晴好 浅野’s scientific contributions

Using Hitachi CT-3, the changes in CT numbers of the kidney were calculated in 10 normal and 12 transplanted kidneys. Two mililiters per kg of meglumine diatrizoate (Angiografin(R)) was given intravenously in bolus fashion. Kidneys were scanned before injection, at termination of injection and correctly 10 minutes after injection. In control group, the CT numbers of the cortex, the medulla and the aorta showed rapid increase after contrast administration. Ten minutes after administration of medium, the CT numbers of the medulla remained a little higher than the cortex, though that of the aorta showed rapid decrease. In contrast to control group, in transplanted kidneys the CT numbers of the cortex and medulla showed less increase than the control group just after contrast administration. Moreover, in the recipients who have had good graft function the CT numbers of the cortex and medulla showed gradual increase, in the recipients who have had poor graft function the CT numbers showed gradual decrease 10 minutes after injection. Enhancing indices calculated from the formula: [CT numbers 10 minutes after contrast enhancement / CT numbers before contrast enhancement] were inversely proportional to the serum creatinine. These results lead to the conclusion that the CT scans employing contrast enhancement method after kidney transplantation has the diagnostic value of graft function in addition to diagnostic usefulness for post-transplantation complications such as hematoma, urinoma or Iyrnphocele.

1973年9月から1979年11月までの6年間に行なわれた生体腎同種移植患者50例,51回の移植後の補液管理について検討した.受腎者の補液管理の方法の相違により,グループ1:中心静脈圧を観察しつつ,移植1時間ごとに尿量を測定し,その同量を補液,グループ2:中心静脈圧,一部スワンガンツカテーテルを挿入し,さまざまのパラメーターを観察しつゝ心不全が起こらない限り,尿量と無関係に可及的大量の補液を行なった,2群に分けた.腎移植後1週間以内に血清クレアチニンが2.5 mg/dl以下に低下しない症例を,移植後急性尿細管壊死発生症例(虚血性障害発生群),2.5 mg/dl以下に低下した症例を機能良好群と定義した.検討成績では,グループ1の術中および術当日の補液量はグループ2と比べあきらかに少なかった.またグループ1の術中および術当日尿量はグループ2と比べ有意に少なかった.グループ1はグループ2に比し,術後血清クレアチニンの低下が遅延し,クレアチニンクリアランスが低い傾向がみられたが統計的有意差はみられなかった.グループ1の術当日のFENaはグループ2より高い傾向を示した.グループ1の機能良好群の血流再開5時間後,10時間後,15時間後,20時間後のCVPの平均値はグループ2の機能良好群の各々の平均と比べあきらかに低かったが,グループ1, 2の虚血性障害発生群との間に差を認めなかった.グループ1の急性尿細管壊死の発生頻度は22例中8例(36.3%)で,グループ2の29例中3例(10.3%)と比べ,あきらかに高かった.グループ1の1年移植腎実測生着率は72.4%で,グループ2の75.9%と差はみられなかった.グループ1の1年患者実測生存率は77.3%で,グループ2の96.6%に比しあきらかに低かった.以上より,生体同種腎移植後は心不全が起こらないかぎり,術後尿量にかゝわらず可及的大量の補液をすることが,移植後急性尿細管壊死による腎障害の防止に重要であることを強調した A major concern during the early post-transplantation period is fluid management. This study analyzes the difference between two approaches to fluid management in 49 subjects who had had renal transplants plus one subject who had had two renal transplants because of chronic rejection. All patients were divided into two groups. In group 1 (LDI-22), the urine lost each hour was replaced with an equal volume of half normal saline and 5 % glucose in water, and in group 2 (LD23-51), massive fluid management with half or quarter saline was undertaken, cardiac parameters were checked and the administration of fluids was controlled by a Swan-Ganz catheter to avoid cardiac failure, additional fluids being administered when the Swan-Ganz catheter reading was lower than normal. The cases in which serum creatinine after one postoperative week remained above 2.5 mg/dl were classified as acute tubular necrosis (ATN), and those with lower values as non-ATN. The average volume of infusion during operation (1l46±490 vs 2698±939 ml/m2BSA) and on transplant day (2262±892 vs 2897 ±855 ml/m2BSA) was significantly smaller in Group I (P<O. 005). The average urine output during operation (187 ± 135 vs 524±306 mljm2BSA) and on the transplant day (2125± 1399 vs 3548 ± 1435 ml/m2BSA) was also significantly smaller in Group I (P<0.005). Postoperative serum creatinine reduction in Group I was some what delayed, but the delay was not statistically significant. FENa during the first postoperative day was higher in Group (4. 38±3. 20 vs 2. 75±1. 75%). The GVP monitored for 20 hours after declamping in the cases without ATN was significantly lower in Group 1 than in Group 2, but, in the cases with ATN, the difference between Group 1 and 2 was not statistically significant. The incidence of cases with ATN was significantly higher in Group 1 (36.3 vs 10.3%) (P<0.01). The actuarial one-year graft survival was 72.4% in group 1 and 75.9% in Group 2 and the difference was not statistically significant. The actuarial one-year patient survival rate was lower in Group 1 (77.3 vs 96.6%) (P<0.05). From the data described above, it might be tentatively concluded that checking the cardiac parameters to avoid cardiac failure "and massive fluid management through the use of the Swan-Ganz catheter might be useful in preventing postoperative ATN in living related renal allogreft recipients.

