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In 2008, a 65-year-old woman was referred to our department because of a right renal tumor detected by computed tomography (CT) that was associated with macroscopic hematuria. She underwent right hemicolectomy for ascending colon cancer in 2003, and right lower lobectomy for lung metastasis of colon cancer in 2004. CT, magnetic resonance imaging, fluorodeoxyglucose positron emission tomographycomputed tomography and bone scintigraphy did not indicate any other metastatic lesion except the right renal mass ; therefore, open right nephrectomy was performed. Results of the histopathologic examination demonstrated renal metastasis of colon cancer. Although administration of chemotherapy was continued, the patient died of multiple metastases 8 months after the right nephrectomy.

陰嚢内容の異常を主訴とした男性患者において陰嚢部超音波検査を行った.精巣を10Mhzのリニア型のプローベを用いて観察し, 1画面に5個以上の石灰化を認めるものをclassic type(CTM), 5個未満をlimited type(LTM)と分類した.今迄に14例に精巣微小石灰化を認め, このうち6例がLTM, 8例がCTMであり, CTMの1例に精巣癌の合併を認めた.受診理由は急性精巣上体炎が最も多く, 精液瘤や静脈瘤等も認められたが, LTMとCTMとの間に明らかな差はなかった.検査所見では, 急性精巣上体炎と精管炎の5例がクラミジアが陽性であった.他に淋病とモルガン菌を1例づつ認めた.精液検査を2例で行い, うち1例で軽度の乏精子症を認めた.腫瘍マーカーを5例で検査したが, 全て正常範囲であった, Testicular microlithiasis (TM) is a comparatively rare condition in which calcified congelations fill the lumina of the seminiferous tubules. Using high-frequency linear transducers (10 MHz), TM is easily demonstrated as tiny punctate echogenic foci, which typically do not give an acoustic shadow, and is classified into classic type (CTM) and limited type (LTM) on the basis of the presence of five or more microliths at least on one image of the testes. Fourteen patients were found to have TM, 6 of which were LTM and 8 were CTM. In one patient with CTM, coexisting mixed germ cell tumor (seminoma, embryonal cell carcinoma) was demonstrated. Until further data are available, it seems reasonable to consider patients with TM as having an increased risk of developing a primary testicular tumor.

55歳女性.患者は突然の右側腹部痛を主訴に近医を受診, 腹部CTにて右腎血腫が疑われ, 著者らの施設へ紹介入院となった.入院時の腹部CTにて腎血管脂肪腫の自然破裂と診断し, 右腎動脈造影にて腎下極末梢の小動脈瘤を確認後, 腫瘍塞栓術を行った.しかし, 第3病日目には4単位の輸血にもかかわらず, 貧血の急速な進行と右胸水貯留, 呼吸状態の悪化を認めたため, 緊急手術を施行した.手術所見では腎下極から腎外に発育する腫瘍の破裂を認め, Gerota筋膜内には血腫の貯留がみられたため, 右腎摘除術を行ったところ, 良好な術後経過が得られた, A 55-year-old woman presented with sudden right lower abdominal pain. Computed tomography demonstrated retroperitoneal hematoma associated with minus-density area, diagnosed as spontaneous rupture of angiomyolipoma. Super-selective transarterial embolization was performed, but anemia and right abdominal pain became worse in spite of conservative therapy including transfusion, indicating re-rupture of the renal tumor. Although partial nephrectomy was planned, right nephrectomy was finally performed because of massive intraoperative bleeding. Accurate diagnosis and prompt treatment are required when life-threatening rupture of renal tumor is suspected.

56歳男.約3年前に出現した右上腹部圧迫感を主訴に受診し, 腹部CTで右腎腫瘍を指摘された.画像検査で悪性腫瘍が否定できない充実性腫瘍と診断し, 用手補助腹腔鏡下右腎摘除術を施行した.腫瘍は充実性で明らかな出血壊死像は見られず, 胞巣状に増殖する腺管状に配列した好酸性腫瘍細胞を認め, 後天性嚢胞性腎疾患(ACDK)に合併した腎オンコサイトーマと診断された.術後は経過良好で, 右上腹部圧迫感が消失した.約6ヵ月後に献腎移植術を施行し, 移植術から約18ヵ月経過現在, 移植腎機能は良好で, 腎腫瘍の再発徴候は認めていない, A case of renal oncocytoma associated with acquired cystic disease of kidney (ACDK) in a 56-year-old man is reported. He had received hemodialysis for 15 years because of chronic renal failure. Computed tomography (CT) was performed because of distention in the upper abdomen, revealing a right renal tumor. He underwent laparoscopic right nephrectomy, and was diagnosed with renal oncocytoma. There have been reported 8 cases of renal oncocytoma in hemodialysis patients, and our case was the third one associated with ACDK in the literature.

