聡 平林’s scientific contributions

One hundred and three kidneys with calculi in 100 patients, were treated by conservative renal surgery from Jan., 1980 to Dec., 1982. The operative technique consisted of pyelolithotomy, extended pyelolithotomy, dismembered pyelolithotomy, nephrolithotomy (bivalve or anatrophic nephrolithotomy) partial nephrectomy and pyelo-nephrolithotomy. Intraoperative X-ray and coagulum lithotomy were employed when pyelolithotomy was performed. Thirty-five residual calculi in 20 kidneys were observed on postoperative X-ray film. The rate of residual calculi was 19.4%. Factors causing residual calculi, were analysed on these 103 kidneys. The factors were as follows; the shape of calculi: staghorn calculus with multiple small calculi, the shape of the renal collecting system: narrow pelvis with narrow caliceal neck and dilatated calices, and the operative technique: nephrolithotomy. These results suggested that it would be necessary to minimize residual calculi when performing nephrolithotomy.

A 41-year-old man, who complained of left dull lumbago, was admitted in January, 1982. Excretory pyelogram showed a non-functioning left kidney with calculi. Cystoscopic examination revealed non-papillary broad base tumor on left trigon and multiple small cystic tumor around it. Retrograde and antegrade pyelogram showed no filling defect that suggested a tumor. Mucinous adenocarcinoma was emonstrated in the biopsy specimen from bladder tumor. The gastrointestinal, respiratory and other genitourinary tracts were examined but no tumor lesion could be found. Therefore, primary adenocarcinoma of the bladder was highly suspected. Firstly, the left kidney was removed in February, 1982. Then in March, 1982 radical cystectomy and lymphadenectomy were done and the urinary tract was reconstructed using an ileal conduit. No urachal remnant was found. Histopathological examination of surgical specimens revealed mucinous adenocarcinoma of the bladder with cystitis cystica and cystitis glandularis.

同種生体腎移植44例について検討した.1)移植術直後よりNCMC活性は著しく低下し移植後6ヵ月を経ると更に低値をとりその傾向は腎移植後3年まで続き,4年を経過すると,再び高値をとる症例がみられた.2)急性拒絶反応合併時,NCMC活性は有意に高値を示したが,慢性拒絶反応合併時は不変であった.3)免疫抑制剤とNCMC活性の検討よりNCMC活性の抑制に,腎移直後より6ヵ月の期間ではSteroid剤及びAzathioprine (Az)剤の関与が,また,腎移植後4年以降の時期ではAz剤の関与が示唆された Natural cell-mediated cytotoxicity (NCMC) displayed by peripheral blood mononuclear cells of kidney allograft recipients was examined against K562 cells to demonstrate the kinetics of NCMC activity in the posttransplant period. On 44 kidney allograft recipients 301 NCMC assays were performed between 1 and 84 months after transplantation. These patients were treated with the conventional immunosuppressive treatment consisting of steroid and azathioprine. NCMC activity sharply decreased after transplant surgery. A decreased NCMC activity continued during the first 6 months and the mean NCMC value was 19.2 +/- 14.1. In the second 30 months, NCMC activity also constantly decreased, almost to 10. It was lower than that of the first 6 months (P less than 0.01). After 37 months, some patients restored a normal NCMC activity and others showed a decreased NCMC activity. The mean value was 27.4 +/- 20.6 in the third 48 months. The depression of NCMC activity might be caused by the large dose of steroid and azathioprine in the first 6 months. In the third 48 months, NCMC activity might be dependent on the dosage of azathioprine alone. The activation of NCMC activity might be caused by acute rejection crisis.

慢性前立腺炎患者の血清中および前立腺液中のエノキサシン(ENX)濃度を測定した.血清濃度は平均1.24 μg/ml,前立腺液内濃度は平均0.69 μg/ml,対血清比は平均0.58と高い値を示した.今回求められた前立腺液濃度は代表的グラム陰性桿菌である大腸菌や変形菌のENXの80%最小発育阻止濃度を上回る結果である To examine the diffusion of enoxacin into the prostatic fluid of patients with chronic prostatitis, the serum level and the expressed prostatic secretion (EPS) level of enoxacin were measured. Enoxacin was administered orally at a dose of 200 mg in 24 chronic prostatitis patients. One hour later, blood and EPS samples were taken. The level of enoxacin was measured by the bioassay using E. coli (Kp strain). In 24 patients, the mean value of enoxacin was 1.24 micrograms/ml in the serum and 0.69 micrograms/ml in the EPS. The mean ratio of EPS/serum was 0.58. These results indicated that enoxacin diffused well into the prostatic fluid of chronic prostatitis patients.

