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Le Duc-Camey antireflux ureteroileal implantation was evaluated clinically; by applying to various types of urinary reconstruction utilizing the ileum. Nineteen ureters in 10 cases including five Kock continent ileal urinary reservoirs (Kock pouches); five ileal conduit urinary diversions and one Goodwin ileocystoplasty were performed from March 1987 to August 1988. Male and female ratio was 8 to 2 and the average age was 61.7 years old. The post operative observation period was 13.9 months on the average. The outline of the operative procedure was as follows: a 3 cm sulcus was created in the mucosa along the long axis of the ileum; the ureter was passed from the serosal surface to the luminal surface and the adventitia of the ureter and the mucosa were sutured at three points in each side using 3-0 absorbable ligature to implant the ureter in the mucosal sulcus. The ureteral end was spatulated 3 mm in the upper wall and it was fixed to the mucosa by three stitches. A ureteral stent catheter, 7-8 Fr. in diameter, was indwelled in the ureter. Additional stitches were placed to strengthen the fixation on the outside surface of Kock pouches or a Goodwin ileocystoplasty. The afferent limb was not fabricated in Kock pouches because ileoureteral reflux could be prevented by the implantation technique on the pouch. Radiological evaluation was done taking IVP, loopography, pouchgraphy and cytography periodically after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

A 41-year-old male was admitted to the hospital for frequent urination and severe retardation before voiding. Roentgenography revealed exophytic lesions which were located mainly in the trigone of the bladder, and he underwent transurethral resection. The pathological diagnosis was cystitis glandularis. There was no literature which reported cystitis glandularis causing urinary disturbance. This case, moreover, had been diagnosed as cystitis glandularis 13 years before by endoscopical biopsy. The origin of cystitis glandularis and its potentiality as a pre-malignant lesion were discussed from the clinical course for over 10 years.

A case with priapism in a 66-year-old male due to malignant lymphoma is reported. Physical examination revealed an erected penis and enlarged lymph nodes in left neck and bilateral inguinal areas. Rectal digital examination of prostate revealed an irregular surface and swollen hard left lobe. Open biopsy of the bladder and vesicostomy were carried out. Several nodular lesions in the trigone and in the left wall were excised. Pathologically the diagnosis was malignant lymphoma, diffuse, large cell type and clinical stage was stage IV. CHOP therapy with bleomycin and methotrexate was performed. Priapism disappeared 7 days after the initiation of the chemotherapy, but impotence has been noticed after the chemotherapy for more than one year. This will be the first case with priapism due to malignant lymphoma reported in Japan so far.

Although total pelvic exenteration is performed for central recurrent or persistent uterine cervical carcinoma, the patient is damaged both physiologically and psychologically by its massive surgical procedure and complications as well as the loss of the vagina. Vaginal reconstruction at the time of surgery brings much advantageous satisfaction to the patient's future life and a strong bond with her husband. Furthermore, a new reconstructed vagina occuping the pelvic cavity prevents intestinal herniation and is available for bimanual examination in the follow-up to surgery. A case of recurrent cervical carcinoma is presented, with reconstruction of the vagina and conduit using the sigmoid colon in total pelvic exenteration.

We studied the incidence of goiters and that of thyroid antibodies in 278 patients with diabetes mellitus, in whom six subjects with primary hypothyroidism were excluded, and measured their serum TSH concentrations. The incidence of goiters was 31.8%, and was higher in females than in males. The incidence of goiters in diabetics under the age of 40 was higher than that in subjects more than 40 years old, and the incidence of microsome antibodies and thyroglobulin antibodies were found to be 18.5% and 1.8%, respectively, in these two groups. The percentage of microsome antibodies was lower in diabetics between the ages of 40 and 60 than in diabetics under the age of 40 or over the age of 60. The incidence of goiters and microsome antibodies was not related to the treatment of diabetes mellitus. There was a significantly positive correlation between serum TSH concentration and age in diabetics with serum TSH levels less than 5 microU/ml. As a result, although the incidence of goiters in diabetics was found to decrease with age, the incidence of thyroid antibodies and serum TSH levels were found to increase. These findings suggest that it might be possible to observe atrophic autoimmune thyroiditis, sometimes resulting in subclinical hypothyroidism, in aged diabetics.

