親輔 平岩’s scientific contributions

複雑性尿路感染症の21例に対して,T-2588を投与した.1)総合臨床効果は著効7例(33.3%),有効8例(38.1%),無効6例(28.6%)と総合有効率は71.4%でった.2)疾患病態群別における有効率は,第1群100%,第3群100%,第4群83.3%,第5群16.7%,第6群100%であった.3)分離された35株中27株(77.1%)が消失した.グラム陽性菌は8株中5株(62.5%)グラム陰性菌は27株中22株(81.5%)であった.4) MIC値が6.25 μg/ml以下の細菌はすべて陰性化し,MIC値と細菌の消失率はよく相関していた.5)自・他覚的副作用及び臨床検査値異常はすべて認められなかった The clinical effectiveness and safety of T-2588 were evaluated in 21 patients with complicated urinary tract infections. Six hundred mg of T-2588 per day was administered orally in three divided doses for 14 days. The results were excellent in 7 cases (33.3%), moderate in 8 cases (38.1%) and poor in 6 cases (28.6%), and the effectiveness rate was 71.4%. The effectiveness rates of the single infection group and mixed infection group were 91.7% and 44.4%, respectively. The overall bacteriological eradication rate obtained was 77.1%, and those of gram-positive cocci and gram-negative rods were 62.5% and 81.5%, respectively. None of the 21 cases, had any significant side effects and abnormal laboratory findings. From the above results, T-2588 is considered to be a useful antibiotic in the treatment of complicated urinary tract infections.

An 81-year-old woman was admitted to our clinic due to gross hematuria. A large bulky pedunculated mass was found in the bladder by cystoscopic examination. Subtotal cystectomy and bilateral cutaneostomy was performed on January 12, 1987. Histologically the tumor was composed of carcinomatous and sarcomatous elements. The carcinomatous element was composed fundamentally of grade 2, transitional cell carcinoma with numerous foci of squamous metaplasia. The sarcomatous element was composed of myxosarcomatous, chondro-sarcomatous pattern and non-differentiated malignant spindle cell component. Immunohistochemical examination demonstrated the presence of cytokeratin and epithelial membrane antigen in the spindle cell and more obvious carcinomatous regions, using the avidin-biotin conjugated immunoperoxidase technique. The patient died 3 months after operation. Autopsy findings showed multiple organ metastasis which were composed of carcinomatous and sarcomatous elements.

1)ヒト原発性尿管移行上皮癌(grade 2, stage B)からヌードマウス可移植株(AMUT-1)を樹立した.2) AMUT-1は,5代以降ほぼ100%の生着率を示し,安定した一定の増殖を示した.3) AMUT-1は,継代を繰り返しても原腫瘍の形態学的および生物学的性格をよく維持した.4)本腫瘍はCEA産生腫瘍と考えられた The tumor line in nude mice is one of the most important experimental animal models for oncodevelopmental studies. We implanted a human ureteral tumor into nude mice, established the tumor line, AM-UT-1, and maintained it by serial transplantation. The characteristics of this tumor line in nude mice are reported. Histologically, the original tumor was a transitional cell carcinoma (grade II, stage B). The transplanted tumor grew locally and had a constant growth pattern during serial passage until the 13th passage in nude recipients and maintained the basic histological, immunohistochemical findings of the original tumor. Both original tumor and serial transplanted tumor had carcinoembryonic antigen (CEA)-producing activity. A high level of serum CEA was also recognized in nude mice.

