The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
Volume 81 , Issue 10
Showing 1-19 articles out of 19 articles from the selected issue
  • Akimi Ogawa
    1990 Volume 81 Issue 10 Pages 1445-1457
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Download PDF (1962K)
  • Daisuke Yamada
    1990 Volume 81 Issue 10 Pages 1458-1465
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The distribution of clinical isolates from patients with prostatitis and pathogenecity of the isolates were studied. A new method for measuring the bacteria-specific immunoglobulins in expressed prostatic secretion (EPS) was developed and used for the detection of local immuno-reaction against pathogenic bacteria in the cases with prostatitis. There were no cases. with increased antibodies specific for gram-positive cocci (GPC), indicating that the pathogenesity of GPC in bacterial prostatitis was doubtful. On the other hand, specific antibodies against gram negative rods (GNR) were elevated in all cases with acute prostatitis and changes of the antibody titers were correlated well to clinical courses. The present clinicostatistic and immuno-biological studies re-confirmed that E. coli was the main organism in uncomplicated bacterial prostatitis.
    Download PDF (2249K)
  • Daisuke Yamada
    1990 Volume 81 Issue 10 Pages 1466-1472
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The virulence factors of E. coli in bacterial prostatitis were studied using 59 E. coli isolated from uncomplicated prostatitis.
    O-antigens of prostatitis-derived E. coli belonged to some specific serotypes such as 0-4, 6, 18, 22 and the haemolysin production was positive in 64.4%. With regard to the fimbriae, the majority of the strains had type 1 fimbriae (81.4%).
    Mannose resistant (MR) fimbriae were also positive in 59.3% and both type 1 and MR fimbriae were positive in 55.9%. Among MR strains, P-fimbriated and S-fimbriated strains were present in 25.7% and 28.6%, respectively, indicating that these two MR fimbriae were not always specific for the prostatitis-derived E. coli. Although the specific adhesion of E. coli onto the human prostatic epithelium mediated by MR-fimbriae was equivocal, that mediated by type 1 fimbriae was observed clearly. Therefore, type 1 fimbriae was thought to be one of the most significant virulence factors in the pathogenesis of prostatitis caused by E. coli.
    Download PDF (3394K)
  • Hiroyuki Ishii, Yuichi Osa, Tatsuya Okano, Shigoe Isaka, Kousaku Yasud ...
    1990 Volume 81 Issue 10 Pages 1473-1479
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Six patients, with advanced germ cell tumor refractory to prior chemotherapy including cis-platinum and etoposide, were treated by high dose chemotherapy and autologous bone marrow transplantation. Etoposide (1200-1800mg/m2), cyclophosphamide (120mg/kg) and cis-platinum (60-120mg/m2) were given and the autologous bone marrow was infused 72 hours after the last dose of chemotherapy. Two patients were treated by high dose chemotherapy three times. The regimen of the third high dose chemotherapy was etoposide (1800mg/m2), cyclophosphamide (120mg/kg), adriamycin (80mg/m2), ACNU (200mg/m2) and 254S (100mg/m2). One patient died of cerebral hemorrhage 7 days after ABMT. Of the 5 patients evaluable for response, 4 responded: one patient obtained a complete response and 3 a partial response.
    Download PDF (975K)
  • Shin'ya Takahashi, Toshihito Tanaka, Atsuo Ashiki
    1990 Volume 81 Issue 10 Pages 1480-1486
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Recently MRSA occupies a prominent position in nosocominal infections. We experienced 9 cases of severe MRSA infections in our department during the 10 months from Apr. 1989 to Jan. 1990. We investigated the clinical background of them.
    The results of studies were as followed:
    1) All cases were inpatients.
    2) All cases were considered to be compromised hosts.
    3) In 7 cases many kinds of catheters and apparatuses were pre-indwelled.
    4) In 8 cases over 2 kinds of antibiotics and in 7 cases 3rd generation cephems were pre-administered.
    5) The 5 cases, who were selected for coagulase typing, all belonged to type II.
