It had been believed that carcinoma of the penis was rather rare in the developed countries comparing with that in the underdeveloping countries, however, the recent epidemiological studies failed to reveal any clear difference of the incidence of carcinoma of the penis all over the world.
In these days so called successful treatment is coming to be evaluated by the quality of life (QOL) after surgical or nonsurgical treatment (especially sexual function tended to be considered very important factors altering QOL).
I want to emphasize the following issues in this report.
1. Erythroplasia of Queyrat and Bowen's disease are carcinoma in situ and should be dealt as carcinoma of the penis.
2. relation of human papilloma virus and carcinoma of penis.
3. usefulness of TNM classification over Jackson's classification.
4. SCC antigen is a reliable tumor marker of carcinoma of the penis?
5. effectiveness of chemotherapy based on BLM combined with radiation therapy for carcinoma of the penis.
6. usefulness of Mohs microscopically controlled surgery and modified groin dissection.
It is generally accepted that since carcinoma of the penis is a rare disease and for one institution up to 50 cases can be experienced during 20 years in Japan, there exist no integrated study involving a large number of institutions. I really wish a certain form of group study to be completed and the results from this study utilized to overcome the present problems for the treatment of carcinoma of the penis.

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Bladder tumors were induced in rats by the oral administration of 0.025% N-butyl-N-(hydroxybutyl) nitrosamine (BBN). In order to study the suppressive effects of rat interferon-α (IFN-α) on induction of carcinogenesis in vivo, rats were treated with IFN-α i. m. twice a week. The treatment began at 5th week of BBN administration. The bladder mucosa was observed macroscopically and microscopically, and NK activity was examined. The results were as follows.
1) There was no significant difference in the bladder to body weight ratio between the BBN+IFN-α and BBN groups in during stage A (10th-14th week when changes in the mucous membrance such as hypertrophy in the bladder wall or vascular formation are observed). This ratio in the BBN+IFN-α group was less than that in the BBN group in during stages B and C (15th-19th week and 20th-30th week respectively when tumors are visually recognizable).
2) The rate of carcinogenesis in the BBN+INF-α group was less than that in the BBN group in stages A and C.
3) The pathological grade and stage of the bladder cancer in the BBN+IFN-α group were lower than those in the BBN group in stages B and C.
4) There was no significant difference in NK activity between the two groups in stage A, but NK activity of the BBN+IFN-α group was higher than that of the BBN group in stage B.
5) These findings substantiated the hypothesis that IFN-α can suppress tumor-growth in BBN induced bladder carcinoma.

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This report clarified the direct damage to renal cell ultrastructure on shock wave exposure. The renal cortex of the rabbit was exposed to the shock waves (1200bar) generated by the piezo-ceramics. The change was examined by electron microscopy immediately after 20 shots exposure and 500 shots exposure as well as one week after 500 shots exposure. In all groups, the most critical damage was observed in the proximal tubule. Immediately after 20 shots exposure, large vacuoles were found to be enclosed by infoldings in the proximal tubular cell. The damaged cell lost its brush border and jutted out into the lumen. The ruins of organelles (nuclei, mitochondria, etc.) were seen in the lumina of proximal and distal tubules. The damage progressed, in the 500 shots exposure group, to include the distal tubular cytoplasm. One week after the 500 shots exposure, a few of atrophic tubular cells were found in wide scars. The tubular cell which contained a deformed nucleus and destroyed organelles was desquamated from the basement membrane. The change in the tubular cell after shock wave exposure was apparently different from that after such intervention as one hour ischemia. It was concluded that the direct damage to renal cells by underwater shock wave exposure was really present.

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16 patients (7 male, 9 female) ranging in age from 13 to 71 (44.1±18.4) years old with clinically diagnosed pheochromocytoma were prospectively evaluated with CT (N=16), MRI (N=16), ¹³¹I-MIBG (N=10) and operative findings in order to evaluate their diagnostic efficacy.
1. Normal adrenal glands appeared less intense than the liver on T1-weighted image (T1WI), less intense than or isointense with the liver on both proton density image (PDI) and T2-weighted image (T2WI).
2. Pheochromocytomas with high urinary noradrenaline level appeared less intense than the liver on T1WI, more intense on T2W1 and showed accumulation of radioisotope on ¹³¹I-MIBG scintigraphy. In cases with normal urinary noradrenaline level, they appeared less intense than or isointense with the liver on all pulse sequences (T1WI, PDI and T2WI).
3. Although diagnostic accuracy of localization was 81.3% (13/16) by CT, 93.8% (15/16) by MRI and 90% (9/10) by ¹³¹I-MIBG scintigraphy, MIBG scintigraphy showed higher diagnostic ability in cases with multiple lesions or recurrent tumors.

