Shigeru Miyagata

Microwave Coagulation Therapy for Urinary Bladder Tumors

A new device has been developed for microwave coagulation of urinary bladder tumors. Twenty-one patients with urinary bladder tumors were treated by irradiation with microwave energy of 2,450 MHz. Results were obtained as follows: (1) microwave coagulation was performed in 21 patients with transitional cell carcinoma of the urinary bladder. Excluding 4 patients who subsequently received radical cystectomy, 17 patients showed a complete response, although 2 patients subsequently developed recurrences in different parts of the bladder within the following several months. Histological examination of the excised specimen revealed complete eradication of the tumor in 2 patients. In the remaining 2 patients with high-stage tumor (T4), viable tumor cells were noted in the urethra or vaginal wall. (2) Although neither technical difficulties nor severe complications were encountered, transient urinary frequency and calcification of the bladder wall were noted. The results of this study indicate that microwave coagulation may be used in the treatment of both superficial and invasive tumors.

Combination Therapy with Microwave Coagulation and Intracavitary Irradiation for Bladder Cancer

Twenty-five patients with transitional cell carcinoma of the bladder have been treated with combined therapy consisting of microwave regional coagulation and intracavitary irradiation. A remote-controlled after-loading system was utilized for the radiation therapy. The follow-up period ranged from 6 to 19 months with an average of 11.4 months. Tumor stages were Tis (n = 2), Ta or T1 (n = 17), T2 (n = 2), T3 (n = 3) and T4 (n = 1), and grades were G1 (n = 10), G2 (n = 11) and G3 (n = 4). In 23 patients (92%), there was no endoscopic or histologic evidence of tumor after the initial treatment. Heterotopic recurrences were found after 2 or 3 months in 3 patients who received microwave regional coagulation or intracavitary regional irradiation. Additional intracavitary whole bladder mucosal irradiation was performed for 10 patients with multiple tumors and frequent recurrent tumors. Nine patients had no recurrence (average follow-up 11 months). Our preliminary findings indicate that combination therapy of microwave coagulation and intracavitary irradiation is a useful treatment for bladder cancer.

A case of transurethral microwave coagulation therapy for urinary bladder diverticulum

We applied transurethral microwave coagulation therapy to urinary bladder diverticulum. The case is 71-year-old female who had two large diverticulums, 11 × 9 × 7 cm in size on the right lateral wall and 5 × 5 × 4 cm in size on the anterior wall. Electrode resection of diverticular neck was performed, and then all of the inside mucosa was coagulated with a microwave energy of 100 watts. This procedure was able to be performed safely to the end without any complications. After the operation, both diverticulums disappeared. It supposed that the transurethral microwave coagulation therapy was a useful procedure for the endoscopic treatment of urinary bladder diverticulum.

Long-term intravenous administration of vancomycin to a hemodialysis patient.

症例は30歳男性. MOFのためポリスルフォン膜 (F60) を使用し4L置換のHDFを連日4時間施行していた. 血液培養にてVCMのみに感受性を示すMRSAが検出されたためVCM500mg/日を5%ブドウ糖液250mlに溶解しHDF後に1-1.5時間かけて隔日毎に, 1か月間点滴静注した. HDF前に採血しVCMの血中濃度を測定した. 血中濃度の平均は, 投与後1日目25.5±4.3μg/ml, 2日目16.8±2.7μg/mlであり, 長期の連続投与にもかかわらず蓄積傾向は認められなかった. 投与中止後は血中濃度は徐々に減少し, 最終投与7日後には3.2μg/mlとなった. この間, VCMの副作用と考えられるものは認められなかった.

Clinical aspects of chronic renal failure at the initiation of regular dialysis treatment

昭和45年11月より昭和60年12月までに慢性透析に導入した患者148名について透析導入時を中心として臨床統計観察を行った.148名中男性は93名, 女性は55名で, 男女比は1.69:1であった. 年齢は14歳から78歳で, 平均年齢は48.4歳であった.原疾患は慢性糸球体腎炎が64名と一番多く, つづいて糖尿病の21名であったが, 原疾患が不明な患者も22名に達していた.透析導入時の主訴については, 倦怠感と疲労感が48.0%と最も多かった. 臨床検査成績では導入時, 心胸比53.5±8.2%, BUN 111±36mg/dl, Cr 11.6±4.9mg/dlであった.昭和61年1月1日現在, 148名中55名が死亡しており, 死因の第一位は心不全19名, 第二位は脳血管障害12名であった. 透析導入後の実測生存率についてみると, 5年生存率56.7%, 10年生存率46.1%であった.

Serological observations of anti IgA antibodies found in a patient with SLE.

Serum IgA deficiency with anti IgA antibodies at the high titer was found in a patient with renal failure due to SLE. Before detection of anti IgA antibodies, she had experienced severe anaphylactoid reactions at the start of the plasma exchange therapy. Afterwards anti IgA antibodies were found by double diffusion in agarose gel and in the IgG fraction of the patient serum, and were directed against only IgA1 subclass. IgA2 was detected by double diffusion method with commercial anti IgA2 antisera. The patient was lacking in IgA, but had secretory component in her saliva.The patient is now well controlled by hemodialysis three times a week for renal failure and by transfusion of washed red blood cells without leukocytes for anemia. Accordingly, irk case of a patient who has little amount of serum IgA requires blood or blood products, anti IgA antibodies should be investigated carefully before administration to avoid anti IgA mediated transfusion reactions.

Impedance Urine Bolusmetry (bolus volumeおよびfrequency測定) による腎孟尿管機能の評価

New equipment based on field gradient principle for measurement of cross sectional area of ureteral urine bolus has been developed. Inside the probe consisted of a Fr.4 ureteral catheter, there are 4 ring impedance electrodes and a bipolar ring ureteromyographic electrode. Ex vivo experiments has proved high values in reliability and reproducibility of obtained cross sectional area of urine bolus through an impedance method. Following results have been obtained through animal and clinical experiments. As urine bolus passed through the impedance electrodes, impedance represented the cross sectional area of urine bolus. The ureteral activity corresponded to the increase of urine flow changed as follows, ureteral peristaltic frequency increased, cross sectional area of urine bolus increased, length of urine bolus increased, during maximum diuresis, peristaltic activity diminished and continuous flow presented through ureteral column. It will be useful method for experimental or clinical evaluation of ureteral function.

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.