Kunio Yamaguchi

Clinical characteristics of aldosterone-producing microadenoma, macroadenoma, and idiopathic hyperaldosteronism in 93 patients with primary aldosteronism.

Primary aldosteronism (PA) due to aldosterone-producing adenoma (APA) is a form of surgically curable secondary hypertension, and distinguishing APA from idiopathic hyperaldosteronism (IHA) is important for treatment. We made a differential diagnosis between APA and IHA using imaging tests such as adrenal CT and MRI as well as adrenal venous sampling (AVS) in all 93 cases of PA presenting at our institutions over the last decade. We identified 27 patients with aldosterone-producing microadenoma (APmicroA), all of whom could be diagnosed by AVS but not by the imaging tests. Then, we compared the clinical and roentgenological findings of these 27 patients with those of 42 patients with aldosterone-producing macroadenoma (APmacroA) and of 24 patients with IHA. Using surgically removed adrenal tissues, histopathological examinations and immunohistochemical analyses of steroidogenic enzymes were conducted. The findings for APmicroA were similar to those for APmacroA, except with respect to the diameter of the adrenal adenomas. Endocrinological and roentgenological findings for APmicroA were similar to those for IHA, but not to those for APmacroA. The rate of cure of hypertension was much greater in patients with APmicroA than in patients with APmacroA after the unilateral adrenalectomy (odds ratio, 4.0; p=0.028). In conclusion, it is important to accurately diagnose APmicroA, in which the laterality of the hyperproduction of aldosterone is only detectable by AVS, and to treat these patients by unilateral adrenalectomy in order to avoid long-term medical treatment and prevent hypertensive vascular complications.

Low dose tamsulosin for stone expulsion after extracorporeal shock wave lithotripsy: Efficacy in Japanese male patients with ureteral stone

Objective:  We evaluated the efficacy of low dose tamsulosin after extracorporeal shock wave lithotripsy (ESWL) in Japanese male patients with ureteral stone.

Neuroendocrine differentiation in stage D2 prostate cancers

Objectives:  Chromogranin A (CgA) and neuro‐specific enolase (NSE) are gaining acceptance as markers of several types of neuroendocrine tumors and the concentration of CgA and NSE have been reported to be elevated in relation to neuroendocrine differentiation of prostate cancer. The aim of the present study was to examine the correlation between the immunohistochemical (IHC) findings and serum value for CgA and NSE in untreated stage D2 prostate cancer patients.

Laparoscopic adrenalectomy in patients with large adrenal tumors

Objectives: The maximum size of adrenal tumors that should be removed by laparoscopic adrenalectomy is controversial. We conducted a retrospective comparison of the results of laparoscopic adrenalectomy between patients with adrenal tumors ≥6 cm (‘large tumors’) and patients with adrenal tumors <6 cm (‘small tumors’).

The Incidence of Cystinuria in Japan

Screening tests for cystinuria were done in approximately 110,000 children and students. The rates of discovery were chemical cystinuria 920 to 1, cystine crystalluria 16,000 to 1 and homozygous cystinuria 18,000 to 1 (8,000 to 1 if a correction was made by the rates of performances of secondary screening and urinary amino acid assay). No stone formation was observed in a 7-year followup of 6 patients considered to be homozygotes. A correlation was observed between urinary cystine and urinary uric acid levels in 39 cases of chemical cystinuria.

Efficacy and safety of laparoscopic surgery for pheochromocytoma

Objective: Laparoscopic surgery for primary aldosteronoma and Cushings syndrome is well established. We report on our experiences with laparoscopic adrenalectomy for pheochromocytoma, and assess the efficacy and safety of the laparoscopic approach.

Evaluation of docetaxel plus estramustine in the treatment of patients with hormone‐refractory prostate cancer

Objectives:  To investigate the feasibility and efficacy of docetaxel‐based chemotherapy in patients with hormone‐refractory prostate cancer (HRPC).

Primary Localized Amyloidosis of the Ureter Associated with Osseous Metaplasia

A case of primary localized amyloidosis of the ureter associated with osseous metaplasia, presenting as a calcification on computerized tomography, is reported. We believe this is the second such case to be reported in the world literature. The previous 34 cases of primary amyloidosis of the ureter are reviewed and the clinical presentations and treatments discussed. The difficulties of distinguishing the condition from transitional cell carcinoma of the ureter is emphasized. Surgical treatment should be conservative, if possible.

Androphilic protein studied histochemically in stage D2 prostatic cancer.

Androphilic protein in prostatic cancer was histochemically observed with dihydrotestosterone (DHT), R 1881, and mibolerone as ligands. Cancer cells were equally stained with fluorescent R 1881 and mibolerone, and this fluorescence seems to be made up of both the androgen receptor and progestin‐binding protein. The staining with fluorescent DHT was weak. Sixty‐two Stage D2 prostatic cancer patients were examined with histochemical androphilic protein, and they then received endocrine therapy. The presence of fluorescence of R 1881 was not correlated with grade, but a relationship between the presence of fluorescence and the response to endocrine therapy was noticed 6 months after the start of treatment. Moreover, fluorescence‐positive patients showed better survival than fluorescence‐negative patients. An examination with fluorescent DHT revealed a similar tendency to that of R 1881, but the frequency of positive fluorescence was lower, indicating that R 1881 is a suitable ligand in this type of study.

Histochemical study of R1881-binding protein, prostatic acid phosphatase, prostate-specific antigen, and r-seminoprotein in prostatic cancer.

A histochemical study on R1881-binding protein, prostatic acid phosphatase (PAP), prostate-specific antigen (PA) and r-seminoprotein was conducted. These parameters and histologic grades were compared to each other and with the responsiveness to endocrine therapy. A good correlation was found between histologic grade and presence or absence of R1881-binding protein in the tissue. Presence or absence of R1881-binding protein as well as histologic grade correlated well with responsiveness to endocrine therapy. Positive staining patterns of PAP, PA, and r-seminoprotein in the tissues were similar to each other, particularly between PA and r-seminoprotein. However, no correlation was found between the histologic grade and ratios of PAP, PA or r-seminoprotein-positive cells. Nor was any correlation seen between the ratio of these marker-positive cells and responsiveness to endocrine therapy.