Toru Hyodo

Transrectal high-intensity focused ultrasound for treatment of patients with stage T1b-2n0m0 localized prostate cancer: a preliminary report

OBJECTIVES To present our preliminary clinical results of transrectal high-intensity focused ultrasound (HIFU) in Stage T1b-2N0M0 prostate cancer. Efforts are being made to provide minimally invasive alternative treatment options with equal efficacy and fewer side effects. HIFU delivers ultrasound energy with rapid thermal necrosis of tissue in the focal region without damaging the surrounding tissue. METHODS We performed 28 HIFU treatments in 20 patients with biopsy-proven localized prostate cancer using a modified Sonablate-200 HIFU device. All patient characteristics and the clinical outcome of 20 patients followed up more than 6 months (mean 13.5) were analyzed. RESULTS A complete response was obtained in 100% (20 of 20) of patients, as evidenced by a negative postoperative prostate biopsy and no elevation on three successive prostate-specific antigen (PSA) determinations. Of the 20 patients, 13 (65%), 5 (25%), and 2 (10%) had PSA nadirs of less than 0.50 ng/mL, 0.50 to 1.00 ng/mL, and 1.01 to 2.00 ng/mL, respectively. Rectourethral fistula and urethral stricture were noted in 1 and 2 patients, respectively, and 1 patient underwent transurethral resection of the prostate because of prolonged urinary retention. CONCLUSIONS Our results show that HIFU can be performed without an incision, with a less severe side effect profile, and, unlike most other prostate treatments, is repeatable. Transrectal HIFU may be a useful option for patients with localized prostate cancer. Its long-term efficacy will be determined by additional follow-up and a Phase II trial.

Treatment of localized prostate cancer using high-intensity focused ultrasound

To evaluate the biochemical disease‐free survival (DFS), predictors of clinical outcome and morbidity of patients with localized prostate cancer treated with high‐intensity focused ultrasound (HIFU), a noninvasive treatment that induces complete coagulative necrosis of a tumour at depth through the intact skin.

Five years experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer

Background:  High‐intensity focused ultrasound (HIFU) is a minimally invasive technique used in achieve coagulation necrosis. We evaluated biochemical disease‐free survival rates, predictors of clinical outcome and morbidity in patients with localized prostate cancer treated with HIFU.

Immediate Effect of Shakuyaku-kanzo-to on Muscle Cramp in Hemodialysis Patients

We administered 2.5 g of Shakuyaku-kanzo-to granule to 61 patients who had muscle cramp during hemodialysis (HD) sessions and examined its immediate effects. We selected 10 patients who wanted to take the drug at home, out of cases, for whom the drug was effective on the study described above and had them take the drug in the same way at the beginning of muscle cramp at home examined the effects. In the study during HD sessions, muscle cramp and its associated pain disappeared in 5.3 ± 3.9 min on average in 54 out of 61 cases. In the study of patients who took the drug at home, muscle cramp disappeared within 10 min in all cases. Shakuyaku-kanzo-to is thought to be very useful for muscle cramp during HD sessions of hemodialized patients because it has immediate effects by its oral administration on the occasion of cramp. With regard to the muscle cramp, which appears at home after HD sessions, the patients can cope with it by taking the drug by themselves. This is an epoch-making therapy, for it was impossible to cope with muscle cramp except in hospitals because the therapy of muscle cramp was limited to intravenous infusion of hypertonic solutions of dextrose, mannitol, and saline during HD sessions.

The Immediate Effect of Shakuyaku-kanzo-to, Traditional Japanese Herbal Medicine, for Muscular Cramps during Maintenance Hemodialysis

Accessible online at: www.karger.com/journals/nef Dear Sir, Muscular cramps in patients with chronic renal failure undergoing hemodialysis are very common and the incidence reportedly reaches 20% in all patients [1]. Shakuyaku-kanzo-to is a traditional Japanese herbal medicine which is composed of Paeonia root (Shakuyaku) and Glycyrrhiza root (Kanzo) and is used for the treatment of muscular cramps in patients with normal renal function in Japan. We elucidated the effect of this herbal medicine for muscular cramps in hemodialysis patients. The subjects included 23 hemodialysis patients who experienced muscular cramps during hemodialysis (10 males and 13 females; 3 diabetics and 20 nondiabetics; mean age, 57.2 B 9.0 years; mean duration of dialysis, 8.2 B 6.6 years), with a total of 61 episodes of muscular cramps. Shakuyakukanzo-to Extract Granules for Ethical Use (TJ68: Tsumura & Co., Japan) were administered at a single dose of 2.5 g immediately after the complaint of muscular cramps during hemodialysis. Muscular cramps disappeared in 54 (88.5%) of the 61 episodes. The mean time to disappearance of muscular cramps and associated pain was 5.4 B 3.9 min. No adverse reaction occurred at the single use of Shakuyaku-kanzo-to during hemodialysis.

Antitumor effect of bcl-2 antisense phosphorothioate oligodeoxynucleotides on human renal-cell carcinoma cells in vitro and in mice.

