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第30回アストロダイナミクスシンポジウム (2020年7月20-21日. オンライン開催), The 30th Workshop on JAXA Astrodynamics and Flight Mechanics 2020 (July 20-21, 2020. Online Meeting), 資料番号: SA6000158006, レポート番号: A-6

We investigated the optimum initial dose and timing of administration of α1A-adrenoceptor antagonist silodosin for treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH/LUTS). Ninety-eight patients were given a 4 mg dose after breakfast (group A), 4 mg after supper (group B), or 4 mg after breakfast and after supper (group C). At baseline, 4, 8 and 12 weeks after treatment, we assessed International Prostate Symptom Score (IPSS) and quality of life (QOL) index. Twenty-five percent or less improvement of total IPSS and no improvement of QOL index compared with baseline were defined as treatment failure at each evaluation point. Otherwise treatment was considered effective. In group A and group B, patients with treatment failure at 4 or 8 weeks after treatment, the dose of silodosin was increased to 8 mg daily. At the end of the study, 83 patients were evaluable. At 12 weeks after treatment, 20 of the 31 patients in group A and 22 of the 29 patients in group B remained on the 4 mg dose ; silodosin was effective in 65 and 76% of the patients, respectively. When patients with dose escalation were included, silodosin was effective in 81 and 90% of the patients, respectivery. Silodosin was effective in 18 of the 23(78%) patients in group C, although improvement of total IPSS and voiding symptom score of IPSS at 12 weeks after treatment was better in group C than in group A or group B, the difference was not significant. In patients with IPSS less than 20, the degree of improvement of IPSS was similar among the 3 groups. In contrast, in patients with IPSS of 20 or greater the degree of improvement was better in group C than in group B or group C, but the difference was not significant. Storage symptom score of IPSS was significantly improved in all 3 groups without any significant difference among the 3 groups. Three patients (52, 59 and 76 years old) experienced abnormal ejaculation. In conclusion, 4 mg of silodosin daily showed effectiveness against BPH/LUTS, but 8 mg of silodosin daily might be better for patients with severe LUTS.

著者らは27名の健常者と138名の慢性透析患者を対象として, whole PTH(W-PTH), intact PTH(I-PTH), PTH ratio(PTH1-84とnon 1-84 PTHの比)を測定または算出し, 骨型ALP(BAP)やインタクトオステオカルシン(BGP-I)などの血中骨代謝マーカーと比較した.また, 2次性副甲状腺機能亢進症により副甲状腺全摘出術(PTx)を受けた10名の患者を対象として, 手術前後の各パラメーターの変化について検討し, W-PTH, PTH ratioの有用性を検討した.その結果, 1)健常者と透析患者の両群でW-PTHとI-PTHの間には非常に強い相関を認めた(p, For measurement of parathyroid hormone (PTH), the intact PTH (I-PTH) assay is generally used. However, I-PTH assay apparently detects PTH 7-84 fragments, in addition to PTH 1-84. The whole PTH (W-PTH) assay exhibits no cross-reactivity with PTH 7-84. Ratio of PTH 1-84 to non-(1-84) PTH has been proposed as a non-invasive indicator of bone turnover in patients with end-stage renal disease (ESRD). We evaluated the efficacy of W-PTH assay and 1-84/non-(1-84) PTH ratio in hemodialysis patients and patients who had undergone parathyroidectomy. PTH levels were measured using W-PTH and I-PTH assays in 138 hemodialysis patients, 27 healthy controls and 10 patients who were scheduled to undergo parathyroidectomy for secondary hyperparathyroidism. Alkaline phosphatase, bone alkaline phosphatase and intact osteocalcin were also measured for comparison with 1-84/non-(1-84) PTH ratio. W-PTH was strongly correlated with I-PTH in both groups, and with all three bone metabolic markers in hemodialysis patients. In hemodialysis patients, both PTH and bone metabolic markers were significantly lower in the subgroup with a PTH ratio or = 1.0. However, PTH ratio exhibited no significant correlation with bone metabolism markers. PTH ratio was higher after parathyroidectomy than before. W-PTH and I-PTH assays offer identical indicators of bone metabolism in ESRD patients. However, 1-84/non-(1-84) PTH ratio may be of limited diagnostic use regarding bone turnover if a cut-off value of 1.0 is used. PTH 1-84 may be secreted relatively more than non-(1-84) PTH after parathyroidectomy, due to decreases in serum calcium. As the W-PTH assay allows easy calculation of non-(1-84) PTH by subtracting the I-PTH value, this assay contributes to identification of the function of non-(1-84) PTH fragments in various conditions.

射精管の異常拡張を呈する男性不妊症の2例。経尿道的な精丘部の切開によって1例に精液所見の改善をみ妊娠にも成功した, Two cases of male infertility with pathological dilatation of ejaculatory duct are reported. In both cases, the dilatated wall of the ejaculatory duct was incised at the vermontanum with a cold knife endoscopically. After the incision, the findings of semen analysis of one case improved markedly and his wife became pregnant. In another case, semen analysis was not improved. Transurethral incision seemed to be a useful modality for the treatment of pathological dilatation of ejaculatory duct.

68歳男, 血液透析患者。acyclovir投与により, 中枢神経系の著明な副作用を経験した。すみやかな血液浄化療法による対処により短期間で症状を改善することができた, A case of renal failure in a patient with severe central nervous system symptoms during oral acyclovir medication is reported. A 68-year-old man maintained on hemodialysis was given oral acyclovir 4, 000 mg daily in divided doses because of herpes zoster affecting the left C3/5 dermatomes. He had vomiting and confusion 36 hours after administration. He had no focal neurological signs. The symptoms resolved 4 days after cessation of acyclovir administration and blood purification every day. Because of its high therapeutic index the use of acyclovir is associated with few side effects. In patients with renal failure the half-life of acyclovir is prolonged, this report indicates the importance of adhering to the dosage reductions in patients with renal failure.