The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
Volume 85 , Issue 11
Showing 1-16 articles out of 16 articles from the selected issue
  • Yoichi Arai
    1994 Volume 85 Issue 11 Pages 1575-1592
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
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  • Syuu Nabeshima, Motoyuki Masai, Jun Shimazaki, Haruo Ito
    1994 Volume 85 Issue 11 Pages 1593-1600
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Factors influencing the growth of renal calculi were examined. In order to calculate the volume of stone on X-ray film, stones obtained from open operation or spontaneous passage were measured long (a) and short (b) diameter, and equation to obtain stone volume was assumed. Stone volume=0.43 (πab (a+b))/12+0.04 was the mostly related to the volume measured by water volume, when size was less than 2cm in diameter.
    Using the equation, factors influencing the growth of renal calculi of 136 kidney, which were followed over 6 months, were studied with monovariate analysis. Of the 136 kidneys, 36 have calcium oxalete stones, 54 have mixed stones with calcium oxalate and calcium phosphate, 3 have mixed stones with calcium oxalate and uric acid, and other 43 have stones with unknown composition. Uric acid stones, cystine stones and infectious stones were excluded in the study.
    Growth of stone was greater in male than in female. Pelvic stones grew rapidly than renal caliceal stones.
    The patients were divided into two groups by growth rate; non growing (<10%/year), and growing group (>10%/year), respectively. Excretion of urinary calcium was high in the growing group. Urinary magnesium/calcium was low in the growing group.
    When divided into two groups by growth volume; non growing (<0.005cm3/year), and growing group (>0.005cm3/year), respectively, excretion of urinary calcium was high in the growing group and urinary magnesium/calcium was low in the growing group.
    It was concluded that risk factor of stone growth were male, renal pelvic stone, high output of urinary calcium and low value of urinary magnesium/calcium as far as stones less than 2cm in diameter.
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  • Akihiko Yamasaki
    1994 Volume 85 Issue 11 Pages 1601-1609
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    To evaluate the risk factors related to the long-term outcome of endourologic treatment of urinary calculi, data from the rates of recurrence or re-growth in 145 patients with 167 renal units who were observed for more than 3 months at the Hiroshima University Hospital, were reviewed. The factors included in the present analysis were age, previous stone, location, number, size and composition of stone and procedures of treatment. Of 167 renal units, the overall recurrence and re-growth rates were 17% and 10%, respectively. The earliest recurrence and re-growth appeared at 3 months after the treatment, and 71% of recurrence and 81% of re-growth occurred within 2 years. In 9 out of 20 renal units (45%) with unsuccessful treatment, residual stones enlarged during the follow-up. Stone located in renal calyx and pelvis, previous stone, multiple stones, size of stone more than 20mm, stone composed of calcium oxalate and/or calcium phosphate and struvite stone were likely to be risk factors. However, on the univariate analysis there were no significance of difference among these variables. On the results of analysis by Cox's proportional hazards model, characteristics such as stone located in renal calyx and pelvis, size of stone more than 20mm (p<0.01), treatment with percutaneous nephrolithotripsy (PNL), previous stone, size of stone between 10mm and 20mm, and multiple stones (p<0.05), were significantly related to either recurrence or re-growth of stone. Four variables, stone located in renal calyx and pelvis, previous stone, upper ureteral and UPJ stone, and size of stone between 10mm and 20mm, were entered by stepwise selection, resulting that the last one was an inhibitory factor and the others were promoting factors. Logistic regression analysis also showed that previous stone, unsuccessful treatment, stone located in renal calyx and pelvis, and multiple stones were significantly related to either recurrence or re-growth (p<0.05). Results obtained by the stepwise selection demonstrated that 3 variables, previous stone, treatment with PNL and unsuccessful treatment, were promoting factors and one variable, age more than 61-year-old, was an inhibitory factor. On the prediction of recurrence or re-growth using above 4 variables, the correct diagnosis was 67.0%. Both analyses by Cox's proportional hazards model and logistic regression analysis indicated that characteristics such as previous stone, stone located in renal calyx and pelvis, and multiple stones were significantly correlated with recurrence or re-growth of stone. In these variables, previous stone was the most important risk factor. These results indicate that periodical checkup including a preventive procedures is mandatory in a high risk patient. In addition, thorough fragmentation of stones and complete removal of fragments, combined with ESWL and chemolysis, if needed, is ultimately responsible for successful treatment of urinary calculi.
