Takashi Tsujino

Laparoscopic treatment of a retrocaval ureter

A retrocaval ureter was treated laparoscopically with good success. The retrocaval segment of the ureter was easily separated and the ureter was reanastomosed using a laparoscopic suturing technique. Laparoscopic surgery is useful for the treatment of a retrocaval ureter with minimal postoperative pain and a short convalescence.

Clinical evaluation of long-term treatment using cernitin pollen extract in patients with benign prostatic hyperplasia

Seventy-nine patients with benign prostatic hyperplasia (BPH) were treated with cernitin pollen extract. Patient ages ranged from 62 to 89 years (mean, 68 years). Mean baseline prostatic volume was 33.2 cm3. Cernitin pollen extract was administered in a dosage of 126 mg (2 tablets, 63 mg each), three times a day, for more than 12 weeks. Symptom scores, based on a modified Boyarsky scoring scale, uroflowmetry, prostatic volume, residual urine volume, and urinalysis results were examined before and after administration of cernitin pollen extract. Symptom scores significantly decreased from baseline, and the favorable results continued during the treatment period. Urine maximum flow rate and average flow rate increased significantly from 9.3 mL/s to 11 mL/s and from 5.1 mL/s to 6 mL/s, respectively. Residual urine volume decreased significantly from 54.2 mL to less than 30 mL. There was no change in prostatic volume. However, 28 patients treated for more than 1 year showed a mean decrease of prostatic volume to 26.5 cm3. No adverse reactions were observed. Clinical efficacy at 12 weeks was rated excellent, good, satisfactory, and poor in 11%, 39%, 35%, and 15% of patients, respectively. Overall clinical efficacy was 85%. In conclusion, cernitin pollen extract showed a mild beneficial effect on prostatic volume and urination variables in patients with symptomatic BPH.

Is a cystic lesion located at the midline of the prostate a müllerian duct cyst? Analysis of aspirated fluid and histopathological study of the cyst wall.

OBJECTIVE In 6 patients, ranging in age from 26 to 71 years, we analyzed aspirated fluid and histologically studied cystic lesions located at the midline of the prostate. METHODS Digital rectal examination, ultrasonography, magnetic resonance imaging, and aspiration of cystic fluid were performed to evaluate size, contents, and location of the cystic lesion. A 22-gauge needle was inserted into the cystic lesion perineally under ultrasound guidance. After extracting fluid for cytology and measurement of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP), a specimen from the prostate involving the cystic wall was collected. Hematoxylin-eosin staining and immunohistochemical staining for PSA were performed. RESULTS All aspirated fluid specimens were yellowish and clear without any sperm or malignant cells. The PSA levels in the fluid ranged between 90 and 670 x 10(4) ng/ml, while the PAP levels were between 168 and 4,000 ng/ml. These levels of PSA and PAP were significantly higher as compared with those in the serum. The cystic wall was lined with cuboidal or columnar epithelium. Some epithelial cells from the cystic wall showed positive immunostaining for PSA. CONCLUSIONS Not all cystic lesions located at the midline of the prostate are müllerian duct cysts, and there is a high probability that the lesion could be a cystadenoma or a simple cyst of the prostate.

Effect of ciclosporin on cardiac output and regional blood flow in rats : ciclosporin-induced nephropathy and its prevention with calcium channel blocker

The effect of ciclosporin (CS) on cardiac output (CO) and regional blood flow was studied using the microsphere method in heminephrectomized rats with and without renal arterial clamping prior to the administration of CS. The effect of a calcium (Ca) channel blocker, verapamil, was also examined on CS-induced nephropathy. CS at a dose of 40 mg/kg per day was given orally using a gastric tube for 7 days. Verapamil was given in the drinking water for 7 days. Significant increases in blood urea nitrogen (BUN) and serum creatinine (sCr) with a significant decrease in renal inulin clearance (CIn) were noted after 7 days of CS administration in both intact and ischemic-kidney groups, indicating the development of CS-induced nephropathy. The ischemic-kidney group showed a significantly severe nephropathy as compared with the intact-kidney group. As for change in CO and regional blood flow, CS caused a significant decrease in CO, renal blood flow (RBF) and brain blood flow, while hepatic arterial blood flow and muscular blood flow significantly increased. The renal outer cortical blood flow decreased markedly while the inner cortical blood flow remained unchanged. Although verapamil slightly but significantly decreased mean arterial blood pressure in CS-treated rats, CO and its distribution did not change. BUN and sCr were not significantly ameliorated in the intact-kidney group. However, in the ischemic-kidney group, verapamil caused a significant improvement in RBF, ameliorating CS-induced elevation of BUN and sCr, and a decrease in CIn.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatic blood flow and drug metabolism in glycerol-rechallenged rats

SummaryTo analyze the hepatic blood flow and drug metabolism during glycerol-induced acute renal failure, 24 male Wistar rats were randomly divided into three groups: Group I received an intra-muscular injection of 1 ml/100g body weight 50% glycerol, group II a second injection on day 14 and group III a second injection on day 42 after the first injection respectively. The inulin clearance, the aminopyrine N-demethylase activity, the NADPH-cytochrome P-450 activity and the cardiac output and blood flow to the organs were measured before and after glycerol injection. The total hepatic and renal blood flow decreased less significantly in group II compared to group I and III. Various P 450 activities were kept on a high level only in group II. This observation indicates that the maintenance not only of renal but also of hepatic blood flow plays an important role in preventing the development of glycerol-induced acute renal failure. The mechanism may be the induction of various P 450 activities resulting in an increased hepatic clearance of nephrotoxic substances.

New method of retrograde urethrography. Clinical study of autourethrography

Autourethrography (A-UG), a new method of retrograde urethrography was developed, in which the patient injects the contrast medium by himself under fluoroscopical observation by urologists out side of the room. For clinical study of A-UG, comparative study between A-UG and the conventional retrograde urethrography (C-UG) was performed on 20 patients with benign prostatic hypertrophy. The mean age was 68.8 years (range 49-85 years) in A-UG and 69.4 years (range 61-86 years) in C-UG. We evaluated complications of A-UG, compared with these of C-UG. Opacification of the posterior urethra was achieved in all but one in A-UG. None of these patients in A-UG experienced pain during the examination of A-UG. On the other hand, all patient experienced pain in C-UG. Urethral bleeding occurred in only one of 19 patients in A-UG, compared with eighteen of 20 patients in C-UG. Extravasation occurred in one of 19 patients in A-UG, compared with three patients of 20 patients in C-UG. A-UG left the urologists free from the radiological exposure. It is concluded that A-UG is highly useful examination for patients and urologists.