Prostatic cancer was the first malignancy in which tumor markers could be used to follow the responce to therapy or progression of the prostate cancer. The use of these tumor markers has been of significant clinical value in diagnosis and follow-up of patients. Over the years, significant technical improvements have been made on the sensitivity and specificity of the assays for prostatic acid phosphatase.

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In Self-defense Force Hospitals we often treat pilots with renal stones who will be exposed to high gravity (G) load after the treatment. Because the regulation prohibits the flight of a pilot with urolithiasis, the stone must be removed completely by noninvasive procedure. Percutaneous nephrolithotomy, therefore, is one of the treatment of choice in such patients. The effect of G load on the kidney, in particular, on the renin-angiotensin-aldosterone (R-A-A) system and the safety of percutaneous nephrolithotomy in a pilot who is exposed to high G load have not been adequately investigated. In this study, I examined the effect of G load in canine kidney model.
The effect of G load on R-A-A system: Twenty-two adult mongrel dogs of a mean weight of 10.9kg. maintained on a normal Na⁺ intake were studied. To dogs in the sitting position, high G load was given. The exposure to G load consisted of maximum load of 8G for 45 seconds with the onset ratio of 0.1G/sec. for group 1, and 5 courses of maximum G load of 8G for 10 seconds with the onset ratio of 2.5G/sec., followed by 1.5G for 60 seconds for group 2. Plasma renin activity was unchanged in group 1, but it increased in group 2. Plasma aldosterone increased from 68.6±17.9 to 252.0±56.4pg/ml (p<0.005) in group 1. and from 191.8±40.6 to 479.2±76.0pg/ml (p<0.005) in group 2 after G load. Angiotensin II decreased from 129.0±19.4 to 84.7±19.1pg/ml (p<0.05) after G load in group 2. These data suggest that the increase in plasma aldosterone after G load is independent of the reninangiotensin system. It is considered that the alteration of R-A-A system was caused by the change of blood flow distribution due to the effect of G load.
The tolerance to G load on the kidney following subcutaneous nephrostomy: Unilateral subcutaneous nephrostomies were carried out under pentobarbital anesthesia in 15 adult female mongrel dogs. Each experimental dog was exposed to high G load 2 or 4 weeks after removal of the nephrostomy tube. Excretory urography, renal angiography and renal function tests were performed before and after G load. Excretory urograms demonstrated no remarkable changes at all after G load in all dogs. Renal angiograms revealed small renal infarction along the nephrostomy tract in almost all dogs. But the lesion was not aggravated after G load. No significant changes on renal function were observed in any dogs after G load. The subcutaneous nephrostomy before G load was tolerated quite well by all experimental dogs.

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We examined the correlation between the intrapelvic vessels, especially prostatic vessels, and the vertebral venous system in the male dog by radiography.
Aorta abdominalis branches the right and left external iliac arteries at the 6th lumbar vertebra, and is divided into the right and left internal iliac arteries and arteria sacralis mediana at the 7th lumbar vertebra. Arteria urogenitalis arises from the internal iliac artery at the middle of articulatio iliosacralis, and is divided into arteria vesicalis caudalis cranially and arteria prostatica caudally. Arteria prostatica is divided in the prostatic capsule and distributed to the prostatic parenchyma in which arteries form the network.
Vena prostatica is distributed to the prostatic parenchyma, forming the network and entered vena urogenitalis after joining vena vesicalis caudalis. Vena urogenitalis joins the internal iliac vein, and then the common iliac vein and vena cava posterior after joining the external iliac vein.
The anastomosis between the intrapelvic vein and the vertebral venous system is formed by the vena intervertebralis. The vertebral venous system is anastomosed with the vena cava posterior, the common iliac vein, the internal iliac vein and vena pudenda interna.

