[Preoperative use of erythropoietin (rH-EPO) and determination of optimal doses in patients with benign prostatic hypertrophy for future autologous blood transfusion].

BACKGROUND: Recently, autologous blood transfusion has been widely endorsed, because of the adverse effects attributed to homologous blood transfusion. We found that the administration of recombinant human erythropoietin (rH-EPO) permitted the preoperative collection of an adequate volume of autologous blood in a short period of time. This reduced or eliminated the need for homologous blood transfusion. METHODS: To determine optimal dosage of rH-EPO, I conducted a randomized, controlled trial in 86 patients with benign prostatic hypertrophy (BPH) scheduled for transurethral resection of the prostate (TUR-P). The patients from whom approximately 10% of their total blood volume was removed, received six different doses of rH-EPO either intravenously or subctaneously. All patients received iron sulfate 100 mg orally once a day during the study. RESULTS: I found that 9,000 IU of rH-EPO given intravenously daily or 10,500 IU of rH-EPO injected subcutaneously every third day for a week were optimal dosages. These schedules ennabled us to withdraw approximately 400 ml of blood prior to operation without adverse effects. CONCLUSION: I conclude that the efficacy of rH-EPO is greater when administered subcutaneously rather than intravenously. It is clear that rH-EPO increases the ability of patients about to undergo selective surgery to donate greater amounts of blood for future autologous transfusion.

[Statistic studies on bacteria isolated from urinary tract infections (report 6: isolation rate and drug sensitivity from 1988 through 1989)].

We examined the bacteria isolated from urine of patients in our department from 1988 though 1989. A total of 809 strains were isolated from the outpatients. They were 241 strains of gram-positive bacteria (29.8%). E. coli (32.0%) was isolated most frequently, followed by Enterococcus spp. (9.9%), Proteus group (7.4%), S. epidermidis (6.2%), P. aeruginosa (5.1%) and others. A total of 412 strains were isolated from the inpatients. They consisted of 173 strains of gram-positive bacteria (42.0%). Enterococcus spp. (17.0%) was isolated most frequently, followed by P. aeruginosa (12.6%), S. epidermidis (9.7%), E. coli (7.3%), S. aureus (6.6%) and others. Fewer P. aeruginosa, S. marcescens and Proteus group were isolated from the outpatients and fewer S. marcescens, E. coli and K. pneumoniae from inpatients than previously. More S. aureus were isolated abruptly from the inpatients and more E. coli were isolated from the outpatients than previously. E. cloacae, S. epidermidis, S. aureus and Corynebacterium spp. all isolated from inpatients showed lower antimicrobial sensitivity than those isolated from the outpatients.

[Preoperative collection of autologous blood with recombinant human erythropoietin therapy].

The major problems in liquid storage of donated blood are the limitation of blood volume preserved and the time consumed. We studied on the usefulness of utilization of recombinant human erythropoietin (rH-EPO) for preoperative collection of autologous blood. Patients were divided into 2 groups: Group 1 (12 patients) received 3000 unit of rH-EPO intravenously every day. Group 2 (10 patients) was not treated with rH-EPO. All the patients were given ferrous sulfate 100 mg of iron orally every day. As a rule, 400 ml blood was donated two or three times a week for rH-EPO treated group, while, for control group 400 ml blood was collected once a week. Some patients did not donate 400 ml because of their critical condition. The blood volume preserved became 780.9 +/- 284.1 ml in Group 1, and 910.8 +/- 263.9 ml in Group 2. However, the number of days until operation were significantly shorter in Group 1 (8.7 +/- 3.6 days) than in Group 2 (26.2 +/- 11.2 days). Hemoglobin and Hematocrit levels recovered promptly in rH-EPO treated group. In control group, 2 patients complained of nausea and vomiting caused by severe anemia. On the other hand, no one with rH-EPO therapy did not show any side effects and complications. Our study indicates that the administration of rH-EPO enables us to collect an adequate volume of autologous blood preoperatively in a shorter period of time.

[Primary osteosarcoma of the bladder: a case report].

A case report of primary osteosarcoma of the bladder is herein presented. A 75-year-old man presented with asymptomatic macrohematuria. Cystoscopic examination revealed a large tumor with a broad base arisen on the anterior wall. Pelvic computed tomographic scan showed multiple calcifications in the tumor itself. Total cystectomy and ileal conduit were performed. Histopathological diagnosis was osteosarcoma. The patient died 10 weeks after surgery. Metastasis to lung, heart, lymphnode, ureter and peritoneum were identified by autopsy. Primary osteosarcoma of the bladder is a rare tumor, only 25 cases have been reported previously. The prognosis of this tumor is very poor. Nineteen of these patients died within 6 months.

[Clinical statistics on operations for inpatients at Department of Urology, Tokai University Hospital 1975-1989].

Operations on inpatients during the 15-year period from 1975 to 1989 were analyzed statistically. A total of 3,791 operations were performed at our Department of Urology, including 717 operations on the kidney, 316 operations on the ureter, 583 operations on the bladder, 811 operations on the prostate, 136 operations on the urethra, 1,097 operations on the scrotum, 43 operations on the adrenal gland, 19 operations on the retroperitoneal space and 69 operations on other organs.

[Giant müllerian duct cyst: a case report].

A case of giant müllerian duct cyst is reported. The patient was a 27-year-old male, complaining of microscopic hematuria. A giant cystic abdominal mass was palpable. After screening examination including ultrasound tomography, intravenous pyelography, computed tomography and magnetic resonance-imaging, müllerian duct cyst was suspected. Operation for this cyst was performed with median incision. The cyst measured 25 x 21 x 14 cm. The surface as smooth and consistency was soft. Included fluid was slightly turbid and yellowish measuring 2,200 ml. This was considered to be the largest müllerian duct cyst case reported in the Japanese literature.