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Laparoscopic Nephroureterectomy for Adult Patient with Primary Obstructive Megaureter
Kimito Osaka,Kazuhide Makiyama,Shinji Ohtake,Hiroyuki Yamanaka,Futoshi Sano,Noboru Nakaigawa,Yoshinobu Kubota
Case Reports in Urology , 2013, DOI: 10.1155/2013/124710
Abstract: A 29-year-old female with a complaint of abdominal distension was referred to our hospital. She had a history of being treated for pyelonephritis three times. By computed tomography and retrograde pyelography, she was diagnosed with adult left primary megaureter. Her left renal function was severely deteriorated. She hoped for surgical intervention before becoming pregnant. Laparoscopic nephroureterectomy for megaureters seems to be difficult due to the large size. By sucking urine from an inserted ureteral catheter and setting trocar positions, we successfully performed laparoscopic nephroureterectomy for megaureter. 1. Introduction Primary obstructive megaureter (POM) is a common disease in children, although it is uncommon in adults. The condition is characterized by an intrinsic congenital obstruction at the lower end of the ureter [1]. Today, many cases are detected in utero by antenatal ultrasonography [2]. POM in children is usually asymptomatic and can be treated conservatively in most cases [3]. However, compared with the clinical course in children, POM in adults is different. POM in adults can present with flank pain, recurrent urinary tract infection, and urolithiasis. In addition to these complications, little spontaneous regression can be anticipated by the maturation of the vesicoureteral junction [4]. POM in adults requires more aggressive surgical interventions than POM in childhood. We present a case of laparoscopic nephroureterectomy for a young adult female with POM. 2. Case Presentation A 29-year-old female with a complaint of abdominal distention was referred to our hospital. She had been treated with antibiotics for acute pyelonephritis three times when she was 6, 20, and 28 years old. Blood test results including renal function and urine test were normal. Abdominal computed tomography (CT) scan demonstrated markedly dilated left calyceal structures, a pelvis with thinning renal parenchyma, and left ureter from the proximal to the distal end (Figure 1). Retrograde pyelography revealed the absence of anatomical malformation of the ureteral orifice and the absence of vesicoureteral reflux (Figure 2). Urinary cytology of the left ureter was negative. Split function of the left kidney function was less than 10% in renal scintigraphy. The diagnosis was megaureter due to stricture of the vesicoureteral junction. The patient hoped for surgery before becoming pregnant. Laparoscopic nephroureterectomy was performed by an intraperitoneal approach. Prior to the laparoscopic procedure, an open-ended 6Fr left ureteral stent was placed. During
Well-Differentiated Extraskeletal Osteosarcoma Arising from the Retroperitoneum That Recurred as Anaplastic Spindle Cell Sarcoma
Hiromasa Arai,Yasushi Rino,Teppei Nishii,Norio Yukawa,Nobuyuki Wada,Hisashi Oshiro,Tsuyoshi Ishida,Noboru Nakaigawa,Munetaka Masuda
Case Reports in Medicine , 2010, DOI: 10.1155/2010/327591
Abstract: Extraskeletal osteosarcoma is an uncommon high-grade malignant soft tissue sarcoma. Well-differentiated extraskeletal osteosarcoma is thought to have a better prognosis than classical extraskeletal osteosarcoma, but dedifferentiation after recurrence has also been reported. We present a case of a primary retroperitoneal extraskeletal osteosarcoma in a 62-year-old Japanese woman. Abdominal CT revealed a large mass with diffuse calcification in the right retroperitoneal space and tumor resection was performed. The histopathological diagnosis was well-differentiated retroperitoneal extraskeletal osteosarcoma. She was followed up by CT every 6 months without adjuvant radiotherapy and chemotherapy for 31 months until anaplastic high-grade spindle cell sarcoma recurred in the retroperitoneum. Our case is the seventh reported description of well-differentiated extraskeletal sarcoma, and the first to arise in the retroperitoneum and recur as an entirely dedifferentiated spindle cell sarcoma.
