[Postoperative intravesical installation of tetrahydropyranyl-adriamycin (THP) and cytosine arabinoside (CA) for superficial bladder cancer: clinical results of prophylactic effects on recurrence].

Intravesical instillation of tetrahydropyranyl-adriamycin (THP) and cytosine arabinoside (CA) was performed on 42 patients with superficial bladder cancer after transurethral resection (TUR) for the purpose of prophylaxis of recurrence. The instillation was carried out with 30 mg of THP dissolved in 30 ml of distilled water and 200 mg of CA (total 40 ml). These drugs were instilled 7 times for the initial 2 weeks after TUR, and then 7 times every two weeks, 8 times every month, and 4 times every three months. Cases eligible for evaluation of efficacy were 38 out of 42 patients. The cumulative non-recurrence rate at one, two and three years were 94%, 84% and 75%, respectively. These high non-recurrence rates were demonstrated regardless of the size, number and pathological grade of the tumors. Severe bladder irritability was demonstrated in 8 (19%) of 42 patients, but generalized side effects were not seen in any case. The reformed regimen with 20 mg of THP in 30 ml of physiological saline solution was then performed on trial in several patients and there were no severe symptoms. THP combined with CA seems to be remarkably effective for the prophylaxis of recurrence, while a high concentration of THP in distilled water may lead to severe bladder irritability.

[Severe central nervous system symptoms following oral administration of acyclovir in a patient with chronic renal failure: a case report].

A case of renal failure in a patient with severe central nervous system symptoms during oral acyclovir medication is reported. A 68-year-old man maintained on hemodialysis was given oral acyclovir 4,000 mg daily in divided doses because of herpes zoster affecting the left C3/5 dermatomes. He had vomiting and confusion 36 hours after administration. He had no focal neurological signs. The symptoms resolved 4 days after cessation of acyclovir administration and blood purification every day. Because of its high therapeutic index the use of acyclovir is associated with few side effects. In patients with renal failure the half-life of acyclovir is prolonged, this report indicates the importance of adhering to the dosage reductions in patients with renal failure.

[Two cases of male infertility with pathological dilatation of ejaculatory duct].

Two cases of male infertility with pathological dilatation of ejaculatory duct are reported. In both cases, the dilatated wall of the ejaculatory duct was incised at the vermontanum with a cold knife endoscopically. After the incision, the findings of semen analysis of one case improved markedly and his wife became pregnant. In another case, semen analysis was not improved. Transurethral incision seemed to be a useful modality for the treatment of pathological dilatation of ejaculatory duct.

[A clinical study of 33 cases of renal pelvic and ureteral tumors].

Thirty-three cases of primary renal pelvic and/or ureteral tumors, i.e., 14 renal pelvic tumors, 14 ureteral tumors and 5 renal pelvic and ureteral tumors, treated at our hospital between November, 1976 and August, 1987 are reviewed retrospectively. Tumor occurred on the right side in 18 cases, left side in 14 cases and bilateral in one case. The patients ranged in age from 33 to 77 years (average 65.7 years), the sex ratio was 4.5:1 with male predominance over female. The most frequent symptoms were gross hematuria in 22 cases (67%). Interval from onset of initial symptoms to first visit within one month for 23 cases (70%). The major findings of excretory urograms were non-visualizing kidney in 18 cases (55%) and filling defect in 12 cases (36%). Positive urinary cytology was obtained in 18 cases (55%). Operative therapy was performed in all cases, namely, total nephroureterectomy with partial cystectomy in 21 cases (64%) and nephrectomy with transurethral ureterectomy in 7 cases (21%). Histopathologically, all cases but one case of squamous cell carcinoma were transitional cell carcinoma. Subsequent bladder tumors were found in 10 cases (30%). The overall survival rate at 1, 3 and 5 years were 84%, 68% and 61%, respectively by Kaplan-Meier method. In this series, grade and stage of tumor were the most influential factors for prognosis.

[Study of the prostatic tissue cefbuperazone (CBPZ) level].

The concentration of Cefbuperazone (CBPZ) was determined in the prostatic tissue and serum of 23 patients with benign prostatic hypertrophy. One or 2 of CBPZ was injected intravenously prior to transurethral prostatectomy. The mean CBPZ level in prostatic tissue and tissue/serum ratio at 1 hour was 17.4 +/- 7.2 micrograms/g (28.9 +/- 9.1%) in 10 patients administered 1 g of CBPZ, and 34.7 +/- 1C.2 micrograms/g (35.7 +/- 13.2%) in 13 patients administered 2 g of CBPZ. Serum and prostatic tissue CBPZ levels responded satisfactorily to the dose of CBPZ. Weights of resected prostatic tissue were not correlated to the tissue CBPZ level. Judging from the inhibitory concentration of CBPZ (minimum inhibitory concentration 80), the prostatic tissue CBPZ level was sufficient against pathogenic bacteria, particularly E. coli, K. pneumoiae and P. mirabilis for a relatively long time. For this reason CBPZ is a very useful drug for treatment of bacterial prostatitis and postoperative infection of prostate.