Search

We present a case of a muellerian duct cyst in a 55 year-old man. A cystic lesion was incidentally found between the prostate and the bladder on transabdominal ultrasound examination. Computerized tomography revealed a low density area homogeneous and round with a clear margin. Both urethrocystgram and vesiculogram demonstrated no cystic lesion. On diagnosis of muellerian duct cyst percutaneous needle aspiration was performed under ultrasound control. The aspirated fluid was yellow, clear and negative for cytology. Microscopically no spermatozoa were found in it. Minocycline (100 mg) was injected into the cyst. No recurrence has occurred since the operation. The literature of the cyst was briefly reviewed.

1)慢性膀胱炎, 慢性前立腺炎, 前立腺肥大症の術後などに基づくと考えられる頻尿, 尿失禁を訴える患者109例を対象に塩酸テロジリンの有用性を検討した.2)最終全般改善度は92.7%であった.3)安全度は97.3%であった.4)有用度は91.8%であったが, 9例に副作用を認め, そのうち4例は投与中止に至った, We evaluated the effectiveness and side effects of terodiline hydrochloride in 109 patients with urinary frequency and urinary incontinence. The drug was administered at a dose of 24 mg once a day or 12 mg twice a day for 4 weeks. Symptoms such as urinary frequency and urinary incontinence were alleviated in 101 out of 109 patients (92.7%). Mild side effects such as thirst, dysuria, sense of residual urine, orthostatic hypotension and arrhythmia were observed in 9 out of 109 patients (8.2%). Side effects such as orthostatic hypotension and arrhythmia were observed on the 28th day or the 20th day of the administration, but these symptoms disappeared with discontinued use of this medicine. The results obtained from this study suggest that terodiline hydrochloride may be greatly useful for the patients with urinary frequency and urinary incontinence. But we must take account of the side effects such as orthostatic hypotension and arrhythmia.

1)テラゾシンの前立腺肥大症に伴う排尿障害に対する臨床効果および副作用について, 91例, 18施設の多施設臨床試験を実施した.試験は1週間以上の観察期, 6週間の治療期とし, 観察期および治療2週目, 4週目, 6週目に自覚症状, 他覚所見(尿流量率, 排尿量, 残尿量)の変化を評価した.超音波断層法, 尿道造影, CTスキャンなどで前立腺の推定重量を求め, 前立腺の大きさと本剤の効果についても検討した.観察期にはプラセボ錠を投与し, 治療は塩酸テラゾシン1 mg/日を初期投与量とし2週目で自覚症状が改善以上であれば1 mg/日の投与量を維持し, やや改善以下であれば2 mg/日に増量, 4週目で改善以上であれば2 mg/日の投与量を維持し, やや改善以下であれば4 mg/日に増量し, 6週目に最終効果判定をする.1 mg→2 mg→4 mgの漸増法とした.2)自覚症状の累積改善率は, 1 mg/日では18.5%, 2 mg/日までで55.6%, 4 mg/日までで65.4%であった.観察期の自覚症状の強いものの方が症状の改善度が高く, 治療終了時には自覚症状スコアは観察期のスコアにかかわらずほぼ同じレベルに収束した.3)自排尿量, 最大尿流量率, 平均尿流量率, 残尿率, ノモグラムスコアは, いずれも治療後有意に改善した.残尿量, 排尿開始までの時間については有意差はえられなかった.前立腺重量と最大尿流量率, ノモグラムスコアの改善度の間に有意な相関は認めなかった.他覚所見の累積改善率は, 1 mg/日では13.2%, 2 mg/日までで42.1%, 4 mg/日までで50.0%であった.4)全般改善度の累積改善率は, 1 mg/日14.5%, 2 mg/日までで50.0%, 4 mg/日までで61.8%であった.5)副作用は, ふらつき6件, 立ちくらみ2件, 耳鳴り, むかつき, かすみ目各1件の計11件(10例)で, 発現率は11.6%であった.5例は臨床上問題なく服薬を継続し, 1例は減量して服薬を継続した.服薬を中止したのは4例, 4.7%であった.本薬に起因すると思われる臨床検査値異常は認められなかった.拡張期血圧の有意な低下を認めたが, 収縮期血圧, 脈拍に有意な変動を認めなかった, In this study the multicenter, fixed-flexible dose regimen was taken to evaluate the effective dose range of Terazosin for the treatment of micturition disturbance in benign prostatic hypertrophy (BPH) and to clarify the characteristics of patients who are more responsive to Terazosin therapy. After a 1-week washout (placebo) the first two weeks 1 mg/day of Terazosin was administered, then depending on efficacy of subjective symptoms, Terazosin doses were increased up to 2 mg/day and 4 mg/day at intervals of two weeks. After six weeks the final efficacy and safety were assessed. The subjective symptom improvement rate was 18.5% by 1 mg/day, 55.6% by 2 mg/day and 65.4% by 4 mg/day cumulatively. The objective symptom improvement rate were 13.2% by 1 mg/day, 42.1% by 2 mg/day and 50.0% by 4 mg/day cumulatively. The global improvement rate was 14.5% by 1 mg/day, 50.0% by 2 mg/day and 61.8% by 4 mg/day cumulatively. The patients who had a higher subjective symptom score in the lead-in period were more improved rather than those who had a lower score. In objective symptoms, voided volume, maximum flow rate (MFR), MFR nomogram score and average flow rate improved and the ratio of residual urine volume decreased. There was no relationship between clinical improvement on either subjective or objective symptoms and prostatic weight. Adverse reactions, such as dizziness, vertigo, tinnitus, nausea and blurred vision; were seen in 10 cases. In conclusion Terazosin was effective and well tolerated for the treatment of patients who had micturition disturbance with BPH in the dose range of 2 to 4 mg/day.

