Hiroaki Itatani

Surgical repair of varicocele at puberty: preventive treatment for fertility improvement.

In 40 pubertal boys with a varicocele a comparative followup study was performed to evaluate the efficacy of surgical correction of the varicocele in this age group in regard to improvement of fertility after completion of sexual maturation. The varicocele was corrected surgically in 24 patients and it was left uncorrected in 16. Testicular atrophy was noted in all cases at the initial visit and after followup. Of the 24 corrected patients 16 had atrophy of at least 1 testis before surgical treatment, whereas only 7 demonstrated atrophy after followup. Of the 16 uncorrected patients testicular atrophy was noted in 8 at the initial visit but 12 had atrophy after followup. Semen examination of 23 patients who had completed sexual maturation demonstrated a higher quality of routine seminal parameters, for example sperm density, sperm motility and percentage of morphologically normal spermatozoa, in the corrected group than in the uncorrected group.

Excision Repair Cross-Complementing Group 1 May Predict the Efficacy of Chemoradiation Therapy for Muscle-Invasive Bladder Cancer

Purpose: Chemoradiation therapy (CRT) is now widely recognized as bladder-preserving therapy for muscle-invasive bladder cancer (MIBC). However, some patients who fail CRT may miss the chance to be cured by cystectomy. Therefore, it is important to select patients with MIBC who are expected to have a good response to CRT. Several reports indicate that the excision repair cross-complementing group 1 (ERCC1) gene is associated with resistance to cisplatin and radiation therapy. In this study, we examined the correlation between ERCC1 and CRT in vitro and in vivo in bladder cancer. Experimental Design: Bladder cancer cell lines T24, 5637, Cl8-2 (multidrug-resistant subline of T24), and CDDP10-3 (cisplatin-resistant subline of T24) were used for in vitro assays to measure ERCC1 expression level and growth inhibition with cisplatin or ionizing radiation (IR). We then examined by immunohistochemistry that whether ERCC1 nuclear staining correlates with the efficacy of CRT using cisplatin in 22 patients with MIBC. Results: Cl8-2 cells expressed ERCC1 mRNA 5.96-fold higher than did T24. Cl8-2 and CDDP10-3 were more resistant to cisplatin or IR than was T24. Resistance to IR, but not to cisplatin, was removed by suppressing ERCC1 using siRNA in both Cl8-2 and CDDP10-3 cells. In immunohistochemistry with ERCC1, 6 of 8 positive cases did not have complete response to CRT, whereas 12 of 14 negative cases had complete response. Sensitivity and specificity were 75% and 85.7%, respectively (P = 0.008). Conclusion: Although further study is needed, ERCC1 expression level may predict the efficacy of CRT for MIBC. Clin Cancer Res; 17(8); 2561–9. ©2010 AACR.

Testicular Responsiveness to Long-Term Administration of hCG and hMG in Patients with Hypogonadotrophic Hypogonadism

Steroidogenic responsiveness and amelioration of sperm number and motility following long-term intramuscular hCG and hMG administration were evaluated in 18 males with hypogonadotrophic hypogonadism (HH). The patients consisted of 13 patients with isolated gonadotrophin deficiency (IGD) and 5 patients hypophysectomized at an early or middle pubertal period. Basal serum levels of testosterone and 17 beta-estradiol were within prepubertal range in all patients before the treatment. Serum testosterone levels reached the normal adult male levels within 12-24 months of the treatment in only 2 of 7 younger patients and 1 of 6 older patients with IGD, whereas in all hypophysectomized patients serum levels of both testosterone and 17 beta-estradiol increased to the levels found in normal adult males within 6 months of the treatment. The mean peak levels of serum testosterone and 17 beta-estradiol, respectively, during the treatment were 2.1 +/- 0.8 (SD) ng/ml and 10.8 +/- 4.9 (SD) pg/ml in younger patients with IGD, 1.4 +/- 0.9 ng/ml and 9.7 +/- 5.1 pg/ml in older patients with IGD and 6.0 +/- 1.2 ng/ml and 34.2 +/- 14.8 pg/ml in hypophysectomized patients. Quantitative improvement in both sperm density and sperm motility were found in 4 of 7 younger patients, 1 of 6 older patients with IGD and all hypophysectomized patients, but only 3 of hypophysectomized patients (3 of 18 patients) could become fertile.

