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Koji Yoshimura,
Shingo Yamamoto,
Akihiro Kawauchi,
Mikio Ito,
Shuichi Nakagawa,
Yasuki Horii,
Yoshihito Higashi,
Yasuhiko Okamura,
Yoshihiro Yamazoe,
Fuminori Nin, [......],
Mikio Maekawa,
Tomohito Kitamori,
Tadashi Aoki,
Toshiyuki Kamoto,
Masahiro Nakao,
Osamu Ogawa,
Tsuneharu Miki,
Hiroshi Ohe,
Tetsuro Muratani,
Tetsuro Matsumoto
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ABSTRACT: The data of sexually transmitted urethritis in males have been collected at 24 institutes in Kyoto Prefecture since October, 2002. The data collected from January to December in 2004 are summarized herein. A total of 1,275 patients were diagnosed with urethritis during this period. Microbiological examinations isolated Neisseria gonorrhoeae alone in 368 (29%), Chlamydia tracomatis alone in 336 (26%), both in 85 (7%), and others in 453 (36%). Male patients under 20 years old tended to have Chlamydial urethritis, alone or combined with gonococcal infection, and had a predominant infectious source, a non-commercial-sexual-worker female partner, suggesting a profound problem in sexual life of adolescents. The urologist preferred to use quinolones as the first therapeutic modality against male urethritis. However, drug resistance of N. gonorrhoeae, especially against quinolones, has rapidly progressed, which was also observed by a sensitivity examination test. Antibiotics should be used adequately against male urethrits according to the recent guidelines.
Hinyokika kiyo. Acta urologica Japonica 05/2006; 52(4):265-70.
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ABSTRACT: A prospective randomized study was conducted to evaluate the efficacy of prophylactic intravesical instillation of pirarubicin (THP) prior to transurethral resection (TUR) of superficial bladder cancer. A total of 63 patients were randomized into two groups, the THP group and the control group. In the THP group, 30 mg of THP dissolved in 50 ml saline was administered 4 times intravesically for 4 consecutive days before TUR. In the control group, no instillation was performed before TUR. The patients were followed by cystoscopy and urinary cytology every 3 months. The non-recurrence rates in the THP group and control group were 54.1% versus 37.6% at 1 year and 40.4% versus 26.8% at 2 years, respectively (P = 0.086). Time to recurrence for tumors larger than 1 cm was significantly longer in the THP group (P = 0.0137). Time to recurrence for single and grade 1+2 tumors tended to be longer in the THP group (P = 0.09, P = 0.079). No significant adverse effects were observed in any patient. Our findings suggest that intravesical THP instillation prior to TUR would be effective for patients with single, low grade lesions larger than 1 cm of superficial bladder cancer.
Hinyokika kiyo. Acta urologica Japonica 08/2005; 51(7):439-42.
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Shingo Yamamoto,
Yasuharu Kunishima,
Sojun Kanamaru,
Noriyuki Ito,
Hidefumi Kinoshita,
Toshiyuki Kamoto,
Osamu Ogawa,
Yoichi Arai,
Kazuhiro Okumura,
Toshiro Terachi, [......],
Nobuyuki Nishikawa, Shuichi Hida,
Mitsuo Nonomura,
Akito Terai,
Keiji Ogura,
Kenji Mitsumori,
Kazuo Nishimura,
Hiroyuki Onishi,
Yasuki Horii,
Toshinari Yamasaki
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ABSTRACT: In order to assess the ability of our protocol for antibiotic prophylaxis to prevent perioperative infections in urologic surgery, 1,353 operations of open and laparoscopic urologic surgery conducted in 21 hospitals between September 2002 and August 2003 were subjected to analyses. We classified surgical procedures into four categories by invasiveness and contamination levels: Category A; clean less invasive surgery, Category B; clean invasive or clean-contaminated surgery, Category C; surgery with urinary tract diversion using the intestine. Prophylactic antibiotics were administrated intravenously according to our protocol, such as Category A; first or second generation cephems or penicillins on the operative day only, Category B; first and second generation cephems or penicillins for 3 days, and Category C; first, second or third generation cephems or penicillins for 4 days. The wound conditions and general conditions were evaluated in terms of the surgical site infection (SSI) as well as remote infection (RI) up to postoperative day (POD) 30. The SSI rate highest (23.3%) for surgery with intestinal urinary diversion, followed by 10.0% for surgery for lower urinary tract, 8.9% for nephroureterctomy, and 6.0% for radical prostatectomy. The SSI rates in clean surgery including open and laparoscopic nephrectomy/adrenalectomy were 0.7 and 1.4%, respectively. In SSIs, gram-positive cocci such as methicillin-resistant Staphylococcus aureus (58.8%) or Enterobacter faecalis (26.5%) were the most common pathogen. Similarly, the RI rate was the highest (35.2%) for surgery using intestinal urinary diversion, followed by 16.7% for surgery for lower urinary tract, 11.4% for nephroureterctomy, and 7.6% for radical prostatectomy, while RI rates for clean surgery were less than 5%. RIs most frequently reported were urinary tract infections (2.6%) where Pseudomonas aeruginosa (20.3%) and Enterobacter faecalis (15.3%) were the major causative microorganisms. Parameters such as age, obesity, nutritional status (low proteinemia), diabetes mellitus, lung disease, duration of operation, and blood loss volume were recognized as risk factors for SSI or RI in several operative procedures. Postoperative body temperatures, peripheral white blood counts, C reactive protein (CRP) levels in POD 3 were much higher than those in POD 2 in cases suffering from perioperative infections, especially suggesting that CRP could be a predictable marker for perioperative infections.
