Shinshi Noda

Holmium: yttrium-aluminum-garnet laser for endoscopic lithotripsy

OBJECTIVES To evaluate the holmium:yttrium-aluminum-garnet (Ho:YAG) laser for endoscopic lithotripsy on patients diagnosed with urinary tract calculi. METHODS Thirty-eight procedures utilizing transurethral ureterolithotripsy or percutaneous nephroureteral lithotripsy were evaluated: 5 renal calculi, 31 ureteral calculi (most in the upper ureter), 1 ureteropelvic junction calculus, and 1 bladder calculus. These were mainly in cases that, after being treated with extracorporeal shock-wave lithotripsy (ESWL), were contraindicated for further ESWL. Laser parameters included energy of 0.5 to 1.0 J/pulse and pulse rate of 5 to 10 Hz. RESULTS Composition of calculi was determined in 26 procedures. The Ho:YAG laser was effective for fragmenting all types of calculi. Patient outcome evaluated at 6 weeks after treatment showed that 33 of 38 procedures (87%) were effective. Residual calculi in 4 of the 5 unsuccessful procedures were less than 5 mm in size and judged to be able to pass spontaneously. In the remaining procedure, the calculus was passed spontaneously 3 months after treatment. No severe damage to tissues or adverse effects to the body were observed due to the Ho:YAG laser. CONCLUSIONS On the basis of these results, we determine that this wavelength is effective for lithotripsy in addition to its previously reported usefulness for soft tissue applications, and, thus, is a cost-effective and highly useful clinical device.

Phase I trial of patient‐oriented vaccination in HLA‐A2‐positive patients with metastatic hormone‐refractory prostate cancer

To evaluate the safety and toxicity of peptide vaccination for patients with metastatic hormone‐refractory prostate cancer (HRPC) based on pre‐existing peptide‐specific cytotoxic T‐lymphocyte (CTL) precursors in the circulation, 10 patients positive for human leukocyte antigen (HLA)‐A2 with metastatic HRPC were enrolled in a phase I study. Peptide‐specific CTL‐precursors reactive to 16 kinds of vaccine candidates in the pre‐vaccination peripheral blood mononuclear cells (PBMCs) were measured, and patients were followed by vaccination with only positive peptides (up to 4 kinds of peptides). Serum prostate‐specific antigen (PSA) levels were monitored regularly. The peptide vaccination was safe and well tolerated with no major adverse effects. The most common toxicities were dermatologic reactions at the injection site. Increased CTL response to peptides was observed in 4 of 10 patients. Anti‐peptide IgG was also detected in post‐vaccination sera of 7 of 10 patients. One patient showed the disappearance of a pelvic bone metastasis after five vaccinations. Three patients showed a decrease of serum PSA level from the baseline after the vaccination, but no patients showed a serum PSA level decrease of ∼50%. The median survival duration of study patients was 22 months with follow‐up from 3 to 27 months. We consider that the increase in cellular and humoral immune responses, and decrease in PSA level in some patients justify further development of peptide vaccination for metastatic HRPC patients. (Cancer Sci 2004; 95: 77–84)

Serum levels of bone turnover markers parallel the results of bone scintigraphy in monitoring bone activity of prostate cancer

OBJECTIVES To investigate the usefulness of bone turnover markers as a modality for monitoring bone metastasis in patients with prostate cancer with bone metastasis. METHODS Serial measurements of pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), carboxyterminal pro-peptide of type I procollagen (PICP), prostate-specific antigen (PSA), and the percentage of the positive area on the bone scan were prospectively performed before and after hormonal therapy in 84 patients with prostate cancer with bone metastasis for median follow-up of 29 months. RESULTS Serial ICTP and PICP levels in 48 patients without progression of bone metastasis demonstrated a downward trend during treatment and were almost within the normal range by the end of follow-up. The remaining 36 patients, who had PSA failure with progression of bone metastasis, showed an upward trend for serial ICTP and PICP levels before the progression of bone metastasis. The rates of detecting bone progression using bone turnover markers were higher than those using PSA levels on the basis of the percentage of clinical effectiveness and receiver operating characteristic curves. CONCLUSIONS Serial measurement of bone turnover markers is useful for monitoring the bone activity of prostate cancer and might detect early progression of bone metastasis in patients with PSA failure.

CUMULATIVE RENAL DAMAGE IN DOGS BY REPEATED TREATMENT WITH EXTRACORPOREAL SHOCK WAVES

Background: Extracorporeal shock wave Iithotripsy (ESWL) has become a routine method for the treatment of renal and ureteral calculi. Occasionally, multisequential ESWL tredtments and high energy shock waves are required to treat large calculi. The purpose of the study was to compare renal histopathologic damage caused by varying the application of shock waves.

