Clinical Outcome of Elderly Kidney Transplant Recipients from Spousal Donors.

INTRODUCTION: Patients aged 60 years and older stand for the fastest growing group of patients with end-stage renal disease worldwide, and the need for kidney transplants among this population is rising. In Japan, living donor kidney transplantation is mainly performed to deal with the severe shortage of deceased donors, and the number of spousal transplants is currently increasing. PATIENTS AND METHODS: A total of 164 patients with ESRD underwent living donor kidney transplantation at our institution, of whom 21 patients aged 60 years and older had spousal kidney transplantation. ABO-incompatible kidney transplantation was performed in 5 of the 21 cases. We analyzed these recipients. RESULTS: Patient and graft survival rates were 100%. The incidence of acute rejection was 23.8%. Eight patients experienced cytomegalovirus viremia, two patients experienced Pneumocystis jiroveci infection, and one experienced bacterial pneumonia. Two patients developed cancers and underwent curative operation after transplantation. CONCLUSIONS: Elderly kidney transplantation from spousal donors is associated with age-related immune dysfunction, which may develop infections and malignancies and could be immunologically high risk due to the high rate of ABO-incompatibility and poor histocompatibility. An effort to minimize the adverse effect of immunosuppression and to reduce the risk of acute rejection may be needed for an excellent long-term outcome.

[Primitive neuroectodermal tumor of kidney : a case report].

A 16-year-old man was referred to our hospital for asymptomatic gross hematuria. The findings of abdominal ultrasonography were normal. A month later, gross hematuria disappeared, and he was not followed after that. A month later, the patient was taken to our hospital in an ambulance for severe back pain and recurring gross hematuria. Computed tomography (CT) revealed a large right renal tumor with tumor thrombus penetrating inside the inferior vena cava. The patient underwent radical nephrectomy and embolectomy. The pathological diagnosis of the tumor was diagnosed as primitive neuroectodermal tumor (PNET) of kidney by immunostaining and gene analysis. We started adjuvant chemotherapy soon after the operation. However, at 10 months after, multiple pulmonary metastases were detected. The patient was treated with salvage chemotherapy, surgery and irradiation therapy as combined modality therapy. Nevertheless, he died 18 months after the diagnosis.

[A case of elderly donor in living kidney transplant after radical radiotherapy for prostate cancer].

A 72-year-old man came to our clinic as a candidate of the donor of renal transplantation for his 44-year-old daughter. However, his serum PSA was found elevated, and he was diagnosed with stage C prostate cancer. He received neoadjuvant androgen deprivation therapy and subsequent IMRT as a definitive curative therapy. Since his PSA remained at a very low level after IMRT for three years, we performed systematic 16-site prostate biopsy, which revealed no viable prostate cancer cells. His renal function seemed to be normal and no functional difference was noted between the two kidneys. Then, his left kidney was harvested by hand-assisted retroperitoneal laparoscopic approach, and transplanted to his daughter successfully. The suitability of a donor with two potential problems-advanced age and a history of prostatic cancer-was discussed, together with a review of the literature.

New cystoscopic diagnosis for interstitial cystitis/painful bladder syndrome using narrow-band imaging system.

OBJECTIVES: Diagnosing the bladder lesions associated with interstitial cystitis/painful bladder syndrome (IC/PBS) is sometimes difficult for general urologists. We therefore aimed to develop an IC/PBS diagnosis method using a cystoscope with a narrow-band imaging (NBI) system that can detect mucosal angiogenic lesions. METHODS: Fifty-two subjects suspected of having IC between October 2006 and June 2007 were included in this study. There were 49 women and three men, ranging in age from 19 through 85 with an average age of 59. First, conventional cystoscopy under spinal anesthesia was performed to examine the ulcerative lesions by a urological specialist. Then, other health care professionals made a separate observation of capillary-rich areas of the superficial layer of the bladder mucosa by cystoscopy with the NBI system. RESULTS: Among the 52 patients, 37 cases were found to have ulcers by conventional cystoscopy, which were also recognized as capillary-rich brownish areas using the NBI system (100% accuracy); 13 cases were found to have NBI-positive areas without ulcer, which were coincided with those with petechial hemorrhages and glomerulations following subsequent hydrodistention; and two cases of normal mucosa were detected. Furthermore, six cases of bladder cancer (carcinoma in situ) were detected by biopsies that were obtained from the ulcerative lesions positively identified by NBI cystoscopy. CONCLUSIONS: Examining the urinary bladder mucosa with a flexible cystoscope with the NBI system makes it possible to easily detect ulcers of bladder mucosa and areas with angiogenesis. Therefore, it is considered that the use of a flexible cystoscope with the NBI system is highly practical for the IC/PBS diagnosis.

[One-year experience of Men's Outpatient Health Care Unit without specifying the category of disease].

The Men's Outpatient Health Care Unit was established in April 2006 in Kyoto City Hospital. In this outpatient unit, medical services are provided to males of all ages and with any category of complaints. For patients' privacy, the unit is situated on a different floor from the other outpatient ward, and all-male staff handles from reservation to examination. Furthermore, each patient is given 30 minutes to provide enough time for counseling and examination. To our knowledge, this system was established for the first time in Japan. During the first one year, a total of 106 new patients visited this ward with a large variety of chief complaints : sexual dysfunction, urinary disorder, consultation for aging male, consultation for size and shape of the penis, and so forth. Over 25% of patients disinclined against visiting the conventional urological ward. Furthermore, over 25% of patients revealed that they were hesitant to see female staffs including clerks and nurses. Although more facilities in Japan are recently providing gender-specific medical services, most of them are directed to the female gender. Our experience of this health care system suggested that male-specific gender medicine should become more widespread and cover various categories of diseases.