(Purposes) Serum D-arabinitol were measured 1) differentiate between invasive candidasis and colonization in the urinary tract 2) evaluate its efficacy for early diagnosis and treatment monitor of invasive candidasis. (Materials and Methods) 1. Laboratory study: Serum D-arabinitol levels were measured in both candida infected rats and control rats. The cut-off levels were determined by the comparison of the two groups. Serum levels of D-arabinitol and CAND-TEC were measured every day per after candida was inoculated. Furthermore, the candida infected rats were treated with fluconazole (0.5mg/body), and the changes of serum levels of D-arabinitol and CAND-TEC were observed. 2. Clinical study: Serum D-arabinitol, CAND-TEC and β-D-glucan were measured to evaluate its efficacy for early diagnosis in the group with candida positive urine cultures. (Results) The cut-off levels of D-arabinitol were set 2.0μg/ml, at which sensitivity was high, and specificity acceptable. The serum level of D-arabinitol raised as candida infection was established and lowered after treatment was started. CAND-TEC was negative in all materials. High levels of D-arabinitol and β-D-glucan was measured in invasive candidasis, and lowere by fluconazole treatment. CAND-TEC had a low positive rate. (Conclusion) Serum D-arabinitol level was sensitive for the early diagnosis of invasive candidasis and its efficacy as a monitor for treatment effects was implied.
(Background) MR urography (MRU) is an image diagnostic method which provides us with the image of urinary retention under non-invasive procedures. This time, MRU was conducted in the patients who were suspected to have urinary passage disorder, and its clinical usefulness was compared with that of drip infusion pyelography (DIP) or retrograde pyelography (RP). (Methods) The study was conducted in 65 patients who were suspected to have obstructive uropathy based on the ultrasonographic findings. MRU was conducted by means of fast SE method to obtain heavy T2-weighted image. The urogram was reconstructed by means of MIP (maximum intensity projection) method. As imaging examinations, MRU, DIP and RP were conducted respectively in 65, 47 and 27 patients. Evaluation of clinical usefulness of MRU and its indications were conducted with respect to (1) the dehree of urinary retention which is identifiable by MRU by (2) comparing performance of MRU and that of other image diagnostic methods based on the scores given to MRU and other methods according to the following scale; Urinary tract is not identifiable 0 point Urinary tract is slightly identifiable 1 point The obstructive region is almost clearly identifiable 2 points The lesion causative for obstruction is identifiable 3 points. (Results) 1) Mild urinary retention for which overall image of urinary tract was barely identifi-able by DIP was identifiable by MRU. 2) In the comparison between DIP and MRU, 24 patients whose urinary tracts were totally unidentifiable by DIP was given was 2.4 points in the average for the identifiability of urinary retention by MRU. Conversely, only poor images were attainable by MRU in the patients whose urinary flow was clearly seen in DIP. The patients whose urinary flow was clearly seen in RP was give 1.9 points in the average for the identifiability of urinary retention by MRU, indicationg that relatively poor images were attainable by MRU in those patients. (Conclusion) Mild urinary retention for which overall image of urinary tract was barely identifi-able by DIP was identifiable by MRU. Therefore, it is suggested that MRU is more useful in the case that only poor images were attainable by DIP. MRU is not the one which can replace RP including urinary cytodiagnosis but is useful to identify the location of the urinary tract tumor which is unidentifiable by RP or to monitor the progress of the urinary obstruction caused by benign diseases.
(Back ground) This study investigated the feasibility and long term results of retrograde endopyelotomy with the Acucise ureteral cutting balloon device in the management of ureteropelvic junction (UPJ) obstruction. (Methods) Thirteen patients (primary: 12, secondary: 1, male: 7, female: 6, mean age: 36) with UPJ obstruction were treated by the Acucise under fluoroscopic guidance. After cutting the stenotic area electrically using cutting wire and dilatation by the balloon, ureteral catheter (7-14 Fr) was in-serted for 6-8 weeks. (Results) The mean operative time was 43 minutes, the median postoperative hospital stay was 4 days. The subjective success rate (disappearance of the abdominal pain) was 92% (11/12) and the objective success rate evaluated by radiographic studies was 62% (8/13). One patient needed a transfusion but no other major complication occurred in the treatment. The failure 5 patients were now under conservative follow up. (Conclusion) Our limited data suggest that endopyelotomy with the Acucise device offer lower morbidity with slightly lower success rate compared other endopyelotomies. We believe that Acucise endopyelotomy can be an appropriate one of the first-line therapy for UPJO.
