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Post-transurethral resection (TUR) status in the prostate and urinary bladder has been infrequently documented. Furthermore, sequential changes in eosinophil count in peripheral blood (PB) after TUR have not been investigated in detail. In the present study, eosinophil counts and changes in eosinophils in PB were examined before to after TUR of the prostate (P) in 20 patients with benign prostatic hyperplasia. Among them, 14 patients exhibited increased numbers of eosinophils, the greatest increase being 17%. After TUR to treat bladder tumor (BT), massive infiltration of eosinophils into the resected areas, peaking 1 month later, was also detected in 8 of 15 cases of post-TUR cystitis. The PB eosinophil counts increased by more than 5% in two of five cases of post-TUR cystitis in which eosinophil counts were obtained before and after surgery. Most infiltrating eosinophils reacted positively to antibodies to eosinophil cationic proteins. These results indicated that, in patients with post-TUR prostatitis, the number of eosinophils in PB increased, and peaked 1 month later, with infiltration by eosinophils observed. Pathologists and urologists should be aware of the potential for increase in eosinophils not only in regions of TUR but also in PB.

透析患者の血糖 (BG) コントロールの指標としてグリコヘモグロビン (HbA1c) およびグリコアルブミン (GA) の2つを比較検討した. 対象は, 糖尿病を有する慢性維持血液透析患者41名 (男性31名, 女性10名, 平均年齢65±9歳) であり, 全例が昼間透析である. 透析来院時に, 透析開始時, 透析中昼食前, 透析終了時の3ポイントで血糖値を, また透析開始時の採血でHbA1cとGAを測定し, それぞれの関係を検討した. また, 同日から遡り過去4週および2週間の透析開始時平均血糖値 (朝食後平均143分後) を求め, これら平均値とHbA1c, GAおよび他の因子との関係についても検討した. 結果は, GAとHbA1cとは良好な相関関係が認められた (r=0.663, p

Post-transcriptional modification of p53 by phosphorylation has been proposed to be an important mechanism of p53 stabilization and functional regulation. Phosphorylation of p53 Ser392, in particular, activates specific DNA binding functions by stabilizing p53 tetramer formation. This study evaluated the relationship between p53 Ser392 phosphorylation and various types of p53 missense mutation detected in urothelial transitional cell carcinomas (TCCs), with stratification ofthe mutations according to the functional domains elucidated by the crystal structure of the p53protein. Of 41 TCCs with missense mutations, 26 (63.4%) exhibited immunopositivity with Ser392 phospho-specific p53 antibody. In comparison to structural mutations, the missense mutations at exon 7 (p=0.0307) or located in regions that affect direct DNA binding ability (p=0.0273) were significantly associated with Ser392 immunopositivity. No statistically significant relationship was found between Ser392 immunoreactivity and other different types of p53 mutation. The prevalence of cases exhibiting Ser392-positive immunostaining was higher forhigh-grade (p

今回, 高血圧を有する慢性血液透析患者20例を対象に24時間血圧測定 (ABPM) を施行しその解析および血圧日内変動パターンと臨床的パラメーターとくに動脈硬化危険因子/透析関連予後不良因子との関連について検討した. 患者は夜間血圧降下率により2群に分けられた (dipper型とnon-dipper型). Non-dipper型が55% (11/20) にみられた. non-dipper型では, dipper型と比して有意にHt値が低かった (28±3 vs 32±2, p

Loss of DNA mismatch repair due to diminished expression or mutation of hMLH1 is associated with genomic instability followed by cancer. We performed genetic analyses of hMLH1 to determine whether hMLH1 alterations have a role in urothelial tumorigenesis.We examined genomic DNA from 118 sporadic transitional cell carcinomas, including 83 bladder and 35 renal pelvis or ureter cases, for aberrant promoter methylation and mutation in the hMLH1 gene. Immunohistochemical reactivity to hMLH1 protein and genome instability in these transitional cell carcinomas were also studied.Two of the 118 cases (1.7%) had microsatellite instability and hMLH1 promoter methylation with loss of or reduced hMLH1 protein expression. A single transitional cell carcinoma (0.8%) without microsatellite instability had an hMLH1 missense mutation with a C-to-T transition, resulting in the substitution Arg217 --Cys. Immunostaining with antihMLH1 antibody was found in this transitional cell carcinoma.To our knowledge these findings provide the first in vivo evidence for the type and frequency of possible involvement of promoter methylation and mutation of hMLH1 in sporadic urothelial transitional cell carcinoma. They also suggest that hMLH1 alterations may not account for many cases of sporadic transitional cell carcinoma tumorigenesis.

