Health status of university football athletes through multidimensional screening

OBJECTIVE

Adequate conditioning results from various physical, environmental, and psychological factors in sports activities. In this study, we aimed to clarify the concurrence and relevance of injuries, psychological problems, and sleep disturbance in university football (soccer) players. Biomechanical characteristics and risk factors for those injuries were also investigated.

METHODS

Overall, 1,084 university football players participated in this cross-sectional study using a web-based health history questionnaire. Assessments were made via the presence of injuries for physical problems, the Athlete Psychological Strain Questionnaire (APSQ) for psychological problems, and the Athlete Sleep Screening Questionnaire (ASSQ) for sleep difficulties.

RESULTS

There were 200 (19%) athletes with injuries; 413 (38%) of these were APSQ-positive, 246 (23%) were ASSQ-positive, and 468 (43%) athletes had no physical, psychological, or sleep problems. APSQ-positive respondents were significantly more likely to have a current injury than those who were APSQ-negative. No significant difference was observed between the number of ASSQ-positive and -negative respondents and current injuries. Those with sleep problems were significantly more likely to have psychological problems.

CONCLUSION

More than 60% of university football players had one or more physical, psychological, or sleep problems. Players may have co-occurring problems, and it is important to address them for these athletes to reach peak performance.

Injury data collection and utilisation practices in university sports teams: A cross-sectional study

OBJECTIVES

This study aimed to examine injury surveillance practices in a variety of university sports teams and barriers and facilitators for injury data collection and utilisation.

DESIGN

Cross-sectional study.

SETTING

University sports teams in Japan.

PARTICIPANTS

Medical, coaching, and other staff (non-medical/-coaching staff) of the university sports teams in Japan.

MAIN OUTCOME MEASURES

The survey included 31 questions that examined the barriers and facilitators for injury data collection, and the type of data on injury and exposure collected.

RESULTS

Injury data were collected during matches for 69 teams (48.3%) and training for 61 teams (42.7%). Injuries were primarily captured by athletic trainers in teams with medical staff, coaching staff and athletes in teams without medical staff. Common barriers in collecting and utilising injury data included limited funding for trained personnel and lack of time for medical staff to record data. Facilitating factors included clarification of the methods employed in recording and utilising injury data for teams with medical staff and the deployment of trained personnel to record injuries for teams without medical staff.

CONCLUSIONS

Approximately half of the Japanese university teams collected injury data. Considering barriers and facilitators is crucial to facilitate the collection and utilisation of injury data.

Influence of Surveillance Methods in the Detection of Sports Injuries and Illnesses

Background

Epidemiological data on sports injuries and illnesses depend on the surveillance methodology and the definition of the health problems. The effect of different surveillance methods on the data collection has been investigated for overuse injuries, but not for other health problems such as traumatic injuries and illnesses.

Purpose

The purpose of this study was to investigate the new surveillance method developed by the Oslo Sports Trauma Research Center (OSTRC), which is based on any complaint definition (new method), to identify health problems compared with the traditional surveillance method, which is based on time loss definition.

Study design

Descriptive epidemiology study.

Methods

A total of 62 Japanese athletes were prospectively followed-up for 18 weeks to assess differences in health problems identified by both new and traditional methods. Every week, the athletes completed the Japanese version of the OSTRC questionnaire (OSTRC-H2.​JP), whereas the teams' athletic trainers registered health problems with a time loss definition. The numbers of health problems identified via each surveillance method were calculated and compared with each other to assess any differences between their results.

Results

The average weekly response rate to the OSTRC-H2.​JP was 82.1% (95% CI, 79.8-84.3). This new method recorded 3.1 times more health problems (3.1 times more injuries and 2.8 times more illnesses) than the traditional method. The difference between both surveillance methods' counts was greater for overuse injuries (5.3 times) than for traumatic injuries (2.5 times).

Conclusions

This study found that the new method captured more than three times as many health problems as the traditional method. In particular, the difference between both methods' counts was greater for overuse injuries than for traumatic injuries.

Level of evidence

2b.

Sports Injury Surveillance Systems and Guidelines in Japan: A Systematic Review

This systematic review aimed to identify sports injury surveillance systems (ISSs) and injury surveillance guidelines (ISGs) developed and currently used in Japan. Additionally, the extent to which ISSs and ISGs developed overseas are employed in Japan was also examined. A systematic search of electronic databases was performed in March 2021. Prospective studies that investigated sports injuries and targeted Japanese athletes or sports in Japan were included to identify the following: (1) details of the ISSs or ISGs developed among sports in Japan, and (2) characteristics of studies focusing on sports in Japan employing ISSs or ISGs developed overseas and the method of use. A total of five ISSs developed among sports in Japan were included, most of which were based on insurance benefits or condolence payment systems. In total, 23 studies used ISSs or ISGs developed overseas, more than half of which were used as a resource for the development of other data collection tools or methods, indicating that the definition of injury and/or classification of items are modified based on the needs among sports in Japan. This review highlights the necessity of establishing club-based or organisational ISSs and ISGs that are appropriate for sports in Japan.

Injury pattern based on player positions in Japanese university handball: a cross-sectional study of 2056 players

BACKGROUND

Although it is evident that the risk of injury in handball varies according to player position, it is unclear whether the characteristics of these injuries also differ. The aim of this study was to characterise and compare the position-associated injury profiles of university handball players in Japan.

METHODS

A total of 2056 participants who played in the 2018 and 2019 Japanese National University Handball Championships were included in this cross-sectional study. A self-reported injury questionnaire regarding demographic and injury-related information was administered.