塩酸タムスロシンあるいはナフトピジルを1ヵ月以上投与しても夜間排尿回数が2回以上の前立腺肥大症患者52例(平均年齢72.1歳)を対象として, 塩酸フラボキサート400～600mg/日を8～12週投与し, その有用性と安全性を検討した。塩酸フラボキサート投与前後で夜間排尿回数は3.8回→2.7回へ有意に減少し, 国際前立腺症状スコア, QOLスコア, 前立腺肥大症影響度スコアもそれぞれ15.2点→12.5点, 4.3点→3.9点, 5.3点→4.2点へ有意に低下した。投与期間中14例(26.9%)に消化器症状を主とする副作用を認め, そのうち8例は投与を中止したが, いずれも重篤ではなかった。α1遮断薬投与中の前立腺肥大症患者に対して塩酸フラボキサートを就寝前に追加投与する治療法は, 前立腺肥大症に伴う夜間頻尿に対する治療の選択肢の1つとなりうると考えられた。 We examined the effectiveness of supplemental administration of flavoxate hydrochloride in patients with benign prostatic hyperplasia (BPH) whose nocturia was not adequately relieved by an alpha1-adrenoceptor blocker. Fifty-two patients who had two or more nocturnal micturition after administration of tamsulosin hydrochloride or naftopidil for 4 weeks or more received 400-600 mg of flavoxate hydrochloride in addition to an alpha1-adrenoceptor blocker for another 8-12 weeks. With supplemental administration of flavoxate hydrochloride, significant improvement was observed in the number of nocturnal micturition, total International Prostate Sympton Score, quality of life score and BPH impact index. No significant change was observed in the voided volume, Qmax, voiding time and residual urine volume. Supplemental administration of flavoxate hydrochloride is therefore effective for the improvement of nocturia and QOL in BPH patients resistant to an alpha1-adrenoceptor blocker.

Clinical effect of Estracyt was investigated in prostatic cancer patients. Twenty seven patients had been previously treated and 20 had not received prior treatment. Improvement rate of subjective symptoms was 85% in the previously untreated patients and that of objective findings was 85%, while those rates were 44% and 50% in the previously treated patients, respectively. Most of the adverse reactions were changes in mamma and mammary papilla which were considered to be due to the estrogenic activity.

Excretory urography was performed using iohexol (Omnipaque 300 and Omnipaque 350) on 388 patients requiring urography in the Department of Urology, Nagoya University School of Medicine and 10 affiliated hospitals. Adverse reactions were observed in 3 cases (0.8%), but they were all mild. Good image efficacy was obtained in more than 95% of the patients injected 20 ml, 40 ml, and 100 ml of Omnipaque 300 and 40 ml of Omnipaque 350. There was no difference in the results of image efficacy between 40 ml (Omnipaque 300) and 100 ml (Omnipaque 300) groups. Therefore, the use of 40 ml of Omnipaque 300 for excretory urography was considered to be a very useful screening method for the urinary tract.

A case of emphysematous pyelonephritis is presented. A 66-year-old woman with diabetes mellitus was hospitalized for sudden pyrexia and left abdominal pain on January 13, 1987. She had shown preshock, pre-disseminated intravascular coagulation, hyperglycemia and renal dysfunction. Plain X-ray films of the abdomen and abdominal computer tomographic scanning showed a gas shadow in the left kidney. Retrograde pyelography demonstrated the left complete ureteral obstruction. A diagnosis was made of emphysematous pyelonephritis associated with diabetes mellitus and ureteral obstruction. Left nephrectomy was performed on January 17, 1987, and the pus obtained from the kidney yielded E. coli. After the operation, she has been doing well with diabetes mellitus under good control without insulin therapy. Thirty two cases of emphysematous pyelonephritis in the Japanese literature including our case are reviewed.

