洋一 岸’s scientific contributions

A case of multiple renal leiomyoma of the right kidney in a 60-year-old woman, complaining of lower abdominal pain of two months duration, is presented. Ultrasonography, intravenous pyelography and CT scan showed the masses at the right renal sinus and hilus. Selective right renal angiography demonstrated very hypovascular tumors. Right radical nephrectomy was performed. There were two lobulated tumors with no connections, which were elastic hard in consistency and smooth in surface; one was 4 x 2 x 2 cm in size and located at the renal sinus between the upper and middle calyces, the other was 6.5 x 5 x 4 cm in size and located at the renal hilus, apart from the renal parenchyma, pelvis, artery and vein. Histological examination revealed these tumors to be benign leiomyoma. Both were covered with the Gerota's fascia, but not the renal capsule. The renal parenchyma was completely covered with the renal capsule histologically, although these tumors were closely attached to the parenchyma on gross examination. The tumor at renal sinus was considered to arise from the outer layer of the renal pelvis or from the blood vessel in the connective tissues at renal sinus. The tumor at renal hilus was considered to arise from the blood vessel in the connective tissues at renal hilus. This appears to be the first reported case as multiple renal leiomyoma in both Japanese and English literatures.

1981年1月1日から5年間に当院を訪れた前立腺癌の新来患者74例の集計を行った.1)初診時年齢の平均は72.2±7.7歳であり,65歳から85歳までが87.9%を占めた.2)主訴は,排尿困難(75.7%),頻尿(52.7%)が多かった.3)進行癌(病期C, D)が70%を占めた.4)初回治療法としては,内分泌療法が88.9%(64/72例)であり,エストロゲン療法とLH-RHアナログ単独療法の割合は1.7:1であった.5)初回内分泌療法施行例の21.9%(14/64例)は再燃・増悪で治療を中断した.6)病理組織学的には,低分化型が約半数をしめた.7) 5年間の経過観察中,確認できた死亡例は22例(29.7%)であった.うち前立腺癌死は全体の12.1%(9/74例)であった Seventy-four new cases of prostatic carcinoma treated between 1981 and 1985 were analyzed. The patients were between 40 and 86 years old with a mean age of 72.2 +/- 7.7 years. More than 70% of the patients had clinical stage C and D carcinoma. All cases proved histologically to be adenocarcinoma of the prostate. Eighteen patients had well differentiated, 21 moderately differentiated and 35 poorly differentiated adenocarcinoma. Various hormonal treatments were performed as the initial treatment in 88.9% (64/72) of the cases. Among them, 37 cases were treated by estrogen and 22 cases by luteinizing hormone releasing hormone analogues. Fourteen of 64 patients (21.9%) who received hormonal treatment discontinued the therapy within 10.1 +/- 9.1 months because of relapse of the disease or no therapeutic response. Salvage therapy following hormonal treatment were chemotherapy (9/14) and radiation therapy (4/14). During the 5-year follow up 12.1% (9/74) of the patients died due to prostatic carcinoma.