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  • Kiyoshi Hirasawa, Yukio Homma, Masaya Oshi, Eiji Higashihara, Kazuki K ...
    1994 Volume 85 Issue 11 Pages 1610-1615
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A chronological analysis of the clinical features and treatments of advanced prostatic cancer, stages C and D, was performed in 154 cases treated from 1976 through 1991. These cases were divided into two chronological groups: 61 cases treated between 1976 and 1983, and 93 cases between 1984 and 1991.
    Concerning demographic features and diagnosis, the number of patients with lymphnode metastasis was higher in the latter group. There was also increase in cases who were urologically asymptomatic and detected by checkup digital rectal examination or by the elevation of serum prostatic tumor markers. Histopathological differentiation was consistent between the two groups; more than 70% of cancers were moderately and poorly differentiated adenocarcinoma. As for the treatment, total prostatectomy was performed in eight cases in the latter against none in the earlier, but hormonal therapy remained the main treatment throughout the periods: 74.2% in the earlier and 70.7% in the latter. However the methods of the therapy have clearly changed; estorogens and castration were used less often in the latter period, while LH-RH analogues and antiandrogens replaced them although the therapy was equally effective in 82.3% of the cases in the earlier and in 90.4% in the later period and five-year survival rate and the progression-free survival rate at three years showed no significant difference between the two periods.
    These results showed 1) refined quality of diagnosis 2) a change in mode of hormonal therapy and 3) no detectable improvement of survival in these 16 years. Development of more effective therapies would be warranted for a better survival.
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  • Takumi Yamada, Hitoshi Masuda, Katsushi Nagahama, Gaku Arai, Tetsuro T ...
    1994 Volume 85 Issue 11 Pages 1616-1621
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Operative results of ileal neobladder by the Hautmann procedure were studied in the patients with bladder cancer.
    From 1990 to 1993, 23 patients underwent total cystoprostatectomy for transitional cell carcinomas of the bladder. In 12 of these patients, an ileal neobladder was constructed for total bladder replacement under the following criteria; patients 1) with cancer confined in the bladder (T3b, M0, N0 or less), 20 without carcinoma in situ extending to more than half of urothelium of the bladder, 3) without cancerous lesion in the bladder neck or the prostatic urethra, 4) with performance status of 0 and the age of 75 or less. Pathologically, the disease was grade 2 in 3 patients, grade 3 in 9, stage pT1b in 3, stage pT2 in 4, stage pT3a in 1 and stage pT3b in 4. Two of 3 patients with the disease of stage pT1b had multiple papillary tumors. The remaining one patient had microinvasive cancer that carcinoma in situ infiltrated into submucosal area. Radical cystoprostatectomy and total bladder replacement by Hautmann procedure was performed in all patients.
    The maximum neobladder capacity was 349.5±58.1ml (mean±SD). The intravesical pressure at maximum capacity was 30.6±6.2cmH2O. At half maximum capacity, the intravesical pressure was 17.1±6.8cmH2O. the maximum urethral closure pressure and the functional urethral length were 89.2±38.1cmH2O and 25.5±7.0mm, respectively. One patient had stress urinary incontinence. Slight nocturnal incontinence was found in 2 patients and nocturia was 1.86±0.55 times. The maximum and mean urinary flow rate were 18.17±8.74ml/sec and 7.84±5.48ml/sec., respectively. Of 2 patients who died of cancer, the one had pelvic recurrence and the other had lung and brain metastases. The survival interval of survivor was 18.1±9.6 months. Urethral recurrence, vesicoureteral reflux and/or deterioration of the upper urinary tract have been found in none of the patients.
