宜久 竹内’s scientific contributions

One hundred and three kidneys with calculi in 100 patients, were treated by conservative renal surgery from Jan., 1980 to Dec., 1982. The operative technique consisted of pyelolithotomy, extended pyelolithotomy, dismembered pyelolithotomy, nephrolithotomy (bivalve or anatrophic nephrolithotomy) partial nephrectomy and pyelo-nephrolithotomy. Intraoperative X-ray and coagulum lithotomy were employed when pyelolithotomy was performed. Thirty-five residual calculi in 20 kidneys were observed on postoperative X-ray film. The rate of residual calculi was 19.4%. Factors causing residual calculi, were analysed on these 103 kidneys. The factors were as follows; the shape of calculi: staghorn calculus with multiple small calculi, the shape of the renal collecting system: narrow pelvis with narrow caliceal neck and dilatated calices, and the operative technique: nephrolithotomy. These results suggested that it would be necessary to minimize residual calculi when performing nephrolithotomy.

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 randomized clinical trial was conducted to determine the optimum does of iohexol (iodine concentration 300 mgI/ml) as a contrast agent for excretory urography in screening outpatients. Cases were divided into two groups, 30 cases in Group A receiving 0.4 ml/kg of iohexol and 29 cases in group B receiving 0.8 ml/kg. Urography was performed at intervals of 5 minutes and 10 minutes following the injection. The diagnostic effectiveness of various X-ray images including nephrograms, the pyelocaliceal system, ureter and bladder were assessed. There was a significant disparity between the two groups during pyelocaliceal urography after 5 minutes, with a fair diagnosis attainable for 73.3% of group A versus 89.6% for group B (P less than 0.05), but after 10 minutes the rates for the two groups had evened out to 93.4% for group A and 96.6% for group B. During urography of the ureter after 5 minutes, only 16.6% of the cases in group A could be easily diagnosed against 51.7% of the cases in group B (P less than 0.05). However, after 10 minutes the rate for group A was up to 56.7% while the rate for group B was 82.8% (P less than 0.1). In the ureter after 5 minutes, non-diagnosable images constituted 26.7% of group A and 10.4% of group B, while after 10 minutes this had dropped to 16.6% for group A and 0% for group B. A comprehensive study of these results suggests that for diagnostic screenings which use iohexol as a contrast agent in excretory urography, optimal results may be obtained using iohexol in amounts of between 0.4 ml/kg and 0.8 ml/kg.

右精巣の無痛性腫脹を主訴とした39歳男で,超音波検査及びMRIは両側同期精巣腫瘍を描出した.両側高位精巣摘除術を行った.組織学的に退形成性セミノーマと診断された.術後,傍大動脈及び骨盤領域に予防的照射療法を行った.5ヵ月以上の追跡中,転移の徴候は認められなかった A 39-year-old man was referred to our hospital with right testicular swelling. Ultrasonography and magnetic resonance imaging revealed bilateral, synchronous testicular tumors. Bilateral high inguinal orchiectomy was performed. Histological examination revealed anaplastic seminomas. Prophylactic radiation therapy was performed in the para-aortic and pelvic regions postoperatively, and no signs of metastasis have been found during the follow-up period of more than 5 months. Including the present case, 186 cases of bilateral testicular tumors reported in Japan are reviewed.

A 41-year-old man, who complained of left dull lumbago, was admitted in January, 1982. Excretory pyelogram showed a non-functioning left kidney with calculi. Cystoscopic examination revealed non-papillary broad base tumor on left trigon and multiple small cystic tumor around it. Retrograde and antegrade pyelogram showed no filling defect that suggested a tumor. Mucinous adenocarcinoma was emonstrated in the biopsy specimen from bladder tumor. The gastrointestinal, respiratory and other genitourinary tracts were examined but no tumor lesion could be found. Therefore, primary adenocarcinoma of the bladder was highly suspected. Firstly, the left kidney was removed in February, 1982. Then in March, 1982 radical cystectomy and lymphadenectomy were done and the urinary tract was reconstructed using an ileal conduit. No urachal remnant was found. Histopathological examination of surgical specimens revealed mucinous adenocarcinoma of the bladder with cystitis cystica and cystitis glandularis.