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It has been widely recognized that cyclosporine A (CyA) is useful in transplantation of the kidneys. On the other hand, the nephrotoxicity as one of its adverse effects is clinically important. There have been accumulated pieces of pathological evidence that CyA causes the renal proximal tubule damage. However, there are few reports available on the changes in the proximal tubular function. Recently, lithium clearance (C_Li) has been employed to assess the proximal tubular function in CyA nephrotoxicity, because lithium ions are mainly reabsorbed throughout the proximal tubules in the same proportion as sodium and water. Several studies have already shown that long-term CyA administration results in a decrease in C_Li reflecting enhanced lithium ion reabsorption. I studied, in male Sprague-Dawley rats, 1) whether short term and small dose of CyA administration which does not induce the renal tubular cell damage affects C_Li and 2) the possibility that high salt intake influences C_Li in CyA nephrotoxicity. Then, I divided rats into 6 groups: three groups were allowed the access to water, but the other three groups of rats were allowed to drink only saline. Group 2 and 3 were received 12.5mg/kg and 25mg/kg, respectively, of CyA intraperitoneally every day. As for creatinine clearance (Ccr), Ccr of group 3 (CyA 25) was the lowest, being significantly different from the other two groups. The most important result is fractional reabsorption of sodium and water in the proximal tubule. There is a significant difference between 1-A (vehicle, H₂O) and 2-A (CyA 12.5, H₂O), but no significant difference between 1-B (vehicle, saline) and 2-B (CyA 12.5, saline). These data sugest that high salt intake supresses the fractional deliverly of sodium and water from the proximal tubule into the distal nephron.
The urinary excretion level of NAG is not significantly different among all groups. It means that, under this experimental condition, CyA does not cause cellular damage of the proximal tubule.

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We reviewed 66 patients with stage A adenocarcinoma of the prostate who were treated at our 7 affiliated hospitals in Yokohama between 1984 and 1988.
Of 1377 patients who underwent subcapsular prostatectomy (SCP) or transurethral resection of the prostate (TUR-P) for benign prostatic hyperplasia, 66 patients (4.8%) were diagnosed as an incidental carcinoma of the prostate. Of these patients, 36 and 30 were in stage A1 and A2, respectively. In the 66 patients, 59 (4.5%) were detected in 1315 TUR-P and 7 (11.3%) in 62 SCP. Elderly patients over 80 years of age had a higher risk of stage A2 disease.
In histological grade, well, moderately and poorly differentiated adenocarcinoma were found in 48 patients (72.7%), 13 (19.7%) and 5 (7.6%), respectively. Among the patients with stage A prostate carcinoma the majority of the age-group less than 79 years old had well differentiated adenocarcinoma. In the age-group more than 80 years old, there were 6 (37.5%) moderately and 2 (12.5%) poorly differentiated tumors. In other words, the age-group more than 80 years old tended to have the moderately or poorly differentiated adenocarcinoma more frequently than those other decades.
We expect an increase in the number of patients with stage A2 disease in the future with the expansion of the operative indication, especially in elderly patients.

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Nuclear DNA content of paraffin-embedded tissue from 38 adrenal neoplasms and 9 histologically normal adrenal glands was analyzed using flow cytometry. Histological diagnosis of thirty-eight adrenal neoplasms were 3 adrenocortical carcinomas, 20 adrenocortical adenomas and 15 pheochromocytomas. In 33 cases (87%) of the 38 tumors the determination of DNA ploidy was possible. All 9 control specimens showed DNA diploid pattern in DNA histogram. In adrenocortical neoplasms the incidence of DNA aneuploidy was 0% (0 of 17) in adenomas and 100% (2 of 2) in carcinomas. All 17 adrenocortical adenomas which showed DNA diploid pattern are clinically benign. On the other hand, both 2 cases of adrenocortical carcinoma which showed DNA aneuploidy died within 1 year. These data suggest that DNA aneuploidy may be useful as a prognostic factor in adrenocortical neoplasm. With regard to pheochromocytoma, DNA aneuploidy was detected in 4 of 14 patients (29%). However, all 14 cases were clinically benign. In pheochromocytoma DNA aneuploidy was not found to be correlated with prognosis.

