The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
Volume 82 , Issue 8
Showing 1-17 articles out of 17 articles from the selected issue
  • Ken Koshida
    1991 Volume 82 Issue 8 Pages 1201-1205
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
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  • Bunshiro Saito
    1991 Volume 82 Issue 8 Pages 1206-1210
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    To evaluate the process of tumor progression in BBN induced bladder cancer, BBN was administered to C57BL/6 mice for 10 weeks. The mice were sacrificed every week from the 5th week to the 22nd week.
    The urinary bladder was embedded in paraffin block for histopathological examination and was sampled for DNA content analysis by flow cytometry.
    The results were as follows:
    1. In the histopathological findings, the incidence of atypical hyperplasia of the urinary bladder, indicative of a precancerous state, was 29% 7 weeks after the initiation with BBN. And the cancer was found in 74% of the mice 9 weeks after the initiation.
    2. In the analysis of nuclear DNA content, the atypical hyperplasia and the incipient cancer of the urinary bladder were all DNA diploid, and the DNA aneuploid was found in 50% of the cancer group 11 weeks after the initiation.
    3. These data suggest that the change of nuclear DNA content is an occurrence after the completion of the carcinogenesis in BBN induced bladder cancer of mice.
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  • Ken Marumo, Munehisa Ueno, Junro Muraki, Masaaki Tachibana, Nobuhiro D ...
    1991 Volume 82 Issue 8 Pages 1211-1217
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Subcutaneous injection of human recombinant interleukin 1 (IL-1) β was given to 9 patients with urological malignancies (5 renal cell carcinoma, 2 bladder carcinoma, 1 renal pelvic tumor, and 1 testicular tumor), at an initial dose of 1×104 units on days 1 and 2, and there after weekly for 4 weeks. The dose was increased by 1×104 units weekly up to final dose of 4×104 units. Peripheral blood mononuclear cells (PBMC) were isolated from patients on day 3 in week 2 and week 4, and lymphokineactivated killer (LAK) activity against Daudi cells was measured using 4hr 51Cr-release assay, after incubation with human recombinant interleukin 2 (IL-2) of 50 units/ml for 72 hours. Proliferation of lymphocytes was measured by tritiated thymidine incorporation after incubation with IL-2 for 72 hours. IL-1β increased the number of peripheral blood granulocytes and lymphocytes, but did not increase the numbers of monocytes and platelets. IL-1β significantly augmented IL-2-induced LAK activity in vitro, but this augmentation was neither accompanied by the increase of IL-2 receptorpositive cell ratio in peripheral blood lymphocytes nor enhancement of IL-2-induced proliferation of lymphocytes. Administration of IL-1β increased LAK activity of the patients, despite the fact that IL-1β did not increase LAK activity in vitro. The result suggests that IL-1β-stimulated LAK activity may be mediated by the induction of some cytokines in the patients. We conclude that IL-1 may bring some benefits to patients with urological cancer whose bone marrow are suppressed by chemotherapy or irradiation, and that combination of IL-1 and IL-2 may be effective by their synergistic anti-tumor activities in the treatment of urological malignancies.
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  • Katsuya Nonomura, Akira Kashiwagi, Kazuyuki Maeno, Satoshi Nagamori, Y ...
    1991 Volume 82 Issue 8 Pages 1218-1226
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    In the last decade, many continent urinary diversions have been developed for the cystectomized patients. Mainz pouch, which seems to be a sophisticated one without using an alloplastic prosthesis, was adopted in our clinic. We preliminarily report our result in 11 patients who underwent a Mainz pouch procedure in the last 2 years: 1 for bladder augmentation, 5 for total bladder substitution after cystoprostatectomy and 5 (including 2 females) for continent urinary diversion. The mean age of them was 54 years old and the follow up periods ranged from 6 to 24 months.
