Biomedical subjects
Publications and source records attributed to H Washida.
We report 3 cases of müllerian duct cyst. Percutaneous puncture, aspiration and instillation of a sclerosing agent under ultrasound guidance was performed in each case. Ultrasound is valuable in the diagnosis is of cysts in the region of the prostate and seminal vesicles. Aspiration under ultrasound guidance would also be of therapeutic value.
The endoscopic image processing system which has a very small change coupled device (CCD) at the distal tip of an endoscope, can give us a quite different imaging information from the conventional optical endoscopes, of which the main functions were just to "see inside the human body". The advantage of this endoscopic image processing system has been well recognized but, since the scope diameter could not be made smaller due to the size limitations of the CCD chip itself, the system has not been utilized in the field of Urology. In cooperation with Olympus Optical Co., we have studied a system called Urological Video Information System (UVIS) in order to utilize the image processing system for Urology. In our system a special light source with RGB light output is utilized together with a conventional optical cystoscope and a video converter is connected to the eyepiece of the scope in order to observe endoscopic images on the monitor. Endoscopic images can be stored in an image filing system when necessary. The image quality of UVIS is inferior to that of the conventional cystoscopes at the moment and there are several other technical problems to solve but, as witnessed in the field of Gastroenterology, it is expected that this kind of electronic system will become much more important in the future. This report covers the current problems and some considerations of them as an initial study.
Clinical effects of ST-95 (fosfomycin) on infections of the urinary tract were studied on the basis of morphological changes of the urinary bacteria. The subjects were 22 inpatients with complex infections of the urinary tract. ST-95 was dissolved in physiologic saline (2 g/100 ml) and administered intravenously by drip infusion over a 1-hour period twice daily for 5 days. According to the UTI criteria, the treatment was effective in 13 (81%) of the 16 evaluable cases. The present effectiveness in 8 patients with chronic catheterization was 75%. No side effects were observed in any patient. Among the laboratory data, GOT and GPT were slightly increased in 1 patient, but their relations with the treatment were unknown. In one patient (P. vulgaris; MIC: 12.5 micrograms/ml), changes in the urinary ST-95 concentration, viable bacterial count, and morphology of the bacteria were studied after the initial administration. The urinary viable cell count was 1.5 x 10(7) cells/ml before administration, but it was reduced to 1.6 x 10(4) cells/ml at the end of the 1-hour infusion, and decreased progressively thereafter to complete disappearance after 12 hours. Under differential interference microscopy, filamentous debris of bacteria and spherical bacteria with irregular surface were observed from immediately after the end of the administration. By transmission electron microscopy, the cell wall showed a number of projections with formation of vacuolar structures in the space between the cell wall and the irregularly-shaped cytoplasms. In conclusion, the results of administration of ST-95 in complex infections of the urinary tract were satisfactory. The morphological changes of the bacteria suggested that this agent acts at an early stage of cell wall synthesis.
Computerized tomography was performed on 19 patients diagnosed as having uncomplicated acute pyelonephritis. The relationship was investigated among the laboratory findings, presence of flank pain, clinical course and severity of the lesions detected by computerized tomography. In patients febrile for less than 2 weeks healing as assessed by computerized tomography took an average of 76 days. However, in patients with repeated febrile episodes occurring for longer than 2 weeks healing was delayed until an average 232 days after onset. Computerized tomography findings generally correlated well with the erythrocyte sedimentation rate, C-reactive protein level, and presence of pyuria and flank pain. However, in patients with a prolonged course computerized tomography proved to be a more reliable indicator of progress than either the results of laboratory tests or the symptoms. In conclusion, computerized tomography was useful in the diagnosis, assessment of severity and evaluation of healing of acute pyelonephritis.
