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Liquid fibrin sealants, together with sheet-type hemostatic agents, have been used during partial nephrectomies to secure effective hemostasis at the suture site. Using animal kidneys, we investigated which hemostatic agent might adhere most effectively to the renal tissue and serve best as a bolster. Liquid fibrin sealant alone, or in combination with a sheet-type hemostat, such as collagen, gelatin or oxidized-cellulose hemostat, was applied to the cut surface of the kidney of anesthetized rabbits, and the differences in the degree of adherence to the kidney and resultant hemostatic efficacy were evaluated. Histological analyses were also carried out to compare the degree of adherence of each of the aforementioned hemostats to the kidney tissue. Fibrin sealant plus the collagen or gelatin hemostat was found to have a stronger hemostatic effect than fibrin sealant applied alone or fibrin sealant plus oxidized-cellulose hemostat. The histological investigation showed that the fibrin sealant adhered well to kidney tissue when it was applied with the collagen or gelatin hemostat, showing the advantage of combining these two materials for achieving effective hemostasis. Fibrin sealant used in combination with the collagen or gelatin hemostat was the most suitable for obtaining a reinforced hemostatic effect at the suture site in a partial nephrectomy animal model.

維持透析患者にみられた特発性小腸穿孔の1例を経験したので報告する. 患者は1994年より閉塞性腎不全のため維持透析施行中の70歳女性で, 2004年2月5日腹痛が出現し, 翌日の透析時, 同症状がさらに増悪し, 筋性防御, Blumberg徴候が陽性となったため救急入院した. 腹部単純X線立位像および腹部CTにて横隔膜下に腹腔内遊離ガス像を認め, 消化管穿孔による汎発性腹膜炎と診断し緊急開腹術を施行した. 全身麻酔下に開腹すると, 空腸に約10mmの穿孔を認める以外, 腹腔内に異常が認められず, 穿孔部を含めて長さ5cmの空腸を切除し, 小腸端々吻合術を行った. 術後経過は順調で同年3月12日に軽快退院した. 切除部の病理組織では出血性壊死を伴った穿孔がみられたが, ほかに虚血性, 慢性炎症性, 悪性変化など認めなかった. 穿孔の原因を特定する所見が認められず特発性小腸穿孔と診断した. 維持透析患者の特発性小腸穿孔は文献的にまれであり, 重篤な合併症の予防のためには即刻の開腹術が必要であると考えられる.

A 68-year-old man with a history of nephrectomy of the right kidney was admitted to our hospital with a 1-month history of polyuria (> 41 per day). He also exhibited hyposthenuria, which was unresponsive to treatment with exogenous vasopressin. Radiographic examination revealed partial obstruction of the left ureter and moderate hydronephrosis. The cause of the obstruction was cancer of the ureter. After drainage using a nephrostomy tube, the polyuria and hyposthenuria were gradually resolved. This is the first known case of nephrogenic diabetes insipidus due to hydronephrosis in a patient with a solitary kidney.

Background: The kidney eliminates the major fraction of plasma oxalate. It is well known that oxalate is freely filtered by glomeruli and secreted by the proximal tubules. However, the renal handling of oxalate in distal nephrons, which is considered as playing an important role in stone formation, remains obscure. Methods: At 15–180 min after intravenous injection of 14C-oxalate to rats, the intrarenal localization of radioactivity was quantitatively measured by the radioluminographic method using a bioimaging analyzer. Tissue radioactivity was compared with plasma, and urinary radioactivities were measured by a liquid scintillation counter. The control study was conducted with 14C-inulin. Results: The radioactivity of 14C-oxalate in the papilla was 10 times greater than in the cortex and eight times greater than in the medulla 180 min after injection when almost no radioactivity was present in the urine. In contrast, the radioactivity of 14C-inulin was nine times less in the papilla than in the cortex at the same time. Conclusion: Oxalate remains in the renal papilla for an extended period. This accumulation of oxalate may be attributed to calcium oxalate crystal fixation along the deep nephron which is considered to be the first step of stone formation.

