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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.

1)慢性膀胱炎, 慢性前立腺炎, 前立腺肥大症の術後などに基づくと考えられる頻尿, 尿失禁を訴える患者109例を対象に塩酸テロジリンの有用性を検討した.2)最終全般改善度は92.7%であった.3)安全度は97.3%であった.4)有用度は91.8%であったが, 9例に副作用を認め, そのうち4例は投与中止に至った, We evaluated the effectiveness and side effects of terodiline hydrochloride in 109 patients with urinary frequency and urinary incontinence. The drug was administered at a dose of 24 mg once a day or 12 mg twice a day for 4 weeks. Symptoms such as urinary frequency and urinary incontinence were alleviated in 101 out of 109 patients (92.7%). Mild side effects such as thirst, dysuria, sense of residual urine, orthostatic hypotension and arrhythmia were observed in 9 out of 109 patients (8.2%). Side effects such as orthostatic hypotension and arrhythmia were observed on the 28th day or the 20th day of the administration, but these symptoms disappeared with discontinued use of this medicine. The results obtained from this study suggest that terodiline hydrochloride may be greatly useful for the patients with urinary frequency and urinary incontinence. But we must take account of the side effects such as orthostatic hypotension and arrhythmia.

1)テラゾシンの前立腺肥大症に伴う排尿障害に対する臨床効果および副作用について, 91例, 18施設の多施設臨床試験を実施した.試験は1週間以上の観察期, 6週間の治療期とし, 観察期および治療2週目, 4週目, 6週目に自覚症状, 他覚所見(尿流量率, 排尿量, 残尿量)の変化を評価した.超音波断層法, 尿道造影, CTスキャンなどで前立腺の推定重量を求め, 前立腺の大きさと本剤の効果についても検討した.観察期にはプラセボ錠を投与し, 治療は塩酸テラゾシン1 mg/日を初期投与量とし2週目で自覚症状が改善以上であれば1 mg/日の投与量を維持し, やや改善以下であれば2 mg/日に増量, 4週目で改善以上であれば2 mg/日の投与量を維持し, やや改善以下であれば4 mg/日に増量し, 6週目に最終効果判定をする.1 mg→2 mg→4 mgの漸増法とした.2)自覚症状の累積改善率は, 1 mg/日では18.5%, 2 mg/日までで55.6%, 4 mg/日までで65.4%であった.観察期の自覚症状の強いものの方が症状の改善度が高く, 治療終了時には自覚症状スコアは観察期のスコアにかかわらずほぼ同じレベルに収束した.3)自排尿量, 最大尿流量率, 平均尿流量率, 残尿率, ノモグラムスコアは, いずれも治療後有意に改善した.残尿量, 排尿開始までの時間については有意差はえられなかった.前立腺重量と最大尿流量率, ノモグラムスコアの改善度の間に有意な相関は認めなかった.他覚所見の累積改善率は, 1 mg/日では13.2%, 2 mg/日までで42.1%, 4 mg/日までで50.0%であった.4)全般改善度の累積改善率は, 1 mg/日14.5%, 2 mg/日までで50.0%, 4 mg/日までで61.8%であった.5)副作用は, ふらつき6件, 立ちくらみ2件, 耳鳴り, むかつき, かすみ目各1件の計11件(10例)で, 発現率は11.6%であった.5例は臨床上問題なく服薬を継続し, 1例は減量して服薬を継続した.服薬を中止したのは4例, 4.7%であった.本薬に起因すると思われる臨床検査値異常は認められなかった.拡張期血圧の有意な低下を認めたが, 収縮期血圧, 脈拍に有意な変動を認めなかった, In this study the multicenter, fixed-flexible dose regimen was taken to evaluate the effective dose range of Terazosin for the treatment of micturition disturbance in benign prostatic hypertrophy (BPH) and to clarify the characteristics of patients who are more responsive to Terazosin therapy. After a 1-week washout (placebo) the first two weeks 1 mg/day of Terazosin was administered, then depending on efficacy of subjective symptoms, Terazosin doses were increased up to 2 mg/day and 4 mg/day at intervals of two weeks. After six weeks the final efficacy and safety were assessed. The subjective symptom improvement rate was 18.5% by 1 mg/day, 55.6% by 2 mg/day and 65.4% by 4 mg/day cumulatively. The objective symptom improvement rate were 13.2% by 1 mg/day, 42.1% by 2 mg/day and 50.0% by 4 mg/day cumulatively. The global improvement rate was 14.5% by 1 mg/day, 50.0% by 2 mg/day and 61.8% by 4 mg/day cumulatively. The patients who had a higher subjective symptom score in the lead-in period were more improved rather than those who had a lower score. In objective symptoms, voided volume, maximum flow rate (MFR), MFR nomogram score and average flow rate improved and the ratio of residual urine volume decreased. There was no relationship between clinical improvement on either subjective or objective symptoms and prostatic weight. Adverse reactions, such as dizziness, vertigo, tinnitus, nausea and blurred vision; were seen in 10 cases. In conclusion Terazosin was effective and well tolerated for the treatment of patients who had micturition disturbance with BPH in the dose range of 2 to 4 mg/day.

