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application/pdf, We have investigated complex perovskite oxide ceramics with nominal composition of (Ba1-xCax)(Scv2Nbv2)03 (0.35 < X < 0.50). It has been confirmed that solid solutions could be prepared with whole range of x by continuous change in cubic lattice constant with x. However, impurities are easy to be included in the ceramic samples and it is very difficult to prepare single phase samples. Contrast of back scattered electron image reflects homogeneity for distribution of chemical composition. The back scattered electron images were observed for selected ceramic samples with the composition to obtain knowledge for phase generations in the samples. An interesting micro structure occurred suddenly at x = 0.47 and another interesting structure occurred at x = 0.475 with increasing x.

後腹膜原発の軟部組織肉腫3例を報告した.症例1は30歳男性, 症例2は31歳女性で, 左胸痛, 腹部膨満感を自覚した.CTで腫瘍を認め, 腫瘍摘出術を行った.腫瘍と左腎, 脾臓との癒着は強固であった.摘除標本の重量は症例1:3000g, 症例2:2000gで, 病理組織学的に後腹膜原発のfibrosarcoma, undifferential sarcomaと診断された.2例とも腫瘍断端陽性を一部に認め, その後再発した.症例1は再腫瘍摘出術を行ったが, 初回手術から約1年半後に, 症例2は術後約2ヵ月半後に死亡した.尚, 症例1は, 再腫瘍摘出術の病理組織像も原発巣と同様であった.症例3は73歳女性で, 心不全フォロー中に腫瘍を指摘され, 腫瘍摘出術を行った.重量は2420gで, 病理組織学的にwell-differentiated liposarcomaが一部で脱分化したものと診断された.一部に腫瘍細胞を認めた.術後1年2ヵ月後に局所再発が出現し, 2回目の腫瘍摘除術を行った.病理組織診断は初回同様differentiated liposarcomaであった, Soft tissue sarcomas (STS) are rare tumors that comprise only 1% of all malignancies. The retroperitoneum is an uncommon site of origin for them, accounting for about 10% of all STS. In case 1, a 30-year-old man complaining of chest pain was found to have a retroperitoneal tumor around the left kidney by computed tomography (CT). The tumor was removed along with the left kidney. Histologically, it was fibrosarcoma 3, 000 g in weight. In case 2, a 31-year-old woman complaining of abdominal distension was found to have a retroperitoneal tumor by CT. The tumor was removed in the same way. It was undifferentiated sarcoma 2, 000 g in weight. In case 3, a 73-year-old woman, who had no complaint was found to have mass in the left lateral region during follow up for cardiac failure. She was referred to our department for treatment of retroperitoneal tumor revealed by ultrasound and CT. The tumor was dedifferentiated liposarcoma 2, 420 g in weight. All three patients had local recurrences, and two of them underwent a second surgical procedure.

57歳男性.患者は頻尿を主訴に近医を受診, 直腸診にて前立腺腫瘤を指摘され, 著者らの施設へ紹介となった.入院時, 血清PSAの軽度上昇を認め, 経直腸エコーでは前立腺背側に精嚢へ突出する28×23×18mm大の内部不均一な腫瘤を認めた.経直腸エコーガイド下前立腺針生検の結果, leiomyosarcomaと診断し, 前立腺全摘術を施行したところ, 病理組織学的には前立腺原発のP-STUMPと診断され, 術後11ヵ月経過現在, 再発・転移は認められず, 経過も良好である, Sarcomas and related proliferative lesions of specialized prostatic stroma are rare. Lesions have been classified into prostatic stromal tumor of uncertain malignant potential (P-STUMP) and prostatic stromal sarcoma based on the degree of stromal cellularity, presence of mitotic figures, necrosis, and stromal overgrowth. STUMPs are considered neoplastic, based on the observations that they may diffusely infiltrate the prostate gland and extend into adjacent tissues, and often recur. Although most cases of STUMPs do not behave in an aggressive fashion, occasional cases have been documented to recur rapidly after resection and a minority have progressed to stromal sarcoma. Here we describe a case of P-STUMP. A 57-year-old male went to his family doctor because of pollakisuria. Digital examination revealed abnormal findings in the prostate, then he was referred to our medical center. The mass was palpable in the left lobe of the prostate; it was elastic hard, surface smooth, about 2 cm in diameter. Serum PSA was elevated slightly (5.42 mg /dl). We diagnosed firstly leiomyosarcoma by transrectal ultra sound guided needle biopsy of the prostate. Then we performed radical prostatectomy. Finally we made the pathological diagnosis of P-STUMP. After 11 months, there is no sign of metastasis or recurrence.

