1,721,017 research outputs found
Chronic allograft nephropathy: its diagnosis and treatment
Get PDFThe process of chronic allograft nephropathy (CAN) is primarily concerned with disparity in major histocompatibility. However, changes similar to CAN have been seen in human kidney transplants between identical twins, as well as in rat kidney isografts. Such changes cannot be explained by antigen-dependent factors; antigen-independent factors are likely to be involved in the onset of CAN. A CAN-type picture also was seen in a rat single kidney model subjected to ischemic injury, indicating the importance of ischemia in the process of CAN. In the present study, CAN was accelerated by renal ablation in a rat kidney transplant model with reduced nephron number. Conversely, recipients with increased renal mass bearing two allografts, did not show any signs of CAN. These observations suggested that a non-allogenic factor such as ischemia and insufficient nephron number is critical in the development of CAN, and thus the etiology of CAN is hypothesized as follows. Many factors such as ischemic injury, acute rejection or infection reduce the functioning nephron number, which causes hyperfiltration in remaining nephrons leading to glomerulosclerosis. This in turn, further reduces the functioning nephron number. These progressive events may reinforce further the stimulus of hyperfiltration, thereby establishing a self-sustaining vicious cycle. Any factor preventing the reduction of functioning nephron number, can be a candidate for treatment. Herein, we showed that treatment with hepatocyte growth factor (HGF), a renotropic factor, in the initial disease stage prevented further development of CAN
Verification of Testicular Cancer Guidelines
Get PDFTesticular cancer is a rare disease that affects 1-2 in 100, 000 people in Japan ; however, it is a very significant disease in that it has a high prevalence amongst young adults aged in their 20s and 30s and it brings about metastasis from a relatively early stage. The 2009 edition of the Testicular Cancer Clinical Practice Guidelines sets out a detailed summary of 32 clinical questions (CQ) considered necessary in routine clinical practice across the fields of epidemiology, diagnosis, treatment, etc, in the form of recommendations and commentary. These CQs are considered extremely important in understanding the foundation of future testicular cancer treatment guidelines. In this symposium, five doctors gave lectures consisting of the following contents in which they validated the guidelines and gave concrete clinical practice examples through cases they had experienced themselves with regards to the treatment strategies for (1) stage I patients, (2) patients with advanced cancer and (3) patients with extragonadal germ cell tumors. (1) Stage I patients : In seminoma cases, the doctors focused on the relapse prevention effect provided by single-agent carboplatin adjuvant chemotherapy. In non-seminoma cases, treatment options were considered according to risk based on the presence or absence of vascular invasion, a prognostic factor. (2) Patients with advanced cancer : 30% of testicular cancers are metastatic and progress to advanced cancer. In refractory cases resistant to bleomycin, etoposide and cisplatin therapy, etoposide ifosfamide, and cisplatin therapy and vinblastine, ifosfamide and cisplatin therapy have been used, but without satisfactory results and the development of new salvage chemotherapy is an important issue. The therapeutic strategies against advanced testicular cancer were narrowed down to (2) -1) therapeutic effects from ultra-high-dose chemotherapy, (2) -2) salvage chemotherapy in cases where residual tumors are observed in induction chemotherapy and (2) -3) minimally invasive surgical treatment for residual tumors after chemotherapy. Concrete clinical cases from basic treatment strategies to the latest findings in refractory cancer patients were presented and considered in detail. (3) Patients with extragonadal germ cell tumors : Extragonadal germ cell tumors account for less than 5% of all germ cell tumors, but they can be cured with multimodality therapy. Therefore, it is important to reach an accurate diagnosis and provide the correct treatment. This disease is suspected in patients with elevated α-fetoprotein and human chorionic gonadotropin without the appearance of tumors in the testes, and tumors can be observed on the center line of the body such as the mediastinum or retroperitoneum. Traditionally, computed tomography-guided biopsy has been carried out in diagnosis. However, new techniques such as endoscopic ultrasound-guided biopsy have also been reported in recent years and the latest information, including treatments, was presented at this symposium
Treatment for locally advanced prostate cancer : value of surgery