Multinucleated giant cells (MGC) detected in the submucosal layer of human urinary bladder mainly associated with transitional cell carcinoma were examined immunohistochemically and ultrastructurally. The cases examined totaled 29, namely 14 cases with transitional cell carcinoma and another 15 cases mostly with malignancy in other organs. Histologically, MGC were smooth, irregular or dendritic in shape, and tended to increase in number in the vicinity of cancer or marked inflammation. They were consistently positive for not only vimentin, but also MB-2, and CD34, and were mostly positive for proliferating cell nuclear antigen (PCNA), but not MIB-1 (Ki-67) and HLA-DRalpha antigens. On occasion, antibodies to alpha-smooth muscle actin (alpha-SMA), muscle actin (M-actin), CD68 (KP-1) and alpha subunit of S-100 protein also yielded positive reactions. Interestingly, aggregated short bulbous processes were ultrastructurally observed on their surface in parts. These findings suggested that MGC in the submucosal layer of human urinary bladder were MB-2 and CD34-positive multipotential mesenchymal cells with no mitotic activity expressing fibroblastic (vimentin), myofibroblastic (alpha-SMA), or histiocytic (CD68) markers mostly in the vicinity of malignancy, and that these MGC were formed by fusion of mononuclear cells expressing identical markers with those of MGC. Further investigations are needed to clarify the exact function of MGC in human urinary bladder.

慢性透析患者に合併した胸部および腹部大動脈瘤の3症例を経験した. 症例1は48歳, 男性で主訴は腹痛と背部痛, 腹部CTで最大径10cmの解離性大動脈瘤 (DeBakey IIIb) を認め, 腎下部腹部人工血管置換術および胸腹部置換術を施行した. 術後に後腹膜膿瘍を認め, 敗血症のため術後3か月目に死亡した. 症例2は62歳, 男性で主訴は腹痛, 嘔吐. 腹部CTおよび腹部超音波検査で最大径5cmの腹部大動脈瘤を認め, 腹部人工血管置換術を施行した. 術後経過良好であったが, 術後40日目に脳内出血を併発し死亡した. 症例3は81歳, 男性で主訴は腹部腫瘤. 腹部CTで最大径5cmの腹部大動脈瘤を認めたが, 高齢であり保存的療法で経過観察を行い現在も健在である. 透析患者に合併した大動脈瘤に対しては破裂例の予後が悪いことから, 早期発見と積極的な外科療法の必要性が強調されている. しかし, 依然リスクの高い手術であり周術期管理には十分な注意が必要であると考えられる.

症例: 82歳, 男性. 慢性糸球体腎炎による腎不全にて1992年9月血液透析に導入. 1996年12月末より食欲不振が続き, 1997年1月16日歩行困難, 発熱, 経口摂取不可, 意識レベル低下したため入院となった. 胸部X-Pにて肺炎と診断し, 抗生物質投与と全身管理を行った. WBC 8,200, CRP 8.9mg/dl, CKが538IU/lと軽度上昇認めた. 頭部CTに異常はなかった. 1月17日LDH 737IU/l, CK 1,467IU/l, CRP 8.3mg/dlと, CKの著明な増加を認めた. ECG, 心エコーに心筋梗塞の所見はなかった. 1月20日, CK 109IU/lと正常化. 1月22日, 呼びかけに開眼する程度の意識状態であった. 患者は1991年より近医にてパーキンソン病にてlevodopa/carbidopa合剤を服用していたが, 入院1週間前より, levodopa製剤を服用していなかった. 意識障害, 発熱, 高CK血症からドーパミン中止による悪性症候群を考え, levodopa/carbidopa合剤の経口投与を開始した. 次第に意識レベルは上昇し, 2月末には入院前の状態に近いところまで回復した.パーキンソン・クリーゼの誘因として, (1) 抗パーキンソン病薬の中断 (2) 肺炎 (3) 低栄養状態が考えられた. 治療としては, 全身状態の改善はもちろんのこと, 極期においてもlevodopa製剤は可能な限り継続することが肝要と考えられた.