過去5年間にDornier社腎結石破砕装置HMIIIを用いてESWLを施行し, 追跡可能であった1, 200例の単一結石について検討した.1)長径20 mm以下の結石については, 腎盂・腎杯部で最も成績がよく84%の成功率をえた.成績不良部位は尿管で62%の成功率であった.2)尿管結石について検討するとin situ症例と尿管カテーテル使用症例の間には成績上, 差はないが, D-Jカテーテル留置症例では10 mmより大きな結石でin situ症例および尿管カテーテル使用症例に比し, 有意に成績は良かった.3)術前IV, We performed extracorporeal shock-wave lithotripsy (ESWL) on 1, 701 patients in a total of 2, 438 sessions using the Dornier kidney lithotriptor Model HM III from July 1985 to the end of June 1990. Among the patients with a solitary stone, 1, 200 cases were available for the follow-up study in which the results of ESWL were analyzed according to the location and size of the stone. ESWL performed against stones at pelvis and calyces gave the best results. The results obtained on stones less than 20 mm in diameter were especially favorable with a success rate of 84%. ESWL performed against ureter stones showed poor results with a success rate of 62% for the stones smaller than 20 mm in diameter. We further studied the results of ESWL performed against ureter stones by dividing the patients into three groups: the patients treated in situ, the patients with ureteral stents and the patients with D-J stents. The results for stones larger than 10 mm in diameter were significantly better in the patients with D-J stents than in the patients treated in situ or the patients with ureteral stents. Among the patients treated in situ, the results were significantly worse for impacted stones than for non-impacted stones when the stone size was 10-20 mm in diameter.

22例の症例についてmetallic spiralを用いた治療を試みた.その年齢は56～91歳(平従76.6歳)で, 原疾患としてはBPHで, 直腸癌術後および糖尿病性神経因性膀胱を合併したのがそれぞれ1例, 脳梗塞後が2例いた.それら症例の治療前の排尿状態は, 尿閉のため留置カテーテルがあった症例は16例, 排尿障害のある症例は6例であった.治療後の尿流量面からの評価では, 排尿量100～230 ml(平均172 ml), MFR 13～21 ml/秒(17.3 ml/秒), AFR 4～12 ml/秒(8.2 ml/秒)で, 残尿量も30 ml以下が20例, 200 mlが1例であった.このうち留置ステントの膀胱側への移動は6例見られたが4例は再度留置した.尿道ステントに伴う会陰部不快感は3例に見られ2例は抜去せざるを得なかった.尿失禁, 膿尿の持続や尿路感染症, 結晶の付着など特に治療を必要とする症例は観察されなかった, Treatment using a metallic spiral was attempted on 22 patients. They had urinary retention in 16 cases and dysuria in 6. In 21 of them, the spiral was successfully placed under transrectal ultrasound control. In all 21 patients, voiding was possible immediately after placement of the spiral. As for urodynamic study, urine volume was 100-230 ml (mean: 172 ml), maximum flow rate was 13-21 ml/sec (mean: 17.3 ml/sec), and average flow rate was 4-12 ml/sec (mean: 8.2 ml/sec). Residual urine volume was less than 30 ml in 20 patients and 200 ml in one. As for complications, proximal migration of the spiral was observed in 6 patients. In 4 of them, the new spiral was placed. Perineal discomfort was seen in 3 patients, in 2 the spiral was removed. Pyuria associated with bacterial infection did not continue after the treatment in patients having a catheter. Severe urge incontinence and encrustation were never seen. The above findings suggest that, though a longterm study has not done, this treatment could be an effective treatment particularly for the elderly patients with general complications and/or who require removal of an indwelling catheter for clinical or social reasons.

