著者

中川 隆

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.12, no.11, pp.1159-1178, 1966-11

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I. A radioisotope renogram rapidly reflects the changing p attern of plasma isotope-carrier (131I-Hippuran) concentration, dynamic "effective" volume of its distribution in body fluids, and principally its accumulation in renal area and output therefrom. 1. Diffusion and accumulation processes are given as Irpg(t)C,(0o=(/(-R-SPtF)Rd-(RPF)L)C2,(t)d(1t ) where I: injected isotope, Cp(t) : its plasma concentration, Vpo(t): distribution space, RPF: effective rena l plasma flow. 2. Excretion process is given as VwCui(t)=S:C(RPF)tCp(it=).Ro FrL iC u,(0)dt, (2) where 172,4: equivalent volume of urinary tract, : urine flow rate, CvA: urinary con centration. 3. Urinary excre t i on e(t) is given as e(t)=eR (t)+ei(t) ft et(t)=Jo FtCui.(t dt(3) where Ti : transportation lag. 4. Renogram record r t ( t) is given as r i (t)=ko[(jRPF)iC.2,(Stt)FditC ut(t.Ti)dt+(Back(g4r)o und)tj where k: a proportional constant. 5. Background will b e given as (Ba ckground)t=b,. Vp o(t)C2,(t) (5) 1160 中川=RI-Renogramの定量的分析に関する研究第1編 where bi: proportional constant II. The distribution space of 131I-Hippuran. 1) The volume of the blood and body tissues contaminated by 131I-Hippuran by single injection was measured according to the following formula. Trep(t) I. Ce(t + T ) D(t) 2) Table 1 and Fig. 1 show the distribution space measured with a patient of uterine cancer with renal damage and a normal subject. 3) This values of the distribution spa c e was adopted as the fundamental quality which is assumed to be independent of the renal functions and decides CC(t) in equation (1). 4) However, further investigations are necessary to decide whether the dist r i bution space V.(t) is completely independent of personal conditions of individual patients e. g. blood c irculation disturbance, renal function disturbance, etc. III. The renal extraction ratio of 131I-Hip p uran. 1) Renal extraction ratios of 131 I -Hippuran and PAH were compared by means of the venous canulation technique (Fig. 3) with 19 mongolian dogs. (a) The extraction ratio of RISA administered by si n gle intravenous injection, which was 0.00 as is shown in Table 2 (Dog No. 1), confirmed that this technique could not significantly affect the renal circulation. (b) With si n gle injection of 131I-Hippuran (Dogs No. 2, 3, 4, 5, 6), the plamsa extraction ratio decreased with the lapse of time (Tables 3, 4, 5, 6, 7 and Fig. 5). (c) With single injection of PAH (Dogs No. 8, 9, 10, 11, 12, 13 ) , no significant change could be observed in the plasma extraction ratio with the lapse of time. (d) With continuous injection of 131I-Hippuran (Dogs No. 13, 1 4 , 15, 16), the plasma extraction ratio showed no change with the lapse of time. (Tables 14, 15, 16, 17 and Fig. 8). (e) With continuous injection of PAH (Dogs No. 17, 18, 19), no change could be obse r v ed in the plasma extraction ratio (Tables 18, 19, 20 and Fig. 9). 2) According to true RPF=Cx/Ex (Cx : renal clearanc e of PAH or 131I-Hippuran, Es: extraction tatio of PAH or 131I-Hippuran), effective RPF (CI-Hippuran)by single injection (131I-Hippuran by single injection is used in RI-renography) was confirmed to decrea se with the lapse of time, while eff. RPF (C.PAR) by single injection showed no change with the lapse of time. 3) The change of the extraction ratio of 131I-Hippuran with the lapse of time is thought to be accounted for either by the existence of free iodine in 131I-Hippuran or by the penetration of 131I-Hippuran from the plasma into the red blood cell. However, further investigation seem to need on this fact.

