Details of a Researcher - HINOTSU Shiro

Papers - HINOTSU Shiro

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Effect of HMG-CoA reductase inhibitors on blood pressure in hypertensive patients treated with blood pressure-lowering agents: Retrospective study using an anti-hypertensive drug database

S. Hashimoto, H. Urushihara, S. Hinotsu, S. Kosugi, K. Kawakami

European Review for Medical and Pharmacological Sciences 16 ( 2 ) 235 - 241 2012 [Refereed]

Background and Objectives: We used a Japanese antihypertensive drug database to investigate the blood pressure-lowering effect of statins in hypertensive patients receiving antihypertensive medication. We also examined the class effect of antihypertensive drugs on blood pressure lowering by statins. Material and Methods: The Risk/Benefit Assessment of Drugs-Analysis and Response (RAD-AR) Council has developed an antihypertensive drug database which contains the results of post-marketing surveillance for various antihypertensive agents from 143,509 antihypertensive users in clinical settings. Antihypertensive patients in the database with concurrent hyperlipidemia were grouped into statin users and non-users, and changes in systolic and diastolic blood pressure over a three-month period were compared. Further, the class effects of antihypertensive drugs on the lipid lowering effects of statins were also investigated. Results: A total of 1,070 statin users and 1,974 non-users were analyzed. Changes in systolic blood pressure were significantly greater in the statin user than in the non-user group (mean difference: 1.63 mmHg, p=0.03). In contrast, no significant effect of statin use was observed on the change in diastolic blood pressure (DBP) (0.87 mmHg, p = 0.08). When stratified by antihypertensive class, reductions in blood pressure were greater in statin user groups for all antihypertensive classes without statistical significance, except for a significant change in DBP in those receiving beta-blockers (mean difference: 2.98 mmHg, p = 0.03). Discussion: The present study documented that statin's effect on blood pressure in hypertensive patients with hyperlipidemia in clinical setting is statistically significant but has a minimal significance. With regard to class differences among antihypertensive agents, the decrease was greatest in the DBP of patients treated with beta-blockers. In contrast, no significant changes were seen in the ACE inhibitor or Ca antagonist subgroups. One possible explanation for the differential effects of antihypertensive class in our study might be the lack of a vasodilatation effect.

PubMed

Clinical usefulness of pit patterns for detecting colonic lesions requiring surgical treatment

Yasutoshi Kobayashi, Shin-ei Kudo, Hideyuki Miyachi, Toshihisa Hosoya, Nobunao Ikehara, Kazuo Ohtsuka, Hiroshi Kashida, Shigeharu Hamatani, Shiro Hinotsu, Koji Kawakami

INTERNATIONAL JOURNAL OF COLORECTAL DISEASE ( SPRINGER ) 26 ( 12 ) 1531 - 1540 2011.12 [Refereed]

Background The number of patients suffering from colorectal cancer is increasing. According to Japanese guidelines, lesions with a submucosal invasive depth > 1,000 mu m should be treated with radical proctocolectomy. We propose and evaluate a new clinical classification for pit patterns that uses endoscopy to assess lesion depth for determination of the appropriate therapeutic approach for early colorectal cancers and adenomas. Methods Endoscopic images of colorectal adenomas and early cancer cases with type V(I) pit pattern, resected surgically or endoscopically from April 2002 to April 2007 at Showa University Yokohama Northern Hospital, were utilized for analysis. Each image was retrospectively analyzed for (A) pit narrowness, (B) irregular pit margins, and (C) indistinct stromal staining. Sensitivity, specificity, and predictive value were evaluated as major outcomes, using pathological results as the standard. Result In total, 186 cases were assessed. With all features considered (A, B, and C), the sensitivity, specificity, and positive and negative predictive values were 47.8%, 86.3%, 66.0%, and 74.2%, respectively. When limited to two features (A and B), these values were 75.3%, 81.2%, 70.2%, and 84.8%, respectively. Conclusion Our results suggest that the established criteria can, to a certain degree, distinguish between high and low irregularity in colorectal lesions with V(I) pit pattern indicating submucosal cancer infiltration of more or less than 1,000 mu m with the clinical consequence of surgery versus endoscopic mucosal resection/endoscopic mucosal dissection.