Cyclin E gene alteration in the cell cycle plays an important role in carcinogenesis, while p53 protein affects different phase checkpoint pathways by activating p21WAF1/CIP1 in the normal cell cycle. We immunohistochemically examined the expression of cyclin E and p53 proteins in 121 patients with transitional cell carcinoma (TCC) of the renal pelvis and ureter to determine their significance for tumour behaviour and patient prognosis. Cyclin E and p53 immunostaining of the nucleus was observed in 36 tumours (29.8%) and 35 tumours (28.9%) respectively. A significant percentage, 69.4% (25 out of 36 tumours), of the cyclin E-positive tumours exhibited simultaneous labelling for p53 (P < 0.05). Mirror-section technique was performed in five selected double-positive tumours to identify cancer cells that were nuclei positive for both cyclin E and p53. The prevalence of cases simultaneously exhibiting both cyclin E and p53 immunostaining was higher in the high-grade tumours (P < 0.01) than in the other types of tumours. Patients with TCCs coexpressing cyclin E and p53 had a significantly poorer prognosis than those expressing neither cyclin E nor p53 (P < 0.001). These in vivo findings provide evidence for cyclin E protein overexpression in TCCs intimately associated with p53 alteration and suggest that simultaneous overexpression of both cyclin E and p53 is related to tumour behaviour and poor prognosis. Images Figure 1

自己血輸血は短期間に頻回の採血を必要とするため, 慢性貧血状態である透析患者では, 採血時の合併症や採血後の貧血に十分な注意が必要である. 今回, 待機的手術に際して自己血輸血を施行した漫性血液透析患者の2例を経験したので報告する.症例1は45歳, 女性. 主訴は両側の下肢痛. 腰椎X-P, MRIで腰椎の変形と椎間板腔の著明な狭小化を認め, 腰椎椎間板ヘルニアと診断された. 術前2週および1週間前に自己血を400mlずつ計800ml採血し, 椎弓部分切除術を施行した. 遺伝子組換え型ヒトエリスロポエチン (rHuEPO) は週3回3000IUの透析時静脈内投与から初回採血時より週1回24000IUの皮下投与に変更した. 初回採血時のHtは28%で, 術前のHtも同様に28%に保持可能であった.症例2は51歳, 男性. 主訴は無症候性血尿. CT検査にて膀胱腫瘍を認め, 生検にて非乳頭状広基性の扁平上皮癌と診断され, 膀胱全摘術を施行した. 自己血貯血は予定手術日の3週および2週前の透析終了後にそれぞれ400mlずつ採血したが, 予定手術日が延期となったため, 3回目の採血日に第1回目の自己血400mlを透析中に戻し輸血した後800ml採血し, 計1200mlの自己血貯血を行った. rHuEPOの投与は, 週2回1500IUの透析時静脈内投与から初回採血時より週1回24000IUの皮下注に変更した. 初回採血時のHt値は30%, Hb値は10.4g/dlで, 3回の採血を通じてHt値, Hb値ともにほとんど減少を認めなかった.以上の結果より, 慢性貧漁状態である透析患者でも, rHuEPOを投与することで採血前後の貧血に備え, normovolemic phlebotomyになるよう採血方法に注意すれば, 非透析患者と同様に比較的安全に自己血採血が可能であることが示唆された.

貧血を有する血液透析 (HD) 患者で血清トランスフェリンレセプター (sTfR) 値がrecombinant human erythropoietin (rHuEPO) 投与量を決定する上で有効な指標となりうるかを検討した.対象は新たにrHuEPO治療を開始したHD患者42例 (透析導入期12例, 維持期30例) で, 鉄欠乏が疑われた症例は除いた. rHuEPO治療開始時より8週間経時的に造血パラメータ (Ht, Hb, RBC, MCV, WBC, Plt, 網状赤血球), 鉄パラメータ [血清鉄 (sFe), ferritin (sFt), TIBC, UIBC, transferrin (Tf)] およびsTfR値を測定した. sTfRはELISA法およびラテックス凝集法によりsTfR-Tf complex (TRC) 値として測定した. rHuEPOnoの治療効果は前値に比した治療開始8週後のHt値の変化量 (ΔHt) で観察した.Ht, RBC, Hb値はrHuEPO治療開始1週後より有意に上昇し8週後まで上昇した. TRC値は1, 2, 4週後とも前値に比して有意に上昇した. ΔHtは, 前値に比した1, 2, 4週後のTRCの変化量 (1, 2, 4週後のTRC値-前TRC値) および変化率 (TRC変化量/前TRC値×100) と有意の正の相関を示した. 特に1週後のTRCの変化量が最も強い相関性 (R=0.513, p

recombinant erythropoietin (r-HuEPO) 維持投与中で, Ht30%以上に維持できている血液透析患者 (r-HuEPO反応良好群) のうち鉄欠乏 (フェリチン (Frt)