1)TUR-P患者においてCDZMは,静脈内投与で速やかな前立腺内組織移行性を示した。2)CDZM 1gと2g投与間にdose responseが認められた。3)CDZMは,泌尿器科領域感染症の起炎菌に対するMICに比して,十分な組織移行性を示した。細菌性前立腺炎および前立腺疾患術後の感染予防に対し,CDZMは,有効な薬剤である Twenty-four patients suffering from prostate hyperplasia were given venous injections of CDZM of either 1 or 2 g at specific intervals (30 min, 1, 2 and 4 hr) before surgery. Blood samples from the injected vein and tissue samples from the prostate were subsequently taken. In this study, the concentrations of CDZM in the prostate tissue (P) and in serum (S), as well as the ratio of the tissue to serum concentrations (P/S) were determined. In patients given 1 g injections, P ranged from 5.26-48.10 micrograms/g, while S ranged from 25.40-130.00 micrograms/ml and P/S ranged from 12.6-37.0%. In the patients given 2 g injections, P ranged from 9.40-49.20 micrograms/g, S ranged from 62.30-234.00 micrograms/ml and P/S ranged from 9.3-29.1%. CDZM exhibited excellent transmigration to the prostate tissue. Inflammatory bacteria present in prostatitis and urinary tract infections are generally those of E. coli, Proteus sp., but because the P range was much higher than the ratio of MIC, CDZM is expected to be useful against infections in the field of urology.

1974年より10年間に原発性尿管腫瘍15例を経験した.その間の外来新患者数は10,230名,入院患者数1433名であった.男11例,女4例,60歳代が最も多く,平均65.5歳である.左5例,右10例,発生部位上部2例,下部13例であった.主訴は肉眼的血尿12例,腹部腫瘍,側腹部痛,体重減少各1例であった.IVPでは無機能腎11例,陰影欠損3例,水腎1例で,尿細胞診陽性9例であった.手術的療法は腎尿管摘出術兼膀胱部切除術10例,腎尿管摘出術兼膀胱全摘出術2例,試験開腹術のみ3例であった.術後の補助療法は化学療法のみ3例,放射線療法は4例であった.他の尿路上皮腫瘍の併発は膀胱に4例みた.病理組織学的には全例移行上皮癌であった.grade別では0はなく,12例,27例,36例,stage別では,01例,A5例,B1例,Cはなく,D8例であった.実測生存率は1年59%,3年と5年ともに42%であった.予後に影響する因子としては,gradeとstageが最も重要である The 15 cases of the primary ureteral tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The incidence of primary ureteral tumors among the outpatients in our urologic clinic was 0.15%. The patients ranged in age from 50 to 75 years old (average: 65.5 years old). There were 11 males and 4 females, the ratio being 2.8:1.0. The right ureter and the lower third of the ureter were involved more frequently than other areas. The most frequent symptom was macrohematuria which was seen in 12 cases (80%). The major finding of IVP was non-functioning kidney, which was seen in 11 cases (73.3). Positive urinary cytology was obtained in 9 cases (60%). Twelve patients underwent nephroureterectomy with bladder cuff or total cystectomy. Histologically, all cases were transitional cell carcinoma. Simultaneous urothelial tumors were seen in the bladder in 4 cases (26.7%). The over-all actual survival rates at 1, 3 and 5 years were 59%, 42%, 42%, respectively. The 5-year actual survival rate was 63% for the low grade group and 0% for the high grade group. The 5-year actual survival rate was 82% for the low stage group and 0% for the high stage group. Among several factors, grade and stage of the tumor were the most influencing factors for prognosis.

99nTc-rhenium collidを用いたリンパ節シンチグラフィーを31症例に施行した.病理検索との比較ではoverall accuracy 83%,sensitivity 86%,speciticity 80%となり悪性腫瘍のリンパ節転移の検索,並びにその進展度診断における補助診断法として有用と思われた.本法は手技が容易で,頻回施行可能であり,また生理的なリンパ節の状態を把えうる特徴がある Clinical efficacy of lymphoscintigraphy was evaluated in 31 cases of urological disease. To diagnose metastatic change of malignant tumor, 99mTc-rhenium colloid (5mCi) was administrated from bilateral pedal region. Of these patients 12 had true positive finding, 2 had false positive finding, 2 had false negative finding, and 8 had true negative finding defined by lymphoscintigram and pathological finding. Overall accuracy of lymphoscintigraphy revealed 83% in correlation of pathological finding, 78% in lymphangiography. Accuracy between lymphangiography and pathological finding was 80%. The overall clinical efficacy of lymphoscintigraphy was the same as lymphangiography. The merit of this method was that we can examine easily, painlessly, and frequently.

