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Volume 79, Issue 11
Displaying 1-18 of 18 articles from this issue
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Masa-aki Kuwahara, Yoshikatsu Tanahashi, Naomasa Ioritani, Isao Numata ...1988 Volume 79 Issue 11 Pages 1739-1744
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSTransurethral ureterolithotripsy (TUL) was performed on 200 patients in the outpatient clinic without fluoroscopic control. Continuous, or one-shot caudal epidural anesthesia was generally adopted to secure the patient's walk after the treatment. The overall rate of stone removal in one session was 51%, however, if confined to the lower ureteral stone, it was 67%. The stone-free rate for all outpatients was 80% in the followuped 183 cases. As acute complications, fever (>37°C), bleeding and ureteral perforation occurred in 3 (2%), 5 (3%) and 7 (4%) cases, respectively. As late complications, ureteral stricture developed in 4 cases. Two of them were operated on, and the other 2 were controlled by placement of a double-J stent. The results indicate that TUL can be performed in the outpatient clinic on selected cases.View full abstractDownload PDF (878K) -
Hideki Fuse, Hidenori Sumiya, Koichiro Akakura, Jun Shimazaki, Shino M ...1988 Volume 79 Issue 11 Pages 1745-1750
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSAt the Chiba University Hospital and Asahi General Hospital between 1979 and 1986, 1266 cases of benign prostatic hypertrophy were treated by prostatectomy (mainly retropubic) (643 cases) or transurethral resection of the prostate (TURP) (623 cases), and their histological examinations were performed. Twenty-six cases (4.0%) of incidental carcinoma were detected by prostatectomy; 13 and 13 cases were in stage A1 and A2, respectively. Forty-seven cases (7.5%) of incidental carcinoma were detected by TURP; 26 and 21 cases were in stage A1 and A2, respectively. As a result, 73 cases (5.8%) of incidental carcinoma were detected; 39 and 34 cases were in stage A1 and A2, respectively. There were no differences between the mean age of stage A1 and that of A2. The mean weight of specimens categorized as A2 seemed to be large when compared with that as A1, but no differences were noticed. The mean weight of specimens obtained by TURP in A1 was similar to that in A2. The grade in A2 were 47%, 47% and 6% in the order of highly, moderately and poorly differentiated adenocarcinomas. Four cases of A2, 3 moderately and 1 poorly differentiated, progressed into clinical carcinoma; 3 of which had no treatment postoperatively and the last one received inadequate endocrine therapy. In these cases, the mean period between diagnosis of A2 and clinical carcinoma was 3 years. In A2 that received full treatments, no clinical carcinomas were found up to 8 years. On the contrary, A1 cases showed no progression irrespective of the presence or absence of treatments. It is concluded that stage A2 should be treated further, while A1 may be observed without treatment.View full abstractDownload PDF (776K) -
Yutaka Chiba, Seiichi Orikasa1988 Volume 79 Issue 11 Pages 1751-1760
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSTo study the localized renal damage from percutaneous nephroureterolithotomy (PNL), 3 divided DMSA renal scintigraphy in 41 renal units and dynamic CT in 17 renal units were performed.
1) Localized renal damages corresponding to the nephrostomy tract estimated by 3 divided DMSA renal scintigraphy were almost recovered by 6 months after PNL in most cases. But in 17 of the 41 renal units (41%), the postoperative renal scintigram showed low uptake or cold area at the nephrostomy tract.
2) In several cases which showed cold area in postoperative renal scintigram, dynamic CT showed linear or diffuse low density area with sclerotic cortical deformity at the posterior wall of the kidney.
These results indicate that an anatomically proper site of the puncture and a smaller nephrostomy size are mandatory to minimize localized renal damage from PNL.View full abstractDownload PDF (7562K) -
Masataka Hirai, Masaru Nakano, Tomomi Ushiyama, Hiroaki Masuda, Nobuta ...1988 Volume 79 Issue 11 Pages 1761-1764
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSSeven patients with advanced prostatic cancer were treated with the combination of prostatic hyperthermia (RF-wave of 13.56MHz and chemotherapy (VP-16+peplomycin). It was spossible to heat prostatic tumors up to higher than 42°C in 4 cases.
