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Sphincter‐preserving procedures (SPPs) for surgical treatment of low‐lying rectal tumors have advanced considerably. However, their oncological safety for locally advanced low rectal cancer compared with abdominoperineal resection (APR) is contentious. We retrospectively analyzed cohort data of 1500 consecutive patients who underwent elective resection for stage II‐III rectal cancer between 2010 and 2011. Patients with tumors 2‐5 cm from the anal verge and clinical stage T3‐4 were eligible. Primary outcome was 3‐year local recurrence rate, and confounding effects were minimized by propensity score matching. The study involved 794 patients (456 SPPs and 338 APR). Before matching, candidates for APR were more likely to have lower and advanced lesions, whereas SPPs were carried out more often following preoperative treatment, by laparoscopic approach, and at institutions with higher case volume. After matching, 398 patients (199 each for SPPs and APR) were included in the analysis sample. Postoperative morbidity was similar between the SPPs and APR groups (38% vs 39%; RR 0.98, 95% CI 0.77‐1.27). Margin involvement was present in eight patients in the SPPs group (one and seven at the distal and radial margins, respectively) and in 12 patients in the APR group. No difference in 3‐year local recurrence rate was noted between the two groups (11% vs 14%; HR 0.77, 95% CI 0.42‐1.41). In this observational study, comparability was ensured by adjusting for possible confounding factors. Our results suggest that SPPs and APR for locally advanced low rectal cancer have demonstrably equivalent oncological local control.

症例は67歳女性で, 1ヵ月ほど前から右腹部痛出現の為来院し, 単純X線像では右腎内に小結石を認めるのみで, 排泄性腎盂造影(IVP)では右水腎症を認めた.精査目的で入院待機中に右側腹部の疝痛発作のため他院泌尿器科に緊急入院し, IVPで上部尿路溢流を合併する右水腎症, 腹部CTで右腎背側の尿貯留腫と骨盤内腫瘤を認めた.前医でのCT検査で右骨盤内尿管腹側に腫瘤を認め, 右尿管はこれより近位で水尿管を呈し, 骨盤内腫瘤と水尿管の接する部位に嵌頓していない尿管結石が認められ, 右腎背側には尿貯留腫を認めた.以上より, 右水腎症は骨盤内腫瘤による圧迫によるもので, 今回そこに結石が下降したため上部尿路外溢流と疝痛発作が起こったものと考えられた.骨盤内腫瘤のCTガイド下針生検結果は慢性炎症細胞の浸潤のみで, 尿貯留腫を伴う骨盤内腫瘍の診断で腫瘍摘出術を施行した.摘出標本の病理組織学的所見から虫垂膿瘍と診断された, We report a case of appendiceal abscess complicated with right hydronephrosis in a 67-year-old woman. She visited our department complaining of right flank pain. Intravenous pyelography (IVP) showed hydronephrosis and hydroureter on right and a narrow ureter at the pelvic brim. A pelvic computed tomographic scan revealed a low density area measuring 44 x 37 mm in size, anterior to the right ureter, which was thought to be a pelvic tumor. Further examination did not reveal the origin of the tumor. An exploratory laparotomy was performed. The tumor developed from the cecum and adhered to the right ureter. The appendix was not found. The tumor was resected with the cecum while the ureter was preserved. Histological investigations revealed an appendiceal abscess. The postoperative course was uneventful. IVP after the operation showed the hydronephrosis to have resolved.

