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A case of adult renal hamartoma resembling congenital mesoblastic nephroma
Get PDFA 35-year old man was hospitalized for left flank pain. IVP showed left non-visualizing kidney with multiple renal calculi. Selective renal arteriogram revealed avascular mass in the left upper pole. The upper calyx was irregularly distorted. Left nephrectomy was carried out. Grossly, the upper pole was replaced by whitish, firm and homogeneous tumor, which was 7 X 7 cm in diameter and protruded into the upper calyx. Histologically, the tumor was composed of both epithelial and mesenchymal components. The epithelial elements consisted of cysts and tubules, and the mesenchymal elements of loosely textured fibroblasts and smooth muscle cells. Other elements could not be identified. This case was diagnosed as renal hamartoma histologically resembling congenital mesoblastic nephroma of infancy. Congenital mesoblastic nephroma is rare in adults. Continued maturation may finally transform it either to benign mixed tumor as in our case or fibromatous tumor if stroma matures dominantly
Primary localized amyloidosis of the urinary bladder: a case report
Get PDFA case of primary localized amyloidosis of the bladder during a twelve-year period is described. The initial symptom was miction pain when she was 43 years old. Cystoscopic examination revealed yellowish elevated lesion with hemorrhage at the right side of the bladder neck. Transurethral resection was performed, but two years later recurrence was found at the trigonum as well as the original site. The two lesions were apart. She remained asymptomatic for the following ten years until she returned to us with bladder symptoms. Cystoscopy showed the lesion was more diffuse and the posterior wall was involved in continuity with the trigonum. Complete transurethral resection was not possible because of generalized bladder involvement. Our case illustrates the clinically benign but slowly progressive nature of amyloidosis of the bladder. Multifocal recurrence is also to be noted. Our current treatment policy is conservative treatment with careful follow-up. She is asymptomatic three months postoperatively
Two-week administration of low-dose Hachimi-jio-gan (Ba-Wei Di-Huang-Wan) for patients with benign prostatic hyperplasia
No full text前立腺肥大症に対する八味地黄丸の少量2週間投与による治療成績を検討した.対象は, 前立腺肥大症で前治療を受けていない41名(平均年齢65.2歳)で, 八味地黄丸エキス剤1日4.0gを2週間投与し, 塩酸タムスロシン0.2mg/日投与の70名(平均年齢66.9歳)をコントロールとして比較した.その結果, 自覚症状では尿勢低下および残尿量で, 国際前立腺スコア(I-PSS)の総スコア, 排尿症状サブスコア, QOLスコアで有意な改善を認めた.コントロールとの比較では主観的にI-PSS総スコアやQOLなどで塩酸タムスロシンの方が有意に良好であったが, 最大尿流量では八味丸で有意に改善度が高かった.また, 2つの治療効果判定基準の評価ではどちらの基準でも有効は約40%で, I-PSS, QOL, 機能のいずれかが有効な群では無効群に比し投薬前の残尿感スコアが有意に高く, QOLスコアが高い傾向が認められた.以上, 残尿感が主訴の患者には本薬剤がよい適応と考えられたWe evaluated the efficacy and side effects of two-week administration of low-dose "Hachimi-jio-gan (Ba-Wei Di-Huang-Wan)" for 41 patients with benign prostatic hyperplasia and searched for any predictors of good response to this agent. Although two of the 41 patients could not finish administration due to epigastric discomfort, there were no other side effects. "Hachimi-jio-gan" significantly reduced scores of emptying, weak stream, total score and quality of life score according to the International Prostate Symptom Score, although the degree of reduction was inferior to that induced by tamsulosin administration. "Hachimi-jio-gan" significantly improved max flow rate, and the degree of this improvement was superior to that induced by tamsulosin administration. Approximately 40% of patients were good responders to "Hachimi-jio-gan" therapy. Severe sensation of incomplete emptying was a predictor of good response
Spinal anesthesia with isobaric bupivacaine for percutaneous nephro-ureterolithotomy
Get PDF1)麻酔高の安定に20～30分を要し, Dibucaincより若干長かった.この間は血圧低下や徐脈に対する注意が必要であるが, その後の循環動態は安定しており, 体位変換による血圧の変動は少なかった.2)側臥位でL3/4もしくはL2/3から0.5%Bupivacaine 3.5 mlを用いることにより, T4までの冷感の消失, T6までの麻酔高が期待できた.