Cancer of the prostate is the most common neoplasm which is metastatic to bone. Early detection of skeletal involvement is important in predicting prognosis and selecting the proper therapy.
The purpose of this study is to assess the usefulness of bone scintigraphy utilizing ^99mTc-Sn-Polyphosphate (Tc-Poly P) or ^99mTc-Sn-Pyrophosphate (Tc-Pyro P), a new skeletal scanning agent, for the detection of metastases from carcinoma of the prostate. Material and Method:
Selected for study were 32 patients with various clinical stages of prostatic carcinoma. The age ranged from 50 to 80 years old. Histologic proof of the diseases was obtained prior to scanning.
Tc-Poly P or Tc-Pyro P was prepared in the usual manner (adding 4-6ml of ^99mTc pertechnetate solution to the kit). Each patient was given 5 to 10mCi of it intravenously. From 2 to 5 hours after injection, scintigraphy was performed with a scintillation camera (Nuclear Chicago, Pho/Gamma HP) or a scintillation scanner (Aloka, JSS-104 or Shimazu, SCC-130W).
An x-ray bone survey of the whole body was done and serum acid phosphatase and serum alkaline phosphatase were determined. All of the scintigrams and radiographs were reviewed by the authors. They were judged to be abnormal (positive) or normal (negative) depending on presence or absence of increased uptake of isotopes or bone metastases.
Result:
Eighteen patients (56%) had radiographic evidence of bone metastases with all of the lesions being osteoplastic in type. In each case the scintigrams showed increased concentration of Tc-Poly P or Tc-Pyro P in the corresponding areas. The extent of tumor involvement as delineated on the scintigram was generally the same as or greater than that shown on the radiograph. Seventeen patients (53%) had abnormally elevated serum acid phosphatase and fifteen patients (47%) had abnormally elevated alkaline phosphatase.
Twenty patients had abnormal scintigram. Of the patients with abnormal scintigram, eighteen (90%) had radiographic evidence of bone metastases. Thirteen patients (65%) had unusually high serum alkaline phosphatase level. Unusually high serum acid phosphatase level was slightly less frequent (12 patients, 60%).
Twelve patients had normal Tc-Poly P or Tc-Pyro P scintigram. None of them had radiographic evidence of bone metastases and abnormally elevated serum alkaline phosphatase. Four patients (33%) in this group had elevated serum acid phosphatase.
Histological findings of the abnormal areas noted on scintigrams were studied in seven cases. Metastatic carcinomas were proved in two of five cases of biopsy and in two cases of autopsy. Regions with abmormal scintigrams and with normal x-rays were ribs (7 cases), sterns (5 cases), skulls (3 cases), cervical and thoracic vertebrae, coccyx and femur (each 1 case).
Conclusion:
In this study, we have investigated the use of Tc-Poly P or Tc-Pyro P bone scintigraphy in an attempt to find a more accurate method for the early detection of osseous metastases from prostatic carcinoma.
The results of our study suggest that Tc-Poly P or Tc-Pyro P bone scintigraphy is more sensitive than skeletal radiography in the detection of metastases from carcinoma of the prostate. We feel that Tc-Poly P or Tc-Pyro P bone scintigraphy is a more valuable diagnostic tool than x-ray bone survey, serum acid phosphatase and serum alkaline phosphatase in managing patients with prostatic carcinoma. However, further investigation is necessary before its significance can be fully evaluated.

抄録全体を表示

The bacterial flora of the normal urethra, especially anaerobic flora, has been poorly documented. In this paper the aerobic and anaerobic flora of the normal urethra was studied.
Aerobes were isolated in 100% of 178 urethras. 21% of the aerobes were gram negative bacilli.
Anaerobes were isolated in 48% of 100 male urethras and 45% of 78 female urethras. Multiple strains of anaerobes were found. Peptococcus (32%) (P. anaerobius, P. asaccharolyticus), Corynebacterium (19%) (C. avidum, C. liquefaciens), Bacteroides (17%) (B. fragilis) and Peptostreptococcus (16%) (P. magnus) were the most predominant anaerobes.
When examined immediately after micturition, the bacterial count was found to be reduced fairly, but this reduction was recovered in 2hrs. almost completely.
The bacterial cultivation carried out on consecutive days showed spontaneous variations in the count and species of aerobic as well as anaerobic bacterial flora of the urethra.
The antibiotics susceptibility test of these anaerobic strains was also performed.
It is the author's opinion that the studies on anaerobic urinary infections should be based on the studies of normal anaerobic flora.

