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The patient was a 63-year-old man with biopsy Gleason score of 4＋5 prostate cancer with an initial prostate specific antigen level of (PSA) 51.2ng/ml. On imaging examination, extracapsular invasion, rectal invasion, and pararectal lymph node metastasis were found (cT4N1M0). After 4 years of androgen deprivation therapy, PSA decreased to 0.631ng/ml, and then increased gradually to1.2ng/ml. Computed tomographic scan showed that the primary tumor had shrunk and lymph node metastasis had disappeared; so salvage robot-assisted resection of the prostate (RARP) was performed for non-metastatic castration-resistant prostate cancer (m0CRPC). Since PSA decreased to an undetactable level, hormone therapy was terminated at 1 year. The patient remained recurrence-free for 3 years after surgery. RARP may be effective for m0CRPC, enabling discontinuation of androgen deprivation therapy.

超伝導の原理に基づく論理回路の一種である，単一磁束量子回路の動作を説明するためのインタラクティブ可視化手法について述べる．宇宙探査に関わる将来構想のひとつとして，単一磁束量子回路を用いたデバイスを宇宙機に搭載することが検討されている．単一磁束量子回路はデバイスの動作に係る電力消費が極めて小さく，また演算速度の高速化も期待されている．一方で単一磁束量子回路はCPU やメモリ等，半導体デバイスの論理回路と動作原理が大きく異なるため，その理解の助けとなるような可視化ツールが有用であると期待される．本稿においては，単一磁束量子回路の動作について，WebGL ベースのAPI 等のJavaScript を用いたインタラクティブ可視化アプリケーションを構築し，その課題や将来展望等について検討した．, This paper describes a method of interactive visualization for explaining the behavior of Single Flux Quantum (SFQ) circuits, a kind of logic circuit based on the principle of superconductivity. For the space exploration in the future, there has been an idea to develop devices based on SFQ circuits onboard spacecraft. SFQ circuits are expected to have extremely low power consumption and high computational speed during operation. On the other hand, since the principle of SFQ circuits is greatly different from that of logic circuits of semiconductor devices such as CPUs and memories, visualization tools for understanding such type of circuits are expected to be useful. In this paper we developed an interactive visualization application for SFQ circuits using JavaScript libraries including WebGL-based APIs and discussed issues as well as prospects., 形態: カラー図版あり, Physical characteristics: Original contains color illustrations, 資料番号: AA2230028004, レポート番号: JAXA-RR-22-009

Testicular epidermoid cysts are relatively rare, accounting for about 1% of all testicular tumors, and are often treated by high orchiectomy. We describe here the case of a testicular epidermoid cyst treated by testicle-sparing surgery due to a preoperative diagnosis. A 23-year-old man complained of a painless mass in the right scrotum. Physical examination revealed a firm little fingertip-sized smooth-surfaced mass in the right testis. Ultrasonography showed a hypoechoic lesion with an echogenic rim in the right testis. A T2-weighted magnetic resonance image showed a well-demarcated mass with a low signal outline. On the basis of a preoperative diagnosis of epidermoid cyst, intraoperative testicular frozen section was performed, and the mass was resected surgically while preserving the testis.

From April 2007 to April 2018, we performed lymph node dissection in 305 cases of laparoscopic radical prostatectomy and 202 cases of robot-assisted radical prostatectomy at our hospital, and there were 68 cases with positive lymph node metastasis (pN1). Of these 68 cases, we examined retrospectively 62 cases in which extended lymph node dissection (ELND) was performed. The median number of removed lymph nodes was 25 (interquartile range [IQR] ; 18-34) and the median number of metastatic lymph nodes was 1 (IQR ; 1-3). Postoperative prostate-specific antigen (PSA) recurrence was observed in 40 of the 62 patients. The median time to PSA recurrence was 24 months. After univariate analysis, PSA at initial diagnosis (iPSA) of 10 ng/ml or more, pathological Gleason score (pGS) of 8 or more, total number of lymph node metastases of 2 or more, and positive surgical margin (RM＋) were found to be riskfactors of PSA recurrence. In multivariate analysis, iPSA of 10 ng/ml or more, pGS of 8 or more and RM＋ were independent riskfactors of PSA recurrence (p＜0.05). In the cases without riskfactors such as iPSA≥10, pGS≥8, and RM＋, immediate postoperative adjuvant therapy may be avoided even with pN1.

