Shigeki Matsuo

Health-related quality of life of ileocecal rectal bladder compared with ileal conduit diversion: A questionnaire survey

Background : The ileocecal rectal bladder (IRB) after cystectomy has been devised, in which continence is controlled by the anal sphincter. To assess how this procedure influences postoperative health‐related quality of life (QOL), IRB patients were compared with ileal conduit (IC) patients using a questionnaire mail‐out.

A Case of Incomplete Renal Tubular Acidosis (Type 1) Associated with Medullary Sponge Kidney Followed By Nephrocalcinosis

A case is reported of incomplete renal tubular acidosis (type 1) associated with medullary sponge kidney followed by nephrocalcinosis. Although several cases of classic renal tubular acidosis associated with medullary sponge kidney have been documented a case of incomplete renal tubular acidosis associated with medullary sponge kidney seems to be rare. We recommend examination for incomplete renal tubular acidosis in patients with medullary sponge kidney and nephrocalcinosis without systemic acidosis.

Effects of Ethylenediaminetetraacetic Acid-4 Sodium Solution on the Surface of Renal Calculi and the Uroepithelium

Tetrasodium ethylenediaminetetraacetic acid is one of the most effective agents that dissolve renal calculi, especially calculi containing calcium. To study the dissolving process of calculi in solutions, with or without trypsin, serial thin sections of renal calculi composed of calcium oxalate and/or phosphate were prepared and observed by polarizing microscopy. The effects of the solution on the surface of human renal calculi and rat uroepithelium also were studied by scanning electron microscopy. A remarkable difference in solubility was noted between the crystalline and the amorphous components in struvite calculi. Under the polarizing microscope the dissolving effect of 5 per cent tetrasodium ethylenediaminetetraacetic acid solution on struvite after 30 minutes of incubation was equivalent to the use of saline for 24 hours. The effect of trypsin was not apparent. However, under the scanning electron microscope trypsin accelerated the dissolving effect of the tetrasodium ethylenediaminetetraacetic acid solution in struvite and calcium oxalate calculi. The contradictory findings of the ineffectiveness of trypsin on the thin sections as opposed to the pronounced changes seen on the surface of the calculi could be attributed to the difference in the exposed area. The results suggest that trypsin does not seem to dissolve calculi but mainly facilitates the solution to permeate the calculi. The cellular arrangement of the uroepithelium was preserved in tetrasodium solution and in 0.04 per cent trypsin tetrasodium ethylenediaminetetraacetic acid solution.

Clearance and Safety of the Radiocontrast Medium Iopamidol in Peritoneal Dialysis Patients

Although the characteristics and safety of radiocontrast media in peritoneal dialysis (PD) patients are not yet well defined, their use in PD patients is considered generally safe. In this study, we evaluated clearance and adverse events of iopamidol in PD patients. We measured the iopamidol concentration in the plasma, dialysate, and urine of 11 patients. Iopamidol clearance from patient plasma was delayed with a half-life of 33.3 h, and the elimination ratio was 83.6% for 96 h. We retrospectively investigated adverse events occurring in a total of 50 stable PD patients who underwent a total of 64 angiographic computed tomography (CT) scans. In 64 angiographic CT scans, two cases of adverse events were observed. Our results suggest that iopamidol can be eliminated by regular PD and careful observation for adverse events are necessary for the safe use of radiocontrast media.

Two years of bicalutamide monotherapy in patients with biochemical relapse after radical prostatectomy

Background Salvage treatments for biochemical relapse (BCR) after radical prostatectomy (RP) have several problems in terms of indications or adverse events. We studied the possibility of 2 years of bicalutamide monotherapy for BCR after RP. Methods Patients who showed BCR (prostate-specific antigen (PSA) ≥ 0.2 ng/ml) after RP were recruited. Protocol treatment was planned as 2 years of bicalutamide (80 mg/day) followed by observation. Protocol treatment failure was defined as PSA re-elevation of ≥0.2 ng/ml, clinical progression, any other treatments, or discontinuation or restart of bicalutamide. Primary endpoint of this study is time to protocol treatment failure from initiation of bicalutamide. Results A total of 91 patients were registered between 2003 and 2009. Median age and PSA at initiating bicalutamide were 68 (range, 55-78) years and 0.32 (range, 0.19-7.91) ng/ml. Twenty-four (26.4%) patients could not complete 2 years of bicalutamide mainly due to progression of disease. Of the 91 patients, 2- and 5-year protocol treatment failure-free survivals were 74.6% and 33.0%, with a median follow-up of 76 (range, 11-118) months. Median time from initiating bicalutamide to treatment failure was 43 (95% confidence interval, 33-47) months. High-risk status at RP and time to BCR after RP < 6 months were significant predictors of second BCR. Conclusions Two years of bicalutamide monotherapy should not be recommended as standard management for BCR after RP, but might be feasible for selected patients who do not have high-risk status at RP and short time to BCR.

Clinical evaluation of bicarbonate dialysis

重炭酸透析については, 最近いくつかの報告がなされており, 酢酸透析に比較し不快な症状の少ない透析ができる点で, その有効性が見直されている. 今回我々は, 透析時間を5時間から4時間に短縮し, 透析効果について5時間の酢酸透析と比較し検討を加えた.その結果, pH, HCO-3濃度, B. E. は, 4時間透析にもかかわらず酢酸透析に比較し透析後有意に上昇し, アシドーシスの改善効果が優れていた. 特にpHの改善が顕著で, 透析開始2時間で7,332±0.026から7.403±0.04まで上昇していた.尿素窒素, クレアチニン, 尿酸値は, 透析後有意に低下し, 除去率では, 5時間の酢酸透析と比較し劣らない結果を得た. 特にクレアチニンの除去率は, 酢酸透析の44.1±6.4%に比し, 重炭酸透析では, 52.7±4.4%と有意に高値を示した. また長期的にみた窒素代謝産物の透析前値の上昇, 及び体重の増加はまったく認められなかった. 透析ごとの体重減少量の比較では, 酢酸透析で2.0±0.4kg, 重炭酸透析で23±0.3kgと両者間に有意の差をみなかった. Ca濃度については, 透析後有意に上昇し, 低Ca血症は改善されていた.以上の所見より, 重炭酸透析では, 酸-塩基平衡の改善が効率よくしかも迅速であり, 透析中の不快な症状が少ないばかりでなく, 透析終了時まで十分な血液流量, 及び適正な限外濾過圧を維持することができ, 今後大面積-短時間透析において非常に有利であると判断した.