In adrenal surgery, of note are increase of the incidence of incidentaloma because of a rapid advance of various image diagnostic procedures, change of the approach of choice due to the more accurate preoperative localization of the adrenal lesions, and the treatment of bilateral lesions. Additionally, the treatments of adrenocortical carcinoma and malignant pheochromocytoma and the method of cortisol withdrawal in Cushing's syndrome were reviewed and discussed. It is important for urologists to perform adrenal surgery appropriately by preoperatively elucidating the full picture of adrenal disorder.
In the present study it was attempted to investigate the urine storage function of the pons in the decerebrate cats. Firstly, the area where an increase in the urethral sphincter EMG activity was induced by electrical microstimulation in the ventrolateral part of the dorsolateral pontine tegmentum was identified. Next, the effect of electrical stimulation and chemical stimulations by carbachol, noradrenaline, enkephalin or GABA on the reflex micturition induced by bladder filling was studied. The sites of electrical and chemical stimulations were anatomically distributed in the nucleus locus subcoeruleus (LSC). The electrical stimulation of the LSC produced increases in the urethral sphincter EMG activity and in bladder capacity. The carbachol, noradrenaline and enkephalin microinjection into the LSC produced an increase in bladder capacity. On the other hand, the GABA injection produced decreases in bladder capacity and urethral sphincter EMG activity. From these results, it can be concluded that neurons in the LSC seem to perform an important role in the storage phase.
We are interested in the therapeutic response to chemotherapy and radiotherapy of relapsed prostate cancer. In 9 cases of prostate cancer treated by endocrine therapy, tumor markers (PAP·PA·γ-Sm·Leu-7) and cell types at the start of endocrine therapy and that taken at a hormone independent point were compared between prostatic tissue obtained. All cases had a period of response to endocrine therapy, but subsequently relapsed. The results were divided into the following 3 groups: Group I (changed cell type·decreased positive rate of markers) had the shortest response duration to endocrine therapy and there was no response to chemotherapy; Group II (unchanged cell type·decreased positive rate of markers) had a long response duration and slow progression under endocrine therapy; Group III (unchanged cell type·unchanged positive rate of markers) was chemo- or radiotherapy sensitive during post-endocrine therapy relapse. These results suggest that this is an effective method which dictated the choice of treatment method and allowed an approximate prognosis for relapsed prostate cancer previously treated by endocrine therapy.
We clinically investigated 150 subjects suffering from renal cellular cancers as to their diagnostic opportunities. They underwent medical treatment after being hospitalized in the urology section of Gunma University from 1961 to 1988. We divided the cases into two groups to be compared: 63 cases in the first period (1961 to 1979) before introduction of ultrasound (US) and scan (CT), and 87 cases in the second period (1980 to 1988) after introduction of the above devices. The number of patients increased in the second period, year by year. Evaluation of symptoms indicated that 62 of the 63 cases in the first period belonged to the suspected category; the remaining one (1.6%) belonged to the incidental category, but its diagnosis followed intravenous pyelography (IVP). Out of the 87 cases in the second period, 29 (33.3%) belonged to te incidental category which was recognized to be increasing; 19 cases were diagnosed based on US findings, and 6 cases on CT. Concerning prognosis, a significantly favorable prognosis was indicated for the second-period cases, as compared with those of the first period, from the statistical point of view. With respect to progressive degree and prognosis of 58 suspected cases and 29 incidental cases in the second period, statistically there were significantly more cases of low grade and, therefore, with favorable prognosis in the latter. Application of US and CT raised the level of diagnostic technique for renal cellular cancer; particularly there was an increase in cases which were incidenttally diagnosed by US and CT in close examination for other diseases (regular physical examination, health examination, complete physical examination in a hospital, or continuous medical treatment), which was a possible factor affecting prognosis.
A new experimental method to test the effect of drugs on tumor induced osteolysis using a transplantable bladder tumor (MBT-2) in mice has been designed. The method consists of inoculating tumor cells sc over the calvaria in mice, causing in a local tumor with fragmentation of the bone. This was accompanied by adjacent osteoblastic changes, which were evaluated by X-ray and histological examination. APD, a bisphosphonate derivative, at a dose of 3mg/kg to 10mg/kg sc protected the bone by decreasing the extent of osteolysis as judged by the same criteria. This inhibition was obtained without apparent effect on the growth of the bladder tumor in mice.
We studied cytological changes by endocrine therapies of prostatic carcinoma in 31 cases. We originated a method of cytology, in which a prostatic fluid collecting catheter was used. This has been already reported in previous papers. By the therapies, carcinoma cells usually became edematous, swollen, squamous and finally keratinized and in the cytoplasm hematoxylin-stained granules often appeared. These findings were usually seen in two weeks after the onset of the endocrine therapy. But the degree of the changes differed among the cases and among the therapies. In some there was no response or only squamous metaplasia was found. Most of the carcinoma cells were viable. In these cases the therapies were thought to be ineffective and their motality was high. On the contrary, in those with only keratinized cells, the therapies were thought to be effective and the mortality was low. We conclude that the cytological methods were useful for evaluating the therapies.
