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Various types of tumors, including benign tumors, arise from the renal parenchyma or renal capsule, but it is difficult to predict the histological type preoperatively. Here, we report a case of perirenal non-specific lymphadenitis resected laparoscopically. A 79-year-old man with a history of diabetic mellitus and noninvasive bladder cancer had an incidentally-detected enhanced mass in contact with the surface of the left kidney. Given the possibility that the tumor was malignant, we resected the mass laparoscopically. Intraoperative findings revealed that the tumor did not invade the renal parenchyma, and it could be easily resected. Microscopic findings showed that the tumor consisted of inflammation of a lymph node, lymphoid follicles with hyperplasia of germ center and granulomatous inflammation with giant cells, and there was no malignant finding. Despite various additional examinations, the specific cause of the lymphadenitis was not clarified, leading to a final diagnosis of non-specific lymphadenitis. To our knowledge this is the first report about perirenal non-specific lymphadenitis difficult to distinguish from perirenal malignant tumor in preoperative computed tomography imaging.

We report a case of renal arteriovenous fistula, which was found during treatment for pyelonephritis. A 61-year-old woman was referred to our hospital because of lumbar backache and infectious fever. The computed tomographic scan showed right hydronephrosis and perinephritis. We treated her conservatively for pyelonephritis, but 5 days later, the contrast-enhanced computed tomographic scan showed retroperitoneal hemorrhage. Renal angiography demonstrated an arteriovenous fistula in the central portion of the right kidney. Superselective transcatheter arterial embolization of the AVF was performed. Hemostasis was possible by embolization. She has not had any recurrence of renal arteriovenous fistula. To our knowledge, this is the 5th report of a rupture in the retroperitoneum of an arteriovenous fistula, and renal arteriovenous fistula with the pyelonephritis is very rare.

A retrospective analysis was done on the outcomes of 278 patients who underwent radical prostatectomies at our institutions from November, 1994 to April, 2006. The treatment outcomes measured were disease-specific survival and prostate specific antigen (PSA) biochemical failure-free survival rates. Univariate and multivariate analyses were performed on patient age, clinical T-stage, Gleason sum at the time of prostate biopsy, PSA value before treatment, and any patient history of neoadjuvant hormone therapy. For all patients, the overall survival and the disease-specific survival rates at 10 years were 96.3 and 99.3%, respectively, with PSA biochemical failure-free survival rates at 5 and 10 years of 67.9 and 55.1%, respectively. On multivariate analysis, both the PSA values (> 20 ng/ml) and Gleason sums (> or = 7) were statistically significant independent risk factors for PSA biochemical failure after radical prostatectomy. Neoadjuvant hormone therapy was found to have no effect on PSA biochemical failure.

ウロカルンの新製剤である小型化錠と従来製剤(0号硬カプセル剤)との臨床的同等性試験を実施した.体外衝撃波結石破砕術後, 腹部超音波断層法により残石が確認された腎結石症例を対象とした.小型化錠群40例, カプセル群40例の2群に無作為に分けて, 腹部超音波断層法および腎尿管膀胱部単純X線撮影(KUB)を用いて, 排石効果の有効性, 安全性について評価した.治験薬投与期間は最大12週間とした.その結果, 両投与群とも有効率は70%であり, 完全排石率は小型化錠群で35%, カプセル群で42.5%であった.腹部超音波断層法では有効率の経時的な上昇を示し, 治験薬投与終了あるいは中止時におけるKUBでは両投与群とも有効率, 完全排石率が82.5%であった.副作用は, 下痢が各群に2例ずつ, 口渇1例, 肝機能異常1例を小型化錠群に認めた.服薬アンケート調査より, 小型化錠はカプセルと比較して小さく, 服用しやすいということが示唆された.ウロカルン小型化錠は従来製剤と同等の排石効果を有し, 安全性においても特に問題となる副作用は認めなかった, We performed a clinical trial on patients with upper urinary tract stone disease (renal stone disease) to prove the clinical equivalence as the target for removal of renal stones between the new formulation (miniaturized tablet) and the conventional formulation (capsule) of UROCALUN. The clinically effective rate of both formulations was the same at 70% (28 of 40 cases), and it was suggested that these two formulations possess the same clinical efficacy. Adverse drug reactions were observed in 10.0% (4 of 40 cases) with the tablet and 5.0% (2 of 40 cases) with the capsule. There were no significant differences between the two formulations in the incidence of adverse drug reactions, and there were no clinically significant safety problems. In the questionnaire survey for patients about medication compliance, we found that the patients felt the miniaturized tablets were much easier to swallow than the conventional formulation. In conclusion, it is suggested that the miniaturized tablet contributes to improve the medication compliance for patients and thus it is expected to improve the clinical efficacy.

再発危険因子検索のため, pTa33例とpTl46例の膀胱癌患者にKi-67, c-erbB-2, p53と多薬剤耐性蛋白(MRP)を免疫組織化学的に検討した.その結果, pTl, 広基性, 腫瘍径の大きな腫瘍(>3cm)の再発率は高かった.また, Ki-67, c-erbB-2, p53の過剰発現症例の再発率は, 有意に高かったが, MRP発現と再発とは関連がなかった.多変量解析では, 腫瘍径の大きな腫瘍とKi-67高発現が再発の独立した予後因子であった.腫瘍径が1cm未満の症例の再発は, Ki-67およびp53過剰発現が関連した.Ki-67高発現により, grage2.pTlおよび単発腫瘍において, 再発の高い症例を識別できた.このことより, 増殖関連蛋白を臨床病理因子に加えることにより, 重要な予後を規定する情報となることを示しており, Ki-67高発現が信頼しうる再発予後因子であると考えられた, The current clinicopathologic study for evaluation of superficial bladder cancer still has limitations in predicting the true behavior of recurrence. To determine the high-risk recurrence factors, we studied the influence of Ki-67, c-erbB-2, p53 and multidrug resistance-associated protein (MRP) expression. Samples were obtained from 33 pTa and 46pT1 diagnosed bladder cancer patients with a mean follow-up of 48.7 +/- 30.6 months. The contingency table method, Kaplan-Meier curve and multivariate analysis were used to evaluate the association among the immunohistochemical factors expression, clinicopathologic parameters with tumor recurrence. Stage pT1 tumors, sessile tumors and large tumors (> 3 cm) showed a significantly high recurrence rate (p = 0.0158, p = 0.0162, p = 0.0001 respectively). Tumors with overexpression of Ki-67, c-erbB-2 and p53 were more likely to recur (p = 0.0035, p = 0.0027, p = 0.0076 respectively), MRP expression was not associated with recurrence. Multivariate analysis showed that large tumors and high Ki-67 expression were independent indicators of recurrence. On the other hand, in tumors less than 1 cm, recurrence was significantly correlated with overexpression of Ki-67 and p53. High Ki-67 expression could discriminate higher recurrence cases in grade 2, pT1 and single tumors. The c-erbB-2 overexpression was more frequently associated with recurrence in sessile tumors, large tumors, multiple and grade 1 tumors. The p53 overexpression also predicted a higher risk of recurrence in pTa tumors. These data demonstrated that the use of proliferative related proteins yields significant prognostic information in addition to clinicopathological factors, high Ki-67 expression is a reliable indicator of recurrence. A combination rather than any factor alone could more accurately predict tumor recurrence.

