Yoshihisa Tasaki

Predictors of Lower Pole Renal Stone Clearance After Extracorporeal Shock Wave Lithotripsy

ABSTRACTPurpose: Lower pole renal stones are well known to show a poor stone clearance rate after extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Marietta, Georgia). In the current study we analyzed several anatomical factors as predictors of lower pole stone clearance that may be used to indicate the usefulness of ESWL in such patients.Materials and Methods: Between January 1993 and October 2000, 63 patients with a unilateral single lower pole stone of 2 cm. or less were included in the study. Excretory urography was done to determine the lower infundibulopelvic angle, caliceal pelvic height, lower infundibular length and diameter, lower infundibular length-to-diameter ratio and number of lower pole minor calices. Stone-free status was assessed by x-ray.Results: The overall stone clearance rate was 54% (34 of 63 patients). While caliceal pelvic height, lower infundibular diameter, length, length-to-diameter ratio and number of minor calices were different in the stone-free and resi...

Lower Incidence of Inguinal Hernia: Minilaparotomy Radical Retropubic Prostatectomy Compared with Conventional Technique

Introduction: The purpose of the present study was to compare the incidence of inguinal hernias after conventional and minilaparotomy (minilap) radical retropubic prostatectomy (RRP). Patients and Methods: In this retrospective study, we review our experience with 70 consecutive patients with prostate cancer who underwent prostatectomy from April 1995 through March 2001. Of these, 35 patients had conventional RRP, and 35 patients had minilap RRP. Results: Conventional RRP and minilap RRP groups were similar in body mass index (mean 24.4 and 23.5), operative time (mean 260 and 241 min), previous lower abdominal operation record (mean 37.1 and 25.7%), and post-prostatectomy anastomotic strictures (mean 11.4 and 14.3%). The volume of the estimated blood loss was significantly less for minilap RRP (mean 1,220 ml) than for conventional RRP (mean 1,666 ml; p = 0.0194). The incidence of postoperative inguinal hernias was 17.1% (6 of 35), 2.9% (1 of 35), and 3.2% (1 of 31) in conventional RRP, minilap RRP, and unoperated groups, respectively. The incidence of inguinal hernias after minilap RRP was significantly lower than after conventional RRP (p = 0.0464). Seven patients with postoperative inguinal hernias had a high incidence of postoperative strictures (42.9%), while 63 patients without hernia had a low incidence (9.5%). There was a significant difference in developing postoperative strictures between patients with hernia and those without (p = 0.0124). While postoperative stricture and operative technique were different in the hernia and hernia-free groups on univariate analysis, multivariate logistic analysis revealed that the operative technique was an independent factor for the occurrence of inguinal hernias (p = 0.0419). Conclusion: Minilap RRP compares favorably with conventional RRP in view of the postoperative inguinal hernia development.

Spontaneous Rupture of Adrenal Pheochromocytoma

A 39-year-old woman presented with a 2-year history of frequent episodes of headache, nausea and palpitations. Blood pressure had generally been stable but paroxysmally increased to 180/110 to 210/130 mm. Hg. At hospitalization serum adrenaline was 1,768 pg./ml., serum noradrenaline was 3,449 pg./ml., urine adrenaline was 1,170 g. per day and urinary vanillylmandelic acid was 31.5 mg. per day. Computerized tomography (CT) showed a left adrenal mass (fig. 1, A), and scintigraphy with iodine metaiodobenzylguanidine revealed a high accumulation in the mass. Based on these data left adrenal pheochromocytoma was diagnosed, and 0.5 mg. doxazosin mesylate was started to increase circulatory plasma volume. Subsequently, the patient experienced attacks that were more frequent and severe than before (fig. 2). Severe back pain, palpitations and vomiting persisted for a few minutes several times a day, and she was prescribed sublingual nifedipine and kept on bed rest. Two days after starting -blockade, the patient complained of sudden unbearable pain in the back and chest. Blood pressure increased to 300/180 mm. Hg and pulse rate was 140 beats per minute. Under the diagnosis of hypertensive crisis 5 mg. phentolamine was administered intravenously, and blood pressure decreased to 100/60 mm. Hg. Despite the blood pressure being well controlled, severe pain had steadily progressed from the time of onset. Ruptured pheochromocytoma was diagnosed by CT, which demonstrated a large hematoma in the right retroperitoneal space (fig. 1, B). After cardiac function was checked by electrocardiogram and ultrasonography, 4 units blood was transfused and volume supplementation was performed, while vasodilator phentolamine was administered under continuous monitoring of central venous pressure and direct blood pressure. Left adrenalectomy and drainage of the retroperitoneal hematoma were performed 7 hours after the onset of spontaneous rupture. The patient was placed under general anesthesia after good urine output was confirmed. A hemi-chevron incision was made and transperitoneal adrenalectomy was performed. Blood pressure was maintained at 90/50 to 110/80 mm. Hg and stabilized with phentolamine and alprostadil during the procedure. Hematoma volume was approximately 1,000 gm. and operative time was 120 minutes. Pathological diagnosis was adrenal pheochromocytoma (4 4 5 cm.). A laceration was found between the adrenal gland and tumor. Postoperatively blood pressure normalized without medication, and serum and urine catecholamines returned to normal.