極細硬性尿管鏡Micro 6及びパルス波ダイレーザー砕石装置Paltholithを用いてTULを施行した. 1)全対象例138例における成功率は82.6%であった. 2)TULを第一選択とした症例における成功率, 残石率はESWL後補助療法で施行された症例よりも良好な傾向にあり, efficiency quotientは0.75であった. 3)U2, U3の下部尿管における成功率はそれぞれ96.0%, 86.2%と良好な結果が得られた. 4)以上より, TULは, U2及びU3の下部尿管結石に対して第一選択治療となりうることが示唆された, Between September 1993 and December 1996, 138 patients underwent transurethral ureterolithotripsy (TUL) either as primary treatment or as a second-line therapy after extracorporeal shock wave lithotripsy. In all patients, a semirigid 6.0 F ureteroscope was used. Lithotripsy was performed using a pulsed-dye laser. The overall success rate was 82.6%. The success rates according to the location of stones were as follows, 76.9% for stones in the upper ureter (U1), 96.0% for those in the midureter (U2), and 86.2% for those in the distal ureter (U3). In 68 patients treated with TUL as primary therapy, the success rate was 88.2% and efficiency quotient, which was modified for TUL was 0.75. Complications were rare: no ureteral perforations and no major bleeding occurred, but urosepsis developed in 2 patients. In conclusion, transurethral ureterolithotripsy using a small caliber ureteroscope with pulsed-dye laser is recommended as the primary treatment for mid- and distal ureteral stones, because of its superior success rate. In addition, for upper ureteral stones, laser tripsy is recommended as a helpful auxiliary procedure.

We report a case of appendiceal abscess complicated with right hydronephrosis in a 67-year-old woman. She visited our department complaining of right flank pain. Intravenous pyelography (IVP) showed hydronephrosis and hydroureter on right and a narrow ureter at the pelvic brim. A pelvic computed tomographic scan revealed a low density area measuring 44 x 37 mm in size, anterior to the right ureter, which was thought to be a pelvic tumor. Further examination did not reveal the origin of the tumor. An exploratory laparotomy was performed. The tumor developed from the cecum and adhered to the right ureter. The appendix was not found. The tumor was resected with the cecum while the ureter was preserved. Histological investigations revealed an appendiceal abscess. The postoperative course was uneventful. IVP after the operation showed the hydronephrosis to have resolved.

Between September 1993 and December 1996, 138 patients underwent transurethral ureterolithotripsy (TUL) either as primary treatment or as a second-line therapy after extracorporeal shock wave lithotripsy. In all patients, a semirigid 6.0 F ureteroscope was used. Lithotripsy was performed using a pulsed-dye laser. The overall success rate was 82.6%. The success rates according to the location of stones were as follows, 76.9% for stones in the upper ureter (U1), 96.0% for those in the midureter (U2), and 86.2% for those in the distal ureter (U3). In 68 patients treated with TUL as primary therapy, the success rate was 88.2% and efficiency quotient, which was modified for TUL was 0.75. Complications were rare: no ureteral perforations and no major bleeding occurred, but urosepsis developed in 2 patients. In conclusion, transurethral ureterolithotripsy using a small caliber ureteroscope with pulsed-dye laser is recommended as the primary treatment for mid- and distal ureteral stones, because of its superior success rate. In addition, for upper ureteral stones, laser tripsy is recommended as a helpful auxiliary procedure.

