Hata M

Gasless Laparoscopy-Assisted Nephrectomy without Tissue Morcellation for Renal Carcinoma

PURPOSE The efficacy of gasless laparoscopy-assisted nephrectomy for renal tumors is determined. MATERIALS AND METHODS Seven patients with renal tumors underwent gasless laparoscopy-assisted nephrectomy. The results were compared to those of patients undergoing open nephrectomy. RESULTS Although a long operating time was required, convalescence was significantly more rapid. En bloc removal of the kidney and complete pathological examination were possible in all patients. CONCLUSIONS This procedure may be useful for the treatment of noninvasive renal carcinoma, especially in patients with cardiovascular and/or ventilatory complications. However, long-term followup is necessary to confirm the efficacy in preventing recurrence.

Bredinin treatment in clinical kidney allografting

Bredinin, a new nucleoside antibiotic isolated from Eupenicillium brefeldianum, and steroids were used as immunosuppressive agents in 31 renal transplant patients; 17 of them received grafts from living-related donors and 14 from cadavers. The one-year graft survival rates were 100% in renal recipients from living donors and 69.2% in cadaver kidney recipients. There was no serious complication from the use of these immunosuppressive agents.

Plasminogen Activators and Plasminogen Activator Inhibitor 1 in Urinary Tract Cancer

The plasminogen activation system is considered to play an important role in cancer growth and metastasis. Both plasminogen activators (PAs) and their fast-acting inhibitors are produced in tumor cells and their surrounding tissues. In order to clarify the influence of the existence of malignant tumor in urinary tract on the systemic fibrinolytic activity, we designed a study in which we compared the plasma levels of PAs and their inhibitors between before and after radical resection of tumors. Fourteen patients with renal cell carcinoma and 14 patients with transitional cell carcinoma participated in the study. In both groups, plasma levels of tissue-type plasminogen activator and urokinase-type plasminogen activator before the operation were higher than those 15 days after operation. The plasma level of plasminogen activator inhibitor 1 (PAI-1), however, did not change after the operation in the renal cell carcinoma group, and it decreased slightly in the transitional cell carcinoma group although it was not significant. When these values of the groups with or without metastasis were compared to other organs or lymph nodes, the PAI-1 level before operation was significantly higher in the group with metastasis than that without metastasis. In the three groups divided by the degree of atypia, PAI-1 level in the most atypical group was the highest. These results suggest that the fibrinolytic system in the plasma of cancer patients may play an important role in tumor growth and metastasis.

Results of the treatment of prostatic cancer

Two hundred and twenty patients with prostatic cancer were treated in our clinic during the past ten years between April, 1977 and March, 1987. The age distribution was from 45 to 91 years old and more than half of patients were in seventies. Stages A, B, C and D were 3.5%, 19.7%, 21.2% and 55.6%, respectively. Hormonal therapy was given in 175 cases (79.5%) as an initial treatment. The first therapy showed effectiveness in 181 (83.8%) of 216 cases; in 153 (87.4%) of 175 cases treated by hormonal therapy. Reactivation after the initial treatment was observed in 59 (32.6%) of 181 cases; in 48 (31.4%) of 153 cases treated by hormonal therapy. The interval between the start of treatment and reactivation for the stage D was significantly shorter than that for the other stages. Elevation of serum alkaline-phosphatase levels, accelerated erythrocyte sedimentation rate and hydronephrosis were significant risk factors for reactivation. Of the 220 cases, 51 (23.2%) died of advanced cancer. The overall 5-year survival rate was 41.2%. High grade and high stage were significantly related to the poor prognosis. In our studies, as hormonal therapy, maintenance on 100 mg of diethylstilbestrol diphosphate daily was found effective for the treatment of prostatic cancer.

Treatment of 255 patients with bladder tumors

During about 10 years from November, 1977 to March, 1987, two hundreds and fifty-five patients with bladder tumors were treated at the Department of Urology, Hamamatsu University School of Medicine and the affiliated hospitals. There were 198 males and 57 females with the highest age incidence in the seventies. Histologically, 242, 11 and 2 tumors were of transitional cell, squamous cell and adenocarcinoma, respectively. Of the 242 transitional cell carcinomas, 7 were Tis; 43 Ta, 111 T1, 33 T2, 19 T3, 5 T4, 14 M+ (with metastatic lesion), and 10 TX. As to grading, 6 was G0; 66 G1, 100 G2, 64 G3, and 6 GX. Staging was correlated with grading. The 5-year survival rates (Kaplan-Meiers method) were 64% in patients with transitional cell carcinoma; 58% in those with squamous cell carcinoma. In patients with transitional cell carcinoma, the 5-year survival rates were 100% for G0, 73% for G1, 73% for G2 and 40% for G3. As to staging, the 5-year survival rates were 67%, 81%, 81%, 35%, 41%, 40% and 12% in patients with stage of Tis, Ta, T1, T2, T3, T4 and M+, respectively. As to the initial treatment, the 5-year survival rates after TUR (137 cases), partial cystectomy (4 cases) and total cystectomy (56 cases) were 81%, 36% and 61%, respectively. The rate of intravesical recurrence after TUR was evaluated with the cumulative non-recurrence rate calculated by Kaplan-Meiers method.(ABSTRACT TRUNCATED AT 250 WORDS)

Lymphocytapheresis and plasma exchange in renal transplantation

腎移植において, 免疫抑制処置としてのリンパ球除去 (LA) と血漿交換 (PE) の有効性について検討した. LAとPEは, いずれもblood cell separator (IBM 2997) を用いて, 施行された.LAは, 生体腎移植29症例の移植前免疫抑制処理として施行した. その結果, 移植腎1年および3年生着率は, それぞれ93%と88%であった.PEは, 14回の急性拒絶反応と, 15回の慢性拒絶反応の治療として施行された. PEによる治療を施行した急性拒絶反応は, ステロイドの大量投与が危険である急性拒絶反応あるいは, vascular typeの急性拒絶反応である. PEの拒絶反応に対する有効率は, 急性拒絶反応では79%, 一方慢性拒絶反応では40%であった. LPおよびPEは, 腎移植の臨床において, 有効かつ安全な免疫抑制法である可能性が示唆された.