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1)27例の非neoadjuvant治療群で, 臨床病期の正診率は48.2%, understagingが44.4%, overstagingが7.4%.42例のneoadjuvant治療群では, 臨床病期の正診率は54.8%, understagingが35.7%, downstaging或いはoverstagingが9.5%であった. 2)治療前PA値は, 病理病期をよく反映しており, pT0とpT3症例, pT0とpN(+)症例及びpT2とpN(+)症例の間には統計学的な差が認められた.又, 再発症例の治療前PA値は, 非再発症例より高かった, Between 1989 and 1991, 815 cases of prostatic carcinoma were registered in the Tokai Urological Cancer Registry. We investigated the clinical features and prognosis of 69 patients who underwent radical prostatectomy. The median age and clinical stage, were 65.9 +/- 4.7 years and A in 7 patients, 66.3 +/- 5.8 years and B in 31, 68.2 +/- 2.7 years and C in 26, 63.4 +/- 13.5 years and N(+) in 5. Neoadjuvant therapy consisting of endocrine therapy and chemoendocrine therapy was administered to 28 and 14 patients, respectively. In comparison to the clinical stage, pathologically, 4 cases (9.5%) showed downstaging or overstaging, 15 (35.7%) understaging and 23 (54.8%) accurate staging in the neoadjuvant therapy group, and, respectively, 2 (7.4%), 12 (44.4%) and 13 (48.2%) in the non-neoadjuvant therapy group. There was a significant difference in the pretreatment prostatic antigen (PA) value between pT0 and pT3 (p < 0.05), between pT0 and pN(+) (p < 0.01) and between pT2 and pN(+) (p < 0.05). In addition, the pretreatment PA value in the recurrence group was higher than that in the non-recurrence group in both neoadjuvant and non-neoadjuvant groups, with a significant difference (p < 0.01) in the neoadjuvant group. Cancer recurrence was noticed in 2 patients given non-neoadjuvant therapy and 3 given neoadjuvant therapy. There was no significant difference in the non-recurrence rate with the pathological stage either with or without neoadjuvant therapy. However, the non-recurrence rate in the neoadjuvant therapy group was higher than that in the non-neoadjuvant therapy group.

精巣摘除術とエストロゲン療法が主に採用されていた1989年からの3年間に登録された前立腺癌について集計を行い, あわせて予後を調査した.病期C, Dの5年実測生存率は病期C51.6%, 病期D30.3%で, 1980年代前半の厚生省研究班の調査時と比べて変りがなかった, Of 815 patients with prostatic carcinoma registered in Tokai Urological Cancer Registry between 1989 and 1991, 683 patients followed up until April to July 1992 were analyzed. The patients were between 48 and 94 years old (mean 73.2). The clinical stage was A in 96 (14.1%), B in 118 (17.3%), C in 117 (17.1%) and D in 352 (51.5%) patients. The histological study well differentiated adenocarcinoma in 150 (22%) patients, moderately differentiated adenocarcinoma in 305 (44.6%), and poorly differentiated adenocarcinoma in 194 (28.4%) patients. There were 12 undifferentiated adenocarcinomas and 22 were not classified. The incidence of patients with poorly differentiated adenocarcinoma increased with the progression of clinical stage. Hormonal therapy was the main treatment (92.8%) and a variety of hormonal therapies with surgery or chemotherapy were attempted through out the clinical stages. Overall survival rate at 5 years was 48.6%. The 5-year survival rage for stage A, B, C and D carcinoma was 84.7, 93.1, 51.8 and 30.3%, respectively. Significant differences in the survival of patients were noted among stage A or B, stage C and stage D (Logrank test: p < 0.0001). The 5-year survival rate was 70.2% for well differentiated, 53.0% for moderately differentiated, and 32.6% for poorly differentiated adenocarcinoma (Logrank test: p < 0.0001). Disease-specific death was observed in 128 patients (66%), and cardio- or cerebrovascular death accounted for 16 (8%) deaths.

15名の若年者精巣上体炎患者から得られた尿及び尿道スワブを対象とした.クラミジアトラコマチスによる尿道炎はEIA法では僅かに20%に認められたのみであったが, PCR法では87%の患者に認められた.この差は統計学的に有意であった.13例のPCR陽性例のうちEIA法でも陽性と判定された症例は僅かに3例のみであった.以上より, PCR法は男の尿中におけるクラミジアトラコマチス検出に感受性が高く, 急性精巣上体炎患者におけるクラミジア感染症の非侵襲的なスクリーニング法として有用である, Specimens from 15 young patients presenting with acute epididymitis were tested for the presence of Chlamydia trachomatis by an enzyme immunoassay (EIA), polymerase chain reaction (PCR), and for other bacteria by standard laboratory techniques. C. trachomatis urethral infection was detected in 3 patients by an EIA test of the urethral swabs (20%) and in 13 patients by the PCR (87%). This difference in detection rate was statistically significant (p < 0.005). Thirteen specimens were positive by the PCR, but only three of them were positive by the EIA method. These findings indicate that the PCR assay is a highly sensitive assay for the detection of C. trachomatis in male urine specimens and provides a noninvasive technique for routine screening of chlamydia infection in the patient with acute epididymitis.

微小穿刺法と微小灌流法を用いた。精細管の管内アンドロゲン濃度は間質液中のその濃度が10-2, 000nMに増大するに従い直線的に増大したが, 精巣上体頭部における管内アンドロゲン濃度は間質液中の濃度が増大するに従い双曲線的に増大し, 精細管におけるそれよりもはるかに高い値を示した。灌流液中に0.1nMのジニトロフェノール, 0.1mMのKCN, 100μg/mlのサイクロヘキサミドを加えたとき, 管内アンドロゲンの移行は組織ATP濃度とともに有意に減少した。アンドロゲン結合蛋白を含まない人工的精上体頭部の管内液で管内を灌流したとき濃度勾配に抗したアンドロゲン移行は完全に抑制された, The mechanisms involved in the maintenance of the endocrinological microenvironment of the seminiferous and epididymal tubules were examined in a series of experiments utilizing in vivo microperifusion, microperfusion, and micropuncture technique. The intraluminal 3H-androgen concentration in the seminiferous tubules increased linearly as the interstitial 3H-androgen concentrations increased from 10 nM to 2, 000 nM, but in the caput epididymidal tubules, the intraluminal 3H-androgen concentration increased hyperbolically across the same range of peritubular 3H-androgen concentration. Intraluminal 3H-androgen concentrations in the caput epididymidis did not rise above approximately 340 nM even when the peritubular 3H-androgen concentration exceeded 2, 000 nM. Perifusion of caput tubules with 0.1 mM dinitrophenol or potassium cyanide or 100 micrograms/ml cyclohexamide significantly reduced the proluminal 3H-androgen movement, but tubules perifused with control medium did not support antigrade 3H-androgen movement in the absence of native lumen fluids which contain androgen-binding protein. Energy-requiring protein synthesis is necessary for antigrade 3H-androgen movement in the caput epididymidis, but the mechanism for the interaction of intracellular protein(s) and 3H-androgen movement remains undetermined.

