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症例は54歳, 男性。1900年, CGNにて血液透析導入となった。2005年2月に肉眼的血尿が出現。CTにて右腎癌を指摘され, 3月9日当科紹介。当科にて施行したCTでは直径7cm大の右腎腫瘍とともに下大静脈内の肝静脈流入部まで達する腫瘍塞栓を認めた。右腎腫瘍, 下大静脈塞栓, T3bN0M0 stage IIIの診断で4月28日, 根治的右腎摘除ならびに腫瘍塞栓摘除術を施行した。手術時間4時間28分, 出血量1, 400ml, 摘出標本は重量800g, 病理所見はrenal cell carcinoma, G2, pT3bであった。術前の凝固系検査は異常を認めなかったが, 肝硬変が原因と考えられる出血時間の延長と血小板数の低下を認めたため, 周術期は血小板輸血などにて対応した。術後経過は良好で, 後出血などの術後合併症もなく, 術後18日目に退院した。現在IFNα投与にて後療法を施行中であるが, 再発を認めていない。透析患者における下大静脈腫瘍塞栓を伴う腎癌に対して外科的治療を施行した症例についての報告例については比較的少なく, 文献的考察も含めて報告する。(著者抄録), A 54-year-old man who had been under hemodialysis therapy for 16 years presented with gross hematuria at our department in February 2005. Imaging findings revealed right renal tumor of8.2 cm in diameter. In addition, the tumor extended into inferior vena cava at the level of the hepatic vein. There were no findings of distant metastasis. Right radical nephrectomy and thrombectomy were performed on April 2006. Histopathological analysis showed that the tumor was renal cell carcinoma of clear cell type, grade 2. Postoperative course was uneventful, and the adjuvant therapy with interferon alpha was initiated. He has been free from recurrence for 22 months after surgery.

Reperfusion of organ allografts induces a potent inflammatory response that directs rapid memory T cell, neutrophil, and macrophage graft infiltration and their activation to express functions mediating graft tissue injury. The role of cardiac allograft IL-1 receptor (IL-1R) signaling in this early inflammation and the downstream primary alloimmune response was investigated. When compared with complete MHC-mismatched wild-type cardiac allografts, IL-1R(-/-) allografts had marked decreases in endogenous memory CD8 T cell and neutrophil infiltration and expression of proinflammatory mediators at early times after transplant, whereas endogenous memory CD4 T cell and macrophage infiltration was not decreased. IL-1R(-/-) allograft recipients also had marked decreases in de novo donor-reactive CD8, but not CD4, T cell development to IFN-γ-producing cells. CD8 T cell-mediated rejection of IL-1R(-/-) cardiac allografts took 3 wk longer than wild-type allografts. Cardiac allografts from reciprocal bone marrow reconstituted IL-1R(-/-)/wild-type chimeric donors indicated that IL-1R signaling on graft nonhematopoietic-derived, but not bone marrow-derived, cells is required for the potent donor-reactive memory and primary CD8 T cell alloimmune responses observed in response to wild-type allografts. These studies implicate IL-1R-mediated signals by allograft parenchymal cells in generating the stimuli-provoking development and elicitation of optimal alloimmune responses to the grafts.

症例1(83歳男).CAPD導入100日後に右鼠径部の膨隆を認め, 右鼠径ヘルニアの診断でヘルニア根治術を行った.術前, 術後の透析については, 血液透析管理としていたが, 術後4日目に患者本人の自己判断にて, CAPDを施行し翌日来院した.理学所見では, 下腹部および鼠径部に膨隆, 浮腫などを認めず, その後5回の血液透析を施行した後, 術後16日目にCAPDを再開した.症例2(73歳女).CAPD導入248日目頃より右鼠径部の膨隆を自覚し, 右鼠径ヘルニアの診断でヘルニア根治術を行った.術後6日目よりCAPDを再開した.術後3ヵ月経過したが, 再発を認めず, 現在もCAPDを継続している, We report two cases of subacute inguinal swelling in uremic patients on continuous ambulatory peritoneal dialysis (CAPD). Computed tomography, scintigraphy demonstrated a mass in the right groin. Surgical repair of an inguinal hernia resulted in complete resolution of the inguinal swelling. Both patients could restart continuous ambulatory peritoneal dialysis, without complication.

