Kiichi Suzuki

Intracavernous Injection of Prostaglandin E1 for the Treatment of Erectile Impotence

We administered intracavernous injections of 20 micrograms. prostaglandin E1 to 135 patients with impotence, and evaluated the effects and side effects. Among 135 patients who underwent intracavernous injection of prostaglandin E1 complete erection was observed in 83 (62 per cent), while incomplete erection was noted in 33 (24 per cent). In both groups the erection was sufficient for sexual intercourse. Tumescence without rigidity was noted in 12 patients and no response was obtained in 7. Poor response was seen frequently in patients with disorders of the vascular system and/or damage to the cavernous body of the penis. Priapism after the injection was not observed. Moreover, we never observed any other severe side effects. Intracavernous injection of prostaglandin E1 could be applicable to the therapy of impotence, especially that due to neurogenic disturbance. Since prostaglandin E1 acts quickly and loses its validity rapidly it is considered to be a more suitable agent than other vasoactive drugs.

Ultrasonic Diagnosis of Renal Cell Carcinoma in Hemodialysis Patients

Abdominal ultrasonic examination (US) was performed in 1556 patients on hemodialysis for 7 years and 6 months from April 1955 to September 1992. Renal cell carcinoma (RCC) proved histologically by operation was found in 36 patients (41 kidneys). Among the 36, RCC developed from the contracted kidney in 15, the individual kidney after renal transplantation in 3, and from ACDK (acquired cystic disease of the kidney) in 18. Among the 18 (ACDK), multiple tumors were found in the unilateral kidney in 8 and in bilateral kidney in 5. RCC was detected at the rate of 2.3% in patients on hemodialysis (1 out of 43). It was 29 time as high as in healthy persons (RCC was found in 22 out of 27933 at our Health Check-up Center, 0.079%). RCC was diagnosed 100% by US, 68% by CT, and 55% by angiography. US is the most excellent examination for the diagnosis of RCC in patients on hemodialysis.

Clinical and pathological studies of renal cell carcinoma and acquired cystic disease of the kidney in chronic dialysis patients.

我々は, 1984年4月から1992年1月までに長期透析患者1,352名において発生した27例の腎細胞癌 (RCC) を経験した. その発見率は約50人に1人 (2.0%) でcontrol群と比較すると約29倍の高率であった. この27例のRCCおよびcontrol群のRCCに対し臨床・病理学的検討を加えるとともに, 対象とした261例の透析患者をHD群とCAPD群, ACDK群と非ACDK群に分類し平均年齢, 透析期間, 原疾患等の比較検討を行った. Control群に選定した当院の検診受診者29,657名より発生した21例のRCCは全例単発であり, 組織学的細胞型が全て単一で, 摘出腎に認められた嚢胞は, その上皮が単層で, 増殖・癒合傾向を示さなかった. これに対し長期透析群より発生したRCC例では, 癌が両側・多発性に発生し, 複数の組織学的細胞型が混在する傾向を示した. さらに, 摘出腎に嚢胞が多数認められ, 嚢胞上皮は重層化し, 異形成や過形成性変化を92%の症例で認めた. これらの変化は前癌状態である可能性が示唆された.またACDKを “超音波検査法にて一側腎に2個以上の嚢胞を認めるとき” と定義したところHD例の60.9%, CAPD例の50.7%にACDKを合併し, 透析導入前の患者においても約7.8%にACDKを認めた. ACDKは男性で若年者, 透析期間が長く, 慢性糸球体腎炎および腎硬化症を原疾患にもつ群より高率に発生し, 糖尿病性腎症の群からの発生は有意に低かった. 本検討より長期透析患者に発生したRCCおよび摘出腎に認められた嚢胞上皮は特徴的な病理組織学的所見を呈し, また, ACDKは透析の方法によらずに発生し, さらに, 透析前の患者にも出現することから, 嚢胞発生には慢性腎不全がいかなる状態で存続していたかが重要である可能性が示唆された. 我々は, 長期透析患者の腎に嚢胞が一つでも確認されれば, これを癌発生の危険因子と捉え厳重に経過観察していく必要があると考えている.