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Economical elements including surgical fee and hosipital stay become larger in the selection of surgical methods for the treatment of urinary stones. Then, urologists need to explain to patients the treatment cost to obtain informed consent. By comparing the data from participants' answer to Debate 1 at the 82th annual meeting of the Japanese Urological Association (April 2002, Tokyo) and questionnaire responses from the members of the annual meeting of central division of Japanese Urological Association (November 2002, Nagoya), we surveyed the trends of surgical methods on the treatments of staghorn caliculi and lower ureter stones. Furthermore, we clarified the cost of these methods. Based on the status of world countries, we demonstrate the ideal selection including economical aspects on the selection of endourological method.

前立腺針生検施行654例.1回目で癌が検出されたのは239例で, 陰性例のうち104例に2回目を行い, 16例に検出された.更に3回目が39例中4例, 4回目は10例中3例の検出であった.再検査で最終的に癌が検出された23例(A群)とされなかった81例(B群)において, 年齢, PSA, PSA density, PSA velocityに有意差はなかった.再検査時の所見で, MRIのT2強調像でlow intensityのあるものを陽性とすると, p=0.118, 感度79%, 特異度42%, 経直腸エコーでlow echoic areaのあるものを陽性とした場合はp=0.134, 感度74%, 特異度48%, 直腸診はp=0.027, 感度65%, 特異度59%で, 直腸診にのみ有意差を認めた.生検でatypical findings(AF)とされ再検査を施行した症例では, 9例中6例に癌が検出された.AFの内訳は「高分化腺癌を疑うが検体量少なく判別困難」3例, 「核異型があるが癌とは言い切れない」5例, 「ハイグレードprostatic intraepithelial neoplasia」1例であった, We retrospectively analyzed the results of 104 patients who underwent a second prostate needle biopsy. Between January 1993 and September 2000, 654 needle biopsies were performed and cancer was found in 239 patients. Among the other 415 patients, 104 patients underwent a second biopsy. The average prostate specific antigen (PSA) value was 9.6 ng/ml (2.0-30.9) (Tandem R conversion value). Cancer was detected in 16 out of 104 cases (15%) at the second biopsy, 4 out of 39 (10%) at the third biopsy, and 3 out of 10 (30%) at the fourth biopsy. The age, PSA value, digital examination, echography, and magnetic resonance imaging (MRI) were not helpful in distinguishing the patients with prostate cancer and atypical histological findings at the previous biopsy were the most important information. Among the 9 patients who showed atypical findings at the previous biopsy, 6 (67%) had cancer.

29歳男.後腹膜リンパ節転移巣から発見され原発巣と考えられた左精巣には明らかなviable cellを認めず瘢痕組織のみであり, burned-out testicular tumorと考えられた1例であった.原発巣と考えられた左精巣には特に症状を認めなかった.しかし注意深い触診により萎縮した精巣と小結節を触知可能であり, 更に超音波検査により触診で触れた小結節と一致した部位の小エコー領域を認め, 原発巣検索に超音波検査は有用であった.精巣腫瘍stage IIBと考え, ブレオマイシン, エトポシド, シスプラチンを用いた併用化学療法を3コース施行した.ブレオマイシンによると思われる発疹が出現したため2コース目以降は他の2剤により治療した.残存する後腹膜腫瘍に対し手術を施行した.左腎は腫大リンパ節と強度に癒着し左尿管は腫大リンパ節に巻き込まれるように存在していた為, 後腹膜リンパ節郭清に加え左腎摘除術を併せて行った, A 29-year-old man was referred to our hospital with loss of appetite and a left lower abdominal mass. A small nodule was palpable in his left testis and ultrasonographic examination demonstrated that the nodule was low echoic. Computed tomography showed a large mass in his left retroperitoneal space. We thought the mass was a metastatic lesion from a testicular tumor. Left orchiectomy was done and microscopic examination revealed no viable tumor cells. Only fibrous tissue, small calcified areas, and hyaline bodies were found. As tumor markers were normalized after 3 courses of chemotherapy with bleomycin, etoposide, and cisplatine, the retroperitoneal mass was removed with the left kidney. It consisted of embryonal carcinoma, mature teratoma, and yolk sac tumor. One course of adjuvant chemotherapy was done and the patient has since been free from recurrence. We suppose that the tumor was a so-called 'burned-out' testicular tumor.

