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A 63-year-old woman underwent laparoscopic sacrocolpopexy for pelvic organ prolapse. Four days postoperatively, she underwent an abdominal computed tomography scan because she developed a stomachache, and a strangulated bowel obstruction was suspected. The patient then underwent an emergency laparotomy which revealed strangulation of the small intestine caused by a band formed between the stump of a barbed suture and the mesentery. The strangulation was released by resecting the stump, and intestinal resection was not necessary. Nine days following the re-intervention, the patient was discharged from our hospital. As of four months after the surgery, she has not experienced any recurrence of pelvic organ prolapse or other postoperative complications. We need some ingenuity when using barbed suture in situations where the thread and the intestine come into contact.

A 77-year-old man underwent robot-assisted laparoscopic radical cystectomy with pelvic lymph node dissection and ileal conduit for bladder carcinoma. Six months postoperatively, multiple lung metastases and a sacral bone metastasis were detected on computed tomography (CT). The patient then received gemcitabine-carboplatin (G-CBDCA) because he had renal dysfunction, which is a contraindication for cisplatin. After two courses of G-CBDCA, pembrolizumab was started because the lung metastases showed progression. The patient then underwent gemcitabine-paclitaxel (GP) chemotherapy (G : 1, 000 mg/m² on days 1, 8, and 15 ; P : 180 mg/m² on day 1 ; every 4 weeks) as third-line treatment because of further progression after two courses of pembrolizumab. The lung metastases showed an almost complete response after two courses of GP. Additionally, after two courses, the lung metastases showed a complete response, and no abnormal fluorodeoxyglucose uptake in the sacral bone metastasis was seen on positron emission tomography-CT. The patient suffered neutropenia and anemia as adverse effects ; however, these disappeared after discontinuing gemcitabine. Chemotherapy was discontinued after the four courses in accordance with the patient’s wishes, and he has remained free from recurrence for 2 months after discontinuing therapy.

A 63-year-old woman underwent laparoscopic sacrocolpopexy for pelvic organ prolapse. Four days postoperatively, she underwent an abdominal computed tomography scan because she developed a stomachache, and a strangulated bowel obstruction was suspected. The patient then underwent an emergency laparotomy which revealed strangulation of the small intestine caused by a band formed between the stump of a barbed suture and the mesentery. The strangulation was released by resecting the stump, and intestinal resection was not necessary. Nine days following the re-intervention, the patient was discharged from our hospital. As of four months after the surgery, she has not experienced any recurrence of pelvic organ prolapse or other postoperative complications. We need some ingenuity when using barbed suture in situations where the thread and the intestine come into contact.

A 66-year-old male with bladder cancer underwent radical cystectomy and ileal conduit construction. The pathological diagnosis was urothelial carcinoma with squamous differentiation (pT3b). Computed tomography (CT) 18 months postoperatively revealed a right external iliac lymph node metastasis. He was treated with systemic chemotherapy after placement of bilateral ureteral stents, but CT following chemotherapy revealed an increase in the size of the metastasis, and the patient was diagnosed with progressive disease. Radiotherapy to the metastasis was selected as local therapy, but the patient was at risk of an uretero-arterial fistula because the right external iliac artery and the right ureter adjacent to the metastasis were involved in the irradiated field. The right external iliac lymph node metastasis was irradiated with a dose of 50 Gy after stent grafting for the right external iliac artery to prevent an ureteroarterial fistula. He had no adverse events, including hematuria after radiotherapy, but died of cancer cachexia 12 months after radiotherapy.

