崇興 広瀬’s scientific contributions

This report presented the case of extopic ending of the ureter in a 41-year-old man. He visited our clinic because of right abdominal mass. Excretory pyelography and percutaneous pyelography showed right hydronephroureter of the upper half of the kidney. Right heminephroureterectomy was performed. Ureterography during the operation revealed the right ureter opening in the seminal vesicle. After operation seminal vesiculography demonstrated the lower end of the ureter and dilated seminal vesicle. The lower end of the ureter and seminal vesicle were extirpated on the second operation by transsacral approach. This case is the 36th report of male ectopic ureter. The literature were reviewed with emphasis on treatment.

From January through March of 1985, the Sapporo Clinical Research Group for STD treated 69 cases of gonococcal infections (61 cases of male gonococcal urethritis and 8 cases of female gonococcal cervicitis) at its facilities in Sapporo City. The therapeutic efficacy of one shot therapy of Spectinomycin (SPCM) was investigated, and an epidemiological study on the cases and bacteriological studies on the isolated strains of Neisseria gonorrhoeae were made. The male patients were between 19 and 55 years old, with a peak age distribution in the younger half of the twenties. The female patients were between 18 and 40 years old. The major source of infections was a so-called special massage parlor which accounted for 36.1% of male cases. The isolation rate of PPNG were 16.7% (11/66). The MIC (inoculum size; 10(6) CFU/ml) of SPCM ranged from 3.13 to 25 micrograms/ml regardless of beta-lactamase production. In male patients, the eradication rate (efficacy rate) of N. gonorrhoeae by SPCM was 94.7% on the first day, 93.6% on the third day and 100% on the seventh day after 2 g one shot therapy. In female patients, the rate was 100% on the third and seventh day after 2 g one shot therapy, and 75% on the first day, 66.7% on third day and 100% on seventh day after 4 g one shot therapy. We considered that one shot therapy of SPCM was effective for gonococcal infection also in the present time. Especially SPCM was effective for infections by PPNG, since it was not resolved by beta-lactamase of N. gonorrhoeae. Positive rate of Chlamydia trachomatis was 16.3% in male gonococcal urethritis, and the serous discharge tended to remain longer in the positive patients than in the negative patients. There was only one side effect (1.4%), therefore SPCM was recognized to be a safely administrated antimicrobial agent.

CPRは1回0.5 gまたは1.0 gを,CAZは1回1.0 gを1日2回,点滴静注により5日間連続投与し,臨床効果はUTI薬効評価基準により評価した.総投与症例530例中効果判定が可能であった症例はCPR 1日1 g投与群141例,CPR 1日2 g投与群136例,CAZ 1日2 g投与群140例であった.CPRは複雑性尿路感染症に対してCAZと同様に有用性の高い薬剤である We carried out a randomized multi-center study comparing cefpirome (CPR) 0.5 g b.i.d. (1 g group), 1.0 g b.i.d. (2 g group) and ceftazidime (CAZ) 1.0 g b.i.d. (CAZ group) in the treatment of complicated urinary tract infections. Patients who were over 16 years old and had underlying urinary tract disease, with bacteriuria of more than 10(4) cells ml or more and pyuria of more than 5 WBCs/hpf (x 400) or more were randomly allocated to receive either 0.5 g of CPR, 1.0 g of CPR or 1.0 g of CAZ twice a day for 5 days by intravenous drip infusion. The overall clinical efficacy of the treatment was evaluated by the criteria of the Japanese UTI Committee as excellent, moderate or poor, on the basis of the changes in pyuria and bacteriuria. A total of 530 patients were treated. Of these, 141 patients in the 1 g group, 136 in the 2 g group, and 140 in the CAZ group were evaluable for clinical efficacy. No significant differences in background characteristics were observed among the treatment groups. The overall clinical efficacy rate of the 1 g group, the 2 g group and the CAZ group was 80.1%, 76.5% and 71.4%, respectively. The differences were not statistically significant. The overall bacteriological eradication rate of the 1 g group, the 2 g group and the CAZ group was 81.0%, 88.1% and 83.8%. The differences were not statistically significant either. Against the enterococcus group, however, eradication rates were higher significantly in the 1 g and 2 g groups than in the CAZ group. The incidence of adverse reactions was 2.2% in the 1 g group, 0.6% in the 2 g group and 2.9% in the CAZ group. Abnormal laboratory data after medication were observed in 10.8% of the 1 g group, 12.1% of the 2 g group and 10.2% of the CAZ group, the difference not being statistically significant. There were no serious untoward reactions to medication. From the results obtained in this study, we consider that CPR is at least as useful as CAZ in the treatment of complicated urinary tract infections.