ESWLを施行し, 追跡可能であった911例の単一結石について, 1)男性では女性に比し, 尿管結石の頻度が高かった.2)腎盂・腎杯に存在する結石に対するESWLの成績が最も良好で, 20 mm以下で87%の成功率を得た.3) ESWL成績不良部位は尿管で, 嵌頓結石症例では結石サイズが小さくとも, TULやD-Jステントカテーテル留置下でのESWLを行うべきである, At Osaka City University Hospital, we performed extracorporeal shock-wave lithotripsy (ESWL) for 1277 patients in a total of 1788 sessions using Dornier kidney lithotripter Model HM III from July, 1985 to the end of December, 1988. Among the patients with a solitary stone, 911 cases were available for the follow-up study and we have compared the results among these cases in respect to the stone location and size. The results obtained were as follows: the ratio of kidney stone to ureter stone was found to be 2.2:1 in male, and 3.8:1 in female patients. This indicates that ureter stones are more frequently found in male than in female patients. In addition, we compared the size of kidney stones found in the patients including 415 male and 243 female patients. Stones larger than 20 mm were more frequently found in female than in male patients. Moreover, a stone composition study of these patients showed that the contents of both phosphate calcium and magnesium ammonium phosphate were higher in female than in male patients. ESWL performed against stones at pelvis and calyces exhibited the best results. The results obtained with the stones less than 20 mm in diameter were especially favorable with a success rate of 100% for the stones less than 10 mm and 83% for the stones 10-20 mm, in diameter, while the results with the stones larger than 20 mm in diameter were rather poor with a success rate of 31%. ESWL performed against ureter stones showed poor results with a success rate of 63% for the stones smaller than 20 mm in diameter.

We studied the efficacy of intravesical instillation chemotherapy of anticancer agents including cylocide (CA) in the prevention of recurrence of bladder tumor after surgery. Totally 60 patients with superficial bladder tumor were enrolled into the study. The patients were randomly assigned to either one of three groups: CA 300 mg alone, CA 200 mg + mitomycin C (MMC) 10 mg, and CA 180 mg + adriamycin (ADM) 20 mg. These drugs were initially instilled once a day for one week, and then once a month until 2 years after surgery. Thereafter, the patients were followed up without instillation. The cumulative non-recurrence rates in the CA group was 76.5, 60.0 and 60.0% at 1, 2 and 3 years after the removal of bladder tumor, respectively, while that in the CA + MMC treated group 90.9, 75.3, and 75.3% and that in the CA + ADM treated group, 95.1, 82.9 and 82.9%, respectively. The recurrence rate in the CA, CA + MMC and CA + ADM treated group was 35.3, 27.3 and 19.0%, respectively, the recurrence indices 1.84, 1.07 and 0.74, and the mean times between recurrence 10.8, 16.5 and 18.0 months, respectively. Side effects were noted in 3 of the 17 cases (17.6%) in the CA group, in 3 of the 22 cases (13.6%) in the CA + MMC group and in 3 of the 21 cases (14.3%) in the CA + ADM treated group. These data show that intravesical CA instillation in combination with MMC or ADM is more effective for the prevention of recurrence than that of CA alone.

USAによる去勢術は, 従来のsurgical subcapsular orchiectomyとほぼ同様の効果のある術式と考えられた, We report a technique for performing subcapsular orchiectomy using the ultrasonic surgical aspirator (USA). The procedure was simple and safe, and was completed within one hour in 2 patients on whom it was carried out. Operative complications such as bleeding, postoperative pain and wound swelling were minimal, and compression dressings were not necessary. Postoperatively, the serum testosterone value was lowered to the castrate level. We conclude that subcapsular orchiectomy using USA is superior to conventional bilateral scrotal orchiectomy, and will be a useful option.

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 report a technique for performing subcapsular orchiectomy using the ultrasonic surgical aspirator (USA). The procedure was simple and safe, and was completed within one hour in 2 patients on whom it was carried out. Operative complications such as bleeding, postoperative pain and wound swelling were minimal, and compression dressings were not necessary. Postoperatively, the serum testosterone value was lowered to the castrate level. We conclude that subcapsular orchiectomy using USA is superior to conventional bilateral scrotal orchiectomy, and will be a useful option.

