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膀胱癌を含む高次重複癌の4例.第1例は70歳男性で, 膀胱移行上皮癌, 前立腺小腺房性高分化型腺癌, 膵高分化型腺癌の3重複癌で, 悪液質で死亡した.第2例は69歳男性であり, 膀胱移行上皮癌, 陰茎扁平上皮癌, 喉頭扁平上皮癌の3重複癌で, 発症後6年経過したが, 再発を認めていない.第3例は78歳の男性で, 膀胱移行上皮癌, 胃中分化型腺癌, 前立腺小腺房性高分化型腺癌, 肺微小扁平上皮癌の4重複癌で, 胃癌の広汎転移により閉塞性黄疸・腎不全を併発し死亡した.第4例は76歳男性で, 膀胱移行上皮癌, 頸部鰓性癌, 頬部扁平上皮癌, 直腸高分化型腺癌の4重複癌であり, 第1癌発症後17年を経過したが, 再発なく生存している, Two cases of triple primary neoplasm and two cases of quadruple primary neoplasm including transitional cell carcinoma (TCC) of bladder are reported. The first case was a 70-year-old male who had bladder cancer, occult cancer of prostate (adenocarcinoma) and highly differentiated adenocarcinoma of pancreas. He died of cachexy. The second case was a 69-year-old male. This case was also triple primary neoplasm including bladder cancer, squamous cell carcinoma (SCC) of penis and SCC of larynx. The third case was a 78-year-old male who had bladder cancer, adenocarcinoma of prostate similar to that of the first case, adenocarcinoma of stomach, and SCC of lung. He died of obstructive jaundice and renal failure owing to massive metastases of gastric cancer. The fourth case was a 78-year-old male who had four primary neoplasms such as bladder cancer, branchiogenic epithelial carcinoma, SCC of buccal mucosa and adenocarcinoma of rectum.

Percutaneous antegrade pyelography under ultrasonic real-time guidance was performed in 18 cases of obstructive hydronephrosis, which were poorly visualized the renal collecting system on excretory urography and in which or retrograde pyelography could not be performed successfully. This technique was safe, accurate and easy, and provided significant diagnostic information in these cases. With the patient under local anesthesia an 18 gauge spinal needle was inserted into the renal pelvis. Approximately 10-20 ml fluid were withdrawn from the renal pelvis for cytology and culture. After the injection of contrast medium radiograms were obtained in adequate positions. Delayed films were obtained when indicated. In 8 cases pelvic and/or ureter tumor was diagnosed. In two cases congenital anomalies were diagnosed, one had complete obstruction at the ureteropelvic junction and the other had complete obstruction at the ureterovesical junction. In the other three cases ureter ligation and in 5 cases ureter stenosis were diagnosed. The quality of the aspirated urine was dark-red in 6 cases, positive cytology, in 6 cases, all of which had pelvic and/or ureter tumors. No severe complications were observed.

