英輔 三矢’s scientific contributions

1973年9月から1979年11月までの6年間に行なわれた生体腎同種移植患者50例,51回の移植後の補液管理について検討した.受腎者の補液管理の方法の相違により,グループ1:中心静脈圧を観察しつつ,移植1時間ごとに尿量を測定し,その同量を補液,グループ2:中心静脈圧,一部スワンガンツカテーテルを挿入し,さまざまのパラメーターを観察しつゝ心不全が起こらない限り,尿量と無関係に可及的大量の補液を行なった,2群に分けた.腎移植後1週間以内に血清クレアチニンが2.5 mg/dl以下に低下しない症例を,移植後急性尿細管壊死発生症例(虚血性障害発生群),2.5 mg/dl以下に低下した症例を機能良好群と定義した.検討成績では,グループ1の術中および術当日の補液量はグループ2と比べあきらかに少なかった.またグループ1の術中および術当日尿量はグループ2と比べ有意に少なかった.グループ1はグループ2に比し,術後血清クレアチニンの低下が遅延し,クレアチニンクリアランスが低い傾向がみられたが統計的有意差はみられなかった.グループ1の術当日のFENaはグループ2より高い傾向を示した.グループ1の機能良好群の血流再開5時間後,10時間後,15時間後,20時間後のCVPの平均値はグループ2の機能良好群の各々の平均と比べあきらかに低かったが,グループ1, 2の虚血性障害発生群との間に差を認めなかった.グループ1の急性尿細管壊死の発生頻度は22例中8例(36.3%)で,グループ2の29例中3例(10.3%)と比べ,あきらかに高かった.グループ1の1年移植腎実測生着率は72.4%で,グループ2の75.9%と差はみられなかった.グループ1の1年患者実測生存率は77.3%で,グループ2の96.6%に比しあきらかに低かった.以上より,生体同種腎移植後は心不全が起こらないかぎり,術後尿量にかゝわらず可及的大量の補液をすることが,移植後急性尿細管壊死による腎障害の防止に重要であることを強調した A major concern during the early post-transplantation period is fluid management. This study analyzes the difference between two approaches to fluid management in 49 subjects who had had renal transplants plus one subject who had had two renal transplants because of chronic rejection. All patients were divided into two groups. In group 1 (LDI-22), the urine lost each hour was replaced with an equal volume of half normal saline and 5 % glucose in water, and in group 2 (LD23-51), massive fluid management with half or quarter saline was undertaken, cardiac parameters were checked and the administration of fluids was controlled by a Swan-Ganz catheter to avoid cardiac failure, additional fluids being administered when the Swan-Ganz catheter reading was lower than normal. The cases in which serum creatinine after one postoperative week remained above 2.5 mg/dl were classified as acute tubular necrosis (ATN), and those with lower values as non-ATN. The average volume of infusion during operation (1l46±490 vs 2698±939 ml/m2BSA) and on transplant day (2262±892 vs 2897 ±855 ml/m2BSA) was significantly smaller in Group I (P<O. 005). The average urine output during operation (187 ± 135 vs 524±306 mljm2BSA) and on the transplant day (2125± 1399 vs 3548 ± 1435 ml/m2BSA) was also significantly smaller in Group I (P<0.005). Postoperative serum creatinine reduction in Group I was some what delayed, but the delay was not statistically significant. FENa during the first postoperative day was higher in Group (4. 38±3. 20 vs 2. 75±1. 75%). The GVP monitored for 20 hours after declamping in the cases without ATN was significantly lower in Group 1 than in Group 2, but, in the cases with ATN, the difference between Group 1 and 2 was not statistically significant. The incidence of cases with ATN was significantly higher in Group 1 (36.3 vs 10.3%) (P<0.01). The actuarial one-year graft survival was 72.4% in group 1 and 75.9% in Group 2 and the difference was not statistically significant. The actuarial one-year patient survival rate was lower in Group 1 (77.3 vs 96.6%) (P<0.05). From the data described above, it might be tentatively concluded that checking the cardiac parameters to avoid cardiac failure "and massive fluid management through the use of the Swan-Ganz catheter might be useful in preventing postoperative ATN in living related renal allogreft recipients.