52歳女性, 高度の慢性腎不全例で急速に歩行困難をきたし血液透析 (HD) 導入したが改善せず, ステロイド・パルス (MP) 療法を行い, 軽快したギラン・バレー症候群 (GBS) の1例を経験した. 感冒を前駆症状とし潜伏期間は約19日, 伸展期は6日, 症状極期重症度はHughesらの分類でgrade 4, 罹病期間は約300日であった. GBSは急性に発症する運動麻痺主体の急性炎症性脱髄性多発根神経炎であるが, 腎不全を伴う場合は急速進行型の尿毒症性多発神経炎 (accelerated uremic neuropathy: AUN) との区別が困難なことが多い. ともに急速な経過をとって運動障害優位の末梢神経障害を呈し, 髄液蛋白増加や電気生理学的, 病理学的に脱髄所見を示し得る可能性があるなどの類似点があるためと考えられる. 両者の鑑別診断についても若干の考察を加えた.

鉄飽和指数 (FeSI) 16%未満の血液透析患者にクエン酸第一鉄ナトリウムを投与し, その有用性とともに, 鉄欠乏を把握するに適切な指標を検討した.エポ併用群では鉄補充に伴いHbの有意の増加がみられ貧血が改善されたが, 鉄単独群ではHbは変化せず, 鉄が造血に有効に利用されていないことが示唆された. フェリチン (Frt)

The distribution of S-100 protein positive dendritic cells (S100-DCs) inside the cancer nest and the expression of HLA-DR alpha antigen (HLA-DR) and blood group antigen (BGA) on cancer cells in 90 cases of transitional cell carcinoma (TCC) of the urinary bladder were immunohistochemically investigated in relation to the degree of malignancy and its prognosis. A dense infiltration of S100-DCs inside the cancer nest ("many", i.e. more than 10DCs/HPF) was detected in 47 (52%) out of 90 cases. The HLA-DR positive cancer cells (DR-CCs) were detected in 24 cases (27%), including in the 16 most dense cases ("many", i.e. more than 100DR-CCs/HPF). BGA positive cancer cells (BGA-CCs) were detected in 49 cases (54%) ("positive", i.e. more than 100BGA-CCs/HPF). In connection with the degree of malignancy and with the number of cases affected by S100-DCs infiltration. HLA-DR expression and BGA expression. A statistical analysis showed significant correlation between the number of cases affected by S100-DC and each clinicopathological factor including G, pT, ly, v, and showed also between that affected by BGA expression and each clinicopathological factor including G, pT, INF, but showed no significant correlation between that affected by HLA-DR and each clinicopathological factor. As regards the prognosis, the 10-year survival rates for all 90 cases were 60.4%. In the 10-year survival rate, S100-DCs "many'' (77.7%) and "few'' (39.0%), DR-CCs "many'' (85.7%) and "no'' (56.9%), DR-CCs "many'' and "few'' (43.8%), BGA-CCs "positive'' (74.3%) and BGA-CCs "negative'' (46.5%) were statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

長期透析患者が増加するにつれ, 透析アミロイド骨関節障害は重大な合併症となっている. 今回, 膝関節炎にて関節滑液の貯留する維持透析患者8例 (男性2例, 女性6例, 平均年齢65.9歳, 平均透析歴106か月) の関節滑液中アミロイドの存在について検討し, 滑液および血清β2-M濃度についてもあわせて検討した. コントロールとして腎機能正常者の関節滑液についても同様の検討を行った. アミロイド染色において, コントロール群ではアミロイドは証明されなかったが, 維持透析患者群では8例中6例にアミロイドが証明された. 6例の平均透析歴は132.0か月で, うち4例では手根管症候群を合併し, 典型的なsynovial amyloidosisと考えられたが, 61か月と比較的短い透析歴の患者でもアミロイドが証明された. この事実は透析導入後比較的早期に関節滑膜へアミロイド沈着が発生することを示唆しており, この患者では, 現在膝関節以外の臨床症状はないものの, 透析歴が長くなれば他の部分症の顕性化が予想される. 次に, 維持透析患者群における滑液中β2-M濃度18.3±4.9mg/lは血清濃度31.5±7.6mg/lに比し有意に低く, この理由として, コントロール群で両者間に有意差のないことより, 維持透析患者の関節炎時の関節滑液中には蛋白分解酵素の存在が推察されるが, アミロイドが関節滑膜に多量に沈着している症例では血管やリンパ管の循環不全による組織液の移送障害からくる希釈なども推察される. また, 維持透析患者群, コントロール群の両群において血清および関節滑液中β2-M濃度の間には有意な正の相関が認められた.

