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Additional file 2. Correlations between the body composition indices of each body segment and changes in body temperature.

Additional file 1. Relationships between changes in body temperature and body composition indices with significant associations.

76歳女.2年前から近医で腹圧性尿失禁, 慢性膀胱炎の診断のもと治療を受けていた.今回, 夜間頻尿と膿尿が増悪し, 超音波検査で膀胱内左尿管口部に腫瘍性病変を認められ紹介受診した.膀胱鏡検査で左尿管口から膀胱内に突出する腫瘤を認めた.膀胱鏡下に生検したところ線維上皮性ポリープが疑われ, 硬性尿管鏡下にポリープ切除術を行った.ポリープは左尿管口より約2cm上方の尿管右壁2時方向に茎を有していた.手術ではまず, 浮動性のポリープを切除しやすくするため膀胱鏡下にバスケット鉗子でポリープ先端を把持し固定した.続いて, 尿管鏡下に単電極の凝固導子を用いてポリープの茎を全周性に凝固し, 生検鉗子で茎を把持しポリープを一塊として摘出した.摘出標本は5×2×1cm大で, 病理組織学的に線維上皮性ポリープと診断した.術後経過は良好で, 症状は改善した, A case of a giant fibroepithelial polyp of the ureter is presented. A 76-year-old woman was pointed out to have a tumorus lesion in the urinary bladder by ultrasonography. Intravenous pyelography showed a filling defect in the lower portion of the left ureter and bladder. Cystoscopy revealed a tumor with a smooth surface sticking out of the left ureteral orifice. After demonstration of benign ureteral polyp without malignancy by biopsy, ureteroscopic resection was performed. The stalk of the polyp was coagulated and removed with biopsy forceps under ureteroscopy. Pathological diagnosis was a fibroepithelial polyp. There were no findings of polyp recurrence or ureteral stenosis at 9 months after the operation. The diagnosis and management of fibroepithelial polyp are discussed.

interferon-α(IFNα), interleukin-2(IL-2), gemcitabineによる3剤併用免疫化学療法を施行した転移性腎細胞癌4例の治療成績について検討した.症例1(35歳男):IFNα, IL-2投与に抵抗性の傍大動脈リンパ節転移があり, 3剤併用免疫化学療法にて収縮率99%以上を獲得した.その後, 転移巣の増大は認めていない.症例2(51歳女):IFNα抵抗性の肺転移があり, 3剤併用免疫化学療法にて31%の縮小を得たが, 6ヵ月後に転移巣の増大を認めた.症例3(51歳男):IFNα投与が困難な皮膚転移, 対側腎の多発転移があり, 悪心嘔吐のため3剤併用投与は中止した.治療開始12ヵ月後, 対側腎転移に変化はない.症例4(52歳女):IFNα, IL-2抵抗性の肺転移があり, 進行性腎細胞癌の予後不良因子4項目以上を有した.転移巣が増大し, 発熱が強く, 3剤併用免疫化学療法は中止した.治療開始後6ヵ月で癌死した.副作用として発熱, 悪心嘔吐, 白血球減少, 貧血を認めたが, 3剤併用免疫化学療法は転移性腎細胞癌の有効な治療法でありうることが示唆された, Immunochemotherapy consisting of interferon-alpha (IFN-alpha), interleukin-2 (IL-2), and gemcitabine (GEM) for metastatic renal cell carcinoma. A partial response maintained for 15 months, was obtained in one case resistant to IFN-alpha and IL-2 of para-aortic lymph node metastases (case 1). A minor response with 30% reduction of lung metastasis was obtained in one IFN-alpha resistant case, and the duration was 6 months (case 2). In one case, in contra-lateral renal metastasis, no disease progression was obtained for 6 months (case 3). One case with resistance to IFN-alpha and IL-2, and who had preoperative abnormalities of corrected serum calcium, serum c-reactive protein and hemoglobin, had progressive disease and died of cancer after 6 months (case 4). Grade 3 toxicity was noted in leucopenia (4/4), anemia (1/4), and nausea/ vomiting (1/4). Although the response duration was short, the combination immunochemotherapy consisting of IFN-alpha, IL-2 and GEM may be a promising salvage regimen for the patients with metastatic renal cell carcinoma.

鏡視下副腎摘出術について, 副腎腫瘍52例を対象に検討した.51例で手術は完遂され, 1例は気腹装置不調による出血量が増加により開放手術に移行した.輸血は上記1例と術後の後腹膜出血1例に行われた.次に, 開放性副腎摘出手術30例と鏡視下手術と比較すると, 平均手術時間に有意差は認めなかったが, 平均出血量では鏡視下例が有意に少なかった.また, 術後回復では, 平均経口摂取開始, 平均歩行開始ともに, 鏡視下症例で有意に早かった.鏡視下手術の手術時間は術者が手術経験を重ねるとともに, 明らかに短縮された.また, 経験を積んだ術者の指導のもと, 新たな執刀医でも安全に, 短い手術時間で手術が施行された, We performed 52 laparoscopic adrenalectomies between January 1997 and March 2003. In 51 patients, adrenal tumors were successfully removed laparoscopically. In one patient, the laparoscopic procedure was converted to open surgery because of insufflator's trouble and hemorrhage. Perioperative blood transfusion was required in two patients; one for intraoperative and another for postoperative bleeding. We compared laparoscopic adrenalectomy with conventional open surgery which had been performed in our clinic before the laparoscopic adrenalectomy era. The mean operative time of the laparoscopic adrenalectomy (187 +/- 59 min) was not significantly longer than that of the open surgery (193 +/- 49 min). The mean estimated blood loss of laparoscopic adrenalectomy (75 +/- 145 g) was significantly less than that of the open surgery (438 +/- 447 g). Time to oral intake and ambulation for laparoscopic adrenalectomy were significantly earlier than those of the open surgery. Operation time was significantly shortened as the experience of this surgery was accumulated. The results of our experience support the concept that laparoscopic adrenalectomy is safe and is a standard treatment for surgical treatment of adrenal tumors.