    The antimesenteric longitudinal incision of the ileum and cecum and their sutures were performed similarly to the usual detubularized intestinal pouch. The ureteral reimplantation to the colonic segment was accomplished by the submucosal tunnel method. Although the ureteral hiatus was initially positioned at the anal edge of the colon, a new hiatal creation by stabbing the more oral portion of the colon according to the Goodwin's ureterocolic anastomosis was subsequently employed to avoid the trouble of closure of this portion. When the urethral anastomosis was archieved by 4-5 interrupted sutures between the most dependent portion of the cecum and the urethral stump after cystoprostatectomy, the mucosa was everted to the colonic serosa to provent the stricture. The continent stoma was created by an intussusception of the proximal ileum, which was stabilized by the seromuscular stripping and 2-3 rows of external metal staples.
    Complication of the alimentary system occurred in 6 of 11 cases (55%), though they were successfully treated by an appropriate conservative management except one who suffered an ileostomy and nephrostomy because of severe panperitonitis. There was no trouble in the ureteral reimplantation. In 3 of 5 cases (60%), the transurethral resection of the portion of ceco-urethral anastomosis was required for voiding or urethral catheterization. In 5 cases with an abdominal stoma for continent diversion, the revision of the stoma location was archieved in only one case because of the catheterization difficulty. The high capcity and low pressure pouch (around 350ml and below 20cmH2O, respectively, at 3 months after operation) were obtained and urinary continent mechanism was preserved in all cases expect one with subsequent nephrostomy.
    In this initial series, 10 patients were finally continent and there is no evidence of tumor recurrence and metastasis in patients with urotherial malignancy.
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  • Toshikazu Okaneya, Shinsuke Ikado, Akimi Ogawa
    1991 Volume 82 Issue 8 Pages 1227-1232
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Forty patients with carcinoma in situ of the bladder were reviewed. They included 15 patients with primary carcinoma in situ, 8 with secondary carcinoma in situ and 17 with concurrent carcinoma in situ. Twenty-one (66%) of 32 patients with primary or concurrent carcinoma in situ complained of urinary frequency and pain on urination, whereas no patients with secondary carcinoma in situ complained of such symptoms. Nearly all patients with concurrent or secondary carcinoma in situ had gross hematuria, whereas only 7 (47%) of 15 patients with primary carcinoma in situ had gross hematuria. Two patients without any symptoms were diagnosed by incidental positive urinary cytology. Concurrent carcinoma in situ was always associated with multiple papillary tumor. Dominant grade of the papillary tumor was classified as grade 3 in 11 patients and as grade 2 in 6. The simultaneous presence of carcinoma in situ of the urethra was found in 13 (46%) patients and those of the ureter in 17 (74%). Fourteen patients (35%) with carcinoma in situ developed an invasive carcinoma. Of these, 4 (10%) died of cancer. Bacillus calmette-guerin instillation was effective in 13 of 15 patients (87%). These results indicate that carcinoma in situ of the bladder may develop an invasive cancer, may remain in the epithelia, or may be associated with multiple superficial tumor. It should be emphasized that patients with multiple superficial bladder tumor may be associated with carcinoma in situ even if the superficial tumors are of low grade and urine cytology is negative.
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  • Yuji Oyabu, Tsukasa Mihara, Nobuyuki Yoshitake, Shogo Ueda, Kei Matsuo ...
    1991 Volume 82 Issue 8 Pages 1233-1240
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Seventy-eight patients with testicular tumors were treated in our clinic between April, 1972 and October, 1990.
    The average age of patients with seminoma (37.5yrs) was higher than that (24.5yrs) of those with non-seminomatous germ cell tumor (NSGCT). Histopathologically, 34 patients had seminoma and 36 patients had NSGCT. The remaining 8 patients had non-germinal cell tumors.
    The 5-year survival rate was 76.7%, 90.3% and 75.8% for all patients, seminoma group and NSGCT group, respectively. As for seminoma group, the 5-year survival rate was 100%, 50.0% and 33.3% for Stage I, Stage IIb and Stage III, respectively. The survival rate of Stage IIb and Stage III in seminoma group were lower than Stage I statistically. In NSGCT group, the 5-year survival rate was 100% for Stage I and 26.7% for Stage III, between the two groups there was significant difference.
