(Background & Methods) A cell line obtained from a primary lesion of renal cell carcinoma was newly established and observed to produce erythropoietin (Ep) continuously in vivo as well as in vitro. The histopathological and biological characteristics of this cell line were then analyzed in pararell with a study initiated on the role of cAMP on Ep production.
(Results) The cells were subsequently serially transplanted into nude mice. The levels of Ep and hematocrit in the mice were found to correlate very closely with the tumor size. The histology of the xenograft was similar to the original tumor cells which constituted a nearly clear cell type and was immunostained positively for Ep. Ultrastructually, Ep was localized in the perinuclear space, with part of the rough surface of the endoplasmic reticulum. In vitro, the cells grew exponentially with an approximate population doubling time of 2 days. The mRNA of Ep was detected using the RT-PCR method. The number of chromosomes in the cells ranged from 117 to 147 and featured complicated rearrangements and marker chromosomes. Forskkolin, a well-known activater of adenylate cyclase which in turn generated the accumulation of cyclic AMP, produced a significant dose-related enhancement of Ep biosynthesis both in the cells and in the spent culture medium.
(Conclusions) Based on the results derived from the foregoing analysis of this new cell line, cAMP was found to play a salient role both in Ep biosynthesis as well as in Ep release.

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(Purpose) Male erectile capacity has been often evaluated with the maximum changes of penile circumference during nocturnal penile tumescence (NPT) by erectometer. However, it has not been fully established that the changes actually reflect penile rigidity. In this paper, we evaluated how the maximum change (the increase in circumference or its rate) of the circumference is related to penile rigidity.
(Patients and Methods) The study included 116 men with or without complaints of sexual dysfunction. The maximum increase (penile circumference on erection —that when flaccid) and increase rate {(penile circumference on erection —that when flaccid)/penile circumference when flaccid} of penile circumference and penile rigidity were studied during artificial erection induced by intracavernous injection of vasoactivedrugs.
(Results) When the maximum increase of penile circumference on erection was 21mm or more, more than 80% of men achieved adequate rigidity of the penile for vaginal penetration. However, if the increase was 10mm or less, all men had poor rigidity. In men having an increase of 11mm or more and less than 21mm, more than 80% did not achieve adequate rigidity if their penile circumference in the flaccid state was less than 95mm. In contrast, 80% or more of the men showed penile rigidity sufficient for vaginal penetration when the flaccid circumference was 95mm or more. Studies on the maximum increase rate revealed results similar to those in the study on the maximum increase. These two parameters had a similar diagnostic accuracy for evaluating penile rigidity.
(Conclusions) A higher prediction rate for penile rigidity was achieved by adding the parameter of penile circumference in the flaccid state to the maximum increase or increase rate of penile circumference. Thus, evaluation of erectile capacity by maximum changes (the increase in circumference or its rate) of penile circumference with an erectometer can be used for screening of men with sexual dysfunction.

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(Background) Recent studies have shown that ^99mTc-methoxy-isobutyl-isonitrile (^99mTc-MIBI), a new agent for myocardial perfusion imaging, can be successfully applied to parathyroid imaging. We evaluated the efficacy of ^99mTc-MIBI scintigraphy for preoperative localization of enlarged parathyroid glands in patients with hyperparathyroidism.
(Patients and Methods) From June 1994 to September 1996, 24 patients with biochemical confirmation of hyperparathyroidism were studied with ^99mTc-MIBI scintigraphy prior to operation. Eleven patients had primary hyperparathyroidism (PHPT) and 13 had secondary hyperparathyroidism (SHPT) associated with chronic renal failure, including one patient with recurrent disease after subtotal parathyroidectomy. A positive ^99mTc-MIBI scan for an enlarged gland was difined as an area of persistent focal uptake on the delayed image acquired at 150min after intravenous injection of 600MBq of ^99mTc-MIBI.
(Results) Of 11 patients with PHPT, 10, were found to have solitary parathyroid adenomas at surgery and one patient had primary hyperplasia. ^99mTc-MIBI scintigraphy accurately detected 9 of 10 adenomas and 2 of 3 hyperplastic glands with no false positive results. Both of the two glands that were not detected by ^99mTc-MIBI weighed 200mg. The mean weight of the 11 glands that were visualized was 1264mg (range 300-4300mg). The sensitivity and predictive value positive for PHPT were 84.6% and 100%, respectively. In 13 patients with SHPT, all of 49 parathroid glands were identified during surgery, with 43 hyperplastic glands and 6 normal-size glands. Of 43 hyperplastic glands, 28 were detected by ^99mTc-MIBI and there was significant difference between the mean weight of these 28 glands (999mg, range 290-2630mg) and that of the 15 nonimaged hyperplastic glands (283mg, range 90-540mg). None of the six normal glands were imaged with ^99mTc-MIBI. One patient had a false positive scan caused by a thyroid nodule. The sensitivity and predictive value positive for SHPT were 65.1% and 96.6%, respectively.
(Conclusion) ^99mTc-MIBI scintigraphy is an excellent imaging method for localization of enlarged parathyroid glands in patients with hyperparathyroidism, especially with PHPT. However, it has the difficulty to demonstrate enlarged glands smaller than 300mg in weight.

