for treating progressive testicular cancer. To access the surgical approach to the retrocrual space, we performed a dissection. The left diaphragm crus was adjacent to the left adrenal glad, the right one to the inferior vena cava. The ventral site of the aortic hiatus was not fully visible because of superior mesenteric and celiac arteries and surrounding connective tissue. Left side approach is the only route to retrocrual space, when the routine procedure for the approach to retroperitoneal space is used. To resect a metastatic mass in retrocrual space completely, other approaches, such as the thoracic approach, procedures for total gastrectomy, are necessary.

For 7 cases of bladder stones, we carried out transurethral lithotripsy by using an ultrasonic lithotripter (UL), an electrohydraulic lithotripter (EHL) or a ballistic lithotripter (BL), and evaluated the safety, usefulness and therapeutic indication for each lithotripter.With the UL, though the power was weakest, there was little stone movement at irradiation and the view was good owing to continuous irrigation, and there was no mucosal injury due to misdirected irradiation. With the EHL, though the power was strongest, stone movement at irradiation was greatest, and mucosal injury occurred due to misdirected irradiation, and the probe was exhausted rapidly. BL was similar to EHL, but BL is more useful than EHL when safety and running cost are considered.From our consideration, small stones less than 2 cm can be treated by UL only. In case of larger stones, we recommend that the stone be divided into small pieces by BL at first and that the small fragments be disintegrated by UL.

We reviewed 37 cases of acute scrotum experienced in Tone Chuo Hospital between June 1 1987 and December 31, 1994. The final diagnoses in 37 were trauma in 6, tumor in 3, acute epididymitis in 21, torsion of testicular cord in 4, torsion of appendage in 2 and acute orchitis in 1. Patient mean age were 41.4 in trauma, 30.0 in tumor, 43.8 in acute epididymitis, 10.5 intorsion of testicular cord, 8.0 in torsion of appendage and 27 in acute orchitis. The interval between onset and hospital visit were 5.8 hours in trauma, 84 hours in tumor, 72.6 hours in acute epididymitis, 7.25 hours in torsion of testicular cord, 42 hours in torsion of appendage and 24 hours in acute orchitis. The testes in 4 cases torted intravaginally and had anatomical abnormality of testis fixation. We performed orchiopexy for the affected sides and other sides, which also had an abnormality of testis fixation. We were able to preserve all testes except for 3 cases of tumor.

Estrogen plays an important role in the development of benign prostatic hyperplasia (BPH), as has been shown in both experimental and clinical studies. T determine the endocrine environment of BPH, serum total testosterone (Total-T), free testosterone (Free-T), and estradiol (E2) conceptions were measured, and the relationship between these levels and prostate size and volume was analyzed. Blood samples were collected from subjects who attended the mass screening for prostate disease performed by our institute. No significant correlations were found between Total-T levels, Free-T levels, and prostate size, as determined by digital rectal examination. However, E2 levels and the ratios for E2 levels and the ratios for E2/Total-T and E2/Free-T were significantly correlated with prostate size. To confirm these relationships, prostate volume was calculated from transrectal ultrasonographic images. E2 levels and these two ratios were, indeed, highly correlated with prostate volume. These results suggest that an estrogen-dominant environment plays an important role in the development of BPH.

Primary chemotherapy and postchemotherapeutic salvage surgery for residual tumors were definite strategies for progressive testicular cancer. To resect multiple metastatic lesions, the one-stage operation consisted of retroperitoneal lymphnode dissection, thoracotomy, sternotomy or cervical dissection was performed by the staffs of urological and surgical units. Although the operation took a rather long time, no definite complications did not occur.The metastatic lesions were able to be resected completely in all cases.Recurrence occured in 2 patients with pure teratoma and another salvage surgery was performed to them. As a current status, three patients have no evidence of disease and one have no radiographical abnormality with a slight elevation of β-hCG level. We concluded that the one-stage operation for multiple lesions was well tolerable and was beneficial for the management of progressive testicular cancer.

For 36 (37 stones) patients with upper urinary calculi, 41 extracorporeal shock wave lithotripsies (ESWL) were performed using the Dornier MFL 5000. Of these cases, 8 (9 stones) patients had renal calculi and the remaining 28 patients had a ureteral calculus. As for the treatment number, 34 cases received single treatment, 2 cases twice and 1 case 4 times.Two patients received epidural anesthesia and the remainder received analgesic suppositories to suppress treatment induced pain. In order to accurately detect the location of the stone, ultrasound was selected as the method for 2 treatments, while fluoroscopic imaging was selected for 39 treatments. Average shock wave number per treatment was 3055 shots, and the average treatment time was 98 minutes. Auxiliary procedures before ESWL were required in 9 patients : four insertion ureteral catheter, one indwelling J stent, three saline infusions to the urinary bladder, and one nephrostography.The overall success rate (stone free and residual fragments less than 4 mm, 1 month after ESWL) was 89.2%, and the rates were 88.9% for renal calculi and 89.3% for ureteral calculus. As for complications, slight hematuria occurred in 80% of 41 treatments.ESWL, using a Dornier MFL 5000, were considered to be safe and effective.

Background and Objective: To demonstrate surgical complications in transurethral balloon laser prostatectomy by medium-term, follow-up observation. Study Design/Materials and Methods: Three dogs were treated with transurethral laser irradiation using 15 watts for 20 minutes at 60°C at a 5 mm depth of the prostate, one dog was for 5 minutes with same parameters, and one dog was with only laser balloon probe as a control. All animals were followed for 24 weeks. Results: A large cavity in the prostatic urethra was formed in laser-treated animals 4 weeks later, whereas the cavity in the balloon-treated animals was not shown. Cavity volume did not significantly change for 6 months, and there was no bladder neck stricture or urethral stenosis observed in any case. An increase in collagen fibers in the periurethral tissue was barely observed by Mallory staining. Conclusion: The risk of bladder neck stricture and urethral stenosis was estimated to be low for transurethral balloon laser prostatectomy. © 1995 Wiley-Liss, Inc.

A 21-year old man with embryonal carcinoma arising from anterior mediastinum was treated with high dose chemotherapy with autologous bone marrow transplantation. His elevated α-fetoprotein level was decreased and the metastatic pulmonary lesion was disappeared. Surgical specimen of the residual tumor revealed complete necrosis. He has no signs of recurrence of tumor after 4 years of completion of the treatment. We thought that an early intensive chemotherapy for poor-risk tumor brought successful outcome.