[Clinical statistics on inpatients and operations at Mishina Urological Office between July, 1984 to December, 1990]

The total number of inpatients was 1,309. There were 1020 males and 289 females, the male to female ratio being 3.5: 1. The major diseases seen in inpatients were benign prostatic hypertrophy, bladder tumor, prostatic carcinoma, ureteral stone, urethral diverticulum, bladder neck contracture, inguinal hernia and renal tumor. The total number of patients operated on was 1,211; 953 males and 258 females. These operations were performed at 11 hospitals using a semi-open system. Major operations were transurethral resections of prostatic and bladder tumor, subcapsular prostatectomy, castration, urethral diverticulectomy, nephrectomy, inguinal hernioplasty, ureterolithotomy, radical cystectomy and transurethral ureterolithotripsy. New operation methods were radical prostatectomy by Walsh's method, Kock pouch, penis prosthesis implantation, transurethral incision of bladder diverticular orifice, Gil-Vernet method for VUR and Stamey's method for stress incontinence. Major small operations and examinations for outpatients were transperineal prostatic needle biopsies, transurethral urethral and bladder mucosal biopsies, phimotomy, transurethral intravesical surgery and percutaneous renal cyst puncture.

[Aging in the human tongue from autopsies. Histometrical study. 1. Degree of stenosis of lingual arteries]

Tongues from 119 autopsies were fixed in 20% neutral formalin. The transversely cut segments from the middle parts of the tongues were embedded in paraffin. Histologic sections of 5 microns thickness were prepared. Lingual tissue were examined histologically. Specimens were stained by hematoxylin-eosin, elastica van Gieson, and Azan-Mallory stainings. The stenotic index of human lingual arteries (area of lumen/area of intima and lumen of lingual artery x 100) (S.I) was calculated on the elastica van Gieson-stained slides by using an image analyzer system (Pias, LA555N). The results were as follows: 1. The lingual arteries, showed rupture and multilamellation of lamina elastica interna, as well as proliferation of intimal elastic fiber in almost all cases. 2. A decrease in the S.I was indicated in the lingual arteries with the progress of aging. 3. Calcification was observed at the intima and media of lingual arteries in a small number of cases (5 cases). These findings indicated that histological changes due to arteriosclerosis of lingual arteries was intimal thickening and lipid deposion; atherosclerotic changes was not observed.

[A case report of phylloides tumor of the prostate: review of the literature and analysis of bizarre giant cell origin]

A case of phylloides tumor of the prostate in a 58-year-old male is presented. The tumor was composed of columnar cystic folds and pleomorphic stromal elements including bizarre giant cells. Electron microscopic examination, which was performed using specimens embedded in paraffin blocks, revealed that the bizarre giant cells originated from the smooth muscle. The postoperative course was uneventful, with no evidence of local recurrence or metastasis for more than 2 years after operation.

[Experimental study on glucose turnover and amino acid metabolism after total pancreatectomy]

Glucose turnover and plasma amino acid profile were measured in total pancreatectomized dogs to clarify the mechanism of hyperaminoacidemia after total pancreatectomy. Twenty-one male mongrel dogs underwent total gastrectomy and pancreatectomy and were divided into two groups. I(-) group (n = 11) was treated without insulin and I(+) group (n = 10) received insulin postoperatively. Another 15 dogs of S group received only splenectomy. Glucose appearance rate (Ra), plasma amino acid profile and blood sugar level (BS) were measured before operation, and on the 1st and 3rd postoperative days. Significantly higher Ra and BS were observed in I(-) group than in S group postoperatively and either decreased or unaltered by the glucagon infusion. On the other hand, Ra and BS in I(+) group were maintained at the same levels as S group and increased significantly by the glucagon infusion. Hyperaminoacidemia was observed after total pancreatectomy regardless of insulin treatment. Branched chain amino acids (BCAA) were significantly elevated in I(-) group but not in I(+) group. Glucagon infusion decreased almost all amino acids levels except BCAA in both groups. These results suggest that mechanism of hyperaminoacidemia observed in totally pancreatectomized dogs is the reduced amino acids uptake by the liver related to glucagon deficiency.

