(Backgrounds) The prognosis of patients with incidentally detected renal cell carcinoma is better than that of patients with symptomatic renal cell carcinoma. These incidentalomas include those discovered by ultrasonography at health check-up and those found during examinations for unrelated disease. In this study, we investigated the prognosis of the patients of the health check-up group and the unrelated disease group.
(Methods) From April 1987 to March 1997, 263 patients with renal cell carcinoma were treated in our department including 166 incidentalomas (63.1%). The occasion of incidental detection was divided into 2 groups; 90 cases as health check-up group and 76 cases as unrelated disease group.
(Results) The mean age was 52.9±9.7 years for health check-up group and 65.1±11.4 years for unrelated disease group (p<0.01). The mean evaluated tumor size was 3.6±1.6cm for health check-up group and 4.4±2.6cm for unrelated disease group (p<0.05). The survival rates were significantly different in the two groups (p<0.01); the 5- and 10-year survival rate for health check-up group was 91.5% and 55.9%, respectively and for unrelated disease group 79.4% and 66.1%, respectively.
(Conclusion) These results suggested that examination by ultrasonography at health check-up lead to detection of smaller renal cell carcinoma and improve the prognosis further.

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(Purpose) There has not been an established method to distinguish initial lymphatics from blood capillaries under the light microscopy. In this study, we examined the usefullness of the immunohistochemical staining method using a monoclonal anti-desmoplakin antibody in identifying initial lymphatics under the light microscopy. The specificity of this reaction was confirmed by the immuno-electron microscopy.
(Material and Methods) The cryostat sections of the human foreskin were observed under light microscopy by indirect immunoperoxidase method with the anti-desmoplakin mouse monoclonal antibody, and compared with the hematoxylin and eosin sections. These cryostat sections were also observed under electron microscopy by pre-embedding immunoperoxidase method with the same antibody.
(Results) Under the light microscopy, the initial lymphatics of the human foreskin were visualized by the method with anti-desmoplakin antibody. These lymphatics were mainly distributed in the dermal layer, on the other hand, rarely seen in dermal papillae. Being usually found in closed shape, the lumens of initial lymphatics were hardly recognized as initial lymphatics by the ordinary hematoxylin and eosin staining.
Under the immuno-transmission electron microscopy, the peroxidase-desmoplakin antibody precipitations were located on the surface of the endothelial cells of the vasculature which lacked pericytes and basal lamina, and was composed of endothelial cells alone. By these features of the vascular structures, the vessel reacting with anti-desmoplakin antibody was identified as initial lymphatics.
(Conclusion) This study shows the reliability and specificity of the immuno-histochemical method byu anti-desmoplakin antibody in identifying initial lymphatics under light microscopy, and this metho will be useful in studying the fine distribution of lymphatic vessels in normal human tissue.

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(Purpose) We investigated the effectivness and toxicity of VIP therapy as a first-line chemotherapy for patients with metastatic germ cell tumor.
(Patients and methods) From March 1994 to October 1997, we treated 16 patients with VIP therapy consisting of etoposide (100mg/m²), ifosfamide, (1.2g/m²) and cisplatin (20mg/m²), all of which were generally given daily for 5 consecutive days every 3 weeks. Of the 16 patients, 6 were classified into a good, 5 into an intermediate, and 5 into a poor prognostic group according to the International Germ Cell Consensus Classification.
(Results) Thirteen patients (81%) achieved complete response with VIP alone or VIP plus surgery. Three-year survival rate was 100% in good and intermediate prognostic group, while 40% in poor prognostic group. Although all patients had Grade 3 or higher myelosuppression, the treatment was well tolerated and no patient died of treatment-related complications.
(Conclusions) VIP appears to be an effective and safe regimen as an induction chemotherapy for good and intermediate risk patients with germ cell tumor. However, more intensive regimen may be necessary for poor-risk patients.

