Phenoxybenzamine was administered with or without propranolol to 20 cases of pheochromocytoma prior to surgery. Blood pressure decreased to normal range in 13 out of 17 cases with hypertension. Remaining 3 cases were originally normotensive. The administration technique and the effect of phenoxybenzamine are discussed from surgical viewpoint.

View full abstract

Dynamic and pharmacologic urethral pressure profile (UPP) studies were performed on 68 individuals to investigate the neurogenic control of and its contribution to the activity of the sphincteric urethra.
Control profile at rest and with stepwise increase of bladder volume were obtained. Drugs administered were sympathomimetics [noradrenaline (α-stimulant), proterenol (β-stimulant)], sympatholytics [regitine (α-blocker), applobal (β-blocker)], parasympathomimetic [besacholine] and parasympatholytic [buscopan]. Maximum urethral pressure and total urethral length which is the summation of functional urethral length and distal urethral segment were defined as UPmax and UL=fUL+DUS. FUL is the length from the internal urethral orifice to the point where leakage occurred with a fall in UPmax.
Results.
1) Normal individuals: Normal females demonstrated a stable profile with UPmax [adults (13) 46.5±7.6mmHg, children (8) 41.5±15mmHg] situated at midurethra. Relative predominance of DUS in the adults, 40% vs 25%, was an interesting difference between the two groups. In normal males (5) Upmax was 46.0±11.1mmHg and fUL was 3.6±0.6cm. α-block, independent of its cardiovascular effect, lowered the profile most, followed by spinal anesthesia and anticholinergic medication. The profile was increased on bladder distention with or without drugs, none becoming incontinent.
2) Stress incontinent patients (2) failed to increased profile on bladder distention. α-block aggravated this trend further with urinary leakage even on supine position. A patient with stress urge incontinence demonstrated an unstable profile similar to that of uninhibited bladder.
3) In the prostatectomized patients (15) with open prostatic cavity, profile (UPmax 32.7±6.9mmHg, fUL 1.35±0.37cm) was obtained only distal to the cavity where “passive” continence zone and rhabdosphincter exist. Again α-block affected this most. Some experienced incontinence following α-block albeit none before. Pudendal block affected in lesser degree and disturbed only rarely the “active” continence. Other drugs had no effect nor did spinal anesthesia on T 10 level. Successive administration of pudendal block, α-block and buscopan failed to abolish the sphincteric tonicity which is enough to sustain continence.
4) a) Patients with uninhibited bladder (8) showed unstable urethra with bladder distention. This was further augmented by besacholine and was ameriolated by buscopan, while α-block had no effect nor did the others. Synchronization of this unstable activity with uninhibited contraction and urethrovesical regurgitation was confirmed. b) In myelodysplasia (5), in whom dysplasia of the sphincteric neuromuscularity is expected, profile was generally low compared to the normal. Sphincteric incompetency was unquestionable, which was further exaggerated with α-block. When besacholie was given after α-block, profile remained low while detrusor supersensitivity was noted in the bladder. c) In patients (5) with iatrogenic autonomous neurogenic bladder as a result of radical intrapelvic procedures, both denervating factors and structural aberration from the loss of the posterior support were considered to account for the spincteric incompetency. Among them those with intact pudendal innervation responded normally to bladder distention with increase in profile and continence.
5) Lumbar sympathectomy (2) had no effect on UPP.
Sphincteric urethra was surmised as a complexly integrated detrusor-trigono-rhabdomuscular tube with triple parasympathetic-sympathetic-somatic innervation. Intactness of this neuromuscularity with inherent tonicity is essential for the sound sphincteric activity. A functionally normal urethra was defined as one which could withstand various dynamic and pharmacologic stresses. Evidence was presented for the predominant rol