Clinical efficacy of Cefmetazole was evaluated at four university hospitals and their related hospitals in Nagoya. For the treatment of urinary tract infections with or without complications, 177 patients were administered Cefmetazole. Of these patients, 69 had chronic complicated urinary tract infection defined in the UTI manual and 20 had simple acute pyelonephritis. The other urological infections for which Cefmetazole was administered included prostatitis, epididymitis, urosepsis and wound infections. Fifty four patients were given Cefmetazole intravenously after urological operation to prevent wound and urinary tract infections. The overall clinical efficacy of Cefmetazole for UTI was 76.8%; 84.4% for group 1, 85.7% for group 3, 75% for group 4, 44.4% for group 5 and 66.6% for group 6. In acute pyelonephritis due to E. coli, Klebsiella, Serratia, S. aureus, alpha-Streptococcus and S. epidermidis all patients were cured by Cefmetazole administration. Clinical efficacy of Cefmetazole was assessed to be excellent in 6 cases of prostatitis and 6 cases of acute epididymitis. E. Coli, Serratia and some organisms disappeared from blood after the administration of Cefmetazole but Pseudomonas persisted even after treatment. Postoperative administration of Cefmetazole was effective for eradication of bacteria from the urine in 26 out of 30 patients and in prevention of infection in 24 cases. After the administration of Cefmetazole skin eruption was observed in one patient and nausea in another. Slight elevation of GOT, GPT and total bilirubin was noted in 3 of the 177 patients after medication.

前報と同一の対象について,HE染色では,思春期以後の停留精巣で精細管壁の肥厚と不整蛇行が認められ,肥厚部はAzanで濃染した.肥厚は10歳頃から出現した.Weigert染色で弾力線維が認められるのは停留精巣では思春期以後のことであり,それも貧弱であった.電顕下に,停留精巣の基底膜は,思春期前では内・外各1層より成りinfoldingは見られず,思春期後には外層の多層化が著明であった.線維層では膠原線維の増生が見られたが,それは5歳時より確認できた.細胞層では,筋様細胞が思春期になって出現したが,思春期後でも,細胞辺縁のmicropinocytic vesicleの発達は不良であり,また,細胞間の膠原線維増殖が著明で,筋様細胞や線維芽細胞の表面は不整となり,細胞突起も蛇行した Morphological changes in the wall of the seminiferous tubules in the cryptorchid testes were studied using light and electron microscopy. Seventy four unilateral and bilateral cryptorchids (aged 2 to 37 years) were selected, and biopsied specimens were stained with H-E, Azan and Weigert for light microscopic observation. Twenty eight of these specimens were also examined by electron microscopy. In the undescended testes, light microscopy showed irregularity and thickening of the wall (tunica propria), and the thickened wall strongly reacted to the Azan stain. This thickening of the tunica propria was observed to begin at puberty, but was not found in the contralateral scrotal testes of the cryptorchids or in the normal testes. The wall of the normal adult testes was well stained by the Weigert stain, suggesting the presence of elastin. In the undescended testes, however, the wall was not stained in prepubertal or pubertal patients, and even after puberty the wall was stained much less than that in the contralateral scrotal testes and the normal controls. On electron microscopic observation, various ultrastructural changes were noticed in each component of the tubular wall; basement membrane, fibrous layer and cellular layer. In the undescended testes, the lamina densa of the basement membrane consisted of one layer with a serrated outer margin throughout the pre-pubertal and pubertal periods, while after puberty the lamina densa underwent marked multiple lamella formation and increased in thickness. In the fibrous layer was already noticed in the undescended testes of 5-year-old cryptorchids. The development of myoid cells in the cellular layer during puberty was observed to be delayed. The morphological changes occurring in the seminiferous tubular wall of the cryptorchid testes were believed to be related to the impaired spermatogenesis often found in cryptorchidism.