BACKGROUND AND PURPOSE Programmed cell death is a genetically regulated pathway that is altered in many cancers. This process is, in part, regulated by the bcl-2 oncogene. Antisense oligodeoxynucleotides (ODNs) targeted to specific oncogenes have been used with some therapeutic success in animal models of leukemia and melanoma cells and human Hodgkins lymphoma. We evaluated the effects of antisense ODNs targeted to the bcl-2 oncogene on the proliferation of human renal-cell carcinoma (RCC) cells in vitro and on the growth of human RCC xenografts in BALBc nude (nu/nu) mice. MATERIALS AND METHODS Expression bcl-2 mRNA in five RCC cell lines (ACHN, Caki-1, RCZ, RCW, and OS-RC-2) was analyzed by reverse transcriptase-polymerase chain reaction. The effects of phosphorothioated ODNs containing human bcl-2 sense and bcl-2 antisense sequences that were transfected with Lipofectin on the proliferation and viability of cultures of established human RCC cell lines were determined by MTS assay. The expression of Bcl-2 protein in ACHN tumor cells following antisense bcl-2 (AS2) ODN treatment was evaluated by Western blot analysis, and the extent of apoptosis in these cells was determined by fluorescence-activated cell sorter (FACS) analysis. The antitumor activity in ACHN xenografts in nu/nu mice was monitored by measuring differences in tumor weight in treated and control mice. RESULTS Expression of bcl-2 mRNA was detected in all five RCC lines. Treatment with antisense bcl-2 ODNs inhibited the growth of all tested RCC cells and decreased Bcl-2 protein expression in ACHN cells. The AS2 antisense ODN complementary to the coding region of bcl-2 mRNA showed a superior antiproliferative effect compared with AS1 ODN complementary to the translation initiation region. Inhibition by antisense bcl-2 ODNs of ACHN cells was dose dependent. The FACS analysis revealed that growth inhibition was associated with the induction of programmed cell death. In vivo, AS2 ODN antitumor activity was noted in locally injected groups. CONCLUSIONS Treatment of human RCC with antisense ODNs targeted to bcl-2 inhibits growth and is associated with the induction of programmed cell death. These results suggest therapeutic use of antisense bcl2 in the treatment of RCC.

Differential Diagnosis between Glomerular and Nonglomerular Hematuria by Automated Urinary Flow Cytometer

Objective, fast and easy methods have not been established in the examination of urine sediment to differentiate between glomerular and nonglomerular hematuria. In this study, we used a newly developed automated urinary flow cytometer that can clearly recognize red blood cells (RBC), white blood cells, epithelial cells, bacteria and crystals by their size and fluorescence intensity without sedimentation. 98 urine samples from 31 glomerular and 67 nonglomerular lesions were analyzed by the device, and the criteria to determine the origin of hematuria were established based on the results. Additional 108 cases were tested to evaluate the validity of these criteria. According to the analysis of histograms of urinary RBC size distribution, cases in whom ≥80% of all RBC have forward scatter (FSC) intensities ≦126 and <80% of all RBC have FSC intensities ≥84 were regarded as representing the glomerular type. Cases in whom ≥80% of all RBC have intensities FCS ≥84 and <80% all RBC have FSC intensities ≦126 were regarded as representing the nonglomerular type. Cases in whom <80% of all RBC have FSC intensities ≦126 and <80% of all RBC have FCS intensities ≥84 were regarded as the mixed type. Cases in whom ≥80% of all RBC have FSC intensities ≦126 and ≥80% of all RBC have FSC intensities ≥84 were regarded as the nonglomerular type. The sensitivity for glomerular RBC in the first 98 cases was 90.3% and the specificity 92.5%, and in the second 108 cases the values were 100 and 86.6%, respectively. The automated urinary flow cytometer is useful as a means for routine differential diagnosis of hematuria, and at least it is promising as the screening test for differentiation between glomerular and nonglomerular hematuria, because it can examine numerous samples within a short time and does not necessitate any special skill or knowledge.

Analysis of urinary red blood cells of healthy individuals by an automated urinary flow cytometer

A newly developed automated urinary flow cytometer allows clear discrimination of erythrocytes from other solid components of urine. In this study, the normal range of the urinary erythrocyte count and the source of urinary erythrocytes in healthy individuals were investigated using this analyzer. For the diagnosis of the source of the urinary erythrocytes, Kitasato University Kidney Center criteria for this analyzer were applied. The subjects were 133 regularly employed volunteers (age range 20-48 years, mean 30.5) who noted no urinary tract symptoms and showed normal blood pressure, consisting of 41 females not in their menstrual period (age range 20-39 years, mean 24.8) and 92 males (age range 20-48 years, mean 33.1). Mid-stream voided urine was collected from these subjects using urine sampling cups, immediately transferred to 50-ml sterilized Spitz tubes, and analyzed within 30 min using the automated urinary flow cytometer. Urinary erythrocytes were derived from glomeruli in all samples of healthy subjects. The urinary erythrocyte count showed a logarithmic normal distribution. Values 2 SD of the urinary erythrocyte count in healthy individuals or higher were regarded as abnormal, and hematuria was considered to be positive when 11.0/microliter or more erythrocytes were observed by this analyzer. The finding by this analyzer corresponded to the report of Birch et al.

Ammonium acid urate urolithiasis in Japan

Aim:  Ammonium acid urate (AAU) calculi are a rare urolithiasis in developed countries but are endemic in developing countries. We assessed the features of AAU urolithiasis in Japanese patients.

Individual application of the kidney disease quality of life (KDQOL) instrument to monitor the health status of dialysis patients.

Accessible online at: www.karger.com/journals/nef Dear Sir, Recently, the Kidney Disease Quality of Life (KDQOL®) Instrument, consisting of SF-36 and the kidney disease targeted scales, was developed and has been accepted among many countries because of the scientific and statistical accuracy. Originally, these scales were developed for the group comparisons and not for the individual use [1]. Nevertheless, Meyer et al. [2] reported that the SF-36 was useful in monitoring individual dialysis patients’ health status. We speculated that KDQOL questionnaire might be also as useful as the SF-36 for the individual use. Here, we collect individual KDQOL scores and monitor 1 case before and after a medical intervention, as Meyer et al. [2] had tried. 108 seminight hemodialysis patients, mostly socially rehabilitated responded to