R. Hattori

Magnetic resonance images of hematospermia

Seminal vesicles and their adjacent structures were studied using magnetic resonance imaging (MRI) in 7 normal volunteers and 15 patients with hematospermia. Normal seminal vesicles are depicted on T2-weighted images either as a mixture of high- and low-signal granules or as a convolution of tubules with a diameter of less than 0.5 cm. Fourteen of the 15 patients with hematospermia exhibited abnormalities on MRI. Dilatation or cyst formation in the seminal vesicle was observed in 13 patients, and a dilatation of the midline structure was seen in 3 patients. Abnormal signal intensity of the seminal vesicles was seen in 11 patients and was thought to be due to subacute hemorrhage.

Detection of muscle layer invasion with submillimeter pixel MR images: Staging of bladder carcinoma

Conventional magnetic resonance (MR) images used for the pelvic organs generally have a pixel size of 1.3 mm x 1.3 mm. We obtained images with a higher resolution than conventional images, and evaluated the usefulness of this type of image in staging urinary bladder carcinoma. Twenty-six patients having either transurethral resection of bladder tumor (TUR-BT) or cystectomy were retrospectively studied. T2-weighted images of the bladder were acquired with a 20 cm field-of-view, a matrix size of 224 x 224 (pixel size: 0.9 mm x 0.9 mm), and a slice thickness of 7 mm using a 0.5 T system. MR appearances of the carcinoma were divided into the following five categories: no abnormality found on the inner surface of the bladder wall (0), high signal layer or protrusion without breakage of the wall (I), partial disruption of the wall (II), transmural disruption of the wall (III), and complete disruption with mass formations in the perivesicular region (IV). These findings were correlated with the TNM pathologic staging determined from each tissue specimen. A prediction for muscle layer invasion was calculated by selecting pathologic stage pT2 and MR category III as a boundary measure. The accuracy was 96.2%, the sensitivity 100.0%, and the specificity 91.7%. The results obtained indicate that submillimeter pixel MR imaging shows promise as a noninvasive method for the preoperative staging of bladder cancers.

Long time follow up of CD28- CD4+ T cells in living kidney transplant patients.

Abstract:  We previously reported that the CD28− CD4+ T cell subpopulation was expanded in the kidney allograft patients with long graft survival, although these T cells were rarely found in patients with graft survival <5 yr. To understand the CD28− CD4+ T cells in the long‐term acceptance of kidney allografts, we examined functions of this population and performed a 4 yr follow up study. Peripheral blood mononuclear cells (PBMC) were obtained from 47 long‐term living related kidney allograft recipients. CD28+ CD4+ and CD28− CD4+ T cells purified by cell sorting were analyzed for expression of V repertoire. Donor‐specific response was examined in mixed lymphocyte reaction (MLR). A follow up study with long‐term kidney allograft patients was performed for 4 yr about the rate of CD28− CD4+ T cells. Eleven patients were examined by MLRs against donors and third party. Four patients with a marked increase of CD28− CD4+ T cells showed the donor‐specific responses appeared to be lower when compared with third party‐specific responses. Freshly sorted CD28− CD4+ T cells showed a restricted V repertoire, whereas the V usage of CD28+ CD4+ T cells from the same patients was much diversified. Such difference in V repertoire was not evident between the two populations from healthy control. A follow up study showed the ratio of CD28− CD4+ T cells appeared to be lower in patients who were suspected of chronic rejection. These unusual CD4+ T cells might be related to the long‐term acceptance of human transplant allografts.

