Renal artery stenosis is one of the most important forms of secondary hypertension. For years, the only causative treatment was nephrectomy. With rapid advances in cardiovascular and transplantation surgery, operative prosedures in renovascular hypertension become more and more sophisticated. Revascularization is superior to medical management of renovascular hypertension in terms of preserved renal function. In recent years, surgical result have been excellent, and even patients with rather complex forms of renovascular hypertension have been successfully operated upon. New classes of antihypertensive drugs, particularly β-blockers and angiotensin I converting enzyme inhibitors, have enabled the control of blood pressure in most patients with renovascular hypertension but do not assure preservation of renal function. Finally, a fascinating technique, the percutaneous transluminal renal angioplasty, has rapidly advanced to become one of the most popular methods in the treatment of hypertension secondary to renal artery stenosis. However, percutaneous transluminal renal angioplasty is the treatment of choice for most nonostial, nonocclusive lesions.

View full abstract

To study the effect of natural killer (NK) activity on chemical carcinogenesis in urinary bladder cancer, beige mice (NK difficient mice) and C57BL/6 mice (NK normal mice) received N-bytyl-(4-hydroxybutyl) nitrosamine (BBN) in drinking-water. The effect was evaluated by measuring the incidence of early neoplastic change in the urinary bladder. OK-432, a biological response modifier, was administrated in drinking-water and its effect on carcinogenesis was evaluated.
The beige and C57BL/6 mice were divided into two groups. Group A, C57BL/6 mice and group C, beige mice received 0.1% BBN in their drinking-water. Group B, C57BL/6 mice, and group D, beige mice, received 0.1% BBN and OK-432 (5KE/1000ml) in their drinking-water for 4 weeks. The mice were sacrificed at 12, 14, 16, 18 and 24 weeks after BBN administration and the urinary bladder was examined histologically by light and scanning electron microscopy.
In the light microscopic findings, all groups had no neoplastic change at 12, 14 and 16 weeks, although at 18 and 24 weeks, neoplastic changes were observed. The incidence at 18 weeks was 0/10 in group A, 0/8 in group B, 2/5 in group C and 3/9 in group D and that at 24 weeks was 1/8 in group A, 1/9 in group B, 2/5 in group C and 3/6 in group D. (p<0.01 between beige and C57/BL/6 mice at 18 weeks).
In the scanning electron microscopic findings, cells with a cobble stone appearance, pleomorphic microvilli and short uniform microvilli on luminal surfaces are observed during cacinogenesis in urinary bladder. Their incidence was 2/10 in group A, 1/11 in group B, 5/6 in group C and 4/5 in group D at 16 weeks, 2/10 in group A, 0/8 in group B, 7/10 in group C and 7/9 in group D at 18 weeks and 0/8 in group A, 0/9 in group B, 4/6 in group C and 3/6 in group D at 24 weeks. (p<0.01, between beige and C57BL/6 mice at 16, 18 and 24 weeks).
In conclusion, urinary bladder carcinogenesis induced by BBN neoplastic lesion was observed earlier in beige mice lacking NK activity than in C57BL/6 mice.
These results suggest an important role of NK activity in immune surveillance of chemical carcinogenesis in the urinary bladder.

View full abstract

⁵¹Cr-release assay is a popular method to measure the cytotoxicity of natural killer cells, so-called NK activity, but this assay includes trouble-some steps and management because of using radioisotope (RI) reagent.
ATP-chemiluminescence assay (ATP assay), a new method, does not require RI. This assay measures intracellular adenosintriphosphate (ATP) volume by Luciferin-Luciferase reaction.
In the research for this paper, the NK activity in 40 healthy donors, 40 patients with urological benign deseases and 39 patients with malignant tumors was measured by both ⁵¹Cr-release and ATP assay.
The values obtained by these two methods showed a high correlation (r=0.78). And the NK activity in patients with malignant tumors was lower in high stage patients than it was in low stage patients.
These results proposed that ATP assay would be more suitable than ⁵¹Cr-release assay for measuring not only NK activity but also the other cytotoxic tests, because ATP is present only in living cells and that, in patients with genitourinary malignant tumors, NK activity of peripheral blood would be a useful tumor marker.