Retroperitoneoscopic radical nephrectomy with a small incision for renal cell carcinoma: Comparison with the conventional method
Hiroki Ito, Kazuhide Makiyama, Takashi Kawahara, Futoshi Sano, Takayuki Murakami, Narihiko Hayashi, Yasuhide Miyoshi, Noboru Nakaigawa, Masahiro Yao, Yoshinobu Kubota
Journal of Negative Results in BioMedicine , 2011, DOI: 10.1186/1477-5751-10-11
Abstract: Among the cases of T1N0M0 suspicious renal cell carcinoma treated at Yokohama City University between May 2003 and June 2009, the A method was performed in 51 cases and the B method was performed in 33 cases. The factors in the outcomes compared between the A and B methods were the duration of procedure, volume of bleeding, volume of transfusion, weight of the specimen, incidence of peritoneal injury, rate of conversion to open surgery, and perioperative complications.The duration of the procedure was 214.4 ± 46.9 minutes in the A method group and 208.1 ± 36.4 minutes in the B method group (p = 0.518). The volume of bleeding and the weight of the specimen were 105.5 ± 283.2 ml and 335.1 ± 137.4 g in the A method group and 44.8 ± 116 ml (p = 0.247) and 309.2 ± 126 g (p = 0.385) in the B method group. There was no significant difference in all factors analyzed.The A method would be highly possible to produce stable results, even during the introduction period when the staff and the institution are still unfamiliar with the retroperitoneoscopic surgery.The technical progress in laparoscopic surgery for renal cell carcinoma has been remarkable. Many institutions have introduced laparoscopic radical nephrectomy for renal cell carcinoma and even retroperitoneoscopic radical nephrectomy for renal cell carcinoma [1]. In recent years, these surgical methods are in widespread use, and the number of reports [2,3] about complications associated with surgery is rising. It has become important to identify how such a surgery can be completed in a safe manner during the introduction period when institutions and staff are still unfamiliar with these surgical methods.When retroperitoneoscopic radical nephrectomy for renal cell carcinoma was introduced into our institution, we performed a combined small skin incision method in our hospital. That's because we thought that the combined small skin incision method was safer than the conventional method that all procedures were performed w
Nonfunctioning Juxtaglomerular Cell Tumor
Ryoko Sakata,Hiroaki Shimoyamada,Masahiro Yanagisawa,Takayuki Murakami,Kazuhide Makiyama,Noboru Nakaigawa,Yoshiaki Inayama,Kenichi Ohashi,Yoji Nagashima,Masahiro Yao,Yoshinobu Kubota
Case Reports in Pathology , 2013, DOI: 10.1155/2013/973865
Abstract: The juxtaglomerular cell tumor (JGCT) is a rare renal tumor characterized by excessive renin secretion causing intractable hypertension and hypokalemia. However, asymptomatic nonfunctioning JGCT is extremely rare. Here, we report a case of nonfunctioning JGCT in a 31-year-old woman. The patient presented with a left renal tumor without hypertension or hypokalemia. Under a clinical diagnosis of renal cell carcinoma, radical nephrectomy was performed. The tumor was located in the middle portion adjacent to the renal pelvis, measuring 2?cm in size. Pathologically, the tumor was composed of cuboidal cells forming a solid arrangement, immunohistochemically positive for renin. Based on these findings, the tumor was diagnosed as JGCT. In cases with hyperreninism, preoperative diagnosis of JGCT is straightforward but difficult in nonfunctioning case. Generally, JGCT presents a benign biological behavior. Therefore, we should take nonfunctioning JGCT into the differential diagnoses for renal tumors, especially in younger patients to avoid excessive surgery. 1. Introduction Juxtaglomerular cell tumor (JGCT), a neoplasm derived from the juxtaglomerular cell of the kidney, was first described by Robertoson et al. and Kihara et al. [1, 2]. Since then, approximately 100 cases have been reported in the literature. Clinically, this tumor is characterized by hypertension due to excessive renin secretion by tumor cells causing secondary hyperaldosteronism [1–3]. Generally, its preoperative diagnosis is relatively easy, because of typical presence of hypertension concomitant with hypokalemia. However, it is quite difficult in cases of asymptomatic nonfunctioning JGCT [3]. Here, we present a case of nonfunctioning JGCT, which is the fourth case reported so far to the best of our knowledge [4–6]. 2. Case Report A 31-year-old woman was referred to our hospital with a left renal tumor incidentally detected during examination for left-side abdominal pain. She had no history of hypertension, and her blood pressure at presentation was 116/62?mmHg. All the laboratory data, including electrolyte levels, were within normal ranges. Unfortunately, preoperative plasma renin activity was not assayed. Unenhanced computed tomography (CT) revealed solitary well-circumscribed mass lesion measuring 2?cm with fine calcifications in the middle portion adjacent to the renal pelvis of the left kidney. Dynamic-enhanced CT demonstrated that the tumor was not enhanced in the corticomedullary (early) phase but enhanced in the excretory (late) phase (Figure 1). Magnetic resonance image (MRI) showed
Bi-Directional Signal Transmission in EPR Correlation  [PDF]
Noboru Hokkyo
Journal of Modern Physics (JMP) , 2014, DOI: 10.4236/jmp.2014.514134

A solution of nonlocal EPR correlation between counter-propagating pair of polarization entangled photons emitted from a common source at S and detected at points P and Q is sought outside the EPR’s reality criterion of local causality but within the framework of time-symmetric quantum electrodynamics allowing the bi-directional signal transmission P \"\" S \"\" Q on the double-light cone where the future and the past cones share common light paths connecting the photon source S and the detection points P and Q.