1)TUR-P術前に尿路感染症のない前立腺肥大症患者を対象に, 注射剤と経口剤の感染予防効果を比較検討するため, multicenter prospective randomized studyを施行した。2)注射剤としてcefotiam(CTM), 経口剤としてtosufloxacin(TFLX)を用いた。手術当日より7日間, CTM 4g/日あるいはTFLX 300mg/日投与の無作為割り付けをした。3)登録は150症例であったが, 124例は術前のカテーテルかつ尿路感染の既往なしのlow risk groupであった。Low risk groupでは発熱の頻度の差は, 点推定でTFLX投与群がCTM投与群より4.4%少なかったが, 統計学的に有意な差ではなかった。4)複雑性尿路感染症発症率は, 術後4～5日目, 9～12日目, 23～27日目および37～40日目の各検査時でCTM投与群, TFLX投与群両群間に有意な差を認めなかった。Low risk groupの感染率はCTM投与群で, それぞれ8.3%, 16.4%, 25.0%および23.9%またTFLX投与群で6.7%, 16.7%, 29.6%および36.7%であった, To compare the prophylactic effect of oral and intravenous antibiotics against postoperative fever and urinary tract infection (UTI) after transurethral resection of the prostate (TUR-P), we conducted a multi-center prospective randomized study. The incidence of pyrexia over 38 degrees C was defined as the primary endpoint. One hundred and fifty patients with sterile urine before TUR-P were entered into this study. The patients were allocated randomly into the two arms; arm A cefotiam 4 g a day for 7 days, arm B tosufloxacin 300 mg a day for 7 days, based on the stratification into the 4 groups determined with/without preoperative indwelling catheters and with/without the history of preoperative UTI. Of these patients, 143 were eligible. We divided 124 patients without preoperative UTI and without indwelling catheters as the "low risk group", and the other 19 patients with preoperative UTI and/or with indwelling catheters as the "high risk group". In the low risk group, 9 patients out of 63 (14.3%) in arm A and 6 out of 61 (9.8%) in arm B had pyrexia during 7 postoperative days. The incidence of fever in arm B was 4.4% less than that in arm A and the 95% confidence limit was from -7% to 16%. In the high risk group, 4 out of 11 (36.4%) patients in arm A and none of 8 in arm B had fever but the difference was not significant. The incidence of post operative UTI in the low risk group on the 4 to 5, 9 to 12, 23 to 26 and 37 to 40 postoperative days was 8.3, 16.4, 25.0 and 23.9% in arm A and 6.7, 16.7, 29.6 and 36.7% in arm B, respectively. The prophylactic effect of oral administration of tosufloxacin is equivalent to that of the intravenous administration of cefotiam. The use of oral antibiotics is beneficial to reducing the cost of medication.

35歳以下の急性精巣上体炎患者32名および彼らの性的パートナー18名について細菌学的検討を行った。男性では, 尿道swabによるクラミジア抗原の検出と顕微鏡検査, 尿培養, 血清中クラミジア抗体の測定を行った。56%において病原微生物が同定され, 最も多いものはクラミジアトラコマティスであり, 11例に検出された。女性パートナーについては, 子宮頸管粘膜上皮細胞をswabで擦過しクラミジア抗原を検出し, さらに尿培養, 血清中クラミジア抗体の測定を行った。9例が, クラミジア感染による精巣上体炎患者のパートナーであり, 彼らの78%は, クラミジアに感染していた, Untreated infection of female partners by men with chlamydial epididymitis may have serious effects on the partners' fertility. To assess the need for detailed microbiological investigation, 32 patients, 35 years old or younger, with epididymitis and their sexual partners were examined. The patients underwent thorough evaluations, including chlamydia isolation, microscopy of urethral swab, bacterial culture, and chlamydia serologic testing. An infective cause was identified in 56% of the patients. The most common microorganism was Chlamydia trachomatis. This microorganism was identified from urethral swabs in 11 patients (34%). A total of 18 sexual partners were traced and investigated for chlamydia antigen by cervical swab, urinary bacterial culture, and chlamydia serologic testing. Of the 18 female sexual partners screened, 9 were partners of patients with chlamydial epididymitis; 78% of these women had the same infection. Young men with epididymitis, as well as their partners, should undergo full microbiological evaluation including Chlamydia trachomatis for adequate treatment of this infection.

1)内分泌療法未治療の前立腺癌症例に対し, 375mg/日の用量で単独療法として使用しえる。この際, testosterone産生阻害療法に比し, 「生活の質」が保たれる。2)内分泌療法再燃例に対しても, ある程度その効果が期待できる。3)フルタミドと他の精巣性testosterone阻害剤との併用で, その併用効果が期待できる。4)また, LH-RHアナログの投与によるflare-up現象をフルタミドを併用することにより予防することが可能である, The phase II study of flutamide, a pure anti-androgen, was performed to estimate the clinical doses on 165 hormone untreated or treated patients with prostatic cancer. The hormone-untreated patients were given orally flutamide of 90, 375, 750 or 1, 125 mg/day in three divided doses daily for 12 weeks. Responses were not observed at the 90 mg/day dose except for improvement of clinical symptoms. However, an objective response rate of 48.8-46.7% was obtained at 375-1, 125 mg/day doses. In hormone-treated patients including cases refractory to the previous hormonal treatment, the objective response rates were 13.3 and 8.3% in 375 and 750 mg/day flutamide groups, respectively. Side effects such as gynecomastia, nausea, vomiting, diarrhea, and abnormal laboratory findings such as the elevation of hepatic transaminases were observed. The incidence increased dose-dependently. Determinations of serum hormone levels revealed an increase in testosterone levels by the use of flutamide. In conclusion 375 mg/day of flutamide is the optimal dose in monotherapy for hormone-untreated patients with prostatic cancer, where the quality of life can be maintained compared with therapies involving testosterone suppression. This dose is also expected to show some efficacy in cases refractory to hormone treatment.

急性単純性膀胱炎76例にCefixime(CFIX)の効果を試した。BID群43例中UTI薬効基準に合致した33例では, 排尿痛消失28例(85%)であった。膿尿は正常化23例(70%)であった。細菌尿は陰性化24例(73%)で総合臨床有効率94%であった。主治医判定では有効率91%であった。UID群(一回200mgを一回投与)では28例中薬効基準合致22例中, 排尿痛消失は20例(91%), 膿尿正常化14例(64%), 細菌尿陰性化14例(64%)で総合有効率は96%であった。主治医判定では有効率82%であった。一般にE. coliに対して優れた感受性を示し, 副作用はUID群のうち1例のみ口内炎が発症したが変更により消失した, A comparative study of cefixime (CFIX), a new oral cephem antibiotic, was carried out at the Department of Urology, Nagoya University Hospital and its four affiliated hospitals to evaluate the clinical efficacy and safety of two dosage regimens of CFIX, given either in twice daily doses (BID group) or once daily dose (UID group), in the treatment of acute uncomplicated cystitis. Forty six female patients (BID group) were administered the daily dose of 200 mg in two divided doses for 3 days, 30 female patients (UID group) were administered 200 mg once daily for 3 days. The clinical efficacy was evaluated in 33 cases from the BID group and in 22 cases from the UID group, respectively, according to the criteria recommended by the Japan UTI Committee. In the BID group, the clinical efficacy was evaluated as excellent in 18 cases, moderate in 13 and poor in 2, with an overall clinical effectiveness rate of 94%. In the UID group, it was evaluated as excellent in 9 cases, moderate in 12 and poor in 1, with an overall clinical effectiveness rate of 96%. Safety was monitored in 71 patients, and only one case of stomatitis was seen in the UID group. This findings suggest that 200 mg once daily dosing regimen of cefixime is as effective as 100 mg twice daily dosing regimen in treatment of acute uncomplicated cystitis, and is well tolerated in terms of safety.

1)前立腺癌では, 39.8%, 前立腺肥大では, 100%にER-D5陽性の結果がえられ, ER-D5陽性前立腺癌症例の方が, 治療開始後一定期間はER-D5陰性症例より明らかに高い生存率をえた.2)前立腺癌再燃のため, 再度前立腺癌組織採取が可能であった症例では, 再燃時には, ER-D5陽性は1例も認めなかった, The existence of an estrogen receptor and various other sex steroid receptors has been confirmed in prostatic cancer. However, the action mechanism of hormone therapy and relationship between the disappearance of hormone response, which is observed in the recurrence of prostatic cancer, and various sex steroid receptors have yet to be identified. The use of monoclonal antibody ERICA is known as a method of detecting the estrogen receptor in the immuno-histological chemistry method. However, this monoclonal antibody is difficult to use on paraffin sections. Therefore, using monoclonal antibody D5, which allows ER-D5 detection of the estrogen receptor related antigen on paraffin sections, we investigated whether or not estrogen receptors are present in the prostatic cancer preparation and studied the survival rate of prostatic cancer as well as relationship with recurrence. Positive ER-D5 results were obtained in 37 of 93 prostatic cancer cases (39.8%) and in all 20 prostatic hypertrophy cases (100%). ER-D5 tended to be more densely stained in prostatic hypertrophy than in prostatic cancer. The survival rate was obviously higher in the ER-D5 positive prostatic cancer cases than in ER-D5 negative cases for a certain period of time after the start of treatment. Despite differences in the histo-differentiation degree and clinical stage of prostatic cancer, the ER-D5 positive percentage did not change and remained between 35% and 45%. In cases where another prostatic cancer preparation was taken because of recurrence of prostatic cancer, there were no ER-D5 positive cases at the time of recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