    The higher serum LDH and HCG levels, the lower the survival rate in NSGCT. Serum AFP, β-HCG levels and ESR were unrelated to the survival rate.
    The survival rate for the patients treated by the chemotherapy including CDDP was compared to those treated by the other therapy in germ cell tumor (≥Stage IIb). The survival rate of CDDP group was higher than the others (p<0.01).
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  • Shinya Kobayashi
    1991 Volume 82 Issue 8 Pages 1241-1249
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Radioligand binding assay and receptor autoradiography were undertaken to characterize α1-adrenoceptors and to clarify their localization in human prostate.
    Eleven open prostatectomy specimens obtained from patients with benign prostatic hypertrophy were used for radioligand binding assay. The binding of [3H]-prazosin to prostatic crude membrane fraction was a saturable process of high affinity. Scatchard analysis of the specific [3H]-prazosin binding indicated the existence of a single population of receptor sites with an equilibrium dissociation constant of 1.00±0.19nM (mean±SE) and a maximum binding capacity of 20.8±3.56fmol/mg protein (mean±SE). α-Adrenergic antagonists competed for [3H]-prazosin binding in an order of potency: prazosin≥bunazosin>phentolamine>yohimbine, suggesting that the binding sites for [3H]-prazosin have characteristics of α1-adrenoceptors.
    To study the distribution of α1-adrenoceptors in prostatic tissues obtained from total cystoprostatectomy specimens of six male bladder tumor patients, we used for autoradiography (±)-β([125I]Iodo-4-hydroxyphenyl)-ethyl-aminomethyl-tetralone ([125I]-HEAT). Peripheral zone (PZ), central zone (CZ) and preprostatic region were dissected from the tissues and incubated with [125I]-HEAT, followed by an autoradiographic procedure. Distribution of α1-adrenoceptors was quantitated by grain counting using a light microscope equipped with a micrometer. The specific binding sites for [125I]-HEAT were demonstrated predominantly in the fibromuscular stroma of CZ, that of PZ, preprostatic sphincter and subordinately in the glandular epithelium of CZ, but not in the glandular epithelium of PZ and periurethral glands. In the fibromuscular portion, the specific binding sites in both CZ and the preprostatic sphincter were significantly higher than in PZ. The specific binding sites in the glandular epithelium of CZ were significantly less than those in the fibromuscular stroma of PZ. These results show that the human prostate has a zonal difference in the distribution of α1-adrenoceptors, probably reflecting functional difference in these regions.
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  • Soichiro Hasegawa, Kanefusa Kato, Munehisa Takashi, Yuanyuan Zhu, Keii ...
    1991 Volume 82 Issue 8 Pages 1250-1255
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    In order to demonstrate that the extracorporeal shockwave lithotripsy (ESWL) for urolithiasis causes a renal damage, we immunoassayed S100a0 protein and creatine kinase isozymes (CK-B & CK-M) in the serum and urine from patients with renal stone (N=21) and those with ureteral stone (N=18) before and after ESWL. S100a0 protein and CK-B, which are localized in the proximal renal tubules at relatively high concentrations, were enhanced more or less both in the urine and serum samples after the treatment in both groups of patients. Since CK-M, which is mainly localized in muscle tissue, also increased in both groups of patients, S100a0 protein and CK-B may be derived not only from kidney, but also from muscle tissues.
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  • Atsumi Hanawa
    1991 Volume 82 Issue 8 Pages 1256-1264
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The effects of prostaglandin (PG) E1, E2 and F2α on isolated smooth muscles of rabbit bladder and urethra were studied by in vitro techniques for recording contractile activities. To examine the mechanism of PGs' effect, intracellular cyclic AMP content was also measured by radioimmunoassay.