2021年度宇宙科学情報解析シンポジウム(2022年2月18日. オンライン開催), Space Science Informatics Symposium FY2021(February 18, 2022. Online Meeting), 資料番号: SA6000169007

Herein we present simple methods to prevent postoperative inguinal hernia (IH) after extraperitoneal and transperitoneal robot-assisted radical prostatectomy (RARP). Among 275 patients who underwent RARP between January 2014 and December 2016 at our institution, we evaluated 143 and 115 patients who underwent extraperitoneal-RARP (e-RARP) and transperitoneal-RARP (t-RARP), respectively, after excluding those with intraoperative detection of IH (17 patients). In the e-RARP group, all 143 patients (286 groins) underwent an IH prevention procedure. In the t-RARP group, the first 22 patients (44 groins) did not undergo an IH prevention procedure, whereas 29 patients (37 groins) with patent processus vaginalis (PPV) among the last 93 patients underwent the procedure. The IH prevention procedure during e-RARP included release of the vas deferens from the peritoneum and spermatic cord, and peritoneal dissection of the spermatic cord at the internal inguinal ring. The IH prevention procedure during t-RARP included release of the vas deferens from the peritoneum and spermatic cord, complete circumferential dissection of the peritoneum around the PPV at the level of the internal inguinal ring, and ligation of the PPV with a Hem-o- Loc○R clip. In the e-RARP group, postoperative IH occurred in 3 of the 143 patients (1.9%) during the follow-up period of 22.0±9.2 months. In the first subgroup of t-RARP, postoperative IH developed in 4 of the 22 patients (18%) during the follow-up period of 33.1±12.1 months, whereas in the last t-RARP group, postoperative IH developed in 3 of the 93 patients (3.3%) during the follow-up period of 20.1±8.6 months. Different IH prevention procedures performed in patients undergoing e-RARP and t-RARP were simple and effective in preventing postoperative IH.

Sixty eight patients had robot-assisted radical prostatectomy (RARP) from January 2016 to April 2017 with estimated blood loss of less than 500 ml. We compared the postoperative complication rates and the length of hospital stay between 34 of these patients who had pelvic drain placement (PD group), and the remaining 34 patients who had no drain placement (ND group). The approach was intraperitoneal in 25 patients in each group. The PD and ND groups were comparable for age (69.5 vs 70 yrs, P=0.459), clinical Gleason Score (6/7/≧8) 2/17/15 vs 3/8/23 (P=0.077), clinical stage (1c/2/3) 3/25/6 vs 1/25/8 (p=0. 539), operative time (311 vs 309 min, P=0.868), and estimated blood loss (p=0.166). The PD group had significantly higher median PSA level than the ND group (8.01 vs 6.25 ng/ml, P=0.023). Incidence of 30- day overall complications in the PD group (35 events) was lower than that in the ND group (38 events). All complications were classified as Clavien Dindo grade I. The postoperative hospital stay was 8 days in the PD group and 7 days in the ND group, showing no prolongation in the ND group. Pelvic drainage may be omitted after RARP without increasing postoperative complications or prolonging the hospital stay.

Traumatic adrenal injury is quite rare. From January 2008 to March 2018, out of 287 patients with genitourinary trauma, 23 patients (8%) were diagnosed with traumatic adrenal injury at Kobe City Medical Center General Hospital. We retrospectively reviewed the medical records and assessed the traumatic category, image findings and outcome. All 23 patients were bluntly injured. The causes of traumatic adrenal injury were motor vehicle accident (11 patients : 48%) and falls (9 patients : 39%). The majority of injuries occurred on the right side (18 patients : 78%). Associated injuries occurred in all 23 patients, most frequently in the liver (57%) and ribs (57%). Extravasation of contrast materials was identified on computed tomography (CT) in 4 patients (17%). Although 22 patients (96%) were conservatively managed, only 1 patient was treated by transcatherter arterial embolization because of hypotension. One patient died of intraabdominal bleeding. To our knowledge, the present study is the largest on traumatic adrenal injury in Japan.

A 76-year-old man with a history of hypertension was admitted with high fever and left scrotal pain. Laboratory findings revealed high serum C-reactive protein levels. The left epididymis appeared to be swollen on computed tomography. The patient was diagnosed with bacterial epididymitis and treatment with antibiotics was initiated. Despite treatment, his left scrotal pain and fever did not improve. Additionally, he developed right scrotal and posterior neck pain. For histopathological diagnosis, a left high orchiectomy was performed and the findings revealed thickened arteriolar walls with infiltration of inflammatory cells around the testis, leading to a final diagnosis of systemic polyarteritis nodosa. Treatment with steroids led to complete resolution of the patient’s systemic pain and inflammation.