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.

We evaluated the effectiveness and side effects of terodiline hydrochloride in 109 patients with urinary frequency and urinary incontinence. The drug was administered at a dose of 24 mg once a day or 12 mg twice a day for 4 weeks. Symptoms such as urinary frequency and urinary incontinence were alleviated in 101 out of 109 patients (92.7%). Mild side effects such as thirst, dysuria, sense of residual urine, orthostatic hypotension and arrhythmia were observed in 9 out of 109 patients (8.2%). Side effects such as orthostatic hypotension and arrhythmia were observed on the 28th day or the 20th day of the administration, but these symptoms disappeared with discontinued use of this medicine. The results obtained from this study suggest that terodiline hydrochloride may be greatly useful for the patients with urinary frequency and urinary incontinence. But we must take account of the side effects such as orthostatic hypotension and arrhythmia.

In this study the multicenter, fixed-flexible dose regimen was taken to evaluate the effective dose range of Terazosin for the treatment of micturition disturbance in benign prostatic hypertrophy (BPH) and to clarify the characteristics of patients who are more responsive to Terazosin therapy. After a 1-week washout (placebo) the first two weeks 1 mg/day of Terazosin was administered, then depending on efficacy of subjective symptoms, Terazosin doses were increased up to 2 mg/day and 4 mg/day at intervals of two weeks. After six weeks the final efficacy and safety were assessed. The subjective symptom improvement rate was 18.5% by 1 mg/day, 55.6% by 2 mg/day and 65.4% by 4 mg/day cumulatively. The objective symptom improvement rate were 13.2% by 1 mg/day, 42.1% by 2 mg/day and 50.0% by 4 mg/day cumulatively. The global improvement rate was 14.5% by 1 mg/day, 50.0% by 2 mg/day and 61.8% by 4 mg/day cumulatively. The patients who had a higher subjective symptom score in the lead-in period were more improved rather than those who had a lower score. In objective symptoms, voided volume, maximum flow rate (MFR), MFR nomogram score and average flow rate improved and the ratio of residual urine volume decreased. There was no relationship between clinical improvement on either subjective or objective symptoms and prostatic weight. Adverse reactions, such as dizziness, vertigo, tinnitus, nausea and blurred vision; were seen in 10 cases. In conclusion Terazosin was effective and well tolerated for the treatment of patients who had micturition disturbance with BPH in the dose range of 2 to 4 mg/day.

Treatment using a metallic spiral was attempted on 22 patients. They had urinary retention in 16 cases and dysuria in 6. In 21 of them, the spiral was successfully placed under transrectal ultrasound control. In all 21 patients, voiding was possible immediately after placement of the spiral. As for urodynamic study, urine volume was 100-230 ml (mean: 172 ml), maximum flow rate was 13-21 ml/sec (mean: 17.3 ml/sec), and average flow rate was 4-12 ml/sec (mean: 8.2 ml/sec). Residual urine volume was less than 30 ml in 20 patients and 200 ml in one. As for complications, proximal migration of the spiral was observed in 6 patients. In 4 of them, the new spiral was placed. Perineal discomfort was seen in 3 patients, in 2 the spiral was removed. Pyuria associated with bacterial infection did not continue after the treatment in patients having a catheter. Severe urge incontinence and encrustation were never seen. The above findings suggest that, though a longterm study has not done, this treatment could be an effective treatment particularly for the elderly patients with general complications and/or who require removal of an indwelling catheter for clinical or social reasons.

We performed extracorporeal shock-wave lithotripsy (ESWL) on 1, 701 patients in a total of 2, 438 sessions using the Dornier kidney lithotriptor Model HM III from July 1985 to the end of June 1990. Among the patients with a solitary stone, 1, 200 cases were available for the follow-up study in which the results of ESWL were analyzed according to the location and size of the stone. ESWL performed against stones at pelvis and calyces gave the best results. The results obtained on stones less than 20 mm in diameter were especially favorable with a success rate of 84%. ESWL performed against ureter stones showed poor results with a success rate of 62% for the stones smaller than 20 mm in diameter. We further studied the results of ESWL performed against ureter stones by dividing the patients into three groups: the patients treated in situ, the patients with ureteral stents and the patients with D-J stents. The results for stones larger than 10 mm in diameter were significantly better in the patients with D-J stents than in the patients treated in situ or the patients with ureteral stents. Among the patients treated in situ, the results were significantly worse for impacted stones than for non-impacted stones when the stone size was 10-20 mm in diameter.