長期臥床高齢者で, 膀胱結石が下降して嵌頓した女性尿道結石を2例経験した.1例は婦人科の内診の際に前膣壁から腫瘤を触れ, 1例は寮母がオムツ内の肉眼的な血尿に気づいたことが発見の端緒であった.痴呆, 精神障害, 麻痺があると症状を自覚できなかったり訴えることができず, 診断の遅れが膀胱結石の成長, 女性では珍しい尿道への嵌頓につながったものと推測された.長期臥床者の尿路感染症や血尿を診る際, 結石の可能性を念頭に置くことが早期診断のために必要と考えられた, A 78-year-old female suffering from a cerebral infarction and subdural hematoma was referred to us due to a hard mass in the anterior vaginal wall which was disclosed during gynecological examination. An abdominal X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) showed that a large spindle-shaped stone, 60 x 42 mm in size, was impacting the urethra. It was impossible to catheterize the urethra. The stone gradually projected through the external urethral meatus and was removed by grasping and drawing with forceps. Another 83-year-old female with senile dementia was referred to us because of macrohematuria. An abdominal X-ray and CT showed the presence of two oval bladder stones, 32 x 24 mm and 30 x 21 mm in size. During a follow-up, one of the stones projected partially through the external urethral meatus and was removed by drawing with forceps. After a week, the other stone impacted the urethra and was removed in the same way. Both women were frail, bedridden institutionalized elderly with severe dementia, and their urination had been managed with diapers for years. As the proportion of elderly people in Japan rapidly increases, female urethral stones migrating from the urinary bladder, once very rare, may increase in number, to which we must pay attention.

筆者らの施設において過去11年間に治療した新鮮前立腺癌107症例について検討した.初診時年齢は53～89歳に分布し, 平均70.8±8.0歳で, 年齢分布は50歳代7例, 60歳代40例, 70歳代43例, 80歳代17例であった.初診時のstageは, stage A 3例, stage B 19例, stage C 50例, stage D 35例であり, 組織学的分化度は, 高分化型腺癌 26例, 中分化型腺癌 47例, 低分化型腺癌 34例であった.stage別の5年生存率はB 93.8%, C 82.1%, D 56.9%でCとDの間には有意差を認めた.病理組織別5年生存率は高分化型腺癌100%, 中分化型腺癌78.0%, 低分化型腺癌53.2%で高分化型と低分化型の間には有意差が認められた.病理組織別5年非再燃率は高分化型腺癌100%, 中分化型腺癌64.9%, 低分化型腺癌44.5%で高分化型と中分化型の間, 高分化型と低分化型の間には有意差が認められた.stage C症例における手術施行例と手術非施行例の5年生存率, 5年非再燃率に有意差を認められなかった, One hundred and seven patients with prostate cancer were treated at Mie University Hospital during the past 12 years between 1988 and 1999. They were between 53 and 83 years old, with an average age of 70.8 years old. The clinical stage was defined as A, B, C and D in 3 (2.8%), 19 (17.8%), 50 (46.7%) and 35 (32.7%) patients, respectively. At initial diagnosis, the tumor was well, moderately and poorly differentiated adenocarcinoma in 26 (24.3%), 47 (43.9%) and 34 (31.8%) patients, respectively. The median follow-up period was 52.3 months. The overall 1, 3 and 5-year survival rates were 98.0%, 86.8% and 75.2%, respectively. The 5-year survival rates for stage A, B, C and D were 100%, 93.8%, 82.1% and 56.9%, respectively. A significant difference (p = 0.017) in 5-year survival rate was noted between stage C and D. The 5-year survival rate was 100% for well differentiated, 78.0% for moderately differentiated, and 53.2% for poorly differentiated adenocarcinoma. A significant difference (p = 0.0016) in the 5-year survival rate was noted between well differentiated and poorly differentiated adenocarcinoma. According to the therapy, the 5-year survival rate in stage C was 86.2% for the radical prostatectomy group and 84.0% for the endocrine therapy group. There was no significant difference between these 2 treatment groups. Endocrine therapies, classified into maximum androgen blockade (MAB) and endocrine therapy other than MAB were performed for stage D as an initial therapy. Although the prognosis in the patients treated with MAB was better than that with other endocrine therapies, there was no significant difference between these 2 endocrine treatment groups.

症例は24歳男性で, 10歳時に左仙腸関節部横紋筋肉腫にて腫瘍摘出術を施行し, 残存腫瘍に対して27ヵ月に亘っての全身化学療法(Vincristine[VCR]/ActinomycinD[ACD]/Cyclophosphamide[CPM]/Doxorubicin[DXR])を受け寛解し, その後再発は認めていない.抗癌剤の総投与量はCMP 43.4g, VCR 21.6mg, ACD 16.9mg, DXR 486mgであった.2ヵ月ほど前から排尿時痛を認め, 近医にてクラミジア尿道炎の診断で投薬を受けたが軽快せず, 静脈性腎盂造影にて左腎盂に欠損像を認めたため精査加療目的で紹介来院した.左腎盂造影で陰影欠損像が認められ, 腎盂尿の細胞診はclass Iであった.腹部CT・MRI所見からCPM投与による二次性発癌の左腎盂腫瘍と考え, 左腎尿管全摘徐術を施行した.摘出腎の割面において腎盂より隆起する37×29mmの非乳頭状広基性腫瘍を認めた.術後補助化学療法は施行せず経過観察中であるが, 術後17ヵ月現在, 腫瘍の転移・再発は認めていない, We report a case of transitional cell carcinoma in the left renal pelvis, which occurred in a 24-year-old man. He had been treated with cyclophosphamide (CPM) for a period of 27 months for retroperitoneal rhabdomyosarcoma diagnosed at the age of 10. At first 1.2 g CPM had been given twice intravenously for 3 months, followed by oral administration of 41 g CPM for 23 months. Drip infusion pyelography revealed a filling defect in the left renal pelvis. A left renal pelvic tumor was strongly suspected on computerized tomography and magnetic resonance imaging. Left nephroureterectomy was then performed. Histological diagnosis of the left renal pelvic tumor was transitional cell carcinoma, grade 2, pT1N0M0. No recurrence was defected 17 months later. This case seems to be the second case of cyclophosphamide-induced upper urothelial carcinoma reported in Japan.