聖隷三方原病院で経験した治癒的切除された腎盂尿管癌30例について検討した.1)pT3とpV1が有意な予後因子であった.2)pT2以上, grade 3成分, pV1が有意な再発危険因子であった.3)治癒的切除された腎盂尿管癌に対して化学療法の有効性は認められなかった, We retrospectively studied 30 patients who underwent curative surgery for renal pelvic and/or ureteral cancer between August 1987 and August 1998. Their clinicopathological features were classified by the criteria of the Japanese Urological Association. The 1-, 3-, and 5-year cause-specific survival rates were, respectively, 100, 95.5, and 85.1%, while the disease-free rates were 100, 78.9, and 78.9% by the Kaplan-Meier method. Prognostic factors were evaluated by the log-rank test. The significant prognostic factors were pT3 and pV1 for cause-specific survival (p = 0.0277, p = 0.0025), while pT2 (or higher), grade 3, and pV1 were significant for disease-free survival (p = 0.0271, p = 0.0327, and p = 0.0002). Nine patients who received adjuvant chemotherapy are alive, but 3 patients have relapsed. Chemotherapy did not have a significant effect on the cause-specific survival or disease-free survival.

A case of primary malignant lymphoma of the bladder is reported. A 61-year-old female visited our outpatient clinic with the chief complaints of asymptomatic grosshematuria and was recognized as having a bladder tumor by abdominal ultrasonography. On cystoscopic examination, the tumor was non-papillary and dome-like in shape. Computed tomography revealed that the bladder tumor was invading into the bladder wall. The histopathological study of endoscopic biopsy specimen revealed malignant lymphoma. After further examinations, it was diagnosed as primary malignant lymphoma of bladder, stage IE (Ann Arbor classification). Four courses of CHOP regimen (cyclophosphamide, vincristine, doxorubicin, predonisolone) was performed and no lymphoma cell was found by re-biopsy at the primary site. No local or distant recurrence was found during the 15 months' follow up.

A 70-year-old woman was admitted to our hospital complaining of epigastralgia. Computed tomography, ultrasonography and magnetic resonance imaging revealed a round tumor measuring 6 cm in diameter, which was located in the medial side of the right kidney. It was successfully removed without injury to the surrounding large vessels and organs. Histological diagnosis was benign neurofibroma. This is the 27th case of solitary retroperitoneal neurofibroma reported in Japan.

Between August 1995 and March 1997, 197 patients underwent 257 treatments for 217 stones by extracorporeal shock wave lithotripsy (ESWL) using a Lithodiagnost M (Philips, Holland). There were 149 males and 48 females with an average age of 50.6 years, ranging from 15 to 85 years. There were 53 stones located in the renal pelvis and calices (R2), 20 stones at the pelvi-ureteric junction (PUJ) (R3), 101 stones in the upper ureter (U1), 15 stones in the middle ureter (U2) and 28 stones in the lower ureter (U3). The average number of sessions was 1.18 and the average number of shock waves per stone was 3, 546. Efficacy was evaluated 3 months after the final ESWL. The success rate was 95.4% (207/217), with complete disappearance of stones in 71.4% (155/217) and residual stones of less than 4 mm diameter in 24% (52/217). No severe complications, except for subcapsular renal hematoma in one patient, were observed. These results indicate that almost all upper urinary tract stones can be successfully treated by ESWL monotherapy.

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.

A 71-year-old woman with loss of appetite was referred to our hospital. Imaging diagnosis revealed a large, cystically dilated left kidney with a solid tumor inside the cavity and right hydronephrosis. A chest X-ray revealed multiple metastatic lesions. A horseshoe kidney was found intraoperatively and left nephroureterectomy with partial cystectomy was performed. Histological diagnosis was poorly differentiated transitional cell carcinoma. She died of progressive pulmonary metastases 2 weeks after operation. This is the 19th case of a renal pelvic tumor associated with a horseshoe kidney reported in the Japanese literature. The diagnosis was confounded by the extreme dilation and deformity of the hydronephrotic kidney.

44歳男.ABO血液型不適合生体腎移植の1例を経験した.低蛋白, 低アルブミン血症に留意すれば, ABO血液型不適合生体腎移植術前処置としての二重濾過血漿分離交換法(DEPP)による赤血球抗体の除去は有用であると思われた, A 40-year-old female, whose blood type was A, Rh+, was admitted to our hospital for kidney transplantation from her younger brother whose blood type was B, Rh+. Before the transplantation, we performed 4 sessions of double filtration plasmapheresis (DFPP) to remove the anti-B antibodies. The serum anti-B antibody titer lowered from X32 to X4. The kidney transplantation was carried out following the splenectomy. The warm ischemic time was 8 minutes and the cold ischemic time was 47 minutes. Five immuno-suppressive agents including cyclospolin, azathioprine, prednisolone, anti-lymphocyte globulin (ALG), and deoxyspergualin were administered in the initial period. Nine days after the transplantation, an acute rejection occurred, and 15 sessions of hemodialysis were needed. However, Methylprednisolone and OKT3 treatment resulted in recovery of the graft function. Seventy-four days after the transplantation, she was discharged with the serum creatinine concentration of 1.3 mg/dl. The DFPP before transplantation was useful to remove the anti-RBC antibody from the patient receiving an ABO incompatible kidney allograft.

