Tetsuo Nozaki

Enhancement of ultrasound‐mediated gene transfection by membrane modification

Ultrasound‐mediated gene transfection (USMGT) with an echo contrast agent could be a new promising physical method of triggering localized gene delivery, but the effect is still modest. The aim of this study is to devise a method to improve efficiency of USMGT. We examined the effect of lidocaine and different temperatures on USMGT, each of which is a known membrane modifier, since the plasma membrane can be considered a site of action in USMGT.

Early quality of life outcomes in patients with prostate cancer managed by high-dose-rate brachytherapy as monotherapy.

Objectives:  To evaluate the early quality of life outcomes in prostate cancer patients managed by high‐dose‐rate brachytherapy as monotherapy.

Effects of microbubbles on ultrasound-mediated gene transfer in human prostate cancer PC3 cells : Comparison among Levovist, YM454, and MRX-815H

We compared the enhancement effects of three different echo contrast agents (ECAs); Levovist, YM454, and MRX-815H as artificial microbubbles on ultrasound mediated gene transfection (USMGT) with 1MHz ultrasound at 0.2MPa using a luciferase expression vector in PC3 cells and elucidated the mechanisms of differences of USMGT facilitation by these ECAs. At a concentration of each ECA that induced iso-survival, ECAs with lipid shell (YM454 and MRX-815H) facilitated USMGT higher than those without shell (Levovist), and the order of the ECAs facilitating free radical formation by sonication was; YM454>MRX-815H>Levovist. These results suggested that the lipid shell type ECAs facilitated gene transfer higher than that by the non-shell type ECA.

Usefulness of single photon emission computed tomography imaging in the detection of lumbar vertebral metastases from prostate cancer

Objective:  To determine whether single photon emission computed tomography (SPECT) is useful in the detection of prostate cancer bone metastases in the lumbar vertebrae.

Efficacy of DynaCT for surgical navigation during complex laparoscopic surgery: an initial experience

BackgroundPrecise understanding of surgical anatomy is required during complex laparoscopic surgery (CLS). The purpose of this study was to present our initial operative experience with CLS facilitated by surgical navigation through DynaCT technology.MethodsIntraoperative computed tomography (CT) images of two CLS cases were obtained by a C-arm DynaCT system (Artis Zeego, Siemens Healthcare, Erlangen, Germany). Image reconstruction was performed on a workstation to define particular anatomical structures of the target tumor. The reconstructed CT images were repeatedly displayed on a submonitor. The surgeon then compared the CT images with a laparoscopic image of the surgical field, thus providing a virtual map to the surgeon.ResultsUsing the near-real-time surgical navigation system, the surgeon could visualize the surgical anatomy and easily perform the CLS. All procedures were performed successfully with a satisfactory diagnostic yield.ConclusionThis novel technology has great potential for application in CLS because it enables generation of accurate depictions of small target tumors and increases the surgeon’s confidence during the procedure.

Laparoscopic ureterolysis for idiopathic retroperitoneal fibrosis

Abstract  Three patients with idiopathic retroperitoneal fibrosis underwent laparoscopic ureterolysis. Two patients were bilateral cases which were performed successfully as a one stage procedure. Another patient, who was unsuccessfully treated, had a long ureteral stricture. Laparoscopic ureterolysis may be a useful alternative to open surgical management especially in bilateral cases, except for patients with a long ureteral stricture.

Laparoscopic Resection of Adrenal and Extra-Adrenal Pheochromocytoma

BACKGROUND AND PURPOSE Laparoscopic resection of extra-adrenal pheochromocytoma (EAPs) necessitates meticulous surgical procedures because of changes in anatomic disposition and/or proximity to major blood vessels. Complete resection can be traumatic and may cause an increase in catecholamine levels. We present our experiences with laparoscopic resection of EAP (LEAP) and compare the intraoperative hemodynamics with those during laparoscopic resection of adrenal pheochromocytoma (LAP). PATIENTS AND METHODS We retrospectively reviewed the medical records of five patients who underwent LEAP (retrocaval EAP, n=2; interaortocaval EAP, n=1; periadrenal EAP, n=2) and five who underwent LAP between October 2001 and October 2011. We also evaluated fluctuations in blood pressure (BP) reported during both surgeries. RESULTS The tumors were successfully resected under laparoscopic guidance in both groups, and conversion to open surgery or blood transfusion was not needed. Intraoperative hypertension (BP>200 mm Hg) was observed in three LEAP and four LAP patients, whereas intraoperative hypotension (BP<80 mm Hg) was observed in five LEAP and three LAP patients. No significant differences were observed between groups, however. CONCLUSIONS Laparoscopy is the method of choice for surgeons experienced in EAP resection because it is feasible and reproducible with appropriate preoperative planning, similar to LAP.