74歳女の本症例ではCTにて気腫性変化が腎盂腎杯に限局していたこと, 患側に軽度水腎症が認められたこと, 膀胱鏡所見にて右尿管口を栓するような所見を認めたこと, 抗生剤に対する反応が良好であったこと, 血糖コントロールが比較的良好であったこと, などからSingle Jカテーテル挿入によるドレナージのみで, 腎摘出術は施行せずに治癒しえた.気腫性膀胱炎に対しては, 膀胱バルーンカテーテル留置にて神経因性膀胱による排尿障害を改善させ治癒せしめた.又, 腎静態シンチグラムにて左右腎機能に差は認められなかったことより, 気腫性変化は腎杯の粘膜に留まっており, 腎機能障害が生じなかったと思われる, A 74-year-old woman with diabetes mellitus had a high fever, and was treated with antibiotics and insulin in another hospital. She was referred to our department, because CT scan showed the right hydronephrosis and the abnormal gas shadow in the right renal calyces. Ureteral catheterization was performed on the right side and cloudy urine was drained. Urine culture yielded E. coli. Since submucosal emphysematous changes were demonstrated in the bladder mucosa by cystoscopy, she was diagnosed with emphysematous pyelonephritis with emphysematous cystitis associated with diabetes mellitus. Administration of antibiotics and insulin and the ureteral catheter drainage improved her condition immediately. Abnormal gas shadow on CT scan and submucosal emphysema on cystoscopy disappeared. We reviewed 110 cases of emphysematous pyelonephritis and 23 cases of emphysematous cystitis including our case in Japan, and report their clinical characteristics.

1)Endorectal MRIの有用性は, 膀胱癌では病期診断, 前立腺癌では精嚢腺浸潤の高い正診率で示された. 2)magnetization transfer contrastは, 前立腺癌の局在診断に有用な検査法である, We retrospectively studied the staging accuracy of endorectal magnetic resonance imaging (MRI) in comparison with transrectal ultrasound examination (TRUS) for 71 localized bladder cancers and 19 localized prostate cancers (PC) radically resected. The accuracy of clinical staging for bladder cancer in endorectal MRI and TRUS was 85.9% and 69.2%, respectively. The presence or absence of the continuity of submucosal enhancement on T2-weighted MRI images could be useful for the staging of bladder cancer. The accuracy of the seminal vesicular invasion for prostate cancer in endorectal MRI and TRUS was 95% and 63%, respectively. To determine whether magnetization transfer contrast (MTC) provides additional information in the diagnosis of prostate cancer, the magnetization transfer ratios (MTRs) were calculated in 22 patients with PC, 5 with benign prostatic hyperplasia (BPH) and 4 controls. The mean MTR in the peripheral zone of the normal prostate (8.0% +/- 3.4 [standard deviation]) showed a statistically significant decrease relative to that in the inner zone of the normal prostate (27.4% +/- 3.4, p < 0.01), BPH (25.5% +/- 3.7, p < 0.01), pre-treatment PC (30.6% +/- 5.9, p < 0.01), and PC after hormonal therapy (20.3% +/- 6.3, p < 0.01). The mean MTR in pre-treatment PC was significantly higher than that in BPH, or in PC after hormonal therapy (p < 0.01). MTC was considered to be useful for conspicuity of prostate cancer lesion.

A 7-year-old boy had a fever of 39 degrees C. Abdominal computed tomography (CT) revealed marked left hydronephrosis with hydroureter. Percutaneous nephrostomy was performed. Salmonella infanitis was detected from the drainage urine. Cystourethrography after nephrostomy showed bilateral vesicoureteral reflex (VUR). On the left side, ureteropelvic junction (UPJ) stenosis was found. Left fistelography showed hydronephrosis, but the ureter was not visualized. A mechanism like a valve at the left UPJ was suggested; the bladder urine was able to ascend to the pelvis but not to be drained from the pelvis. The left renal function was not expected to recover from the findings of renal scintigram and CT. Left nephroureterectomy and right anti-VUR operation were performed. The extirpated renal and ureteral specimens revealed a nonpapillary tumorous structure like a valve at the left UPJ. The histological examination of the valve-like structure revealed the presence of two muscle layers without an adventitia folded at the UPJ.

1)術前BOAIにより, 浸潤性腫瘍(T2以上)の27.0%にTUR-Btが施行され, 膀胱を温存することが可能となった.その長期成績を検討すると, 膀胱を温存しても予後は良好であり, 術前動注療法は, minimum invasive surgeryを可能にする. 2)膀胱温存のためには正確な腫瘍の深達度診断が必要である.経直腸MRIは従来の画像診断法と比べて, 深達度診断の正診率を向上させることが可能, The possibility of bladder preservation by preoperative balloon occluded arterial infusion (BOAI) chemotherapy was studied in 111 patients with locally invasive bladder cancer. BOAI was performed by blocking the blood flow of the internal iliac artery and by performing intra-arterial infusion of adriamycin (50 mg/body) and cisplatin (100 mg/body). Before BOAI the clinical diagnosis was T2 in 36, T3a in 29, T3b in 27, T4 in 11 and after BOAI it was T0 in 1, T1 in 27, T2 in 25, T3a in 20, T3b in 20, and T4 in 10. Down staging was observed on diagnostic images in 46.6%. Thirty patients (27.0%) received transurethral resection of bladder tumor (TUR-Bt) and their bladder could be preserved. The 5-year cancer-specific survival rate was 100% in pT0 (n = 9), 97.5% in pT1 (n = 47), 79.9% in pT2 (n = 21), 80.0% in pT3a (n = 6), 39.9% in pT3b (n = 18) and 51.9% in pT4 cases (n = 9). For the bladder preservation, accurate staging diagnosis is required. Since 1992, endorectal magnetic resonance imaging (MRI) has been used in addition to imaging diagnosis for improving the accuracy of staging diagnosis. The accuracies of staging diagnosis with and without endorectal MRI were 62.5% and 44.0%, respectively. BOAI as a neoadjuvant chemotherapy has the possibility of bladder-preserving therapy in locally invasive bladder cancer. Also, the endorectal MRI can improve the accuracy of staging diagnosis, which is important for the bladder preservation.

Various types of tumors, including benign tumors, arise from the renal parenchyma or renal capsule, but it is difficult to predict the histological type preoperatively. Here, we report a case of perirenal non-specific lymphadenitis resected laparoscopically. A 79-year-old man with a history of diabetic mellitus and noninvasive bladder cancer had an incidentally-detected enhanced mass in contact with the surface of the left kidney. Given the possibility that the tumor was malignant, we resected the mass laparoscopically. Intraoperative findings revealed that the tumor did not invade the renal parenchyma, and it could be easily resected. Microscopic findings showed that the tumor consisted of inflammation of a lymph node, lymphoid follicles with hyperplasia of germ center and granulomatous inflammation with giant cells, and there was no malignant finding. Despite various additional examinations, the specific cause of the lymphadenitis was not clarified, leading to a final diagnosis of non-specific lymphadenitis. To our knowledge this is the first report about perirenal non-specific lymphadenitis difficult to distinguish from perirenal malignant tumor in preoperative computed tomography imaging.

