秀夫 日比’s scientific contributions

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.

54歳女.甲状腺機能亢進症の治療中であったが,腹痛,便秘の検査の為,入院し,腹部CTで左腎上極部に3×3cmの低密度の腫瘍を発見,又,傍大動脈リンパ節腫大があり,泌尿器科に転科して根治的腎剔出術を行った.リンパ節その他に転移は認めなかった.消化管検査で他にcarcinoid症候群を示す所見は認めなかった.剔出腫瘍の割面は淡黄色で,組織学的に鍍銀法その他でchromograminAと非特異的enolaseの染色性が陽性,電顕では腫瘍細胞中に神経分泌顆粒(dense core granule)を多数認めた.手術後13ヵ月で転移や再発を認めていない.腎の原発性carcinoidは稀で,本例は26例目の報告である A 54-year-old woman was referred to our institute because of abdominal pain and constipation. The computed tomography of the abdomen revealed a 3 x 3 cm of low density tumor at the upper pole of the left kidney and para-aortic lymphadenopathy. Gastrointestinal investigation revealed no particular findings suggesting a carcinoid syndrome associated with the left kidney tumor. The specimen of the resected tumor showed staining pattern specific to carcinoid tumor; positive staining for chromogranin A and neuron-specific-enolase. Electron microscopy confirmed the presence of dense-core granules in the tumor cells. No evidence of metastasis or recurrence was noted for 13 months after the operation. This was a very rare case of primary renal carcinoid, representing the 26th case in the literature.

A case report of a bizarre leiomyoma of the scrotum in a 46-year-old male is presented with a review of the literature. The patient was admitted to our hospital with the chief complaint of swelling of the left scrotal content for about 20 years. The tumor was surgically removed easily. Histological findings revealed bizarre leiomyoma. This case is the first report of bizarre leiomyoma of the scrotum in Japan.

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.

急性単純性膀胱炎(AUC) 46例,慢性複雑性膀胱炎(CCC) 47例,急性単純性腎盂腎炎(AUP) 8例,急性前立腺(AP) 22例,計123例の患者尿より分離したE. coli 123株と健常人の糞便由来のE. coli 55株を用いた.1)血清型別では,AUC, AUP由来株でO 1,O 6の頻度が高く,この型は糞便由来株では認められなかった.2) MS線毛の保有率はAUC 60.9%,CCC 27.7%,AUP 87.5%,AP 68.2%であり,P線毛の保有率はAUC 69.7%,CCC 51.2%,AUP 62.5%,AP 54.5%であった.糞便由来株のMS, P線毛保有率は30.9%,25.5%であった.3)ヘモリジン産生株の占める割合は,AUC 95.7%,CCC 55.3%,AUP 100%,AP 90.9%であり,糞便由来株で23.6%であった.4)尿中剥離上皮細胞への付着率は,尿路感染症由来株で44.7%,糞便由来株で21.6%であった One hundred and twenty three strains of Escherichia coli isolated from the urine of patients with urogenital infections and 55 strains isolated from the fecal samples of healthy individuals were assayed for 0 antigen and hemolysin production as virulence factors, and for pilus type and in vitro tests of adhesion to human exfoliated uroepithelial cells as colonization factors. The incidence of MS pili in Escherichia coli isolated from patients with acute uncomplicated cystitis, chronic complicated cystitis, acute uncomplicated pyelonephritis and acute prostatitis was 60.9%, 22.7%, 87.5%, 68.2% and 30.9%, respectively. The incidence of P pili was 69.7%, 51.2%, 62.5%, 54.5% and 25.5%, respectively. The strains showing haemolysin production had MS pili and P pili, which show strong virulence. MS pili strains and P pili strains isolated from the patients with acute uncomplicated cystitis and acute uncomplicated pyelonephritis adhered to human exfoliated uroepithelial cells well. Consequently, the pilus type might be the most significant colonization factor in uncomplicated urogenital infection which is shown by the normal defense mechanism in host side.

We report two cases of malignant lymphoma of the penis. A 64-year-old man presented with painful indurations of the penis. A computerized tomography (CT) scan showed a swollen retroperitoneal lymph node 5 cm in diameter. Penectomy confirmed the diagnosis of B cell malignant lymphoma, diffuse large type. Despite systemic chemotherapy with a CHOP regimen, he died of disease 7 months postoperatively. The second case was in a 63-year-old man presenting with multiple nodules in the penis and scrotum. Biopsy of a scrotal nodule revealed B cell malignant lymphoma, diffuse medium size type. A CT scan demonstrated widespread lesions (stage III E). He has been in complete remission for 10 months following, multidisciplinary treatments. We reviewed 21 cases of malignant lymphoma of the penis which have been reported in the literature.