[Thirteen cases of female urethral diverticula]

We report 13 cases of female urethral diverticula which were diagnosed at the Mishina Urological Office between July, 1984 and June, 1987. The 8 cases among them were discovered between July, 1986 and June, 1987 in the office, because the positive pressure urethrography has been energetically performed to detect female urethral diverticulum since November, 1985. The number of female outpatients in this period was 285, and the occurrence rate of the female urethral diverticula was 2.8%. Transvaginal diverticulectomy was performed in 5 of the 13 cases, using methylene blue-coagulum as an adjunct to the surgery. Postoperative course was uneventful in all cases. We herein reviewed the literature on this disease in addition to 65 cases including our cases since 1980.

[A case of sigmoidovesical and ileovesical fistula with bladder papilloma complicating colonic diverticulitis]

The clinical course of sigmoidovesical and ileovesical fistula due to rupture of colonic diverticulitis is reported. The patient, a 41-year-old male, who had been suffering from intestinocutaneous fistula for 16 months since drainage of abdominal abscess had chief complaints of cloudy urine and fecaluria. Cystoscopic examination revealed bladder papilloma land edema at the apex area of the bladder. Abscess and fistula were identified with transurethral ultrasonotomography and fistulography, respectively. Primary resection was performed after intravesical instillation of mitomycin-C and postoperative course was uneventful. Histological findings of the specimen revealed disappearance of bladder papilloma for the instillation therapy. Statistical analysis was made on 73 cases of sigmoidovesical fistula due to colonic diverticulitis reported in Japan including my own case.

[Clinical statistics on outpatients and operations at Mishina Urological Office between July 1984-June 1986]

The total number of outpatients was 2,012. There were 1,402 males and 610 females. The male to female ratio being 2.3:1. The major diseases seen in outpatients were benign prostatic hypertrophy, chronic prostatitis, prostatic stone, chronic cystitis, chronic pyelonephritis and ureteral stones. The total number of patients operated on was 347; 281 males and 66 females. These operations were performed at 11 hospitals using our semi-open system. Major operations were transurethral resection of prostate, subcapsular prostatectomy, transurethral resection of bladder tumor, YV plasty of bladder neck, ureterolithotomy and partial cystectomy.

[Penile implantation surgery for organic impotence due to radical cystectomy or prostatectomy]

Implantation surgery was performed twelve times in eleven patients with organic impotence, mainly due to radical cystectomy and prostatectomy against malignancy, between March, 1982 and April, 1987. A self-contained type prosthesis (AMS Hydroflex(TM] was used in 7 cases, reservoir type inflatable prosthesis (AMS 700TM) in 2, malleable semirigid type (ESKA-Jonas Silicon Silver(TM) Trimming Tip Version) in 2, and nonmalleable semirigid type (Fuji system Finney type) in 1 case. In the last case, the prosthesis was replaced by AMS Hydroflex 4.5 years later at patient's wish. Excellent results and good patients' acceptance were gained with inflatable-type prosthesis (AMS 700 and Hydroflex) in 7 out of 8 cases (88%), whereas concealment problems were produced by semirigid type prosthesis (Finney and Jonas). Experience with AMS Hydroflex penile implantation is reported for the first time in the Japanese literature. Intraoperatively, it was sometimes difficult to implant a pair of Hydroflex rods into both of the corpus cavernosum. Postoperative perineal pain was almost constantly seen and in one patient, penile edema continued for three weeks and subsided spontaneously in two months. In another patient, the length of the prosthesis (15 cm) was short, and exchange to the longer one (17 cm) was necessary. In this patient, the longer Hydroflex caused erosion of the glans to necessitate its removal on one side. From our experience, the diameter (11 mm) of the Hydroflex seems to be too big for the average Japanese patient. The operative procedures and results of each kind of the prostheses are briefly discussed.

[Histopathological study of secondary ureteral tumors occurring in 4 cases of bladder tumors]

Ureteral tumors were found in 4 out of 88 patients with bladder tumors who had been followed up at our clinic between July 4, 1984 and June 30, 1986. Radical nephroureterectomy and partial cystectomy were performed in 3 of them, and transurethral resection in the remaining one. The pathogenesis of the secondary ureteral tumors was discussed from the standpoints of implantation by vesicoureteral reflux, multicentricity, lymphatic or vascular spread and direct extension along the mucosa in these 4 cases. The ureteral tumor might have occurred in cases with multiple, recurrent or high grade bladder tumors and in cases with bladder tumors suffering from vesico-ureteral reflux. This study suggests that urine cytology, cystoscopy, retrograde cystography and excretory urography might be necessary in the cases of bladder tumors that had been treated with surgery with bladder preserved.