A 77-year-old man underwent robot-assisted laparoscopic radical cystectomy with pelvic lymph node dissection and ileal conduit for bladder carcinoma. Six months postoperatively, multiple lung metastases and a sacral bone metastasis were detected on computed tomography (CT). The patient then received gemcitabine-carboplatin (G-CBDCA) because he had renal dysfunction, which is a contraindication for cisplatin. After two courses of G-CBDCA, pembrolizumab was started because the lung metastases showed progression. The patient then underwent gemcitabine-paclitaxel (GP) chemotherapy (G : 1, 000 mg/m² on days 1, 8, and 15 ; P : 180 mg/m² on day 1 ; every 4 weeks) as third-line treatment because of further progression after two courses of pembrolizumab. The lung metastases showed an almost complete response after two courses of GP. Additionally, after two courses, the lung metastases showed a complete response, and no abnormal fluorodeoxyglucose uptake in the sacral bone metastasis was seen on positron emission tomography-CT. The patient suffered neutropenia and anemia as adverse effects ; however, these disappeared after discontinuing gemcitabine. Chemotherapy was discontinued after the four courses in accordance with the patient’s wishes, and he has remained free from recurrence for 2 months after discontinuing therapy.

A 71-year-old man was admitted to the department of general surgery at our hospital due to constipation. A large bowel endoscopic examination revealed a stenosis of the rectum near the anus. The pathological diagnosis of the biopsy was poorly differentiated adenocarcinoma. After a computed tomography/magnetic resonance imaging examination, rectal cancer infiltrating the prostate was the diagnosis. External beam radiation therapy and chemotherapy were performed. After those neoadjuvant therapies, an abdominoperineal resection of the rectum (Miles) and a retropubic radical prostatectomy were performed. The final pathological diagnosis was prostate cancer infiltrating the rectum. Prostate cancer infiltrating the rectum is rare because of the Denonvillier's fascia barrier. However, it is difficult to distinguish prostate cancer infiltrating the rectum from rectal cancer infiltrating the prostate. Thus, when we see rectal cancer infiltrating the prostate, prostate cancer infiltrating the rectum should be suspected, serum prostate specific antigen (PSA) level should be determined, and PSA immunostaining should be performed.

A 66-year-old male with bladder cancer underwent radical cystectomy and ileal conduit construction. The pathological diagnosis was urothelial carcinoma with squamous differentiation (pT3b). Computed tomography (CT) 18 months postoperatively revealed a right external iliac lymph node metastasis. He was treated with systemic chemotherapy after placement of bilateral ureteral stents, but CT following chemotherapy revealed an increase in the size of the metastasis, and the patient was diagnosed with progressive disease. Radiotherapy to the metastasis was selected as local therapy, but the patient was at risk of an uretero-arterial fistula because the right external iliac artery and the right ureter adjacent to the metastasis were involved in the irradiated field. The right external iliac lymph node metastasis was irradiated with a dose of 50 Gy after stent grafting for the right external iliac artery to prevent an ureteroarterial fistula. He had no adverse events, including hematuria after radiotherapy, but died of cancer cachexia 12 months after radiotherapy.

A 24-year-old woman with a high fever presented at our hospital. She had been diagnosed with Kabuki syndrome at the age of 4 years because she had the typical facial features of the condition ; she had undergone living donor renal transplantation 12 years prior. She was prescribed a course of antibiotics to treat pyelonephritis of the transplanted kidney and the high fever disappeared, but the fever developed again 3 days after the discharge. Abdominal computed tomography revealed a tubular structure of recent onset running from the left dorsal side to the lower part of the bladder. This structure was filled with pus, which we drained. We also performed laparoscopic ureterectomy of the left ureter to achieve a complete cure. No complication was observed after the surgery and the graft renal function did not deteriorate further.

A 71-year-old man was admitted to the department of general surgery at our hospital due to constipation. A large bowel endoscopic examination revealed a stenosis of the rectum near the anus. The pathological diagnosis of the biopsy was poorly differentiated adenocarcinoma. After a computed tomography/magnetic resonance imaging examination, rectal cancer infiltrating the prostate was the diagnosis. External beam radiation therapy and chemotherapy were performed. After those neoadjuvant therapies, an abdominoperineal resection of the rectum (Miles) and a retropubic radical prostatectomy were performed. The final pathological diagnosis was prostate cancer infiltrating the rectum. Prostate cancer infiltrating the rectum is rare because of the Denonvillier's fascia barrier. However, it is difficult to distinguish prostate cancer infiltrating the rectum from rectal cancer infiltrating the prostate. Thus, when we see rectal cancer infiltrating the prostate, prostate cancer infiltrating the rectum should be suspected, serum prostate specific antigen (PSA) level should be determined, and PSA immunostaining should be performed.