腎細胞癌の治癒的切除術施行例44例を対象にrIFNα-2b投与に関する臨床的検討を行った.1) 44例のstage分類(Robson)は1が29例, 2が15例であった.2)適格例42例中, 再発が認められた症例は5例であり, うち2例が死亡している.再発から死亡までの期間は2ヵ月と6ヵ月であった.3)適格例の42例中, 死亡例は3例であり, 累積生存率は1年生存率97.6%, 2年生存率89.7%であった.4) IFN初期治療終了後のIFNαおよびIFNγ産生能は前者においてすべて低下(4/4)し, 後者においては3例が上昇(3/4), 1例が正常値を示した.5) 2-5AS活性は評価できた4症例において, いずれもrIFNα-2b投与により上昇が認められた.6)副作用を認めたものは24例であり, 発熱が22例と最も多く, その他に白血球数減少, 肝機能障害などを認めたが, 多くは投与継続が可能であり副作用による中止例は5例であった.7)抗rIFNα-2b抗体について22例で継続的に測定したが, いずれも測定限界値未満であった, A clinical trial using interferon alpha 2b (IFN alpha-2b) for prophylactic therapy was done on 44 patients who had received nephrectomy for renal cell carcinoma. Principally, the daily intramuscular injection of 3 of 6 million units of IFN alpha-2b was done for 4 consecutive weeks after 2 weeks postoperatively and thereafter followed by injection once every 2 weeks. The clinical evaluation was done for the recurrence rate, the survival rate, the IFN alpha and IFN gamma producing ability, the activity of 2', 5' oligoadenylate synthetase (2-5AS) and the side effect. Out of 44 cases entered, 42 were completely evaluable and recurrence was observed in 5 (11.9%) of the 42 cases. The recurrence rate was 5.5% and 16.4%, at the first and second year, respectively. Three (7.1%) of the 42 patients died. The survival rate was 97.6% at the first year, 89.7% at the second year for the followup study. The IFN alpha producing capacity was low in all of the 4 evaluable cases. The IFN gamma producing capacity was high in 3 cases and normal in 1 case. 2-5AS, the enzyme produced by IFN, was activated by IFN alpha-2b administration in all of the 4 evaluable cases. Side effects were observed in 24 (54.5%) of the 44 cases. The main side effect was fever. Leucopenia, general fatigue, appetite loss, temporary elevation of liver transaminase were also observed. However, there were only 5 cases (11.4%) in which administration of IFN alpha-2b had to be discontinued.

The patient was a 56-year-old male. Renal cyst and intracystic mass were incidentally found in the right kidney by ultrasound sonography. Intracystic mass was enhanced. At operation, intracystic fluid was clear and yellow, and its cytology was negative. However, rapid histological examination of the intracystic mass showed malignancy. Accordingly, nephrectomy was performed. We then reviewed the characteristics of the intracystic fluid in renal cell carcinoma reported in Japan and found that 70% was bloody intracystic fluid and 30% showed positive cytology. These findings suggested that we should to be more careful when diagnosing renal cyst associated with renal cell carcinoma only by the examination of the intracystic fluid.

マウス膀胱腫瘍(MBT-2)を用いてin vivoでTNFと各種癌化学療法剤(5-FU, CPM, CDDP, ADM)との併用効果を検討した.MBT-2にC3H/HeNマウスに移植し, 移植後10日目よりTNF 3, 000単位を10日間連続で腹腔内投与し各種癌化学療法剤は移植後10日目に1回だけ腹腔内投与を行った.腫瘍移植後20日目に効果を検討した.5-FU, CPM, ADMはTNFと併用することにより抗腫瘍効果が増強されたがCDDPでは増強効果を認めなかった, The antitumor activity of combination therapy of recombinant human tumor necrosis factor alpha (rHu-TNF alpha) and chemotherapeutic agents against murine bladder tumor (MBT-2) was studied. Tumors were intradermally transplanted into the hind leg of C3H-HeN mice and allowed to grow until they reached a diameter of 8 to 10 mm 10 days after transplantation. TNF (3, 000 units) was given intraperitoneally from day 10 to day 19, and the chemotherapeutic agents, 5-FU (60 mg/kg), CPM (100 mg/kg), CDDP (10 mg/kg) and ADM (5 mg/kg), were applied once intraperitoneally on day 10. The antitumor effects were evaluated based on tumor volume on day 20. 5-FU, CPM and ADM enhanced the antitumor effect when combined with TNF, but CDDP did not. These findings suggest that combination therapy of TNF and certain antitumor chemotherapeutic agents is effective cancer treatment.

A 19-year-old female visited our hospital because of primary amenorrhea. She was genetically (46XY) male. Her breasts were poorly developed. She had no pubic or axillary hair. The phenotype was female, and the vagina had a short and closed end. Plasma testosterone (T) and 5-alpha dihydrotestosterone (DTH) were low. However, DHT was elevated by ex vivo T load. The testis, which was atropic, epididymis and vas deferens, which were well developed, were found and resected by operation. The amount of androgen receptors of the skin tissue of the external genitalia was normal. These findings suggested that male pseudohermaphroditism with incomplete testicular feminization syndrome may have been caused by androgen resistance syndrome due to the disorder of androgen receptor complex, genetic information or post receptor.

膀胱保存手術後の術後再発予防に対するHCFUの効果およびHCFUとSLAの併用効果を検討した.1) 57例の膀胱手術後の再発は1年2例, 2年15例であった.2) 87例を対象として, 封筒法にてHCFUおよびSLA併用群とHCFU単独群での再発予防効果は, 1年以上で併用群で成績が良好であった.3)副作用は11例にみられたが, 重篤な副作用は1例もなかった, To treat superficial bladder cancer or invasive bladder cancer presenting as a solitary tumor, conservative therapy such as transurethral resection of bladder tumor or partial cystectomy has long been carried out. We studied the effect of 1-hexylcarbamoyl-5-fluorouracil (HCFU), and the effects of the combination of HCFU and 2.5-di-O-acetyl-D-glucaro-(1-4)(6-3) dilactone (SLA) which is an anti-beta-glucuronidase agent, for preventive therapy. In the patients treated with HCFU, the recurrence rate was 3.6% and 26.6% one year and two years, respectively, after conservative operation. In the patients treated with both SLA and HCFU, the recurrence rate was lower than in those treated with HCFU one year or more after conservative operation, and a long-term preventive effect was expected for nondrinkers.

At Osaka City University, 1, 987 patients with urolithiasis have been treated by extra-corporeal shockwave lithotripsy (ESWL) during a four-year period. We treated 5 patients with horseshoe kidney and the obtained results were analyzed retrospectively. Three of these patients, who had a solitary stone could successfully be treated by ESWL as monotherapy. One who had multiple stones required transurethral lithotripsy after ESWL due to stone-street. The remaining 1 patient who had undergone heminephrectomy developed perirenal hematoma after ESWL, which spontaneously disappeared without any specific treatment. We discuss the special care related to the use of ESWL in the horseshoe kidney.