Get PDFSurgical therapy is not only a therapeutic method but also an important procedure to provide useful information in determining a postoperative treatment strategy. Compared with postoperative cancer staging based on specimens obtained during surgery, more than 30% of cancers were inaccurately staged preoperatively, even when a current advanced diagnostic imaging technique was used. Compared with postoperative histological 30-40% of cancer staging were inaccurately staged based on a preoperative biopsy. These misstaging cases pose a significantly important problem. Approximately 15% and 30% of clinical stage C prostate cancers have been rated as pT2 and pN(+), respectively. Patients with pT3 prostate cancer who underwent radical prostatectomy had 5-year and 10-year overall survival rates of 82% and 67%, respectively, which were comparable to those in patients with pT2 prostate cancer (82% and 67%, respectively). However, patients with prostate cancer rated as pT4 and pN(+) had very poor outcomes with 5-year overall survival rates of 42.4% and 32.6%, respectively. Therefore, even in patients with stage C prostate cancer, surgical therapy should be recommended if no infiltration of adjacent tissue has been noted and the operation is applicable; and an optimal postoperative therapeutic strategy should be selected based on the accurate pathological staging and histological grading using postoperative pathological specimens. Such approaches will prevent unnecessary hormone therapy in patients with pT2 prostate cancer and prevent missing optimal timing for radical cure, as well as allowing appropriate therapy to be selected for patients with pT4 and pN(+) prostate cancer, for whom prognosis may be poor
Molecular targeting therapy for bladder cancer
No full textMolecular-targeted drugs are agents that act on molecules which are specifically expressed in cancer, or on molecules whose expression is increased in cancer compared to normal tissue, and suppress the growth, infiltration and metastasis of cancer while affecting normal tissue as little as possible by selectively impairing function in cancer tissue. The major molecular targets in cancer therapy include oncogene products, growth factors and their receptors, signal-transducing molecules, hormone receptors, cell cycle-related proteins, telomerase-related molecules, apoptosis-related molecules, angiogenesis-related molecules, anticancer drug resistance/sensitivity factors, transcription factors, and molecules related to infiltration and metastasis. This paper reports on the molecular-targeted drugs currently considered for bladder cancer
Comprehensive Management of Residual Tumor in Patients with an Advanced Testicular Tumor
Get PDFTreatment for metastatic testicular tumors is based on risk stratification according to International Germ Cell Cancer Collaborative Group classification and consists of cisplatin-based chemotherapy and resection of residual tumors. The indication of residual tumor resection is sometimes controversial. The residual tumor is under surveillance without resection after chemotherapy of pure seminoma, but the residual tumor is resected after chemotherapy in most cases of nonseminomatous tumors. The Japanese Urological Association has established guidelines on testicular tumor useful for the evidence-based treatment in Japan. The indication and surgical techniques for retroperitoneal residual tumor resection after chemotherapy are discussed
Successful Testicular Sperm Extraction in an Azoospermic Man with Postpubertal Mumps Orchitis
Get PDFA 46-year-old man who has a child from a previous marriage without artificial reproductive technologies was referred to our hospital with a chief complaint of infertility. He had suffered from bilateral orchitis after parotitis six years ago. On physical examination, both testes were soft and 4 ml in size. Semen analysis showed azoospermia and the serum follicle stimulating hormone value was high (36.9 mIU/ml). Microdissection testicular sperm extraction was performed, and motile sperm were successfully retrieved. The histological examination showed increased thickness of the basement membrane and, peritubular fibrosis in most seminiferous tubules, with few focal areas of normal spermatogenesis
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Retroperitoneal liposarcoma surgically repaired with Boari flap
Get PDFRetroperitoneal liposarcoma is rare. Here we describe a case of retroperitoneal liposarcoma in a 61-year-old male. Preoperative computed tomography revealed an intraabdominal huge mass, and a clinical diagnosis of liposarcoma. Intraoperatively, the mass involved the right kidney and bladder, completely surrounding the right ureter. The tumor and the lower half ureter were removed. Successful reconstruction of a neoureter was performed with the Boari flap coupled with nephropexy and a psoas hitch. The detailed salient steps performed in this case are reported, together with a review of the literature.61歳男。全身倦怠感を主訴とした。腹部に巨大な腫瘤を触れ、炎症所見、CRP値の上昇を認めた。CTにて巨大腫瘍を認め、MRIで第一腰椎の高さから骨盤部にかけて長径で30cmの腫瘍を認めた。手術を施行すると、腫瘍は周辺臓器と癒着し、右尿管を巻き込んで存在していた。右尿管を腫瘍とともに一塊として摘除したが、術中所見で後腹膜のあらゆる部位への直接浸潤を認め、腫瘍全摘除術は可能であったが根治性はないと判断した。そこで、術後化学療法施行の際の腎機能温存のため、右腎を温存することとした。Boari flapに腎を固定し、psoas hitchを併用した尿管-膀胱新吻合を行って尿路を再建した。病理組織学的に悪性線維性組織球症の所見を認め、liposarcoma、 dedifferentiated typeと診断した。術後2ヵ月で右側の水腎は認めず、順調に経過した
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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