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To examine the efficacy and safety of tadalafil in the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia with chronic pelvic pain syndrome, we treated 23 Japanese men with tadalafil 5 mg once daily for 4 weeks. The mean age of the participantswas58.7 yearsand the prostate volume was25. 2 ml. Significant improvementsin total International Prostatic Symptom Score, International Prostatic Symptom Score Quality of Life Index, total National Institutes of Health Chronic Prostatitis Symptom Index score, pain subscore, urinary symptom subscore, and quality of life impact subscore, were observed for tadalafil versus before treatment. These findings confirm that tadalafil is a valuable new treatment option for patients with benign prostatic hyperplasia complicated by chronic pelvic pain syndrome.

45歳女。腹部CTにて左腎腫瘍を認め、根治的腎摘出術を施行し、病理診断はrenal cell carcinoma、clear cell typeであった。約11ヵ月後の経腟超音波検査で左卵巣嚢胞を認め、内部にhigh echoicな腫瘤性病変を認めたためMRIを行い、腫瘤はチョコレート嚢胞と考えられた。その後腫瘍の増大、内部にlow echoic areaを認め、腹腔鏡下左卵巣摘出術を行った。術中、左卵巣と腹膜・広間膜の癒着、右卵巣の一部腹膜癒着を認め、術中迅速病理検査で境界悪性との結果が得られたため両側卵巣子宮摘出術へ変更した。病理組織診断はrenal cell carcinoma、clear cell carcinomaの転移であった。術後INFα治療は同意が得られず、無治療にて経過観察していたところ、肺転移巣などが徐々に進行し死亡した。, A 45-year-old woman underwent left radical nephrectomy in April 2002. Pathological diagnosis was a renal cell carcinoma, clear cell subtype, pT3a, v(-), NO. One year later, abdominal ultrasound revealed a left ovarian tumor which had an enlargement tendency. A laparoscopic bilateral salpingooophorectomy was performed. Immunohistochemical analysis confirmed the diagnosis of metastatic ovarian renal cell carcinoma. This is the 20th case in the literature.

To examine the efficacy and safety of tadalafil in the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia with chronic pelvic pain syndrome, we treated 23 Japanese men with tadalafil 5 mg once daily for 4 weeks. The mean age of the participantswas58.7 yearsand the prostate volume was25. 2 ml. Significant improvementsin total International Prostatic Symptom Score, International Prostatic Symptom Score Quality of Life Index, total National Institutes of Health Chronic Prostatitis Symptom Index score, pain subscore, urinary symptom subscore, and quality of life impact subscore, were observed for tadalafil versus before treatment. These findings confirm that tadalafil is a valuable new treatment option for patients with benign prostatic hyperplasia complicated by chronic pelvic pain syndrome.

39歳女.患者は17歳の時, 関節炎および蝶形紅斑, 発熱で発症し, 23歳時に全身性エリテマトーデス(SLE)と診断された.プレドニゾロンの内服治療を受けていたが, 発熱はじめ両下肢の脱力とともに排尿困難感を自覚した.更に呼吸困難, 全身の筋肉痛が出現, 3ヵ月後の退院時には排尿状態は自排尿可能であったが, 尿失禁を認めた.以後, 全身性浮腫が出現し, 腹部CTにて両側水腎症を認めた.腎盂腎炎を繰り返し, 膀胱尿管逆流, 膀胱憩室を認めた.膀胱憩室切除術, 回腸利用膀胱拡大術を施行した結果, 病理組織検査では, 高度の炎症細胞浸潤と肉芽組織の形成を認め, 膀胱憩室炎の診断であった.術後3ヵ月で水腎症, 尿失禁は完全に消失し, 膀胱容量は300mlまで増加した, A 39-year-old female with systemic lupus erythematosus (SLE) with a neurogenic bladder is described. She developed voiding disturbance with paraplegia and sensory disturbance on her inferior limb. Clinical findings suggested elevated activities of SLE with transverse myelitis. Although her symptoms were improved after one course of methylprednisolone pulse therapy, clean intermittent catheterization was required for urinary incontinence and residual urine. One year later, bilateral hydronephrosis and vesical diverticulitis developed, and thus augmentation ileocystoplasty was performed. After three months of the operation, hydronephrosis and urinary incontinence resolved with frequent clean intermittent catheterization. We should not overlook lower urinary tract symptoms in patients with SLE. We advocate performing a surgical procedure in cases in which conservative treatments are not effective.