男子尿道狭窄80例に対して直視下内尿道切開術を施行した.1)3ヵ月から5年間経過観察し,非再発率は43.2%であった.2)再発の時期は50%が3ヵ月以内に,80%が1年以内であった.3)数回の手術により再発率が著しく低下した.4)外傷性尿道狭窄が炎症性尿道狭窄に比して有意に再発しやすかった.5)カテーテル留置期間に関しては4日留置例の再発が少なかった.6)狭窄の部位,長さ,径,数に関する再発率には有意差がなかった Internal urethrotomies under direct vision for urethral strictures were carried out in 80 male patients during the past 5 years. None of the patients died and morbidity was minimal. The immediate postoperative success rate was 96.3%. A retrospective review of results showed an overall cure rate of 43.2%. In the patients in whom the stricture recurred after the first operation, the recurrence was recognized in 50% during the first three months and in 80% during the first year. Repeated operations resulted in a significantly higher cure rate than the initial operation. The results were unrelated to the site, length, width, or the multiplicity of the stricture. However, the recurrence rate was significantly higher for traumatic strictures than inflammatory ones. The recurrence rate was lowest when the catheter was indwelling for 4 days.

We studied the epidemiology of 109 cases of gonococcal infections (105 males with urethritis and 4 females with cervicitis), together with the basic and clinical effects of cefetamet pivoxil in the cases. The peak of age distribution of the male patients was in the younger half of their twenties, and all of the 4 female cases were between 20 and 39 years old. The major source of infections in the males younger than 25 years old was their girl friends or so-called pick-up friends, and that of the males older than 25 years old workers serving at an amusement center, for example, bars and so-called special massage parlor, which accounted for about three fourths of the male cases between 35 and 44 years old. The distribution of the MIC (inoculum size; 10(6) CFU/ml) of Cefetamet against beta-lactamase non penicillinase producing Neisseria gonorrhoeae (non-PPNG) ranged from 0.025 to 0.1 microgram/ml and that against beta-lactamase producing Neisseria gonorrhoeae ranged from 0.025 to 0.05 microgram/ml. The isolation rate of PPNG was 10.2% (9/88). In male patients with gonococcal urethritis, the efficacy rate was 100% on days 3 and 7 for 1,000 mg single dose and 7-day treatment and 500 mg single dose treatment. One of the cases treated with 250 mg single dose therapy was unchanged at 3, but the efficacy rate of the remaining cases was 100% at day 7. Complicated urethritis with C. trachomatis was noticed in 25.7% (5/105) of the male urethritis and in 25.0% (1/4) of the female cervicitis cases. The only side effect was diarrhea observed in 1 of the 124 case (0.8%).

Urethritis in males and cervicitis in females, which were sexually transmitted diseases, were treated with NY-198, a new quinolone antibiotic, and its efficacy was studied. Seventeen male patients with gonorrheal urethritis were administered a single 300 mg dose of NY-198. The efficacy rate on the 3rd day after administration was 100%, but it was 85.7% on the 7th day due to recurrence in 1 patient. The results of treatment of non-gonorrheal infections were as follow. In this treatment, NY-198 was administered in a daily dose of 600 mg in 3 divided doses for 14 consecutive days. In the treatment of chlamydial urethritis of males, the efficacy rate in 26 patients was 84.6% on the 7th day and 84.0% on the 14th day in 25 patients. In the treatment of chlamydial cervicitis, the efficacy rate was 100% on both the 7th (3/3) and 14th (6/6) days. In the treatment of non-gonorrheal and non-chlamydial cervicitis, the efficacy rate was 100% on the 7th day (1/1) and 50% (1/2) on 14th day. The efficacy rate in all 40 males with non-gonorrheal urethritis was 85.0% on the 7th day and 88.9% for 36 patients on the 14th day, while that in all 4 females with cervicitis was 100% on the 7th day and 87.5% on the 14th day. No side effects were seen in any of the patients. Overall, NY-198 had an efficacy rate of 80% in the treatment of chlamydial infections. NY-198 was found to be a useful drug which is efficacious in the treatment of all STD-related microbes such as gonococci and chlamydia.

