Hideki Takeshita

Head-mounted display for a personal integrated image monitoring system: ureteral stent placement.

The personal head-mounted display (HMD) has emerged as a novel image monitoring system. We present here the application of a high-definition organic electroluminescent binocular HMD in ureteral stent placement. Our HMD system displayed multiple forms of information such as integrated, sharp, high-contrast images using a four-split screen or a picture-in-picture technique both seamlessly and synchronously. When both the operator and the assistant wore an HMD, they could continuously and simultaneously monitor the cystoscopic and fluoroscopic images in an ergonomically natural position. Furthermore, each participant was able to modulate the displayed images depending on the procedure. In all five cases, both the operator and the assistant successfully used this system with no unfavorable event. No participants experienced any HMD wear-related adverse effects. We therefore believe this HMD system might be potentially beneficial during ureteral stent placement procedures. Furthermore, it is compact, easily introduced and affordable.

Clinical Application of a Modern High-Definition Head-Mounted Display in Sonography

Because of the remarkably improved image quality and wearability of modern head‐mounted displays, a monitoring system using a head‐mounted display rather than a fixed‐site monitor for sonographic scanning has the potential to improve the diagnostic performance and lessen the examiners physical burden during a sonographic examination. In a preclinical setting, 2 head‐mounted displays, the HMZ‐T2 (Sony Corporation, Tokyo, Japan) and the Wrap1200 (Vuzix Corporation, Rochester, NY), were found to be applicable to sonography. In a clinical setting, the feasibility of the HMZ‐T2 was shown by its good image quality and acceptable wearability. This modern device is appropriate for clinical use in sonography.

Preliminary report of multimodal treatment with ifosfamide, 5-fluorouracil, etoposide and cisplatin (IFEP chemotherapy) against metastatic adenocarcinoma of the urachus

Abstract:  We report the effectiveness of a combination chemotherapy consisting of ifosfamide, 5‐fluorouracil, etoposide and cisplatin (IFEP chemotherapy) against metastatic adenocarcinoma of the urachus. From April 1995 to November 2004, four patients with adenocarcinoma of the urachus who developed metastases after definitive surgery were treated with the IFEP chemotherapy followed by consolidative radiotherapy or salvage surgery in good responders. During the median follow‐up period of 26 months, three of the four patients responded to the regimen (75%). In one patient with pulmonary metastases, four cycles of the IFEP chemotherapy, followed by stereotactic consolidative radiotherapy resulted in a complete remission for more than 8 years. Two patients achieved partial remission after the IFEP chemotherapy. We have demonstrated the IFEP chemotherapy is one of the most effective chemotherapy regimens against metastatic adenocarcinoma of the urachus. A multimodal treatment strategy, even with curative intent, can be considered when a sufficient effect was obtained by the IFEP chemotherapy.

A head-mounted display-based personal integrated-image monitoring system for transurethral resection of the prostate

The head-mounted display (HMD) is a new image monitoring system. We developed the Personal Integrated-image Monitoring System (PIM System) using the HMD (HMZ-T2, Sony Corporation, Tokyo, Japan) in combination with video splitters and multiplexers as a surgical guide system for transurethral resection of the prostate (TURP). The imaging information obtained from the cystoscope, the transurethral ultrasonography (TRUS), the video camera attached to the HMD, and the patients vital signs monitor were split and integrated by the PIM System and a composite image was displayed by the HMD using a four-split screen technique. Wearing the HMD, the lead surgeon and the assistant could simultaneously and continuously monitor the same information displayed by the HMD in an ergonomically efficient posture. Each participant could independently rearrange the images comprising the composite image depending on the engaging step. Two benign prostatic hyperplasia (BPH) patients underwent TURP performed by surgeons guided with this system. In both cases, the TURP procedure was successfully performed, and their postoperative clinical courses had no remarkable unfavorable events. During the procedure, none of the participants experienced any HMD-wear related adverse effects or reported any discomfort.

Instructive head-mounted display system: pointing device using a vision-based finger tracking technique applied to surgical education

Introduction The head-mounted display (HMD) system is a novel personalized imaging monitoring system for use in a medical setting. Aim To support interactive intraoperative communication among HMD wearers, we integrated vision-based finger tracking into our system as a pointing device. Material and methods Our vision-based finger tracking system is composed of a commercially available real-time video camera, which is mounted on the modern HMD, and computer software that enables tracking of the tip of the operators index finger and superimposing the marker on the endoscopic view. Results We used this system in an experimental demonstration. The operator used the finger-tracking pointer to explain the intraoperative findings of transurethral resection for bladder cancer to medical students. Conclusions This finger tracking system-based pointing device can function as a supportive tool for the HMD system, enabling interactive instruction and communication between the operator and other attending physicians or medical students.