著者

森 直樹 鄭 則秀 垣本 健一 原 恒男 小出 卓生

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.45, no.5, pp.343-347, 1999-05

被引用文献数

2

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症例1:64歳男.1995年5月食道癌(扁平上皮癌)に対し右開胸開腹食道亜全摘術を施行した.7ヵ月後右腎腫瘍を指摘され,右根治的腎摘除し,転移性扁平上皮癌であった.7ヵ月後死亡した.症例2:63歳男.右気胸に対する手術中,右肺に腫瘍を認め右肺上葉を切除した.腺癌であった.術後,腹部CTで右腎腫瘍を指摘され,右根治的腎摘除術を施行した.組織学的に転移性中分化型腺癌であり,7ヵ月後死亡した.症例3:69歳男,原発性右肺癌に対し右中葉切除,下葉部分切除を行った.腺癌であった.術前後の腹部CT,エコーで左腎嚢胞の増大を認め,開腹生検,転移性腎癌と診断し,右腎摘除術を施行したが,10ヵ月後死亡したSince solitary metastatic renal tumors are not commonly diagnosed before death, the conclusive treatment of the metastatic renal tumor has not been established. We report three cases of metastatic renal tumors and discuss the indication of surgical therapy for metastatic renal tumors. The first case was in a 64-year-old male who underwent esophagectomy for squamous cell carcinoma. Seven months after the operation, a right renal tumor was found. The second case was in a 63-year-old male who underwent right upper pneumonectomy for adenocarcinoma with a right renal tumor, which seemed to be a solitary metastasis. The third case was in a 69-year-old male who underwent right pneumonectomy for adenocarcinoma. One month after the initial operation, a left renal cystic tumor was found. Since, in all cases, the tumors seemed to be solitary metastatic renal tumors without any other metastatic lesions, nephrectomy was performed. Unfortunately, however, the nephrectomy did not improve prognosis and all three patients did within 10 months after the nephrectomy. Nephrectomy may not be recommended in cases of metastatic renal tumors even if no other metastatic lesions can be found by various image examinations.

著者

齋藤 一隆 湯村 寧 千葉 喜美男 広川 信

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.43, no.1, pp.45-47, 1997-01

被引用文献数

1

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無症候性肉眼的血尿を主訴とした12歳男児で,排尿性尿路造影は重症右水腎症及び上部尿管の陰影欠損を示した.尿管ポリープによる右水腎症と診断した.尿管部分切除及び端々吻合を行った.切除尿管にポリープが認められ,組織学的に線維上皮性ポリープと診断された.術後6ヵ月に右水腎症は寛解を示したWe reported a case of ureteral polyp in a 12-year-old boy whose chief complaint was asymptomatic gross hematuria. An excretory urogram revealed severe right hydronephrosis with a filling defect of the upper ureter. Our diagnosis was right hydronephrosis due to the ureteral polyp. A partial ureterectomy with an end-to-end anastomosis was performed. A polyp was found in the excised ureter and the histological diagnosis was a fibroepithelial polyp. Six months after the operation, the right hydronephrosis showed remission.

著者

片山 喬 吉田 豊彦 近藤 洋一郎 奥村 康

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.17, no.9, pp.561-567, 1971-09

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A five-year-old boy was admitted because of precocious puberty. He suddenly died while various examinations were going on. Autopsy revealed the intraventricular hemorrhage, which is probably cause of his death, from the pineal teratoma. Discussions were made on the relation between sexual precocity and the pineal tumor.

著者

大川 順正

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.45, no.6, pp.385-392, 1999-06

著者

北村 雅哉 西村 憲二 三浦 秀信 松宮 清美 奥山 明彦 小森 和彦 藤岡 秀樹 古賀 実 竹山 政美

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.46, no.8, pp.587-590, 2000-08

