Pyuria is one of the most important signs in evaluating the clinical effect of chemotherapeutics for urinary tract infections. We, therefore, investigated several experimental conditions in making wet spun film of urinary sediment.
Results are summarized as follows:
1) Since leucocyte detecting rate is highest in 1, 500r.p.m., 10min., the decanting method, using a 1cc. Komagome pipette for mixing, we think this condition is most suitable for making wet spun film of urinary sediment. 2) Coefficiency of variation in this experimental condition is 42%. 3) By using this method, when bacterial count is over 10⁵/ml., one or more bacteria per HPF is always detectable in a simple stained film. 4) Normal range of leucocyte number is assigned to be determined hereafter.

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The pressure of upper urinary tract of 250 cases selected from outpatients and inpatients of the urological clinic of Shinshu University Hospital was measured by means of the strain gauge manometer. In the cases, pathologic changes or condition of the upper urinary tract were observed in excretory urography and other routine examinations. Response of the upper urinary tract to drugs was also observed in some cases.
1) In cases of ureteral calculi, the ureter below the calculus had a tendency to decrease the frequency and the amplitude of peristaltic contraction in comparison with the unaffected ureter. On the contrary, the ureter above the calculus, as far as hydronephrosis did not occur above it, increased contraction frequency and resting pressure in comparison with the ureter below the calculus or unaffected ureter. In some cases, peristalsis in the renal pelvis were seen. In the cases of renal calculi, the ureter did not have a constant tendency in contraction frequency, but a half of the cases decreased amplitude and resting pressure as compared with unaffected side.
2) In the cases of nephroptosis, uncommon contraction waves in the renal pelvis, multiphasic contraction waves of the ureter, and ureteral pressure curve characteristic of ureteral obstruction were observed. Some of their excretory urograms showed pyelo-renal backflow.
3) In the cases of inflammatory ureteral stenosis, no or poor contraction waves and high resting pressure were observed at the affected part. Waves derived from respiration and pulsation were also observed at the part.
4) Most of urometrograms that showed high renal pelvic and ureteral pressure were the same type that was observed at experimental ureteral obstruction, Clinically many of these cases had lumbar or flank pain and hematuria which were considered as the result of elevation of the renal pelvic or ureteral pressure. In some of those, cystoscopic finding showed edema, hyperemia and narrowing of the ureteral orifice, and elevation of the interureteric ridge In some excretory urograms of these patients, pyelo-renal backflow, only nephrogram due to contrast material, and narrowing of the renal pelvis and ureter were seen.
5) In the cases which had severe vesico-ureteral reflux, decrease in contraction frequency and contraction amplitude and low resting pressure were observed, In response of ureter to bladder filling and voiding, both urometrograms of ureter and bladder were exactly parallel in the cases which had severe VUR. As VUR was less serious, the response of ureter became nearly normal.
6) Urometrograms in each stadium of hydronephrosis were observed. In the initial stadium of hydronephrosis, pressure of ureter and renal pelvis above obstruction was normal or high, and contraction frequency was normal or increased. In some cases, urometrograms showed the same type that was observed at experimental ureteral obstruction, and contraction waves in the renal pelvis were seen. As hydronephrosis developed, lowering of ureteral activity and renal pelvic pressure were seen.
7) Effect of drug on the ureteral activity was studied with TTFD (Alinamin F) and Piribenzil methyl sulfate (Acabel). The former increased ureteral contraction frequency and the latter decreased it, but the causes of these effects were still unknown.

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Five cases of bladder cancer were treated with continuous infusion of Mitomycin C into the internal iliac artery. The histological changes of the cancer cells and DNA content in nucleus were studied.
1) No relationship between histological malignancy and DNA content was found.
2) In four cases, decrease of DNA content with diminition in the range of DNA distribution and shift of the peak to the left was noted after the administration of Mitomycin C in the amount of 70-80mg.
3) Histological changes did not always parallel to changes of the DNA content.
Histological changes and DNA content in nucleus of canine bladder epithelium were studied in four groups administered 1mg/kg of Mitomycin C as follows,
Group 1. Systemic administration
Group 2. One shot injection into the internal iliac artery
Group 3. Infusion into the lumen of the urinary bladder
Group 4. Continuous injection into the internal iliac artery
1) No definite morphological changes were shown in groups 1 and 2, whereas atrophy, flattening and exfoliation of epithelial cells were revealed in groups 3 and 4.
2) DNA content in the nucleus of epithelial cells showed no changes in groups 1, 2 and 3 but decreased in group 4.

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The renal excretion of the agent and the changes in renal tissue were studied in four groups of dogs administered 1mg/kg of Mitomycin C as follows,
Group 1. Systemic administration
Group 2. One shot injection into the internal iliac artery
Group 3. Infusion into the lumen of the urinary bladder
Group 4. Continuous injection into the internal iliac artery
The results were as follows:
1) The concentration in systemic blood was highest at 5 minutes after administration in group 1 and 2, fal ling rapidly afterward. In group 3, the agent could not be detected after 5 minutes and thereafter only a trace was found in systemic bloods In group 4, the systemic blood concentration rose slowly for 6 hours and then kept following 18 hours.
2) From 25 to 30 per cent of total amount of administered drug were recovered in 24 hour urine in. groups 1, 2 and 4, while 6 per cent was recovered in group 3. The rate of renal excretion of the agent was not always parallel to blood concentration.
3) Histologically, swelling of glomerulus and epithelium of the proximal tubules were revealed in groups 1 and 2 at 90 minutes after administration, but generally recovered after 24 hours. In group 3, no histological changes were found. In group 4, swelling of glomerulus, atrophy of tubular cells and edema of renal medulla were found.
4) Activities of alkaline phosphatase and succinic dehydrogenase in renal tissue were normal in all groups. Activities of acid phosphatase, lactic dehydrogenase, glucose-6-phsphate dehydrogenase and monoamine oxidase decreased in groups 1, 2 and 4, most supressed in group 4.