The results of severl pre-operative localizing methods and pathological findings were compared in 11 patients with primary hyperparathyroidism. 1. The accuracy rate was highest with selective blood sampling from the thyroid vein and MRI, which was 75% with both methods. The 3rd was dual photon scintigraphy, the accuracy rate being 62.5%. The 4th was ultrasonography, 57.1%, and the rate was lowest with CT, 25%. 2. MRI-a new localizing method-has a weak point that it cannot differentiate lymphnodes from parathyroid adenoma/hyperplasia. 3. Not to overlook small lesion of primary hyperplasia, several localizing methods should be performed before initial neck exploration.
Fifteen patients with low compliance bladder of varying etiologies (neurogenic bladder, radiation induced contracted bladder after radical hysterectomy, bladder tuberculosis and interstitial cystitis) underwent augmentation enterocystoplasty. The ileocecal tubular segment was used in 12 patients, ileal-patch in 2 and ileal-cup patch in 1. In all patients in whom partial reconstruction was done, the functional bladder capacity satisfactorily increased and the maximum detrusor pressure was low. The upper urinary tract did not deteriorate in 12 patients. Three died from recurrence of uterine or bladder cancer. Five neurogenic patients were managed by intermittent self-catheterization postoperatively. Another 10 patients was dry without voiding difficulty. Of 18 ureteral reimplantations in ileocecal cystoplasty, 13 had reflux without resultant progressive hydronephrosis. In 3 patients ureteral reimplantation was not required without reflux after ileal-patch and ileal-cup patch cystoplasty.
In the animal experiments, glomerular filtration rate (GFR) values were estimated from the urinary response to the intravenously administrated iopamidol. By introducing some reasonable assumptions, mass balance equations about the contrast medium were transformed and GFR was defined as the ratio of logarithm of urinary concentration by time. Urinary concentrations were determined by measuring the photodensity on the X-ray film of urine specimens. Obtained values of GFR were well fitted to those obtained by the analysis of the plasma disappearence curve. The advantage of this method is that measurement of urinary volume is not necessary.
One hundred twenty-four cases of renal cell carinoma treated at Department of Urology, The University of Tokyo were analyzed for their clinical characteristics and prognosis. To be noted were the recent increase of incidentally detected cases, kidney-sparing technique in curative surgery and adjuvant therapy using biological response modifiers. Prognosis was more favorable in cases with incidental detection, normal ESR or cystic pattern in pathological architecture, whereas that of cases with metastatic lesions or Grade 3 tumors was ominous. Tumor stage as TUMV or Robson stage was useful to predict the prognosis, although one stage contained cases of considerably different survival periods. These results suggested that the efforts to improve prognosis in the present practice should include early detection of renal cancer by promoting health check-up and development of preventive measure of postoperative recurrence. A more proper staging system might also be needed to analyze clinical studies.
Penile blood flow (PBF) was measured by the Xe-133 clearance method. In 16 patients, complete erection was obtained by visual sexsual stimulation (VSS). Their mean PBF before and after erection were 1.95ml/100g/min and 10.71ml/100g/min, respectively. In 69 patients, full erection was obtained by intracavernous injection of 20μg prostagrandin E1 (PGE1). Their mean PBF before and after administration were 2.00ml/100g/min and 6.28ml/100g/min, respectively. The mechanism of erection by intracavernous PGE1 was different from that of physiological erection, since the mean PBF after PGE1 was apparently lower than VSS. In diabetic and geriatric patients, the mean PBF before PGE1 was lower than that of cerebrospinal disorder patients. This result indicated that arterial lesion was the main cause of impotence in diabetic and geriatric patients. In some patients, while mean PBF after PGE1 injection was considered to be sufficient, full erection was not obtaind. A venous impotence was suspected in such cases. Thus, vasculogenic impotence could be diagnosed by investigating PBF before and after PGE1 injection.
A 41-year-old woman visited our hospital with chief complaint of hypertension which was refractory to multiple antihypertensive drugs. Her blood pressure was 200/140mmHg and her plasma renin activity was as high as 3.1ng/ml/hr. Angiography revealed bilateral renal artery stenosis. To determine the laterality of the kidney which were responsible for her hypertension, the 99mTc-DTPA renal shintigraphy with captopril was performed. The estimated GFR of the right kidney was lowered than that of the control, while there was no change in the left kidney. Subsequentry Percutaneous Transluminal Angioplasty (PTA) was performed to the right kidney. Postoperatively blood pressure remained elevated as well as serum renin level. 99mTc-DTPA scintigraphy with captpril was repeated and revealed no decrease in the GFR of the right kidney this time, but significant reduction in the GFR of the left kidney. After the second PTA to the left kidney, her blood pressure was finally normalized. Postoperatively GFR of both kidneys was not affected by captopril on renal scintigraphy, and currently she has remained normotensive without medication. 99mT-DTPA scintigraphy with captopril appears to be a useful method to diagnose the laterality and to evaluate in clinical response to therapeutic intervention.