クラミジア性尿道炎患者に対して1日600 mgのOfloxacinを14日間投与した.1) 26例全例でクラミジアは陰性化した.2)排尿痛,尿道違和感など自覚症状は全例で消失した.3)初尿中多形核白血球(PMN),尿道分泌物の量および尿道分泌物中PMNの改善率は薬剤投与14日目で各々15/22,21/22,20/21と良好であった.4)総合臨床効果は薬剤投与7日目,14日目,21日目で各々15/24, 18/22, 19/21であった.5)副作用は2例に認められが,軽症であった.6)薬剤の投与期間は約2週間が適切と考えられた Clinical effects of ofloxacin (OFLX) in the treatment of the patients with chlamydial urethritis was studied. OFLX was administered at a dose of 200 mg, three times daily (600 mg) for 14 days. In all of the 26 patients with chlamydial urethritis, C. trachomatis was eliminated in 7 to 14 days after the start of administration. The subjective clinical symptoms such as pain on urination and abnormal urethral feeling was disappeared in all cases within 7 days after the administration. The objective clinical symptoms, urethral discharge, polymorphonuclear leukocyte (PMNL) in urethral discharge and PMNL in first urine were improved in 94, 68, 91% respectively on 14 days after the administration. Overall clinical efficacy rate of OFLX on 7 days, 14 days and 21 days after the administration in this study was 63, 82, 91% respectively. Whereas subjective symptoms of side effects were noted in 2 patients (7.6%), any additional medical care was needed in none of them. Because of the marked improvement of clinical symptoms and the safety administration, OFLX could be the first regimen to be chosen for the treatment of the patients with chlamydial urethritis.

A case with localized amyloidosis of the ureter was presented. This is the fifteenth case in the world and the first case of autotransplantation of the kidney, performed in this disease. The patient was a 62-year-old man who complained of intermittent gross hematuria and left flank pain. Clinical features of the localized amyloidosis of the ureter are similar to those of ureteral neoplasm. Autotransplantation of the kidney was performed to the left iliac fossa in order to preserve renal function because of no malignancy on a biopsy specimen. A localized amyloidosis of the ureter was diagnosed on the histological examination of the specimen after surgery. During one year after surgery, a good renal function without a recurrence has been confirmed. Classification of the amyloidosis was discussed. Diagnosis, prognosis and treatment of the localized amyloidosis of the ureter were also discussed.

A case with intrarenal A-V fistula resulting from percutaneous needle biopsy treated by ex vivo renal surgery was presented. A 16-year-old boy had had 2 times biopsies on the left kidney performed as a study for proteinuria. Continuous gross hematuria was a chief complaint. Blood pressure was 130-80 and no nephrosclerosis by histopathologic diagnosis. Transfemoral renal arteriography confirmed the presence of a A-V fistula with saccular type aneurysm in the upper pole of the left kidney. Ex vivo renal surgery was chosen as a curative treatment of A-V fistula and aneurysm. The reason why ex vivo renal surgery was chosen for this case was that A-V fistula was located in the renal cortex of the upper pole near the middle portion associated with saccular type aneurysm. The kidney was transplanted to the ipsilateral iliac fossa. The function of the transplanted kidney was well maintained and gross hematuria disappeared after operation. Indications and operative procedures of ex vivo renal surgery for intrarenal A-V fistula as this case were also discussed.

A case with multiple renal calculi and inlimdibulopelvic stenosis as late complication of renal injury was presented. The patient had suffered renal injury, classified as "severe fracture" from blunt trauma 9 years ago. Urological examinations revealed multiple renal calculi and infundibulopelvic stenosis on his right kidney. So ex vivo surgery was performed for the complete removal of multiple calculi and intrarenal pyeloplasty. After surgery, urinary tract infection disappeared and renal function improved. Operative details and renal calculi as late complication of renal injury are also discussed.

A case of 2,8-dihydroxyadenine renal stones was presented. The patient, a 36-year-old woman, was diagnosed as bilateral renal stones in 1966. Radiologic examination revealed bilateral multiple renal stones. In May 1970 left renal stones were removed surgically. The removed stones were not analyzed at that time. After then her total renal function gradually deteriorated. In October 1978 right renal stones were removed surgically. The serum creatinine level was 6.4 mg/dl. An analysis of the removed stones showed them to be mainly composed of 2,B-dihydroxyadenine. Determination of adenine phosphoribosyltransferase activity in erythrocyte lysate showed a partial deficiency of adenine phosphoribosyltransferase. This case is the ninth case of 2,8-dihydroxyadenine stone in the world. The 2,8-dihydroxyadenine stone accompanied with a partial deficiency of adenine phosphoribosyltransferase was the third in the world. We presented the summary of the case and discussed the analytical methods of the stone.

Bilateral nephrocarcinoma in a 57-year-old woman was treated successfully with simultaneous bilateral nephrectomy and hemodialysis. The patient is well now over 3 years and 7 months after operation without recurrence of tumor. The literature was reviewed and the methods of the treatment were also discussed.