Thirteen patients with carcinoma of the bladder have been treated by arterial infusion of doxorubicin hydrochloride pre-operatively. Teflon catheters 0.25 mm in diameter were inserted by the Seldinger technique and the tips were placed in the aorta between the origin of the inferior mesenteric artery and the aortic bifurcation. The doses administered ranged from 80 mgs to 250 mgs with an average of 125 mgs. A response rate of 69% was seen. In 3 cases tumours disappeared; in a further 6 patients some tumour regression was apparent. One patient died from cardiac insufficiency. Although this method of treatment remains to be fully evaluated, preliminary results suggest that it may be an effective pre-operative treatment.

The objective of this study was to develop a biodegradable material for use in reconstructive surgery of the bladder to serve a temporary function until normal regrowth of the host's tissue is completed. The biodegradable material can serve as a base over which the new bladder can regenerate. At the conclusion of the regrowth of the new tissue, the temporary material could be consumed by the body and therefore not have to be removed. Material evaluation showed that 70% acetic anhydride treated bovine pericardium was digested and dissolved in 4 weeks when implanted subcutaneously in dogs. Based upon this, supplementation of the bladder using this material was performed on 5 dogs. One dog showed urinary leakage and was sacrificed after 1 week. In 3 dogs examined 4, 6, and 48 weeks after implantation, respectively, the implanted material had been dissolved. In one animal autopsied at 10.5 months, a small remnant of the material still remained. Post-operative observation of the animals, excretory pyelocystograms and cystometry confirmed that the material applied was useful for experimental urinary bladder supplementation.

Plasma renin activity (PRA), plasma renin concentration (PRC), inactive renin concentration (IRC) and total renin concentration (TRC) were measured in 31 normal controls and in 8 patients with hyperthyroidism. TRC was determined as angiotensin I generated with sheep renin substrate after an acid activation of plasma. The angiotensin I of non-acidified plasma was expressed as PRC. IRC was calculated as TRC minus PRC. The mean values for PRA, PRC, IRC and TRC were significantly (P less than 0.05 to P less than 0.01) higher in the hyperthyroid patients than in the normal or euthyroid controls. The administration of a beta 1-adrenergic blocker, metoprolol (120 mg/day for 14 days), produced a significant (P less than 0.05 to P less than 0.01) fall in levels of T4, PRA and TRC, and reduced the active renin ratio calculated from PRC/TRC significantly (P less than 0.025), as compared to the pretreatment values. Our observations support the idea that the higher PRA in hyperthyroidism is due to an increased secretion of renin. Furthermore, the results may indicate that the conversion of inactive to active renin is accelerated in hyperthyroidism, possibly by an increased sympathetic activity.

The clinical efficacy and safety of Cefodizime (CDZM), a new cephem antibiotic, was objectively compared with that of Cefotaxime (CTX) in patients with respiratory infections under a well-controlled comparative study. Patients were administered CDZM or CTX by drip infusion b.i.d. for 14 days in principle at a daily dose of two grams. The parameters assessed were clinical efficacy, safety and clinical usefulness. The following results were obtained: 1. On the basis of committee judgement the clinical efficacy rate was 78.1% (125/160) for the CDZM group, 82.7% (124/150) for the CTX group, and no significant difference was observed between the two drug groups. On the other hand, on the basis of judgement by physicians in charge, the clinical efficacy rate was 83.1% (133/160) for the CDZM group, 83.9% (125/149) for the CTX group, and no significant difference was observed between the two groups. 2. The corresponding figures for patients with pneumonia and pulmonary suppuration were 82.4% (70/85) for the CDZM group, 79.7% (59/74) for the CTX group and no significant difference was observed according to the committee judgement. The judgement by physicians in charge also revealed 83.5% (71/85) for the CDZM group and 82.2% (60/73) for the CTX group. No significant difference was noted between the two groups. While, the committee judgement for the clinical efficacy in patients with chronic respiratory tract infections showed 73.3% (55/75) for the CDZM group, 85.5% (65/76) for the CTX group, and no significant difference was observed between the two drug groups. The corresponding figures were 82.7% (62/75) for the CDZM group, 85.5% (65/76) for the CTX group, and no significant difference was observed between the two drug groups on the judgement by physicians in charge. Furthermore, the clinical efficacy of both drugs on chronic respiratory tract infections was assessed according to "Criteria for Evaluation of Clinical Efficacy of Chemotherapeutics on Chronic Respiratory Tract Infection". It was 76.8% (53/69) for the CDZM group, 76.3% (58/76) for the CTX group, and no significant difference was observed between the two groups. 3. The bacteriological eradication rate of causative pathogens was 92.4% out of 66 patients treated with CDZM and 95.5% out of 67 patients treated with CTX in whom judgement was possible. No significant difference was observed between the two drug groups. 4. The adverse reactions occurred in 4 (2.2%) patients for the CDZM group and 8 (4.5%) patients for the CTX group respectively, with no significant inter-group difference in frequency of these reactions for all cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Six normal volunteers were tested to ascertain the dose-dependency and reproducibility of the prolactin response to metoclopramide. Furthermore, pretreatments with 1-dopa or cyproheptadine were performed. The same subjects also received intravenously 500 microgram TRH. The oral administration of 5 mg metoclopramide produced a significant rise in prolactin at 60 min and a maximal elevation at 90 min. The intravenous administration of 5 mg metoclopramide produced a significant increment at 15 min and a maximal prolactin level at 30 min. Peak prolactin levels following i.v. administration of the drug were greater than those after oral administration. Intravenous administration of 1 mg of metoclopramide produced a potential increment in plasma prolactin. Maximal prolactin response to 1 mg i.v. metoclopramide was similar to that found with 500 microgram i.v. TRH. Reproducibilities of prolactin response were good in all doses and modes of administration of metoclopramide. Pretreatment with 1-dopa inhibited the metoclopramide-induced prolactin response, but pretreatment with cyproheptadine did not influence the prolactin response to metoclopramide. Metoclopramide is a good and reproducible stimulator of prolactin secretion.

