In 75 cases of renal cell cancer, in whom the original renal tumor was successfully removed, the effect of anticancer chemotherapy and irradiation was evaluated.
The following conclusion was obtained.
1) It is not necessary to give anticancer chemotherapy or postoperative radiotherapy in those cases whose erythrocyte sedimentation rates (ESR) were below 30 per hour.
2) On the other hand, in the cases showing ESR over 30 per hour, the combination of anticancer chemotherapy and irradiation with the operation revealed the best result.
3) In the cases ESR over 30 per hour, irradiation combined with the operation has brought better result when compared with the combined anticancer chemotherapy. It is likely that postoperative metastasis would occur following local recurrence and subsequently distant metastasis could be prevented by suppressing the activity of local remnants of cancer cells by radiotherapy.
4) As we do not have any anticancer agents specifically effective to renal cell carcinoma at present time, it would be recommended to make the best use of the current anticancer drugs by developing a simple and practical drug senstivity test for cancer and accordingly pick up appropriate drugs with which immunologically effective procedures could be also combined. Therefore, the authors have been investigating a new method of the new simple drug sensitivity test using C-8-adenine which was briefly described here.

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For the past 4 years and half 39 cases with ejaculatory disturbance were experienced in our clinic.
1) Age and Incidence. The incidence of ejaculatory disturbance was 0.5% of the whole outpatients of our clinic. The age of the patients ranged between 17 to 40 years with the highest incidence in the thirties.
2) Classification of ejaculatory disturbance. In this report ejaculatory disturbance was classified into 4 groups: Group A; the patients who complained of abscence of both ejaculation and orgasm; Group B, the patients who complained of absence of ejaculation but maintained orgasm; Group C, the patients who maintained both ejaculation and orgasm; Group D, the patients who maintained ejaculation but complained of loss of orgasm. The incidence of these 4 groups were as follows: Group A, 15 cases (38%); Group B, 8 cases (21%); Group C, 13 cases (33%); and Group D, 3 cases (8%).
3) Past history. In Group A, 6 cases had past history of mental diseases; 1 case, polyomyelitis; and 1 case, stomach ulcer. In these cases ejaculatory disturbance occurred during the medication for the diseases. Therefore, these diseases or the medication for them were suspected to be the causative factors of ejaculatory disturbance. No specific history which was suspected of relation to ejaculatory disturbance was found in Group B, C, and D.
4) Physical examinations. No remarkable findings were obtained in the physical examinations throughout the groups.
5) X-ray examinations. Plain films of lumbo-pelvic region. Spina bifida occulta was seen in 4 cases of 39 cases with ejaculatory disturbance; abnormal enlargement of the intravertebral space, in 1 case; and deformity in the lumbar vertebra, in 1 case. The relation between these anomalies and ejaculatory disturbance could not be clarified.
Cystography. No remarkable finding was seen in Group A, C, and D. In Group B patency of the internal urethral orifice was seen in 7 cases. In 6 of these 7 cases the internal urethral orifice opened slightly by abdominal straining and in 1 case the orifice was seen patent without the straining. In one case irregularity of the internal urethral orifice was seen. Retrograde ejaculation occurred by masturbation in these cases. Therefore, cystography was found to be effective in diagnosis of retrograde ejaculation.
Urethro-vesicography. In 1 case of Group B patency of the internal urethral orifice was seen and in 1 case irregularity of the posterior urethra was seen. In Groups A, C, and D no remarkable finding was seen.
6) Reflexes and sensory and motor disturbances. Some cases of ejaculatory disturbance showed abnormality in reflexes, sensory and/or motor disturbances. However, the relation between these disturbances and ejaculatory disturbance was not clarified.
7) Cystometrogram. In 13 of 15 cases of Group A some abnormalities were suspected in the higher center of the urinary bladder. The cystometrogram in these cases was hypotonic without micturition contraction. Both the effect of nitrazepam administration and respiratory effect on the cystometrogram were clearly seen. Two of 15 cases showed disturbance of the peripheral nerves in addition to them. In Group B there was no case which showed abnormal cystometrogram except for a case in which the lesion was suspected in the lower region of the spinal cord. In Group C and D there was no case which showed abnormal cystometrogram.
8) Treatment. In Group A vitamin B₁, vitamin E, androgen, tranquilizers and imipramine hydrochloride were administered, but no remarkable effect was obtained by them. However, trihydroxpropiophenone, a COMT inhibitor, showed marked effect on 2 cases of Group A. In Group B the internal urethral orifice was narrowed by plastic operation. After the operation ejaculation became normal with normal orgasm. In the cases of Group C and D, the same drugs as in the Group A were used. But no remarkable effect was obtained by these drugs except for a case of Group C

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By the use of selective renal arteriography, the effect of PGE₁ on arteriogram was studied in 30 patients with hematuria. Renal arteriography before and after injection of 50 mcg of PGE₁ into the renal vascular bed revealed the following results.
1) At the moment of 0.5 second after the initiation of injection of contrast medium, it advanced more peripherally after the PGE₁ injection compared to the control study. In some cases, maximal arterial phase appeared earlier with PGE₁ than without this agent.
2) The maximal nephrogram was visualized earlier after PGE₁ injection than control. When the size of the nephrogram was compared, it was enlarged when PGE₁ was used.
3) The maximal visualization of renal vein occurred earlier with PGE₁ than the control study.
4) Dopamine (500 mcg) was also shown to have approximately same effect as PGE₁ (50 mcg). As shown in this study, the vasodilative effect of PGE₁ was successfully demonstrated by means of radiological method.
These results suggest that PGE₁ might be a useful pharmacologic adjunct in renal arteriography. Furthermore, PG could be a good therapeutic agent in the case of an inadequate renal circulation caused by shock or operation of kidney.

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The operative technics for the correction of hydronephrosis due to obstruction at the ureteropelvic junction have been discussed. There are two different types of technics: (1) nondismembered pyeloplasty that molds and restructures the ureteropelvic junction without completely dismembering it, and (2) dismembered pyeloplasty that interrupts the continuity of the transport system. Since Anderson-Hynes reported the technic, which belongs to dismembered pyeloplasty, for retrocaval ureter in 1949 many articles with satisfactory result have been published.
Anderson-Hynes pyeloplasty for the hydronephrosis secondary to intrinsic obstruction of the ureteropelvic junction has been performed in 58 cases with good results in 77% radiographically, and in 93% symptomatically and poor results in 7% in six and half years in duration since 1968 at the Department of Urology, Osaka University Hospital.
Comparing to the operative technics and methods employed in the preceding ten years, however, there are big changes: No dismembered pyeloplasty and nephrectomy in 65% had been performed in the past, while no nondismembered pyeloplasty and no nephrectomy in the recent six and half years.
On the basis of these the discussion about the complete resection of the redundant renal pelvis and obstructed ureteral segment were made with reviewing the literatures from the view point of blood supply and nerve regeneration of the ureter. It has been demonstrated that the defect or marked fibrosis of the smooth muscle in the obstructed ureteral segment will cause the hydronephrosis due to interference of the ureteral peristaltic activity. Also it would be difficult to resect the redundant renal pelvis completely with nondismembered pyeloplasty. Otherwise the relative hydronephrosis might be recurred in a longterm follow-up.
From the experiences of Anderson-Hynes pyeloplasty it would be suggested that complete resection of the redundant renal pelvis and pathological ureteral segment should be performed and elimination of splints and diversionary drainage tubes reduces infection and might increase the possibility of long-term success.

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