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(Objectives) To evaluate the safety and oncologic efficacy of laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) >7 cm, we retrospectively reviewed the clinical outcome and long-term cancer control of patients who underwent LRN in comparison to open radical nephrectomy (ORN). (Patients and methods) The clinical records of 79 patients with RCC >7 cm, who underwent radical nephrectomy (37 LRN; 42 ORN) between 1993 and 2014, were reviewed. (Results) The 2 groups (LRN and ORN) were comparable regarding age, body mass index and mean tumor size (86.5 mm vs. 94.6 mm).The operative time was significantly longer in the LRN group than ORN group (204 min vs. 168 min; p

Prostate-specific antigen screening has significantly increased the percentage of men who are diagnosed with low-risk prostate cancer. All men undergoing retropubic radical prostatectomy for primary treatment of prostate cancer from April 2004 to September 2010 in our hospital were examined in order to determine whether active surveillance criteria could be applied to Japanese men. From pathological data of prostate biopsies, whether these men met five published criteria for active surveillance (Johns Hopkins Medical Institution, Prostate Cancer Research International: Active Surveillance Study, University of California, San Francisco, Toronto and Kakehi criteria) was evaluated. Men who met any of the criteria had a statistically significant lower extracapsular extension rate and organ-confinement rate. From the view of the possibility of Gleason upgrading and organ-confinement rate, the Johns Hopkins Medical Institution and Prostate Cancer Research International: Active Surveillance Study criteria showed to be appropriate for Japanese patients. However, the present study had limitations of selection bias and a limited number of cases.

Objective: We evaluated the efficacy of low dose tamsulosin after extracorporeal shock wave lithotripsy (ESWL) in Japanese male patients with ureteral stone. Methods: One hundred and two Japanese male patients with ureteral stones who underwent ESWL were randomly divided into three groups. Group A (38 patients) was given tamsulosin (0.2 mg/day); group B (30 patients) was given c horeito, a herbal medicine (7.5 g/day); and group C (34 patients) received no medication. Stone clearance was assessed at 1, 7, 14, and 28 days after ESWL using plain abdominal radiography and abdominal ultrasonography. After 28 days, stone delivery was checked every 2 weeks. Results: The stone-free rate was 84.21%, 90%, and 88.24% for groups A, B, and C, respectively (P = 0.3425). The mean expulsion time was 15.66 ± 6.14 days in group A, 27.74 ± 25.36 days in group B, and 35.47 ± 53.70 days in group C. The expulsion time of group A was significantly shorter than that of groups B (P = 0.0116) and C (P = 0.0424). Conclusions: The addition of tamsulosin to conservative treatment appeared to be effective in shortening the stone expulsion time.

Objectives: Chromogranin A (CgA) and neuro-specific enolase (NSE) are gaining acceptance as markers of several types of neuroendocrine tumors and the concentration of CgA and NSE have been reported to be elevated in relation to neuroendocrine differentiation of prostate cancer. The aim of the present study was to examine the correlation between the immunohistochemical (IHC) findings and serum value for CgA and NSE in untreated stage D2 prostate cancer patients. Methods: Immunohistochemistry was carried out using antibodies against CgA and NSE in 58 patients and, pretreatment serum CgA and NSE levels were measured by monoclonal immunoradiometric assay in 18 patients with stage D2 prostate cancer treated by androgen ablation. We examined the relationship of the pretreatment serum level to IHC findings for CgA and NSE in prostate cancer patients to clinicopathological parameters, and prognosis. Also, we evaluated the correlation of IHC findings to serum levels for CgA and NSE. Results: There was a statistically significant correlation between CgA positivity and serum CgA level (P = 0.0421). However, there was no statistically significant correlation between NSE positivity and serum NSE level (P > 0.05). We divided stage D2 patients into three groups according to IHC positivity of CgA and NSE. The cause-specific survival was significantly poorer in patients with strongly positive (++) patients for independent CgA and combined CgA with NSE (P = 0.0379). Multivariate analysis of cause-specific survivals in patients with stage D2 prostate cancer demonstrated that strong IHC stain was considered as independent variable associated with greater risk of death (P = 0.0142). Conclusion: Neuroendocrine differentiation in stage D2 prostate cancer has attracted considerable attention as a potentially findings prognosis. Thus, CgA had a stronger relationship between serum levels and IHC positivity in contrast to NSE, suggesting clinical usefulness as a tumor marker in predicting the extent of neuroendocrine differentiation in prostate cancer.