RESULTS

The overall prevalence of injury during the one-year period preceding the questionnaire was 44.1%, and back (47.9%) and line (49.2%) players exhibited a higher proportion of injuries than players in other positions (p < 0.001). The ankle, knee, and shoulder/clavicle were the most common body regions affected by traumatic injuries, and knee and shoulder/clavicle injuries differed based on player positions (p = 0.033). Conversely, overuse injuries predominantly affected the lumber spine/lower back, knee, and foot/toe, although there were no significant differences between player positions (p = 0.188). In terms of the injury mechanism, line players exhibited a higher proportion of contact injuries and goalkeepers had a higher proportion of non-contact injuries than that of other positions (p < 0.001).

CONCLUSIONS

Back and line players experienced more injuries than players in other positions. Depending on the player position, there were significant differences in the prevalence and patterns of injury. Therefore, injury prevention measures need to consider the characteristics of injuries based on player positions.

Injuries in Japanese university handball: a study among 1017 players

The aim of this study was to examine the injury profile of Japanese university handball players. In this cross-sectional study, a total of 1017 participants who played in the 2018 Japanese National University Handball Championship were followed. The incidence within the previous year was 0.59 [95% CI, confidence interval: 0.56-0.62] per player per year. The ankle (33.3%), knee (23.6%), and shoulder/clavicle (12.6%) were the body regions most affected by traumatic mechanisms, while the lumbar spine/lower back (26.0%), knee (15.7%), and shoulder (15.0%) were the body regions most affected by overuse mechanisms. Sprain (30.7%), ligamentous rupture (23.2%), and fracture (11.8%) were the main types of traumatic injuries, and stress fracture (25.0%) and lesion of meniscus or cartilage (25.0%) were the main types of overuse injuries. Female players were 1.5 times more likely (OR, odds ratio: 1.55 [95% CI: 1.20-2.01]) to experience an injury than their male counterparts, and line players were also 1.5 times more likely (OR: 1.49 [95% CI: 1.00-2.21]) to experience an injury than their wing counterparts. This study showed that there is a need for increased injury prevention efforts in Japanese handball, especially among female players.

Injury pattern according to player position in Japanese youth handball: A cross-sectional study among 2377 players

OBJECTIVE

Although the incidence and pattern of injuries in youth handball have widely been investigated, it is unclear whether the characteristics of injuries differ on the basis of player position. This study aimed at revealing the player position-based injury profile in Japanese youth handball players.

DESIGN

Cross-sectional.

SETTING

Injury questionnaire.

PARTICIPANTS

Overall, 2377 participants who played in the 2018 and 2019 Japanese National High School Handball Championships were included.

MAIN OUTCOME MEASURES

Prevalence, body region, type, severity, and mechanism of injuries were collected through a questionnaire.

RESULTS

The overall prevalence of injury within the previous year was 46.7%, and the proportion of back players (52.8%) who sustained at least one injury was higher than that of players in other positions (p < 0.001). Differences in player positions were found among overuse injuries by body region, with a higher proportion of the lower leg and knee in wings and backs, respectively (p = 0.047). Among traumatic injuries, a higher proportion of ligamentous rupture in backs and fracture in lines were seen (p = 0.011).

CONCLUSION

There were significant differences in the prevalence and patterns of injuries between player positions. Therefore, injury prevention programmes should consider the characteristics of player positions.

An update of the Japanese Oslo Sports Trauma Research Center questionnaires on overuse injuries and health problems

Monitoring the health of athletes is important for their protection, and questionnaires such as those produced by the Oslo Sports Trauma Research Center (OSTRC) are a valuable tool in this process. In 2020, several changes were made to the OSTRC questionnaires (OSTRC-O, OSTRC-H), including changes to the wording, structure, and logic of the original questionnaires. In the present study, the Japanese versions of the OSTRC questionnaires (OSTRC-O.JP, OSTRC-H.JP) were revised to meet the requirements of the updated versions and to analyse new and previously collected data to illustrate the impact of the changes on Japanese athletes. Proposed changes were categorized as minor or more substantial; minor changes were effected to the questionnaire instructions and to the wording of all four questions, and more substantial changes were made to the wording of question 2. The updated questionnaires also included changes to questionnaire logic and answer categories. To assess the consequences of the changes to the wording of question 2, 101 athletes were asked to complete the OSTRC-H.JP, which included both the original and updated versions of question 2, over 10 consecutive weeks. We calculated the number of health problems identified when new gatekeeper logic was and was not applied, using 1585 OSTRC-H.JP responses to assess the consequences of the changes to the questionnaire logic. The kappa coefficient, which measures the level of agreement between the responses to question 2 of the original and updated versions, was high. By applying gatekeeper logic, there was a remarkable reduction in the number of injuries and illnesses among all health problems but less reduction in substantial health problems and time loss health problems. These changes will make it easier for Japanese athletes to complete the questionnaires and improve the quality of collected data.

Effect of Forefoot Strike on Lower Extremity Muscle Activity and Knee Joint Angle During Cutting in Female Team Handball Players

Background

The purpose of this study is to examine the effects of different strike forms, during cutting, on knee joint angle and lower limb muscle activity.

Methods

Surface electromyography was used to measure muscle activity in individuals performing cutting manoeuvres involving either rearfoot strikes (RFS) or forefoot strikes (FFS). Three-dimensional motion analysis was used to calculate changes in knee angles, during cutting, and to determine the relationship between muscle activity and knee joint angle. Force plates were synchronized with electromyography measurements to compare muscle activity immediately before and after foot strike.

Results

The valgus angle tends to be smaller during FFS cutting than during RFS cutting. Just prior to ground contact, biceps femoris, semitendinosus, and lateral head of the gastrocnemius muscle activities were significantly greater during FFS cutting than during RFS cutting; tibialis anterior muscle activity was greater during RFS cutting. Immediately after ground contact, biceps femoris and lateral head of the gastrocnemius muscle activities were significantly greater during FFS cutting than during RFS cutting; tibialis anterior muscle activity was significantly lower during FFS cutting.

