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Whether endosymbionts can survive amoebal encystations remains a significant challenge in cellular biology. The survival of the endosymbiotic bacteria Protochlamydia belonging to environmental chlamydiae in acanthamoebae following encystation was therefore assessed. The bacteria were observed in cysts and the bacterial transcripts (16S rRNA and/or groEL) were also detected in amoeba cultures following encystation. Furthermore, the bacterial replication and the growth was confirmed in trophozoites reverted from cysts. Thus, these results demonstrated that Protochlamydia could survive in acanthamoebae following encystation. Our findings suggest that amoeba cysts might be further studied in order to elucidate the their role in the environmental survival of endosymbionts.

In this study we investigated the influences of decreased levels of activities of daily living (ADL), especially in bedridden patients, on lower urinary tract dysfunction and urinary management during hospital care. All 1, 106 non-urological inpatients (896 non-bedridden patients and 210 bedridden patients) with an indwelling urethral catheter treated at Noto General Hospital between April 2006 and October 2009 were retrospectively evaluated. Maximum bladder capacity and post-void residual urine volume (PVR) were evaluated with uroflowmetry or voiding cystourethrography at the time the catheter was removed. Clean intermittent catheterization (CIC) and drug administration were performed for patients who had a PVR of 100 ml or more. Bedridden patients required urinary interventions at a higher rate than did non-bedridden patients (bedridden : 29.0%, non-bedridden : 17.6%). Although indwelling urethral catheters were reinserted in 13 patients in the bedridden group and 16 patients in the non-bedridden group, many patients in both groups could be free from the catheter. Our results indicate that patients with low ADL are vulnerable to impaired bladder emptying, and early diagnosis of impaired bladder emptying and active urinary management are required to solve their urinary problems.

We report a case of a mixed epithelial and stromal tumor of the kidney. A 64-year-old female who had no complaint was found to have a left renal tumor by computed tomography (CT) for an examination of a right breast tumor and was referred to our department. CT revealed a gradually enhancing 5 cm mass in the left kidney. The patient underwent left radical nephrectomy, and the tumor was histologically diagnosed as a mixed epithelial and stromal tumor. The patient has been followed up for 6 months with no evidence of local recurrence or metastasis.

塩酸タムスロシンを4週間以上投与されたにも拘わらず改善効果不十分な症例に対し, 酢酸クロルマジノン徐放錠を16週間併用し, その臨床効果と前立腺縮小効果について検討した. 1)I-PSSによる自覚症状の検討では, 頻尿, 尿線途絶, 尿勢, いきみに有意の改善が認められた.また合計点においても有意な改善が認められた.特に閉塞症状に有意の改善が認められた. 2)経直腸的超音波検査による前立腺推定容積の検討では, 前立腺全体及びtransition zone共に有意な縮小が認められた. 3)他覚所見では, 最大尿流量率に有意の改善が認められた.また, 残尿量及び残尿率は投与12週までは有意な改善が認められた. 4)副作用では1例に肝機能障害が認められ, 投薬が中止された. 5)臨床検査値では, 赤血球数, ヘモグロビン値の有意の低下が認められたが, 正常範囲内であった, Alpha adrenergic blocker has become the first choice in the medical treatment of benign prostatic hyperplasia (BPH). The efficacy of alpha adrenergic blocker has been suggested to be related to the prostatic tissue components, and to be ineffective in treating the clinical symptoms caused by BPH in some cases. The efficacy and prostate reduction of an anti-androgenic agent, chlormadinone acetate, combined with alpha adrenergic blocker, tamsulosin hydrochloride, were evaluated using 40-BPH patients insufficiently treated with tamsulosin hydrochloride alone. Fifty mg of chlormadinone acetate and 0.2 mg of tamsulosin hydrochloride were administered orally once a day for 16 weeks to patients with a prostate subjective symptoms score, I-PSS, of greater than 13 or a peak flow rate of less than 12 ml/s, even after the treatment with 0.2 mg of tamsulosin hydrochloride alone for more than four weeks. Total I-PSS decreased significantly after four weeks. The total irritative symptom score did not change for 16 weeks, but the total obstructive symptom score decreased significantly, as did the total I-PSS. In objective data, the estimated volume of both total prostate and the transition zone on transrectal ultrasonogram decreased significantly at the end of the treatment, and the peak flow rate decreased significantly after 12 weeks. These findings suggest that the addition of chlormadinone acetate may be a reasonable alternative in the treatment of BPH patients responding insufficiently to tamsulosin hydrochloride alone, and that combination therapy using chlormadinone acetate and tamsulosin hydrochloride may be useful for BPH patients with serious obstructive symptoms.