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精巣内精子抽出術(TESE)のうち先天性精管欠損,ヘルニア術後,パイプカット術後など明らかな閉塞性無精子症を除いた44例を対象に非閉塞性無精子症で精子の回収を予測するパラメータを検討した.JSC,精巣容量,FSHで相関がある結果であったがJSC8以上の症例を除外すると相関はなくなり,絶対的パラメータとはなり得なかった.受精に関しては妻の年齢,精子運動性の有無,精巣容量が有意なパラメータとなった.マイクロドロップレット法を用いたCryo TESE-ICSIは新鮮精子を用いたTESE-ICSIと同等の受精率が得られ,無用なパートナーへの侵襲を避けるのに有用と思われたWe reviewed 44 cases of non-obstructive azoospermia treated by testicular sperm extraction and intracytoplasmic sperm injection (ICSI) from July, 1997 to September 1999 at our institutes. Testicular sperm were retrieved from 32 patients (72.7%). ICSI was performed on 29 patients and the partners of 15 patients (46.9%) became pregnant. Out of 10 patients with histology of Sertoli-cell-only, we could retrieve sperm from 3 patients (30%). Testicular volume, Johnsen's score count (JSC), and FSH were significant parameters to predict the recovery of testicular sperm from the patients, but if only the patients with JSC less than 8, are analyzed, none of them was significant parameter. Chromosomal abnormality was not a significant parameter. The partner's age, motility of recovered sperm and testicular volume correlated with the fertilization rate. Chromosomal abnormality or the usage of cryopreserved sperm was not a significant parameter to predict fertilization.

著者

長浜 克志 山田 拓己 一柳 暢孝 酒井 康之 鎌田 成芳 福田 博志 谷沢 晶子 渡辺 徹 斉藤 博 堀内 晋 町田 竜也

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.48, no.1, pp.1-6, 2002-01

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Hautmann型膀胱再建術中,癌死・他因死・追跡不能を除く20例(男16例・女4例,29~73歳)を対象に,術後の回腸新膀胱の蓄尿・排尿状態を尿流動態検査(UDS)とアンケート調査により解析した.排尿回数は夜間に2回以上起床し排尿している例が19例中8例と高率であった.また,尿失禁は19例中昼間2例,就寝後12例にみられたが昼間は尿パッド平均2枚,夜間は1枚で対処可能であった.排尿時間は18例中9例が1分以内に排尿を終えたが3例では3分以上を要した.排尿状態については18例中満足8例,不満3例であった.USDを施行できたのは11例で観察期間は平均34.2±21.9ヵ月であった.残尿量は27.8±28.2ml,新膀胱最大容量は395.2±96.8mlで膀胱内圧は充分に低値であった.排尿時,外尿道括約筋筋電図で明らかな電位増強を11例中10例と高率に認めたWe analyzed the functional and urodynamic characteristics in 19 patients with ileal neobladder by the Hautmann procedure. A questionnaire survey by mail was performed for functional information of neobladder. Seventeen of the 19 patients (89.5%) could voluntarily void via the urethra and the others needed clean intermittent self catheterization (CIC) because of their significant residual volume. Eight of the 19 patients (42.1%) micturated at least two times at night. Two of the 19 patients (10.5%) were incontinent in the day time and 12 (63.2%) in the night time. They needed 2 pads in the day time and one pad at night on average. Eight out of 18 patients (44.4%) were satisfied with their micturition state. A urodynamic study showed the neobladder to be a low-pressure reservoir with a mean capacity of 395.2 +/- 96.8 ml. The mean residual volume of the patients without CIC was 27.8 +/- 28.2 ml. In 10 out of 11 patients high frequency and high amplitude spikes were seen by the perineal electromyogram in the voiding phase.

著者

鈴木 裕志 蟹本 雄右 岡田 謙一郎 石井 靖

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.41, no.4, pp.269-277, 1995-04