1)ヒト膀胱はangiotensin 1, 2いずれに対しても強い収縮反応を示した.2) angiotensin 2に対する収縮反応はCa-free Krebs中ではほぼ完全に消失した.verapamilやindomethacinによる抑制効果は僅かであった.3) captoprilによりangiotensin 1の抑制作用は完全に抑制された.saralasinによりangiotensin 1, 2の収縮作用は完全に抑制された.4)神経因性膀胱のangiotensin 1, 2に対する収縮反応は, いずれもコントロールに比較して減弱していた.ただし, ED50値には差を認めなかった, The response of the human detrusor muscle to angiotensins and the difference in contractility between neurogenic and control bladders were examined. Both angiotensin I and II induced potent contraction of the human detrusor muscle. In Ca-free Krebs' solution the contractile response to angiotensin II was abolished. However, verapamil and indomethacin suppressed it only slightly. Captopril blocked completely the response to angiotensin I, and saralasin inhibited completely the response to both angiotensin I and II. The contraction strength in response to both angiotensin I and II was significantly weaker in the neurogenic bladder than in the control. However, there was no difference in the value of ED50 between the two groups. These findings suggest that angiotensin I is converted to angiotensin II by angiotensin converting enzyme at the detrusor, and that angiotensin II subsequently contracts the detrusor muscle through angiotensin II receptors. The contractility of the neurogenic bladder in response to angiotensin was significantly lower compared to that of the control.

Bladder dysfunction is one of the major symptomatologies characteristic to HAM (HTLV-I associated myelopathy). Four patients, 3 females and 1 male, were diagnosed by neurologists to have HAM with spastic gait disturbance and increased titer of antibody to HTLV-I. They complained of urge incontinence, bed wetting, difficulty in micturition and/or pollakisuria. Urodynamically, in 3 of them severe uninhibited detrusor contractions were observed. On the other hand, in one case detrusor contractility was lost completely at voiding. In all patients, bladder sensation was well preserved. Corticosteroids and interferon could not improve their urological symptoms. Clean intermittent catheterization (CIC) put on 3 patients who had a significant amount of residue relieved them of urinary incontinence. We believe that HAM in patients suffering from severe difficulty in micturition is a good indication for CIC.

前立腺肥大症30例, 肉芽腫性前立腺炎(結核)1例, 前立腺癌22例, 前立腺部移行上皮癌1例および膀胱移行上皮癌の前立腺浸潤1例より採取した検体を材料とした.経直腸的吸引細胞診法は各症例に対し1回行い, 全視野における総細胞数が1, 000に満たないものは原則として除外した.吸引スメアに対してモノクローナル抗体Ki-67を使用した免疫組織化学染色を行った.1)前立腺癌の増殖能は前立腺良性疾患に比して明らかに高かった.2)低分化型腺癌は, 高および中分化型腺癌に比してKi-67 labeling indexが若干高値を示した.3)移行上皮癌は腺癌に比してKi-67 labeling indexが高値を示した.4)経直腸的前立腺吸引細胞診法に本染色法を応用することは, 前立腺癌早期診断の一助となる, Immunohistochemical staining using monoclonal antibody Ki-67 was performed in 30 patients with benign prostatic hypertrophy (BPH), one with prostatic tuberculosis (TB), 22 with prostatic adenocarcinoma, one with prostatic transitional cell carcinoma and one with prostatic invasion from a bladder cancer. Specimens were aspirated from the prostate transrectally and a cytological smear were made. This antibody is specific for a proliferation-associated nuclear antigen. Alkaline phosphatase anti-alkaline phosphatase stained immunopositive nuclei red making positive or negative specimens easy to recognize. In BPH and TB smears, no immunopositive cell was reactive with Ki-67. In prostatic malignancy were found many immunopositive cells ranging from 2.5 to 10.2% (mean 5.9%) in prostatic adenocarcinoma (n = 22), and from 11.9 to 24.3% (mean 18.1%) in prostatic transitional cell carcinoma. Transitional cell carcinoma may have a much greater growth fraction than adenocarcinoma in prostatic tissue. Poorly differentiated adenocarcinoma showed a higher growth fraction (from 4.2 to 10.2%, mean 6.9%) than well differentiated (from 3.1 to 8.9%, mean 5.8%) and moderately differentiated adenocarcinoma (from 2.5 to 10.1%, mean 5.6%), but this difference was not significant. There was no correlation with age, clinical stage, bone metastasis or Bocking's cytological grade. In conclusion, immunohistochemical staining using Ki-67 on aspirated prostatic smear is visualizes the growth fraction of prostatic disease well and is useful to diagnose prostate cancer.

A case of vesical endometriosis with unilateral renal agenesis is reported. A 13-year-old girl complained of difficulty in urination and lower abdominal pain during the menstruation. Detail urological examinations revealed left renal agenesis and intravesical cystic mass. The mass was located in the left vesical lateral wall, obstructing the vesical outlet and containing dark-brown-coloured fluid in it. She finally suffered from urinary retention following the menstruation and underwent a resection of the mass together with a part of the vesical wall. During the operation, the uterus was found to be a bicornate one. The resected mass was diagnosed as an endometriosis based on the histological findings. Eighteen months after the operation she is free from any symptoms during the menstruation and recurrence of endometriosis.

回腸膀胱では残尿が50 ml以下ならば間欠的導尿を行わないで経過をみているが, 長時間経過した場合, reservoirの過伸展による腸管壁の変化, およびそれにともなうreservoir容量の変化が, 今後の問題点となりうる, From September 1989 to March 1990, 6 male patients with invasive bladder cancer, 49 to 70 years old in age, underwent bladder replacement with the ileum (the urethral Kock pouch) after radical cystectomy. Follow up ranged between 3 and 9 months. Urodynamic evaluation showed the ileal bladder to be a low pressure reservoir with a capacity that increased to more than 250 ml. The ileal bladder was emptied by straining without significant residual urine in all patients except one who was performing intermittent self-catheterization. All patients were continent in the daytime. However, all patients required pads at night because of occasional loss of a little urine. Excretory urograms revealed excellent upper tract function. The procedure is suitable whenever the urethra can be preserved after cystectomy for cancer.

腎盂尿管の上皮性腫瘍症例62例について生存に影響を及ぼす因子を検討した.1)生存曲線上, 年齢, 数, 多中心発生, 大きさ, 組織型, stage, 異型度, 発育様式, 浸潤増殖様式, リンパ管侵襲, 静脈侵襲の11因子が予後に関係していた.2)比例ハザードモデルによる単因子別での検討では, リンパ管侵襲, 発育様式, stage, 静脈侵襲, 年齢, 異型度, 多中心発生の7因子がこの順で有意に予後に関係していた.3)比例ハザードモデルによる多変量解析からは, リンパ管侵襲, 発育様式の2因子が予後因子として重要である, Sixty-two patients with epithelial tumors of the renal pelvis and the ureter were studied with respect to 16 clinicopathological factors and their relationship to the patients survival. The cumulative survival curves are depicted by the Kaplan-Meier method and the statistical difference in the survival rates were detected in 11 factors, age, tumor number, multicentricity, tumor size, histological tumor type, stage, grade, growth pattern, infiltration pattern, lymphatic invasion and venous invasion. Cox's proportional hazard model was applied to evaluate the contribution of these 11 factors to survival. With the univariate analysis, lymphatic invasion showed the greatest hazard ratio followed by growth pattern, stage, venous invasion, age, and grade in this order. Stepwise selection of these factors based on the relative magnitude of their contribution to the survival with Cox's proportional hazard model revealed the most important factor for survival as the lymphatic invasion (hazard ratio 5.29), followed by growth pattern (hazard ratio 2.89). In conclusion, patients with tumor lymphatic invasion and tumor of non-papillary growth pattern showed poor prognosis, and adjuvant chemotherapy should be performed on them to improve their survival.