Sodium pentosan polysulfate (SPP), a semi-synthetic glycosaminoglycan, was administered to rats with hyperoxaluria, induced by a vitamin B6 deficient diet, as a model of calcium oxalate stone formation. We studied the preventive effects of SPP on stone formation as well as its inhibitory effects on stone growth by autoradiography and radioluminography after intravenous injection of (14)C-oxalate. The rats were divided into non-treated and SPP-treated groups. The non-treated rats were divided into three groups: one group was fed a regular diet, while the other two groups were fed a vitamin B6 deficient diet for 2 and 4 weeks, respectively. The SPP-treated rats were divided into two groups: one group was intravenously injected with SPP from the start of the vitamin B6 deficient diet for a total of 4 weeks and the other group was injected with the same amount of SPP after 2 weeks of the diet for 2 weeks. (14)C-oxalate renal macroautoradiograms were prepared, and calcium oxalate deposits in the renal tissues were compared between the non-treated and SPP-treated groups. The preventive effects on calcium oxalate stone formation were clearly observed in the group injected with SPP for 4 weeks. Even in the other SPP-treated group, in which the administration of SPP was started at 2 weeks after the start of the diet when calcium oxalate stone formation was already observed, the size of the calcium oxalate deposits observed after 4 weeks was smaller than that in the non-treated group fed a vitamin B6 deficient diet for 4 weeks. In conclusion, our results show that SPP has not only preventive effects on calcium oxalate stone formation but also growth inhibitory effects on stones in hyperoxaluric rats.

We treated two cases of interstitial cystitis (IC) that were resistant to some conventional therapies with hyperbaric oxygen (HBO). Both patients underwent 20 sessions of 100% oxygen inhalation (2.0 atmosphere absolute for 60 min/day x 5 days/week for 4 weeks) in a hyperbaric chamber. The period of follow up was 12 months for case 1 and 9 months for case 2. After a course of HBO, the bladder mucosal ulcer (Hunner's ulcer) disappeared, and changes from baseline in pain and urinary frequency was constitutively inhibited. There were no adverse events during the 20 treatment sessions. One woman (case 1) had mild Eustachian tube dysfunction, resulting in a transient hearing impairment. HBO seems to be an option for treatment of IC resistant to conventional therapies.

Background: Patients with benign prostatic hyperplasia (BPH) have a wide range of concentrations of PSA. However, it is not known what factors influence the concentration of serum PSA other than the prostate volume. BPH is composed of an enlarged transition zone (TZ) and other zones (nonTZ). The TZ is thought to play a more important role than the non TZ in determining the concentration of serum PSA in BPH patients. Methods: We investigated the individual glandular zone volume, the amount of PSA produced by each zone and the PSA density in each zone in 23 patients with histologically-confirmed BPH. The PSA density in the TZ was calculated by dividing the difference between the serum PSA before and after surgical resection by the specimen weight. We examined the influence of these parameters on the concentration of serum PSA in BPH patients. Results: The serum PSA concentration correlated with the amount of PSA produced by the TZ (r= 0.90, P< 0.01), but not the nonTZ (r= 0.25, P= 0.29). The concentration of serum PSA also showed a significant correlation with the TZ volume (r= 0.67, P

高血圧症状がまったくなく,耐糖能異常で薬物治療中の患者の無症候性褐色細胞腫摘出術の麻酔を経験した。その腫瘍は腹部超音波検査で偶然発見されたものであった。症候性に準じた術前・術中管理を行ない,安定した循環動態が得られた。また,術後耐糖能が改善した。本症例および他症例の考察から無症候性であっても,術前循環管理の施行が望ましい。また,麻酔管理上有用と思われる褐色細胞腫の分類を示した。さらに,血漿中カテコラミンの種類と濃度が術中管理の困難さを示唆すると考えられた。

Liquid fibrin sealants, together with sheet-type hemostatic agents, have been used during partial nephrectomies to secure effective hemostasis at the suture site. Using animal kidneys, we investigated which hemostatic agent might adhere most effectively to the renal tissue and serve best as a bolster. Liquid fibrin sealant alone, or in combination with a sheet-type hemostat, such as collagen, gelatin or oxidized-cellulose hemostat, was applied to the cut surface of the kidney of anesthetized rabbits, and the differences in the degree of adherence to the kidney and resultant hemostatic efficacy were evaluated. Histological analyses were also carried out to compare the degree of adherence of each of the aforementioned hemostats to the kidney tissue. Fibrin sealant plus the collagen or gelatin hemostat was found to have a stronger hemostatic effect than fibrin sealant applied alone or fibrin sealant plus oxidized-cellulose hemostat. The histological investigation showed that the fibrin sealant adhered well to kidney tissue when it was applied with the collagen or gelatin hemostat, showing the advantage of combining these two materials for achieving effective hemostasis. Fibrin sealant used in combination with the collagen or gelatin hemostat was the most suitable for obtaining a reinforced hemostatic effect at the suture site in a partial nephrectomy animal model.