We studied the efficacy of intravesical instillation chemotherapy of anticancer agents including cylocide (CA) in the prevention of recurrence of bladder tumor after surgery. Totally 60 patients with superficial bladder tumor were enrolled into the study. The patients were randomly assigned to either one of three groups: CA 300 mg alone, CA 200 mg + mitomycin C (MMC) 10 mg, and CA 180 mg + adriamycin (ADM) 20 mg. These drugs were initially instilled once a day for one week, and then once a month until 2 years after surgery. Thereafter, the patients were followed up without instillation. The cumulative non-recurrence rates in the CA group was 76.5, 60.0 and 60.0% at 1, 2 and 3 years after the removal of bladder tumor, respectively, while that in the CA + MMC treated group 90.9, 75.3, and 75.3% and that in the CA + ADM treated group, 95.1, 82.9 and 82.9%, respectively. The recurrence rate in the CA, CA + MMC and CA + ADM treated group was 35.3, 27.3 and 19.0%, respectively, the recurrence indices 1.84, 1.07 and 0.74, and the mean times between recurrence 10.8, 16.5 and 18.0 months, respectively. Side effects were noted in 3 of the 17 cases (17.6%) in the CA group, in 3 of the 22 cases (13.6%) in the CA + MMC group and in 3 of the 21 cases (14.3%) in the CA + ADM treated group. These data show that intravesical CA instillation in combination with MMC or ADM is more effective for the prevention of recurrence than that of CA alone.

At Osaka City University Hospital, we performed extracorporeal shock-wave lithotripsy (ESWL) for 1277 patients in a total of 1788 sessions using Dornier kidney lithotripter Model HM III from July, 1985 to the end of December, 1988. Among the patients with a solitary stone, 911 cases were available for the follow-up study and we have compared the results among these cases in respect to the stone location and size. The results obtained were as follows: the ratio of kidney stone to ureter stone was found to be 2.2:1 in male, and 3.8:1 in female patients. This indicates that ureter stones are more frequently found in male than in female patients. In addition, we compared the size of kidney stones found in the patients including 415 male and 243 female patients. Stones larger than 20 mm were more frequently found in female than in male patients. Moreover, a stone composition study of these patients showed that the contents of both phosphate calcium and magnesium ammonium phosphate were higher in female than in male patients. ESWL performed against stones at pelvis and calyces exhibited the best results. The results obtained with the stones less than 20 mm in diameter were especially favorable with a success rate of 100% for the stones less than 10 mm and 83% for the stones 10-20 mm, in diameter, while the results with the stones larger than 20 mm in diameter were rather poor with a success rate of 31%. ESWL performed against ureter stones showed poor results with a success rate of 63% for the stones smaller than 20 mm in diameter.

1) 121例の上部尿路結石症に対しESWLを施行し, 1ヵ月で56%, 3ヵ月で78%にKUB上結石陰影を認めなくなった.自排可能の大きさとなった19例を含めると95%の症例において良好な成績が得られた.2)血尿, 疝痛などの併発症状を認めたが, これらは数日で消失する軽微なものであり, また血清LDH, GPK, GOT, ALD, T-Bilの上昇を認めたが臨床上特に処置を必要としなかった.3) ESWLは早期社会復帰が可能であり適応となる症例には優れた治療法である, The first 121 cases of upper urinary tract stone treated by extracorporeal shock wave lithotripsy (ESWL) at our clinic were analyzed. Three months after ESWL, 78% of the patients became stone free, and 17% of the patients had residual stone fragments which were less than 5 mm in diameter and considered passable. The success rate was therefore about 94.6%. No severe side effects were observed, although temporary elevations in serum creatinine phosphokinase, lactate dehydrogenase, glutamic-oxaloacetic transaminase, aldolase and total bilirubin occurred. These results indicated that ESWL was a safe and effective procedure for upper urinary tract stones.

