亨 古川’s scientific contributions

高位精巣摘除術2年後に後腹膜に再発した3歳男児の精巣卵黄嚢腫例に対し化学療法およびリンパ節廓清術を施行し,完全寛解をえた。VAC療法により顆粒球減少症・脱毛・口内炎等の合併症を認めたが,顆粒球減少症に対してはG-CSFの投与により予定した治療を完遂しえた。小児精巣腫瘍に対するVAC療法は有効で安全な治療法と考えられた A case of recurrent yolk sac tumor in a three-year-and five-month old child is reported. Left high orchiectomy was performed two years earlier at which time no evidence of metastatic disease was demonstrated. Twenty-four months postoperatively, serum alpha-fetoprotein (alpha-FP) was elevated and recurrent mass appeared in the left para aortic region. Treatment by VAC regimen consisting of vincristine, actinomycin D and cyclophosphamide was performed. Complete response was obtained after two courses of this therapy, which was confirmed by retroperitoneal lymphadenectomy. We believe that this chemotherapy is effective and safe for the treatment of yolk sac tumor of infantile testis.

αインターフェロンを用いて尖圭コンジローム18例の治療を試みた.1)局所投与を行った17例中完全消失は,6例に認めた.2)総投与量が12×106単位を越えた,11例での完全消失は5例であった.3)完全消失例の6ヵ月以内の再発は認められなかった Eighteen cases of condyloma acuminata were treated by human lymphoblastoid interferon (HLBI). Seventeen were male and one was female. Five cases were recurrent cases. Except one patient, all the patients were administered HLBI by intralesional injection. Five patients were treated by single injection. Others were given 2 to 8 injections during one to 5 weeks. Total dose varied from 3 x 10(6) to 24 x 10(6) U. Of the eighteen patients, 6 showed a complete response and 3 a partial response (greater than 50% reduction in size of the lesion). In 5 of the 11 patients (45%) who were treated with a total dosage of more than 12 x 10(6) U, the lesion was completely cleared. Six patients who showed a complete response did not experience recurrent disease during the 6-month follow-up period. In conclusion, intralesional administration of HLBI for condyloma acuminata proved to be effective.

1歳8ヵ月女児,結石の嵌頓により腎後性腎不全となったシスチン尿症に対し,経皮的腎瘻造設後,溶解療法とPNLの併用により結石の完全除去を行い得た A 20-month-old child was admitted to our hospital due to obstructive renal failure caused by cystine calculi. After recovering from the renal failure by bilateral percutaneous nephrostomy, pelvic irrigation with N-acetylcysteine was performed using a 12Fr. flexible double lumen catheter. In 2 weeks the calculus was reduced by 39% in size, then residual calculi were successfully removed by percutaneous nephrolithotripsy using 11.5Fr. rigid ureteroscope and postoperative irrigation with N-acetylcysteine.

症例は66歳男性で,貧血による心電図異常(ST低下)で筆者らの施設の循環器科に入院した.輸血によりST変化は改善したが,下腹部に小児頭大の腫瘤が触知され画像診断にて後腹膜腫瘍を疑われ精査加療目的で泌尿器科へ転科となった.腹部CT・MRI所見から後腹膜悪性腫瘍と診断し,遠隔転移を認めないことから腫瘍に癒着した膀胱および回腸の一部を合併切除する形で一塊とし腫瘍切除した.摘出標本の病理組織学所見から後腹膜原発の血管肉腫と診断した.術後6ヵ月に前回摘出部に局所再発したが遠隔転移を認めないので腫瘍摘出術,小腸部分切除術を施行した.術後補助療法としてIL-2を40万単位/日,週3回術後47週まで点滴静注(総投与量3000万単位)した.しかし,腫瘍の後腹膜腔再発と増大は防げず,最初の手術から9ヵ月後腸閉塞,乏尿のため人工肛門造設術,腎瘻造設術を施行したが,悪液質の進行,全身衰弱のため術後375日に死亡した We report a case of angiosarcoma in the retroperitoneal cavity. A 66-year-old man was admitted to our hospital with the complaint of chest discomfort. Imaging studies including computed tomography scan and magnetic resonance imaging revealed a large solid retroperitoneal mass adjacent to the bladder. There was no evidence of metastasis. The tumor was surgically resected and histopathologically diagnosed as angiosarcoma from the positive staining for VIIIth factor, mitotic figures and abnormal endothelial cells. Six months after surgery, local recurrence adjacent to the bladder appeared. We resected the mass and started adjuvant therapy using Interleukin-2. However, he died of progressed disease one year after the first operation.

1)1990年7月より1993年10月迄に膀胱腫瘍に対する膀胱全摘後のKock式自排尿型代用膀胱症例37例で,その長期成績を検討した. 2)術後3ヵ月の時点で,35例中32例が,術後4年以上経過した患者では22例中19例が自排尿のみで管理が可能.自排尿可能な患者のうち殆ど失禁のない例は術後3ヵ月では25/35,術後4年以上では15/21. 3)術後のパウチに起因した合併症として,輸入脚滑脱3例・パウチ尿道吻合部狭窄5例及びパウチ内結石2例の10例に計14回の再手術を要した. 4)現在生存中の患者にアンケートを施行したところ,19例中8例(42%)は排尿状態に不満があるか,QOLが制限されていると答えた. 5)本法は煩雑な術式のため合併症はやや多いが,排尿状態に関しては長期的に安定している術式と考えられた We analyzed the long-term results and the quality of life in patients who received orthotopic lower urinary tract reconstruction using the Kock ileal neobladder. Between July 1990 and October 1993, 37 consecutive patients including 2 females received orthotopic hemi-Kock neobladder after radical cystectomy. In these patients, we analyzed the urinary continence, complications and urethral recurrence, and performed a questionnaire survey by mail. Good continence all day had been achieved in 71% of the patients 4 years after surgery. The rate of the pouch-related complications requiring reoperation was 27%. There was no urethral recurrence. Compared with preoperative conditions, 42% were not satisfied with urination. In these dissatisfied patients, the need to use pads in the daytime, sensation of residual urine and weak urine stream were significantly more frequent than in satisfied patients. In summary, the rate of complications was higher than that of other methods. However, the Kock orthotopic ileal neobladder is a stable procedure providing good function over the long-term.

A case of ureteral complication observed after endopyelotomy is reported. A 19-year-old female patient suffering from right hydronephrosis due to uretero pelvic junction stenosis was treated with endopyelotomy. The stenotic ureter was incised by cold knife for a distance of 5 cm through full thickness. The cut ureteral segment was intubated with a ureteral stent catheter of 10 Fr calibre. The top of the catheter was advanced 1 cm from the edge of the incised ureter. To prevent protrusion of the catheter tip, a flexible guide wire 0.038 inches in diameter was inserted into the catheter and the tip of the guide wire was advanced to the bladder. Antegrade pyelography performed 3 weeks after the operation revealed a lesion resembling a pseudo-ureter. It was made by the catheter that had slipped out of the incised ureter. The lumen of the true ureter was also preserved without stenosis. After removal of the stent catheter and safety guide wire, the true ureter was intubated with a double J catheter of 10 Fr calibre. One week later the pseudo-ureter was not demonstrated by excretory urography performed. Finally, hydronephrosis due to uretero pelvic junction stenosis was treated successfully.