常雄 西浦’s scientific contributions

健康人18例のCICの平均は2.7%で,SDは±3.0%であり,この成績より2SDに近い10%以下を正常値とした.泌尿器科的良性疾患患者9例のそれは2.9±2.7%であり,いずれの症例ほ正常値であった.腎細胞癌患者9例での陽性率は33%,前立腺癌患者16例のそれは19%と比較的高値を示したが,膀胱腫瘍患者21例の陽性率は5%と低く,さらに腎盂尿管腫瘍患者3例においては1例も陽性を認めなかった.なお,腎細胞癌患者9例についての検討で,摘出標本の大きさとCIC値との間に相関は得られずむしろ逆相関の傾向を認めた Circulating immune complexes (CIC) were detected and quantitated in 49 patients with urological malignant diseases (9 cases of renal cell cancer, 3 cases of renal pelvic and ureter cancer, 21 cases of bladder cancer and 16 cases of prostatic cancer), 9 patients with urological benign diseases and in normal subjects by the polyethylene-glycol precipitation complement consumption test (PEG-CC test). The average CIC level was 2.7 +/- 3.0% in 18 normal subjects and the normal range was less than 10% of the CIC level. CIC level of patients with renal cell cancer was 14.3 +/- 20.1%, being elevated in 3 of the 9 patients, that of patients with renal pelvic and ureter cancer was 4.7 +/- 4.6%, being within the normal range in 3 cases, that of patients with bladder cancer was 4.7 +/- 4.4%, being elevated in 1 of 21 patients, and that of patients with prostatic cancer was 8.9 +/- 15.4%, being elevated in 3 of 16 patients. In urological malignant diseases such as renal cell cancer and prostatic cancer the CIC values were relatively high.

37施設で,神経因性膀胱233例を対象に,ロバベロン注射剤を標準薬とし,KN-7錠剤の経口投与による排尿障害に対する有用性を,二重盲検群間比較試験で比較検討した.解析対象例はKN-7群108例,ロバベロン群107例である.KN-7群は1日6錠投与した.改善度の効果判定では改善以上K群40.7%,R群38.7%,やゝ改善以上それぞれ76.9%,72.6%と有意差はなかった.臨床所見中改善の良かった項目は,尿意,残尿感,尿失禁,排尿までの時間,排尿時間,尿勢-排尿力と尿線中断の改善などで,これらの改善以上はK群35.8%,R群30.8%で,有意差はなかった.副作用はK群0.9%,R群6.8%,K群が有意に少なかった.両剤とも主として下痢で,R群ではその他頭痛,頻脈,肝機能障害,発熱感などを少数例認めた.臨床検査値ではGOT, GPTの上昇が2例あった.有用度有用以上はK群46.3%,R群45.8%で有意差はなかった.疾患別では,末梢神経疾患,膀胱の性状では弛緩性,時期では12ヵ月以内の例で特に改善率が高かった.以上から,KN-7錠剤は,ロバベロン注射剤に比べ,同等の効果が期待でき,安全性も高く,長期投与あるいは外来患者の治療にも適する The clinical effectiveness, safety and usefulness of KN-7 tablet as a new oral application of the prostatic extract, on urinary dysfunction of neurogenic bladder were compared with those of Robaveron injection by the double-blind test method. In the study, 2 tablets t.i.d. and a shot of intramuscular injection 1 ml a day were given successively for 3 weeks. A total of 233 cases were reported from 37 facilities belonging to the KN-7 Clinical Research Group. Some of them were excluded or dropped out. The number of cases used for analysing the effectiveness, safety and usefulness were 214, 232 and 215, respectively. There was no bias between the two groups with a significant homogeneity in the background. In the overall clinical effectiveness, the effective rate including excellent, moderate and slightly effective was 76.9% with KN-7 and 77.4% with Robaveron. In the clinical usefulness, the rate of usefulness of slightly useful or above was 75.0% with KN-7 and 75.7% with Robaveron. There was no significant difference between the two groups in the clinical effective and useful rates at a significant level of 5%. Side effects were observed in 1 of the 114 (0.9%) patients given KN-7 and 8 of the 118 (6.8%) patients given Robaveron. The incidence of adverse reactions with KN-7 was significantly lower than that with Robaveron. Based on the results, it was concluded that KN-7 tablets, 2 tablets t.i.d., would be as effective and useful as a Robaveron injection 1 ml daily and safer than the latter in the treatment of neurogenic bladder.