    Spontaneous contractile force of muscle strips isolated from rabbit urinary bladder dome and base was increased dose-dependently by administration of PGE1, E2 or F2α. Isolated muscle strips from bladder dome responded to PG more markedly than those from bladder base. The rank order of potency to induce contractile responses was PGF2α>PGE2>PGE1 in both dome and base muscles.
    Spontaneous contractile force of muscle strips isolated from rabbit urethra was increased dose-dependently by administration of PGF2α, and, in contrast, was decreased dose-dependently by PGE1 or E2.
    These effects were not affected by pretreatment with atropine, phentolamine, propranolol and tetrodotoxin, but were significantly inhibited by pretreatment with verapamil, a Ca-antagonist. Cyclic AMP accumulation in urethral muscle strips significantly increased after administration of PGE1.
    These results demonstrated that contractile response of rabbit bladder smooth muscle to PG was mainly induced by Ca2+ influx and that cyclic AMP was related to the relaxation of rabbit urethral smooth muscle by PGE1.
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  • Kazuyuki Maeno, Yuichiro Shinno, Katsuya Nonomura, Tomohiko Koyanagi
    1991 Volume 82 Issue 8 Pages 1265-1272
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    For assessing the long-term outcome of patients after transurethral prostatic resection (TUR-P), telephone interview in terms of the urinary symptom and the sexual function was conducted on 191 cases who underwent TUR-P in Hokkaido University Hospital from 1982 to 1988. Adequate replies were obtained from 137 patients (71.7%), whose mean age was 70.2 years old and mean follow up period was 4.8 years.
    Subjective urinary symptoms, which are mainly classified as dysuria, frequency and incontinence, were improved in 114/120 (95.0%), 99/108 (91.7%), and 20/21 (95.2%) respectively. Overall symptom-free rates of dysuria, frequency, and incontinence were 85.1% (114/134), 86.6% (116/134), and 90.3% (121/134). Morbidity of incontinence following TUR-P was only 6/134 (4.5%). There was one deaths (0.7%) at 2 weeks after TUR-P, but was not attributable to the operative procedure itself. Although 82 cases (59.9%) had risk factors such as the cardiovascular disease, malignancy or other systemic disorders, they did not jeopardize the postoperative course nor were attributed to the mortality. Uninhibited contraction and/or vesical denervation supersensibility on perioperative cystometrogram were found in 53/84 (63%). These urodynamic abnormalities were not considered to be postoperative urinary symptoms. Postoperatively, the decrease in libido was noted in 12/63 (19%), but its causal relation to the procedure was obscure in most of the patients.
    We believe TUR-P can offer a satisfactory outcome in the majority of the patients with minimum risk.
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  • Hirotsugu Uemura, Seiichiro Ozono, Yoshiki Hayashi, Yoshihiko Hirao, E ...
    1991 Volume 82 Issue 8 Pages 1273-1280
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    During the 5 years from January, 1985 to December, 1989, 88 patients with transitional cell carcinoma of the renal pelvis and/or ureter were operated curatively in the Department of Urology, Nara Medical University and the affiliated hospitals. There were 66 males and 22 females (3:1) and the mean age was 66.0 years old ranging from 34 to 82. Staging of the renal pelvic and ureteral cancer of each patient was determined by General Rule for Clinical and Pathological Studies on Renal Pelvic and Ureteral Cancer established jointly by Japanese Urological Association and The Japanese Society of Pathology in 1990. The over-all survival rates at 1 and 3 years were 91.2% and 74.0%, respectively. The 3 year survival rates of TS and TE were 80.5% and 41.7%. As for grading, the 3-year survival rates were 75.0% for G1, 70.1% for G2, and 75.2% for G3, respectively. The stage of the tumors affected the prognosis. Of 88 patients 26 (Group 1) received cisplatin based combination chemotherapy as a postoperative adjuvant therapy, and the remaining 62 (Group 2) received no such cytotoxic adjuvant chemotherapy. The 3-year survival rates were 63.3% in Group 1 and 78.9% in Group 2, however mean age of Group 1 was significantly younger than that of Group 2. In spite of the age matched trial, there were no significant differences in survival rates between both groups. Adverse effects of cisplatin based combination chemotherapy included gastrointestinal symptom, fatigue, alopecia and leukopenia, however no serious toxicity was seen. These results suggest that prospective randomized trial would be clarified the efficacy of postoperative adjuvant chemotherapy for patients with renal pelvic and/or ureteral cancer.
