Kazuhiko Tozuka

Effect of citrate and pyrophosphate on the stability of calcium oxalate dihydrate

Abstract The effect of citrate and pyrophosphate on the stability of calcium oxalate dihydrate (COD) was studied in an aqueous solution over 7 days. COD was precipitated from 1.0 × 10−2 mol/l calcium oxalate solution with the addition of citrate and/or pyrophosphate and separated by centrifugation immediately, 48 h and 7␣days after the precipitation. The percentage of COD in the precipitate, determined by X-ray diffraction, increased with a rise in citrate or pyrophosphate concentration and reached ≥90% at a citrate concentration of 1.0 × 10−3 mol/l or a pyrophosphate concentration of 2.0 × 10−4 mol/l. The resulting COD was completely transformed into calcium oxalate monohydrate within 48 h when the precipitate was composed of <90% COD. Nearly pure COD produced with pyrophosphate was stable over 7 days while that with citrate underwent partial transformation within 48 h. An additive effect of citrate and pyrophosphate was found on the stability of COD. It was concluded that a pyrophosphate concentration above a critical point was sufficient to prevent solution-mediated transformation of COD, and this critical point might be lowered to the physiological range with the presence of citrate.

Study of Passed Stones by Means of X-rays, Infrared and Thermal Analyses

X-ray powder diffraction, infrared spectroscopy and thermal analysis were used to study 108 stones that had been passed spontaneously from the upper urinary tract. The presence of apatite in pure calcium oxalate stones classified by x-ray diffraction was confirmed by infrared analysis of the ignited product. Consequently, 102 of 108 stones were found to be composed of weddellite and/or whewellite, and apatite. Besides the contents of weddellite, whewellite and apatite, the content of organic matrix also was estimated by thermal analysis in 102 stones, ranging from 1.1 to 17.2 per cent. The stones then were divided into 3 groups according to the principal constituent: 1) weddellite, 2) whewellite and 3) apatite. Weddellite stones were significantly heavier and significantly higher in apatite content than whewellite stones. It is suggested that weddellite calculi tend to become larger than whewellite stones. The apatite content was correlated with the ratio of weddellite to weddellite plus whewellite ( r equals 0.528), and the content of organic matrix was correlated with the whewellite content (r equals 0.708). Thus, it is considered that the weddellite-apatite and whewellite-organic matrix associations have important roles in the development and growth of weddellite and whewellite calculi, respectively.

Leiomyoma of the Ureter

We report a case of leiomyoma of the ureter, and the patient underwent partial ureteral resection. This is the 8th case reported after 1955, and the clinical features of ureteral leiomyomas of these 8 cases are discussed.

Intraarterial infusion chemotherapy with [Sar1, Ile8]angiotensin II for bladder cancer

Thirty-three patients with primary bladder cancer (nine stage T1 with multifocal tumors and 24 stage T2–4) were treated with intraarterial infusion chemotherapy including cisplatin, doxorubicin, and [Sar1, Ile8] Angiotensin II(AT II). Of the 32 evaluable patients, 12 had pathologically proven complete response (CR), 19 showed partial response (PR), and one showed no change (NC); the overall response rate (CR + PR) was 97%. The blood pressure increased in response to the administration of [Sar1, Ile8] AT II in all the patients; the mean increase in the systolic blood pressure was 36 mmHg. Most of the side effects were mild to moderate in severity, transient in nature, and included nausea/vomiting (100%), alopecia (84%), leukopenia (66%), headache (9%), nephrotoxicity (6%), diarrhea (3%), skin pigmentation (3%), and neurotoxicity (3%). One patient who dropped out of the study developed hemiplegia as a result of cerebral infarction. The findings indicate that it is necessary to exercise caution in selecting the patients to be subjected to this therapy. We conclude that intraarterial infusion chemotherapy combined with a vasoconstrictor has a significant effect not only against multifocal superficial bladder cancer but also against invasive bladder cancer.

Study of Calcium Phosphate Crystalluria

When the frequency of heavy calcium phosphate crystalluria was compared among postprandial urine specimens collected from 152 healthy persons (group 1) and 108 patients with calcium urolithiasis (group 2), there was no significant difference between these groups. However, the frequency of crystalluria was significantly greater in 49 patients in group 2 who required or had required surgical intervention for calcium stone disease than in group 1 (p less than 0.05). Calcium phosphate precipitates collected from 7 urine specimens by repeated centrifugation were studied by infrared, X-ray, thermal and electron probe analyses. The principal component of the precipitates was poorly crystallized apatite associated with some organic material. The precipitates from the 7 samples appeared as aggregates of fine spherules less than 1 micron. in diameter, and the calcium-to-phosphate molar ratio of a spherule ranged from 1.02 to 1.19. We conclude that not only calcium oxalate crystalluria but calcium phosphate crystalluria may have an important role in the formation of urinary stones.

A case of leiomyosarcoma of the renal vein

A 54-year-old woman presented with a 6-month history of left back pain. She had undergone left mastectomy for breast cancer in 1993 and hysterectomy for cervical cancer in 1997. Excretory urography showed no abnormality in the left collecting system, but right hydronephrosis caused by a midureteral stone. She was treated by transurethral ureterolithotripsy first. Computerized tomography showed a 4 x 3 cm. mass enhanced slightly by contrast medium at the left renal hilus. The tumor was bordered laterally by the left kidney and posteriorly by the left renal vein which appeared normal on magnetic resonance imaging. Selective left renal angiography revealed no abnormality. Radical en bloc excision of the tumor with the left kidney and adrenal gland was performed. Pathological examination showed a well differentiated leiomyosarcoma arising from the renal vein; the tumor cells stained positive for alpha-smooth muscle actin, vimentin and desmin and negative for S 100-protein. She was free of symptoms and there was no evidence of local recurrence or distant metastases 22 months postoperatively.

Evaluation of multidisciplinary treatment of bladder cancer, especially in chemoimmunotherapy (ADM and OK-432) as a consolidation therapy

SummaryThe relapse rate of bladder cancer (transitional cell Ca) is said to be about 45%–80% even after tumor resection. Multidisciplinary treatment was designed and studied to prevent such recurrence. This treatment was designed to have three steps: induction, consolidation, and maintenance therapy. Following surgical tumor removal, OK-432 and Adriamycin (ADM) were administered as consolidation therapy, followed by administration of PSK and carboquone (CQ) in small amounts as maintenance therapy continuously for about 3 years, and the course was observed.In both consolidation and maintenance groups various non-specific immunoparameters were superior in groups receiving combined immunotherapeutic agents. Thus, the use of immunotherapeutic agents in combination with chemotherapeutic agents was considered to be effective. The 3-year recurrence rate was only 8% in the multidisciplinary treatment group, while that in the non-multidisciplinary treatment group was 61%. This approach, especially with chemoimmunotherapy (ADM and OK-432) as a consolidation therapeutic mode, is therefore considered to be useful for the prevention of recurrence.