Expression of the product of the c-erbB-2 gene, a proto-oncogene related to, but distinct from c-erbB-1 encoding the epidermal growth factor receptor (EGF-R), was investigated in human urinary bladder carcinomas. In addition, levels of EGF-R and transferrin receptor were also analyzed using an immunohistochemical approach, and the results compared with histological pattern and grading, and tumor staging. Increased expression of c-erb B-2 product was found in 32% of cases (7/22), a positive reaction being observed in 60% of transitional cell carcinoma (TCC) Grade 3 lesions (3/5), 20% of Grade 2 TCCs (2/10) and 100% of adenocarcinomas (AC) (2/2), but in none of the cases of squamous cell carcinoma (SCC). Although no statistical correlation with staging was evident, TCCs or SCCs of high grade and stage often showed EGF-R-positive staining, whereas other well differentiated lesions and normal bladder epithelium were generally negative. Most cases of urinary bladder carcinoma were positive for the transferrin receptor, which was not detected in normal bladder. The results thus suggested that a positive reaction for c-erbB-2 product is correlated with TCC histological grading or AC morphology. A high intensity of EGF-R staining in human bladder carcinomas may be associated with poor differentiation and invasion, whereas transferrin receptor expression might reflect tumor growth.
A total of 75 cases of bladder tumors were treated with contact Nd:YAG laser therapy from February 1984 to April 1988. In 14 of 75 cases post-therapeutic total cystectomy was performed and laser irradiated areas were evaluated pathologically. The results were as given below. 1. The irradiated area a was well demarcated from the non-irradiated area and had ulceration and granulation. 2. Ulceration extended to the deep muscle layer but no perforations were noted in any cases. 3. Although intensive edema was present in the fresh granulation, by approximately Post-irradiation week 3 the fibroblast cells and the fibrous cells had appeared and new vascular growth was manifest. A year later very small scarred tissues, distinctly demarcated from the surrounding tissues, appeared or the granulation was absorbed. Carbonized foreign bodies were incorporated in the granulation with the confirmed presence of the giant cells ingesting the foreign bodies. 4. With the exception of two cases where eosinophilic invasion was predominant, neutrophilic infiltration was predominant in the granulation throughout the cases. 5. In cases at Stage T3, the irradiated beds were suspected of having residual cancer cells. 6. Contact irradiation would not be accompanied by transfer of the cancer cells. It was concluded that contact Nd:YAG laser therapy could be safely instituted in the treatment of bladder tumors in which transurethral treatment would be indicated.
Acute focal bacterial nephritis refers to a renal mass caused by acute focal infection. We report a case of acute focal bacterial nephritis, herein. The case was in a 56-year-old woman, who was hospitalized with the chief complaint of left flank pain, chills and fever. Intravenous pyelography suggested the presence of a mass in the upper pole of the left kidney. Ultrasonography showed a hypoechoic mass, CT scan revealed a round, low density mass. Antibiotic therapy resulted in resolution of symptoms, and a follow-up CT scan and ultrasonography showed complete resolution of the renal mass.
The expression of a number of enzymes involved in drug metabolism, membrane function etc. was compared in hyperplastic and neoplastic lesions of the rat bladder and in human bladder tumours. Transitional cell carcinomas (TCC) in both rat and Man were characterized by decreased alkaline phosphatase (ALP) and increased gamma-glutamyl transpeptidase (GGT), beta-glucuronidase (beta-G1), succinate dehydrogenase (SD) and glucose-6-phosphate dehydrogenase (G6PD) activities. In addition, binding for antibodies specific for different cytochrome P-450 species (UT50, PB3a, MC1, MC2) and microsomal epoxide hydrolase (mEHb) was elevated in both murine and human tumours. Comparison of the enzyme phenotype in hyperplastic lesions induced by freeze ulceration or uracil administration with that in preneoplastic papillary or nodular hyperplasia (PNH) and TCC suggested, however, that most of the alteration in enzyme content or activity was non-specific and related to requirements for epithelial cell proliferation. On the other hand, the decreased ALP, and increased GGT and beta-G1 activity appeared more directly related to neoplastic transformation. The results suggested that qualitative differences exist between reactive hyperplasia and preneoplastic or neoplastic lesions in the urinary bladder. The finding of increased cytochrome P-450, in clear contrast to the reduction characteristic of preneoplastic hepatic lesions, may be important with regard to the observed difference in neoplastic transformation between the bladder and liver in response to drug metabolising enzyme inducers.