1974年1月より1981年6月までに岐阜大学泌尿器科において施行した恥骨上式前立腺被膜下切除術123例について,統計的観察をおこなった.1)最年少48歳,最年長89歳で平均年齢は70.1歳であった.2)平均術中出血量は590 mlであったか,硬膜外麻酔が全身麻酔に比し有意に出血量が少なく,麻酔方法が出血量の最大の因子であった.摘出重量と出血量にも相関を認めた.3)摘出重量は平均33.4 gで,年齢が増加するにつれ重量も増加していたが,術中に膀胱頸部硬化症の合併が重量20 g以下で27%と高率に認められた.術前残尿量と摘出重量とには相関を認めなかった.4)潜在性前立腺癌は4.1%に認められた.5)術後の副睾丸炎発症の予防としての精管切断術は意義が少ない.6)術後の尿路感染症は術前の細菌尿の有無とよく相関を示し,術前の細菌尿に対するコントロールが重要である Results of operation were analyzed statistically in 123 patients who underwent suprapubic prostatectomy for benign prostatic hypertrophy from 1974 through 1981. Age of the patients ranged from 48 to 89 years and the mean age was 70.1 years. The average amount of blood loss during operation was 590 ml. Amount of blood loss in patients operated under epidural anesthesia was less than that in the patients operated under general anesthesia. Furthermore, significant correlation was observed between amount of blood loss and the weights of enucleated prostate glands. The average weight of enucleated prostate glands was 33.4 g and the weight increased as the patient's age increased. Histological examination of the enucleated specimens revealed occult carcinoma in 4.1% of the patients. Association of bladder neck sclerosis was observed in 27% of the patients whose prostate weighed less than 20 g. Significance of prophylactic vasectomy for the prevention of postoperative epididymitis was considered to be low. Incidence of postoperative bacteriuria was higher in patients who had bacteriuria preoperatively than those without preoperative bacteriuria. Therefore, eradication of preoperative bacteriuria seemed important in the prevention of postoperative bacteriuria. No significant correlation was observed between postoperative residual urine volume and the weight of the enucleated prostate glands.

We present a case of a 32-month-old boy with teratoma accompanied by yolk sac carcinoma and embryonal carcinoma of the right testicle. To treat the gradual rise in serum AFP value 3 months postoperatively, he received combined chemotherapy including VCR, CPM and ADM followed by bilateral retroperitoneal lymph node dissection. The preaortic lymph node disclosed, pathologically, yolk sac carcinoma and embryonal carcinoma, which demonstrated neither degeneration nor necrosis despite remarkable decrease in serum AFP value after the chemotherapy. The patient had normal AFP value and no evidence of recurrent disease 36 months after the lymph node dissection. We emphasize the discrepancy between the response of the tumor marker after the chemotherapy and the histologic alteration. Furthermore, the management of infantile testicular cancer is discussed.

Tubeless ureterocutaneostomyの腎盂細菌叢の存在とその検出方法につき考察した.1) Single lumen catheterを使用するストーマからの腎盂導尿法は皮膚細菌叢の混入による汚染も少なく,有用な方法になりうると想像した.2)腎盂内細菌叢の出現率は19腎・尿管中9/19であったが,うち,膿尿(毎視野5個以上の白血球が存在)の合併は2腎・尿管のみであった.3)水腎症の存在と腎盂細菌叢の出現間には有意な関係は認めなかった.4)腎盂細菌叢の経時的変遷では菌交代または消失はS. faecalisにもっとも多く,その他,S. aureus, S. epidermidis, P. aeruginosaであった.この問題の詳細は不明であった The presence of bacteria at the renal pelvis and the methods of their detection were studied in 11 patients with catheter-free cutaneous ureterostomy (tubeless ureterocutaneostomy). These patients had had total radical cystectomy due to bladder carcinoma. Of these, 5 patients had single-sided stoma with 9 kidney-ureter units and 6 patients had bilateral stoma with 10 units, excluding 2 ureters because of indwelling catheters. The urine obtained both from the renal pelvis with a single lumen catheter and from the pouch were used in the bacterial culture test and urinalysis. The aseptic swab after touching the skin around the stoma was also cultured for bacteria. Of 19 kidney-ureter units, 9 (47%) were found to have bacteria in urine obtained from catheterization. However, only 2 units (11%) were observed to be accompanied with pyuria. In this method, the rate of bacterial appearance was higher in single-sided stomas than in bilateral ones. There was no statistical correlation between the presence of hydronephrosis and the rate of bacterial appearance. In conclusion, the method of single lumen catheterization might be of great use for analysis of urinary tract infections in patients with such conditions.

過去5年6ヵ月間に施行された172例の尿管尿の細胞診について臨床的に検討した.本法の偽陽性は1例/139例(0.7%)であったものの,上部尿路上皮癌においても6例/17例(35%)と低い陽性率であった.特にpapillary non-invasive tumors, stage-pTa, grade 1症例では陽性例は全く認められなかった.経皮的腎盂腔穿刺による腎盂尿の尿細胞診を実施した7例のうち5例に陽性所見を認め,臨床的に有用であった One hundred and seventy-two patients with upper urinary tract disease were examined by cytological study of ureteral urine which was taken by ureteral catheterization. Of 139 patients with benign disease or ureteral stricture due to non-urological cancer, only one case with renal cyst revealed positive findings (false positive rate: 0.7%). Two positive cases, which were a renal hemorrhage without followup and a uterine cervical cancer with squamous cancer cells in the ureteral urine, were excluded. Although 6 of 17 (35%) uroepithelial cancers in the upper urinary tract were registered as positive, this examination was little use for detecting stage pTa, grade 1 or papillary non-invasive tumors. However, 2 out of 12 (17%) renal pelvic or ureteral cancer patients with negative results of voided urine were cytologically detected by ureteral urine. Five out of 6 cases of these cancers demonstrated malignant cells in the renal pelvic urine sampled from surgical specimen. We have recently experienced aspiration cytology for upper urinary tract disease, using the percutaneous puncture method, and five of 7 upper urinary tract patients were cytologically diagnosed. This procedure could be valuable for detecting even patients with associated bladder cancer or failure of ureteral catheterization.

