Sixty-four patients with prostatic cancer were treated by various methods including total prostatectomy, castration, administration of hormone agents, estramustine phosphate disodium (EMP), anticancer chemotherapy agents by VIP-regimen and radiation at The 2nd Tokyo National Hospital, Tokyo, from 1980 to April 1985.
Early efficacy rates at 12 weeks were as follows; in CR+MR of estrogen therapy group, they were 760 (stages A, B, and C), and 590 (stage D). For groups of no change and progressive deterioration, it was 16% (stage D). Of EMP group, CR+MR cases were 86% (stages A, B, and C), and 43% (stage D), dead cases were 430 (stage D). Of VIP-regimen group MR cases were 670 (stage D), dead cases were 330 (stage D). Radiation therapy was responsible for local pain.
Actual survival rates (Kaplan-Meier) at 1, 3 and 5 years in untreated group (n=58) were 93%, 73%, and 72%, respectively. In refractory group (n=6) they were 90%, 41%, and 30%, respectively. They were 97%, 83%, and 82% for stages A, B, and C, respectively. They were 84%, 43%, and 0% for stage D. In G-1 group they were 95%, 78%, and 74%. And in G-3 group they were 86%, 37% and 36%.

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Effect of intraoperative, intravesical radiotherapy was clinically evaluated. Recurrences occurred in 3 of 13 paients, from outside of the direct radiation field. It is, therefore, important to define the area where cancer might exist, and intraoperative radiotherapy can be applied even for invasive cancer as long as all the area is covered.

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Between October 28, 1978 and August 31, 1986, 33 cases of kidney transplantation were performed in National Cardiovascular Center, of which 18 recipients received the kidneys from cadaveric donors and 15 recipients from living related donors. Histocompatibility was one of the important factors that affected the outcome of living donor transplantation treated with azathioprin (AZ). However, there was no significant difference between histocompatibility and graft survival in the living related transplants treated with cyclosporin (CsA) and the cadaveric kidney transplants. The preoperative blood transfusion did not improve the graft survivals especially in CsA-treated recipients. The major factors that affected the outcome of kidney transplantation were acute tubular necrosis (ATN), grafted kidneys from infectious cadaver donors and preoperative condition of the recipients. Therefore, an increase in the number of cadaveric donors and a use of the grafts from brain death cadavers will be the only solutions to overcome these problems.

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Sixty-one cases (42 males and 19 females) who had received regular dialysis/renal transplantation between the age of 6 and 18 in 9 sanatoriums up to September 1985 were studied retrospectively.
Glomerulonephritis/nephrotic syndrome accounted for three quarters of primary diseases and each of chronic pyelonephritis, renal hypo- and dysplasia and Alport's syndrome did for several percents. From the fact that about 30 percents of patients were detected by school urinalysis and that cases aged from 6 to 8 predominated in the patients, the need of preschool urinalysis was suggested. In 10 patients dialysis was started within 1 year after the onset or detection. Many children especially those weighed less than 35kg received IPD at the beginning of dialysis. After maintenance dialysis by HD in 55 cases and by CAPD in 6, 14 received renal allografts of which 10 were surviving.
Patient's outcome after 1 to 162 (mean 44) months from the first dialysis was that 38 and 10 cases were alive each on dialysis and renal transplantation, and 11 died and 2 unknown. Brain hemorrhage was most common cause of death.
Six out of 38 patients whose present status was known had problems in rehabilitation. Three quarters of patients not yet received renal transplantation were anxious for being recipients, so socio-medical establishment of renal replacement therapy seems to be expected.

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Fourteen courses of plasma exchanges were performed in a 11-year-old boy, who had had diffuse proliferative lupus nephritis, during the past 2 years.
He presented with hematuria and proteinuria detected by school screening urinalysis before 2 years. His first renal biopsy revealed diffuse proliferatve glomerulonephritis with foci of tuft necrosis, fibrin deposition and crescent formation by light microscopic examination. Immunofluorescent stains for IgG, C₁q and C₄ showed diffuse fine to coarse granular depositions along glomerular tufts. Subepithelial and subendothelial electron-dense deposits, intraendothelial microtubular structures were observed by electron microscopic examination.
He was treated with plasma exchanges, pulse therapy and oral administration of prednisolone and cyclophosphamide for 2 years. His second renal biopsy was performed at August 12, 1986, and it revealed mild proliferative changes, slight and segmental fluorescence of IgG, C₁q and C₄. Electron-dense deposits disappeared.
These results suggest that plasma exchanges may be useful for the treatment of diffuse proliferative lupus nephritis.

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A case is reported in which ataxia developed during the course of chronic renal failure.
This case was characterized by basal ganglia calcification in spite of hyperparathyroidism resulting from chronic renal failure, and an increase in T cells and natural killer cells in spite of chronic renal failure.
We postulate that the ataxia may result from neurotoxic effect of parathyroid hormone, or an increase in natural killer cells which have the same antigenicity as oligodendrocytes.