A 63-year-old man with microscopic hematuria underwent contrast-enhanced CT, which showed multiple bilateral renal masses. Percutaneous biopsy results indicated renal oncocytosis. The tumors remained unchanged for 3 years. Renal oncocytosis is a very rare tumor, but it is an established disease entity characterized by numerous oncocytic tumors and diffuse (sporadic) renal parenchymal epithelial oncocytic changes on an analysis histopathology. Although renal oncocytosis can be sporadic or part of Birt-Hogg-Dube syndrome (BHDS), our case did not associate with BHDS because of absence of lung cyst.

We report the surgical procedures and perioperative outcomes of off-clamp, non-renorrhaphy robotassisted partial nephrectomy (RAPN) in 7 out of 76 patients who underwent RAPN with off-clamp and nonrenorrhaphy between February 2015 and August 2017. The approach was chosen depending on the location of the tumor. Tumor enucleation was performed by using sharp incision and blunt dissection. For hemostasis, the soft-coagulation system was used and TachoSil○R was placed on the resection bed. As a rule, renorrhaphy was not performed. Median (range) patient age was 67 years (40-79), tumor size ; 14 mm (12-18), operative time ; 139 minutes (102-166), console time ; 51 minutes (41-75), estimate blood loss ; 10 ml (0-100). No patients required a perioperative blood transfusion. Median (range) tumor intraparenchymal depth was 10.4 mm (4.3-15.5) and distance from urinary collecting system was 9.3 mm (4.1-13.0). Pseudoaneurysm and urine leakage were not observed. No complications classified as Clavien-Dindo grade higher than grade 1 appeared. No cases had a positive surgical margin. Median (range) estimated glomerular filtration rate (eGFR) change rate at 3 months after surgery was 0% (−12.7-14.5). Off-clamp, non-renorrhaphy RAPN with the soft-coagulation system and TachoSil® is a feasible and safe procedure for patients carefully selected among those with superficial tumors.

We report the incidence and characteristics of lymphoceles after robot-assisted radical prostatectomy (RARP). Computed tomography was performed on 79 patients one month after RARP or when symptoms appeared. The lymphocele was defined as a cystic lesion over 10 mm in diameter. Symptomatic and asymptomatic lymphoceles were identified in 25% (20/79) of all cases, and in 40.9% (18/44) of the cases with lymph node dissection (LND). Symptomatic lymphoceles were identified in 2.5% (2/79) of all cases. Lymphoceles were significantly associated with LND, pathological stage over T3, longer period of indwelling drain tube, and higher volume fluid of drain tube (p

A 61-year-old man with a left renal mass, which was detected by ultrasound during a routine health examination, was referred to our department. The patient had a surgical history of two pneumothorax operations, and the patient's brother also had a history of pneumothorax surgery. A case of Birt-Hogg-Dubé (BHD) syndrome was suspected based on patient history. The pathological diagnosis of the resected tumor, which used robot-assisted laparoscopic partial nephrectomy, was determined to be chromophobe renal cell carcinoma (grade 2, pT1a). BHD syndrome was confirmed by genetic testing, where a nonsense mutation of exon 9 in the FOLLICULIN (FLCN) gene was detected. The patient is currently alive 10 months after surgery.

Recently, holmium laserenucleation of the prostate (HoLEP) was associated with less bleeding compared with transurethral resection of prostate. Since 2012, we have performed HoLEP for benign prostatic hyperplasia (BPH) under continuous oral antithrombotics (OA). Between October 2004 and March 2015, 54 patients with BPH underwent HoLEP while on OA at our hospital. Eight patients underwent HoLEP without OA cessation and 46 patients with temporary OA cessation. No significant between-group difference was observed in age, prostate volume, transitional zone prostate volume, operation time, resection weight, resection weight per minute, urethral catheter duration, Hb decrease on day 1 post- HoLEP, hospital stay after HoLEP, bleeding intraoperative rate, bleeding rate after HoLEP and transfusion rate. None presented embolic complications. HoLEP was safe without OA cessation. However, highvolume BPH patients without OA cessation required intraoperative transfusion. Thus, high-volume BPH patients may benefit from OA cessation.

We retrospectively evaluated the efficacy and toxicity of low-dose estramustine phosphate (EMP) monotherapy in patients with castration-resistant prostate cancer (CRPC). We administered EMP at 140 or 280 mg/day to 89 patients between January 2003 and December 2012. None of the patients were receiving concomitant dexamethasone and none had ever been treated with docetaxel. Fifty-three patients (59.6%) experienced a decline in prostate-specific antigen (PSA) levels, including 20 (22.5%) with a decline of more than 50%. The median time to PSA progression was 90 days. PSA-progression-free survival was significantly longer in patients treated with EMP 140 mg compared with patients treated with EMP 280 mg, and there was no significant difference in the incidence of adverse events between the two groups. The most frequent toxicities were nausea and anorexia. Two patients had grade 3 adverse events of pulmonary embolism and liver dysfunction. EMP treatment was discontinued in nine patients (10.1%) because of side effects (nausea and anorexia in 7, liver dysfunction and lacunar infarction in 1). Low-dose EMP monotherapy is well tolerated and can effectively reduce PSA levels.