    6) All cases had almost similar patterns of drug sensitivity and were resistant to large amounts of antibiotics. All cases had good sensitivity to minocycline.
    7)The results: 3 died of sepsis and respiratory failure and 6 were alive (MRSA strains were still isolated in 3 cases and were eradicated in the other 3 cases 1-4 months after the therapy was started).
    Download PDF (971K)
  • Tomotaka Hattori, Yasunori Terashima, Makoto Hara, Masao Akimoto
    1990 Volume 81 Issue 10 Pages 1487-1493
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    It is well known that Epidermal Growth Factor (EGF) is a cell-regulating factor for variety of tissues in vitro including normal and malignant cells. Furthermore, Takano et al reported that a decreased expression of EGF receptor in clones of human cancer KB cell line might be one of the pleiotropic properties of multidrug-resistant cells. However, both the influence of EGF on human urological cancer cell lines and the relation between EGF receptors and sensitivities of antitumor drugs on these cell lines have not been fully descrived. We have studied the effects of EGF on growth of 4 transitional carcinoma cell lines of bladder (TCCaB), 1 squamous cell carcinoma cell line of bladder (SCCaB), 5 renal cell carcinoma cell lines (RCC) and 3 prostatic carcinoma cell lines (CaP), as well as the relationship between the number of EGF receptors and drug sensitivities of these cell lines in vitro against methotrexate, vinblastine, adriamycine, cisplatin and etoposide (VP16). The present results determined by the in vitro colony forming efficiency method showed that exogenous addition of EGF to cell cultures at 0.1ng/ml stimulated the growth of SCCaB by 169.0%, and at 1ng/ml inhibited that of RCC by 2.9%-79.1%, relative to control. The more EGF receptors by 125I-EGF binding assay, the higher inhibition of VP16 on the growth of these cell lines.
    These results suggested that EGF stimulated the gwoth of SCCaB and inhibited the growth of RCC in vitro, and we found that these phenomena were correlated with neither the number of EGF receptors nor affinities of that receptors. Furthermore, the number of EGF receptors may be correlated with the resistance of VP16 to growth-inhibitory effects.
    Download PDF (936K)
  • Kyun Pak, Chol Jang Kim, Akira Ishida, Mayumi Kushima, Tadao Tomoyoshi ...
    1990 Volume 81 Issue 10 Pages 1494-1499
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Cyclosporin (CsA) has powerful immunosuppressive properties, and its recent application to organ transplantation has resulted in markedly improved graft survival. However, CsA has certain adverse side effects, the most notable being nephrotoxicity and hepatotoxicity. Among other untoward effects, little is known about the effects of CsA on the reproductive organs. Since good graft survival is now expected with CsA, the long term effect of the drug on the gonads should be monitored carefully, paricularly for young recipients. Prior to investigation of the effect of CsA on the testis, the level of CsA in semen of the adult renal transplant patients were measured.
    Twelve samples of semen from eight recipients, mean age 35 (SD 9), were collected by masturbation in the morning just before taking CsA after more than 5 day abstinence, and it was frozen at -80°C. They had been taking immunosuppressants that were a combination of either CsA and prednisolone, or CsA, azathioprine and prednisolone for 5 to 63 months. The dose of CsA was 3.7mg/kg to 5.0mg/kg. The range of the level of serum creatinine was 1.1mg/dl to 2.9mg/dl. CsA in whole blood was measured by high performance liquid chromatography (HPLC), and CsA in semen was also measured by HPLC after extracting CsA with diethylether.
    The level of CsA in semen was 27ng/ml to 165ng/ml and that in whole blood was 51ng/ml to 133ng/ml. The relation between both levels was linear (r=0.68, p<0.05). Thus, we first demonstrated the level of CsA in semen of renal transplant patients, and it is considered to be similar to the trough level of CsA in whole blood.
    At present, we have no available data about the effect of CsA in semen. However, CsA in semen may provide an unfavourable environment for sperm and this factor should be considered in investigation of fertility problems in transplant patients.