16歳男で, 頭痛, 発熱に続いて排尿困難と両下肢の感覚障害が出現した.血清マイコプラズマ抗体高値, MRI T2強調像での胸腰髄の高信号・腫脹等の所見からマイコプラズマ感染による急性横断性脊髄炎と診断された.ステロイドパルス療法を行い, マイコプラズマ抗体は2ヵ月後に正常化, 下肢の感覚も回復したが, 夜間尿失禁や頻尿が残存し, 夜間尿失禁は18ヵ月後の現在まで続いている, We report a case of urinary retention complicated with acute transverse myelitis caused by Mycoplasma pneumoniae. A 16-year-old man visited a clinic because of urinary retention, fever, muscle weakness and sensory disturbance of lower extremities. He was referred to our hospital for further examination. He was diagnosed with acute transverse myelitis due to M. pneumoniae infection based on cerebrospinal fluid examination, serum titer of antibody to M. pneumoniae and magnetic resonance imaging. He was treated with corticosteroids for acute myelitis. A urethral catheter was indwellt for urinary retention. His muscle strength and sensory of lower extremities improved after 2 months of treatment, and he was discharged from our hospital. However, since urinary frequency, urge incontinence and weak urinary stream persisted, he was referred to us for further examination. A pressure-flow study examination showed a decreased maximum urinary flow rate and the findings of detrusor sphincter dyssnergia. We diagnosed him with uninhibited bladder and detrusor sphincter dyssnergia. We administered propiverine hydrochloride and imipramine hydrochloride, and his symptoms subsided significantly. Now, (8 months) after this medication, he still has incontinence at night.

65歳女.慢性頭痛のためセデス末(フェナセチン含有量400mg/包)を内服していたが, その後, 市販薬のセデスA錠(フェナセチン含有せず)に内服変更していた.又, 近医の処方によりサリイタミン(フェナセチン含有量250mg/包)2包/日を内服していた.通算のフェナセチン総摂取量は約8kgであった.無症候性肉眼的血尿で受診した.DIPにより左腎盂腫瘍と診断した.左腎盂尿管全摘出術を施行した.術後経過は良好で退院し, 経過観察中である.組織学的所見は移行上皮癌grade 2で, 腫瘍胞巣は乳頭状増殖を示し明らかな浸潤傾向は見られず腎盂上皮に限局していた, A 65-year-old female had been taking analgesics containing phenacetin, because of severe headaches since 1958. The total dose of phenacetin that she had taken was calculated to be 8.0 kg. She visited the department of urology in our hospital in August, 1999 complaining of gross hematuria. A solid mass was detected in her left renal pelvis on the abdominal computed tomographic (CT) scan. Under the diagnosis of a left renal pelvic tumor, nephrouretectomy was performed in September, 1999. Histopathological diagnosis was grade 2 transitional cell carcinoma. Interstitial nephritis was also observed. Our case is the twenty-second report of an urinary tract tumor associated with phenacetin abuse in Japan.

27歳女.男児出産後, 1ヵ月に2～3日続く38℃以上の熱発があり, 感冒薬, 抗生剤を処方されたが, 39℃の熱発のため受診した.腹部造影CTで左腎頭側に腫瘤を認め, 内部は不均一に造影効果を認め, 副腎腫瘍が疑われた.アンギオグラフィーで大動脈から分岐する血管より全体に栄養される腫瘤像を認め, non-functionの副腎腫瘍と診断し, 悪性を強く疑い, 腹腔鏡下腫瘍摘出術を施行した.免疫組織化学染色所見より, 悪性中皮腫と診断した.術後1.5年経過したが, 再発を認めず, 極めて稀な症例と思われた, Malignant mesothelioma is a neoplasm which tends to develop along serosal surfaces, such as the pleura and peritoneum. We report a rare case of malignant retroperitoneal mesothelioma in a 27-year-old woman. The patient was admitted with a chief compliant of intermittent high fever once a month, and left retroperitoneal tumor was detected by dynamic abdominal computed tomography. Since an adrenal tumor was suspected, laparoscopic tumor extirpation was performed. Immunohistochemically tumor cells were positive for calretinin and thrombomodulin, but negative for carcinoembryonic antigen (CEA) and Ber-Ep4. Based on these findings, primary malignant retroperitoneal mesothelioma was diagnosed.