出血性素因を有する尿路結石症患者に対して, 凝固因子ならびに血小板補充療法を行うことで安全にESWLを施行できた3例を報告すると共に, 出血性素因別に若干の文献的考察を加えた, We describe our experience with extracorporeal shock wave lithotripsy (ESWL) in three patients with coagulation disorders (one case of hemophilia A, and two cases of thromboasthenia). We successfully performed ESWL using factor VIII or transfusion of platelets without any severe hemorrhagic complications, such as perirenal and subcapsural hematomas. We consider that adequate supplement of coagulation factor or platelets may lower the risk of hemorrhagic complications in coagulopathic patients who undergo ESWL.

We examined whether paracrine factors produced by prostate cancer cells can modulate bone metabolism in proportion to the volume of cancer cells in bone metastasis. Endocrine factors produced by prostate cancer cells affect both phosphate and 1, 25-dihydroxyvitamin D metabolisms. Levels of urine pyridinoline (U-Pyr) excretion and serum carboxy-terminal propeptide of type 1 procollagen (P1CP) in patients with bone metastasis were significantly higher than those in patients without bone metastasis (P< 0.05). In patients with bone metastasis (n= 1 7), serum prostate-specific antigen (PSA) levels were significantly correlated with the levels of U-Pyr and urine deoxypyridinoline (U-dPyr) excretion, serum cross-linked carboxyterminal telopeptide of type 1 collagen (1CTP), and P1CP levels (p < 0.05). However, serum PSA levels were not correlated with U-Pyr, U-dPyr excretions, serum ICTP and P1CP levels in patients without bone metastasis. Therefore, prostate cancer cells appear to have some paracrine effects on bone cells. In controls (n=15), serum 1, 25dihydroxyvitamin D levels (1, 25-(OH)2D) were inversely correlated with serum phosphorus levels (P

Herein, we report a case of quadruple cancer arising from the prostate, stomach, rectum and urinary bladder. A 92-year-old man was admitted to our hospital on March, 1996, with complaints of macroscopic hematuria and micturition pain. He had a history of prostate cancer (no details) at the age of 67, and subtotal gastrectomy for gastric cancer (tubular adenocarcinoma, conclusive stage Ia) at the age of 89. He underwent a polypectomy for rectal cancer (well-differentiated adenocarcinoma)2 at the age of 90. There was no evidence of local recurrence or metastasis of these three carcinomas. Cystoscopy revealed multiple papillary tumors which were resected transurethrally. At the same time transrectal needle biopsy of prostate was performed. Pathology revealed transitional cell carcinoma G2 of urinary bladder and well differentiated adenocarcinoma of prostate. The postoperative course was uneventful and the patient has been doing well without recurrence of bladder cancer during the follow-up period of six months.

67歳女, 両側腎梗塞に対し, ウロキナーゼ腎動脈内迅速大量投与及び持続投与が有効であった.両側とも動脈内注入血栓溶解療法で再開通が得られたが, 治療開始の遅れのため造影CT, シンチグラム上では梗塞部の腎機能の回復は得られなかった, A 67-year-old woman was admitted with aching pain in her left flank and nausea. Bilateral renal infarctions were noticed by CT scan and arteriography. Selective intra-arterial thrombolytic therapy was performed. Urokinase (UK) was administered through a balloon catheter embedded into the occlusive segment of the left renal artery selectively. UK (20, 000 units/hour) was continuously infused after short-term high dose UK (360, 000) infusion. In spite of recanalization of the occluded artery, CT scan and renoscintigraphy image did not suggest recovery of renal function. Conservative intra-arterial thrombolytic therapy is considered to be the most effective treatment for renal infarction.

We report a case of xanthogranuloma of the bladder following herniorrhaphy. The patient complained of urinary frequency, residual feeling, and presented with a solid mass located on the dome of the bladder. He had undergone previous inguinal herniorrhaphy. Transurethral biopsy revealed an inflammatory change. Partial cystectomy was carried out for en bloc removal of the tumor. The histological diagnosis was xanthogranuloma of the bladder. Postoperatively, the symptoms disappeared. This is the sixth case report of xanthogranuloma of the urinary bladder and the first case following herniorrhaphy in the Japanese literature.

53歳男.幼少時より皮膚腫瘤が認められ, 5歳の時von Recklinghausen病(R病)を指摘された.肉眼的血尿, 頻尿, 排尿時痛を主訴とし入院.体表に大小様々のcafe-au-lait spotを認め, 全身に多数の神経線維腫を認めた.下腹部やや左側よりに鶏卵大の腫瘤を触知, 膀胱尿道造影で膀胱内に長径10cmの陰影欠損を認め, 膀胱鏡にて尿道内に突出する白色の非乳頭状腫瘤を認め生検で移行上皮癌と診断した.術前バルーン阻血下動注療法(シスプラチン, アドリアマイシン)を施行, 膀胱腫瘍は92.8%の縮小率を認めたが, 膀胱全摘除術とハウトマン法による回腸膀胱造設術を施行した.術後8週より化学療法を3コース行った, A 53-year-old man was admitted to our hospital with urinary frequency and miction pain. He had von Recklinghausen's disease with multiple cafe-au-lait spots and neurofibromatosis. Computed tomography scan and magnetic resonance imaging revealed an invasive bladder tumor 10 cm in diameter, and not metastasis. He was diagnosed as having a bladder tumor (T3a N0 M0 with von Recklinghausen's disease. After balloon occluded arterial infusion (BOAI) chemotherapy, total cystectomy was performed. Pathological diagnosis was transitional cell carcinoma, G3, pT3aN0M0. We reviewed and discussed 97 cases of carcinoma associated with von Recklinghausen's disease reported in the Japanese literature. Only 5 cases of bladder cancer have been reported, including the present case.

1)27例の非neoadjuvant治療群で, 臨床病期の正診率は48.2%, understagingが44.4%, overstagingが7.4%.42例のneoadjuvant治療群では, 臨床病期の正診率は54.8%, understagingが35.7%, downstaging或いはoverstagingが9.5%であった. 2)治療前PA値は, 病理病期をよく反映しており, pT0とpT3症例, pT0とpN(+)症例及びpT2とpN(+)症例の間には統計学的な差が認められた.又, 再発症例の治療前PA値は, 非再発症例より高かった, Between 1989 and 1991, 815 cases of prostatic carcinoma were registered in the Tokai Urological Cancer Registry. We investigated the clinical features and prognosis of 69 patients who underwent radical prostatectomy. The median age and clinical stage, were 65.9 +/- 4.7 years and A in 7 patients, 66.3 +/- 5.8 years and B in 31, 68.2 +/- 2.7 years and C in 26, 63.4 +/- 13.5 years and N(+) in 5. Neoadjuvant therapy consisting of endocrine therapy and chemoendocrine therapy was administered to 28 and 14 patients, respectively. In comparison to the clinical stage, pathologically, 4 cases (9.5%) showed downstaging or overstaging, 15 (35.7%) understaging and 23 (54.8%) accurate staging in the neoadjuvant therapy group, and, respectively, 2 (7.4%), 12 (44.4%) and 13 (48.2%) in the non-neoadjuvant therapy group. There was a significant difference in the pretreatment prostatic antigen (PA) value between pT0 and pT3 (p < 0.05), between pT0 and pN(+) (p < 0.01) and between pT2 and pN(+) (p < 0.05). In addition, the pretreatment PA value in the recurrence group was higher than that in the non-recurrence group in both neoadjuvant and non-neoadjuvant groups, with a significant difference (p < 0.01) in the neoadjuvant group. Cancer recurrence was noticed in 2 patients given non-neoadjuvant therapy and 3 given neoadjuvant therapy. There was no significant difference in the non-recurrence rate with the pathological stage either with or without neoadjuvant therapy. However, the non-recurrence rate in the neoadjuvant therapy group was higher than that in the non-neoadjuvant therapy group.

