修 説田’s scientific contributions

Two cases with angiomyolipoma were reported. The one was a 52-year-old housewife whose chief complaint was pain in the right abdomen. Her past history included adenoma cebaceum on the face, fits of epilepsy in her infancy, ichthysislike exanthems in lower thighs and kidney tumor on both sides on IVP. On the diagnosis of Bourneville-Pringle phacomatosis, she underwent an operation for the removal of the right kidney and partial resection of the uppermost part of the left kidney. Histopathologically, she was diagnosed as angiomyolipoma. The other case was a 36-year-old housewife whose chief complaint was pain in the right abdomen with cholelithiasis. In the course of the operation to remove the gallbladder, a right kidney tumor was detected accidentally, resulting in the concurrent removal of the right kidney. Histopathologically, a diagnosis of angiomyolipoma was made. The latter case was free from the Bourneville-Pringle phacomatosis. To the best of our collection, a total of 80 cases, including these cases, has been reported in Japan. A clinical statistic observation was made with priority given to these cases.

A case of blind-ending bifid ureter is presented. A 65-year-old man was admitted with the complaint of dysuria. He had no past episode of left flank pain or pyelonephritis. Digital examination and urethrography suggested benign prostatic hypertrophy. Drip infusion pyelography showed an abnormal cavity at the lower portion of the left ureter. He was diagnosed as benign prostate hypertrophy and left blind-ending bifid ureter. During suprapubic prostatectomy, the bifid ureter was resectd. The related reports are reviewed in the Japanese literature.

前立腺肥大症103例に対しロバベロン錠の臨床効果を検討した.1日6錠,3週間連続投与を原則とした.残尿量は病期にかかわらず減少した.収縮振幅は全病期で増加した.残尿減少率は1,2,3期と投与前残尿量に比例し高い伸び率を示した.膀胱内圧測定,尿道抵抗測定と尿流量測定などからロバベロン錠の効果は膀胱利尿筋に直接作用し,筋力の増強に寄与するためと考えた.主治医の有効性判定から,残尿の少ない1期例に対する自覚症状の改善も期待できた.副作用はロバベロン注射剤と同種のものを数例にみ,発現率3.9%であった.以上から,ロバベロン錠は前立腺肥大症の保存的治療薬とし,注射剤と同等の効果が期待でき,安全に使用できると考えた Therapeutic effect of Robaveron tablet (KN-7) was studied on 101 patients with urinary disturbance accompanied by benign prostatic hypertrophy. Robaveron tablet, which contains 20 mg of a swine prostatic extract per tablet, was administered 6 tablets daily for 3 weeks in principle. Evaluation of drug efficacy was based on residual urine, cystometric findings, urethral pressure profile, uroflowmetry and subjective symptoms. Remarkable decrease of residual urine was observed at all stages of Guyon classification, in parallel with increases of cystometric pressure amplitude and average flow rate. Rate of residual urine reduction rose in proportion to the higher stage or bulkier volume of residual urine. Improvements of subjective symptoms were also obtained. The overall effectiveness, rated slightly improved or better was 76.8%. Side effects were seen at a low rate of 3.9%, and there were no abnormal changes directly due to the drug in clinical laboratory tests. These results indicate that Robaveron tablets act on the detrusor muscle and contribute to improve the depressed voiding efficiency and incidental symptoms of the subjects.

A case of postpartum spontaneous rupture of angiomyolipoma in a 27-year-old woman with the chief complaints of right flank pain and fever was reported. Physical examinations revealed an infant-head sized, hard elastic mass with a smooth surface in the right flank. Laboratory studies showed a decrease of Hb to 9.0 g/dl and Ht to 26.5%, and elevated LDH (2914 IU/l). Angiomyolipoma was suspected with ultrasonography, CT scan and angiography. Transperitoneal right nephrectomy was performed. The right kidney and tumor weighed 1,870 g. Pathological diagnosis also confirmed angiomyolipoma of the kidney. Discussion of the case and a brief review of the literature on spontaneous rupture of angiomyolipoma in the intra- and postpartum are made.

A 17-year-old woman consulted our clinic with the complaint of gross hematuria and lower abdominal pain. Blood examination showed severe anemia and renal failure. Emergent hemodialysis and blood transfusion were performed. CT scanning revealed left retroperitoneal hematoma, right severe hydronephrosis and loss of uterus shadow. Under diagnosis of left renal rupture, left nephrectomy and removal of retroperitoneal hematoma were performed. The area of rupture in the left renal pelvis was identified on its posterior wall. Postoperatively renal function did not improve and periodic hemodialysis has been done.