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.

腹膜外アプローチによる腹腔鏡下骨盤内リンパ節切除術は, 少ないトロッカー及び人数で操作可能であり, 閉鎖腔の視野も良く, 炭酸ガス送気(送気圧5mmHg)の影響もなく, 手術侵襲等について更に検討を要する点もあるが, 腹腔からのアプローチに代わりうる方法と考えられた, Between February 1994 and February 1995, we performed retroperitoneal laparoscopic pelvic lymphadenectomy on 7 patients with prostate cancer between 63 and 76 years old, consisting of 6 patients with clinical stage B2, and 1 patient with stage C. Retroperitoneal laparoscopic procedures were performed under general anesthesia. First, the prevesical space was separated by a balloon dissector to create the working space. Then, three trocars were inserted into the retroperitoneal space at the lower abdominal midline. Except for the first patient, only two surgeons were needed to dissect the obturator lymph nodes, under 5 mmHg CO2 insufflation. The mean operating time was 133 minutes for bilateral lymphadenectomy. The mean number of removed lymph nodes was 4.8 on the left side and 4.2 on the right side. The estimated blood loss ranged from 10 to 66 ml. As none of the patients showed node involvement on the microscopic examination of the frozen section, they immediately underwent total prostatectomy. Additionally removed lymph nodes were 0.8 on the left side and 1.5 on the right side. As for intraoperative complications, endotidal CO2 was elevated in the first patient, but the other patients had no complications. Retroperitoneal laparoscopic pelvic lymphadenectomy is a safe and useful procedure, and may facilitate a lymphadenectomy better than a peritoneal procedure.

A woman successfully delivered two children after cadaveric kidney transplantation. She received a kidney graft at the age of 18 years because of end-stage renal failure due to chronic glomerulonephritis. Eighteen months after surgery, she became pregnant. As she was receiving immunosuppressive therapy with cyclosporin, azathioprine, mizoribine and prednisolone, we discontinued mizoribine. The child was delivered by a caesarean section in week 30 of gestation. Both the increase of liver enzymes and the decrease of creatinine clearance were slight and transient. She successfully delivered another child just a few days before the 4th anniversary of her kidney transplantation. Including this patient, we have experienced 11 deliveries by women bearing kidney grafts. Intensive joint management with the obstetric service is necessary to achieve successful delivery without losing the graft.

We report a case of prostate cancer showing a complete remission after LH-RH agonist neoadjuvant therapy. A 69-year-old man was referred to our department complaining of pain on urination and urge incontinence. The serum prostate specific antigen (PSA) level was 41.6 ng/ml. Needle biopsy specimens from both lobes revealed moderately differentiated adenocarcinoma. Chest X-ray, computed tomographic (CT) scan, and bone scintigraphy demonstrated neither distant metastasis nor local invasion. LH-RH agonist was administered on a monthly basis as neoadjuvant therapy. After 4 injections, pelvic lymph node dissection and radical prostatectomy were performed on January 11, 1993. Thorough examination did not reveal any cancer cells in the removed specimen. The patient was discharged 30 days after the operation and has shown no evidence of distant metastasis or local recurrence as long as 19 months later.

We treated two children with 2, 8-dihydroxyadenine urolithiasis for over 7 years. The male prepositus was admitted to the hospital because of anuria when he was 10 months old. Bilateral urinary stones had caused the anuria. The stones were 2, 8-dihydroxyadenine and his APRT activity was low. He has been treated with about 5.0 mg/kg/day of allopurinol without purine diet restriction. His sister, 3 years old at that time, also was found to have a renal stone. She has been treated with about 3.3 mg/kg/day of allopurinol without restricting purine. The allopurinol therapy without purine-restriction resulted in normal growth of both children with neither the recurrence of stone nor renal impairment.

動脈瘤のあるドナー腎を用いた生体腎移植の1例を報告した。1)腎は十分に灌流して冷却すれば阻血によく耐え, 2時間程度であれば血流再開後の腎機能の発現に影響を与えない。2)予想阻血時間が2時間程度なら灌流液は乳酸加リンゲル液で十分である。3)ドナー腎に動脈瘤があっても体外腎手術を適用すれば移植が可能である, A case of living related renal transplantation using a kidney with renal arterial aneurysm is reported. The size of the renal arterial aneurysm was 15 mm in diameter. After ex vivo aneurysm removal, the graft was transplanted to the right iliac fossa. The total ischemic time was 79 minutes, and the urine flow started 5 minutes after declamping. In Japan, eight patients are reported to have successfully received a renal graft after removing its aneurysm extracorporeally. Renal transplantation is possible even when the donor kidney has a renal arterial aneurysm.