Dibekacin (DKB) was administered to patients with complicated urinary tract infections without any indwelling catheter to evaluate objectively and comparatively the efficacy, safety and usefulness of intravenous drip infusion once daily and twice daily in a well-controlled study. A 50 mg dose of DKB was administered twice a day to group A, and a 100 mg dose was given once a day to group B. In both groups the drug was given by 1-hr i.v. infusion for 5 consecutive days. Drug efficacy was evaluated in 72 (group A: 36, group B: 36) of the 83 patients treated, and the safety was evaluated on 81 patients (group A: 41, group B: 40). There were no significant differences in the background characteristics between the two groups. The overall clinical efficacy judged by the Committee for Evaluation of Clinical Efficacy was "excellent" in 14% and "moderate" in 50% of group A, and "excellent" in 17% and "moderate" in 64% of group B, the efficacy being higher for group B than group A, but the difference was not statistically significant. The overall drug efficacy rate for each type of infection excluding group 2, was slightly higher in group B, but this difference was not significant either. The overall clinical efficacy for each site of infection, was higher for group B but the differences were not significant. The overall clinical efficacy as judged by the attending physicians was "excellent" in 17% and "moderate" in 58% of group A, and "excellent" in 25% and "moderate" in 61% of group B. The intergroup difference was thus smaller than that judged by the Committee. The elimination rates against bacteriuria were 58% for both groups A and B, and the decrease rates including "cleared" were 42% against pyuria for both groups A and B. Bacteriological evaluation, showed that there was no significant difference in the eradication rates, between group A (65%) and group B (70%). But the eradication rate for gram-positive bacteria was 40% in group A and 81% in group B, there being a significant difference (P less than 0.05) between them. The evaluation of usefulness gave 44% and 53% "satisfactory" rates, respectively, for groups A and B. The results for the "average score" were also the same in both groups. There were no side effects in any of the 81 patients examined. Abnormal laboratory test values attributed to the drug were seen only in 3 and 2 patients in groups A and B, respectively, there being no difference between the groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Clinical efficacy of combination therapy with fosfomycin (FOM) and dibekacin (DKB) was studied in patients with complicated urinary tract infection (UTI). Of the 55 patients accumulated from 7 urology institutes, 39 patients who had pyuria of 5 or more white blood cells per high power field, bacteriuria of 10[4] or more• bacteria per ml of urine and underlying urinary diseases were evaluated for clinical efficacy. Patients received 4g of intravenous FOM and 100 or 200mg of intramuscular DKB a day for 5 to 7 days. The overall clinical efficacy of treatment was evaluated by the criteria proposed by the UTI Committee in Japan as excellent, moderate or poor. Of the 39 patients evaluated for clinical efficacy, 13 patients (33.3%) were infected with multiple organisms and 30 patients (76.9%) had indwelling catheters. The overall results of treatment were excellent in 17.9%, moderate in 64.1% and poor in 17.9%, overall effectiveness rate being 82. 1 %. Of the 52 strains isolated from 39 patients, 48 strains (92.3%) were eradicated and only 4 strains (7.7%) persisted. Side effects were recorded in all 55 patients including those excluded from the evaluation of clinical efficacy. Subjective side effects were not observed in any of the 55 patients. Drugrelated aggravations in laboratory test results were observed in 6 patients (10.9%) but most of them were slight and transient changes; the combination of FOM and DKB appeared to be well tolerated. From the results obtained in this study, combination therapy of FOM and DKB seemed useful in the treatment of complicated UTI, especially those due to multiple orgenisms and those associated with indwelling catheters.

