正範 柳岡’s scientific contributions

Using Hitachi CT-3, the changes in CT numbers of the kidney were calculated in 10 normal and 12 transplanted kidneys. Two mililiters per kg of meglumine diatrizoate (Angiografin(R)) was given intravenously in bolus fashion. Kidneys were scanned before injection, at termination of injection and correctly 10 minutes after injection. In control group, the CT numbers of the cortex, the medulla and the aorta showed rapid increase after contrast administration. Ten minutes after administration of medium, the CT numbers of the medulla remained a little higher than the cortex, though that of the aorta showed rapid decrease. In contrast to control group, in transplanted kidneys the CT numbers of the cortex and medulla showed less increase than the control group just after contrast administration. Moreover, in the recipients who have had good graft function the CT numbers of the cortex and medulla showed gradual increase, in the recipients who have had poor graft function the CT numbers showed gradual decrease 10 minutes after injection. Enhancing indices calculated from the formula: [CT numbers 10 minutes after contrast enhancement / CT numbers before contrast enhancement] were inversely proportional to the serum creatinine. These results lead to the conclusion that the CT scans employing contrast enhancement method after kidney transplantation has the diagnostic value of graft function in addition to diagnostic usefulness for post-transplantation complications such as hematoma, urinoma or Iyrnphocele.

MK-0787/MK-0791をUTIを主とした感染症や,感染防止目的で35例36回,原則として1日0.5 g×2を10日間以上にわたり投与した.1)評価可能26例で有効以上は,治療初期で88.5%,終了時で92.3%であった.有用性についても全く同様の成績を得た.P. aeruginasa等を含む分離菌35株の全てが治療後除菌された.投与後出現菌は,真菌類が多かった.2)長期投与の方が短期投与に比べて,有用性が高い傾向を認めた.3)副作用として,嘔吐による中止例が1例あった.臨床検査値異常では,血小板減少1件,好酸球増多1件,GOT上昇2件,GPT上昇3件,γ-GTP上昇1件をみたが,変動幅は小さく,中止により可逆的であった MK-0787 (Imipenem)/MK-0791 (Cilastatin sodium), a new compound of Thienamycin, was administered in treatment of 35 patients (36 cases) with chronic complicated UTI or for prevention of serious infections with much complicated factors. The patients were principally treated at a daily dose of 1 g for over 10 days. The efficacy rate of 26 patients who were evaluable in the early phase (4-7 days) was 88.5%, while it became up to 92.3% in the final phase judgment. As for clinical usefulness, the result was obtained to be as high as that of the clinical efficacy. In bacteriological study, 35 strains were clinically isolated including 7 strains of P. aeruginosa from UTI. All the strains disappeared with an eradication rate of 100% after treatment. Strains appearing after Imipenem/Cilastatin sodium treatment mainly consisted of fungi. Usefulness judgements tended to be greater in the final phase than in the early phase. As for side effects, vomiting was recorded in one case, in which the administration was discontinued. In laboratory findings there were 3 cases with elevated GPT, 2 cases with elevated GOT, one case with elevated gamma-GTP, one with thrombocytopenia, and one with eosinophilia each, but these abnormal values were slight and transient. In summary our clinical study showed that Imipenem/Cilastatin sodium was a very effective antibiotic in treatment on moderate or serious UTI or preventive use for infections in compromised hosts. Considering the features of this agent, it might be more effective and useful for clinical use in treatment on polymicrobial infections including stubborn organisms than any other antimicrobial compounds. Furthermore, it was safe and well tolerable in a long term treatment.

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.