前立腺肥大症に伴う排尿障害患者に対して塩酸タムスロシン0.2mg/日を7週間投与して, その臨床的有用性を検討した. 1)自覚症状スコアは有意に改善した. 2)残尿量及び残尿率は有意に減少した. 3)尿流検査で排尿量, 最大尿流率及び平均尿流率は有意に増加した. 4)尿道内圧曲線で前立腺部尿道内圧は有意に低下した. 5)膀胱内圧曲線で初発尿意時膀胱容量は有意に増加した. 6)副作用は3例の軽度検査値上昇以外は認められなかった, The efficacy and safety of tamsulosin hydrochloride were evaluated in 54 patients with bladder outlet obstruction associated with benign prostatic hyperplasia. Oral tamsulosin hydrochloride 0.2 mg was administered once daily for 7 weeks. The international prostate symptom score, residual urine, uroflowmetrogram, urethral pressure profile and cystometrogram were obtained before and after treatment. The international prostate symptom score improved significantly, and the residual urine volume and ratio of residual urine decreased significantly. In uroflometry, voided volume, maximum flow rate and average flow rate increased significantly. In urethral pressure profile, prostatic urethral pressure decreased significantly. In cystometry, bladder capacity at the first sensation increased significantly. No adverse reactions except for slight elevation in laboratory data in 3 patients were observed. In conclusion, tamsulosin hydrochloride is a useful drug in the treatment of bladder outlet obstruction associated with benign prostatic hyperplasia.

雌性正常イヌをα-chloralose urethane麻酔下に肛門電気刺激を行った結果, 生理的食塩水の持続的注入時にみられる膀胱の周期的な反射性収縮を抑制するためには5～10 Hzの低周波数刺激が適当であるとの結果をえた.過活動型膀胱が認められる切迫性尿失禁患者18例を以下の刺激条件にて肛門電気刺激を行った.持続時間0.2 msec, 周波数5 Hz, 強度は患者の耐えうる最大強度(30～150 V), 30分間刺激を週5回の頻度で10回行った.18例中12例に尿失禁の消失がみられ, 肛門電気刺激前後の初発尿意量, 最大膀胱容量に有意の増加が認められたが, 最大尿道閉鎖圧, 残尿量に関しては, 有意の増減はみられなかった.症例を不安定膀胱群と神経因性膀胱群に分類して比較を行った場合, 自覚症状の改善率に関しては, 両群間に有意差はみられなかったが, 神経因性膀胱群では初発尿意量, 最大膀胱容量に有意の増加が認められた.塩酸terodilineなどの薬剤併用群と非併用群とに分類した場合(併用群は18例中11例), 尿失禁の改善率は併用群に有意に高かった, To determine the most effective parameter of functional electrical stimulation of the anal sphincter (FES), the present study was carried out in female mongrel dogs anesthetized with alpha-chloralose urethane. When spontaneous and rhythmic micturition contractions of the bladder were present, they were more effectively inhibited by the stimulation with low frequency (5 to 10 Hz). Based on the results of this experiment 18 patients with urge incontinence were treated by maximal electrical stimulation with the following parameters. The duration for each stimulus was 0.2 msec, frequency 5 Hz, amplitude 30 to 150 volts. Every patient received ten treatments for two weeks, each lasting for 30 minutes. A clinical cure for urge incontinence was noted in 12 patients. As for urodynamic studies, FES increased significantly the volumes of the first desire to void (FDV) and maximum desire to void (MDV); however, it did not increase significantly the maximum urethral closure pressure or residual urine volume. Eighteen patients were divided into two groups; an unstable bladder group and a neurogenic bladder group. In the latter, the increases in volumes of FDV and MDV were significant. Second, 18 patients were divided into two groups according to the administration of lack of anticholinergic agents. For subjective symptoms, the rate of improvement of urge incontinence was significantly higher in the group administered the agents. These findings suggested that FES was very useful for the treatment of urge incontinence, with its efficacy augmented by the administration of anticholinergic agents.

頻尿, 尿失禁を主訴とする患者51例(神経因性膀胱18例, 腹圧性尿失禁12例, 神経性頻尿10例, 不安定膀胱8例, その他3例)に対し, 塩酸テロジリン1日24 mg, 塩酸クレンブテロール20～40 μgを投与し尿失禁の改善度は中等度改善以上は18例, 軽度改善以上は25例であった.他覚所見では, 初発尿意時膀胱容量, 最大膀胱容量は平均41 mlと有意に増加した.膀胱コンプライアンスも平均2.5 ml/cmH2Oと有意に増加した.しかし, 最高尿道内圧は0.5 cmH2Oと僅かに上昇したのみであった.尿流量測定, 残尿量測定結果でも有意な変化はなかった.全般改善度は著明改善6例, 中等度改善20例, 軽度改善11例, 不変13例, 悪化1例であった.特に腹圧性尿失禁においては, 12例中著明改善2例, 中等度改善7例と好結果が得られた.副作用は13例に見られ, 手指振戦が7例と多く, 塩酸クレンブテロール1日20 μg投与群に有意に少なかった.以上より, 両薬剤の併用投与は頻尿, 尿失禁に有効な治療法と考えられ, 特に腹圧性尿失禁に対してはより高い有用性が期待できる, The clinical effectiveness and safety of terodiline hydrochloride and clenbuterol hydrochloride were studied on 51 patients with neurogenic bladder, stress incontinence, unstable bladder and others, the chief complaints of which were urinary frequency or urinary incontinence. Overall improvement was graded as marked in 6 patients (11.8%), moderate in 20 patients (39.2%), slight in 11 patients (21.6%), unchanged in 13 patients (25.5%) and aggravated in one. The patients impression was "good" or better in 56.9%. There were a total of 13 cases (25.5%) of adverse reactions, namely, 7 cases of finger tremor, 3 cases of dry mouth and others. These reactions disappeared rapidly after the discontinuance of drug administration. The clinical efficacy in the treatment of subjective symptoms was 71.4% for urinary incontinence, 56.4% for diurnal pollakisuria. The examination of lower urethral functions demonstrated a significant (p less than 0.01) increase in bladder capacity at first desire and maximum desire to void. However, we found no significant increase in urethral clossure pressure. The findings of this study suggest that terodiline hydrochloride and clenbuterol hydrochloride are very useful for the treatment of urinary frequency and incontinence.