57歳女.2年前に右尿管癌を発症し摘出術を施行した.そのさい術前に尿管狭窄に対して一時的に右腎瘻を留置した.今回, 右腰背部皮下に腫瘤が出現し, 尿管癌の転移を疑い腫瘤切除術を施行した.切除標本の病理組織像は尿管癌と酷似しており, 腫瘍の部位が2年前の腎瘻穿刺ライン上にあることから尿管癌のneedle tract implantationと診断した, Malignant metastasis along the needle tract, called "needle tract implantation" (NTI), has been demonstrated for numerous carcinomas, including prostate, colon and liver. We report a case of NTI of ureteral carcinoma following percutaneous nephrostomy tube replacement. A 57-year-old woman was found to have a subcutaneous mass at the site of nephrostomy. She had a past history of right nephroureterectomy for ureteral carcinoma about one year earlier, and a nephrostomy tube had been inserted before diagnosis postoperatively. We resected the subcutaneous mass. Pathological diagnosis was urothelial carcinoma closely resembling right ureteral carcinoma. To our knowledge, this is the seventh reported case of NTI of upper urinary tract urothelial carcinoma. Percutaneous manipulation carries a potential risk of local tumor spillage and NTI in the nephrostomy tract.

50歳男.主訴は左腰背部痛.CT・MRI検査で左後腹膜腔に辺縁石灰化を伴う嚢胞性の巨大腫瘤を認め, また右腎は腎盂尿管移行部狭窄による水腎症を認めた.左後腹膜腫瘍の診断で, 後腹膜腫瘍摘除術および下行結腸合併切除術を施行した.病理組織学的診断は水腎症が長期存在していた左腎実質から発生した腎悪性末梢神経鞘腫瘍(MPNST)であった.術後3ヵ月, 左下肺野多発性転移のため死亡した, We report a case of malignant peripheral nerve sheath tumor (MPNST) of the kidney. A 50-year-old man was referred to our hospital because of left back pain. Computed tomographic scan and magnetic resonance imaging revealed a huge left retroperitoneal tumor (30 x 13 x 11 cm), which consisted of a solid tumor with calcification surrounding the cystic component. He underwent resection of the retroperitoneal tumor and additional descending colectomy. Histopathological examination revealed MPNST arising from severely atrophic renal parenchyma of giant hydronephrosis. He died of tumor metastasis to the lungs 3 months after the operation. To our knowledge, this is the fourth case of MPNST of the kidney, moreover the third case arising from the renal parenchyma to be reported in Japan.

