機能的腎体積測定による術後分腎機能評価の検討

PURPOSE:The change in functional renal volume (FRV) has an absolute influence on renal function after nephrectomy (Nx) or nephron-sparing surgery (NSS). In this study, we prospectively examined whether the postoperative renal function following Nx and NSS could be accurately predicted and assessed the reproducibility of our newly developed 3-D image reconstruction system (Kashihara) to measure the FRV. METHODS:We enrolled 98 patients who underwent Nx and 41 patients who underwent NSS from April 2006 to September 2009 to predict postoperative FRV and renal function. FRV was measured before and after (1 month and 1 year) renal surgery. The postoperative estimated glomerular filtration rate (eGFR) was predicted from the preoperative eGFR calculated from the serum creatinine (sCr) level and the ratio of the postoperative/preoperative FRV. To assess the reproducibility and accuracy of our newly developed 3-dimensional (3-D) image reconstruction system, FRV was measured by five examiners using images obtained by CT (five cases) and MRI (five cases). RESULTS:Significant correlation was found both for FRV and for renal function between the predictive values and the actually measured values at 1 month and 1 year after surgery, not only in the Nx group, but also in the NSS group. The accuracy and reproducibility could be confirmed both with CT and MRI studies. CONCLUSIONS:The postoperative FRV and renal function could be predicted preoperatively using a 3-D image reconstructive system, preoperative routine diagnostic imaging, and preoperative sCr level.博士（医学）・乙第1369号・平成27年11月27日© Springer-Verlag Berlin Heidelberg 2015The final publication is available at Springer via http://dx.doi.org/10.1007/s00345-014-1470-

Estimated functional renal parenchymal volume predicts the split renal function following renal surgery.

PURPOSE:The change in functional renal volume (FRV) has an absolute influence on renal function after nephrectomy (Nx) or nephron-sparing surgery (NSS). In this study, we prospectively examined whether the postoperative renal function following Nx and NSS could be accurately predicted and assessed the reproducibility of our newly developed 3-D image reconstruction system (Kashihara) to measure the FRV. METHODS:We enrolled 98 patients who underwent Nx and 41 patients who underwent NSS from April 2006 to September 2009 to predict postoperative FRV and renal function. FRV was measured before and after (1 month and 1 year) renal surgery. The postoperative estimated glomerular filtration rate (eGFR) was predicted from the preoperative eGFR calculated from the serum creatinine (sCr) level and the ratio of the postoperative/preoperative FRV. To assess the reproducibility and accuracy of our newly developed 3-dimensional (3-D) image reconstruction system, FRV was measured by five examiners using images obtained by CT (five cases) and MRI (five cases). RESULTS:Significant correlation was found both for FRV and for renal function between the predictive values and the actually measured values at 1 month and 1 year after surgery, not only in the Nx group, but also in the NSS group. The accuracy and reproducibility could be confirmed both with CT and MRI studies. CONCLUSIONS:The postoperative FRV and renal function could be predicted preoperatively using a 3-D image reconstructive system, preoperative routine diagnostic imaging, and preoperative sCr level.博士（医学）・乙第1369号・平成27年11月27日© Springer-Verlag Berlin Heidelberg 2015The final publication is available at Springer via http://dx.doi.org/10.1007/s00345-014-1470-7identifier:World journal of urology Vol.33 No.10 p.1571-1577 (2015.10)identifier:07244983identifier:http://ginmu.naramed-u.ac.jp/dspace/handle/10564/3107identifier:World journal of urology Vol. No. p., 33(10): 1571-157

A CASE OF MALIGNANT RENAL NEOPLASM WITH RHABDOID FEATURES IN AN ADULT

We report a case of malignant neoplasm with rhabdoid features of the kidney in a 68 year old man. To our knowledge malignant rhabdoid tumor of the kidney (MRTK) has been limited to the pediatric age group. Malignant renal neoplasm similar to MRTK occurring in adults is very rare. However, there has been a recent review in which the authors found 23/480 cases of renal cell carcinoma (RCC) (4.7%) exhibiting rhabdoid features, all in adults. In the present case, examination of many sections of tumor-affected tissue revealed no sign of any other malignant tumor included RCC, so-called pure adult malignant rhabdoid tumor in the kidney. MRTK does not respond well to aggressive chemotherapy regimens and survival tends to be short. This patient remains alive with no metastasis and local recurrence more than 45 months from the operation without adjuvant therapy

The Inhibitory Action of Kohamaic Acid A Derivatives on Mammalian DNA Polymerase β

molecule