    Good operative results were achieved by the Hautmann ileal neobladder in the patients with bladder cancer.
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  • Noriaki Masui, Kazuo Kumano, Setsuo Mashimo, Tadao Endo
    1994 Volume 85 Issue 11 Pages 1622-1628
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Endothelin (ET) has been suggested to be involved in acute graft rejection of kidney transplantation and cyclosporin A (CsA) nephrotoxicity. For clarification of the patho-physiological role of ET in the early post-transplantation period, plasma endothelin-1 (ET-1) was measured by specific radioimmunoassay in renal transplant recipients, patients on maintenance hemodialysis (HD) and healthy volunteers.
    Twelve transplant recipients were used in this study, 8 of whom were living related subjects and 4 cadaver. Plasma ET-1 and graft function were measured each day, from 1 day prior and 7 days following transplantation and every week up to 5 weeks postoperatively. Plasma ET was measured in 20 other transplant recipients with stable function (serum creatinine≤1.8mg/dl), 20 maintenance HD patients with no residual renal function and 6 healthy volunteers.
    Mean plasma ET-1 was 13.0±4.5pg/ml in 20 recipients with stable graft function, 21.7±6.5 in 20 HD patients and 1.5±0.4 in healthy volunteers. These differences are statistically significant (p<0.02). Plasma ET-1 showed significant dectrease from 21.8±7.2pg/ml prior to transplantation to 12.8±4.0 when urinary output reached more than 1000ml in living and cadaveric transplantation subjects. All three acute vascular rejections clearly indicated histologically increased plasma ET-1 accompanied by an increase in serum creatinine. A significant positive liner correlation was noted between plasma ET-1 and serum creatinine during the first week following living transplantation. Two patients with clinically and histologically suspected CsA nephrotoxicity showed transient increase in plasma ET-1. These results suggest that ET-1 may be importantly related to the pathogeneiss of post-transplant vascular complications such as CsA nephrotoxicity and vascular rejection.
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  • Shunji Nishio, Satoshi Hamada, Shinji Nabeshima, Masayoshi Yokoyama, M ...
    1994 Volume 85 Issue 11 Pages 1629-1635
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We performed percutaneous endopyeloplasty on 20 patients between February, 1988 and July, 1993. Eighteen patients had primary and two had secondary ureteropelvic junction (UPJ) obstructions. There were 15 female and 5 male patients, whose ages ranged from 14 to 77, with an average of 43.6. The length of the follow-up after pyeloplasty ranged from 4 to 69 months with an average of 28.7 months. Among the 20 patients, there were 4 high insertion type cases, a bifid renal pelvis in one case and one case combined with a renal stone Incisions were made with a hook-shaped cold knife and Ono's transplevic extraureteral approach was used in most patients. Catheters were placed at the upper and the lower of renal pelvis in the patient with a bifid renal pelvis. In the case with a renal stone, pyeloplasty was successively performed after percutaneous nephrolithotomy in a single session. An endopyelotomy stent (14 Fr) was indwelled for 6 weeks in all patients except one.
    All patients had a low grade fever and abdominal pain for a few days after their operations, but there were no major complications. In nineteen patients (95%), the symptoms improved and their obstructive patterns disappeared or improved during follow-up. Complete ureteral stricture was found in one case at the removal of the stent and open pyeloplasty was performed.
    Percutaneous endopyeloplasty is a safe and useful technique, but further evaluation and/or better techniques are needed for avoiding recurrence of obstruction.
