直 村松’s scientific contributions

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.

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.

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.

Sultamicillin, a new semisynthetic oral beta-lactam antibiotic, was evaluated for its antibacteria susceptibility and clinical efficacy against urinary tract infection (UTI), and the following results were obtained. The sensitivity of sultamicillin (SBTPC) on 518 strains of clinical isolates from the urine were tested and compared to ampicillin (ABPC). S. aureus, S. epidermidis, Enterococcus sp., Streptococcus sp., E. coli, K. pneumoniae, K. oxytoca, P. mirabilis, M. morganii and Acinetobacter sp. showed high sensitivity to SBTPC. The antibacterial activity of SBTPC was superior to that of ABPC in most strains and especially more superior in beta-lactamase producing strains. The clinical effectiveness rate on a total of 15 patients with acute uncomplicated cystitis was 93.3% and the eradication rate of causative organisms was 93.3%. On 15 patients with chronic complicated UTI, the clinical effectiveness rate was 73.3% and eradication rate was 76.5%. Side effects (diarrhea) were observed in 3 cases, but this symptom was not severe and soon disappeared. Abnormal laboratory data due to the drug were not observed.

膀胱腫瘍82例においてABC法を使用し型物質の検出を行ない,1) ABC法は操作が簡便で感度が高く,backgroundも低く特異的である.2) Low grade 60例中34例が陽性,high grade 22例中21例が陰性であり,有意差が認められた.3) Low stage 63例中35例が陽性,high stage 19例がすべて陰性があり,有意差が認められた.4) Low grade・low stage 38症例のうち再発のみられたものは,陽性24症例中9症例,陰性14症例中10例であり,有意差が認められた ABH isoantigens in 82 cases with bladder tumor of various grades and stages were investigated by the avidin-biotin-peroxidase complex (ABC) method. Correlation of ABC expression for isoantigens with pathological findings on the grading and staging system of the bladder tumors were as follow: Of 60 cases of low grade tumors, 34 (56.7%) were positive and of 22 cases of high grade tumors, 21 (95.5%) were negative. Of 63 cases of low stage tumors, 35 (55.6%) were positive and all 19 cases of high stage tumors, (100%) were negative. The isoantigens in the tissue of the bladder tumors tended to disappear as the histologic anaplasia of the tumor progressed. There was a high correlation between the histological grade, stage and ABC expression (p less than 0.01). In a follow-up study of 38 patients with low grade, low stage, initial transitional cell carcinoma, 9 of the 24 patients positive for ABC expression (37.5%) showed recurrence during the 1 to 6 year follow-up period, whereas 10 of the 14 patients negative for ABC expression 10 (71.4%) did. There was a high correlation between the recurrence rate and ABC expression (p less than 0.05). Therefore, the analysis in the bladder tumors may be valuable for prediction of malignant potential, especially for the low grade, low stage tumors.

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.

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.

1974年から10年間に原発性腎盂腫瘍(PPT)18例を経験し,同期間の外来患者数,入院患者中のPPAの割合はそれぞれ0.15%,1.05%であった.性別は男11例,女4例,左側9例,右側6例,平均年齢は58.3%であった.主訴は肉眼的血尿12例,側腹部痛1例,全身倦怠感2例で,IVPでは無機能腎8例,陰影欠損2例,水腎2例,腎杯変形3例であった.尿細胞疹陽性は8例であった.手術は腎尿管全摘出術兼膀胱部分切除術7例,腎尿管摘出術1例,腎摘出術7例で,術後の補助療法は化学療法5例,放射線療法2例に行った.術後尿路上皮腫瘍の発生は残存尿管兼膀胱1例,膀胱のみは7例にみ,全例2年以内に発生した.病理組織学的には,移行上皮癌14例,扁平上皮癌1例であった.Grade別では0は無く,1が1例,2 5例,3 9例で,stage別では0が1例,A 2例,B 0例,C 7例,D 5例であった.実測生存率は3年67%,5年48%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 renal pelvic tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The patients ranged in age from 41 to 74 years old (average: 58.3 years old). There were 11 males and 4 females, the ratio being 2.8:1.0. The affected side was left in 9 cases and right in 6 cases. 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 8 cases (53.3%). Positive urinary cytology was obtained in 8 cases (53.3%). As the surgical method, total nephroureterectomy with bladder cuff was performed in 8 cases, nephroureterectomy in one case and nephrectomy in 6 cases. Histologically, 14 cases were transitional cell carcinoma and one case was squamous cell carcinoma. Simultaneous urothelial tumors were seen in the bladder of 2 patients. A subsequent ureteral tumor was found in one of the 7 cases in which ureters were resected incompletely, and subsequent bladder tumors were found in 8 of the 15 cases receiving surgical treatment in the follow-up period. All of tumors were found within 2 years after operation. Over-all actual survival rates at 1, 3 and 5 years were 87%, 67%, 48%, respectively. Three and 5 year actual survival rates were 100%, 100% respectively for the low stage group and 59%, 29% respectively for the high stage group. Three and 5 year actual survival rates were 100%, 78%, respectively for the low grade group and 44%, 27% respectively for the high grade group. Among several factors, stage and grade of the tumor were the most influencing factors for prognosis.

The effectiveness of interferon alpha (HLBI) for nude mouse transplantable human renal cell carcinoma 72nd general meeting, in combination with UFT and 5-Fu, was examined using, 1 x 10(7) IU/kg, 2 x 10(7) IU/kg HLBI; 25 mg/kg 5-Fu; and 10 mg/kg, 20 mg/kg UFT, administered for 10 consecutive days. The ratio of relative mean tumor weight of treated group to control group was under 42% for the combination of 25 mg/kg (I.P.) 5-Fu, 20 mg/kg UFT, and HLBI and the effect was particularly clear for the combination with 2 x 10(7) IU/kg which indicated a grade IIA histologic classification. In comparison with the control groups only UFT (20 mg/kg) and HLBI (2 x 10(7) IU/kg) showed significant inhibition when administered alone. Although none of the drugs had an inhibitory effect when administered alone, in combined use they showed a strong antitumor effect which was more than synergistic. Orally administered 5-Fu showed a statistically significant difference only in the combination with 2 x 10(7) IU/kg HLBI. Furthermore, the concentration of 5-Fu in the tumor tissue was not affected by the route of administration or drug combination, whereas that in the serum was below the limit of detection in the intraperitoneally administered cases, 0.0096 +/- 0.0079 microgram/ml, lower than the value for orally administered cases. The 5-Fu concentration was 0.026 +/- 0.012 microgram/ml for orally administered UFT which was significantly higher than the value obtained for orally administered 5-Fu. Thus, combination therapy of HLBI and UFT for renal cell carcinoma is expected to be clinically useful.

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%.