The aim of this study was to clarify the effects of metabolic syndrome on benign prostatic hyperplasia (BPH) by use of transabdominal ultrasonography in healthy males, the subjects of this study were 333 Japanese men. All subjects were divided to two groups; 146 subjects in the smaller group (prostatic anteroposterior size

Objective: Laparoscopic surgery for primary aldosteronoma and Cushing's syndrome is well established. We report on our experiences with laparoscopic adrenalectomy for pheochromocytoma, and assess the efficacy and safety of the laparoscopic approach. Methods: Between April 1998 and April 2003, a total of 23 patients underwent laparoscopic adrenalectomy for pheochromocytoma at Chiba University Hospital and Yokohama Rosai Hospital, Japan. We compared the surgical outcomes of these patients with those of 106 patients with adrenal tumors due to other pathologies who underwent laparoscopic adrenalectomy during the same period. Results: The mean tumor size of pheochromocytoma was 4.96 cm. Mean operative time was 192.7 min, and mean estimated blood loss was 130 mL. Neither mean operative time nor mean estimated blood loss was greater for patients with pheochromocytoma. Intraoperative hypertension (systolic blood pressure > 180 mmHg) occurred in 39.1% (9/23) of patients with pheochromocytoma. During the follow-up period, there were no mortalities or recurrences of endocrinopathy. Conclusions: Laparoscopic adrenalectomy for pheochromocytoma is a safe and minimally invasive procedure.

Objective To compare the effectiveness and efficiency of transperitoneal anterior laparoscopic adrenalectomy with that of retroperitoneal posterior laparoscopic adrenalectomy. Patients and methods A retrospective comparison was undertaken of 28 patients who underwent transperitoneal anterior laparoscopy with 22 patients who underwent retroperitoneal posterior laparoscopy between April 1994 and November 2000. There were 18 men and 32 women (mean age 51.0 years, range 23–68) with varying diagnoses. Of the 50 patients, 31 had primary aldosteronism, eight had Cushing's syndrome, three had phaeochromocytoma, one had an 18-hydroxydeoxycorticosterone-induced adenoma and seven had non-functioning adrenal adenoma. Adrenal tumours were confirmed by hormonal assays, biochemical tests and computed tomography. To determine the site of the functioning adenoma, hormones were assayed from adrenal vein sampling. Thirty adrenal tumours were located on the right and 20 on the left. Results There were no significant differences in general demographic variables between the transperitoneal and retroperitoneal groups. The mean duration of surgery for transperitoneal and retroperitoneal laparoscopy was 202 and 221 min, respectively, and the mean blood loss 113 and 192 mL, respectively. The time to first oral intake, days to full diet, time until ambulatory and duration of hospitalization did not differ significantly between the two approaches. As the body mass index increased, the duration of surgery increased for both approaches. As more procedures were performed the duration of surgery decreased for both approaches. Conclusions There were no significant differences between the transperitoneal and retroperitoneal approaches for laparoscopic adrenalectomy.

The sterol 14α-demethylation inhibitors 1-(4-substituted phenoxymethyl)-2, 2-dimethylpropyl imidazole-1-carboxylates and their corresponding thiocarboxylates were optimized for maximum in-vitro activity against Botrytis cinerea Pers. ex Fr. in terms of the lipophilic parameter π. The activity of both carboxylates and thiocarboxylates was strongly related with π and predicted to be maximum at π 1.38 and 0.72 respectively. However, the preventive efficacy of the carboxylates against B. cinerea on Solanum melongena L. grown in a greenhouse did not correlate with the parameter. Despite the unfavourable lower lipophilicity, compounds with p-alkoxy substituents were superior to those with any other substituent. Moreover, the p-methoxy-substituted thiocarboxylate 46 was much less effective in greenhouse tests than the corresponding carboxylate 15, despite their equivalent in-vitro activity. To clarify these discrepancies, hydrolytic and photolytic stabilities of several representative compounds including 15 and 46 were investigated. The carboxylates examined were much more labile to hydrolysis than the thiocarboxylate 46; however, the four thiocarboxylates studied were less stable to light than the carboxylates. Consequently, the above discrepancies were attributable mainly to the superior stability of the carboxylates to photolysis as compared to the thiocarboxylates.

