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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.

症例1:73歳男。6年前に浸潤性膀胱癌で膀胱全摘, 回腸導管造設術を行った。発熱, 左腰痛で受診し, CTで軽度左水腎症, 左尿管拡張を認めたが明らかな閉塞機転はなく, 極細上部消化管内視鏡を行った。内視鏡の生検鉗子を用い腫瘍を2ヶ所生検し, 病巣は移行上皮癌であった。腫瘍再発による左水腎症で追加治療を提案したが強く拒否され外来でフォローした。症例2:70歳男。1年前に浸潤性膀胱癌で膀胱全摘, 回腸導管造設術を行った。術後CTで右水腎症及び骨盤内腫瘤を認め, 逆行性に尿管ステントを留置するため内視鏡検査を行った。尿管ステント留置後, 抗癌剤による治療を開始した。, Using extra slim gastrointestinal endoscopes, we have examined ileal conduits in two patients. This endoscope has almost the same caliber as a flexible cystoscope and has multiple manipulation levers and channels as ordinal gastrointestinal endoscopes. It is often difficult to examine ileal conduits with flexible cystoscopes because ileal conduits lack continent mechanisms and cannot be dilated adequately with water irrigation. With air insufflations, extra slim gastrointestinal endoscopes could adequately distend ileal conduits, and with multiple levers, they provided much more freedom of manipulation than flexible cystoscopes. Visualization of ureterointestinal anastomosis sites and biopsy of tumors could be performed very easily. We strongly recommend the use of extra slim gastrointestinal endoscopes than flexible cystoscopes when retrograde examinations and procedures are necessary in patients with ileal conduits.

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.

We report a case of collecting duct carcinoma (Bellini duct carcinoma) of the left kidney accompanied with a tumor thrombus in the inferior vena cava and the lymph node metastasis. A 69-year-old male presented with gross hematuria and left flank dullness. Computed tomography revealed an isodensity tumor in the left kidney with tumor extension into the inferior vena cava and the regional lymph node swelling. The T1-weighted magnetic resonance image displayed a slightly heterogeneous low-intensity-mass. Renal angiography revealed a hypervascular tumor. We performed left radical nephrectomy with tumor thrombectomy and regional lymphadenectomy. Histopathological examination revealed a collecting duct carcinoma (pT3bN1M0V2a). Seven months after surgery, multiple metastates in bone and liver developed. Then we performed systemic chemotherapy consisting of methotrexate and cisplatin. However, the patient died from the carcinoma 10 months postoperatively.

1)デキサメサゾンは, IL-6産生腎細胞株NC 65の増殖を濃度依存的に抑制した。2)IL-6レセプターmRNAのアンチセンスオリゴヌクレオチドおよび抗IL-6レセプター抗体はNC 65の増殖を抑制したが, IL-6mRNAのアンチセンスオリゴヌクレオチドおよび抗IL-6抗体では増殖抑制は認められなかった, Interleukin-6 (IL-6) has been demonstrated to be an autocrine growth factor of renal cell carcinoma in vitro and released IL-6 has been thought to elicit the acute phase response in vivo. We investigated the possibility of anti-IL-6 therapy of IL-6-producing renal cell carcinoma. There was a dose-dependent decrease in the number of colonies formed in vitro of NC65 renal cell carcinoma cell line in the presence of dexamethasone which is known to inhibit the induction of IL-6 messenger RNA. IL-6 receptor antisense oligonucleotide and anti-IL-6 receptor antibody also showed growth inhibition of NC65 cells. IL-6 antisense oligonucleotide and anti-IL-6 antibody did not alter the proliferation of NC65 cells. These findings suggest that inhibitors of IL-6 production or IL-6 function may be useful for some renal call carcinoma patients.