塩酸タムスロシンあるいはナフトピジルを1ヵ月以上投与しても夜間排尿回数が2回以上の前立腺肥大症患者52例(平均年齢72.1歳)を対象として, 塩酸フラボキサート400～600mg/日を8～12週投与し, その有用性と安全性を検討した。塩酸フラボキサート投与前後で夜間排尿回数は3.8回→2.7回へ有意に減少し, 国際前立腺症状スコア, QOLスコア, 前立腺肥大症影響度スコアもそれぞれ15.2点→12.5点, 4.3点→3.9点, 5.3点→4.2点へ有意に低下した。投与期間中14例(26.9%)に消化器症状を主とする副作用を認め, そのうち8例は投与を中止したが, いずれも重篤ではなかった。α1遮断薬投与中の前立腺肥大症患者に対して塩酸フラボキサートを就寝前に追加投与する治療法は, 前立腺肥大症に伴う夜間頻尿に対する治療の選択肢の1つとなりうると考えられた。 We examined the effectiveness of supplemental administration of flavoxate hydrochloride in patients with benign prostatic hyperplasia (BPH) whose nocturia was not adequately relieved by an alpha1-adrenoceptor blocker. Fifty-two patients who had two or more nocturnal micturition after administration of tamsulosin hydrochloride or naftopidil for 4 weeks or more received 400-600 mg of flavoxate hydrochloride in addition to an alpha1-adrenoceptor blocker for another 8-12 weeks. With supplemental administration of flavoxate hydrochloride, significant improvement was observed in the number of nocturnal micturition, total International Prostate Sympton Score, quality of life score and BPH impact index. No significant change was observed in the voided volume, Qmax, voiding time and residual urine volume. Supplemental administration of flavoxate hydrochloride is therefore effective for the improvement of nocturia and QOL in BPH patients resistant to an alpha1-adrenoceptor blocker.

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.

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.

前立腺肥大症を主とする下部尿路通過障害に対してTURを施行した355例について,術前の尿路感染,術後の化学療法,術後の尿路感染への対応と手術効果について検討した.1)術前感染について:カテーテル留置症例の91%に感染を認めたことより,カテーテル管理は重要である.術前感染群では非感染群に比し明らかに排尿障害の程度は強いが,術後の排尿状態にそれ自体影響を及ぼす結果は得られなかった.2)術後の化学療法について抗生物質の投与は術後細菌尿の発生を予防する意味では有効であった.3)術後感染について残尿の持続する症例で術後感染が持続したことより,尿流の改善,つまり前立腺組織の適切な切除が術後感染を抑える重要な因子である Three hundred and fifty five patients were treated with transurethral resection of the prostate for the relief of partial urinary obstruction. Of these, 188 had suffered from bacteriuria before surgery and the remaining 167 had been free of urinary infection before surgery. Urinary infection was caused by urethral instrumentation including indwelling catheter for various periods of time. A significant correlation between volume of residual urine and preoperative infection was demonstrated. No correlation between preoperative infection and postoperative voiding efficiency was however noticed though significant improvement in voiding was demonstrated by postoperative uroflowmetry.

前立腺および膀胱の切除術を行った21例を対象として,cefpiramide (CPM) 2 gを静注し,一定時間後の前立腺および膀胱壁組織への移行性を検討し,薬動力学的解析を行った.1)前立腺組織移行は投与後12分～3時間40分で28.4～131 μg/g,対血清比は0.15～0.63であった.また前立腺組織内のGPM半減期は3.29 hrを示した.膀胱壁については症例が2例と少ないが,いずれも高濃度を示した.2) CPMの前立腺および膀胱壁組織への移行は良好であり,その強い抗菌力と相まって,術後感染症の治療に有用性の高い薬剤である The cefpiramide (CPM) concentration in prostatic tissue of 19 patients with benign prostatic hypertrophy and bladder wall of 2 patients with bladder tumors was measured, after 2 g of CPM was administered intravenously by bolus technique prior to operation. Prostatic tissue level was 28.4 to 131 micrograms/g and tissue to serum ratio 0.15 to 0.63 at 12 min. to 220 min. after administration. The T1/2 of CPM in prostatic tissue was 3.29 hours. The bladder wall level was high at both determinations. CPM level in prostatic tissue and bladder wall covered the minimum inhibitory concentration of many bacteria detected from the infected sites. Therefore, CPM which has a strong antimicrobial activity can be considered as a highly useful antibiotic for the treatment of postoperative infections.

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.

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%).