原発性上皮小体機能亢進症により上皮小体腫瘍摘出術を行い病理組織が確認された18例を対象とした.術後反回神経麻痺等の重篤な合併症を併発した症例は認めなかった.病理組織は全例単発の腺腫で過形成, 癌腫は認めなかった.なお全例術後に血清カルシウム及び上皮小体ホルモンの正常化を認めた.摘出した腺は全部で24腺で腺腫が18腺, 正常上皮小体が6腺であった.局在診断成績は腺腫18腺中17腺が91mTc-methoxy-isobutyl-isonitrile(MIBI)シンチグラフィーで描出された.sensitivityは94.4%, positive predictive value (PPV)は94.4%であった.超音波断層検査ではsensitivityは52.9%, PPVは81.8%であり, MRI検査ではsensitivityは80.0%, PPVは92.3%であった, We evaluated the usefulness of 99mTc-methoxy-isobutyl-isonitrile (MIBI) dual phase scintigraphy for detecting hyperfunctioning parathyroid adenoma. We retrospectively reviewed 18 hyperparathyroid patients who received MIBI prior to neck exploration and compared the radiological findings of MIBI with ultrasonography (US) and magnetic resonance imaging (MRI). Fifteen patients were studied with MRI, and 17 patients were examined with US. All patients were found to have a solitary parathyroid adenoma histopathologically. MIBI correctly revealed the location of 17 adenomas among 18 confirmed tumors. In our series, there was one false-positive case that was found to have thyroid adenoma. The diagnostic sensitivity of MIBI MRI and US was 94.4%, 80% and 52.5%, respectively. The positive predictive value (PPV) was 94.4% for MIBI, 81.8% for MRI and 92.3% for US. We conclude that MIBI is useful and accurate for the preoperative localization of adenoma in primary hyperparathyroidism.

64歳男.PSA高値を主訴とした.入院時, PSAは11ng/mlと高値を示し, 前立腺右葉に一部石様硬の結節を触知した.系統的前立腺針生検を行い, 右葉に触知する結節部を追加生検し, 同部より, 中分化型腺癌, Gleason score 7の診断を得た.骨盤部MRIにて前立腺右葉にT2強調像にてhigh intensityを呈し, dynamic MRIにて早期より濃染するmassを認めた.以上より, 前立腺癌, T2N0M0, stage B1と診断された.恥骨後式根治的前立腺全摘除術を施行し, 病理組織学的所見より原発性前立腺粘液癌と診断した.前立腺粘液癌は稀であり, 調べ得た限りでは, 本邦報告例は自験例を含め46例であった, We present a case of mucinous carcinoma of prostate. A 64-year-old man visited our hospital because of high score of prostate specific antigen (PSA). Prostatic biopsies were performed twice, but cancer was not found. Since the PSA value elevated gradually and a hard nodule in the right lobe of prostate became palpable, we repeated the biopsy that revealed cancer. Retropubic radical prostatectomy was performed and pathological examination revealed mucinous carcinoma of prostate. Mucinous carcinoma of prostate is rare, and to our knowledge, only 46 cases have been reported in the Japanese literature.

70歳男性.1年前に尿道狭窄に対する直視下内尿道切開術の既往があり, 術後, 定期的に尿道ブジーを行っていたが排尿困難, 尿線散乱が持続するため受診した.尿道鏡検査を施行したところ, 狭窄の切開部に腫瘤を認め, 内視鏡下に経尿道的切除術を施行した.病理組織学的所見では, 腫瘤は正常な尿道上皮に覆われており, 腫瘤の内部は海綿体状の構造を呈し, 直視下内尿道切開術によって脆弱となった部位からの尿道海綿体の突出であると考えられた.術後排尿困難は軽快し, 尿道鏡検査では腫瘤切除部位に瘢痕を認めるが, 尿道内に腫瘤, 狭窄の再発は認めていない, A 70-year-old man underwent transurethral resection of the prostate (TURP) in February 1999 and he received optical urethrotomy because of urethral stricture in May. In May 2000, a distal urethral tumor was found by urethroscopy. Endoscopic resection of the urethral tumor was performed. The tumor consisted of normal urethral epithelial tissue and had a cavernous structure. We conclude that the tumor was vegetation of the corpus spongiosum penis.

