Biomedical subjects
Publications and source records attributed to J Kawamura.
A recent six year statistic survey was carried out on the patients in the Urological Outpatients Clinic of Kyoto University Hospital.
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The patients seen between January 1979 and December 1981 were reviewed. The outpatients according to our classification of the patients, presented the most frequently with infections, followed by urogenital tumors and anomalies. Urogenital tumors and urolithiasis were the predominant diseases of the inpatients. The representative operations were TUR-P and prostatectomy.
Between 1975 and 1982, 39 patients underwent total cystectomy and urinary diversion at our hospitals. The type of urinary diversions were ileal conduit (32 cases) and ureterocutaneostomy (7 cases). Preoperative irradiation was used in 10 patients. The postoperative mortality rate was 2.6%. Early complications occurred in 38.5% and included wound infection, acute pyelonephritis, intestinal obstruction, pelvic infection, intestinal leakage and/or medical complications. Ureteroileal stricture was most frequent in late complications. Over-all relative 1-, 3-, and 5-year survival rates were 92.4, 56.6, 41.7%, respectively. Survival was dependent on the stage and the grade of the tumor. No significant difference was found between the older (greater than or equal to 65 years old) and the younger (less than 65 years old) groups.
Renal scintigraphy and regional renography using I-123- orthoiodohippurate were performed in 26 cases of obstructive nephropathy. After 1 mCi of I-123- orthoiodohippurate was given intravenously, serial renal scintigrams were obtained for 25 minutes and regional renogram curves were derived from the whole kidney, the cortical and pelvic areas. At the same time, renal functional images with Tmax as the peak arrival time were processed. Tmax in normal cases ranged from 2 to 3 minutes in the cortex and from 4 to 5 minutes in the pelvis, while there was some delay in Tmax in the obstructive nephropathy. In the case of acute ureteral obstruction by stones, most of the regional renograms in the cortex and pelvis improved soon after the removal of the obstruction. On the contrary, in the case of chronic obstructive nephropathy obstructive patterns on renogram curves was usually observed postoperatively. However, in some cases, functional images in cortical and/or pelvic areas showed marked recovery before improvement of findings on renograms or IVP. I-123- orthoiodohippurate renoscintigraphy is a useful adjunct for assessing pre- and post-operative renal function in obstructive nephropathy. Particularly, the analysis of regional renogram curves enables early prediction of postoperative recovery, and the functional image enables early detection of the functional recovery of the hydronephrotic kidney.
Cysts of the parathyroid glands are uncommon, and, moreover functioning parathyroid cysts that cause primary hyperparathyroidism are rare. Herein is reported a 53-year-old female with primary hyperparathyroidism accompanied by 2 parathyroid cysts, in one of which adenoma was noticed. Forty-two cases of parathyroid cysts were found in the Japanese literature. Twelve of them were in the hyperparathyroid state, but infarction of the adenoma lead to cystic degeneration in most of such cases and so the cyst wall were lined with adenoma cells. In only 2 cases including our case were the cyst walls lined with cuboid cells and the adenoma evident in the wall. The pathogenesis of our case seems to be a common embryonic defect or dilatation of vestigial remnants rather than a degenerative change of the adenoma.
A statistic survey was carried out on the patients, diseases, and operations experienced at the urological ward of Kyoto University Hospital during the years of 1977 to 1982.
Herein we report a 36-year-old man with hyperparathyroidism and a past history of internal irradiation to the thyroid. Twelve years previously at age 24 years he had received 8 mCi of radioactive iodine for Graves' disease. An additional dose of 4 mCi was required 3 years later. A right lower parathyroid adenoma (28 X 23 X 20 mm, 5.7 g) was found at neck exploration. Although the association of external ionizing radiation to the head and neck and the subsequent development of hyperfunctioning parathyroid glands has been described in recent years, there are only 4 cases in the literature of parathyroid surgery for hyperparathyroidism secondary to earlier treatment with radioactive iodine for Graves' disease. In a long-term follow-up of 180 patients treated with radioactive iodine for Graves' disease, neither hypercalcemia nor hypophosphatemia was found. Whether internal radiation therapy can be a causative factor in the development of hyperparathyroidism should be elucidated in future. However, it seems reasonable to suggest that patients whose hyperthyroidism has been treated with radioactive iodine should have their serum calcium levels examined at 5-year intervals.
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Five cases of presumed acute viral encephalitis with convulsions were examined with radioisotope (RI) cisternography six and 24 hours after an intrathecal injection of 1 mCi of pentetic acid labeled with either ytterbium 169 or indium 111. All cases showed abnormalities with this study. The "cold" areas observed with RI cisternography were well correlated with abnormal foci on the EEG. Although the findings are nonspecific, the CSF dynamics and patency of the subarachnoid space are easily examined by RI cisternography without appreciable complications. It is a useful supplementary diagnostic method to depict the extent of lobar abnormalities of cerebral cortex, particularly at an early stage, that either narrow or obliterate subarachnoid space and CSF pathways.
We report on a patient with renal artery stenosis who had only 1 kidney and in whom acute renal impairment developed with transient anuria after the administration of captopril. Although inhibition of the angiotensin-converting enzyme is considered to be efficient treatment for hypertension associated with chronic renal failure, care should be taken when captopril is administered initially to a patient with decreased renal function, under the conditions of sodium and water depletion. The renovascular hypertension in this patient was treated successfully by renal autotransplantation.
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