抄録全体を表示

A 24-year-old man visited the hospital with the chief complaint of pain in the left abdomen, and was diagnosed as left ureteral calculus. On physical examination, the content in the right scrotum was normally palpated, but there were two testis-like tumors in the left side. The patient was almost normal on inspection, and there was no abnormality on radiographic examination of the urinary tract. When the left scrotum was opened, both tumors looked like testis in appearance, as shown in
Fig. 1. The size of the tumor in the upper part was 2.0×2.5×1.8cm, and that in the lower part 2.0×2.5×1.8cm. Both were attached to the epididymis. There was one spermatic duct (Fig. 6, Type V). Specimens for histological examination were taken from both testes, and tumors were restored in the scrotum. Histologically, there was nearly normal capacity of spermatogenesis (Fig. 2).
There have been only 6 reports in Japan including our case, on the histological observation of polymorphism. In foreign countries, there were 41 reports on polymorphism (Table 1).
Based on these reports, the cases of polymorphism are summarized as follows:
1) There were many cases in which polymorphism was revealed when the patients visited hospitals because of torsion of the spermatic cord and were operated as inguinal hernia. Otherwise, it was revealed when the operation of inguinal hernia was performed. In Japan, 3 cases were revealed during operation for tumors, a case on operation for hydrocele testis, and a case on operation for retentio testis.
2) The age of the patients who were found to have polymorphism ranged from three months in the youngest to seventy-five years in the oldest. In addition, seventy percent of the patients with polymorphism were in their teens and twenties. In Japan, the ages of the patients were 9, 22, 24, 28 and 37-year-old.
3) There were three testes in all cases.
4) The lesion was in the left side in 67%. There were 3 cases with lesion in the left side and 2 cases in the right side in Japan.
5) There were various sizes, from the size seen only by histological observation to the normal size. However, most of them were smaller than normal testis, which were about 2 cm in length.
6) About 50% of testes were regarded as retention testis. Fig. 3 shows the location of testis. It is interesting that the embryological disturbance prevented testis from descending. Only one case was with retention testis in Japan.
7) The morphology of the polyorchism is various (Fig. 4).
We classified it into 6 types, as shown in Fig. 5. Many cases belonged to I, II and V types. There were 1 case in the I type, 1 case in the II type and 2 cases in the V type in Japan.
8) In the function of spermatogenesis, the cases in which spermatogenesis was seen were 68% including the cases with scar. Of these cases, only 5 cases were regarded as normal. Spermatogenesis was seen in 3 cases, one of which revealed normal spermatogenesis.
9) Diagnosis was made histologically.
10) Torsion of the spermatic cord and inguinal hernia were often seen as complications. In addition, there were other complications such as hydrocele testis of the scrotum, epididymis and male sterility. There were also some reports on teratoma, choriocarcinoma and rhabdomyosarcoma as complications with tumors.
11) When bilateral testes were small, both should be excised. When only one testis was small, it should be excised. In the restoration, the testis should be fixed to prevent the torsion of the spermatic cord.

抄録全体を表示

Three cases of priapism have been surgically treated during the past eight months. Urethral injury was followed by priapism in two cases, and local infection caused by cavernography seemed mainly responsible in the other. Bypass formation of venous drainage, i. e. corpus-saphenous and cavernospongiosum anastomosis, was successfully performed on these cases. Once the conventional treatment fails to subside the penile engorgement, we believe, the surgical intervention such as attempted here should be considered as soon as possible.

抄録全体を表示