We performed ligation of the crura penis for 34 impotents with corporal veno-occlusive insufficiency without arterial insufficiency and neural dysfunction from October 1987 to April 1991. Ages ranged from 24 to 72 (52.6 +/- 12.7) years old and follow up period was from 1 to 41 (17.7 +/- 12.6) months. For six patients ligation of the crura only was performed, for 22 ligation of the crura and deep dorsal vein (DDV) as well was performed at the same time, and for 6 crural ligation was performed after ligation of DDV. These operations required less than one hour and there were no severe complications. The postoperative results at 1 month were as follows: Excellent (sufficient spontaneous erection was recovered); 18, Improved (complete erection with intracavernous papaverine injection was achieved); 13, and Failure; 3. Erectile function was maintained only in 50% of the 18 pts. graded excellent. Ninety percent of the 31 patients graded either excellent or improved could maintain erectile function after 40 months with papaverine injection. Venous surgeries could not be a primary treatment for correcting the outflow abnormalities (of the veins). So it is conceivable that failure or recurrence could occur during a long follow up period. We concluded that crural ligation was acceptable as the first line treatment for erectile dysfunction due to corporal veno-occlusive insufficiency because of its relative non-invasiveness compared to other venous surgeries.

目的: 腎性貧血に対するリコンビナント・ヒト・エリスロポエチン (r-HuEPO) の至適投与量を明らかにするため多施設共同試験を実施した. 対象と方法: 慢性腎不全血液透析患者でHt値25%以下の症例273例を対象とした. 初期投与を3群 (1,500IU×3/W, 1,500IU×2/W, 3,000×2/W) に分類し, Ht値が27-33%に達した時点より維持投与に移行し, Ht値を30%前後に維持するように投与量を変更もしくは休薬した. 結果: 初期投与では投与後4週後のHt値は3群とも有意な上昇を示し, 3群間では3,000×2/Wが有意に高値であり, その効果は用量依存性であった. 12週目では3群間に差がなく, 貧血改善を緩徐に行うためには1,500IU×2/Wで十分であった. 維持投与量は, 低用量に移行し, 4,500IU/W以下が約80%を占めた. しかしながらHt値30%を維持するためには25%の症例で6,000IU/Wの投与が必要であった. 副作用は34例 (12.5%) に認められ, 主要な副作用は血圧上昇で, 投与量が増えるに従い, その発生頻度が増加した. 6,000IU/W投与する場合, 血圧の上昇を懸念する必要があると思われた.

AIあるいはFe骨症7例に対してDesferrioxamine (DFO) を長期投与し, その結果を検討した.DFO投与後, 全例骨痛の改善がみられた. 治療前に骨生検施行した7例中6例に骨石灰化前線にAIおよびFe沈着を認めた. DFO治療中の2例および治療後の2例の計4例に, AI沈着が認められた. しかし, Fe沈着の消失あるいは減弱した症例もみられ, DFO治療によってAIよりFe除去が早期にそしてより多く起こるのではないかと考えられた. また, 治療後, 臨床的にたとえ著明な改善がみられた症例でも, 組織学上完治する可能性は少ないのではないかと推定される. また, AI骨症には, AIとFeが同時に石灰化前線に沈着をみることからAI骨症はAI-Fe骨症でもあるという概念を常に念頭においておかねばなるまい.骨シンチグラムにて治療経過観察を行ったが, 殆どの症例で骨痛消失後から遅れて骨シンチグラム上の改善がみられた. DFOの投与必要期間は骨シンチグラム上の改善がみられることが大きな指標になると考えられた.

