Effect of urine pH on uric acid excretion by manipulating food materials.

A potential utilization of dietary intervention for reducing hyperuricemia was tested by managing food materials. Within the framework of the Japanese Government's health promotion program, we made recipes that consisted of more protein-rich and less vegetable/fruit-rich materials for the acidic diet and others composed of less protein-rich and more vegetable/fruit-rich materials for the alkaline diet. We have shown that urine alkalization facilitates uric acid excretion. In this study, it has been clarified with simultaneous measurements of both serum and urine uric acid concentration that acidic diets increase serum uric acid together with a decrease of uric acid excretion. The ratio (R) of uric acid clearance/creatinine clearance was calculated. On the third experimental day, the relative R, referring to that of the first day for the acidic diet, became smaller than that for the alkaline diet, indicating that in acidic urine, uric acid excretion is limited by more active reabsorption, compared with that in alkaline urine. Taken together, we tentatively conclude that dietary intervention may well be the safest and the most economical way for the prevention of hyperuricemia.

Long term follow-up of atrioventricular valve function after repair of atrioventricular septal defect.

To elucidate the factors which are associated with early and late operative results of atrioventricular septal defects, 102 consecutive patients who underwent reparative operation of atrioventricular septal defects (AVSD) in our institution since 1968 were studied. Our operative technique was basically the same through this period. That is the two patch method in its complete form (the so-called Shirotani's method) and preferential use of cleft closure supplemented with Kay-Reed-Wooler type annuloplasty. Early mortality (< 30 days) rate was 18.6%. More than 80% of the early deaths were not related to atrioventricular valve malfunction. Non-complete closure of the cleft, high preoperative pulmonary vascular resistance, deficient atrioventricular valve, and complete form showed independent correlations with early mortality in multiple logistic regression analysis. For operative survivors, event-free survival curves, for atrioventricular valve related reoperations were drawn for various factors. Two late deaths and 3 late atrioventricular-valve-related reoperations occurred. The event-free actuarial survival for operative survivors at 5, 10, and 20 years were 97.0%, 89.4%, and 89.4%, respectively. The survival analysis revealed that preoperative high pulmonary vascular resistance, preoperative severe atrioventricular regurgitation, and preoperative large cardiothoracic ratio in chest radiogram were related with late event occurrence. Higher early mortality in our series may be attributable to relatively advanced pulmonary vascular occlusive disease rather than post repair atrioventricular valve malfunction. On the other hand, our late results were rather good. We concluded that the Shirotani's method and preferential use of cleft closure supplemented with Kay-Reed-Wooler type annuloplasty was effective for most of atrioventricular valves in atrioventricular septal defects. Early surgical intervention before pulmonary vascular disease progression or atrioventricular valve regurgitation development is also important.

[A case of giant vesical calculus after ileocystostomy].

A 52-year-old female, who had undergone nephrectomy and ileocystostomy for right-renal tuberculosis and contracted bladder 19 years earlier was seen with anemia and metabolic acidosis. Radiographic findings demonstrated that the patient suffered from a giant vesical calculus. Cystolithotomy was performed and the removed calculus weighed 460 g. Of the 66 cases of giant vesical calculus weighing more than 200 g reported in our country only 7 were in females.

[Congenital anterior urethral diverticulum: report of a case].

A case of congenital urethral diverticulum is reported. A 6-month-old male was admitted with difficulty to urinate and swelling of the base of penile shaft. Anterior urethral diverticulum was demonstrated by means of retrograde urethrography. A diverticulectomy combined with cystostomy was performed under the general anesthesia. Although the histological findings were insufficient to determine whether the urethral diverticulum was congenital or acquired, the former was strongly suspected judging from his clinical course. He developed urethrocutaneous fistula, one of the most common postoperative complication, on the 7th post-operative day. A complete cure of the fistula was achieved by the conservative treatment. We collected and analyzed 49 cases of congenital anterior urethral diverticulum of male children in Japan.

[A clinical study on renal pelvic and ureteral tumors].

Thirty-seven cases of renal pelvic and ureteral tumors treated at our hospitals between January, 1975 and December, 1985 were reviewed. There were 15 renal pelvic tumors, 19 primary ureteral tumors and 3 ureteropelvic tumors. There were 26 males and 11 females and their average age was 62.5 years old ranging from 37 to 82. The most frequent chief complaint was macroscopic hematuria, which was seen in 89% of the patients (33/37). It was 35% of the patients (13/37) who visited our hospitals more than one month but less than three months after the appearance of symptoms. The positive rate of urine cytology was 69%. Total nephroureterectomy was performed on 22 patients and the other surgical treatments were done on 13 patients. Histological examination revealed transitional cell carcinoma in all cases. The overall actual postoperative survival rate at 1, 3 and 5 years was 83.9%, 68.0% and 68.0%, respectively, as measured by the Kaplan-Meier's method. None of the patients who survived more than 3 years after surgery died. The actual 3 and 5 year survival rates in cases of ureteropelvic tumors were slightly lower than those in the case of bladder tumors. There was no evidence in this series to show the usefulness of postoperative adjuvant chemotherapy.

[Retrograde nephrostomy for percutaneous nephrolithotomy].

Between June, 1985 and November, 1986, 25 patients at our institute underwent retrograde nephrostomy placement to provide percutaneous access to the kidney for percutaneous nephrolithotomy (PNL) of renal or upper ureteral calculi. Overall, retrograde nephrostomy was successfully completed through the desired calyx in 80% of the patients and calculi were successfully removed by the subsequent PNL. There were 5 failures primarily due to wrong indication and inexperience with the technique. The procedures had been done without significant complications in this series including unsuccessful cases. On the basis of our experiences, it is practically important for successful retrograde nephrostomy to fix the tip of the catheter firmly in the desired calyx until the puncture wire is advanced into the renal parenchyma. It is also important to aim the puncture wire at the skin in a favorable direction to avoid adjacent visceral penetration. Retrograde nephrostomy is a useful aid for percutaneous calculus removal particularly in patients with nondilated intrarenal collecting systems, because this new technique allows precise tract placement to the kidney required for efficient calculus manipulation with less risk than that associated with conventional percutaneous nephrostomy.

[Evaluation of immunosuppressive acid protein in genitourinary malignant diseases].

Clinical significance of serum immunosuppressive acid protein (IAP) was evaluated on the basis of experience on 55 patients with genitourinary malignant disease and 49 control patients. Although the measurement of serum level of IAP is not good enough to diagnose early stage of cancer, patients with 800 micrograms/ml or more of serum IAP can be suspected to have malignant diseases. With the exception of prostatic cancer, both mean serum level and positive rate of IAP were higher in patients with high stage of disease than in those with low stage. Furthermore, on an individual basis, serum level of IAP was elevated with the progress of malignant tumor and was reduced with effective treatment. Thus, serum IAP is considered as a valuable nonspecific tumor marker in monitoring clinical course of genitourinary malignant diseases except for cancer of the prostate. In patients with advanced prostatic cancer, no definite correlation was seen between serum IAP and stage of disease, histopathological finding or serum prostatic acid phosphatase.