症例は78歳男性で, 2ヵ月前の喉頭癌摘出術時に術前の尿道カテーテル留置の際, 肉眼的血尿を認めたため, 術後に紹介来診した.膀胱鏡にて右膀胱頂部に直径約5cmの非乳頭状広基性の腫瘍を認め精査加療目的で入院となった.経尿道的膀胱腫瘍生検の結果, 腫瘍表面は凝血塊に覆われ石灰化が著明で生検組織標本からは腫瘍細胞は得られなかったが, 画像所見から筋層浸潤を強く疑い, 術前診断T3bN0M0として膀胱全摘除術および回腸導管造設術を施行した.摘出標本の病理組織学的所見から肉腫様癌(sarcomatoid carcinoma), grade 3, pT3bpN0と診断された.術後4日目にMRSAによる創部感染に基づく腹膜炎を発症し, 術後5日目に腹膜炎に対する腹腔内洗浄・ドレナージの再手術を施行し, 塩酸バンコマイシンによる化学療法を行った.再手術後の経過は良好で, 術後10ヵ月の現在再発は認めていない, The patient was a 78-year-old man with gross hematuria. A non-papillary and non-pedunculated tumor was found on the posterior wall of the bladder by cystoscopic examination. Total cystectomy with construction of ileal conduit was performed. Histologically, the tumor was composed of carcinomatous and sarcomatous elements. The carcinomatous element was compatible with grade 3 transitional cell carcinoma. The sarcomatous element was composed of osteosarcomatous, chondrosarcomatous pattern and undifferentiated malignant spindle cell component. Immunohistochemical examination demonstrated the presence of keratin, cytokeratin and epithelial membrane antigen in both carcinomatous and sarcomatous elements. Therefore, we diagnosed this tumor as sarcomatoid carcinoma. The patient has remained well without any evidence of recurrence for 10 months after operation.

1)2°HPT 20例に活性型VDのパルス療法を実施した.13例に有効であり保存的に治療が可能であったが, 無効の6例と, 1例が再発を繰り返すため最終的に7例にPTXを実施した.2)パルス療法有効例でも, 治療に伴い全例で平均1.8±1.0mg/dlの血清Ca値の上昇が認められた.3)パルス療法無効例は有効例と比較して, 有意に上皮小体が大きかった.又, 血清Ca, P, Alpも有意に高かった.4)PTXを実施した7例では, 5例までがその最大の上皮小体が1gを超え, 組織学的に結節性過形成を呈した.5)PTX直前まで可能なかぎり活性型VDを投与して, 血清Alpを低下させた.術後の経静脈的Ca投与量は術直前の血清Alpと相関し, Alpを下げることで, 術後の血清Caの管理が容易であった可能性がある, The oral active vitamin D pulse therapy was performed for 20 chronic hemodialysis patients with secondary hyperparathyroidism (2 degrees HPT). Before pulse therapy, all patients showed high-turnover bone diseases, elevated serum alkaline phosphatase (Alp) and elevated serum parathyroid hormone (PTH). They had at least one parathyroid gland detected by ultrasonography. In one patient, serum PTH level did not decrease during three months. In five patients, hypercalcemia was observed so that the pulse therapy was with drawn. Another patient was resistant to the second pulse therapy for recurrence of 2 degrees HPT. Total parathyroidectomy and autotransplantation was performed in these seven patients. The size of parathyroid gland in patients undergoing surgical treatment was significantly larger than those estimated by ultrasonography in patients successfully treated with pulse therapy (p < 0.005). In all patients with surgical treatment, the conventional oral active vitamin D therapy was performed with caution to hypercalcemia preoperatively. The preoperative Alp levels decreased compared with those of at the beginning of the pulse therapy. Postoperatively, the total amount of intravenous administered calcium decreased, and serum calcium levels were easily controlled.

RT-PCR法は前立腺癌のリンパ節転移及び骨転移のより正確な評価を可能にし, 臨床的局在性前立腺癌の病理学的病期の術前予測を可能にする.更に, RT-PCR法は前立腺癌の予後因子となりうる, We summarized and reviewed published reports, including our studies, on the reverse transcription-polymerase chain reaction (RT-PCR) detection of micrometastatic prostate cancer cells in lymph nodes, bone marrow and peripheral blood. Some published data preliminarily suggest that the RT-PCR assay of micrometastatic prostate cancer cells may allow a more accurate assessment of lymph node and bone metastases of prostate cancer, and offer a presurgical prediction of the pathological stage of clinically localized disease. In addition, the RT-PCR assay may have a unique prognostic value in prostate cancer. However, controversy remains over the clinical significance of the RT-PCR assay. This assay could potentially develop into a diagnostic procedure for the clinical decision making in patients with prostate cancer. To establish the clinical significance of the RT-PCR assay, further optimized and standardized RT-PCR assay studies are needed, investigating large populations and involving long-term follow-up for the determination of any association between the results of the RT-PCR assay and specific clinical outcome.