進行性胚細胞腫瘍12例の治療経験, およびそのRisk criteriaについて検討を加えた.自験例でのretrospective studyではThe Indiana Staging Systemが最も有用である.より正確な予後の予測には第12染色体短腕の増幅等, 新たな予後因子の検索も必要である, The development of cisplatin-based chemotherapy has achieved a high cure rate in patients with advanced germ cell tumors (GCT) and it is more important to predict the prognosis of each patient before treatment and select the most suitable regimen of therapy. To date, 4 risk criteria for GCT are presented. From November, 1985 to April, 1991 our treatment protocol for GCT consisted of VAB-6 (vinblastine, actinomycin D, bleomycin, cisplatinum) or PVeBV (vinblastine, etoposide, bleomycin, high-dose cisplatin) as the induction chemotherapy and VIP (etoposide, ifosfamide, cisplatin) as the salvage chemotherapy. In total, 12 patients were entered on this protocol. They were divided into 2 groups based on the actual clinical course. Those who achieved complete remission within 3 cycles of chemotherapy were divided into "good response group" and others were into "poor response group". These results were compared with those classified by the 4 risk criteria. As a result of our study "The Indiana Staging System" seemed to be the most useful.

A Clinical statistic survey was carried out on the patients, diseases, and the treatments undertaken at the Ward of Department of Urology, Kyoto University Hospital during the years of 1985 to 1988.

A 77-year-old woman with a previous history of pelvic fracture had suffered from recurrent cystitis. In the excretory urography, post-void upright film revealed the bladder hernia associated with the bladder diverticulum. Transurethral incision and fulguration of the bladder diverticulum and left inguinal herniography was performed. There has been no recurrence since then.

A 51-year-old man was admitted with the complaint of left scrotal swelling (11 x 5 x 5 cm). He had undergone left nephrectomy and removal of tumor thrombus in inferior vena cava due to renal cell carcinoma. Nine months after the nephrectomy, left scrotal enlargement was noticed. Left high orchiectomy was performed on January 20, 1988. A clear cell carcinoma was present in spermatic cord and pampiniform plexus histologically but testis and epididymis were intact. Renal cell carcinoma seemed to disseminate retrograde through the spermatic vein to spermatic cord. The metastatic tumor of spermatic cord from renal cell carcinoma is very rare and this case is the fifth case in the Japanese literature.

We used prazosin (alpha-blocker) for preoperative management of three patients with pheochromocytoma. All patients had episodic hypertension with headache and palpitation. The first dose of prazosin caused blood pressure to drop in one of three patients, but no significant hypotension was observed. By the daily dose of 6-8 mg prazosin with or without propranolol, subjective symptoms of the patients were improved and the frequency of the hypertensive attack was decreased Operations were carried out without significant complications, but phentramine and nitroprusside were required because of rapid rise of blood pressure during induction of anesthesia and surgical manipulation.

Wilms tumor is one of the most common malignant neoplasms in children. In the last 2 decades the survival rate of children with this disease has dramatically increased. However, in adults, the guideline for its management is less clear. We herein report the prolonged survival of a patient with advanced adult Wilms tumor after treatment with chemotherapy, irradiation and operations. Adult Wilms tumor should be treated aggressively with a well-timed combination of surgery, chemotherapy and radiotherapy (i.e., multimodal treatment), even if the stage of the disease was advanced. Thereby, we suspect that the prognosis of adult Wilms tumor would be markedly improved.

前回の入院患者臨床統計に引き続き1983年1月から1984年12月までの臨床統計を行なった.入院患者予算ベッド数は60で, 占拠率は常時ほぼ80%以上であった.患者数は825名, 性別男子670名, 女子155名で, 男子の比率が増加しているが, 主に前立腺肥大症を含む, 尿路性器腫瘍の増加による.50歳以上の入院が1983年54.1%, 1984年55.8%であった.頻度の高い腫瘍, 結石, 尿路性器奇型の頻度は, 1983年度でそれぞれ47.5, 21.4, 22.6%であり, 1984年には45.2, 25.1, 16.2の割合であった.腫瘍のうちでは前立腺腫瘍, 膀胱腫瘍が大半を占めた.結石では上部尿路結石症が著増を示し, 尿路性器奇形では腎嚢胞をこの項に含めた.尿路性器腫瘍患者の割合は, 1979年以後は1981年を除き常に40%を越えている.死亡46名, 剖検率80.4%であった.年間の手術件数は手術の対象となった臓器の組み合わせで分類した, A clinical statistic survey was carried out on the patients, diseases, and the treatments undertaken at the Ward of Department of Urology, Kyoto University Hospital during the years of 1983 to 1984.