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In order to clarify factors affecting recurrence, we reviewed 115 renal cell carcinoma patients without distant metastasis at diagnosis (Mo) treated from January 1975 to March 1990 at Sapporo Medical College Hospital. Of these 115 patients, recurrence (metastasis) was found in 23 (20.0%). The non-recurrence rate was 70.6% after the 5-year and 56.5% after the 10-year follow up. In 22 out of 23 patients, recurrence appeared within 3 years following surgery. Multivariate analysis by Cox's proportional hazard model revealed that lymph node metastasis was the most significant factor for recurrence in the 115 patients followed by stage of the primary tumor and pre-operative acute phase reactant (fever, ESR and α2-globulin) in this order.
When the analysis was performed in the 88 patients who was in less advanced stage (pNopVo-1a), pre-operative acute phase reactant (fever, ESR and α2-globulin) was identified as the only significant factor affecting recurrence. This result suggests that pre-operative acute phase reactant is the most important risk factor for recurrence in this group of patients.

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Epithelioid cells that had grown in short-term cultures derived from 10 cases of adenocarcinoma (PCa) and 10 cases of hyperplasia (BPH) of the prostate were karyotyped by the G-banding method for the pathogenesis of these disease. PCa specimens included 4 well, 2 moderately, and 4 poorly defferentiated types, and were obtained by perineal needle biopsy from 4 patients in stage B and 6 patients in stage D₂. Cells liberated from metastatic lymph node lesions of 2 patients with poorly defferentiated PCa were also analyzed directly without cultivation in vitro. All BPH specimens were obatained by prostatectomy, and cells that had grown in epithelioid pattern in short-term cultures were analyzed. In PCa, hyperploidy was seen in all but 2 cases. Structure analysis disclosed abnormality of chromosome 16 in 4PCa, delection of Y in 3PCa, abnormality of chromosomes 7, 14, 15, 18, and 19 in 2PCa, and abnormality of chromosomes 3, 4, 17, and 21 in 1PCa. Multiple markers were observed in 1 patient, and hyperploidy in another patient with metastatic lymph nodes. All but 2 cases of BPH were diploid. Normal male karyotypes were seen in 6BPH. Trisomy of chromosomes 7 and 16 were observed in 2BPH. Of 4 patients with stage B PCa, 3 who have been alive for 3 years to date had multiple abnormalities, whereas 1 patient who died 2 years after diagnosis had few abnormalities. Of 8 patients with stage D₂PCa, 2 patients who have been alive for 3 years to date had no or few abnormalities, while 6 patients who died 1.5-3 years after diagnosis had multiple abnormalities. These findings indicate that chromosomal abnormalities may be seen in many PCa but not in BPH, and that PCa with many abnormalities may be more malignant than PCa with few abnormalities.

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Male Wistar rats were administered with 0.1% N-ethyl-N-hydroxyethyl nitrosamine (EHEN)-containing diet for 2 weeks, and were then Rept for further 23 weeks on basal diet. At 25 weeks, the rats were divided into three groups. Group I was fed on basal diet to 40 weeks. Group II was fed on 2% cholestyramine-containing diet to 40 weeks. Group III was fed on 0.02% compactin-containing diet to 40 weeks. At 40 weeks after the start of experiment, the rats were sacrificed and examined histologically for the incidence of renal cell tumors (RCT) and dysplastic foci (DF) of the kidney.
The serum levels of total cholesterol at 40 weeks were 108.9±23.4, 78.8±12.5, 95.6±43.4mg/dl in Groups I, II and III, respectively. The levels were significantly lower in Groups II and III (p<0.01, 0.05, respectively, Wilcoxon test) than Group I.
The average numbers of DF were 4.5±4.1, 1.3±0.3, 2.3±2.0per cm² of kidney slices in Groups I, II and III, respectively. DF were significantly less in Group II than Group I (p<0.025, Wilcoxon test), and less in Group III than Group I (not statistically significant). There was no statistical difference between Groups II and III.
RCT were observed in 9 of 34 kidneys (26%), 2 of 18 (11%), 1 of 20 (5%) in Groups, I, II and III, respectively. The ratios of kidneys with RCT were lower in Group II than Group I (not statistically significant), and lower in Group III than Group I (p<0.05, qui-square test). There was no statistical difference between Groups II and III. RCT were classified into gross and microscopic lesions. Four gross RCT were found in 4 rats of Group I; no gross RCT was in Groups II and III. There were 5 microscopic RCT in 5 rats, 3 in 2, 1 in 1 in Groups I, II and III, respectively.
In Group I, serum levels of total cholesterol were compared between the following subgroups; the rats with RCT and/or with more than 10DF per kidney, and the rats without RCT and with less than 10DF per kidney. The mean level was 120.8±1.8mg/dl in the former subgroup, which was significantly higher than that (94.1±19.6mg/dl) in the latter subgroup (p<0.025, Wilcoxon test).
The serum cholesterol was suggested to act as a promoter in the development of DF and RCT.

