Atsushi Tajima

Laparoscopic Adrenalectomy: Clinical Experience with 12 Cases

Laparoscopic adrenalectomy is a new procedure for the treatment of adrenal tumors. The clinical experience with this operation in 12 patients is reported. While adrenal tumors are relatively small and seem to be good candidates for laparoscopic surgery, this procedure is difficult because of the anatomical location. In our study laparoscopic adrenalectomy appeared to be successful, although massive bleeding occurred in 3 patients. These problems should be overcome as the technique is improved and new laparoscopic instruments are introduced.

Usefulness of Fiberoptic Pyeloureteroscope in the Diagnosis of the Upper Urinary Tract Lesions

Fiberscopes for the observation of the upper urinary tract (pyeloureteroscopes) have improved markedly in terms of resolution and durability. With these improved pyeloureteroscopes, transurethral observation of upper urinary tract lesions was performed 42 times in 40 cases from April 1979 to May 1983. The guide tube method (J. Urol. 112: 176-178, 1974) was used for insertion of the fiberscope into the ureter. At present, our transurethrally passed pyeloureteroscope is useful in the diagnosis of some upper urinary tract lesions which are not visualized or confirmed by other current image diagnostic procedures. However, it should be noted that it does not visualize all parts of the upper urinary tract - especially the lower calyx. Insertion to the target is also sometimes difficult and we must be careful in the interpretation of findings because of inevitable image distortion and the similarity between inflammation and urothelial tumor.

Operative Fiberoptic Nephroureteroscopy: Removal of Upper Ureteral and Renal Calculi

We tested 2 prototypes of an operating fiberoptic nephroureteroscope, measuring 3.5 and 4.5 mm. in diameter, that have an adequate working channel for auxiliary instruments and irrigation. Difficulty in passing the fiberscope through the ureteral orifice was overcome by dilation with balloon and polytetrafluoroethylene (Teflon) dilators. Our initial trial for stone retrieval under fiberscopic control was performed on 21 patients with upper ureteral and renal calculi. A stone was removed successfully in 15 of the 21 patients (71 per cent). After electrohydraulic lithotripsy calculi were extracted successfully in 9 of 11 patients (82 per cent). Three patients suffered ureteral perforation. The fiberscope was especially helpful when an upper ureteral stone moved back to the kidney during stone manipulation.

Hydronephrosis in ACI/N rats

Of 45 ACI/N rats 9 were found with renal agenesis and 2 with hydronephrosis. The hydronephrosis may have been due to faulty development of the mesonephric duct.

Intraoperative blood pressure control by ATP in pheochromocytoma

Three cases of pheochromocytoma which were successfully treated with the use of adenosine triphosphate (ATP) during the operation are reported. The mechanism of the hypotensive effect of ATP has been proved due to the antagonizing action of the agent to the vasoconstriction by noradrenaline and/or sympathetic nerve stimulation. In these 3 cases, ATP has been safely and effectively applied to control blood pressure in pheochromocytoma. ATP could be used as the first-choice drug to keep the circulatory state stable during surgery for pheochromocytoma.

Foot Switch Photography with a Lecture Scope in Cystourethroscopy

Photography during cystourethroscopy has been made lighter and easier with a new system involving a special lecture scope and a 16 mm. camera. With this system endoscopic photographs can be made by pushing a foot pedal. Therefore, the system allows for free movement and full control of the cystourethroscope. Bright and sharp photographs are produced, making them useful in the diagnosis of a case. In addition, the same view can be observed by an operator and an assistant simultaneously.

Clinical effect of gabexate mesilate as an anticoagulant in hemodialysis in renal transplantation patients with hemorrharagic tendencies

メシル酸ガベキサート (パナベート®) を, 出血傾向を有する移植腎機能が不十分である5人の腎移植者の血液透析の局所抗凝固剤として用いた. 血液透析の回路には, 二連式チェンバーを使用し, メシル酸ガベキサートは動脈側より注入し, その投与量は, 患者それぞれのヘマトクリット値と活性化部分トロンボプラスチン時間によって決めた. すなわちヘマトクリット値が高値あるいは活性化部分トロンボプラスチン時間が短縮している場合は, メシル酸ガベキサートの投与量を増量し, 逆の場合は, その投与量を減量した. またメシル酸ガベキサートは, 1時間当たり170-250mlの生理食塩水で希釈して投与した. その結果1時間当たり500-800mgのメシル酸ガベキサートの投与量で安全かつ十分満足できる血液透析を行うことができた. 2症例では, 少量のヘパリンを併用したが, 残り3例ではヘパリンを全く使用しなかった. 我々の方法では, メシル酸ガベキサートの投与量は, 従来報告されている投与量より少量ですみ, 臨床上十分満足できる結果が得られた.

Lymphocytapheresis and plasma exchange in renal transplantation

腎移植において, 免疫抑制処置としてのリンパ球除去 (LA) と血漿交換 (PE) の有効性について検討した. LAとPEは, いずれもblood cell separator (IBM 2997) を用いて, 施行された.LAは, 生体腎移植29症例の移植前免疫抑制処理として施行した. その結果, 移植腎1年および3年生着率は, それぞれ93%と88%であった.PEは, 14回の急性拒絶反応と, 15回の慢性拒絶反応の治療として施行された. PEによる治療を施行した急性拒絶反応は, ステロイドの大量投与が危険である急性拒絶反応あるいは, vascular typeの急性拒絶反応である. PEの拒絶反応に対する有効率は, 急性拒絶反応では79%, 一方慢性拒絶反応では40%であった. LPおよびPEは, 腎移植の臨床において, 有効かつ安全な免疫抑制法である可能性が示唆された.