Excretory urography was performed using iohexol (Omnipaque 300 and Omnipaque 350) on 388 patients requiring urography in the Department of Urology, Nagoya University School of Medicine and 10 affiliated hospitals. Adverse reactions were observed in 3 cases (0.8%), but they were all mild. Good image efficacy was obtained in more than 95% of the patients injected 20 ml, 40 ml, and 100 ml of Omnipaque 300 and 40 ml of Omnipaque 350. There was no difference in the results of image efficacy between 40 ml (Omnipaque 300) and 100 ml (Omnipaque 300) groups. Therefore, the use of 40 ml of Omnipaque 300 for excretory urography was considered to be a very useful screening method for the urinary tract.

A seventeen-year-old girl, who had had an ileal conduit urinary diversion at 5 years of age, underwent a urinary undiversion 12 years after the initial operation. She has been suffering from recurrent episodes of urinary tract infection with fever. The preoperative evaluation revealed dilatation of the bilateral pelvis and ureters on an excretory urography. Ileal conduitgraphy revealed urinary reflux from the ileal loop to the bilateral upper urinary tracts. Cyclic bladder hydrodilatation through a suprapubic cystostomy was performed and a precise urodynamic study was done on the lower urinary tract. The vesical capacity increased from 40 ml to 300 ml in a month. Cystometry and urethral pressure profile revealed a stable bladder with good detrusor contraction and preserved urethral continence. Voiding status was satisfactory with only a small amount of residue. The undiversion was undertaken as follows. The ureters were once isolated from the ileal loop and their distal ends were everted in length of 5 mm to be nipples in shape. The ureters were reanastomosed to the proximal end of the ileal loop with submucosal tunnels of 2 cm. The ileal loop was then tapered and implanted to the bladder with a submucosal tunnel of 5 cm. Eight months after the undiversion, she enjoys good urination, free from urinary tract infection. Although moderate hydronephrosis remains bilaterally, renal function is stable.

P線毛保有大腸菌より精製したP線毛を抗原とした酵素抗体法(ELISA法)により, 各種尿路性器感染症患者のP線毛に対する血中抗体価を測定した.1)成人女子急性腎盂腎炎患者のP線毛に対する抗体価は, 発症後10日を経過すると上昇がみられ, 成人女子対照群および成人女子膀胱炎患者の抗体価に比べ有意に高く(p, The serum antibody response to P-fimbriae of Escherichia coli in patients with genitourinary infections was investigated with enzyme linked immunosorbent assay (ELISA) for P-fimbriae-specific IgG antibody. 1) Female patients with acute pyelonephritis had a significantly (P less than 0.01) higher titer of serum IgG antibody by ELISA, compared with patients with acute cystitis or control subjects. The prevalence of positive serum IgG antibody response was 65% in patients with acute pyelonephritis. 2) Patients with epididymitis with high fever had a significantly (P less than 0.01) higher titer of serum IgG antibody by ELISA, compared with patients with epididymitis without fever or control subjects. The prevalence of positive serum IgG antibody response was 60% in patients with epididymitis with high fever. Therefore, 65% of female patients with acute pyelonephritis and 60% of patients with epididymitis with high fever are infected with P-fimbriated E. coli. The measurement of serum antibody response to P-fimbriae must be helpful for the diagnosis and the antibiotic therapy of epididymitis.

A 37-year-old man consulted our hospital with a complaint of male infertility. He was masculine but 159.9 cm in height. His beard, axillary hair and pubic hair were all normal. The penis and scrotum were also normal, but bilateral testes were very small (1 ml. respectively). Semen analysis revealed azoospermia. Endocrinological examination showed elevated serum lactating hormone and follicle stimulating hormone level, and extremely low level of serum testosterone. Testicular biopsy disclosed severely hyalinized seminiferous tubules and hyperplasia of Leydig cells. No ovarian tissue could be detected. The chromosomal analysis revealed a karyotype of 46 XX. This case was diagnosed as a case of 46XX male. The Japanese literature of 46XX male is reviewed.

1歳男児, 10ヵ月男児。共に鼠径ヘルニアと停留精巣を伴ったミュラー管遺残症候群であった, Persistent Mullerian duct syndrome is characterized by the retention of mullerian derivatives in patients otherwise normally virilized. Clinically, the persistence of uterus and tubes leads either to cryptorchidism or inguinal hernia. The condition is usually discovered at surgery. We report two boys with this anomaly. In each case, hysterectomy and orchidopexy were carried out. The gonads were testes and the karyotype was 46, XY. Long-term follow up for these patients is necessary because of an increased risk of testicular tumors and infertility which will develop in future.

1)尿道癌および外陰癌の2例にcontinent cystoileostomyを作成した。2)continent cystoileostomyは確実な尿禁制がえられる尿路変向術であり, 膀胱保存が可能な症例で尿道が使用できない場合には有用な方法である, We performed continent cystoileostomy in which the technique of Kock's efferent nipple was utilized, on two female patients with urethral cancer and vulvar cancer. We recommend continent cystoileostomy for the patient who needs urethrectomy but whose bladder function can be preserved.

We report on a case of iatrogenic obstruction of the vas deferens following herniorrhaphy, successfully treated by vasovasostomy after an obstructive interval of 31 years, with his wife achieving pregnancy.

A case of simultaneous bilateral renal pelvic tumors is reported. A 64-year-old man with the chief complaint of gross hematuria and left flank pain was admitted. Clinical investigations revealed a tumor in the right pelvis and ureter, and another tumor in the left renal pelvis. The right ureteral tumor had invaded the bladder. Right nephroureterectomy, total cystectomy, left partial pyelectomy and ureterocutaneostomy were performed. By pathological examination, right renal pelvic and ureteral tumors were non-papillary transitional cell carcinoma, grade 3, pT4, and the left renal pelvic tumor was papillary transitional cell carcinoma, grade 2, pT1. To our knowledge, this is the 16th case of simultaneous bilateral urothelial tumors of the upper urinary tract in Japan.

We present a case of bladder transitional cell carcinoma with sigmoidovesical fistula due to diverticulitis. The patient was a 65-year-old male who had been suffering from recurrent abdominal pain with high fever for the past 6 months. He noticed pneumaturia and cloudy urine several times. He visited a doctor complaining of macroscopic hematuria and high fever, and was treated under the diagnosis of acute prostatitis. In our University Hospital cystoscopy showed a papillary bladder tumor. Pathological study of the tumor revealed transitional cell carcinoma, grade II, noninvasive type. Multiple diverticulosis of sigmoid colon was identified with barium enema examination. We performed transurethral resection of the bladder tumor. Three weeks later, the sigmoidovesical fistula was treated by primary resection of the sigmoid colon and wedge resection of the bladder including fistula.

We report a case of granulomatous prostatitis after intravesical BCG immunotherapy for superficial bladder cancer. A 58-year-old man presented with gross hematuria. Cystoscopic examination revealed multiple tumors at the posterior wall of the bladder. The patient underwent transurethral resection of the tumor. Intravesical BCG immunotherapy was postoperatively followed and it eradicated the disease. Digital examination revealed that the prostate became stony-hard and larger 10 weeks after the initial BCG immunotherapy. A needle aspiration cytology and biopsy of the prostate revealed the granulomatous prostatitis due to BCG immunotherapy.