72歳男.全身こむら返りが出現し, 芍薬甘草湯が投与され症状は軽快した.その後, 外来で高血圧, 低カリウム血症が出現し, 腹部CTを施行したところ左副腎に最大径1cmの腫瘍が認められた為, 受診した.血漿レニン濃度及び血漿アルドステロン濃度が低値で原発性アルドステロン症が否定的であった為, 内服薬の関与を疑い, 芍薬甘草湯を中止した.低カリウム血症と高血圧は改善した.著明低値を示していた血漿レニン濃度は, 中止後上昇し, やや低めの値ながら正常域に回復した.血漿アルドステロン濃度も中止後速やかに上昇し, 以後安定した.以上の治療経過より, 芍薬甘草湯による偽アルドステロン症と内分泌非活性副腎腫瘍の合併例と診断し, 退院となった.以後外来経過観察中であるが, 内分泌活性の出現及び左副腎腫瘍の増大は認めていない, A 72-year-old man was diagnosed with hypertension, hypokalemia, and left adrenal tumor at another hospital, and was referred to our hospital on suspicion of primary aldosteronism. Investigations revealed low plasma aldosterone concentration, and the left adrenal tumor proved to be nonfunctioning, not hyperfunctioning. "Licorice" had been prescribed for the treatment of recurrent cramps in his calf. After stopping the licorice, his condition changed to normokalemia strongly suggesting that his pseudoaldosteronism had been caused by the drug. We reviewed 140 reports on licorice-induced pseudoaldosteronism in Japan, and found a second patient who might have suffered a similar coincidental nonfunctioning adrenal tumor.

全国多施設の共同研究により, 腎細胞癌に対するn-TNFとn-IFN-αの併用療法による有効性と安全性を検討した.1)腎細胞癌31例においてPRが4例認められ奏効率は12.9%であった.IFN-αが前治療に使用された症例にも有効例が認められたことより, 本併用療法の有用性が示唆された.2)副作用は(35例/36例)に認められ, おもな自他覚的副作用は発熱72.2%, 悪寒・戦慄69.4%, 食欲不振22.2%, 全身倦怠感16.7%であり, おもな臨床検査値異常は白血球減少47.2%, 血小板減少22.2%, GOT上昇16.7%, GPT上昇13.9%であった.ほとんどの症例が解熱剤等の処置あるいは無処置で投与継続可能であった.本併用療法による副作用の増強はほとんどなかった, The combination therapy with natural type human tumor necrosis factor (n-TNF; MHR-24) and human lymphoblastoid interferon-alpha (n-IFN-alpha; MOR-22) was investigated for antitumor effect against renal cell carcinoma in a multiclinic cooperative study throughout Japan. The "Response criteria of Japan Society for Cancer Therapy" were followed for the handling of subjects and the evaluation of antitumor effect. MHR-24 was administered at a daily dosage of 5, 000-10, 000 JRU by intravenous drip and MOR-22 at a dosage of 5, 000, 000 IU daily was administered intramuscularly at the same time. Both drugs were administered for 4 weeks or longer. A total of 36 patients were enrolled as subjects in the study. None of them were classified as ineligible. Five patients, were classified as imperfectly evaluable, and 31, as evaluable for the results of treatment. The responses in the evaluable patients were partial response (PR) in 4 patients, minor response (MR) in 3 patients, no change (NC) in 14 patients and progressive disease (PD) in 10 patients, with a response rate of 12.9%. Adverse reactions to the therapy were investigated in all 36 patients. The frequent subjective and objective reactions that occurred were fever, rigors and shivering, anorexia, and generalized malaise, and the frequent abnormal laboratory findings were leukopenia, thrombocytopenia, elevation of GOT, and elevation of GPT.

69歳男.本邦8例目の報告と考えられる陰茎に転移を生じた腎癌例を報告した.悪性腫瘍の陰茎転移は殆どが重要臓器を含む多臓器転移の1症状であり, 予後は極めて不良と考えられた, Penile metastasis is rare. It occurs in the advanced stage of genitourinary cancer, with many other metastases in various organs. All 7 patients with penile metastasis of renal cell cancer, reported in the Japanese literature, died within a year. Our case was not the exception. A 69-year-old male presented with right flank pain and penile induration. Right renal cancer with liver invasion and multiple pulmonary metastases were found. Microscopic examination revealed a sarcomatous pattern. He died 4 months later.