愛知医科大学附属病院にて経験した睾丸腫瘍について臨床的観察をおこなった.1) 1974～1983年までの10年間に19例を経験した.この期間中の男子外来患者数は6,097名,男子入院患者数は1,097名で,睾丸腫瘍の割合は,それぞれ0.31%と1.73%であった.2)年齢は,10歳以下の小児期と20～40歳代にピークがみられ,平均年齢は27.8歳であった.3)患側は左11例,右側8例であった.4)主訴としては,睾丸の無痛性腫脹が17例(89.4%)を占めた.5)停留睾丸および外傷の既往を持ったものはなかった.6)組織学的分類では,1型9例,2型4例,3型1例,4型4例,malignant lymphoma 1例であった.7)実測生存率は3年および5年ともに81.8%であった.8)治療は全例に高位除睾術を施行,ただし後腹膜リンパ節郭清術はおこなっていない.術後の補助療法としては放射線療法,化学療法の単独あるいは併用をおこなった The 19 cases of testicular tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The incidence of testicular tumors among the male outpatients in our urologic clinic was 0.31%. The patients ranged in age from 1 to 76 years old (average: 27.8 years old). The affected side was the left side in 11 and the right side in 8 cases. The most frequent symptom was a painless mass of the testis. Histopathological diagnosis according to the classification by Dixon and Moore was type I in 9 cases, type II in 4 cases, type II in 1 case, type IV in 4 cases. Thus germinal tumors accounted for 18 (94.7%) of the cases. One case (5.3%) of malignant lymphoma was non-germinal. As for the age distribution, two peaks were noted in testicular tumors, especially in cases with potential embryonal carcinoma, between 1 and 2 years and between 19 and 32 years. On the other hand, the cases with potential seminoma showed one peak between 25 and 44 years. The treatment consisted of high orchiectomy alone, orchiectomy with radiation, orchiectomy with chemotherapy or orchiectomy with radiation and chemotherapy. Retroperitoneal lymphadenectomy was not done in any case. The over-all 3-year and 5-year actual survival rates were both 92%.

Sultamicillin, a new semisynthetic oral beta-lactam antibiotic, was evaluated for its antibacteria susceptibility and clinical efficacy against urinary tract infection (UTI), and the following results were obtained. The sensitivity of sultamicillin (SBTPC) on 518 strains of clinical isolates from the urine were tested and compared to ampicillin (ABPC). S. aureus, S. epidermidis, Enterococcus sp., Streptococcus sp., E. coli, K. pneumoniae, K. oxytoca, P. mirabilis, M. morganii and Acinetobacter sp. showed high sensitivity to SBTPC. The antibacterial activity of SBTPC was superior to that of ABPC in most strains and especially more superior in beta-lactamase producing strains. The clinical effectiveness rate on a total of 15 patients with acute uncomplicated cystitis was 93.3% and the eradication rate of causative organisms was 93.3%. On 15 patients with chronic complicated UTI, the clinical effectiveness rate was 73.3% and eradication rate was 76.5%. Side effects (diarrhea) were observed in 3 cases, but this symptom was not severe and soon disappeared. Abnormal laboratory data due to the drug were not observed.

