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Additional file 1. The association of GA with the endpoints. These tables show hazard ratios of 1 % increase in GA for each endpoint in sensitivity analyses. (docx 19.5KB)

Additional file 2. A flow diagram of the study population and multivariable-adjusted restricted cubic spline curves (95% CI) of the association between mean GA or HbA1c levels and each endpoint. (pptx 186.8KB)

Herein we report a case of paraganglioma. The metastatic lesion was incidentally found in a 64-year-old man by chest roentgenography. The primary tumor was extra-adrenal and was revealed to be malignant. The patient was normotensive without clinical symptoms despite extreme high serum and urinary dopamine levels. A venous injection of 5 mg metoclopramide elicited a significant increase of the blood pressure. This phenomenon disappeared after surgical excisions of the primary and metastatic lesions. The metoclopramide test is considered to be useful to diagnose asymptomatic paraganglioma.

The clinical efficacy of norfloxacin (NFLX) was evaluated on 40 patients. They had subjective symptoms suggestive of prostate inflammations and more than five white blood cells (WBC)/hpf in their prostatic secretions (EPS) or VB3. Of these, gram negative rods were isolated from the EPS in 3 patients and gram positive cocci were obtained in 26 patients. The overall clinical efficacy was determined at the second week. The effectiveness rate of the subjective symptoms was 82.5%. The effectiveness rate of the WBC in the EPS was 47.4%. The effectiveness rate of the bacteria in the EPS was 64.3%. The overall clinical effectiveness rate was 77.8%. A subjective side effect was observed only in one patient who had skin eruption like urticaria. Mild liver dysfunction of blood chemistry analysis was shown only in two patients but they had had long standing chronic hepatitis. We conclude that NFLX is an effective drug for the patients with chronic prostatitis.

A 58-year-old man was admitted to our hospital with the complaint of pollakisuria and micturitional pain. The urine cytology showed malignant cells suggesting the urothelial cancer, but various examinations could not reveal the malignant lesion. The prostate was also normal by the digital examination, endoscopy, roentgenography, ultrasonography and serum markers, and the transperineal prostate biopsy showed no malignancy. Three years after the first admission the prostate showed slight hardness and the transperineal biopsy suggested adenocarcinoma of the prostate. Hormonal therapy was then started and the prostate showed no remarkable change until about two years later, when rapid progression of the prostatic tumor was recognized. The transperineal biopsy of the prostate revealed the transitional cell carcinoma with negative staining of Alcian-Blue, PAS and PSA (prostate specific antigen). The epithelia of the bladder and posterior urethra were normal. The radical cystoprostatectomy was done and the histological diagnosis was the pure type of primary transitional cell carcinoma of the prostate. The literatures were reviewed and the clinical differentiation between transitional cell carcinoma and adenocarcinoma of the prostate was discussed.

Fourteen cases of urogenital tumors (9 prostatic carcinomas, 4 renal cell carcinomas and 1 bladder carcinoma) which had bone metastases were treated with eel-calcitonin, Elcitonin injections for relief of bony pain. Forty mgs. of Elcitonin was injected intramuscularly, 2 to 3 times a week, to out-patients. Forty to 80 mgs. of Elcitonin was injected intramuscularly, daily to hospitalized patients. Relief of the pain was obtained in 71.4% of all patients (71.4% of out-patients and 71.4% of hospitalized patients) and especially in 88.9% of prostatic carcinoma patients. Hypercalcemia was seen in only one patient of renal cell carcinoma. It is considered that Elcitonin treatment is useful for relief of bony pain in the patients with bone metastases, with or without hypercalcemia.

Intravesical instillation of dimethyl sulfoxide (DMSO) was used in the treatment of patients with intractable urinary frequency due to chronic prostatitis, chronic cystitis, tuberculous contracted bladder and interstitial cystitis. Before the application of this therapy, all 4 patients were examined carefully to rule out cases of acute infectious diseases of the urinary tract, active urinary tuberculosis, neurogenic bladder and carcinoma in situ of the bladder. Three of the four patients achieved an excellent response both subjectively and objectively. In the United States, intravesical instillation of DMSO had already been established as the specific method in the treatment of interstitial cystitis and no side effects have been reported so far. Therefore, we recommend the use of intravesical instillation of DMSO more commonly in various forms of intractable urinary frequency.

1) QM90(尿流量曲線の中央の90%の排尿量におけるaverge flow rate (AFR))は, AFR, MFR (maximum flow rate)と同様に, 200 ml以下の排尿量では, 排尿量と正の相関で増量し, 200 ml以上は一定値をとる.2) Tdesc (MFRに達した時から総排尿量の95%が排尿される迄の時間)は, 排尿量と正の相関で増加した.3)(dQ/dT) max(尿流量曲線の立上りの傾きの最大値)は, ばらつきが大きく, 正常群と異常群を明確に区別し得なかった.4)(dL/dT) 40(膀胱容量が残り40 mlとなった時の膀胱壁の収縮速度)は, 排尿量に依存せず, その正常下限は12.5 mm/secで, 異常群と明確に区別され, 利用価値が高い, Uroflowmeter has been well documented as an indispensible tool in lower urinary tract diagnosis. In this study 145 normal urinary flow curves in 36 healthy adult males were analysed using the Male Uroflow Diagnostic Interpretation (MUDI) of the DISA urological investigation system. In MUDI, the flow rate pattern is analysed and quantified by previously defined parameters. Then the computed values of these parameters are compared with the values observed in healthy subjects. Finally, the results are conveniently presented on an output sheet. One of the newly defined parameters, (dL/dT) 40, i.e., the bladder contraction velocity at 40 ml before the end of micturition, was situated within the range of 12.5 to 28.3 mm/sec (20.4 +/- 3.9 mm/sec) in healthy males. The variable (dL/dT) 40 did not depend on voided volume and provided excellent discrimination between the control group of healthy males and the group of patients with dysuria. MUDI improves the faults of previous uroflowmetry systems and provides (dL/dT) 40 by which micturition patterns can be discriminated to be good and bad ones. So MUDI seems to be quite versatile in daily urological clinics.