22例の症例についてmetallic spiralを用いた治療を試みた.その年齢は56～91歳(平従76.6歳)で, 原疾患としてはBPHで, 直腸癌術後および糖尿病性神経因性膀胱を合併したのがそれぞれ1例, 脳梗塞後が2例いた.それら症例の治療前の排尿状態は, 尿閉のため留置カテーテルがあった症例は16例, 排尿障害のある症例は6例であった.治療後の尿流量面からの評価では, 排尿量100～230 ml(平均172 ml), MFR 13～21 ml/秒(17.3 ml/秒), AFR 4～12 ml/秒(8.2 ml/秒)で, 残尿量も30 ml以下が20例, 200 mlが1例であった.このうち留置ステントの膀胱側への移動は6例見られたが4例は再度留置した.尿道ステントに伴う会陰部不快感は3例に見られ2例は抜去せざるを得なかった.尿失禁, 膿尿の持続や尿路感染症, 結晶の付着など特に治療を必要とする症例は観察されなかった, Treatment using a metallic spiral was attempted on 22 patients. They had urinary retention in 16 cases and dysuria in 6. In 21 of them, the spiral was successfully placed under transrectal ultrasound control. In all 21 patients, voiding was possible immediately after placement of the spiral. As for urodynamic study, urine volume was 100-230 ml (mean: 172 ml), maximum flow rate was 13-21 ml/sec (mean: 17.3 ml/sec), and average flow rate was 4-12 ml/sec (mean: 8.2 ml/sec). Residual urine volume was less than 30 ml in 20 patients and 200 ml in one. As for complications, proximal migration of the spiral was observed in 6 patients. In 4 of them, the new spiral was placed. Perineal discomfort was seen in 3 patients, in 2 the spiral was removed. Pyuria associated with bacterial infection did not continue after the treatment in patients having a catheter. Severe urge incontinence and encrustation were never seen. The above findings suggest that, though a longterm study has not done, this treatment could be an effective treatment particularly for the elderly patients with general complications and/or who require removal of an indwelling catheter for clinical or social reasons.

30例のバルーン非留置のBPH患者に計10回, 経直腸的温熱療法を行い, 自・他覚所見より短期および長期成績を検討した.1)短期成績としては, ほとんどの症例で治療後自覚症状の改善, とくに夜間排尿回数, 昼間排尿回数および尿線の改善がみられ, 1ヵ月間持続した.他覚所見としては, 残尿量, 最大尿流量率, 平均尿流量率の改善を多くの症例でみたが, 前立腺重量では治療前後で差はなかった.2) 6ヵ月の長期follow例では, 24例で自・他覚所見のいずれかで改善が持続し, 両方とも改善の持続した症例は16例であった.3)治療に伴う合併症としてはapplicator挿入時の痛みと温度上昇に伴う肛門内熱感程度で, 局所麻酔のみでapplicator挿入も容易で, 治療による肝, 腎障害などは全例でみられなかった.4)以上より, 合併症を有し手術困難なBPHに対し, 本治療法は有用な治療法の1つと考えられた, Transrectal hyperthermia was performed on 30 patients with benign prostatic hyperplasia twice a week for a total of ten times with the temperature of the prostatic tissue set at 43.0 degrees C. In our in vitro experiment using an agar phantom, the highest temperature was observed at approx. 1.5 cm from the point where the 915-MHz microwave was generated. Our histopathological study of the prostatic tissue, resected at open surgery after three days of hyperthermia, indicated that the effect of hyperthermia first occurred in the interstitial tissues, and then extended to the epithelial cells. Subjective symptoms and objective findings were evaluated. In almost all cases, improvement was observed in subjective symptoms after completion of the treatment. The residual urine volume improved significantly. Also, significant improvement was observed in our urodynamics study. In 16 out of 30 cases (53%), both subjective symptoms and objective findings were still improved after six months.

BPHに起因した排尿障害を有する40症例に対しlarge prostaic dilation catheterを使用した尿道拡張術を施行した.最長観察期間は22ヵ月, 平均観察期間は9.5ヵ月であった.1)術中の愁訴として, 尿意切迫感が32例にみられた.術後肉眼的血尿はほとんど全例でみられたが, 輸血などを必要とした例はなかった.2)拡張後, 残尿量は減少し, 平均尿流率, 最大尿流率も5.7から8.2 ml/sec, 10.4から15.6 ml/secへと改善していた.3) IT typeとIF typeに分類し検討すると, IF typeのBPHの方が高い臨床効果を示していた.尿閉21例中12例に留置カテーテルの抜去が可能であった.無効の症例はいずれも膀胱内に突出する中葉肥大を伴うのBPHであった, Transurethral balloon dilatation therapy was performed on 40 patients with benign prostatic hypertrophy (BPH) under local anesthesia. During the procedure, urinary urgency occurred in 80% of the patients. After prostatic dilatation, macrohematuria was observed in almost all patients. The longest follow-up period after dilatation was now 22 months, and the average was 9.5 months. After treatment, residual urine volume decreased, and average flow rate and maximal flow rate improved from 5.7 and 10.4 ml/sec to 8.2 and 15.6 ml/sec, respectively. Overall clinical efficacy was 67.5%. Urethral dilatation therapy was thought to be an effective and non-invasive therapy for BPH.