99mTc-mercaptoacetyl Triglycine Renography to Monitor Renal Transplant Function Among Kidneys from Donors After Cardiac Death

PURPOSE Delayed graft function usually occurs after kidney transplantation from donors after cardiac death, It is important to monitor graft function during the anuric period, but there have been few useful tools. Consequently, we evaluated the availability of (99m)-Tc mercaptoacetyltriglycine (MAG3) renography. METHODS Thirty-two patients underwent renal transplantation from donors after cardiac death between June 2, 2005, and April 14, 2011. One patient was excluded due to an acute rejection episode which developed during the dialysis period. The first (99m)Tc-MAG3 renogram was performed as early as possible after the operation and repeated until the patient was weaned from dialysis. The corrected tubular extraction rate (cTER; mL/min/1.73 m(2)) was calculated; it represents the MAG3 clearance corrected by body surface area. RESULTS cTER was low immediately after transplantation, but increased gradually until the patient was weaned from dialysis. A significant correlation was observed between early cTER and the period of dialysis-dependence (r = -0.677, P < .001) as well as the short-term best corrected creatinine clearance (r = 0.526, P = .002). CONCLUSION We observed that graft function can be monitored by routinely performing (99m)Tc-MAG3 renography after transplantation of kidneys from donors after cardiac death.

Long-term results of endopyeloureterotomy using the transpelvic extraureteral approach

OBJECTIVES To review our clinical results to confirm the long-term efficacy of the operative technique of endopyeloureterotomy using the transpelvic extraureteral approach that we developed. METHODS We treated 123 patients with ureteropelvic junction obstruction or upper ureteral stenosis by percutaneous endopyeloureterotomy using the transpelvic extraureteral approach between 1988 and 1999. All were followed up for at least 1 year (mean 58 months). Sixty-eight patients were male and 55 female between the ages of 3 and 78 years (mean 36). We evaluated the efficacy of our procedure preoperatively and then regularly every 6 to 12 months postoperatively using excretory urography and technetium-99m DTPA renography. RESULTS Our results showed that 115 (90.6%) of 127 procedures relieved the obstruction without any severe complications. In the 107 cases of ureteropelvic junction obstruction, we alleviated the stricture in 96 (90%). In the 20 cases of upper ureteral stenosis, our procedure alleviated the stricture in 19 (95%). In the 47 cases of a stenotic segment of 2 cm or more in length, 43 of our procedures led to a significant improvement (91.5%). Long-term follow-up of the 123 patients revealed late recurrence in 5 patients, despite the initial success. CONCLUSIONS Percutaneous endopyeloureterotomy using the transpelvic extraureteral approach should be considered the first choice of treatment for ureteropelvic junction obstruction and upper third ureteral stenosis, even if the stenotic segment is 2 or more cm long.

Correlation between treated hypertension in prepregnancy and transplanted kidney function deterioration during pregnancy even if within pregnancy permission criteria.

Neither pregnancy nor birth is easy in female patients with chronic renal failure, but after kidney transplantation, childbirth is possible when the graft function is good. There are few guidelines for pregnancy permission and multiple reports of decreased transplanted kidney function after pregnancy. In this study, we analyzed factors that influenced transplanted kidney function deterioration during pregnancy. Twenty-one women among 33 total pregnancies have given birth in our institution. Factors analyzed were donor and recipient age at transplantation, birth age of recipient, living or cadaveric donor, hemodialysis period before transplantation, delivery method, presence of hypertension and protein urea at the beginning of pregnancy, and period between pregnancy and transplantation. Maternal graft function at the beginning of the pregnancy was 1.16 ± 0.39 mg/dL (range = 0.5-2.1). A rise in serum creatinine (S-Cr) before delivery was observed in 10/21 cases: six cases showed a rise in S-Cr levels at 1 or more years after delivery. From the analysis, graft function at the beginning of pregnancy became a significant factor correlating with the elevation of S-Cr levels during pregnancy (P = .002). Patients were divided into two groups by S-Cr levels at the beginning of pregnancy: group A was S-Cr ≤ 1; group B was S-Cr 1-2 mg/dL. All group A cases showed stable graft function before and after delivery. Some individuals in group B experienced deterioration of graft function during pregnancy; the others had stable graft function. The presence of treated hypertension at the beginning of pregnancy in group B significantly impacted renal dysfunction during pregnancy (P < .05). In conclusion, the presence of treated hypertension at the beginning of pregnancy was a significant risk factor for functional deterioration of the transplanted kidney during pregnancy even if the individual was initially within pregnancy permission criteria.