Conclusions

The results of the present study suggest that the hamstrings demonstrate greater activity, immediately after foot strike, during FFS cutting than during RFS cutting. Thus, FFS cutting may involve a lower risk of anterior cruciate ligament injury than does RFS cutting.

Globule-coil transition of denatured globular protein investigated by a microwave dielectric technique

A mechanism for the gel-glass transition of denatured globular protein has been explained from the viewpoint of the globule-coil transition with microwave dielectric measurements using a time domain reflectometry (TDR) method. Boiled egg white, which is an aqueous gel of egg white prepared by heat treatment at 100 degrees C, becomes a glass on drying. In the gel state, the relaxation processes corresponding to the orientation of bulk water and the micro-Brownian motion of peptide chains of denatured protein were observed around 10 GHz and 10 MHz, respectively. When the gel-glass transition occurred, the relaxation strength for bulk water decreased rapidly as evaporation and breaking of water structure occurred. Simultaneously, the relaxation strength for micro-Brownian motion increased abruptly, as the structure of globular protein varied from globule state to coiled state. It is considered that the protein molecule spreads out and takes up a coiled state by reductions of hydrophobic and hydrophilic interactions of the globular protein. These reductions occur through a decrease in the amount of water.

Time domain reflectometry: measurement of free water in normal lung and pulmonary edema

The free water content of lung tissue was investigated by dielectric spectroscopy in normal lungs and in pulmonary edema induced by oleic acid in rats. The dielectric relaxation in a frequency range of 10(7) to 10(10) Hz was measured with the time domain reflectometry method at 25 degreesC. Three dielectric relaxation processes were analyzed for the lung tissue. A high-frequency process around 10 GHz was attributed to the orientation of free water molecules based on the relaxation time [log tauh (in s) = -11.03]. The dielectric strength (Delta epsilon) of this high-frequency peak (Delta epsilonh) should reflect the amount of free water in the tissue. Because the measured Delta epsilonh depended on the air content of the lung samples, the value of Delta epsilonh was corrected for the air content of each sample as determined by the point-counting method in the area where the time domain reflectometry data were obtained. The lungs of rats that received an injection of oleic acid had a significantly increased free water content [(Delta epsilonh of lung/Delta epsilon of pure water) x density of pure water] compared with that in the normal lung (0.76 vs. 0.59 g/cm3). These results indicate that free water occupies approximately 60% of the total volume of normal lung tissue and that there is an increase in free water in pulmonary edema.

Histamine-induced cortisol secretion from bovine adrenocortical cells: co-incubated with bovine adrenal medullary cells

Histamine at concentrations higher than 10(-9) M significantly elicited cortisol secretion from bovine adrenocortical (BAC) cells co-incubated with bovine adrenal medullary (BAM) cells, suggesting that BAM cells are responsible for histamine-induced cortisol secretion. Cortisol secretion from BAC cells co-incubated with BAM cells was also elicited by both an H1 agonist, 2-methylhistamine, and an H2 agonist, 4-methylhistamine. However, 4-methylhistamine was much less effective than 2-methylhistamine. Histamine-induced cortisol secretion was inhibited not only by H1 antagonists (pyrilamine and diphenhydramine) but also by H2 antagonists (cimetidine and ranitidine). Histamine effectively increased 45Ca uptake and IP3 production in BAM cells. These responses were antagonized by the H1 antagonist but not by the H2 antagonist. Histamine-induced cortisol secretion from BAC cells co-incubated with BAM cells was inhibited by beta-adrenoceptor antagonists, propranolol and timolol, as well as an NK1-receptor antagonist, D-Arg1-D-Trp7,9-Leu11-substance P. These results indicate that histamine can induce cortisol secretion from BAC cells at physiological concentrations through H1 receptors on BAM cells, and catecholamine and substance P may participate in histamine-induced cortisol secretion.

In vivo dielectric analysis of free water content of biomaterials by time domain reflectometry

A method of in vivo analysis of the free water content in living organisms by dielectric analysis in the time domain is described. Human skin is chosen as an example of living tissue. The cells suitable for the measurement of various layers of human skin and calculation procedures for the waveform reflected from the probe end are described. The approach was confirmed to be effective for the determination of the water content through measurement of the standard samples, keratin-water mixtures. This method was also applied to human skin in vivo. Water content data measured with a probe specially designed for surface layer analysis were sensitive to humidity around the subject. The formula expressing the relation between the electrical field character of the probe, the permittivity depth profile, and the measured permittivity was used to analyze the water content profile as a function of the depth from the skin surface. The use of several kinds of probes, differing in their electric field characteristics, permitted evaluation of the water content depth profile of human skin. This procedure is easy and applicable to any sample due to its simplicity. The measurement needs only a touch of the probe on a sample spot. It is therefore a promising method of physicochemical research on living organisms and biomaterials.

[Extracorporeal shock wave lithotripsy in an 8-month-old infant]

An 8-month-old boy who presented with pyrexia and vomiting was referred to the pediatric clinic of Kitasato University Hospital. He was found to have hematuria, proteinuria and pyuria. Abdominal X-ray film showed calcification suggesting renal staghorn calculus in the bilateral kidneys. At 10-months and 11-months, we succeeded in treating him with extracorporeal shock wave lithotripsy (ESWL) without complications.

