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肥満, 腰痛を呈した43歳女で, 血漿コルチゾール値は正常で, ACTH値は低下していた.両側副腎静脈血中コルチゾール値は著明に上昇していた.CTで両側副腎腫大を認めた.131I-adosterolシンチグラム上, 右側にのみ強い取り込みを認めた.右副腎全摘によりクッシング症候群は寛解し, 病理診断は直径3.5cmの副腎皮質腺腫であった.9年でクッシング症候群が再発し, 3cmの副腎皮質腺腫を含む左副腎亜全摘を行った.経口ステロイド補充で術後回復は順調であった, A 43-year-old woman presented with obesity and lumbago. Endocrinological examinations revealed normal plasma cortisol levels and a suppressed serum adrenocorticotropic hormone (ACTH) level. On venous sampling, markedly elevated plasma cortisol levels were observed for bilateral adrenal veins (243 and 62.3 micrograms/dl on the right and left sides, respectively). Although the computed tomogram revealed bilaterally enlarged adrenal glands, 131I-adosterol scintigram showed a strong uptake only on the right side. Right adrenalectomy successfully relieved Cushing's syndrome. Pathological diagnosis was adrenocortical adenoma, 3.5 cm in diameter. Cushing's syndrome recurred in 9 years. At that time, she underwent left subtotal adrenalectomy including a 3-cm adrenocortical adenoma. Postoperative convalescence has been uneventful with oral steroid supplementation. All 14 previously reported cases of bilateral adrenocortical adenoma (BAA) causing Cushing's syndrome as well as the present case were concurrent and dominant in females of reproductive age. This suggests that some cofactors other than ACTH, such as estrogen, contribute to the pathogenesis of BAA.

前立腺癌症例の内分泌療法に伴う血中PSAの変化をfree PSAとtotal PSAに分け検討した.治療開始後3～4ヵ月のPSAの減少率はfree PSAよりもtotal PSAで大きいことが示された.即ち内分泌療法に伴うPSAの減少はfree PSAよりもcomplex PSAで大きいことが示された, The post-diagnostic changes in the free to total PSA ratio in the serum of patients with prostate carcinoma, after the initiation of endocrine treatment were examined. Two-week pretreatment with either chlormadinone acetate (100 mg/day) or flutamide (375 ng/day) was administered orally to 14 patients with newly diagnosed advanced prostate carcinoma (clinical stage was C in 2, Dl in 1 and D2 in 11). Then the LH-RH analogue was injected. Total and free PSA in the serum of these patients were measured every 4 weeks by the Ab bead PSA (Eiken) and the recently developed assay for free PSA by Eiken, respectively. The follow-up period ranged from 3 to 9 months with a median of 6 months. Levels of both total and free PSAs decreased significantly following the endocrine treatment, while free to total PSA ratio at 4 to 16 weeks after the start of LH-RH analogue was increased significantly compared to the pretreatment level (p < 0.05). These findings suggest that the rate of decrease of complex PSA during the first 4 months after the beginning of treatment may exceed that of free PSA in the serum of patients with advanced prostate carcinoma initially treated with endocrine therapy.

PSAの免疫認識の点からモノクローナル抗体・モノクローナル抗体の組み合わせ, モノクローナル抗体・ポリクローナル抗体の組み合わせ, ポリクローナル抗体・ポリクローナル抗体の組み合わせとし, Delfia法, ACS法, Eiken法をこれらの代表的キットとして検討した.PSAの血中存在様式であるfree PSAとACT-PSAの免疫認識にキット間で大きな違いがあること, free PSAとACT-PSAの比率が僅か3症例であるが症例間で大きく異なることが示された.前立腺癌の診断及びモニター上血中PSAを, total PSA値のみならずfree PSAとACT-PSAの存在様式別にも表現しておくことが重要である可能性を示唆した, To study immunorecognition of free type and complex type prostate-specific antigen (PSA) by current commercial PSA assays, sera from 3 patients with stage D2 prostate cancer were separated by Sephacryl S-200 chromatography and determined by Delfia PSA, ACS-PSA and Eiken PA kits. Two antibodies used in the 3 kits are 2 monoclonal, 1 monoclonal and 1 polyclonal and 2 polyclonal antibodies, respectively. Following chromatography, two PSA peaks were obtained in all patients. One was about 100 kDa and the other about 30 kDa. The former was considered to be the complex type PSA (complex with alpha-1 antichymotrypsin) and the latter to be free type PSA. As to free type PSA, the ACS-PSA kit and Eiken PA kit quantitated PSA values approximately 5.1 and 2.5 times higher than the Delfia PSA kit. For complex type PSA, the quantity determined by ACS-PSA kit was approximately 1.3 times higher than that determined by the Delfia PSA kit, while the quantity determined by the Eiken PA kit was about one third of that determined by Delfia PSA kit. The ratio of complex type PSA to total PSA (free type PSA + complex type PSA) was 74.8 +/- 14.9% (mean +/- SD) when determined by Delfia PSA kit, 59.3 +/- 18.4% by ACS-PSA kit and 52.9 +/- 13.8% by Eiken PA kit. The range of this ratio determined by ACS-PSA kit was from 47.3% to 80.5% in the 3 patients. These findings suggest that there are qualitative differences in immunorecognition of free type PSA and complex type PSA among current commercial PSA assays and that there are quantitative differences in the ratio of the 2 forms of PSA in serum among prostatic cancer patients. The measurement and follow-up of both free type and complex type PSA might be important for diagnosis and monitoring of prostate cancer.