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A method for the enzymatic determination of the serum citrate using citrate lyase is described. The optimum pH was equal to or higher than 8.6. Prior to the determination of the serum citrate, the samples were deproteinized with perchloric acid. After the precipitation of the proteins, potassium hydroxide was added under an ice-cooling condition in order to neutralize the solution.
The recovery rates of the citrate added to serum ranged from 92% to 108%, and the coefficient of variation of triplicate assay was 4.2%.
The mean serum value of 17 healthy subjects was 1.57mg/dl, with a range of 1.03-2.03mg/dl.
In seven healthy subjects, 3g of sodium-potassium citrate was administrated orally and the serum citrate was measured 0, 15, 30, 45, 60, and 120min later. The serum citrate was significantly increased in the periods between 15 and 60min.

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The relationship between bladder movements and the intramural ureter was studied in the dog by recording electromyograms of the intramural and extravesical ureters recorded during bladder filling and contraction. Bladder filling was achieved by instilling physiological saline at a rate of 10ml/min to a volume of 5ml/kg, while bladder contraction was induced by electrical stimulation. For electromyography, an electrode was inserted transperitoneally into both the extravesical ureter and the intramural ureter after it had been separated from the extravesical ureter. A cystostomy for the instillation of water and another cystostomy for the measurement of intravesical pressure were also made in the bladder.
During bladder filling at an intravesical pressure of about 10cmH₂O, the frequency of the action potentials in the intramural ureter showed no significant difference to those in the extravesical ureter. In addition, during bladder contraction at a greatly increased intravesical pressure of about 5 times the precontraction level, the frequency of the action potentials in the intramural ureter was not significant by different from those in the extravesical ureter, and also from its own precontraction value.
The above findings suggest that action potentials in the intramural ureter are not affected by bladder movements such as filling or contraction, and that the ureter continues to actively transport urine to the bladder during such movements.

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Clinical usefulness of the α₁-blocker and β-stimulant combined therapy for idiopathic male infertility has already been reported by Yamamoto et al. But the same trial followed by us revealed only a slight effectiveness and substantial adverse effects due to β-stimulation. The mechanism of the α₁-blocker and β-stimulant combined therapy is not yet established. In order to investigate its mechanism, fundamental study of a₁-receptor assay in the specimens of testis and various parts of male accessory sex organs obtained at the time of operation was done in this study. In addition the usefulness of α₁-blocker therapy for idiopathic male infertility was also examined clinically.
The tissues used in this study were obtained from patients with prostatic cancer (23 cases), benign prostatic hyperplasia (24 cases), bladder cancer (6 cases), chronic epididymitis (3 cases), azoospermia due to disorders of vas deferens (5 cases) and a vasectomized man. Tritium labeled bunazosin was used as the ligand. The crude membrane fraction was extracted from the sample, with or without phentolamine incubated for 20min at 37°C. Maximal binding sites (Bmax) and the dissociation constant (Kd) were obtained by Scatchard plot analysis.
Twenty-two infertile men were treated by oral administration of α₁-blocker (bunazosin, 3mg/day) for 24 weeks.
The results were as follows:
1) Bmax in the testis, epididymis, vas deferens and prostate, expressed as fmol, per mg. protein, was 2.27±1.74, 16.62±6.19, 29.44±17.81, 27.77±12.0, respectively (mean±S. D.).
2) Bmax in the rete testis was relatively high among various parts of the testis and seminiferous tubules.
3) Overall effective rates of sperm density and the sperm motility were noted in 36% at 12 weeks and 60% at 24 weeks after the therapy.
4) There was no clinical effect in tipaents with azoospermia and a slight effectiveness in patients with elevated plasma gonadotropin levels.
5) Adverse effect was reduced to 9.1%.
These results suggest that the α₁-blocker therapy for idiopathic male infertility is clinically useful and that the mechanism of the therapy is through the action on male accessory sex organs behind the testis.