Hinyokika kiyo. Acta urologica Japonica 11/2004; 50(10):673-83.
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ABSTRACT: We describe here a case in which 99mTc-Sn-N-pyridoxy-5-methyltryptophan (99mTc-PMT) scintigraphy was useful in diagnosing renal metastasis of hepatocellular carcinoma (HCC). A 62-year-old man who had undergone hepatectomy for HCC presented 6 years after initial diagnosis with left flank pain and was found on CT and MRI to have a tumor in the left kidney. Hepatobiliary scintigraphy using 99Tc-PMT was performed, and 99mTc-PMT accumulation was found in the tumor. Nephrectomy was performed and metastasis of HCC was confirmed.
Annals of Nuclear Medicine 07/2003; 17(4):333-6. · 1.50 Impact Factor
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ABSTRACT: We report a case of left adrenocortical carcinoma in a 23-year-old man. His chief complaints were spike fever attack and general malaise. Imaging examination revealed a heterogeneously enhanced mass at the site of the left adrenal gland. Non-functional adrenocortical carcinoma was suspected from hormonal studies. The mass was removed together with the left kidney because of severe adhesion to the renal pedicle. The histopathological findings showed adrenocortical carcinoma (pT3N0M0). Three months after surgery, local recurrence appeared and the tumor grew larger rapidly. Spike fever attack reappeared. No distant metastasis was detected. Two courses of systemic chemotherapy with o, p'-DDD, VP-16, adriamycin and cisplatinum were performed. Computed tomography after the chemotherapy showed progression. Although o, p'-DDD was administered continuously, the patient died of cancerous cachexia 8 months after the surgery. Autopsy could not be done.
Hinyokika kiyo. Acta urologica Japonica 12/2002; 48(11):667-70.
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ABSTRACT: A-50-year-old patient visited our hospital to have further examination for left renal mass. Drip infusion pyelography revealed a cluster of calculi in the upper pole of the left kidney. Computed tomography and magnetic resonance imaging revealed a heterogeneous mass on the left side of a horseshoe kidney. Left nephrectomy was performed through an abdominal transperitoneal approach. An operation for dividing isthmus was simultaneously done using a microwave tissue coagulator. Histopathological findings showed grade 1 > 2, pT1aN0M0, clear cell subtype, renal cell carcinoma. Convalescence was uneventful and the patient was free of tumor at one year postoperatively.
Hinyokika kiyo. Acta urologica Japonica 07/2002; 48(7):439-41.
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ABSTRACT: A 52-year-old man was admitted to our hospital complaining of high grade fever and painful swelling of the scrotum. Although debridement of the scrotum and inguinal region was immediately carried out, the inflammation extended to the right abdominal region 2 days later. We tunneled the newly infected areas and placed Penrose drains through the tunnels, so that complete drainage was achieved with minimal tissue loss. The infection was controlled by frequent irrigation of the wound and antibiotic administration. Forty days after the admission the defect of the skin was reconstructed by using a meshed skin graft, and the patient was discharged on the 68th hospital day. We concluded that limited debridement with placement of through-and-through drains might have produced a good result with minimal tissue loss.
Hinyokika kiyo. Acta urologica Japonica 04/2002; 48(3):163-5.