Early assessment by FDG-PET/CT of patients with advanced renal cell carcinoma treated with tyrosine kinase inhibitors is predictive of disease course
Daiki Ueno, Masahiro Yao, Ukihide Tateishi, Ryogo Minamimoto, Kazuhide Makiyama, Narihiko Hayashi, Futoshi Sano, Takayuki Murakami, Takeshi Kishida, Takeshi Miura, Kazuki Kobayashi, Sumio Noguchi, Ichiro Ikeda, Yoshiharu Ohgo, Tomio Inoue, Yoshinobu Kubota, Noboru Nakaigawa
BMC Cancer , 2012, DOI: 10.1186/1471-2407-12-162
Abstract: Patients for whom TKI treatment for advanced RCC was planned were enrolled. FDG PET/CT was performed before TKI treatment and after one month of TKI treatment. The relations of the FDGPET/CT assessment to progression free survival (PFS) and overall survival (OS) were investigated.Thirty-five patients were enrolled (sunitinib 19 cases, sorafenib 16 cases). The patients with RCC showing high SUVmax in pretreatment FDG PET/CT demonstrated short PFS (P =0.024, hazard ratio 1.137, 95% CI 1.017-1.271) and short OS (P =0.004, hazard ratio 1.210 95% CI 1.062-1.379). Thirty patients (sunitinib 16 cases, sorafenib 14 cases) were evaluated again after 1?month. The PFS of the patients whose SUVmax decreased<20% was shorter than that of the patients whose SUVmax decreased<20% (P?=?0.027, hazard ratio 3.043, 95% CI 1.134-8.167). The PFS of patients whose tumor diameter sum increased was shorter than that of the patient with tumors whose diameter sum did not (P =0.006, hazard ratio 4.555, 95% CI 1.543-13.448).The patients were classified into three response groups: good responder (diameter sum did not increase, and SUVmax decreased?≥?20%), intermediate responder (diameter sum did not increase, and SUVmax decreased<20%), and poor responder (diameter sum increased, or one or more new lesions appeared). The median PFS of good, intermediate, and poor responders were 458?±?146?days, 131?±?9?days, and 88?±?26?days (good vs. intermediate P?=?0.0366, intermediate vs. poor P?=?0.0097, log-rank test). Additionally the mean OSs were 999?±?70?days, 469?±?34?days, and 374?±?125?days, respectively (good vs. intermediate P?=?0.0385, intermediate vs. poor P?=?0.0305, log-rank test).The evaluation of RCC response to TKI by tumor size and FDG uptake using FDG PET/CT after 1?month can predict PFS and OS.
Impact of maximum Standardized Uptake Value (SUVmax) evaluated by 18-Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT) on survival for patients with advanced renal cell carcinoma: a preliminary report
Kazuhiro Namura, Ryogo Minamimoto, Masahiro Yao, Kazuhide Makiyama, Takayuki Murakami, Futoshi Sano, Narihiko Hayashi, Ukihide Tateishi, Hanako Ishigaki, Takeshi Kishida, Takeshi Miura, Kazuki Kobayashi, Sumio Noguchi, Tomio Inoue, Yoshinobu Kubota, Noboru Nakaigawa
BMC Cancer , 2010, DOI: 10.1186/1471-2407-10-667
Abstract: A total of 26 patients with advanced or metastatic RCC were enrolled in this study. The FDG uptake of all RCC lesions diagnosed by conventional CT was evaluated by 18F-FDG PET/CT. The impact of SUVmax on patient survival was analyzed prospectively.FDG uptake was detected in 230 of 243 lesions (94.7%) excluding lung or liver metastases with diameters of less than 1 cm. The SUVmax of 26 patients ranged between 1.4 and 16.6 (mean 8.8 ± 4.0). The patients with RCC tumors showing high SUVmax demonstrated poor prognosis (P = 0.005 hazard ratio 1.326, 95% CI 1.089-1.614). The survival between patients with SUVmax equal to the mean of SUVmax, 8.8 or more and patients with SUVmax less than 8.8 were statistically different (P = 0.0012). This is the first report to evaluate the impact of SUVmax on advanced RCC patient survival. However, the number of patients and the follow-up period were still not extensive enough to settle this important question conclusively.The survival of patients with advanced RCC can be predicted by evaluating their SUVmax using 18F-FDG-PET/CT. 18F-FDG-PET/CT has potency as an "imaging biomarker" to provide helpful information for the clinical decision-making.Renal cell carcinoma (RCC) accounts for 3% of all adult cancers [1]. Approximately 30% of patients are diagnosed with metastases and an additional 20-40% of patients develop