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ラットでの性ホルモン誘発非細菌性前立腺炎モデルを用い, 既報の抗炎症作用を病理組織学的に確認すると共に, その作用機序究明の一環として, cernitin pollen-extract(CN)の炎症性サイトカイン(IL-1β, IL-6及びTNF-α)に対する作用を検討した.その結果, 対照群で認められた前立腺組織中のIL-6及びTNF-αの増加を用量依存的に抑制した.この抑制作用がCNの抗炎症作用に重要な因子であると推測された, Cernitin pollen-extract (Cernilton, CN) is a preparation made from eight kinds of pollen and has been used for various prostatic diseases in Japan and Europe. We reported previously that CN possessed a recovery action on the sex-hormone-induced nonbacterial prostatitis in rats. To clarify the possible mechanism of action of CN, we investigated the effects of CN on inflammatory cytokines (IL-1 beta, IL-6 and TNF-alpha) in the same model. Aged Wistar rats were castrated and injected 17 beta-estradiol (0.25 mg/kg/day, s.c.) for 30 days. CN (630 and 1, 260 mg/kg, p.o.) or testosterone (2.5 mg/kg, s.c.) was administered for the last 14 days of the treatment of 17 beta-estradiol. In control rats, prostatic IL-6 and TNF-alpha contents were increased approximately 2-3 fold, and acinar glandular inflammation and stromal proliferation were found histopathologically, as compared with those of intact rats. On the other hand, CN decreased the increased contents of cytokines in a dose-dependent manner. The histopathological changes mentioned above were restored in rats treated with 1, 260 mg/kg. Testosterone also ameliorated them significantly. These results indicate that CN has an anti-inflammatory action, and that the inhibitory effect of CN on the prostatic inflammatory cytokine is an important factor in its action.

前立腺癌による転移性脳腫瘍を認めた.血清PSA値が正常であるにも拘わらず, 低分化前立腺癌であった.脳転移巣による神経症状に対して, ガンマナイフ治療が有効であり, 患者のQOLを著しく向上することができた, A 59-year-old male visited us with a chief complaint of dysuria. The serum prostate specific antigen (PSA) level was within normal limits, and intravenous pyelography and urethrocystography showed no abnormal findings. Because of his urinary retention, transurethral resection of prostate was performed under a clinical diagnosis of benign prostatic hyperplasia. The pathological diagnosis was poorly differentiated adenocarcinoma of the prostate. Not only combination hormone therapy with goserelin acetate and flutamide, but also intermittent arterial infusion chemotherapy with cisplatin (CDDP) and pirarubicin (THP) using a reservoir system was administered. Additionally total pelvic irradiation was delivered. Magnetic resonance imaging (MRI) demonstrated that his prostate was reduced to less than 50% in size and he had no difficulty in voiding. He suddenly developed dysarthria and hemiplegia 3 months later. MRI and computed tomography (CT) revealed multiple brain metastases. After the gamma knife radiosurgery, neurological findings disappeared and MRI showed dramatic shrinkage of metastatic brain tumors. Metastasis to the pancreas was recognized on CT and he died of multiple organ failure 30 months after his first visit.

1997年5月～1998年2月の間に腎結石40例, 尿管結石40例(男性60例, 女性20例)についてドルニエリソトリプターコンパクトを用いた治療を行った.結石のサイズは5～80mmであった.大多数の症例は無麻酔で行ったが, 3例に硬膜外麻酔を必要とした.また4例に尿管ステント留置後に治療を行った.全ての症例において結石砕石は認められた.1ヵ月後の評価では砕石効果と完全排石率は91%と54%, 又, 3ヵ月後の評価では砕石効果と完全排石率は91%と68%であった.腎盂腎炎や腎周囲血腫, 大量の血尿等の重篤な副作用はみられなかった.ドルニエリソトリプターコンパクトは腎尿管結石の治療において安全で砕石効果が優れていると考えられた, Between May 1997 and February 1998, 40 cases of renal stones and 40 cases of ureteral stones in 60 males and 20 females were treated with the Dornier Lithotripter Compact. The size of the stones ranged from 5 mm to 80 mm. Three patients required epidural anesthesia and 4 patients required a ureteral stent. Fragmentation of the stones was observed in all patients. After 1 month, the efficacy and stone free rates were 91% and 54%, respectively. After 3 months, they were 91% and 68%, respectively. There were no serious side effects such as pyelonephritis, perirenal hematomas, and massive hematuria. In conclusion, the Dornier Lithotripter Compact proved to be a safe and highly effective lithotripter for the treatment of renal and ureteral stones.