Is Estimated Donor Glomerular Filtration Rate Before Death a Better Predictor of Decreased-Donor Kidney Function?

The worldwide shortage of deceased-donor kidneys for transplantation has become a serious issue in the past decade, leading to study of marginal donors. However, both the availability and the utility of kidneys from deceased donors are still unclear. The aim of the present study was to evaluate another method to estimate donor kidney function rather than using donor creatinine (Cr). We studied 129 recipients of deceased-donor kidneys from Maastriche donor categories III and IV. We analyzed donor Cr levels before death and recipient Cr levels at 1 year after transplant, as well as estimated glomerular filtration rates (eGFR). There was no significant difference in donor Cr levels at admission to the hospital and before death according to eGFR at 1 year after transplantation: <30 mL/min/1.73 m(2) versus ≧30 mL/min/1.73 m(2). However, recipients whose donors showed lower average eGFR levels on admission displayed better renal function at 1 year after transplant (P = .025). In conclusion, donor Cr levels before death was a less useful measurement to relate to recipient renal function; eGFR provided a better index.

Anti-HLA Antibody Reduced Graft Survival in Living-Related Transplants: Over 20-Years Experience: 2079

Introduction: Recently, many studies showed effects of HAL antibody to kidney transplants. However, longer behavior and impact of HLA antibody were not clear. In this study, the role of HLA antibodies in allograft rejection was examined utilizing a unique resource of sera collected annually and stored over a 23-year period from patients with rejected or retained grafts. Methods: We selected 60 transplant patients who received kidney from 1984 to 1999, and whose serum samples were available annually. During 23 years, 32 patients were rejected their grafts and 28 had functioning grafts. Their samples were tested for HLA Class I and Class II antibodies by flow cytometry, ELISA, or cytotoxicity. For analyzing specific HLA antibodies, we used Labscreen Single antigen (One Lambda). Results: HLA antibodies were found in 81% of patients who rejected grafts, compared to 50% with functioning transplants (p=0.0001). In addition, even if living-related transplants had good kidney function for a longer time, some living-related patients gradually developed HLA antibodies with stable functioning grafts.

Laparoscopic cytoreductive nephrectomy with cytokine therapy for metastatic renal cell carcinomas compared with open nephrectomy

Introduction: We retrospectively reviewed and compared the operation records and long‐term results of patients with metastatic renal cell carcinoma (mRCC) who underwent laparoscopic cytoreductive nephrectomy and those who underwent open procedure.

DIRECT VISUALIZATION OF CORTICAL PERITUBULAR CAPILLARY OF HUMAN TRANSPLANT KIDNEY WITH REPERFUSION INJURY USING A MAGNIFYING ENDOSCOPY

Aims: We developed the direct imaging system of renal microcirculation by a magnifying-endoscopy, which enabled the movement of erythrocyte to be visualized in glumerular and cortical peritubular capillary (CPC). The aim of this study is to clarify the early microhemodynamic condition in CPC of transplanted kidney, which is believed to be crucial in early graft function. Methods: Erythrocyte velocity in CPC was analyzed in 13 recipients of living-related (10) and cadaveric donor (3) renal transplants at 20, 60, 90 and 120 minutes after re-perfusion. In living-related donors, erythrocyte velocity in CPC was also measured before nephrectomy. Microhemodynamic parameters were quantified off-line by the sepatiotemporal analysis using a computer-assisted image original program system. Results: Ischemic time, duration of ATN and lowest S-Cr level after kidney transplantation in 13 recipients are shown in table 1. Although erythrocyte velocity was significantly reduced at 20 and 60 minutes after reperfusion in living-related donor transplants, it recovered to base line values at 120minutes (Table 2). In cadaveric donor transplants erythrocyte velocity in CPC after revasculization was significantly lower than that of living-related donor transplants.