12例のMSに対しurodynamic studyを施行した.overactive bladder (bl) 4例・normoactive bl 5例・underactive bl 3例であった.4例には排尿筋括約筋協調不全(DSD)を合併していた.重症例にはoveractive bl症例及びDSD合併例が多い傾向にあり, α-blocker・choline作動薬などの使用, 間歇導尿などが行われ, 良好な排尿管理が可能であった, During a period of 4.5 years, neurological and urodynamic evaluation was done on 12 patients with multiple sclerosis between 20 and 67 years old with an average age of 47.6 years. Pyramidal dysfunction (100%), sensory disturbance (100%) and brain stem dysfunction (60%) were common neurological signs. All patients were assessed by the Kurtzke's rating of neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Of the 12 cases 6 were diagnosed as severe multiple sclerosis (EDSS greater than or equal to 4.5) and the remainders were diagnosed as relatively mild (EDSS less than 4.5). Neurourologic evaluation was performed by rapid filling carbon dioxide cystometry and sphincter electromyography. Cystometry revealed overactive bladder in 4 (33%), underactive bladder in 3 (25%) and normoactive bladder in 5 (42%) of the 12 cases. Of the 6 severe cases of multiple sclerosis, 3 (50%) showed overactive bladder, while only 1 of the 6 (17%) mild cases showed overactive bladder. Detrusor sphincter dyssynergia (DSD) was observed in 4 of the 9 (67%) severe cases and none of the 6 mild cases. The presence of overactive bladder or DSD seems to correlate with the severity of multiple sclerosis.

To evaluate the effect of UFT, a mixture of ftorafur and uracil in a ratio of 1:4, in preventing postoperative recurrence of bladder cancer, we performed a randomized controlled study with a non-medication group as control. UFT was given orally 400 mg a day for 6 months. Of 111 patients, 56 were given UFT and 55 were followed up without any medication. The non-recurrence rate in the group treated with UFT was 62.8% after 1 year and 36.3% after 2 years of follow up, and that of the control group was 45.7% and 39.5%, respectively. The rate of non-recurrence in the UFT group was significantly higher (p less than 0.05) than that of the control group during the period of follow up for 2 years. The incidence of side effects was 6.8% in UFT patients. These results indicate the clinical usefulness of prophylactic administration of UFT for bladder cancer patients.

In this study we investigated the influences of decreased levels of activities of daily living (ADL), especially in bedridden patients, on lower urinary tract dysfunction and urinary management during hospital care. All 1, 106 non-urological inpatients (896 non-bedridden patients and 210 bedridden patients) with an indwelling urethral catheter treated at Noto General Hospital between April 2006 and October 2009 were retrospectively evaluated. Maximum bladder capacity and post-void residual urine volume (PVR) were evaluated with uroflowmetry or voiding cystourethrography at the time the catheter was removed. Clean intermittent catheterization (CIC) and drug administration were performed for patients who had a PVR of 100 ml or more. Bedridden patients required urinary interventions at a higher rate than did non-bedridden patients (bedridden : 29.0%, non-bedridden : 17.6%). Although indwelling urethral catheters were reinserted in 13 patients in the bedridden group and 16 patients in the non-bedridden group, many patients in both groups could be free from the catheter. Our results indicate that patients with low ADL are vulnerable to impaired bladder emptying, and early diagnosis of impaired bladder emptying and active urinary management are required to solve their urinary problems.

We report a case of a mixed epithelial and stromal tumor of the kidney. A 64-year-old female who had no complaint was found to have a left renal tumor by computed tomography (CT) for an examination of a right breast tumor and was referred to our department. CT revealed a gradually enhancing 5 cm mass in the left kidney. The patient underwent left radical nephrectomy, and the tumor was histologically diagnosed as a mixed epithelial and stromal tumor. The patient has been followed up for 6 months with no evidence of local recurrence or metastasis.

