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In Japan, reports on the association of individual characteristics, and geographical distance and time with clinical outcomes for neurological emergencies involving helicopter emergency medical services (HEMS) are scarce. Using Tochigi HEMS data (2010-2018), we assessed the characteristics of 1,170 emergency neurological patients (e.g., stroke, neurotrauma, and seizure) at the base hospital, which covered 58% of all HEMS patients in the prefecture. After initial treatment in the emergency room, emergency physicians confirmed the clinical outcomes of each patient compared to those at the incident sites (recovery/non-recovery). We calculated the geographic distance from the base hospital to each incident site, and estimated and adjusted odds ratios (aOR) and 95% confidence intervals (CI) for non-recovery against distance. The mean distance between the incident site and base hospital was 22.0 ± 11.7 km, and 77.4% of patients recovered following initial treatment. Two peak age groups were observed among emergency neurological diseases, including seizures in patients who were aged < 5 years and stroke and neurotrauma in patients who were aged 70-80 years. The percentages of stroke, traumatic head and brain injury, and seizure were 35.8%, 29.2%, and 22.8%, respectively. The incidence of stroke (aOR = 11.8, 95% CI 6.86-20.3) and neurotrauma (aOR = 4.86, 95% CI 2.78-8.51) independently predicted a poor prognosis. However, no significant association was observed with the distance from the base hospital. Therefore, in the Tochigi prefecture, geographical disparities may not affect the short-term prognosis of patients with neurological emergencies who were transported by HEMS.

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Objective: The objective of this study was to identify lymphatic vessels draining from the prostate by using a fluorescence navigation (FN) system. Methods: Fourteen subjects were candidates for radical retropubic prostatectomy (RRP) and pelvic lymph node dissection (PLND). After an indocyanine green solution was injected into the prostate during RRP, lymphatic vessels draining from the prostate were analyzed using a FN system. After PLND based on lymphatic mapping by the FN system (in vivo probing) was performed in the external iliac, obturator and internal iliac regions; the fluorescence of the removed lymph nodes (LNs) was analyzed on the bench (ex vivo probing). Results: Under in vivo and ex vivo probing, the fluorescence intensity of internal iliac nodes was greater than that of external iliac or obturator nodes. Conclusion: The current study suggests that using a FN system after injecting indocyanine green is a safe and rational approach for detecting the lymphatic channel draining from the prostate. The major lymphatic pathway involved in the spreading of prostate cancer appears to relate to internal iliac LNs, which would mean that the standard PLND covering external iliac and obturator regions would not keep the cancer from spreading. Objectif : L’objectif de l’etude etait de reperer les vaisseaux lymphatiques quittant la prostate a l’aide d’un systeme d’imagerie par fluorescence (IF). Methodologie : Quatorze sujets devaient subir une prostatectomie radicale retropubienne (PRR) et une lymphadenectomie pelvienne. Apres injection d’une solution de vert d’indocyanine dans la prostate pendant la PRR, les vaisseaux lymphatiques drainant la prostate ont ete analyses par IF. Une lymphadenectomie pelvienne fondee sur la cartographie lymphatique par IF (exploration in vivo) a ensuite ete realisee dans les regions de la fosse iliaque externe, de l’obturateur et de la fosse iliaque interne; la fluorescence des ganglions lymphatiques retires a ete analysee sans delai (exploration ex vivo). Resultats : Lors de l’exploration in vivo et ex vivo, l’intensite de la fluorescence des ganglions iliaques internes etait plus forte que celle des ganglions iliaques externes ou des ganglions obturateurs. Conclusion : Cette etude porte a croire que l’IF apres injection de vert d’indocyanine est une methode sure et rationnelle pour reperer les vaisseaux lymphatiques drainant la prostate. La principale voie lymphatique de propagation du cancer de la prostate semble etre reliee aux ganglions lymphatiques iliaques internes, ce qui signifie que la lymphadenectomie pelvienne standard retirant les ganglions iliaques externes et obturateurs n’empecherait pas le cancer de se propager.