症例1は49歳女性で, 腹部超音波検査にて膀胱後壁に接する嚢胞様腫瘤を指摘され, 紹介来院した.排尿後の静脈性腎盂造影の立位像で膀胱下方に造影剤の貯留を認め, 逆行性膀胱尿管造影で尿道周囲に5×5×7.5cmの造影剤の貯留を認めた.MRIでは尿道全周を取り囲むように腫瘤が存在していた.以上の所見から尿道憩室と診断し, 経腟的尿道憩室摘除術および憩室口閉鎖術を施行した.病理組織学的所見では壁は炎症性肉芽組織が大半を占め内面は一部移行上皮で被われていた.症例2は36歳女性で, 第2子の妊娠5ヵ月頃より会陰部痛を認め, 産婦人科にて腟前壁の腫瘤を指摘され, 出産後に紹介来診した.腹部超音波検査で尿道を全周性に取り巻く多房性嚢胞を認め, 排尿時膀胱尿道造影で尿道周囲に3×3×4cmの造影剤貯留が認められた.CT・MRI所見で尿道全周を取り囲んだ憩室が認められ, 症例1と同様の手術を施行した.病理組織学的所見は炎症性肉芽組織を認めるのみであった, We report two cases of female urethral diverticula. A 49-year-old woman (case 1) complained of perineal pain when she voided urine. A 36-year-old woman (case 2) complained of perineal pain. In both cases, intravenous pyerography and urethrography revealed diverticula around their urethra, and we diagnosed them with urethral diverticula which surrounded their urethra by magnetic resonance imaging. We treated them by transvaginal diverticulectomy. Case 2 was successfully treated, but the diverticulum recurred after one year in case 1. There are over 200 reported cases of female diverticula in the Japanese literature, but a urethral diverticulum surrounding the urethra is rare.

Urological procedures for progressive renal dysfunction due to polycystic kidney disease (PKD) such as percutaneous puncture of renal cysts are merely symptomatic treatments and have little effect on renal function. At present, the two most effective methods of preventing renal dysfunction are blood pressure management and dietetic therapy, which are more effective with early initiation. Moreover, as PKD is an autosomal dominant disease, there is a high risk that family members of the patient may have asymptomatic PKD. It is essential to identify and treat such potential patients at an early stage in order to prevent progressive renal dysfunction. In place of the traditional nephrectomy, we attempted transcutaneous renal arterial embolization (TRAE) for hemorrhage into renal cysts, hematuria and obstruction of intestine due to proliferation of cysts after the introduction of hemodialysis. When TRAE was carried out on one kidney, the cysts in the other kidney proliferated and even though the renal arteries were completely embolized, it required 5 to 6 weeks for the kidney to contract. Our conclusions are TRAE is effective with no adverse reactions for PKD. These results suggest that in the future TRAE may become the preferred treatment for PKD in place of nephrectomy.

1)陰嚢内に発生したepidermoid cystの2例を経験したので報告した.41歳男, 47歳男, Epidermoid cystの診断にはMRIが非常に有用と考えられた, A 41-year-old man and a 47-year-old man presented with an intrascrotal mass. The routine studies and ultrasonography showed that the mass was not associated with the testis, epididymis or spermatic cord, but the magnetic resonance imaging was the most useful for making a preoperative diagnosis. Both patients received transscrotal resection of the mass, the histopathological diagnosis of which was epidermoid cyst. A total of 24 cases of epidermoid cyst have been reported in the Japanese literature.

