佳成 小野’s scientific contributions

We report a case of fibroepithelial polyps of the ureter in a 18-year-old boy with the chief complaint of left flank pain. An excretory urogram and retrograde pyelogram revealed left hydronephrosis and a filling defect at the pelvic-ureteral junction. This ureteral disorder was corrected by the renal autotransplantation for conserving the renal function. The pathological diagnosis was fibroepithelial polyps of the ureter. Convalescence was uneventful and after 3 months of follow up, excretory urogram and 99mTc-DTPA renogram showed good renal function and improvement of hydronephrosis. Along with our case, we briefly reviewed 32 cases of ureteral polyp in men under 20 years old.

A clinical study was carried out on 78 patients, 80 kidneys with renal calculi treated by conservative renal operation such as pyelolithotomy, extended pyelolithotomy, partial nephrectomy and nephrolithotomy from Jan. 1978 to Dec. 1979. Thirty-five residual calculi in 18 kidneys were noticed by postoperative X-ray (22.5%). These 80 kidneys with renal calculi were classified into 4 groups from the type of calculi and 4 groups from the type of renal collecting system to find out factors causing residual calculi. As to the type of calculi, the ratio of residual calculi was 52.4% in multiple calculi and 43.8% in complicated staghorn calculi. No residual calculi were noticed in single calculus or staghorn calculus. As to the type of renal collecting system, residual calculi were noticed in 10 kidneys with narrow pelvis, narrow calyceal neck and dilatated calyx (43.5%), and in 3 kidneys with dilatated pelvis, narrow calyceal neck and dilatated calyx (37.5%). In other two types residual calculi rate were 14.3% and 8.6%. These results indicated that factors causing residual calculi were the number of calculi and renal collecting system with narrow calyceal neck and dilatated calyx.

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.

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.

1)対象は生体腎移植の移植前治療として胸管ドレナージによるリンパ球除去を施行した13症例である.CsA 300 mg乃至400 mgを経口投与した場合,胸管リンパ液中のCsA濃度は血清濃度に比べて著しく高かった.CsA 100 mgを静脈内に投与した場合,胸管リンパ液中のCsA濃度は全血濃度に比べて低かった.2)腎移植術を施行し,手術中にリンパ節を採取した20例についてリンパ節組織内のCsA濃度を測定した.リンバ節のCsA濃度は185から7890 ng/ml,平均3222 ng/gであり,末梢血からリンパ節への拡散率(CsAリンパ節濃度/末梢血清濃度)は3.9から38.9,平均17.1であった.拡散率は経口,静注投与群間に差をみなかった To clarify the distribution and the kinetics of ciclosporin (CSA) in the lymphatic system, we measured the CSA level of the lymph from the thoracic duct drainage (TDD) and that of the peripheral blood after oral or intravenous administration of CSA in 13 TDD pretreated patients. We also measured the CSA level of the iliac lymph nodes in 20 patients undergoing transplant surgery. The mean CSA level of the lymph was 1,647 ng/ml in the first 2 hours, 1,551 mg/dl in the next 10 hours and 254 ng/dl in the last 12 hours in orally administered patients and the mean CSA level of the peripheral blood was 746 ng/ml at 2 hours, 263 ng/ml at 12 hours and 119 ng/ml at 24 hours later. In intravenous administration, the mean CSA level of the lymph was 68 ng/ml, 58 ng/ml and 33 ng/ml and the mean CSA level of the peripheral blood was 452 ng/ml, 105 ng/ml and 88 ng/ml respectively. The mean CSA level of the lymph node was 3,222 ng/g and the mean diffusion rate from the peripheral blood to the lymph node was 17.1. There was no difference between oral and intravenous administration. These results indicated that (1) there is a second pathway in which orally administered CSA is transported from small bowel to general circulation; via mesenteric lymph duct, thoracic duct and subclavic vein and (2) CSA is selectively uptaken by lymph node. CSA might suppress the activation of T cells in the lymph node and the lymph more effectively than in the peripheral blood.

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.