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  • Yukiko Nishijima, Kenkichi Koiso, Ryosuke Nemoto
    1994 Volume 85 Issue 11 Pages 1636-1642
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The biology of skeletal metastasis is poorly understood. In order to establish an animal model of spinal bone metastasis, we injected MBT-2 tumor cells into the tail vein of C3H/He mice while the inferior vena cava was occluded. By this technique, the tumor cells were transferred into the vertebral plexus. Spinal lesions developped in 12 of 15 (80%) experimental mice and in none of the control mice. All bone lesions resulted in local bone destruction. The predominant site of bone metastasis was lumbarvertebrae; other affected sites were thrpelvis and coccyges. This model should be of value in understanding the pathogenesis of spinalbone metastasis and in studying the effects of various agents on the prevention and control of spinal lesions.
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  • Masato Tamura, Susumu Kagawa, Kazunori Kimura, Yasuo Kawanishi, Yoshih ...
    1994 Volume 85 Issue 11 Pages 1643-1648
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Recently, nitric oxide (NO) has been thought to be a neuronal messenger to evoke penile erection. NO synthase (NOS)-containing nerve fibers were identified and localized in human penile tissue, but detail distribution of NOS-containing nerve fibers in the human penis was unclear. In the present study we examined their distribution using histochemisal staining of NADPH diaphorase (ND), which is a specific marker of neuronal NOS.
    In the crura penis some various sizes of ND-positive nerve bundles were observed in the cavernous spaces. In the penile shaft large bundles (>50μm) decreased in number and were observed only near deep artery. There were abundant ND-positive nerve terminals with fine varicosity innervating both corpus cavernous smooth muscles and deep, dorsal and helicine arteries. In the wall of deep dorsal vein there were also many groups of ND-positive fibers. Endothelium of deep artery and its large branches was clearly ND-positive, but parts of endothelium of deep dorsal vein or corpus cavernous sinus were only faintly stained. Some of the dorsal penile nerve fibers were ND-positive. In corpus spongiosum many ND-positive nerve fibers were observed and urethelium was clearly ND-positive.
    In conclusion, NO may have an important role in the function of both corpus cavernosum and corpus spongiosum because NOS-containing nerve fibers were widely distributed in both cavernous tissues.
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  • Junro Muraki, Akihiko Tokue, Masaaki Nakazono
    1994 Volume 85 Issue 11 Pages 1649-1655
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Tumor infiltrating lymphocyte (TIL) is commonly observed in renal cell carcinoma (RCC) tissues. First step of lymphocyte accumulation in cancerous tissues is the lymphocyte migration toward cancer cells. However, no conclusion has been drawn which cytokine is involved in TIL of RCC. The purpose of this study is the identification of a lymphocyte chemotactic factor (chemokine) produced by a newly established RCC cell line.
    A new human renal cancer cell line (TC-2) was established from a primary site of a 52-year-old man. A marked lymphocyte infiltration was noticed at the cancer tissue. A tissue culture has been continued for 24 months. Flow cytometric analysis of this cell line revealed DNA aneuploidy. A human karyotype, with a modal number of 72, and consistent abnormalities, such as 4q+ and 5q-, were demonstrated by Giemsa banding analysis.
    Approximately 2.9 fold of lymphocyte chemotactic activity was detected in the culture supernatant of TC-2 cells (TC-2CM) as measured by in vitro migration assay. Sixty percent of this activity was abrogated by adding the neutralizing antibody against interleukin-8 (IL-8) into TC-2CM. Analysis of surface markers of migrating lymphocytes disclosed that lymphocytes expressing CD3, CD8 and CD16 phenotype predominantly showed migration. These results suggested that chemotactic activity for lymphocytes derived from TC-2 cells was partly IL-8.
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  • Kenji Watanabe, Akimi Ogawa, Mari Kiyono, Takehisa Yoneyama, Osamu Mur ...
