孝充 佐藤’s scientific contributions

過去約2年間に前立腺肥大症15例に対し,改良恥骨後式前立腺摘除術を施行した.その結果は従来の方法と比較し術中出血量,術後肉眼的血尿持続期間が減少し,全般的により確実で安全な手術方法となり,副睾丸炎の併発は皆無となった The retropubic prostatectomy is performed mostly for prostatic hypertrophy. By performing the preventive suture-ligation of the bilateral prostatic arteries which are running among the vesicoprostatic pedicle before prostatectomy, massive bleeding from bladder neck and prostatic bed can be controlled well, and ligation of bilateral spermatic cord prevents retrograde epididymitis. This surgical procedure makes retropubic prostatectomy easy.

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.

A case of long ureteral polyp is presented. The patient was a 62-year-old woman complaining of asymptomatic macrohematuria. Radiological examinations revealed ureteral tumor. A tumor was found with cystoendoscopy, and by transurethral biopsy in bladder the tumor was not malignant. Polypectomy was performed. The tumor removed was fibrous polyp measuring about 8 cm in length.

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.

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.

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.

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.

模擬高度6,000 m急性負荷実験施行時尿中NAG, BMGを測定した.1) 5症例1日目,1群尿のNAGは1.96±0.53, BMGは128.6±121.9であった.2) NAGの変化については5症例中2例に3群において正常範囲を越える著明な上昇を認め,5症例5日間の比較検討では3群は他群尿に対し有意の差の上昇を認めた.3) NAG 5日間の経時的変化は1～4群のいずれにおいても認められず,連続負荷によるNAG排泄の増加傾向は認められなかった.4) BMGの変化は軽徴であり,有意の上昇は認められなかった.5)高所負荷による反応は個人差が大きく作用していた The changes in NAG and BMG concentration in the urine during sudden exposure to a simulated 6,000 m altitude (354 mmHg) were studied. Subjects were 5 healthy male volunteers before a mountain climbing expedition (20-25 years old). Decompression was commenced at 11:00 and terminated at 17:00 (2-h ascent, 2-h sojourn, 2-h return) for 5 successive days. Urine was discarded at 9:00 and thereafter collected at 11:00 (group I), 14:00 (group II) 17:00 (group III), and 9:00 the next day (group IV) and urinary NAG and BMG was measured. The rate of NAG indicated elevation above 5.0 U/L in 2 cases in group III and elevation which was significantly different from that of the other 3 groups. In the other 3 cases, significant elevation was not observed, but for group III as a whole NAG excretion was significantly elevated compared of the other 3 groups. However, increased excretion of NAG was not observed on all 5 successive days. The change in BMG values was smaller than that of the NAG values and no significant elevation was observed in any of the 4 groups. Increasing urinary excretion of NAG by sudden exposure to a high altitude indicated excessive destroy of epithelium in the proximal tubules, but this change was reversible.

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.

1974年から10年間に原発性腎盂腫瘍(PPT)18例を経験し,同期間の外来患者数,入院患者中のPPAの割合はそれぞれ0.15%,1.05%であった.性別は男11例,女4例,左側9例,右側6例,平均年齢は58.3%であった.主訴は肉眼的血尿12例,側腹部痛1例,全身倦怠感2例で,IVPでは無機能腎8例,陰影欠損2例,水腎2例,腎杯変形3例であった.尿細胞疹陽性は8例であった.手術は腎尿管全摘出術兼膀胱部分切除術7例,腎尿管摘出術1例,腎摘出術7例で,術後の補助療法は化学療法5例,放射線療法2例に行った.術後尿路上皮腫瘍の発生は残存尿管兼膀胱1例,膀胱のみは7例にみ,全例2年以内に発生した.病理組織学的には,移行上皮癌14例,扁平上皮癌1例であった.Grade別では0は無く,1が1例,2 5例,3 9例で,stage別では0が1例,A 2例,B 0例,C 7例,D 5例であった.実測生存率は3年67%,5年48%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 renal pelvic tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The patients ranged in age from 41 to 74 years old (average: 58.3 years old). There were 11 males and 4 females, the ratio being 2.8:1.0. The affected side was left in 9 cases and right in 6 cases. 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 8 cases (53.3%). Positive urinary cytology was obtained in 8 cases (53.3%). As the surgical method, total nephroureterectomy with bladder cuff was performed in 8 cases, nephroureterectomy in one case and nephrectomy in 6 cases. Histologically, 14 cases were transitional cell carcinoma and one case was squamous cell carcinoma. Simultaneous urothelial tumors were seen in the bladder of 2 patients. A subsequent ureteral tumor was found in one of the 7 cases in which ureters were resected incompletely, and subsequent bladder tumors were found in 8 of the 15 cases receiving surgical treatment in the follow-up period. All of tumors were found within 2 years after operation. Over-all actual survival rates at 1, 3 and 5 years were 87%, 67%, 48%, respectively. Three and 5 year actual survival rates were 100%, 100% respectively for the low stage group and 59%, 29% respectively for the high stage group. Three and 5 year actual survival rates were 100%, 78%, respectively for the low grade group and 44%, 27% respectively for the high grade group. Among several factors, stage and grade of the tumor were the most influencing factors for prognosis.