A case of cecoureterocele in a 22-month-old girl is reported. She was admitted because of recurrent urinary tract infection associated with fever and dysuria. Excretory urogram showed a left duplex kidney with hydroureteronephrosis of the upper and lower moieties. Although the left upper moiety was hypofunctioned, some excretion of contrast medium was noted. Voiding cystourethrography demonstrated reflux into the left upper moiety, and a prominent dilation of the bladder neck and the urethra. Bladder sonography demonstrated an ectopic ureterocele at the bladder neck, and it was diagnosed as a cecoureterocele by endoscopic examination. Left pyelopyelostomy, total ureterectomy from the left upper half kidney and open resection of the ureterocele were performed together with reimplantation of the left lower ureter using Cohen technique in 1 stage. At the operation, the left lower ureter was confirmed as a typical obstructive megaureter. Convalescence was uneventful, and postoperative excretory urogram revealed an improvement of the left pyeloureterogram. But the postoperative voiding cystourethrography showed a remnant of cecoureterocele in the urethra causing bladder outlet obstruction. Endoscopic incision of the remnant cele wall in the urethra resulted in marked improvement in voiding and complete resolution of urinary tract infection. A brief review of cecoureterocele was given.
From January through December 1986, the urethral smear specimens from 132 male urethritis patients were examined by using Chlamydia trachomatis direct specimen test (Micro Trak). C. trachomatis was detected in 59 (44.7%) out of 132 male urethritis patients, 8 (30.8%) out of 26 patients with gonococcal urethritis (GU), and 51 (48.1%) out of 106 patients with non-gonococcal urethritis (NGU). In 5 (31.3%) out of 16 cases, already treated in other hospitals, infection of C. trachomatis was revealed. The age distribution of the patients with chlamydial urethritis (NGU-C) was between 19 and 52 years old, and the average was 30.9 years old. The peak incubation periods of GU and NGU-C were seen within 7 days and between 8 and 14 days, respectively. In NGU-C patients, 70.6% of them showed WBC less than or equal to 9/hpf in first voided urine sediment. The source of infection was a non-prostitute in 22.2% and a prostitute in 72.2% of GU, while in NGU-C 23.5% was infected from a non-prostitute, and 62.7% from a prostitute. Ofloxacin (OFLX) was administered in a daily dosage of 600 mg (in 3 divided oral doses) for 5 to 14 days in 38 NGU-C patients, and C. trachomatis was eliminated in all cases after the treatment.
Two cases of renal oncocytoma are reported. These patients were a 67-year-old man and a 74-year-old man who had incidentally been indicated to have a right renal mass lesion by echography in other hospitals. In both cases, enhanced computed tomographic scan showed a low density renal mass. In selective renal angiogram of the two cases, a spoke-wheel configuration of vessels could be seen in one case, but there was no evidence of renal mass in another. Total nephrectomy was performed in each case. Two masses were pathologically diagnosed as oncocytoma, constructed of large eosinophilic cells with granular cytoplasm and small regular nuclei. These two patients have been well for more than 2 years after the surgery. These are the 25th and 26th cases of renal oncocytoma reported in Japan before December, 1988.
