Serum LH and FSH levels were measured in prepuberal and pubescent boys, normal adult men and patients with testicular disorders by double antibody radioimmunoassay.
Serum concentrations of LH and FSH were determined in specimens obtained sequentially at 20 minute intervals for six hour periods in two young healthy men, a castrated man, a eunuchoid and one subject with Klinefelter's syndrome. From 4-7 abrupt elevations occurred in the 2 young adult males and the castrated man, but fluctuations in LH and FSH levels were less marked in the eunuchoid and the patient with Klinefelter's syndrome.
Serum LH and FSH levels in normal children and adults classified according to age were also measured. Although both serum LH and FSH level increased after 9 years of age in normal boys, the rate of increase of serum LH level became greater from prepuberty to pubescence while FSH levels increased only gradually.
There was a small, but significant, rise in serum LH and FSH concentration in men from the third decade (LH 30.9±15.6 (SD) ng/ml; FSH 103.3±46.3 (SD) ng/ml) to the fourth decade (LH 53.2±42.0 ng/ml; FSH 142.3±75.8ng/ml). The mean levels of LH and FSH in men over the sixth decade (LH71.3±49.1ng/ml; FSH 368.8±299.4ng/ml) were significantly higher than the mean level during the 2nd and 3rd decades.
From a practical standpoint, serum gonadotropins were also measured in boys with cryptorchism, subjects with Klinefelter's syndrome and castrated men. Serum FSH levels in boys with cryptorchism were generally higher than in normal boys of comparable ages. Serum LH and FSH levels from castrated men or subjects with Klinefelter's syndrome were remarkably elevated (LH 110 to 660ng/ml; FSH 255 to 2750ng/ml).
100 μg of synthetic LH-RH was administered to 4 adult males, 8 aged males and 12 subjects with Klinefelter's syndrome. The maximum net increases of LH were 254.4, 335.2 and 635.8ng/ml and serum LH showed increases of 10.9, 4.6 and 5.0 times the basal level, respectively. The maximum net increases of serum FSH were 169.0, 485.0 and 803.3ng/ml. The serum FSH rose 2.6, 2.2 and 2.0 times the pretest level of each group, respectively. The maximum response of serum LH was observed within 90 minutes in all cases but one who was 79 yrs old.
It is generally agreed that clomiphene citrate stimulates the pituitary-Leydig cell axis in men by inducing LH and FSH release. But, one subject showed a significant decrease in LH and FSH during clomiphene administration (200mg daily for 3 days), and another case revealed stimulation in FSH and a decrease in LH during administration.
Responses of serum gonadotropins after insulin injection and influence of surgical stress on serum gonadotropins were also studied.

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With the cases of partial cystectomy for bladder cancer, the clinical effect of ureteroneocystostomy on the upper urinary tract activity was studied by examining the IVP findings as well as the location of the neostomy, and the following results were obtained.
1) No VUR was found in 98% of the cases in both sides, including neostomised side, one year after the surgery.
2) No hydronephrotic sign on the IVP film could be found in 92% of the cases one year after operation.
3) IVP findings one year after the operation were investigated according to the location of the ureteroneocystostomy. Exellent results were obtained in the cases with the neostomy on the dorsal wall or the dome of the bladder, and the cases with lateral wall neostomy was subsequently followed.
Most satisfactory results were obtained in the cases with the neostomy on the opposite side of partial cystectomy, even in the time of discharge. With the results obtained above, it is assumed that the ureteroneocystostomy combined with the partial cystectomy for bladder cancer should be performed on the lateral wall or the dome of the bladder. Furthermore, the neostomy on the opposite side seems to be effective in preventing the unexpected effect on the upper urinary tract immediately after the surgery.