Prostate-specific antigen screening has significantly increased the percentage of men who are diagnosed with low-risk prostate cancer. All men undergoing retropubic radical prostatectomy for primary treatment of prostate cancer from April 2004 to September 2010 in our hospital were examined in order to determine whether active surveillance criteria could be applied to Japanese men. From pathological data of prostate biopsies, whether these men met five published criteria for active surveillance (Johns Hopkins Medical Institution, Prostate Cancer Research International: Active Surveillance Study, University of California, San Francisco, Toronto and Kakehi criteria) was evaluated. Men who met any of the criteria had a statistically significant lower extracapsular extension rate and organ-confinement rate. From the view of the possibility of Gleason upgrading and organ-confinement rate, the Johns Hopkins Medical Institution and Prostate Cancer Research International: Active Surveillance Study criteria showed to be appropriate for Japanese patients. However, the present study had limitations of selection bias and a limited number of cases.

Objectives: To investigate the feasibility and efficacy of docetaxel-based chemotherapy in patients with hormone-refractory prostate cancer (HRPC). Methods: Forty-six consecutive HRPC patients treated between January 2003 and March 2008 were included in this analysis. Docetaxel was given at a dose of 35 mg/m2 twice every 3 weeks and oral estramustine concurrently for three consecutive days during weeks 1 and 2 of each cycle. During each treatment week, the dose of estramustine was 1260 mg on the first day, 980 mg on the second day and 840 mg on the third day. Patients were premedicated with 4 mg twice a day of oral dexamethasone for three consecutive days. Treatment was continued until evidence of disease progression or unacceptable toxicity. Prostate-specific antigen (PSA) levels were evaluated at least once every 4 weeks. Results: Patients received a median of three cycles of chemotherapy. Of the evaluable 46 patients, 25 (54%) had a ≥50% PSA decline and 12 (26%) had a ≥75% PSA decline. Median time to PSA progression and overall survival time were 10.1 and 27.0 months, respectively. Median follow-up was 15.0 months. Major severe toxicities were grade 3 or 4 leukopenia in five (11%) patients. Mild toxicities included grade 1 or 2 nausea in eight (17%) patients. Two patients could not continue the treatment because of interstitial pneumonitis and a gastric hemorrhage, respectively. Conclusions: Docetaxel plus estramustine chemotherapy represents an active and well tolerated treatment for Japanese HRPC patients.

The effect of the novel imidazole-1-carboxylates (1-(4-substituted phenoxymethyl)-2,2-dimethylpropyl imidazole-1-carboxylates), which have a carbonyl group linking to the 1-position of imidazole, on growth and sterol biosynthesis in Botrytis cinerea was studied. The present fungicidal compounds severely suppressed the mycelial growth of B. cinerea with a concomitant decrease in the ergosterol level and the accumulation of 14α-methyl sterols, indicating inhibition of sterol 14α-demethylase. The 14α-demethylation is well known to be catalyzed by cytochrome P450-dependent monooxygenase, which gives type II spectral changes by interacting with 14α-demethylation inhibitors such as prochloraz. Imidazole-1-carboxylates produced type II spectra with rat liver P450. These results demonstrate that the inhibition of 14α-demethylation is the mode of action of the present azole fungicides.