Background: Nephrogenic adenoma is an uncommon, benign metaplastic lesion occurring in the urothelium, usually as a response to chronic irritation or trauma. It is rarely encountered in hemodialysis patients. Endoscopically, these lesions can easily be mistaken for malignant tumors. Methods/Results: We report on a case of nephrogenic adenoma of the bladder in a chronic hemodialysis patient that was large and mistakenly diagnosed as transitional cell carcinoma in the initial biopsy. Histopathological examination of the total cystectomy specimen demonstrated the correct diagnosis of nephrogenic adenoma. Conclusion: Increased awareness by urologists and pathologists of nephrogenic adenoma may lead to its more accurate diagnosis.

After extracorporeal shock wave lithotripsy (ESWL), perinephric hematomas, while uncommon, are a serious complication involving the risk of blood transfusion and subsequent impairment of renal function. We report a rare case of ESWL-induced renal laceration in which an expanding retroperitoneal hematoma required blood transfusion but was treated successfully without surgical intervention.

It is known that a common p53 polymorphism, encodingeither proline (Pro) or arginine (Arg) at residue 72, produces marked change in the structure of p53. Furthermore, the Arg72-containing allele is preferentially mutated and retained in various human tumors, suggesting that polymorphic residue within p53 modifies mutant behavior. We studied to determine whether Arg72 could be a risk factor for p53 mutations in human transitional cell carcinomas (TCCs). In addition, the relationship between the status of p53 codon 72 polymorphism and clinicopathological factors of this tumor were also analyzed.We analyzed the correlation between the p53 mutations and genotypes of its codon 72 using genomic DNAs from the TCCs by direct DNA sequencing. Loss of heterozygosity was determined using a p53 microsatellite marker (TP53) amplified by PCR.There was a bias to mutate and express the Arg allele in the p53 -mutated TCCs arising in individuals with heterozygosity (Pro/Arg). The Arg72-containing allele was preferentially retained in these tumors. The prevalence of cases with p53 mutations within Arg72-containing allele was higher for advanced-stage TCCs (chi(2) = 5.320, P = 0.021) than for TCCs with those arising in Pro72-containing allele.Our in vivo findings suggested that p53 mutation alleles containing Arg72 are preferentially selected during tumorigenesis and affect mutant behavior in TCCs, and revealed that TCCs with p53 mutation arising in Arg72-containing allele became progressively more abundant with increase in tumor stage.

Ninety-four patients with transitional cell carcinoma (TCC) of the renal pelvis and ureter, including dysplastic lesions, were studied for p53 and bcl-2 protein expression by immunohistochemistry. Twenty-one patients were also studied for p53 gene mutations by direct sequencing and for bcl-2 gene rearrangement by Southern blot analysis. Overexpressed p53 protein was detected in 26 cases (27.7 per cent). bcl-2 immunostaining was observed in 21 tumours (22.3 per cent), including four cases with labelling for p53. Furthermore, the dysplastic lesions surrounding 19 p53-positive tumours also stained for p53. bcl-2 expression was also detected frequently in dysplastic lesions adjacent to 14 bcl-2-positive TCCs. Positive reactions of dysplastic lesions were also found adjacent to 37 bcl-2-negative tumours. p53 point mutation was detected in 6 of 21 cases. Five of the six cases were positive for p53 protein. blc-2 positivity was detected in 3 of 21 tumours, without bcl-2 gene rearrangements in the major breakpoint region. Overexpressed p53 protein was frequently detected in both high-grade (P < 0.05) and invasive tumours (P < 0.05). In three cases of p53-positive non-papillary invasive tumours, bcl-2 was found in non-invasive portions, but was not present in invasive areas. These findings suggest that overexpression (mutation) of p53 and/or bcl-2 protein may be early events in tumourigenesis and that p53 alterations in particular are essential for the maintenance of a malignant phenotype in tumour development.