A 65-year-oldman with urination difficulty visited our hospital. Because his prostate-specific antigen level was 1, 619 ng/ml, we performeda prostate biopsy. The biopsy specimen yielded a diagnosis of adenocarcinoma with a Gleason score of 4＋4. Computedtomography and bone scintigraphy showed lymph node, lung, and bone metastasis (cT3bN1M1). After 13 months of combined androgen blockade, he underwent treatment with a bisphosphonate. At 22 months of treatment, he developed bisphosphonaterelated osteonecrosis of the jaw, andall necrotic bone and teeth were removed. He subsequently underwent repeated cleaning and fixation (splinting) for an oral fistula andmand ibular fracture. Emergency transcatheter arterial embolization was then performed to treat a bleeding of the facial artery aneurysm. An oral infection and aspiration pneumonia repeatedly developed secondary to the oral fistula. The patient underwent a gastrostomy, after which his nutritional status improved and he was discharged.

単一磁束量子(Single-Flux-Quantum;SFQ)マイクロプロセッサは,超伝導体素子によって構成され,極めて低消費電力で動作する次世代プロセッサである.デバイスの特性上,CMOSプロセッサと異なる新たなパイプライン構成およびビット幅の設計空間が考えられる.そこで,本稿ではSFQマイクロプロセッサの性能モデリングを行い,モデルに基づくマイクロアーキテクチャ探索を行う., Single-Flux-Quantum (SFQ) is a promising device technology to implement high-performance low-power microprocessors. Since it operates at the superconductive condition, the negative impact of resistance can dramatically reduced. Previous design of a SFQ microprocessor employs a bit-serial implementation for instruction pipelining. However, since there is a trade-off between bit-level parallelism and operation frequency, it is still not clear that this kind of bit-level operation is suitable for SFQ microprocessors. To answer this question, this paper explore the SFQ pipeline micro-architecture and evaluates their performance., IEICE Technical Report;CPM2013-115, IEICE Technical Report;ICD2013-92

We report a case of primary mucosa-associated lymphoid tissue (MALT)-type lymphoma of the urinary bladder, which temporarily regressed after antibiotic therapy and progressed 1 year after the treatment. The patient was a 72-year-old female with a history of recurrent cystitis. She was referred to our hospital for microscopic hematuria. Urinalysis also showed microscopic pyuria and cystoscopy revealed an erythematous and edematous submucosal lesion in the right side wall of the bladder. She was diagnosed with acute cystitis and treated with antibiotics. Cystoscopy after 2 months was normal. However, she presented with macroscopic hematuria and fever 1 year after the treatment. Computed tomography (CT) scan showed a solitary mass measuring 25×40 mm above the right ureteric orifice and right hydronephrosis. Transurethral resection was performed, and the histopathological findings were consistent with MALT-type lymphoma. No evidence of lymphoma was found on positron emission tomography-CT scan and bone marrow biopsy, and she was diagnosed with primary MALT-type lymphoma of the bladder. She was successfully treated with a combination of rituximab and radiotherapy. Since MALT-type lymphoma of the bladder sometimes regresses temporarily after antibiotic therpy, it should be followed carefully.

Fe-36wt%Ni invar alloy has been widely used for precision parts where dimensional changes with temperature are unfavorable. In the viewpoint of industrial application, high-strength with low-thermal-expansion alloys are in increased demand for structural members such as power cables and electronic devices. Additions of alloying elements to and cold working on Fe-Ni alloys are effective methods that enable the alloys to strengthen, although these modifications also influence the magnitude of thermal expansion. In this study, effects of additions of 0.2wt%C and/or 0.8wt%V on hardness and thermal expansion of cold-drawn and aged Fe-36wt%Ni invar alloys are reported. Hardness in solution-treated and as-drawn conditions increased with addition of C, and, when both C and V were added, hardness of the alloy reached its maximum after aged at 650℃. Besides an increase in hardness with addition of any of C and V, thermal expansion below Tc became smaller in as-drawn condition than in solution-treated condition. Measurements of positron lifetimes revealed that vacancies introduced by cold-drawing were annealed out through aging up to 300℃ and dislocation motion was activated at 500℃. Both vacancies and dislocations, especially C-dislocation complexes, seemingly influence the decrease in thermal expansion. While graphite precipitation in the C-added invar alloy showed no hardening, addition of C and V to invar alloy resulted in secondary hardening by vanadium carbide precipitation when aged over 500℃, which realized high-hardness and low-thermal-expansion.