札幌市における淋菌感染症120例について,症例の疫学的検討を行なうとともに,NFLXの淋菌感染症に対する基礎的,臨床的検討を行った.年齢分布は男女とも20代前半にピークを認めた.感染源は男子では10代はガールフレンド,pick-upなどの素人が70.6%を占め,女子では配偶者が50%,患者自身が特殊浴場従業女子であるものが50%であった.NFLXのN. gonorrhoeaeに対するMIC分布は,0.025 μg/mlにピークをもち,0.0125～3.13 μg/mlに分布した.penicillinase producing Neisseria gonorrhoeae (PPNG)は症例より分離したN. gonorrhoeae 104株中21株(20.2%)であったが,これらのNFLXに対するMICは18株(85.7%)が0.1 μg/ml以下に,3株(14.3%)が1.56～3.13 μg/mlに分布した.NFLX 200 mg経口投与後の血清中濃度は投与2時間後に平均0.72 μg/mlとピークに達し,尿道分泌中濃度は投与1時間後に平均0.5 μg/mlとピークに達した.NFLX 600 mg, 7日間経口投与による淋菌感染症に対する治療成績は,男子尿道炎における有効率が3日間投与で97.4%,7日間投与で93.1%であり,女子子宮頸管炎における有効率は3日間,7日間投与とも100%であり,本剤は淋菌感染症と対する化学療法剤として高い有効性が認められた.淋菌感染症におけるChlamydia trachomatid (C. trachomatis)感染の合併は,男子尿道炎で32.7%,女子子宮頸管炎で20%であり,これらの症例においてはNFLXによる治療後も陰性例よりも分泌物の残存率が高く,引き続きC. trachomatisに対する化学療法が必要と考えられた.NFLX投与による副作用は全く認められず,NFLXは安全に投与できる薬剤と考えられた We studied the basic and clinical effects of norfloxacin (NFLX) in 120 patients with gonococcal infections (110 men with urethritis and 10 women with cervicitis)--all residents at Sapporo City; and epidemiologically analyzed the sources of their infections. The male patients were between 16 and 67 years old and the female patients were between 20 and 61 years old, with a peak in the early 20s both for sexes. 70.6% of the male patients in their 10s were infected from their girl friends or so-called pick-up friends and 50% of the female patients from their husbands. The other half of the female were workers serving at so-called special massage parlors. The minimum inhibitory concentration (MIC) of NFLX against N. gonorrhoeae distributed was 0.0125 approximately 3.13 micrograms/ml, with a peak at 0.025 micrograms/ml. NFLX inhibited 93.3% of the clinical strains of this species at less than 0.1 microgram/ml and 96.2% at less than 1 microgram/ml, where the inoculation was 10(6) CFU/ml. Twenty one (20.2%) of the 104 N. gonorrhoeae strains were penicillinase-producing one (PPNG). NFLX inhibited 18 of these PPNG (85.7%) at less than 0.1 microgram/ml and the other 3 strains at 1.56 approximately 3.13 micrograms/ml. Oral administration of 200 mg NFLX showed the average peak serum level of 0.72 micrograms/microliter in 2 hours and the average peak level in the urethral secretions of 0.5 micrograms/ml in one hour. These two concentrations of NFLX covered 95.2% of the MIC distribution against N. gonorrhoeae. The clinical efficacy of 600 mg NFLX (peros) was 97.4 and 93.1% for a 3-and 7-day treatment for male urethritis; and 100% for both 3-and 7-day treatment for female cervicitis. Complicated urethritis with C. trachomatis was noticed in 32.7% of the male urethritis and in 20% of the female cervicitis cases. Urethral secretions among about half of these patients were observed even after treatment with NFLX. As a subsequent treatment, another effective chemotherapeutic is required against C. trachomatis. No adverse reactions were detected with NFLX. All the above results demonstrate that NFLX is a highly effective and safe chemotherapeutic agent for treatment of gonorrhoea.