DOI PubMed

Maintenance therapy with bacillus Calmette-Guérin Connaught strain clearly prolongs recurrence-free survival following transurethral resection of bladder tumour for non-muscle-invasive bladder cancer.

Shiro Hinotsu, Hideyuki Akaza, Seiji Naito, Seiichiro Ozono, Yoshiteru Sumiyoshi, Sumio Noguchi, Akito Yamaguchi, Satoshi Nagamori, Akito Terai, Yasutomo Nasu, Haruki Kume, Yoshihiko Tomita, Yoshinori Tanaka, Shoji Samma, Hirotsugu Uemura, Hirofumi Koga, Tomoyasu Tsushima

BJU international 108 ( 2 ) 187 - 95 2011.07 [Refereed] [International journal]

OBJECTIVE: • To confirm the recurrence-preventing efficacy and safety of 18-month bacillus Calmette-Guérin (BCG) maintenance therapy for non-muscle-invasive bladder cancer. PATIENTS AND METHODS: • The enrolled patients had been diagnosed with recurrent or multiple non-muscle-invasive bladder cancer (stage Ta or T1) after complete transurethral resection of bladder tumours (TURBT). • The patients were randomized into three treatment groups: a maintenance group (BCG, 81 mg, intravesically instilled once weekly for 6 weeks as induction therapy, followed by three once-weekly instillations at 3, 6, 12 and 18 months after initiation of the induction therapy), a non-maintenance group (BCG, 81 mg, intravesically instilled once weekly for 6 weeks) and an epirubicin group (epirubicin, 40 mg, intravesically instilled nine times). The primary endpoint was recurrence-free survival (RFS). RESULTS: • Efficacy analysis was performed for 115 of the full-analysis-set population of 116 eligible patients, including 41 maintenance group patients, 42 non-maintenance group patients and 32 epirubicin group patients. • At the 2-year median point of the overall actual follow-up period, the final cumulative RFS rates in the maintenance, non-maintenance and epirubicin groups were 84.6%, 65.4% and 27.7%, respectively. • The RFS following TURBT was significantly prolonged in the maintenance group compared with the non-maintenance group (generalized Wilcoxon test, P= 0.0190). CONCLUSION: • BCG maintenance therapy significantly prolonged the post-TURBT RFS compared with BCG induction therapy alone or epirubicin intravesical therapy.

DOI PubMed

The current status of umbilical cord blood collection in Japanese medical centers: Survey of obstetricians

Noriko Tada, Shiro Hinotsu, Hisashi Urushihara, Fumiyo Kita, Shunro Kai, Tsuneo A. Takahashi, Shunichi Kato, Minoko Takanashi, Kiminari Ito, Hideaki Sawai, Taira Maekawa, Shinji Kosugi, Koji Kawakami

TRANSFUSION AND APHERESIS SCIENCE ( PERGAMON-ELSEVIER SCIENCE LTD ) 44 ( 3 ) 263 - 268 2011.06 [Refereed]

As the first step of UCB banking, UCB collection has an important role in banking procedures. The aim of this study was to reveal the current status of UCB collection and discuss the management of the UCB bank. We conducted a questionnaire survey at medical centers collecting UCB, followed by semi-structured interviews with some respondents. Out of 38 institutes, 11 respondents (28.9%) thought that collection of UCB in addition to their routine medical services puts a burden on physicians. The obstetricians involved in the UCB collection are generally willing to participate in the procedure under current circumstances at medical institutes. (C) 2011 Elsevier Ltd. All rights reserved.