A Prospective, Randomized, Controlled, Multicenter Study of Naftopidil for Treatment of Male Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia: 75 mg Once Daily in the Evening Compared to 25 mg Thrice Daily

Introduction: We examined the tolerability of dosage methods of naftopidil in the treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH/male LUTS). Patients and Methods: A total of 80 patients with BPH/male LUTS who had an International Prostate Symptom Score (IPSS) ≧8 and IPSS quality of life (QoL) ≧2 were enrolled and randomly administered naftopidil for 8 weeks at either 75 mg once daily (OD) in the evening (group O; n = 41) or 25 mg thrice daily (TID) in the morning, afternoon and evening (group T; n = 39). Results: IPSS total score, IPSS-QoL and BPH impact index (BII) were significantly improved for both groups at 8 weeks after starting treatment compared to baseline. IPSS total score and daytime and 24-hour voiding frequencies were significantly improved at 8 weeks after starting treatment for group O in comparison to group T. Group O showed a significantly better degree of change in BII in comparison to group T. Conclusions: Naftopidil 75 mg OD in the evening was better tolerated than naftopidil 25 mg TID for the objective parameter and BII.

POSTOPERATIVE CHANGES OF SPERM CHROMATIN HETEROGENEITY, USING ACRIDINE ORANGE STAINING, IN VARICOCELE PATIENTS

The aim of this study was to evaluate postoperative changes in sperm chromatin heterogeneity in varicocele patients. In 15 infertile patients with varicocele, sperm parameters including concentration, motility, and morphology were evaluated before and after surgical correction of varicocele. Sperm motion analysis using computer-assisted semen analyzer (CASA) was also performed. To analyze the sperm nuclear proteins, the acridine orange staining method was used. On semen analysis, sperm concentration and motility significantly increased after surgery (p = 0.002, p = 0.003, respectively), although sperm morphology was unaltered postoperatively. CASA parameters, including velocity, linearity, amplitude of lateral head displacement and beat cross frequency were unaltered postoperatively. On the other hand, acridine orange staining significantly increased postoperatively (p = 0.002). Varicocele influences the sperm chromatin condition, as well as sperm concentration and motility.

Laparoscopic resection of retrocaval paraganglioma.

OBJECTIVES Definitive treatment of paraganglioma is by surgical resection. Laparoscopic resection of the paraganglioma presents a unique surgical challenge due to inherent risks associated with excessive catecholamine release during surgical manipulation and variable anatomic presentation. In this report, we present our experience with the laparoscopic resection of the retrocaval paraganglioma. METHODS Between October 2001 and November 2007, 2 patients underwent the laparoscopic resection of a retrocaval paraganglioma. In both cases, the tumors were located just behind the inferior vena cava (IVC) without evidence of vessel-wall invasion. The maximum diameter of the tumor was 47 and 44 mm, respectively. There was extrinsic compression of the IVC in an anterior direction by the tumor. To expose the tumor surface completely, the IVC was mobilized medially. Thereafter, we proceeded with dissection of the posterior attachment of the tumor by using a Harmonic Scalpel (Ethicon, Cincinnati, OH). Finally, the tumor and the right adrenal gland were extracted in an endobag. RESULTS In both cases, the tumors were successfully removed laparoscopically without the need for conversion or blood transfusion. The operative time was 440 and 195 minutes, respectively. There were no significant postoperative complications. CONCLUSIONS To our knowledge, this is the first report of the laparoscopic resection of a retrocaval paraganglioma. For the resection of a paraganglioma, in this location, laparoscopy has the advantage of precise visualization, which helps to resect the tumor completely. Laparoscopic resection of a paraganglioma, despite the high level of compression of the IVC, is a feasible, reproducible technique with appropriate preoperative planning.