    1994 Volume 85 Issue 11 Pages 1656-1663
    Published: November 20, 1994
    Released: November 29, 2010
    JOURNALS FREE ACCESS
    We reviewed 17 patients who had first undergone one-stage hypospadias repair. According to the criteria proposed by Keating and Duckett, the operative procedure performed was the MAGPI procedure in 2 patients, the pyramid procedure in 2, the Mathieu procedure in 1, the onlay island flap procedure in 6, the transverse preputial island flap and glans channel procedure (Duckett) in 4 and a combined method using the buccal and bladder mucosa graft in 2. The age of the patients ranged from 11 months to 22 years (median age 3.2 years). Postoperative follow-up ranged from 3 to 30 months (mean 7 months). Postoperative complications requiring revision occurred in 4 patients; urethrocutaneous fistula developed in 1 patient with the onlay island flap, urethral strcuture at the anastomosis and meatus in 1 patient with the transverse preputial island flap, meatal retraction in 1 patient with the mucosal graft, and urethral stricture at the distal anastomosis and bladder stone in the other patient with the mucosal graft. These complications were successfully revised by simple operations. Ventral skin tethering caused by scar contracture developed in 2 patients with the preputial island flap, and spontaneously improved with time in 1 patient. These results indicate that the criteria proposed by Keating and Duckett is proper to select an operative procedure for hypospadias.
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  • Tetsuro Onishi, Yukihiko Ohishi, Fujio Masuda, Norio Iizuka, Yasuyuki ...
    1994 Volume 85 Issue 11 Pages 1664-1672
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We studied on prognostic factors in 106 patients with stage 4B renal cell carcinoma having distant metastases at the diagnosis. In this study, we excluded patients who died after nephrectomy within 30 days and those who died without cancer. As the result, significant differences were observed upon the 8 factors in those patients as summarized bellow:
    1) The histological malignancy (grade): there observed an improved survival in patients with grade II compared to those with grade III and IV.
    2) The opportunity of diagnosis: we classified the patients into 4 types: patients with urinary symptoms, those with non-urinary symptoms, those with metastatic symptoms and those with tumours found incidentally. There observed an improved survival in patients with tumours found incidentally compared to those with urinary symptoms and non-urinary symptoms.
    3) The number of 5 laboratory findings such as anaemia, positive reaction of C-reactive protein (CRP), elevation of erythrocyte sedimentation rate (ESR), elevation of alpha 2-globulin and immunosuppressive acidic protein (TAP): there observed an improved survival in patients with less than 2 abnormal laboratory findings compared to those with more than 3.
    4) The regional lymph node metastasis: there observed an improved survival in patients without lymph node metastasis compared to those with lymph node metastasis.
    5) The number of metastatic organ: there observed an improved survival in patients with one organ metastasis compared to those with more than two.
    6) The treatment modality: there observd an improved survival in patients receiving interferon (IFN) therapy/IFN plus chemotherapy than those receiving chemotherapy alone.
    7) Preoperative renal embolization: there observed an improved survival in patients receiving embolization compared to those who did not receive embolization.
    8) Operative treatment for metastatic regions: although the number of patients who underwent the resection of metastasis was limited, there observed an improved survival in patients who underwent the resection of metastasis compared to those who did not undergo the operation.
    We conclude that the above mentioned 8 factors concerning tumour, patients (host) and the modality of treatment are very important for understanding the survival of patients with stage 4B renal cell carcinoma following nephrectomy. Furthermore, it is needed to establish a more effective treatment modality for these patients.
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  • Shinichi Ohshima, Tamio Fujita, Yoshinari Ono, Norio Katoh, Osamu Mats ...
    1994 Volume 85 Issue 11 Pages 1673-1678
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The results have been reviewed of 41 patients with end stage polycystic kidney disease on maintenance hemodialysis. The patients ranged in age from 34 to 83 years with an average age of 55 years and 25 patients were male, 16 were female. The duration of maintenance hemodialysis in the patients was from 1 to 200 months with an average time of 69 months.