女子急性単純性膀胱炎の126例に対し, OFLX 300mg 1日1回3日間投与と, 同薬100mg 1日3回3日間投与の比較検討をした。UTI薬効評価可能のそれぞれ, 42例と43例とでは, ともに総合臨床効果の98%を呈するなど, 自覚症状・膿尿・細菌尿に対する効果も主治医による効果判定にも, あるいは第7病日における再発検討にても, ほとんど両群に差をみとめなかった。自覚的副作用は両群あわせてもわずかに1.2%であり, 全例に臨検値を検討しなかったため, 概括安全度に対する検討は不十分であった, A comparative study of ofloxacin (OFLX), a new oral quinolone, was carried out at the Department of Urology, Osaka University Hospital and its eighteen affiliated hospitals to evaluate the clinical efficacy and safety of daily dose of 300 mg, given either once daily dose (SID group), or in three divided doses (TID group), in the treatment of acute uncomplicated cystitis in women. Clinical efficacy was evaluated in 42 cases from the SID group, and 43 cases from TID group, respectively, according to the criteria by the Japanese UTI Committee. In the SID group, the clinical efficacy was evaluated as excellent in 29 cases, moderate in 12 and poor in 1, with an overall clinical effectiveness rate of 98%. In the TID group, it was evaluated as excellent in 25 cases, moderate in 17 and poor in 1, with an overall clinical effectiveness rate of 98%. Safety was monitored only by subjective complaints. In the SID group, no subjective side effects appeared (0%). In the TID group, one of the 43 women (2.3%) complained of borborygmus. These findings suggest that there was no significant difference between the two groups in the safety and efficacy of ofloxacin.

A case of left adrenal adenoma with bilateral testicular Leydig cell tumor in a 38-year-old man is reported. He had received bilateral orchiectomy for testicular Leydig cell tumor at the age of 37. After operation computed tomography revealed left adrenal mass and aldosterone-secreting adrenal tumor was suspected. Left adrenalectomy was performed and histopathological diagnosis was adrenocortical adenoma. Serum ACTH, aldosterone and plasma renin activity were still high after operation. The adrenal cortex and gonads are of common embryologic origin and the histologic pattern may overlap. Examination of the adrenal gland is necessary for the patient with a testicular Leydig cell tumor.

37名の上部尿路結石症患者の37部位の結石に対しESWLを行い, 治療終了後1ヵ月目の時点における総合有用度判定の結果で, "きわめて有用"あるいは"有用"と判定されたのが合わせて27例あり, 重篤な副作用や合併症を生じた症例はなかったことより, EDAP LT-01 PLUSはESWL治療機器として有用なものであると判定した, With EDAP LT-01 PLUS, a new extracorporeal shock wave lithotriptor which generates shock waves by 320 ceramic elements activated by the piezoelectric effect and which was produced to be used for the treatments of both urolithiasis and gall bladder stones, we performed extracorporeal shock wave lithotripsy (ESWL) on 37 patients with urolithiasis between November 22, 1989 and July 31, 1990. Thirty seven target stones of 37 patients were located in the renal calyx (11 cases), renal pelvis (3 cases), UPJ (6 cases), renal calyx and pelvis (1 case), renal calyx and UPJ (1 case), renal calyx and upper ureter (1 case), upper ureter (9 cases), middle ureter (1 case), and lower ureter (4 cases). None of the patients needed anesthesia. The average number of treatments per case was 2.9 and the average total times of treatment per case was 196 minutes. The overall stone-free rate one month after the last ESWL treatment was 54.1% (20/37), and no patients had any major side-effects. Judging from our present clinical application, we concluded that EDAP LT-01 PLUS is a useful extracorporeal shock wave lithotriptor for urolithiasis.

A case of benign hemorrhagic renal cyst in a 64-year-old man is reported. The patient was admitted to our hospital for further evaluation of left upper abdominal mass. CT scan and ultrasonic sonography showed a left giant renal cystic mass. The characteristic findings were thick and irregular wall and heterogeneous contents of the cystic mass. Selective renal arteriography showed a hypervascular area in a part of the cyst wall and hemorrhagic cyst was suspected by MR imaging. The presence of a malignant tumor in the cyst wall was suspected, and radical nephrectomy was performed. The specimen measured 18 x 12 x 8 cm and weighed 1, 170 g. The cyst contained bloody fluid and a hemorrhagic degenerating mass. Pathohistological examination showed no evidence of malignant tumor at any site of the cyst wall.