1996年6月までの15年9ヵ月間に, 施行した生体腎移植6例, 死体腎移植32例についての臨床統計を報告した.死体腎移植のみにおけるKaplan-Meier法を用いた生着率の検討では, レシピエント年齢, 術前の透析期間, の項目において有意差を認めたが, HLA typing, シクロスポリン使用の有無, などの項目においては, 有意差を認めなかった.また, 術後1年以内の拒絶反応の有無, 術後1年目の血清Crレベルの2点において, 明らかな有意差は認められなかったものの, その傾向から, 移植腎生着の長期予後を占う因子となる可能性が示唆された, A statistic survey was made on the clinical results of living and cadaveric renal transplantations performed at our department between October 1980 and June 1996. A total of 38 patients received 6 living and 32 cadaveric renal transplants. The graft and patient survival rates of a living renal transplantation were 83.3% and 100% at 3 years, respectively. The graft survival rate of cadaveric renal transplantation was 66.3% at 3 years and 56.0% at 5 years. In a cadaveric renal transplantation, patients with episodes of acute rejection within 12 months showed a significantly worse graft survival rate. This clinical parameter seems to be a prognostic factor for a long-term graft survival.

外来ESWL治療前に99mTc-DTPAレノグラフィならびに利尿レノグラフィを施行した尿管結石79症例に関して検討を加えた.単一尿管結石患者でレノグラムパターンが正常型, 或いは閉塞型であっても利尿レノグラムで反応なし, の型であれば外来ESWLで治療できる(単独治療で完全排石が期待できる)ことが示された, We analyzed the 99mTc-DTPA renogram with and without diuresis to predict the possibility of stone discharge on the outpatient basis by renogram patterns. Between October, 1993 and December, 1995, 99mTc-DTPA renography was performed in 79 patients with a single ureteral stone. The 99mTc-DTPA renogram pattern was classified into the three types of normal function, obstruction and lower function patterns and the complete stone discharge rate was 93, 63 and 25%, respectively. In addition, diuretic renography using Furosemide was performed in patients with an obstruction pattern and the three renogram patterns of return to the normal curve, a diuretic response and no response were obtained; the complete stone discharge rate was 44, 65.3 and 93%, respectively. From this study, patients with a single ureteral stone with a normal pattern on the regular DTPA renogram and patients with no response pattern on the diuretic renogram, even if in such patients an obstructive pattern was seen on the regular DTPA renogram, seem to be a good candidate for obtaining a high rate of a stone discharge with extracorporeal shock wave lithotripsy (ESWL) treatment in the outpatients basis.

1)前立腺癌部位はT2強調像で, 大部分が低信号で, 一部が中間信号で認められた.前立腺被膜浸潤は, 被膜断裂像・辺縁不規則像・前立腺周囲の静脈叢の低信号・前立腺周囲脂肪織の低信号で表された.精嚢腺浸潤は, 造影T1強調像の高信号とT2強調像の低信号で表された.又, T2強調像で前立腺の鮮明なzonal anatomyがみられた. 2)Stagingの正診率は, TRUSでは57%, 経直腸的MRIでは79%であった.精嚢腺浸潤の正診率は, TRUSで57%, 経直腸的MRIでは93%と, 統計学的に有意差を認めた. 3)Neoadjuvant治療の前後で, 前立腺全体の縮小率は43.2%であった, We retrospectively studied the staging accuracy of endorectal magnetic resonance imaging (MRI) using a surface coil for 14 localized prostatic cancers resected by retropubic radical prostatectomy. The prostatic tumor in the peripheral zone was mostly demonstrated as a low signal intensity on the T2 weighted image, and prostatic capsular invasion was indicated as an interruption of prostatic capsule, irregularity of glandular margins, and a low signal intensity of periprostatic venous plexus on the T2 weighted image. The seminal vesicular invasion was seen as a high signal intensity on the enhanced T1 weighted image, and a low signal intensity on the T2 weighted image. The clear prostatic zonal anatomy was demonstrated on the T2 weighted image. The accuracies of clinical staging in endorectal MRI and transrectal ultrasound examination (TRUS) were 79% and 57%, respectively. Also, the accuracies of seminal vesicular invasion in endorectal MRI and TRUS were 93% and 57%, respectively. The endorectal MRI revealed more accurately the seminal vesicular invasion than TRUS (p = 0.038), but there was no significant difference in the accuracy of detecting prostatic capsular invasion between endorectal MRI (79%) and TRUS (71%). The reduction of prostatic volume after 4 months of endocrine neoadjuvant therapy (LH-RH agonist) was compared in each prostatic intraglandular zone with the T2 weighted image. The total prostatic reduction rate was 43.2%. The reduction rate in the peripheral zone (64.8%) was more than two-fold that (29.7%) in the central gland (transition zone + central zone). The endorectal MRI may greatly contribute to the local staging of prostatic cancer, especially to the diagnosis of seminal vesicular invasion.

80歳男では, 乳頭状腫瘤はフルオロウラシル軟膏塗布により消失した.退院後再発, 消失を繰り返し, 軟膏を塗布していたが, 胸部大動脈瘤破裂により死亡した.45歳男では, フルオロウラシル軟膏或いはブレオマイシン軟膏の塗布に続いて局所切除を行った.現在肉眼的に再発は認められていない, Herein, we report two cases of giant condyloma of the penis treated with penis-sparing methods. In the first case, the papillomatous tumor disappeared with topical use of fluorouracil ointment. In the second case, the tumor was treated with topical use of fluorouracil or bleomycin hydrochloride, followed by the resection of tumor. Giant condylomas reported in the recent 13 years are reviewed and methods of treatment discussed.

