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神戸女学院大学の教職課程における音楽科教育法の授業において、初めて模擬授業を行う大学生16名を対象に、9つの段階で構成される模擬授業の指導をおこなった。指導の最終段階において、それぞれの学生は中学生を想定した30分の音楽の模擬授業を行った。これらの模擬授業について14の観点で構成される評価シートに基づいて評価を行った。得られた16の模擬授業の評価結果を分析したところ、授業を構成する9つの観点（導入の工夫、話し方の工夫、発問の工夫、作業指示の工夫、意見発表の工夫、指導の工夫、評価の工夫、時間配分の工夫、学習のまとめの工夫）において、教員養成における実践力指導力向上の課題が明らかとなった。, In the class of music education method course of the teacher training program at Kobe College,the teaching guidance of a trial lesson with 9 teaching stages was provided to 16 college students who experienced the lesson for the first time. In the last stage, each student conducted a 30 minute-music trial lesson for junior high school students. The trial lesson was assessed by an evaluation sheet consisting of 14 viewpoints. Analyzing the evaluation results of 16 trial lessons, it was clarified that the study found issues in 9 viewpoints as structuring the lesson: ingenuity of introduction, way of speaking, questioning, work instruction, view/opinion presentation, guidance, evaluation, time management, and summarization of learning contents.

Objective To confirm the efficacy of using Seprafilm® (Genzyme Corp., Cambridge, MA, USA) for wrapping the ureter to treat the ureteric stenosis caused by retroperitoneal fibrosis (RPF). Patients and Methods Between August 2010 and September 2012, 11 ureters in eight patients with RPF (seven males and one female, mean age 65 years) were treated. The mean (range) length of the narrow segment of the ureter was 30 (10–90) mm. During surgery, after having been released from adhesive tissue, the stenotic segment of the ureter was wrapped with Seprafilm to isolate it from the surrounding tissue. A radiographic follow-up was performed every 6 months using computed tomography, i.v. pyelography and/or 99mTc-mercapto-acetylglycyl-glycyl-glycine (99mTc-MAG3) renal scintigraphy. Results For the unilateral operations, the mean estimated blood loss was 39 mL, and the mean operating time was 154 min. All ureters were isolated from the fibrotic tissue and wrapped with Seprafilm successfully without major complications. During the mean follow-up period of 17 months, no ureteric restenoses were observed in the affected sides, but new stenosis occurred in the contralateral side of the ureter in one patient. Conclusions Although the follow-up period is still limited, we believe that the use of Seprafilm has the potential to become an effective option in the treatment of ureteric stenosis caused by RPF, when the omentum cannot be used. To establish the relative advantages of using Seprafilm over performing a standard omental wrap, further experimentation will be required to compare the two techniques.

A small number of cases of small bowel obstruction caused by foods without the formation of phytobezoars have been reported. Repeated small bowel obstruction due to the ingestion of the same food is extremely rare. We present the case of 63-year-old woman who developed small bowel obstruction twice due to the ingestion of chestnuts without the formation of phytobezoars. This is the first reported case of repeated small bowel obstruction caused by chestnut ingestion. Careful interviews are necessary to determine the meal history of elderly patients and psychiatric patients.

Meckel憩室は一般的に無症状のため，治療の必要はないが，穿孔をきたすなどの有症状症例が治療の対象となるとされている．症例は約3年前に胃全摘が施行された67歳の男性である．下腹部痛を訴え，原因不明の腹膜炎として開腹手術が施行された．開腹時，腹腔内を検索すると，腸管外に4.3cmの魚骨が認められた．穿孔部位を検索すると，回腸末端より約50cm口側にMeckel憩室が認められ，その先端部に魚骨の穿孔部位が認められた．魚骨によるMeckel憩室穿孔と診断され，憩室切除術が施行された．本症例は本邦に16例の報告があり，比較的稀である．報告例の中に胃全摘後の症例は見あたらなかったが，胃全摘は低酸状態と小腸への易通過性のため，魚骨による消化管穿孔の重大な危険因子と考えられた．今回われわれは胃全摘術後患者に発症した魚骨によるMeckel憩室穿孔の1例を経験したので文献的考察を加えて報告する．

Since November 1982, 276 primary cadaveric kidney transplants have been performed using kidneys from non-heart beating donors. Between November 1982 and December 1986, 49 transplant patients were treated with cyclosporine and steroid immunosuppressive therapy (CSA regimen). Twenty-seven patients were treated with low dose cyclosporine (initial dosage, 4 mg/kg/day), steroid therapy, and a 21-day course of 500 mg/day antilymphocyte globulin (ALG 1 regimen) between January 1987 and December 1987. Seventy-nine patients were treated with low dose cyclosporine (initial dosage, 6 mg/ kg/day), steroid therapy, and a 14-day course of 1,000 mg/day antilymphocyte globulin (ALG 2 regimen) between January 1988 and June 1990, and 85 patients were treated with low dose cyclosporine (initial dosage, 6 mg/ kg/day), steroid therapy, and a 14-day course of 1,000 mg/day antilymphocyte globulin followed by 2 mg/kg/day mizoribine (ALG 3 regimen) between July 1990 and May 1995. Ten patients, who showed hypersensitivity to antilymphocyte globulin therapy, were treated with low dose cyclosporine, steroid therapy, and mizoribine. Finally, 26 patients were treated with FK506 and steroid therapy (FK506 regimen) between June 1990 and February 1992. Graft survival was 78% at 1 year, 69% at 3 years, 63% at 5 years, and 51% at 10 years in the CSA regimen group and 67% at 1 year, 52% at 3 years, and 48% at 5 years in the ALG 1 regimen group. It was 85% at 1 year, 70% at 3 years, and 62% at 5 years in the ALG 2 regimen group and 87% at 1 year and 67% at 3 years in the ALG 3 regimen group. In the FK506 regimen group, graft survival was 92% at 1 year and 80% at 3-5 years. Never-functioning grafts were observed in 3 CSA patients (6%), 1 ALG 1 patient (4%), 3 ALG 2 patients (4%), 3 ALG 3 patients (4%), and 1 FK506 patient (4%). These results indicate that low dose cyclosporine (initial dosage, 6 mg/kg/day), steroid therapy, and a 14 day course of antilymphocyte globulin therapy is beneficial for cadaveric renal transplant patients receiving kidneys from non-heart beating donors; FK506 and steroid therapy might be more effective than cyclosporine based immunosuppressive therapies even in such patients.