経尿道的前立腺切除術にて明らかな残存腫瘍を認めない39例の膀胱腫瘍症例を対象に, 制癌剤の膀胱療法兼OK-432全身投与(A群)および制癌剤膀注療法のみ(B群)を行い, 両群間の非再発率を比較検討した.1) A, B両群間の患者背景因子には差を認めなかった.2)非再発率は, 全症例ではA B群間で差を認めなかったが, 初発例・stage T0症例ではB群が, 再発例・stage T1, 2症例ではA群が有効であった.3) OK-432投与によると思われるSU-PS皮内反応の増強が示された.4)膀注療法およびOK-432注射に由来する重篤な副作用は認められなかった, To evaluate the effects of bladder instillation chemotherapy of anticancer agents with OK-432 intradermal injection (group A) in preventing postoperative recurrence of bladder carcinoma, a randomized controlled study with intravesical instillation chemotherapy of anticancer agents (group B) as the reference standard was performed. As the anticancer agents, pepleomycin (PEP) was usually used at a concentration of 30 mg/30 ml physiological saline. OK-432 injection dose was gradually increased from 0.5 KE to 5.0 KE and maintenance dose was decided by local skin reactions. There were no differences in the patient's background factors between group A (22 cases) and group B (17 cases). The no-recurrence rate of bladder carcinoma was similar in the two groups, but the no-recurrence rate for the virgin tumor or the stage T0 cases was higher in group B. On the other hand, the values for the recurrent cases or the stage T1, 2 cases was higher in group A. The SU-PS skin reaction as an immunological response was significantly higher in group A. There were no severe side effects derived from anticancer bladder instillation or OK-432 injection.

Eight years have passed since extracorporeal shock-wave lithotripsy (ESWL) was used clinically for the first time, and now its usefulness is recognized all over the world. At first, variable cases were considered to be contra-indicative, one of which was the radiolucent calculi. This time for two cases of the radiolucent calculi we performed ESWL under retrograde pyelography. Using this technique, we brought the filling defect of RP into the focus of the shock waves. The stones were effectively disintegrated and these patients became stone-free in five weeks.

尿路感染症28例, 対照群11例について尿中Candidaの検出と血中Candida抗体の関連性および宿主免疫能との関係について検討した.1)尿中Candida陽性群のCandida抗体は明らかに上昇していたが, 71歳以上の高齢者では低値を示す症例があった.2)尿中Candida陽性群のHA titerとOKT-3, 4およびOKT-4/8比との間には正の相関があり, OKT-8との間に負の相関があった.3)治療前・後のHA titerの観察にて治療効果を知る可能性が示唆された, The serum candida antibody (HA titer) was measured by means of indirect hemagglutination test in 28 patients with complicated urinary tract infections (UTI) and 11 control subjects. The peripheral lymphocytes subsets (OKT-3, 4, 8 and 4/8 ratio) were also examined in same patients. The 17 UTI patients who had Candida species in their urine had a higher HA titer than the other UTI patients without Candida or control subjects, but elderly UTI patients (over 71 years old) did not show higher HA titer. A positive correlation was seen between HA titer and OKT-3, 4 or 4/8 ratio. On the other hand, HA titer and OKT-8 showed a negative relationship. Therefore, the ability to produce the candida antibody might be closely related to the host cellular immune responsiveness.

Clinical efficacy of ofloxacin (OFLX) against complicated urinary tract infections was examined in 20 patients. OFLX was administrated orally at a dose of 200 mg, three times (daily 600 mg) for 14 to 102 days. The overall clinical efficacy was rated excellent in 8 cases (40%), moderate in 7 cases (35%) and poor in 5 cases (25%) with a total efficacy of 75%. Bacteriological efficacy, 17 out of 24 strains (70.8%) isolated were eradicated after OFLX administration. The strains that appeared after OFLX treatment were P. cepacia and Candida sp. No severe side effects were found in these patients.

The clinical effects of ninzin-to with daiokanso-to were studied on 15 patients with chronic renal failure. The level of urea nitrogen and creatinine in sera was slightly decreased in early days of treatment (about 3 months long), but thereafter these levels were gradually increased in many patients and 2 patients needed hemodialysis treatment. The effects of these drugs against subjective symptoms were found in bowel habits, general malasia and anorexia. The overall effective rate was 80% in early term and 60% in late term. There were no severe adverse reactions.