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(Backgrounds) We report the results of microscopic penile revascularization in patients with arteriogenic erectile dysfunction.
(Methods) One patient with localized obstruction of the common penile artery underwent the Michal II penile revascularization, 13 patients underwent the Furlow-Fisher procedure, and 5 patients underwent the Hauri procedure. The mean age was 33.0 years and the mean follow-up period was 32 months (4-80 months). Eight patients were tobacco smokers, one patient was over 50 years old. Surgery was considered successful when the patients had a permeable anastomosis and were able to achieve satisfactory erection resulting in normal sexual intercourse.
(Results) All surgery was successful except for one patient who had undergone the Furlow-Fisher procedure. In Spite of antithrombotic therapy, graft occlusion occurred in two patients. Post operative glans hypervascularity occurred in two patients.
(Conclusion) Penile revascularization surgery is a highly effective treatment for selected patients. There is a need for further study of graft occlusion and glans hypervascularity.

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(Backgrounds) It has been demonstrated that leukocyte infiltration, mainly of macrophages and lymphocytes, into obstructed kidneys (OBK) of rats during unilateral ureteral obstruction (UUO). Chemokines (C-C subfamily) may be involved in this mechanisms. Thus, we accessed the gene expression of chemokines in renal cortex of rats with UUO.
(Materials and methods) Female SD rats were sacrificed at various time points after UUO. mRNA expression of MCP-1, RANTES and MIP-1α was determined by semi-quantitative RT-PCR.
(Results) Control kidneys (CNK) showed a weak mRNA expression of MCP-1, RANTES and MIP-1α. OBKs showed an increase in MCP-1 at 2 hours of UUO and a significant increase at 4 hours of UUO as compared with CNKs or contralateral unobstructed kidneys (CLK). The mRNA levels of RANTES and MIP-1α were not increased until 72 hours of UUO in CLKs or OBKs. There were slight, but significant, differences of RANTES and MIP-1αa expression between OBKs and CNKs at 120 hours of UUO.
(Conclusions) We suggest that the early increase in MCP-1 contributes to the leukocyte infiltration and that RANTES and MIP-1α plays a partial role in a late increases.

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We have sometimes encountered intractable cases of nephrolithiasis, even though ESWL and endourology have dramatically developed at the present time. We could obtain satisfactory result in the treatment of intractable right nephrolithiasis with ureterocalicostomy. Case: The patient was a 39-year-old man having undergone PNL, ESWL, pyelolithotomy for right nephrolithiasis. Ten-odd stones, measuring 5-20mm in diameter, were detected, and his IVP revealed mild hydronephrosis with the ureteropelvic junction stenosis. Pyeloplasty was thought to be difficult to perform. Thus the stones were removed through an incision made on the lowermost portion of the kidney followed by ureterocalicostomy on September 9, 1993. After clamping of the renal artery, the lowermost portion of the renal parenchyma was resected, and the lower calyx was sufficiently exposed. Adequate hemostasis of the cut surface was made, and the renal artery was then declamped. Many stones, measuring 20mm or less, were removed through the lower calyx, and the lower calyx and the ureter were anastomosed. After operation, ESWL was additionally performed for residue stones. The IVP in July 1997 demonstrated the sufficiently patent anastomosed site without hydronephrosis or recurrence of nephrolithiasis. Discussion: Anastomosis between the lower calyx and the ureter is an effective therapeutic method because it dose not interfere urine stream or small stone passage. However, it is not easy to make anastomosis in this site because the calyceal wall is very fragile. Several cases have been reported to have stenosis in the anastomosed site. We supposed that it is an excellent method for the treatment of refractory nephrolithiasis if the procedure is selected only for appropriate candidates.

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We report a case of segmental infarction of a testicle seen in a 28-year-old man with right lower abdominal pain who visited our hospital. On physical examination, the right testicle was slightly elevated and Prehn's sign was positive. As torsion of the right spermatic cord was suspected, ultrasonography and color Doppler sonography were performed, revealing sufficient blood supply in the right spermatic cord and in the most part of the right testicle. However, a low echogenic area without blood flow was noted in the upper pole of testicle. Since CT and MRI findings couldn't rule out a testicular tumor, right high orchiectomy was performed. The specimen revealed a hemorrhagic area, histologically proved to be segmental hemorrhagic infarction of the testicle. Segmental infarction of a testicle is rare and our case is the 31th case in the world literature (the 7th case in Japan).

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