浸潤性膀胱癌56例に対してリザーバー動注化学療法を施行した.内46例に骨盤内血流改変術を併用した. 1)46例中42例, 91%に良好な血流改変が行われていた. 2)腫瘍に対する近接効果は評価を行えた50例中CR23例, PR17例, NC6例, PD4例で奏効率80%であった. 3)追跡可能であった54例の累積生存率は1年83.7%, 3年61.2%, 5年52.6%, 8年52.6%. 4)CR例23例中検討可能であった22例におけるCR判定後の無再発率は1年91.8%, 2年85.2%, 3年65.6%, 5年58.3%, 7年58.3%. 5)合併症として留置カテーテル閉塞6例, カテーテル・ポート部感染3例, 副作用として軽度の消化器症状5例, 軽度の下肢痛2例, 骨髄抑制の疑い1例を認めた, Fifty-six patients with locally invasive bladder cancer were treated by chemotherapy with intermittent arterial infusion from an implanted reservoir and alteration of intrapelvic blood flow. The tip of an infusion catheter was inserted selectively into an internal iliac artery by an angiographic technique. Superior gluteal artery and the other internal iliac artery were then embolized with steel coils so that the drugs would perfuse throughout the tumor through a single catheter. Treatment consisted of intermittent injection of cisplatin (10 mg/body) and doxorubicin (10 mg/body) or epirubicin (10 mg/body) or pirarubicin (10 mg/body) in a ten-minute period every week (for the first 8 weeks) or every two weeks (after the 8th week). Fifty patients were objectively evaluated and the response rate was 80%. The overall survival rate in 54 patients at 1, 3, 5 and 8 years was 83.7%, 61.2%, 52.6%, and 52.6%. The 1-, 2-, 3-, 5- and 7-year disease free survival rate in evaluable 22 patients who showed a complete response (CR) was 91.8%, 85.2%, 65.6%, 58.3% and 58.3%. No serious side effects, such as severe myelosuppression or renal and/or liver dysfunction, were noted during treatment. These findings suggest that intermittent arterial chemotherapy with an implanted reservoir is clinically useful. This procedure appears safe and is easily performed in the outpatient clinic for the treatment of locally advanced bladder cancer.

症例1は41歳女, 主訴は頻尿.超音波検査, 点滴注入腎盂造影, CTなどで膀胱左前壁に大きな充実性腫瘍を認め, MRIのT1強調像では内部均一な低信号, T2強調像では内部不均一な低信号の腫瘍であった.膀胱鏡では大きな粘膜下腫瘍を認めた.膀胱部分切除を行い, 以後36ヵ月間, 再発, 転移をみない.症例2は32歳男, 主訴は肉眼的血尿.膀胱の超音波検査とMRIで前壁に大きな腫瘍が見られた.膀胱鏡では前壁に粘膜下腫瘍を認めたが, 尿細胞診では悪性所見は無かった.生検試料では粘膜に炎症反応を見るに止まった.膀胱部分切除を行い, 29ヵ月間再発, 転移を見ない.両腫瘍の組織診断は膀胱の平滑筋腫であった, We report 2 cases of leiomyoma of the urinary bladder. A 41-year-old female visited our hospital with the complaint of pollakisuria. A solid tumor of the urinary bladder was found by ultrasonography. A large shadow defect at the left-anterior wall was shown by drip infusion pyelography (DIP). Computed tomographic scan (CT) and magnetic resonance imaging (MRI) also revealed a large tumor. T1-weighted image revealed a homogeneous low intensity tumor and T2-weighted image disclosed heterogeneous low intensity tumor. Cystoscopy revealed a large submucosal tumor. Partial cystectomy was performed, and she has had neither recurrence nor metastasis for 36 months. A 32-year-old male was referred to our hospital with the complaint of macrohematuria. A solid tumor of the urinary bladder was found by ultrasonography. A shadow defect was not clearly detected by DIP. A large tumor was detected on the anterior wall by MRI. T1-weighted image showed a homogeneous low intensity tumor and T2-weighted image disclosed a high intensity tumor. Cystoscopy revealed a submucosal tumor on the anterior wall. Urine cytology did not suggest a malignancy. The biopsied specimens revealed only an inflammatory change in the mucosa. Partial cystectomy was carried out. He has had neither recurrence nor metastasis for 29 months. Histological diagnosis in both cases was leiomyoma of the urinary bladder.

A case of left renal pelvic cancer with a high level of serum CA19-9 is reported. Radiological examination showed a left renal pelvic cancer with lymph node metastasis, but did not reveal any tumors producing CA19-9 in any other organs. Chemotherapy was performed in addition to left total nephroureterectomy. The serum level of CA19-9 decreased to the normal range within three weeks after the operation. Immunohistochemical examination demonstrated that CA19-9 might have been produced from the tumor cells themselves in this case.