Chromogranin A (CgA) and neuro-specific enolase (NSE) are gaining acceptance as markers of several types of neuroendocrine tumors and the concentration of CgA and NSE have been reported to be elevated in relation to neuroendocrine differentiation of prostate cancer. The aim of the present study was to examine the correlation between the immunohistochemical (IHC) findings and serum value for CgA and NSE in untreated stage D(2) prostate cancer patients.Immunohistochemistry was carried out using antibodies against CgA and NSE in 58 patients and, pretreatment serum CgA and NSE levels were measured by monoclonal immunoradiometric assay in 18 patients with stage D(2) prostate cancer treated by androgen ablation. We examined the relationship of the pretreatment serum level to IHC findings for CgA and NSE in prostate cancer patients to clinicopathological parameters, and prognosis. Also, we evaluated the correlation of IHC findings to serum levels for CgA and NSE.There was a statistically significant correlation between CgA positivity and serum CgA level (P = 0.0421). However, there was no statistically significant correlation between NSE positivity and serum NSE level (P0.05). We divided stage D(2) patients into three groups according to IHC positivity of CgA and NSE. The cause-specific survival was significantly poorer in patients with strongly positive (++) patients for independent CgA and combined CgA with NSE (P = 0.0379). Multivariate analysis of cause-specific survivals in patients with stage D(2) prostate cancer demonstrated that strong IHC stain was considered as independent variable associated with greater risk of death (P = 0.0142).Neuroendocrine differentiation in stage D(2) prostate cancer has attracted considerable attention as a potentially findings prognosis. Thus, CgA had a stronger relationship between serum levels and IHC positivity in contrast to NSE, suggesting clinical usefulness as a tumor marker in predicting the extent of neuroendocrine differentiation in prostate cancer.

We evaluated the efficacy of low dose tamsulosin after extracorporeal shock wave lithotripsy (ESWL) in Japanese male patients with ureteral stone.One hundred and two Japanese male patients with ureteral stones who underwent ESWL were randomly divided into three groups. Group A (38 patients) was given tamsulosin (0.2 mg/day); group B (30 patients) was given c horeito, a herbal medicine (7.5 g/day); and group C (34 patients) received no medication. Stone clearance was assessed at 1, 7, 14, and 28 days after ESWL using plain abdominal radiography and abdominal ultrasonography. After 28 days, stone delivery was checked every 2 weeks.The stone-free rate was 84.21%, 90%, and 88.24% for groups A, B, and C, respectively (P = 0.3425). The mean expulsion time was 15.66 +/- 6.14 days in group A, 27.74 +/- 25.36 days in group B, and 35.47 +/- 53.70 days in group C. The expulsion time of group A was significantly shorter than that of groups B (P = 0.0116) and C (P = 0.0424).The addition of tamsulosin to conservative treatment appeared to be effective in shortening the stone expulsion time.

Primary aldosteronism (PA) due to aldosterone-producing adenoma (APA) is a form of surgically curable secondary hypertension, and distinguishing APA from idiopathic hyperaldosteronism (IHA) is important for treatment. We made a differential diagnosis between APA and IHA using imaging tests such as adrenal CT and MRI as well as adrenal venous sampling (AVS) in all 93 cases of PA presenting at our institutions over the last decade. We identified 27 patients with aldosterone-producing microadenoma (APmicroA), all of whom could be diagnosed by AVS but not by the imaging tests. Then, we compared the clinical and roent-genological findings of these 27 patients with those of 42 patients with aldosterone-producing macroadenoma (APmacroA) and of 24 patients with IHA. Using surgically removed adrenal tissues, histopathological examinations and immunohistochemical analyses of steroidogenic enzymes were conducted. The findings for APmicroA were similar to those for APmacroA, except with respect to the diameter of the adrenal adenomas. Endocrinological and roentgenological findings for APmicroA were similar to those for IHA, but not to those for APmacroA. The rate of cure of hypertension was much greater in patients with APmicroA than in patients with APmacroA after the unilateral adrenalectomy (odds ratio, 4.0; p=0.028). In conclusion, it is important to accurately diagnose APmicroA, in which the laterality of the hyperproduction of aldosterone is only detectable by AVS, and to treat these patients by unilateral adrenalectomy in order to avoid long-term medical treatment and prevent hypertensive vascular complications.

Objectives: The maximum size of adrenal tumors that should be removed by laparoscopic adrenalectomy is controversial. We conducted a retrospective comparison of the results of laparoscopic adrenalectomy between patients with adrenal tumors ≥6 cm (‘large tumors’) and patients with adrenal tumors

症例は36歳,男性.健診の腹部エコーで両側副腎部に腫瘍を指摘された.尿中カテコラミン高値であり,腹部CT上両側副腎部に腫瘤を認め,またMIBGシンチ上同部に集積を認めたことから褐色細胞腫と診断した.生涯の補充療法の負担と副腎クリーゼのリスクを考慮して右副腎全摘,左側腫瘍核出術を施行した.本手術施行例は稀少で報告例も少ない.また家系内に両側褐色細胞腫が多発する興味深い症例であるので報告した.