性器ヘルペス154例の疫学的検討とアシクロビル錠による治療学的検討を行った.1)性器ヘルペスは近年増加傾向にあった.2)皮疹の範囲と鼠径リンパ節腫脹は初発では両側に,再発では片側にみられることが多かった.3)皮疹の性状は初発では散在性に広がり,再発では集簇性に固まってみられることが多かった.4)外陰部痛,下肢疼痛,下肢違和感などの局所症状と倦怠感,食思不振などの全身症状は女性の方が男性より高頻度にみられた.5)発熱,倦怠感,食思不振などの全身症状は初発の方が再発よりも高頻度にみられた.6)ウイルス型別ではHSV-1型は初発男性で15.8%,初発女性で27.7%に認められた.7)直接蛍光抗体法による診断は,ウイルス分離培養法により診断された検体の約60%において診断可能であった A clinical study for genital herpes was conducted on 154 patients and the efficacy of treatment with oral acyclovir was investigated in 51 of these patients. The diagnosis was confirmed by direct immunofluorescence or viral isolation from the lesion. This disease has increased in both males and females in recent years and was found in 2.3-2.9% of the out-patients examined in 1986. Seventy percent of the patients were between 20 and 30 years old. About 70% of the male patients had phimosis. In patients with the first infection, bilateral eruption (62%) and lymphadenopathy (54%) were more common than unilateral lesions. However, in those with recurrent infection, unilateral eruption (72%) and lymphadenopathy (52%) were more common. Sixty two percent of those with the first infection had scattered eruption on external genitalia, but 71% with recurrent infection, had lesions concentrated in several areas. Local symptoms such as pain in the external genitalia (male: female, 16%: 85%), pain in the lower extremities (26%: 45%), discomfort in the lower extremities (20%: 41%) and systemic symptoms such as malaise (22%: 48%) and anorexia (4%: 35%) were seen more frequently in females than in males. In addition, systemic symptoms such as fever (first episode: recurrent episode, 36%: 4%), malaise (34%: 9%) and anorexia (18%: 2%) were seen more frequently in patients with the first episode than in those with recurrence. HSV type 1 infections were found in 16% of males and 28% of females with the first episode, but were less common in the recurrent episode, 0% and 13%, respectively. Direct immunofluorescence was positive in 75 (59%) of 128 samples diagnosed by viral isolation. Treatment with oral acyclovir tablets, 200 mg five times daily, was very effective in 26 of 30 patients (87%). No side effects were observed. In this study, acyclovir tablet has been shown to be a very effective and well-tolerated treatment for genital herpes infections.

膀胱尿管新吻合術を行う場合,尿管が短い症例に対しBoari法8例,Psoas-Hitch法8例を施行した.1)術式の選択に関しては初期の4例には粘膜下トンネルを作成しないBoari法を行ったが,後期はBoari法とPsoas-Hitch法を選択して施行してきた.膀胱を総腸骨動静脈上方まで伸展でき,尿管が粘膜下トンネルを作る余裕のある症例に対してはPsoas-Hitch法を行い,尿管に余裕のない他の症例に対してはBoari法を行った.2)初期に行ったBoari法の2例とPsoas-Hitch法の1例にVURを認めた.尿管狭窄は全例に存在しなかった.3)水腎症はほとんどが改善もしくは不変であり,腎機能においても術後異常を認める症例は存在しなかった Vesicoureteroneostomy was performed by Boari's method on 8 patients and the psoas-hitch method on 8 patients during the 16 years from 1969 to 1986. Although Boari's method without the formation of a submucosal tunnel was employed for the initial 4 patients, the formation of this type of tunnel was a general principle for all patients thereafter. In choosing the surgical method, the psoas-hitch method was assigned to patients in whom it was possible to extend the urinary bladder to the upper part of the common iliac vessel and in whom the ureter allowed the formation of a submucosal tunnel, and Boari's method was assigned to those in whom it is was not possible to reach the ureter or to form a submucosal tunnel or in whom the ureter would be tensed. The mean length of the resected section of ureter was 75 mm for Boari's method and 43.2 mm for the psoas-hitch method. Follow-up observations revealed the presence of VUR in 2 patients who underwent surgery by the initial form of Boari's method and in 1 patient who underwent surgery by the psoas-hitch method. There was no ureteral stenosis or renal hypofunction in any of the patients.

An accurate preoperative diagnosis of xanthogranulomatous pyelonephritis is difficult because of its clinical and radiological similarities to renal cell carcinoma. We report two cases of xanthogranulomatous pyelonephritis. Furthermore, in an attempt to clarify the clinical distinction between this entity and renal cell carcinoma, we summarize the clinical characteristics of 143 cases with xanthogranulomatous pyelonephritis in the literature and 126 cases with renal cell carcinoma experienced in our clinic. According to the clinical reviews, several characteristics of xanthogranulomatous pyelonephritis were revealed. 1) Presence of history of pyelonephritis. 2) gamma-globulinemia in blood chemistry. 3) Non-visualizing kidney on the excretory urogram. 4) Hypovascular or avascular features and dilatation of renal capsular arteries on angiogram. 5) Heterogenous renal mass and thickness of Gerota's fascia on computed tomogram. 6) Positive uptake of renal mass in Ga-scintigram. When some of these features are found in the renal mass, the case could be of xanthogranulomatous pyelonephritis and therefore a kidney preserving operation should be considered.