Cisplatinの持続点滴を11例に施行し, 点滴中および点滴終了後の血漿中のtotal Pt, filt-Ptを測定した.さらに, 2コンパートメント・モデルに従い, 非線型最小二乗法によりfilt-Ptの各種の薬理学的パラメーターを算出した.1)点滴終了後filt-Ptは二相性の減衰を示し, 点滴終了22～24時間後でも測定範囲内にあった.filt-PtのT(1/2)βの延長, Cltotの低値が認められ, AUCは短期静注法の3倍以上の値を示し, 薬理学的有利性を認めた.2)副作用では, 消化器症状の高度の嘔吐は持続点滴により改善される傾向にあるものの, 嘔気の持続日数は短縮されなかった.腎毒性は軽度であった, Cisplatin was administered to 11 patients as a continuous infusion, 25 mg/m2/day for 1 to 4 days. Total and filterable platinum in plasma were monitored for 12 courses and a pharmacokinetic study was carried out in 7 patients by computerized nonlinear least-squares analysis. Following interruption of the infusion, the decrease of plasma filterable platinum was biphasic, with initial and terminal half-life of 21.6 +/- 11.4 min and 31.7 +/- 27.1 hr. Filterable platinum was still detectable in plasma 24 hours after the end of infusion. The total AUC exposure of filterable platinum for 24 hrs, 48 hrs and 96 hrs infusion were 3.67 micrograms.hr/ml, 13.68 micrograms.hr/ml and 14.75 micrograms.hr/ml, which were at least 3-fold higher than that observed for the short-term infusion of equal dose in literature. Gastrointestinal toxicity was evaluated and compared with short-term infusion of equal dose. In the continuous-infusion patients, the reduction of vomiting was observed but the duration of nausea was not shortened.

Between June, 1983 and December, 1988, 40 patients with primary bladder tumor underwent total cystectomy. Of the 40 patients, 33 (82.5%) were treated by total cystectomy at first presentation. Only 7 patients (17.5%) had prior history of bladder tumors. The mean time from the onset of symptoms to consultation was 11.5 months. In 68.5% of the evaluable 35 patients, gross hematuria was the first symptom. In 74.4% of the 39 evaluable patients, preoperative urine cytology was positive. If class III (suspicious) was included, the positive urine cytology rate was 82.1%. The operative mortality rate was 15%. Early complications occurred in 52.5% of the 40 patients. Late complications occurred in 35.3% of the 34 patients. The 1-, 2- and 3-year actual survival rates of the 40 patients were 69.6%, 65.5% and 65.5% respectively. The 2-year survival rate according to pathologic stage was 14.3% for patients in pT4, 43.8% in pT3b, 75% in pT3a, 100% in pT2, 78.8% in pT1 and 100% in pT0 + pTis. Of the 28 patients who underwent pelvic lymphadenectomy, 8 (28.6%) had positive nodes, including 1 of 1 (100%) in pT4, 5 of 7 (71.4%) in pT3b, 1 of 6 (16.7%) in pT3a, 1 of 4 (25%) in pT2 and 0 of 10 (0%) in pT1 + pT0 + pTis. The prognosis of the 7 patients who had prior history of bladder tumor was poor. The selection of initial therapy and the clinical follow-up should be done carefully.