Secondary hypertension (SH) including endocrine hypertension has been reported to be uncommon. We estimated the prevalence of SH among hypertensive patients. We prospectively studied 1,020 hypertensive patients. As an initial screening, we measured plasma aldosterone concentration, plasma renin activity, serum cortisol concentration and plasma catecholamine concentration and conducted abdominal ultrasonography (US). As a secondary screening, we performed furosemide plus upright test, captopril renography, dexamethasone suppression test, 24-h urine catecholamine measurement and abdominal CT. Finally, primary aldosteronism with the exception of idiopathic hyperaldosteronism, pheochromocytoma, and Cushing's syndrome were diagnosed by histopathological examination of surgical specimens. Idiopathic hyperaldosteronism was clinically diagnosed by adrenocorticotrophic hormone (ACTH)-stimulated adrenal venous sampling and renovascular hypertension by renal arteriography. There were 61 patients with primary aldosteronism, 5 with renovascular hypertension, 11 with Cushing's syndrome, 10 with preclinical Cushing's syndrome and 6 with pheochromocytoma, and the prevalence of SH was 9.1% among 1,020 hypertensive patients. In 76 (82%) of 93 patients with SH, hypertension was cured or improved after unilateral adrenalectomy, transsphenoidal pituitary adenectomy or percutaneous transluminal angioplasty. With the exception of US and CT, all initial and secondary screening tests were found to be sensitive and specific for differentiating SH from essential hypertension (EH). In conclusion, the measurement of various hormone concentrations was very sensitive for ruling out SH--a condition for which, in the present study, there were few specific signs or symptoms--while CT and US examinations were not always useful for differentiating SH from EH. The prevalence of curable SH among hypertensive subjects was higher in this study, which was conducted by our simple method of screening tests, than in previous reports. Hypertensive patients should be screened for SH and the underlying disease treated appropriately to avoid long-term use of antihypertensive drugs and risks of atherosclerotic complications.

Among four patients with silicate calculi, stones were spontaneously discharged in two and after extracorporeal shock-wave lithotripsy in two. Two of them had a history of taking magnesium silicate. Thirty two cases of silicate calculi previously reported in the Japanese literature were reviewed.

Primary aldosteronism is classified as aldosterone-producing adenoma (APA), idiopathic hyperaldosteronism (IHA), unilateral adrenal hyperplasia (UAH), primary adrenal hyperplasia (PAH), adrenal cancer, and glucocorticoid-remediable aldosteronism. We describe here 4 cases of primary aldosteronism due to unilateral hyperaldosteronemia, demonstrating unique histopathologic findings, such as unilateral multiple adrenocortical micronodules in the affected adrenals. Thirty-three patients with primary aldosteronism were consecutively admitted; 27 of them were treated by unilateral adrenalectomy. Four of them also had unilateral adrenal hypersecretion of aldosterone by selective adrenal venous sampling and adrenocortical multiple micronodules without an adenoma. These patients had hyporeninemic hyperaldosteronism with normokalemic hypertension. In these patients, furosemide plus upright test failed to increase plasma renin activity (PRA); the ratio of plasma aldosterone concentration (PAC) to PRA at 90 minutes after captopril administration was similar to that in patients with IHA and APA. Aldosterone concentrations were increased in each unilateral adrenal vein, and poorly encapsulated multiple adrenocortical micronodules from 2 to 3 mm in diameter were microscopically detected in the resected adrenal glands. Immunohistochemical analysis of steroidogenic enzymes, including cholesterol side chain cleavage, 3beta-hydroxysteroid dehydrogenase, 21-hydroxylase, 17alpha-hydroxylase, and 11beta-hydroxylase, indicated that the cortical cells within these micronodules were active in aldosterone production, while the non-nodular zona glomerulosa cells were inactive. We conclude that the clinical and pathologic characteristics of our 4 cases with unilateral multiple adrenocortical micronodules (UMN) are distinct from those of APA, IHA, UAH, and PAH. Furthermore, unilateral hyperaldosteronemia induced by UMN may be frequently misdiagnosed, because standard imaging tests, which cannot always detect tiny abnormalities of adrenals, showed "normal adrenal glands" in these patients. Thus, primary aldosteronism due to UMN should be carefully examined for differential diagnosis of each form of hyperaldosteronemia.

