INTRAVESICAL BACILLUS CALMETTE-GUERIN IN THE TREATMENT OF SUPERFICIAL BLADDER CANCER

Between March 1988 and September 1989, 29 patients with superficial bladder cancer (Stages CIS, Ta and T1) were treated with intravesical bacillus Calmette-Guerin (BCG). The patients (23 males and 6 females) ranged in age from 42 to 83 years (average 67.4 years). A suspension containing 80 mg of BCG (Tokyo-strain 172) was instilled into the bladder once a week for 8 weeks. Six patients were treated after transurethral resection (TUR-Bt) as prophylaxis. After treamtment, all patients indicate no recurrence at this time. The remaining 23 patients with visible bladder tumor were treated as antitumor effect. Of the 11 patients with CIS, 8 patients (72.7%) were proved to be free of disease by random biopsy and urinary cytology. Three patients (27.5%) had no evidence of CIS by random biopsy and cystoscopy but have persistent positive urinary cytology. As for superficial tumor (Ta, T1), 9 patients (75.0%) had a complete response but another 3 patients (25.0%) indicated no response. Regarding side effects, irritable bladder in 75%, gross hematuria in 27.6% and fever (over 38℃) in 27.6% of patients were observed. These results suggest that intravesical BCG may be useful in the therapy of superficial bladder cancer as well as in the prophylaxis for recurrent tumor following TUR-Bt. However, clinical efficacy and total dose of BCG should be clarified by long term observation

Comparative double-blind trial of KN-7 tablet and Robaveron injection in the treatment of neurogenic bladder

37施設で, 神経因性膀胱233例を対象に, ロバベロン注射剤を標準薬とし, KN-7錠剤の経口投与による排尿障害に対する有用性を, 二重盲検群間比較試験で比較検討した.解析対象例はKN-7群108例, ロバベロン群107例である.KN-7群は1日6錠投与した.改善度の効果判定では改善以上K群40.7%, R群38.7%, やゝ改善以上それぞれ76.9%, 72.6%と有意差はなかった.臨床所見中改善の良かった項目は, 尿意, 残尿感, 尿失禁, 排尿までの時間, 排尿時間, 尿勢-排尿力と尿線中断の改善などで, これらの改善以上はK群35.8%, R群30.8%で, 有意差はなかった.副作用はK群0.9%, R群6.8%, K群が有意に少なかった.両剤とも主として下痢で, R群ではその他頭痛, 頻脈, 肝機能障害, 発熱感などを少数例認めた.臨床検査値ではGOT, GPTの上昇が2例あった.有用度有用以上はK群46.3%, R群45.8%で有意差はなかった.疾患別では, 末梢神経疾患, 膀胱の性状では弛緩性, 時期では12ヵ月以内の例で特に改善率が高かった.以上から, KN-7錠剤は, ロバベロン注射剤に比べ, 同等の効果が期待でき, 安全性も高く, 長期投与あるいは外来患者の治療にも適するThe clinical effectiveness, safety and usefulness of KN-7 tablet as a new oral application of the prostatic extract, on urinary dysfunction of neurogenic bladder were compared with those of Robaveron injection by the double-blind test method. In the study, 2 tablets t.i.d. and a shot of intramuscular injection 1 ml a day were given successively for 3 weeks. A total of 233 cases were reported from 37 facilities belonging to the KN-7 Clinical Research Group. Some of them were excluded or dropped out. The number of cases used for analysing the effectiveness, safety and usefulness were 214, 232 and 215, respectively. There was no bias between the two groups with a significant homogeneity in the background. In the overall clinical effectiveness, the effective rate including excellent, moderate and slightly effective was 76.9% with KN-7 and 77.4% with Robaveron. In the clinical usefulness, the rate of usefulness of slightly useful or above was 75.0% with KN-7 and 75.7% with Robaveron. There was no significant difference between the two groups in the clinical effective and useful rates at a significant level of 5%. Side effects were observed in 1 of the 114 (0.9%) patients given KN-7 and 8 of the 118 (6.8%) patients given Robaveron. The incidence of adverse reactions with KN-7 was significantly lower than that with Robaveron. Based on the results, it was concluded that KN-7 tablets, 2 tablets t.i.d., would be as effective and useful as a Robaveron injection 1 ml daily and safer than the latter in the treatment of neurogenic bladder

A case of congenital mesoblastic nephroma growing with a polypoid pattern in the renal pelvis and ureter

Congenital mesoblastic nephroma (CMN) is an unusual renal tumor, similar in some respects to Wilms' tumor and reported only in infants. We report a case of CMN in a 2-year-old boy. He was referred to us with a right abdominal mass. Excretory urogram, arteriogram and computed tomogram revealed a large malignant renal tumor on the right side. With a clinical diagnosis of Wilms' tumor of the right kidney, he received radiation and chemotherapy. After radiation and chemotherapy, tumor size was decreased. Right nephrectomy was performed on April 22, 1982. The kidney and tumor weighed 270 g and measured 12 X 7 X 5 cm. The tumor extended to the renal pelvis and the ureter with polypoid growth pattern. Microscopically, the tumor was composed of compact interlacing bundles of elongated fibromyomatous cells. Islands of entrapped glomeruli and tubules were also detected within the tumor. He was well and had no signs of recurrence of tumor at the age of 3 years