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Continuous ambulatory peritoneal dialysis (CAPD) was introduced for 7 patients (2 male, 5 female), ranging in age from 32 to 67 years. Of these 7 patients, 3 were continued on CAPD, 3 died and one transferred to hemodialysis because of repeated bouts of peritonitis. We observed 18 episodes of peritonitis among 6 of 7 patients. The diagnosis of peritonitis was based on clinical presentation of abdominal symptoms, cloudy drainage with dialysate cell counts greater than 100/mm³, finally culture for aerobic and anaerobic organisms using the culture bottle before addition of antibiotics. Most of patients, who lived close to the hospital within 30km, were admitted to the hospital as soon as possible with the cloudy drained bag. Forty-four % of cultures were only Staphylococcus epidermidis, the remainders demonstrated no growth of any organism in spite of cloudy dialysate. Frequent intraperitoneal exchange of dialysis (IPD) was introduced using the automatic cycler machine for one or two days until the drained solution became clear. Cephem antibiotics and aminoglycosides were administrated to the dialysis solution and in combination with parenteral. It is recently reported that frequent exchanges of dialysate reduce bacterial phagocytosis and antibacterial defense when the peritonitis develops. However, we obtained the useful effects on rapid improvement for abdominal distress, reduction of intraperitoneal organism and prevention of decreased ultrafiltration in peritonitis.
Other complications of CAPD were related to catheter such as catheter dislocation, obstruction, spontaneous removal from the abdominal cavity, and dialysate leakage around the catheter insertion site. The latter problem was resolved by either leaving one litter of dialysate in the abdomen from the bag or converting to IPD using the automatic cycler machine. In addition to minor complications resulting from intra-abdominal pressure, there were inguinal hernia, incisional hernia, hemorrhoid with bowel constipation, hypotension, low backache and pruritus. Most of these complications were not serious enough to necessitate interruption of CAPD.

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Cases of severely injured kidney by trauma usually require surgical treatment, while moderately or mildly injured cases often undergo conservative therapy for observations on the clinical course. However, reports on the complications or sequelae in the cases of the latter have been few. We encountered two school children who showed urinary retention in the posterior peritoneal cavity as a delayed complication of sports injury of the kidney. This paper reports these two unusual cases.
Case 1. A nine-year-old boy, a primary school pupil. With the abdominal swelling on the right and macroscopic hematuria as the chief complaints, he was admitted to a nearby hospital in February, 1980. The injury was sustained when he fell off the horizontal bar about 3 hours before at school. Roentgenograms taken after one week of conservative therapy revealed findings of right hydronephrosis and extrarenal leakage of urine, and the patient was referred to this hospital. Surgical findings revealed a lacerated wound measuring 1.5cm in the pelvis of the kidney, from which urine was leaking. Case 2. A 13-year-old boy, a junior high school student. With abdominal pain as the chief complaint and with visceral rupture suspected, he was admitted to the Life-Saving Center of this hospital in July, 1984. A kick he got while practicing soccer accounted for the injury. As angiogram of the kidney revealed injury at the peripheral region of the renal lower pole and formation of hematoma in the posterior peritoneal cavity, he was transferred to this clinic and was on a conservative therapy.
The DIP examination done at 14 days after the operation showed enlargement of the pelvis of the right kidney and extrarenal leakage of urine. Surgical findings also showed partially lacerated mucosa of the calyx of the kidney in the urinary fistula.
Cases showing damaged mucosa of the pelvis and calyx of the kidney as in our cases require nephrostomy and closing of the damaged mucosa.

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We report a case of 55-year-old woman with renal cell carcinoma metastasized to the contralateral adrenal gland. Her complaints were macroscopic hematuria and right back pain. CT revealed right renal tumor and contralateral adrenal mass. Arteriography and echogram revealed right renal tumor, too. But they did not reveal contralateral adrenal mass. A diagnosis of right renal cell carcinoma with left adrenal metastasis was made, and right nephrectomy and left adrenalectomy were performed. In our case, right adrenal gland was preserved, because right adrenal gland had normal appearance. We reviewed 10 cases of renal cell carcinoma metastasized to the contralateral adrenal gland in the Japanese literatures. And in this report, we insisted on the effectiveness of pre-operative CT evaluation in the diagnosis of renal cell carcinoma.

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Percutaneous removal of renal and ureteral calculi was performed in 56 patients (59 kidneys, male 38, female 18) between January 1985 to June 1986.
Most of the percutaneous nephrolithotomy procedures were done at our institution as a 1-stage procedure (72, 9 per cent) and the majority were performed under epidural anesthesia (69.5 per cent).
We attaind a free of stones in 89.8 per cent of the patients judged by the plain films (KUB) and clinically success rate was 93.2 per cent.
One patient died from drug-induced fluminant hepatitis at 20th postoperative day but there was no another serious complications.
We proposed the preoperative procedure of percutaneous nephrolithotomy for ureteral calculi, since preoperative dislodging of ureteral stones to renal pelvis by retrograde flushing or with PUJ occlusion balloon catheter and J-guide wire was capable, and this was an easy and safe operation.