DOI PubMed

Night-to-night variability of sleep latency significantly predicts the magnitude of subsequent change in sleep latency during placebo administration

Atsushi Ogawa, Shiro Hinotsu, Hisashi Urushihara, Koji Kawakami

SLEEP MEDICINE ( ELSEVIER SCIENCE BV ) 12 ( 6 ) 565 - 571 2011.06 [Refereed]

Objective: To investigate the association between subjective sleep latency (sSL) fluctuation during the lead-in period and the placebo response in the subsequent double-blind period. Methods: The current study is a secondary analysis of data from the placebo arm (380 patients) of a double-blind study in outpatients with primary insomnia. Results: Higher fluctuation of lead-in sSL was associated with a greater decrease in sSL in the subsequent weeks. Multivariate analysis suggested that a wider standard deviation for daily sSL and a higher weekly mean sSL during the lead-in period were independent predictors of greater improvement in mean sSL during the subsequent weeks of placebo treatment. Likewise, a wider standard deviation and lower mean of subjective total sleep time (sTST) during the lead-in period were independent predictors of greater improvement in mean sTST in the subsequent weeks, but predictability of change in sTST with these parameters appears lower than those for sSL (R-2 = 0.13 and 0.44, respectively, in Week 2). Conclusions: The importance of night-to-night variability of sSL in sleep assessment is highlighted. Excluding patients with high variability of lead-in sSL should be considered in clinical studies evaluating an effect on sleep onset, especially in the early stages of clinical development. (C) 2011 Elsevier B.V. All rights reserved.

DOI PubMed

[An international comparison of epidemiologic factors of prostate cancer].

Hinotsu S

Nihon rinsho. Japanese journal of clinical medicine 69 Suppl 5 187 - 192 2011.06 [Refereed]

PubMed

[Urologic cancer and NCCN guideline].

Hinotsu S

Gan to kagaku ryoho. Cancer & chemotherapy 38 ( 1 ) 59 - 63 2011.01 [Refereed]

PubMed

治療費の国際比較-乳癌患者におけるシミュレーション-

川上浩司, 樋之津史郎, 浜田将太

内閣府経済社会総合研究所ディスカッションペーパー 2011 [Refereed]

わが国における高脂血症治療薬の適正使用にかかる経済的評価(2)

川上浩司, 樋之津史郎, 漆原尚巳, 大西佳恵

内閣府経済社会総合研究所ディスカッションペーパー 2011 [Refereed]

Cancer death from non-muscle invasive bladder cancer: Report of the Japanese Urological Association of data from the 1999-2001 registry in Japan

Eijiro Okajima, Hiroyuki Fujimoto, Yoichi Mizutani, Eiji Kikuchi, Hirofumi Koga, Shiro Hinotsu, Nobuo Shinohara, Tsuneharu Miki

INTERNATIONAL JOURNAL OF UROLOGY ( WILEY-BLACKWELL ) 17 ( 11 ) 905 - 912 2010.11 [Refereed]

Objectives: Our aim was to clarify the risk factors of cancer death in order to reduce mortality from T1 bladder cancer. Methods: The Japan registration database (1999-2001) was used for the analysis. Data were collected at least 3 years after the initial diagnosis. Cause-specific survival using a Kaplan-Meier survival estimation with the log-rank method was evaluated. Univariate and multivariate analysis using the Cox proportional hazard model was also carried out. The 1997 TNM classification was used for pathological staging, and the 1973 WHO classification was used for pathological grading. Results: There were 76 cancer deaths among a total of 1919 clinical T1 cases. Regardless of the subsequent treatment strategies, non-papillary tumor appearance, non-peduncular tumor stalk, multiple tumors, a tumor size greater than 3 cm, positive urinary cytology and pathological grade 3 were found to be statistically significant in cancer death by univariate analysis. By multivariate analysis, non-papillary tumor appearance, positive urinary cytology and a tumor size greater than 3 cm were confirmed as significant risk factors. Cancer death cases were found in 47.4% of worst-grade 2 tumors, and in 67.1% of predominantly grade 1 or 2 tumors. Conclusion: Non-papillary tumor appearance, positive urinary cytology and a tumor size greater than 3 cm should be included to enable the assessment of risk criteria in cancer death from T1 bladder cancer.

