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局所浸潤性膀胱癌9例に対し術前動注化学療法(IAC)を施行する際, 生検組織より行った制癌剤感受性試験の結果に基づき制癌剤を選択した.これに引き続いて膀胱全摘を行い, 治療効果を摘出標本の組織学的効果, 遠隔成績より検討した. 1)全例において制癌剤感受性の評価が可能であった.感受性試験の結果に基づくIACの組織学的効果はG3が3例, G2, G1b, G1aがそれぞれ2例であり, 結局9例中3例においてpCR, 4例でdownstagingが得られた. 2)平均観察期間38.9ヵ月の時点において, 9例中7例でNEDが保たれていたが, 2例は術後2年以内に遠隔転移により癌死した, We investigated the clinical usefulness of individualization of chemotherapeutic regimen in neoadjuvant intra-arterial chemotherapy for locally invasive bladder cancer. Anticancer drugs were selected according to the results of an in vitro chemosensitivity test (collagen matrix assay or succinic dehydrogenase inhibition test). Nine patients with locally invasive bladder cancer received 1 to 4 courses of neoadjuvant intra-arterial chemotherapy, followed by radical cystectomy. Histopathological responses in the cystectomized specimens were grade 3 in 3 cases, grade 2 in 2, grade 1b in 2 and no response in 2. Pathologically, a complete response and downstaging were observed in 3 and 4 cases, respectively. Seven of the 9 patients were alive no evidence of disease with a mean follow-up period of 38.9 months, whereas 2 patients died of metastasis within 2 years. Six of the 7 patients who showed a complete response or down staging have been free of recurrence. These findings suggest that our chemotherapeutic strategy may improve the prognosis for locally invasive bladder cancer.

ビカルタミド1日1回50mg群, 80mg及び100mgを12週間投与する3群比較の無作為化非盲検試験を実施した. 1)登録症例は124例で, 適格例は122例であった. 2)総合効果における奏効率は50mg群, 80mg群及び100mg群でそれぞれ50.5%, 61.0%及び53.7%であった. 3)PSAに対する奏効率は50mg群, 80mg群及び100mg群でそれぞれ84.2%, 92.7%及び97.6%であった. 4)副作用発現率は3群ほぼ6割で副作用による中止例は80mg群の1例のみで, 安全度において3群間に有意差はなかった.主な副作用は乳房腫脹, 乳房圧痛等であった, To investigate the efficacy and safety of bicalutamide (Casodex(R)) with its clinically recommended dose, the randomized early phase II study was performed in 124 patients with prostatic cancer (stage C, D). The patients were given 50, 80 or 100 mg of bicalutamide orally once a day in fixed doses for 12 weeks ; 122 patients were eligible for evaluation. The overall response rate was 50.0% (20/40); 61.0% (25/41) and 53.7% (22/41) in the 50 mg, 80 mg and 100 mg groups, respectively. The response rate in prostate lesion, bone and lymph node metastases was slightly higher in the 80 mg group than in the 50 mg and 100 mg groups. The proportion of patients showing a response with regard to serum PSA (CR and PR) was 84.2, 92.7 and 97.6% in the 50, 80 and 100 mg groups, respectively. The incidence of adverse reactions was 65.0, 61.0 and 61.0% in the 50, 80 and 100 mg groups, respectively, and there was no significant difference in overall safety rating in the three groups. Frequent adverse reactions were gynecomastia and breast pain. Only one patient in the 80 ing group was withdrawn due to shortness of breath. Serum concentrations of LH, testosterone and estradiol increased significantly after treatment. Bicalutamide was concluded to be effective and well tolerated in patients with prostatic cancer, and its recommended dose was 80 mg once daily.

35歳女.下大静脈浸潤を伴い, 血管撮影検査でhypervascularな像を呈す, 不全型, 腎明細胞肉腫に分類される成人Wilms腫瘍の例, The patient was a 35-year-old female with the chief complaint of macrohematuria. Computerized tomographic (CT) scan, ultrasonography and magnetic resonance imaging (MRI) revealed the presence of a large and inhomogeneous mass in the left kidney, and a tumor thrombus growing in the inferior vena cava. Angiography also showed a hypervascular tumor in the left kidney. The chest X-ray and CT scan demonstrated multiple metastatic lesions in the bilateral lungs. Radical nephrectomy and thrombectomy was performed under the diagnosis of left renal tumor with its invasion of inferior vena cava. Pathological findings revealed that this tumor was nephroblastoma, and its type was clear cell sarcoma of the kidney (CCSK). The patient received chemotherapy according to National Wilms' Tumor Study (NWTS) IV chemotherapeutic drug regimen. In general, CCSK is known to have poor prognosis. However, doxorubicin has been reported to have a relatively good antitumor effect for CCSK. However, in this case, the evaluation after the first course of chemotherapy was progressive disease, because some new lesions appeared, although most old pulmonary metastatic lesions were reduced.