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精巣の血流遮断と解除,放射線照射,およびホルモン投与の3つの条件下で31P MRSを測定した。1)血流遮断後,ATPはすみやかに減少し60分以内に完全に消失した。2) 3時間までの血流遮断では遮断解除後にATPの回復が認められたが,4時間以上の遮断では解除後もATPの回復は認められなかった。3)放射線照射2週間後ではPME/β-ATP比およびPME/PDE比の減少が認められ,PMEの減少は造精機能障害の指標として有用と考えられた。4)ホルモン投与によるgonadotropin抑制モデルでは,PME/PDE比の減少とPDE/β-ATPの増加を認め,PDEの増加も造精機能障害の第二の指標となりうるTo evaluate the efficacy of 31P magnetic resonance spectroscopy (31P MRS) as a diagnostic method for abnormal testicular function, we examined three conditions using rat testes, ischemia, irradiation, and hormone manipulation. 1) Ischemia: Immediately after clamping of the feeding vessels, ATP signals began to fall and disappeared within 60 minutes. With the release of blood supply after 3 hours of ischemia, ATP appeared within 2 hours. However, after more than 4 hours of ischemia, ATP did not recover within 2 hours and the testis became necrotic after 1 week. 2) Irradiation: 31P MRS of the testis 2 weeks after irradiation with 10 Gy., 9 MeV showed a significant decrease (P < 0.05) in the PME/beta-ATP ratio from 1.30 +/- 0.11 (control level) to 1.11 +/- 0.12 and a decrease in PME/PDE ratio from 1.43 +/- 0.17 to 1.13 +/- 0.20. However 3 weeks later, the PME/beta-ATP ratio recovered to a control level. 3) Hormone manipulation: In the testes 5 weeks after weekly intramuscular injections of estradiol benzoate and testosterone enanthate, PDE/beta-ATP ratio significantly increased (P < 0.01) from 0.83 +/- 0.09 (control level) to 1.03 +/- 0.19. 31P MRS is a non-invasive method for evaluation of various testicular abnormalities, and ATP signals may be useful to evaluate an acute ischemic change for example testicular torstion and the changes of PME, PDE signals may be useful parameters in the assessment of the status of spermatogenesis.

著者

中野 悦次 吉岡 俊昭 松田 稔 園田 孝夫 矢野 久雄 伊原 義博 黒田 秀也 岸本 知己 櫻井 勗 内田 欽也 児島 康行 中村 隆幸 清原 久和 佐川 史郎 関井 謙一郎 古武 敏彦 宇佐美 道之 三木 恒治 黒田 昌男 細木 茂 前田 修 友岡 義夫 吉村 一宏 水谷 修太郎 岩尾 典夫 三好 進 井上 彦八郎 本城 充 藤岡 秀樹 本多 正人 高羽 津 岡 聖次 松宮 清美 原 恒男 三宅 修 坂口 洋 竹山 政美 板谷 宏彬 宇都宮 正登 伊東 博 新 武三 永野 俊介 市川 靖二 野島 道生 長船 匡男 客野 宮治 山口 誓司 多田 安温

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.36, no.5, pp.635-642, 1990-05

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膀胱乳剤にフェルビナクのエチルエステルを封入させたLM-001静注剤を尿路結石による疼痛と膀胱・前立腺手術後の膀胱切迫感に対する有効性ならびに安全性について検討した.1)尿路結石による疼痛に対しては53例中49例に効果がみられた.有効例49例中41例までが本剤投与15分以内に効果が発現した.また26例において効果が24時間以上持続した.2)膀胱・前立腺手術後の膀胱切迫感に対しても29例中25例に効果がみられた.有効例25例中16例までが15分以内に効果発現した.また13例において効果が24時間以上持続した.3)副作用として血管痛,熱感,視力軽度低下,血圧の一時低下がみられたが,いずれもきわめて軽度で何ら処置することもなく短期間に消失した.また,3例に白血球増多,1例にA1-pの上昇がみられたが,その程度は軽度であり,すぐに正常化した.4)LM-001は尿路結石による疼痛の緩和と膀胱・前立腺手術後の膀胱切迫感に対し,速効性で高い有効率を示し,かつ作用時間が長いこと,また副作用がきわめて少ないことから優れた薬剤と評価し得たClinical effect of LM-001, a prostaglandin synthetic inhibitor developed from a drug delivery system, was evaluated in 54 patients with pain from urinary tract stones (stone pain) and 32 with vesical urgency after an operation on bladder or prostate. LM-001, felbinac ethyl incorporated in lipid microsphere, wes intravenously administered at the onset of stone pain or vesical urgency. Of 54 with stones and 32 with urgency, 53 and 29 were eligible for response, respectively. The symptoms improved or disappeared in some cases just after the administration and in the majority of patients within 15 minutes, in 49 of 53 patients with stone pain. Further, the effectiveness lasted over 24 hours in 26 of the 49 responding to this agent. On one hand, improvement or disappearance of vesical urgency was recognized in 25 of 29 patients, and the effectiveness was observed shortly after injection in 16 and lasted over 24 hours in 13 cases. Toxicities of this drug were investigated in 54 patients with stone pain and 32 with urinary urgency. Side effects consisted of pain at the injection site in 4, a slight fall of blood pressure in 1, slight visual disturbance in 1, body heat sensation in 1, leukocytosis in 3 and elevation of alkaline phosphatase in 1. These symptoms were transient and disappeared without use of any agent. LM-001 is concluded to be a useful drug for controlling stone pain and vesical urgency since an immediate effect, long durability and high response rates were obtained without severe side

