The gonadotropin levels following castration, exogenous estrogen and testosterone administration were studied in human males.
Serum LH and FSH levels were measured by radioimmunoassay in patients with prostatic canter following castration and estrogen therapy. Effects of testosterone on gonadotropins were examined in patients with Klinefelter's syndrome recieving androgen replacement therapy.
1. After the castration, serum LH and FSH levels increased gradually in all six patients, and reached levels 3.5, 2.6 times higher than previous values at 7th postoperative day, respectively.
2. Administration of estrogen (Diethylstilbestrol diphosphate) suppressed both LH and FSH. FSH levels were more easily suppressed than LH levels. The doses of estrogen required to suppress the gonadotropins to the lowest level were about 30 to 60mg/day for DES-diphosphate and 10 to 30mg/day for Hexestrol.
3. By the administration of testosterone propionate (25-100mg. im.), LH levels were markedly suppressed. FSH levels were also suppressed but not so marked as LH levels.

View full abstract

The fine structural alterations of the glomeruli and interstitium were studied in two human renal allografts associated with the episode of an early acute rejection. Specimens were obtained immediately after the renal transplantation, during acute rejection and after successful treatment of a rejection crisis.
Kidney tissues taken immediately after transplantation showed no significant changes except mild edema in the interstitium.
During acute rejection, both endothelial and epithelial cells of the glomeruli were proliferated. Amorphous materials were accumulated subendothelially at the basement membrane of the glomerulus.
The thickening and tortuousness of the basement membranes were frequently observed. Mesangial cells were also hypertrophied with increased amount of mesangial matrix. Edema as well as infiltration of lymphoid cells and plasma cells were the prominent features in the interstitium. Capillaries were also affected.
The vascular and interstitial changes will be the cause of renal ischemia, which in turn contribute to the clinical manifestation of the acute rejection.
Rejection crisis were successfully treated by decapsulation, irradiation and immunosuppressive agents. Renal function recovered in both cases. At this time, cell infiltrations were less prominent. Vascular lesions, however, persisted both in glomeruli and interstitium. Even the advanced lesions of the basement membrane were appreciated in some glomerular tufts.
Vascular alterations at the time of clinical regression seem to be irreversible and insidiously progressed by current therapy. Persistence and progression of these alterations will finally result in deterioration of the renal function.

View full abstract

Clinical statistics on out-patients who visited our urological clinic during the past ten years from 1961 to 1970 gave the following results.
The incidence of main urological diseases during the past 10 years are shown in fig 1.
Urolithiasis did not increase. The so called stone wave was absent.
Genitourinary tuberculosis decreased (fig 2). In the age distribution of patients suffering from genitourinary tuberculosis, two maximal values were seen. One was between 25 and 29 of age and another between 40 and 45 (fig 3). The latter showed a tendency to move to higher age further.
Movable Kidney was seen in 21.8 per cent of female patients. This value was very high in comparison with those reported in Japan and foreign countries. The reason for this is not clear.

View full abstract

If continuous recording of the intravesical volume from outside of the body using a simple apparatus becomes possible, it will surely be helpful in the physiological and pathophysiological study of the urinary bladder.
Principle and method.
A certain amount (30μ Curie) of isotope (¹³¹I-hippuran) was put into the bladder and suprapubic radioactivity during the process of bladder expansion was continuously recorded with a special collimeter (2cm in diameter) and correlated with the intravesical volume.
a) Study with ballon.
After 30μ Curie of the isotope was instilled into the balloon, water was poured in steps. Tip of collimeter was fixed at the height of 5cm from the center of the empty balloon. Recorded radioactivity decreased stepweise and it was well correlated with the instilled water volume.
b) Study with dog's bladder.
Isotopic solution was instilled into the dog's empty bladder and the lower abdominal midline radioactivity was recorded at the point of 0, 5, 10 and 15cm cephalad to the pubic symphysis, at the skin surface. The radioactivity was heighest at 10cm cephalad to the symphysis in middle sized dogs, and at 5cm in small dogs.
Next, the collimeter was placed at the point of the heighest radioactivity and recording was made during the stepwise retrograde instillation of water into the bladder. The result was the same as in the case of balloons, showing a stepseise decrease of radioactivity in accordance with increasing water volume.
c) Study in clinical cases.
At first 30μ Curie of ¹³¹I-hippuran was instilled into the empty bladder of a male adult and radioactivity at the skin level of the low abdominal midline was recorded during retrograde water instillation. This was repeated by shifting the collimeter on the skin. The curve shows the mount-shaped pattern, and its peak point was dependent upon the distance of collimater from the pubic symphysis. The water volume at the peak of the curve in this case was respectively 10cc, 50cc, 250cc and 400cc when the distance from the symphysis was 0cm, 2cm, 4cm and 6cm. The peak was higher when the recording place is nearer to the pubic symphysis. Therafter we recorded the radioactivity in the following manner: At first 20ml of isotope solution was instilled into the empty bladder and the point of maximum count was found out in the midline. (Usually, it was at the upper edge of the pubic symphysis, but in some cases 1 or 2cm cephalad to it.). The collimeter was fixed at this point and then radioactivity was recorded during the stepwise dilution of radioisotope.
Thirteen adult patients (11 men, 2 women) were examined in the above manner. In some cases, the highest point of the curve was at the start in which the intravesical volume was 20ml, but in others the peak was found at the volume over 20ml. The reproducibility of the curve was verified by repeated examination in each case including a case who had marked bladder deformity. Therefore, if the curve of suprapubic radioactivity during retrograde water instillation was recorded in. advance it could be used as a control to estimate the irtravesical volume during the expanding process of the bladder with urine from the kidney. Application of this method to the excretory cystometory was satisfactory. Furthermore, this method was valuable to estimate the urine-time ratio in diagnosis of intermittent hydronephrosis induced by alchoholic beverage.