Changes in the management of urolithiasis: endourologic treatment of calculi in the upper urinary tract

Three hundred seventy cases with calculi in upper urinary tract were treated by endourology, 210 cases were subjects of percutaneous nephrolithotripsy (PNL) and 160 cases of transurethral ureterolithotripsy (TUL), in Nara Medical University Hospital and 13 affiliated hospitals. Of the PNL cases, PNL was completed in 184 cases (87.6%) and not completed in 16 cases (12.4%). 168 cases (80.0%) had successful results by PNL alone, stone-free or stone fragments less than 5 mm, in spite of the stone location and size. No serious adverse effect was experienced throughout the study. However, changes like a scar formation or fibrosis around the nephrostomy tract were revealed as a late complication by excretory urography, computed tomography and renal scanning. Of the 160 TUL cases, TUL was successful in 132 cases (82.5%) and unsuccessful in 28 cases (17.5%). The results of TUL for the calculi above the upper iliac cresta were not favorable, success rate for stone 6-10 mm in diameter was 70.3% and that for stones larger than 11 mm 37.5%. However, the results of TUL for the calculi below the upper ileac cresta were favorable, the success rate for the 6-10 mm calculi was 91.5% and for the calculi larger than 11 mm 88.4%. Of 28 TUL failures, 7 cases underwent PNL and 21 cases received open surgery. Throughout our endourologic treatments, the most problematic stone was calculi impact in the ureter. The indication of endourology for the calculi in upper urinary tract is discussed with consideration of ESWL which is becoming the main stream of stone treatment

A clinical observation on pyeloplasty in obstruction of the ureteropelvic junction. Special consideration on Anderson-Hynes pyeloplasty

1) 1963年より20年間に, 奈良県立医科大学泌尿器科学教室および関連病院において腎盂形成術をおこなった35腎の臨床的観察および術後成績について, 排泄性腎盂造影であきらかな改善を認めたものは67.6%, レノグラムで改善を認めたものは66.6%, 自覚症状および臨床症状の改善を認めたものは93.0%で, そのうちAnderson-Hynes pyeloplasty施行例(27腎)ではさらに良好な成績であった.2) Anderson-Hynes pyeloplasty施行例において術後成績と年齢, 術前の尿路感染症の有無, スプリントカテーテルおよび腎瘻管の設置期間, 術後の尿路感染症の持続期間, さらに腎瘻管の設置期間と術後尿路感染症の持続期間の関係について検討した.年齢と術後成績では10歳以下においてもっとも術後の改善度が高かったが, 他の年代に比べて有意ではなかった.術前の尿路感染症の有無, スプリントカテーテルおよび腎瘻管設置期間と術後成績の間には一定の関係は認めなかった.術後16日以内に腎瘻管を抜去しえた症例においては, 術後の尿路感染症の改善および腎機能の改善がきわめてよかったThirty-three patients (thirty-five kidneys) underwent pyeloplasty for hydronephrosis due to obstruction of ureteropelvic junction between 1963 and 1982 in our department. Renal function was judged to have improved in 68 and 67% of the patients from the radiogram and radioisotope renogram, respectively, Anderson-Hynes pyeloplasty was performed on 27 kidneys. In these kidneys, the improvement of renal function as judged from the radiogram and radioisotope renogram was 74 and 71%, respectively. Postoperative results were compared according to age, preoperative urinary tract infection (UTI), indwelling periods of nephrostomy and splint catheter, and duration of postoperative UTI. In addition the relationship between indwelling periods of nephrostomy catheter and the duration of postoperative UTI are discussed. Infants under 10 years old had the best improvement. Preoperative UTI and indwelling periods of nephrostomy and splint catheter were not directly related with post operative results. The cases with nephrostomy catheter which could be removed within the 16th day after operation had excellent improvement on UTI and also in renal function

EXPERIMENTAL AND CLINICAL STUDIES OF URINTARY BLADDER CANTCER

Bladder tumors induced by BBN in rats and dogs were useful for the clinical studies of human urinary bladder tumors and experimental chemotherapy. 5-FU, FT-207, CQ, VCR and CDDP were effective as single agents; and, the combination of FT-207 and OK-432, FT-207, ADM and OK-432, and, VCR, BLM and ADM were effective in significantly inhibiting the development of bladder tumors induced by BBN in Wistar rats. In clinical cases, the administration of FT-207, bladder instillation of an anticancer drug, and pre-operative intra-arterial infusion of MMC in addition to bladder instillation were prophylactic for the recurrence of the superficial urinary bladder cancers significantly within one year after operation. ADM, CDDP and radiation were effective regimens for advanced urinary bladder cancers. Multidisciplinary treatment was useful in treating advanced urinary bladder cancers

CLINICAL EFFECT OF TRANEXAMIC ACID TO CONTROL HEMORRHAGE DURING AND FOLLOWING PROSTATECTOMY IN PROSTATIC HYPERTROPHY : A STUDY WITH A DOUBLE BLIND METHOD