A case of synchronous triple primary cancer occurring in the prostate, kidney and urinary bladder is reported. A 74-year-old man had been complaining of macroscopic hematuria, dysuria and residual sensation of urine since January 1994. Pathological analysis of prostate revealed poorly differentiated adenocarcinoma in March, 1994. Bone and Ga scintigraphy gave no evidence of metastasis. Computerized tomography (CT) revealed irregularity of a part of the margin of prostate (T2N0M0) and enhanced mass with a diameter of 3 cm localized at the hilus of the right kidney. Excretory urography showed a shadow defect in the right pelvis and elevation of the bladder base. In spite of the appearance of class 5 in urine cytology, no tumor was detected in the bladder by cystoscopy. Angiography confirmed the presence of a hypervascular tumor in the right kidney. He underwent right-sided nephroureterectomy in April, 1994, because not only right pelvic tumor but also right renal tumor was suspected. Histological examination of the renal tumor revealed clear cell carcinoma (T2N0M0). Then, he did not visit our hospital for 8 months. In January, 1995 a papillary broadbase tumor was found near the bladder neck by cystoscopy. Transurethral resection of the tumor (TUR-Bt) was performed in February, 1995. Pathological analysis of the tumor revealed TCC G1 pT1 (T1N0M0).

A 66-year-old female underwent left lower lobectomy for her lung cancer (adenocarcinoma) in November 1992, followed by the resection of brain metastasis in October 1993. Later, a left renal tumor with paraaortic lymph node swelling was found by a follow-up abdominal CT. She was treated with left nephrectomy and the resection of the paraaortic lymph nodes in June 1997. The histopathology of the resected tumor and the lymph nodes revealed a metastatic renal tumor originating from the pulmonary adenocarcinoma. There have been 38 reported cases of metastatic renal tumor from lung cancer in the Japanese literature.

正常ラットにおけるthaw mount法を用いた14C-標識蓚酸の経時的腎ミクロオートラジオグラムでは, 投与された14C-標識蓚酸はその大部分が尿中に排泄された後も, 集合管上皮細胞内及びその周囲の間質に一時的に停滞することが観察され, この蓚酸の停滞が蓚酸カルシウム結石発症にかかわっていることが強く示唆された.事実, 過蓚酸尿症ラットにおいては, 集合管上皮細胞内及びその周囲の間質での蓚酸カルシウム結晶の析出沈着が最初に出現し, この析出沈着した結晶が次第に成長することが, X線分析を併用した14C-標識蓚酸腎ミクロオートラジオグラフィーにより証明された, To elucidate the intrarenal distribution of oxalate and to reveal the first site of calcium oxalate crystal fixation along the nephron, we carried out 14C-oxalate renal microautoradiography by the thaw mount method 30, 60 and 90 min after intravenous administration of 14C-oxalate, in normal rats and in hyperoxaluric rats fed a vitamin B6-deficient diet for 4 and 9 weeks. In normal rats, radioactivity was observed in the entire kidney area at 30 min after the injection and at 90 min there was radioactivity only in the papilla, where radioactivity appeared in the parenchyma, mamely the epithelial cells of collecting ducts and the surrounding interstitial tissue. In hyperoxaluric rats, microautoradiograms showed the spotted deposits of 14C-oxalate in both renal papilla and medulla. In 600 x magnification of the autoradiograms, most of the deposits were detected in the epithelial cells of collecting ducts and the surrounding interstitial tissue. These deposits were identified by a polarizing microscope and X-ray microanalysis as crystal deposits of calcium oxalate. These results indicated that oxalate remained for an extended period of time in the epithelial cells of collecting ducts and in the surrounding interstitial tissue in renal papilla, and the calcium oxalate crystals fixed to the same tissue was the first step in the development of calcium oxalate stones.