1996

前報と同一の対象について, HE染色では, 思春期以後の停留精巣で精細管壁の肥厚と不整蛇行が認められ, 肥厚部はAzanで濃染した.肥厚は10歳頃から出現した.Weigert染色で弾力線維が認められるのは停留精巣では思春期以後のことであり, それも貧弱であった.電顕下に, 停留精巣の基底膜は, 思春期前では内・外各1層より成りinfoldingは見られず, 思春期後には外層の多層化が著明であった.線維層では膠原線維の増生が見られたが, それは5歳時より確認できた.細胞層では, 筋様細胞が思春期になって出現したが, 思春期後でも, 細胞辺縁のmicropinocytic vesicleの発達は不良であり, また, 細胞間の膠原線維増殖が著明で, 筋様細胞や線維芽細胞の表面は不整となり, 細胞突起も蛇行した, Morphological changes in the wall of the seminiferous tubules in the cryptorchid testes were studied using light and electron microscopy. Seventy four unilateral and bilateral cryptorchids (aged 2 to 37 years) were selected, and biopsied specimens were stained with H-E, Azan and Weigert for light microscopic observation. Twenty eight of these specimens were also examined by electron microscopy. In the undescended testes, light microscopy showed irregularity and thickening of the wall (tunica propria), and the thickened wall strongly reacted to the Azan stain. This thickening of the tunica propria was observed to begin at puberty, but was not found in the contralateral scrotal testes of the cryptorchids or in the normal testes. The wall of the normal adult testes was well stained by the Weigert stain, suggesting the presence of elastin. In the undescended testes, however, the wall was not stained in prepubertal or pubertal patients, and even after puberty the wall was stained much less than that in the contralateral scrotal testes and the normal controls. On electron microscopic observation, various ultrastructural changes were noticed in each component of the tubular wall; basement membrane, fibrous layer and cellular layer. In the undescended testes, the lamina densa of the basement membrane consisted of one layer with a serrated outer margin throughout the pre-pubertal and pubertal periods, while after puberty the lamina densa underwent marked multiple lamella formation and increased in thickness. In the fibrous layer was already noticed in the undescended testes of 5-year-old cryptorchids. The development of myoid cells in the cellular layer during puberty was observed to be delayed. The morphological changes occurring in the seminiferous tubular wall of the cryptorchid testes were believed to be related to the impaired spermatogenesis often found in cryptorchidism.

A 63-year-old male with transitional cell carcinoma of the bladder underwent total cystectomy. Five years later sequential excretory urography and urinary cytologic examination revealed tumor recurrence in the left pelvis and ureter; left nephroureterectomy was performed in July, 1984. In December, 1985, he complained of macrohematuria and urinary cytology was positive. Ileal conduitgraphy showed filling defects at the bilateral uretero-ileal anastomosis, where two papillary lesions were disclosed by endoscopic examination. In January, 1986, total extirpation of the ileal conduit and reconstruction of a new ileal conduit was performed. Macroscopically the two lesions were found to be a papillary tumor at left uretero-ileal anastomosis and a polypoid tumor distal to right uretero-ileal anastomosis. Histological examination revealed both tumors to be grade II transitional cell carcinoma. This rare case is discussed and the literature is reviewed.

進行尿路上皮癌患者に対して補助化学療法としてVCR, MMC, BLMを用いた3者併用療法を9例に施行しCDDP, PEP, MMCを用いた3者併用療法を13例に施行した.平均観察期間は16.5ヵ月であり無腫瘍生存期間は14.5ヵ月である.化学療法別ではVMB群では9例中3例33.3%が無腫瘍生存, PPM群では13例中53.8%が無腫瘍生存である.単純な比較はできないがPPM療法の方が良好な成績である.重篤な副作用はみられなかった, The effect of postoperative adjuvant chemotherapy was studied in 22 cases of advanced urinary epithelial cancer. Vincristine, mitomycin C and bleomycin (VMB) was administered in combination to 9 prophase cases from December, 1980 to March, 1982 and cis-dichlorodiamine platinum, peplomycin and mitomycin C (PPM) in combination to 13 anaphase cases from April, 1982 to November, 1984. The site was renal pelvic cancer in 3 cases, cancer of the ureter in 3 cases, cancer of the bladder in 13 cases, cancer of the pelvis, ureter, and bladder in 1 case, and recurrence of pelvic cancer following bladder cancer in 2 cases. The degree of invasion was pTa in 2 cases, pT1 in 1 case, pT2 in 1 case, pT3 in 11 cases and pT4 in 5 cases. Lymph node metastasis had occurred in 9 cases, no metastasis in 8 cases and it was unclear in the remaining 6 cases. The mean observation period was 16.5 months; 10 patients were alive without any tumors, one patient was alive with a tumor, 11 patients died of cancer, and one patient died intercurrently. The mean postoperative survival period in the mortality cases was 14.5 months. According to the classified type of chemotherapy received, there were 3 out of 9 cases (33.3%) who survived without tumors after receiving VMP and 7 out of 13 cases (53.8%) in the PPM group who survived without tumors. Although a simple comparison cannot be made, it appears that PPM therapy is superior. No severe side-effects were observed.

Objectives and methods of the study: Although superficial bladder carcinoma can be surgically eliminated by TUR, recurrence is common. Various attempts have been made to prevent recurrence, but to date an excellent prophylactic method with few adverse reactions has not been established. We conducted a clinical trial study for prophylaxis of bladder carcinoma recurrence, using intravesical instillation of bleomycin, a drug which cause little local irritation, in combination with bestatin, a recently developed immunomodulator. Bleomycin was selected on the bases of experimental results. That is, in beagle dogs, the 1-hour intravesical instillation of bleomycin gained a drug concentration in the bladder wall of 2.08 micrograms/g, which is approximately 4 times higher than that in the intravenous administration of the same dose. The above bleomycin concentration was thought enough to obtain a good clinical effect. A total of 124 patients were randomly divided into the two treatment groups: An only bleomycin intravesical instillation group (60 mg on each treatment day) (58 patients) and a bleomycin with bestatin (60 mg per every day) group (66 patients). In the 2-year follow-up period the recurrence of bladder carcinoma in the two treatment groups was studied. Analysis of non-recurrence rate by life-table method and Kaplan-Meier method: The non-recurrence rate of the bladder carcinoma every three months was calculated by the life-table and Kaplan-Meier methods. The non-recurrence rate in the bleomycin group was approximately the same as the rates in adriamycin or mitomycin reported in the literature. In the bleomycin + bestatin group, the recurrence rates at 9 months and 12 months were significantly (at P = 0.09 and P = 0.08, respectively) lower, and in addition, even the 2-year overall non-recurrence rate curves showed a nearly significant difference (P = 0.179). Especially in the case of papillary pedunculated tumors, the difference in the non-recurrence rate curves was almost statistically significant (P = 0.104). The stratified analysis on the basis of various tumor factors, were as follows. Pathological grade: Although no differences were found in Grades 1 and 2, the bleomycin + bestatin group had a lower recurrence rate in Grade 3 cases (P = 0.1).(ABSTRACT TRUNCATED AT 400 WORDS)

Two cases of long ureteral polyps are presented. The patients were a 46-and a 40-year-old women, complaining of gross hematuria and miction pain respectively. Excretory urographies showed filling defects of right ureter and lower part of left ureter respectively. Right and left total nephroureterectomy with bladder cuff were respectively performed because of malignant possibility. The tumors removed were benign polyps, measuring 19 and 5 cm in length, respectively. The 19 cm polyp is the longest in Japan. The former case was suspected as hamartoma from mullerian duct and the latter as simple fibro-epithelial polyp.

A case of malignant fibrous histiocytoma (MFH) occurring in th retroperitoneum with giant pyonephrosis is reported. The patient was a 45-year-old male and his chief complaint was an abdominal mass. The abdominal fullness progressed so rapidly that he was admitted to our hospital. After examination, this case was diagnosed as a malignant tumor with left hydronephrosis, and an operation was performed on August 5, 1982. At operation, the left kidney contained about 11, 000 ml of a pus-like fluid and in the retroperitoneum was found a hen-egg-sized solid tumor which was invading into the left kidney and the feeding vessels of the descending colon. So the tumor, left kidney and a part of the descending colon were resected en bloc. Pathological diagnosis was malignant fibrous histiocytoma. Chemotherapy (PPM regimen) and immunotherapy (OK-432) were administered after the operation, but multiple metastases appeared in the liver and bilateral lungs within 3 months. Then, the CY-VA-DIC regimen was followed. But, local recurrence was found in about 5 months, and the patient died on the 174 th day after the operation. Local recurrence and metastases in the liver, bilateral lungs, pleura and bones were confirmed at autopsy. Besides our case, a review of case reports of retroperitoneal MFH in Japan and comments are presented.

