Search

An 84-year-old man was referred to our hospital with swollen right cervical lymph nodes. Computed tomography showed right supraclavicular and mediastinal lymph node enlargement, and fluorodeoxyglucose positronemissiontomography showed multiple areas of abnormally increased radioactivity inthe right supraclavicular and mediastinal lymph nodes, right ninth rib, and left fifth and seventh ribs. Biopsy of the right supraclavicular lymph node revealed metastatic adenocarcinoma with partial immunohistochemical staining for prostate specific antigen (PSA). Serum PSA levels were not elevated (2.01 ng/ml). An 8-core transrectal prostatic biopsy was negative. Thus, we could not determine the primary site of the adenocarcinoma. The patient was diagnosed with carcinoma of an unknown primary site and followed without chemotherapy. Four years later, he was referred to our hospital due to right hydronephrosis. Serum PSA level was 31. 1 ng/ml. The tumor was not palpable by rectal examination. A 12-core transrectal prostatic biopsy revealed a poorly differentiated adenocarcinoma. Computed tomography revealed metastases in the left axilla, para-aortic, and pelvic lymph nodes as well as in the lung. We diagnosed the patient with prostate cancer, and combined androgen blockade (CAB) was administered. Metastases in the lymph nodes, lung, and bone were reduced on imaging after 1 month of therapy. Therefore, a definitive diagnosis of prostate cancer T1cN1M1c was made. Dutasteride had been administered as a benign prostate hyperplasia treatment 2 years before his first visit, which may have made the definitive diagnosis of prostate cancer difficult. In contrast, dutasteride may have delayed the progressionof prostate cancer inthis patient.

Seminal vesicle cyst is a rare disease and is often asymptomatic. We present a case of huge seminal vesicle cyst connected to the abdominal wall and observed as a subcutaneous abscess. An 89-year-old man presented with asymptomatic spontaneous rupture of the left lower abdominal subcutaneous abscess. Computed tomography (CT) showed a relatively low intensity cystic mass located in the Retzius' space just below the abscess, surrounding the right bladder wall laterally and connecting to the right seminal vesicle posteriorly. Biopsy of the skin around the subcutaneous abscess and aspiration biopsy of the pelvic cystic fluid showed no evidence of malignancy. We diagnosed the lesion as a seminal vesicle cyst with bacterial infection. The patient was treated with antibiotics and there has been no relapse.

We described a 63-year-old man who was diagnosed with clinical T1c prostate cancer, with a Gleason score of 6 (3＋3), and a preoperative prostate-specific antigen (PSA) level of 5. 27 ng/ml. Radical prostatectomy(RP) was performed and final pathologyshowed Gleason score 3＋4, pT2c with negative surgical margin. In spite of suggested surgical radicality, PSA was 3.32, 4.78, 5.93 ng/ml, at 1, 2, and 3 months after RP, respectively. However, radiological investigation revealed no metastasis. Because of this clinical discrepancy, we checked the PSA-α1-antichemotrypsin level and found it to be ≦0.1 ng/ml. From these results, false PSA elevation caused byinterference of positive heterophilic antibodies was suggested and demonstrated byseveral immunoassays.