Serum level of osteocalcin was measured by radioimmunoassay in 52 patients with chronic renal failure and 92 control subjects. The patients were treated by usual hemodialysis over a 3-month period. The osteocalcin level of the patients was significantly higher than that of the control subjects, but the patients with diabetic nephropathy had a lower osteocalcin level than the patients with non-diabetic nephropathy. There was a significant correlation between serum osteocalcin level and alkaline phosphatase or PTH level. On the other hand, there was no relationship between serum osteocalcin level and various parameters such as bone mineral contents, and bone cortex volume measured by the microdensitometry method. Hemodialysis affected the serum osteocalcin level. The clinical value of osteocalcin as a parameter of bone formation in chronic hemodialysis patients was discussed.

1)複雑性尿路感染症患者例を対象としてCTRX 1.0 gを1日1回投与した場合の効果をUTI評価基準に基づいて判定した.2)その結果, Excellent 20%, Moderate 65%, Poor 15%でoverall effectiveness rateは85%であった.3) UTI感染群別でみるとカテーテル留置例であるG-1, G-5群における効果が他の群に比して劣っていた.4)細菌学的効果は分離菌27株のうち17株(62.8%)が消失し, disk法による感受性テストではE. coli, P. aerginosa, S. epidermidisなどに対する感受性が高かった.5)腎機能障害者(血液透析患者)におけるCTRXの血中濃度の経時的変化を検討した.その結果, 投与4時間目以後plateauとなり, 長時間にわたり高い血中濃度が維持された.また, 血液透析によるCTRXの除去効果は著明なものでなく, 透析・非透析日に関係なく同一条件で投与可能と考えられた.6) CTRXの投与に由来すると思われる重篤な副作用や血液所見の異常値は認められなかった, Clinical efficacy of ceftriaxone (CTRX) against complicated urinary tract infections in 20 patients was examined, and the serum CTRX level was also measured in the patients with chronic renal failure (CRF). CTRX was administered at a dose of 1.0 g once a day for 5 to 10 days. The overall clinical efficacy was rated excellent in 4 cases (20%), moderate in 13 cases (65%) and poor in 3 cases (15%) with a total efficacy of 85%. Seventeen out of 27 strains (62.8%) isolated were eradicated after CTRX administration. In the patients with CRF, serum levels were very high and showed a plateau 4 hours after the injection. Furthermore, CTRX may not be removed by usual hemodialysis treatment. There were no severe side effects due to CTRX in these patients.

A case of an infectious urachal cyst that presented as a lower abdominal mass in a 44-year-old man is reported. There was no urinary tract infection. Cystoscopy revealed the dome retracted. All other investigations were normal without microscopic hematuria. Laparotomy revealed the mass attached to the small intestine because of infection. The mass was excised after partial resection of small intestine and partial cystectomy.

The clinical effects of ninzin-to with daiokanso-to were studied on 15 patients with chronic renal failure. The level of urea nitrogen and creatinine in sera was slightly decreased in early days of treatment (about 3 months long), but thereafter these levels were gradually increased in many patients and 2 patients needed hemodialysis treatment. The effects of these drugs against subjective symptoms were found in bowel habits, general malasia and anorexia. The overall effective rate was 80% in early term and 60% in late term. There were no severe adverse reactions.

Clinical and fundamental study of Guanabenz were performed in 20 hypertensive patients with renal failure, who were treated by maintenance hemodialysis treatment. The patients received 2 mg of Guanabenz orally, twice a day for 3 months or more. The clinical efficacy of good control was attained in 65%, and of fair control in 90%. On the other hand, the objective and subjective effects of Guanabenz were compared between short term (within one year long) hemodialysis patients and long term (over one year) patients. The overall clinical efficacy was higher in short term patients. The serum level of Guanabenz in hemodialysis patients showed a maximum value at 2-4 hours after administration. As Guanabenz might not be removed so much by hemodialysis, the administration schedule and daily dosage were discussed. There were no severe side effects arising from administration of Guanabenz.

Clinical efficacy of ceftriaxone (CTRX) against complicated urinary tract infections in 20 patients was examined, and the serum CTRX level was also measured in the patients with chronic renal failure (CRF). CTRX was administered at a dose of 1.0 g once a day for 5 to 10 days. The overall clinical efficacy was rated excellent in 4 cases (20%), moderate in 13 cases (65%) and poor in 3 cases (15%) with a total efficacy of 85%. Seventeen out of 27 strains (62.8%) isolated were eradicated after CTRX administration. In the patients with CRF, serum levels were very high and showed a plateau 4 hours after the injection. Furthermore, CTRX may not be removed by usual hemodialysis treatment. There were no severe side effects due to CTRX in these patients.