1)尿管結石の長径1 cm以下の場合, 1～2 cmの非嵌頓の場合には無処置ESWL, それ以外の結石ではTUL等との併用を行うべきである.2)シスチン結石の破砕はやや困難であるが, 1回の衝撃波数を増やさず, 治療回数を増し, 経口投与による結石融解を併用したESWLが可能になる, We report our experience with extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral and cystine stones, which are known to be difficult to treat by this method. First, in order to determine the effectiveness of the ureteral catheter in the destruction of ureteral stones, we compared the clinical results of 121 patients treated without the catheter and 141 patients inserted with the catheter. There was no significant difference in the success rate between the two groups regardless of stone size, which indicates that the use of the ureteral catheter had no effect on the outcome of treatment. We then studied the clinical results of impacted ureteral stones which are especially difficult to destroy. Excretory urography was performed to non-invasively diagnose these stones, and those without visualization in the ureter below the stone were diagnosed as impacted stones and treated by ESWL without the ureteral catheter. Among the stones with a diameter of 1 to 2 cm, the success rate was significantly lower in impacted stones compared to non-impacted stone. These findings suggest that ESWL treatment without the ureteral catheter may be effective for ureteral stones with a diameter of less than 1 cm and non-impacted stones with a diameter of 1 to 2 cm, while combination therapy with other methods such as TUL may be better for other stones. We also performed ESWL on 6 patients with renal stones and 2 patients with ureteral stones which were cystine stones. Renal stones required an average 4.1 treatment with an average of 1, 875 shocks per treatment, and ureteral stones required 1.5 treatment with an average of 1, 833 shocks.(ABSTRACT TRUNCATED AT 250 WORDS)

片側腎摘ラットの腎動脈を20分間閉塞して虚血腎モデルを作製し, CsA, verapamil (V)併用時の全身循環動態, 肝・腎ミクロゾームP-450の変動を検討した.動物は対照群(C群), CsA群, CsA+V群, Is群, IS+CsA群, Is+CsA+V群の6群に分けた.1) CsAは各群の血中BUN, 血清クレアチニン(sCr)を有意に増加せしめ, 腎イヌリンクリアランス(Cin)を有意に減少せしめた.Is群に比べてCsAは心拍出量を有意に減少せしめ, 特に血中BUN, sCrが有意に減少していたIs+CsA群の腎血流量は減少していた.CsA+V群のCinもまたIs群より有意に減少していた.Is+CsA+V群のCinと腎血流量はIs+CsA群より有意に上昇していた.2)腎ミクロゾームチトクロームP-450比含量, ラウリン酸およびPGAω水酸化酵素活性の増加はIs+CsA群で認められた.3)正常腎におけるCsA-induced Nephropathyの進展はVで抑制できなかったが, 虚血腎では明らかにその進展がVによって抑制された, We have examined the effect of verapamil on CsA-induced nephropathy by measurement of systemic hemodynamics including each organ blood flow using the microsphere method in ischemic kidney model of hemi-nephrectomized Wistar rats. Hepatic and renal microsomal cytochrome P-450 contents and their enzyme activities were measured to study the correlation between CsA-induced nephropathy and induction of hepatic and renal microsomal cytochrome P-450. All rats were hemi-nephrectomized (l-nephrectomy) and were classified into the following 6 groups: 1) control groups, 2) CsA at a dose of 40 mg/kg per day orally for 7 days (CsA group), 3) Oral administration of verapamil for 7 days in the CsA group (CsA + V group), 4) 20 min clamping of the remaining right kidney pedicle (Ischemic, Is group), 5) CsA was administered in the Is group (Is + CsA group), 6) Addition of verapamil to CsA in the Is + CsA group (Is + CsA + V group). Verapamil was given in the drinking water and the average dose calculated from the amount of drinking was 4.7 +/- 1.0 mg/kg per day and 5.2 +/- 0.7 mg/kg per day for the CsA + V group and the Is + CsA + V group, respectively. CsA caused significant increases in BUN and serum creatinine (sCr) with a significant decreases in renal inulin clearance (CIn) in all groups. When compared with the Is group, CsA caused significant decreases in cardiac output and all organ blood flow especially in renal blood flow with significant increases in BUN and sCr in the Is + CsA group.2+ degree of nephropathy.(ABSTRACT TRUNCATED AT 250 WORDS)

膀胱腫瘍12症例に対しHPC-PEP膀胱内注入療法を行い, 著効2例・有効5例・無効5例の結果を得た.血中にはいずれの時期においてもPEPは検出されず, 腫瘍内には投与7日目に平均0.36 μg/gr (0.11～1.02), 14日目に0.19 (0.1～0.27)認められた, Peplomycin emulsified in hydroxypropyl cellulosum (HPC-PEP) was prepared for intravesical chemotherapy. Clinical efficacy of HPC-PEP and tissue concentration of peplomycin (PEP) were studied in 12 patients with bladder tumor. Histopathology showed transitional cell carcinoma; 2 in grade 1, 8 in grade 2, and 2 in grade 3. The total volume of 30 ml HPC-PEP was prepared from a mixture of 2% HPC and 90 mg PEP in 15 ml saline, and was intravesically administered through a urethral catheter and retained for two hours. Clinical evaluation 7 days after the initial instillation demonstrated good tumor regression in 2, good response in 5, and no change in 5. The mean PEP level in tumor tissue was 0.36 microgram/gr after 7 days and 0.19 microgram/gr even after 14 days. These clinical observations and tissue levels of PEP suggest that HPC-PEP might be useful as an intravesical instillation agent for bladder tumor.

ESWLを施行し, 追跡可能であった911例の単一結石について, 1)男性では女性に比し, 尿管結石の頻度が高かった.2)腎盂・腎杯に存在する結石に対するESWLの成績が最も良好で, 20 mm以下で87%の成功率を得た.3) ESWL成績不良部位は尿管で, 嵌頓結石症例では結石サイズが小さくとも, TULやD-Jステントカテーテル留置下でのESWLを行うべきである, At Osaka City University Hospital, we performed extracorporeal shock-wave lithotripsy (ESWL) for 1277 patients in a total of 1788 sessions using Dornier kidney lithotripter Model HM III from July, 1985 to the end of December, 1988. Among the patients with a solitary stone, 911 cases were available for the follow-up study and we have compared the results among these cases in respect to the stone location and size. The results obtained were as follows: the ratio of kidney stone to ureter stone was found to be 2.2:1 in male, and 3.8:1 in female patients. This indicates that ureter stones are more frequently found in male than in female patients. In addition, we compared the size of kidney stones found in the patients including 415 male and 243 female patients. Stones larger than 20 mm were more frequently found in female than in male patients. Moreover, a stone composition study of these patients showed that the contents of both phosphate calcium and magnesium ammonium phosphate were higher in female than in male patients. ESWL performed against stones at pelvis and calyces exhibited the best results. The results obtained with the stones less than 20 mm in diameter were especially favorable with a success rate of 100% for the stones less than 10 mm and 83% for the stones 10-20 mm, in diameter, while the results with the stones larger than 20 mm in diameter were rather poor with a success rate of 31%. ESWL performed against ureter stones showed poor results with a success rate of 63% for the stones smaller than 20 mm in diameter.