Simultaneous bilateral testicular metastases from renal clear cell carcinoma: A case report and review of the literature.

Metastasis from renal cell carcinoma (RCC) to the testis is rare. This case report presented an extremely rare case of simultaneous bilateral testicular metastases from RCC in a 65-year-old man who had experienced indolent scrotal enlargement over a period of several months. Scrotal ultrasonography showed 4.0- and 2.0-cm-sized masses in the left and right testes, respectively. Contrast-enhanced computed tomography identified multiple tumors in the kidneys, the pancreas and the left adrenal gland. Left orchiectomy and pathological examination were performed and indicated testicular metastasis from clear cell RCC. The patient underwent complete surgical resection of all residual lesions. Postoperative follow-up examination without adjuvant therapy identified no recurrence over 11 months. This study also reviewed existing literature and determined that retrograde venous spread from the primary kidney tumor to the testis may be an important pathway for testicular metastasis from RCC. In conclusion, RCC can result in testicular metastases not only unilaterally, but also bilaterally, as was observed in the present case.

Randomized Crossover Comparison of the Short-Term Efficacy and Safety of Single Half-Dose Silodosin and Tamsulosin Hydrochoride in Men With Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

To compare the efficacy and safety of single half‐dose silodosin and single full‐dose tamsulosin in Japanese men with lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH).

Obstinate cough as a sole presenting symptom of non-metastatic renal cell carcinoma

Abstract:  Renal cell carcinoma (RCC) causes many kinds of symptoms such as hypercalcemia, hypertension, polycythemia and fever. Here we describe a rare case of RCC presenting with a persistent cough. After radical nephrectomy, the obstinate cough disappeared. When the tumor recurred locally, the cough also recurred. Furthermore, the cough disappeared completely again after the removal of the recurrent tumor. Although all the clinical findings suggested that the RCC caused the cough, we could not identify a specific humoral substance responsible for the cough.

Bone Abnormal Signal Incidentally Found in Pre-Biopsy Diffusion-Weighted MRI for Suspected Prostate Cancer: What Does It Reflect?

Objective: To clarify the clinical significance of incidentally found diffusion-weighted MRI (DW-MRI)-positive findings on pre-biopsy MRI in patients with suspected prostate cancer. Patients and Methods: 754 consecutive patients with suspected prostate cancer underwent pelvic MRI including DW-MRI. 43 DW-MRI-positive bone lesions were found in 27 patients. Imaging findings of these lesions were compared with the clinical diagnosis. Results: Of the 43 DW-MRI-positive bone lesions, 21 (48.8%) were diagnosed as metastatic prostate cancer. The remaining 22 (51.2%) were diagnosed as red bone marrow in 17, enchondroma in 1, ganglion in 1, osteoma in 1, fibrous dysplasia in 1 and bone infarction in 1. Enchondroma, ganglion, osteoma and fibrous dysplasia all showed T1-weighted imaging (T1WI) low and T2-weighted imaging (T2WI) high signals, while others, including prostate cancer metastases, showed T1WI and T2WI low signals. Of the 40 lesions with T1WI and T2WI low signals, metastatic prostate cancer had higher apparent diffusion coefficient values (median 0.42 × 10-3 mm2/s) than other lesions (0.26 × 10-3 mm2/s; p < 0.0001). Conclusions: DW-MRI-positive bone lesions represent various coexisting types of bone lesions, including metastatic cancer in patients with suspected prostate cancer. T2WI findings and apparent diffusion coefficient values can be helpful in diagnosing metastatic cancer.

IgG4-Related Prostatitis Impairs Objective Urinary Function as with Benign Prostate Hyperplasia: A Case Report Successfully Treated with Transurethral Resection.

We report a case of IgG4‐related prostatitis successfully treated with transurethral resection of the prostate (TUR‐P). A 47‐year‐old man with a history of autoimmune pancreatitis and sclerosing cholangitis presented with lower urinary tract symptoms. Because ultrasonography revealed a mildly enlarged prostate and uroflowmetry showed a severely diminished flow curve, benign prostatic hyperplasia was diagnosed. Despite the administration of α1‐blockers, the patients condition did not improve, and TUR‐P was performed in accordance with his wish.