A 37-year-old man was sent to our department from the Radiology Department on July 19, 1984 with the diagnosis of right renal cell carcinoma with metastases to the right humerus and bilateral lungs. He was nephrectomized immediately and administered 10 X 10(6) units of alpha-interferon i. m. every other day for 3 months during the admission and 30 X 10(6) units once a week for more than 3 months after discharge. Although in addition to humeral and lung metastases, brain metastasis was found a week after the operation, interferon showed a remarkable effect and produced get a complete response in the humeral and brain metastases, and partial response in the lung metastasis. We think this is, perhaps, the first case of CR in brain metastasis so far. We conclude that interferon can be the first choice drug as an adjuvant chemotherapy against renal cell carcinoma.

PVB療法を施行した14例の進行睾丸腫瘍の治療成績を報告した.14例中CRが4例,PRが6例で全体の奏効率は71.4%であった.CR後2例が再発した.死亡例は9例,全例癌死であった.CRの得られなかった症例9例が死亡した Two patients with stage II, 12 patients with stage III advanced testicular cancer, were treated with a combination of CDDP, vinblastine and bleomycin. Four of the cases (28.6%) achieved a complete response and 6 (42.9%) achieved a partial response. The over all response rate was 71.4%. After CR, 2 cases (50%) showed relapse. Although the treatment confirms some efficacy of the drug regimen, the prognosis is poor in bulky metastasis. Early induction therapy with etoposide is necessary in cases of high volume metastasis.

1973年より1983年の間に原発性膀胱癌95例に対し膀胱全摘除を行なった.「泌尿器科,病理膀胱癌取扱い規約」に従い,その病理組織と予後についての検討を加えた.膀胱癌の組織型別には,移行上皮癌87例,扁平上皮癌5例,腺癌2例および未分化癌1例であった.全体の5年実測生存率は36.0%であった.増殖様式に関しては,乳頭状非浸潤型100%,乳頭状浸潤型25.8%,非乳頭状浸潤型34.8%であった.5年生存率と進展度との関係では,pTa 81.1%,pT1 64.7%,pT2 40.1%,pT3a 30.5%,pT3b 22.6%,pT4 6.7%であり,移行上皮癌87例のうち5年生存率と悪性度との関係では,grade 1 100%,grade 2 43.0%,grade 3 32.1%であった.予後指標としては,壁内リンパ球浸潤,血管浸潤および壁内浸潤の病理組織学的様式が重要であった Total cystectomy was performed on 95 patients with primary urinary bladder cancer between 1973 and 1983. Histopathological and prognostic studies were reviewed according to the general rules for clinical and pathological studies on bladder cancer. The cancer histological type were transitional cell carcinoma in 87 cases, squamous cell carcinoma in 5 cases, adenocarcinoma in 2 cases, and undifferentiated carcinoma in 1 case. The overall 5-year actuarial survival rate was 36.0%. As for the growth pattern of the bladder cancer, the 5-year survival rates for the patients with papillary non-invasive type (PNT), papillary invasive type (PIT), and non-papillary invasive type (NIT) were 100%, 25.8% and 34.8% respectively. As for the stage, the 5-year survival rates for the patients with pTa, pT1, pT2, pT3a, pT3b, and pT4 were 81.8%, 64.7%, 40.1%, 30.5%, 22.6% and 6.7% respectively. Of 87 patients with transitional cell carcinoma, the 5-year survival rates for the patients with grade 1, grade 2 and grade 3 were 100%, 43.0% and 32.1% respectively. Intramural lymphatic invasion and vascular invasion and intramural histopathological mode of spread were significant indicators of prognosis.

The patients who undergo total cystectomy for high stage bladder carcinoma have poor prognosis because of local extension or distant metastases. In the case of recurrent lesions after total cystectomy, radiotherapy and chemotherapy are generally selected. In some cases of recurrent tumors localized within the pelvic cavity and with no distant metastases, however, surgical resection of the tumor is effective in local disease control combined with radio- and chemotherapy. Surgical treatment is not only effective in reducing the cell number in a bulky tumor, but also improves clinical symptoms and conditions such as pain, bleeding, rectal irritability, intestinal obstruction and so on. We present here three patients who underwent extensive operation for pelvic recurrence of bladder carcinoma following total cystectomy. Two of these cases died of progressive disease, nine months and five months after the extensive operations. The third patient died of acute pericarditis thirteen months after the second operation. Autopsy revealed that the surgical treatment was effective in controlling the local recurrence in the third case. Furthermore, some problems regarding pelvic recurrence and surgical treatment are discussed.