PYRIDINOLINE CROSS-LINKED CARBOXYTERMINAL TELOPEPTIDE OF TYPE I COLLAGEN AS A USEFUL MARKER FOR MONITORING METASTATIC BONE ACTIVITY IN MEN WITH PROSTATE CANCER

PURPOSE We investigated the clinical usefulness of measuring the serum concentrations of pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) and carboxyterminal propeptide of type I procollagen (PICP) as markers for monitoring metastatic bone activity in patients with prostate cancer. MATERIALS AND METHODS Serum levels of ICTP, PICP, alkaline phosphatase, prostatic acid phosphatase and prostate specific antigen (PSA) were analyzed in 104 untreated patients with prostate cancer, including 62 with and 42 without bone metastasis. Serial measurements of ICTP, PICP and PSA were performed during hormonal therapy in 35 of 62 prostate cancer patients with bone metastasis. RESULTS Serum levels of all markers except prostatic acid phosphatase were significantly higher with than without bone metastasis. The median values of each marker increased according to the extent of bone metastasis. Serial ICTP, PICP and PSA in 19 patients with a partial response or no change in bone scans demonstrated a downward trend after treatment, while in 16 with progression they showed an upward trend after treatment. The rate of detecting bone metastasis and progression using ICTP were highest compared with other markers based on the percent clinical effectiveness and receiver operating characteristic curves. CONCLUSIONS Measuring serum ICTP may be useful for detecting bone metastasis and prostate cancer progression, and may augment PSA and bone scan monitoring of metastatic bone activity.

Transurethral holmium laser resection of the prostate.

PURPOSE We evaluated the efficacy of the holmium:YAG laser for transurethral endoscopic prostatectomy for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS We treated 103 patients with BPH with holmium:YAG laser resection of the prostate. A high power holmium laser generating a maximum of 60 or 81 W. was used in a pulsed mode, applying energy directly to prostatic tissue via a forward firing 550 micron. fiber transurethrally under direct vision. Treatment outcome was evaluated by the International Prostate Symptom Score, quality of life score, maximum flow rate and post-void residual urine volume. We also compared holmium laser surgery and transurethral resection of the prostate for operative factors, such as surgical duration, bleeding volume and catheterization time. RESULTS Average symptom score, quality of life score, peak flow rate and post-void residual significantly improved at 1 week, 1 month and 3 months postoperatively, with improvement maintained up to 36 months postoperatively in the holmium:YAG group. Intraoperative bleeding volume was significantly lower and catheterization time was significantly shorter for holmium:YAG than for transurethral prostatic resection. Use of the holmium laser caused no complications. CONCLUSIONS Because of its effectiveness and safety holmium:YAG resection is a viable potential surgical alternative for symptomatic BPH. The holmium:YAG laser has been verified to be useful for many purposes in urology.

Early catheter removal 3 days after radical retropubic prostatectomy

Aim: We investigated the feasibility and safety of the early removal of urethral catheters 3 days after radical retropubic prostatectomy.

Primary carcinoid of the testis associated with carcinoid syndrome

Abstract Testicular carcinoid is a rare disease accounting for less than 1% of all testicular neoplasms. It rarely manifests symptoms of carcinoid syndrome. Recent reports have noted that only 1.1–3.1% of testicular carcinoid tumors are complicated by carcinoid syndrome. In general, large tumor size and the presence of carcinoid syndrome are features associated with a malignant course. In the present case, pathological findings revealed pure carcinoid of the testis without metastasis. Moreover, watery diarrhea due to carcinoid syndrome disappeared and the serum serotonin level normalized following orchiectomy. The patient was followed up for 12 months with whole body computed tomography scan and assessment of serotonin levels. To date, there is no evidence of tumor recurrence. These findings suggest that monitoring serum serotonin levels may be useful as a marker during follow up of this type of tumor.

Expression of the SART3 tumor rejection antigen in renal cell carcinoma

PURPOSE We recently reported that SART3 tumor rejection antigen is recognized by HLA class I restricted cytotoxic T lymphocytes from patients with esophageal cancer. We now investigate the expression of SART3 antigen in renal cell carcinoma to identify an appropriate molecule that may be used in specific immunotherapy of renal cell carcinoma. MATERIALS AND METHODS Renal cell carcinoma and nontumorous kidney tissues were obtained at surgery. A section of each sample was minced with scissors and stored at -80C until use. SART3 antigen expression was examined in uncultured renal cell carcinoma and nontumorous kidney tissues. We also evaluated the ability of derived peptides to include cytotoxic T lymphocytes in peripheral blood mononuclear cells from patients with renal cell carcinoma. RESULTS The SART3 antigen was detected in all renal cell carcinoma cell lines, primary cultures of renal cell carcinoma and nontumorous kidney tissues, and in the cytosol of 57% and 15% of renal cell carcinoma and nontumorous kidney tissues, respectively. HLA-A2402 restricted and tumor specific cytotoxic T lymphocytes (KE4) used in cloning of the SART3 gene were significantly cytotoxic to cells from renal cell carcinoma cell lines and primary cultures of renal cell carcinoma tissue but they did not lyse normal cells, including those from primary cultures of nontumorous kidney tissue. The SART3 peptides derived from positions 109-118 and 315-323 induced HLA-A24 restricted cytotoxic T lymphocytes to renal cell carcinoma cells from peripheral blood mononuclear cells of patients with renal cell carcinoma. CONCLUSIONS The SART3 antigen and derived peptides may be applied to the specific immunotherapy of HLA-A24+ renal cell carcinoma.

Endoscopic lithotripsy with the holmium:YAG laser.

The holmium:YAG (Ho:YAG) laser can be used not only for soft tissue but also for hard tissue such as urinary calculi. The objective of this study was to assess the usefulness of the Ho:YAG laser for endoscopic lithotripsy in patients with urinary tract stone.