OBJECTIVE To investigate the longitudinal alteration of health-related quality of life (HRQL) up to 5 years after radical perineal prostatectomy (RPP) among Japanese patients with localized prostate cancer. PATIENTS AND METHODS In all, 194 patients who had RPP were included in this longitudinal survey. The validated RAND 36-Item Health Survey (SF-36) and the University of California, Los Angeles Prostate Cancer Index (UCLA-PCI) were used to evaluate the HRQL. RESULTS Among the UCLA-PCI urinary domains, urinary function scores decreased at 3 months after RPP, but they increased 6 months after RPP. Likewise, urinary bother showed a transient decrease at 3 months, but had returned to the baseline level 6 months after RPP. Sexual function (SF) was drastically decreased at 3 months after RPP, but had slightly increased 1 year after RPP. Patients who had a nerve-sparing (NS) RPP showed better SF-related HRQL than those who did not at 6 months after RPP. This favourable alteration involving SF-related HRQL was closely associated with the NS procedure, but not with the patient age. Multivariate analysis showed that later recovery of SF was essentially related to the use of NS RPP, while early recovery of sexual bother was closely related to the patient age. CONCLUSIONS Our results confirmed the positive effect of RPP on the long-term HRQL in Japanese patients. Although NS surgery conferred the benefit of the recovery of SF, older Japanese patients were not greatly concerned about their decreased SF-related HRQL. The current results provide primary evidence for predicting the alteration of HRQL and understanding the effect of patient age and NS surgery on HRQL after RPP.

Metastatic prostate cancer (PC) is incurable by androgen deprivation therapy alone, due to the presence of androgen-independent/supersensitive cells in hormone-naive PC. A 67-year-old man was diagnosed with PC (Gleason score, 5 + 4) with multiple bone metastases. He was treated by chemohormonal therapy with cisplatin and estramustine phosphate (EMP) followed by maximal androgen blockade, and showed a complete response. As of the time of writing, no clinical or prostate-specific antigen recurrence has been observed for over 15 years, despite cessation of the treatment. This is the first report to indicate a possible cure of metastatic PC by chemohormonal therapy combined with appropriate anti-tumor drugs targeted to both androgen-independent and -dependent clones before the hormone-refractory state.

To establish the appropriate inhalation induction technique using a high concentration of sevoflurane in the elderly.Forty-five patients, aged 70-79-yr-old, were randomly divided into three groups: 1) Group I: anesthesia was induced with propofol 2 mg x kg(-1) and sevoflurane 2% (n = 15); 2) Group II: anesthesia was induced with a three- minute inhalation of sevoflurane 8%; 3) Group III: anesthesia was induced with inhalation of sevoflurane using a gradual reduction technique (8, 6, 4% for each minute). In Groups II and III, a modified vital capacity inhalation induction was performed. Mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO(2)) were measured continuously during induction. In addition, induction time and adverse events related to anesthetic induction were recorded.The induction time in Group I was significantly shorter than that in Groups II and III (P0.05). However, there was no difference in the induction time between Groups II and III. In Groups II and III, the majority of patients required additional breaths. In comparison with the other groups, stability of MAP was maintained in Group III. The variations of HR in all groups were small. During induction, no patient experienced a decrease in SpO(2) below 96%, except for two patients in Group I. Severe respiratory adverse events were not observed. Other adverse events were similar in all groups.Our results suggest that a high concentration sevoflurane induction using a gradual reduction technique may be an acceptable alternative to standard iv induction in elderly patients.

1964 VALIDATION OF SUBJECTIVE BENEFIT AFTER INTRAPROSTATIC BOTULINUS TOXIN A INJECTION IN PATIENTS WITH PROSTATIC HYPERTROPHY – AN EVIDENCE BY REAL-TIME TISSUE ELASTOGRAPHY Takeo Hiraoka*, Hiroaki Shiina, Shogo Inoue, Masahiro Sumura, Shinji Urakami, Satoshi Honda, Koji Wake, Mikio Igawa. Izumo, Japan. INTRODUCTION AND OBJECTIVE: Recent reports have indicated intraprostatic botulinus toxin A (BTX-A) injection as an attractive alternative to TUR-P. The purpose of this study is to validate the clinical usefulness of BTX-A injection into the prostate as a minimal invasive treatment for BPH. METHODS: Twenty-two BPH patients (average age 74 years old) were employed in this study. The eligible criteria for inclusion are