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Case 1, a 63 year old government official was admitted to our hospital on November 4, 1965, for asymptomatic hematuria. X-ray finding of his chest and other examinations were normal. Cystoscopy revealed almost major part of the cavity was occupied with a large bleeding tumor. Cystogram and arteriogram showed a gross tumor in the left wall. No function of the left kindey was found on IVP, renogram and renoscintigram.
On November 15, 1965, partial resection of the bladder and left nephrectomy were performed. Histologically, the tumor was a transitional cell carcinoma with marked proliferation. Neither infiltration beyond the bladder wall nor metastasis to the left kidney and ureter was found. Anti-cancer therapy with Endoxan (cyclophosphamide, total 1100mg) and irradiation by tele-cobalt (total fields doses 10989r.) were carried out in the postoperative course. The patient was discharged on February. 13, 1966.
On April 27, 1966, no visible tumor in the bladder was found cystoscopically. From this time, penile erection without sexual libido was developed sometimes and then gradually its erection became almost constant. In June, the priapism became painful and tender. From July, the patient complained of disturbance of micturition and perineal pain when sitting for a long time. The patient was readmitted on July 28, 1966, on account of painful priapism. The glans and urethra were soft. The cavernous body was firm and mostly smooth except for the left side of the radix. Histological examination of a specimen obtained from radix of the penis revealed the transitional cell carcinoma. On August 12, 1966, total emasculation was performed. Cystoscopy after opertation showed no relapse of the bladder. The sections of the penile specimen were white-yellow, homogenous and firm, without hemorrhage and no property of cavernous body remained. The infiltration reached the submucosal tissue. In the subcutaneous tissue of the penis, several masses of the cancer tissue were seen in the blood vessels. Following the operation, anti-cancer therapy with Mitomycin C (total 50mg) and tele-cobalt irradiation (5000r.) were done. The X-ray film of the chest revealed small doubtful shadows in the left upper lung on the 36th day after operation and they were identified as metastatic tumors by tomography. The patient committed suicide by hanging at 64th day after operation.
Autopsy revealed extensive pulmonary metastases which were composed of miliary to bean sized nodules.
Case 2, a 62 year-old office man was admitted to our hospital with hematuria on November 12, 1965, after treatments of TUR and irradiation of tele-cobalt for transitional cell carcinoma of the bladder six months age, elsewhere. By cystoscopy and cystography the recurrent tumor was detected in the right wall. Silent right kidney was revealed on IVP, renogram and renoscintigram. Other examinations were normal
On November 24, 1965, total cystectomy, right nephroureterectomy and ileal conduit were performed. The patient had been readmitted with erection and induration in the penis on January 14, 1967 for 2 months duration. On January 23, 1967, total penile extirpation, and bilateral inguinal lymphadenectomy were performed. Histologically, the skin, right inguinal lymph node and penile corpus cavernosum revealed the transitional cell carcinoma. Both lungs, 5th lumbal vertebra, sacral bone and pubic bone were metastasized roentgenologically after operation. The patient died of carcinoma of the lung on July 25, 1967, at his home.
Case 3, a 79-year-old professor was admitted with light erected state and induration in the penis on January 22, 1967. He was treated with antiandrogenic hormones for medullary carcinoma of the prostate for 55 months. On February 6, 1967, a total penile extirpation was performed. Histologically, the penis had the transitional cell carcinoma same as above cases. Three months after operation the patient was dead with the carcinoma. Autopsy revealed recur

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Case. A 26-year-old woman. The chief complaints were right abdominal pain and fever. The X-ray film revealed a thump-tip sized shadow of calculus at the right uretero-renal pelvic junction and a little finger-tip sized one in the right kidney. No evidence of excreton was present in the right kidney.
The removed kidney was filled with thick pus in the cavernously dilated renal pelvis and calyx having a yellow color. Histological examination revealed infiltrates of inflammatory cells and accumulations of large foamy cells. The fat staining for foamy cells was positive. E. cofl was detected by pus culture.
The calculi in both urinary tract and kidney were yellow or yellowish. The surfaces were smooth and had waxy luster. By infrared absorption spectrum, it was proved that the calculi were composed of pure cystine. The calculus powder by resolving with ammonium solution revealed the typical hexagonal form of crystal.
We summerized 91 reported foreign cases of xanthogranulomatous pyelonephritis. 31 of which were men and 60, women (the ratio of men to women is 1:2). Their ages ranged from 11 months to 82 years. 80 cases (88%), however, were over 30 years old. 75 cases showed the lesional side, of which 42 cases had the lesion in the left, 32 cases in the right and 1 case bilaterally (the third case reported by Schlagenhaufer (1916) was thought to be bilateral) and 54 cases (59%) were associated with renal calculi. In Japan 7 cases had been reported and this presented case was the eighth.
Regarding cases of cystine calculi, those reported in Japan amounted to 50 including this case.
There was no report on xanthogranulomatous pyelonephritis associated with cystine calculus.

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