We reported two cases of primary sclerosing lipogranuloma in the scrotum. We performed tumor resection in both cases, but in one of the two cases tumor recurrence was observed 7 days after the removal. Sixty-three cases have been reported in our country, and we discuss the diagnosis and treatment with reference to previous reports.

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.

1984～1987年の間に検討した前立腺癌200例中, 本剤経口投与開始から1年以上継続観察し得た96例について検討した.96例中33例では主治療に本剤を用い, 63例では本剤治療前に他の薬物が用いられていた.12例は本剤単独で, 84例は合併療法であった.初回治療38例, 維持療法37例, 再燃時治療11例, その他10例であった.本剤の効果判定可能67例では, 著効10例, 有効16例, やや有効15例, 無効26例であった.1, 3及び5年生存率はそれぞれ92.6%, 66.0%, 及び46.3%であった.22例で副作用がみられ, 中3例で投与を中止した, Two hundred patients with prostatic cancer were enrolled in our previous study between 1984 and 1987. In this study, 96 patients of them were observed for 1 year or more after oral administration of Estracyt (estramustine sodium phosphate). Of these 96 cases, 33 patients were treated with Estracyt as primary treatment and 63 patient had been treated with other treatments before Estracyt treatment. Twelve patients were treated only with Estracyt and 84 patients also received other treatments. Thirty-eight patients were on primary therapy, 37 patients were on maintenance therapy, and 11 patients were on primary therapy, 37 patients were on maintenance therapy, and 11 patients were on the re-activated stage therapy and 10 patients were others. In conclusion, among the 67 cases in which the due judgement of the effect was possible, Estracyt was markedly effective in 10 cases (14.9%), effective in 16 cases (23.9%), slightly effective in 15 cases (22.4%) and ineffective in 26 cases (38.8%). The survival rate was 92.6% at the first year, 66.0% at the third year and 46.3% at the fifth year in the follow-up study. Adverse reactions were observed in 22 cases (22.9%), among which the administration was discontinued in 3 cases.

良く撹拌して気泡を混じた10%グリセリン溶液を膀胱内に注入すると, 排尿の全経過を通じて, 経直腸的超音波探触子により尿流線が観察できた.ビデオ記録解析上, 気泡の追跡により尿流線速度を測定した所, 膀胱内で約28.4 cm/秒で, 膀胱頸部で116.6 cm/秒に増加した, Although many urodynamic techniques have been used to evaluate the function of the lower urinary tract, the principles of these measurements are only based on a relationship between flow rate and pressure. In addition to these measurements, the intravesical urine stream would provide useful information on urodynamics. We have experimentally attempted to visualize the urine stream in a bladder using transrectal ultrasound examination. Since an air-particle is a good target for ultrasound visualization, we instillated a 10% glycerine solution into the bladder for the maintenance of air-particles. Before instillation, this glycerine solution was strongly shaken so that air-particles were kept in the solution. The urine stream was successfully observed throughout the whole process of voiding. In video-recording analysis, the velocity of urine stream was measured by tracing some air-particles. The velocity of urine stream was approximately 28.4 cm/sec in the body and increased to 116.6 cm/sec at the bladder neck. Thus, the urine stream was accelerated toward the urethra during voiding. Therefore, it seems that visualization of the urine stream offers a new parameter for evaluation of urodynamic studies.

良性前立腺肥大症49例で1日1或いは2回本剤を投与した所, 自・他覚的症状は有意に改善された.残尿量及び残尿率は有意に減少した.平均及び最大尿流量率は有意に増加した.適正量は, 1日1回, 25～75 mg, 或いは1日2回, 25～100 mgと思われた.有害反応及び異常な臨床検査所見は軽度であった, A new alpha 1-adrenergic receptor antagonist, KT-611 (naftopidil) antagonized dose dependently the contraction induced by agonists, noradrenaline and phenylephrine in the human prostatic tissue. KT-611 at a dosage of once or twice a day was evaluated for its effects on 49 patients with benign prostatic hypertrophy. The drug improved subjective and objective symptoms significantly. The residual urine was reduced in volume and percentage significantly. The average and maximum flow rates increased significantly. The optimal dosage was presumed to be in the range of 25 to 75 mg once a day or 25 to 100 mg twice a day. Adverse reactions and abnormal laboratory findings were all slight. KT-611 was concluded to be useful in the treatment of patients with benign prostatic hypertrophy.