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Since the ureteral obstruction secondary to the abdominal aneurysm has been rare in the Japanese literatures, we report two cases. The aneurysm of the aorta commonly causes bilateral ureteral obstruction. The advanced case becomes uremic. Retroperitoneal fibrosis accounts for this condition. However, the results of biopsy from periureteral tissue in our cases did not show any fibrotic changes. There may exist unknown etiology.
The incidence of this disease will be increasing in Japan, so that the urologists must share the responsibility with the vascular surgeons to establish the diagnostic methods and the treatment.

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⁶⁰Cobalt gamma rays or 10 MV x-rays were used in the radiotherapeutic management of 188 patients with urological neoplasms at Kumamoto National Hospital between 1967 and 1985. In the retrospective study, therapeutical results in testicular tumors (15 patients), in prostatic cancer (37 patients) and in bladder cancer (84 patients) were analyzed.
Fifteen patients of testicular tumors constituted 14 patients of seminoma and 1 patient of embryonal carcinoma. The five-year survival rate of 10 patients without lymph node metastasis was 100% and that of 5 patients with lymph node metastasis was 40%.
Radiotherapy for prostatic cancer was started from 1979 in our hospital. According to the stage classification of Whitmore, 4 patients had stage B cancer, 15 patients had stage C cancer and 18 patients had stage D cancer. Overall five-year survival rate was 19%; stages B and C, 32%; stage D, 16%.
Fifty-four of 84 patients with bladder cancer were irradiated curatively with doses given more than 30 Gy, 17 patients of them were irradiated preoperatively or postoperatively and 13 patients of them were irradiated palliatively. As for the stage classification of Jewett-Marshall, 16 patients had stage B cancer, 51 patients had stage C cancer and 7 patients had stage D cancer. The five-year survival rate of 54 patients who had received a curative irradiation was 16%, and that of 17 patients who were treated by pre- or postoperative irradiation was 55%.

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The value of estimating serum sialic acid, with use of automatic chemical analyzer of centrifuge-type (Cobas Bio), has been assessed in patients with malignant and non-malignant diseases and compared with that of measured serum glycoprotein (α₁-AG), mucoprotein (ASP) and enzymes in the same patients. Positive correlations were found between sialic acid and al-AG and mucoprotein. The level of serum sialic acid was elevated in lung carcinoma and in the advanced cases with breast carcinoma. By contrast, elevation was rarely encountered in hepatocellular carcinoma. From the present study, clinical role of measuring serum sialic acid has been established as a nonspecific marker of malignancy.

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The changes in lecithin: cholesterol acyltransferase (LCAT) activity during pregnancy and postpartum have been seldom reported. In this study LCAT activity in the second and third trimesters of pregnancy and postpartum was examined as well as serum total cholesterol (TC) and HDL-cholesterol (HDL-C). Twenty-six normal women (age range 20-33 years) were studied at the 15th week of pregnancy, in the third trimester (32nd, 34th, 36th and 38th week) and at 35.9±6.9 (SD) days (28-44 days) postpartum.
LCAT activity increased from 78±15 nmol/ml/h at the 15th week to 91±17nmol/ml/h at the 32nd week (p<0.05), and remained at about this level until the 38th week. It decreased after delivery, and by 35.9±6.9 days had reached 64±15nmol/ml/h. This was still much lower than the mean at the 15th week of pregnancy (p<0.01). TC level rose from 184±25mg/dl at the 15th week to 244±51mg/dl at the 32nd week (p<0.01), and to 259±47mg/dl at the 38th week (p<0.001). No significant difference was found between TC at the 32nd week and 38th week of pregnancy. TC reached 228±45 mg/dl at 35.9±6.9 days postpartum. This was lower than the mean at the 36th or 38th week of pregnancy (p<0.05, respectively). There was no significant difference between TC at the 32nd or 34th week of pregnancy and postpartum. TC after delivery was much higher than the mean at the 15th week of pregnancy (p<0.001). HDL-C remained steady from the 15th to the 38th week at about the mean of 70mg/dl and fell to 66±20 mg/dl postpartum. No significant difference was found between HDL-C during pregnancy and postpartum.
These abnormalities of lipid metabolism during pregnancy and postpartum might have an effect on development of diseases such as atherosclerosis. The detailed studies of lipid metabolism accompanied by pregnancy may be required.

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Valproate is an effective anti-convulsant agent both in animals and in man. We studied the interaction between valproate and ethanol from a social standpoint. Pentylenetetrazol (PTZ, 50$sim;70mg) i. p. injection caused spontaneous hyperactivity, clonic convulsion from 2 minutes after administration. The 50% convulsive dose (CD 50) was about 55mg i. p. Valproate 200mg. p. o. inhibited about 38% of the convulsion induced by the dose of CD 80 PTZ. When the rats were chronically treated by ethanol, this inhibitory effect of valproate was further increased by 59%. The plasma level of valproate was highest at 30 min after administration of valproate 200mg/kg, p. o. in control rats. In contrast, in chronically ethanol-treated rats, its plasma level was as high as about 3-fold of control rats. Succinate dehydrogenase activity was significantly decreased in liver mitochondria fractions from chronic ethanol-treated rats. These results suggest that the high plasma level of valproate and the stronger inhibitory effect on convulsion may be involved in the decrease of metabolic process of liver mitochondria due to liver injury casused by ethanol.

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