Akio Emoto

Prognostic value of tumor‐associated macrophage count in human bladder cancer

Background : We determined the tumor‐associated macrophage (TAM) count to investigate its importance in predicting clinical outcome or prognosis in patients with bladder cancer.

CLINICAL SIGNIFICANCE OF MULTI-DRUG RESISTANCE ASSOCIATED PROTEIN AND P-GLYCOPROTEIN IN PATIENTS WITH BLADDER CANCER

PURPOSE The clinical significance of multi-drug resistant proteins, such as multi-drug resistance associated protein and P-glycoprotein, in terms of prognostic value was determined in patients with bladder cancer. MATERIALS AND METHODS The expression of multi-drug resistance associated protein and P-glycoprotein was investigated immunohistochemically before and after chemotherapy. The relationship between expression of these multi-drug resistant proteins and clinical outcome assessed by tumor recurrence rate, cystectomy rate and 5-year survival rate was also investigated in 33 patients with bladder cancer. RESULTS Before chemotherapy multi-drug resistance associated protein expression was observed in 1 of 28 patients (4%) while P-glycoprotein expression was observed in 22 of 33 (67%). Multi-drug resistance associated protein induction by chemotherapy was observed in 6 of 28 patients (21%), whereas P-glycoprotein induction was noted in 4 (14%). Multi-drug resistance associated protein in this disease is induced more frequently by high dose (more than 300 mg.) than low dose (less than 300 mg.) anthracyclines (p < 0.01). Immunohistochemical analysis also revealed co-expression of multi-drug resistance associated protein and P-glycoprotein in 5 of 28 patients (18%) after chemotherapy. However, there was no significant correlation between positive P-glycoprotein expression before chemotherapy and clinical outcome. CONCLUSIONS Multi-drug resistance associated protein as well as P-glycoprotein mediated multi-drug resistance may be induced after chemotherapy for bladder tumors. However, the presence of P-glycoprotein before chemotherapy does not predict clinical outcome in patients with bladder cancer.

Muscarinic Receptor Subtypes and Receptor-Coupled Phosphatidylinositol Hydrolysis in Rat Bladder Smooth Muscle

Background:

Calcium supplement necessary to correct hypocalcemia after total parathyroidectomy for renal osteodystrophy

Background : Prediction of the extent of calcium supplement will facilitate safe and efficient management of hypocalcemia in the early postoperative stage of total parathyroidectomy with autotransplantation (PTXa) in patients with renal osteodystrophy.

Prediction of alpha-blocker response in men with benign prostatic hyperplasia by magnetic resonance imaging.

OBJECTIVES To assess the value of magnetic resonance imaging (MRI) for predicting the alpha-blocker response in men with symptomatic benign prostatic hyperplasia (BPH) and to examine the relationship between MRI and the area density of smooth muscle cells in BPH. METHODS Twenty-eight men were consecutively enrolled in this study and received tamsulosin 0.2 mg once daily for 4 to 6 weeks. The efficacy of tamsulosin was determined by measuring improvements in the maximum urinary flow rate (Qmax) and International Prostate Symptom Score (IPSS). The patients underwent T2-weighted MRI and were separated into a high (H) or iso-low (IL) group according to the signal intensity of the inner gland of the prostate compared with that of bone marrow of the proximal femur head. The area density of smooth muscle cells was determined using immunostaining with antiactin antibody in 16 prostate specimens. RESULTS IPSS significantly decreased after the administration of tamsulosin from 16 +/- 1 to 8 +/- 1 (n = 28, P <0.0001 ), and 76.7% of the patients had an improved IPSS of 25% or greater. Qmax was significantly increased in group IL (P = 0.03) but not in group H. Of the patients in group IL, 53.3% had a Qmax response (an increase of Qmax of 30% or more); 15.4% did so in group H (P = 0.04). The area density of smooth muscle cells was 48.1 +/- 3.7% in group IL (n = 9) and 36.7 +/- 3.2% in group H (n = 7, P = 0.04). CONCLUSIONS MRI is useful in estimating the area density of smooth muscle cells in the prostate and in predicting Qmax response for alpha-blocker therapy in patients with symptomatic BPH.

Induction of Tubulogenesis of Microvascular Endothelial Cells by Basic Fibroblast Growth Factor from Human SN12C Renal Cancer Cells

PURPOSE To investigate the role of basic fibroblast growth factor (b-FGF) in angiogenesis in renal cell carcinoma. MATERIALS AND METHODS We examined b-FGF expression in 25 patients with renal cell carcinoma (RCC) by reverse transcriptase polymerase chain reaction (RT-PCR). We measured the tube formation by human omental microvascular endothelial (HOME) cells induced by b-FGF in a three-dimensional collagen gel in the absence or presence of SN12C human renal cancer cells by means of computer-image analysis. RESULTS RT-PCR analysis detected b-FGF m-RNA in 20 (80%) of 25 patients with RCC. The tube formation of HOME cells was increased in the presence of SN12C cells overexpressing b-FGF mRNA, induced by exogenous b-FGF in a dose dependent manner and completely inhibited by anti-b-FGF antibody. CONCLUSIONS Basic-FGF may develop tumor angiogenesis by inducing microvessel tubulogenesis in patients with RCC.

[Laparoscopy-assisted total nephroureterectomy for renal pelvic and/or lower ureteral cancer].

PURPOSE The usefulness of laparoscopy-assisted total nephroureterectomy for patients with renal pelvic and lower ureteral cancer is evaluated. MATERIAL Seven patients with renal pelvic cancer and four with lower ureteral cancer performed laparoscopy-assisted total nephroureterectomy from May 1997 to December 2000 (Ten males and one female, mean age 68.5 year-old). METHOD Of the 11 patients, the initial one received preoperative embolization of the renal artery. Under general anesthesia laparoscopy-assisted total nephroureterectomy underwent via transperitoneal approach in three patients and retroperitoneal approach in eight. After the kidney was completely dissected under laparoscopic procedure, it was delivered en bloc with ureter from the skin incision in the lower abdomen. RESULT Two patients needed conversion to open surgery. The mean operating time of nine patients except for conversion cases was 272 minutes and the mean blood loss was 313 ml. There was no major complication associated with laparoscopic procedure. There was no significant difference in both complication and recurrence rate between laparoscopy-assisted total nephroureterectomy and open surgery. CONCLUSION Laparoscopy-assisted total nephroureterectomy is an useful procedure for the treatment of patients with renal pelvic and lower ureteral cancer because it enables us to remove out the kidney and ureter from one small lower abdominal incision.