Alpha adrenergic blocker has become the first choice in the medical treatment of benign prostatic hyperplasia (BPH). The efficacy of alpha adrenergic blocker has been suggested to be related to the prostatic tissue components, and to be ineffective in treating the clinical symptoms caused by BPH in some cases. The efficacy and prostate reduction of an anti-androgenic agent, chlormadinone acetate, combined with alpha adrenergic blocker, tamsulosin hydrochloride, were evaluated using 40-BPH patients insufficiently treated with tamsulosin hydrochloride alone. Fifty mg of chlormadinone acetate and 0.2 mg of tamsulosin hydrochloride were administered orally once a day for 16 weeks to patients with a prostate subjective symptoms score, I-PSS, of greater than 13 or a peak flow rate of less than 12 ml/s, even after the treatment with 0.2 mg of tamsulosin hydrochloride alone for more than four weeks. Total I-PSS decreased significantly after four weeks. The total irritative symptom score did not change for 16 weeks, but the total obstructive symptom score decreased significantly, as did the total I-PSS. In objective data, the estimated volume of both total prostate and the transition zone on transrectal ultrasonogram decreased significantly at the end of the treatment, and the peak flow rate decreased significantly after 12 weeks. These findings suggest that the addition of chlormadinone acetate may be a reasonable alternative in the treatment of BPH patients responding insufficiently to tamsulosin hydrochloride alone, and that combination therapy using chlormadinone acetate and tamsulosin hydrochloride may be useful for BPH patients with serious obstructive symptoms.

The efficacy and safety of tamsulosin hydrochloride were evaluated in 54 patients with bladder outlet obstruction associated with benign prostatic hyperplasia. Oral tamsulosin hydrochloride 0.2 mg was administered once daily for 7 weeks. The international prostate symptom score, residual urine, uroflowmetrogram, urethral pressure profile and cystometrogram were obtained before and after treatment. The international prostate symptom score improved significantly, and the residual urine volume and ratio of residual urine decreased significantly. In uroflometry, voided volume, maximum flow rate and average flow rate increased significantly. In urethral pressure profile, prostatic urethral pressure decreased significantly. In cystometry, bladder capacity at the first sensation increased significantly. No adverse reactions except for slight elevation in laboratory data in 3 patients were observed. In conclusion, tamsulosin hydrochloride is a useful drug in the treatment of bladder outlet obstruction associated with benign prostatic hyperplasia.

To determine the most effective parameter of functional electrical stimulation of the anal sphincter (FES), the present study was carried out in female mongrel dogs anesthetized with alpha-chloralose urethane. When spontaneous and rhythmic micturition contractions of the bladder were present, they were more effectively inhibited by the stimulation with low frequency (5 to 10 Hz). Based on the results of this experiment 18 patients with urge incontinence were treated by maximal electrical stimulation with the following parameters. The duration for each stimulus was 0.2 msec, frequency 5 Hz, amplitude 30 to 150 volts. Every patient received ten treatments for two weeks, each lasting for 30 minutes. A clinical cure for urge incontinence was noted in 12 patients. As for urodynamic studies, FES increased significantly the volumes of the first desire to void (FDV) and maximum desire to void (MDV); however, it did not increase significantly the maximum urethral closure pressure or residual urine volume. Eighteen patients were divided into two groups; an unstable bladder group and a neurogenic bladder group. In the latter, the increases in volumes of FDV and MDV were significant. Second, 18 patients were divided into two groups according to the administration of lack of anticholinergic agents. For subjective symptoms, the rate of improvement of urge incontinence was significantly higher in the group administered the agents. These findings suggested that FES was very useful for the treatment of urge incontinence, with its efficacy augmented by the administration of anticholinergic agents.

The clinical effectiveness and safety of terodiline hydrochloride and clenbuterol hydrochloride were studied on 51 patients with neurogenic bladder, stress incontinence, unstable bladder and others, the chief complaints of which were urinary frequency or urinary incontinence. Overall improvement was graded as marked in 6 patients (11.8%), moderate in 20 patients (39.2%), slight in 11 patients (21.6%), unchanged in 13 patients (25.5%) and aggravated in one. The patients impression was "good" or better in 56.9%. There were a total of 13 cases (25.5%) of adverse reactions, namely, 7 cases of finger tremor, 3 cases of dry mouth and others. These reactions disappeared rapidly after the discontinuance of drug administration. The clinical efficacy in the treatment of subjective symptoms was 71.4% for urinary incontinence, 56.4% for diurnal pollakisuria. The examination of lower urethral functions demonstrated a significant (p less than 0.01) increase in bladder capacity at first desire and maximum desire to void. However, we found no significant increase in urethral clossure pressure. The findings of this study suggest that terodiline hydrochloride and clenbuterol hydrochloride are very useful for the treatment of urinary frequency and incontinence.

During a period of 4.5 years, neurological and urodynamic evaluation was done on 12 patients with multiple sclerosis between 20 and 67 years old with an average age of 47.6 years. Pyramidal dysfunction (100%), sensory disturbance (100%) and brain stem dysfunction (60%) were common neurological signs. All patients were assessed by the Kurtzke's rating of neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Of the 12 cases 6 were diagnosed as severe multiple sclerosis (EDSS greater than or equal to 4.5) and the remainders were diagnosed as relatively mild (EDSS less than 4.5). Neurourologic evaluation was performed by rapid filling carbon dioxide cystometry and sphincter electromyography. Cystometry revealed overactive bladder in 4 (33%), underactive bladder in 3 (25%) and normoactive bladder in 5 (42%) of the 12 cases. Of the 6 severe cases of multiple sclerosis, 3 (50%) showed overactive bladder, while only 1 of the 6 (17%) mild cases showed overactive bladder. Detrusor sphincter dyssynergia (DSD) was observed in 4 of the 9 (67%) severe cases and none of the 6 mild cases. The presence of overactive bladder or DSD seems to correlate with the severity of multiple sclerosis.