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Retrospective study on the frequency of associsted bladder cancer and the influence on the prognosis was carried out in 170 cases of renal pelvic and ureteral cancer. The number of cases of associated bladder cancer coexistent with renal pelvic and ureteral cancer was 31 (18.2%), and the number of subsequent cases 3 (19.4%). The frequency of occurrence of the primaly tumor site was 27.2% in the renal pelvis, 45.6% in the ureter and 58.3% in both renal pelvis and ureter. Multiple tumors occurring in the renal pelvis and ureter occupy a high percentage. As for the degree of differentiation, many cases were subsequent to G1. As for the stage, a few cases with bladder cancer were subsequent to T4, but there was no definite tendency in the occurrence of bladder cancer. The prognosis of renal pelvic and ureteral cancer: the 10-year survival rate was 93.3% for G1, 66.6% for G2 and 12.4% for G3. As can be seen, there was good correlation with the pathological gradings. It must be remembered, however, that 5-year survival rates in cases of associated bladder cancer of coexistent type, in cases of subsequent type and in cases without associated bladder cancer were 56.2%, 72.7% and 64.8%, respectively: there was no significant difference. Bladder cancer associated with renal pelvic and ureteral cancer makes the therapy troublsome, but no influence on the prognosis was observed. Therapy in conformity with the pathological grading and stage is regarded as particulary important in cases of associated bladder cancer.

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Renal damages after ESWL treatment were examined by Gd-DTPA enhanced dynamic MRI.
Gd-DTPA was used as the contrast medium and fast magnetic resonance imaging with suspended respiration using the flip angle of 20 degrees and gradient echo technique at 0.5 Tesla was used for photographing.
In normal kidneys, a low intensity band was observed with the passage of Gd-DTPA through the kidney from 1 to 2 minites after the injection. In patients who underwent ESWL treatment, however, the low intensity band which was observed before ESWL treatment became partly obscure after ESWL treatment. Furthermore, these find changes in the renal parenchyma could not be fully datected by usual MRI which does not use Gd-DTPA.
Gd-DTPA enhanced dynamic MRI was considered to be effective for finding the limited dose of shock waves for ESWL treatment.

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Lymphocyte subsets were examined in renal cell carcinoma (TILs), adjacent non-tumor renal tissue and peripheral blood (PBLs) by flow cytometry and histochemistry in eighteen patients with renal cell carcinoma. CD5-positive cells were predominant in the TILs in 14 patients. In the renal cell carcinoma tissue, CD8-positive cells were predominant over CD4-positive cells, resulting in a less than unity ratio of CD4/CF8-positive cells. The lymphocyte number was significantly in adjacent normal renal tissue than in renal cell carcinoma. However, lymphocyte subsets ratios were not significantly different between these two tissues. PBLs showed the same proportions (CD4/CD8 mean 1.9±0.8) as the previously published healthy controlled data. The proportions of CD8-positive cells were significantly increased (p<0.05) and those of CD4-positive cells were also significantly decreased (p<0.01) in the TILs. The infiltrating pattern of TILs in 17 patients was divided histochemically into cluster (N=7), single (N=4), and mixed types (N=6). The cluster and mixed types were significantly more common in grade 1 tumors and the single type was more common in the grade 2 tumors (p<0.05). The pT3 tumors showed the single type of TIL infiltration pattern, but showed no significant difference. In the cluster pattern of TILs, CD8-positive cells were surrounded by CD4-positive cells. Non-tumorous kidneys showed no infiltration of lymphocytes, except in 2 patients of pyelonephritis. These results suggest that cytotoxic T-cells stained as CD8 play an immunoreactive role against renal cell carcinoma.