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  • Hiroomi Nakatsu, Motoyuki Masai, Tatsuya Okano, Shigeo Isaka, Jun Shim ...
    1991 Volume 82 Issue 8 Pages 1281-1285
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Urinary cytological examination was performed on 1032 patients of urolithiasis at the Department of Urology, Chiba University Hospital between 1980 and 1990. Seven hundred twenty-four were male and 308 were female, and the mean age was 44 years. The results of cytological examination of I-II and IV-V were classified as negative and positive, respectively. Eleven patients (1.1%) were positive, 2 of whom were found to be with renal pelvic tumor. False-positive findings were noticed in 9 cases (0.9%), and the abnormal cytologic changes in these cases disappeared after the calculi were removed. In negative cytological cases, 2 cases of renal pelvic tumor were found, one at nephrectomy and the other at percutaneous nephrolithotripsy. These cases were with staghorn calcli with hydronephrosis. The significance of cytological examination in management of calculous diseases were discussed.
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  • Akira Ishikawa, Michiko Sakaguchi, Masaru Nakano, Tomomi Ushiyama, Nob ...
    1991 Volume 82 Issue 8 Pages 1286-1291
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    To elucidate the relationship between Cyclosporine (Cs) induced nephrotoxicity and juxtaglomerular (JG) apparatus, we carried out biochemical and morphological experiments using mice.
    Adult male ICR strain mice weighing about 40g were used. The mice were divided into 2 groups: the Cs group (Cs 50mg/kg/day was orally given for 14 consecutive days) and the control group (olive oil for 14 days). Urine was stored for 24 hours on the day 0, 7 and 14 and urine volume and concentrations of urinary creatinine (u-Cr) and urinary potassium (u-K) were measured in each group. All the mice were sacrificed and examined on the 15th day. Concentrations of serum creatinine (s-Cr), serum potassium (s-K), plasma renin activity (PRA), plasma aldosterone (Ald) were noted in each group. The kidneys were also examined histologically with light and electron microscopes.
    The Cs group showed significant increases of s-K, PRA and Ald and a significant decrease of creatinine clearance compared with the control group. Histologically, the Cs group demonstrated focal vacuolar changes in the proximal tubular cells and an increase in the number of granules in the JG cells.
    Each granule of the Cs group was larger than that of the control group.
    Cs certainly stimulates the renin-angiotensin-aldosterone system and causes consequently a secondary aldosteronism.
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  • Satoru Takahashi, Nobuo Moriyama, Yukio Homma, Eiji Higashihara, Yoshi ...
    1991 Volume 82 Issue 8 Pages 1292-1298
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    It has been known that α1-adrenoceptors play an important role in urethral contraction. The incompetence of the urethral contraction is a cause of stress incontinence. We studied the urodynamic effects of a selective α1-adrenoceptor agonist (midodrine hydrochloride) on the bladder and urethra of female dogs. Under anesthesia with intravenous chloralose, four doses (0.03, 0.1, 0.3 and 1.0mg/kg) of midodrine were administered intravenously and urodynamic studies including cystometry, urethral pressure profilometry and electromyography (EMG) of the external urethral sphincter were performed. The administration of midodrine induced a significant increase of the maximum closing pressure in the proximal portion of the urethra (p<0.05 at 0.03mg/kg and p<0.01 at 0.1, 0.3, 1.0mg/kg). There were no significant changes in the functional profile length, the closing pressure at the external sphincters, the maximum bladder pressure, bladder capacity and bladder compliance. The administration of 0.3mg/kg or more of midodrine produced a significant increase in the mean arterial blood pressure. After midodrine administration, transient increases in the external sphincter EMG activities were recognized. The activities showed the synergistic pattern during the bladder contractions.