症例は80歳代男性，右下腹部腫瘤を主訴に受診し，CT，USで回盲部周囲膿瘍と診断されたため，当科に紹介された．まず，保存的治療を開始したところ，膿瘍の突然の縮小が認められ，その後の注腸造影，大腸内視鏡検査でS状結腸に膿瘍腔と交通する瘻孔の存在と虫垂開口部の腫瘍が認められた．保存的治療は困難と考えられたため，開腹手術を施行した．膿瘍は回盲部から外側の腹壁，腸腰筋上を被う様に存在した．術中肉眼所見では右側結腸の炎症が先に生じ，S状結腸を巻き込む形で炎症が波及し，癒着，外側からの瘻孔形成に至ったと考えられた．切除標本では虫垂粘膜面から虫垂開口部方向にかけて広基性，隆起性の虫垂腫瘍が露出している所見が認められ，病理組織学的診断により，高分化型腺癌と診断された．今回，われわれはS状結腸に穿破した回盲部周囲膿瘍の精査中に発見された虫垂癌の1例を経験したので若干の文献的考察を加えて報告する．

AIMS Folic acid is one of water-soluble Vitamin B group and plays an important role in proliferating cells of the fetus. A multicentered, randomized control trial proved in 1991 that folic acid supplements of 4 mg per day periconceptionally administered to 1031 women who were recruited from 7 countries and had afflicted prior pregnancy successfully prevented 72% of recurrence of neural tube defects. As a primary prevention method, the Government has recommended to take 400 microgram of folate supplements per day from 4 weeks before and 12 weeks after conception. Because of huge amount of folate being demanded in the first trimester, this vitamin is called as "vitamin for women" or "vitamin for fetuses". We herewith report results of questionnaire study performed among urologists. MATERIALS AND METHODS A questionnaire was sent July 2007 to 400 urologists randomly selected from the Membership Directory of the Japanese Urological Association 2006 whether they are aware of the role of folic acid and how they guide young women or pregnant women on their life style. One hundred sixty-one responses were obtained (40%). RESULTS Thirty-six percent of urologists were aware of the important role of folic acid in the critical stage of fetal development, which was significantly elevated compared to 26% observed in 2002 (p = 0.037). Fifty-seven percent of urologists acquired this information through Japanese Urological Association or medical journals, 17% through mass media, and 7% through internet. Those who guided young women or pregnant women to refrain from smoking, to abstain from alcohol, to take well-balanced meals and to take folate supplements were 73%, 62%, 67% and 7%, respectively. Ninety-two percent of urologists agreed to provide this information to young women or pregnant women. CONCLUSION Birth incidence of spina bifida has been increasing in Japan. In order to suppress incidence of this congenital anomaly, Urologists are requested to send young women a message that maternal periconceptional intake of folate will suppress the risk of congenital anomalies.

A 58-year old female was referred to our hospital due to left renal cyst that was pointed out at her health check-up. Abdominal CT scan showed left hydronephrosis with a 20 x 12 x 11cm tumor. The serum CA19-9 level elevated to 4,400 U/ml. Urinary cytology in the left renal pelvis was negative, therefore we could not diagnose whether the mass was renal cell carcinoma or renal pelvic tumor before surgery. She underwent left radical nephrectomy, and frozen section revealed renal cell carcinoma. Immunohistological stain clarified CA19-9 was limited to epithelium lining the renal pelvis and was not contained in carcinoma cells. After the surgery, the serum CA19-9 decreased to the normal range. Serum CA19-9 is known to be sometimes elevated in patients with urothelial carcinoma, but rarely elevated in those with renal cell carcinoma. We thought that hydronephrosis by tumor occlusion caused CA19-9 elevation in our case.

Aim: The efficacy, safety and hospital costs of the tension-free vaginal tape procedure were compared with the pubovaginal sling operation. Methods: A total of 60 women urodynamically diagnosed as having stress or mixed urinary incontinence were operated on using either the tension-free vaginal tape or pubovaginal sling operation in a prospective manner. Preoperative characteristics of the women were not significantly different for the groups. The women were followed for up to 24 months. Results: In the tension-free vaginal tape group, the operation time was shorter, numbers of analgesics postoperatively required were less and hospital charges were less expensive compared to those in the pubovaginal sling operation (P

A 72-year-old man referred our hospital with the chief complaint of macroscopic hematuria. He had undergone simple left nephrectomy for left renal stone when he was 27-years-old. His urine cytology showed class IIIb. They were 4 times. We performed random biopsy of the bladder and retrograde pyelography of the right But they were no positive findings for the cause of hematuria and for the existence of malignancy. After 2 months, he had macroscopic hematuria again. Cystoscopic re-examination revealed a fibrin out of the residual left ureteral orifice. Computed tomographic scan showed a perivesical mass. The diagnosis was the carcinoma of the ureteral stump. We performed ureterectomy. The pathological study revealed the undifferentiated carcinoma. This case is the first report of the undifferentiated carcinoma occurred on the residual ureteral stump in the Japanese literature.