前立腺肥大症患者を, エビプロット錠1日3回, 1回2錠内服の46例(男・平均65.8歳:A群)と, エビプロット錠の主成分を倍量含むEVI-F錠1回1錠内服の46例(男・平均63.6歳:B群)に封筒法により無作為に割付け, 効果を比較した。国際前立腺症状スコア(IPSS)の合計は投与開始時A群15.6, B群14.9, 投与後4週ではそれぞれ11.6, 11.2, 8週後では9.4, 8.8と有意に低下し, 両群間で有意差はなかった。スコア変化量, 症状改善度にも両群で有意差はなかった。またQOLスコアおよびIPPSの各サブスコアも同様に有意な改善を示し, 両群間で有意差はなかった。副作用はA群6例9件, B群3例3件に認めたが, ほとんどは軽度で臨床的に問題はなく, 発現率に両群間で有意差はなかった。治験後のアンケート調査で飲みやすいと回答したのはA群72.9%, B群95.7%であった。EVI-F錠はエビプロット錠と同等の有効性と安全性を有していることが確認され, 服薬状況を向上させる可能性も示唆された。, We compared the usefulness of Eviprostat tablet, a therapeutic agent for benign prostatic hyperplasia (BPH), and EVI-F tablet, a new formulation of Eviprostat containing two times more active ingredients (Chimaphila umbellata extract, Populus tremula extract, Pulsatilla pratensis extract, Equisetum arvense extract and purified wheat germ oil) and consequently designed to reduce the number of tablets per dose by half. In this study, patients with BPH were randomly assigned to either Eviprostat group (6 tabs/day) or EVI-F group (3 tabs/day) using the envelope method. The clinical efficacy of these two drugs were evaluated by the International Prostate Symptom Score (IPSS) and QOL score at the end of the treatment period, and their safety was evaluated by the incidence of side effects. Based on the clinical study guidelines for dysuria, the change in the IPSS total score and QOL score were comparable to the previously reported data for other treatment agents for BPH, and these indices showed gradual improvement with the treatment period. Both treatments were well tolerated. The clinical usefulness of the monotherapy with EVI-F tablet or Eviprostat tablet was reasonably demonstrated in this study. Furthermore, both treatments reduced nocturia, which has an impact on the QOL of patients with BPH.

A 33-year-old woman was admitted with macrohematuria after contusion in the left lumber region. The excretory urogram showed no abnormal findings, but color doppler and RI-angiography revealed infrarenal left-sided inferior vena cava (left IVC). The pressure in the dilated left renal vein was higher than that in the right one. Renal contusion in addition to the congestion of the left renal vein due to left IVC was thought to be the cause of hematuria in this case. Hematuria disappeared after retrograde instillation of 0.2% AgNO3 water solution into the left renal pelvis. Left IVC rarely presents clinical symptoms, and is usually found by chance on CT scan or ultrasonography during examinations for upper abdominal organs. Our case is the 69th one of left IVC in Japan, and belongs to Type 2' according to our classification of left IVC.

A case of diverticular stones in the male anterior urethra with retrocaval ureter is reported. A 26-year-old man visited our hospital for examination, who had experienced spontaneous stone discharge a few days earlier. Computed tomographic (CT) scan with ureteral catheterization and urethrography revealed a retrocaval ureter and urethral diverticular stones. Resection of urethral diverticulum with 7 stones and right ureteroplasty were performed. The urethrography and drip infusion pyelography (DIP) 9 months after operation showed no abnormal findings. The largest stone was 28 x 22 x 20 mm in size and 20 g in weight. The main components were ammonium dihydrogen-urate (70%), carbonate apatite and struvite. Histological feature of the epithelium of the urethral diverticulum indicated normal skin with hairs. Pathological diagnosis was para-urethral dermoid cyst. Our case is the 67th case of the male urethral diverticular stones and the first case of those with retrocaval ureter in Japan.

We developed a convenient animal experimental model to study the effects of passive smoking on urinary mutagenicity. Rats were individually placed into metabolic cages, and were exposed to a side-stream of cigarette smoke under specific conditions. Then 24-hour urine collections were performed. Mutagenicity was investigated by the Ames test using the Salmonella typhimurium strains TA98 and TA100. In strain TA98, the mutagenicity of urine was 5.4-fold and 5.3-fold increased with and without metabolic activation, respectively, by exposure to cigarette smoke, and that in strain TA100 was 4.7-fold and 4.4-fold increased. Using this animal model, the effect of passive smoking on urinary mutagenicity can be investigated conveniently. This model can be applied to a variety of experiments.