View full abstract

We investigated natural killer (NK) activity and T-lymphocyte subsets in peripheral blood and regional lymph nodes in order to examine the host's defence mechanisms against cancer.
The materials were obtained from 26 patients with genitourinary cancer and 9 patients with benign diseases, who were used as controls. NK activity was measured by ATP-chemiluminescence (ATP) assay, a new method which is well correlated to the ⁵¹Cr-release assay, and T-lymphocyte subsets were stained with anti-Leu-2, -3, -4, -7, and -11 monoclonal antibody.
The NK activity of regional lymph nodes was lower than that of the peripheral blood in all 35 cases, and the percentage of Leu 7+ and Leu 11+ cells was in agreement with that of the NK activity detected by ATP assay. In the peripheral blood, the percentage of Leu 3+ cells was lower in high stage patients than it was in low stage patients and controls, but in the regional lymph nodes it was paradoxically higher.
The NK activity of regional lymph nodes against autologous tumor cells was low in 8 patients with bladder cancer.
It appears from this study that the regional lymph nodes have no function as immunoloigcal barriers for metastasis and we therefore conclude that they should be dissected during surgery.

View full abstract

Susceptibility of various antimicrobial agents against clinically isolated Staphylococcus aureus was evaluated by Kirby Bauer methods. The incidence of MRSA (Methicillin cephem resistant Staphylococcus aureus) was also investigated. When S. aureus was isolated from urine, the clinical background of the case was further studied.
The results are listed below;
1) M1N0 showed the highest susceptibility rate (83.1%) against 537 strains of S. aureus tested, followed by CMZ (63.7%) and CET (63.5%). The susceptibility rate of DMPPC was 41.9%. The incidence of MRSA was 31.3%.
2) In effusion, MRSA was most highly isolated (72.2%).
3) S. aureus isolated from blood and sputa was relatively more resistant to β-lactams.
4) Strains from urine showed relatively high susceptibility rates. No MRSA was isolated from urine.
5) Thirteen out of twenty-four cases, whose urines were proven to be S. aureus positive, were polymicrobial infection patients.

View full abstract

The purpose of this study is to investigate changes of glycoconjugates in the cancer cells of the urinary bladder by means of immunohitochemical methods.
The normal bladder epithelium, cancerous lesions, and non-malignant epithelia of the tumor bearing bladder were examined by staining by avidin-biotin-peroxidase complex methods using blood group isoantigens (BGA) and lectins.
The materials were obtained from 48 cystectomized specimens in our hospital in these seven years. Anti-A, B and H monoclonal antibodies were used for detecting BGA. GSI-A₄, UEA-1, LTA-M, BPA, DBA and PNA were used as probes for lectins.
The changes of glycoconjugates in the cancer cells of the bladder and in non-malignant epithelia of the tumor bearing bladder were studied by using six kinds of lectins. Each lection binding retes of the primary lesions and the metastasized lesions was comparatively investigated. Positive rates for BGA of the high grade tumor was lower than that of the low grade. In the high grade tumor, GSI-A₄, PNA and BPA showed high binding rates, while the DBA binding rate was low.
The correlation between the histopathological grading of bladder tumor and the changes of glycoconjugates in the cells was suggestive of cancerous process.

View full abstract

Compliance and histological findings of dilated ureters in dogs were successively examined after partial ligature. Ureteral compliance was measured by the impedance method using a special probe. This probe, with a balloon at the tip, is equipped with two detecting electrodes and two generating electrodes. Adult mongrel dogs were anesthetized with pentobarbital, and the lower part of the extravesical ureter was partially ligated. At 1, 2, 4, 8, 12, and 26 weeks after ligature, ureteral complicance and histological findings were investigated. Moreover, the closure pressure and the initial cross sectional area of the dilated ureter were measured. The results of the study were as follows:
1) In the dilated ureter, compliance increased gradually for 8 weeks after ligature. However, compliance began to decrease at 12 weeks.
2) The ureteral closure pressure of the normal ureter was statistically higher than that of the dilated ureter.
3) The initial cross sectional area of the normal ureter was statistically lower than that of the dilated ureter.
4) Hypertrophy and hyperplasia of the muscle bundles were found in the dilated ureteral wall.
5) The stellate configuration of the ureteral epithelium almost disappeared 8 weeks after ligature.
6) The proliferation of connective tissues around the muscle bundles was observed 8 weeks after ligature.
7) Ureteral compliance increased in proportion to hypertrophy of the muscle. However, compliance decreased with the increase of the proliferation of connective tissues. These results indicated that the decrease in compliance caused by the proliferation of the connectie tissues was one of the reasons for dysfunction of urine transport in the dilated ureter. Moreover, the value of compliance through the impedance method was considered to be a useful parameter of ureteral function.