Mechanisms responsible for the development of focal segmental sclerotic lesions of the glomerulus (FSGS lesions) in transplanted kidneys were investigated by morphometric analysis. The mean glomerular area and the interstitial area were measured using computerized image analysis to compare implantation biopsies (so-called 1-h biopsies; 1Bx) with later biopsies (episode Bx; EBx) that had been taken for diagnostic purposes to identify the cause of deteriorating renal function. Groups of patients with (group A, n = 15) or without (group B, n = 10) FSGS lesions were compared. Twelve of 15 in group A and all in group B had lost graft function due to chronic allograft nephropathy. It was found that neither the mean glomerular area nor the interstitial area differed significantly between the two groups in either 1 Bx or EBx. The interstitial area was significantly increased (P = 0.007) and the mean glomerular area tended to be increased (P = 0.085) in EBx compared with IBx in group A but not in group B. The serum creatinine level at the time of EBx in group A correlated with the interstitial area (P = 0.031) but not the mean glomerular area. However, there was no similar correlation in group B. In conclusion, factors for the development of FSGS lesions in transplanted kidneys may be the increase in interstitial area and possible glomerular hypertrophy following transplantation, rather than pre-existing reduced renal mass of the donor kidneys.

Objectives Risk of having fetus affected with neural tube defects can be reduced by maternal periconceptional folic acid supplementation. The purpose of the present study is to investigate how folate is taken from diets and to measure plasma folate concentrations. Subjects and methods A total of 222 women comprising 5 groups, i.e., healthy women, mothers of myelodysplastic patients, pregnant women, myelodysplastic patients, nurse students, participated in our study. Food frequency questionnaires kept 3 days were analyzed based on the 5th standard table of food composition in Japan. Plasma folate concentrations were measured by means of chemiluminescent immunoassay method. Changes in plasma folate concentrations and possible adverse effects following the folic acid supplementation for 16 weeks were also investigated. Results The dietary intake of folate, plasma folate concentration and energy intake averaged 293 micrograms/day, 8.1 ng/ml and 1,857 Kcal, respectively, among the subjects. Pregnant women took the largest amount of folate from diets and demonstrated the highest plasma folate concentration among the groups. The dietary folate in myelodysplastic patients and nurse students was significantly lower compared to that of healthy women. The Recommended Dietary Allowance of folate was not fulfilled in 22% of non-pregnant adult women and 72% of pregnant women. The dietary folate was mainly taken from the 3rd food group but the 4th group of food was consumed most. Mean folate intake was significantly correlated with circulating concentrations of serum folate (p = 0.012 r = 0.186). The consecutive administration of 400 micrograms supplements for 16 weeks increased a baseline plasma value of 8.7 ng/ml to 32.6 but fell down rapidly to 17.3 24 hours later without any adverse effects. Conclusions The dietary folate and serum folate concentrations averaged 293 micrograms/day and 8.1 ng/ml, respectively. The former is the first report based on the 5th standard table of food composition in Japan. Majority of pregnant women took less dietary folate than what recommended by the government. Those who are capable of becoming pregnant are recommended to consume much of the 3rd food group and those who are planning to become pregnant are recommended to take 400 micrograms of folic acid supplements from 4 weeks before to 12 weeks after conception.

To confirm the efficacy of using Seprafilm® (Genzyme Corp., Cambridge, MA, USA) for wrapping the ureter to treat the ureteric stenosis caused by retroperitoneal fibrosis (RPF).Between August 2010 and September 2012, 11 ureters in eight patients with RPF (seven males and one female, mean age 65 years) were treated. The mean (range) length of the narrow segment of the ureter was 30 (10-90) mm. During surgery, after having been released from adhesive tissue, the stenotic segment of the ureter was wrapped with Seprafilm to isolate it from the surrounding tissue. A radiographic follow-up was performed every 6 months using computed tomography, i.v. pyelography and/or (99m) Tc-mercapto-acetylglycyl-glycyl-glycine ((99m) Tc-MAG3) renal scintigraphy.For the unilateral operations, the mean estimated blood loss was 39 mL, and the mean operating time was 154 min. All ureters were isolated from the fibrotic tissue and wrapped with Seprafilm successfully without major complications. During the mean follow-up period of 17 months, no ureteric restenoses were observed in the affected sides, but new stenosis occurred in the contralateral side of the ureter in one patient.Although the follow-up period is still limited, we believe that the use of Seprafilm has the potential to become an effective option in the treatment of ureteric stenosis caused by RPF, when the omentum cannot be used. To establish the relative advantages of using Seprafilm over performing a standard omental wrap, further experimentation will be required to compare the two techniques.

Dense amorphous PLZT films with composition (Pb0.925La0.075) (Zr0.4Ti0.6)O3 were deposited on Pt/MgO (100) substrates by rf-magnetron sputtering without heating the substrates and were subsequently crystallized by postdeposition annealing. The optimum conditions in the two-step annealing process to crystallize the amorphous PLZT films were investigated. The post-deposition-annealed films showed excellent crystallinity and c-axis orientation when the amorphous PLZT films were annealed in an oxygen flow at a soaking temperature for the initial nucleation process of T1=300°C, a temperature for crystal growth process of T2=750°C, and the T2-soaking time of t2=60min. Conventional Pt/PLZT/Pt capacitors were fabricated by forming Pt top electrodes on crystallized 300-nm-thick PLZT films. The remanent polarization and the coercive field of the present capacitors, which indicated almost symmetric P-E hysteresis loops, were 2Pr≅30μC/cm2 and 2Ec≅90kV/cm, respectively. The high-endurance PLZT capacitors with excellent ferroelectric properties produced by the present optimized crystallization have great potential for application to nonvolatile memory devices.

A 71-year old male visited our hospital with a chief complaint of pollakisuria. The needle biopsies of the prostate were performed with PSA 8.0 ng/ml, and he was diagnosed as moderately differentiated adenocarcinoma. Imaging techniques revealed a right complete duplicated upper urinary system with an ectopic ureter draining to the prostatic urethra. He received radical prostatectomy with concomitant anastomosis of ureter to ureter. There is no evidence of hydronephrosis or tumor recurrence 11 months after operation. This is, to our knowledge, the second case report describing the association of radical prostatectomy and ectopic ureter.