74歳男で, 肉眼的血尿を主訴とした.逆行性腎盂造影検査で腎盂に突出する陰影が認められた.尿管鏡検査では, 腎盂から上部尿管にかけて粘膜の浮腫を伴った不整な肥厚と, 同部位からの数ヶ所の出血が認められた.同部位の分腎尿検査の結果はclass IIIa, 擦過細胞診はclass IIIb, TCC suspectedであった.これらの所見から腎盂腫瘍を強く疑い腎尿管全摘術を行ったが, 術後の病理組織診でeosinに淡染する無構造・硝子様物質の沈着を認め, 各種染色法によってアミロイドAL蛋白であることが判明したため, 本例をALアミロイドーシスと診断された, We report a case of localized amyloidosis of the renal pelvis and upper ureter arising in a 74-year-old man who presented at our hospital with gross hematuria. The intravenous pyelogram showed right hydronephrosis and stenosis of right renal pelvis and upper ureter. The cystoscopy view was normal, but the right retrograde-ureteropyelogram showed a long irregular stricture of the renal pelvis. Ureteroscopy was performed and rubbing biopsy of edematous, bleeding lesion suggested class IIIb, transitional cell carcinoma. With the diagnosis of a right renal pelvic tumor, right nephroureterectomy was performed. The histology report stated "massive deposits of amyloids are seen in the segment of macroscopically abnormal renal pelvis". Amyloidosis of the renal pelvis is a rare entity and 12 cases were reported in the Japanese and English literature.

39歳男性.患者は, 33歳時から左陰嚢の腫大と発熱を繰り返し, 近医で左精巣上体炎として抗生剤治療を受けていた.その後, 38度台の発熱, 左陰嚢からの排膿で著者らの施設へ受診となり, 陰嚢内膿瘍を疑い膿瘍切除術を施行したが, 膿瘍は精巣上体や尿道と離れており原因特定はできなかった.そして, さらに11ヵ月後, 再度39度台の発熱と左陰嚢から会陰部までの腫脹が生じたため患者は入院となったが, MRIでは膿瘍は精巣と尿道海綿体間にあり, 尿道海綿体との境界が不明瞭であった.そのため内視鏡検査を施行したところ, 球部尿道に経2mmの瘻孔を認め, 膀胱瘻を増設して膿瘍切除術を施行した.病理所見では結合組織内に炎症細胞が浸潤し, 肉芽と膠原線維が著明に増加していた.術後は順調に解熱し, 再感染も認めず治癒した, We report a case of perineal subcutaneous abscess due to urethral fistula in a patient with spinal cord injury. A 39-year-old male visited our hospital complaining of left scrotal swelling and fever. The left scrotum and perineal skin were swollen to the size of a goose egg, and pus was discharged from the perineal swollen bump. Magnetic resonance imaging (MRI) suggested an urethral fistula with a large subcutaneous abscess. The abscess was resected with debridement of necrotic tissue, and a cystostomy was placed. Endoscopy revealed a fistula in the bulbar urethra. The characteristics of this rare entity are discussed.

症例は39歳の男性で, 1990年に両側黒点・視野欠損, 左側霧視, 口腔内アフタ, アクネ様皮疹が出現, 1年後, 下肢のふるえ, しびれ感, 歩行障害等の錐体路徴候, 小脳失調を認め, 神経ベーチェット病と診断された.排尿症状については3年後に尿失禁が出現し, その程度は次第に増強し, 1994年4月に泌尿器科を受診した.尿流動態検査では, 膀胱内圧測定において初発尿意時膀胱容量は184ml, 最大尿意時膀胱容量は254ml とほぼ正常であった.しかし, 蓄尿時に弱い無抑制収縮と同時に括約筋収縮の増強を認め, 排尿括約筋協調不全の状態で, 下腹部を叩打して排尿を行っていた, Behcet disease is a systemic vasculitis of unknown cause with variable clinical features. The central nervous system may also be involved in about 10% of the patients with Behcet disease. Half of them show marked central nervous system symptoms and are diagnosed as neuro-Behcet disease. Voiding symptom is seen in about 5% of the patients with neuro-Behcet disease. We report a case of neuropathic vesico-urethral dysfunction in a 39-year-old man with neuro-Behcet disease. Its radiological and urodynamic features and treatment are also presented with some discussion.

We report a case of perineal subcutaneous abscess due to urethral fistula in a patient with spinal cord injury. A 39-year-old male visited our hospital complaining of left scrotal swelling and fever. The left scrotum and perineal skin were swollen to the size of a goose egg, and pus was discharged from the perineal swollen bump. Magnetic resonance imaging (MRI) suggested an urethral fistula with a large subcutaneous abscess. The abscess was resected with debridement of necrotic tissue, and a cystostomy was placed. Endoscopy revealed a fistula in the bulbar urethra. The characteristics of this rare entity are discussed.