下大静脈腫瘍塞栓を有する腎細胞癌19例について臨床的検討を行った. 1)手術例は非手術例に比し, その予後がよい傾向にあり, 特に転移のない症例でその傾向が強かった. 2)組織学的にみると, clear cell subtype例は, granular cell subtype例より有意にその予後がよい傾向にあった. 3)下大静脈に腫瘍塞栓がある場合にも, 術前に詳細な画像診断を行い, 隣接臓器への浸潤の有無, 転移の有無, 転移の数, 腫瘍塞栓の位置等を考慮し, 症例を的確に選び, 積極的に手術療法を行うべきである, Nineteen patients with renal cell carcinoma with tumor extension into the inferior vena cava (IVC) were investigated between January, 1973 and March, 1994. The patients were between 50 and 78 years old with a mean of 65.9 years. The male to female ratio was 1.7 to 1. Thirteen tumors were on the right side and 6 on the left side. In 12 patients, both nephrectomy and removal of the tumor thrombus were performed. The survival rate in the operated group was 60% at 5 years. Histologically, 7 cases were diagnosed as clear cell subtype and 5 cases as granular cell subtype. From this study, an extended operative intervention such as radical nephrectomy combined with tumor thrombectomy of the IVC with or without cavectomy was suggested in the case of renal cell carcinoma without any other metastatic lesions and histopathologically of the clear cell subtype.

Herein, we report two cases of squamous cell carcinoma of the ureter. The first case was in a 56-year-old-male. Total cystectomy and ileal conduit were performed because of bladder tumor suspected to be accompanied by carcinoma in situ and atrophic urinary bladder induced by chronic cystitis in December, 1993. Pathological examination revealed transitional cell carcinoma (TCC) > squamous cell carcinoma (SCC), G2 > G1, INF beta, pT1, 1y1, v1. He complained of back pain under medical observation in December, 1994. Left hydronephrosis was found and antegrade pyelography showed leakage from the left pelvic ureteral junction. Urinary cytology revealed class V and suggested TCC. He received left nephroureterectomy, and pathohistological examination of resected specimen revealed SCC, INF gamma, pT3, pRo, pLx, pVx, pNo, pMo. CABO chemotherapy (cisplatin, methotrexate, bleomycin, vincristine) was performed postoperatively. The second case was in a 61-year-old female. She complained of macrohematuria in the course of observation of pyelonephritis. Drip infusion pyelography showed right hydronephrosis and retrograde ureterogram revealed stenosis of the right lower ureter. Urinary cytology revealed class V. Nephroureterectomy and bladder cuff were performed. The tumor was histologically diagnosed as SCC > TCC, INF beta, pT3, pRo, pLo, pVo, pNo, pMo. Postoperatively, CABO chemotherapy was performed. So far, no recurrence has been observed. Fifty five cases of squamous cell carcinoma of ureter were collected from the Japanese literatures including our cases.

過去10年間に経験した腎angiomyolipoma14例の統計的検討を行い, これを含め1994年10月までの本邦報告例計739例の統計的考察を行った. 1)脂肪成分の検出率は, US, CT, MRIで, それぞれ88.1%, 86.5%, 80.8%の高率であった.Angiographyでは, AMLに特徴的とされる動脈瘤は71.4%に, A-V shuntの欠如は48.1%と半分以下に記載があるにすぎず, onion peel appearanceにいたっては, わずか4.9%であった. 2)小腫瘤, 脂肪成分の少ない例などの鑑別困難例も多く, また腎癌との合併例などの可能性も考慮し, AMLの画像診断はangiographyをも含め総合的に行うべきと思われた. 3)経過観察可能の症例は, 明らかに脂肪成分を認め, 無症状で, 腫瘍の大きさは3cm未満とした方がよい. 4)最近では, 腎摘出術の割合は30%まで低下してきており, 代わって経過観察が増加していた, In 10 years the diagnosis of renal angiomyolipoma (RAML) was made in 14 patients (male-to female ratio 1:3.7) at our institution; 1 case was associated with tuberous sclerosis (TS) and 1 case had regional lymph node involvement. A statistical study was done on data taken from 739 cases of RAML in the Japanese literature, including our cases. The male to female ratio was 1 to 3. Twenty eight percent of the cases were associated with TS. The ratio of bilateral cases to the unilateral one was 1 to 3. The main clinical signs were flank pain, abdominal mass, hematuria and fever elevation. Recently the ratio of nephrectomy has decreased to 30%. The percentage of detecting the fat component by ultrasonography (US), computed tomography (CT) and magnetic resonance imaging were 88.1%, 86.5% and 80.8% respectively. The percentages of visualizing hypervascularity, aneurysms, absence of arterio-venous shunt and onion peel appearance by selective renal angiography were 77.3%, 71.4%, 48.1% and 4.9% respectively. Small (less than 3 cm), asymptomatic, simple lesions with adipose component may be observed annually by CT and US until more experiences is gained with surveillance of these patients. Embolization was useful for emergency cases or pre-treatment of nephron sparing surgery, but insufficient by itself. As there still remain problems in the diagnosis of RAML, especially in the case of very small tumors, in the case with almost no adipose component and in the case associated with renal cell carcinoma, the diagnosis of RAML should be made synthetically including angiography.

腎細胞癌100例を対象とし検討した. 1)PCNA陽性率は, grade, stageと相関し, さらにgrade 2群を予後の異なる2つのsubgroupに細分可能で, PCNA陽性率は従来の病理組織学的な予後規定因子を補助しうる, 重要な予後規定因子である. 2)DNA aneuploid群はDNA diploid群に対し予後不良の傾向にあったが有意差はなかった.腎細胞癌にはDNA heterogeneityを示すものがあり, DNA ploidy解析は, 1腫瘍につき1個の検体で評価した場合, 予後規定因子にはならなかった, In the present study the prognostic value of proliferating cell nuclear antigen (PCNA) index and tumor DNA content were evaluated in 100 patients with renal cell carcinoma. The survival rate of patients with aneuploid tumors was not significantly different from that of those with diploid tumors. DNA ploidy could not be a prognostic factor. PCNA expression was determined by immunohistochemical staining using the PC10 clone. PCNA indices ranged from 2.6 to 33.6% with mean indices of 10.2, 15.7 and 27.9% for grades 1 to 3. There was a significant difference between the indices of each grade of tumor. Patients with a PCNA index of less than 13.6% had a longer survival time than the patients having tumors with a PCNA index of more than 13.6% (p < 0.05). Furthermore, within the group of grade 2 tumors, patients with a lower PCNA index had a significantly better prognosis (p < 0.05). Our findings demonstrated that the PCNA index provides significant prognostic information for renal cell carcinoma.

Primary small cell carcinoma of the renal pelvis is rare. We report a case of combined small cell and transitional cell carcinoma of the renal pelvis. The patient was a 78-year-old man with macrohematuria. He was diagnosed with right pelvic tumor by right retrograde pyelography and computerized tomography. A right radical nephroureterectomy was performed. Histological sections of the tumor showed a mixture of small cell and grade 2 transitional cell carcinoma. Positivity for Grimelius was noted in the small cell component. Masson-Fontana, chromogranin A, serotonin, keratin, leucocyte common antigen (LCA), neuron specific enolase (NSE), adrenocorticotropic hormone (ACTH), growth hormone (GH) and somatostatin were negative. Ultrastructurally, the tumor cells were tightly packed and attached together by scattered desmosomes. There were no neurosecretory granules. Seven months after operation, the patient died with peritonitis carcinomatosa. At autopsy, a metastatic tumor was found in the liver and retroperitoneal lymph node. Other organs were not involved. Especially, there were no abnormalities in the lungs.