Reversal by a Dihydropyridine Derivative of Non-P-Glycoprotein-Mediated Multidrug Resistance in Etoposide-Resistant Human Prostatic Cancer Cell Line

PURPOSE We have isolated etoposide-resistant prostatic cancer cell lines, P/VP10 and P/VP20, to investigate the multidrug resistance (MDR) mechanism and to find MDR reversal agents. MATERIALS AND METHODS We examined expression of MDR-related genes and screened reversal agents of MDR in P/VP20 cells. RESULTS These cells demonstrated a non-P-glycoprotein (P-gp)-mediated MDR phenotype with overexpression of MDR-associated protein (MRP) mRNA due to MRP DNA amplification. A 1,4-dihydropyridine derivative, bis(4-pyridylmethyl)4-[2-(3-methyl-5,6- dihydro-1,4-dithiinyl)]-2,6-dimethyl-1,4-dihydropyridine-3,5-dicar boxylate (NIK250), was found to overcome MDR in P/VP20 cells. CONCLUSIONS NIK250 might be useful in reversing MDR, which often develops during chemotherapy of advanced or hormone-resistant prostatic cancer.

Three Approaches for Laparoscopic Unroofing of Simple and Complicated Renal Cysts

We report 2 cases of simple renal cysts which were marsupialized with 2 laparoscopic approaches involving either transperitoneal, with reflection of the colon medially or dissection through the mesocolon, and a case of a multilocular renal cyst which was treated by the retroperitoneal approach. Although laparoscopic unroofing of a renal cyst is a safe and effective alternative to open surgical techniques, the transperitoneal approach should only be used for simple renal cysts. The retroperitoneal approach for complicated renal cysts may be indicated if preoperative examinations exclude the possibility of malignancy.

Testis Sparing Surgery for Infantile Synchronous Bilateral Teratoma of the Testis

We report a rare case of infantile synchronous bilateral testicular teratoma treated by testis sparing surgery. Preoperative ultrasonography, tumor marker status and intraoperative findings were suggestive of benign neoplasia. Under these circumstances we performed high orchiectomy for the left testis and testis sparing surgery for the right. Surgical treatment of teratoma in childhood is controversial, especially when it occurs bilaterally. In this report we discuss testis sparing surgery as the treatment for this disease.

Retroperitoneoscopic treatment of ovarian vein syndrome.

In this paper, we describe a case of ovarian vein syndrome (OVS) successfully treated with retroperitoneoscopic techniques. A 41-year-old woman complained with right flank pain, especially with a recumbent position. OVS was diagnosed and ureterolysis and ovarian vein resection were successfully performed, using retroperitoneoscopic techniques. The patient has been completely pain free for 36 months of follow-up. To our knowledge, no previous reports have described the retroperitoneoscopic treatment of OVS. With the minimally invasive approach, postoperative recovery and patient quality of life were markedly improved.

Emphysematous cystitis following brain contusion.

Emphysematous cystitis is a rare disorder most commonly seen in patients with urinary tract infection and diabetes mellitus. We present a nondiabetic case of a 46-year-old woman with this entity following brain contusion.