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(Background) We tried a new procedure of gas-less laparoscopy assisted radical nephrectomy.
(Methods) Prior to insertion of laparoscope, pararectal incision approximately 7 cm in length was made to enter into the intraabdominal cavity. A 12mm trocar was placed just below the umbilicus and a flexible electroscope was inserted through it. A 10cm size disposable fan for lifting up the abdominal wall was indwelled through the under space of trocar port. After appropriately lifting up the abdominal wall, a 10mm trocar for working channel was placed at mid-axillar line. Under laparoscopic and trans-laparotomic views, radical nephrectomy was performed using the combined techinique of laparoscopic and open surgery.
(Results) Seven patients have been successfully treated with this procedure. The mean operating time of this procedure was significantly shorter than that of totally laparoscopic nephrectomy. The recovery time from the operation was as short as usual laparoscopic nephrectomy.
(Conclusion) We thought that this procedure could open a new scope of laparoscopic surgery.

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(Purpose) A decision tree in diagnosis of incidentally detected adrenal masses (incidentaloma) was made on the basis of these results.
(Methods) The clinical usefulness of adrenal scintigraphy with ¹³¹I-adosterol and ultrasonically guided tumor biopsy was investigated in 44 patients.
(Results) Adrenal scintigraphy was performed in 32 patients, of whom 21 were found to have an increased uptake in the tumor, including 19 cases of cortical adenoma and 2 of hematoma. No abnormal uptake was found in the remaining 11 patients, including 2 of cortical adenoma, 1 of adrenocortical oncocytoma and 8 of non-cortical tumors. Adrenal scintigraphy was thus thought to be useful in the differentiation of cortical tumor from non-cortical tumor, showing the sensitivity of 86%, the specificity of 80% and the diagnostic accuracy of 84%.
Cytological or histological study on speciments obtained by percutaneous adrenal tumor biopsy was performed in 19 patients, of whom 18 (95%) were correctly diagnosed in terms of the malignancy of incidentaloma.
(Conclsions) Taken together, the differential diagnosis and the surgical indication of adrenal incidentaloma could be made successfully based on adrenal scintigraphy and tumor biopsy.

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(Background) The objective of this study is to evaluate the results and advantages of laparoscopic investigation of nonpalpable testis.
(Method) Since March 1986 to May 1996, we performed laparoscopy to investigate 88 nonpalpable testes of 74 cases under general anesthesia. On condition that testis was found intraabdominaly, orchiectomy or orchiopexy was performed subsequently. With a finding of vas deferens and/or spermatic vessels entering into internal ring, inguinal canal was explored surgically. If both vas deferens and spermatic vessels were absent or blind-ending intraab-dominaly, no further examination was performed with a diagnosis of vanishing testis.
(Results) Location of testes found in this study were as follows. Twenty three (26.1%) testes were found intraabdominally, 36 (40.9%) were intracanalicularly, 13 (14.8%) were distal to external inguinal ring, and 16 (18.2%) were vanishing testes. To those 39 (44.3%) intraabdominal and vanishing cases did not need inguinal exploration.
(Conclusion) In conclusion, a laparoscopic examination for nonpalpable testis is the most effective and less invasive procedure to make sure or preclude the location of the gonad. And in 18% of those who were enrolled in this study, no further surgical interventions were needed. An accurate locating of nonpalpable testis permits site-specific planning of surgical management.

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(Background) The objective of this report is to evaluate the upper urinary tract changes of the patients with spina bifida who have been followed up for more than 10 years.
(Methods) We analyzed 228 patients (97 males and 131 females) of spina bifida. Mean patient age was 18.7 years (10 to 51 years) and follow up period ranged from 10 to 27 years (mean 13.4 years). Upper urinary tract deterioration (Hydroureter and/or hydronephrosis), vesicoureteral reflux (VUR) and bladder deformity were investigated by excretory urography and voiding cystourethrography. We compared these 3 parameters in the initial and final examinations.
(Results) In the initial examinations, upper urinary tract deterioration, VUR and bladder deformity were observed in 32.9%, 33.3% and 40.0%, respectively. During the follow up period, upper urinary tract was improved in 47.3% and VUR in 80.0%. Bladder deformity was disappeared in 14.4%. On the other hand, upper urinary tract was deteriorated in 9.3%. VUR and bladder deformity was newly developed or progressed in 8.0% and 29.3%, respectively. Finally, upper urinary tract deterioration, VUR and bladder deformity were observed in 31.3%, 18.2% and 52.0%, respectively.
(Conclusion) These results revealed that upper urinary tract and VUR were relatively controlled, however, bladder deformity was increased in its frequency. To prevent upper utrinary tract deterioration, further analysis of sequential changes of urinary tract conditions shouled be demanded.

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Bosniak classification of renal cystic massesis an extremely useful management tool. Of category I-IV by Bosniak, category III lesion is moderately complicated cyst, which cannot be confidently distinguished from malignancy radiologically. Here, we reviewed the clinical course of 5 patients with pathoglogically proven category III mass by Bosniak in order to evaluate the usefulness of magnetic resonance imaging (MRI) and renal angiography. Two of the 5 lesions were benign (hemorrhagic cyst) and the others were malignant (RCC). On MRI, the results of 5 lesions were true positive in 1 and false negative in 2. On angiography, the results were true positive in 2 and false negative in 1. MRI has an important role in detection of mass. Angiography is necessary for making a definitive diagnosis of the indeterminate renal cystic masses on US and CT as RCC, but cannot increase enough diagnostic confidence in small cystic renal masses. We experienced indeterminate 2 masses (case 1 and 4) on these four imaging techniques, which were RCC and hemorrhagic cyst, respectively. In category III lesions, if malignant finding was detected by MRI or angiography, we believe that surgical exploration should be performed. But, an absolute decision tree for management of the complicated renal cystic mass has not been published, and further investigation should be required.

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