膀胱結石33例の治療においてHolmium:YAG laser(H群)とLithoclast(L群)を使用した膀胱砕石術を行い, その治療成績を比較した.その結果H群, L群とも1回の治療で完全に結石は消失したが, L群1例においては砕石片が大きく, 結石除去の際Ho.laserを併用したため単独完全排石率が90%となった.平均手術時間はH群よりL群の方が短く済む傾向にあったが有意差は認めなかった.平均退院可能日は, H群において脳梗塞の既往のある術後尿閉のため前立腺炎を起こした1例を除けば, 両群ともほぼ同等になった.砕石力を比較する指標として手術時間(t)/結石体積(V)を計算し両群で比較したところ, H群の平均t/V値がL群に比し高く, 有意差を認めた.以上より, 現時点ではHo.laserが最も有用な砕石器であると考える, From March 1995 to March 1999, endoscopic lithotripsy of bladder stones was done for 33 patients. We used Holmium:YAG laser for the initial 23 patients, and the Swiss Lithoclast for the recent 10 patients. We compared the safety and efficacy of the two modalities. Both lithotriptors were safe and effective to fragment the bladder stones. All the patients became stone-free at one session. However, we needed to use the Holmium:YAG laser in one patient to disintegrate the larger fragments after Lithoclast. For a big stone, Holmium:YAG laser is preferable.

TAP-144-SRの前立腺癌に対する比較対照試験をリン酸ジエチルスチルベストロールを対照薬として行った.有効性では, 前立腺癌の判定基準の適格例で, TAP群54.5%(36/66), 対照群47.1%(32/68)のPR例が得られ, 両群間に有意差はみられなかった.病巣別効果や自他覚症状に対する効果でも両群間に差はみられなかった.PAPなど腫瘍マーカーに対して対照群の方が有意に優れる効果を示した.内分泌効果では両群とも全例で血清testosteroneがcastration levelに低下した.安全性については, 副作用発現率はTAP群64.1%(41/64)に対し, 対照群は95.4%(62/65)と有意に高く, 対照群で4例が副作用のため試験が中止された.主治医判定による全般安全度では"問題あり"と判定された症例はTAP群6.3%(4/64), 対照群36.9%(24/65)であった.主治医判定による有用度では"有用"以上でみると, TAP群65.6%(42/64), 対照群52.3%(34/65)であった, A randomized controlled phase III clinical trial comparing TAP-144-SR (TAP) and diethylstilbestrol diphosphate was conducted for patients with prostatic cancer. Patients with Stage B, C, or D disease, who were previously untreated, were enrolled. TAP-144-SR 3.75 mg was administered subcutaneously at 4-week intervals for 12 weeks (a total of 3 injections) in the TAP-144-SR group, while 100 mg of diethylstilbestrol diphosphate was administered orally three times a day (before meals) for 12 weeks in the control group. A total of 141 patients were enrolled using a centralized telephone registration system. Four of these patients were ineligible, and there were 3 drop-outs who never received drugs because they withdrew their consents to participate in the trial. These 7 were excluded from the evaluation, and as a result, 134 patients (66 in the TAP group and 68 in the control group) were evaluable in safety and efficacy. Between the two groups, there were no significant differences in patient characteristics, except the age distribution. Clinical response rates (CR+PR) in evaluable patients according to the criteria of Japanese Prostatic Cancer Study Group were 54.5% in the TAP group and 47.1% in the control group. In addition, the rates according to the criteria for Evaluating the Direct Response to Chemotherapy in Solid Carcinomas and NPCP criteria were 7.6% in the TAP group and 8.8% in the control group and 18.2% in the TAP group and 20.6% in the control group, respectively. Using any of the three criteria, there were no significant differences in response rate between the two groups. The incidence of side effects was 64.1% in the TAP group and 95.4% in the control group; the incidence being significantly higher in the control group (p less than 0.001; chi 2-test). Therefore, the overall safety was significantly greater in the TAP group than in the control group (p less than 0.001; chi 2-test). On the basis of the efficacy and safety the clinical usefulness rate of TAP-144-SR was significantly higher than that of diethylstilbestrol diphosphate (p = 0.038; U-test). In conclusion, TAP-144-SR was confirmed to be more useful than diethylstilbestrol diphosphate as a standard drug for hormonal therapy of prostatic cancer.

A 60-year-old man visited our hospital because of a painless swelling of the left scrotal content which enlarged gradually for these five years. He had no history of trauma at the perineum. Tumor markers such as HCG, AFP and CEA were within normal limits. Left high orchiectomy was carried out after the admission under the diagnosis of suspicious testicular cancer. The resected mass, 16.5 x 12.5 x 9.5 cm in diameter and 900 g in weight, was encapsulated within the tunica vaginalis by a fibrous membrane and contained about 300 ml of reddish black liquid. The normally-appearing left testis was located separately from the mass. Microscopic examination revealed depositions of cholesterine crista in the wall, which are characteristic for a chronic hematocele.