The tumor size was reduced in 6 cases after the treatment.
As side effects, slight skin burning (1 case), anorexia (1 case) and diarrhea (3 cases) were noted.
This new treatment might be effective for hormone-resistant prostatic cancer.View full abstractDownload PDF (1893K) -
Pharmacokinetic Study on its EfficacyRyoji Yasumoto, Masazumi Asakawa, Yukichi Ozaki, Akinori Horii, Masaru ...1988 Volume 79 Issue 11 Pages 1765-1768
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSPharmacokinetic study in 11 patients with bladder tumor to pharmacodynamically evaluate the efficacy of a new Peplomycin emulsion in Hydroxypropylcellulosum (HPC-PEP), which was recently developed at our department. Of the 11 patients, 8 received instillation of HPC-PEP at a diluted concentration of 3000μg/ml and the remaining 3 was intravesically given the corresponding amount of PEP in saline. The results were pharmacodynamically analysed for the comparative efficacy with intravesical treatment of saline-PEP as to the following 3 aspects, 1) change of urinary PEP level after the instillation 2) transition of PEP to serum, and 3) pharmacodynamic parameters relating to urinary levels at different times. Of pharmacodynamic parameters, the half life of this agent was calculated from the formula on the basis of pharmacodynamic analysis of PEP clearance from the bladder compartment. The mean levels of urinary PEP were (61.0μg/ml (15-90μg/ml), 16.41μg/ml (0.09-73μg/ml), 18.3μg/ml (0.3-105μg/ml), 13.1μg/ml (0.24-50μg/ml) and 6.25μg/ml (0.07-53μg/ml), 6, 12 and 24 hours and 2 and 3 days after the instillation, respectively, and, thereafter, decreased below the minimum measurable value. In contrast, urinary PEP was marginally detected at the level of 0.05μg/ml (0.04-0.06μg/ml) only 3 hours after a conventional instillation using saline PEP and, thereafter, below the minimum detectable value any time. No significant serum level of PEP was detected at any time after both of the instillation modalities. The half life was 4.18 and 51.0 hours, respectively, after saline PEP and HPC-PEP instillations. These results suggested that intravesically given HPC-PEP was pharmacokinetically retained longer than the conventional saline PEP preparation by means of virtually enhanced affinity to the bladder mucosa with no transport to systemic blood flow via bladder wall. Therefore, PEP emulsion in HPC might be one of the most useful preparations with less adverse effect not only to conservatively treat a primary bladder tumor but also to prevent recurrence of the tumor after the initial transurethral resection.View full abstractDownload PDF (589K) -
Diagnosis and TreatmentKen Sato, Satoru Ishikawa, Masakazu Tsutsum, Akira Sasaki, Koji Kawai, ...1988 Volume 79 Issue 11 Pages 1769-1773
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSA total of 160 flexible cystourethroscopic procedures were performed on 85 patients. The most common indication was monitoring of patients with a prior urotherial tumor (45 bladder tumors and 4 urethral tumors). Other indications for endoscopy were: prostatic cancer (4), hematuria (7), urethral stricture (3), retrograde pyelography (7), and removal of a double-J stent (3). The scope was easily inserted into the bladder in all pateints except 3 with urethral stricture. Bladder tumors were found in 30 times in 26 cases. In 10 of these 26 patients, cold cup biopsies were performed through the flexible scope. Findings with the flexible system were equivalent to those with the rigid endoscopy in 20 patients with bladder tumors. Eight cases with superficial tumors were treated with Nd: YAG laser by a flexible scope succesfully. All procedures were performed under topical anesthesia in the office. These reuslts suggest that the technique is safe, efficient and cost-effective.View full abstractDownload PDF (2375K) -
Akihiko Furuhata, Katsuaki Ogawa, Toyoaki Yamaguchi, Toshimichi Sugawa ...1988 Volume 79 Issue 11 Pages 1774-1781
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSSix cases of paraplegia due to metastasis of a testicular tumor were reported. The paralysis was caused by vertebral epidural metastasis in 5 cases of these 6 and by a compression fracture of vertebra in the remaining 1 case. In the former 5 cases there were premonitory symptoms before the paralysis occurred. Myelography proved to be effective in diagnosing vertebral lesions. Therepeutic results in this small series of cases were briefly summarized as follows: neurologic response rate, 3/6 or 50%; complete response rate of tumor, 4/6 or 67%; 2 cases had “no evidence disease” of long duration.
