An elderly woman with a history of cholecystectomy and a re-operation for postoperative peritonitis underwent extracorporeal shock wave lithotripsy (ESWL) for right and left renal pelvic calculi, 11 ¥ 6 and 12 ¥ 5 mm in size, to which 2400 and 1400 shots at 20 kV were given, respectively, on the same day. During the evening after the operation, the patient started to complain of upper abdominal pain. Laboratory examination on the next day revealed elevations in blood and urine amylase levels and a diagnosis of pancreatitis was made. Conservative treatment, including administration of protease inhibitor, did not improve her symptoms; abdominal distension became marked and she underwent laparotomy. Necrosection and indwelling of several drain tubes in abdomen were performed with an operative diagnosis of acute necrotic pancreatitis. With daily irrigation of drain tubes and treatment for methicillin-resistant Staphyloococcus aureus infection of the lungs and abdominal cavity, septicemia and duodenal fistula, the patient gradually recovered and was discharged on postoperative day 151. It was suggested that ESWL was responsible for the acute pancreatitis. Either an obstruction of the pancreatic duct by fragments of common duct stone, or mechanical injury of the pancreas due to adhesion between the pancreas and surrounding tissue caused by the lapalotomy, was considered as a possible cause of pancreatitis. To our knowledge, there has been no previous report of severe acute pancreatitis and the present case suggests that ESWL may cause severe pancreatic even in cases without stone shadow in the bile, common duct or pancreatic duct.
Recent papers reported that the balance between the production of IL-1ra and IL-1 probably influences the regulation of host responses, the severity and prolongation of the inflammatory reaction in some diseases. Therefore, in our continuing investigation to clarify the significance of leukocytosis and its prolongation in prostatic fluid from prostatitis patients, we investigated whether low levels of IL-1ra versus IL-1β secreted in prostatic fluid were the cause of prolonged prostatitis, especially nonbacterial prostatitis (NBP). As a result of the present study, we concluded that a low level of IL-1ra in relation to that of IL-1 secreted in prostatic fluid is unlikely to cause prolongation of NBP for the following reasons: (1) IL-1β was detected in 5 of 10 cases (50.0%), but was slightly elevated in only 2 cases (20.0%) at 14 and 17 pg/ml; (2) the average IL-1ra level was not statistically low compared with that in prostatic fluid from acute bacterial prostatitis (ABP) patients who were cured promptly with antibiotics, and (3) in 5 cases of NBP in which IL-1β was detected, the average IL-1ra/IL-1β ratio was 118 which was comparable to or even higher than that in 3 ABP and 14 acute bacterial cystitis cases in which IL-1β was detected and the ratios were 40 and 88, respectively.
Introduction: No established technique for locating solitary carcinoma in situ (CIS) of the urinary bladder or CIS accompanying bladder cancer has been determined. Here we investigated whether the location of CIS of the urinary bladder can be macroscopically ascertained by instilling pirarubicin hydrochloride (THP) into the urinary bladder. Patients and Methods: We dissolved 50 mg of THP in 50 ml of distilled water, and instilled the resulting solution into the urinary bladder. After 5 min, the urinary bladder is examined using a cystoscope. The study group consisted of 30 subjects (23 men and 7 women). Results: THP uptake was seen in 19 flat (nontumorous) areas of the bladder mucosa in 13 patients. Of these, 11 lesions in 6 patients were confirmed to be CIS. THP uptake was also seen in flat malignant lesions such as bladder cancer invasion into the prostatic urethra, and in benign lesions such as chronic cystitis and urothelial hyperplasia. Conclusions: The present method can be useful to find easily and macroscopically the location of flat malignant lesions such as CIS.
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