The purpose of the present study is to determine the change in blood concentration of interleukin-2 (IL-2) after intravenous injection in hemodialysis patients and to assess its safety. Four hemodialysis patients who underwent nephrectomy due to renal cell carcinoma were treated with IL-2 at a dose of 350 000-700 000 JRU by intravenous injection. Pharmacokinetic parameters were analyzed from the serum IL-2 concentration, which reached its peak just after the end of infusion, followed by biphasic elimination, and was below the detection limit in all patients at 24 h postinfusion. In comparison with patients with normal renal function, the volume of distribution in the serum compartment was almost comparable (3820 +/- 2020 mL). Clearance (50.47 +/- 11.50 mL/min) decreased to 40%, and the half-life of the distribution phase (0.45 +/- 0.19 h) and that of the terminal phase (1.72 +/- 0.20 h) were distinctly longer. The area under the blood concentration-time curve was about two-fold higher than that of non-hemodialysis patients. In all patients, there were no serious adverse reactions. The results of the present study suggest that intravenous IL-2 therapy can be safely performed in hemodialysis patients.

CAPD療法施行時の排液混濁は, 腹膜炎以外の原因による場合は稀である. 我々は食事性に排液混濁をきたしたと考えられたCAPD患者を経験し, 排液成分の検討から以下の結果を得た. 1. 排液中の細胞成分は腹膜炎合併例と比べて少なく, 細菌は検出されなかった. 2. 食事性排液混濁時, 排液中の総蛋白, アルブミン, 総脂質, β-リポ蛋白, コレステロール濃度はCAPD患者の腹膜炎合併例と同程度に高値であり, 中性脂肪の濃度は腹膜炎合併例より有意に高値であった. 3. 食事性排液混濁例では, 排液が肉眼的に透明な平常時でも総脂質, リン脂質, コレステロール濃度は正常CAPD患者の排液中より高濃度であった. 4. 食事性排液混濁例では脂肪乳剤の静脈内投与では排液混濁はみられなかった. 以上から, 食事性排液混濁例では, 食事摂取によるリンパの増流に伴って腹腔内へ蛋白や脂質が漏出し排液混濁をきたしたと考えられた. これらの症例では排液の混濁は一過性で栄養状態に大きな変化はみられず, 特に治療は必要としなかった.

We treated two cases of interstitial cystitis (IC) that were resistant to some conventional therapies with hyperbaric oxygen (HBO). Both patients underwent 20 sessions of 100% oxygen inhalation (2.0 atmosphere absolute for 60 min/day x 5 days/week for 4 weeks) in a hyperbaric chamber. The period of follow up was 12 months for case 1 and 9 months for case 2. After a course of HBO, the bladder mucosal ulcer (Hunner's ulcer) disappeared, and changes from baseline in pain and urinary frequency was constitutively inhibited. There were no adverse events during the 20 treatment sessions. One woman (case 1) had mild Eustachian tube dysfunction, resulting in a transient hearing impairment. HBO seems to be an option for treatment of IC resistant to conventional therapies.

We performed laparoscopic Lich-Gregoir antireflux plasty on 4 patients with primary vesicoureteral reflux. All procedures were conducted using the extraperitoneal approach. The average surgical time was 230 min. There were no complications. After surgery, voiding cysturethrograms showed no reflux in all patients.

食事に含まれるMg含有量と他の栄養素含有量の関係を明らかにし, CAPD患者のMgバランスを検討して以下の結果を得た.1. 単位エネルギー当りの食事に含まれるMg含有量は, Ca, P, Na, タンパク質含有量と正の相関を示したが, K含有量との相関はみられなかった. 2. CAPD患者のMg摂取量と血清Mg値は正の相関を示し, 血清Mg値と腹膜透析液へのMg排出量も正の相関を示した. しかしMg摂取量とMg排出量の間には相関がみられなかった.以上のことから, 食事中のMg含有量は, 他の栄養素含有量と密接な関係があることが示された. 特にCAPD患者では, 食事からのMg摂取は血清Mg値に関与する重要な因子であることが示された.