Objective: A prospective randomized study was undertaken to determine whether prophylactic maintenance instillation of epirubicin following induction treatment is beneficial in pati

We evaluated the efficacy of laparoscopic radical nephrectomy for removing kidneys with small volume renal cell carcinoma.25 patients (19 men and 6 women, mean age 59) who had a kidney with small volume renal cell carcinoma (diameter less than 5 cm.), underwent laparoscopic radical nephrectomy. The kidney was dissected laparoscopically together with the adrenal gland, perirenal fatty tissue and Gerota's fascia. In 11 patients, we used the transperitoneal approach and in the remaining 14 we used the retroperitoneal approach, in which a working space is created by finger and balloon dissection. We maneuvered the kidney into the laparoscopy sack, which was then removed through an additional 5 to 6 cm. incision.All 25 kidneys were removed successfully. Mean operation time was 5.3 hours and mean estimated blood loss was 335 ml. There were 5 complications, including a patient who suffered an injury to the duodenum, which was treated by open duodenojejunostomy. Full convalescence occurred at an average 23 days. No metastatic disease, no local recurrence and no seeding at the port sites occurred during the followup of 7 to 49 months (mean, 22 months).Laparoscopic radical nephrectomy is recommended as a minimally invasive procedure for removing kidneys with small volume renal cell carcinoma.

Purpose: We evaluated efficacy of the retroperitoneal approach for laparoscopic nephrectomy of kidneys with benign disease.Materials and Methods: Eight men and 12 women (mean age 55 years) with severely damaged kidneys underwent laparoscopic retroperitoneal nephrectomy. One patient had a history of multiple open abdominal and gynecological operations. Kidneys were removed laparoscopically from the working space, which was created by finger and balloon dissection, and maintained by carbon dioxide insufflation in the retroperitoneal cavity.Results: All kidneys were removed successfully via this procedure. Mean operative time was 3.3 hours and mean estimated blood loss was 135 ml. One patient experienced bleeding from the injured capsular artery just after removal of the kidney.Conclusions: The retroperitoneal approach is recommended for laparoscopic nephrectomy.

Between February and November 1994, we performed laparoscopic retroperitoneal adrenalectomy in five patients with benign adrenal tumors to confirm the efficacy of this operation. Using digital dissection and a balloon, we created a working space in the retroperitoneal cavity before we dissected the adrenal gland and removed it under laparoscopic observation. The adrenal glands of all five patients were removed without any complications. The mean operative time was 3.4 hours, and the mean estimated blood loss was 148 mL. The average postoperative hospital stay was 10 days, and the average full recovery time was 19 days. We concluded that the retroperitoneal approach is an advantageous and safe procedure in the laparoscopic removal of the adrenal gland with benign tumor.

The currently study focused on the influence of delayed graft function on the long-term graft success rate in cadaver kidneys without any mismatches for HLA-DRB1. Donor-recipient HLA-DRB1 was determined by the significant two-locus linkages of HLA-B and -DRB1. The overall 5-year graft success rate was 88 % in an HLA-DRB1-compatible group, significantly higher than the 69 % in an HLA-DRB1 mismatch group (P < 0.05) and the 66 % in an HLA-DR mismatch (P < 0.01). Delayed graft function was observed in 182 of 223 transplants. This high incidence of 82 % is due to the fact that, in Japan, kidney procurement may only occur after cardiac arrest. The incidence did not differ in each group. The 5-year success rate for grafts with delayed function was 87 % in the HLA-DRB1-compatible group, again significantly superior to the 68 % in the HLA-DRB1 mismatch group and the 63 % in the HLA-DR mismatch cases (P < 0.05). There was, thus, no difference in graft success rate for each group, with or without delayed graft function. Consequently, we feel that delayed graft function has no impact on the long-term outcome in transplants without mismatches for HLA-DRB1.

PURPOSE: To examine the efficacy of laparoscopic radical nephrectomy (LPRNX) for patients with small renal cell carcinoma, the clinical result of 10 patients treated with this procedure was analysed. MATERIALS: Ten patients with renal cell carcinoma measuring diameter less than 5 cm were treated by LPRNX between July 1992 and October 1994. Four cases had T1N0M0 disease and 6 had T2N0M0 disease. Of the 10 patients, seven had right sided tumor and three had left sided tumor. METHOD: Trans-abdominal approach was employed for the initial 8 cases. Retroperitoneal approach was applied for the last 2 cases. Five trocars were placed through lateral abdominal wall. Intraperitoneal or retroperitoneal cavity was insffulated with CO2 at 12 mmHg. A kidney was dissected endoscopically with Gerota's fascia, peri renal fatty tissue and adrenal gland as en bloc fashion. It was trapped into the laparoscopy sack and pulled out of the body through a 4 to 5 cm incision without morcellation. RESULTS: Average operation time was 331 minutes and average bleeding was 380 ml. All the kidneys were removed by endoscopic technique. As major complications, we experienced a cases of splenic injury and a cases of adrenal injury. The bleeding of both cases was successfully managed by endoscopical procedure, however, transfusion was needed for the last case. Pathological examination of specimens revealed renal cell carcinoma in all ten cases. Average hospital stay after surgery was 10.6 days and average duration to the convalescence was 20 days. There was no episode of recurrence in all 10 patients for 2 to 29 months (Mean: 15.2 months) followed up period. CONCLUSION: Although further technical progress was expected, LPRNX is a potential operative procedure that realizes minimally invasive therapy for the patients with small volume of renal cell carcinoma.