P. aeruginosaによる複雑性尿路感染症に対するCPMの治療効果と副作用を評価する目的で, CPM 2g/日とCFS 2g/日の二重盲検法による比較試験をおこなった.総投与例数は274例で, うち効果を判定し得たのはCPM群136例, CFS群118例であった.1) P. aeruginosaを含む感染症では, CPMあるいはCFSを1日2g, 5日間投与時の効果では, 前者の有効率が有意に高かった.2) P. aeruginosaのみを対象にした場合も同様であった.3) P. aeruginosaを含む感染で細菌尿の陰性化率はCPM群はCFS群より有意に高かった.4)交代菌の出現は, CFS群でS. faecalisの出現率が有意に高く, 全体的にもCFS群の投与後の細菌出現率が有意に高かった, 5)薬剤投与開始前の分離菌のMICでは, CPM群の方がCFS群よりもMICの低いものが多かった.6)副作用発現率, 臨床検査値の異常化は両群間に差はなかった, The therapeutic efficacy and safety of Cefpiramide (CPM, SM-1652) at a 2 g/day dose were objectively compared with those of Cefsulodin (CFS) at a 2 g/day dose in patients with chronic complicated urinary tract infections (UTI) by P. aeruginosa in a double-blind study at 46 institutions in Japan. The results are as follows: The therapeutic efficacy was analyzed in 254 patients (136 cases administered CPM and 118 cases administered CFS) after excluding 20 cases as drop-out. Among 254 cases, the number of patients with infection of P. aeruginosa was 190 cases (100 cases administered CPM and 90 cases administered CFS), while that with infection of organisms other than P. aeruginosa was 64 cases (36 cases administered CPM and 28 cases administered CFS). By the administration of a 2 g/day dose for 5 days, the overall clinical effective rate of CPM was significantly higher than that of CFS in total patients. When the patients were classified into 2 groups with respect to causative organisms (P. aeruginosa and others), the clinical effective rate of CPM in patients with infections of P. aeruginosa was significantly higher than that of CFS, while the clinical effective rate of CPM in patients with infection of other organisms than P. aeruginosa was the same as that of CFS. As to the bacteriological effect on bacteriuria, the eradication rate of CPM was significantly higher than that of CFS not only against all causative organisms but also against P. aeruginosa. The rate of replacement by S. faecalis was significantly higher in the CFS-treated group than in the CPM-treated group. The same result was obtained on the rate of replacement by other organisms. The MIC values of CPM for isolated organisms before drug administration were lower than those of CFS. The incidence rates of side effects and the abnormal findings of clinical laboratory tests were the same for the CPM- and CFS-treated groups. From the results, it was concluded that CPM is a useful drug for the treatment of patients with chronic complicated urinary tract infections caused by P. aeruginosa.

黄体形成ホルモン分泌刺激ホルモン(LHRH)誘導体Buserelin (Hoe766)の前立腺癌に対する有効性と安全性, 内分泌動態に検討を加えた.試験1の単回投与は前立腺癌3例と前立腺肥大症7例, 試験2および3は病期BないしDの前立腺癌それぞれ40例, 70例を対象とした.試験1の単回投与で本剤がLHRHと同様の動態を示し, 試験2の3ヵ月間投与で至適用量を検討したところ, 500 μg×3/日が初期導入として優れていた.3ヵ月間投与後の有効率は従来の治療法である去勢あるいは抗男性ホルモン剤と遜色がなかった.本剤の長期投与の評価対象は経時的に減少し, 特に病期Dの減少率が高かったが, 組織分化度別の減少率はほぼ一定であった.副作用は本剤投与後3ヵ月以内に発現し, 中止に至った3例を除く6例は本薬の主作用によるもので症状も軽度であった.心血管系や肝障害などは見られなかった.以上より本剤は合併症の多い高齢者の前立腺癌に対し, 短期, 長期とも副作用の少ない有用性の高い薬剤であると結論できた, Seventy three patients with prostatic carcinoma (PC) and 7 patients with benign prostatic hypertrophy (BPH) in 12 institutes subcutaneously received single and multiple doses of Hoe 766, and clinical efficacy, safety and endocrine effects of drug were examined. In a single doses study, six doses were subcutaneously administered to 7 BPH and 3 with PC. Gonadotropin and testosterone levels in the blood were increased following all these doses. In a multiple study, 7 kinds of doses were given to 40 patients with PC. The optimum doses of subcutaneous injection was decided to be 500 x 3 micrograms/day based on gonadotropin and testosterone suppression. Objective response by NPCP's criteria was observed in 35.3% (complete response 5.9%, partial response 29.4%) following 3 months of Hoe 766 treatment. Adverse reactions were observed in 9 cases (12.8%): Treatment was discontinued in 3 cases (eruption in 2, nausea and vomiting in 1), and continued in 6 cases (8.6%) without any treatment required. Buserelin was thus considered to be an effective, safe drug to treat prostatic carcinoma.

Analgesic diect of trihydroxybenzene (Dilospan) was evaluated on urolithiasis patients by a simple double blind method with hyoscine-N-butylbromide as the active placebo and glucose as the inert placebo. Seventy-one cases were chosen from six institutions. As to the effect within 5 minutes after injection, Dilospan was significantly superior to the placebos. The effective rate within 30 minutes was 75% in Dilospan, 63% in the active placebo, and 52% in the inert placebo. Dilospan will be valuable in order to control pain in an emergency state.

