Akira Komiya

Does presence of prostate cancer affect serum testosterone levels in clinically localized prostate cancer patients

The relationships between serum level of testosterone (T) and prostate cancer (PCa) are complex. The present study evaluated whether presence of PCa alters serum T levels. Subjects were 125 patients with clinically localized PCa treated using radical prostatectomy (RP), for whom pretreatment T levels were recorded. We investigated clinical and pathological factors such as pretreatment serum T level, age, pretreatment prostate-specific antigen, Gleason score and pathological stage. Serum T and human luteinizing hormone (LH) levels before and after RP were then compared in 118 of the 125 patients. Mean pretreatment T level was significantly higher in patients with organ-confined PCa (pT2; 4.03±1.50u2009ngu2009ml−1) than in patients with nonorgan-confined cancer (pT3; 3.42±1.06u2009ngu2009ml−1; P=0.0438). No association existed between pretreatment serum T level and pathological Gleason score. After RP, serum T level (5.60±1.90u2009ngu2009ml−1) was significantly elevated compared to preoperative level (3.89±1.43u2009ngu2009ml−1; P<0.0001). In parallel, significant increases were seen in postoperative serum LH level (6.86±3.64u2009ngu2009ml−1) compared to preoperative level (5.11±2.47u2009ngu2009ml−1; P=0.0001). In contrast, differences in serum T levels according to pathological stage disappeared postoperatively (P=0.5513). Significant increases in serum T and LH levels were seen after RP, compared to preoperative levels in parallel. This study suggests that serum T levels are altered by the presence of PCa, supporting the possibility that PCa may inhibit serum T levels with negative feedback in the hypothalamic–pituitary axis.

High predictive accuracy of Aldosteronoma Resolution Score in Japanese patients with aldosterone-producing adenoma.

BACKGROUNDnPrimary aldosteronism caused by aldosterone-producing adenoma is the most common curable cause of secondary hypertension, but despite resection, many patients continue to require antihypertensive medications to control their blood pressure postoperatively. The Aldosteronoma Resolution Score is a preoperative 4-item predictive model for the complete postoperative resolution of hypertension. Our aim was to validate the accuracy of this model in predicting postoperative resolution of hypertension in Japanese patients.nnnMETHODSnThe records of 91 Japanese patients who underwent unilateral adrenalectomy for aldosterone-producing adenoma were surveyed retrospectively. Patients were distributed into 2 groups according to whether blood pressure was normal without antihypertensive medications at 6 months postoperatively. Clinical and biochemical data were evaluated at baseline and after the 6-month follow-up.nnnRESULTSnAt 6 months, blood pressure had normalized in 45% of the patients without antihypertensive medications. Multivariate logistic regression analysis revealed that patients who had complete resolution of hypertension were significantly more likely to have been taking ≤2 antihypertensive medications preoperatively, have a duration of hypertension of <6 years, and be female. The predictive accuracy of the Aldosteronoma Resolution Score was assessed using the area under the curve of receiver operator characteristics analysis. The value of the area under the curve was 0.81.nnnCONCLUSIONnOur external validation revealed that the Aldosteronoma Resolution Score developed using Western data can identify accurately Japanese individuals with aldosterone-producing adenoma who are likely to have complete resolution of hypertension after adrenalectomy.

Serum active hepatocyte growth factor (AHGF) in benign prostatic disease and prostate cancer

Hepatocyte growth factor (HGF) is secreted as an inactive single‐chain precursor called pro‐HGF. Pro‐HGF is converted to an active two‐chain form by HGF activator and matriptase. We attempted to clarify whether serum levels of active HGF (AHGF) could be used as a marker of prostate cancer.

Evaluation of the Sperm Motility Analyzer System (SMAS) for the Assessment of Sperm Quality in Infertile Men

Eighty-one fresh semen samples were analyzed to compare the sperm parameters obtained using the new Sperm Motility Analysis System (SMAS; version 1.0, Kaga Electronics, Tokyo, Japan) with the CellSoftTM Series 3000 (CRYO Resources, New York, USA) computer-assisted semen analysis (CASA) system and conventional manual semen analysis, based on WHO guidelines.. Significant correlations of sperm concentration (p<0.0001) and sperm motility (p<0.0001) were observed between SMAS and manual semen analysis estimates. There were also significant correlations of sperm concentration (p=0.0003) and sperm motility (p<0.0001) between SMAS and CellSoft estimates. Significant correlations for motility-related parameters were demonstrated in sperm velocity (p<0.0001), and linearity (linear velocity (VSL) divided by curvilinear velocity (VCL)×100) (p<0.0001), amplitude of lateral head displacement (ALH) (p<0.0001), and beat/cross frequency (BCF) (p=0.0127), between SMAS and CellSoft estimates. In this study, we showed the usefulness of the new SMAS, which has high reliability in estimating sperm concentration, sperm motility, velocity and linearity compared with CellSoft. SMAS can be a promising alternative, providing cost-effective semen analysis with the utility of the CASA system.