1) 150例の再発性・特発性蓚酸カルシウム尿路結石症を対象として, 最低2年間を目標として, アロプリノール投与による結石再発予防の臨床的検討をおこなった.2)検討可能症例134例(男性113例, 女性21例, 平均年齢42.7歳)を, 結石の発生・再発様式により多発型23例とepisode型111例に分類し, 全例について結石の再発・増大の有無を, episode型については統計学的にも治療前後の再発率の検討をおこなった.3)全症例の結石再発・増大に関しては, 多発型23例中19例に再発・増大を認めず, 4例のみに増大を認めた.episode型111例については59例に再発を認めず, 52例に再発を認めた.134例全例を通じては78例(58.2%)に再発または既存結石の増大は認めず, 56例(41.8%)に再発・増大を認めた.4) episode型111例のアロプリノール投与前後の再発率を統計学的に比較した.111例全例の治療前後の再発率, 治療開始時に結石を有しなかった37例の治療前後の再発率, 治療前後2年間ずつの同期間の再発率を比較しえた79例のいずれにおいても, アロプリノール投与により再発率の有意の低下が観察された, We studied the effect of allopurinol on the prevention of stone recurrence in 134 patients with recurrent, idiopathic calcium nephrolithiasis. They consisted of 113 male patients and 21 female, between 16 and 72 years with an average age of 42.7. The patients were divided into two groups according to the type of stone occurrence; those with multiple stones without previous stone episodes (multiple stone group), and the those with recurrent stones (stone episode group). Twenty three patients belonged to the multiple stone group and 111 patients belonged to the stone episode group. The stones in 19 of the 23 patients in the multiple stone group remained stable throughout the study, while stones in 4 grew. Fifty-nine of the 111 patients in the stone episode group were free from recurrence, but the others showed recurrence. Statistical analyses was done on the stone episode group. The stone recurrence rate of all of the 111 cases showed significant decrease during prophylactic treatment with allopurinol (p less than 0.01), although the observation period before treatment was 73.0 +/- 65.8 months and that during and after treatment was 28.2 +/- 12.1 months. During the two years before and after prophylaxis 79 patients also showed a significantly decreased recurrence rate. Moreover, regarding 37 cases without any stones at the start of treatment, stone recurrence rate decreased significantly after the administration of allopurinol. Throughout this study, we used a new method for evaluating reasonable stone recurrence. It did not calculate the number of stones recurred, but the stone-forming circumstance in each kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of 46, Xp+, Y with gonadal dysgenesis is described. The patient was a 14-year-old boy with short status (129 cm) complaint of underdeveloped testicle. IVP and cystourethrogram showed no abnormality. Chromosomal analysis of peripheral lymphocytes revealed 46, Xp+, Y. Histological examination of the specimen obtained by testicular biopsy revealed an immature tubule-like structure without spermatogenesis. Chromosomal study on his mother who was also short status revealed a karyotype of 46, X, Xp+ in peripheral lymphocytes.

1972年1月から10年間の原発性尿管癌24例の臨床的観察をおこなった.1)尿管癌が泌尿器科外来新患患者の0.17%を占めた.2) 41～84歳, 平均年齢は65歳であった.3)男:女は3:1であった.4)左側に多く, 下部尿管1/3に多かった.5)臨床症状は, 肉眼的血尿が19例ともっとも多く, ついで, 腰痛6例であった.6)尿細胞診は, 18例9例が陽性であった.7)膀胱鏡検査では, 腫瘍の尿管口からの突出を4例に認め, ついで尿管口部の隆起を2例に認めた.8)排泄性腎盂造影では, 24例中10例に陰影欠損を認め, 逆行性腎盂造影では10例全例に陰影欠損を認めた.9) CTは9例中4例に腫瘍部に一致しmassを認めた.10)腎尿管全摘除兼膀胱部分切除術あるいは膀胱全摘除術を14例に施行した.11)5年生存率は56.5%で, 予後は, 浸潤度, 悪性度と密接に関係した, A clinical survey was performed on 24 cases of primary ureteral tumors treated in our University Hospital between Jan. 1972 and Dec. 1981. The incidence of primary ureteral tumors was 0.17% among the outpatients in our urologic clinic. The patients ranged from 41 to 84 years old in age (average age: 65 years), and the male to female ratio was 3 to 1. The left ureter and the lower third of the ureter were involved more frequently. The most frequent initial symptom was macrohematuria seen in 19 cases (79%), followed by loin pain seen in 6 cases (25%). A cytologic study of the voided urine or ureteral urine was carried out in 18 cases and positive results were obtained in 9 cases (50%). Cystoscopic examination revealed a tumor protruding through the ureteral orifice in 16.7% (4 of 24 cases), followed by bulging orifice in 8.3% (2 of 24 cases). Excretory pyelography showed ureteral filling defects in 41.7% (10 of 24 cases). Retrograde pyelography showed ureteral filling defects in 100% (10 of 10 cases). CT showed a mass region in 44.4% (4 of 9 cases). A total of 14 patients underwent nephroureterectomy with partial or total cystectomy (66.7%). The overall 5-year-survival rate was 56.5% and could be directly associated with grade and stage of tumors.