56例の男子淋菌性尿道炎に対しNFLX, 600 mg/dayを7日間投与し,3日目,7日目にその効果を検討した.3日目で77.8%著効,7日目に94.4%が著効であり7日目までに100%有効と認められた.淋菌のMICを14株についてAMPCおよびNFLXについて測定した.AMPC, NFLXともに耐菌性は見られなかったが,NFLXはAMPCに比べMICの中央値は全体に低い値(0.05 μg/ml)を示した Fifty six males with gonococcal urethritis were administered 600 mg of norfloxacin (NFLX) daily for 7 days, before the effects were examined. The pharmaceutical effects were studied on the third and the seventh day after administration. Pronounced effectiveness of 77.8%, effectiveness of 19.4% and ineffectiveness of 2.8% were found on the third day after administration, and pronounced effectiveness of 94.4%, effectiveness of 5.6% and ineffectiveness of 0% were found on the seventh day after administration. Effectiveness of 100% was obtained up to the seventh day. Minimum inhibitory concentration (MIC) of NFLX and ampicillin (AMPC) were determined for 14 strains. The peak of MIC of NFLX was found at 0.05 micrograms/ml and all strains were 0.78 micrograms/ml or lower. The peak of MIC of AMPC was 0.1 microgram/ml. MICs of both drugs were 0.78 micrograms/ml or lower, and resistant bacteria were not found. In view of the analyses of age distribution of patients and source of infection, the peak was found in the twenties and the source of infection in 64.7% were, so-called, professional women.

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.

55～83歳の前立腺肥大症患者35例において,本剤1.5 mg/日投与群と3.0 mg/日投与群とを比較したが,主治医による自覚症状改善度,他覚所見改善度,全般改善度,概括安全度,有用度の判定,並びに判定委員会による薬剤効果の判定において,両群間に統計学的有意差が認められず,初回投与量は1.5 mg/日が至適と考えられた.12週間投与した症例で特徴的な副作用はなかった.主治医判定における12週後の改善度は,4週後の改善度に比べ低かった.しかし判定委員会判定で自覚症状の重症度及び他覚所見は,12週後では4週に比べ,より改善が認められた Thirty-five patients with prostatic hyperplasia were entered into a randomized controlled study using bunazosin hydrochloride(alpha 1-adrenergic blocker). Eighteen patients were allocated to be treated with an initial dose of 1.5 mg/day (group 1) and 17 patients received an initial dose of 3.0 mg/day (group 2). Subjective symptoms and parameters of urodynamic studies were evaluated after 4 weeks and 12 weeks. There were 5 withdrawals or exclusions within 4 weeks and 6 within 12 weeks. Therefore, 15 patients in group 1 and 15 patients in group 2 were eligible for evaluation at 4 weeks, 12 patients in group 1 and 11 patients in group 2 were eligible for evaluation at 12 weeks. The rates of the improvement in subjective symptoms such as retarded urination, protracted urination, weakened urinary stream, abdominal straining on voiding, and sense of residual urine were 40%, 25% in group 1 and 46.7%, 36.4% in group 2, at 4 weeks and at 12 weeks, respectively. The rate of improvement in objective parameters of the urodynamic study such as voiding volume, residual volume, maximum flow rate and average flow rate were 26.7%, 16.7% in group 1 and 26.7%, 20.0% in group 2, at 4 weeks and at 12 weeks, respectively. Thus, these improvements were not correlated with the dosage of drug. Adverse effects such as diarrhea, mild headache, palpitation and gastric disturbance were observed in 2 patients in group 1, and 3 patients in group 2. In the 24 patients treated with the drug over 12 weeks, there were no specific adverse effects due to prolonged administration. These findings showed that bunazosin hydrochloride is beneficial for the treatment of prostatic hyperplasia, and could be safety administered for a prolonged period of time up to 12 weeks.

34例の複雑性因子が多く,かつ重症な感染症の治療や感染防止にCAZ 1回1 gを1日2回9～30日にわたり静注または点滴静注し,感染症25例に対して著効6例,有効14例,やや有効例4,無効1例であり,また,術後感染防止上も75%の有効率を得た.副作用は無かったが,検査上肝機能異常4例,及び白血球減少症1例が認められた CAZ was administered to 34 patients in the field of urology for treatment or prevention of serious infections with many complicated factors. The duration of treatment ranged from 9 to 30 days, the most frequent being 14 days, which was the duration originally set as the standard. As the results CAZ was considered to be one of the drugs of choice in the cases requiring long-term treatment, from the viewpoint of both efficacy and usefulness.