Ichiro Takeuchi

THE ROLE OF LYMPH-NODE DISSECTION IN THE TREATMENT OF UPPER URINARY TRACT CANCER: A MULTI-INSTITUTIONAL STUDY

To determine the role of lymph‐node (LN) dissection in patients undergoing surgery for upper urinary tract (UUT) cancer.

Pre‐emptive renal transplantation in children

Abstract Background: Renal transplantation is a definitive therapeutic modality in end‐stage renal disease (ESRD). Most ESRD patients in Japan experience dialysis prior to renal transplantation. The present study was undertaken to examine the usefulness of pre‐emptive renal transplantation (PET).

Feasibility of Tri-Weekly Docetaxel-Based Chemotherapy for Elderly Patients (Age 75 and Older) with Castration-Resistant Prostate Cancer

Objectives: To evaluate the efficacy and safety of docetaxel-based chemotherapy for elderly metastatic castration-resistant prostate cancer (CRPC) patients aged 75 or higher. Methods: Twenty CRPC patients aged 75 or higher (older group) and 31 CRPC patients younger than 75 years (younger group) were treated by a regimen of docetaxel (70 mg/m2) once every 3 weeks. Adjustment for docetaxel dosage and period per cycle was subject to investigator’s judgment. Results: The median relative dose intensity of both groups was 0.84, while the median dose intensity and the number of treatment cycles of the younger and older groups were 14.6 versus 12.3 mg/m2/week (p = 0.021), and 9 versus 8 cycles (p = 0.15), respectively. In the older group, PSA response rate was 50%, median time to biochemical progression was 7.5 months, and median survival time was 15.5 months, without any significant difference compared to those of the younger group. No significant difference in the incidence of grade 3–4 adverse events was noted between both groups. All these parameters for efficacy are comparable to those reported for tri-weekly docetaxel regimen. Conclusions: Tri-weekly treatment by docetaxel (70 mg/m2) with proper adjustment might contribute to maintaining efficacy and safety of the treatment for elderly CRPC patients.

Intravenous digital subtraction angiography and helical computed tomography in evaluation of living renal donors

Abstract Objectives: The present study was carried out to evaluate the accuracy of helical computed tomography (CT) and intravenous digital subtraction angiography (IV‐DSA) on anatomical assessment of renal vasculature for living renal donors.

Biosynthetic Study on Antihypercholesterolemic Agent Phomoidride: General Biogenesis of Fungal Dimeric Anhydrides

To elucidate the general biosynthetic pathway of fungal dimeric anhydrides, a gene cluster for the biosynthesis of the antihy-percholesterolemic agent phomoidride was identified by heterologous expression of candidate genes encoding the highly reducing polyketide synthase, alkylcitrate synthase (ACS), and alkylcitrate dehydratase (ACDH). An in vitro analysis of ACS and ACDH revealed that they give rise to anhydride monomers. Based on the established monomer biosynthesis, we propose a general biogenesis of dimeric anhydrides involving a single donor unit and four acceptor units.

Kidney Transplantation in Patients with Neurovesical Dysfunction

Background: Five renal recipients with neurovesical dysfunction (NVD) were retrospectively reviewed focusing on anatomical and urodynamic abnormalities of the lower urinary tract and their management prior to kidney transplantation.

Surgery for Renovascular Diseases: A Single-Center Experience in Revascularizing Renal Artery Stenosis and Aneurysm