View full abstract

From September 1986 to August 1987, heavy precipitation of amorphous calcium phosphate, that is phosphaturia, was found at our outpatient clinic in 153 postprandial urine specimens from 115 patients, in 1.5% of all the specimens examined during this period. One patient was excluded because he had both urolithiasis and urinary tract infection. The remaining 152 specimens with phosphaturia were then divided into 3 groups; Group I from patients with urolithiasis, Group II from patients with urinary tract infection and Group III from patients without either urolithiasis or urinary tract infection (Phosphaturia Group, Table 1). It is evident from this table that phosphaturia is repeated more frequently in patients with urolithiasis than in patients without urolithiasis (p<0.01).
200 urine specimens examined during this period were selected randomly. Three bloody or purulent specimens were excluded. The remaining 197 specimens from 189 patients were divided into 3 groups, as in the phosphaturia group (Control Group, Table 2). When the proportion of the number of specimens to the total is compared between the phosphaturia group and the control group, it is clear that phosphaturia is found more frequently in specimens from patients with urolithiasis than in specimens from patients without urolithiasis (p<0.01).
Since phosphaturia was almost always found in the specimens with urine pH≥7, 486 patients, in whom the pH of the first urine specimen was equal to or above 7, were selected from among 1434 patients undergoing urinalyses during this period and divided into 3 groups as has been described above (Table 3). It is evident from this table that the frequency of phosphaturia is significantly higher in patients with urolithiasis than in patients without urolithiasis (p<0.05). It is concluded that phosphaturia may be associated with the formation of calcium stones, but not with urinary tract infection.

View full abstract

Congenital urethral stenosis in boys occurs at the junction of the entodermal primary urethra and ectodermal secondary urethra. Endoscopically this lesion is recongnized as a ring-form stenosis just distal to the external urethral sphincter. It has been considered as rare congenital anomaly in American literature. But in our experience congenital urethral stenosis is an important cause of recurrent urinary tract infections, enuresis, pollakisuria or hematuria in pediatric urological practice. It also disturbs spontaneous healing of vesicoureteral reflux. The most effective treatment of this lesion is optic internal urethrotomy under direct vision. We would like to report our experience of optic internal urethrotomy for congenital urethral stenosis in boys.
From 1974 to 1986, 226 boys with congenital bulbar urethral stenosis were treated in our clinic. Optic internal urethrotomy was performed using a Sachse urethrotome with a 10 or 13 Fr. sheath. Of the 176 ureters with vesicoureteral reflux, spontaneous disappearance of reflux after optic internal urethrotomy was noted in 62.5% of Grade I-II, 65.0% of Grade III, 28.9% of Grade IV and 16.7% of Grade V ureters. These spontaneous disappearance rates were significantly higher than those of primary vesicoureteral reflux in Grade III, IV and V ureters. Of the drug-resistant enuretic boys with a congenital bulbar urethral stenosis, enuresis disappeared or ameliorated in 69.4% after optic internal urethrotomy. Furthermore, urinary tract infections were mostly prevented by optic internal urethrotomy, irrespective of the presence or absence of vesicoureteral reflux.
Our results support the view that congenital urethral stenosis (urethral ring) is an important clinical entity in pediatric urology.

View full abstract

The clinical significance of serum basic fetoprotein (BFP) in renal cell carcinoma was investigated in comparison with serum immunosuppressive acid protein (IAP). Investigated in this study were 46 patients with renal cell carcinoma, 31 males and 15 females ranging in age from 40 to 85 years (mean age: 56 years). According to Robson's system of staging, 10 cases (22%) had a stage I disease, 14 cases (30%) a stage II disease, and 18 (39%) a stage IV disease. The positivity rate for and levels of serum BFP were found higher as disease stage avanced, with 54% of the entire cases and 72% of stage IV cases being positive for serum BFP. On the other hand, 76% of 34 cases for whom assay of serum IAP was feasible and 79% of stage IV cases were positive for serum IAP, thus here again the positivity rate for and serum levels of the marker became increasingly higher with avancing disease stage. Simultaneous assay of serum BFP and IAP demonstrated that 85% of stage IV renal cell carcinoma cases were positive for at least one of the two marders. A study of changes in these tumor markers before and after curative resection of the tumor showed that BFP decreased below the preoperative level within 1 week postoperatively in 92% and even returned to nomal in 75% of cases who were positive for the tumor markers preoperatively, while serum IAP reduced below the preoperative level in 82% and returned to nomal in 27% of the cases preoperatively.