    Download PDF (773K)
  • Kyun Pak, Chol Jang Kim, Hitoshi Inoue, Yoshihiko Wakabayashi, Jin Wat ...
    1990 Volume 81 Issue 10 Pages 1500-1505
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    To study the hemodialysis period following cadaveric renal transplantation, we reviewed 18 consecutive cadaver donor kidney pairs of which one kidney was transplanted at Shiga University of Medical Science (SUMS) while the contralateral kidney was transplanted at Kyoto Prefectural Medical University (KPMU) between January 1983 and September 1988. Of these 18 pairs, graft function was satisfactory and the recipient was free from hemodialysis in 13 pairs. However, the postoperative hemodialysis periods were different between the two centers.
    To clarify the factors causing this difference, recipient factors, such as age, HLA matching, total ischemic time of the graft (TIT), immunosuppression, onset of diuresis and postoperative complications were studied. There were no significant differences in age, HLA matching, or immunosuppression. TIT of cases at SUMS was significantly longer than that of cases at KPMU. The postoperative hemodialysis period at SUMS was 25.8 days and that at KPMU was 17.8 days, however, the difference was not statistically significant.
    The results of this study indicate that TIT seems to be a major factor relating to delayed graft function in cadaveric renal transplantation.
    Download PDF (738K)
  • Akio Nishino, Kiyoshi Koshida, Hajime Yamamoto, Tadao Uchibayashi, Kat ...
    1990 Volume 81 Issue 10 Pages 1506-1512
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Placental alkaline phosphatase (PLAP) levels in sera and tissues from 40 patients with testicular tumor were measured using a monoclonal immunocatalytic assay. The mean value of the PLAP levels of seminoma tissues was found to be 92-fold higher than that of normal testes, being significantly high compared with that of nonseminoma tissues. The mean value of the serum PLAP levels from patient's with seminoma was also significantly higher than that from patients with nonseminoma. In 2 groups of seminoma and mixed type tumor cotnaining seminoma and nonseminoma components, the PLAP levels of tissues from patients who had high levels of the serum PLAP (≥100mKAU) were significantly higher than those from patients who had normal serum PLAP levels (<100mKAU). In the seminoma or mixed type tumor groups, the serum PLAP levels of all patients who had high levels before treatment decreased to within a normal range after orchiectomy with or without chemotherapy or radiation therapy.
    We conclude that PALP seems to be an useful tumor marker for the diagnosis and the monitoring of response to treatment in patients with seminoma.
    Download PDF (850K)
  • Shigeyuki Yanagi, Tadashi Kotake, Kunio Yamaguchi, Haruo Ito
    1990 Volume 81 Issue 10 Pages 1513-1517
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Pulse volume recordings were obtained in 53 patients who were hospitalized with urological disorders other than impotence. This method seems to record the total blood volume changes in the peins. Pulse volume recordings also were found to correlate with the value of Penile Brachial pressure Index (PBI). Therefore, it proved to be valuable for estimating penile perfusion.
    Pulse volume recording is a simple, reliable and adaptable screening method for abnormal penile blood flow. Further investigation is necessary to determine the precision with which the method can detect alnormality of penile blood flow in patients with abnormal venous return.
    Download PDF (2170K)
  • Hiroshi Hashimoto, Masato Sasaki, Makoto Fujisawa, Shigeo Kaneko, Sohe ...
    1990 Volume 81 Issue 10 Pages 1518-1524
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We studied whether bromodeoxyuridine (BrdU)-labeling method showing the population and/or distribution of S-phase cells in tumor tissues is useful to detect the precancerous lesions of bladder.