[A case of solitary metastasis from renal cell carcinoma to the thyroid gland]

A case of solitary metastasis with renal cell carcinoma to the thyroid gland is presented. The patient was a 54-year-old man found to have an abnormal mass in the neck. He had a past history of radical nephrectomy orignating from the right renal cell carcinoma 5 years earlier (pT2N0M0, G2 > 3, alveolar type, clear cell subtype). Ultrasonography revealed a tumor mass in the right hemithyroid gland. Right hemithyroidectomy was performed on April 19, 1995. Histopathologically, the removed thyroid tumor showed clear cell carcinoma. The possibility of a primary thyroid tumor was ruled out by immunohistochemical thyroglobulin staining, and the present case was thus diagnosed as of metastatic thyroid tumor of renal cell carcinoma. The present case is the 12th case of thyroid solitary metastasis of renal cell carcinoma reported in Japan to date.

Dielectric properties of human fetal organ tissues at radio frequencies

The in vitro dielectric properties of human fetal organ tissues were measured in the frequency range from 100 kHz to 500 MHz at 24 degrees C. The dielectric measurements were performed by using a network analyzer (HP4195A) and a coaxial line capacitive sensor. The tested samples, including skin, muscle, heart, lung, liver, kidney, spleen, and brain tissues, were obtained from the legal abortion of five women with 14-16 weeks gestation periods.

[Clinical experience with the artificial urinary sphincter AMS 800 for male incontinence]

BACKGROUND

The aim of this study is to evaluate the therapeutic efficacy of artificial urinary sphincter AMS 800 implants for male patients with urinary incontinence.

METHODS

Eleven male patients with urinary incontinence were treated by implantation of the artificial urinary sphincter AMS 800 between 1988 and 1992. Patient age at the surgery ranged from 14 to 79 years, with a mean age of 58 years. At presentation, 9 patients (82%) had true incontinence and 2 had overflow incontinence, and medical treatments and/or surgical procedures (Teflon injections in 2 and Sling procedure in 1) had been attempted previously elsewhere in all patients. The etiologies of incontinence were post-prostatectomy (transurethral resection in 4 and radical retropubic prostatectomy in 4) in 8 patients (73%) and myelomeningocele, spinal cord injury, pelvic trauma in one each. There were 5 patients with abnormal cystometrogram, and 2 of them were performing intermittent self catheterization. Vesicoureteral reflux was determined in 2 patients preoperatively, which were surgically corrected one year before AMS800 implant in a patient and simultaneously in another patient. The cuff was placed around the bulbous urethra (9), pendulous urethra (1) or bladder neck (1). The device was activated 6 weeks post implantation, and the assessment of therapeutic effects was started 2 weeks after activation.

RESULTS

Follow up ranged from 3 weeks to 75 months, with a mean of 56 months, if 3 cases done explantation due to periprosthetic infections were excluded. After AMS 800 implantation 5 patients (45%) were completely continent, 4(36%) required the use of not more than 1 pad per day, while a patient was not satisfied with the results and another patient was not definitive because of early explantation before device activation. Hence complete or near complete continence was achieved in 9 patients (81%). A patient is performing intermittent self catheterization in conjunction with the AMS 800 without any complications up until now. There were 3 periprosthetic infections (27%) associated with 2 cuff erosions, that consequently required explantation. Besides periprosthetic infection, neither complications nor mechanical device failures was experienced.

CONCLUSION

In conclusion, the AMS 800 artificial urinary sphincter was safe with reasonable mechanical reliability and offered acceptable and satisfactory urinary control to the selected patients with incontinence.

Dielectric study of the cooperative order-disorder transition in aqueous solutions of schizophyllan, a triple-helical polysaccharide

Schizophyllan exists in aqueous solution as a triple helix, which is intact at room temperature. Its aqueous solution forms some ordered structure at low temperatures but undergoes a sharp transition to a disordered structure as the temperature is raised. The transition temperature Tc is about 7 and 18 degrees C for H2O and D2O solutions, respectively. This transition was followed by time-domain reflectometry to investigate dynamic aspects of the transition. In addition to a major peak around 10 GHz, the dielectric dispersion curve of a 20 wt % schizophyllan in D2O exhibited a small peak around 100 MHz below Tc and around 10 MHz above Tc. The major peak is due to bulk water, whereas the 100 MHz peak is assigned to "bound" or "structured" water, and that around 10 MHz to side-chain glucose residues. However, unlike usual bound water reported for biopolymer solutions, this "structured" water disappears abruptly when the temperature becomes close to Tc without accompanying a conformational transition of the main chain. The above assignment is consistent with the structure of the ordered phase derived from previous static data that it consists of side-chain glucose residues along with nearby water molecules surrounding the helix core that are interacting with each other loosely through hydrogen bonds, and spreads radially only a layer of one or two water molecules but a long distance along the helix axis.

[Changes of plasma endothelin level in the early post-renal transplantation period]

Endothelin (ET) has been suggested to be involved in acute graft rejection of kidney transplantation and cyclosporin A (CsA) nephrotoxicity. For clarification of the pathophysiological role of ET in the early post-transplantation period, plasma endothelin-1 (ET-1) was measured by specific radioimmunoassay in renal transplant recipients, patients on maintenance hemodialysis (HD) and healthy volunteers. Twelve transplant recipients were used in this study, 8 of whom were living related subjects and 4 cadaver. Plasma ET-1 and graft function were measured each day, from 1 day prior and 7 days following transplantation and every week up to 5 weeks postoperatively. Plasma ET was measured in 20 other transplant recipients with stable function (serum creatinine < or = 1.8 mg/dl), 20 maintenance HD patients with no residual renal function and 6 healthy volunteers. Mean plasma ET-1 was 13.0 +/- 4.5 pg/ml in 20 recipients with stable graft function, 21.7 +/- 6.5 in 20 HD patients and 1.5 +/- 0.4 in healthy volunteers. These differences are statistically significant (p < 0.02). Plasma ET-1 showed significant decrease from 21.8 +/- 7.2 pg/ml prior to transplantation to 12.8 +/- 4.0 when urinary output reached more than 1000 ml in living and cadaveric transplantation subjects. All three acute vascular rejections clearly indicated histologically increased plasma ET-1 accompanied by an increase in serum creatinine. A significant positive liner correlation was noted between plasma ET-1 and serum creatinine during the first week following living transplantation. Two patients with clinically and histologically suspected CsA nephrotoxicity showed transient increase in plasma ET-1.(ABSTRACT TRUNCATED AT 250 WORDS)