Living renal transplantation (Tx) was carried out on a 41-year-old male undergoing hemodialysis for a six-month period because of end-stage renal failure due to chronic glomerulonephritis. Tacrolimus (FK 506) was used as one of immunosuppressants. The graft worked immediately after Tx. However, his blood sugar level rose extremely high and use of insulin (IS) was required. At the second postoperative day, 0.3 mg/kg/day of FK506 was administered and the trough level (TL) was as high as 65 ng/ml. The serum IS level decreased from the pre-Tx value of 22 microU/ml to 12 microU/ml. With decrease in the dose of FK506, the TL was normalized, and the dose of IS could be decreased. FK506 has been reported to inhibit IS secretion. Therefore, we must be careful to evaluate the blood glucose level in the use of FK506 for patients with poor glucose tolerance.

A 64-year-old man presented with the painless hard swelling of left scrotal content. Left orchiectomy with high ligation of the spermatic cord was performed with clinical diagnosis of testicular tumor. Histopathologically, it was diagnosed as leiomyosarcoma arising from the spermatic cord. There has been neither local recurrence nor metastasis for 5 months after operation. This is the 20th case of leiomyosarcoma of the spermatic cord in Japan.

(1)自験例7例の腎癌において, CT.超音波断層法, 動脈造影法のそれぞれの方法で, 術前stage診断をおこない, 手術または剖検によるstage診断と比較した.(2) stage 1の診断については, CT.動脈造影法が有用であったが, 超音波断層法では, stage 2との鑑別が困難であった.(3) stage 4Aの診断は, CT.超音波断層法で可能であった, Preoperative diagnosis of stage is very important in choosing the best treatment for renal cell carcinoma. The present study reports the accuracy of preoperative tumor staging by CT, ultrasonography (U. I. Octoson) and angiography in 7 cases of renal cell carcinoma. The preoperative stagings were compared with operative or autopsy findings. By operation and autopsy of the 7 cases, 3, 1 and 3 cases were confirmed to be at stages 1, 2 and 4A, respectively. In stage 1 which was confirmed by operation, CT and angiography seemed to be more useful than ultrasonography. It was difficult to distinguish stage 1 from stage 2 by ultrasonography, because the perinephric fatty tissue was not demonstrated as a distinct structure on the echogram. CT and ultrasonography were valuable in making the preoperative diagnosis of stage 4A cases. In conclusion, a more accurate preoperative staging of renal cell carcinoma would be possible when the diagnosis is based on the findings obtained by CT, ultrasonography and angiography.

A 57-year-old man was admitted to our hospital on August 7, 1978 with the chief complaint of left leg pain and claudication. Physical examination revealed a huge, hard, smooth, movable mass in left flank. Chest film showed multiple nodular tumors in both lungs. Osteolytic lesion in left fibula was noted by bone survey. IVP and angiography confirmed left renal tumor. Left nephrectomy was performed on September 18, 1978. The specimen weighed 1130 grams and measured 19.0×9.5×8.0 cm. Histopathological diagnosis was adenocarcinoma of the left kidney. Postoperatively, FT-207 was given 750 mg a day as adjuvant chemotherapy. One year after nephrectomy, X-rays revealed regression of the pulmonary and fibular metastases. Whether nephrectomy should be indicated in stage D renal carcinoma has been controversial. Although the percentage to induce spontaneous regression of metastases following nephrectomy is very low, the present case allures us to perform adjunctive nephrectomy in the good risk stage D cases.