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.

We report a rare case of primary hyperparathyroidism with a functioning parathyroid cyst in a 45-year-old male. He was a recurrent stone former, and consulted our hospital for further examinations of hypercalcemia. Plasma levels of intact parathyroid hormone (PTH) were elevated to 130 pg/ml. Ultrasonography, computed tomography and magnetic resonance imaging revealed a parathyroid cyst on the right lobe of the thyroid gland. We performed right superior parathyroidectomy. Histological examination demonstrated a secondary pseudocyst resulting from cystic degeneration of a parathyroid adenoma. Plasma levels of intact PTH normalized after operation. To our knowledge, only 48 cases of functioning parathyroid cyst were reported in the Japanese literature. We discuss the clinical features and histological evidence of functioning parathyroid cyst.

A 41-year-old woman was hospitalized for evaluation of diabetes mellitus and hypertension. The hormonal and radiological examinations revealed that she had pheochromocytoma of bilateral adrenal gland and medullary carcinoma of thyroid gland. Therefore, she was diagnosed as having Sipple's syndrome. She had no definite familial history, but her two sisters, already dead, had been strongly suspected of having had pheochromocytoma. First, bilateral adrenalectomy was performed and secondly, total thyroidectomy, excision of parathyroid and cervical lymph node dissection were performed. Histopathological diagnosis was pheochromocytoma of bilateral adrenal gland, medullary carcinoma of thyroid gland and chief cell hyperplasia of parathyroid gland. We report a case of Sipple's syndrome, which probably is the 88th case in Japan, with the review of the previous Japanese literature.

A case of primary carcinoma in situ of the ureter in a 77-year-old man is reported. The patient had been to another hospital with right flank pain and macroscopic hematuria. Ultrasound sonogram showed right hydronephrosis. An excretory urogram showed right hydronephrosis and stenosis of right ureter. He was referred to our hospital for further evaluation and treatment. Retrograde pyelogram demonstrated a right ureteral stricture at the level of S1-2, but no space occupying lesion was detected in the ureter. Cytology of voided urine was negative for malignant cells and no other abnormal findings were present. Probe laparotomy was performed under the preoperative diagnosis of ureteral stricture. During the operation, frozen section examination of the stenotic ureter showed carcinoma in situ and so we performed right total nephroureterectomy with a bladder cuff. Pathologic diagnosis was primary carcinoma in situ of the right ureter. The patient has been doing well for six months postoperatively with no evidence of recurrent or metastatic disease.

With Sonolith 3000, a new extracorporeal shock wave lithotriptor, we performed extracorporeal shock wave lithotripsy (ESWL) on 34 patients with upper urinary stones, including 5 patients with target stones of this clinical application in both sides. The 39 target stones in the 34 patients were located in the renal calyx (13 cases), renal pelvis (14 cases), renal calyx and pelvis (1 case), renal pelvis and ureter (1 case), and upper ureter (10 cases). The ultrasound-aiming system gave a satisfactory imaging of the target stones in 94.9% of cases (37/39 cases). During the ESWL treatment, 32 patients (94.2%) did not need anesthesia, but 2 patients (5.9%) needed epidural anesthesia because of intolerable pain and/or terror of pain. The average number of treatments per case was 2.08, and the average dose of shock waves per treatment was 3, 691.1. The stone-free rate on the 14th, 42nd and 90th days after the last ESWL treatment were 28.2% (11/39), 51.3% (20/39) and 64.1% (25/39), respectively. Out of 39 cases, 31 cases (79.5%) were either stone-free or had only sand-like residual stones on the 90th day. Most cases had minimal side effects, such as transient macroscopic hematuria (100.0%), skin eruption (50.0%) and back pain (41.2%), but one case needed a 1, 200 ml transfusion because of perirenal hematoma immediately after 1st session of ESWL treatment with 2, 300 shock waves (13 kv). The serum total bilirubin level on 1st day after the last session of ESWL treatment was significantly increased when compared with the preoperative level, but the level was not significantly increased after the 1st session.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of testicular tumor (embryonal cell carcinoma with choriocarcinoma) in a 42-year-old man treated with renal autotransplantation is presented. After four courses of chemotherapy (carboplatin, vinblastine and bleomycin), we performed retroperitoneal lymph node dissection. At the operation, one of the swelling lymph nodes involved left renal artery completely, so we performed left renal autotransplantation and promoted more effective lymph node dissection. After the operation, renal function was impaired but returned completely in a short time. Autotransplantation provides excellent bench visualization of renal lesions and stable graft function. Therefore, this procedure should be taken into consideration when nephrectomy cannot be avoided.