DOI PubMed

Updated Japanese Urological Association Guidelines on prostate-specific antigen-based screening for prostate cancer in 2010

Seiji Naito, Yoshiyuki Kakehi, Akihiko Okuyama, Tomoaki Imamura, Hideo Yasunaga, Hideyuki Akaza, Shiro Hinotsu, Yoichi Arai, Takushi Dokiya, Shin Egawa, Kazuhiro Suzuki, Hirofumi Koga, Naoya Masumori, Koichiro Akakura, Kiyotaka Kawashima, Koji Okihara, Kazuto Ito

INTERNATIONAL JOURNAL OF UROLOGY ( WILEY-BLACKWELL ) 17 ( 10 ) 830 - 838 2010.10 [Refereed]

The exposure rate of screening for prostate cancer using prostate-specific antigen (PSA) in Japan is still very low compared with that in the USA or western Europe. The mortality rate of prostate cancer will increase in the future and in 2020 it will be 2.8-fold higher than in 2000. Therefore, there is an urgent need to determine the best available countermeasures to decrease the rate of prostate cancer death. PSA screening, which can reduce the risk of death as a result of prostate cancer, should be offered to all men at risk of developing prostate cancer with fact sheets showing updated benefits and drawbacks of screening for prostate cancer.

DOI

Prostate Cancer Working Group Report

Mikio Namiki, Hideyuki Akaza, Sang Eun Lee, Jae-Mann Song, Rainy Umbas, Liqun Zhou, Boon Cheok Lee, Christopher Cheng, Moon Kee Chung, Takashi Fukagai, Shiro Hinotsu, Shigeo Horie

JAPANESE JOURNAL OF CLINICAL ONCOLOGY ( OXFORD UNIV PRESS ) 40 i70 - i75 2010.09 [Refereed]

The incidence of prostate cancer, while still lower than in Western nations, is increasing rapidly in Asian countries due to a more westernized lifestyle. Prostate cancer mortality is declining in the USA, where most prostate cancers are diagnosed in the early stage. In contrast, the mortality rates of prostate cancer in Asian countries are expected to continue to increase, because the percentage of advanced-stage prostate cancers remains high. Therefore, early detection by prostate-specific antigen screening and a comprehensive strategy for cancer prevention are essential for Asian people. The exposure rate of prostate-specific antigen screening is very low in Asian countries. Increased prostate-specific antigen screening may reduce the mortality rate. The stances regarding population screening differ among countries. Urological associations should promote population screening. Reliable data from Asian countries are needed. The prostate cancer incidence is low in Asian countries, perhaps due to high soy consumption. Isoflavones may prevent prostate cancer in Asian countries, but that is not yet clear. A large, multinational study in Asia is needed to clarify whether or not isoflavone consumption shows efficacy in preventing prostate cancer. Clinical data suggest that hormonal therapy is more effective in Asians than in Westerners. Clinical guidelines should consider including hormonal therapy as one of the options for the treatment of localized prostate cancer. At the same time, effort should be made to decrease the adverse effects of each treatment. Collaborative studies on the treatment of prostate cancer should be carried out among Asian countries.

DOI PubMed

Clinical Trials and Approval of Anti-cancer Agents

Masaru Iwasaki, Shiro Hinotsu, Jun Katsura

JAPANESE JOURNAL OF CLINICAL ONCOLOGY ( OXFORD UNIV PRESS ) 40 i65 - i69 2010.09 [Refereed]

