英二 西川’s scientific contributions

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.

CPZ 2 gをOne shotにて静脈内に投与し血清および泌尿器系臓器組織内の濃度を測定した.1)健康成人における血清濃度には30分後に最高値が得られ,その値は122.1±4.2 μg/mlで以後漸減し,240分後では25.0±2.1 μg/mlであった.全身麻酔下の手術例においても30分後に最高値が得られ,その値は159.0±3.9 μg/mlで以後漸減し,240分後では54.0±14.6 μg/mlであった.2)前立腺組織内濃度は30分後に最高値が得られ,その値は80.9±3.6 μg/gで以後漸減し,180分後では21.2 μg/gであった.3)膀胱壁内濃度は60分後に最高値が得られ,その値は52.1±1.3 μg/gで以後漸減し,240分後では24.3 μg/gであった.4)腎組織内濃度は90分後に最高値が得られ,その値は94.0±14.5 μg/gで以後漸減し,300分後では27.5 μg/gであった The concentration of Cefoperazone (CPZ) in urological organs and serum was measured after the intravenous administration of 2 g of CPZ. Serum levels on healthy adults attained a maximal value of 122.1 +/- 4.2 micrograms/ml at 30 minutes. Serum levels of patients operated under general anesthesia attained a maximal value of 159.0 +/- 13.9 micrograms/ml at 30 minutes. Serum concentration on operated cases continued to be 1.3-2.2 fold higher than that of the healthy adults. Prostate tissue levels attained a maximal value of 80.9 +/- 3.6 micrograms/g at 30 minutes, vesical tissue levels were 52.1 +/- 1.3 microgram/g at 60 minutes and renal tissue were 94.0 +/- 14.5 micrograms/g at 90 minutes. Judging from the minimal inhibitory concentration of CPZ, CPZ seemed to be clinically useful in the treatment of urological infections.

症例は15歳男性.無症候性肉眼的血尿を認め近医にて抗生剤を投与され肉眼的血尿は消失した.その後も肉眼的血尿が持続したため精査目的で入院した.膀胱鏡を施行したところ,膀胱後壁右側寄りに径約2cmの乳頭状有茎性腫瘍を認めた.オリーブ油を勝脱内に注入した骨盤部CTでは,膀胱後壁に径24×18mmの有茎性腫瘍を認めたが,膀胱壁外浸潤を疑わせる所見はなく,骨盤内リンパ節腫脹も認めなかった.以上より表在性膀胱腫瘍の診断で,腰椎麻酔下にTUR-Btを施行した.組織学的所見は移行上皮癌,grade I,pTaであった.術後経過は良好で,BCG 80mgの膀胱内注入療法を施行した.術後2年の現時点において再発・転移は認められていない A 15-year-old male was referred to our hospital with the chief complaint of gross hematuria. Cystoscopic examination revealed a papillary tumor on the posterior wall. Transurethral resection of the bladder tumor was performed. Histological examination of the excised tumor showed transitional cell carcinoma, grade 1, pTa. Recurrence has not been observed for about 2 years after the operation. We investigated 54 previously reported Japanese cases of bladder cancer before age twenty including the present case.

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.

手術的摘出標本で病理組織学的に膀胱移行上皮癌と診断された83症例106組織を対象とし,Thomsen-Friedenreich antigen (T-ag)を検索し,その抗原性の変化と病理組織学的異型度,病理組織学的深達度および再発との関係について調べ,さらにABH isoantigen (ABH-ag)と比較検討した結果,膀胱腫瘍におけるT-agならびにABH-agの検索は腫瘍のmalignant potentialを知るうえで有用な手段であり,また両抗原を組み合わせて行うことにより,low grad・low stage腫瘍の予後をより正確に予測できるものと考えられた Thomsen Friedenreich antigen (T-ag), ABH isoantigen (ABH-ag) in 106 cases with bladder tumor (all transitional cell carcinoma) of various histological grades and stages were investigated by the Avidin-Biotin-Peroxidase Complex (ABC) method. There was a correlation between histological grade, stage and deletion of the antigenicity (T-ag and ABH-ag). In a follow-up study of 45 patients with low grade and low stage tumor, the recurrence rate after surgery of the cases with abnormal antigenicity (T-ag and ABH-ag) was significantly higher than that of the cases with the normal antigenicity. Combination of two markers (T-ag and ABH-ag) was significantly more effective than the single marker.

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.

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.

愛知医科大学附属病院にて経験した睾丸腫瘍について臨床的観察をおこなった.1) 1974～1983年までの10年間に19例を経験した.この期間中の男子外来患者数は6,097名,男子入院患者数は1,097名で,睾丸腫瘍の割合は,それぞれ0.31%と1.73%であった.2)年齢は,10歳以下の小児期と20～40歳代にピークがみられ,平均年齢は27.8歳であった.3)患側は左11例,右側8例であった.4)主訴としては,睾丸の無痛性腫脹が17例(89.4%)を占めた.5)停留睾丸および外傷の既往を持ったものはなかった.6)組織学的分類では,1型9例,2型4例,3型1例,4型4例,malignant lymphoma 1例であった.7)実測生存率は3年および5年ともに81.8%であった.8)治療は全例に高位除睾術を施行,ただし後腹膜リンパ節郭清術はおこなっていない.術後の補助療法としては放射線療法,化学療法の単独あるいは併用をおこなった The 19 cases of testicular tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The incidence of testicular tumors among the male outpatients in our urologic clinic was 0.31%. The patients ranged in age from 1 to 76 years old (average: 27.8 years old). The affected side was the left side in 11 and the right side in 8 cases. The most frequent symptom was a painless mass of the testis. Histopathological diagnosis according to the classification by Dixon and Moore was type I in 9 cases, type II in 4 cases, type II in 1 case, type IV in 4 cases. Thus germinal tumors accounted for 18 (94.7%) of the cases. One case (5.3%) of malignant lymphoma was non-germinal. As for the age distribution, two peaks were noted in testicular tumors, especially in cases with potential embryonal carcinoma, between 1 and 2 years and between 19 and 32 years. On the other hand, the cases with potential seminoma showed one peak between 25 and 44 years. The treatment consisted of high orchiectomy alone, orchiectomy with radiation, orchiectomy with chemotherapy or orchiectomy with radiation and chemotherapy. Retroperitoneal lymphadenectomy was not done in any case. The over-all 3-year and 5-year actual survival rates were both 92%.

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.