男子不妊症396例(25施設)に対するMethyl-B12の有用性を, 6, 000 μg/日投与群, 1, 500 μg/日投与群, Placebo投与群の12週間投与による二重盲検比較試験により検討した.WHOの規定とも合致することから, 精子数20×100/ml以下の症例について治療効果の検討を試みた.運動率50%以下, LH 13.5 mIU/ml以下の正常範囲にとどまる症例では, 精子数の正常化した症例がPlacebo群に比して6, 000 μg群, 1, 500 μg群で有意に多く認められ, 精子数, 運動率, LH値の3パラメーターを変化させながら治療効果が有効となる条件を検討したところ, 計57.1%の症例で治療効果が期待できる効果となった.また重篤な副作用は認められず, 安全性の高い薬剤であることが確認された.以上の結果から, 上記の条件における乏精子症に本剤, とくに6, 000 μg/日投与は有効な薬剤であると考える, The clinical efficacy of mecobalamin in the treatment of male infertility was investigated by means of a multicenter collaborative study with 25 participating institutions. The study was carried out as a double-blind, comparative trial using three administration groups: 6, 000 micrograms of mecobalamin per day, 1, 500 micrograms of mecobalamin per day and a placebo group for 12 wk. The following results were obtained. 1. The total number of evaluated subjects was 375, consisting of 125 in the 6, 000 micrograms/day mecobalamin group, 124 in the 1, 500 micrograms/day mecobalamin group and 126 in the placebo group. There were no significant differences among the three administration groups in terms of the patient's background factors. 2. When all of the patients were analyzed, there were no statistically significant differences among the three administration groups in terms of the efficacy in relation to the sperm count or the motility rate. 3. However, it was decided to perform a more detailed analysis of the therapeutic efficacy in patients whose pretreatment sperm counts were 20 x 10(6)/ml or less. The reasons for this decision were two-fold: 1) There was a large degree of fluctuation in patients whose pretreatment sperm counts showed a mean value of more than 20 x 10(6)/ml for two or more determinations, and it was surmised that this fluctuation might have masked any therapeutic effect in those cases. 2) The WHO definition of oligozoospermia was recently decided as a sperm count of 20 x 10(6)/ml or less.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of primary adenocarcinoma of the urinary bladder occurring in a patient with type 1 multiple endocrine adenomatosis (MEA) is presented. The patient was a 36-year-old female who had a past history of type 1 multiple endocrine adenomatosis, namely, adenomatosis of the parathyroid gland, insulin and gastrin-producing adenomatosis of the pancreas, and prolactin-producing pituitary adenoma. She was admitted in January 1981 with the complaints of gross hematuria, pollakisuria and micturition pain lasting for about one year and a half. Cystoscopic examination revealed four solid tumors in the posterior and left lateral walls of the bladder with diffuse mucosal hyperemia. Biopsy of the tumors disclosed that they were adenocarcinoma. Clinical examinations revealed that there was no extravesical primary malignant neoplasm in this case. Radical cystectomy with urinary diversion by ileal conduit was performed on January 22, 1981. Histological examination revealed that the tumor was adenocarcinoma originating from the vesical mucosa. Follow-up for over three years since the time of surgery has not shown any sign of tumor recurrence or occurrence of extravesical malignant neoplasm. In addition, 28 cases of primary adenocarcinoma of urinary bladder in Japan reported during the last 25 years are reviewed and analyzed.

A 50-year-old man, who had undergone operation of esophageal carcinoma 2 years earlier, was admitted with the complaints of right flank pain and macroscopic hematuria. Intravenous urogram showed right unvisualized kidney. Right retrograde pyelography showed the dilatation of calices and irregularity of middle and lower calices. Computed tomography revealed severe hydronephrosis of the right kidney. Right nephrectomy was performed under the diagnosis of either renal pelvic cancer or esophageal cancer metastatic to the kidney. Pathological examination revealed metastatic squamous cell carcinoma from esophagus. The patient was treated by radiotherapy but died 4 months after the surgical treatment. Literature on eight case of metastatic renal cancer from esophagus is reviewed.

接着, 縫合部補強, 止血を目的として, 21回使用した.有用性は100%と考える.副作用としては, 1例で術後長期にわたる肝障害を示したが, Tisseelによるものとは判定できなかった.局所の組織反応は, かなり強いが接着力は強く止血効果も優れている, Our experience with the use of a new biological tissue adhesive (Tisseel) consisting of highly concentrated human fibrinogen, thrombin and factor XIII in urologic surgery is reported. In 21 operations (18 patients), Tisseel was used for the purpose of tissue adhesion and reduction of sutures of the renal parenchymal wound in nephrolithotomy, water tight sealing in suture part of expanded pyelolithtomy and vasovasostomy, and local hemostasis of oozing in prostatectomized fossa. Tisseel was not responsible for the two unsuccessful trials; and, undesirable complications due to this adhesive were few. Our results revealed that this new fibrin adhesive will be useful for urologic surgery.

The patients who undergo total cystectomy for high stage bladder carcinoma have poor prognosis because of local extension or distant metastases. In the case of recurrent lesions after total cystectomy, radiotherapy and chemotherapy are generally selected. In some cases of recurrent tumors localized within the pelvic cavity and with no distant metastases, however, surgical resection of the tumor is effective in local disease control combined with radio- and chemotherapy. Surgical treatment is not only effective in reducing the cell number in a bulky tumor, but also improves clinical symptoms and conditions such as pain, bleeding, rectal irritability, intestinal obstruction and so on. We present here three patients who underwent extensive operation for pelvic recurrence of bladder carcinoma following total cystectomy. Two of these cases died of progressive disease, nine months and five months after the extensive operations. The third patient died of acute pericarditis thirteen months after the second operation. Autopsy revealed that the surgical treatment was effective in controlling the local recurrence in the third case. Furthermore, some problems regarding pelvic recurrence and surgical treatment are discussed.

A case is presented of priapism resulting from disseminated intravascular coagulopathy (DIC), which was diagnosed by pathological studies of the amputated penis and skin biopsy. To our knowledge, this is the first case reported in Japan. This 72-year-old-man visited a hospital complaining of fever and cough, and was administrated for treatment of bronchitis and liver cirrhosis. A few days after admission, multiple purpura with edema and pain appeared over the skin regions on the bilateral knee joint, foot joint and upper extremities. A week after purpura appeared, priapism began. Regardless of irrigation and aspiration of corpora cavernosa and glans-cavernosa-fistula creation, penile necrosis developed. We had to perform penile amputation. The pathology of the amputated penis and skin, and blood coagulative examination suggested that DIC resulted in priapism. DIC was controllable by the use of FOY and heparin. He was discharged and is an outpatient.

Three cases of renal angiomyolipoma are reported. The first case was a 53-year-old female with the complaint of left flank pain. In both cases selective angiography revealed a renal tumor, and computerized tomography disclosed a renal mass with low density corresponding to the fat tissue. From several examinations these two cases were preoperatively diagnosed as renal angiomyolipoma and nephrectomy was performed. Histopathological diagnosis was renal angiomyolipoma. The third case was a 64-year-old female with the complaints of left flank pain and macrohematuria. In this case computerized tomography revealed a renal mass which did not have a low density area. The possibility of renal cell carcinoma was considered and nephrectomy was performed. Histological diagnosis was renal angiomyolipoma which was primarily composed of smooth muscle cells. The first case had a calcified lesion in the brain. But there was no evidence of tuberous sclerosis in the following two cases. Some problems in diagnosis and treatment of renal angiomyolipoma are presented, and a statistical study is made on 194 reported cases of renal angiomyolipoma in Japan.

