(Background) Small changes in the oxalate concentration exert a greater impact on the urinary clacium oxalate saturation than those in the calcium concentration. Urinary oxalate arises from ascorbate in 30-40% and glycolate in 50-60%. Glycolic acid plays and intermediate role in glyoxylate metabolism being involved in both its synthesis and degradation. A large variation in urinary glycolate values reported in the literature and a potential key role in calcium oxalate urolithiasis prompted us to measure accurately urinary glycolate. (Method) The ion chromatography used was a Model IC-100 lon Chromatoanalyzer (Yokokawa Electric Co., Ltd.), connected to an autosampler, Model KSST-601 (Kyowa Seimitsu Co., Ltd.). The separator column was TSK-gel IC-anion-PW (Tosoh Co., Ltd.). As the eluent, 0.01mM phthalate and, as the scavenger, 50mM dodecylbenzenesulfonic acid were used at a flow rate of 2ml/min. 24-hour urine samples were obtained from 30 normal healthy males, aged from 20 to 57 years, and 20 male Wistar-strain rats (approximately 160gm.). These samples were treated with charcoal and diluted 100-fold with distilled water for the determination of glycolate. (Results) The minimum detectable limit for glycolate was 0.41μmol/l in a standard solution, and the regression line for the standard curve from 0.4μmol/l to 2.0mmol/l glycolate had a significant correlation coefficient (In Y=0.882×In X-2.304, r=0.996, p<0.01). The intra-run coefficient of variation was 3.44%. The overall intra-run and inter-run coefficient of variation, including the sampling and dilution of urine, were 3.92% and 3.38% respectively. The recovery from the addition of a known amount of glycolate to each 10 urine samples was 100.2±7.41% (mean±S. D.). A comparison of our method with the enzymatic method yielded a significant correlation between the results (r=0.997, p<0.01). The 24-hour urinary glycolate excretion in 30 normal men was 0.205 to 1.372mmol/day (0.746±0.344mmol/day, mean±S. D.), while that in male Wistar rats was 4.868 to 7.347μmol/day (6.077±2.289μmol/day, mean±S. D.), as measured in 20 consecutive rat urine samples. (Conclusion) The urinary glycolate determination by ion chromatography is simple and not time consuming, requiring a 100-fold dilution of charcoal treated urine and 20 minutes at most for analysis. This method has been proven to be sensitive, specific and reproducible.
(Background) The impact of pelvic lymph node dissection on the survival of patients with lymph node positive bladder cancer is controversial. We analyzed the records of the bladder cancer patients treated with radical cystectomy. (Methods) Between 1976 and 1993, 84 patients with transitional cell carcinoma of the bladder were treated with radical cystectomy at Tokyo Metropolitan Komagome General Hospital. Sixteen patients (19.0%) had pathologically proved nodal metastases. These patients' records were reviewed with regard to pathological status, and the outcome compared with negative lymph node patients. The two patients with pN3, which we could not completely undergo lymph node dissection of, were excluded from the analyses for recurrence and survival. (Results) There were 10 males and 6 females, aged between 47 and 83 with a mean of 68.3 years. There were significant differences between the patients with positive lymph node and negative in the rate of grade 3 and the rate of infiltration of cancer to the vein and lymphatics of the bladder walls. The frequency of the patients of positive lymph node was 5.3% in pT1, 10.0% in pT2, 28.6% in pT3a, 32.0% in pT3b, 50.0% in pT4, and none in pTis, pTa and pT4is. The five-year survival rates estimated by the Kaplan-Meier method were 68.6% over all 82 patients, 75.7% for the patients with negative lymph node and 30.7% for positive. Of the patients with positive lymph node, two-year survival was 80.0% for pT2-3a, versus 0% for pT3b-4. This difference was highly significant (p<0.01). But survival analysis for pT2-3a showed no significant difference between the lymph node negative patients and positive. The recurrence rate was 57.1% (8 of 14) in patients with positive lymph node and seven patients suffered from distant metastases. All the patients which had recurrent tumors died by bladder cancer. (Conclusion) Radical cystectomy with lymph node dissection can provide favorable outome in lymph node positive patients with low stage (pT2-3a). But the patients with high stage (≥pT3b) were poor prognosis. Most of the patients died by distant metastases.
(Background and Object) The cases with adult hydronephrosis are usually performed either conservative surgery or nephrectomy according to the grade of residual renal function. The residual renal function of adult hydronephrosis are usually suspected with analysis of concentration and/or clearance of the renal urine content after percutaneous nephrostomy. However, percutaneous nephrostomy is invasive and risky. On the other hand, post-contrast computed tomography (CT) is non-invasive. We studied whether post-contrast CT is available for the assessment of residual renal function of adult hydronephrosis and also studied the indication for conservative surgery of adult hydronephrosis on post-contrast CT (Materials and Methods) Conservative surgery or nephrectomy was performed in 14 patients with adult hydronephrosis in the duration from April, 1986 to March, 1995. All of 14 patients (14 kidneys) hydronephrosis were retrospectively studied of the character in the indication for conservative surgery by post-contrast CT before surgery. (Results) The indication for conservative surgery of adult hydronephrosis on post-contrast CT are (1) well enhanced renal parenchyma exist round the kidney, even if it is very thin, and (2) excretion of contrast medium to renal calyx are showed. (Conclusion) It was concluded that post-contrast CT might be useful for the assessment of residual renal function of adult hydronephrosis.