The patient was a 24-year-old female, who had clinical and laboratory findings of Cushing's syndrome with slight virilizative changes. CT scan, ultrasound sonography and scintigraphy demonstrated that there was a functioning tumor at the right adrenal region. Thus we performed right adrenalectomy. The tumor was a characteristic black adenoma of adrenal gland, and it microscopically consisted of compact cells with remarkable intracellular pigmented granules. Thirty-two cases of functioning adrenal black adenoma have been reported in our country and all of them were associated with Cushing's syndrome.

A 26-year-old male with urachal abscess was demonstrated. Ultrasonography, CT and MRI revealed that there was a mass at the supravesical region, which was connected to the umbilicus. However, a differential diagnosis as to whether the mass was a tumor or an abscess was difficult from these examinations. Thus we performed an open biopsy. A pathological examination revealed no malignant change in the biopsy specimen. On the other hand, the pathological diagnosis of a follicular tumor located at the roof of the urinary bladder was TCC G2, but we considered that, this change was a reactive hyperplasia with dysplasia resulting from chronic inflammation of urachal abscess. Thus, the complete excision of urachal abscess and partial cystectomy were performed. The serial sections of the bladder wall revealed no malignant changes. We reviewed similar cases reported in our country and discussed various factors causing urachal abscess, especially related to the infectious root.

We report a case of idiopathic calcinosis of the scrotum. The patient was a 33-year-old male with a complaint of multiple scrotal nodules, from which white chalky materials occasionally broke out. The nodules were first noticed 17 years ago, and since then gradually increased in size and number. Sometimes he had felt itching on the scrotum, but otherwise he had been in good health. Blood analysis and biochemical analysis revealed normal findings. In addition, there were no abnormal findings in serum electrolyte analysis including calcium and phosphate concentrations. Analysis of the intra-nodular content by infrared spectrophotometry showed that it consisted of calcium phosphate (52%) and magnesium ammonium phosphate (48%). We reviewed the literature and discuss the etiology of this disease.

We report a case of an unusual foreign body in the urinary bladder. A 66-year-old male had undergone an operation of rectal cancer 6 years previously. He visited our hospital with irritative urinary symptoms. Urinalysis showed hematopyuria, and X-ray examination revealed a curved fine shadow (about 2 cm in length and 3 mm in width) at the vesical region. In cystoscopic examination, a calcified surgical suture needle was identified on the trigonal region. The needle was removed transurethrally by a stone crushing forceps. Thus, it was assumed that the needle had been left in the abdominal cavity at the operation 6 years ago and it had migrated into the bladder during these 6 years. Many cases of foreign bodies in the urinary bladder have been reported. However, to our knowledge, this is the first report of a surgical suture needle, in the bladder.

A 43-year-old woman with anterior spinal artery syndrome was admitted with complaints of tetraplegia and urinary retention. Her bladder had capacity of more than 500 ml and was inactive, with low voltage of external urethral sphincter. She was treated with distigmine bromide and intermittent catheterization. 50 days later, urodynamic study showed normal bladder and incomplete coordination of external sphincter. A 78-year-old man had chief complaints of urinary retention and paraplegia. A catheter was left indwell for 6 months. Then he was treated with intermittent catheterization, but urgency incontinence was still observed. We discussed the therapy of neurogenic bladder due to the anterior spinal artery syndrome.