[Usefulness and limitation of digital rectal examination and imaging studies in staging prostate cancer]

The diagnostic usefulness of digital rectal examination (DRE), transrectal ultrasonography (TRUS), magnetic resonance imaging (MRI) and computed tomography (CT) was compared in the differentiation of stage B from stage C prostate cancer. Eighteen patients who had undergone radical retropubic prostatectomy were included in this study. Overall, the positive predictive values (PPV) for detecting extraprostatic disease (extracapsular extension, seminal vesicle invasion) were 100% for DRE, 88.9% for TRUS and 80.0% for MRI, respectively. Corresponding figures for accuracy in detecting extraprostatic spread were 55.6%, 66.7% and 61.1%, respectively. The PPV and accuracy for detecting extraprostatic disease in 13 patients with localized cancer (< stage B) were 75.0%, 53.8% for TRUS and 66.7%, 53.8% for MRI, respectively. Both of these examinations appeared to be superior to DRE alone. The PPV and accuracy increased when findings on TRUS and MRI coincided. Computed tomography was less accurate than MRI in diagnosing nodal involvement because of the higher incidence of false positives. Further efforts should be focused on enhancing preoperative diagnostic precision in staging prostate cancer because of the limited usefulness of the current imaging techniques. Development of more reliable diagnostic modalities or designing ideal combination of these studies are desperately needed.

Emphysematous pyelonephritis, ureteritis, and cystitis in a diabetic patient

This paper presents a case of gas-forming infection of the urinary tract in a diabetic patient. Plain film and computed tomography scans of the abdomen greatly facilitated clarification of the entire inflammatory process. The patient was cured by early nephrectomy conducted following unsuccessful treatment by percutaneous drainage.

[A case of renal oncocytoma]

A case of renal oncocytoma found incidentally by routine medical checkups is reported. An asymptomatic 70-year-old male was found to have a right renal mass by abdominal ultrasonography. Selective renal arteriography supported the diagnosis of renal oncocytoma with a typical appearance of "spoke-wheel" pattern. Right radical nephrectomy was performed. However, in consideration of the possibility of renal cell carcinoma. The diagnosis of renal oncocytoma was finally confirmed pathologically. The present case represents the 58th renal oncocytomas reported in Japan as of December 1992.

[Two cases of bladder cancer in patients with chronic renal failure]

We report here two cases of bladder cancer in patients with chronic renal failure who had been treated with hemodialysis. Case 1: A 58-year-old male on hemodialysis for 3 years visited with a complaint of gross hematuria. Transurethral resection of the bladder tumor (TUR-Bt) was performed and histopathological examination showed grade 1, stage pTa transitional cell carcinoma (TCC). The patient was followed for 4 years postoperatively without recurrence. Case 2: A 64-year-old male with hemodialysis for 1 week was referred to our department with a gross hematuria. TUR-Bt was conducted and histopathological findings showed grade 2, stage pT1b TCC. In April, 1992, he revisited our hospital with bladder tamponade due to massive hematuria, and TUR-Bt was performed. Histopathologically, the tumors were grade 2, stage pT2 TCC. He was followed for 1 year without recurrence.

[Prophylactic combination therapy after TUR of superficial bladder cancer]

We evaluated 63 patients with superficial bladder cancer (pTa, pTl) who were treated with instillation of bleomycin +/- bacillus Calmette-Guerin (BCG) and administration of uraciltfutraful (UFT) for prophylaxis of tumor recurrence after transurethral resection (TUR). The patients were randomly assigned to groups A and B after transurethral resection by the closed envelope method. Group A (34 cases) was designed as continuous diluted intravesical instillation of bleomycin (120 mg/2,000 ml saline solution/day repeated for 3 days), instillation BCG (40 mg/40 ml saline solution/weekly 6 times) and UFT (400 mg orally/day for 2 years maximum). Group B (29 cases) was designed as the aforementioned minus BCG instillation. Cumulative non-recurrence rates in group A and group B were 80.1% and 72.1% at the time of three years, which revealed no significant difference between the two groups (p = 0.265, generalized Wilcoxon test). The high recurrent incidence of superficial bladder cancer is primarily due to the multifocal nature of the cancer or implantation of tumor cells at the time of the subsequent transurethral resection. The procedure was performed safely with no severe side effects. Our method might be useful to reduce the recurrences of superficial bladder cancer after transurethral resection of bladder (TUR).

Infrequent involvement of p53 mutations and loss of heterozygosity of 17p in the tumorigenesis of renal cell carcinoma

Restriction fragment length polymorphism (RFLP) analysis and the polymerase chain reaction of the single-strand conformation polymorphism (PCR-SSCP) method were conducted to assess the loss of heterozygosity of chromosome 17p and mutations of the p53 gene in 30 surgical specimens of human renal cell carcinoma. Six of 29 tumors (20.6%) showed loss of heterozygosity on chromosome 17p in RFLP analysis, and in none of 21 tumors could a mutation be found on exons 5 to 8 of the p53 gene in PCR-SSCP analysis. We conclude that the p53 gene mutation does not play a role in the development of the majority of cases of renal cell carcinoma and that there may be another tumor suppressor gene on 17p.