(Background) Because of improvement in the management for life-threatening complications of spina bifida, qualitiy of life in the patient has become better and pregnancy is becoming more common problem in adolescent and adult female patients. In this paper, we reported patients with spina bifida who became pregnant and delivered a baby. (Methods) There were 6 deliveries from 5 patients. Mean patient age at the first pregnancy was 27.6 years (ranged from 26 to 32 years). Four patients had undergone surgical managements before pregnancy, of whom 1 had augmentation cystoplasty. Urological and obstetrical conditions during the pregnancy were analyzed. (Results) Upper urinary tract deterioration, which was transient, was observed in 3 pregnancies. Serum BUN and creatinine levels remained stable throughout pregnancy in 4 patients. Pyelonephritis complicated 3 of 6 pregnancies. Delivery was vaginal in 4 and by cesarean section in 2. There were 7 obstetrical complications, which consisted of premature labor (2), uterine inertia (2), cephalo pelvic disproportion (2) and hydramnios (1). There were no significant anomalies in the newborns of these patients. (Conclusion) To achieve successful pregnancy and delivery in the patient with spina bifida, careful urological and obstetrical observation for the potential complications is needed.
(Background) International Prostate Symptom Score (IPSS), which is a self-administered questionnaire consisting of 7 questions with 6 categories, has been used in many countries as the standard scale of subjective urinary symptoms of patients with prostatism. In Japan, although we have already used the Japanese version at daily clinical situations, the reproducibility and validity of it have never been examined. We tried to assess the reproducibility and unidimensionality of the questionnaire. (Patients and Methods) 64 out-patients with benign prostatic hyperplasia were asked to fill the self-administered questionnaires, first at the hospital, and second at home. (Results) The weighted kappa statistics were low in almost all the items (0.10-0.75), so the reproducibility was evaluated to be poor. For as reasons, it was suggested that understandings of Japanese translation and recognition of frequency about chronic urinary symptoms were difficult for the respondents. The results of principal component analysis showed that the item for nocturia measures a different aspect from what the other items measured. So the unidimensionality of the scale was also not confirmed. (Conclusion) These results suggested that IPSS Japanse version should be further modified, especially on its Japanese translation, and then the unidimensionality should be examined again.
(Purpose) To determine the efficiency of gasless laparoscopic adrenalectomy, this procedure was compared to that with pneumoperitoneum. (Patients and Methods) Between February 1994 and December 1996, 17 gasless laparoscopic adrenalectomy were performed in 5 men and 12 women, 36 to 79 years old. Clinical diagnosis was primary aldosteronism in 8, pheocromocytoma in 2, incidentaloma in 4 and adrenal cyst in 3. When gasless laparoscopic adrenalectomy was performed, the laparoscope was inserted through the upper margin of the umbilicus by open laparotomy. To create a workable space, a 1.2mm Kirschner wire was advanced subcutaneously below the costal arch and attached to a retractor. Operating time, estimated blood loss, changes of the end tidal CO2 concentration during operation, operative complications and postoperative course were compared to those with pneumoperitoneum in 12 cases. (Results) In both procedures, satisfying workable spaces were created in all cases. The mean operating time and estimated blood loss were 245min and 201ml without pneumoperitoneum, 317min and 274ml with pneumoperitoneum, respectively. The mean changes of end tidial CO2 concentration during operation were 3.2mmHg witout pneumoperitoneum and 5.1mmHg with pneumoperitoneum. As operative complications, open operations were required in 2 cases (1 without pneumoperitoneum and another with pneumoperitoneum) to control intraoperative bleeding. They had the histories of transabdominal operations. Postoperative bleeding was observed in 2 cases (1 without pneumoperitoneum and another with pneumoperitoneum). One of them (with pneumoperitoneum) needed surgical management for hemostasis. Fever over 38°C that occurred in 1 case with pneumoperitoneum appeared to be absorption fever. No differences were observed in the number of the days to the start of oral intake and for postoperative hospitalization between the two groups. (Conclusions) Gasless laparoscopic adrenalectomy is available for most adrenal tumors. Suction could be used unrestrictedly and there were no hemodynamic or ventilatory effects due to pneumoperitoneum. This procedure appears to be safe and advantageous for the treatment of most adrenal tumors.
An 86-year-old was admitted to our hospital with the complaint of uritnary retension. Ultrasonography and CT scan revealed a large cystic intrapelvic mass which was palpated on the bilateral inguinal portion, when the needle aspiration was performed, we aspirated serous fluid which a consentration of prostate-specific antigen (PSA) was remarkably elavated to 6200ng/ml. Following hormonal therapy with diethylstilbestrol diphosphate, maximum androgen blockade with Flutaminde and LH-RH analog was performed. But no reduction in the size of the cyst was observed, he died from dyspnea caused by carcinomatosa 91 days later. Autopsy revealed a papillary cystadenocarcinoma of the prostate. Furthermore, we revealed that the cyst is primary and neoplastic changes supervened in this case. Seven cases of papillary cystadenocarcinoma of the prostate in the Japanese letarature are reviewed briefly.
A case of MEN type I in a 64-year-old man is reported. He had undergone partial duodenectomy because of gastric ulcer and multiple duodenal polyps (gastrin secreting carcinoid). Blood examination revealed hypercalcemia, hyperPTHemia, and hyperprolactinemia. Neck US and CT showed enlargement of 4 parathyroid glands. Brain MRI revealed the microadenoma in left pituitary gland. Total parathyroidectomy with auto-transplantation in the left forarm were performed. Histological examination showed the hyperplasia of the parathyroid. Three and a half year after parathyroidectomy, there was no evidence of recurrence of gastrin secreting tumor and hyperparathyroidism, and enlargement of pituitary microadenoma. This is the first MEN type I case in Japan which have detected 3 endocrine tumors clinically with gastrin secreting duodenal carcinoid.