    The bladder lesions were induced by 0.05% N-butyl-N (4-hydroxybutyl) nitrosamine (BBN) in drinking water for ten weeks in five male rats (Wister-Imamichi). BrdU (50mg/kg) was injected to intraperitoneal space two hours before the resection of the bladder. The detection of positive cells (S-phase cells taking BrdU) was performed by peroxidase-antiperoxidase method. From five bladder specimens 144 lesions (simple hyperplasia (S)-73, papillary or nodular hyperplasia (PN)-57, papilloma (Pa)-14) were analysed. The labeling index (the ratio of positive cells to all epithelial cells in one lesion) showed no significant difference among the lesions (S, PN, and Pa).
    For analyses of the distribution patterns of S-phase cells, we investigated whether positive cells aside from basal layers and/or the serial positive cells in basal layers were seen or not in each lesion. The ratios of lesions containing positive cells aside from basal layers were 11% (8/73), 60% (34/57) and 100% (14/14) in S, PN and Pa lesions. The serial positive cells in basal layers were observed in 6% (4/73), 25% (14/57) and 50% (7/14) of S, PN and Pa lesions. Those differences were statistically significant.
    Above mentioned results suggest that the appearance of S-phase cells aside from basal layers and/or the serial S-phase cells in basal layers is characteristic change in precancerous lesions, which is useful for sooner detection of bladder carcinogenesis.
    Download PDF (6925K)
  • Ryoji Yasumoto, Masazumi Asakawa, Hidetaka Yoshihara, Wataru Sakamoto, ...
    1990 Volume 81 Issue 10 Pages 1525-1529
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A clinical study was made on 108 male patients who underwent cystectomy. The posterior urethra and partial anterior urethra were removed in 47 cases, half of the pendicular urethra was removed in 13 cases and the anterior urethra up to the fossa navicularis was removed in 48 cases. Out of 60 cases without urethrectomy, urethral recurrence was observed in 13 cases (21.7%), while no recurrence was observed in the cases treated with urethrectomy. The average period of time from cystectomy to urethral recurrence was 24.7 months (11-39 months). Urethral cancer of such early stages as pIa and pIb were found in 3 and 6 cases, respectively. Stage pT2 was found in 4 cases. Grade 1 cancer was found in 3 cases, grade 2, in 5 cases, and 3 in 5 cases. The proximal end of the pendicular urethra was found to be the most frequent site for recurrence with 11 cases exhibiting recurrence at this location and 2 cases at the mid-portion of the pendicular urethra. Many cases exhibited multiple recurrence of tumor of visually grayish, velvety and non-papillary type which was histologically all transitional cell carcinoma. Bladder tumor with higher grade tendend to cause urethral cancer recurrence with higher grade. Bladder tumors at multiple locations from the trigone to the lateral and posterior walls tended to cause recurrence in the urethra (p<0.05). Of all the cases, 10 cases underwent urethrectomy and 2 cases penectomy. 12 cases received chemotherapy and 5 cases radiation therapy as postoperative adjuvant treatments. For cases without any surgical treatment, anti-cancer drugs adherent to mucous membrane were instilled into the urethra. Consequently, all the 5 patients who were unable to undergo a total urethrectomy due to urethral recurrence died of cancer. The mortality rate for the cases with urethral recurrence was 38.5% (5 out of 13 cases), which is higher than that of 2.1% (one in 47 cases) for those which underwent cystectomy without causing recurrence.
    Download PDF (662K)
  • Shigeo Isaka, Koichiro Akakura, Jun Shimazaki, Yoshiaki Kumamoto, Taka ...
    1990 Volume 81 Issue 10 Pages 1530-1536
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Histological effects of endocrine therapy were evaluated in one hundred and four prostatic cancer patients by new criteria presented by the comittee of “General Rule for Clinical and Pathological Studies on Prostatic Cancer”. Route and time of biopsy, clinical stage and histological grade were related to histological effects. Biopsy specimens taken within three months from the start of the therapy tended to score rather low marks and this tendency is especially apparent with low grade cancers. Histological effects evaluated by the present method correlated well with prognosis in localized stages (stage B, C and D1). In metastatic cases, however, local effects were not related to the prognosis.
    Download PDF (902K)
  • Shigeru Saiki, Norio Meguro, Teruo Morita, Yoshio Tomooka, Osamu Maeda ...