    In conclusion, lower dose administration of a selective α1-adrenoceptor agonist (midodrine) specifically produced an increase of the closing pressure in the proximal portion of the urethra without affecting blood pressure. These results suggest that midodrine is useful for the treatment of stress incontinence in humans.
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  • Masao Ando, Hideki Nagamatsu, Akiko Tanizawa, Hiroyuki Oshima, Kentaro ...
    1991 Volume 82 Issue 8 Pages 1299-1304
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Urinary incontinence among institutionalyzed elderly were analyzed from clinical and social viewpoints.
    The patient group included 25 males and 107 females with an average age of 78 years (ranged from 66 to 92). They had neither highly impaired performance status nor severe dementia. Forty-nine of them (37%) underwent urological examination. Urge incontinence was common among male patients, while urge, stress or mixed incontinence were prevalent in female patients. Thirty-six per cent of the patients had to use pads, diapers and others for their incontinence, while other needed no special protection for their incontinence. Incontinence caused limitation of social activity in 30% of the patients.
    Many causal factors were assumed for incontinence in elderly; weakness of the pelvic muscles, urinary tract infection, cerebrovascular disorders, neurological disorders and prior pelvic surgery. Prostatic carcinoma or urethral stricture caused overflow incontinence in a few patients. Diuretics or tranquilizers appeared to lead incontinence in some patients. Nine of 18 patients undergoing cystometry had overactive detrusor.
    Majority of the incontinent elderly showed no intention to visit clinics. Therefore, it recommended to keep staffs in elderly institutions as well as elderly themselves informed that incontinence in the elderly should be treated, which in turn improves the quality of life.
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  • Wataru Sakamoto, Taketoshi Kishimoto, Tatsuya Nakatani, Manabu Kouno, ...
    1991 Volume 82 Issue 8 Pages 1305-1308
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A 74-year-old male was urgently admitted to our hospital because of consciousness disturbance. Laboratory data showed remarkable hypercalcemia (7.8mEq/L), hypophosphatemia, low % TRP, low intact PTH level, normal nephrogenic cyclic AMP and normal 1, 25 (OH)2D level. Serum bone Gla protein, which was thought to express osteoblastic activity, was low. Serum tartarate resistant acid phosphatase and urinary excretion of hydroxyploline, which were thought to express osteoclastic activity, were high. CT scan showed an enlarged mass in the left renal pelvis, which was found to be a squamous cell carcinoma (SCC) by biopsy through percutaneous nephroscopy. Bone scintigram appeared normal. Therefore, we diagnosed it as renal pelvic SCC with humoral hypercalcemia of malignancy (HHM) and performed left nephrectomy. After nephrectomy, serum calcium returned to normal. But after a few weeks, lung metastasis appeared and serum calcium was reelevated. As to PTH related protein (PTHrP) which was thought to induce HHM, PTHrP content of the resected tumor measured by RIA assay was 13pmol/g wet weight of tissue, which suggested that this tumor might have been producing PTHrP.
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  • Osamu Muraishi, Akimi Ogawa, Haruaki Kato, Noboru Okada
    1991 Volume 82 Issue 8 Pages 1309-1312
    Published: August 20, 1991
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    In two female patients with severe radiation cystitis, aged 69 and 62 years, the bladder was augmented by an operationally resected segment of the gastric body. The segment, which was vascularized by the right gastroepiploic vessels, was anastomosed to the dome of the bladder. Both ureters were implanted to the gastric segment in one patient. Convalescence was uneventful. No gastric or urinary complication developed. Eight and two months postoperatively both patients were continent of urine and able to urinate satisfactorily. We believe that a gastric segment is a suitable alternative to an intestinal segment in reconstructing the urinary tract.
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