前立腺肥大症に対するCernilton(R)の有用性を検討するため, Paraprost(R)を対照薬とする多施設二重盲検群間比較試験を行った.1)総投与症例数192例中, 総合効果は159例, 総合安全度は178例, 有用度は159例について集計解析した.解析対象例と除外・脱落例の症例の構成および患者の背景因子において両群間に偏りはみられなかった.2)委員会と主治医判定による総合結果, 患者の印象のいずれにおいてもCN群の成績はPP群より高かったが, 両群間に有意差はなかった.3)自覚症状全般改善度の推移において, 4週後の委員会判定による中等度改善以上の改善率でCN群はPP群より有意に優れていた.また排尿困難の有力な指標である苒延性排尿に対する改善率でCN群はPP群より有意に優れていた.4)他覚所見の計測値の検討では, CN群は残尿量, 平均排尿量率, 最大排尿量率, 前立腺重量(Thumann計測)において投与前後の比較で有意の改善が認められた.また残尿量の段階推移においてもCN群で有意の改善が認められた.5)副作用, 臨床検査値で新たな異常値の発現のいずれもCN群にはみられなかった.6)委員会判定による有用度は, CN群はかなり有用以上で49.1%, PP群は41.2%でCN群の成績はPP群より高かったが両群間に有意差はなかった, A multiple center double blind study was performed to study the effectiveness of Cernilton (CN) on benign prostatic hypertrophy in comparison to Paraprost (PP). Among a total of 192 patients, overall effect was studied on 159 patients, overall safety rate on 178 patients and rate of effectiveness on 159 patients. There were no differences between the two groups in the selected patients, criteria for exclusion and drop out cases or background data of the patients. Impression of patients and overall effect by committee and physician judgment were slightly higher in the CN group compared to the PP group, but there was no significant difference between the two groups. For the improvement in subjective symptoms, the rate of moderate improvement or more after 4 weeks by committee judgement was higher in the CN group compared to the PP group. The rate of improvement in protracted miction, which is an effective marker of urinary disturbance, was also higher in the CN group compared to the PP group. An analysis of objective symptoms showed a significant improvement in residual urinary volume, average flow rate, maximum flow rate and prostatic weight in the CN group. A significant improvement in the phased change of residual urinary volume was also seen in the CN group. No side effects or abnormalities in clinical test levels were noted in the CN group. By committee judgement, the rate of more than moderate effectiveness was 49.1% in the CN group compared to 41.2% in the PP group, but there was no significant difference between the two groups. By physician's judgment, the rate of more than moderate effectiveness was 49.4% in the CN group compared to 46.3% in the PP group, but there was also no significant difference between the two groups. These results suggested that Cernilton was an effective drug for benign prostatic hypertrophy.

We studied the efficacy of intravesical instillation chemotherapy of anticancer agents including cylocide (CA) in the prevention of recurrence of bladder tumor after surgery. Totally 60 patients with superficial bladder tumor were enrolled into the study. The patients were randomly assigned to either one of three groups: CA 300 mg alone, CA 200 mg + mitomycin C (MMC) 10 mg, and CA 180 mg + adriamycin (ADM) 20 mg. These drugs were initially instilled once a day for one week, and then once a month until 2 years after surgery. Thereafter, the patients were followed up without instillation. The cumulative non-recurrence rates in the CA group was 76.5, 60.0 and 60.0% at 1, 2 and 3 years after the removal of bladder tumor, respectively, while that in the CA + MMC treated group 90.9, 75.3, and 75.3% and that in the CA + ADM treated group, 95.1, 82.9 and 82.9%, respectively. The recurrence rate in the CA, CA + MMC and CA + ADM treated group was 35.3, 27.3 and 19.0%, respectively, the recurrence indices 1.84, 1.07 and 0.74, and the mean times between recurrence 10.8, 16.5 and 18.0 months, respectively. Side effects were noted in 3 of the 17 cases (17.6%) in the CA group, in 3 of the 22 cases (13.6%) in the CA + MMC group and in 3 of the 21 cases (14.3%) in the CA + ADM treated group. These data show that intravesical CA instillation in combination with MMC or ADM is more effective for the prevention of recurrence than that of CA alone.

A 51-year-old male patient with diabetes mellitus consulted his home doctor because of high fever and right flank pain. Urinalysis showed marked pyuria. Treatment with antibiotics was not completely effective, and he was referred to our hospital for further examination and treatment. CT scan showed an abnormal gas shadow in right renal parenchyma. He was diagnosed with emphysematous pyelonephritis and right subcapsular nephrectomy was done after the control of diabetes mellitus. We reviewed 57 cases of emphysematous pyelonephritis including our case in the Japanese literature, and we discussed about its etiology, symptomatology, choice of treatment and prognosis.

We present a case of a muellerian duct cyst in a 55 year-old man. A cystic lesion was incidentally found between the prostate and the bladder on transabdominal ultrasound examination. Computerized tomography revealed a low density area homogeneous and round with a clear margin. Both urethrocystgram and vesiculogram demonstrated no cystic lesion. On diagnosis of muellerian duct cyst percutaneous needle aspiration was performed under ultrasound control. The aspirated fluid was yellow, clear and negative for cytology. Microscopically no spermatozoa were found in it. Minocycline (100 mg) was injected into the cyst. No recurrence has occurred since the operation. The literature of the cyst was briefly reviewed.

We evaluated the effectiveness and side effects of terodiline hydrochloride in 109 patients with urinary frequency and urinary incontinence. The drug was administered at a dose of 24 mg once a day or 12 mg twice a day for 4 weeks. Symptoms such as urinary frequency and urinary incontinence were alleviated in 101 out of 109 patients (92.7%). Mild side effects such as thirst, dysuria, sense of residual urine, orthostatic hypotension and arrhythmia were observed in 9 out of 109 patients (8.2%). Side effects such as orthostatic hypotension and arrhythmia were observed on the 28th day or the 20th day of the administration, but these symptoms disappeared with discontinued use of this medicine. The results obtained from this study suggest that terodiline hydrochloride may be greatly useful for the patients with urinary frequency and urinary incontinence. But we must take account of the side effects such as orthostatic hypotension and arrhythmia.