The numerical calculations using new material constants were in good agreement with the experimental results of the temperature-related SAW properties on the langasite substrate with Euler angle (0°,140°,φ). The temperature-related SAW properties as a function of the IDT metal thickness were also experimentally investigated. It was revealed that a thicker metal leads to a lower turnover temperature. Furthermore we investigated the NSPUDT (natural single phase unidirectional transducer) properties of langasite with Euler angle (0°,140°,25°) experimentally. Its directivity was almost equal to one estimated by the calculation based on the coupling of mode (COM) model. This NSPUDT property is a promising feature for the low-loss IF filter.

Eighteen patients of proximal hypospadia underwent operations by our two-stage method. First stage operation was done by exaggerated Nesbit's method. The foreskin was transposed to the ventral surface of the penis as a flap that is long enough to be brought to the top of the glans. The second-stage procedure was done after a minimum of 6 months. The urethral tube was formed around the Foley catheter with a flap, its peripheral end being one to two centimeters proximal to the sulcus. For one to two centimeters the distal flap was freed. The tubularization was done by a continuous 4-0 nylon suture, which was removed after ten days. The tube was passed to the top of the glans through the tunnel and sutured to the glans with 5-0 nylon. Urinary diversion was not performed. In one case the new urethral orifice receded and reoperation was done. The operations in the other 17 cases were successful without stricture or fistula formation.

Pulse volume recordings were obtained in 53 patients who were hospitalized with urological disorders other than impotence. This method seems to record the total blood volume changes in the penis. Pulse volume recordings also were found to correlate with the value of Penile Brachial pressure Index (PBI). Therefore, it proved to be valuable for estimating penile perfusion. Pulse volume recording is a simple, reliable and adaptable screening method for abnormal penile blood flow. Further investigation is necessary to determine the precision with which the method can detect abnormality of penile blood flow in patients with abnormal venous return.

In this study, we carried out experimental research on the directivity of surface acoustic wave (SAW) filters with Al, W and Ta electrodes formed on langasite single-crystal wafers, in order to find electrode materials that make the natural unidirectionality disappear. The results proved that by using W and Ta, the natural unidirectionality disappears at the normalized thickness (h/λ) of 0.033–0.037. This suggests a potential application of these metals as electrode materials for langasite-based SAW filters so that the design process of the single-phase unidirectional transducer (SPUDT) filter can be simplified by using tools for conventional SPUDT filters.

The propagation characteristics of Rayleigh waves on a Y-rotated La3Ga5SiO14 (langasite) substrate are evaluated with the use of newly obtained material constants. The calculated phase velocity, the power flow angle (PFA), the coupling electromechanical coefficient (K2), the temperature coefficient of delay (TCD) and the diffraction coefficient (γ) are shown as contour maps. The revised numerical calculations were in much better agreement with the experimental results of the temperature characteristics on the langasite substrate with Euler angle (0°, 140°, φ). Moreover, the temperature characteristics as a function of the metal thickness were experimentally investigated. It was found that a thicker metal leads to a lower turnover temperature. Finally, an example of the frequency response of the transversal filter designed for IS95 is shown.

Comparison of the resonance frequency of surface acoustic wave (SAW) resonators fabricated on defect-free and highly defective lithium tetraborate wafers was attempted. The intrinsic variation of SAW velocity due to crystal defects, impurities and chemical compositional inhomogeneities for lithium tetraborate wafers is smaller than ±0.011%. In addition, the variation of SAW velocity in a wafer is influenced by the device fabrication process rather than the lithium tetraborate substrate quality.

Twenty-nine cases of mandibular distomolars have been reported in the Japanese literature. The details of three additional cases are presented.