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Seventeen patients with various grades of kidney function were injected each with cefsulodin (CFS) 1 g dissolved in 20 ml of saline. Serum and urine concentrations of CFS were determined using high performance liquid chromatography up to 24 hours after administration. Pharmacokinetic analysis was done using a two-compartment model. The results were discussed by comparing creatinine clearance (Ccr) values divided into 4 groups: greater than or equal to 70 ml/min (group I), 50-less than 70 ml/min (group II), 30-less than 50 ml/min (group III), and less than 30 ml/min (group IV). A delay in the disappearance of CFS from the blood was observed with a decrease in Ccr. Half-lives of CFS in blood (T 1/2 beta) were 1.03 hours (group I), 2.09 hours (group II), 3.44 hours (group III), and 4.52 hours (group IV). Serum clearance (Cls) and Ccr were found to be related with an equation: Cls = 1.60 x Ccr + 7.70. The correlation coefficient (r) was 0.881. Ccr and T 1/2 beta were found to be related with an equation: T 1/2 beta = 31.27 x Ccr-0.688, and the area under the curve (AUC) was found to be related to Ccr with AUC = 4,226 x Ccr-0.81. Urinary excretion rates up to 24 hours after administration were 84.4% (group I), 69.1% (group II), 67.5% (group III), and 56.5% (group IV). This means that CFS is excreted in urine with a relatively high recovery even in the case of low Ccr less than 30 ml/min.
Cutaneous ureterostomies, in which urostomas were made by a free nipple method, were performed on 14 ureters of 10 patients. The free nipple method was evaluated from the standing point of stoma care. Catheterless cutaneous ureterostomy was applied in 8 of the 10 patients. Six patients had to have catheters, and the catheter was not needed in 2 patients. The reasons for reindwelling the catheter in 6 patients were: 1) the urostoma had come to be at skin level by disturbance of blood supply for the ureter, and 2) urine puddled just on the urostoma and oozed out between the skin and Varicare flange. It may be concluded that the free nipple method is not satisfactory as urostoma in cutaneous ureterostomy for advancing the quality of life of the ostomate. A further study is in progress.
A synthetic contact sapphire endoprobe attached to the quartz fiber of a neodymium:yttrium aluminum garnet (Nd:YAG) laser had been used in the transurethral treatment of bladder tumors. A total of 68 operations have been carried out in 48 patients. The contact probe was placed directly into the tumor under direct vision. Using 15-20 watts of laser energy, the tumor blanched and underwent necrosis. The technique was easy to apply, and bleeding was minimal. Damage to the ureteral orifice and ureter in the bladder wall at repeat cystoscopy appeared less than with conventional electrocautery or noncontact laser treatment. The technique of contact Nd:YAG laser surgery will have an important role in the transurethral treatment of bladder tumors.
The effects of cefbuperazone (CBPZ) on the morphology of Escherichia coli in the urine of 10 patients with acute simple cystitis were studied by differential interference contrast microscopy and electron microscopy. The urine specimens were collected via catheter before, 5, 10, 15 and 30 minutes after intravenous administration of 0.25 g CBPZ. The minimum inhibitory concentrations for 8 Escherichia coli strains isolated from 8 patients against CBPZ were from 0.05 to 0.2 mcg/ml except one strain. The mean urinary concentrations at 5, 10, 15 and 30 minutes after administration of CBPZ were 274.8, 1181.5, 1343.4 and 931.5 mcg/ml, respectively. Urinalysis improved within 30 minutes after the administration. Filamentous cells of Escherichia coli were observed until 30 minutes after the administration. They had vacuole-like, and spheroplast and bulge formation were also observed in tested cases. CBPZ is suggested to have a high affinity for penicillin-binding protein (PBP) 3 and moderate affinity for PBP 1b and PBP 1a.
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Thirteen patients with recurrent superficial bladder tumors were treated by combined intravesical instillation of Aclacinomycin-A (ACM) and cytosine arabinoside (CA). Prophylactic effects of this combined instillation therapy were studied in 7 patients. A solution of 200 micrograms/ml of ACM and 600 micrograms/ml of CA was instilled into the bladder. The instillation aimed for treatment was carried out once a week until ten treatments had been given. Complete response was attained in 2 patients and partial response in 3 patients, but tumor size increased by more than 50% in 6 of the 13 patients. No change was observed in the remaining 2 patients. Recurrence of the tumors was observed in 3 of the 7 patients who were treated by this prophylactic combined instillation therapy. Local side effects such as bladder irritability were found in 2 of the 20 patients. No systemic side effects were noted in any patients. Although the side effects were reduced, we were not satisfied with the results of this therapy.