metastases after radical nephrectomy with curative intent [2,3]. The outcome of patients with metastatic RCC is poor, with a median survival time of 10 to 21 months [4,5]Classical cytokine therapies have been the only systematic treatments available for advanced RCC for a long time [6-9]. The oncogenic mechanism of RCC has been elucidated and agents that target relevant biological pathways have been investigated. Multiple tyrosine kinase inhibitors (multiple TKIs) targeting vascular endothelial growth factor receptor (VEGFR) such as sunitinib and sorafenib have revolutionized the treatment of RCC [10,11]. Although mammalian tar
Prostate Carcinogenesis with Diabetes and Androgen-Deprivation-Therapy-Related Diabetes: An Update
Noboru Hara
Experimental Diabetes Research , 2012, DOI: 10.1155/2012/801610
Abstract: Prostate cancer and the androgen deprivation therapy (ADT) thereof are involved in diabetes in terms of diabetes-associated carcinogenesis and ADT-related metabolic disorder, respectively. The aim of this study is to systematically review relevant literature. About 218,000 men are estimated to be newly diagnosed with prostate cancer every year in the United States. Approximately 10% of them are still found with metastasis, and in addition to them, about 30% of patients with nonmetastatic prostate cancer recently experience ADT. Population-based studies have shown that dissimilar to other malignancies, type 2 diabetes is associated with a lower incidence of prostate cancer, whereas recent large cohort studies have reported the association of diabetes with advanced high-grade prostate cancer. Although the reason for the lower prevalence of prostate cancer among diabetic men remains unknown, the lower serum testosterone and PSA levels in them can account for the increased risk of advanced disease at diagnosis. Meanwhile, insulin resistance already appears in 25–60% of the patients 3 months after the introduction of ADT, and long-term ADT leads to a higher incidence of diabetes (reported hazard ratio of 1.28–1.44). Although the possible relevance of cytokines such as Il-6 and TNF-α to ADT-related diabetes has been suggested, its mechanism is poorly understood.
A New Look at the Most Successful Prodrugs for Active Vitamin D (D Hormone): Alfacalcidol and Doxercalciferol
Noboru Kubodera
Molecules , 2009, DOI: 10.3390/molecules14103869
Abstract: Alfacalcidol (1α-hydroxyvitamin D3) has been widely used since 1981 as a prodrug for calcitriol (1α,25-dihydroxyvitamin D3) in the treatment of hypocalcemia, chronic renal failure, hypoparathyroidism and osteoporosis. More recently, doxercalciferol (1α-hydroxyvitamin D2) has been used since 1999 as a prodrug for 1α,25-dihydroxyvitamin D2 for the treatment of secondary hyperparathyroidism. Currently, six forms of vitamin D are known. They range from vitamin D2 to vitamin D7 and are distinguished by their differing side chains. Only vitamin D2 and vitamin D3 have been found to be biologically active based on the elucidation of activation pathways. Alfacalcidol and osteoporosis/doxercalciferol and secondary hyperparathyroidism are discussed, with a new look at old compounds including their practical syntheses.
Considerations on HAM/TSP: rediscovering Tumaco
Yasuda, Noboru;
Arquivos de Neuro-Psiquiatria , 1993, DOI: 10.1590/S0004-282X1993000100023
Abstract: considerations are made on the role of htl.v-i in the etiopathogeny of ham/ tsp. neuroepidemiologic data reported in the literature are revisited for this purpose. among results of this evaluation it is pointed-out that the gkinawan community of brazil presents ethnographic and demographic characteristics which are ideal for designining new studies. for instance, analyses on htlv-i and on ham/tsp in face of the cohort of such community classified according to time and direction of the migration (japan-brazil and vice-versa), will ensure promising results for the understanding of etiopathogeny of ham/tsp. they can also be paths towards clarifying the simultaneous generating, of geographical foci of the disease distant one the other, as that of tumaco and that of south japan.
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