1983, 1984年の2年間の当科外来患者臨床統計を行なった.1983年は男性3070人, 女性1715人で合計4821人, 1984年は男性3152人, 女性1703人の合計4855人で男女比はほゞ2:1であった.年齢階層別には1983年と比べ1984年には70歳以上が5倍弱の増加を示した.疾患別患者数では尿石症は下部尿路結石の割合が依然として低く, 全尿石症の2～3%に過ぎなかった.腎盂腎炎の頻度は前回調査と同じで女性が男性の2倍を占めた.STDの明らかな増加は見られなかった.尿性器結核も前回とほゞ同じ傾向であった.尿性器腫瘍も前回と比べ著しい変化を示したものはなく, その他の上・下部尿路疾患もほゞ同様であったが, 原因不明熱で来院する患者の増加が予測された.内視鏡検査は1983年には延べ1157件, 1984年には970件, IVPやDIPは年間約2400件行なわれた, The statistics of the patients seen at our Urological Outpatients Clinic during 1983 and 1984 are reviewed.

過去4年間に経験した腎外傷22例について臨床的観察を行った.1)男性若年者にやや多く, 約60%は交通事故によるものであった.2)腎外傷度分類で挫傷13例, 軽度裂傷4例, 高度裂傷2例, 破裂1例, 腎茎断裂2例であった.3)保存的治療19例, 腎摘除術2例, 血腫除去術1例であった.死亡例はなかった.4)診断にはCT, 血管造影が有用であり, とくに後者は即時手術の適応の決定に有用であった, Between June, 1984 and May, 1988, 22 cases of renal injury were treated. There were 13 males and 9 females. The most frequent causes were traffic accidents (13 cases) and the next were falls (7 cases). Associated injuries were seen in 9 cases, including bone fractures, head injuries, liver lacerations, hemothorax and splenic laceration. Out of the 22 patients, there were 13 cases of renal contusion, 6 cases of renal laceration, 1 case of renal rupture and 2 cases of pedicle injury. Evaluation was made by IVP, CT, arteriography and so on. Arteriography was the most useful method whether immediate surgery should be done or not. Three cases were treated surgically (2 nephrectomies for rupture and pedicle injury, 1 drainage for laceration). The other cases were treated conservatively and no complications have been seen.

A 70-year-old man, who had squamous cell carcinoma of lung, complained of urethral pain. Physical examination revealed an induration of the bulbous urethra and a month later corpora cavernosa were involved. Biopsy was performed and pathological diagnosis was metastatic penile tumor originating from squamous cell carcinoma of lung. Several days after the biopsy the patient died of pleuritis carcinomatosa. Metastatic penile tumor is a rare disease and only 87 cases have been reported in Japan. We review the literature on metastatic penile tumors.

We report a case of bilateral synchronous renal cancers for which only right radical nephrectomy was performed at another hospital. Five years later we performed partial nephrectomy (enucleation) for the left renal cancer. By computed tomographic scans we studied the radiological change of this tumor which occurred during a five-year period. We found a slow doubling time of this tumor. Three years after enucleation, tumor recurrence was noticed and we performed left partial nephrectomy with a normal parenchymal margin. We reviewed the literature about enucleation of renal cancer.