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ABSTRACT: 23例の前立腺癌の患者に対しMRIを施行した.うち6例に前立腺全摘術を施行,そのうち5例は摘出標本のMRIを施行し,摘出標本の全割切片を作製し,比較検討した.正常の前立腺は内,外腺に分かれて摘出され,両者の間には信号の無い境界線が存在する.さらに正常の前立腺外線はT2強調画像において,内腺よりhigh intensityを示したが,外腺内の癌の部分は正常の外腺よりlow intensityを示した.また,外腺に発生した癌が内腺に浸潤していく部分に一致して内,外腺の境界線の一部もしくは全部の消失を認めた.これらの所見はin vivoのMRIでも認められた.MRIは,前立腺癌のlocal stagingに関し臨床的価値がある Magnetic resonance imaging (MRI) of the prostate was accomplished in 23 patients who had prostatic cancer histologically proved by needle biopsy. Five prostates resected out of 23 patients with prostatic cancer were available for in vitro MRI. The MRI findings of the normal peripheral zone of the prostate had a high signal intensity on T2 weighted image, and the cancer nests in the peripheral zone had lower signal intensity than the normal peripheral zone. A partial or total destruction of the border line between outer zone and inner zone was observed besides than microscopic invasions. MRI also enabled us to differentiate the cancerous foci from the normal tissue at a different signal intensity of imaging in some selected cases in which the resected specimen was examined by in vitro MRI.
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ABSTRACT: 33例の腎腫瘍に対しMRI, CTを施行し,stagingおよび鑑別診断における意義について検討した.33例の内訳は腎癌29例,腎血管筋脂肪腫3例,腎癌と鑑別の難しかった腎盂癌1例である.stagingの正診率は両者に差は認めなかった.静脈浸潤,リンパ節転移,隣接臓器への浸潤に関してはMRIの方が正確な傾向があったが,腎周囲脂肪織への浸潤に関してはMRIは僅かに正確であったに過ぎなかった.また,鑑別診断の目的で,MRIで%コントラスト(腎腫瘍のintensity/腸腰筋のintensity×100)を計算した.clear cell typeの腎癌ではT1強調画像における%コントラストは,100前後,T2強調画像では大部分の症例で50以下を示したのに対し,spindle cell typeの腎癌ではT1画像では109であったが,T2画像では65～85と高値を示した.腎血管筋脂肪腫では明らかに脂肪成分と思われる部分以外の部位で%コントラストを計算したところ,T1画像では3例とも50以下,T2画像では2例で50以上,他の1例は21～38の値を示した.このように症例は少ないが,%コントラストを計算することによってある程度鑑別診断が可能であると予想された The usefulness of magnetic resonance imaging (MRI) was compared with that of computed tomography (CT). Twenty-nine patients with renal cell carcinoma, 3 with angiomyolipomas and 1 with renal pelvic cancer, were examined by both MRI and CT. MRI and CT showed similar results in staging cases of renal cell carcinoma. However, MRI may be more sensitive in detecting the venous extension, metastatic adenopathy, and adjacent organ invasion. In predicting the involvement of perinephric fat, however, MRI is only marginally superior to CT. To demonstrate the usefulness of MRI in differentiating renal cell carcinoma from other renal tumors, the density of renal tumor and that of the psoas muscle were determined using a densitiometer, and the percent (%) contrast (the intensity of the renal tumor/the intensity of the psoas muscle X 100) was calculated. In most patients with clear cell type renal carcinoma, the % contrast value in the T1 weighted images was about 100. In the T2 weighted images, the maximum value of the % contrast value was 50 or less in most patients. In one patient with spindle cell type (sarcomatoid type) carcinoma, the % contrast value was 109 in the T1 weighted images, but was 65-85, at most, in the T2 weighted images. In patients with renal angiomyolipomas, the % contrast values were calculated exclusive of the fatty components. The % contrast value of the T1 weighted images was 50 or less in all 3 patients, and that of the T2 weighted images was 50 or more in 2 patients and 21-38 in the others.(ABSTRACT TRUNCATED AT 250 WORDS)
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Osamu Yoshida,
Tadao Kiriyama,
Kenichiro Okada,
Yoichi Takahashi, Shuichi Hida,
Koji Matsuda,
Yasuki Horii,
Kiyohide Nakagawa,
Takuo Fukuyama,
Takashi Nakagawa,
Miharu Sasaki,
Kazuo Nishimura,
Shuzo Machida,
Yoichi Tanaka
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ABSTRACT: 泌尿器科的疾患患者278例に,Cephalothin (CET)およびCephapirin (CEPR)を経静脈的に投与したときの,静脈炎の発生について比較検討した.CETまたはCEPR 2 gを1日2回,5～7日間点滴静注にて投与した.CET投与群140例とCEPR投与群138例では,CET群21%,CEPR群14%に静脈炎発生が認められた.CEPRおよびCETともに1日投与量を増加すると,静脈炎の発生頻度も増加する傾向があった.1日5 g以上投与群ではCET群の方が静脈炎の発生頻度は高かった.静脈用カテーテル留置により投与した群では静脈炎の発生頻度は高く,とくにCET1日6 gを投与した群ではCEPRにくらべ有意に高い頻度で静脈炎が発生した