View full abstract

With the aim of establishing methods for the prevention of recurrent formation of urinary oxalate containing calculi, the author made the following examinations.
1) Statistics on the composition of calculi, causative disease, and recurrence in 884 patients with upper urinary tract calculi.
2) Statistical studies on uric acid metabolism in 63 patients with oxalate containing calculi.
The following results were obtained.
1) Analysis of calculus composition in 299 of the 884 cases showed that there were 136 cases of calcium oxalate-calcium phosphate calculi, 70 cases of calcium oxalate calculi, and 31 cases of calcium oxalate-ammonium magnesium phosphate calculi. Causative disease was established in 199 cases, including 125 cases of hyperuricemia, 16 cases of sponge kidney, and 14 cases of calyceal diverticulum. The recurrence rate for all 884 case was 16.6%; while that for the 191 cases of known etiology was 33.5%, the rates according to specific diseases being 4 out of 7 cases in cystinuria, 5 out of 9 cases in hyperparathyroidism, and 46 out of 125 cases in hyperuricemia.
2) High frequency of recurrence was seen in patients with hyperexcretion of urinary uric acid (over 700mg/24 hours) viz, in 18 out of 32 cases. On the other hand, only 6 out of 31 cases of recurrence were seen among a group of hyperuricemics with normal urinary uric acid excretion.
The results suggest a relation between hyperuricosuria and oxalate containing calculi formation, irrespective of serum uric acid value.

View full abstract

With the aim of establishing methods for the prevention of recurrent formation of urinary oxalate containing calculi, the author made the following examinations.
1) Urinary uric acid excretion and urinary pH in 43 cases of urinary oxalate containing calculus.
2) Control of urinary uric acid excretion with 4-hydroxypyrazolo (3, 4-D) pyrimidine (allopurinol).
3) The effect of allopurinol on urinary calcium, magnesium, and phosphate excretion.
4) Prevention of recurrence, and side effects caused by allopurinol in 11 cases of recurrent urinary oxalate containing calculus.
The following results were obtained.
1) Of the 43 patients with urinary oxalate containing stones of unknown etiology except for abnormality of uric acid metabolism, 15 out of 21 cases (71.4%) having a urinary pH value of below 6.0 and urinary uric acid excretion of over 500mg/24 hours showed recurrence of stone formation. On the other hand, recurrence was seen in only 4 out of 22 patients with urinary pH of over 6.0 and urinary uric acid excretion of under 500mg/24 hours.
2) A significant decrease in 24-hour urinary uric acid excretion was seen after administration of 200-300mg/day of allopurinol.
3) Allopurinol administration did not affect serum calcium, magnesium and phosphate concentrations, or urinary phosphate and magnesium excretion; but it caused a significant decrease of urinary calcium excretion, on the average from 107mg to 88mg (p<0.01).
4) Allopurinol was administered to 11 patients with recurrent urinary oxalate containing calculi of unknown etiology except for abnormality of uric acid metabolism (uric acid excretion over 500mg/24 hours, urinary pH less than 6.0) for from 10 to 43 months. New calculus formation was recognized in no case. Except for one case of skin rash, no side effect of allopurinol was experienced.
5) The results suggest that allopurinol affords successful prophylaxis against recurrent oxalate containing stones in patients without explicit cause of stone formation but with a urinary pH of below 6.0 and urinary uric acid excretion of over 500mg per 24 hours.

View full abstract

In the parts I and II of this study, we explained how increased uric acid metabolism is implicated in the formation of oxalate containing urinary stones.
In part III of our work, with the aim of elucidating the pathological conditions which give rise to this increase in uric acid—the end product of uric acid metabolism—which is so closely related to the onset of urolithiasis, we have given our attention to the importance of primary hyperuricemia induced by disorder in the enzymes Hypoxanthine-Guanine Phosphoribosyl Transferase (HG-PRTase).
We determined the HG-PRTase activity in the peripheral blood of 24 patients with primary hyperuricemia. Of the 24 subjects, 12 had urolithiasis, 11 had gouty arthritis, and 4 had both urolithiasis and gouty arthritis.
HG-PRTase activity was determined by the modified method of Berman et al. Clinical investigation was made on the subjects after the enzyme activity levels had been measured.
The results were as follows.
1) The modified Berman's method was found to give satisfactory results. HG-PRTase values are expressed as mμ/moles/ml packed red blood cells/hour. Enzyme activities in normal control's were found to be: H-PRTase, 468±71; G-PRTase, 373±75; A-PRTase, 165±35mμ/moles/ml packed red blood cells/hour (mean±SD).
2) Among the 24 subjects, activity values lower than normal were found in 8 cases for H-PRTase, and in 2 cases for G-PRTase.
3) With the subjects showing enzyme values lower than normal, it was found that although they had partial enzyme deficiency, their enzyme levels were higher than those in hitherto reported cases of partial enzyme deficiency.
4) One case showed a marked decrease in H-PRTase level, but a G-PRTase activity above normal. The situation in this case could not been understood by the previously held idea that H-PRTase and G-PRTase are identical.
5) No definite relation between H-PRTase and G-PRTase activities and the manifestation of urolithiasis or gouty arthritis was recognized in these 24 cases of primary hyperuricemia.