    Infection of the cysts and pyelonephitis occurred 22 times in 13 patients (32%) and hemorrhage into the cysts occurred 15 times in 13 patients (32%). To control the infection, bilateral nephrectomy was required in 10 patients and 1 patient was undergone unilateral nephrectomy. Of 13 patients with the hemorrhagic cysts, 5 were undergone bilateral nephrectomy and 2 were undergone unilateral nephrectomy. Six patients died during follow up and the cause of death were 1) cardiac failure, 2) cerebral hemorrhage, 3) cardiac infarction, 4) pneumonia after nephrectomy, 5) massive bleeding after second operation for adhesive ileus due to first nephrectomy, 6) unknown. Fourteen patients but one undergone bilateral nephrectomy were followed for an average time of 70 months after nephrectomy. Such as complication due to bilateral nephrectomy, anemia occurred in 13 patients (93%) and hypotension occurred in 5 patients (33%). Bilateral nephrectomy was effective procedure in safety for end stage polycystic kidney patients with the infection and the hemorrhagic cysts because anemia and hypotension which occurred usually after bilateral nephrectomy now can be controlled goodly.
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  • Shotoku Sai, Takashi Kawai, Kumiko Kato, Tatsuro Murase, Munehisa Taka ...
    1994 Volume 85 Issue 11 Pages 1679-1682
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We treated three brothers for prostate cancer. The first brother developed the disease of poorly differentiated adenocarcinoma at the age of 76, and was treated with endocrine therapy but died of recurrent cancer at age 80. The second brother was diagnosed poorly differentiated adenocarcinoma at age 75, and he is alive at age 80 without recurrence after endocrine therapy. The third brother developed moderately differentiated adenocarcinoma at age 58, and was treated with endocrine therapy but died of recurrent cancer at age 73. We have seen few familial cases of prostate cancer. The first such case is reported here in Japan. Eleven similar cases of familial prostate cancer involving three or more brothers have been reported in the Western literature.
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  • Fumihiro Kimura, Hideo Sakamoto, Syunji Shimizu, Fumio Nakajima, Hiros ...
    1994 Volume 85 Issue 11 Pages 1683-1686
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Primary transitional cell carcinoma (TCC) of the bladder occurring during pregnancy is extremely rare and only 16 patients have been reported in the literature. Patient 1: A 24-year-old primigravida at 33 weeks of gestation presented with gross hematuria. Cystoscopy revealed a large bladder tumor. After delivery TUR-Bt was performed. Because of frequent reccurences after TUR-Bt, radical cystectomy was done. Pathological study revealed transitional cell carcinoma, G1-G2, pTa.
    Patient 2: A 34-year-old gravida 11 at 6 weeks of gestation presented with gross hematuria. Cystoscopy revealed a papillary bladder tumor. TUR-Bt was performed after artificial abortion. Pathological study revealed papillary transitional cell carcinoma, G1>G2, pTa. Eighteen patients of TCC of the bladder occuring during pregnancy were reviewed. Fifteen of the 18 patients presented with gross hematuria. All patients had superficial, solitary, grade 1 or 2 papillary TCC, except one grade 3 patient. Cystoscopy should be considered in all pregnant women with gross hematuria. Small TCCs of the bladder during pregnancy can be treated safely by TUR-Bt during pregnancy or after delivery.
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  • Hiroki Sasaki, Kazuhiko Tozuka, Shinichi Hashimoto, Jun Nagai, Tsuneta ...
    1994 Volume 85 Issue 11 Pages 1687-1690
    Published: November 20, 1994
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A 34-year-old woman with tuberous sclerosis presented with an increase of an abdominal mass and intermittent left flank pain on May 20, 1991. Computed tomography showed multiple bilateral renal masses with fatty density areas and a fatty density thrombus in the inferior vena cava, which extended through the right renal vein of the right kidney on ultrasonography. The inferior vena caval thrombus was also demonstrated by magnetic resonance imaging. Since marked deterioration of the right renal function was found on renography, right radical nephrectomy with thrombectomy was performed on July 2. Microscopically all tumors were identical with angiomyolipoma. She was discharged on Jury 20 and has been followed with good renal function at the outpatient clinic for more than 2 years. Follow up CT revealed no interval changes in the left renal masses.
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