67歳男性.高血圧, 糖尿病の精査のため施行された腹部CTで後腹膜腫瘍を疑われ, その精査目的で受診した.腹部超音波検査では左腎腹側に均一な腫瘤を認め, 腹部CTでは同部に造影されない腫瘤を認めた.腹部MRIではT1強調画像で腫瘤は低信号, T2強調画像では不規則な高信号を呈していた.腹部血管造影では, 腫瘍は血管に乏しかった.以上より, 後腹膜腫瘍と診断し, 経腹膜的に手術を施行した.腫瘍は周囲から比較的容易に剥離できた.摘出標本の病理組織学的所見より, 後腹膜神経節細胞腫と診断された.悪性所見は認められなかった, 術後2週間目には軽快退院した, A 67-year-old male presented for examination of a retroperitoneal tumor, incidentally found by abdominal computed tomography (CT). CT and magnetic resonance imaging (MRI) revealed a round heterogeneous tumor, 10 cm in diameter, at the left renal hilus and involving the left renal vein. The tumor was low-intensity on T1-weighted MRI imaging, and high-intensity on T2-weight MRI imaging. The tumor was easily resected via a transabdominal approach. The pathological diagnosis was ganglioneuroma.

A 67-year-old male presented for examination of a retroperitoneal tumor, incidentally found by abdominal computed tomography (CT). CT and magnetic resonance imaging (MRI) revealed a round heterogeneous tumor, 10 cm in diameter, at the left renal hilus and involving the left renal vein. The tumor was low-intensity on T1-weighted MRI imaging, and high-intensity on T2-weight MRI imaging. The tumor was easily resected via a transabdominal approach. The pathological diagnosis was ganglioneuroma.

A 43-year-old woman presented with obesity and lumbago. Endocrinological examinations revealed normal plasma cortisol levels and a suppressed serum adrenocorticotropic hormone (ACTH) level. On venous sampling, markedly elevated plasma cortisol levels were observed for bilateral adrenal veins (243 and 62.3 micrograms/dl on the right and left sides, respectively). Although the computed tomogram revealed bilaterally enlarged adrenal glands, 131I-adosterol scintigram showed a strong uptake only on the right side. Right adrenalectomy successfully relieved Cushing's syndrome. Pathological diagnosis was adrenocortical adenoma, 3.5 cm in diameter. Cushing's syndrome recurred in 9 years. At that time, she underwent left subtotal adrenalectomy including a 3-cm adrenocortical adenoma. Postoperative convalescence has been uneventful with oral steroid supplementation. All 14 previously reported cases of bilateral adrenocortical adenoma (BAA) causing Cushing's syndrome as well as the present case were concurrent and dominant in females of reproductive age. This suggests that some cofactors other than ACTH, such as estrogen, contribute to the pathogenesis of BAA.

The post-diagnostic changes in the free to total PSA ratio in the serum of patients with prostate carcinoma, after the initiation of endocrine treatment were examined. Two-week pretreatment with either chlormadinone acetate (100 mg/day) or flutamide (375 ng/day) was administered orally to 14 patients with newly diagnosed advanced prostate carcinoma (clinical stage was C in 2, Dl in 1 and D2 in 11). Then the LH-RH analogue was injected. Total and free PSA in the serum of these patients were measured every 4 weeks by the Ab bead PSA (Eiken) and the recently developed assay for free PSA by Eiken, respectively. The follow-up period ranged from 3 to 9 months with a median of 6 months. Levels of both total and free PSAs decreased significantly following the endocrine treatment, while free to total PSA ratio at 4 to 16 weeks after the start of LH-RH analogue was increased significantly compared to the pretreatment level (p < 0.05). These findings suggest that the rate of decrease of complex PSA during the first 4 months after the beginning of treatment may exceed that of free PSA in the serum of patients with advanced prostate carcinoma initially treated with endocrine therapy.