Experiences with these cases tell that it is necessary for the physician to bear the possible occurrence of metastasis always in mind while making post-treatment follow-up observations of testicular tumor patients. Metastais, if occurs at all, should be detected as early as possible and whereupon chemotherapy, radiotherapy and surgery should be given in the most apropriate combination and time sequence so that relief of paralysis and eradication of metastatic tumor lesions might be accomplished.View full abstractDownload PDF (5156K) -
Tetsuro Kato, Kazunari Sato, Ryoetsu Abe, Masatsugu Moriyama, Seigi Ts ...1988 Volume 79 Issue 11 Pages 1782-1789
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSForty patients with prostatic carcinoma subjected to transcatheter arterial infusion of microencapsulated anticancer drugs (microchemoembolization) were analyzed with a median follow-up period of 77 months (range, 4-118). Four patients had stage B2 disease, 10 stage C and 26 stage D2; 19 were resistant to prior hormone therapy.
Three microencapsulated drugs (mitomycin C, peplomycin and cisplatin) were employed as a single agent in 33 patients and in combination in 7; mitomycin C was used in 29. Twenty-five patients received a single infusion and the others 2 or 3 infusions. Twenty-three patients underwent subsequent therapy within 3 months irrespective of the therapeutic responses, but 17 were followed without other therapy because of the benefit from chemoembolization in 11 and because of their far advanced disease in 6.
Objective tumor response (CR+PR) was found in 14 (54%) of the 26 evaluable tumors. Improvement of symptoms and signs such as dysuria, pain, hematuria, hydronephrosis and elevated serum acid phosphatase was experienced in 31 (94%) of 33 patients, lasting for one year in 9 (75%) of 12. Severe pain from bone metastasis was well controlled in 2 patients. Accountable side effects such as myelosuppression, pain and skin ulcer occurred in 13 (30%) patients, but these were reversible in all patients except for one suffering from renal insufficiency.
Follow-up results indicated that this mode of therapy would be an effective measure for improving intractable symptoms, for controlling the primary tumor in stage D patients with inactive metastasis as well as in inoperable stages A-C patients, and for reducing postoperative recurrence.View full abstractDownload PDF (1065K) -
Hideari Ihara, Dietmar Neisius, Manfred Ziegler, Eduard Becht, Thomas ...1988 Volume 79 Issue 11 Pages 1790-1797
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSWe present a new second generation lithotripter for extracorporeal shock wave stone disintegration. The new lithotripter (Piezolith 2200) was developed by the Urological Clinic of the University of Saarland (Homburg/Saar, FRG) in cooperation with the Department of Acoustics, the University of Karlsruhe and the Richard Wolf Company.
The Piezolith 2200 uses piezolectrically generated high energy sonic impulses for treatment of urinary calculi. Localization of concrements is performed by means of ultrasound imaging. The treatment unit is movable and may be used anywhere, no special building nor equipments being necessary. Stone disintegration with our piezoelectric shock wave lithotripsy generator (EPL) is painless for patients and thus it is possible to perform without anesthesia or analgesia. Patients with cardiac troubles such as arrhythmia or pace-maker applicants are treated safely as well as patients with skeletal deformity or excessive obesity.
Compared to other systems, our lithotripter is cheaper and the running costs are low.