To evaluate the effect of UFT, a mixture of ftorafur and uracil in a ratio of 1:4, in preventing postoperative recurrence of bladder cancer, we performed a randomized controlled study with a non-medication group as control. UFT was given orally 400 mg a day for 6 months. Of 111 patients, 56 were given UFT and 55 were followed up without any medication. The non-recurrence rate in the group treated with UFT was 62.8% after 1 year and 36.3% after 2 years of follow up, and that of the control group was 45.7% and 39.5%, respectively. The rate of non-recurrence in the UFT group was significantly higher (p less than 0.05) than that of the control group during the period of follow up for 2 years. The incidence of side effects was 6.8% in UFT patients. These results indicate the clinical usefulness of prophylactic administration of UFT for bladder cancer patients.

The clinical effectiveness of oral administration of ONO-995 tablets was determined in 16 patients with areflexic neurogenic bladders, by means of assessing the improvement of their subjective symptoms, amount of residual urine and cystometric findings. An improvement in subjective symptoms was seen in 7 of the 16 patients, and more than 30% decrease in residual urine in the other 9 patients. An increase in pressure amplitude as evidenced by the difference between the maximum voiding pressure and maximum resting pressure on cystometry was observed in 9 patients. A slight increase in the maximum urethral pressure was observed in 8 of the 13 patients selected for the urethral pressure profile study. These results suggest that ONO-995 increases both urethral resistance and detrusor contraction. When improvement of subjective symptoms showing an increase in pressure amplitude by more than 6cm H2O was evaluated as effective, the effective rate was 43.8%. There was no serious adverse reaction.

雌性雑種成犬の膀胱に, 短時間(1時間), 長時間(48時間)の過伸展状態を作成し, 解除2週間後膀胱容量, 膀胱内圧の変化と利尿筋切片のAchに対する収縮反応の変化を調べた.膀胱容量, 膀胱内圧は感染の影響もあり一定の傾向は見出しえなかったが, 非感染群は7頭中6頭に膀胱容量の増加を, 感染群は5頭中4頭に膀胱容量の減少を認めた.感染は膀胱過伸展の両群で42%に認めた.Achに対する収縮反応は, 短時間群, 長時間群とも無処置群に比しあきらかに大きな収縮反応を示し, さらに長時間群では, Ach 10-8 g/ml以下の低濃度域でも収縮反応をみた, The influence of prolonged bladder overdistension on the detrusor muscle was studied in female mongrel dogs. Two overdistending methods were employed, namely, constantly elevated hydrostatic pressure for one hour and bladder neck ligation for 48 hours. The cystometrogram and urinalysis at 2 weeks after release of overdistension were compared with the preoperative estimations. Using the in vitro isometric technique, the contractility of the detrusor muscle strip to acetylcholine was evaluated in the untreated control group and the two overdistended groups. Prolonged bladder overdistension for one hour as well as 48 hours resulted in a high incidence of urinary tract infection. There was no correlation between the cystometric findings before and after overdistension . An increase in contraction response to acetylcholine was observed in both overdistended groups. Besides, a small contraction response to acetylcholine at a lower concentration was observed in the group overdistended for 48 hours. It is suggested that the observed contraction response increase was probably due to axonal degeneration caused by a decrease in the blood supply to the overdistended bladder wall.

10例の膀胱癌症例に対し, エタノール加ペプロマイシン灌流による膀胱癌温熱療法を施行し, うち6例に25%以上の腫瘍縮小効果が認められた.しかし腫瘍の完全消失例が認められなかったことにより, 本療法による根治性は否定的と考えられた, Distilled water containing 40 micrograms/ml peplomycin and 2% ethanol was used as a perfusate in 8 patients with superficial bladder tumors and 2 with deep bladder tumors for 2 hours at 43 degrees C. In addition, immediately before the perfusion treatment, 5 mg of peplomycin was injected intramuscularly. Prior to treatment, the nature and extent of the tumors were determined by ultrasonography, cystoscopy and cystography. The therapeutic effect of the hyperthermic perfusion was evaluated by the same manner as used previously. Partial tumor regression was obtained in 6 of the 8 patients with superficial bladder tumors. The 2 patients with deep bladder tumors showed no tumor regression. Most of the patients had bladder discomfort such as irritation, pollakisuria and so on, during and/or after perfusion. No patient developed acute pyelonephritis.

