Norihisa Takeuchi

The beneficial effects of thoracic duct drainage in HLA-1 haplotype identical kidney transplantation.

The beneficial effects of pre-treatment thoracic duct drainage on graft survival in living related kidney transplantation are presented. Since July 1980 lymphocyte depletion through thoracic duct drainage has been used as pre-treatment therapy in 39 HLA-1 haplotype identical living related kidney transplant patients. Thoracic duct drainage was maintained for 29 to 49 days (mean 36 days) before transplantation and 52 to 215 times 10(9) cells (mean 130 times 10(9) cells) were removed. Postoperative immunosuppression consisted of azathioprine and steroids. Actuarial graft survival was 100 per cent at 3 months, 97 per cent at 6 months through 2 years, 92 per cent at 3 years and 57 per cent at 4 years after transplantation. Patient survival was 100 per cent at 3 months, 97 per cent at 6 months through 3 years and 86 per cent at 4 years. Pre-treatment thoracic duct drainage maintained for more than 28 days could have a significant role on the improvement of the graft survival in HLA-1 haplotype identical kidney transplantation.

Extracorporeal Shock Wave Lithotripsy Using the Dornier MPL 9000 Lithotriptor

336 patients with urinary calculi were treated between June 1988 and October 1991 with extracorporeal shock wave lithotripsy using the Dornier MPL 9000 lithotriptor. Of 352 renal units (a kidney and its ureter), 286 had renal stones, 62 had ureteral stones and 10 had both. There were radiolucent stones in 6 units. The complete disintegration rate was 94%. The mean number of shock waves was 2,973, the range being from 300 to 16,131. In 310 of 447 (64%) sessions, treatment was done without any anesthesia. The rate of complete removal was 67.3% 3 months after the last treatment. Only 11 patients required supplementary treatment consisting of percutaneous nephrolithotripsy and transurethral lithotripsy. There were no severe complications except subcapsular hematomas observed in 2 patients. The Dornier MPL 9000 is a useful lithotriptor for the treatment of urinary calculi, except staghorn calculi.

The evaluation of cystoscopy in the screening of asymptomatic microhematuria

As a prospective study on asymptomatic microhematuria, complete urological examinations including cystoscopy, IVP, ultrasound and urinary cytology were performed on 422 patients over 40 years old between January 1987 and December 1988 (group A). The results of group A was compared with that of retrospective study on 266 patients, who had incomplete urological examination between January 1984 and December 1985 (group B). Cystoscopy was performed on 321 patients (87.2%) in group A and on 108 patients (40.6%) in group B. Bladder tumor was found in 10 cases (2.4%) in group A, including 7 cases of male patients (5.7%), but in only 1 case (0.4%) in group B. Since the negative rate of abnormal urinary cytology was 50% and that of abnormal IVP was 90% in 10 cases of bladder tumor in group A, cystoscopy was considered to be an essential examination for the screening of patients with asymptomatic microhematuria over 40 years old patients.

An Outlet Obstruction Caused by V-Shaped Bar at the Bladder Neck in a Woman

A case of outlet obstruction caused by a V-shaped bar at the bladder neck in a woman was treated successfully by transurethral resection of the bar. The poor urinary flow in our patient was believed to be due to impedance during voiding caused by retraction of the bladder neck in the anteroposterior direction by the bar. Our case is different from previously reported cases.

Clinical experience with ESWL with new Dornier lithotripter MPL 9000

In June 1988, the new type of the lithotripter MPL 9000 (Dornier), which was the first interdisciplinary lithotripter for treatment of urinary and biliary calculi, was installed at the Shakai Hoken Chukyo Hospital. MPL 9000 has some features which enable one to treat with low range of shock wave energy and without anesthesia due to the enlarged aperture of the ellipsoid (210 mm), and locate the stone by computerized two ultrasound probes (coaxial, lateral). Unlike HM-3, the water bath is not used: shock wave is shot through the water cushion. From June to November 1988, 35 patients suffering from 64 urinary calculi were treated. The majority represented caliceal (75%) and pelvic (17%) stones, whereas 5 calculi were treated in the upper and lower ureter. Twenty-four patients were treated in one session and 11 patients needed additional sessions. The given number of shock waves was between 1337 and 3050 per one session and averaged 2403 with low generator voltage (15-18 kv). Twenty sessions (42%) were given without any medication and other 28 sessions (58%) were under analgesia (Pentazocine, i.v.) for the pain complained during the treatment. The rate of successful disintegration (less than 5 mm) was 88%. After the 1-month followup, 47.1% were free of stone, and 62.1% were free after the 3-month. Four patients had arrhythmia and one patient was with a subcapsular renal hematoma. We have concluded that this lithotripter is useful to treat upper and lower urinary tract calculi, in particular radiolucent ones in high risk patients because it is applicable without anesthesia.