We have clinically surveyed the distribution and disk sensitivity of bacterial strains obtained from urine of patients with various urological disease at our department during three (1975-1977) and four (1980-1983) years. Escherichia coli was the most frequently isolated (29.4%) from the outpatients, followed by Staphylococcus epidermidis (17.5%), Pseudomonas cepacia (11.2%) and Serratia marcescens (11.2%). Pseudomonas cepacia was the most frequently isolated (28.0%) from the inpatients, followed by Staphylococcus epidermidis (16.3%) and Serratia marcescens (15.9%). Pseudomonas cepacia which has been increasing was first isolated in 1977 and Serratia marcescens in 1976. They have become the main bacteria causing infections in our hospital. Pseudomonas cepacia was frequently isolated after postoperative prophylactic chemotherapy and Serratia marcescens in the late period of admission. The majority of Pseudomonas cepacia was resistant to all agents except chloramphenicol and doxycycline. Serratia marcescens was also resistant except to gentamicin and doxycycline. In Escherichia coli species, resistant strains increased gradually but they have good sensitivity to gentamicin, dibekacin, colistin and doxycycline. Staphylococcus epidermidis isolated from outpatients had good sensitivity to all agents but increased in incidence of resistant strains isolated from inpatients.

A 63-year-old male was admitted with a complaint of right abdominal mass. A right renal tumor associated with direct invasion to liver and with lobulated cystic lesion and renal solitary cyst were diagnosed preoperatively by aortography and computed tomography. Transperitoneal radical nephrectomy and partial resection of liver metastasis were performed. Histological diagnosis was clear cell carcinoma with dilated tubuli. Tumor invasion to the inferolateral portion of the liver and to the renal solitary cyst wall were demonstrated by both gross and microscopic examinations. The coexistence of tumor and cyst in the same kidney is rare. Our case probably had both the type I and II or III tumors according to Gibson classification. Twenty months after radical nephrectomy, pulmonary metastases were detected by chest x-ray, tomography and bronchial arteriography. All metastatic lesions were replaced by fibrous change 7 months after the four bronchial arterial infusions (BAI) of ADM 30 mg and irradiation with a dose of 5, 000 rads to each lesion. After 9 tumor-free months, recurrence of pulmonary metastases were pointed out by chest x-ray and tomography. They (four coin lesions) were treated with anticancer therapy, mainly irradiation and twice insufficient BAI. Three of them were occupied entirely by fibrous change and another solid one remained in the right pulmonary apex without enlargement for the past 4 months. Radical nephrectomy and partial resection of the liver for the primary renal cell carcinoma with direct invasion to liver, BAI and irradiation for the two pulmonary metastases have kept the patient alive for 4 years.

腎細胞癌58例中18例に腎動脈閉栓術を施行した.18例中初期の10例はADMまたはMMCをone shot injection後にGelfoam, steel coil (G群)を, 最近の8例はabsolute ethanol (A群)を用い塞栓した.1) A群は塞栓物質注入直後に激痛(6/8, 75%)をきたすが帰室後は自制可能であった.G群の直後はほとんど疼痛を訴えないが徐々に強くなり嘔気, 嘔吐をともない, そのために手術を早めざるをえなかった.2)発熱はA群の方がG群より有意に高かった.3) WBC, GOT, GPT, LDHは塞栓2～3日後に一過性の高値を示すが両群間に有意差はなかった.γ-GTP, ALPは緩徐に上昇傾向を示した.4)寄生動脈の豊富な, または局所浸潤があきらかな腎細胞癌には塞栓効果はあまり期待できない.5)組織学的に腫瘍組織と正常腎組織の梗塞性変化はA群の方が強く, 塞栓物質はabsolute ethanolの方がすぐれている.6)高度な梗塞性変化は病理組織診断を困難にすることもある.7)塞栓術は腎細胞癌の予後に好影響はなかった.8)塞栓術は手術操作(腎茎処理)を容易にするが, 単にその目的に絞れば塞栓物質は必ずしも多量を要しない, Renal arterial embolization is often used in the treatment of patients with renal cell carcinoma, either preoperatively to facilitate nephrectomy or as palliative therapy in advanced cases. Eighteen patients (18/58; 31%) underwent renal arterial embolization in our department since 1979, initial 10 cases with Gelfoam and steel coil (group G) and recent 8 cases with absolute ethanol (group A). Clinical studies of daily changes of symptoms and blood chemistry in both groups after embolization were compared and the results were as follows: Severe flank pain was noted immediately after embolization but thereafter well controlled without analgesics in group A. The patients in group G experienced no pain during the procedure of embolization but have had moderate flank pain of two or three days' duration with nausea and/or vomiting and required surgical procedure within a few days after embolization. Post embolization fever in group A was described as higher than that in group G significantly. Leukocytosis was noted to be persistent for up to seven days and blood chemistry showed transient marked elevations of GOT, GPT and LDH immediately after the procedure without significant value in both groups. Embolization to advanced tumor with many parasitic vessels or massive local invasion may not always be available for remaining of viable-appearing tumor cells in venous lumen, as if palliative treatment. Absolute ethanol may be more useful as the embolizing substance than Gelfoam and steel coil by reason of producing wide severe infarction of diseased kidney. Broad marked infarction due to renal arterial embolization may make pathological diagnosis difficult. Immunological effects of renal arterial embolization were not observed in short term patients survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-five of 34 patients who underwent pyeloplasty operation for ureteropelvic junction obstruction were able to be followed up for three months or more after operation. Postoperative results were compared in twenty-six kidneys of these patients according to clinical conditions such as age, duration of indwelling nephrostomy tube and splint catheter, operative method (one-stage or two-stage operation), preoperative urinary tract infections, preoperative grade of hydronephrosis and the postoperative period evaluated. Postoperative results evaluated at three months after operation, revealed no case with excellent improvement. At 36 months after operation excellent improvement rate was 46.7% and there was a significant difference in excellent improvement rate between these times. At 3, 6, 12 and 36 months after operation, improvement rate was 35.7, 55.0, 52.9 and 86.7%, respectively. At 3 and 6 months or more, deterioration rate was 29 and 0%, respectively. It is concluded that evaluation of pyeloplasty should be done at least 6 months after operation and even if renal function is stable at this period, more improvement in renal function can be expected at one year or more after operation.