The results have been reviewed of 41 patients with end stage polycystic kidney disease on maintenance hemodialysis. The patients ranged in age from 34 to 83 years with an average age of 55 years and 25 patients were male, 16 were female. The duration of maintenance hemodialysis in the patients was from 1 to 200 months with an average time of 69 months. Infection of the cysts and pyelonephitis occurred 22 times in 13 patients (32%) and hemorrhage into the cysts occurred 15 times in 13 patients (32%). To control the infection, bilateral nephrectomy was required in 10 patients and 1 patient was undergone unilateral nephrectomy. Of 13 patients with the hemorrhagic cysts, 5 were undergone bilateral nephrectomy and 2 were undergone unilateral nephrectomy. Six patients died during follow up and the cause of death were 1) cardiac failure, 2) cerebral hemorrhage, 3) cardiac infarction, 4) pneumonia after nephrectomy, 5) massive bleeding after second operation for adhesive ileus due to first nephrectomy, 6) unknown. Fourteen patients but one undergone bilateral nephrectomy were followed for an average time of 70 months after nephrectomy. Such as complication due to bilateral nephrectomy, anemia occurred in 13 patients (93%) and hypotension occurred in 5 patients (33%). Bilateral nephrectomy was effective procedure in safety for end stage polycystic kidney patients with the infection and the hemorrhagic cysts because anemia and hypotension which occurred usually after bilateral nephrectomy now can be controlled goodly.

We described the clinical results and efficacy of laparoscopic pelvic lymphadenectomy for localized prostate cancer. This procedure was followed by radical prostatectomy, if metastasis was not found in frozen section. In the presence of positive nodes, optional treatment, such as TUR or castration, other than radical prostatectomy was performed. We performed laparoscopic lymphadenectomy on twenty seven patients between April 1992 and September 1993. They range from 52 to 78 years in age and consist of 4 patients with stage A2, 17 with stage B, and 6 with stage C. We dissected the obturator lymph nodes on bilateral sides. The average operating time was 162 minutes (range 86 to 320 minutes). The average number of nodes removed from the right side was 7.1 +/- 5.9 and 6.1 +/- 4.5 from the left side, which was comparable to the number of lymph nodes obtained by open dissection. Colon injury occurred in one patient, which was managed by laparotomy procedure. Nodal metastases were found in 6 patients by frozen section, and in 10 patients by permanent section. This discrepancy suggested that two-staged operation might be preferable for the localized prostate cancer. Six patients were given suitable therapies besides radical prostatectomy. Laparoscopic pelvic lymphadenectomy is a safe and useful procedure for prostate cancer, especially for the patients who are likely to have nodal metastasis.

One hundred and five patients with renal pelvic and ureteral tumor entered our treatment program between 1982 and 1991. Of 105 patients, 81 had resectable transitional cell carcinoma and were treated with radical or total nephroureterectomy (57 vs. 24) and/or lymph node dissection (66). Adjuvant chemotherapy was added in 26 patients with high stage disease and with lymph node disease. There were 61 male and 20 female patients. Their ages ranged from 36 to 86 years, with a mean of 62 years. The follow-up period was 3 to 114 months, with a mean of 31 months. The estimated 5-year survival was 67% in all 81 patients. Classified according to the pathological stage, 5-year survival was 70% in pTis + pTa disease group, 91% in pT1 group, 88% in pT2 group, 53% in pT3 group, and 27% in pT4 group. Under the grading system, 5-year survival was 100% in grade 1 disease, 74% in grade 2, and 26% in grade 3. It was 78% in 52 patients with negative node disease and 26% in 15 with positive node disease. There were 51 patients (61%) with no recurrent disease. Seventeen patients (21%) had recurrence in the bladder after a median latent period of 8-month, and 15 (19%) patients had recurrence in the retroperitoneum, liver, lung and (or) other site after a median latent period of 8 months. The results of this series were quite similar to those of previous reports. The efficacy of lymph node dissection and adjuvant chemotherapy could not be confirmed.

Since July 1991, we have performed laparoscopic nephrectomy for removal of damaged kidneys in thirteen patients. In addition, we recently developed a new procedure of laparoscopic nephrectomy for renal cell carcinoma and successfully removed the kidney with renal cell carcinoma. Patients' age ranged from 18 to 80 years with the average being 50 years. There were 8 male and 6 female patients. Original disease was calculous disease in 5 patients, vesicoureteral reflux in 4, renovascular disease in 2, ureteropelvic junction obstruction in 1, ectopic ureter in 1 and renal cell carcinoma in 1. The mean size of the diseased kidney was 9 x 5 x 4 cm in the initial 13 cases and 13 x 7 x 6 cm in the case with renal cell carcinoma. The size of the tumor was 2.5 x 2 x 2 cm. In the first 13 patients, nephrectomy was performed as described previously. In the patient with renal cell carcinoma, a new procedure was applied. In the new procedure, five trocars were introduced into the abdominal cavity through the lateral abdominal wall. The kidney was removed en bloc together with the adrenal gland, perirenal fat and Gerota's fascia in the same fashion as traditional radical nephrectomy. Thirteen kidneys were successfully removed, but one failed because of dense adhesion to the surrounding tissue. Three of the 13 patients required additional laparotomies to control bleeding or to remove missed stone.(ABSTRACT TRUNCATED AT 250 WORDS)

The patient was a 36-year-old female who had undergone Auchincloss operation for left breast cancer at another hospital when 29 years old. Three years ago she was transferred from another hospital to our department complaining of dyspnea. Under the diagnosis of cardiac tamponade, we treated her with pericardial drainage and systemic chemotherapy (intravenous dosage of trastuzumab and vinorelbine: VNR), and then pericardial effusion disappeared. Further medical treatment was continued on an outpatient basis. One year later, cardiac tamponade developed again. We performed echo-guided pericardiocentesis and removed 600 mL of bloody effusion. The cytology of the effusion showed class V. Pericardial effusion recurred, so we instilled OK-432 and mitomycin C (MMC) twice. After that the cytology diagnosis became negative, and the heart shadow in chest X-P reduced. The pericardial effusion has never occurred until now. We also gave her systemic chemotherapy (intravenous dosage of trastuzumab)and endocrine therapy (peroral administration of medroxyprogesterone acetate). She made a remarkable recovery with these treatments and could go back to work.