Two cases of saline-responsive metabolic alkalosis associated with high urinary chloride concentrations

Two particular cases of saline-responsive metabolic alkalosis associated with high urinary chloride concentrations were documented. In the first case, pseudoaldosteronism with long term glycylrrhetinic acid ingestion, and in the second case, probably salt losing nephropathy with extracellular fluid volume contraction were the putative causes of metabolic alkalosis, respectively. Sodium chloride loading with saline (0.9% NaCl) infusion to these patients corrected the accompanying hypopotassemic metabolic alkalosis. Recent trends in the pathophysiology of both saline-responsive and saline-resistant metabolic alkalosis were discussed.

[Prophylactic effect of etretinate on the recurrence of superficial bladder tumors--results of a randomized control study]

The recurrence preventing effect of Etretinate on 174 superficial bladder tumors was examined by a randomized study using the envelope method. After transurethral resection of the bladder tumor, the tumor-free patients were divided into two groups, one administered one 10 mg capsule of Etretinate once a day, and the other group untreated (control group). As a rule, the patients were examined for recurrence every 3 months. There were 9 drop outs (9.6%) in the Etretinate group, and 8 (10%) in the control group. Therefore, 85 subjects in the Etretinate group and 72 patients in the control group were analyzed for statistics. The recurrence rate during the observation period of over 2 years was 38% in the control group and 18% in the Etretinate group, the number of relapsing cases in the latter group tending to be decreased (P less than 0.1). The cumulative recurrence inhibition rate for cases observed over one year tested by the Kaplan Meier method tended to be higher in the Etretinate group compared to the control group (P less than 0.1). Etretinate administration had a high recurrence inhibitory effect (P less than 0.05) in the cases of relapse, multiple tumors, and tumors less than 1 cm. Side effects of Etretinate administration were seen in 21 cases (22.3%). The major symptoms were dry lips, cheilitis, stomatitis, dermal desquamation, etc., and drug use was discontinued in 7 cases (7.4%). The symptoms all disappeared after drug administration was discontinued.

Hyperchloremia in patients with chronic renal failure

The electrolyte and acid base composition of steady state chronic renal failure patients were studied. A particular comparison was made between the group of hyperchloremic and normochloremic patients, matched for sex, age, serum creatinine concentration and the etiology of the disease. Hyperchloremia was constantly seen in any stage of the disease in hyperchloremic patients, and they were found to be more acidemic, with lower anion gap, than normochloremic patients. A greater degree of tubular dysfunction than glomerular dysfunction was considered as the cause of acidosis and hyperchloremia in any stage of the disease. Hyperchloremia could be an indication to initiate alkali therapy to protect against further loss of bone mineral and the progression of the disease itself.

Absorption of anticancer drugs through bladder epithelium

Fundamental and clinical evaluations of ten anticancer drugs were performed. The required qualities of an anticancer drug ideal for bladder instillation therapy are thought to be as follows: (1) a high sensitivity for bladder tumor cells; (2) a pKa which provides a high percentage of nonionized molecules in a pH 6-7 solution; (3) a log P in the range from -0.4 to -1.2 or from -7.5 to -8.0; and (4) a molecular weight over 200.

[Comparison between FT-207 and 5-FU on intravesical absorption--experimental study on intravesical absorption in the dog]

FT-207 and 5-FU (1,200 mg) were administered intravesically to 5 mongrel dogs, and their concentration in the serum and bladder wall was measured. The serum concentration was high in both groups because their molecular weights are less than 200. The serum concentration of FT-207 was approximately 40 times higher than that of 5-FU. This difference may be due to the fact that non-ionized molecules in FT-207 account for more than 80% but those in 5-FU account for less than 10%.

The effects of PGE2 on vasopressin--and guanine nucleotide-mediated adenylate cyclase activity in toad bladder membrane

PGE2 inhibited 10 m U/ml vasopressin-induced osmotic water flow of the toad bladder at 2 X 10(-8) M. PGE2 suppressed vasopressin-mediated cyclic AMP accumulation in epithelial cells and also vasopressin-mediated adenylate cyclase activity in a crude homogenate of the cells. However, PGE2 had no effect on cyclic AMP dependent and independent protein phosphorylation. These findings indicate that PGE2 inhibits vasopressin-induced water flow mainly through suppression of adenylate cyclase activity, and that the role of PGE2 at that point in the reaction leading to increased water permeability following cyclic AMP production may be slight. Under conditions in which the hormone and substrate are depleted, PGE2 and guanine nucleotides, such as GTP and Gpp(NH)p, additively bring about an increase in adenylate cyclase activity.