[A case of malignant mesothelioma of the tunica vaginalis testis]

A case of malignant mesothelioma of tunica vaginalis testis experienced in an 83-year-old male who presented with a complaint of left intrascrotal pain is reported. The tentative diagnosis was acute epididymitis. Left epididymectomy was performed following the unsuccessful treatment with antibiotics. The histology of the surgical specimen revealed malignant mesothelioma. Radical excision of the left spermatic cord and scrotal content indicated locally advanced disease with positive surgical margin. Metastatic workup, including abdominal and chest computerized tomography scan, magnetic resonance imaging and bone scan demonstrated presence of metastasis to the paraaortic lymph nodes and the lumber spine. The patient is being followed conservatively in consideration of his age and advanced stage of the disease.

[Reassessment of the sonographic criterion of prostate cancer--nonspecificity of a hypoechoic lesion]

Of 71 patients who underwent ultrasound guided transrectal needle biopsy at the urology clinic in Kitasato University Hospital 19 (26.8%) patients were found to have prostate cancer. The positive predictive value for transrectal ultrasonography (hypoechoic lesion) was disappointing-only 30% (18/60). While hypoechogenicity has been increasingly accepted as the most sensitive ultrasonographic indicator of malignancy, the specificity of hypoechogenicity is related to benign structures that may also appear hypoechoic. Sonographic detection of prostate cancer is also confounded by the presence of iso- and hyperechoic tumors. Experienced sonographer should be alert to this limitation of the current technology of transrectal ultrasound. The advent of the Biopty gun enabled us to take multiple biopsy cores easily and quickly. Liberal use of random systematic biopsy in addition to directed cores from a hypoechoic lesion should enhance the detection of prostate cancer regardless of the tumor echogenicity.

[Role of prostate specific antigen, transrectal ultrasonography, and digital rectal examination in the search for clinical prostate cancer]

Two hundred and thirty-four patients who visited the urology clinic in Kitasato University Hospital were evaluated with digital rectal examination (DRE), serum prostate specific antigen (PSA) study and prostate ultrasonography. Of 71 men who underwent ultrasound-guided transrectal biopsy 19 (26.8%) were found to have prostate cancer, accounting for 8.1% (19/234) of the whole population. When PSA levels were arbitrarily divided into 0 to 2, 2.1 to 10 and greater than 10 ng/ml, the positive DRE was associated with cancer detection rate of 3.3%, 77.8% and 100%, respectively, with an overall detection rate of 32.6%. However, a normal DRE (benign-feeling gland) is associated with much less cancer detection rate of 5.9%, 28.6% and 100%, respectively, with an overall rate of only 16.0%. The positive biopsy rate was 30% (18/60) in the presence of hypoechoic lesions on sonography, but 9.1% (1/11) if absent. The positive predictive value of DRE (32.6%, 15/46) increased to 36.6% (15/41) if a hypoechoic lesion was identified sonographically and to 87.5% (14/16) if PSA levels were abnormal. One patient was found to have a microfocus of well differentiated adenocarcinoma in one of the 6 biopsy cores. Radical retropubic prostatectomy was performed in 9 of the 19 patients with clinically localized prostate cancer. On pathologic examination of the prostatectomy specimens 5 of them were upstaged to positive seminal vesicle or lymph node metastasis. The spectrum of prostate cancer detected by these modern techniques is broad and extends from tiny clinically insignificant cancer to advanced disease in its incurable stage.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prognosis of incidental (stage A) prostatic cancer]

Incidentally discovered prostatic cancer can pursue a benign clinical course or it can rapidly progress. For the purpose of this study, we summarized pathological and clinical results of 107 (5.3%) stage A prostatic cancer patients in 2008 transurethral resection of the prostate for clinically diagnosed benign prostatic hyperplasia. For each patient, 3.9 slides, 13.6 tissue chips per slide and 52.5 tissue chips per patient (from 16 to 140 chips) were examined microscopically. The survival rates of patient with well, moderately and poorly differentiated groups were 62, 37 and 12% at 10 years, and those with Gleason score 2 to 4, 5 to 7 and 8 to 10 group were 63, 42 and 0% respectively. The survival rates in stage A1 (well differentiated or Gleason score 4 or less in less than 5% of the tissue removed during transurethral resection of the prostate) and stage A2 (anything other than stage A1) were 63 and 41% at 10 years, respectively. And cancer specific survival rates in stage A1 and stage A2 were 96% and 64% at 10 years, respectively. The number of cancer specific death were 1 in 30 (3.3%) in stage A1 group and 14 in 77 (18.2%) in stage A2 group. Our results indicated that tumors with low potential for aggressive behavior had a volume extent of less than 5% and a well differentiated group. Aggressive treatments should be recommended to all patients who were diagnosed stage A2 prostatic cancer.