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Information about voiding disturbance was obtained from 34, 140 elderly males in Gunma Aged Club Association (Q group) through a questionnaire and from 8, 129 males by prostate mass screening for prostate disease (MS group) as to: (1) the characteristics of the subjects examined by the mass screening, (2) the relationship between the voiding disturbance and aging and (3) the frequency of voiding disturbance in the normal elderly males.
In MS group, the percentage of young subjects, especially less than 60 years old, who complained voiding disturbance was higher than the expected percentage on the assumption that it increases with aging. The percentage of voiding disturbance in these young subjects was also higher than that of males in the same decade in Q group. In their past and present history, the percentage of benign prostatic hypertrophy (BPH) in these young subjects was higher than the expected percentage on the assumption that the incidence of BPH increases with aging. Judging from these results, it was estimated that they were not satisfied with the medical care by which they were treated or were being treated, and they received this mass screening to obtain consultation for their complains.
Loss of the force was related with the prostate size estimated by digital rectal examination but not with aging. However, nocturia was well related with aging but not with the prostate size. Hesitancy, strain and dribbling were not apparently related with either the prostate size or aging.
It was demonstrated that frequency of nocturia was 0 to 1 in less than 60 years old normal males, 0 to 2 in 60 to 79 years old ones and 0 to 3 in over 80 years old ones. The other symptoms studied in each decade were also analyzed and discussed.

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The immunological study of the major histocompatibility complex (class I, class II and DR antigens), tumour infiltrating lymphocytes (TIL), regional lymph node lymphocytes (RLNL) and peripheral blood lymphocytes (PBL) was evaluated on the basis of immunohistochemical staining using monoclonal antibodies of each subset of lymphocytes in a series of 16 patients with renal cell carcinoma. Two renal cell carcinomas in dialysis patients with acquired cystic disease of the kidneys (ACDK) were also included in this study. With regard to the immunological environment, a comparative study between renal cell carcinoma accompanied with ACDK and 14 other renal cell carcinoma was carried out.
The results are described below:
1) With regard to the expression of MHC antigens in tumour cells, the degrees of expression of MHC class I, class II and DR-antigen in case 1 were higher than that of the other 14 renal cell carcinomas. On the other hand, no expression of MHC was detected in case 2.
2) As to the subsets of TIL, the CD25 (IL-2 receptor) was not expressed in all the renal cell carcinoma. As to the T cell receptor (TCR-alpha/beta chain), the degree of expression was the same in case 1 and the other 14 cases. On the other hand, no TCR was detected in the case 2. As to the other subsets of TIL (CD3, CD4, CD8, CD16 and CD20), the rates of the infiltration were the same in case 1 and the other 14 cases, but those in case 2 were lesser than in all other 14 cases.
3) As to the subsets of RLNL, CD25 was not expressed in all the renal cell carcinomas. The degrees of expression of the TCR-alpha/beta chains were the same in case 1 and the other 14 cases, but not in case 2. As to the other subsets, there observed an elevation of the CD3 (especially CD4) in case 1 compared with the other 14 cases. However, as to case 2, all subsets were reduced compared with case 1 and the other 14 cases.
4) As to the subsets of PBL, the same ratio of each subset was observed in case 1 and the other cases. As to case 2, CD3 (especially CD4) was elevated compared with case 1 and the other 14 cases. We conclude that there are severely immuno-suppressive cases like case 2 in the renal cell carcinoma patients with ACDK caused by dialysis.

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Once a catheter has been passed into the bladder without contamination, there are several possible routes of subsequent infection during drainage period, such as: 1. Entry of bacteria alongside the catheter in the urethra. 2. Introduced bacteria adhered easily to the indwelling catheter and drainage system and colonized. 3. The catheter tip is covered rapidly by various nutrient materials which becomes a good culture medium of sticked bacteria, which is a supply sourse of bacteria into the bladder urine. 4. Although the motile bacilli ascend very slowly through the stagnant tube and no bacteria ascend against a slowly moving column, rapid tranport of organisms occurs in the swirling fluid caused by the passage of rising air bubbleds. 5. Continuous urethral catheter drainage permits an average residual urine volume of 7.3ml. 6. The catheter destroys the antibacterial defense mechanisms of the urinary bladder.
The reasons why in many cases of intermittent self-catheterization (CID) urine becomes sterile despite non-sterile procedure, are as follows. In addition to that CIC has none of the disadvantages of the indwelling catheter, it improves the vesical defense mechanisms deteriorated by high pressure voiding. The number of bacteria reintroduced during catheterization is relatively small and they can be eradicated by usual scheduled catheterization within 4-5 hours without residual urine. CIC must be started before trabeculations or diverticuli are formed, in which bacteria remain. Actual determination of residual urine volume after catheterization will help to prescribe a rational program of CIC.