Positron, the anti-particle of electron, is a very sensitive probe for vacancy-type defects in materials. Annealing behavior of vacancies in aluminum alloys was investigated by positron annihilation spectroscopy. Thermal vacancies were introduced by water-quenching and subsequent isochronal annealing was done. By measuring annealing-temperature dependence of mean positron lifetime, it was clearly observed the stability of vacancy-solute complexes.

Anticoagulant and antiplatelet medications are commonly used for the treatment and prevention of cardiovascular diseases. We studied 84 patients who received heparin as a bridging anticoagulant and antiplatelet therapy during the perioperative period. Hospitalization was extended for adjusting anticoagulant and antiplatelet drugs and also bleeding complications in the perioperative period. There were 25 instances of bleeding complications (29.7%) in this study. These complications mainly occurred when anticoagulant and antiplatelet medications were restarted in the postoperative period. In transurethral surgery, patients taking warfarin and antiplatelet drugs (aspirin or ticlopidine) had a statistically significant increase in bleeding complications compared to patients taking warfarin alone. We compared 51 cases of transurethral resection of bladder tumor, transurethral resection of the prostate holium laser enucleation of the prostate, nephroureterectomy and percutaneous nephrolithotomy with heparinization were compared to 692 cases with no heparinization. The heparinization group had a statistically significant longer hospitalization period and an increase in bleeding complications. There was one instance of thromboembolism (1.2%) in our series. This involved stent thrombosis of a patient who had drug-eluting stent in the left anterior descending coronary artery. She died three days postoperatively. The number of patients taking anticoagulant and/or antiplatelet drugs is predicted to increase in the future due to aging of the population. Guidelines for the management of anticoagulant and antiplatelet therapy in the urological period are considered necessary.

We report a case of bilateral renal calculi in a 1-year-old female with adenine phosphoribosyl transferase (APRT) partial deficiency. She initially visited another institution with high fever as the major complaint. Computed tomography revealed a bilateral renal stone and left hydro nephrosis. In the urine, there were 2, 8-dihydroxyadenine (DHA) crystals. An analysis of the APRT gene revealed the APRT dificiency and the genotype to be APRT*J/APRT*Q0. We perfomed extracorporeal shock wave lithotripsy (ESWL) under general anesthesia, and as dissolution therapy we administered Meylon through the nephrostomy and citric acid orally. The stone disappeared from her kidney. The analysis of the stone fragments revealed 2, 8- dihydroxyadenine (DHA) urolithiasis.

To assess appropriate treatment strategies for transitional cell carcinoma in situ (CIS) of the upper urinary tract (UUT), we evaluated the long-term outcome of Bacillus Calmette-Guérin (BCG) perfusion therapy for CIS of UUT. We retrospectively reviewed the medical records of 24 patients who underwent BCG perfusion therapy for CIS of UUT between August 1993 and August 2009. Patients received at least one course of BCG (once weekly for 6 weeks). The median follow-up period was 48.5 months (range 16-201 months). In 23 patients (96%), cytology became negative after one course of BCG perfusion and 12 patients (50%) remained disease-free for a median follow-up of 38. 5 months. In 11 patients positive cytology recurred, and in five of them nephroureterectomy was performed after radiologic studies showed the presence of a tumor in the UUT. Histopathology showed invasive tumor (pT3) in all cases, and three of them experienced distant metastases after surgery. In conclusion, BCG perfusion therapy is effective for the treatment of CIS of UUT with long-term follow-up. However, in cases with a poor response or recurrence of CIS, there is a high risk of developing invasive tumor. Surgical intervention should be immediately considered in such cases after the first course of BCG perfusion therapy.

An adequate protocol for antimicrobial prophylaxis (AMP) in radical prostatectomy (RP) has not been established. We retrospectively compared the occurrence of perioperative infection following RP between two different AMP protocols. This study included 340 cases with prostate cancer who underwent RP at our institution between January 2005 and December 2008. The 1-day group consisting of 93 cases received a second generation cephem, cefotiam, intravenously during and after the operation on the operative day. The single dose group consisting of 247 cases received cefotiam during the operation only. The incidence of surgical site infection (SSI）and remote infection (RI) was retrospectively investigated. There was no significant difference in the rate of SSI and RI occurrence between the 1-day group (2.2, 0%) and single dose group (3.6, 0.4%) (p=0.52). The single dose protocol of AMP seems sufficient for prevention of perioperative infection in RP.