膀胱腫瘍82例においてABC法を使用し型物質の検出を行ない,1) ABC法は操作が簡便で感度が高く,backgroundも低く特異的である.2) Low grade 60例中34例が陽性,high grade 22例中21例が陰性であり,有意差が認められた.3) Low stage 63例中35例が陽性,high stage 19例がすべて陰性があり,有意差が認められた.4) Low grade・low stage 38症例のうち再発のみられたものは,陽性24症例中9症例,陰性14症例中10例であり,有意差が認められた ABH isoantigens in 82 cases with bladder tumor of various grades and stages were investigated by the avidin-biotin-peroxidase complex (ABC) method. Correlation of ABC expression for isoantigens with pathological findings on the grading and staging system of the bladder tumors were as follow: Of 60 cases of low grade tumors, 34 (56.7%) were positive and of 22 cases of high grade tumors, 21 (95.5%) were negative. Of 63 cases of low stage tumors, 35 (55.6%) were positive and all 19 cases of high stage tumors, (100%) were negative. The isoantigens in the tissue of the bladder tumors tended to disappear as the histologic anaplasia of the tumor progressed. There was a high correlation between the histological grade, stage and ABC expression (p less than 0.01). In a follow-up study of 38 patients with low grade, low stage, initial transitional cell carcinoma, 9 of the 24 patients positive for ABC expression (37.5%) showed recurrence during the 1 to 6 year follow-up period, whereas 10 of the 14 patients negative for ABC expression 10 (71.4%) did. There was a high correlation between the recurrence rate and ABC expression (p less than 0.05). Therefore, the analysis in the bladder tumors may be valuable for prediction of malignant potential, especially for the low grade, low stage tumors.

1983～1987年,愛知医大泌尿器科受診患者を対象とした.外来由来株5,725株の内訳はS. epidermidis (S.e.)(23.8%),Enterococcus sp. (E.s.)(16.5%),E. coil (E.c)(14.7%),Streptococcus sp. (S.s.)(12.6%),Proteus sp. (P.s.)(5.3%)の順であった.特に年次的変化は認められなかった.入院由来株4,748株では,E.s. (23.1%),S.e. (18.7%),真菌(12.9%),P. aeruginosa (P.a.)(8.0%),他のグラム陰性桿菌(GNR)(6.8%)の順であった.年次的変化としてはS.s.の減少とS. aureusの増加,P.s., P.a.の減少,E.c.の増加が認められた.分離菌の感受性としてStaphylococcusはminocycline (MINO)に,E.s.はampicillin, MINOに良好な感受性を示し,E.c.は検討したがすべての抗生物質に良好な感受性を示した.P.a.はNorfloxacinとgentamycin以外は耐性を示す株が多かった Statistical studies were performed on bacterial strains isolated from the urine of patients with various urological disease in our Urological Department between January, 1983 and December, 1987. In 1987, sensitivity tests of antibiotics to various pathogens were carried out. From the outpatients, 5,725 bacterial strains were isolated. S. epidermidis was isolated most frequently (23.8%), followed by Enterococcus species (16.5%), E. coli (14.7%), Streptococcus species (12.6%), Proteus species (5.3%), other GNR (4.6%), P, aeruginosa (4.5%), Klebsiella species (4.4%), and others. From the inpatients, 4,747 bacterial strains were isolated. Enterococcus species was isolated most frequently (23.1%), followed by S. epidermidis (18.7%), Fungi (12.9%), P. aeruginosa (8.0%), other GNR (6.8%), Streptococcus species (5.4%), Enterobacter species (4.8%), E. coli (4.1%), S. aureus (4.1%) and others. Annual change of distribution of organisms indicated that S. aureus from outpatients had a tendency to increase and Streptococcus species had a tendency to decrease. Whereas from inpatients, E. coli, other GNR, Pseudomonas species and Enterobacter species had a tendency to increase, and Streptococcus species, P. aeruginosa, Proteus species and Klebsiella species had a tendency to decrease. S. epidermidis showed a high sensitivity to minocycline and cephalothin, and Enterococcus showed a high sensitivity to ampicillin and minocycline, but did not show good sensitivity to cefoperazone and latamoxef. E. coli showed a high sensitivity to all drug we tested. P. aeruginosa showed a high sensitivity to gentamycin and norflaxacin, but did not show good sensitivity to other many drugs we tested.