In Japan, it has not accepted that kidneys were harvested from a heart beating cadaveric donor. We usually removed kidneys from a donor after a donor was in cardiac arrest. To minimize warm ischemia, we employed in situ perfusion of kidneys and new procedure alternate to evisceration technique in nephrectomy from a cadaveric donor. Our procedures for the harvest of the kidneys from the cadaveric donor were presented and the clinical result of our series were reported. The kidneys was promptly perfused with chilled Ringer's lactate solution through double balloon catheter placed into the aorta, just after cardiac function ceased. Bilateral nephrectomy was performed through a long midline incision from just beneath the xyphoid bone to the pubic bone. Upon entering the abdomen, the small bowel and mesentery were retracted to the right and the posterior parietal peritoneum was incised over the great vessels and through the ligament of Treitz. The peritoneal incision was extended around the right colon so the bowel can be retracted upward and the right kidney was exposed. Then, the peritoneal incision was performed around the left colon to explore the left kidney. Both ureters were transsected as far down toward the bladder as possible. The in situ perfusion was stopped. Thereafter, the superior mesenteric artery was transsected and the duodenum and the pancreas were retracted upward. The proximal vena cava and aorta were transsected at a 2-3 cm above the level of the left renal vein, and the distal vena cava and aorta at a 5-6 cm an below the level of the left renal vein. The kidneys and the great vessels were removed in en block.(ABSTRACT TRUNCATED AT 250 WORDS)

We performed combination chemotherapy in the outpatient clinic on a 47-year-old man with nonresected gastric cancer accompanied by peritoneal dissemination. At first we administered S-1/DOC combination chemotherapy. Afterwards a rise of tumor marker (CEA) occurred accompanying taste disorder and edema of the lower limbs, so we changed to combination chemotherapy for PTX/CDDP. Since the only side effect was numbness, the patient was treated on an outpatient basis while working. The case achieved good QOL by these combination chemotherapy methods for 1 year 10 months post exploratory laparotomy.

スキーヤーの技術レベルを滑走速度 (ターン毎の所要時間の平均値とその分散), 回転孤の形状 (ターン毎の移動の幅と平均値と分散), 滑走方向のずれ, の3のパラメータを用いて評価する方法を提案している.この方法を上級者と初級者の2人のスキーヤーに適用して技術レベルを評価したところ, 良好な結果が得られた.

As a prospective study on asymptomatic microhematuria, complete urological examinations including cystoscopy, IVP, ultrasound and urinary cytology were performed on 422 patients over 40 years old between January 1987 and December 1988 (group A). The results of group A was compared with that of retrospective study on 266 patients, who had incomplete urological examination between January 1984 and December 1985 (group B). Cystoscopy was performed on 321 patients (87.2%) in group A and on 108 patients (40.6%) in group B. Bladder tumor was found in 10 cases (2.4%) in group A, including 7 cases of male patients (5.7%), but in only 1 case (0.4%) in group B. Since the negative rate of abnormal urinary cytology was 50% and that of abnormal IVP was 90% in 10 cases of bladder tumor in group A, cystoscopy was considered to be an essential examination for the screening of patients with asymptomatic microhematuria over 40 years old patients.

Folic acid is one of water-soluble Vitamin B group and plays an important role in proliferating cells of the fetus. A multicentered, randomized control trial proved in 1991 that folic acid supplements of 4 mg per day periconceptionally administered to 1031 women who were recruited from 7 countries and had afflicted prior pregnancy successfully prevented 72% of recurrence of neural tube defects. As a primary prevention method, the Government has recommended to take 400 microgram of folate supplements per day from 4 weeks before and 12 weeks after conception. Because of huge amount of folate being demanded in the first trimester, this vitamin is called as "vitamin for women" or "vitamin for fetuses". We herewith report results of questionnaire study performed among urologists.A questionnaire was sent July 2007 to 400 urologists randomly selected from the Membership Directory of the Japanese Urological Association 2006 whether they are aware of the role of folic acid and how they guide young women or pregnant women on their life style. One hundred sixty-one responses were obtained (40%).Thirty-six percent of urologists were aware of the important role of folic acid in the critical stage of fetal development, which was significantly elevated compared to 26% observed in 2002 (p = 0.037). Fifty-seven percent of urologists acquired this information through Japanese Urological Association or medical journals, 17% through mass media, and 7% through internet. Those who guided young women or pregnant women to refrain from smoking, to abstain from alcohol, to take well-balanced meals and to take folate supplements were 73%, 62%, 67% and 7%, respectively. Ninety-two percent of urologists agreed to provide this information to young women or pregnant women.Birth incidence of spina bifida has been increasing in Japan. In order to suppress incidence of this congenital anomaly, Urologists are requested to send young women a message that maternal periconceptional intake of folate will suppress the risk of congenital anomalies.

We reported a case of metastatic tumor to the diaphragm discovered by rising CEA after operation of ascending colon cancer. A 72-year-old female underwent right hemicolectomy on January 2005. After discharge, she received adjuvant chemotherapy by S-1, but a rise of CEA was shown. Based on exploratory findings, laparotomy was done with the diagnosis of metastasis to the liver(S7). A tumor was present in the right diaphragm, and contacted the liver(S7). Partial resection of the right diaphragm was performed. The removed specimen revealed the same histological findings of the last operated ascending colon. Metastasis to the diaphragm is very rare, especially a solitary one as in this case. Etiologically speaking, the tumor cells might be absorbed or have strayed into peritoneal stomata of the diaphragm.