View full abstract

In chronic hemodialysis the device described by Brescia et al. for a surgically created arteriovenous fistula in the forearm has presented some practical problems. In particular, it is a drawback that two venipunctures are required for dialysis. An improved single needle dialysis system developed by Kopp et al. has gone some way to overcoming these problems. Kopp's single needle dialysis system, however, has a disadvantage of using a costly solenoid clamp, which is necessary for the shift of blood flow in the dialyzer circuit.
The present authors have devised a single two-lumen cannula system to overcome these disadvantages. It is possible to operate this system without the solenoid clamp and also to enhance the dialytic effect. In the single two-lumen cannula, two needles, semi-circular in cross section, are arranged contiguous to one another so as to form a single cannula, circular in cross section. The tip orifices of the two needles are 1.7cm. apart, in order to prevent the mixture of inflowing and outflowing blood. At their bases the needles are connected one to the inflow and the other to the outflow line. Clinical trials of the new dialysis system have given positive results. The system has been found to be simple in operation, safe and effective. Its use is recommended for routine chronic hemodialysis.

View full abstract

Seven cases of carcinoma in situ of the urinary bladder and infiltrative bladder cancer which developed from carcinoma in situ were reported. Our experience and review of literature on this subject show that carcinoma in situ of the urinary bladder simulates chronic cystitis not only in symptoms and cystoscopic findings but also in histological findings of biopsy specimens. Probably due to decreased intercellular cohesiveness, in situ urothelial carcinoma cells exfoliate easily into urine and characteristic histological feature of denuding cystitis, namely denudation of urothelium and submucosal edema and teleangiectasia, is produced. Nontuberculous, abacterial stubborn cystitis with positive urinary cytology strongly suggests carcinoma in situ of the urinary bladder and should be treated as such until otherwise proved.

View full abstract

We recently had the opportunity to study a case of sterile hemorrhagic cystitis associated with cyclophosphamide therapy.
A 48-year-old woman was addmitted to the 1st Dep. of Medicine of our Hospital in September 1973, with persistent anorexia and sensation of fullness in the upper abdomen. After a series of gastrointestinal examination a malignant tumor in the duodenal region was suspected. At lapalotomy in the 1st Dept. of Surgery, a duodenal tumor with extensive invasion was identified. Gastroduodenostomy was performed. Histologic examination of biopsy material revealed reticulum cell sarcoma. The patient received a total of 3, 000mg of cyclophosphamide over a period of 30 days, thereafter bladder symptoms were not seen. Since jaundice appeared on March 7, 1974, she was intravenously readministered cyclophosphamide together with infusion of 5% pentose. The total dose was 3, 000mg in a period of 30 days. A beneficial response to symptomatic treatment for hepatitis ensued. However, 3 days after cessation of the drug therapy, frequency, dysuria and urgency developed. Urinalysis, including culture, revealed no evidence of infection. Thiophenicol and nalidixic acid were given, but the symptoms became extremely severe. Six days later, gross hematuria occurred unassociated with clinical or chemical evience of a bleeding diathesis. On April 16, cystoscopy was performed by us. The entire mucosal aspect of the bladder was involved by a diffuse, intense, hemorrhagic process which obscured all normal landmarks except each ureteral orifice. High infusion was done and sulfamethylthiadiazole, phenazopyridine, and diphehydramine were administered as conservative treatments. Symptoms decreased in severity, and even microhematuria disappeared at 26 days following the occurrence of the bladder symptoms. Evidence of contracted bladder was not seen.
Cyclophosphamide is unique among chemotherapeutic agents which possesses the ability to produce sterile hemorrhagic cystitis. The symptoms are often mild and usually terminate following discontinuation of the drug. However, there are examples of severe, prolonged, and profuse bleeding, occasionally resulting in a fatal outcome. We feel that cyclophosphamide hemorrhagic cystitis embodies points of clinical and pathologic interest.
The pathogenesis of the gross hematuria following cyclophosphamide therapy, histologic findings and several modes of treatment were discussed by reviewing the literature together with our animal experiment.

View full abstract