1997年8月～2006年5月に精巣精子採取術(TESE)を施行した27例(年齢26～44歳)の非閉塞性無精子症(NOA)15例と非NOA12例を初回卵細胞質内精子注入法(ICSI)の際に使用した精子により新鮮精子群18例と凍結精子群9例に分類して比較検討した。新鮮精子群18例中にNOAは11例(61.1%, 平均年齢32.7歳), 非NOAは7例(38.9%, 36.0歳)で, 凍結精子群9例中にNOAは4例(44.4%, 36.0歳), 非NOA群は5例(55.6%, 34.4歳)であった。両群における受精率, 分割率, 良好胚率, 妊娠率, 出生率に差は認めないが, NOAと非NOAに亜分類しての比較では, NOA15例中の新鮮精子群は11例(73.3%), 凍結精子群は4例(26.7%)であり, 受精率, 分割率, 良好胚率において両群間に有意差を認めなかったが, 凍結精子群には妊娠例を認めず, 新鮮精子群では妊娠4例, 出産3例を認めた。また非NOA12例中, 新鮮精子群は7例(58.3%), 凍結精子群は5例(41.7%)であり, 受精率, 分割率, 良好胚率において両群間に有意差は認めず, 妊娠出産は各々1例認めた。NOAに対するICSIには新鮮精子の使用が適しているという可能性については更なる検討が必要であると考えられた。, Testicular sperm can be obtained from patients with non-obstructive azoospermia. However, there is not enough evidence concerning whether fresh or frozen-thawed sperm is better for successful pregnancy. We retrospectively compared initial treatment results of intracytoplasmic sperm injection using fresh and frozen-thawed testicular sperm in our institution. From August 1997 to May 2006, a total of 27 cases including 18 cases using fresh sperm (269 oocytes) and 9 cases using frozen sperm (97 oocytes) were evaluated. In the fresh and frozen sperm groups 33.4 and 32.9%, respectively, developed good quality embryo. There was no significant difference between the two groups in successful pregnancy and birth rates.

Urolithiasis in pediatric patients is relatively rare. Extracorporeal shock wave lithotripsy and endoscopic procedures play a major role in treating pediatric urolithiasis. A 3-year-old girl presented with macroscopic hematuria and right back pain and was diagnosed with a right renal stone (15 mm). Obstruction of ureteropelvic junction was suspected on computed tomography-urography and therefore the patient underwent percutaneous nephrolithotripsy (PNL). The operation was performed using a 12 Fr miniature nephroscope and Ho : YAG laser without any complications. This patient achieved a stone-free status. The stone analysis revealed a mixture of calcium oxalate and ammonium acid urate. PNL with a miniature nephroscope is safe and effective treatment for pediatric urolithiasis.

排尿障害を主訴とする109例に対して2種の蒸散用電極を用いた経尿道的前立腺電気蒸散術を施行した.TVPは従来のTUR-Pと同様の手技で施行することができ, 出血が少なく, 術後早期に症状の改善が認められた.TVPは前立腺肥大症に対する治療として極めて有用であり, その臨床効果もTUR-Pに匹敵する, Transurethral electrovaporization of the prostate (TVP) is a new minimally invasive procedure for treatment of enlargement of prostate. Between April 1996 and September 1997, TVP was carried out in 109 cases with symptoms of lower urinary tract obstruction. A Stortz spike electrode and a Stortz vapor cutting electrode were used for vaporization electrodes. Efficacy parameters evaluated included International Prostate Symptom Score, peak uroflow and postvoid residual volume. By September 1997, 32 cases (spike electrode) and 33 cases (vapor cutting electrode) could be followed up and evaluated. They have shown both subjective and objective voiding improvement. The improvements in subjective symptom scores and objective voiding parameters were not significantly different between the two electrode groups. Early complications included urinary retention, intraoperative burn, stress incontinence, blood transfusion and postoperative hemorrhage. Late complications included urethral stricture, bladder neck contracture and bladder stone. TVP was found to have several advantages, particularly minimal bleeding and the low incidence of postoperative morbidity. The technique is simple and symptoms improve at an early stage following surgery. This study demonstrates that TVP is a safe and effective modality for treatment of BPH. However, long-term studies with larger numbers of patients are needed.