A rare case of primary papillary adenocarcinoma of the renal pelvis is reported. A 75-year-old man was introduced to our institute because of chance hematuria. He had no history of urolithiasis or urinary tract infection. Excretory urography showed a space taking lesion at the lower position of left renal pelvis with low function. Because of advanced stage with paraaortic lymphnode invasion, simple nephrectomy followed by irradiation and systemic chemotherapy with 5-FU was done. He died of pneumonia and acute heart failure after subtotal gastrectomy for peptic ulcer four months after the nephrectomy. Excised specimen revealed papillary adenocarcinoma of the renal pelvis without mucin production. This case was the 51st case reported in the literature. A short review of the disease is also reported.

A rare case of condyloma acuminatum of the urethral meatus in a male child is reported. The patient was five years old and developed a warty mass on the glans penis. He underwent successful resection with a Nd-YAG laser. Excised specimen showed typical characteristics of condyloma acuminatum on histology. Although the disease is thought to develop by a contact infection of human papilloma virus (HPV), the present case had no history suggesting this pathogenesis. At 4 months after operation, no disease recurrence was seen. A short review of the disease found in younger persons is also presented.

女性急性単純性膀胱炎(AUC)の再発判定基準につき9種の経口抗菌薬(計270余症例)の治療後経過観察所見について臨床的に解析を加え,下記の基準決定案を作成した.1)対象患者:投薬前に急性単純性膀胱炎におけるUTI薬効評価基準の患者条件を満足し,規定された投薬期間投薬後に著効であった患者とする.2)投薬期間:薬効評価(3日分投薬)に使用した薬剤を同量で4日分追加し,計7日分とする.3)休薬期間:7日間とする.4)再発判定:膿尿および細菌尿を指標とし,膿尿10個/hpf未満かつ細菌尿104個/ml未満を再発なし,膿尿10個/hpf以上かつ細菌尿104個/ml以上を再発ありとし,それらの中間のものはどちらとも規定しない.5)再発判定時期:7日分投薬後著効であることを確認し,7日間の休薬後に判定する.ただし,休薬期間中に再発が認められる場合はその時点で判定する.6)採尿法:本判定にかかわる(すなわち7日分投薬終了時以降)尿検査は中間尿で行い,陽性所見が出ればカテーテル尿で再検査する.中間尿の採用方法は外陰部清拭(クロールヘキシジン綿)の通常の方法で行う The recurrence of female acute uncomplicated cystitis was investigated clinically. The criteria for the evaluation of recurrences were proposed, as follows; Patients: Target infection is acute uncomplicated cystitis (AUC) which had satisfied the specifications of AUC Criteria by the UTI Committee of Japan and showed the excellent effects of an antimicrobial agent after a definite period of administration. Treatment period: Seven days; after 3 days' administration to evaluate the drug efficacy, patients shall take an additional 4 days' treatment. Interval of follow up proposed was 7 days. Evaluation of recurrence: Parameters of criteria are pyuria and bacteriuria. Recurrence: Pyuria greater than or equal to 10 WBCs/hpf and bacteriuria greater than or equal to 10(4)/ml. Evaluation of the day of recurrence: Evaluation should be made 14 days after the start of treatment. Urine sampling: After 7 days of treatment, midstream urine is collected and in cases with positive findings, catheterized urine should then be collected. Using these criteria it will be possible to evaluate and compare the ability of various antimicrobial agents to cure acute uncomplicated cystitis.

Herein we report a case of primary paraganglioma of the urinary bladder. A 21-year-old woman was admitted to an emergency hospital, because of gross hematuria, dysuria and complete urinary retention. Pelvic CT scan and ultrasonic examination revealed a bladder tumor and coagulated blood mass, then she was referred to our clinic for further treatment. On cystoscopy a dark brown lobular tumor was seen on the anterior wall. The bladder tumor was removed by partial cystectomy. The operative specimen measured 6 X 4 X 3 cm and weighed 50 g. Histological examination showed it to be a paraganglioma of the urinary bladder, which was chromaffin positive. Her serum and urinary catecholamine level were within the normal range after operation. She is now ten months postoperative, free from hematuria, and showing no other symptoms or signs of disease including metastasis.