Between 1980 and 1985, 17 patients with advanced urothelial carcinoma and 13 with metastatic prostatic carcinoma refractory to hormonal therapy were treated with a combination chemotherapy of cyclophosphamide (CPM), adriamycin (ADM) and cis-diammine-dichloroplatinum (CDDP) to evaluate its antitumor effect and toxicity. ADM (1 mg/kg) on day 1, CPM (2 mg/kg) on days 2 through 5 and CDDP (1.5 mg/kg) on days 6 and 7 were administered every 3 weeks. Of the 17 patients with urothelial carcinoma, 13 were eligible for evaluation. One patient achieved CR with a disease-free interval lasting for 29 months, one showed PR (duration of response 2 months), 4 NC and 7 PD, with an overall response rate of 15% (2/13). Of the 13 patients with prostatic carcinoma, 11 could be evaluated. No patients achieved CR, one had PR (duration of response 5 months), 2 NC and 8 PD, with an overall response rate of 9% (1/11). No statistically significant difference in survival was noted between responders (CR + PR) and non-responders (NC + PD) to the combination chemotherapy, irrespective of whether they had metastatic urothelial or prostatic carcinoma. Myelosuppression was frequently noted, with sepsis occurring in one patient. No mortality attributable directly to this regimen was noted.

The development of ultrasonography and CT scanning has facilitated the diagnosis of primary retroperitoneal tumors. However, the tumor resection rate remains low. Factors such as tumor histology and stage of the disease play a role. Angiographic study of the tumor vessels is important in determining the procedures to the used in operative treatment. We present 3 primary retroperitoneal tumors and one malignant adrenal tumor discuss the importance of angiographic evaluation in the resection of recurrent tumors. A flow chart for surgically treated primary retroperitoneal tumor is proposed.

Flow cytometric (FCM) examination of DNA distribution based on heterogeneity index score (HIS) and ploidy pattern and of bladder irrigation specimens were compared with conventional urine cytologic examinations to evaluate the diagnostic efficacy of each method. Of 56 patients with histologically proved bladder tumors, 24 (43%) had positive urine cytology, 41 (73%) had positive FCM, and 45 (80%) had positive urine cytology and/or positive FCM. When bladder tumors were graded histologically, 8 of 11 patients (73%) with grade I bladder carcinoma, 22 of 28 patients (79%) with grade II, and 15 of 17 patients (88%) with grade III had positive urine cytology and/or positive FCM. Of the 28 patients with grade II, 12 with positive urine cytologic results had higher mean HIS (117.5) when compared with 16 (61.1) in whom urine cytology was negative. Of those who continued to have positive FCM in the face of negative findings on cystoscopic and urine cytologic examinations during follow-up, 3 patients eventually were found to have tumors (2 distal ureter, 1 bladder). These results indicate that FCM examinations for DNA distribution of bladder irrigation specimens are as useful as conventional urine cytology in the management of bladder tumors, can be more sensitive for detection and monitoring of the disease, and can contribute further to accurate diagnosis of the disease when combined with conventional urine cytology.