"Neomyson G Injection", containing thiamphenicol aminoacetate hydrochloride, was intravenously given to male adult dogs, and the concentration of thiamphenicol diffused into the bladder tissue as well as its urinary and serum concentrations were determined. It was demonstrated that a major part of the concentration in the bladder tissue came from the blood, while the rest considerable part from the urine. The diffusion rate of thiamphenicol from the urine into the inflammatory bladder tissue was more significantly higher than that into the normal. It was, therefore, suggested that such a drug as maintaining its higher urinary concentration would be more effective in the chemotherapy of urinary tract infection, especially of cystitis.

Clinical efficacy of combination therapy with fosfomycin (FOM) and dibekacin (DKB) was studied in patients with complicated urinary tract infection (UTI). Of the 55 patients accumulated from 7 urology institutes, 39 patients who had pyuria of 5 or more white blood cells per high power field, bacteriuria of 10[4] or more• bacteria per ml of urine and underlying urinary diseases were evaluated for clinical efficacy. Patients received 4g of intravenous FOM and 100 or 200mg of intramuscular DKB a day for 5 to 7 days. The overall clinical efficacy of treatment was evaluated by the criteria proposed by the UTI Committee in Japan as excellent, moderate or poor. Of the 39 patients evaluated for clinical efficacy, 13 patients (33.3%) were infected with multiple organisms and 30 patients (76.9%) had indwelling catheters. The overall results of treatment were excellent in 17.9%, moderate in 64.1% and poor in 17.9%, overall effectiveness rate being 82. 1 %. Of the 52 strains isolated from 39 patients, 48 strains (92.3%) were eradicated and only 4 strains (7.7%) persisted. Side effects were recorded in all 55 patients including those excluded from the evaluation of clinical efficacy. Subjective side effects were not observed in any of the 55 patients. Drugrelated aggravations in laboratory test results were observed in 6 patients (10.9%) but most of them were slight and transient changes; the combination of FOM and DKB appeared to be well tolerated. From the results obtained in this study, combination therapy of FOM and DKB seemed useful in the treatment of complicated UTI, especially those due to multiple orgenisms and those associated with indwelling catheters.

The therapeutic efficacy and safety of Cefpiramide (CPM, SM-1652) at a 2 g/day dose were objectively compared with those of Cefsulodin (CFS) at a 2 g/day dose in patients with chronic complicated urinary tract infections (UTI) by P. aeruginosa in a double-blind study at 46 institutions in Japan. The results are as follows: The therapeutic efficacy was analyzed in 254 patients (136 cases administered CPM and 118 cases administered CFS) after excluding 20 cases as drop-out. Among 254 cases, the number of patients with infection of P. aeruginosa was 190 cases (100 cases administered CPM and 90 cases administered CFS), while that with infection of organisms other than P. aeruginosa was 64 cases (36 cases administered CPM and 28 cases administered CFS). By the administration of a 2 g/day dose for 5 days, the overall clinical effective rate of CPM was significantly higher than that of CFS in total patients. When the patients were classified into 2 groups with respect to causative organisms (P. aeruginosa and others), the clinical effective rate of CPM in patients with infections of P. aeruginosa was significantly higher than that of CFS, while the clinical effective rate of CPM in patients with infection of other organisms than P. aeruginosa was the same as that of CFS. As to the bacteriological effect on bacteriuria, the eradication rate of CPM was significantly higher than that of CFS not only against all causative organisms but also against P. aeruginosa. The rate of replacement by S. faecalis was significantly higher in the CFS-treated group than in the CPM-treated group. The same result was obtained on the rate of replacement by other organisms. The MIC values of CPM for isolated organisms before drug administration were lower than those of CFS. The incidence rates of side effects and the abnormal findings of clinical laboratory tests were the same for the CPM- and CFS-treated groups. From the results, it was concluded that CPM is a useful drug for the treatment of p