58歳男.近医で上左腎腫瘤を指摘され受診した.腹部超音波検査, CTでは左腎下極に突出した腫瘤を認めた.MRIでは腫瘤内部に血性液体の存在が示唆されたが, 腎細胞癌との鑑別は困難であった.選択的左腎動脈造影では腫瘤の位置に血管を認めたが, 腫瘍の新生血管とは断定できず, 同時に施行した選択的動脈造影下CTにより嚢胞状腎細胞癌と診断し, 根治的左腎摘出術を施行した.摘除標本では出血を伴った嚢胞状腎細胞癌を疑う所見であり, 病理組織学的に乳頭状腎細胞癌と診断された.術後経過は良好で, 29ヵ月経た現在再発を認めてない, We report a case of cystic renal cell carcinoma (CRCC). In general, computed tomography (CT) and magnetic resonance imaging (MRI) are sufficient for diagnosing renal cell carcinoma (RCC). However, we often have difficulty in diagnosing CRCC based on these modalities alone. In the present case, to assess the contrast-enhancement of the cyst wall and the septum, we evaluated the usefulness of CT arteriography (CTA) by selective injection of contrast material into the renal artery. We believe that CTA could be a valid option for preoperative radiological differentiation of CRCC.

99mTc-DMSA腎摂取率の再現性を健常成人で評価し, 1側の腎結石に対し, ESWLまたはPNLを施行した48症例で, 治療前後にDMSA腎シンチグラフィを施行し, 治療法の腎機能への影響を検討した。健常成人では99mTc-DMSA腎摂取率は再現性は保たれているが, 数%の変動がみられた。ESWL群, PNL群または両者併用群において治療前後で治療側腎摂取率には有意な変化はみられなかった。各群間を比較すると, PNL群および両者併用群とESWL群との間に有意な差が認められた(p, 99mTc-DMSA renal scintigraphy was utilized to investigate the influence of ESWL on renal function in comparison with that of PNL. In the beginning, the reproducibility of renal uptake rate by the scintigraphy was examined in eleven healthy volunteers under both non-diuretic and diuretic states. The renal uptake rate was shown to be sufficiently reproducible in the same person in the two different trials. However, the differences and the standard deviations were shown to be a few percentages, which were not statistically significant. Changes in the repeated renal uptake rate seem to indicate not only changes of renal function with the treatment but also some technical errors. Herein, to investigate changes in renal function of the therapeutic side, the uptake ratio rate (rate of uptake rate in the therapeutic side/uptake rate in the contral lateral side) was utilized instead of uptake rate. Renal scintigraphy was carried out in 48 patients with unilateral renal stones before and after ESWL or PNL monotherapy or the combined ESWL and PNL therapies. Within one week of treatment, the uptake ratio rate significantly decreased in patients with PNL or the combined ESWL and PNL, although DMSA uptake rate in the therapeutic side did not significantly changes. Neither renal uptake rate nor uptake ratio rate significantly changed after ESWL treatment. There was no significant difference in changes of uptake ratio rate between Siemens Lithostars Plus and the improved Dornier HM-3 lithotriptors. This study indicated that ESWL monotherapy did not affect the uptake ratio rate, although PNL monotherapy and the combined ESWL and PNL therapies may affect the uptake ratio rate to some extent.

対象は転移を有しIFN-αを投与した16名, 転移はなくIFN-αを投与した16名, 転移はなく, IFN-α非投与の25名の腎癌である。腎摘後およびIFN-α投与後にNK細胞比率は低下する傾向を認めた。IFN-α投与後, CD 4陽性細胞比率が有意に上昇を示し活性化CD 4陽性細胞比率とCD 4陽性細胞比率/CD 8陽性細胞比率はやや上昇傾向をみた。CD 8陽性細胞比率と活性化CD 8陽性細胞比率は特に変化を認めなかった。IFN-α投与とCD 4陽性細胞比率の変化の関連を認めた, To study the changes in the subsets of peripheral blood lymphocytes before and after nephrectomy and interferon (IFN) therapy, 57 patients with renal cell carcinoma were divided into three groups; one group consisted of 16 patients with metastasis who had been administered IFN-alpha, one group consisted of 16 patients without metastasis who had been administered IFN-alpha, and the other consisted of 25 patients without metastasis who had not been administered IFN-alpha. Immunological parameters such as percentages of NK (Leu-11+ [Leu-7-) cells, percentages of activated CD4 (Leu-3a+ HLA-DR+) positive cells and percentages of activated CD8 (Leu-2a+ HLA-DR+) positive cells were examined by two color flow cytometry and the percentages of CD4 (Leu-3a+) positive cells, percentages of CD8 (Leu-2a+) positive cells values and the ratio of percentages of CD4 positive cells/percentages of CD8 positive cells were evaluated. The percentages of NK cells showed a tendency to decrease after nephrectomy and the administration of IFN-alpha. The percentage of CD4 positive cells showed a significant increase after the administration of IFN-alpha. The percentage of activated CD4 positive cells and the ratio of percentage of CD4 positive cells/percentage of CD8 positive cells showed a tendency to increase slightly. The percentage of CD8 positive cells and percentage of activated CD8 positive cells showed no particular changes. There was a specific correlation between the administration of IFN-alpha and the changes of percentage of CD4-positive cells and this suggests that the administration of IFN-alpha led to the increase of helper T cells.

1)平成1年より5年間にわたり川越町で前立腺検診を実施し, のべ216名中4名の前立腺癌を発見した。2)腫瘍マーカー(PSA), 直腸診, TRUSの順で, 診断精度が良かった。3)川越町民の前立腺検診に対する希望は対象住民1, 887名中147名(約8%)で, 一般検診希望の34%から大きく離れていた。4)受検率を上げるには, 前立腺疾患の啓蒙を積極的に行い, 関心を抱かせることと, 老健法の範囲に前立腺検診の項目が組み入れられることが必要である。5)私たちの前立腺集団検診のシステムとして一次に問診, 直腸診, PSA, 二次にTRUS+系統的生検を組み入れることが一番効率的である, The results of a mass screening examination for prostate cancer conducted from 1989 to 1993 at a local town, Kawagoe-cho, in Mie Prefecture were evaluated. Among the 216 examinees, 4 were found to have prostate cancer. The most accurate examination was the prostate specific antigen (PSA), which was followed by digital examination and transrectal ultrasound. The applicants for the prostate cancer screening accounted for only 8% of the Kawagoe-cho male residents over 40 years old. An educational campaign of prostate disease in the area must be started to increase the number of applicants. We concluded that the most effective modality for the screening program was a combination of PSA and digital examination in the field study, and transrectal ultrasound accompanied by systemic biopsy results in the second tool for screening.