CFCLのPFへの濃度移行を測定し,臨床的には細菌性前立腺炎の治療に用いて以下の成績をえた.1) PFへの濃度移行は,1 g, i.v.後1時間で平均0.84±0.72 μg/mlで対血清比は2.24%であった.2)細菌性前立腺炎に対してCFCLを1日1 g～2 gを平均6.5日投与した.急性には7例中7例が有効以上で100%の有効率を,慢性には4例中1例で25%の有効率をえた.3)副作用では1例に一過期の発疹を認めた.臨検値の異常は,全例に認めなかった Cefclidin (CFCL), a new injectable cephem antibiotic, was used in the treatment of bacterial prostatitis. Concentration in prostatic fluid (PF): One hour after the i.v. administration of 1 g of CFCL the concentration of PF was 0.84 +/- 0.72 micrograms/ml (n = 4), the ratio of PF/serum being 2.24%. CFCL was administered at a dose of 1-2 g a day for 6.5 days on average. In acute bacterial prostatitis, the efficacy was evaluated as excellent or moderate in all 7 cases (100%), but in chronic cases, the effectiveness rate was as low as one out of 4 cases (25%). In safety profile, transient skin eruption was seen in one patient, but did not require further treatment. Besides this case, no side reactions or abnormal clinical values were encountered. In conclusion, CFCL was evaluated to be very useful in the treatment of acute bacterial prostatitis, caused by gram negative rods.

静岡赤十字病院泌尿器科における1981年から1990年までの10年間の臨床統計を行った.1)入院患者総数は2,830名,主要手術件数は1,922件であった.2)疾患別では閉塞性尿路疾患(25.5%),悪性新生物(23.7%),非特異的感染症(16.4%),尿路結石症(16.1%)の順に多かった.3)手術の臓器別では,前立腺(39.0%),膀胱(22.8%),陰嚢内(9.9%)の順に多く内視鏡手術が全体の55.2%を占めた A statistic survey was made on the patients, diseases and operations experienced at the Urological ward of Shizuoka Red Cross Hospital between 1981 and 1991. The total number of inpatients was 2,830 and the male to female ratio was 3.5 to 1. The most frequent diseases among the inpatients were obstructive uropathy (25.5%), malignant neoplasia (23.7%), non-specific infection (16.4%) urolithiasis (16.1%). The number of operations was 1922. Endoscopic surgery was the most frequent form of operation (55.2%).

AUC 22例とCC-UTI 51例に投与した.1) AUC 1日1回100 mg, 3日間投与を主とした結果,UTI判定基準(19例)で100%の有効率(著効率78.9%)をえた.2) CC-UTI 1日1回200～300 mg, 5日間投与ではUTI判定基準(22例)で45.5%の有効率であった.7日間投与(21例)の主治医判定では61.9%の有効率を示した.総合的には55.1%の有効率であった.3) 2例に腎機能に軽い影響を与えた.自他覚的副作用では9例に副作用の発現をみた.このうち投与中止は2例で Sparfloxacin (SPFX) was evaluated for its clinical efficacy in 22 patients with acute uncomplicated cystitis (AUC) and 51 with chronic complicated urinary tract infection (CC-UTI). SPFX was administered in a single oral daily dose of 100 mg for 3 days to the patients with AUC. According to the UTI criteria, the efficacy rate was 100% (excellent rate was 78.9%). SPFX was also administered in a single oral dose of 200 to 300 mg mostly for 5 days to patients with CC-UTI. The efficacy rate according to the UTI criteria in the evaluable 22 cases was 45.5%. The efficacy rate according to the physicians in charge, evaluated as either excellent or good for the 23 cases treated with SPFX for 7 and 14 days was 65.2%, the overall efficacy rate in 49 cases including the administration for 5 days being 55.1%. In safety profile, subjective side effects were observed in 9 cases (12.3%), in 2 of which the medication was discontinued (2.7%). These side effects, flowever, recovered without any treatment to normal at the completion or discontinuation of the medication. The clinical laboratory values showed a slight elevation of BUN in 2 cases. SPFX was the most potent antimicrobial brug with a long blood elimination half life among the existing current new quinolones (NQs), indicating a possibility of once-a-day treatment regimen. In safety, side effects of SPFX were similar in general to those of other current NQs. Thus, SPFX is regarded as a highly useful antimicrobial drug when the drug is administered with consideration for its unique characteristics.

A case of bilateral testicular tumours of germ cell origin is reported. A 35-year-old man with bilateral testicular swelling visited our clinic. Bilateral high orchiectomy was performed. Histological examination of both resected testis revealed typical seminoma. Postoperative irradiation was performed. The patient is doing well after one year of postoperative follow-up without any sign of metastasis. Besides this case, we found 115 cases of bilateral testicular germ cell tumours in the Japanese literature. There were 39 cases with different and 76 cases with similar histology between the left and right testis. The age distribution, location of testis, time of onset and histological classification of these cases is discussed.