Although Cephem antibiotics are transferred to the prostatic fluid in relatively low levels, they are clinically effective for bacterial prostatitis. In the present study, the prostatic tissue concentration of Latamoxef (LMOX), Cefoperazone (CPZ) and Cefotaxime (CTX) were determined, and their penetration rates into the prostatic tissue were analyzed. Before the transurethral resection of the prostate (TUR-P), 2 g of LMOX (21 patients), 1 g of CPZ (15 patients) and 2 g of CTX (14 patients) were intravenously administered in a total of 50 patients with benign prostatic hypertrophy at our two Hospitals. The prostatic tissue was taken by TUR-P at 30 minutes and 60 minutes after the injection. The serum concentration and the prostatic tissue concentration of the three antibiotics were determined by the bioassay method. Additionally their serum concentration and the prostatic tissue concentration in the six cases of CTX-injected patients were also determined by high performance liquid chromatography (HPLC). The penetration rate into the prostatic tissue was obtained by the formula; the penetration rate = the prostatic tissue concentration/the serum concentration. The prostatic tissue concentrations determined by the bioassay method were, 36.9 +/- 10.6 micrograms/g at 30 minutes after the injection of 2 g of LMOX and 28.0 +/- 9.0 micrograms/g at 60 minutes, 31.0 +/- 8.3 micrograms/g at 30 minutes after the injection of 1 g of CPZ and 21.1 +/- 10.0 micrograms/g at 60 minutes, and 8.8 +/- 4.1 micrograms/g at 30 minutes after the injection of 2 g of CTX and 4.5 +/- 2.0 micrograms/g at 60 minutes (mean +/- S.D.). The penetration rates determined by the bioassay method were 36.2 +/- 10.9% at 30 minutes after the injection of LMOX and 34.8 +/- 15.3% at 60 minutes, 43.6 +/- 14.4% at 30 minutes after the injection of CPZ and 39.7 +/- 24.1% at 60 minutes, and 11.1 +/- 4.1% at 30 minutes after the injection of CTX and 9.6 +/- 3.8% at 60 minutes (mean +/- S.D.). The penetration rate of CPZ and LMOX were significantly higher than that of CTX (P less than 0.05, P less than 0.01). In 6 of the 14 CTX-injected patients, the serum and prostatic tissue concentrations of CTX and its metabolite, desacetyl-CTX, were also determined by HPLC. The penetration rate of CTX into the prostatic tissue was obtained by the formula; the penetration rate of CTX = the prostatic tissue concentration (CTX + Desacetyl-CTX)/the serum concentration (CTX + Desacetyl-CTX).(ABSTRACT TRUNCATED AT 400 WORDS)

1)1990年7月より1993年10月迄に膀胱腫瘍に対する膀胱全摘後のKock式自排尿型代用膀胱症例37例で,その長期成績を検討した. 2)術後3ヵ月の時点で,35例中32例が,術後4年以上経過した患者では22例中19例が自排尿のみで管理が可能.自排尿可能な患者のうち殆ど失禁のない例は術後3ヵ月では25/35,術後4年以上では15/21. 3)術後のパウチに起因した合併症として,輸入脚滑脱3例・パウチ尿道吻合部狭窄5例及びパウチ内結石2例の10例に計14回の再手術を要した. 4)現在生存中の患者にアンケートを施行したところ,19例中8例(42%)は排尿状態に不満があるか,QOLが制限されていると答えた. 5)本法は煩雑な術式のため合併症はやや多いが,排尿状態に関しては長期的に安定している術式と考えられた We analyzed the long-term results and the quality of life in patients who received orthotopic lower urinary tract reconstruction using the Kock ileal neobladder. Between July 1990 and October 1993, 37 consecutive patients including 2 females received orthotopic hemi-Kock neobladder after radical cystectomy. In these patients, we analyzed the urinary continence, complications and urethral recurrence, and performed a questionnaire survey by mail. Good continence all day had been achieved in 71% of the patients 4 years after surgery. The rate of the pouch-related complications requiring reoperation was 27%. There was no urethral recurrence. Compared with preoperative conditions, 42% were not satisfied with urination. In these dissatisfied patients, the need to use pads in the daytime, sensation of residual urine and weak urine stream were significantly more frequent than in satisfied patients. In summary, the rate of complications was higher than that of other methods. However, the Kock orthotopic ileal neobladder is a stable procedure providing good function over the long-term.

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.

A case with localized amyloidosis of the ureter was presented. This is the fifteenth case in the world and the first case of autotransplantation of the kidney, performed in this disease. The patient was a 62-year-old man who complained of intermittent gross hematuria and left flank pain. Clinical features of the localized amyloidosis of the ureter are similar to those of ureteral neoplasm. Autotransplantation of the kidney was performed to the left iliac fossa in order to preserve renal function because of no malignancy on a biopsy specimen. A localized amyloidosis of the ureter was diagnosed on the histological examination of the specimen after surgery. During one year after surgery, a good renal function without a recurrence has been confirmed. Classification of the amyloidosis was discussed. Diagnosis, prognosis and treatment of the localized amyloidosis of the ureter were also discussed.

Seven patients undergoing surgical removal of extensive renal calculi involving a solitary kidney are reviewed. Problems arising from the surgery for the extensive renal calculi in a solitary kidney patient are demonstrated and indication of the surgery is also discussed. From January, 1978 to July, 1984, extensive renal calculi were removed in 7 solitary kidney patients. The operative technique for removing calculi consisted of anatrophic nephrolithotomy (in 2 patients) and ex vivo surgery (in 5 patients). There were 2 operative deaths and 2 major complications. Calculi were completely removed in 6 and 1 patient undergoing anatrophic nephrolithotomy, had a 3 X 4 mm residual calculus. The postoperative serum creatinine was improved in 5 patients. These major complications were observed in the patients who had severe renal dysfunction during the early postoperative period. It was indicated that good renal function should be maintained even during the early postoperative period in the surgery on a solitary kidney patient. Investigating injury to the operated kidney, the early postoperative serum creatinine level was analysed in these 7 patients and 3 patients undergoing ex vivo surgery for removal of aneurysm in a solitary kidney. The results indicated that nephrotomy was the most extensive damage to the kidney. However, pyelotomy and cold ischemia during ex vivo surgery, are not always harmful. In performing surgery for extensive renal calculous disease involving a solitary kidney, we should choose pyelotomy rather than nephrotomy in in situ operation. Ex vivo surgery can provide an effective treatment.