View full abstract

An estrogen-induced testicular interstitial cell tumor (TICT), originated in an A strain mouse testis and maintained in A/St mice, was converted into an ascitic form in A/St mice in our laboratory.
The humoral antibody response to the ascitic TICT in ascitic TICT-bearing mice was demonstrated by sensitive immune adherence reaction.
The antibody reactive transplantation antigen on the ascitic TICT was indicated to be tumor specific.
The antibody response of the tumor-bearing hosts was maximum at their terminal stage of tumor-bearing state and it was even higher than that of the mice which had been immunized subcutaneously with ⁶⁰Co irradiated ascitic TICT cells and resisted against an intraperitoneal transplantation of non-treated tumor cells.
The significance of these results was discussed.

View full abstract

In the present study the interrelationship between fibrinolytic activity and tissue repair of the urinary bladder or bladder urine after burn injury made on the guinea pig bladder epithelium was studied by the histochemical fibrin slide technique. It is well known that the fibrinolytic activity present in tissue and tissue extract is caused by an activating agent (plasminogen activator).
Fibrinolytic activity in the normal bladder wall of guinea pig was observed in relation to some blood vessels in the submucosa or muscular coat. There was also a wide-spread diffuse lysis along the transitional epithelial lining and related with the desquamated epithelial cells lying freely in the bladder cavity.
On injury to normal bladder epithelium the following was observed: A burn injury transiently increased fibrinolytic activity in the thin layer of connective tissue contacting basal membrane (tunica propria) which was adjacent to the injured area. This activity diminished after the 7th day, and the fibrinolytic activity appeared in many hyperplastic blood vessels in the lower part of the lamina propria from the 16th day and gradually decreased on the 30th day after burn injury. Strong proteinase activity observed in some sections occurred in the burned part with necrotic mass extruded into the bladder cavity. It seemed that the proteinase activity could be caused by plasmin formed to activate plasminogen in the necrotic mass by urine containing urokinase. The fibrinolytic activity in the bladder urine increased during the early stage after injury and the activity gradulally decreased with the bladder epithelial healing.
It was found that the thin layer immediately under the epithelium (tunica propria) consists of a vascularized connective tissue which contains reactive capillaries, angioblasts and capillary buds. These reactive cells contain the plasminogen activator. However, such a region is fibrinolytically quiesent under the normal condition. After injury of the bladder epithlium an intense fibrinolytic activity appeared along the tunica propria.
It is considered possible that the intense fibrinolytic activity along the tunica propria must be playing an important role there, such as an origin of the new cells and as resolution of fibrin deposits occurring in early stage of tissue repair.
It has been well known, based on clinical experience, by urologists for many years that the bladder possess remarkable powers of reconstraction even after electro- or partial resection. Our experimental study indicates that the intense fibrinolytic activity along the tunica propria could contribute a defense to production of extensive fibrosis, following the healing process after the bladder epithelium injury.

View full abstract

We experienced a rare case that seemed to be so-called left ovarian vein syndrome, treated successfully by resection of the affected vein. The left ovarian vein showed considerable degree of enlargement and dilatation crossing the ureter at two points, namely S-1 level and 2-3cm below the pyeloureteral junction. Moderate hydroses probably due to the affected vein were observed in the left renal pelvis and ureter. She was able to be delivered of a child within a year after the operative procedures without any trouble. The literature on this subject was reviewed briefly.

View full abstract