Sperm with large nuclear vacuoles and semen quality in the evaluation of male infertility

This study compared the sperm nuclear vacuoles and semen quality in the evaluation of male infertility. One hundred and forty-two semen samples were obtained from patients who visited the Male Infertility Clinic at Toyama University Hospital. Semen samples were evaluated by conventional semen analyses and the Sperm Motility Analysis System (SMAS). In addition, spermatozoa were analyzed at 3,700-6,150x magnification on an inverted microscope equipped with DIC/Nomarski differential interference contrast optics. A large nuclear vacuole (LNV) was defined as one or more vacuoles with the maximum diameter showingu2009>u200950% width of the sperm head. The percentage of spermatozoa with LNV (% LNV) was calculated for each sample. Correlations between the % LNV and parameters in SMAS and conventional semen analyses were analyzed. Processed motile spermatozoa from each sample were evaluated. The mean age of patients was 35 years old. Semen volume was 2.9u2009±u20091.6mL (0.1-11.0; meanu2009±u2009standard deviation, minimum-maximum), sperm count was 39.3u2009±u200954.9 (x106/mL, 0.01-262.0), sperm motility was 25.1u2009±u200917.8% (0-76.0), and normal sperm morphology was 10.3u2009±u200910.1% (0-49.0). After motile spermatozoa selection, we could evaluate % LNV in 125 ejaculates (88.0%) and at least one spermatozoon with LNV was observed in 118 ejaculates (94.4%). The percentage of spermatozoa with LNV was 28.0u2009±u200922.4% (0-100) and % LNV increased significantly when semen quality decreased. The correlation between the % LNV and the semen parameters was weak to moderate; correlation coefficients were -0.3577 in sperm count (pu2009<u20090.0001), -0.2368 in sperm motility (pu2009=u20090.0084), -0.2769 in motile sperm count (pu2009=u20090.019), -0.2419 in total motile sperm count (pu2009=u20090.0070), and -0.1676 in normal sperm morphology (pu2009=u20090.0639). The % LNV did not show a significant correlation with the SMAS parameters except for weak correlation to beat/cross frequency (ru2009=u2009-0.2414, pu2009=u20090.0071). The percentage of spermatozoa with LNV did not have a strong correlation with parameters in conventional semen analysis and SMAS in the patients with male infertility; however, a certain level of negative influence of LNV to sperm quality cannot be excluded.

Efficacy of DynaCT for surgical navigation during complex laparoscopic surgery: an initial experience

BackgroundPrecise understanding of surgical anatomy is required during complex laparoscopic surgery (CLS). The purpose of this study was to present our initial operative experience with CLS facilitated by surgical navigation through DynaCT technology.MethodsIntraoperative computed tomography (CT) images of two CLS cases were obtained by a C-arm DynaCT system (Artis Zeego, Siemens Healthcare, Erlangen, Germany). Image reconstruction was performed on a workstation to define particular anatomical structures of the target tumor. The reconstructed CT images were repeatedly displayed on a submonitor. The surgeon then compared the CT images with a laparoscopic image of the surgical field, thus providing a virtual map to the surgeon.ResultsUsing the near-real-time surgical navigation system, the surgeon could visualize the surgical anatomy and easily perform the CLS. All procedures were performed successfully with a satisfactory diagnostic yield.ConclusionThis novel technology has great potential for application in CLS because it enables generation of accurate depictions of small target tumors and increases the surgeon’s confidence during the procedure.