著者

谷村 忠保

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.6, no.3, pp.153-154, 1960-03

著者

中野 悦次

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.38, no.11, pp.1305-1309, 1992-11

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腎摘除術時すでに転移巣をもつ9例を含む,15例にLAK細胞を週一度,IL-2毎日と併用で治療した。肺転移の10例のうち4例に部分反応(PR)がみられ,腫瘍の縮小がみられる。副作用として頭痛,悪寒,戦慄が全例にみられるが経口解熱剤でコントロールできた。IL-2の副作用として,発熱,浮腫,好酸菌増多があった。PR 4例中1例は脳転移で死亡したが,3例は生存中である。脳転移はNC・PDの例も含めて施行を合わせると脳転移が4例と多いFifteen patients with metastatic renal cell carcinoma (RCC) were treated by administration of autologous lymphokine-activated killer (LAK) cells given together with systemic administration of interleukin-2 (IL-2). Pulmonary metastases alone were found in 10 cases, pulmonary and mediastinal nodal metastases in 3, and pulmonary and bone metastases in 2. LAK cells, generated by incubation in 700 units/ml of IL-2 for 3-4 days, were intravenously administered once a week. In addition, beginning on the day of the first LAK cell infusion, 3.5 x 10(5) units of IL-2 were intravenously infused once or twice a day with occasional supplementation of 3.5 x 10(5) units of IL-2 on each day of LAK cell infusion. The total number of LAK cells and total amount of IL-2 administered per patient in this study ranged from 0.8 x 10(10) to 6.9 x 10(10) cells and from 10.2 x 10(6) to 74.9 x 10(6) units, respectively. As toxic effects caused by the infusion of LAK cells, headache, shaking chills, fever and leukocytosis were found in all cases. Side effects possibly induced by IL-2 infusion were tolerable fever, fluid retention (body weight gain of 2-3 kg) and eosinophilia. Out of 15 patients, a partial response was observed in 4 patients who had pulmonary metastases alone. One of the 4 patients with a partial response was clinically free of disease after undergoing a thoracotomy for resection of residual lesions, but a brain metastasis was detected 10 months after the thoracotomy. The remaining 3 patients are being closely followed up at present.(ABSTRACT TRUNCATED AT 250 WORDS)

著者

岡田 裕作 吉田 修 竹内 秀雄 児玉 宏

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.28, no.4, pp.417-423, 1982-04

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A 23-year-old man who frequently passed pure calcium oxalate urinary stones after resection of about 100 cm of his ileum and all of his colon for Crohn's disease is presented. Various clinical data, including sodium oxalate loading test, disclosed that hyperabsorption of oxalate from the intestine was the cause of recurrent urolithiasis, which had been well controlled by the adherence to a low-oxalate, low-fat diet and medication of calcium lactate for more than two years. To our knowledge, this is the first reported case of enteric hyperoxaluria due to Crohn's disease in Japan.