1)直腸切断術1ヵ月目にみられた尿管瘻の2例を経験した. 2)症例1は尿管ステント留置のみで治癒し, 症例2は腎瘻造設の後, 膀胱尿管新吻合術により治癒した. 3)尿管瘻に対する治療はまず尿管ステント留置を試みるべきである, We report two rare cases of delayed ureteral fistulas which occurred one month following rectal amputation. Case 1 was a 52-year-old male who underwent abdominal perineal resection of the rectum. One month after surgery, the patient had a paralytic ileus. Computed tomographic (CT) scan and drip infusion pyelography showed left ureteral fistula and a large pelvic urinoma. Because retrograde placement of a double-J stent was unsuccessful, antegrade placement of the double-J stent was performed. The fistula and urinoma healed soon after the placement of the double J stent. Case 2 was a 43-year-old male who underwent abdominal sacral resection of the rectum. One month after surgery, a large amount of urine began to drain from the perineal wound. CT scan and retrograde pyelography showed a right ureteral fistula and a large pelvic urinoma. There had been temporary improvement in the discharge without the treatment of the ureteral fistula, only for it to return more profusely. Because placement of a double-J stent was unsuccessful, right percutaneous nephrostomy was performed, after which, a right ureterocysto-neostomy (Boari flap method) was performed. We advocate the initial use of the double-J stent or percutaneous nephrostomy in ureteral fistula. This approach is simple and may cure the fistula. If unsuccessful, it will not hinder subsequent open surgery.

21歳男.右陰嚢内の違和感を主訴とし精巣腫瘍が疑われたが, 術前に施行した骨髄生検の結果, 急性骨髄性白血病(AML)と診断され紹介された.高位精巣摘除術を施行し, 病理結果はembryonal carcinomaであった.精巣腫瘍に対する追加治療は行わず経過観察となった.AMLは化学療法により寛解した.その後, 精巣腫瘍再発をきたし, 腎門部から大動静脈分岐部へおよぶ最大径2cmのリンパ節腫大を多数認め, 胸部単純写真および胸部CTで肺野に多発性の転移を認めた.化学療法(BEP)を開始したが肺梗塞をきたし, IVCフィルター留置後, 化学療法を続行し, 2コースからはEP療法を行い, 4コース完了した.その後完全寛解し経過観察となり腫瘍の再発は認めていない, A 21-year-old male presented with right scrotal discomfort. Right high orchiectomy revealed non-seminoma and he was diagnosed with stage I non-seminoma. Since acute myeloid leukemia (AML) was diagnosed incidentally, no adjuvant therapy was given and he received chemotherapy for AML. One year later, he complained of lumbago and general malaise. Complete remission of AML had been achieved and bone marrow puncture revealed no signs of recurrence. Computed tomography showed retroperitoneal lymph node swelling, inferior vena caval embolus distal to the hepatic vein, and multiple lung nodules. Metastasis of testicular neoplasm was suspected and chemotherapy with Bleomycin, Etoposide, and Cisplatin was started. On the fourth day of chemotherapy, the patient complained of sudden dyspnea and acutely went into shock. Pulmonary embolism was diagnosed and an inferior vena cava filter was placed. Chemotherapy was continued for four courses and the tumor showed complete remission. He has been free of disease for 24 months. In rare cases of testicular cancer with inferior vena caval embolus, the physician should be aware of the possibility of causing pulmonary embolism after chemotherapy.

2例とも年齢53歳男.IL-2投与後各々3.5kg, 7.5kgの体重増加と腹部膨満感が出現し, CTで多量の胸・腹水を認めた.症例2は体液貯留により引き起こされた多臓器不全が原因で死亡した.両例とも体液貯留にvascular leak syndromeが関与していた可能性が考えられた, One of the most common and problematic side effects of interleukin-2 therapy (IL-2) is vascular leak syndrome (VLS). VLS is characterized by an increase in vascular permeability accompanied by extravasation of fluids and proteins from the capillary vessels into the tissues resulting in interstitial edema, weight gain, pleural effusion, ascites in severe form, multiple organ failure. We, herein, report two cases of VLS, which occurred following IL-2 therapy against metastatic renal cell carcinoma. One of them died of multiple organ failure one month after the cessation of IL-2 therapy.