The long term results of 28 HLA 1-haploidentical donor kidney transplant recipients receiving preoperative lymphocyte deletion through thoracic duct drainage and low dose of steroid and azathioprine immunosuppressive treatment were presented. The number of removed lymphocytes was 129.9 +/- 38.1 x 10(9) (mean +/- SD) and the duration of thoracic duct drainage pretreatment was 35 +/- 4 days. Graft survival was 96% at 3 months through 2 years, 89% at 3 years and 84% at 5 years. Patient survival was 100% at 3 months through 2 years and 96% at 3 years through 5 years. Fifteen acute rejection crises were observed in 13 patients within the first 3 months postoperatively. There was no irreversible rejection in the first 3 months. Four chronic rejections were observed in 4 patients. Life-threatening infectious disease was observed in 5 patients, diabetes mellitus in 2 and cataract in 4. These results indicated that the reduction of the dose of steroid in post transplant period might have beneficial effects on the long term graft survival of HLA 1-haploidentical kidney transplant patients receiving TDD pretreatment and the conventional immunosuppressive treatment.

One hundred and forty-four patients primarily receiving kidneys from cadaver donors between Jan., 1978 and Oct., 1989, were reviewed. The patients' ages ranged 14-53 with a mean +/- S.D. of 34.7 +/- 8.0 years old. There were 100 males and 44 females. Twenty kidneys were harvested from heart-beating donors and 124 from non-heart-beating donors. In harvest from non-heart-beating donors, we performed in situ cooling through a double balloon catheter placed in the aorta to minimize prolonged warm ischemia. The number of matched HLA A, B antigens was (mean +/- S.D.) 1.7 +/- 0.8 antigens and for HLA DR antigens, it was 1.2 +/- 0.5. One hundred and nineteen of the 144 recipients have had a history of blood transfusion preoperatively. The patients were treated with four different immunosuppressive protocols; regimen I consisting of horse antilymphocyte globulin (ALG), regimen II of large-dose (14 mg/kg/day) of cyclosporin (CsA) and steroid, regimen IIIa of low-dose (4 mg/kg/day) of CsA, steroid and a short course of ALG (500 mg/day) and regimen IIIb of low-dose (6 mg/kg/day) of CsA, steroid and a short course of ALG (1000 mg/day). Fifteen patients received regimen I therapy from Jan., 1978 to Nov., 1982, 49 received regimen II from Nov., 1982 to Dec., 1986, 23 received regimen IIIa from Jan., 1987 to Dec., 1987 and 57 received regimen IIIb from Jan., 1988 to Oct., 1989.(ABSTRACT TRUNCATED AT 250 WORDS)

Fifty-two patients with obstructive diseases of the upper urinary tract were treated by percutaneous endoscopic surgery between May, 1986 and July, 1989. Fifty-nine procedures consisting of endopyelotomy (24 procedures), endopyeloureterotomy (29) and balloon dilation under direct vision (6) were performed in 54 units of the urinary drainage system. Causative diseases were congenital in 24 units, scar due to calculi in 17, scar due to previous surgery in 11 and tuberculous ureteritis in 2. The postoperative follow-up periods ranged from 3-41 months, mean +/- S.D.; 12.2 +/- 7.3 months. Of the 59 procedures, 49 (83.1%) achieved improvement but 10 could not on the postoperative excretory pyelogram and/or TcDTPA renogram. Three procedures (5.5%) required blood transfusion. Retroperitoneal leakage of the perfusate was observed in 3 procedures (5.0%). No other severe complications were observed. These results indicate that this procedure may be used for the reconstructive surgery in obstructive diseases of the upper urinary tract such as the ureteropelvic junction and the proximal 1/3 ureter.

The results of 20 HLA 1-haploidentical donor kidney transplant patients treated with preoperative lymphocyte deletion through thoracic duct drainage and low dose of cyclosporine and steroid immunosuppressive therapy, were presented. The number of removed lymphocytes was 114 +/- 36 X 10(9) (mean +/- SD) and the duration of thoracic duct drainage was 35 +/- 7 days. Graft survival was 100% at 3-9 months and 89% at 1-2 years after transplantation. Patient survival was 100% at 3-9 months and 89% at 1-2 years. A patient died from lung cancer (adenocarcinoma) in the 9th posttransplant month. Acute rejection was not seen in 20 patients during the first 3 months. Life-threatening infectious disease was never seen either. Diabetes mellitus was observed in 1 patient. No other complications were observed. These results indicated that thoracic duct drainage and low dose cyclosporine and steroid postoperative immunosuppressive treatment might yield complete success in HLA 1-haploidentical kidney transplant patients.

In June 1988, the new type of the lithotripter MPL 9000 (Dornier), which was the first interdisciplinary lithotripter for treatment of urinary and biliary calculi, was installed at the Shakai Hoken Chukyo Hospital. MPL 9000 has some features which enable one to treat with low range of shock wave energy and without anesthesia due to the enlarged aperture of the ellipsoid (210 mm), and locate the stone by computerized two ultrasound probes (coaxial, lateral). Unlike HM-3, the water bath is not used: shock wave is shot through the water cushion. From June to November 1988, 35 patients suffering from 64 urinary calculi were treated. The majority represented caliceal (75%) and pelvic (17%) stones, whereas 5 calculi were treated in the upper and lower ureter. Twenty-four patients were treated in one session and 11 patients needed additional sessions. The given number of shock waves was between 1337 and 3050 per one session and averaged 2403 with low generator voltage (15-18 kv). Twenty sessions (42%) were given without any medication and other 28 sessions (58%) were under analgesia (Pentazocine, i.v.) for the pain complained during the treatment. The rate of successful disintegration (less than 5 mm) was 88%. After the 1-month followup, 47.1% were free of stone, and 62.1% were free after the 3-month. Four patients had arrhythmia and one patient was with a subcapsular renal hematoma. We have concluded that this lithotripter is useful to treat upper and lower urinary tract calculi, in particular radiolucent ones in high risk patients because it is applicable without anesthesia.