    1990 Volume 81 Issue 10 Pages 1537-1542
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Two hybridomas secreting two monoclonal antibodies IgG1 B1.4 and IgG2a B1.6 were obtained by immunizing BALB/c mice with human bladder cancer cell line EJ-1.
    In immunohistochemical staining of cryopreserved tissues, B1.4 reacted with 0 of 9 grade 1 TCC, 6 of 11 grade 2, all of 6 grade 3 and five metastatic specimens.
    The antigen recognized by B1.4 was not expressed by normal urothelial cells but were expressed by vascular endothelial cells and muscle of tunica media.
    The target antigen of B1.6 was expressed by normal urothelial cells and all grade of TCC.
    In this study, it was demonstrated that poorly differentiated bladder cancer and metastatic specimens of bladder cancer express a vascular carbohydrate antigen.
    Taking the escape mechanism of immune surveillance, into consideration, it is possible that the antigen recognized by B1.4 is an indicator of metastatic potential of bladder cancer.
    Download PDF (3165K)
  • Kenjiro Kohri, Yoshikazu Katayama, Tokumi Ishii, Yoshinari Kato, Takas ...
    1990 Volume 81 Issue 10 Pages 1543-1549
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We retrospectively studied the effects and side effects of placing indwelling ureteral stents in 196 cases who underwent extracorporeal shock wave lithotripsy with a ureteral stent.
    The average period of ureteral stenting was approximately 22 days. Placing ureteral stents was mainly for large renal stones (79.3%), single kidney etc. There were no significant differences between the stented and nonstented patients with approximately 2cm sized single renal stone with respect to the stone free rate, stone free period, and symptoms during stenting, which suggested that ureteral stenting might be unnecessary in those patients. High fever was highest in incidence of the symptoms and complications during stenting (17.2%). It occurred frequently in patients with infected stones or cystine stones. The percentages of pyrexia and stone street in patients using Towers type's stents were higher than those using the others. It was also shown that the bladder portions of the stents in patients using Towers peripheral ureteral stents were densely encased in calcerons material and were very brittle. Fortunately the ureteral portions were removed intact. This study suggestis that use of an indwelling ureteral stent may not contribute to the higher rate of being free of stones after the treatment of small to medium sized renal calculi, and that stents should be removed or changed early.
    Download PDF (4848K)
  • Noriomi Miyao, Yoshiaki Kumamoto, Taiji Tsukamoto, Kiyotaka Ohmura, Ki ...
    1990 Volume 81 Issue 10 Pages 1550-1554
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Recent progress in molecular biology suggests a certain relationship between penile cancer and human papilloma virus infection. However, the treatment for penile cancer has not been established since each institute has experienced only a small number of patients. We analyzed the result of our treatment for 14 penile cancer patients during past twenty years. Ten of the 14 patients were initialy treated for the primary lesion with a combination of peplomycin (PEP) or bleomycin (BLM) and radiation therapy. Of these, 9 were found not to have residual viable cancer cells in their primary lesions. No local recurrence was found in all 7 patients in whom the penis was preserved. This result suggests that combination of PEP (BLM) and radiation preserves the penis without increasing the risk of local recurrence.
    Penile cancer-related death did not occur in patients without lymph node metastasis. However, this cancer death did occur in 4 out of 7 patients with lymph node metastasis, suggesting that metastasis is one of the important prognostic factors. PEP (BLM) and radiation therapy with or without regional lymph node dissection did not improve the prognosis of patients with advanced penile carcinoma, such as with pN2, pN3 or distant metastasis. More effective management may be necessary for these patients.
    Download PDF (676K)
  • Asami Ariyoshi, Kazuyuki Sagiyama, Kenji Hasuo, Kazuhiro Oshima, Yoshi ...