1997年8月～2006年5月に精巣精子採取術(TESE)を施行した27例(年齢26～44歳)の非閉塞性無精子症(NOA)15例と非NOA12例を初回卵細胞質内精子注入法(ICSI)の際に使用した精子により新鮮精子群18例と凍結精子群9例に分類して比較検討した。新鮮精子群18例中にNOAは11例(61.1%, 平均年齢32.7歳), 非NOAは7例(38.9%, 36.0歳)で, 凍結精子群9例中にNOAは4例(44.4%, 36.0歳), 非NOA群は5例(55.6%, 34.4歳)であった。両群における受精率, 分割率, 良好胚率, 妊娠率, 出生率に差は認めないが, NOAと非NOAに亜分類しての比較では, NOA15例中の新鮮精子群は11例(73.3%), 凍結精子群は4例(26.7%)であり, 受精率, 分割率, 良好胚率において両群間に有意差を認めなかったが, 凍結精子群には妊娠例を認めず, 新鮮精子群では妊娠4例, 出産3例を認めた。また非NOA12例中, 新鮮精子群は7例(58.3%), 凍結精子群は5例(41.7%)であり, 受精率, 分割率, 良好胚率において両群間に有意差は認めず, 妊娠出産は各々1例認めた。NOAに対するICSIには新鮮精子の使用が適しているという可能性については更なる検討が必要であると考えられた。, Testicular sperm can be obtained from patients with non-obstructive azoospermia. However, there is not enough evidence concerning whether fresh or frozen-thawed sperm is better for successful pregnancy. We retrospectively compared initial treatment results of intracytoplasmic sperm injection using fresh and frozen-thawed testicular sperm in our institution. From August 1997 to May 2006, a total of 27 cases including 18 cases using fresh sperm (269 oocytes) and 9 cases using frozen sperm (97 oocytes) were evaluated. In the fresh and frozen sperm groups 33.4 and 32.9%, respectively, developed good quality embryo. There was no significant difference between the two groups in successful pregnancy and birth rates.

症例は42歳, 男性。AFP値が高いことを指摘されて当院を紹介受診した。この患者は21年間に非セミノーマの右精巣腫瘍の治療歴があった。当院受診時のCTでは右腎静脈から大動脈分岐まで下大静脈を圧排するような形で5×5cmの腫瘍を認めた。当院入院後, シスプラチン・エトポシド・パクリタキセル・イフォスファミドの4剤を併用した化学療法を施行した。しかし, 腫瘍は縮小せずAFP値も上昇した。そのためリンパ節郭清術・右腎摘出術・十二指腸部分切除術・下大静脈切除術を施行した。術後AFP値は正常範囲内に低下して, 現在約48ヵ月経過しているが再発は認めていない。(著者抄録), We report here a case of very late relapse of a nonseminomatous germ cell tumor 21 years after first complete remission. A 42-year-old man, with a clinical history of right testicular cancer, was referred to our hospital with elevated serum alpha-fetoprotein (AFP) level. CT scan demonstrated a 5 x 5 cm retroperitoneal lymph node swelling compressing the inferior vena cava (IVC) extending from the right renal vein down to the bifurcation of the aorta. The patient received a total of four courses of combination chemotherapy consisting of cisplatin, etoposide, paxlitaxel, and ifosfamide. However, the retroperitoneal lymph node metastasis did not respond to chemotherapy, and the serum AFP level increased. Extended bilateral retroperitoneal lymph node dissection with right nephrectomy, partial duodenectomy, and vena cavectomy were performed. The patient has been followed up with no evidence of disease for 48 months after the operation without any further therapy.