The patient was a 56-year-old male. Renal cyst and intracystic mass were incidentally found in the right kidney by ultrasound sonography. Intracystic mass was enhanced. At operation, intracystic fluid was clear and yellow, and its cytology was negative. However, rapid histological examination of the intracystic mass showed malignancy. Accordingly, nephrectomy was performed. We then reviewed the characteristics of the intracystic fluid in renal cell carcinoma reported in Japan and found that 70% was bloody intracystic fluid and 30% showed positive cytology. These findings suggested that we should to be more careful when diagnosing renal cyst associated with renal cell carcinoma only by the examination of the intracystic fluid.

In this study the multicenter, fixed-flexible dose regimen was taken to evaluate the effective dose range of Terazosin for the treatment of micturition disturbance in benign prostatic hypertrophy (BPH) and to clarify the characteristics of patients who are more responsive to Terazosin therapy. After a 1-week washout (placebo) the first two weeks 1 mg/day of Terazosin was administered, then depending on efficacy of subjective symptoms, Terazosin doses were increased up to 2 mg/day and 4 mg/day at intervals of two weeks. After six weeks the final efficacy and safety were assessed. The subjective symptom improvement rate was 18.5% by 1 mg/day, 55.6% by 2 mg/day and 65.4% by 4 mg/day cumulatively. The objective symptom improvement rate were 13.2% by 1 mg/day, 42.1% by 2 mg/day and 50.0% by 4 mg/day cumulatively. The global improvement rate was 14.5% by 1 mg/day, 50.0% by 2 mg/day and 61.8% by 4 mg/day cumulatively. The patients who had a higher subjective symptom score in the lead-in period were more improved rather than those who had a lower score. In objective symptoms, voided volume, maximum flow rate (MFR), MFR nomogram score and average flow rate improved and the ratio of residual urine volume decreased. There was no relationship between clinical improvement on either subjective or objective symptoms and prostatic weight. Adverse reactions, such as dizziness, vertigo, tinnitus, nausea and blurred vision; were seen in 10 cases. In conclusion Terazosin was effective and well tolerated for the treatment of patients who had micturition disturbance with BPH in the dose range of 2 to 4 mg/day.

A clinical trial using interferon alpha 2b (IFN alpha-2b) for prophylactic therapy was done on 44 patients who had received nephrectomy for renal cell carcinoma. Principally, the daily intramuscular injection of 3 of 6 million units of IFN alpha-2b was done for 4 consecutive weeks after 2 weeks postoperatively and thereafter followed by injection once every 2 weeks. The clinical evaluation was done for the recurrence rate, the survival rate, the IFN alpha and IFN gamma producing ability, the activity of 2', 5' oligoadenylate synthetase (2-5AS) and the side effect. Out of 44 cases entered, 42 were completely evaluable and recurrence was observed in 5 (11.9%) of the 42 cases. The recurrence rate was 5.5% and 16.4%, at the first and second year, respectively. Three (7.1%) of the 42 patients died. The survival rate was 97.6% at the first year, 89.7% at the second year for the followup study. The IFN alpha producing capacity was low in all of the 4 evaluable cases. The IFN gamma producing capacity was high in 3 cases and normal in 1 case. 2-5AS, the enzyme produced by IFN, was activated by IFN alpha-2b administration in all of the 4 evaluable cases. Side effects were observed in 24 (54.5%) of the 44 cases. The main side effect was fever. Leucopenia, general fatigue, appetite loss, temporary elevation of liver transaminase were also observed. However, there were only 5 cases (11.4%) in which administration of IFN alpha-2b had to be discontinued.

The antitumor activity of combination therapy of recombinant human tumor necrosis factor alpha (rHu-TNF alpha) and chemotherapeutic agents against murine bladder tumor (MBT-2) was studied. Tumors were intradermally transplanted into the hind leg of C3H-HeN mice and allowed to grow until they reached a diameter of 8 to 10 mm 10 days after transplantation. TNF (3, 000 units) was given intraperitoneally from day 10 to day 19, and the chemotherapeutic agents, 5-FU (60 mg/kg), CPM (100 mg/kg), CDDP (10 mg/kg) and ADM (5 mg/kg), were applied once intraperitoneally on day 10. The antitumor effects were evaluated based on tumor volume on day 20. 5-FU, CPM and ADM enhanced the antitumor effect when combined with TNF, but CDDP did not. These findings suggest that combination therapy of TNF and certain antitumor chemotherapeutic agents is effective cancer treatment.

A 19-year-old female visited our hospital because of primary amenorrhea. She was genetically (46XY) male. Her breasts were poorly developed. She had no pubic or axillary hair. The phenotype was female, and the vagina had a short and closed end. Plasma testosterone (T) and 5-alpha dihydrotestosterone (DTH) were low. However, DHT was elevated by ex vivo T load. The testis, which was atropic, epididymis and vas deferens, which were well developed, were found and resected by operation. The amount of androgen receptors of the skin tissue of the external genitalia was normal. These findings suggested that male pseudohermaphroditism with incomplete testicular feminization syndrome may have been caused by androgen resistance syndrome due to the disorder of androgen receptor complex, genetic information or post receptor.

To treat superficial bladder cancer or invasive bladder cancer presenting as a solitary tumor, conservative therapy such as transurethral resection of bladder tumor or partial cystectomy has long been carried out. We studied the effect of 1-hexylcarbamoyl-5-fluorouracil (HCFU), and the effects of the combination of HCFU and 2.5-di-O-acetyl-D-glucaro-(1-4)(6-3) dilactone (SLA) which is an anti-beta-glucuronidase agent, for preventive therapy. In the patients treated with HCFU, the recurrence rate was 3.6% and 26.6% one year and two years, respectively, after conservative operation. In the patients treated with both SLA and HCFU, the recurrence rate was lower than in those treated with HCFU one year or more after conservative operation, and a long-term preventive effect was expected for nondrinkers.

