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Background : Renal anemia is a very serious problem in hemodialysis patients. In this regard, the investigation was focused on whether ultrapure dialysate could improve renal anemia and the mechanism of renal anemia. / Methods : Ultrapure dialysate was used over a 2 years period for 61 patients on maintenance hemodialysis. During this period, the changes in renal anemia and red blood cell life span were investigated. The changes in the latter were evaluated using the creatine concentration in red blood cell....

Approximately 70% of patients with advanced prostate cancer have bone metastases, which are associated with considerable skeletal morbidity, accompanied by severe bone pain that requires narcotics or palliative radiation therapy, pathological fractures, spinal cord compression and hypercalcemia of malignancy (HCM), which consequentiy lower the patient's quality of life. Bisphosphonates, potent inhibitors of osteoclast activity and survival, therefore inhibiting osteoclast-mediated bone absorption, transiently palliative bone pain and decrease analgesic usage in patients who have hormone-refractory prostate cancer (HRPC) with bone metastases. Recently, a randomized controlled trial showed that a third-generation bisphosphonate, zoledronic acid reduced bone pain and skeletal-related events (SREs). In this manuscript, we reviwed the efficacy of bisphosphonates in HRPC with bone metastases from several clinical studies and discuss treatment of advanced prostate cancer with bisphosphonates.

症例1は72歳女.尿管腫瘍に対する腎尿管全摘術8ヵ月後の膀胱鏡時に膀胱腫瘍を認めた.症例2は57歳女.5回のTUR-Btの後に計6回のBCG膀胱内注入療法を行い, その後の膀胱鏡で2個の膀胱腫瘍を認めた.2例ともTUR-Btを施行.組織学的診断では2例ともnephrogenic adenoma.今回の2例を含めて, これまで計39例の本症が我が国で報告されている.男21例, 女18例で平均年齢は56.5歳.おもな症状は血尿が16例と最多で, ついで頻尿が6例である.本症の誘因としては尿路の外科的手術が16例で, 尿路感染症が9例, BCG膀胱内注入療法が6例である.特にBCGが保険認可された1996年12月以降はBCG膀胱内注入療法に引き続いて起こる症例の比率が高くなっており, 将来的な膀胱nephrogenic adenomaの増加が予想される, In the two cases we report here, tumors were diagnosed as nephrogenic adenoma by pathohistological examination. Case 1 was a 72-year-old female presenting with a bladder tumor 8 months after receiving ureteral tumor surgery. Transurethral resection of bladder tumor (TUR-Bt) was performed. Case 2 was a 57-year-old female who had received intravesical bacillus Calmette-Guerin (BCG) treatment 6 times after her fifth TUR-Bt. Two tumors were found by cystoscopy, and TUR-Bt was performed. There have been 39 cases of nephrogenic adenoma of the bladder reported in Japan; 21 were male and 18 female with a mean age of 56.5 years. The main complaint was hematuria, which was seen in 16 cases followed by pollakisuria in 6 cases. Nephrogenic adenoma occurred after surgery of the urinary tract in 16 cases, followed by urinary tract infection in 9 cases and intravesical BCG treatment in 6 cases. The ratio of cases occurring after intravesical BCG treatment has increased since BCG approval for bladder carcinoma treatment in December 1996 in Japan, and an increase in the number of cases is expected in the future.

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.

Prostate cancer;Progression model;Gene therapy;Osteocalcin promoter;PSA promoter, For the application of gene therapy to bladder cancer, we examined four in vivo gene transfer methods without viral vectors. For lipofection cationic liposomes (Lipofectin) were instilled into murine bladders. The hemagglutinating virus of Japan (HVJ)-liposomes possessing membrane fusion activity were also injected intraluminally. Using a particle gun, rabbit bladder mucosa was bombarded with DNA-coated gold microcarriers. Electrotransfection was examined in rabbit bladder by pulse direct currents (0.15-0.2 A, 50 msec, repeated 8 times) generated between needle electrodes after submucous injection of DNA solution. beta-galactosidase gene and chloramphenicol acetyltransferase (CAT) gene were used as marker genes. Although lipofection was inefficient in normal urothelium, cancerous urothelium was transfected slightly. HVJ-liposomes more efficiently transfected superficial layers of urothelium with a peak of expression on day 5. The particle gun produced non-uniform but efficient transfection in deeper layers of the urothelium. By electrotransfection, submucous interstitial cells were transfected as well as urothelium. No major complications were observed after these four procedures. HVJ-liposomes are potentially useful for the treatment of carcinoma in situ and the latter two methods may be suitable for the adjuvant therapy of localized bladder tumors.

85歳男性.患者は3年半前に排尿困難で受診し, 前立腺生検でpoorly differentiated adenocarcinoma, T3bN0M0と診断された.Combined androgen blockade(CAB)療法で軽快したが, 今回, 再び排尿困難で受診となり, 直腸診で前立腺腫大を認めたため入院となった.検査では貧血と軽度の腎機能障害を認め, 腫瘍マーカーのPSAは感度以下で, CEAとCA19-9は正常値, NSEとPro-GRPが著明に上昇していた.またMRI T2強調像で内部不均一な前立腺, 精嚢の著明な腫大を認め, 更に直腸との境界は不明であったことから浸潤が疑われた.そして前回と全く異なり前立腺生検ではN/C比の高い, 高度異型核を有する未分化な細胞が充実性に存在し, 免疫染色ではPSA染色陰性, NSE, クロモグラニンA, グリメリウス染色陽性と逆の結果を示していた.NE(Neuroendocrine) carcinoma, T4N0M0と診断し, 無治療にて現在も生存中である, Prostatic neuroendocrine (NE) carcinoma is a rare disease with a poor prognosis because of its rapid progression and the androgen-independent characteristic, for which no successful therapy is available presently. We report a case of NE differentiated prostate cancer, which was diagnosed as adenocarcinoma initially and progressed with NE differentiation during the combined androgen blockade therapy.

Approximately 70% of patients with advanced prostate cancer have bone metastases, which are associated with considerable skeletal morbidity, accompanied by severe bone pain that requires narcotics or palliative radiation therapy, pathological fractures, spinal cord compression and hypercalcemia of malignancy (HCM), which consequentiy lower the patient's quality of life. Bisphosphonates, potent inhibitors of osteoclast activity and survival, therefore inhibiting osteoclast-mediated bone absorption, transiently palliative bone pain and decrease analgesic usage in patients who have hormone-refractory prostate cancer (HRPC) with bone metastases. Recently, a randomized controlled trial showed that a third-generation bisphosphonate, zoledronic acid reduced bone pain and skeletal-related events (SREs). In this manuscript, we reviwed the efficacy of bisphosphonates in HRPC with bone metastases from several clinical studies and discuss treatment of advanced prostate cancer with bisphosphonates.

Prostatic neuroendocrine (NE) carcinoma is a rare disease with a poor prognosis because of its rapid progression and the androgen-independent characteristic, for which no successful therapy is available presently. We report a case of NE differentiated prostate cancer, which was diagnosed as adenocarcinoma initially and progressed with NE differentiation during the combined androgen blockade therapy.

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.