BACKGROUND We performed macro and micro-autoradiographic studies using 14C-oxalate in normal and hyperoxaluric rats in order to elucidate intrarenal distribution of oxalate and to determine where calcium oxalate crystal can be adhere in the kidney. METHODS Macro and micro-autoradiographic studies of the kidney in normal rats were carried out at intervals of 15, 30 and 90 min after intravenous administration of 14C-oxalate (37 MBq/kg BW). Hyperoxaluria was induced by vitamin B6 deficient diet. The procedure of macro and micro autoradiography is the same as that in normal rat. RESULTS In normal rats, macroautoradiogram showed that the radioactivity of 14C-oxalate exists in the whole kidney, and microautoradiogram identified this radioactivity mainly in the extraluminal space of renal tubules at 15 min. Macro and micro-autoradiograms taken 90 min after the injection showed practically no radioactivity of 14C-oxalate in the cortex or the medulla, but it was located in the extraluminal space of the papilla. In hyperoxaluric rats, macroautoradiogram showed some spotty accumulations of 14C-oxalate in the inner medulla and papilla. Microautoradiogram revealed that these accumulations are mainly seen in the extraluminal space. CONCLUSION These results indicate that in normal rats the injected 14C-oxalate remains in the renal papilla, especially in the extraluminal space, when nearly all oxalate was excreted by urine, and in hyperoxaluric rats 14C-oxalate exists there as calcium oxalate crystal or microlith.

It is known that the deposition of calcium oxalate crystals in the kidney is the first stage of stone formation. However, the exact location of this deposition in the kidney has not been determined. Hautmann and Oswald1 pointed out that there was a concentration gradient of oxalate and calcium from cortex to medulla of the kidney, and that oxalate and calcium contents in the papilla were hundred times higher than those in urine. These findings indicated that the renal papilla, especially the interstitium of papilla might be the site of the calcium oxalate crystalluric deposition. In the present study, we performed autoradiographic studies on oxalate in hyperoxaluric rats using 14C-oxalate, in order to elucidate the distribution of oxalate in renal tissue and the site of the deposition of calcium oxalate crystals along the nephron.

The pharmacokinetics of oxalate were studied in normal and nephrectomized rats with the use of radioisotope-labelled oxalate. The disappearance of [14C]oxalate from the plasma was analyzed with a two-compartment open model. The pharmacokinetic parameters of oxalate were compared with those for inulin. In normal rats, the plasma half-life of the elimination of oxalate was 0.33 +/- 0.06 h and that for inulin was 0.26 +/- 0.05 h (n = 10, mean +/- SD). The volume of distribution for oxalate was 56.7 +/- 6.80 and that for inulin 34.0 +/- 4.79 ml/100 g body weight, indicating that oxalate has access to additional compartments besides the extracellular volume. The total clearance of oxalate was 1.2 times higher than that for inulin. In nephrectomized rats, however, the plasma half-life of the elimination of oxalate was 1.85 +/- 0.34 h (n = 7, mean +/- SD) and that for inulin was 4.26 +/- 0.78 h. The total clearance of oxalate was 177 +/- 29 and that for inulin was 30 +/- 5 microliters/min/100 g body weight. In order to identify the extrarenal elimination route of oxalate, the bile of nephrectomized rats was collected. The hepatic clearance of oxalate was 31.2 +/- 2.7 microliters/min/100 g body weight. The biliary excretion of oxalate accounts for 17.6% of the total clearance in nephrectomized rats. Thus, other elimination processes of oxalate besides renal and hepatic clearance take place.

Hyperthermic treatment was performed in 31 patients with benign prostatic hypertrophy (BPH). Eight patients of them had a urethral catheter because of urinary retention. The prostate was heated trans-rectally to 43-45 degrees C. The treatment consisted of 10 sessions of 60 min. each. To evaluate this treatment, the following parameters were determined before, during and one week after the last hyperthermia session: subjective symptoms score, and residual urine volume, uroflowmetry and transrectal ultrasound of the prostate as objective data. Symptoms score improve in all patients. Of 8 patients with a catheter, the catheter could be removed from 4 patients. There was no significant change in prostate volume, but significant decreases of residual urine volume, and increases of maximum flow rate and mean flow rate were observed. No adverse reactions were seen. Judging from the above results, this treatment is considered to be useful for patients with BPH.