Ninety-eight cases of transitional-cell carcinoma (TCC) of the renal pelvis and ureter, including dysplastic lesions, were studied for tumor incorporation of human papillomavirus (HPV) type-16 and type-18 DNA by in situ hybridization (ISH) with DNA probes for each HPV viral type. Immunohistochemical analysis of p53 expression was also performed. Fresh tumor tissues from 26 patients were also studied for p53 mutations in exons 4 through 9 by direct sequencing and for HPV infection by polymerase chain reaction (PCR). Thirty-two tumors were positive for HPV DNAs, including 6 double-positive cases. Among these tumors, adjacent dysplastic lesions in 21 cases (66%) also revealed identical reactivity. Overexpressed p53 was detected in 26 cases. Expression of p53 was also detected in dysplastic lesions in 19 out of these 26 cases (73%). Three cases were positive for both HPV DNA and p53 antibody. p53 point mutation was detected in 7 of 26 cases, 6 of which were also positive for p53. HPV type-16 DNA was detected in 6 cases by PCR, 4 of which were also ISH-positive. Overexpressed p53 was frequently detected in invasive and non-papillary tumors (p < 0.01) and in high-grade tumors (p < 0.05). HPV infection was more common in non-invasive and papillary tumors (p < 0.05). These findings suggest that HPV infection or overexpression (mutation) of p53 may be an early event and be related to phenotypes of tumor-cell growth patterns and progression.

血液透析患者236例の尿路感染症の発生頻度およびその特徴について検討した.1年間に自覚症状を伴う尿路感染症は42例17.8%に認められ, 他の臓器感染症とほぼ同等であり, 自覚症状を伴わず膿尿のみを認める症例を加えると76例32.2%にものぼった.血液透析患者は尿路感染症発症のためのいくつかの負の要素をもっているが, その発症には, 原疾患, 治療, 検査などが惹起要因として関与することも多く, 例えば, 糖尿病性腎症では, 糖尿病による神経因性膀胱, 嚢胞腎では, 嚢胞自体による上部尿路閉塞や嚢胞感染, 他にカテーテル操作, ステロイド投与などが惹起要因となる. これらの惹起要因をもつ患者では, 尿路感染症の発症が全身状態の悪化へのひきがねになることもあり, 十分な監視による早期診断, 早期治療が必要である.

透析アミロイドーシスとcystic radiolucency (CRL) との関係を明らかにするため, 手根骨のCRLをGroup 1-4の4つの段階に分類し, 年齢, 透析歴, 慢性腎不全の原因疾患, 遠位橈尺関節におけるvariant, 各種血液生化学的パラメーターについて検討した. また嚢胞化に対する種々の因子の影響度を知るために, 多変量解析を行った. 対象は, 維持透析を受けている150名, 男性85名, 女性65名, 平均年齢53.5±12.2歳, 平均透析期間, 71.9±49.0か月であった. また対照群として, 健康な成人36名, 男性13名, 女性23名を選んだ. CRL陽性率は, 患者群34.7%, 対照群19.4%であり, 患者群の方が有意に陽性率が高かった. また手根管症候群合併患者で87.5%と頻度が高かった. Cystと年齢との関係は, CRLの重症化につれ, その平均年齢が高くなる傾向にあった. Cystと透析期間との関係は, Group4のみが有意に透析期間が長く, 他のgroup間には有意差を認めなかった. 透析期間別のCRL陽性率は透析6年未満までは, 対照群と有意差がなく, 6年以上で有意差を認めた. CRLとulnar varianceとの間には一定の傾向は認められなかった. CRLと血液生化学的パラメーターでは, 血清Ca値がgroup分類に大きく寄与しており, CRLが重症化するほど血清Ca値が上昇する傾向にあり, 血中β2-microglobulin値はgroup分類には影響していなかった. 以上よりアミロイドーシスの診断には治療期間が6年以上の患者で, Group 4 (CRLを3個以上認めるもの) に属するものであることが基準となると考えられた.

A new simplified method has been devised for staining aluminum and has been tested in paraffin sections of bone from 60 patients who have undergone hemodialysis. Iliac crest bone fragments were fixed in 20% phosphate-buffered formalin for less than a day and demineralized at room temperature in 10% phosphate-buffered formalin containing 5% formic acid for only 2 to 3 hr. Four-micron paraffin sections, accompanied by positive controls, were stained with Maloney's aluminum stain, the Berlin blue reaction for iron, dylon or Congo red for amyloid and von Kossa's reaction for calcium. Aluminum and iron were demonstrated particularly at the mineralizing front of bony tissues; aluminum in 52 cases, iron in 45. Dylon staining also gave positive results in 52 cases. It is important in determining whether aluminum deposition is present that the von Kossa reaction remains positive even after demineralization. This method may be more useful for demonstrating aluminum in bony tissues than the complicated and time-cons...