Hideaki Saeki

Immotile Cilia Syndrome Associated with Polycystic Kidney

The immotile cilia syndrome is an inherited disorder characterized by the inability of ciliated structures to beat effectively. The urological manifestation of this syndrome is sterility. We report a case of the immotile cilia syndrome associated with polycystic kidney, which also is a hereditary disease.

Effects of autonomic drugs on in vivo recording of electromyograms of canine renal pelvis and ureter.

The effects of the autonomic drugs (noradrenaline, isoproterenol and acetylcholine) and the urine volume change on the pacemaker of ureteral peristalsis were studied by our new method of the in vivo recording of electromyograms (EMGs) of canine renal pelvis. The EMGs of the pelvicalyceal region showed a two phasic slow-rising potential of amplitude of 20 microV and discharge interval of 5 s and was different from propagated waves and therefore considered to be the pacemaker potentials. In the diuretic state the pacemaker potentials kept a constant discharge interval. On the contrary, the discharge interval of the ureter EMG became shorter and finally corresponded to the pacemaker EMG one to one. These results suggest that the urine transport in the diuretic state is controlled by the change of efficiency of the peristaltic propagation and not by the changes of the discharge of the pacemaker itself. Noradrenaline promoted the ureteral peristalsis and isoproterenol inhibited the ureteral peristalsis. These two drugs had no effects on the pacemaker potentials. Acetylcholine had a great variety of the effects on the ureter EMG and the pacemaker EMG separately. These results suggest that the pacemaker of the ureteral peristalsis is controlled under the influence of the parasympathetic system and the ureter is controlled under the influence of both the sympathetic and parasympathetic system.

The Role of Ureteral Peristaltic Rate and Bolus Volume on Increasing Urine Flow

Electromyogram (EMG) and bolus volume of ureteral peristalsis were measured during gradual and rapid urinary flow increase in mongrel dogs. In acute diuresis induced by furosemide, the ureteral peristaltic rate rose and then the bolus volume increased with a consequent increase of urine flow. During a course of gradually increasing urine secretion, the ureter showed varying responses in respect to peristaltic rate (i.e., increase, no change and decrease) but changes in the bolus volume consistently made up for the rate alterations, thereby eventually maintaining an efficient equilibrium of these two urodynamic parameters to effect an increase in urine flow. The ureteral peristaltic rate increases only several times in polyuria as compared to the rate in oliguria, whereas the bolus volume of urine increases by a factor of 100. This indicates that it is not so much the ureteral peristaltic rate as the bolus volume which plays a principal part in the transport of urine through the ureter.

Bladder carcinoma with werner syndrome

Werner syndrome is a rapid premature aging disease and is considered chromosomal instability syndrome, occasionally associated with malignancy. Urologic malignancy associated with this syndrome is unusual. Herein we report a case of Werner syndrome with urinary bladder carcinoma.

Urinary Retention due to Idiopathic Megacolon

A 58-year-old man with neurogenic bladder dysfunction was hospitalized with chief complaints of urinary retention and abdominal distention. He had been treated for neurogenic bladder due to cerebral infarction for 3 years. The pelvic CT scan and excretory urogram revealed an obstruction of the neck of the bladder due to an abundant stool, which was found to have resulted from adult idiopathic megacolon. A permanent colostomy with sigmoid resection was established. The postoperative urodynamic examination demonstrated improvement of micturition.

Clinical evaluation of bicarbonate dialysis

重炭酸透析については, 最近いくつかの報告がなされており, 酢酸透析に比較し不快な症状の少ない透析ができる点で, その有効性が見直されている. 今回我々は, 透析時間を5時間から4時間に短縮し, 透析効果について5時間の酢酸透析と比較し検討を加えた.その結果, pH, HCO-3濃度, B. E. は, 4時間透析にもかかわらず酢酸透析に比較し透析後有意に上昇し, アシドーシスの改善効果が優れていた. 特にpHの改善が顕著で, 透析開始2時間で7,332±0.026から7.403±0.04まで上昇していた.尿素窒素, クレアチニン, 尿酸値は, 透析後有意に低下し, 除去率では, 5時間の酢酸透析と比較し劣らない結果を得た. 特にクレアチニンの除去率は, 酢酸透析の44.1±6.4%に比し, 重炭酸透析では, 52.7±4.4%と有意に高値を示した. また長期的にみた窒素代謝産物の透析前値の上昇, 及び体重の増加はまったく認められなかった. 透析ごとの体重減少量の比較では, 酢酸透析で2.0±0.4kg, 重炭酸透析で23±0.3kgと両者間に有意の差をみなかった. Ca濃度については, 透析後有意に上昇し, 低Ca血症は改善されていた.以上の所見より, 重炭酸透析では, 酸-塩基平衡の改善が効率よくしかも迅速であり, 透析中の不快な症状が少ないばかりでなく, 透析終了時まで十分な血液流量, 及び適正な限外濾過圧を維持することができ, 今後大面積-短時間透析において非常に有利であると判断した.