腎動脈瘤に対しコイル塞栓術を施行した2例を経験した.症例1は73歳男性.脳梗塞, 心筋梗塞で経過観察中に肉眼的血尿で著者ら施設へ紹介となった.X線, DIP, CTで右腎盂上方に11×10mmの円形石灰化を示す動脈瘤を認め, コイル塞栓術を施行した.術後動脈瘤内の血流は完全に消失し, 末梢への血流は十分保たれていた.症例2は52歳女性.健康診断で両側腎門部に石灰化病変を指摘され紹介受診した.DIP, CTで両側腎門部に動脈瘤を認め, コイル塞栓術を施行した.術後両動脈瘤内の血流は消失し, 末梢への血流は良好に保たれていた.2症例とも外来で定期観察をしているが, コイルの位置の変動は認めていない.腎動脈瘤のコイル塞栓術は簡便で安全に実施でき, 治療適応を広げる可能性があると思われた, Selective transcatheter embolization using an interlocking detachable coil was performed in two cases with renal artery aneurysms. Case 1, a 73-year-old male, was referred to our department complaining of macrohematuria persisting for three days. Case 2, a 52-year-old female, visited our department because calcifications in both renal pedicle areas were found in a health check up. Drip infusion pyelography (DIP) and computerized tomography (CT) revealed in case 1 an aneurysm which was 11 x 10 cm in diameter with nearly circumferential calcification in the right renal pedicle area and in case 2 two aneurysms, one 12 x 10 cm in the right and one 22 x 20 cm in the left with imperfect calcification. Enhanced CT confirmed blood flow in the aneurysms. Because abdominal surgery, was considered to be a highrisks in both cases 1 and 2 the coil embolization was performed. The patients have been followed up after the embolization without any particular complications or changes in the coil location.

A 24-year-old woman with a high fever presented at our hospital. She had been diagnosed with Kabuki syndrome at the age of 4 years because she had the typical facial features of the condition ; she had undergone living donor renal transplantation 12 years prior. She was prescribed a course of antibiotics to treat pyelonephritis of the transplanted kidney and the high fever disappeared, but the fever developed again 3 days after the discharge. Abdominal computed tomography revealed a tubular structure of recent onset running from the left dorsal side to the lower part of the bladder. This structure was filled with pus, which we drained. We also performed laparoscopic ureterectomy of the left ureter to achieve a complete cure. No complication was observed after the surgery and the graft renal function did not deteriorate further.

Testicular sperm can be obtained from patients with non-obstructive azoospermia. However, there is not enough evidence concerning whether fresh or frozen-thawed sperm is better for successful pregnancy. We retrospectively compared initial treatment results of intracytoplasmic sperm injection using fresh and frozen-thawed testicular sperm in our institution. From August 1997 to May 2006, a total of 27 cases including 18 cases using fresh sperm (269 oocytes) and 9 cases using frozen sperm (97 oocytes) were evaluated. In the fresh and frozen sperm groups 33.4 and 32.9%, respectively, developed good quality embryo. There was no significant difference between the two groups in successful pregnancy and birth rates.

Selective transcatheter embolization using an interlocking detachable coil was performed in two cases with renal artery aneurysms. Case 1, a 73-year-old male, was referred to our department complaining of macrohematuria persisting for three days. Case 2, a 52-year-old female, visited our department because calcifications in both renal pedicle areas were found in a health check up. Drip infusion pyelography (DIP) and computerized tomography (CT) revealed in case 1 an aneurysm which was 11 x 10 cm in diameter with nearly circumferential calcification in the right renal pedicle area and in case 2 two aneurysms, one 12 x 10 cm in the right and one 22 x 20 cm in the left with imperfect calcification. Enhanced CT confirmed blood flow in the aneurysms. Because abdominal surgery, was considered to be a highrisks in both cases 1 and 2 the coil embolization was performed. The patients have been followed up after the embolization without any particular complications or changes in the coil location.