We have been studying the cause of idiopathic male infertility by means of testicular biopsy, and already have made several reports. This is a summary of these reports and a presentation of our concept for hypothetic pathogenesis of idiopathic infertile testes. Testicular biopsies were performed by Charny's accepted technique and tissues examined by light microscopic, histochemical, and transmission and scanning electron microscopic procedures. Also the circulatory sexual hormones; follicle stimulating hormone, luteinizing hormone, and testosterone of all patients were measured. The primary pathogenetic changes occur in the seminiferous tubular walls which are thickened by increase in immature collagen fibers and lamellation of seminiferous basement membrane, and they are followed by increase of follicle stimulating hormone. These seminiferous tubular changes occur discontinuously, so the idiopathic infertile seminiferous tubules resemble a rope strangulated in various places, or a tail-like rope gradually becoming thinner. Also, activated mast cells increase around the strangulated places. Thus, spermatogenesis in strangulated tubular parts decreases because of the nutritional disturbance caused by thickened tubular walls, and the strangulation of tubules interferes with the travel of sperms in the seminiferous tubules by interrupted seminiferous tubular peristalsis. Sloughing or disorganization in the infertile seminiferous tubules can be observed. In the infertile testes, Leydig cells generally increase with the elevation in the level of luteinizing hormone, but serum testosterone does not increase. And this normal value of serum testosterone is statistically found to be caused by the degradation in the quality of Leydig cells in idiopathic infertile testes. Also, galactose deficiency in glycoproteins of idiopathic infertile testicular tissue is reported.

We report a case of rhabdomyosarcoma of the prostate. The patient was a 56-year-old man who complained of anal pain and dysuria. Tumor of the prostate was suspected after rectal examination. Multiple metastatic lesions were found in the lungs and liver. A needle biopsy of the prostate revealed rhabdomyosarcoma. He received chemotherapy, using Etoposide and responded slightly. Subsequently VAC-therapy was also performed. Although the patient improved temporarily, he died 4 months after admission.

PVB療法を施行した14例の進行睾丸腫瘍の治療成績を報告した.14例中CRが4例, PRが6例で全体の奏効率は71.4%であった.CR後2例が再発した.死亡例は9例, 全例癌死であった.CRの得られなかった症例9例が死亡した, Two patients with stage II, 12 patients with stage III advanced testicular cancer, were treated with a combination of CDDP, vinblastine and bleomycin. Four of the cases (28.6%) achieved a complete response and 6 (42.9%) achieved a partial response. The over all response rate was 71.4%. After CR, 2 cases (50%) showed relapse. Although the treatment confirms some efficacy of the drug regimen, the prognosis is poor in bulky metastasis. Early induction therapy with etoposide is necessary in cases of high volume metastasis.

1) 20例の尿路感染症に対し, 酵素抗体法によるACBの検出をおこなった.臨床的に診断された感染部位とACBとは, きわめてよく相関した.2) cefaclorの有効率は, 急性単純性膀胱炎80%, 急性腎盂腎炎100%, 複雑性尿路感染症60%であり, 尿路感染症全体では80%であった.3) cefaclorは, 臨床的に腎盂腎炎と診断され, しかもACB陽性の症例に対して100%の有効率を示した.これは臨床的に膀胱炎と診断され, しかもACB陰性の症例に対する有効率87.5%とほとんど差がなく, cefaclorは尿路感染症の治療薬として充分臨床効果が期待できる, Twenty out-patients suffering from urinary tract infections (UTI) were treated with cefaclor. Cefaclor was administrated orally in daily doses of 1, 500 mg for 7 days against 15 cases of simple UTI and 5 cases of complicated UTI. Of 20 cases with acute simple cystitis, acute pyelonephritis and complicated UTI, clinical responses were excellent in 10 cases, good in 6 cases and poor in 4 cases. The efficacy rate was 80%. No side effect was observed. The site of infection determined by the ACB detection method was in good agreement with that determined by clinical findings. Cefaclor appeared to be equally effective in the treatment of both ACB-positive and ACB-negative infections. The presence of absence of antibody-coated bacteria did not correlate with clinical symptoms or response to therapy.

1973年より1983年の間に原発性膀胱癌95例に対し膀胱全摘除を行なった.「泌尿器科, 病理膀胱癌取扱い規約」に従い, その病理組織と予後についての検討を加えた.膀胱癌の組織型別には, 移行上皮癌87例, 扁平上皮癌5例, 腺癌2例および未分化癌1例であった.全体の5年実測生存率は36.0%であった.増殖様式に関しては, 乳頭状非浸潤型100%, 乳頭状浸潤型25.8%, 非乳頭状浸潤型34.8%であった.5年生存率と進展度との関係では, pTa 81.1%, pT1 64.7%, pT2 40.1%, pT3a 30.5%, pT3b 22.6%, pT4 6.7%であり, 移行上皮癌87例のうち5年生存率と悪性度との関係では, grade 1 100%, grade 2 43.0%, grade 3 32.1%であった.予後指標としては, 壁内リンパ球浸潤, 血管浸潤および壁内浸潤の病理組織学的様式が重要であった, Total cystectomy was performed on 95 patients with primary urinary bladder cancer between 1973 and 1983. Histopathological and prognostic studies were reviewed according to the general rules for clinical and pathological studies on bladder cancer. The cancer histological type were transitional cell carcinoma in 87 cases, squamous cell carcinoma in 5 cases, adenocarcinoma in 2 cases, and undifferentiated carcinoma in 1 case. The overall 5-year actuarial survival rate was 36.0%. As for the growth pattern of the bladder cancer, the 5-year survival rates for the patients with papillary non-invasive type (PNT), papillary invasive type (PIT), and non-papillary invasive type (NIT) were 100%, 25.8% and 34.8% respectively. As for the stage, the 5-year survival rates for the patients with pTa, pT1, pT2, pT3a, pT3b, and pT4 were 81.8%, 64.7%, 40.1%, 30.5%, 22.6% and 6.7% respectively. Of 87 patients with transitional cell carcinoma, the 5-year survival rates for the patients with grade 1, grade 2 and grade 3 were 100%, 43.0% and 32.1% respectively. Intramural lymphatic invasion and vascular invasion and intramural histopathological mode of spread were significant indicators of prognosis.

根治的膀胱全摘除術を施行した膀胱癌71例について予後に関与する因子を多変量解析を用いて検討した.今後に影響を及ぼす因子として深達度・手術時期・リンパ節転移が重要であった.術後補助化学療法(PPM療法)は, 深達度・リンパ節転移の二つの主要要因により補正した場合にPPM施行症例では非施行症例に比べて予後に関してやや有利な状態をもたらす可能性が示唆された, Multivariate analysis by Cox's proportional hazard model was performed on 71 bladder cancer patients treated by radical cystectomy to clarify factors affecting survival and to evaluate the efficacy of postoperative adjuvant chemotherapy. Clinicopathologic data included in the analysis were age, sex, interval from onset of symptoms to first consultation, prior tumor history, year of operation and tumor characteristics: size, number, growth pattern, stage, grade, mode of infiltration, lymphatic invasion, lymph-node metastasis and lymphocyte infiltration around tumors. Analysis revealed that stage is the most statistically significant factor for survival (p less than 0.0001); followed by year of operation (p less than 0.05) and lymph node metastasis (p less than 0.1). The above three determinants yielded hazard ratios of 16.6 for stage (pT3a-pT4 vs. pTis-pT2), 2.7 for year of operation (1978-1982 vs. 1983-1987) and 2.4 for lymph node metastasis (positive vs. negative). Postoperative adjuvant chemotherapy consisting of cisplatin, peplomycin and mitomycin C (PPM therapy) seemed to improve survival, when the influence of the major prognostic factors were adjusted by the proportional hazards model. The authors conclude that stage and lymph node metastasis should be considered when postoperative adjuvant treatment is selected for patients with bladder cancer treated by radical cystectomy, and that further prospective randomized trials are mandatory to confirm the efficacy of postoperative adjuvant PPM therapy suggested by the present retrospective multivariate analysis.