制度:新 ; 文部省報告番号:甲2310号 ; 学位の種類:博士(人間科学) ; 授与年月日:2007/3/15 ; 早大学位記番号:新4370

症例1:62歳男.腹部腫瘤に気付いて入院し, 右下腹部に10cm大の腫瘤, 右下肢知覚鈍麻があり, 仙髄腔生検で得た腫瘍細胞はS100蛋白陽性であった.背部からの仙骨内腫瘍剔除に続いて経腹的に手術したところ, 骨盤腔内に小児頭大腫瘍があり, 総腸骨静脈, 内外腸骨動脈と固着しており, 腫瘍核出術を行った. 症例2:35歳女.左臀部痛と左下肢のしびれで受診し, 開腹して径8cmの腫瘍が内外腸骨静脈と固着しており, 被膜を残して腫瘍核出術を行った. 骨盤内Schwannomaで被膜と共に剔出した報告は日本で57例あり, 被膜を残して腫瘍核出術を施行したのは自験例の2例のみであるが, 2例とも再発の徴候はみられていない, A 65-year-old man and a 35-year-old woman were diagnosed with intrapelvic tumors originating from the sacral nerves by computed tomographic (CT) scan, magnetic resonance imaging (MRI) and angiography. These tumors were tightly adhered to the iliac arteries and veins and could not be resected completely. Since the cryostat sections revealed benign schwannomas histopathologically, we enucleated the tumors without the pseudocapsules. All of the 57 intrapelvic schwannomas previously reported in Japan were resected with pseudocapsules. Both of our patients showed improvement of subjective symptoms, but should be followed up and examined for the presence of regrowth of tumors.

博士論文要旨

制度:新 ; 文部省報告番号:乙1050号 ; 学位の種類:博士(工学) ; 授与年月日:1994-10-13 ; 早大学位記番号:新2085 ; 理工学図書館請求番号:1792

A 67-year-old man was found to have a metastatic tumor of left adrenal gland originating from the left renal pelvic and ureteral cancer. Histopathological findings of the renal pelvic and ureteral cancer indicated transitional cell carcinoma, which was the diagnosis for the adrenal tumor. Diagnosis of cancer of the renal pelvis and ureter with metastasis to the adrenal gland before operation is very rare. A review of the literature on the metastasis from cancer of renal pelvis and ureter was made.

A 70-year-old man was admitted to our hospital with the complaint of lower abdominal mass. Previously, he had received partial cystectomy and radiation of 38 Gy for bladder transitional cell carcinoma and transurethral resection of prostate and diethylstilbestrol administration for prostatic adenocarcinoma. The third tumor was located between the bladder and lower abdominal wall with inguinal lymph node swelling. Biopsy specimen revealed malignant lymphoma. After 2 courses of combination chemotherapy consisting of vincristine, prednisolone and procarbazine, complete remission was achieved. We discuss about multiple malignancies including urological organs.