Renal cell carcinoma : Preoperative assessment for enucleative surgery with angiography, CT, and MRI

PURPOSE Our purpose was to assess various imaging methods in detecting a pseudocapsule of renal cell carcinoma (RCC), which is critical for successful tumor enucleation. METHOD In 42 patients with histopathologically proven RCC, images obtained at angiography (n = 42), CT (n = 30), and MRI (n = 19) were investigated retrospectively. All patients underwent treatment (enucleation: n = 15; nephrectomy: n = 27). The imaging criteria for the presence of a pseudocapsule were as follows: a surrounding radiolucent rim on angiography, a low or high density rim on CT, and a low intensity rim on MRI. All images were retrospectively reviewed by three radiologists without knowledge of the clinical and histological findings. RESULTS Thirty-three of 42 RCCs showed a pseudocapsule on the surgical specimen. A pseudocapsule was detected in 67% of tumors (22/33) on angiography, 26% (6/23) on CT, 27% (4/15) on T1-weighted MRI, 93% (14/15) on T2-weighted MRI, 67% (8/12) on dynamic enhanced T1-weighted MRI, and 15% (2/13) on delayed enhanced T1-weighted MRI. CONCLUSION T2-weighted MR images are superior for visualizing a pseudocapsule of RCC and for providing reliable selection criteria for tumor enucleation.

Clinical Manifestations of Calcium Oxalate Monohydrate and Dihydrate Urolithiasis

We studied retrospectively 155 patients with calcium oxalate urolithiasis. The patients were divided into 3 groups: 1) those with calcium oxalate monohydrate, 2) those with calcium oxalate dihydrate and 3) those with mixed calcium oxalate monohydrate and dihydrate. Various differences were noted between patients with calcium oxalate monohydrate and those with calcium oxalate dihydrate, with respect to stone characteristics, spontaneous passage of stones, stone recurrence and multiple occurrence. Most important, we noted that patients with calcium oxalate dihydrate had more stone recurrences than patients with calcium oxalate monohydrate.

Plasma cell granuloma of the renal pelvis.

Abstract We report the second case of plasma cell granuloma of the renal pelvis, which was treated successfully by a conservative operation. In the first case treatment consisted of partial nephrectomy.

INCIDENCE OF PROSTATIC INTRA-EPITHELIAL NEOPLASIA IN OSAKA, JAPAN

High‐grade prostatic intra‐epithelial neoplasia (HGPIN) is the most likely precancerous lesion for prostatic carcinoma. A high incidence of its association with cancer has been reported in Western countries. On the other hand, information regarding its incidence is limited in Japan, where the mortality due to prostate cancer is much lower. We reviewed 53 clinical stage T2 or T3 prostatic cancers of Japanese patients living in Osaka, Japan (mean age, 67.2 years). These cases were subdivided into a pre‐operatively non‐castrated group (34 cases) and a medically or surgically castrated group (19 cases). HGPIN was found in 27 cases. The incidence of HGPIN was significantly lower in the castrated group (21.0%) compared with the non‐castrated group (67.6%). In the non‐castrated group, patient age, pathological stage, Gleason score, tumor size and serum prostate‐specific antigen showed no significant correlation with HGPIN. Advanced pathological stage and tumor size tended to decrease the incidence of HGPIN, although this was not statistically significant. When the study group was limited to stage T2 tumors of the non‐castrated group, the incidence of HGPIN was 81.0%. HGPIN in Japan may also be clinically and etiologically significant as a precursor of clinical cancer. Int. J. Cancer 73:808–811, 1997.

Pituitary-gonadal function in schoolboys with varicocele and indications of varicocelectomy.

Pituitary-gonadal functions were investigated by LH-RH test, HCG test and bilateral testicular biopsies in 5 boys with unilateral varicocele at various pubertal stages and the results were compared with those in the normal boys at puberty. The ages of the patients ranged from 12 to 18 years. With the progress of pubertal stage, both the basal value and response of serum FSH to LH-RH became higher as compared with normal boys. The basal value and response of serum LH showed no significant difference except for one case where higher values and no significant differences in the basal value and response of plasma testosterone to HCG stimulation were observed. The disturbance of spermatogenesis in the affected testis becomes prominent with the progress of puberty, while changes in the testis of opposite side were mild.

Angiomyolipoma and renal cell carcinoma occurring in same kidney: CT evaluation.

A case of angiomyolipoma and renal cell carcinoma occurring adjacently in the same kidney without tuberous sclerosis is reported. It was difficult to differentiate the renal cell carcinoma from the angiomyolipoma by angiography, but CT was able to make this distinction.

A Simple hCG Stimulation Test for Normal and Hypogonadal Males

A simple human chorionic gonadotropin (hCG) test to measure Leydig cell function is described. Plasma testosterone was measured on two occasions, once before intramuscular injection of 10,000 IU of hCG and again four days later. Preliminary tests in 10 adult males showed a maximal increase in plasma testosterone between the third and fifth day that was confirmed in a further 20 normal subjects when measured once on the fourth day. Except for 2 patients with hypospermatogenesis, 24 showed a good response and the mean increase was comparable with that in normal males. Nineteen patients with Klinefelters syndrome usually had lower basal levels and showed a poor response, with the exception of six patients in whom there were moderate but definite increases. Twelve patients with hypogonadotropic hypogonadism had basal testosterone concentrations below 1 ng/ml and eight responded poorly to hCG stimulation. However, four patients showed a moderate but definite response.