A cystometric study was made on 26 patients with sustained cerebral strokes whose cerebral lesions were confirmed by computerized tomography (CT scan). All of them had been free of organic obstruction of the lower urinary tract. These patients were divided into the cerebral infarction (16 cases), the subarachnoid bleeding (4 cases) and cerebral hemorrhage (6 cases) clinically. Moreover, cases of the cerebral infarction were subdivided into the cortical infarction (7 cases), the sub-cortical infarction (6 cases) and the cerebral atrophy (3 cases) from the findings of CT scan. The results are as follows. 1) Seven cases diagnosed as the cortical infarction showed the uninhibited type in 6 cases and the normal type in one case cystometrically. 2) Six cases diagnosed as the sub-cortical infarction showed the uninhibited type in 4 cases and the hypotonic type in 2 cases. 3) Cases of the subarachnoid bleeding and the cerebra hemorrhage showed both types. From these results, the following speculations became possible. a) The cortical infarction has a tendency to bring about the uninhibited neurogenic bladder. b) The sub-cortical infarction has a tendency to bring about the two types, the uninhibited and hypotonic neurogenic bladder. c) The subarachnoid bleeding and cerebral hemorrhage has a tendency to bring about the two types as well. d) Most cases complaining of dysuria are apt to accompany the psychological disorders, especially dementia. This kind of research should be continued in the future.

1978年1月から1982年10月までの間に, 直腸癌, 子宮癌根治手術後に排尿障害を認めた35例につき検討した.これらの症例を, 手術直後より自己導尿法を開始した新鮮例(27例)と, 手術後3ヵ月以降に薬物療法が無効などの理由により自己導尿法を開始した陳旧例(8例)に分類した.35例中16例は, 自己導尿法期間中の膿尿発生率が, 20%以下であった.新鮮例のうち6例は, 自己導尿法開始後1週から7ヵ月の間に残尿率が20%以下となり, 自己導尿法より離脱でき, 10例は自力排尿を認めるも, 残尿率20%以上であり自己導尿法を続けている.さらに11例は, 自己導尿法開始後もまったく自力排尿ができない状態であった.新鮮例中の9症例にUP maxを, 自己導尿法開始前と開始後3ヵ月以降の時点で比較したところ, 正常値以下ながら8例に上昇が認められた.新鮮例11例について, 膀胱内圧所見の変化を検討したが, とくに有意な所見は認められなかった, To determine the effectiveness of non-sterile intermittent self-catheterization, a study was made of 35 patients who had radical surgery of the carcinoma of the uterus or rectum between January, 1978 and October, 1982. These cases were divided into 2 groups; (1) early instituted group of 27 patients who used self-catheterization within 3 months following surgical intervention; (2) late instituted group of 8 patients who received drug treatment for more than 3 months after surgical treatments and then used self-catheterization. After the introduction of self-catheterization, urinary tract infection was evaluated on the basis of the incidence of pyuria defined as more than 5 white blood cells per high magnification field. In 16 of the 35 patients, the incidence of pyuria ranged from 0 to 20 per cent. Regarding prognostic results in the first group the application of self-catheterization, 6 patients had a residual urine ratio ranging from 0 to 20 per cent and were able to void at will. Uroflometry was performed in 9 patients in the first group. In 8 of these patients, UP max values increased 3 months after self-catheterization as compared with those before self-catheterization although their values were still lower than normal. Non-sterile intermittent self-catheterization can shorten the stay in hospital and enable the patient to live a catheter-free life.

男13例, 女9例に先天性神経因性膀胱22例を経験した.1)経過中12例に尿路感染を認め, 男38.3%, 女88.9%であった.2)膀胱内圧所見は過反射型3例, 無反射高緊張型6例, 無反射低緊張型8例で, 過反射型3例, 無反射高緊張型6例中感染のなかったのは1例のみで, 無反射低緊張型は8例中5例であった.3) 13例のUP maxは過反射型では正常かそれ以上で, 無反射型では低値であった.4) 9例のVURでは6例9尿管に逆流を認めた.5)排泄性腎盂造影で, 22例中6例に腎障害を認め, 水腎症が4例, 腎杯の破壊像が2例であった.6)尿路管理の方法とし, 1例に回腸導管2例に自己導尿を行い, 他の19例にはCrede法や薬物療法を行った.興味ある例として4例を選び, 自己導尿, VURに関する問題につき考察した, During the past 10 years, 22 children (13 males and 9 females) had been treated for congenital neurogenic bladder at our department. These cases were reviewed for urinary tract infection, urodynamics, vesicoureteral reflux and renal deterioration. Urinary tract infections were observed during the follow-up period in 12 of the 22 cases (54.6%). The incidence was 38.5% in males and 88.9% in females. Cystometric findings were arbitrarily divided into 3 types; hyperreflexic type, areflexic hypertonic type and areflexic hypotonic type. Of the 17 cases examined, 3 cases were of the hyperreflexic type, 6 cases the areflexic hypertonic type and 8 cases the areflexic hypotonic type. Urinary tract infections were not observed in 5 of the 8 cases categorized as the areflexic hypotonic type compared to one of the 9 cases of the hyperreflexic and areflexic hypertonic types together. UPP was examined in 13 cases. UP max values were lower than normal in the areflexic type cases, but were normal or higher in the hyperreflexic type cases. Vesicoureteral reflux was examined in 9 cases. Reflux was observed in 9 ureters of 6 patients. Renal deterioration was observed in 6 cases; 4 cases of hydronephrosis and 2 cases of pyelonephritis. Management of 22 cases consisted of ileal conduit (1 case), clean intermittent self-catheterization (2 cases) and Cred e maneuver and/or pharmacologic treatments (19 cases). The usefulness of clean intermittent self-catheterization and management for vesicoureteral reflux were discussed centering on 4 selected cases.