Seventy three patients with prostatic carcinoma (PC) and 7 patients with benign prostatic hypertrophy (BPH) in 12 institutes subcutaneously received single and multiple doses of Hoe 766, and clinical efficacy, safety and endocrine effects of drug were examined. In a single doses study, six doses were subcutaneously administered to 7 BPH and 3 with PC. Gonadotropin and testosterone levels in the blood were increased following all these doses. In a multiple study, 7 kinds of doses were given to 40 patients with PC. The optimum doses of subcutaneous injection was decided to be 500 x 3 micrograms/day based on gonadotropin and testosterone suppression. Objective response by NPCP's criteria was observed in 35.3% (complete response 5.9%, partial response 29.4%) following 3 months of Hoe 766 treatment. Adverse reactions were observed in 9 cases (12.8%): Treatment was discontinued in 3 cases (eruption in 2, nausea and vomiting in 1), and continued in 6 cases (8.6%) without any treatment required. Buserelin was thus considered to be an effective, safe drug to treat prostatic carcinoma.

Dibekacin (DKB) was administered to patients with complicated urinary tract infections without any indwelling catheter to evaluate objectively and comparatively the efficacy, safety and usefulness of intravenous drip infusion once daily and twice daily in a well-controlled study. A 50 mg dose of DKB was administered twice a day to group A, and a 100 mg dose was given once a day to group B. In both groups the drug was given by 1-hr i.v. infusion for 5 consecutive days. Drug efficacy was evaluated in 72 (group A: 36, group B: 36) of the 83 patients treated, and the safety was evaluated on 81 patients (group A: 41, group B: 40). There were no significant differences in the background characteristics between the two groups. The overall clinical efficacy judged by the Committee for Evaluation of Clinical Efficacy was "excellent" in 14% and "moderate" in 50% of group A, and "excellent" in 17% and "moderate" in 64% of group B, the efficacy being higher for group B than group A, but the difference was not statistically significant. The overall drug efficacy rate for each type of infection excluding group 2, was slightly higher in group B, but this difference was not significant either. The overall clinical efficacy for each site of infection, was higher for group B but the differences were not significant. The overall clinical efficacy as judged by the attending physicians was "excellent" in 17% and "moderate" in 58% of group A, and "excellent" in 25% and "moderate" in 61% of group B. The intergroup difference was thus smaller than that judged by the Committee. The elimination rates against bacteriuria were 58% for both groups A and B, and the decrease rates including "cleared" were 42% against pyuria for both groups A and B. Bacteriological evaluation, showed that there was no significant difference in the eradication rates, between group A (65%) and group B (70%). But the eradication rate for gram-positive bacteria was 40% in group A and 81% in group B, there being a sign

"Neomyson G Injection", containing thiamphenicol aminoacetate hydrochloride, was intravenously given to male adult dogs, and the concentration of thiamphenicol diffused into the bladder tissue as well as its urinary and serum concentrations were determined. It was demonstrated that a major part of the concentration in the bladder tissue came from the blood, while the rest considerable part from the urine. The diffusion rate of thiamphenicol from the urine into the inflammatory bladder tissue was more significantly higher than that into the normal. It was, therefore, suggested that such a drug as maintaining its higher urinary concentration would be more effective in the chemotherapy of urinary tract infection, especially of cystitis.

Analgesic diect of trihydroxybenzene (Dilospan) was evaluated on urolithiasis patients by a simple double blind method with hyoscine-N-butylbromide as the active placebo and glucose as the inert placebo. Seventy-one cases were chosen from six institutions. As to the effect within 5 minutes after injection, Dilospan was significantly superior to the placebos. The effective rate within 30 minutes was 75% in Dilospan, 63% in the active placebo, and 52% in the inert placebo. Dilospan will be valuable in order to control pain in an emergency state.