(Background) Dominant cancer of transition zone origin of the prostate (TZ cancer) has been frequently detected, because ultrasound-guided systematic biopsies have been generalized. In cases of TZ cancer, we attempted to determine clinical significance of coexistent non-TZ cancer foci. (Materials and Methods) Twenty cases with TZ cancer who underwent radical prostatectomy or cystoprostatectomy were clinicopathologically evaluated using step-sectioned specimens. (Results) In TZ cancer foci, there were extraprostatic extension in 5 cases (25%), seminal vesicle invasion in 2 cases (10%), positive surgical margin in 6 cases (30%) and bladder neck invasion in 4 cases (20%). The extraprostatic extension and the positive surgical margin occurred at the anterior or anterioapical portion of the prostate in all the cases. On the other hand, 17 (85%) had coexistent non-TZ cancer foci. In non-TZ cancer foci, there were extraprostatic extension in 3 cases (15%), seminal vesicle invasion in 1 case (5%) and positive surgical margin in 1 case (5%). The extraprostatic extension and the positive surgical margin occurred at the posteriolateral portion of the prostate in all the cases. In 3 cases a coexistent non-TZ cancer focus showed the extraprostatic extension, the seminal vesicle invasion or the positive surgical margin, although a TZ cancer focus were organ-confined. (Conclusion) We should add attention to coexistent non-TZ cancer foci in TZ cancer cases. Particularly, we believe that pre-operative evaluation of non-TZ cancer foci is needed in TZ cancer cases of the candidates for nerve-sparing radical prostatectomy.
(Aim of Study) The aim of this study is to find out the method for the nephrostomy of which catheter can be introduced from the abdominal wall. (Methods) Subjects were the 7 patients whose agreement for this new method could be obtained. After the general nephrostomy was performed, 3cm skin incision to the outer portion of nephrostomy, as well as 5mm skin incision to the abdominal wall were added, and the subcutneous tunnel between the both skin incisions was made using the special tunneler. A guide wire was introduced into the renal pelvis through the subcutneous tunnel, and then 14F Maleocot catheter was introduced from the abdominal skin incision to the renal pelvis. At the skin incision of the nephrostomy, catheter and subcutaneous tissue were fixed using 3-0 cutgut suture to prevent the outcomming of the catheter. (Results) In case 1 to case 4 showed some trouble, but case 5 to 7 showed no trouble. The operation time and the extent of invasion of our method were as well as that of the general nephrostomy, but the managements by the patients were as simple as that of the ureterocutaneostomy. (Conclusion) The quality of our patients seem to close to that of uretero-cutaneostomy. And for the patients who have hydronephsosis after several type of urinary diversions, our method shoud be recommendable than the general nephrostomy.
17 cases of patients with diabetes mellitus who had urinary frequency symptom for which anticholinergic agents proved ineffective were given Sarpogrelate Hydrochloride (Anplag®), a selective 5-HT 2 receptor antagonist. Efficacy was judged using IPSS and QOL scores after 2 weeks medications, these showed that all cases had improved their urinary frequency during the days as well as the night. This was especially true for the QOL score. One time urinary volume markedly increased, but there was no statistical significance after medication in maximum flow rate and residual urine. At the same time, a separate group of 14 mainly BPH cases did not improve entirely. It is believed that reaction in the detrusor muscle with hyperreflexia of diabetes mellitus patients can reach 5-HT, and its reaction is belived to reach via the 5-HT 2 receptor. This paper is a first clinical report of making use of 5-HT 2 antagonist as hyperactive detrusor on diabetes mellitus patients.
A 2, 510g female newborn was delivered by Cesarian section at 33 weeks gestation due to increasing volume of her huge bladder and bilateral hydronephrosis. Just after birth 190ml of urine was drainaged by catheterization without difficulty. Voiding cystourethrography showed no VUR. She had no ureteral dilation, either. Urodynamic study revealed large bladder capacity and detrusor hypocontractility. Neither neurological nor gastrointestinal abnormality was detected neonatally. Clean intermitted catheterization was performed every 4 hours. At 12 months of her age she had no history of urinary tract infection. However, as she grew up with normal diet, severe constipation became apparent. This is a case of idiopathic intestinal pseudo-obstruction syndrome whose gastrointestinal symptom was masked in the newborn period. Attention should be paid for gastrointestinal tract as well as urinary tract when the bady has congenital megacystis with unknown etiology.
We present a case of spontaneous rupture of renal angiomyolipoma with a tumor thrombus extending from the right renal vein and inferior vena cava to the right atrium. A 41-year-old woman, previously in good health, was referred to our hospital with right flank pain. Computed tomography showed fat densities in both tumor and thrombus. Other imaging examinations also demonstrated a large right renal mass (18cm in diameter), a long tumor thrombus (13cm in length) and a small left renal tumor (1.5cm in diameter). Right nephrectomy and en-bloc removal of the intra caval and intracardiac tumor thrombus were performed on cardiopulumonary bypass. It was pathologically diagnosed as an angiomyolipoma without tuberous sclerosis. At present, three years after surgery the patient is doing well, showing neither metastasis nor increase of the left renal angiomyolipoma. To our knowledge, our case seems to be the 3rd case report of renal angiomyolipoma with a tumor thrombus extending to the right atrium. We conclude that renal angiomyolipoma even with an intra cardiac tumor thrombus can be resected safely and successfully.