37施設で, 神経因性膀胱233例を対象に, ロバベロン注射剤を標準薬とし, KN-7錠剤の経口投与による排尿障害に対する有用性を, 二重盲検群間比較試験で比較検討した.解析対象例はKN-7群108例, ロバベロン群107例である.KN-7群は1日6錠投与した.改善度の効果判定では改善以上K群40.7%, R群38.7%, やゝ改善以上それぞれ76.9%, 72.6%と有意差はなかった.臨床所見中改善の良かった項目は, 尿意, 残尿感, 尿失禁, 排尿までの時間, 排尿時間, 尿勢-排尿力と尿線中断の改善などで, これらの改善以上はK群35.8%, R群30.8%で, 有意差はなかった.副作用はK群0.9%, R群6.8%, K群が有意に少なかった.両剤とも主として下痢で, R群ではその他頭痛, 頻脈, 肝機能障害, 発熱感などを少数例認めた.臨床検査値ではGOT, GPTの上昇が2例あった.有用度有用以上はK群46.3%, R群45.8%で有意差はなかった.疾患別では, 末梢神経疾患, 膀胱の性状では弛緩性, 時期では12ヵ月以内の例で特に改善率が高かった.以上から, KN-7錠剤は, ロバベロン注射剤に比べ, 同等の効果が期待でき, 安全性も高く, 長期投与あるいは外来患者の治療にも適する, The clinical effectiveness, safety and usefulness of KN-7 tablet as a new oral application of the prostatic extract, on urinary dysfunction of neurogenic bladder were compared with those of Robaveron injection by the double-blind test method. In the study, 2 tablets t.i.d. and a shot of intramuscular injection 1 ml a day were given successively for 3 weeks. A total of 233 cases were reported from 37 facilities belonging to the KN-7 Clinical Research Group. Some of them were excluded or dropped out. The number of cases used for analysing the effectiveness, safety and usefulness were 214, 232 and 215, respectively. There was no bias between the two groups with a significant homogeneity in the background. In the overall clinical effectiveness, the effective rate including excellent, moderate and slightly effective was 76.9% with KN-7 and 77.4% with Robaveron. In the clinical usefulness, the rate of usefulness of slightly useful or above was 75.0% with KN-7 and 75.7% with Robaveron. There was no significant difference between the two groups in the clinical effective and useful rates at a significant level of 5%. Side effects were observed in 1 of the 114 (0.9%) patients given KN-7 and 8 of the 118 (6.8%) patients given Robaveron. The incidence of adverse reactions with KN-7 was significantly lower than that with Robaveron. Based on the results, it was concluded that KN-7 tablets, 2 tablets t.i.d., would be as effective and useful as a Robaveron injection 1 ml daily and safer than the latter in the treatment of neurogenic bladder.

A 60-year-old man, who complained of gross hematuria, was admitted because of bilateral renal space occupying lesions on CT-scan. DIP revealed that the right pyelogram was compressed medially and the left pyelogram showed a filling defect due to the presence of coagula. Selective renal arteriography revealed that right kidney was enlarged and had a hypervascular tumor laterally, and left kidney had two oval hypervascular tumors at the upper and middle portions. Von Hippel-Lindau sydrome, tuberous sclerosis and metastatic renal cancer were ruled out as a result of the other examinations. No distant metastases were observed by bone scanning, liver scanning, lymphangiography and chest X-ray studies. Through lumbar incision, bilateral nephrectomy was performed and A-V shunt was constructed on the same time. Hemodialysis was started on the next day. Convalescence was uneventful. But the patient died 67 days after operation with cardiac failure during hemodialysis at the other hospital.

膀胱過伸展のモデルとして雌性雑種成犬の膀胱頸部を糸付きシリコンリングにて結紮し, 48時間の完全尿閉状態を作成した.利尿筋切片のachに対する収縮は尿閉解除後2週群の反応が最大であり, 4週群は無処置群より低い反応を示した.筋層組織像は4週群で筋束への線維増生がみられた.また膀胱血流量を水素ガスクリアランス法を用いて測定し, 48時間尿閉解除直後では膀胱空虚時に比較して63%の血流減少を認めた, To investigate denervation supersensitivity of the detrusor muscle due to prolonged bladder overdistension, overdistended bladders were produced in female mongrel dogs by bladder neck obstruction for 48 hours and the dogs were sacrified 1, 2 and 4 weeks after overdistension. The sensitivity of the detrusor muscle to acetylcholine was measured using the isometric in vitro technique. The bladder wall tissues were examined with Masson's trichrome staining. The blood flow of the bladder wall was determined by the hydrogen gas clearance method. Sensitivity reached a maximum 2 weeks after overdistension, thereafter decreasing to a lower level 4 weeks after overdistension than that of the untreated detrusor muscle. A decrease of blood supply to the bladder wall, the rate being 63% immediately after overdistension, may result in a degeneration of the axon which is more fragile to ischemic changes. Subsequently axonal degeneration may be followed by denervation supersensitivity of the detrusor muscle. Remarkable fibrotic changes of the bladder wall 4 weeks after overdistension suggested a decrease of the detrusor muscle contraction to acetylcholine.

