Biomedical subjects
Publications and source records attributed to J Kawamura.
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The in vivo renal volume was determined using SPECT for 99mTc -DMSA renal imaging. The total renal volume was derived by summing the DMSA distribution volumes of the transaxial slices in the whole kidney. In 20 healthy subjects the renal volume in the right kidney was 220 ml for men and 195.2 ml for women, while that in the left kidney was 213 ml for men and 193.7 ml for women. Differences in those values were not statistically significant. A good correlation was found between renal volumes in both kidneys and body surface area. In 106 kidneys including solitary and pathological kidneys, individual renal volume correlated well with individual DMSA renal uptake rate which demonstrates cortical functioning mass, depending on the cortical blood flow. Thus, SPECT enables an accurate noninvasive means of estimating in vivo functioning renal volume.
A frontal tomographic whole-body gallium-67-citrate scan was performed on 30 patients with renal cell carcinoma. Positive gallium uptake by the kidney in 20 patients (66.7%) correlated well with the clinicopathologically higher stage and grade of the tumor and with abnormal values in prognostic indexes in the blood. Thus, a negative gallium uptake may be indicative of an improved clinical course and longer survival in patients with renal cell carcinoma.
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The diagnostic accuracy of locating parathyroid tumors preoperatively was studied by reviewing 27 cases of hyperparathyroidism experienced at our Department between 1965 and 1983. Computed tomography gave the most accurate prediction (69%), followed by venous sampling for PTH (33%), subtraction scintigraphy with 201T1 and 123I (30%), ultrasonography (29%) and palpation (7%). Although the time required for an operation was not changed, significantly fewer parathyroid glands identified were removed during the operation when they had been located accurately before operation. This enabled quick recovery from postoperative hypocalcemia and ensured a safer operation. Scintigraphy and ultrasonography must first be performed in patients suspected of having hyperparathyroidism, but computed tomography is essential before operation. Venous sampling is indicated only when all other tests are negative, or in cases of re-operation.
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Seventeen solitary renal cysts were punctured with the ultrasound-guided procedure and 26-91% of the cyst volume was replaced with 95% ethanol used as a sclerosing agent of the cyst wall. Ethanol was injected through a 7 F pigtail ureteral catheter, allowed to remain in place for 20 minutes and removed through the catheter. Recovery rate of ethanol was 82.4%. The maximum blood level of ethanol was obtained 30 to 60 minutes after injection, while the maximum urinary excretion rate was observed after 60 to 120 minutes. The maximum blood levels of ethanol ranged from 0.015 to 0.339 mg/ml. There was a positive correlation between injected volume of ethanol and the maximum blood level (r = 0.66) or the total amount of urinary excretion during 12 hours (r = 0.72). Residual ethanol concentrations in the body were calculated from injected volume and recovery rate of ethanol. Only 2.3% of the residual ethanol in the body was excreted in the urine during the first 12 hours after injection. However, urine/blood ratio of ethanol 1 hour after injection was tremendously high with a wide variation between 1.6 and 230.5. Therefore, a large part of the ethanol absorbed from the cyst wall seems to be excreted directly from the kidney, not entering general circulation. From the estimation of the blood and urine levels of ethanol, it is concluded that 95% ethanol can be applied to the renal cyst wall as a sclerosing agent through the percutaneous ultrasound-guided procedure in the case of good recovery of ethanol.
Ultrasound-guided renal cyst puncture was performed on 22 cysts which were then 95% ethanol instilled to prevent recurrence of cystic fluid. Cystic lesions disappeared on the ultrasonogram in the follow-up period of 3 to 28 months. On CT, cystic lesions became smaller size but did not disappear. Average CT numbers of the cyst were 8.75 +/- 3.83 before and 12.96 +/- 3.27 after ethanol instillation. The cystic wall became thicker. Caliceal distortion and/or pelvis compression by cystic lesions improved on IVP 2 to 3 days after ethanol instillation. The renal image on Tc-99m-DMSA scintigram showed morphological improvement and DMSA renal uptake rate increased slightly but significantly 2 to 4 weeks after ethanol instillation. There were no major complications with this procedure except for one case in which the tip of the catheter became stuck in the cyst and broke off when the catheter was removed. A slight local irritable pain was noticed in all cases. Half of the patients had hot flushes and/or somewhat drunken sense but these symptoms were only temporary. Antabuse phenomenon appeared in one case with concomitant use of a cephem antibiotics after ethanol instillation. This method of therapy is a safe non-surgical approach to treat renal cysts. 95% ethanol instillation in the cyst seems to prevent recurrence of cystic fluid.
Twenty cases (3.3%) of hypercalcemia of more than 11.0 mg/dl associated with urogenital malignancy were observed in 610 inpatients during the past 5 years and 6 months (Jan. 1978-June 1983). Incidences were 10 (16.1%) out of 62 cases of renal cell carcinoma, 6 (1.9%) out of 321 cases of bladder cancer, 3 (6.7%) out of 45 cases of renal pelvic and ureteral cancer, and one (1.1%) out of 95 cases of prostatic cancer. As treatment, surgery (radical nephrectomy) and anti-cancer chemotherapy were effective in 3 cases (2 renal cell carcinomas and one renal pelvic cancer). Conservative therapy with hydration combined with either indomethacin, steroid or eel calcitonin was effective in 11 cases, and s-Ca level was decreased by 3.7 mg/dl on the average. Eighteen patients were in the terminal stage of malignancy when hypercalcemia was observed, and died 5 days to 9 months (mean; 2 months) after the onset of hypercalcemia.
To evaluate upper urinary tract and ileal loop functions, dynamic urinary flow studies using I-123 hippuran were performed in 52 kidneys of 27 patients with ileal loop urinary diversion. Analysis of regional renograms enabled easy assessment of the cortical, pelvic and loop functions. Normal pattern was found in 33 cortices (63.5%), 22 pelvis (45.8%) and 14 loops (51.9%). Most of the abnormal findings in the upper urinary tract were delayed excretion and/or retention of the pelvic and ureteral urines. Diagnosis of ileoureteral reflux under normal physiological circumstances was made to compare the pelvic and loop curves. Small peaks and/or irregular spike waves observed in the down slope of the pelvic curve concurrently with the increased activity of the loop curve indicate a production of the ileoureteral reflux associated with ileal movement. This reflux was noted in 22 of the 27 cases (81.5%). Bilateral reflux was evident in 3 cases, and unilateral reflux in 19 cases. Ileoureteral reflux was noticed in 14 of the 15 cases (90%) in which retrograde loopography was performed. Although bilateral reflux was found in 8 cases, the hippuran study revealed bilateral in only one case, unilateral in 5 and no reflux in 2. Thus, I-123 hippuran scintigraphy consisting of sequential renal images, loopograms and regional renograms enables the diagnosis of ileoureteral reflux and obstructive uropathies and is a useful tool to detect functional complications of the upper urinary tract in patients with ileal loop diversion.
We report a case of transitional cell carcinoma of the renal pelvis arising in a pelvic kidney two years after resection of bronchogenic carcinoma. Primary cancer in a pelvic kidney has been rarely described and this is the second reported case of transitional cell carcinoma originating in a pelvic kidney and the first associated with recurrent lung cancer.