1)DA3177(D群) 112例, 臭化ブチルスコポラミン(B群) 111例のうち有効性評価例数はD群97例, B群101例の計198例であった. 2)患者印象は「よくきいた」以上が, D群68.7%, B群53.5%であった. 3)疼痛改善度は「中等度改善」以上が, D群69.1%, B群60.4%であり, D群はB群に比し, 高い改善率が認められた. 4)全般改善度は「中等度改善」以上が, D群70.1%, B群61.4%であった. 5)概括安全度は「安全性に問題なし」が, D群91.5%, B群93.3%であり, 2群間に有意差は認められなかった. 6)「有用」以上の有用率が, D群68.7%, B群60.4%であり, D群はB群に比し, 高い有用率が認められた, A double-blind study was conducted to evaluate the efficacy, safety and usefulness of cimetropium bromide (DA3177) in the patients with pain caused by upper urinary calculus at a daily dose of 75 mg t.i.d. (Group D, 97 patients) in comparison with scopolamine butylbromide at a daily dose of 60 mg t.i.d. (Group B, 101 patients). According to patient's impression, the rate of "moderately improved" or better was significantly higher in Group D (68.7%) than in Group B (53.5%; Wilcoxon 2 sample test: p = 0.0044). For pain, the rate of "moderately improved" or better was 69.1% in Group D and 60.4% in Group B. In global improvement, the rate of "moderately improved" or better was significantly higher in Group D (70.1%) than in Group B (61.4%; Wilcoxon 2 sample test: p = 0.0469). The rate of "no problem in safety" showed no significant difference between Group D (91.5%) and Group B (93.3%). Adverse reactions occurred in 8.5% in Group D and 6.7% in Group B. The major adverse reactions were "dry mouth", "abdominal distension", "constipation" and "nausea". The rate of "useful" or better was 68.7% in Group D, and 60.4% in Group B. In conclusion, DA3177 was confirmed to be a useful drug for patient with pain caused by upper urinary calculus.

21例の女子尿道症候群症例の尿中IL-6, IL-8の測定を行い, インターロイキンの検出率の違いや抗菌剤治療前後での変化について推計学的検討を加えた.これら女子尿道症候群症例中1例にIL-6を, 8例にIL-8が検出され, その値は41.1pg/mgCr, 13.3～560pg/mgCr(平均108.7pg/mgCr).IL-6やIL-8が検出された9症例に対し, スパルフロキサシン 100mgを服用させ, 自覚症状を調べたところ, インターロイキンは測定されなくなり7症例では自覚症状の改善がみられた.残り2名にインターロイキンが検出されたが, うち1症例に症状の改善がみられた, Interleukin-6 (IL-6) and interleukin-8 (IL-8) are important mediators of an inflammatory response. We measured creatinine-collected urinary levels of IL-6 and IL-8 by an enzyme-linked immunosorbent assay in 21 women with urethritis syndrome as well as 20 age-matched healthy women. Urine samples were collected before treatment and after 7 or 14 days of oral administration of sparfloxacin (100 mg once daily). Urinary IL-6 level was elevated in a patient with urethritis syndrome (41.1 pg/mgCr), while urinary IL-8 levels were elevated in 8 (range 13.3 to 560 pg/mgCr). On the other hand, none of the healthy controls showed any detectable urinary level of IL-6 and IL-8. Of the 9 patients with elevated urinary IL-6 or IL-8, symptomatic improvement was obtained after chemotherapy in 8 and urinary interleukins became undetectable in 7. Urinary IL-6 and IL-8 seem to have some role in the induction of urinary symptoms.