To study immunorecognition of free type and complex type prostate-specific antigen (PSA) by current commercial PSA assays, sera from 3 patients with stage D2 prostate cancer were separated by Sephacryl S-200 chromatography and determined by Delfia PSA, ACS-PSA and Eiken PA kits. Two antibodies used in the 3 kits are 2 monoclonal, 1 monoclonal and 1 polyclonal and 2 polyclonal antibodies, respectively. Following chromatography, two PSA peaks were obtained in all patients. One was about 100 kDa and the other about 30 kDa. The former was considered to be the complex type PSA (complex with alpha-1 antichymotrypsin) and the latter to be free type PSA. As to free type PSA, the ACS-PSA kit and Eiken PA kit quantitated PSA values approximately 5.1 and 2.5 times higher than the Delfia PSA kit. For complex type PSA, the quantity determined by ACS-PSA kit was approximately 1.3 times higher than that determined by the Delfia PSA kit, while the quantity determined by the Eiken PA kit was about one third of that determined by Delfia PSA kit. The ratio of complex type PSA to total PSA (free type PSA + complex type PSA) was 74.8 +/- 14.9% (mean +/- SD) when determined by Delfia PSA kit, 59.3 +/- 18.4% by ACS-PSA kit and 52.9 +/- 13.8% by Eiken PA kit. The range of this ratio determined by ACS-PSA kit was from 47.3% to 80.5% in the 3 patients. These findings suggest that there are qualitative differences in immunorecognition of free type PSA and complex type PSA among current commercial PSA assays and that there are quantitative differences in the ratio of the 2 forms of PSA in serum among prostatic cancer patients. The measurement and follow-up of both free type and complex type PSA might be important for diagnosis and monitoring of prostate cancer.

1987年3月10日より5月28日までに46症例, 66回のEMLを施行したのでその治療成績より臨床的検討を行った.EMLは, 1)無麻酔でできる非観血的手術である.2)再手術例や外科的手術で問題のある全身疾患を有する人でも可能なことが多い.3)特に術前・術後の併用処置を必要としないため外来でも治療が受けられると考える, A total of 46 cases underwent 66 treatments with extracorporeal microexplosive lithotripsy (EML) for upper urinary tract calculi between March 10, 1987 and May 28, 1987. The efficacy of EML therapy was investigated in all cases over 3 months. The lithotripter of EML made by the Yachiyoda Co. Ltd (SZ-1) was adapted to a microexplosion (10 mg silver azide) as the source of energy for underwater shock wave generation. Fifteen cases (32.6%) had a history of previous open lithotomy of the same upper urinary tract as being treated by EML. Pre-treatments with ureteral catheters and ureteral stents were performed in 4 and 4 cases (8.7% and 8.7%), respectively. The microexplosions were conducted in syncronization with patient exhalation from 100 to 400 times during 1 session, depending upon the size of the stone. The patients felt pressure only on their back at the pulse of explosion and complained occasionally a dull pain, but this pain was mild and tolerable, and no patients required anesthesia. When stone disintegration was judged to be unsatisfactory, that is the stone remained unfragment or the size of the residual stone fragments was greater than 5 mm., an additional session was performed, usually 1 week after the previous session. On the X-ray film obtained three months after EML treatment, 26 cases (57%) were completely free from stone concerments, 17 cases (37%) had stone fragments of equal to or less than 5 mm and 3 cases (6%) had ones of greater than 5 mm. Treatment of EML alone was performed in 44 cases (96%), while 2 cases (4%) required transurethral stone manipulation following EML.(ABSTRACT TRUNCATED AT 250 WORDS)

A total of 46 cases underwent 66 treatments with extracorporeal microexplosive lithotripsy (EML) for upper urinary tract calculi between March 10, 1987 and May 28, 1987. The efficacy of EML therapy was investigated in all cases over 3 months. The lithotripter of EML made by the Yachiyoda Co. Ltd (SZ-1) was adapted to a microexplosion (10 mg silver azide) as the source of energy for underwater shock wave generation. Fifteen cases (32.6%) had a history of previous open lithotomy of the same upper urinary tract as being treated by EML. Pre-treatments with ureteral catheters and ureteral stents were performed in 4 and 4 cases (8.7% and 8.7%), respectively. The microexplosions were conducted in syncronization with patient exhalation from 100 to 400 times during 1 session, depending upon the size of the stone. The patients felt pressure only on their back at the pulse of explosion and complained occasionally a dull pain, but this pain was mild and tolerable, and no patients required anesthesia. When stone disintegration was judged to be unsatisfactory, that is the stone remained unfragment or the size of the residual stone fragments was greater than 5 mm., an additional session was performed, usually 1 week after the previous session. On the X-ray film obtained three months after EML treatment, 26 cases (57%) were completely free from stone concerments, 17 cases (37%) had stone fragments of equal to or less than 5 mm and 3 cases (6%) had ones of greater than 5 mm. Treatment of EML alone was performed in 44 cases (96%), while 2 cases (4%) required transurethral stone manipulation following EML.(ABSTRACT TRUNCATED AT 250 WORDS)