1)腎後無尿症あるいは水腎症28腎, 尿瘻5腎, 膀胱出血2腎, 経皮的腎尿管切石術(PNL)の術前45腎に対して経皮的腎瘻造設術(NS)を行った.2)超音波ガイド下に経皮的に腎穿刺を行い, 目的とする腎杯に0.038インチ・J型ガイドワイヤーを留置し, マレコー・ネフロストミー・セットの筋膜ダイレーターを用い腎瘻を拡張した.3)水腎症や尿瘻などに対し, Malecot 14 Frあるいは16 Frカテーテルを留置した.PNL術前処理の場合にはMalecot 18 Fr, 24 FrあるいはBardex先穴バルンカテーテル18～22 Frを留置した.4)無尿1例とPNL術前症例1例においてPNSに失敗した.拡張に際してはX線TVによる透視観察が重要である.5) PNS前後で永久的腎瘻群と一時的腎瘻群ではHtはほとんど変化せず, PNL群では数%低下した.6)腎シンチグラム上PNSにより腎実質障害例をみた.7) 37°C以上の発熱をきたしたのは約70%で, うち39°C以上は4腎瘻であった.マレコー・ネフロストミー・セットを用いてのPNSは安全かつ確実な方法である, Ultrasound guided percutaneous nephrostomy (PNS) was performed on 72 patients (80 kidneys) including pretreatment for percutaneous nephro-uretero lithotomy (PNL). PNS was performed for post-renal anuria or hydronephrosis in 23 cases (28 kidneys), for urinary leakage in 4 cases (5 kidneys), for vesical bleeding in 1 case (2 kidneys) and as pretreatment of PNL in 44 cases (45 kidneys). Ultrasound guided renal puncture was done percutaneously and a 0.038 inch J-tipped wire guide was inserted into the suitable calyx. Then the nephrostomy tract was dilated with fascia dilators of Malecot nephrostomy set. A 14 Fr or 16 Fr Malecot catheter was used for hydronephrosis or urinary leakage cases. 18 Fr, 24 Fr Malecot catheter or Bardex balloon catheter 18-22 Fr was inserted for PNL cases. In the PNL group, Ht decreased slightly but there was no need of blood transfusion. In the other groups, Ht did not change. Defect of 99m-Tc-DMSA renal uptake in several cases suggested renal injury at nephrostomied cortex. In about 70% of the cases, a fever of more than 37 degrees C was observed, and in 4 cases, more than 39 degrees C was observed. There were no major complications observed. In conclusion, percutaneous nephrostomy using Malecot nephrostomy set is a safe and effective method.

1) 1983年より1985年まで, 当教室においてVAB-6療法により治療を行なった進行性睾丸腫瘍6症例につき, その治療成績および副作用につき検討した.2)対象症例6例のうちseminomaは1例で, 他の5例は非seminoma (NSGCTT)であり, 病期分類では, 2 B 3例, 3 A 2例, 3 B 2は1例であった.いわゆるbulky tumorのあるものは6例中5例(seminoma 1例, NSGCTT 4例)であった.3) VAB-6療法を初回治療とした症例は5例であり, 残りの1例は他院にて他の化学療法の既往があった.VAB-6化学療法によるCRは2例であり, PRは4例であった.PR症例4例のうち1例は手術療法のみの追加, 3例は手術療法および化学療法の追加にて現在NEDである.4)副作用のうち骨髄抑制に関しては, 全例に一過性の顆粒球減少があり, さらに回を重ねるにつれ貧血の進行が認められたが, 重篤な状況にたった症例はない.腎毒性に関してはCcrの3コース終了後での低下は軽度であった.CDDP多量投与後早期に, GOT, GPTなどの一過性の著明な上昇を認め, 一時的な肝機能障害が示唆された.化療直後の一過性の悪心, 嘔吐は強度で, 種々の処置でもその抑制は困難と思われた.その他, 肺線維症などの重篤な副作用の発現は認められなかった, Between 1983 and 1985, six patients with advanced testicular cancer were treated with 3 cycles of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cisplatinum (VAB-6 combination chemotherapy without maintenance). The histology of the primary tumor was seminoma in one patient and nonseminomatous germ cell testicular tumor (NSGCTT) in 5. Five men with stage III or bulky stage II diseases received no prior chemotherapy but one had received another chemotherapy without cisplatinum. Two patients showed a complete response to chemotherapy. Three were partial responders free of disease after a debulking operation and additional chemotherapy. The other patient who had NSGCTT had recurrence 5 months after the last induction chemotherapy and received additional chemotherapy (PVeBV regimen). Median follow-up was 16 months (range 2 to 28 months) and all patients are alive with no evidence of disease. Severe myelosuppression and serious renal toxicity were not experienced. Marked, but transient elevation of serum transaminase were observed in all patients. These data suggest that this protocol is highly effective and minimally toxic in the treatment of disseminated testicular tumor.