後者の達成により約90分のPNLが可能であった.90分を越えるPNLが予想される場合, 穿刺する椎間はL2/3が適していた.3) T7以下の麻酔高しか得られなければ, クモ膜下腔の再穿刺を行ない0.5%Bupivacaine 2.0 mlを追加したほうが良いThe duration of analgesia and the cardiovascular changes during anesthesia of spinal blockade with isobaric bupivacaine were examined in 36 patients between 21 and 75 years old undergoing percutaneous nephro-ureterolithotomy. Injection of 0.25% or 0.5% bupivacaine 3.0-4.0 ml through the L3-4 or L2-3 intervertebral space in the horizontal posture resulted in spread of hypalgesia to T6 in 30 patients and of analgesia to T6 in about a half of the patients. In six patients, another intrathecal injection of 2 ml of bupivacaine was performed because their analgesia level had been under T8. Although the operation took 32-141 min. (mean 77.7 +/- 27.5 min.), there was no case requiring exigent exchanging anesthesia for general anesthesia. The frequencies of the hypotension, bradycardia and nausea in spinal blockade with isobaric bupivacaine were not so different from those of the previous epidural anesthesia in 29 patients undergoing the same operation. Most of the cardiovascular changes in the spinal blockade with isobaric bupivacaine happened within 20-30 min. after intrathecal injection of bupivacaine. Spinal anesthesia with isobaric bupivacaine proved satisfactory for percutaneous nephro-ureterolithotomy
Incidentally detected renal cell carcinoma: report of two early small cases
Get PDFWe report two cases of small renal cell carcinoma, which were incidentally detected by abdominal computed tomography (CT) and ultrasound. Both tumors were less than 15 mm in diameter and low grade, stage I lesions. Incidentally found renal cancer does not always indicate better prognosis. However, in selected patients with small tumors, surgical enucleation may be an acceptable method of treatment even if the contralateral kidney is normal. Renal screening should be a routine part of abdominal ultrasound. In our institution, ultrasound revealed incidental renal cancer in 0.035% of non-urologic patients
Ureteral injury in endourological treatment of renal and ureteral calculi
Get PDFPercutaneous and transurethral removal of renal and ureteral calculi was performed in 109 cases. Targeted calculi were successfully removed in 105 cases (96.3 per cent), but in five cases combined percutaneous and transurethral procedures were required. Although endourological stone removal resulted in low morbidity rates in many other series, some major complications have also been reported. They include arteriovenous fistula, colo-cutaneous fistula, nephro-duodenal fistula and ureteral avulsion. There were two severe complications in our early experience as well. In one case, a ureteral stenosis was found seven months after two sessions of percutaneous ultrasonic lithotripsy for an upper ureteral stone, and in the other case, a mid-ureteral avulsion was caused by ureteroscopic manipulation. Besides these, we experienced several minor pelvic and ureteral perforations which were easily controlled only by ureteral stent placement. Causes and management of ureteral complications in endourological treatment of renal and ureteral calculi are discussed
Endoscopic stone disintegration using the Lithoclast
Get PDF20例の尿路結石症例(尿管結石11例, 膀胱結石5例, コックパウチ4例)に対しリソクラスト(R)を用い砕石を試みた。自排可能までの破砕効果は90%, 1ヵ月後の無結石率は83%で, わずかの結石遺残を有効にいれると有効率は90%であったWe present our experience with a new and unique device for performing intracorporeal lithotripsy known as the Swiss Lithoclast. This simple device uses compressed air to activate a solid probe in a manner of a jackhammer. This device was used to treat 20 patients with stones in the ureter (11), bladder (5) or a Kock pouch (4). The Lithoclast successfully fragmented 90% of the calculi independent of the composition and salvaged 2 failed ESWL treatments. At one month after the procedure, either alone or in combination of with ESWL, 17 of 20 patients became free of stones. There were no complications related to use of the device. We have found the Swiss Lithoclast to be a safe and effective means of performing intracorporeal lithotripsy for urinary calculi
Two cases of adrenal cysts
Get PDFTwo cases of adrenal cysts are described. The first case is of bilateral adrenal cysts in a 44-year-old woman. It seems to be the first case of bilateral adrenal cysts in the Japanese literature. The second case is of a left adrenal cyst with sandy calcification in a 71-year-old woman presenting with asymptomatic gross hematuria. Several hormone levels in the cyst fluid were higher than in those in the plasma; cortisol and aldosterone in the first case, and cortisol in the latter. This finding suggests that the hormonal study of cyst fluid obtained by percutaneous needle aspiration under ultrasonic guidance is useful in the differential diagnosis of adrenal cyst from those arising from other organs
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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