Tranexamic acid was administered to control hemorrhage during and following prostatectomy in prostatic hypertrophy, and its clinical effect was comparatively investigated with 10% saline as a control drug by means of a double blind method. The follwoing results were obtained. 1. Tranexamic acid was administered to 39 cases and placebo to 37 cases. No significant difference was noted between the two groups in various background factors. 2. The evaluation of clinical effect of each 'drug was decided according to the individual evaluation of the hemostatic effect on blood loss and abnormal bleeding (oozing) during operation and severity of postoperative hematuria. 3. The results were analyzed statiscally and significant difference was observed between these evaluations. Tranexamic acid group showed a highly significant reduction in bleeding during and following prostatectomy. The final clinical effect of tranexamic acid was excellent 51.3%, good 30.8% and poor 17.9%, while the effect of placebo was excellent 37.8%, good 10.8% and poor 51.4%. 4. As the side effect, only one case of tranexamic acid group showed slight nausea. 5. With the results obtained above, it was confirmed that tranexamic acid has marked hemostatic effect to control hemorrhage during and following prostatectomy in prostatic hypertrophy

RESULTS OF TREATMENT FOR TESTICULAR TUMORS

Fifty seven cases of testicular tumors were experienced for the last 16 years (from 1962 to 1978). These cases were reviewed with regard to their chemotherapeutic and prognostic features. 1. In the pathological classification, the testicular tumors in our series consisted of 32 seminomas, 9 embryonal carcinomas, 10 teratomas, and 3 teratocarcinomas. 2. In the distribution by age and pathological type, seminoma had a peak at the age of 20 to 40 and embryonal carcinoma had two peaks at the age of 0 to 9 and 20 to 30. 3. In the chemotherapy, the patients with seminoma (stage III) were administered cyclophosphamide and futraful and the patients with embryonal carcinoma and teratocarcinoma were almost administered actinomycin D. 4. The 5-year observed survival rate of seminoma was 83% and 5-year relative survival rate was 85%. 5. The 5-year observed survival rate of embryonal carcinoma was 100% and the 5-year relative survival rate was 100%. 6. The 5-year observed survival rate of all testicular tumors was 79% and the 5-year relative survival rate was 80%

TREAMENT OF ADVANCED UROGENITAL CANCERS WITH CIS-DIAMMINEDICHLOROPLATINUM (2)

Twenty-seven patients with advanced urogenital cancer, 14 prostatic adenocarcinoma, 5 urinary bladder cancer, 3 non-seminomatous testicular cancer, 1 prostatic transitional cell carcinoma, 1 urethral squamous cell carcinoma, 1 vVilms' tumor, 1 renal cell carcinoma, 1 penile cancer were treated with cis-diamminedichloroplatinum (II) (CDDP). Of 14 prostatic adenocarcinoma, 7 cases were received CDDP single treatment and 7 cases were received CDDP combined treatment with bil. orchiectomy, diethylstilbestrol diphosphate, futraful and picibanyl. Complete response was not observed, but partial responses were observed in 4 cases in single treatment group and 3 cases in combined treatment group. Overall response rate was 50% in advanced prostatic cancers with CDDP treatment, and response rate was 57% with single treatment and 43% with combined treatment. Of 7 cases with CDDP single treatment, however, 5 cases had been received bil. orchiectomy previously, so that response rate was 58% in the patients group with bil. orchiectomy, and no objective response was observed in 2 patients without bil. orchiectomy. Non-seminomatous testicular cancers well responsed to Einhorn's PVB regimen, CDDP, vinblastine and bleomycin. Complete responses were achieved in 2 patients with retroperitoneallymphadnectomy followed by CDDP combined treatment, and partial response was observed in a patient whose multiple bulky lung metastasis regressed remarkably, by 2 courses of CDDP combined treatment. The patient died of cancer 13 months after the CDDP treatment. Urinary bladder cancers responsed to CDDP single treatment. Complete response was not observed, but partial response was in all 5 cases. Prostatic transitional cell carcinoma was achieved complete response with CDDP single treatment. Wilms' tumor with local recurrence, liver and lung metastasis also responsed to CDDP with vinblastine. However, penile cancer, urethral squamous cell carcinoma and renal cell carcinoma did not response to CDDP treatment. In a view of the toxicity, moderate to severe nausea, vomiting and anorexia were observed in all cases during CDDP treatment and following several days. Nephrotoxity was mild in 4 cases and moderate in a case. Anemia was observed in 19 cases (70%), and leucopenia was observed in 8 cases (<3000) and 7 cases (<2000). In this study group, a prostatic cancer patient with liver and extensive bony metastasis died of severe pancytopenia. Peripheral neuropathy, muscle pain and alopecia were observed in all 4 cases treated with vinblastine and CDDP, but alopecia and muscle pain were not observed in other CDDP treatment, and mild peripheral neuropathy was observed in a patient treated without vinblastine. Azospermia was observed in a case treated with PVB regimen, and he was only a case who underwent semen examination. At present, we believe CDDP is one of the most promising chemotherapeutic agent for management of advanced urogenital cancers