The serum candida antibody (HA titer) was measured by means of indirect hemagglutination test in 28 patients with complicated urinary tract infections (UTI) and 11 control subjects. The peripheral lymphocytes subsets (OKT-3, 4, 8 and 4/8 ratio) were also examined in same patients. The 17 UTI patients who had Candida species in their urine had a higher HA titer than the other UTI patients without Candida or control subjects, but elderly UTI patients (over 71 years old) did not show higher HA titer. A positive correlation was seen between HA titer and OKT-3, 4 or 4/8 ratio. On the other hand, HA titer and OKT-8 showed a negative relationship. Therefore, the ability to produce the candida antibody might be closely related to the host cellular immune responsiveness.

To evaluate the effects of bladder instillation chemotherapy of anticancer agents with OK-432 intradermal injection (group A) in preventing postoperative recurrence of bladder carcinoma, a randomized controlled study with intravesical instillation chemotherapy of anticancer agents (group B) as the reference standard was performed. As the anticancer agents, pepleomycin (PEP) was usually used at a concentration of 30 mg/30 ml physiological saline. OK-432 injection dose was gradually increased from 0.5 KE to 5.0 KE and maintenance dose was decided by local skin reactions. There were no differences in the patient's background factors between group A (22 cases) and group B (17 cases). The no-recurrence rate of bladder carcinoma was similar in the two groups, but the no-recurrence rate for the virgin tumor or the stage T0 cases was higher in group B. On the other hand, the values for the recurrent cases or the stage T1, 2 cases was higher in group A. The SU-PS skin reaction as an immunological response was significantly higher in group A. There were no severe side effects derived from anticancer bladder instillation or OK-432 injection.

Eight years have passed since extracorporeal shock-wave lithotripsy (ESWL) was used clinically for the first time, and now its usefulness is recognized all over the world. At first, variable cases were considered to be contra-indicative, one of which was the radiolucent calculi. This time for two cases of the radiolucent calculi we performed ESWL under retrograde pyelography. Using this technique, we brought the filling defect of RP into the focus of the shock waves. The stones were effectively disintegrated and these patients became stone-free in five weeks.

The first 121 cases of upper urinary tract stone treated by extracorporeal shock wave lithotripsy (ESWL) at our clinic were analyzed. Three months after ESWL, 78% of the patients became stone free, and 17% of the patients had residual stone fragments which were less than 5 mm in diameter and considered passable. The success rate was therefore about 94.6%. No severe side effects were observed, although temporary elevations in serum creatinine phosphokinase, lactate dehydrogenase, glutamic-oxaloacetic transaminase, aldolase and total bilirubin occurred. These results indicated that ESWL was a safe and effective procedure for upper urinary tract stones.

Clinical efficacy of ofloxacin (OFLX) against complicated urinary tract infections was examined in 20 patients. OFLX was administrated orally at a dose of 200 mg, three times (daily 600 mg) for 14 to 102 days. The overall clinical efficacy was rated excellent in 8 cases (40%), moderate in 7 cases (35%) and poor in 5 cases (25%) with a total efficacy of 75%. Bacteriological efficacy, 17 out of 24 strains (70.8%) isolated were eradicated after OFLX administration. The strains that appeared after OFLX treatment were P. cepacia and Candida sp. No severe side effects were found in these patients.

Serum level of osteocalcin was measured by radioimmunoassay in 52 patients with chronic renal failure and 92 control subjects. The patients were treated by usual hemodialysis over a 3-month period. The osteocalcin level of the patients was significantly higher than that of the control subjects, but the patients with diabetic nephropathy had a lower osteocalcin level than the patients with non-diabetic nephropathy. There was a significant correlation between serum osteocalcin level and alkaline phosphatase or PTH level. On the other hand, there was no relationship between serum osteocalcin level and various parameters such as bone mineral contents, and bone cortex volume measured by the microdensitometry method. Hemodialysis affected the serum osteocalcin level. The clinical value of osteocalcin as a parameter of bone formation in chronic hemodialysis patients was discussed.

A case of an infectious urachal cyst that presented as a lower abdominal mass in a 44-year-old man is reported. There was no urinary tract infection. Cystoscopy revealed the dome retracted. All other investigations were normal without microscopic hematuria. Laparotomy revealed the mass attached to the small intestine because of infection. The mass was excised after partial resection of small intestine and partial cystectomy.