    1990 Volume 81 Issue 10 Pages 1555-1562
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A series of 185 patients, 133 males and 52 females, were treated by ileal conduit urinary diversion in the past 17 years. The patients ranged in age from 7 months to 81 years with an average of 59 years. Diversions were performed for malignant diseases in 174 patients, 85% of whom underwent a simultaneous radical surgery. The follow-up covered the postoperative period from 4 months to 16 years 8 months with an average of 4 years 8 months.
    Six patients (3%) died within 1 month of operation, and 43 of a total of 58 mortal cases died of cancer thereafter. The survival rates of 143 patients with bladder cancer were 84% for 1 year, 72% for 3 years, 67% for 5 years, 62% for 10 years and 54% for 15 years.
    Early comlications were noticed in 38% of the patients. Delayed wound healing due to local infection (20%) and intestinal obstruction (10%) were the two major complications in this period.
    Late complications were encountered in 51% of the patients. Mild peristomal dermatitis (22%) and gradually developing renal complications (22%) are two major problems in the standard ileal conduit urinary diversion. The latter was significantly more frequent in patients who underwent the operation between 1973 and 1981 than in those who had the surgery between 1982 and 1989. Postoperative hydronephrosis was observed in 15 (13%) of 117 patients who showed normal urograms preoperatively. Ileoureteral reflux was observed in 50% of the cases with nonobstructing conduits, while it increased up to 70% along with obstruction of the conduit. Stricture at the ureteroileal anastomosis and ileoureteral reflux were among the causes of the late hydronephrosis.
    Although various techniques of urinary tract surgery using small and large intestine have been developing recently, ileal conduit urinary diversion still remains to be the most fundamental method of urinary diversion. The importance of postoperative care for possible complications and tumor recurrence can hardly be overestimated after this operation.
    Download PDF (1157K)
  • Senji Hoshi, Seiichi Orikasa, Kazuyuki Yoshikawa, Tatsuo Tochigi, Kuni ...
    1990 Volume 81 Issue 10 Pages 1563-1568
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Percutaneous transabdominal fine needle aspiration biopsy (FNAB) of the pelvic and retroperitoneal lymph nodes was performed in 116 patients with bladder cancer. Metastasis to the regional lymph nodes was determined by this method in 21 patients. FNAB was positive in 10 of 12 patients having unequivocally positive or highly suspicious lymphogram, and in 11 of 104 patients (11%) having normal lymphogram. The results of FNAB were compared to the finding of lymph node dissection (LND) in 51 patients. FNAB and LND were negative in 43 patients and positive in 5. Two patients were FNAB negative but LND positive, and the remaining one case was FNAB positive but LND negative. The correlation between cytological diagnosis of FNAB and histological diagnosis of LND was 94 per cent. The survival rate of the cases of FNAB positive and lymphography negative was significantly higher than that of lymphography positive (p<0.01). The metastasic site of 5 cases with bladder cancer who are alive now without disease after more than 3 years was under the common iliac node and the number of the involved nodes was within 3.
    Download PDF (4322K)
  • Hirokazu Izumi, Motoharu Kajiya, Tetsuo Chiba, Tatsuo Uchida, Hideo Hi ...
    1990 Volume 81 Issue 10 Pages 1569-1573
    Published: October 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Herein we reort a case of ectopic production of hCG by poorly differentiated transitional cell tumor of the renal pelvis. The patient was a 55-year-old male who had been diagnosed at another hospital as having giant hydronephrosis and renal stones and was reffered to our hospital. The plain abdominal CT showed a low-density mass at the lower pole of the right kidney. His serum hCG level was as high as 120mIU/ml. Transperitoneal nephrectomy was performed on July 7, 1987. Histopathological examinations showed the presence of squamous metaplasia within a high-grade transitional cell carcinoma, and immunohistochemical studies revealed the presence of chorionic gonadotropin in some giant cells. Two courses of combination chemotherapy with methotrexate, vinblasting, adriamycin and cisplatin (M-VAC regimen) were given to him from the third week after the operation. However, he died of debility with distant metastasis 6 months after the operation. As far as we know, this is the third reported case in Japan.
    Download PDF (5161K)
feedback
Top