18施設で, 109例の複雑性尿路感染症に対して, CRMNとCTMを, 1日量それぞれ2 gずつを分2混合投与し, 効果と安全性を検討した.効果判定基準に合致した65例では, 対膿尿改善率が54%, 菌消失率が83%, 総合有効率が72%の結果を得た.副作用の頻度は3件と低く, この2剤の併用投与は複雑性尿路感染症に対し, first choiceとして使用する場合, 十分に効果が期待でき, かつ安全な方法である, The combination of carumonam (CRMN) and cefotiam (CTM), expected to have a broader spectrum of coverage in connection with urinary tract infections, was evaluated for its effectiveness and safety at the Department of Urology, Osaka University Hospital and 17 affiliated hospitals. CRMN and CTM were given together to 109 patients with complicated urinary tract infections (UTI), of whom 65 cases satisfied the "Criteria of UTI Committee for the Evaluation of Drug Efficacy in the UTI (3rd Ed.)", which was modified by adopting the midstream urine data for women. CRMN and CTM were administered by drip or one-shot infusion at a total daily dose of 4 g (equally mixed 1 g plus 1 g each, twice a day) for 5 consecutive days or longer. The overall clinical efficacy rate in the 65 cases of complicated UTI was 72%, estimated by the criteria cited above. The efficacy rate according to the infection type groupings was 72% for the 29 patients in the 1st group, 100% for the 1 patient in the 2nd group, 100% for the 7 patients in the 3rd group, 83% for the 6 patients in the 4th group, 50% for the 14 patients in the 5th group and 75% for the 8 patients in the 6th group. The disappearance rate of both urinary Gram positive cocci and Gram negative bacilli was 83.3%. Fifteen strains appeared after the treatment, only 4 of which were Gram positive cocci. Among the 109 patients treated with CRMN+CTM, no subjective side effects were recorded and the abnormalized laboratory findings observed were: eosinophilia in one patient, increases in both GPT and GOT in one patient, and lowered creatinine clearance in one patient. With a broader spectrum and safe regimen, the combination of CRMN/CTM is recommended as the first choice against complicated UTI.

Stress analysis for a strip of which widths are different at the right and left handsides is carried out for before and after occurrence of a crack at a corner of a step. The strip is analyzed as a thin plate bending problem subject to transverse bending and torsion, and as a plane eleastic problem subject to bending in the plane and uniaxial tension. The rational mapping function of a sum of fractional expressions and complex variable method are used. Stress distribution and stress intensity factors are obtained.

1975年1月から10年間の上部尿路原発と思われる尿路上皮癌34例について検討した.1)腫瘍の発生部位は, 腎盂11例, 尿管21例, 腎盂尿管2例であり, 尿管腫瘍の4例は膀胱腫瘍を合併した.2)扁平上皮癌1例, 移行上皮癌33例であったが, 後者の1例では, gradeが不明であった.3)腎盂尿管全摘除術29例, 摘除術3例, 生検のみにとどめたもの2例であった.6例にはCAP療法を施行したが, 平均生存期間28. 3ヵ月, 最長生存期間は37ヵ月であり現在まで死亡例はない.4) Greade, stageのはっきりしているTCC 32例の実測生存率は, 3年および5年で65.5%と53.8%, 相対生存率は71.8%と63.5%であった.腎盂腫瘍と尿管腫瘍との間に, 予後の差はなかった.stage Aが良好な他は, B以上はごく不良であり, low grade, low stageのものも下部尿路における再発が多く, 厳重なfollowが必要と思われた, Thirty-four cases of tumor of the renal pelvis or ureter or both have been treated in our department during the past decade. The primary tumor was in the renal pelvis in 11 cases, in the ureter in 21 cases and in the ureter and renal pelvis in 2 cases, a co-existent tumor in the bladder was found in 4 cases. Seventeen patients had a tumor on the right side and 17 on the left side. The most frequent symptom was gross hematuria (70.6%) and flank pain was the presenting symptom in 7 cases (20.6%). On the intravenous pyelography, a filling defect in the renal pelvis or ureter (41.2%) and nonvisualization (53.0%) were frequent findings. Twenty-nine cases had undergone total nephroureterectomy with resection of a bladder cuff, 3 had simple nephrectomy and 2 had open biopsy alone. Postoperative radiation therapy was done in 1 case, chemotherapy in 10 cases, and 6 cases of them were treated by CAP therapy (cis-dichlorodiamine platinum, doxorubicin and cyclophosphamide). Actual and relative 5-year survival rates were 53.8% and 63.5%, and no significant difference was found in survival rate between the patients with renal pelvic tumors and those with ureteral tumors.