Yukio Osada

Intravesical Therapy with Adriamycin plus Verapamil in Patients with Superficial Bladder Cancer: A Pilot Study

Nineteen patients with histologically proven superficial bladder cancer (Ta, T1) were treated with intravesical instillation of 30 mg of adriamycin (ADM) dissolved in 24 ml physiological saline plus 15 mg of verapamil (VR) (6 ml) every day for 10 days. In spite of the short period of treatment, 6 of the 18 evaluable patients (33.3%) showed complete response (CR) and a further 5 (27.8%) showed partial response (PR). Five of the 6 patients with CR were recurrent cases who had previously received prophylactic intravesical instillation chemotherapy including ADM. Irritative urinary symptoms were observed in 11 of the 19 patients (57.9%). However, these symptoms were mild in the majority of patients and the treatment was completed without interruption in all but 1 patient. There was no significant absorption of ADM and VR into the systemic circulation. No clinical evidence of systemic toxicity was observed. These results suggest that combination of ADM and VR has a possibility to be a useful prophylactic intravesical instillation chemotherapy after endoscopic resection of not only primary but also recurrent chemoresistant bladder cancers.

Surgical Treatment of Renovascular Hypertension Associated with Bilateral Renal Artery Stenosis

We report on 15 patients operated upon for renovascular hypertension associated with bilateral renal artery stenosis. Followup has been for 1 to 12 years. Four of 5 patients with positive split renal function studies and 3 of 5 patients with positive renal vein renin assays underwent unilateral operations on the positive side. All of these patients were cured or improved. The guide for unilateral operations in hypertensive patients with bilateral renal artery stenosis by angiography was the physiological information obtained from the preoperative screening tests, especially the plasma renin activity ratios of the 3 different veins and the split renal function studies.

Bilateral renal artery stenosis and renovascular hypertension in rabbits.

In 21 rabbits bilateral renal artery stenosis was produced by constriction of the right renal artery with 1 of 3 different clips in size followed by left renal artery constriction with the smallest clip. Five to 6 weeks after left renal artery constriction, 5 ml. of the blood samples for the measurement of plasma renin activity (PRA) was taken from both renal veins and the distal vena cava, and the left nephrectomy was performed. In 17 out of 21 rabbits, PRA was determined in 3 different blood veins: L, left renal vein PRA; R, right renal vein PRA; and P, distal vena cava vein PRA. Three PRA patterns, L greater than P greater than or equal to R (A type), L, R greater than P (B type) and R greater than L not equal to P (C type), were observed. Removal of the left kidney caused a significant decrease in the average blood pressure persisting for 5 weeks in the rabbits with the type A pattern of PRA (p less than 0.05). In all 4 animals with the type B or C pattern of PRA hypertension persisted even after removal of the left kidney. Comparison of the PRA values between the venous blood in 3 different vascular trees seems very useful to predict the depressor response that follows nephrectomy of the severer constricted side.

Closure of a Vesicovaginal Fistula Using a Vaginal Flap

Abstract Use of a vaginal flap method to repair a vesicovaginal fistula is reported. This highly successful and less traumatic method of repair can be performed easily by urologists who are less accustomed to the transvaginal procedure.

Chronic cortical nodular interstitial nephritis

Abstract A woman with a hard mass in the right upper quadrant of her abdomen underwent a right nephrectomy. The kidney showed rare pathologic findings, best described as chronic cortical nodular interstitial nephritis. The cortex was replaced, in the most part, with multiple nodular lesions which showed findings of chronic interstitial nephritis. The medulla and the pelvic mucosa showed slight changes without nodular lesion, which were thought to be secondary to the cortical lesions.