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The influence of gram-positive cocci on the postoperative course of transurethral prostatectomy was analysed on 463 patients. The half of isolated cocci was Enterococcus, followed by S. epidermidis and S. aureus. The rates of postoperative urinary infection by gram-negative bacilli were nearly the same for patients with preoperative gram-positive cocci infection and those without any of bacteria (3/79 vs. 9/310). Patients who developed new infection with gram-negative bacilli had fever, in contrast to patients with new gram-positive cocci infection. Gram-positive cocci prolonged the postoperative pyuria but not so long as gram-negative bacilli. All these findings suggest that infection caused by gram-positive cocci is not so severe as that caused by gram-negative bacilli.

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Atypical hyperplasia and latent carcinoma of the prostate from 310 prostates of all age obtained at autopsy were studied. Atypical hyperplasia was graded into 3 groups based on the frequency of nucleoli and cell arrangement.
The results were as follows: the origin of both atypical hyperplasia and latent carcinoma was considered to be in the peripheral zone. The frequency of atypical hyperplasia increased with age. Atypical hyperplasia was found in younger generation than latent carcinoma. Grade of atypical hyperplasia increased with age. Atypical hyperplasia was often coincident with latent carcinoma: 74% of atypical hyperplasia were associated with latent carcinoma. Atypical hyperplasia was significantly associated with multicentric latent carcinoma.
All these findings supported the assumption that atypical hyperplasia was a premalignant lesion.
Clinically, in a case in which atypical hyperplasia is found in biopsy, intense follow-up will be necessary. In particular, in cases of grade 3 atypical hyperplasia, further study for detection of probable coexistent carcinoma is recommended.

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A rare case of metastatic renal tumor originating from a malignant mixed tumor of the submandibular gland is reported.
The patient was a 45-year-old woman with hard masses palpated in the right upper arm and the right upper gluteal region. She had a history of surgical resection of a right submandibular tumor followed by radiotherapy in 1977. Biopsy findings of the gluteal mass suggested a malignant clear cell tumor. A chest X-ray, excretory urogram, CT scan, MRI and renal angiogam were highly suggestive of a right renal cell carcinoma with metastases to the right lung (S₁ & S₁₀), the left 4th and 5th ribs, the right upper arm muscle and the right upper gluteal muscle. Right nephrectomy and resection of the right upper arm and right upper gluteal tumors were performed. Microscopic examination showed that all tumors were malignant mixed tumors. When compared to the previous surgical specimen, the tumors were believed to be identical. The tumors of the lung and ribs subsequently resected were malignant mixed tumors. The patient is well with no objective or subjective evidence of recurrent neoplastic disease 7 months post-operatively.
To our knowledge only one report of metastatic renal tumor originating from a malignant mixed tumor of the salivary gland has been published in Japan. But metastatic renal tumor originating from the same tumor of the submandibular gland has not been reported previously in Japan.

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A case of hypothalamic-pituitary failure is reported. A 28-year-old man who had been treated with testosterone for hypogonadism for two years was admitted to our hospital with the chief complaint of sexual problems.
The serum level of gonadotropins was very low and hypophysial responses to luteinizing hormonreleasing hormon (LH-RH) were good. Treatment was started with subcutaneous pulses of 10μg LH-RH every 120 minutes using a portable infusion pump. Gradually, his potency improved and ejaculation returned. The serum concentration of FSH, LH and testosterone increased to the normal range of adult males and the testicular volume increased rapidly from 5ml to 14ml after 13 weeks of treatment. Sperms appeared in the ejaculated fluid after 25 weeks and, after following 16 weeks, the concentration of sperms increased up to 20×10⁶/ml.
Prolonged pulsatile subcutaneous administration of a low-dose of LH-RH at a physiologic frequency was an effective therapy for pubertal induction and maturation in hypogonadotropic hypogonadism due to hypothalamic-pituitary failure.

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