Objective: Diagnosis and management of renovascular diseases (RVD) at Hokkaido University Hospital was reviewed with particular emphasis on surgical revascularization (SR). Patients and Methods: We studied a total of 33 patients with RVD [16 patients with renal artery stenosis (RAS): group 1, and 17 patients with renal artery aneurysm (RAA): group 2, 10 males, 23 females, aged 9–69 years (median 46), unilateral 24, bilateral 9]. Functional diagnosis of RVD with regard to renovascular hypertension (RVH) was done with the captopril test (CP-T) and captopril-enhanced 99mTc-DTPA (diethylenetriamine-pentaacetic acid) renal scintigraphy (CER). All were subjected to SR. Number, length, size and site of RVD with involvement of branch arteries dictated the choice of operative method but basically in situ repair for main trunk disease (11 kidneys) and ex vivo bench repair with autotransplantation for those beyond the first bifurcation intrarenally involving branched arteries (24 kidneys) were employed. The outcome was analyzed as to blood pressure control, split renal function, and branch renal artery patency. Results: (1) Sensitivity of CP-T and CER was 79 and 77% respectively in group 1, while it was 40 and 38% respectively in group 2. (2) Blood pressure was cured in 66.7% (group 1, 68.8% and group 2, 63.6%) and improved in 22.2% (group 1, 18.8% and group 2, 27.3%) with an overall success rate of 88.9%. (3) Renal function was good in 81.3% (group 1, 83.3% and group 2, 78.6%) and fair in 9.4% (group 1, 0% and group 2, 21.4%) with overall success in 90.7%. (4) Patency was preserved in 90.5% of branch anastomoses. Conclusions: Despite challenging complexities, SR of RVD is feasible with a reasonable amount of morbidity and effective in controlling blood pressure and preserving renal function in the majority of cases.

Immunological Analysis of Rat Renal Transplant Recipients Exhibiting Long‐term Survival Following Treatment with 15‐Deoxyspergualin in the Early Postoperative Phase

Background: We previously reported that short‐term administration of 15‐deoxyspergualin (DSG), 5 mg/kg/day on postoperative days 4 through 7, prolonged survival of rat renal allografts indefinitely. We now report the immunologic environment of DSG‐treated recipients in the early postoperative phase.

Usefulness of Transurethral Incision as a Primary Treatment of Ureterocele in Children

Seventeen patients (11 girls and 6 boys, with bilateral cases in 4 for a total 21 units), in whom ureterocele was diagnosed at from 5 days to 11 years old, were treated with transurethral incision as a primary treatment. Urinary tract infection was the most common presenting sign in 8 patients. A voiding disturbance was observed in 10 patients. Seven units were diagnosed as intravesical ureteroceles of a single system and 14 units as ectopic ones (12 associated with the duplex system and 2 with a single system). De novo reflux occurred in 12 units, but in 5 units resolved spontaneously. All 5 refluxes in mate units improved, and 2 refluxes in the contralateral ureter also disappeared. The control of infection became easy in all patients except for one with a sphincteric ureterocele. Split renal function on 99mTc-diethylenetriamine pentaacetic acid scintigraphy was prominently improved in 5 systems (35.7%) and normal kidney growth was obtained in 11 systems (78.6%). A total of 13 affected units (68.4%), including 7 units (6 intravesical and 1 ectopic) for which transurethral incision seemed to have been the sole necessary treatment, were saved. We believe that transurethral incision of ureteroceles is a very useful technique as a primary treatment for all types of ureteroceles in children of all ages.

Kidney-Alone Transplantation in Diabetic Patients with End-Stage Renal Disease

From January 1989 to December 1995, 5 diabetic patients with end‐stage renal disease (1 woman, 4 men) underwent kidney‐alone transplantation. The mean age of the recipients at the time of transplantation was 37.4 years (range, 32 to 43). Graft function and glucose tolerance was evaluated for 5 to 72 months after surgery. Postoperative complications were seen in 2 patients; nonspecific subcutaneous infections and an asymptomatic partial allograft infarction. All renal allografts were functioning 1 year after transplantation, with a mean serum creatinine level of 1.10mg/dL (range, 0.8 to 1.8mg/dL), and a mean urinary protein level of 1 7.8mg/dL (range, 5 to 27mg/dL). The postoperative daily dose of insulin was higher than the preoperative dose, while the level of glycated hemoglobin (HbA1c) increased after surgery and peaked 6 months after transplantation; 1 year after transplantation it had reverted to the preoperative level. As long as the diabetic complications of the renal allograft recipients are not severe, the short‐term survival and the renal function of diabetic patients with end‐stage renal disease improves after kidney‐alone transplantation, which is still the standard method of treatment in Japan.