Dibekacin (DKB) was administered to patients with complicated urinary tract infections without any indwelling catheter to evaluate objectively and comparatively the efficacy, safety and usefulness of intravenous drip infusion once daily and twice daily in a well-controlled study. A 50 mg dose of DKB was administered twice a day to group A, and a 100 mg dose was given once a day to group B. In both groups the drug was given by 1-hr i.v. infusion for 5 consecutive days. Drug efficacy was evaluated in 72 (group A: 36, group B: 36) of the 83 patients treated, and the safety was evaluated on 81 patients (group A: 41, group B: 40). There were no significant differences in the background characteristics between the two groups. The overall clinical efficacy judged by the Committee for Evaluation of Clinical Efficacy was "excellent" in 14% and "moderate" in 50% of group A, and "excellent" in 17% and "moderate" in 64% of group B, the efficacy being higher for group B than group A, but the difference was not statistically significant. The overall drug efficacy rate for each type of infection excluding group 2, was slightly higher in group B, but this difference was not significant either. The overall clinical efficacy for each site of infection, was higher for group B but the differences were not significant. The overall clinical efficacy as judged by the attending physicians was "excellent" in 17% and "moderate" in 58% of group A, and "excellent" in 25% and "moderate" in 61% of group B. The intergroup difference was thus smaller than that judged by the Committee. The elimination rates against bacteriuria were 58% for both groups A and B, and the decrease rates including "cleared" were 42% against pyuria for both groups A and B. Bacteriological evaluation, showed that there was no significant difference in the eradication rates, between group A (65%) and group B (70%). But the eradication rate for gram-positive bacteria was 40% in group A and 81% in group B, there being a significant difference (P less than 0.05) between them. The evaluation of usefulness gave 44% and 53% "satisfactory" rates, respectively, for groups A and B. The results for the "average score" were also the same in both groups. There were no side effects in any of the 81 patients examined. Abnormal laboratory test values attributed to the drug were seen only in 3 and 2 patients in groups A and B, respectively, there being no difference between the groups.(ABSTRACT TRUNCATED AT 400 WORDS)

女性急性単純性膀胱炎(AUC)の再発判定基準につき9種の経口抗菌薬(計270余症例)の治療後経過観察所見について臨床的に解析を加え,下記の基準決定案を作成した.1)対象患者:投薬前に急性単純性膀胱炎におけるUTI薬効評価基準の患者条件を満足し,規定された投薬期間投薬後に著効であった患者とする.2)投薬期間:薬効評価(3日分投薬)に使用した薬剤を同量で4日分追加し,計7日分とする.3)休薬期間:7日間とする.4)再発判定:膿尿および細菌尿を指標とし,膿尿10個/hpf未満かつ細菌尿104個/ml未満を再発なし,膿尿10個/hpf以上かつ細菌尿104個/ml以上を再発ありとし,それらの中間のものはどちらとも規定しない.5)再発判定時期:7日分投薬後著効であることを確認し,7日間の休薬後に判定する.ただし,休薬期間中に再発が認められる場合はその時点で判定する.6)採尿法:本判定にかかわる(すなわち7日分投薬終了時以降)尿検査は中間尿で行い,陽性所見が出ればカテーテル尿で再検査する.中間尿の採用方法は外陰部清拭(クロールヘキシジン綿)の通常の方法で行う The recurrence of female acute uncomplicated cystitis was investigated clinically. The criteria for the evaluation of recurrences were proposed, as follows; Patients: Target infection is acute uncomplicated cystitis (AUC) which had satisfied the specifications of AUC Criteria by the UTI Committee of Japan and showed the excellent effects of an antimicrobial agent after a definite period of administration. Treatment period: Seven days; after 3 days' administration to evaluate the drug efficacy, patients shall take an additional 4 days' treatment. Interval of follow up proposed was 7 days. Evaluation of recurrence: Parameters of criteria are pyuria and bacteriuria. Recurrence: Pyuria greater than or equal to 10 WBCs/hpf and bacteriuria greater than or equal to 10(4)/ml. Evaluation of the day of recurrence: Evaluation should be made 14 days after the start of treatment. Urine sampling: After 7 days of treatment, midstream urine is collected and in cases with positive findings, catheterized urine should then be collected. Using these criteria it will be possible to evaluate and compare the ability of various antimicrobial agents to cure acute uncomplicated cystitis.