著者

田中 寛 加藤 禎一 柿木 宏介 西尾 正一 前川 正信 辻田 正昭 西島 高明 柏原 昇 甲野 三郎 早原 信行

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.29, no.1, pp.p95-103, 1983-01

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Cefmenoxime (CMX)について,基礎的ならびに臨床的検討を行った.1.健康成人4名に対しCMX250 mgをcross over法を用いて,筋注,静注および1時間の点滴静注の3方法で投与した.各投与法における最高血中濃度(時間),血中半減期はそれぞれ,筋注5.9±0.1 μg/ml(30分),1.41時間,静注11.1±1.2 μg/ml(15分),1.26時間,1時間の点滴静注12.4±1.4(点滴静注終了時)0.94時間であった(いずれもMean±S.E.).またCMXの投与後6時間までの尿中排泄率は,いずれも60~70%であった.2.急性単純性膀胱炎4例に対するCMXの有効率は100%であった.3.複雑性尿路感染症10例に対する有効率は70%であった.無効例はいずれもカテーテル留置例でPseudomonasが存続もしくは菌交代として出現したものであった.なお従来のcephalosporin系抗生剤に耐性のSerratiaが陰性化した.4. CMX投与による自覚的副作用は認められなかった.しかし一過性に軽度のtransaminaseの上昇が1例にみられたBasic and clinical studies were made on Cefmenoxime (CMX), a new cephalosporin antibiotic, and the following results were obtained. The serum concentration of CMX was examined in four healthy adults after administration of 250 mg of CMX by intramuscular injection, intravenous injection and one-hour intravenous drip infusion (cross over). In the case of intramuscular injection, the peak value of 5.9 micrograms/ml was obtained 30 minutes after administration, and the half-life in serum was 1.41 hours. In the case of intravenous drip infusion, injection, a concentration value of 11.1 micrograms/ml on the average was obtained after 15 minutes of administration, and the half-life in serum was 1.26 hours. In the case of intravenous drip infusion, the concentration was 12.4 micrograms/ml upon completion of drip infusion, and CMX disappeared from serum at a half-life of 0.94 hour. The urinary recovery up to 6 hours was from 60 to 70% in each The efficacy rate of this preparation was 100% for 4 cases of acute simple cystitis. The efficacy rate of CMX was 70% for 10 cases of complicated urinary tract infection; the 3 cases in which CMX was not effective were patients with a residual catheter and Pseudomonas persisting or appearing as superinfection. It was noted that Serratia, which was resistant to the conventional cephalosporin antibiotics, became negative. No subjective side effects due to the administration of this preparation were observed. As for abnormal laboratory findings, a slight and transient rise in transaminases was observed in one case. On the basis of the above-mentioned results, it was concluded that CMX is an effective preparation for the treatment of urinary tract infections.

著者

伊藤 伸一郎 横溝 智 今津 哲央 菅尾 英木

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.51, no.11, pp.755-757, 2005-11

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72歳男.表在性膀胱癌へTUR-BtとBCG膀胱内注入を施行してから5年以上再発が見られず,治癒したと思い来院をしていなかったが,血尿及び右側腹部痛が出現した.膀胱鏡で右尿管口を覆う乳頭状広基性腫瘍を指摘され,MRIでは壁外浸潤も見られた.TUR-Bt及び動注化学療法と放射線治療を施行し,腫瘍の完全消失を認めたが,約5年後に再発を認めた.追加治療の動注化学療法は効果が見られず,膀胱全摘術を施行した.術後,再発及び転移徴候は見られなかったが,熱中症による脱水で衰弱し死亡したA 72-year-old man had undergone trasucethral resection of bladder tumor (TUR-Bt) three times from 1990 to 1991 and he had been lost to follow with no recurrence from 1996, came to our hospital complaining of asymptomatic macrohematuria in May 1999. A bladder tumor existed around the right ureteral orifice with right hydronephrosis. MRI and TUR-Bt revealed that the cancer was transitional cell carcinoma (TCC) > small cell carcinoma, G3, pT3b. Because the patient insisted on bladder preservation, intra arterial chemotherapy with cisplatinum (CDDP) and epirubicin (EPI-adr) followed by radiotherapy with CDDP was performed. The treatment resulted in a clinical complete response (CR), and the bladder was preserved. In January 2004, an invasive bladder cancer recurred at the left lateral wall. This time, neoadjuvant intra-arterial chemotherapy with CDDP and EPI-adr, followed by radical cystectomy was performed. Histologically, the recurrent bladder cancer was TCC, G3, pT3b.

