A study on in vitro bioconversion of steroids in normal and pathological human adrenal glands was performed by isotope tracer method. The materials were from two cases of congenital adrenal hyperplasia, two cases of Cushing's syndrome, one case of prostatic carcinoma which was treated by long-term antiandrogen therapy and one case of essential hypertension not associated with any endocrinological disorders. The last one was used as a normal control.
The cell-free homogenate (800xg, supernatant) was prepared from the adrenal gland which was surgically removed. The homogenate was incubated with ¹⁴C-labeled steroid precursors such as 4-¹⁴C-pregnenolone, 4-¹⁴C-dehydroepiandrosterone, 4-¹⁴C-progesterone, 4-¹⁴C-deoxycorticosterone and 4-¹⁴C-deoxycortisol. Enzyme reactions were terminated with rapid extraction of steroids with methylene dichloride. Thin-layer chromatography combined with chemical derivative methods was applied for separation and tentative identification of the metabolites. Then, these metabolites were quantitated by measuring the corresponding radioactivities with a liquid scintillation spectrometer and some of them were identified by constant specific radioactivities through repeated recrystallization with corresponding authentic steroid preparations. Irrespective of whether or not the conditions of in vitro experiments were comparable with the ones observed in vivo, the estimated quantity of the metabolites produced by enzymic reaction in adrenal homogenates could be employed as an index of the related enzymic activity. The results obtained by the present study were as follows:
1) From the quantities of metabolites obtained after incubation of either pregnenolone or progesterone with adrenal homogenate, it was concluded that the main pathway of cortisol biosynthesis in human adrenal glands was pregnenolone→171α-hydroxypregnenolone→17α-hydroxyprogesterone→deoxycortisol→cortisol.
2) Congenital adrenal hyperplasia.
Two female cases of four and fourteen of age with definite masculinization showed positive stimulation and suppression tests of the adrenal functions. In both cases unilateral adrenalectomy was performed and pathological diagnosis of adrenal hyperplasia was confirmed. The incubation study revealed that activities of the 3β-hydroxysteroid dehydrogenase and 17α-hydroxylase were remarkably increased, whereas activities of 21-hydroxylase and 11β-hydroxvlase, especially the former, were specifically decreased. These findings conform with the recognized pathogenesis of congenital adrenal hyperplasia: there exist enzymic defects of 21-hydroxylase and/or 11β-hydroxylase, thus resulting in reduced production of corticoids and in overproduction of androgenic steroids. However, it is noteworthy that, although production of androstenedione was increased, significantly enhanced bioconversion of androstenedione to testosterone was not recognized in the adrenal tissue. The bioconversion of androstenedione to testosterone, which plays a main role in vilirizing manifestation, may be suggested to take place somewhere outside of the adrenal cortex, presumably in the liver and in the systemic blood.
3) Cushing's syndrome.
On female patients at the age of fifteen and twenty-eight with typical clinical features of Cushing's syndrome, bilateral total adrenalectomy was performed. Hyperplasia of the adrenal cortex was pathologically confirmed and, in the right adrenal of the latter case, a well demarcated thum-sized adenoma formation was demonstrated. The in vitro incubation experiment revealed that activities of the 3β-hydroxysteroid dehydrogenase and 21-hydroxylase were significantly elevated, but activities of 17α-hydroxylase and 11β-hydroxylase did not show any significant increase. It was interesting that the patterns of enzymic activities in the adenoma and in the hyperplast