P. aeruginosaによる複雑性尿路感染症に対するCPMの治療効果と副作用を評価する目的で,CPM 2g/日とCFS 2g/日の二重盲検法による比較試験をおこなった.総投与例数は274例で,うち効果を判定し得たのはCPM群136例,CFS群118例であった.1) P. aeruginosaを含む感染症では,CPMあるいはCFSを1日2g,5日間投与時の効果では,前者の有効率が有意に高かった.2) P. aeruginosaのみを対象にした場合も同様であった.3) P. aeruginosaを含む感染で細菌尿の陰性化率はCPM群はCFS群より有意に高かった.4)交代菌の出現は,CFS群でS. faecalisの出現率が有意に高く,全体的にもCFS群の投与後の細菌出現率が有意に高かった,5)薬剤投与開始前の分離菌のMICでは,CPM群の方がCFS群よりもMICの低いものが多かった.6)副作用発現率,臨床検査値の異常化は両群間に差はなかった The therapeutic efficacy and safety of Cefpiramide (CPM, SM-1652) at a 2 g/day dose were objectively compared with those of Cefsulodin (CFS) at a 2 g/day dose in patients with chronic complicated urinary tract infections (UTI) by P. aeruginosa in a double-blind study at 46 institutions in Japan. The results are as follows: The therapeutic efficacy was analyzed in 254 patients (136 cases administered CPM and 118 cases administered CFS) after excluding 20 cases as drop-out. Among 254 cases, the number of patients with infection of P. aeruginosa was 190 cases (100 cases administered CPM and 90 cases administered CFS), while that with infection of organisms other than P. aeruginosa was 64 cases (36 cases administered CPM and 28 cases administered CFS). By the administration of a 2 g/day dose for 5 days, the overall clinical effective rate of CPM was significantly higher than that of CFS in total patients. When the patients were classified into 2 groups with respect to causative organisms (P. aeruginosa and others), the clinical effective rate of CPM in patients with infections of P. aeruginosa was significantly higher than that of CFS, while the clinical effective rate of CPM in patients with infection of other organisms than P. aeruginosa was the same as that of CFS. As to the bacteriological effect on bacteriuria, the eradication rate of CPM was significantly higher than that of CFS not only against all causative organisms but also against P. aeruginosa. The rate of replacement by S. faecalis was significantly higher in the CFS-treated group than in the CPM-treated group. The same result was obtained on the rate of replacement by other organisms. The MIC values of CPM for isolated organisms before drug administration were lower than those of CFS. The incidence rates of side effects and the abnormal findings of clinical laboratory tests were the same for the CPM- and CFS-treated groups. From the results, it was concluded that CPM is a useful drug for the treatment of patients with chronic complicated urinary tract infections caused by P. aeruginosa.

Inverted growth of transitional cell carcinoma in the ureter is reported. A 71-year-old female visited us for right flank pain and gross hematuria. Hematuria from the right ureteral orifice was found by cystoscopy. Intravenous pyelography revealed right hydronephrosis and a filling defect in the right ureter, but the filling defect moved to the lower ureter. Computerized tomographic (CT) scan demonstrated a tiny lesion in the right ureter. Under a tentative diagnosis of right ureteral tumor, flexible fiberoptic ureteroscopy was performed. As a pedunculated tumor with a smooth surface was found, biopsy was performed. Since pathological examination showed malignancy, right nephroureterectomy was performed. Histological diagnosis was transitional cell carcinoma, grade 1. Cancer was covered by normal transitional epithelium, and developed inverted growth. This is a rare case of inverted growth of the transitional cell carcinoma in the ureter.

A case of bladder cancer associated with a growth hormone (GH) producing pituitary tumor is reported. A 67-year-old male underwent hypophysectomy for a GH producing pituitary tumor, 31 months earlier. Although the serum GH decreased postoperatively, recurrence of pituitary tumor with increased serum GH was found and followed by a neurosurgeon. He was referred to our department for asymptomatic gross hematuria. Cystoscopy revealed a papillary pedunculated tumor. Under the diagnosis of superficial bladder tumor, transurethral resection (TUR) was performed. Pathological examination showed transitional cell carcinoma. As the bladder cancer recurred with a high level of serum GH seven months later, TUR was repeated. We reviewed and discussed the relationship between GH or GH producing tumor and bladder cancer.