約3年間に鏡視下手術を行った13例と, ほぼ同時期に行った開放性手術11例との手術成績を比較した.開放性手術で男性が多い傾向にあり, 術前画像診断上の平均腫瘍径は開放性手術で有意に大きかった.鏡視下手術で輸血を要する出血をきたした症例が1例あり, 止血のため開腹手術へ移行した.開放性手術の手術関連合併症は尿瘻1例, 術後出血1例で, 輸血を要した症例は4例あったが3例は自己血だけで充足した.食事開始, 歩行開始は鏡視下症例で有意に早く, 術後入院期間も鏡視下症例で有意に短縮していた.鏡視下手術では開放性手術より有意に鎮痛剤の使用回数が少なかった.術前後に99mTc-DDTPAによる腎シンチグラフィーを行った鏡視下症例3例と開放性症例5例について検討したところ, 患側のGFRは開放性症例で鏡視下症例より低下する傾向を認めた, Partial nephrectomy is widely accepted as a treatment for small renal cell carcinoma. However, the laparoscopic approach has not yet been considered as a standard procedure. We reviewed our 13 retroperitoneoscopic partial nephrectomies and 11 conventional open partial nephrectomies. We have used microwave tissue coagulation for retroperitoneoscopic surgery without renal pedicle clamping between December 1999 and May 2003. The mean operating time for the retroperitoneoscopic group was not significantly longer than that for conventional open surgery group (183 minutes vs 194 minutes). However, the mean blood loss for the retroperitoneoscopic group was less than that for the open group (143 ml vs 512 ml). Histologic evaluation revealed renal cell carcinoma in 10 patients, angiomyolipoma in 2 patients, and lymphoangiomyomatosis in one patient for retroperitoneoscopic group and renal cell carcinoma in 11 patients for the conventional open surgery group. In addition, when compared with the historical control that had undergone conventional partial nephrectomy, laparoscopic cases had significantly shorter postoperative times to oral intake, ambulance, and discharge from hospital. Bowel injury, massive bleeding, urine leakage, and atelectasis occurred in one case each in retroperitoneoscopic surgery. Retroperitoneoscopic surgery in the case of massive bleeding was converted to open surgery. On the other hand, urine leakage and postoperative hemorrhage occurred in one case each in conventional open surgery. Retroperitoneoscopic partial nephrectomy by using microwave tissue coagulation is a useful and less invasive method, whereas this procedure is more challenging than open partial nephrectomy in terms of complications.

55歳男(症例1).左腎盂尿管移行部の診断で, 尿管癌の診断で左腎尿管全摘術を受けた.high-dose MVAC療法施行後, 多発性肝転移が出現した.gemecitabine+carboplatin(GC)療法3コースとGC療法にdocetaxelを加えたGCD療法を肝動注で3コース施行したところ, 肝転移巣は縮小率87.5%となった.2ヵ月後, 多発性の骨転移が出現したため, 放射線療法とGCD療法全身投与を施行中である.46歳男(症例2).局所性尿管癌に対し膀胱全摘術を受け, アジュバント療法としてhigh-dose MVAC療法を3コース施行した.その後, 多発肝, 肺転移および骨盤内リンパ節転移が出現した.全身投与でGC療法2コースとGCD療法2コースを行い, 肝転移巣は縮小しPRを得た.66歳男(症例3).浸潤性膀胱癌多発肝転移に対し, MVAC療法3コースを受けたがPDであった.肝動脈留置カテーテルからGC療法8コースを施行したところ, 無数の肝転移は著明に縮小した.しかし, CEAの上昇を認めたため, 肝動注でGCD療法を6コースを施行したところ, 肝転移巣は再び縮小率87.5%を得た, We report three cases with methotrexate-vinblastin-adriamycin-cisplatin (MVAC) resistant multiple liver metastases of urothelial carcinoma that responded to combination chemotherapy consisting of gemcitabine plus carboplatin (GC) with additional docetaxel (GCD) as salvage chemotherapy. Case 1: A 55-year-old man underwent left nephroureterectomy for ureteral cancer (TCC, G3, pT3pN1M0). Three courses of GC followed by three courses of GCD were given via intra-hepatic arterial infusion for multiple liver metastases, which appeared after adjuvant high-dose MVAC therapy. Complete response was obtained and maintained for 11 months. Case 2: A 46-year-old man underwent radical cystectomy for locally advanced bladder cancer (TCC G3 + adenocarcinoma. pT3pN0M0). Two courses of GC followed by 2 courses of GCD systemic therapies were performed for multiple liver metastases, which appeared after adjuvant high-dose MVAC therapy. Partial response was obtained and maintained for six months. Case 3: A 66-year-old man received three courses of MVAC for multiple metastases of the bladder cancer (TCC, G3, > pT2), which resulted in disease progression. Eight courses of GC followed by six courses of GCD were administrated via intra-hepatic arterial infusion. Partial response was obtained and maintained for 12 months. Although the response duration was still short, GC and GCD may be promising salvage chemotherapeutic regimens for the patients with MVAC-resistant liver metastases of urothelial carcinoma.