Application of a new technique, spiral tissue microarrays constructed using needle biopsy specimens, to prostate cancer research

Tissue microarrays were constructed using prostate needle biopsy specimens obtained from 58 patients who underwent radical prostatectomy for localized or locally advanced prostate cancer (PC). We used the spiral array (SA) technique, a novel approach for tissue array construction in a spiral form, which has advantages over small needle biopsy specimens. Roll-shaped tissue pieces produced by slicing a prostate biopsy tissue block and trimming the cancer segment were used to obtain a tissue array block. Cancer segments measuring >3 mm were incorporated into the tissue arrays. Cancer fragments (n=253) were obtained from formalin-fixed, paraffin-embedded needle biopsy specimens. The median number of cancer fragments per patient was four (1-8, min-max). On SA, the median number of confirmed cancer fragments per patient was four (1-7) and 224 cancer fragments (88.5%) were confirmed histologically. Each core of reeled tissue contained at least one cancer fragment. The expressions of multiple prognostic molecular markers for PC (Ki-67, p53 and bcl-2) were immunohistochemically measured using the SA. The Ki-67 and bcl-2 expressions were significantly associated with the Gleason score (GS). A univariate analysis identified Ki-67, bcl-2 and GS as significant predictors of cancer-specific survival, p53 and bcl-2 as significant predictors of overall survival and Ki-67, adjuvant androgen deprivation and GS as significant predictors of biochemical progression. In a multivariate analysis, p53 was independently associated with overall survival, while adjuvant androgen deprivation and GS were associated with biochemical progression. These results indicate that SA has potential as a new tool for translational research on PC.

Clinical Factors Associated with Sperm DNA Fragmentation in Male Patients with Infertility

Objective. The clinical factors associated with sperm DNA fragmentation (SDF) were investigated in male patients with infertility. Materials and Methods. Fifty-four ejaculates from infertile Japanese males were used. Thirty-three and twenty-one were from the patients with varicoceles and idiopathic causes of infertility, respectively. We performed blood tests, including the serum sex hormone levels, and conventional and computer-assisted semen analyses. The sperm nuclear vacuolization (SNV) was evaluated using a high-magnification microscope. The SDF was evaluated using the sperm chromatin dispersion test (SCDt) to determine the SDF index (SDFI). The SDFI was compared with semen parameters and other clinical variables, including lifestyle factors. Results. The SDFI was 41.3 ± 22.2% (mean ± standard deviation) and did not depend on the cause of infertility. Chronic alcohol use increased the SDFI to 49.6 ± 23.3% compared with 33.9 ± 18.0% in nondrinkers. The SDFI was related to adverse conventional semen parameters and sperm motion characteristics and correlated with the serum FSH level. The SNV showed a tendency to increase with the SDFI. The multivariate analysis revealed that the sperm progressive motility and chronic alcohol use were significant predictors of the SDF. Conclusion. The SCDt should be offered to chronic alcohol users and those with decreased sperm progressive motility.

Herbal medicine in Japan

Abstract Japanese traditional medicines, Kampo medicines (KMs), are usually herbal medicine based on traditional Chinese herbal medicine but developed into a unique form in Japan. At present, 148 kinds of KMs have been approved and are enlisted on the “National Health Insurance Drug Tariff.” About 72% of Japanese physicians prescribe some KMs to their patients. Based on patients symptoms, KMs are given alone or in combination with contemporary western medicines. KMs can manage urological problems including erectile dysfunction, male infertility, lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia, overactive bladder (OAB), urolithiasis as well as late-onset hypogonadism (LOH) in Japan. In mens health clinic, a number of patients is eugonadal with suspicious LOH-related symptoms. Some are not eligible for androgen replacement therapy (ART) while others have no response to ART. To manage these patients, KMs can be used to improve indefinite complaints, or LOH-related symptoms. F...

Importance of Axial Penile Rigidity in Objective Evaluation of Erection Quality in Patients with Erectile Dysfunction – Comparison with Radial Rigidity

Introduction: The aim of this prospective study was to evaluate the usefulness of measurement of axial penile rigidity, compared with radial penile rigidity. Patients and Methods: Twenty-two patients, aged 21–75 years old (a mean of 50), with erectile dysfunction underwent axial penile rigidity measurements by the digital inflection rigidometer (DIR) as well as radial penile rigidity measurements by the RigiScan Plus during intracavernous pharmacological erection testing. Results: A significant correlation was recognized between axial rigidity, and radial rigidity at the tip (p = 0.0024) and base (p = 0.0098) of the penis. In 10 patients, the DIR revealed axial rigidity of 550 g or more, and they also had radial rigidity of 60% or more at the tip and base. In 14 and 17 subjects, radial rigidity of 60% or more was observed at the tip and base, respectively. Four of the former 14 and 7 of the latter 17 had axial rigidity <550 g. Conclusions: A RigiScan results of radial rigidity of 60% or more should be interpreted cautiously and not necessarily regarded as normal.