著者

松尾 康滋 清水 嘉門 松下 磐 辻 裕明 今井 強一 山中 英寿

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.34, no.7, pp.1227-1229, 1988-07

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Two cases urachal carcinoma are presented. Both of them had complaints of macrohematuria. One patient received partial cystectomy, and the other patient had radical cystectomy, peritoneo-umbiliectomy, and ureterosigmoidstomy after CDDP and ADM intraarterial injection. The former patient was found to have distant metastasis 7 months after operation. The latter patient has been disease-free for 4 months. The most important point to cure urachal carcinoma is accurate staging and sufficient first treatment, especially pre-operative intraarterial chemotherapy.

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.55, no.5, pp.287-289, 2009-05

著者

山口 邦久 岡 夏生 井崎 博文 高橋 正幸 福森 知治 金山 博臣 菅 政治

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.54, no.7, pp.493-496, 2008-07

被引用文献数

1

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31歳男。腎不全末期の状態で緊急入院し, 同日血液透析導入となり, 腎生検よりnephrosclerosisであった。約8ヵ月後に父をドナーとする生体腎移植を施行し, 急性尿細管壊死は認めず, 血流直後より初尿を認め, 免疫抑制剤に拒絶反応もなく経過した。術後3週間頃より10000ml前後の1日尿量が続き, 体重減少, 皮膚乾燥, 血清クレアチニン値の上昇を認め, 尿崩症を疑った。MRIでは下垂体の形態異常は認めず, T1強調画像で下垂体後葉の高信号は保たれ, 尿検査で低張尿は認めなかった。高濃度食塩水テストを施行してのバソプレシン分泌の変化の検討では, 血漿浸透圧は上昇したが血漿バソプレシン濃度の上昇は鈍く, 正常バソプレシン分泌範囲を下回り, 不完全型中枢性尿崩症と診断した。デスモプレシン点鼻の開始により尿量は減少し, 体重, 血清クレアニチン値も安定した。現在もデスモプレシンの点鼻投与を継続し, 経過順調であった。A 31-year-old man was sent to hospital for urgent treatment. He was in the terminal state of chronic renal failure, and was placed under hemodialysis immediately. Proteinuria and hypertension had been notified since adolescence, had been left untreated, and there was no record of his conditions, was. Living kidney transplantation was conducted 8 months later. The donor was his father. After the operation, rejection was not recognized, but urine volume per day was not reduced and maintained the level around 10.000 ml. At the same time, the decrease of body weight and the rise in the serum creatinine concentration were noted. The results of magnetic resonance imaging and the hypertonic saline test (Hickey Hare Test) have formed diagnosis of incomplete diabetes insipidus. Immediately after the administration of desmopressin (rhinenchysis), the decrease of urine volume was recognized, and the body weight and serum creatinine concentration became stable.

著者

山本 奈恵 木下 秀文 井上 貴昭 川喜多 繁誠 大口 尚基 六車 光英 河 源 坂口 雄沢 足立 靖 坂井田 紀子 植村 芳子 松田 公志

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.53, no.9, pp.665-669, 2007-09