未治療の前立腺腺癌2症例に本剤を投与し，その効果を検討した。症例1： 71歳， 排尿困難，左大腿部痛を主訴として1978年6月15日当科受診。前立腺は超鶏卵大，石様硬，表面不整，骨盤へ浸潤。左ソケイ部にくるみ大の硬いリンパ腺を触知。骨シンチで多数の転移を認めた。 前立腺の針生検組織像は分化型腺癌であった。pepleomycin 200 mg (1回10mg，静注， 週3回)の投与により前立腺癌，左ソケイ部リンパ腺の著明な縮小がみられ，血清酸ホスファターゼ値が治療前6.5K.A.U.から9.5K.A.U まで低下した。治療終了後の生検組織像は癌細胞の変性，壊死組織の線維化が目立った。 症例2: 74歳，排尿困難で1978年8月19日当科受診。前立腺は鶏卵大，硬，周囲に浸潤。骨シンチで転移巣が多数あり，前立腺生検組織像は未分化型腺癌であった。 pepleomycin投与で自覚症状は症例1ほどの改善はみられず，前立腺癌そのものもあまり縮小しなかったが，残尿は80mlから10mlへ減少した。治療後の前立腺生検所見でも癌細胞の空胞化が著明に認められた。なお副作用としては症例1では著明な皮膚変化がみられたが，症例2でぎ軽度の口内炎を認めるにとどまった。NK 631 投与前後で血中FSH，LH，testosteroneを測定したところ，両症例ともに投与終了後FSH，LH，t estosterone値は投与前値の約1/2となっていた (Table 2)。 つまり， NK 631 の抗腫瘍作用はDNA合成抑制によるということになっているが，前立腺癌に対する抗腫聖書効果はNK631 の下重体抑制による睾丸のLeydig cellよりのandrogen分泌抑制も関与している可能性があることが示唆された。本剤の下垂体抑制効果については今後検討されるべき課題であると考える。, Since the new bleomycin derivative-pepleomycin was reported to be effective for experimentally induced adenocarcinoma of stomach in rats, it was administered in two cases of prostatic cancer. Satisfactory response was obtained in well differentiated carcinoma, meanwhile only histological effect was observed in undifferentiated one. It seems that the effect of pepleomycin on prostatic cancer was brought about by the suppression of DNA synthesis of tumor and also of pituitary function resulting in decreased androgen secretion from Leydig cells.

腎癌7例，腎孟腫瘍7例，孤立性腎嚢胞2例，膀胱腫瘍19例，対照として健康成人45例において血清総燐脂質値を測定すると共に，腎癌5例，腎孟腫瘍2例，孤立性腎嚢胞2例，膀胱腫瘍3例において血清燐脂質の分画値について検討した。腎癌症例では栄養状態良好で，肝障害など他に血清脂質値に影響を与える条件がない時期に血清総燐脂質の低下傾向がみられた。また分画ではphosphatidyl cholineが低下し， phosphatidyl ethanolamine が増加していた.これはGeers らの腎癌組織では正常腎皮質と比較してphosphatidyl cholineのしめる割合が高くphosphatidyl ethanolamineが低いという報告と考え合わせて興味深いことである。また腎孟腫蕩，孤立性腎嚢胞では血清総燐脂質値，燐脂質分画においても異常はみられなかった。この事実は腎のspace occupying lesIons の鑑別にも役立つかもしれない。, Serum phospholipids were evaluated in renal cell carcinoma, renal pelvic tumor, solitary renal cyst and bladder tumor. There was a trend that renal cell carcinoma showed lowered serum total phospholipids with decreased percentage of phosphatidyl choline in the composition, while phosphatidyl ethanolamine was increased in percentage. This trend was not noted in renal pelvic tumor and solitary renal cyst. The fact might be valuable in differentiating space occupying lesions of kidney.

Four cases of metastatic testicular tumor with choriocarcinomatous element were treated with the combination of bleomycin, vincristine, actinomycin D and Picibanil following the removal of the tumor. Of the four patients, complete response was obtained in two and partial response in one. Two complete responders have remained alive without any evidence of the disease.

661 out-patients visited our clinic during the first year after the opening of the clinic on November 28, 1977. These patients were statistically analysed in this report. According to our classification as shown in Table 4, nonspecific urinary tract infection was the highest in frequency (222 cases-30.7%), followed by urinary tract stones (88 cases-12.2%), obstructive uropathy (65 cases-9.0%), congenital anomaly 57 cases-7.9%), malignant neoplasia (37 cases-5.l %) and others.

Our experience with a new endoscopic photography system is reported. The light source (Olympus CLE-F) is connected to both a lamp for observation and one for photography. At the time of photography, the light source is switched to the photography system by the movement of the mirror. The light supply and the exposure time can be controlled automatically. Of particular interest is the new endoscope which has a 5-mm rod lens system. The figures obtained on the 35 mm film are about 21 mm in diameter. The pictures obtained are clear and beautiful as is evident from the photos printed herein.

1. Chlormadinone acetate at the daily dose of 50 mg was administered to 20 patients with benign prostatic hypertrophy. The treatment was performed for 16 weeks, and improvements, marked and moderate, were observed in 11 patients (55%) in the overall judgement. 2. In objective findings, reduction of the prostate gland was observed in 12 out of the twenty patients (60%). 3. Lowering in the serum testosterone and dihydrotestosterone levels was also observed in the treated patients. 4. As side effects of this drug, a decrease of libido was observed in 2 cases (10%) and diarrhea in 2 cases (10%), however, no side effect requiring cessation of the drug was observed.