We studied the mutagenicity of urine of healthy smokers and smokers with bladder tumors by the Ames test. The 41 healthy smokers studied showed a significant increase in urinary mutagenic activity compared to the 24 passive smokers and the 22 non-smokers, but there was no significant difference between the passive smokers and non-smokers. In the 5 healthy subjects, the urinary mutagenic activity increased in accordance with the increase of tobacco consumption. In the 32 healthy subjects and 22 smokers with bladder tumors, the time-course changes of the mutagenicity of urine after smoking were investigated by testing the urine every 2 hours. In the healthy subjects, urinary mutagenic activity was increased up to 4 hours after cigarette smoking and decreased to the level noted before smoking after the 6th hour. By contrast, in the 22 smokers with bladder tumors, the urinary mutagenic activity remained high even after the 6th hour, and only decreased to the level seen before smoking after the 8th hour. The influence of smoking on the mutagenicity of urine tended to protract in smokers with bladder tumors in comparison to healthy smokers. There was no correlation between urinary mutagenic activity and tumor status and recurrence rate of the bladder tumors.

A Clinical statistic survey was carried out on the patients, diseases, and the treatments undertaken at the Ward of Department of Urology, Kyoto University Hospital during the years of 1985 to 1988.

A 67-year-old man was admitted for a complaint of lumbago. The patient had had the three operations for the schwannoma in spinal cord at the Neurosurgical Department of our hospital. Magnetic resonance imaging (MRI) revealed a right infrarenal tumor by chance. The tumor compressed the right kidney and measured 6 x 5 cm in size. On the tentative diagnosis of the retroperitoneal tumor, the patient was referred to the department of urology in our hospital and the tumor was excised. The histological diagnosis of the removed retroperitoneal tumor was schwannoma, and was thought to be heterotopic recurrent schwannoma.

前回の入院患者臨床統計に引き続き1983年1月から1984年12月までの臨床統計を行なった.入院患者予算ベッド数は60で, 占拠率は常時ほぼ80%以上であった.患者数は825名, 性別男子670名, 女子155名で, 男子の比率が増加しているが, 主に前立腺肥大症を含む, 尿路性器腫瘍の増加による.50歳以上の入院が1983年54.1%, 1984年55.8%であった.頻度の高い腫瘍, 結石, 尿路性器奇型の頻度は, 1983年度でそれぞれ47.5, 21.4, 22.6%であり, 1984年には45.2, 25.1, 16.2の割合であった.腫瘍のうちでは前立腺腫瘍, 膀胱腫瘍が大半を占めた.結石では上部尿路結石症が著増を示し, 尿路性器奇形では腎嚢胞をこの項に含めた.尿路性器腫瘍患者の割合は, 1979年以後は1981年を除き常に40%を越えている.死亡46名, 剖検率80.4%であった.年間の手術件数は手術の対象となった臓器の組み合わせで分類した, A clinical statistic survey was carried out on the patients, diseases, and the treatments undertaken at the Ward of Department of Urology, Kyoto University Hospital during the years of 1983 to 1984.

1983, 1984年の2年間の当科外来患者臨床統計を行なった.1983年は男性3070人, 女性1715人で合計4821人, 1984年は男性3152人, 女性1703人の合計4855人で男女比はほゞ2:1であった.年齢階層別には1983年と比べ1984年には70歳以上が5倍弱の増加を示した.疾患別患者数では尿石症は下部尿路結石の割合が依然として低く, 全尿石症の2～3%に過ぎなかった.腎盂腎炎の頻度は前回調査と同じで女性が男性の2倍を占めた.STDの明らかな増加は見られなかった.尿性器結核も前回とほゞ同じ傾向であった.尿性器腫瘍も前回と比べ著しい変化を示したものはなく, その他の上・下部尿路疾患もほゞ同様であったが, 原因不明熱で来院する患者の増加が予測された.内視鏡検査は1983年には延べ1157件, 1984年には970件, IVPやDIPは年間約2400件行なわれた, The statistics of the patients seen at our Urological Outpatients Clinic during 1983 and 1984 are reviewed.

A statistic survey was carried out on the patients, diseases, and operations experienced at the urological ward of Kyoto University Hospital during the years of 1977 to 1982.