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76歳男。患者は頻尿および排尿困難を主訴とした。前立腺生検を施行し, 低分化型前立腺癌およびGleason score 4+5の診断を得た。Maximum androgen blockade(MBA)療法を開始したところ, PSAは低下し, CT上でリンパ節腫脹の消失を認めた。しかし, その後, 腰背部痛が出現し, 疼痛による歩行困難, 嘔吐, 食事摂取困難が生じ緊急入院となった。所見ではFDG-PETで骨以外の病変として右肺尖部, S状結腸に集積を認め, 肺小細胞癌に準じた化学療法を考慮したが, 全身状態の不良にて施行できないまま急速に病状が悪化した。そして症状出現から約3ヵ月後に患者は死亡となった。尚, 剖検所見から本症例は低分化型前立腺癌が脱分化を来し, 多臓器に転移したものと考えられた。A 76-year-old man had been treated with maximum androgen blockade therapy for a poorly-differentiated prostate adenocarcinoma (T3cN1M0, prostate specific antigen (PSA) 65 ng/ml, Gleason Score 4+5=9) since September 2002. By August 2003, his serum PSA levels were undetectable and the lymph node swelling had vanished. However, in December 2004, his serum PSA levels started rising gradually up to 0.66 ng/ml. Radiation therapy on the prostate was then performed (66 Gy). At that time, no metastasis was detected by computed tomography and bone scintigraphy. In August 2005, multiple bone metastases were detected. Immunohistochemical examination of a biopsy specimen from the bone lesion revealed a small cell carcinoma/neuroendocrine cell carcinoma. He died with undetectable PSA levels (less than 0.008 ng/ml) in December 2005. The autopsy showed multiple organ metastases including bone, liver, lungs and others. The immunohistochemical examination revealed pure small cell carcinoma in all metastatic lesions. A precise histological examination of the lungs using a 1 cm serial section could not reveal any tumors compatible with primary lung cancer. We concluded from the clinical history and autopsy findings that his initial poorly-differentiated adenocarcinoma of the prostate dedifferentiated into a pure small cell carcinoma with neuroendocrine differentiation.

著者

三上 洋 伊藤 敬一 吉井 秀彦 小坂 威雄 宮嶋 哲 加地 辰美 浅野 友彦 早川 正道

出版者

泌尿器科紀要刊行会

雑誌

泌尿器科紀要 (ISSN:00181994)

巻号頁・発行日

vol.54, no.1, pp.23-27, 2008-01

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68歳, 男。PSA値上昇を指摘され, 経会陰式前立腺生検よりatypical cellが検出された。6ヵ月後の再生検で前立腺右葉中心に低分化型腺癌と診断され入院となった。臨床病期T2aN0M0の診断で後腹膜鏡下根治的前立腺摘除術および両側骨盤内リンパ節切除を施行した。病理組織診断は低分化型腺癌(Gleason score 3+5)であった。術後3日目にドレーンが自然抜去し, 14日目の膀胱造影で吻合部リーク, ダンベル型の膀胱を認めた。19日目には発熱, 下腹部膨隆が出現し, 骨盤CTにて右側に巨大な液体貯留を認めた。同部にカテーテルを留置し, 内容液はリンパ液と考えられ, リンパ嚢腫と診断した。カテーテルを持続吸引式バッグに接続し, その後ミノサイクリン注入を行った。術後27日目の膀胱造影でリークはなく, 42日目のCTでは嚢腫は消失していた。退院後は外来フォローしているが, リンパ嚢腫の再発は認めていない。A 68-year-old male visited our division with an elevation of PSA level. He underwent a needle biopsy of the prostate, and the histopathological diagnosis was poorly differentiated adenocarcinoma (Gleason score 4+3). The cancer was clinically diagnosed as T2aN0M0, and he underwent extraperitoneal laparoscopic radical prostatectomy and bilateral pelvic lymphadenectomy. Cystography 14 days after the operation still showed leakage at the vesico-urethral anastomosis and a dumbbell shaped bladder. A few days later, prominence of lower abdomen and a slight swelling of right leg presented with a high fever. Computed tomography revealed a giant lymphocele in the retroperitoneal space. We percutaneously punctured the lymphocele by using ultrasonography, inserted a pigtail catheter, and drained 1,000 ml of lymphatic fluid. After the puncture, sclerotherapy with minocycline was performed four times. Twenty days after the puncture, the lymphocele cavity was found to have shrunken and the pigtail catheter was removed. The lymphocele was diminished and did not recur thereafter.