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Many works have been published on the absorption of various drugs by the bladder wall. Nevertheless, there were very few literatures regarding the transport of antibacterial drugs in the bladder wall, especially antibiotics.
In regards to the transmission of antibacterial drugs to the bladder wall, two routes are theoretically inferred, namely through the blood supply to the bladder Wall and through the reabsorption of the drugs by the bladder wall. The present study was designed to delineate the quantitative transport of antibacterial drugs with the emphasis on the reabsorption of antibacterial drugs into the bladder wall of the dog.
1. It was observed that Tetracycline, Colimycin and Streptomycin instilled in the bladder cavity, were transported into the bladder tissue, and were recovered in the urine through the blood stream.
2. These transports were not obviously influenced by PH or the osmolality of the solution for instillation of these drugs.
3. Intravesical pressure did not seem to augment the transport of these drugs in the normal bladder, but, a significant increment of transport were noticed in the inflammatory bladder during the increase of intravesical pressure.
4. Antibiotics instilled in the bladder cavity were transported more effectivelly in the inflammatory bladder than in the normal bladder.
5. The higher the concentration of instilled antibiotics, the more antibiotics were transported to the bladder wall.
6. The antibiotics in the bladder wall were carried through the blood stream as well as urine.
This tendency was more marked in the inflammatory bladder.
7. In conclusion, drugs of higher concentration in the urine are inferred to be more effective for urinary tract infection, especially inflammation of the bladder.

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Sexual dysfunction following perineal exposure and removal of the prostate gland is a common occurrence and well documented in urologic literature. The incidence of impaired potency following forms of prostatectomy, especially retropubic resection, however, has received less attention, thereby providing the basis of investigation for this publication. The case materials for this study were patients treated at the Tohoku University Hospital during the period from January, 1962, to March, 1969.
Excluded from the study were patirents with prostatic cancer and those over 65 years of age. All data for the study were gathered in a form of questionnaire. In each history, such items as sexual desire, morning erections, frequencies and potency in coitus, condition of ejaculation and orgasm were explored. A total of 72 individuals answered the questionnaire.
The operative technic was retropubic prostatectomy. Eighteen patients (25.0 per cent) complained a decrease in sexual desire following prostatectomy.
Twenty three patients (31.9 per cent) reported a reduction in activity of erection during intercourse. Of these 23 patients, 14 had diminished potency and the remaining 9 were totally impotent.
The mean frequency of intercourse was 2.58 per month before operation. Following prostatectomy, it diminished to 1.99 per month.
Fourty-one point seven per cent of the patients (30 individuals) had no ejaculation following operation.
Disturbance in orgasm was found in 37 individuals (51.4 per cent) following prostatectomy.

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Bladder tenesums which develops after lower urinary tract operation, especially after prostatectomy for benign prostatic hypertrophy, is very distressing for the patients as well as for the urologists.
Antispasmodics and analgesics are usually of little use to improve the condition.
The authors tried, in 26 cases (In 21 cases, suprapubic prostatectomy had been performed), epidural anesthesia for bladder tenesmus, which is used for obstetric analgesia and for contol of postoperative pain, and found that the procedure was markedly effective.
Lumbar epidural anesthesia is effective not only for relieving bladder tenesmus, but also for controlling postoperative pain.
It is stressed that epidural anesthesia, carefully performed, is associated with little complication and should be more widely used.

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This is the first case report of adult botryoid sarcoma in Japan.
A 49 years old male visited our clinic, complaining urinary retention. Urological examination revealed a protrusion of the bladder neck at 6 o'clock. The tissue obtained by TUR-Bn was histopathologically diagnosed as a benign polyp.
The patient was lost on follow up until one year later when he showed gross hematuria with massive blood clots. At open surgery multiple polypoid tumors were resected out, which were diagnosed as malignant mesodermal tumors. The patient succumbed 4 months after operation due to local tumor growth and pulmonary metastasis. Autopsy diagnosis was rhabdomyosarcoma of the bladder.
Review of the literature and some discussion concerning botryoid sarcoma especially that of adult were done.

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The adenomatoid tumor is a relatively rare but interesting tumor in the genital tract. We had recently the opportunity to examine two cases of epididymal tumors; one presented a histologically typical, so-called “adenomatoid tumor” appearance and the other was similar to the solitary mesothelioma of pleura. The paper includes discussion of some additional information and further concepts concerning the lesion and their histogenesis.

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