偏側閉塞腎盂内薬剤(アミカシン)移行濃度を測定した.対象患者は9名で, 原疾患は尿管結石8例, 手術による一側尿管結紮1例であった.全例, 硫酸アミカシン100 mg静注後6時間で手術的に閉塞腎盂内尿を全量採取し一部を検体とした.硫酸アミカシン100 mg静注後30, 60, 120, 240, 360分と血液を採取, 正常側は膀胱尿とし2時間ごとに採取し, それぞれ濃度を測定した.血中・尿中アミカシン濃度はAMES TDDキットを用いSubstrate-Labeled Fluorescent Immuno-Assay法で測定した.尿中濃度は測定範囲を超えるため緩衝液で10～15倍に希釈し測定した.1)血中濃度は30分で8.8±1.0 mcg/mlと最高濃度を示し, 以後漸減した.2)健側腎からの各2時間ごとの尿中濃度はそれぞれ155.9±45.4 mcg/ml, 98.8±35.6 mcg/ml, 83.3±33.8 mcg/mlで, 閉塞腎盂尿中濃度は6時間尿とし118.9±52.3 mcg/mlであった.3)尿中排泄量は健側腎からの各2時間尿でそれぞれ28.3±3.4 mg, 9.6±3.6 mg, 9.3±3.5 mgで, 閉塞腎盂内尿中排泄量は16.8±3.0 mgであった.4) 1回100 mgアミカシン投与は閉塞腎感染予防の目的には有効と考えるが, 感染発生時には少なくとも200 mgの投与が必要と考える, Urinary amikacin concentration was determined in 9 patients with severely unilateral ureteral obstruction. Serum levels were within the normal range. The average concentration of amikacin in the urine from obstructed urinary tract was 118.9 mcg/ml 6 hours after 100 mg amikacin iv infusion. Urine concentration from the normal kidney was 155.9 mcg/ml at the first 2 hours after intravenous infusion, 98.8 at the second 2 hours 83.3 at the third 2 hours. Urinary amikacin excretion from severely obstructed urinary tract was about one third of the total excretion from a normal system. In summary, the urinary level in severely obstructed urinary tract after iv infusion of 100 mg amikacin may be enough prophylactically. But at the onset of infection in severely obstructed urinary tract, the administration of at least 200 mg amikacin intravenously is required.

A case of soft vesical calculi is reported. A 72-year-old male, visited our clinic complaining of discharge of white muddy substance. KUB film revealed calcification in the vesical region. Urinalysis showed UTI, and culture of urine was positive for Proteus mirabilis. Thereafter, the patient suffered from discharges of similar calculi several times. Two of three infrared spectroscopic charts showed mixture of calcium phosphate and ammonium hydrogen urate and that of the remaining disclosed magnesium ammonium phosphate. An alcian blue-PAS double staining of this calculus revealed the presence of acid and neutral glycosaminoglycans, and bacterial colonies. These calculi were thought to be different from the so called 'matrix calculi'.