Since January 1986 EPL has been used for routine clinical check-up. Up to June 1987, 806 treatments were performed for a total of 572 kidneys or ureters in 567 patients (561 adults, 6 children). They had calculi of varing sizes in the renal pelvis (n=126) or calyces (n=384), partial (n=24) or complete (n=19) staghorn calculi, or calculi in the proximal ureter (n=19). Of 209 patients who had been followed-up for more than 3 months after EPL-treatment, 184 (88%) became free of stones.
Serious complications such as perirenal hematoma or injuries of the neighbouring organs could not be found. Elevations of serum GOT, LDH, CPK, which have been described in ESWL by Dornier's system, could not be observed.
We conclude that extracorporeal piezoelectric lithotripsy (EPL, Piezolith 2200) is a renovated system in stone therapy.View full abstractDownload PDF (6484K) -
Response to Calcium, Acetylcholine, Prostaglandin and SerotoninMasahiko Saito, Momokazu Gotoh, Kumiko Kato, Atsuo Kondo1988 Volume 79 Issue 11 Pages 1798-1805
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSWe investigated in vitro the contraction-response relationship of the denervated rabbit bladder to Ca++, acetylcholine, prostaglandin, F2α and serotonin.
1) Bladder weight and bladder capacity significantly increased one week after denervation.
2) Denervation supersensitivity to Ca++ was present, which seemed to be accounted for by an increase of the calcium influx through a voltage dependent Ca channel.
3) Supersensitive response to acetylcholine was observed one week, not two weeks, after denervation.
4) Denervation supersensitivity to prostaglandin F2α was not observed.
5) Denervation supersensitivity of a detrusor muscle to serotonin was observed.View full abstractDownload PDF (1098K) -
Consideration for Incidental CarcinomaTakanori Suzuki, Susumu Jinbo, Shigeki Inaba, Toshihiro Shimizu, Kyoic ...1988 Volume 79 Issue 11 Pages 1806-1810
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESS13 prostate glands removed by radical cystectomy and radical prostatectomy were examined histopathologically by the step section method.
Benign prostatic hypertrophy (BPH) was observed in 5 cases. The locations of the hyperplastic nodules were superior, inner and anterior. Prostate cancer was present in 5 cases, and the locations were inner in 1 case, posterior in 3 cases, superior in 3 cases and at the vermontanum level in 2 cases. In the outer origin cases, the more cancer tissues increased beneath the gland capsule, the more these invaded into the stromal tissue between the prostatic ducts and acini, and penetrated into the gland capsule. In cases of prostate cancer with BPH, cancer lesions were located in the surgical capsule. Because cancer tissues might remain after prostatectomy and transurethral resection in cases of incidental carcinoma, it was suggested that repeated prostatic biopsy and transurehtral resection were helpful in defining the extent of stage A.View full abstractDownload PDF (3118K) -
Kazunori Hattori, Katsunori Uchida, Tohru Shimazui, Ryosuke Nemoto, Ke ...1988 Volume 79 Issue 11 Pages 1811-1817
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSThirty-seven patients with transitional bladder cancer were given a 0.5-hour intravenous infusion of bromodeoxyuridine (BrdU) at the time of endoscopic biopsy or transurethral resection to label tumor cells in DNA synthesis phase (S-phase). The tumor specimens were fixed with 70% ethanol, embedded in paraffin, sectioned, and stained by an indirect immunoperoxydase method using anti-BrdU monoclonal antibody as the first antibody. The BrdU labeling index, S-phase fraction (SPF), determined by counting the number of BrdU-labeled cells in the tissue sections. Almost all of grade 1 tumor had an SPF lower than 5% and the mean SPF was 2.7±31.6% (mean±SD), while the means for grade 2 and grade 3 tumor were 8.3±2.1% and 16.7±4.1%, respectively. (p<0.01)
The average SPF for non-invasive tumor (24 cases) and invasive tumor (13 cases) were 6.9±6.0% and 13.3±5.6%, respectively (p<0.05). thus, transitional bladder cancer with a SPF greater than 10% appear to be faster and more invasive than those with an SPF less than 10%; a higher SPF indicates biological malignancy.