View full abstract

Continent urinary reservoir has recently been paid much attention by urologists for its contribution to improvement in quality of life in patients who are in need of urinary diversion.
We, herein, present some preliminary result in the operation of continent ileocecocolonic (ICC) or ileocecal reservoir which was performed on 13 patients.
Since several improvements have been made on the operative procedures for ICC reservoir, the most recent techniques are described below:
A 20-25cm of cecocolonic and 12cm of terminal ileal segment were isolated after a full length mesenteric incision. The cecocolonic segment was longitudinally split open in 15-20cm on its antimesenteric border to be re-configurated later. The mesentery was detached for 8cm in the terminal ileum which was randomly incised into its seromuscular layer. Following the intussusception of the terminal ileum into the cecal lumen, the nipple valve of the ileum was stabilized by three row-staples and two row-paired nonabsorbable surutures. The valve was re-inforced by nonabsorbable sutures and dacron mesh which were placed at the base of the intussusception. The ureter was implanted in the tenia of the colon with antireflux technique of the submucosa tunnel. The distal end of the split cecocolonic segment was, then, folded to and sutured with its proximal end, making a Heineke-Mikulicz type of re-congiurated reservoir. A flush type of stoma was constructed, with dacron mesh placed around the ileum which was fixed to the rectus muscle and its anterior sheath.
Three early postoperative complications (reservoir-ileum fistula, transient paralytic ileus and acute pancreatitis) occurred in each patient, which were then successfully treated by appropriate management. A mild to moderate incontinence was observed in five patients in the early series. However, detubularization of the reservoir and the improved techniques for nipple valve stabilization eliminated this complication in the remaining eight patients, who continued to hold a continence for more than three months. This favorable result was supported, in part, by the urodynamic profiles of the reservoir, since the detubularized reservoir provided a lower pressure and greater capacity.
Our experiences suggested that detubularization of the cecocolonic segment and the imporved techniques to stabilize a nipple valve were crucial for the construction of a well-functioning continent ICC reservoir.

View full abstract

The frequency of MRSA (Methicillin cephem resistant Staphylococcus aureus) infection has increased recently.
A case of septicemia caused by MRSA is reported with discussion on its prophylaxis.

View full abstract

A 29 y. o. female had been associated with Cushing's syndrome, gradually, from 1977. She was advised to get further examination at our hospital on September 1980. A pre-operative diagnosis of Cushing's syndrome due to bilateral adrenocortical tumors was made and right adrenalectomy was peformed on December 22, 1980, as the 1st of two stage operation. The right adrenal, 1.8cm in diameter, had a pigmented nodule and multiple pigmented micronodules, which were diganosed pathologically as primary adrenocortical nodular dysplasia. It was not necessary for this patient to maintain steroid therapy, but after 3 months she complained of the withdrawal syndrome and was administered dexamethasone. Since July, 1981, she had no symptom without adrenocortical steroid administration. In November 1986, she became cushingoid and on June 1, 1987, we performed left adrenalectomy on her. The appearance of the left adrenal was similar to the right. We have found no reports of the cases of adrenocortical nodular dysplasia such as delayed appearance of withdrawal syndrome after unilateral adrenalectomy.
In this case, plasma ACTH had relatively poor correlation with cortisol. Her plasma ACTH was not always suppressed and sometimes within normal range. Her adrenals had not only autonomy but also pituitary dependency. It is concluded that in this case there may have been a pituitary-adrenal dual control.

View full abstract

A 41-year-old male was admitted to the hospital for frequent urination and severe retardation before voiding. Roentgenography revealed exophytic lesions which were located mainly in the trigone of the bladder, and he underwent transurethral resection. The pathological diagnosis was cystitis glandularis. There was no literature which reported cystitis glandularis causing urinary disturbance. This case, moreover, had been diagnosed as cystitis glandularis 13 years before by endoscopical biopsy. The origin of cystitis glandularis and its potentiality as a pre-malignant lesion were discussed from the clinical course for over 10 years.

View full abstract

A forty-two year-old man with left epididymo-testicular malakoplakia was reported. Thirty-two cases of testicular malakoplakia with (5 cases) and without (27 cases) epididymal malakoplakia were reviewed. The mean age was 48.2 year-old. Two-thirds of the cases suffered from right side involvement. All cases except a few cases received orchiectomy within 2.6 months on average from the onset of the symptoms. Diabetes mellitus, malignant diseases, or chronic renal failure seem to have a causal relation to the development of testicular malakoplakia. Six cases of epididymal malakoplakia were also reviewed.

View full abstract