A forty-two-year-old man was seen with right lumbar pain. Physical examination revealed a right flank mass. Conventional excretory urography showed lack of right renal function, whereas left kidney was visualized. Right nephrectomy was performed. A cluster of several different sized cysts was disclosed in the right renal region. The renal surface was smooth. The removed kidney weighed 1,150 g. The ureter was completely obstructed at the ureteropelvic junction. Cysts were filled with matrix calculi. Pathological examination showed dysplastic glomeruli and primitive tubules within loose embryonic mesenchyme between two cysts whose walls consisted of smooth muscle strands and connective tissue. The final diagnosis was a congenital unilateral multicystic kidney with renal matrix calculi. The multicystic kidney is the most common form of renal cystic disease in infancy. However, few cases in adults have been reported. The diagnostic approach, treatment and outcome of a congenital unilateral multicystic kidney are discussed.

1984年7月から同11月までの間に当大学および関連19施設で経験した難治性の複雑性尿路感染症64例を対象として,新しく開発されたquinolone carboxylic acid系薬剤のNFLXを投与し,臨床効果を検討した.なお起炎菌が証明されなかったり,真菌の検出された20例は除外し,計44例を検討対象とした.投与方法は1日600 mg(分3),14日間とした.効果判定はUTI薬効評価基準に準じて行ない,MICも測定した.疾患別の有効率は単独感染62.1%,混合感染60.0%で,単独感染のカテーテル留置例の有効率は50%であった.従来の本剤による報告では有効率が52%～85%であり,今回の成績が平均61%とやゝ低いが,G-1, G-5のカテーテル留置例が多かった結果と考えられる.従ってカテーテル留置群を除くと有効率は67%となり,経口剤単独治療としては満足できるものといえた.細菌学的効果は分離株61株中65.6%に効果を認め,既存の抗菌剤より優れていた.最も多く分離されたP. aeruginosaのMIC分布をみると,MIC 3.13以下に効果を認め,評価できる結果であった.副作用は軽度の胃腸障害を4例に認め,GOTの上昇を1例に認めたに過ぎない.以上の成績より,NFLXは経口抗菌剤として複雑性尿路感染症に有効かつ安全性の高い有用な薬剤といえる The new chemotherapeutic agent NFLX was orally administered 600 mg a day for 5 consecutive days in 44 cases having complicated urinary tract infection, and its clinical efficacy was evaluated. They consisted of 8 marked effective cases, 19 moderately effective cases and 17 ineffective cases, and its overall clinical efficacy was 61%. The bacteria disappeared in 10 cases, and decreased in 9 cases. Thirteen cases showed bacterial alternation, and 12 cases remained unchanged. By type of disease group, the efficacy was slightly inferior in the indwelling catheter group compared with that of the nonindwellt group.

A case of renal oncocytoma is reported. A 56-year-old woman was admitted with the complaint of an abdominal mass. Right transabdominal nephrectomy was performed on January 23, 1984. The resected kidney weighed 262 g and contained a well-demarcated 5 X 5 X 4 cm tumor in the middle portion. The cross section of the tumor was tan-brown. Light microscopic examination disclosed that the greater part of the tumor was composed of cells with abundant, and finely granular eosinophilic cytoplasm and with moderate nuclear pleomorphism. Electron microscopic examination confirmed that the cytoplasm had numerous mitochondria and few other organelles. According to these findings, the tumor was diagnosed as renal oncocytoma. Furthermore, it is noteworthy that in this case there were tubular arrangement of the cells resembling proximal renal tubules in a focal area and a group of cells with considerable nuclear atypia and hyperchromatism in another area. The patient has been well without any local recurrence or distant metastasis ten months after the operation. In addition, fourteen cases of renal oncocytoma in Japan, including the present case, are reviewed.