Our preliminary results suggest that the measurement of the BrdU labeling index of bladder tumors is a new objective and quantitative assay of the biological potential of individual tumors.View full abstractDownload PDF (3898K) -
Yutaka Senga, Yoshiaki Satomi, Momokuni Fukuda, Tetsuya Ebato, Mitsuru ...1988 Volume 79 Issue 11 Pages 1818-1823
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSNSE is widely used as a marker of nerve cells and neuroendocrine cells. As it has become known recently that NSE exists in the renal tubular cells, immunohistochemical study has been performed on 23 cases of renal cell carcinomas using anti NSE antibodies. Seventeen out of 23 cases showed positive reaction. Nine out of 15 cases of the low grade group and all of 8 cases of the high grade group showed positive reaction. Increased metabolism of glycolysis in the tumor cells of the high grade group may be the explanation of this observation. NSE negative cases appear to show slightly better prognosis than those of the positive cases in the low grade cases.
Immunohistochemical study of renal cell carcinomas by using anti-NSE antibody may be of some help to correlate histological findings and prognosis.View full abstractDownload PDF (2957K) -
Tatsuhiko Ohashi, Suguru Matsui, Tomoji Yamada, Nobuo Ohashi, Teruo Sh ...1988 Volume 79 Issue 11 Pages 1824-1828
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSTo study the mechanism of prohibition for the reccurence of bladder tumors by intravesical Bacillus Clamette-Guerin (BCG) treatment, we made a mice system using Freund Complete Adjuvant (FCA) as an immunoactivator and N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) as a carcinogen. C57BL/6 mice mice were treated with BBN and FCA simultaneously, and it was found that the FCA treated group revealed a significantly lowered number of piled layer (NPL) in the bladder epithelium. The FCA which is composed of Bacillus Clamette-Guerin and mineral oil is used to enhance the immune activity in several system. The result obtained in this experiment seemed correlated with the clinical effiency of intravesical BCG treatment to prohibit the reccurence of superficial bladder carcinoma. The result and the resistance of MRL/lpr mice to BBN treatment give us an idea the presence of hyperimmune state at the early phase of development to malignant change is a factor to protect the host from carcinoma.
But when we increase the number of FCA treatment, the NPL values also increased, which gave us a caution to dettermine the dose and number of BCG treatment in the patient.
We suspect the efficiency of BCG may be something like chemopreventing agents (Retinoid etc.), but further experiment is necessary to comfirm it.View full abstractDownload PDF (4010K) -
Hironori Tsujihashi, Hisao Matsuda, Shigeya Uejima, Takeshi Matsuura, ...1988 Volume 79 Issue 11 Pages 1829-1836
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSWe experienced 165 patients with primary bladder tumors treated by transurethral resection (TUR) in the Urological Department of Kinki University Hospital from 1975 to 1987. Among these cases, superficial bladder tumors treated by radical TUR were 133 cases. Of these 133 cases, clinical assessment was performed from several clinical aspects.
The grading of the above was as follows: 57 (G0, 1), 61(G2), and 15 (G3). The ratio between male and female was 3.7: 1 and the tumors were detected nost frequently among patients in their 60s. The positive rates for urinary cytology was 7% (G0, 1), 42.6% (G2), 53.3% (G3) and 28.6% (over all). Urinary cytology is a valuable tool for diagnosis. However, this procedure may be of limited value in the diagnosis for superficial bladder tumors.
The 5-year recurrence rates for all 133 cases were 43%. Although no significant differences were found among the groups, grade, multiplicity and growth pattern (pedunculated or sessile) were likely to be related to recurrence of superficial bladder tumors. We experienced only 2 cases of bladder tumor death following TUR, whereas total cystourethrectomy were indicated in 10 cases of superficial bladder tumors treated by TUR. Five of them were diagnosed as having scondary carcinoma in situ at total cystourethrectomy.