PSAが2ng/ml以上で内分泌療法再開, 0.3ng/ml以下で休薬という新しいプロトコールで間欠的内分泌療法を32例の前立腺癌患者に対して施行したので, その短期成績を報告した.初回休薬期間の中央値は287日と満足のいくものであった.初回治療期間とテストステロン値の回復には負の相関を認め, 初回治療期間が長期であればテストステロン抑制は休薬しても長期持続することが示された.長期に亘る視床下部-下垂体-精巣ホルモン軸の抑制は精巣機能の障害を長期化し, 間欠的内分泌療法に必要なテストステロン値の回復を遅らせるかもしれない, We report a pilot study on a novel protocol of intermittent androgen deprivation (IAD) treatment of prostate cancer (PC), in which androgen deprivation is restarted when serum prostatic specific antigen (PSA) level reached more than 2 ng/ml and is stopped when PSA level decreased below 0.3 ng/ml. Thirty-two patients (aged 60 to 86 years, median 74 years) with prostate cancer (Stage A in 4 patients, B in 20, C in 1, D in 5, and relapse after radical prostatectomy in 2) were treated with IAD. Median serum PSA prior to the start of endocrine therapy was 15.65 (range 2.67 to 306.3) ng/ml. Eleven patients were treated with lutenizing-hormone-releasing hormone (LHRH) agonist alone and 21 were treated with LHRH agonist plus an antiandrogen. Median duration of first endocrine therapy was 572 (range 100 to 1, 543) days. Median serum PSA at the start of first off-phase was 0.038 (range 0.003 to 0.489) ng/ml. After a median of 207 days (range 140 to 843) of follow-up, 19 patients were in the first cycle, 9 in the second cycle, 3 in the third cycle, 1 in the fourth cycle. Two patients developed androgen-independent PC. The median duration of first off-phase of IAD was 287 days. There was a significant inverse relation between the duration of the first on-phase and testosterone level measured 4 months after the cessation of first on-phase therapy (R = -0.518). These results suggest that our protocol provides a reasonable length of off-phase duration and that the long term-androgen deprivation phase might delay the recovery of the testicular endocrine function which should be maintained during the off-phase of IAD.

We report a rare case of a 60-year-old man with a pheochromocytoma detected by a hypertensive crisis immediately after drip infusion urography. The patient initially consulted our hospital complaining of dysuria. He underwent a drip infusion urography and experienced a hypertensive crisis. The next day he was diagnosed with paralytic ileus. An endocrinological examination, abdominal computed tomography and 123I-metaiodobenzyl-guanidine scintigraphy revealed a pheochromocytoma. The tumor mass was removed, and immediately his blood pressure became normal and the paralytic ileus improved; however, temporary postoperative hypoglycemia was seen. Frequent monitoring of his blood glucose and the administration of an appropriate solution of dextrose, both during and after the operation, were recommended.

排尿障害を主訴とする37例に経尿道的前立腺電気蒸散術(TVP)を施行した.TVPは従来のTUR-Pと同様の手技で施行することができ, 出血が少なく, 術後早期に症状の改善が認められた, Transurethral electrovaporization of prostate (TVP) is a new minimally invasive procedure to treat enlargement of prostate. From April 1996 to the end of October, TVP was carried out in 37 cases (mean age, 71.0) with symptoms of urethral obstruction. Standard transurethral resection equipment was utilized. This included a Stortz 26F resectoscope with a Conmed SABRE 2400 electrical current generator. A Stortz 3 mm Spike Electrode was used as the vaporization electrode. The average setting was 250 W for cutting and 80 to 100 W for coagulation. Efficacy parameters evaluated included International Prostate Symptom Score, peak uroflow and postvoid residual volume. By the end of January 1997, 28 cases could be followed up for more than three months after surgery and evaluated. Postvoid residual volume decreased from 68 to 10 and 17 ml at 1 and 3 months. Peak uroflow increased from 8.5 to 15.1 and 17.9 ml/sec at 1 and 3 months. All 28 cases were categorized as effectively treated cases at 1 and 3 months postoperatively. TVP was found to have several advantages, particularly minimal bleeding and the low incidence of postoperative morbidity. The technique is simple and symptoms improve at an early stage following surgery. We intend to continue longer follow up with larger numbers of patients.

69歳女.尿閉を主訴とした陰唇癒着症の例を報告した.本症例は低エストロゲン状態及び左股関節症の既往が誘因であると考えられた, A 69-year-old woman was admitted to our hospital complaining of urinary retention. On examination, the labia was found to be fused extensively, with a pinhole opening at the midline. The adhesions were separated under spinal anesthesia. One year after operation, there remains no recurrence. Etiological factor in labial adhesions are thought to include a combination of local inflammation and estrogen deficiency. In our case, the patient had hip joint disease. Hip joint disease is shown to influence the formation of adhesions by interfering with perineal hygiene and decreasing sexual activity.

A 23-year-old man was admitted to our hospital complaining of swelling and pain in the penis. Examination revealed fracture of the penis. The tear in the tunica albuginea was not palpable on physical examination of the penis, but magnetic resonance imaging (MRI) revealed the exact site of the tear in the tunica albuginea. MRI was very useful in localizing the site of fracture.