[Immunohistochemical study of the prostatic tissues with monoclonal antibody against gamma-seminoprotein. Analyses of benign prostatic hyperplasia, metastatic foci from adenocarcinoma of the prostate and malignant neoplasms other than adenocarcinoma of the prostate]

The immunohistochemical specificity of the monoclonal antibody (43-21-1-1) against gamma-seminoprotein (gamma-Sm) in the prostatic tissues was evaluated by avidin-biotin peroxidase complex method. The normal tissues of various organs, other than male genitourinary organs already examined in the previous study, the brain, skin, spinal cord, tongue, esophagus, stomach, small intestine, rectum, trachea, lung, pleura, diaphragm, liver, spleen, pancreas, mesentery, kidney, lymph node, bone, bone marrow and striated muscle were examined for control study. The prostatic tissues obtained by surgery or biopsy, benign prostatic hyperplasia (BPH; 72) urethral polyp with prostatic-type epithelium (1), bone (3) or testicular (2) metastases from adenocarcinoma of the prostate and malignant neoplasms other than adenocarcinoma of the prostate, including primary small-cell carcinoma (1), secondary embryonal carcinoma (1) and secondary mucinous adenocarcinoma (1) of the prostate were then examined. Since all but 2 (97%) specimens of BPH were obtained by transurethral resection (TUR), which might cause non-specific staining due to electro-mechanical effects, the tissue of BPH obtained by suprapubic prostatectomy were examined simultaneously, serving as a control for immunostaining. The normal tissues of various organs were never stained positively for gamma-Sm. Positive reactions of gamma Sm with this monoclonal antibody were recognized in the cytoplasms of urethral polyp with prostatic-type epithelium, bone or testicular metastases from adenocarcinoma of the prostate. The malignant neoplasms other than adenocarcinoma of the prostate examined in this study, were never stained positively. There was obviously evidence of non-specific staining in the TUR tissues of BPH.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of renal function with dynamic Gd-DTPA-enhanced magnetic resonance imaging after shock wave lithotripsy]

It has already been reported that MR imaging is a superior imaging technique to detect minute anatomical changes in the kidney after ESWL. However, the morphological abnormalities found by MR imaging do not necessarily mean deterioration of the renal function. The purpose of this study is to assess the morphological changes in the kidney and changes in renal function after the ESWL treatment by dynamic MR imaging. A total of 16 patients underwent axial MR imaging before and after ESWL. Dynamic MR was also performed on 11 patients of them within 24 hours after ESWL, and both before and after ESWL in the remaining 5 patients. Eight kidneys showed morphological abnormalities on T1-weight images, and 4 of them showed loss of corticomedullary demarcation. Furthermore, the first MR imaging after injection of GdDTPA revealed focal areas of decreased signal intensity in only 2 of these 4 patients who showed loss of corticomedullary demarcation on previous MR images. However, the second MR imaging 6 months after ESWL showed no abnormality in either of them. The percent contrast of signal intensity increase to fat signal intensity was one minute after GdDTPA injection compared before and after ESWL in 5 of the 16 patients. The values before and after ESWL revealed no statistically significant difference, and no patient showed any remarkable decrease of signal intensity after ESWL. These results suggest that loss of corticomedullary demarcation after ESWL does not necessarily reflect damage to the renal function and that the shock-wave exposure causes no permanent damage to the renal function but only temporary impairment.

[Protein binding of various cephems in healthy subjects and patients with chronic renal failure]

This study was employed to investigate whether the serum protein binding of various cephems [cefpiramide (CPM), cefalotin (CET), latamoxef (LMOX)] differ among healthy subjects and patients with chronic renal failure (CRF) by means of in vitro equilibrium dialysis. The protein binding capacities of cephems in patients with CRF (hemodialysis, continuous ambulatory peritoneal dialysis, non-dialysis) decreased significantly compared to those in healthy subjects. The binding capacities correlated directly with total protein, albumin concentration and correlated inversely with blood urea nitrogen and serum creatinine concentration. In the study of protein binding during and after hemodialysis, the binding capacities of CPM and LMOX decreased immediately after dialysis and then increased with the time. However, the binding capacities of CET increased immediately after dialysis and then decreased. The binding capacities of CPM and LMOX correlated inversely with non-esterified fatty acids (NEFA) and those of CET correlated directly with NEFA. In the study of protein binding in pooled sera from healthy subjects with or without palmitic acid (PA), the binding capacities of CPM and LMOX decreased by increasing the concentration of PA, while those of CET increased by increasing PA up to 3 mM. The changes in binding capacity of cephems during and after hemodialysis have been possibly caused by increase of NEFA due to activation of lipase in use of heparin as an anticoagulant. In conclusion, changes in protein binding capacity of cephems in sera from CRF, which should be taken into consideration to avoid possible side effects.

[A case of retrovesical embryonal cell carcinoma]

We report a case of an extragonadal germ cell tumor in the retrovesical region. The patient complained of a perineal and micturition pain. Urethrography, CT and MRI showed a retrovesical tumor protruding into the bladder. Alfa-fetoprotein was increased to 12,170 ng/ml. Bilateral testes did not contain any palpable mass by careful palpation. No tumor was detected by ultrasonography, either. Clinically, he was diagnosed as having a retrovesical extragonadal germ cell tumor associated with paraaortic lymph-nodes and bilateral pulmonary metastases. Although he was treated by combination chemotherapy (PVB and VAB-6 regimen) and irradiation, he died of carcinomatosis about 6 months after the admission. There was no evidence of tumor in bilateral testes on autopsy. This case was a second case of extragonadal germ cell tumor originating from the retrovesical lesion in the literature.

[Discrepancy between the serum levels of gamma seminoprotein and prostate-specific antigen in patients with prostatic neoplasms. Both true or either untrue]