ビカルタミド1日1回50mg群, 80mg及び100mgを12週間投与する3群比較の無作為化非盲検試験を実施した. 1)登録症例は124例で, 適格例は122例であった. 2)総合効果における奏効率は50mg群, 80mg群及び100mg群でそれぞれ50.5%, 61.0%及び53.7%であった. 3)PSAに対する奏効率は50mg群, 80mg群及び100mg群でそれぞれ84.2%, 92.7%及び97.6%であった. 4)副作用発現率は3群ほぼ6割で副作用による中止例は80mg群の1例のみで, 安全度において3群間に有意差はなかった.主な副作用は乳房腫脹, 乳房圧痛等であった, To investigate the efficacy and safety of bicalutamide (Casodex(R)) with its clinically recommended dose, the randomized early phase II study was performed in 124 patients with prostatic cancer (stage C, D). The patients were given 50, 80 or 100 mg of bicalutamide orally once a day in fixed doses for 12 weeks ; 122 patients were eligible for evaluation. The overall response rate was 50.0% (20/40); 61.0% (25/41) and 53.7% (22/41) in the 50 mg, 80 mg and 100 mg groups, respectively. The response rate in prostate lesion, bone and lymph node metastases was slightly higher in the 80 mg group than in the 50 mg and 100 mg groups. The proportion of patients showing a response with regard to serum PSA (CR and PR) was 84.2, 92.7 and 97.6% in the 50, 80 and 100 mg groups, respectively. The incidence of adverse reactions was 65.0, 61.0 and 61.0% in the 50, 80 and 100 mg groups, respectively, and there was no significant difference in overall safety rating in the three groups. Frequent adverse reactions were gynecomastia and breast pain. Only one patient in the 80 ing group was withdrawn due to shortness of breath. Serum concentrations of LH, testosterone and estradiol increased significantly after treatment. Bicalutamide was concluded to be effective and well tolerated in patients with prostatic cancer, and its recommended dose was 80 mg once daily.

17例の慢性非細菌性前立腺炎にスパルフロキサシンでの治療を行い, 精液中のサイトカイン(IL-1β, IL-6 TNF-α)を測定した.健常男子11例の精液と比べた結果, 健常男子では1例にTNF-αが検出されたが, 他のサイトカインはまったく検出されなかった.慢性前立腺炎では何等かのサイトカインが検出され, 特にIL-6やTNF-α値の検出される頻度はそれぞれ10例中6例(60%)と有意に高かった.慢性前立腺炎での精液中IL-1β, IL-6, TNF-α値の平均値(範囲)はそれぞれ28pg/ml(27-29), 110pg/ml(25-476), 25pg/ml(6-113)であった.これらのサイトカイン値はスパルフロキサシンでの治療にて症状改善と共に正常化した, The detection of various cytokines; interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), was studied in patients with nonbacterial prostatitis (NBP), and the clinical efficacy of sparfloxacin was also reported. The seminal plasma of 11 normal men and 10 patients with NBP were examined for the cytokines. There was no IL-1 beta or IL-6 in the seminal plasma of normal men. TNF-alpha was detected in only one normal man. In the seminal plasma of the patients, IL-1 beta was detected in 2 out of 10, and IL-6 was also detected in 6. TNF-alpha was detected in 6 out of 10 patients with NBP. The rate of detection of IL-6 and TNF-alpha was significantly higher in the patients with NBP than in normal men. The average levels (range) of IL-1 beta, IL-6 and TNF-alpha were 28 pg/ml (27-29), 110 pg/ml (25-476) and 25 pg/ml (6-113), respectively. After treatment with sparfloxacin at a dose of 100 mg to 200 mg per day, their symptoms disappeared. The number of leukocytes in the seminal plasma decreased to the normal level and these cytokines were not detected. The favorable clinical effect was achieved in 13 of the 17 patients (76%). These findings suggested that the cytokines have an important role in the pathogenesis of prostatitis and that the level of the cytokines are useful indicators in patients with prostatitis, particularly with NBP.

74歳男, 血清CA-19-9値とCA-125値の高値を示す腎結石による水腎症を経験した。腎盂尿のこれらの値は高く, 摘出腎の腎盂粘膜にCA-19-9とCA-125が証明された。悪性細胞は認めなかった。腎摘出後のこれらの値は正常値に戻った, A case of hydronephrosis caused by renal stones with elevated serum levels of carbohydrate antigens 19-9 (CA-19-9) and 125 (CA-125) is reported. A 74-year-old woman was hospitalized with pyelonephritis. The results of computerized tomography and endoscopy suggested that the patient did not have pancreatic or ovarian cancer, but laboratory tests were significant for serum CA-19-9 greater than 1, 000 U/ml (normal less than 37) and serum CA-125 78 U/ml (normal less than 35), which are markers for such tumors. Abdominal X-ray films showed stones in the pelvis of the right kidney. Excretory urography showed that the right kidney was not functioning. Computerized tomography showed severe right hydronephrosis with a thin renal cortex. Complete obstruction of the ureteropelvic junction of the kidney was seen by retrograde pyelography. During percutaneous pyelography, aspiration of the pelvic urine was done, and the sample had a high concentration of CA-19-9 (250, 000 U/ml), but no cancer cells. The patients underwent right nephrectomy. The pelvic urine was tested for both CA-19-9 and CA-125 this time, and both were high (190, 000 U/ml and 5, 100 U/ml, respectively). Pathological evaluation showed no evidence of a malignant tumor. The epithelium lining the renal pelvis was stained for both CA-19-9 and CA-125 using the avidin-biotin-peroxidase complex method. Serum levels of the markers returned to normal after nephrectomy.