Nowadays, drug development requires large-scale studies to show the real clinical benefit for the patients, which means recruiting a sufficient number of patients, even internationally. As global studies enable simultaneous delivery of new drugs and sharing of safety information around the world, multinational studies now account for around 20% of Japanese clinical studies. Until recently, drug development has been centered in Western countries, but interest in Asian regions has increased. In this environment, one important factor in drug development is ethnicity. Various cancers show regional patterns in their incidence, and some (such as liver cancer and gastric cancer) show high incidences in Asian countries. Ethnic factors including genetic differences, such as the CYP drug-metabolizing enzymes in the liver and gene mutations, may result in different drug responses in terms of efficacy and safety. Examples of ethnic differences in drug responses were seen with gefitinib, which showed a different efficacy data, and with sunitinib, showing a clearly different toxicity profile between the West and Asia. Therefore, ethnic differences need to be taken into account in the early phase of drug development, and Asian countries need to be involved early in clinical development. Asian collaboration among physicians and networks of specialists is also important, and there is good potential for successful establishment of the infrastructure needed for collaborative clinical trials. Establishment of a so-called third development center in Asian countries that will complement the USA and European centers is highly desired.

DOI PubMed

Antedrug Budesonide by Intrapulmonary Treatment Attenuates Bleomycin-Induced Lung Injury in Rats with Minimal Systemic Adverse Effects

Masayuki Kohno, Mari Haramoto, Oumi Nakajima, Liying Yang, Shiro Hinotsu, Masanao Yokohira, Katsumi Imaida, Koji Kawakami

BIOLOGICAL & PHARMACEUTICAL BULLETIN ( PHARMACEUTICAL SOC JAPAN ) 33 ( 7 ) 1206 - 1211 2010.07 [Refereed]

Corticosteroids are routinely used in patients with pulmonary fibrosis, yet they have several adverse effects. To improve this situation, we used an animal model of pulmonary injury and early fibrosis and investigated whether the combination of an intrapulmonary inhalation device with antedrug budesonide (BUD) administered to the lung had greater efficacy and fewer systemic adverse effects compared to long-acting dexamethasone (DEX). BUD or DEX was administrated either intrapulmonary or intravenously to bleomycin-treated rats. Antiinflammatory and antifibrotic effects were evaluated according to inflammatory cell count, total protein concentration and soluble collagen concentration in bronchoalveolar lavage fluid. The systemic immunosuppressive effects were also assessed by measuring body, spleen and thymus weight. BUD and DEX were compared with respect to their pharmacokinetic profiles in plasma and lung. Intrapulmonary treatment of BUD attenuates various inflammatory and early fibrotic indices with minimal systemic adverse effects compared with DEX. The area under the curve (AUC) of BUD by intrapulmonary spray was 6.6-fold higher than the AUC of DEX in the lung. This study suggests that antedrug BUD by intrapulmonary treatment has local anti-inflammatory and antifibrotic effects with minimal systemic adverse effects.

DOI PubMed

Pattern of intravesical recurrence after surgical treatment for urothelial cancer of the upper urinary tract: A single institutional retrospective long-term follow-up study

Ei-ichiro Takaoka, Shiro Hinotsu, Akira Joraku, Takehiro Oikawa, Noritoshi Sekido, Naoto Miyanaga, Koji Kawai, Toru Shimazui, Hideyuki Akaza

INTERNATIONAL JOURNAL OF UROLOGY ( WILEY-BLACKWELL ) 17 ( 7 ) 623 - 628 2010.07 [Refereed]

Objectives: To estimate the risk of intravesical recurrence in patients with primary urothelial cancer of the upper urinary tract. Methods: Ninety patients who underwent radical nephroureterectomy for clinically localized urothelial cancer of the upper urinary tract were initially considered. Those with a previous and/or concomitant history of bladder cancer, and those who had previously received systemic chemotherapy were excluded. Overall, data from 60 patients with no evidence of bladder cancer and distant or lymph node metastasis were retrospectively reviewed. The clinical course and the risk pattern of intravesical recurrence were estimated by using a smoothing technique on estimated hazard function plots. Multivariate analysis was carried out using a Cox proportional hazards regression model. Results: Mean patient age was 64.7 years. Median follow up was 51.3 months. Thirty patients (50%) had intravesical recurrence during the follow-up period. The peak of intravesical recurrence was detected in the early period (less than 2.5 years) after surgery. The intravesical recurrence hazard became lower afterwards. Nevertheless, it persisted over a long period of time. On univariate and multivariate analyses, none of the clinical or pathological parameters had a statistically significant impact on intravesical recurrence. Conclusions: Even if an intravesical recurrence in patients with upper urinary tract urothelial cancer is more likely in the early period, it persists over a long period of time. This might reflect different mechanisms of recurrence, having a significant impact on the definition of the optimal treatment and follow-up schedules.