Urinary calculi is formed in kindney, urine pipe, bladder and urethra by the biomineralization under the illness conditions. Recently, the study on the field\of the urinary calculi necessarily of utmost importance the knowledge and method of mineralogy, crystallography and so on. 52 calculi samples which were extracted by the operation were examined. The writers have been carried out the frequency of the produced site of the calculi and that of its component and form. Among the treated samples, upper urinary calculi are occupied 88.5% and the ratio are roughly equal to those of the average in Japan. The total number of the calculi in male were 1.67 times than that of female one. It is assumed that the formation site and genetic process for calculi are identified by the feature of calculi form. Most of the small calcium oxalate monohydrate calculi composed of internal zonal structure and shining surface are probably formed in the site where the urine flowed out rapidly and disorderly. Whereas, the calculi which consists of calcium oxalate dehydrate or cystin having woody appearance occurred in the site where urine flowed slowly, during the short period for growth. Further, the calculi that composed of aggregate of crystals were made from the gel state calcium phosphate as a role of paste.@@@病的生鉱化作用により、尿路結石と呼ばれる結石が腎臓、尿管、膀胱、尿道に形成される。近年の尿路結石に関する研究では、結晶学や鉱物学などの幅広い知識や研究方法が必要とされてきている。ここでは、外科手術によって摘出された52個の結石試料を研究の対象とし、その発生部位別頻度および成分別頻度、および形態の特徴などについて述べる。結石の発生部位別頻度については、上部尿路結石が全体の88.5％を占め、全国平均とほぼ等しい。また、男女比は1.67：1と男性が上回っているものの、全国平均の2.5：1より女性比が多い傾向にある。成分別頻度については、蓚酸カルシウム含有結石が78.9％を占めている。また、成分にカルシウムを含む試料をカルシウム結石とすると、その頻度は92.1％にものぼる。結石形態の特徴からは結石発生の部位や形成過程が推測できる。しま状構造や累帯構造を持つ結石は、光沢を示す小さな蓚酸カルシウム1水和物結石が多く、尿の流れが速く乱流する部位（腎杯憩室）で形成されたと考えられる。断面が樹枝状に広がる結石については蓚酸カルシウム2水和物とシスチンが構成成分で、尿の流れの緩やかな部位で短時間に形成されたと考えられる。また、結晶粒が集積してできた結石は、体内では半固形の状態にあるリン酸カルシウム塩がノリのようなはたらきをしたと考えられる。

Urinary calculi, as biocrystals, are grouped into several types and named based on their chemical compositions and the mineralogical features. Among them, calcium that contained calculi showed maximum amount. Mineralogical study on calculi both of the calcium oxalate (partly contained uric acid) and magnesium ammonium phosphate have been described and some genetic process are also discussed. Calcium oxalate samples mainly composed of whewellite and amorphous-like substances, lacking in weddellite. Most of the samples can be divided into crust and based on their in ternal structure which is similar to that of marine manganese nodules. The core zone contains several concentric stripes of light and dark materials, showing so-called colloform and zonal structure. Spherulitic structure which is composed of aggregate of needle whewellite crystals were also observed at the boundary between core and crust. Magnesium ammonium phosphate calculi consists struvite and amorphous-like substances. In cross section, it showed banded structure which is composed of alternate zone of two materials. In both calculi, Ca, Mg, P, C and F were detected by EPMA method. Ca content in generally high with uniformly distribution, and some correlation between Ca and other elements such as Mg and P were observed, locally, in the calcium oxalate samples. In magnesium ammonium phosphate calculi, Mg and P were almost uniformly distributed with high concentration. All elements in calculies probably exist as state of very micro particles.@@@生体結晶として、現在尿路結石にはその種類別にいろいろな構成成分、化学式、鉱物名が与えられている。これらの結石類ではカルシウム系成分が最も多く見出されている。本報文では蓚酸カルシウム（一部尿酸を含む）および燐酸マグネシウム・アンモニウム結石に関する鉱物学的性状を検討し、生成過程についても考察している。蓚酸カルシウム結石は非晶質様物質とwhewellite（1水化物）より構成され、weddellite（2水化物）は特定されない。多くは内部が、内核、外核、外殻部に区分される構造を示し、核部の周りにコロフォーム構造、累帯構造、球顆状構造等が顕著である。燐酸マグネシウム・アンモニウム結石は非晶質様物質とstruviteから構成され、内部にはこれらの互層による多重の帯状構造がみられる。EPMAによる元素分析で、両結石ともCa,Mg,P,O,C,Fが検出される。蓚酸カルシウム結石では試料粒全般にCaが高濃度で均一に分布し、部分的にCaと他のP,Mg,Fが相関関係を示す。また燐酸マグネシウムではMg,P全体に均一に高濃度で分布する。これら結石を構成するすべての元素は極めて微細な粒子として含まれている。

複雑性尿路感染症に初期治療としてTFLX 150mgを1日3回7～14日投与した。その後TFLX 150mg就寝前1回投与を行い4～12週後再発予防効果を検討した。1)初期治療の検討:UTI薬効評価基準に従い評価可能であった45例の総合臨床効果は, 著効31例, 有効8例, 無効6例であった。2)再発予防の検討を行った39例中再発を認めたのは3例であった。3)初期治療, 再発予防検討中TFLXに起因すると思われる副作用はなかった, Forty five patients with complicated urinary tract infections were treated with tosufloxacin (TFLX) in the initial antibacterial treatment. Excellent and moderate responses were obtained in 39 patients (86.7%). No side effects were seen. Clinical efficacy and safety of long-term preventive administration of TFLX (150mg, a day) were also examined in 39 patients who showed an excellent or a moderate response in the initial treatment. The period of the administration ranged from 28 to 112 days (average; 55 days). The rate of preventing recurrence of urinary tract infection was 92.3% on the last day of treatment. These findings suggested that TFLX was useful not only in treating the patients with complicated urinary tract infections but also in preventing recurrence of urinary tract infection.

A 65-year old man, who had had resection of a right ureter tumor two years earlier, was hospitalized with complaints of lower abdominal discomfort and hematuria. Pathological diagnosis of the ureteral tumor was grade 3 transitional cell carcinoma. Computed tomography and magnetic resonance imaging demonstrated a large tumor in the retrovesical space and recurrence of transitional cell carcinoma was suggested. Total pelvic exenteration was performed and pathological diagnosis of the tumor was undifferentiated carcinoma simulating malignant lymphoma. Immunohistochemical examinations revealed no antigens specific for the lymphoid cells or epithelial cells on the specimen. This tumor consisting of undifferentiated carcinoma was considered to be recurrence of transitional cell carcinoma with the diffuse pattern simulating malignant lymphoma proposed by Zukerberg et al.