TZP-4238の腎機能に関し検討した。1)単回投与試験:1)前立腺肥大症患者をそのCCrにより, A群(CCr, The effect of TZP-4238, an antiandrogen drug, on renal function was examined. Single administration test: Patients with prostatic hypertrophy were divided according to creatinine clearance (CCr) into group A (CCr or = 50 ml/min), and hemodynamics after a single administration of TZP-4238 were compared between the two groups. Groups A and B showed similar TZP-4238 hemodynamics, and there was no significant difference in pharmacokinetic parameters or the rate of serum protein binding between them. There was no difference in the hemodynamics of a major metabolite, 15-OH body, between the two groups. Neither was there any significant difference in the urinary excretion rate of TZP-4238 or 15-OH body. There were no findings of adverse clinical significance, and there were no problems with safety. Consecutive administration test: A 16-week consecutive administration study was performed on patients with prostatic hypertrophy associated with relative renal hypofunction. The blood levels determined in 5 patients were in good accordance with the simulation curve drawn from the results of group A. The rates of efficacy, safety and usefulness were 71.4%, 90% and 71.4%, respectively. Mild side effects were observed in one patient, but the 16-week administration was completed in all patients, and no adverse effects on renal function were observed. Favorable blood levels of TZP-4238 were obtained even in patients with prostatic hypertrophy associated with renal hypofunction, and adequate efficacy and safety were achieved even with consecutive administration. Furthermore, the drug had no apparent adverse effect on renal function.

1) 55歳以上の尿潜血反応陽性18名をGFR 60ml/min以下と以上の2群に分け検討した。2)尿中排泄が造影後有意に増加したのは, 尿中γ-GTPは両群とも, 尿中ALBとNAGは腎機能正常群のみに認められた。近位尿細管β2-MG再吸収能は腎機能障害群のみ造影4日目まで一過性に低下傾向を示したが, 6日目には軽快していた, We assessed the nephrotoxicity of a non-ionic contrast medium, Iohexol, in 18 elderly patients. They were divided into two groups. Group 1 consisted of 12 patients with glomerular flow rate (GFR) above 60 ml/min/1.73 m2 (range 69-136; average 96) and group 2 consisted of 6 patients with GFR below 60 ml/min/1.73 m2 (range 38-59; average 49). Urine samples, collected before, immediately after, and on the third and sixth days after drip infused pyeloureterography (DIP) were analyzed for gamma-glutamyl transpeptidase (gamma-GTP), N-acetyl-beta-D-glucosaminidase (NAG), beta 2-microglobulin (beta 2-MG) and albumin. In group 1, immediately after DIP, the urinary excretion of albumin, gamma-GTP and NAG were significantly increased (p < 0.01, p < 0.01, p < 0.01). In group 2, immediately after DIP, the urinary excretion of gamma-GTP and beta 2-MG were significantly increased (p < 0.01, p < 0.1). The gamma-GTP and NAG values in both groups suggest that the damage of proximal tubules cells will not continue for more than 4 days. However, as for the reabsorption of beta 2-MG on proximal tubules, in group 2 the value did not return to the pre DIP level until 6 days after DIP. We believe it is important to postpone injection of non-ionic contrast medium within 6 days of its last usage.