尿路上皮癌526例, 前立腺癌140例を含む2, 521例に対して, プロリフィゲンTPAキット"第一"2を用いて尿中TPA濃度の測定を行った.1)健常人486例の尿中TPA濃度の平均値±標準偏差は199±218 U/lであり, 95%が陰性となる600 U/lをcut off値とした.2)尿路上皮癌の陽性率は57.6%(143/248例), 前立腺再燃例45.5%(5/11例)と高い陽性率を得た.一方, 良性疾患では腎盂腎炎, 膀胱炎, 尿道炎の急性期および水腎症を有する上部尿路結石で62.5～76.5%の高い偽陽性率を示したが, 尿路感染症安定期を含む他の疾患では約20%の偽陽性率にすぎなかった.3)尿路上皮癌において, 尿中TPAと尿細胞診を比較検討したが, 両者の陽性率に差はなく, 併用することにより73.1%の高い陽性率を得た, We have investigated the clinical significance of urinary tissue polypeptide antigen (TPA) as a tumor marker for urothelial cancers. Urinary TPA levels were determined by the immunoradiometric assay of Prolifigen TPA Kit "Daiichi"-II in 486 healthy controls and 1835 patients with various diseases including 526 with urothelial cancers and 140 with prostatic cancer. The mean value of urinary TPA was 199 +/- 213 (1SD)U/1 in 486 healthy controls. 95% of them having a level below 600 U/l. Therefore, 600 U/l was applied as a cut-off level. Positive rates of urothelial cancers and reactivated prostatic cancer were 57.6% (148 of 248 cases) and 45.5% (5 of 11 cases) respectively. On the other hand, the false positive rate of most urological benign diseases was only about 20% except for the acute stage of urinary tract infections and upper urinary tract stones with hydronephrosis. There was no significant difference in the positive rate between urinary TPA level and urinary cytology in urothelial cancers. The combination of both tests raised the positive rate to 73.1%. Therefore, urinary TPA may be useful in the monitoring of urothelial cancers, and the combination of urinary TPA and urinary cytology may increase the diagnostic accuracy.

37施設で, 神経因性膀胱233例を対象に, ロバベロン注射剤を標準薬とし, KN-7錠剤の経口投与による排尿障害に対する有用性を, 二重盲検群間比較試験で比較検討した.解析対象例はKN-7群108例, ロバベロン群107例である.KN-7群は1日6錠投与した.改善度の効果判定では改善以上K群40.7%, R群38.7%, やゝ改善以上それぞれ76.9%, 72.6%と有意差はなかった.臨床所見中改善の良かった項目は, 尿意, 残尿感, 尿失禁, 排尿までの時間, 排尿時間, 尿勢-排尿力と尿線中断の改善などで, これらの改善以上はK群35.8%, R群30.8%で, 有意差はなかった.副作用はK群0.9%, R群6.8%, K群が有意に少なかった.両剤とも主として下痢で, R群ではその他頭痛, 頻脈, 肝機能障害, 発熱感などを少数例認めた.臨床検査値ではGOT, GPTの上昇が2例あった.有用度有用以上はK群46.3%, R群45.8%で有意差はなかった.疾患別では, 末梢神経疾患, 膀胱の性状では弛緩性, 時期では12ヵ月以内の例で特に改善率が高かった.以上から, KN-7錠剤は, ロバベロン注射剤に比べ, 同等の効果が期待でき, 安全性も高く, 長期投与あるいは外来患者の治療にも適する, The clinical effectiveness, safety and usefulness of KN-7 tablet as a new oral application of the prostatic extract, on urinary dysfunction of neurogenic bladder were compared with those of Robaveron injection by the double-blind test method. In the study, 2 tablets t.i.d. and a shot of intramuscular injection 1 ml a day were given successively for 3 weeks. A total of 233 cases were reported from 37 facilities belonging to the KN-7 Clinical Research Group. Some of them were excluded or dropped out. The number of cases used for analysing the effectiveness, safety and usefulness were 214, 232 and 215, respectively. There was no bias between the two groups with a significant homogeneity in the background. In the overall clinical effectiveness, the effective rate including excellent, moderate and slightly effective was 76.9% with KN-7 and 77.4% with Robaveron. In the clinical usefulness, the rate of usefulness of slightly useful or above was 75.0% with KN-7 and 75.7% with Robaveron. There was no significant difference between the two groups in the clinical effective and useful rates at a significant level of 5%. Side effects were observed in 1 of the 114 (0.9%) patients given KN-7 and 8 of the 118 (6.8%) patients given Robaveron. The incidence of adverse reactions with KN-7 was significantly lower than that with Robaveron. Based on the results, it was concluded that KN-7 tablets, 2 tablets t.i.d., would be as effective and useful as a Robaveron injection 1 ml daily and safer than the latter in the treatment of neurogenic bladder.

A case of metastatic tumor of right spermatic cord in a 54-year-old man is reported. He visited our department with the complaint of a painless mass in right inguinal lesion. The initial diagnosis was a right spermatic cord tumor, and then orchiectomy was performed. Since pathological findings showed a poorly differentiated adenocarcinoma, further examinations were done, postoperatively. An upper gastrointestinal series revealed the presence of gastric carcinoma. Thus, these results suggested that the spermatic cord tumor was a metastatic lesion from the gastric carcinoma. Forty eight cases of metastatic tumor of the spermatic cord have been reported in our country. In 26 of these cases, gastric carcinoma metastasized to the spermatic cord.