At Osaka City University, 1, 987 patients with urolithiasis have been treated by extra-corporeal shockwave lithotripsy (ESWL) during a four-year period. We treated 5 patients with horseshoe kidney and the obtained results were analyzed retrospectively. Three of these patients, who had a solitary stone could successfully be treated by ESWL as monotherapy. One who had multiple stones required transurethral lithotripsy after ESWL due to stone-street. The remaining 1 patient who had undergone heminephrectomy developed perirenal hematoma after ESWL, which spontaneously disappeared without any specific treatment. We discuss the special care related to the use of ESWL in the horseshoe kidney.

Treatment using a metallic spiral was attempted on 22 patients. They had urinary retention in 16 cases and dysuria in 6. In 21 of them, the spiral was successfully placed under transrectal ultrasound control. In all 21 patients, voiding was possible immediately after placement of the spiral. As for urodynamic study, urine volume was 100-230 ml (mean: 172 ml), maximum flow rate was 13-21 ml/sec (mean: 17.3 ml/sec), and average flow rate was 4-12 ml/sec (mean: 8.2 ml/sec). Residual urine volume was less than 30 ml in 20 patients and 200 ml in one. As for complications, proximal migration of the spiral was observed in 6 patients. In 4 of them, the new spiral was placed. Perineal discomfort was seen in 3 patients, in 2 the spiral was removed. Pyuria associated with bacterial infection did not continue after the treatment in patients having a catheter. Severe urge incontinence and encrustation were never seen. The above findings suggest that, though a longterm study has not done, this treatment could be an effective treatment particularly for the elderly patients with general complications and/or who require removal of an indwelling catheter for clinical or social reasons.

Transurethral balloon dilatation therapy was performed on 40 patients with benign prostatic hypertrophy (BPH) under local anesthesia. During the procedure, urinary urgency occurred in 80% of the patients. After prostatic dilatation, macrohematuria was observed in almost all patients. The longest follow-up period after dilatation was now 22 months, and the average was 9.5 months. After treatment, residual urine volume decreased, and average flow rate and maximal flow rate improved from 5.7 and 10.4 ml/sec to 8.2 and 15.6 ml/sec, respectively. Overall clinical efficacy was 67.5%. Urethral dilatation therapy was thought to be an effective and non-invasive therapy for BPH.

We have examined the effect of verapamil on CsA-induced nephropathy by measurement of systemic hemodynamics including each organ blood flow using the microsphere method in ischemic kidney model of hemi-nephrectomized Wistar rats. Hepatic and renal microsomal cytochrome P-450 contents and their enzyme activities were measured to study the correlation between CsA-induced nephropathy and induction of hepatic and renal microsomal cytochrome P-450. All rats were hemi-nephrectomized (l-nephrectomy) and were classified into the following 6 groups: 1) control groups, 2) CsA at a dose of 40 mg/kg per day orally for 7 days (CsA group), 3) Oral administration of verapamil for 7 days in the CsA group (CsA + V group), 4) 20 min clamping of the remaining right kidney pedicle (Ischemic, Is group), 5) CsA was administered in the Is group (Is + CsA group), 6) Addition of verapamil to CsA in the Is + CsA group (Is + CsA + V group). Verapamil was given in the drinking water and the average dose calculated from the amount of drinking was 4.7 +/- 1.0 mg/kg per day and 5.2 +/- 0.7 mg/kg per day for the CsA + V group and the Is + CsA + V group, respectively. CsA caused significant increases in BUN and serum creatinine (sCr) with a significant decreases in renal inulin clearance (CIn) in all groups. When compared with the Is group, CsA caused significant decreases in cardiac output and all organ blood flow especially in renal blood flow with significant increases in BUN and sCr in the Is + CsA group.2+ degree of nephropathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Transrectal hyperthermia was performed on 30 patients with benign prostatic hyperplasia twice a week for a total of ten times with the temperature of the prostatic tissue set at 43.0 degrees C. In our in vitro experiment using an agar phantom, the highest temperature was observed at approx. 1.5 cm from the point where the 915-MHz microwave was generated. Our histopathological study of the prostatic tissue, resected at open surgery after three days of hyperthermia, indicated that the effect of hyperthermia first occurred in the interstitial tissues, and then extended to the epithelial cells. Subjective symptoms and objective findings were evaluated. In almost all cases, improvement was observed in subjective symptoms after completion of the treatment. The residual urine volume improved significantly. Also, significant improvement was observed in our urodynamics study. In 16 out of 30 cases (53%), both subjective symptoms and objective findings were still improved after six months.

We report our experience with extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral and cystine stones, which are known to be difficult to treat by this method. First, in order to determine the effectiveness of the ureteral catheter in the destruction of ureteral stones, we compared the clinical results of 121 patients treated without the catheter and 141 patients inserted with the catheter. There was no significant difference in the success rate between the two groups regardless of stone size, which indicates that the use of the ureteral catheter had no effect on the outcome of treatment. We then studied the clinical results of impacted ureteral stones which are especially difficult to destroy. Excretory urography was performed to non-invasively diagnose these stones, and those without visualization in the ureter below the stone were diagnosed as impacted stones and treated by ESWL without the ureteral catheter. Among the stones with a diameter of 1 to 2 cm, the success rate was significantly lower in impacted stones compared to non-impacted stone. These findings suggest that ESWL treatment without the ureteral catheter may be effective for ureteral stones with a diameter of less than 1 cm and non-impacted stones with a diameter of 1 to 2 cm, while combination therapy with other methods such as TUL may be better for other stones. We also performed ESWL on 6 patients with renal stones and 2 patients with ureteral stones which were cystine stones. Renal stones required an average 4.1 treatment with an average of 1, 875 shocks per treatment, and ureteral stones required 1.5 treatment with an average of 1, 833 shocks.(ABSTRACT TRUNCATED AT 250 WORDS)

Peplomycin emulsified in hydroxypropyl cellulosum (HPC-PEP) was prepared for intravesical chemotherapy. Clinical efficacy of HPC-PEP and tissue concentration of peplomycin (PEP) were studied in 12 patients with bladder tumor. Histopathology showed transitional cell carcinoma; 2 in grade 1, 8 in grade 2, and 2 in grade 3. The total volume of 30 ml HPC-PEP was prepared from a mixture of 2% HPC and 90 mg PEP in 15 ml saline, and was intravesically administered through a urethral catheter and retained for two hours. Clinical evaluation 7 days after the initial instillation demonstrated good tumor regression in 2, good response in 5, and no change in 5. The mean PEP level in tumor tissue was 0.36 microgram/gr after 7 days and 0.19 microgram/gr even after 14 days. These clinical observations and tissue levels of PEP suggest that HPC-PEP might be useful as an intravesical instillation agent for bladder tumor.