A 74-year-old male was referred to our hospital due to microhematuria that was pointed out at his health check-up. Cystoscopy showed many papillary bladder tumors under 5 mm in size. Intravenous pyelography also showed deformity of the right kidney and shadow defects in the left renal pelvis. Abdominal computed tomography revealed an 8 cm tumor invading the renal vein in the right kidney, and a 3 cm tumor in the left renal pelvis. Prostate biopsy was performed with PSA 3.4 ng/ml, and he was also diagnosed with prostate carcinoma. First, he received right radical nephrectomy, and secondly left nephroureterectomy and cystectomy. Our case should be called triple cancer because bladder cancer was thought to be daughter tumor of renal pelvic tumor. This is, to our knowledge, the 11th case report that occurred in the urinary tact, and the first case that needed total resection of urinary tract.

We report a case of giant condyloma with malignant degeneration. A 56-year-old male was referred to our hospital due to a penile infection that was resistant to antibiotic therapy for more than a year. The swelling appeared to be a penile cancer. We suspected malignancy and performed penile biopsies twice; however, the histopathological diagnosis was condyloma acuminatum and malignant findings were absent. We continued the antibiotic therapy for 3 months; however, no improvement was achieved. Therefore, total penectomy and urinary diversion were performed. The pathological diagnosis of the resected tissues was not only condyloma but also squamous cell carcinoma, and cancer cells appeared on the cut surface of the specimens. We added radiation therapy. There was no evidence of recurrence or metastasis at 18 months after surgery.

We report a case of retroperitoneal liposarcoma. A 66-year-old male was referred to our hospital for a retroperitoneal tumor that was detected during gallbladder stone examination. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed an extrarenal lipomatous tumor, 20 x 14 x 8 cm in size, in the right retroperitoneal space. He underwent surgical excision of the tumor with concomitant resection of the right kidney and adrenal gland. The resected tissue weighed 730 g. Histological examination revealed a well differentiated liposarcoma. He received no adjuvant therapy.

A 72-year-old man referred our hospital with the chief complaint of macroscopic hematuria. He had undergone simple left nephrectomy for left renal stone when he was 27-years-old. His urine cytology showed class IIIb. They were 4 times. We performed random biopsy of the bladder and retrograde pyelography of the right But they were no positive findings for the cause of hematuria and for the existence of malignancy. After 2 months, he had macroscopic hematuria again. Cystoscopic re-examination revealed a fibrin out of the residual left ureteral orifice. Computed tomographic scan showed a perivesical mass. The diagnosis was the carcinoma of the ureteral stump. We performed ureterectomy. The pathological study revealed the undifferentiated carcinoma. This case is the first report of the undifferentiated carcinoma occurred on the residual ureteral stump in the Japanese literature.

OBJECTIVE The Ministry of Health, Labour and Welfare announced that periconceptional consumption of folic acid will reduce risks of having babies afflicted with Neural Tube Defects (NTDs) in the year of 2000. We assessed awareness of the role of folic acid among urologists and a patient group, how urologists give advices on lifestyle to young women, and what lifestyle the patient group currently maintains. MATERIALS AND METHODS A postal questionnaire survey was conducted involving 400 urologists randomly selected and a group of 250 female patients afflicted with NTDS and 250 mothers who had given birth to babies having NTDs during the past 7 years. Eighty-four percent of urologists aged 40 years and over and 76% of the patient group aged in their 20s and 30s. Response rates were 56% in the former and 52% in the later. RESULTS Twenty-six percent of urologists and 92% of the patient group knew an important role folic acid played in prevention of neural tube defects. While 10% of urologists advised to consume multi-vitamins containing folic acid or folic acid supplements, 25% of myelodysplastics and the mothers took them. Sixty-eight percent of doctors advised to take well-balanced food and 82% of the patent group answered that they do. Over 80% of the doctors and the patient group believed that a folic acid campaign is to be organized to inform young women of childbearing age of possible reduction of the risk. CONCLUSION It is found that proportion of urologists who are aware of a role of periconceptional consumption of folic acid is significantly lower than that of the group of patients (p < 0.0001). Urologists are expected to recognize specific benefits of folic acid in the prevention of NTDs, to advise young women of childbearing age to take well-balanced meals, and to recommend those who wish to be pregnant to consume 400 micrograms of folic acid supplements from 4 weeks before to 12 weeks after conception.

We studied the Nb doping effect on the electrical characteristics of MOCVD-PZT capacitors using uniformly Nb-doped Pb(Zr, Ti)O3 (UND-PZT) and δ-Nb-doped PZT (DND-PZT) prepared by MOCVD. The 2Pr for UND-PZT was small and the UND-PZT hysteresis shifted in a positive direction. However, the 2Pr for DND-PZT decreased by only 5.5% and the hysteresis of DND-PZT didn't shift. In addition, the leakage current of DND-PZT decreased by one order at low bias compared to non-doped PZT, because the δ-Nb-doping layer maintains the barrier height, higher than that of none-doped PZT due to defect compensation. As a result, Nb1% DND-PZT was well suited to use Nb doping which decreases leakage current at low voltage and maintains 2Pr.

We report a patient whose irritable bladder symptoms following Bacillus Calmette Guerin (BCG) instillation were satisfactorily treated by steroid administration. A 59-year-old male had undergone transurethral resection for the bladder carcinoma recurred three times. The histopathological examination revealed the tumor as transitional cell carcinoma, G1 to G2, and pTa. Subsequently an instillation of 80 mg BCG into the bladder was planned 8 times every 7 days. After the 5th instillation he presented with gross hematuria, painful micturition, pollakisuria, urgency and reduced bladder capacity of 15 ml. The dose was reduced to 40 mg and another 3 instillations were accomplished. Since conventional treatments of anti-cholinergics, analgesics and epidural anesthesia were of little help for the subjective symptoms, he was put on the steroid pulse therapy 2 weeks after completion of the BCG regimen. The treatment gradually improved the subjective symptoms and increased the bladder capacity up to 160 ml. In conclusion, we believe that the steroid pulse therapy deserves considering in the early stage of irritable bladder symptoms following BCG instillation.