複雑性尿路感染症に対するDL-8280の有効性,安全性と有用性を客観的に評価するため,Pipemidic acid (PPA)を対照薬とし二重盲検法で比較検討した.DL-8280は1回200 mg, 1日3回,PPAは1回500 mg, 1日4回,を5日間連続経口投与した.総投与例数は311例で,除外,脱落を除く228例(DL-8280群115例,PPA群113例)に対し有効性を評価した.安全性の評価は306例(DL-8280群153例,PPA群153例),有効性の評価は250例(DL-8280群124例,PPA群126例)につきおこなった.両群の背景因子には差はなかった.総合臨床効果は,DL-8280群で著効39.1%,有効80.9%,PPA群それぞれ23.9, 57.5%と比較し有意に高かった.疾患病態群別には,第2群(単独感染,前立腺術後感染症)と第3群(単独感染,上部尿路感染症)を除き,DL-8280群の総合臨床効果はPPA群に比し有意に優っていた.膿尿に対する効果は,正常化率+改善率がDL-8280群で59.1%, PPA群で46.0%で,前者が,優る傾向をみた.細菌尿に対する効果では,DL-8280群の陰性化率は76.5%, PPA群は50.4%で,DL-8280群が有意に優っていた.細菌学的効果では,DL-8280群の分離菌の消失率89.0%に対し,PPA群は72.1%で,有意差であった.グラム陰性桿菌,グラム陽性球菌についてもDL-8280群の消失率は有意に優っていた.主治医による臨床効果はDL-8280群が著効46.1%,有効83.5%で,PPA群はそれぞれ26.5, 61,1%で,前者が有意に優っていた.有用性は,DL-8280群が"非常に満足","満足"合わせて71.8%, PPA群が47.6%でDL-8280群が有意に優っていた.副作用はDL-8280群で11例,PPA群で12例に認め,有意差はなく,大部分は消化器症状で,重篤なものはなかった.臨床検査値悪化もDL-8280群で10例,PPA群で9例にみ,有意差はなかった The clinical efficacy, safety and usefulness of DL-8280 for the treatment of complicated urinary tract infections were compared with those of pipemidic acid (PPA) by a double-blind method. DL-8280 and PPA were orally administered at a daily dose of 600 mg (t.i.d.) and 2.0 g (q.i.d.) for 5 days, respectively. Of the 311 patients who received DL-8280 or PPA, clinical efficacy, safety and usefulness were evaluated in 228 patients (DL-8280, 115; PPA, 113), 306 patients (DL-8280, 153; PPA, 153) and 250 patients (DL-8280, 124; PPA, 126), respectively. There was no significant difference in the background characteristics between the two groups. In the DL-8280 group the overall clinical efficacy was excellent in 39.1% and moderate in 41.7%, the effectiveness rate being 80.9%, whereas in the PPA group it was excellent in 23.9% and moderate in 33.6%, the effectiveness rate being 57.5%. The efficacy in the DL-8280 group was significantly higher than that in the PPA group (P less than 0.001). According to classification by the type of infection, the overall clinical efficacy of DL-8280 in groups except group 2 (monomicrobial infection, post prostatectomy) and group 3 (monomicrobial infection, upper urinary tract infection) was superior to that of PPA, the difference being significant. Pyuria was cleared or improved in 59.1% of the patients treated with DL-8280 and in 46.0% of the patients with PPA. The difference was not significant. Bacteriuria was eliminated in 76.5% in the DL-8280 group and in 50.4% in the PPA group. DL-8280 demonstrated a significantly higher response than PPA (P less than 0.001). Of the bacteria isolated from the DL-8280 group and PPA group 89.0% and 72.1%, respectively, were eradicated after the treatment, a significant difference being observed between the two groups (P less than 0.001). The clinical efficacy evaluated by the doctor in charge was excellent in 46.1% and good in 37.4% of the patients treated with DL-8280 and excellent in 26.5% and good in 34.5% of the patients treated with PPA, the intergroup difference in the efficacy being significant (P less than 0.001). The evaluation of usefulness of DL-8280 and PPA was "satisfactory" for 71.8% and 47.6%, respectively, the difference being significant (P less than 0.001). Side effects were observed in 11 patients (7.2%) in the DL-8280 group and in 12 patients (7.8%) in the PPA group, but none were serious.(ABSTRACT TRUNCATED AT 400 WORDS)