39例に於て, 血中アンチトロンビン3(AT3)値を合成基質法にて測定した.未治療24, 女性ホルモン治療後6, 酢酸クロルマジノン投与後9で, 未治療群におけるAT3値は, 6例を除き正常範囲内であり, 女性ホルモン治療1ヵ月後には23.5%に低下を示し, 1週間ですでに始まっていた.ジエチルスチルベストロール(DESP) 250 mg静脈内投与6例中2例はAT3値の低下は全く示さず, 女性ホルモン治療にても無効の症例がある.DESP 50 mg, エチニルエストラジオール0.5 mg程の少量女性ホルモンでもAT3値が低下したものがあるが, 継続治療の6ヵ月後に正常化するのが一般的である, Since reduced antithrombin III (AT III) activity are associated with increased risk of thromboembolism, we have determined it in 39 patients with prostatic carcinoma. Pre-treatment levels were determined in 24 patients, 6 additional patients with prostatic carcinoma on estrogen treatment and 9 patients on chlormadinone acetate (CMA) therapy. In 12 of 24 patients we studied AT III levels before and after estrogen therapy was initiated. A significant decrease in AT III activity of 23.5% was found after one month on estrogen treatment, the patients on low doses of estrogen. Recovery of the levels of AT III was found after 6 months treatment even in in 5 of 6 patients who had shown depression of AT III levels initially. CMA treatment did not cause its depression. AT III levels was not connected with the stage of the disease or age of the patient.

A case of paratesticular rhabdomyosarcoma is presented. An 18-year-old male was admitted with the complaint of giant scrotal swelling and abdominal fullness on September 5, 1986. Left radical orchiectomy was performed with the pathologic diagnosis of alveolar rhabdomyosarcoma. The tumor was paratesticular in location and had invaded a spermatic cord. Radiological examination showed a gross metastatic mass in retroperitoneal lymph nodes, supraclavicular lymph nodes and Douglas pouch. The patient received induction chemotherapy containing vincristine, actinomycin-D, cyclophosphamide, bleomycin, CDDP and VP-16. After 3 courses, he had no mass in Douglas pouch and supraclavicular lesion. He received retroperitoneal lymph node dissection for residual retroperitoneal mass, and postoperative radiotherapy was given. However, recurrent disease was developed in the paraaortic region with malignant ascites. He was treated with salvage chemotherapy, had without any significant effect. He died of liver dysfunction due to progressive mass in hepatic hilum. A review of the current approach of paratesticular rhabdomyosarcoma with the usefulness of combination chemotherapy is given.

A 59-year old male who had undergone hemodialysis for 5 years, visited our hospital with a complaint of asymptomatic gross hematuria. Urinary cytology was positive and random biopsy revealed invasive transitional cell carcinoma of the bladder. The patient underwent total cystectomy and ureterocutaneostomy. Also right nephrectomy was performed because pathological examination during the operation revealed that the right ureteral margin had carcinoma in situ. Carcinoma in situ involved the right renal pelvis, the right ureter and the bladder in the resected specimen. Frequency of urothelial tumor in patients who undergo hemodialysis is still unknown, and the number of reported cases is too small to acknowledge the natural history of the urothelial tumor in patients on hemodialysis.

Surgical excision of the indurated penile plaque and tunica vaginalis autografting was done in 3 patients. Preoperatively, their chief complaints had not been impotence but penile angulation or pain. Postoperatively, all of them improved and erectile failure was not seen, although hypesthesia of glans developed in all patients. One patient complained of impotence. The patients had been followed from 2 months to 9 months. As prosthesis is not prevailing in Japan and tunica vaginalis is easy to procure and handle, tunica vaginalis autografting is recommended.