We studied the efficacy of intravesical instillation chemotherapy of anticancer agents including cylocide (CA) in the prevention of recurrence of bladder tumor after surgery. Totally 60 patients with superficial bladder tumor were enrolled into the study. The patients were randomly assigned to either one of three groups: CA 300 mg alone, CA 200 mg + mitomycin C (MMC) 10 mg, and CA 180 mg + adriamycin (ADM) 20 mg. These drugs were initially instilled once a day for one week, and then once a month until 2 years after surgery. Thereafter, the patients were followed up without instillation. The cumulative non-recurrence rates in the CA group was 76.5, 60.0 and 60.0% at 1, 2 and 3 years after the removal of bladder tumor, respectively, while that in the CA + MMC treated group 90.9, 75.3, and 75.3% and that in the CA + ADM treated group, 95.1, 82.9 and 82.9%, respectively. The recurrence rate in the CA, CA + MMC and CA + ADM treated group was 35.3, 27.3 and 19.0%, respectively, the recurrence indices 1.84, 1.07 and 0.74, and the mean times between recurrence 10.8, 16.5 and 18.0 months, respectively. Side effects were noted in 3 of the 17 cases (17.6%) in the CA group, in 3 of the 22 cases (13.6%) in the CA + MMC group and in 3 of the 21 cases (14.3%) in the CA + ADM treated group. These data show that intravesical CA instillation in combination with MMC or ADM is more effective for the prevention of recurrence than that of CA alone.

A multiple center double blind study was performed to study the effectiveness of Cernilton (CN) on benign prostatic hypertrophy in comparison to Paraprost (PP). Among a total of 192 patients, overall effect was studied on 159 patients, overall safety rate on 178 patients and rate of effectiveness on 159 patients. There were no differences between the two groups in the selected patients, criteria for exclusion and drop out cases or background data of the patients. Impression of patients and overall effect by committee and physician judgment were slightly higher in the CN group compared to the PP group, but there was no significant difference between the two groups. For the improvement in subjective symptoms, the rate of moderate improvement or more after 4 weeks by committee judgement was higher in the CN group compared to the PP group. The rate of improvement in protracted miction, which is an effective marker of urinary disturbance, was also higher in the CN group compared to the PP group. An analysis of objective symptoms showed a significant improvement in residual urinary volume, average flow rate, maximum flow rate and prostatic weight in the CN group. A significant improvement in the phased change of residual urinary volume was also seen in the CN group. No side effects or abnormalities in clinical test levels were noted in the CN group. By committee judgement, the rate of more than moderate effectiveness was 49.1% in the CN group compared to 41.2% in the PP group, but there was no significant difference between the two groups. By physician's judgment, the rate of more than moderate effectiveness was 49.4% in the CN group compared to 46.3% in the PP group, but there was also no significant difference between the two groups. These results suggested that Cernilton was an effective drug for benign prostatic hypertrophy.

Estramustine phosphate disodium (Estracyt) was used in the treatment of 38 patients with prostatic carcinoma for at least 1 year. Of these patients 37 patients were treated with Estracyt as primary treatment and 1 patient had been treated with another antiandrogenic therapy before the Estracyt treatment. Estracyt was given orally in a dose of 560 mg/day in divided oral doses. The clinical evaluation was done for the change of PAP, the relapse rate, the survival rate and the side effect. Among 22 cases which had shown abnormally high PAP values before the treatment started, the values decreased or normalized in 21 cases (95.5%) in the first year of administration of Estracyt. In 6 cases, however, the values increased again in the second year or later. Relapse was observed in 10 (26.3%) out of 38 cases. Relapse rate was 2.6%, 51.7%, and 51.7%, at the first, third, and fifth year, respectively. Survival rate was 97.4% at the first year, 88.5% at the third year, and 68.8% at the fifth year for the follow-up study. Side effects were observed in 14 (36.8%) out of 38 cases. The main side effect was gynecomastia. Gastro-intestinal disturbance and edema were also observed. However, there were only 2 cases (5.2%) in which administration of Estracyt had to be discontinued.

At Osaka City University Hospital, we performed extracorporeal shock-wave lithotripsy (ESWL) for 1277 patients in a total of 1788 sessions using Dornier kidney lithotripter Model HM III from July, 1985 to the end of December, 1988. Among the patients with a solitary stone, 911 cases were available for the follow-up study and we have compared the results among these cases in respect to the stone location and size. The results obtained were as follows: the ratio of kidney stone to ureter stone was found to be 2.2:1 in male, and 3.8:1 in female patients. This indicates that ureter stones are more frequently found in male than in female patients. In addition, we compared the size of kidney stones found in the patients including 415 male and 243 female patients. Stones larger than 20 mm were more frequently found in female than in male patients. Moreover, a stone composition study of these patients showed that the contents of both phosphate calcium and magnesium ammonium phosphate were higher in female than in male patients. ESWL performed against stones at pelvis and calyces exhibited the best results. The results obtained with the stones less than 20 mm in diameter were especially favorable with a success rate of 100% for the stones less than 10 mm and 83% for the stones 10-20 mm, in diameter, while the results with the stones larger than 20 mm in diameter were rather poor with a success rate of 31%. ESWL performed against ureter stones showed poor results with a success rate of 63% for the stones smaller than 20 mm in diameter.

A 51-year-old male patient with diabetes mellitus consulted his home doctor because of high fever and right flank pain. Urinalysis showed marked pyuria. Treatment with antibiotics was not completely effective, and he was referred to our hospital for further examination and treatment. CT scan showed an abnormal gas shadow in right renal parenchyma. He was diagnosed with emphysematous pyelonephritis and right subcapsular nephrectomy was done after the control of diabetes mellitus. We reviewed 57 cases of emphysematous pyelonephritis including our case in the Japanese literature, and we discussed about its etiology, symptomatology, choice of treatment and prognosis.