30例のBPHについて経尿道的温熱療法装置の有効性, 安全性, 有用性および臨床成績を評価した。自覚症状は70%に改善がみられ, 尿流量検査や残尿量の面で他覚的所見には71%に改善が見られた, Transurethral hyperthermic treatment was performed on 30 patients with benign prostatic hypertrophy (BPH). Two patients had a urethral catheter because of urinary retention. The prostate was heated transurethrally. The treatment consisted of 3-8 sessions of 60 min. each. To evaluate this treatment, the following parameters were determined before and 1-5 weeks after the last hyperthermia session; subjective symptoms score, and as objective data residual urine volume and uroflowmetry. The symptoms score improved in 25 (83%) patients. Of 2 patients with a catheter, the catheter could be removed from 1 patient. Although there was no change in prostatic volume, significant decreases in residual urine volume, and increases of maximum flow rate and mean flow rate were observed. No adverse reactions were seen. Judging from the above results, this treatment is considered to be useful for patients with BPH.

Case 1. A 55-year-old male visited our hospital complaining of dysuria and two-staged micturition. Physical examination revealed a fist sized, elastic soft mass in the left inguinal region. Upright drip infusion pyelography (DIP) showed left inguinal hernia of the bladder. Retrograde urethrography showed bladder neck contracture and a diverticulum. Cystoscopy revealed a indentation in the left bladder wall. Urodynamic studies demonstrated organic obstruction in the lower urinary tract. From these findings, diagnosis was made as bladder hernia and bladder neck contracture. Resection of thin portion of the bladder wall and hernia repair, accompanied by prostatectomy, was performed. Case 2. A 37-year-old male visited our hospital with the history of ureteral stone and chronic prostatitis. Upright DIP incidentally revealed the small right inguinal bladder hernia. Because he had no complaint of dysuria and two-staged micturition, he was observed without surgical treatment.

We experienced a case of peripelvic extravasation after extracorporeal shock wave lithotripsy (ESWL) treatment. A 62-year-old man was admitted to our hospital with a complaint of macroscopic hematuria. The patient was diagnosed as having a radiolucent stone in the right kidney and ESWL treatment was performed to focus the stone by using drip infusion pyelography (DIP) under epidural anesthesia. The patient had right flank pain two weeks after ESWL treatment. DIP and computerized tomography (CT) showed peripelvic extravasation of contrast medium. Right pain improved after a double-J catheter was placed for decreasing intra-pelvic pressure. As a result, the disappearance of peripelvic extravasation was recognized by DIP and CT. We reviewed four cases of peripelvic extravasation after ESWL treatment including our case in the Japanese literatures and discussed the cause of peripelvic extravasation after ESWL treatment.

We report a case of milk of calcium renal stone within a calyceal diverticulum in the patient with left ureteral tumor. The patient was a 77-year-old-man with the chief complaint of asymptomatic microscopic hematuria. A plain film revealed round opaque calcific densities in the left kidney in the supine position and a dense crescent-shaped shadow with a horizontal border in the upright position. An intravenous pyelography showed left hydronephrosis and calculi within a calyceal diverticulum. Computed tomography in the supine position revealed layering of the calcifications in cystic lesion of the left kidney accompanied by left hydronephrosis due to a soft mass in the left ureter and a right renal cyst. Retrograde pyelography revealed a filling defect of the middle portion of the left ureter. Under the diagnosis of milk of calcium renal stone and left ureteral tumor, left total nephroureterectomy and partial cystectomy was performed. Pathological findings indicated transitional epithelium of the diverticulum wall and grade 1 transitional cell carcinoma of the left ureteral tumor.

The patient was a 70-year-old male with invasive bladder cancer. We performed intermittent arterial infusion (ITI) combined with alteration of blood flow in the bladder wall using the contralateral arterial embolization. As for anti-tumor agents, cisplatin (CDDP) 10mg and pirarubic in (THP) 10 mg were selected, and were injected every week for 11 times. Complete response (CR) was noted by cystoscopy and biopsied specimen. In our conclusion. ITI was useful for the treatment of bladder cancer.

We present a case of a muellerian duct cyst in a 55 year-old man. A cystic lesion was incidentally found between the prostate and the bladder on transabdominal ultrasound examination. Computerized tomography revealed a low density area homogeneous and round with a clear margin. Both urethrocystgram and vesiculogram demonstrated no cystic lesion. On diagnosis of muellerian duct cyst percutaneous needle aspiration was performed under ultrasound control. The aspirated fluid was yellow, clear and negative for cytology. Microscopically no spermatozoa were found in it. Minocycline (100 mg) was injected into the cyst. No recurrence has occurred since the operation. The literature of the cyst was briefly reviewed.