Herein we report a case of bladder amyloidosis treated successfully with TUR & DMSO bladder instillation. A diagnosis was made by a biopsy of the bladder epithelium. Amyloid fibrils were confirmed in the biopsy specimen with polarization and electron-microscopy. The patient was treated with TUR. The residual lesion had disappeared with DMSO bladder instillations for 4 months (12X) without side effects after TUR. Thus DMSO bladder instillation with surgical resection seems to be an excellent therapy for bladder amyloidosis.

Seventy seven patients with prostatic carcinoma were treated in our clinic between 1977 and 1986. Most of them were treated by a hormonal agent as the first therapy. None of the 9 stage A1 cases showed any reactivation, but 4 of the 5 stage A2 cases relapsed to metastatic disease. The chemotherapy performed in 3 of the 4 reactivated cases had no obvious effect on the disease. Seven of the 8 patients with stage B disease were alive without relapse. Relapse was seen in the other patient who had poorly differentiated carcinoma and chemotherapy in this case resulted in stable disease for the present. Four of the 15 stage C cases including 3 poorly differentiated carcinomas were hormone resistant or reactivated. For these resistant cases radiotherapy and/or the chemotherapy were performed, but a response was seen in only one case. Consequently, the first therapy for stage A2, B and C of poorly differentiated carcinoma must be improved. Of the 40 stage D cases, 4 patients who were treated by an early combination of hormonal therapy and chemotherapy had a better prognosis than the others. These 4 patients had poorly differentiated carcinomas with multiple bone metastases. Two of these 4 patients were alive without relapse for 17 and 72 months, and one of the 2 patients with relapse was also alive for 75 months. We believe that early chemotherapy is the key for better prognosis in stage D cases.

Herein we report a case of hydrometrocolpos with left renal agenesis of a four-month-old girl. The hydrometrocolpos due to a transverse septum of the vagina and left renal agenesis were confirmed by laparotomy. The transverse septum was incised and cured successfully by the abdominoperineal approach. We have collected 21 cases of hydrometrocolpos with or without urinary tract malformations including our case in the Japanese literature and discussed its etiology and treatments.

Between January, 1983 and January 1988, the diagnosis of hyperparathyroidism was made on 14 patients (8 primary and 6 secondary), and was identified operatively in all. The procedures for image diagnosis were computed tomography (CT), ultrasonography and scintigraphy. Scintigraphy was performed using Tc-99m and Tl-201 by a subtraction technique. For primary hyperparathyroidism, the accuracy of localization was 100% by CT, 87.5% by ultrasonography, 100% by scintigraphy, and 100% by the combination of these three methods. For secondary hyperparathyroidism, it was 68% by CT, 68% by ultrasonography, 36% by scintigraphy and 84% by the combination of these three methods. Ultrasonography and CT were quite useful for imaging of small abnormal parathyroid glands. The accuracy of scintigraphy in secondary hyperparathyroidism was low. Because the swellings of glands do not occur equally in most secondary hyperparathyroidism cases, we consider that large glands absorb the majority of injected radionuclides. Some discussion on merits and demerits of each image procedure was done.

Herein we report two cases of hypogonadism with anosmia or hyposmia (Kallmann's syndrome), a 23-year-old single man (case 1) and a 34-year-old single man. (case 2). Micropenis and small testes were seen in both cases. Central anosima and central hyposmia were found in cases 1 and 2, respectively. Their karyotypes were normal (46, XY). The plasma levels of LH and FSH were low and the reaction to LH-RH test was poor in both cases. After repetitious LH-RH administrations, a good response of plasma LH was recognized in both cases except for a poor response of plasma FSH in case 1, while plasma testosterone remained low in both cases. Their testicular biopsies revealed immature testes without any developed Sertoli and Leydig cells.

無作為割付により, bleomycin膀胱内注入(1回60 mg)単独群およびbleomycin+Bestatin (60 mg/日)併用群に分け, 最長2年間follow-upし, それぞれの再発予防効果につき比較試験を施行した.検討可能症例はbleomycin単独群58例, bleomycin+Bestatin併用群66例で, 平均follow-up期間はそれぞれ550±209日, 584.9±184.7日であった.Bleomycin膀胱内注入のみによっても, adriamycin, mitomycin cの効果に劣らない再発予防効果が認められたが, それにimmunomodulatorであるBestatinを併用することが, その効果をより有意に高めるという成績になった.ことに治療開始1年以内において, Bestatinの併用効果がより明確に現われた.総合的に見て悪性度が中等程度の表在性膀胱腫瘍(たとえば乳頭状有茎, 単発, pT1, pT2, G3)において, とくに再発予防効果が高かった, Serum and prostatic tissue levels of Ceftizoxime (CZX) were measured in 37 patients with benign prostatic hypertrophy after intravenous infusion of 0.5 g or 1 g or 2 g of CZX. The prostatic tissue level of CZX was sufficient for the treatment of prostatic infection. Serum and prostatic tissue levels of CZX were maintained satisfactorily by the dose of CZX. Neither the weight of extracted prostatic tissue nor the renal function of the patient was correlated to the tissue level of CZX.