Serum levels of prostatic acid phosphatase (PAP), gamma-seminoprotein (gamma-Sm) and prostate-specific antigen (PSA) were determined simultaneously in 57 patients with benign prostatic hyperplasia (BPH) and in 50 untreated patients with prostatic cancer (adenocarcinoma, N = 47 and non-adenocarcinoma, N = 3). The correlations between the serum levels of gamma-Sm and PSA in these patients were assessed by linear regression analysis. Some fundamental studies were added for explaining the causes of discrepancy between the serum levels of gamma-Sm and PSA. All of BPH group underwent transurethral resection of the prostate (TURP) and the sera were obtained for measurements before, immediately after and 18 hours after TURP. The gamma-Sm correlated well with the PSA in the sera obtained before (r = 0.76) and 18 hours after (r = 0.73) TURP. However, there was no correlation (r = 0.26) between them in the sera obtained immediately after TURP. In 47 untreated patients with adenocarcinoma of the prostate, no significant correlation (r = 0.19) between serum levels of gamma-Sm and PSA was observed, although there was correlation (r = 0.51) between those of PAP and PSA. When these patients were classified into two groups, M0 (stage A-C; N = 26) and M1 (stage D; N = 21), however, the serum gamma-Sm correlated with the serum PSA in M0 group (r = 0.57), but didn't in M1 group (r = 0.11). Furthermore, the differences in the means of PAP (p less than 0.05) and PSA (p less than 0.001) between M0 group and M1 group were statistically significant, although the serum gamma-Sm failed to distinguish M0 from M1. The anti-PSA antibody of "PSA Kit" reacted against the standard gamma-Sm adopted from "gamma-Sm Kit". Surprisingly, the anti-gamma-Sm antibody of "gamma-Sm Kit" also reacted against the standard PSA adopted from "PSA Kit". The gamma-Sm and PSA apparently cross-reacted each other. The quantitative analyses with serial dilution of the sera were done by using each assay in 3 patients whose serum levels of gamma-Sm were markedly different from those of PSA. The dilution curve for PAP appeared to be rectilineal, and that for PSA also appeared to be approximately rectilineal. However, the gamma-Sm assay failed to be proportional. In conclusion, the correlation between serum levels of gamma-Sm and PSA was absent in certain circumstances, when the true values of them were expected to be much higher than those determined.(ABSTRACT TRUNCATED AT 400 WORDS)

[Clinical statistics of the bladder tumor--clinical and pathological aspects of 325 cases]

We analyzed 325 primary bladder tumor patients who were treated in our hospital during the past 15 years. There were 242 males and 83 females who were between 20 and 84 years old with an average age of 63 years old. The most frequent complaint was macroscopic hematuria in 76.9% of the patients (250/325). Cystoscopically, a single tumor was seen in 71%, the tumor was medium sized (1 to 3 cm) in 32%, and 56% were papillary tumors with a stalk. Histologically, 300 (92.3%) cases were transitional cell carcinoma. There were 42, 206 and 52 patients with grades 1, 2 and 3 transitional cell carcinoma and stage Tis, Ta, T1, T2, T3a, T3b, T2-4M1 and Tx were 2,46, 151, 30, 15, 16, 37 and 3 cases each. Transurethral resection was performed in 231 (71.1%), partial cystectomy in 6 (1.8%) and total cystectomy in 44 (12.5%) cases each.

[Clinical statistics of the bladder tumor--survival rates of 325 cases]

To study the relationship between clinical features and prognosis of the bladder tumor, 325 patients who were treated in our hospital were analyzed. The overall 5-year and 10-year actual survival rates were 65% and 51%. There was no statistical significance in the actual survival rate between the single and multiple tumor group. Although, there was a significant difference in tumor size, tumor growing type and the mode of treatment. The ten-year survival rates for grades 1, 2 and 3 cases were 76%, 57% and 18%, respectively. There was a significant difference between grades 1 and 3 (p less than 0.001) and grades 2 and 3 (p less than 0.001). The ten-year survival rates for stages Ta, T1, T2, T3a, T3b and T2-4 M1 were 79%, 68%, 43%, 0%, 19% and 5%, respectively. There was a significant difference between the Ta, 1 and T2-4 group (p less than 0.001).

[Clinical effect of oxybutynin hydrochloride (1 mg/tablet)]

The clinical efficacy of oxybutynin hydrochloride was studied on 21 patients with neurogenic bladder or unstable bladder complaining of urinary frequency, urgency and urgent incontinence. Oxybutynin hydrochloride (1 mg/tablet) was administered orally for 26.7 days, on average, 3 mg per day in 3 and 6 mg per day in 18 patients and the usefulness of this drug was assessed subjectively and objectively. Of 21 patients treated, 9 had neurogenic bladder and 10 had unstable bladder. Urinary frequency was normalized in 6 out of 16 (37.5%), urgency ceased in 6 out of 17 (35.7%) and urgent incontinence disappeared in 9 out of 14 (50%) patients. The mean volume at the first desire to void and the maximum cystometric capacity increased significantly on the cystometrogram after the administration of oxybutynin hydrochloride (p less than 0.01). Furthermore, the maximum vesical pressure decreased significantly (p less than 0.05). The maximum urinary flow rate increased slightly (p less than 0.1) and the residual urine volume significantly increased (p less than 0.05) after medication, although no changes were observed in tidal voiding volume or mean urinary flow rate. Of 20 patients, 9 showed improvement globally (45%), although no subjective or objective improvement was observed in 4 (20%) patients. Marked side effects were observed in 5 cases (two of acute urinary retention, each of increased urgency, residual urine and liver dysfunction), and side effects were seen in 10 of the 21 (47.6%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Microwave dielectric study on hydration of moist collagen

Two dielectric relaxation peaks were found in moist collagen by the time domain reflectometry. The low-frequency peak around 100 MHz moves little as the water content is varied. Its relaxation strength depends on the content and vanishes for completely dried collagen. This process is concluded to be due to water molecules strongly bound to the tropocollagen. Amount of the bound water is estimated as 0.12 g water/g collagen. Twenty-one water molecules are bound to one repeat of the triple helix. The existence of stringlike water chains is suggested. If the water content is less than 0.5 g water/g collagen, the high frequency peak locates between those of bound and bulk water. Water among the tropo-collagen is weakly bound to the collagen. In the higher region it does not change much with the content, being close to that of bulk water. The bulk water appears in this region.