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Abdominal ultrasonography was performed in a total of 19, 933 persons at the health care center of our hospital from April 1987 to March 1991. Among them, 16 persons were diagnosed as having renal cell carcinoma and underwent operation.
Renal cell carcinoma was detected in one out of 1245 persons (0.08%) by ultrasonography. Of these 16 persons, 15 were males and one was a female and they ranged in age from 38 to 64 years (average age 50.8 years).
The tumors were located in the left kidney in 9 and in the right kidney in 7. Regarding the size of the resected tumors, 7 (44%) belonged to T₁ and 9 (56%) to T₂ by TNM classification of UICC. The minimum size of the tumors was 1.2×1.3cm.
Most of the patients had small renal cell carcinoma and all have survived. Abdominal ultrasonography at the health care center is the most effective method of examination for early diagnosis of renal cell carcinoma.

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Two hundred patients with upper urinary tract stones underwent in situ ESWL with Lithostar during the recent 20 months at Kanagawa Prefectural Atsugi Hospital. Actual residual stone rates were calculated based on the period from the initiation of the treatment to the stone free status, and discussed according to the location and size of the stone treated.
Total 200 patients were submitted to 1.67±0.97 treatment sessions with 6742±5545 shock waves. After 3 months, 148 patients (78%) showed stone free status, and 32 patients (16%) had residual stones less than 4mm. The actual residual stone rates were 90.5%, 66.5%, 39.1%, 26.9% and 17.9% after 1, 3, 6, 12 and 20 weeks, respectively. The residual stone rate were lower in the lower ureter, ureteropelvic junction, upper ureter, renal parenchyma or diverticulm and renal pelvis or calyx in order. As for the size, the larger the stones the higher the residual stone rates; the therapeutic results were significantly worse in patient group of stones larger than 21mm compared to the patient group of smaller stones (p<1%). The destructed stones were passed gradually up to 6th week after in situ ESWL, however, after that fragments seldom passed out.
Therefore, it was concluted that decision on the additinal or combination therapeutic intervention, if necessary, should be made after 6 weeks. Combination therapy with endoscopic surgery and/or others was seemingly needed for the patients with stones of more than 21mm in size and of renal pelvis and renal calyx to improve the rates of stone free.

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A case of urinary undiversion in a 19 year old man with high ileal loop, who at the age of 1 year was inadvertently cystectomized for probable acute urinary retention masquerading as acute abdomen, is reported. The ileo-ceco-colonic segment was isolated and the colon was partially detubularized. After ileocecal intussusception and stabilization to the cecal wall (Hendren), a segment of ileal patch was applied to form an Indiana type pouch. The ileal loop was free from the abdominal wall and its distal end was anastomosed to the terminal ileum of the pouch. Undiversion was completed by connecting the pouch at its dependent portion with the remnant prostatic urethra. At 4 months postoperatively the pouch functions quite satisfactorily as a low pressure and good volume reservoir that empties well without reflux. His erectile and ejaculatory function have also been maintained.

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We report on a 58-year-old male treated with transcatheter embolization for arteriovenous fistula due to renal injury. The patient was transferred to our hospital on December 10, 1989, with left renal injury and left temporal bone fractures. Enhanced CT revealed parenchymal fracture with peri-renal hematoma in the left kidney. Antibiotics were prescribed to prevent bacterial infection of the injured kidney. Urine cleared and pain in the left loin area disappeared 17 days later. However, on December 28, gross hematuria and pain in the left flank suddenly reappeared. He was given a blood transfusion and was diagnosed with re-bleeding from the injured kidney. Renal angiography performed on January 10, 1990, revealed arteriovenous fistula of the kidney. Transcatheter embolization was done using a metal coil to close the arteriovenous fistula. The patient has had no further problems or complaints. Excretory pyelogram showed no hydronephrosis in the left kidney. TcDMSA renoscintiscan showed a defect in the mid-portion of the kidney. These results suggest that transcatheter embolization can be useful to alleviate arteriovenous fistula in cases of renal injury.

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