DOI PubMed

Prostate cancer

Shiro Hinotsu

Japanese Journal of Cancer and Chemotherapy ( Japanese Journal of Cancer and Chemotherapy Publishers Inc. ) 37 ( 4 ) 620 - 623 2010.04 [Refereed]

The first edition of Clinical Practice Guidelines for Prostate Cancer was created mainly by the Japanese Urological Association as a part of the 2003-2004 Ministry of Health, Labour and Welfare (MHLW) Scientific Research Fund-supported Thorough Researches for the Evaluation of Medical Technologies. The guidelines were aimed to be used by general urologists committed to the treatment of all stages of prostate cancer patients. The guidelines supervised by the Japanese Urological Association were published in May 2006. The present edition of the guidelines are accepted as a good summary of prostate cancer treatment. However, since the present edition is over 3 years old, a revision of the guidelines is planned to update the contents and findings. In this article, I will summarize the chanaes and updates in each field.

PubMed

FOXO1 and TCF7L2 Genes Involved in Metastasis and Poor Prognosis in Clear Cell Renal Cell Carcinoma

Takahiro Kojima, Toru Shimazui, Ryo Horie, Shiro Hinotsu, Takehiro Oikawa, Koji Kawai, Hideaki Suzuki, Kohji Meno, Hideyuki Akaza, Kazuhiko Uchida

GENES CHROMOSOMES & CANCER ( WILEY-LISS ) 49 ( 4 ) 379 - 389 2010.04 [Refereed]

The goal of this study was to identify genes related to the metastasis of clear cell renal cell carcinoma (CRCC). We analyzed copy number alterations in renal tissue specimens of patients with CRCC patients with or without metastasis by using high-resolution single-nucleotide polymorphism (SNP) arrays and then integrated these data with gene expression profiling data obtained using oligonucleotide microarrays. The expression levels of target genes were determined by quantitative real-time RT-PCR (qRT-PCR) with an independent tumor set. An analysis of specimens from 23 CRCC cases with SNP arrays revealed that hemizygous deletions at 10q and 13q were found only in cases of metastatic disease. We found the homozygous deletion of TCF7L2 at 10q25.2 in an aggressive case that had hemizygous deletions at 10q. In addition, a qRT-PCR analysis of TCF7L2 mRNA levels in tumor samples revealed significantly lower levels in patients with metastasis when compared with those without metastasis. FOX01 was identified as a down-regulated gene in the minimal overlapping region of the 13q hemizygous deletion in CRCC. Decreased FOXO1 expression was significantly correlated with metastasis and poor survival outcome. Knockdown of FOX01 inhibited apoptosis after doxorubicin treatment in CRCC cells and reduced the expression of downstream genes involved in cell proliferation (CDKN1B) and survival (BCL2L11). Lower levels of FOXO1 expression were associated with decreased expression of CDKN1B and BCL2L11 in CRCC specimens. We conclude that FOXO1 and TCF7L2 are involved in metastasis and that molecules in these signaling pathways may be targets for diagnostic procedures and therapies for CRCC. (C) 2010 Wiley-Liss, Inc.