10年間に経験した上部尿路癌は腎癌29例,腎盂癌14例,尿管癌9例の計52例で,これらについて臨床統計学的検討をおこなった.1)腎癌,腎盂癌,尿管癌はともに男子例に多い傾向をみとめた.左右差はとくにみとめなかった.2)腎癌の好発年齢は40歳代に比し,腎盂癌は70歳代,尿管癌は60歳代と,腎癌のほうが若年齢層に多くみとめられた.3)初発症状はいずれも肉眼的血尿がもっとも多かったが,腎癌の42%にたいし腎盂・尿管癌は60%と,後者のほうが高頻度であった.4)腎癌と尿管癌の5年生存率が68%, 80%であるのにたいし腎盂癌は37%と予後不良であった.5)腎癌・腎盂癌・尿管癌の高深達度群は低深達度群に比し5年予後は不良であった.6)腎癌では初発症状発生より手術までの期間が短いほど,予後は良い傾向であったが,腎盂・尿管癌ではむしろ短いほど予後不良という傾向であった.7)腎癌では女子のほうが男子に比し予後が良い傾向であった.8)腎癌の摘出腎重量が大きいほど,予後不良であった.9)腎癌の低深達度群においては治療法と予後との間にはあきらかな関連性をみとめなかった A clinical survey was done on 52 patients with carcinoma of the upper urinary tract (29 renal carcinomas, 14 renal pelvic carcinomas and 9 ureteral carcinomas) treated in our Department during the recent 10 years (l970~1979). Renal, pelvic and ureteral carcinoma occurred more in males than in females. The age groups in which renal, pelvic and ureteral carcinoma were seen most frequently were the 40s, 70s and 60s, respectively. The most frequent primary symptom in these three carcinomas was gross hematuria. The 5-year survival rate of renal carcinoma and ureteral carcinoma were 68 and 80 %, respectively, while that of pelvic carcinoma was 37%. For all 3 kinds of carcinomas, the prognosis of patients with high stage cancer was significantly worse than that of patients with low stage cancer. The prognosis of the group of patients with renal carcinoma undergoing operations within 3 months was better than that of the patients undergoing operations after 3 months from the onset of primary symptoms. However, the reverse was the case for patients with pelvic or ureteral carcinoma. In renal carcinoma, the prognosis of female patients was better than that of male patients. In renal carcinoma, the prognosis of patients with a heavier kidney removed was significantly worse than that of the patients with a lighter kidney removed. There was no apparent relationship between the method of therapy and the prognosis of patients with low stage renal carcinoma.

A case of pure, primary testicular carcinoid tumor in a 27-seven-year-old male is reported. The patient presented with a painless enlargement of the right testis but the serum markers for testicular cancer, including alpha-fetoprotein, beta-human chorionic gonadotropin and lactate dehydrogenase, were not elevated. Right orchiectomy was performed. Histologically, the tumor showed a typical appearance of carcinoid tumor. Further examinations such as barium studies, computed tomographic scan and Ga scintigraphy, showed no other lesions, and he received an adjuvant chemotherapy of cyclophosphamide, 5-fluorouracil and adriamycin. He is well and free from symptoms 17 months after surgery.

Therapeutic effect of Robaveron Tablet (KN-7) was studied on 128 patients suffering from neurogenic bladder. Robaveron Tablet was administered 6 tablets daily for 3 weeks. The effect was evaluated by the residual urine, subjective symptoms, cystometric findings, urethral pressure profile and uroflowmetry. Remarkable decrease of residual urine was observed regardless of position of injury. The pressure amplitude defined as the difference between the maximum voiding pressure and the maximum resting pressure increased on any group of neurogenic bladder. The effectiveness, rated as moderately improved or better was 76.9% for brain disorders, 58.3% for upper motor neuron lesion and 75.7% for lower motor neuron lesion of spinal injuries, 58.3% for peripheral nervous injuries and 100% for others. No remarkable abnormality was observed in the results of side effects or clinical laboratory tests.

Using the new enzymatic assay for isolation and determination of polyamine in blood presented in Report 4, the polyamines in the blood were isolated and determined in 84 patients with genitourinary cancer. In the early diagnosis, the positive rates of each fraction were not so high, but, relatively high positive rates were demonstrated, when any one of the polyamines were found positive: namely, 85.7% in renal cell cancer, 66.7% in renal pelvic and ureteral cancer, 44.0% in bladder cancers. These results seem to support the usefulness of the new method, and encourage further investigation of polyamines in the blood as tumor markers.

Herein we report a case of perirenal encysted hematoma secondary to renal cell adenocarcinoma. A 57-year-old woman was hospitalized because of a palpable mass in the left flank. She had had an episode of left flank pain. X-ray studies demonstrated a tumor in the left kidney and a large cystic mass beneath the left kidney. The cyst was excised by nephrectomy. Histological examination of the large cyst revealed perirenal encysted hematoma secondary to renal cell adenocarcinoma. Six months postoperatively, she is now free from left lumbar pain, and alive with lung and liver metastasis.