Although most superifical bladder tumors can be controlled by adequate TUR, strict surveillance is mandatory especially for recurrent superficial bladder tumors.View full abstractDownload PDF (927K) -
Kazuhiro Takai, Tadao Kakizoe, Ken-ichi Tobisu, Yoshinori Tanaka, Shin ...1988 Volume 79 Issue 11 Pages 1837-1847
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSThe reason for poor prognosis observed in squamous cell carcinoma (SCC) was analytically studied.
From 1963 to 1986, 186 patients with bladder cancer underwent total cystectomy. Nine cases had SCC, 26 had SCC mixed with transitional cell carcinoma (TCC) (mixed type), 68 had TCC of Grade 3 and 83 had TCC of Grade l and 2. These four groups were examined with regard to the clinicopathological features and prognosis.
SCC and mixed SCC and TCC groups exhibited a female predominance took the form of dominant nonpapillary sessile carcinomas and invasive carcinomas of pT3 and pT4. In these two groups, hydronephrosis and local recurrence after cystectomy were observed at a higher rate than other groups indicating that they showed a more invasive growth. It is believed that TCC develops from squamous metaplasia of the transitional epithelium. However, concomitant leukoplakia and squamous metaplasia were not disclosed on the noncancerous urothelial epithelium in the SCC group. In the mixed type, the Grade 3 TCC were most frequently combined with SCC. Five-year survival rates in increasing order were 26% in mixed type, 32% in SCC, 55%in Grade 3 TCC and 73% in Grade l and 2 TCC.
These results suggest that, at the very beginning of carcinogenesis, both SCC and mixed type carcinomas already acquired the invasive nature, having very poor prognosis. Treatment for SCC and SCC+TCC groups should be carefully planned, probably with combination of radical cystectomy and chemotherapy.View full abstractDownload PDF (3004K) -
A Case ReportKazuhiro Yoshimura, Shigeru Saiki, Masao Kuroda, Hisakazu Kiyohara, To ...1988 Volume 79 Issue 11 Pages 1848-1851
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSA 54-year-old man was hospitalized with a chief complaint of voiding pain. The patient was treated with transurethral resection of the papillary bladder tumors. The histopathological diagnosis was transitional cell carcinoma, G2, pTa. Urinary cytology was still positive after transurethral resection. Cold cup biopsies showed carcinoma in situ of the bladder. He was given 80mg BCG intravesical instillations every week for six weeks. Both urinary cytology and cold cup biopsies became negative after intravesical BCG treatment. Three weeks after initiating BCG treatment, the patient began to complain of gross hematuria, frequency, urgency and pain on urination. The irritative voiding symptoms did not respond to conservative therapy and bladder capacity was reduced to 50ml. Total cystectomy and construction of an ileal conduit were performed 7 months after BCG treatment. The bladder mucosa was edematous with areas of superficial hemorrhagic changes. The surface epithelium was denuded and no tumor cells were noted. Tuberculous inflammatory changes with caseous necrosis, lymphocyte infiltration and giant cells were found in submucosa of the bladder.View full abstractDownload PDF (3306K) -
Takuya Okutani, Yoshikatsu Kobukata, Mitsuto Kodama, Chikao Masu, Yosh ...1988 Volume 79 Issue 11 Pages 1852-1857
Published: November 20, 1988
Released on J-STAGE: July 23, 2010
JOURNAL FREE ACCESSA 53-years-old man was admitted to our hospital complaining of a painless mass in the scrotum, which measured about 6cm in diameter. The mass had a hard consistency with no transillumination of light. Other physical examination was normal. Laboratory work including blood chemistries, complete blood count and urinalysis were normal. The chest plain film and intravenous pyelography were normal. At operation, the testis and epididymis appeared normal. A complete tumor resection and ilioinguinal lymphadenectomy were performed. Histological diagnosis was malignant mesothelioma. He was additionally treated by chemotherapy and irradiation, but he died of the cancer fifteen months after the operation. Our case is the 24th case of intrascratal malignant mesothelioma in the literature.View full abstractDownload PDF (5922K)
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