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Hormonal therapy for prostate cancer: Current topics and future perspectives

Hiroyoshi Suzuki, Shiro Hinotsu, Hideyuki Akaza, Yasuhisa Fujii, Satoru Kawakami, Kazunori Kihara, Koichiro Akakura, Motofumi Suzuki, Tadaichi Kitamura, Yukio Homma, Atsushi Mizokami

INTERNATIONAL JOURNAL OF UROLOGY ( WILEY-BLACKWELL ) 17 ( 4 ) 302 - 313 2010.04 [Refereed]

DOI PubMed

Relationship Between Low Back Pain and Competitive Sports Activities During Youth

Mika Hangai, Koji Kaneoka, Yu Okubo, Shumpei Miyakawa, Shiro Hinotsu, Naoki Mukai, Masataka Sakane, Naoyuki Ochiai

AMERICAN JOURNAL OF SPORTS MEDICINE ( SAGE PUBLICATIONS INC ) 38 ( 4 ) 791 - 796 2010.04 [Refereed]

Background: Low back pain is a significant problem not only for the adult, but also during youth. However, the relationship between low back pain during youth and the duration or types of competitive sports has not been clarified. Hypothesis: Low back pain during youth is associated with the duration and types of competitive sports. Study Design: Cross-sectional study; Level of evidence, 4. Methods: Study participants were 4667 new university students who, from 2004 to 2006, answered a questionnaire concerning low back pain and their participation in competitive sports. The participants were divided into a "no'' group (NO), a middle group (MID), and a high group (HI) based on the duration of participation in competitive sports. The answers to the questionnaire were analyzed using the Cochran-Mantel-Haenszel test. Furthermore, we selected students who had participated in the same sport for 5 or more years and categorized the students according to the type of sport. Differences in low back pain among the groups were analyzed using logistic regression with the NO group as the reference group. Results: There were statistically significant linear associations in the NO, MID, and HI groups, with 50.0%, 61.8%, and 71.7%, respectively, of the students experiencing low back pain. Among the NO, MID, and HI groups, 4.4%, 5.7%, 9.6%, respectively, had experienced school absence due to low back pain; and 4.0%, 8.5%, and 14.6%, respectively had low back pain with associated lower extremity pain and numbness. All 8 sports groups that were analyzed had experienced low back pain significantly higher than the NO group, and the odds ratios differed by sport with the highest (3.8) for the volleyball group. Conclusion: Excessive exposure to competitive sports activities during youth was associated with low back pain and symptoms in the lower extremities, with the severity varying with the sport. To reduce low back pain in youth, factors that may be causing low back pain, such as sport-specific postures and motions, need to be investigated.

DOI PubMed

Non muscle invasive bladder cancer cases initially failing to respond to bacillus Calmette-Guérin intravesical instillation therapy

Takehiko Okamura, Hidetoshi Akita, Yoshihiro Hashimoto, Keiichi Tozawa, Shiro Hinotsu, Hideyuki Akaza, Kenjiro Kohri

Current Urology 4 ( 1 ) 18 - 24 2010.01 [Refereed]

Objective: Bacillus Calmette-Guérin (BCG) is used as the gold standard for prevention of recurrence after transurethral resection of bladder tumor of non muscle invasive bladder cancer. However, in some cases the outcome is not optimal. In order to assess the possible impact of different variables on outcome, the present clinical evaluation of initially failed cases was performed. Patients and Methods: A total of 68 patients treated with BCG were evaluated. All suffered recurrence. Their original urothelial carcinomas were: G1/G2/G3 = 13/41/14, and Ta/T1 = 30/38. Thirteen high-risk T1G3 cases were included. Intravesical chemotherapy pretreatment was given to 10 cases. Results: The overall progression-free survival rates at 3, 5 and 10 years were 83.3, 80.9, and 72.0% respectively, with cancer-specific survival rates of 98.3, 89.0 and 89.0%. High-risk T1G3 patients were confirmed to have higher progression rates (p = 0.03, log-rank test). Total cystectomy was performed in 5 of 13 T1G3 patients, one died during the follow-up. Additional BCG treatments were performed for 8 patients, and all of them remain alive at the present time. Conclusions: These findings indicate that the response to BCG is definitely influenced by high-risk category, so that early selection of total cystectomy may improve the prognosis with T1G3 patients. However, it was also suggested that more than 1 course of BCG is a feasible option in some cases with a tendency for a worse outcome when pretreated with anti-cancer drugs. Copyright © 2010 S. Karger AG.

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