The first case is a 59-year-old man who had left flank pain and nausea. KUB, excretory urograms and CT scan showed a left ureteral stone at the ureterovesical junction associated with spontaneous rupture of the left renal pelvis. Percutaneous nephrostomy was performed. The ureteral stone was spontaneously discharged on the 4th postoperative day and extravasation of contrast medium from the left renal pelvis disappeared. The second case is a 42-year-old man who was admitted with bilateral flank pain, nausea and vomiting. KUB and excretory urograms showed bilateral hydronephrosis due to small bilateral ureteral stones. Serum BUN and creatinine had risen to 41 and 5.1 mg/dl, respectively, on the day after admission. Percutaneous nephrostomy to the left kidney was performed. BUN and creatinine were normalized immediately and the bilateral ureteral stones were spontaneously discharged by the 9th postoperative day. After the nephrostomy catheters were removed, no complications occurred in either case and KUB and excretory urograms showed normal findings.

女子急性膀胱炎114症例に対してNFLX, OFLX, あるいはTMP-SMXを1日分のみ投与した結果について検討した.1)総合臨床効果では著効率89%, 有効率8%で, 無効率は3%のみであった.2)再発は経過観察できた61例中8例(13%)において認められたが, これは1回目再来時に著効と判定された症例の8%であった.3)起炎菌がS. epidermidisである症例は, E. coliである症例に対し有効率, 再発率ともに明らかに劣っていた, The effect of a single day treatment with 600 mg norfloxacin 600 mg ofloxacin or 1, 920 mg trimethoprim-sulfamethoxazol was determined on 114 patients with acute cystitis. The overall clinical efficacy was excellent in 101 patients (89%), moderate in 9 patients (8%) and poor in 4 patients (3%). Recurrence was observed in 8 cases (8%) within 6 weeks after the treatment. The effectiveness rate and the recurrence rate were inferior in those caused by S. epidermidis compared with those caused by E. coli.

We have diagnosed and treated two siblings with megacystis and hydronephrosis secondary to polyuria, resulting from congenital nephrogenic diabetes insipidus. This report mainly refers to the voiding dysfunction of the urinary bladder in the patients. The patients had neither neurological disorder, anatomical outlet obstruction nor vesico-ureteral reflux. Urodynamically, both of them showed a normal urethral pressure profile, but the cystometric findings were different; an uninhibited bladder in the elder brother, a high compliance bladder in the younger brother. The difference between these cystometic findings is discussed on the basis of functional changes of the overdistended detrusor.

A cystometric study was made on 26 patients with sustained cerebral strokes whose cerebral lesions were confirmed by computerized tomography (CT scan). All of them had been free of organic obstruction of the lower urinary tract. These patients were divided into the cerebral infarction (16 cases), the subarachnoid bleeding (4 cases) and cerebral hemorrhage (6 cases) clinically. Moreover, cases of the cerebral infarction were subdivided into the cortical infarction (7 cases), the sub-cortical infarction (6 cases) and the cerebral atrophy (3 cases) from the findings of CT scan. The results are as follows. 1) Seven cases diagnosed as the cortical infarction showed the uninhibited type in 6 cases and the normal type in one case cystometrically. 2) Six cases diagnosed as the sub-cortical infarction showed the uninhibited type in 4 cases and the hypotonic type in 2 cases. 3) Cases of the subarachnoid bleeding and the cerebra hemorrhage showed both types. From these results, the following speculations became possible. a) The cortical infarction has a tendency to bring about the uninhibited neurogenic bladder. b) The sub-cortical infarction has a tendency to bring about the two types, the uninhibited and hypotonic neurogenic bladder. c) The subarachnoid bleeding and cerebral hemorrhage has a tendency to bring about the two types as well. d) Most cases complaining of dysuria are apt to accompany the psychological disorders, especially dementia. This kind of research should be continued in the future.

A 60-year-old man, who complained of gross hematuria, was admitted because of bilateral renal space occupying lesions on CT-scan. DIP revealed that the right pyelogram was compressed medially and the left pyelogram showed a filling defect due to the presence of coagula. Selective renal arteriography revealed that right kidney was enlarged and had a hypervascular tumor laterally, and left kidney had two oval hypervascular tumors at the upper and middle portions. Von Hippel-Lindau sydrome, tuberous sclerosis and metastatic renal cancer were ruled out as a result of the other examinations. No distant metastases were observed by bone scanning, liver scanning, lymphangiography and chest X-ray studies. Through lumbar incision, bilateral nephrectomy was performed and A-V shunt was constructed on the same time. Hemodialysis was started on the next day. Convalescence was uneventful. But the patient died 67 days after operation with cardiac failure during hemodialysis at the other hospital.