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Xanthogranulomatous pyelonephritis is a peculiar type of renal infections, which is characterized by butter-yellow granuloma with accumulation of lipid-containing macrophages (foam cells) and infiltration of lymphocytes and plasma cells. The lesion is often associated with obstruction of the upper collecting system and urolithiasis. Herein the authors reported six cases of xanthogranulomatous pyelonephritis experienced at the Department of Urology, Niigata University Hospital from 1970 through 1973. These were one male and five female patients, the oldest being 58-year-old and the youngest being 3-year-old. Of the 6 cases, 5 were of the diffuse type (non-functioning) and one was of the localized type with considerably preserved renal function. Four cases were associated with lithiasis, one with infected hydronephrosis and the remaining one with tuberculous ureteral stenosis. All of them underwent nephrectomy.
Reviewing Japanese literaturs, a total number of 47 reported cases, of which 15 were male and 32 were female, were counted. Of them, 32 were of the diffuse type, 12 were of the localized type, 2 were of the perirenal type and one could not be classified. In cases of the diffuse type, all were associated with obstruction of the upper urinary tract, 17 being urolithiasis, 5 being tuberculous stenosis, 3 being congenital hydronephrosis and 7 being of miscellaneous condition. In the 12 cases of the localized type, 5 were associated with urinary tract obstruction. In 85% of the total cases, there were some types of urinary obstruction, 22 cases having urolithiasis.
Reviewing the reported cases, chief etiological factors were urolithiasis, urinary tract infection and obstruction. Representative clinical findings were fever (76%), flank or back pain (59%), abdominal mass (30%), bladder irritation (23%) and hematuria (15%). The laboratory data showed pyuria, anemia, a considerable acceleration of erythrocyte sedimentation rate and hypergammerglobulinemia, but they were not pathognostic.
Nephrectomy was a treatment of choice, because of advanced destruction of the renal tissue and because of occasional difficulty in differentiation from renal carcinoma.

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Four cases of renal angiomyolipoma are reported. All of them are female and two of them are with tuberous sclerosis.
Case 1: IVP revealed distortion of the left upper calyces and the aortogram showed extravasation of radiopaque dye in the upper region of the left kidney and neo-vascularization beyond renal contour, which were suggessive of renal cancer. In this case, correct diagnosis was not made preoperatively.
Case 2, Case 3: As there were signs of tuberous sclerosis, angiomyolipoma were highly considered preoperatively.
Case 4: The patient was with asymptomatic hematuria. Selective angiography demonstrated neo-vascularization protruding from the outline of the left kidney, which were highly suggestive of angiomyolipoma. On operation, frozen section diagnosis comfirmed angiomyolipoma. The all four patients are surviving in healthy condition.
In 1969, Nonaka et al. collected 16 cases from Japanese literatures and added 3 cases of his own. The authors collected additional 28 cases including these four cases reported in this paper. The clinical features of these 47 cases analyzed as following:
1) Of the 47 patients, 9 were male and 38 were female. The youngest was 17 years old male and the oldest was 58 years old female. The average age was 33.7 years (32 years for male and 27.4 years for female).
2) Eighteen patients (38%) were with tuberous sclerosis. Six of them were male and 12 were female. The rest of the 28 patients were without tuberous sclerosis. Three of them were male and 25 were female.
3) Sixteen patients had this tumor unilaterally in the right kidney, 27 patients in the left and 4 patients bilaterally. All the 4 patients with bilateral tumors were with tuberous sclerosis.
4) Nine tumors were seen in the upper pole, 12 were in the lowerepole, 7 were in the central or hilar region of the kidney. In three cases, the tumors occupied both upper pole and hilar region. The location of the 12 tumors were not given in their literature.
5) The majority of the patients had some clinical symptoms. Pain and tenderness was present in almost all the patients. Thirty two percent of the patient had hematuria and 30% of them had palpable mass. Fever, anemia and gastrointestinal symptoms were seen in some cases. Retroperitoneal hemorrhage due to spontaneous rupture occurred in 7 cases. Emergency operation was performed.
6) Renal angiography can be of diagnostic help in cases of angiomyolipoma. Careful interpretation of the angiogram and clinical manifestations enables us to differentiate this tumor from renal carcinoma.
7) Nephrectomy was done in 40 (85%) patients, partial nephrectomy in 2, and only biopsy was done in 3 patients.

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