正常成人6名を対照とし, 2～37歳の片側及び両側性停留精巣患者74例についてそれぞれ生検により間細胞を観察した.思春期前の停留精巣では, 成熟型間細胞は殆どなかったが, 思春期後では, 正常精巣におけるよりも過形成が認められ, その過形成を光顕下各対象の全視野の精細管数, 間細胞数, 間細胞塊数, セルトリ細胞数及びそれら相互の関係の面から検討した結果, 間細胞塊数/精細管数が, 過形成の定量的評価に最も有用と考えられた.この評価法でも, 過形成は健側において, より著明であった.正常成人精巣には, 電顕下で, 未熟型並びに成熟型間細胞が区別されたが, 停留精巣においては, 5歳以後でも成熟型間細胞は殆ど見られず, 思春期になってその出現を見たが, 依然として前駆細胞が優位を占め, 成熟型細胞が多くなるのは, その後のことであった.HCGを投与した患児の停留精巣では5歳でも成熟型細胞が出現した反面, 思春期後の停留精巣には, 種々の退行性変化が認められた, A morphological study of the Leydig's cells in the testes of cryptorchid patients was made by light and electron microscopy. Seventy four unilateral and bilateral cryptorchids (aged 2 to 37 years) were selected for light microscopic observation, and 28 of these specimens were also examined by electron microscopy. In 5 cases of pre-pubertal and pubertal cryptorchids, tissue specimens were biopsied after 20, 000 units of HCG had been given and examined similarly. In addition, Leydig's cell density was evaluated quantitatively in the undescended and contralateral scrotal testes of 12 post-pubertal patients. This was based on the determination of the total number of Leydig's cells, Leydig's cell clusters and seminiferous tubules in the entire histologic section of each biopsy and the calculation of the following indices; mean number of Leydig's cells per tubule, mean number of Leydig's cell clusters per tubule and mean number of Leydig's cells per cluster. In addition, the number of Sertoli's cells was counted, and the ratio of Leydig's cells to Sertoli's cells was also calculated. In the undescended testes, almost no mature Leydig's cells were found by light or electron microscopy during pre-pubertal periods; and, even in puberty they were few, while immature precursor Leydig's cells were abundant. In the 5 cases treated preoperatively with HCG, even at 5 years, mature Leydig's cells were observed by light and electron microscopy. On the contrary, after puberty, not only the undescended but also the contralateral scrotal testes of the cryptorchids had more mature Leydig's cells than the normal controls. This Leydig's cell hyperplasia was also confirmed by the quantitative analysis of Leydig's cell density. In the mature Leydig's cells of the undescended testes, however, the electron microscopic observation showed marked regressive changes, in cytology especially prominent depletion of the smooth endoplasmic reticulum and frequent occurrence of specific cytoplasmic inclusion bodies. Such regressive changes as found in the cells of the undescended testes were not observed in the cells of the contralateral scrotal testes. Thus, the morphological alteration of Leydig's cells observed here suggest that the cells are in a dysfunctional condition and that the androgen production is consequently decreased in the undescended testes of cryptorchid patients.

Workers in the dye manufacturing industry have a high risk of urinary bladder cancer. There may also be a high relative risk of bladder cancer in occupational dye users. Nine occupational dye users were found to have bladder cancer. The period of engaging with dye work ranged from 5 to 40 years. Seven patients had bladder cancer and the other 2 patients had lesions both in the bladder and in the renal pelvis. Histopathology of all cases was transitional cell carcinoma. Three cases were classified into grade 1 and 6 cases into grade 2. One patient died of bladder cancer. The other 8 patients are alive. Four cases recurred after TUR therapy. It is necessary to establish systemic mass screening examination of occupational dye users for the early diagnosis of bladder cancer.

特発性男子不妊症の精巣間質のLeydig細胞の定量化を行い, 精子数による比較あるいは血中ホルモン, 精細管の障害程度との関係をしらべ, また, Leydig細胞の超微構造を観察した.精細管断面1個あたりの平均のLeydig細胞数は, 健常人に比して乏精子症, 無精子症ともに有意に増加していた.また, この値は, 血中LHおよびFSHと有意の正の相関, Johnsen's scoreとは有意の負の相関を示したが, 血中テストステロンとは相関を示さなかった.次いで, SERの発達度によってLeydig細胞を3型に分類し, 健常人と不妊症患者間での各型の差異について検索した, Testicular biopsy was performed on 51 patients with idiopathic male infertility and 13 normal fertile adults. The biopsied specimens were examined by light and electron microscopy. A quantitative evaluation of Leydig cell number was made by determining the mean number of Leydig cells per one cross section of seminiferous tubule in the entire histologic section of each specimen, which was defined as "Leydig cell index". In both oligospermic and azoospermic groups, the Leydig cell index was significantly elevated as compared with in that the normal group, which indicated the presence of Leydig cell hyperplasia in the infertile testis. In addition, this index significantly correlated with serum luteinizing hormone and follicle stimulating hormone levels but not with serum testosterone level. Leydig cells were classified into three types based upon their morphological characteristics. Type I Leydig cells were functionally active and mature ones, with a smooth-surfaced round or oval nucleus, had abundant smooth endoplasmic reticulum (SER), characteristic mitochondria and relatively few lysosomes. Type II Leydig cells were functionally less active, and contained an irregularly shaped nucleus, less abundant SER, mitochondria with undeveloped cristae and relatively few lysosomes. Type III Leydig cells included immature and regressive cells, which were considered to have almost no hormone secreting function. The immature Leydig cells were spindle-shaped and had few cell organelles. The regressive cells had poorly developed SER and many secondary lysosomes in the cytoplasm. In the normal group, type I Leydig cells are the most numerous but in the infertile groups type II Leydig cells are the most numerous. However, in the latter, there is no significant difference in relative number of each Leydig cell type among the groups classified according to the number of sperm or Leydig cell. In summary, Leydig cell hyperplasia observed in the testis of the infertile patients was supposed to be induced by the elevation of the serum LH. Despite of the significant increase in Leydig cell number, the serum testosterone was not elevated, and this was considered to be due to the fact that the hyperplastic cells are mainly composed of functionally less active type II Leydig cells. In addition, especially in the severe hyperplastic group, not only type II but also type I Leydig cells increased in number. However, in this group, the serum testosterone level was not elevated. Therefore, the function of type I Leydig cells was suggested to be impaired.

男25例, 女5例(平均33歳), 交通事故に因るもの19, 転落5, スポーツ外傷2であった.CTでは排泄性腎盂造影に比し異常所見検出に感度が高く, 重症度判定に有用である.保存的治療を行った27例は, 顕微鏡的血尿は腎挫傷で4.1日, 小裂傷で13日, 大裂傷で42日であった, To evaluate the diagnostic value of radiographic examinations in renal trauma, 30 patients treated between April, 1985 and March, 1988 were examined. The 25 male and 5 female patients ranged in age from 10 to 74 years, with 17 (57%) less than 30 years of age. Causes of injuries were traffic accidents in 19 patients (63%), falls in 5 (17%), sports in 2 (7%), and others in 4 (13%). Twenty-nine patients (97%) had hematuria and 3 (10%) had shock due to renal injury. The presence of shock indicated severe renal injury, but the degree of hematuria did not correlate to severity of injury. Of the 30 patients, 18 (60%) had renal contusions, 7 (23%) had minor lacerations, 4 (13%) had major lacerations and one had vascular injury. One patient had penetrating trauma and the other 29 had blunt trauma. Two patients (7%) had pre-existing renal anomalies. Associated injuries were present in 16 patients (53%). The presence of associated injuries had no relation to the severity of the renal injury. Computerized tomography (CT) with contrast medium was more sensitive to abnormal findings, especially subcapsular and perirenal hematoma, than excretory pyelography. Findings of renal angiography provided additional anatomical information for deciding immediate surgical treatment and for selecting operative methods for salvage of the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

Rowatinex were used in the twenty-four cases o f urolithiasis and obtained results as follows: 1. In eighteen cases (75%), Rowatinex showed effective for urolithiasis. Spontaneous excretion of calculi were seen in fourteen cases (58.3) of them and descending of calculi were observed by plain film in four cases (16.9%) of them. Six cases (25%) did not respond to Rowatinex therapy. 2. Improvement o f the subjective symptoms following Rowatinex therapy were seen in twenty-one cases (87.5%). 3. Expelled calcu l i were all smaller than 0.8 cm in their diameter. 4. Rowatinex is recommended not only for the dissolut i o n and acceleration of dischargruy calculi but for prevention of their recurrence.