ACI/Nラットを1群16匹とし， 膀胱発癌剤であるN-butyl-N-(4-hydroxybutyl) nitrosamineを0.025%溶液として12週間自由飲水させた。免疫賦活作用をもつ多糖体とされているKrestinを50mg/kg隔日腹腔内注射した群を発癌予防群とした。発癌予防群においては悪性度の高い腫瘍の発生が抑制される傾向がみられ，発癌剤投与開始から24ないし28週に検索したラット8匹中Grade2以上の腫瘍の発生していたのは1匹であった。

イソタコフォレーシスを尿路結石の分析に応用することを試みた。本法は液相で行なう電気泳動法で，イオンは泳動槽である細管内で移動度の順に並び，等濃度かつ等速で移動する。これを今回用いた材器(島津IP-IB) の場合は電位差で検出する。つまり電位の高さによってイオンを同定し，検出器を通過する所要時間でイオン量を定量する。本法は微量定量法で、あり，短時間に，簡単な手技で多種類の陽イオンまたは陰イオンを同時に分離定量できるが，尿路結石分析のための条件を全面的に満足するものではなかった。移動度の遅い尿酸，シスチン，キサンチンの分離定量には別の溶液を用いる必要があった。しかしながら，液相で行なう短時間，同時定量法であるという特徴を生かせば，今後の尿路結石の研究に有力な武器になる可能性がある。, Newly devised isotachophoretic apparatus was used for the analysis of urinary tract stones and was found to be useful for rapid and simple quantitative analysis.

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.

A two-compartment model of kidney cells is designed. The first compartment is the cytoplasm, the other is a large organelle fraction consisting of lysosomes and mitochondria. Drugs easily accumulated in the second compartment are considered to be harmful to the kidney. Although small molecular antibiotics move across membranes, they reach a certain equilibrium within 30 minutes. Therefore reproducible values of antibiotic concentrations in both fractions can be obtained. The two-compartment model provides a new approach to pharmacokinetic study at a subcellular level.

尿中Alanine aminopeptidase活性を検討した.正常では2単位/1以下であり, 活性値の上昇は腎炎, 腎盂腎炎, あるいはなんらかの腎障害を示唆する, The value of assaying urinary alanine aminopeptidase activity was examined. The activity of normal urine was below 2 IU/1. High urinary alanine aminopeptidase was found to suggest the presence of nephritis, pyelonephritis, or other nephrotoxic processes.

The possibility of many persons viewing the same field together has been long desired in urological endoscopy, not only for objective diagnosis and proper treatment but also as an aid in teaching. Since 1978, the authors have been using the video-system consisting of an MK- 309C as a video-camera with a television monitor, the connecting scope between the endoscope and the video-camera, and a CLX as a light source. This system has been used in cystourethroscopy, TUR and fiberscopy of the upper urinary tract by our pyeloureteroscope . The features of this system are to use the connecting scope which allows television monitoring of the findings without disturbing the handling of the endoscope by the operator, the three-tube video-camera which transmits the pictures in quite natural color and good resolution to the television monitor and the very bright light source which gives clear views of the lesions. The endoscopic field that could be viewed simultaneously by many persons using this system proved to be satisfactory.

The role of transurethral resection in the treatment of prostatic cancer IS discussed. As it is well known that hormone therapy cannot successfully treat all prostatic cancer, any possible therapeutic approaches must be utilized in combination. Transurethral resection has been widely accepted as the method to relieve patients with prostatic cancer from the urinary outlet obstruction. It is an easy and safe procedure. Both radiotherapy and chemotherapy, and even hormone therapy, damage normal cells or organs as adverse effects. Immunotherapy cannot destroy many cancer cells. In contrast, transurethral resection can selectively remove many cancer cells as a surgical procedure. So it may be recommended to resect as many cancer cells as possible, then succeeding therapies will become more effective. Another reason to recommend much resection is that because a variety of histological patterns are found within a prostate. Exact histological type can only be revealed after examination was done on various parts of the cancer tissue. The therapy must be decided considering the exact histological pattern.

An instrument was developed to establish a tract through the muscle layer for percutaneous nephrostomy. The specially designed clamp holds a guide wire or rod and opens the muscle layer easily and safely. It is not as dangerous as a knife and is inexpensive compared with a disposable balloon dilator.

A simple method to visualize the rat kidney is described. Under ether anesthesia 0.2 ml ofmeglumine iodamide (64.9%, solution of 3-acetamide-methyl-5-acetamide-2, 4, 6-triiodobenzoic acid) for 100gm of body weight is injected by the percutaneous transcardiac way. Satisfactory pyelogram is obtained in rats by this way. The immediate film reveals nephrogram and those taken between 5 and 15 minutes after the injection give pyelogram.