We performed electron microscopic studies on the mechanism of renal stone formation, using dd strain male mice which were given Vitamin D₂. The results obtained were as follows.
1. Koch's colloidal microbodies (about 300 to 500mμ in diameter) which showed circular structure were observed in the proximal tubular lumen. It was found that these microbodies passed through the brush border in between the microvilli and were transported into the tubular epithelium. These microbodies increased in size and number and revealed concentric circle structure which contained layered membranes and the lumen was filled with these microbodies. In the microvilli of brush border were observed disorder and destruction.
2. Electron dense tubular invaginations were seen and lysosomes which showed electron dense and myelinic structure were increased in number. Mitochondrial matrix revealed clear alteration, swelling and disappearance of the cristae.

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In an attempt to throw light on the problem of cryptorchidism, the author conducted a controlled experiment on three adult groups consisting of normal subjects and patients with unilateral or bilateral cryptorchidism. Their plasma levels of FSH, LH and testosterone were measured and compared among groups before and after LH-RH loading. As a result, it has been found that both groups of cryptorchidism had comparatively high levels at baseline for both FSH and LH in plasma, especially in the bilateral group, and positively responded to LH-RH loading, indicating their hypothalamo-hypophyseal systems probably functioning normally.
The plasma levels of testosterone at base line were highest in the unilateral cryptorchidism, next in the normal, and lowest in the bilateral cryptorchidism group. But their reaction with loaded LHRH was generally poor in both groups of cryptorchidism, suggesting that, in cryptorchid cases, unilateral and bilateral alike, the capacity of the testicle to secrete testosterone was generally depressed, freeing central suppression. That probably accounts for the high values of plasma FSH and LH observed in such patients.
The quantitative reciprocal correlation observed between plasma FSH and testosterone indicated the negative feedback regulation clearly active for FSH and testosterone. Presumably FSH is playing some role in the secretion of testosterone.

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Forty cases of adrenal diseases, including 20 cases of primary aldosteronism, 8 cases of Cushing's syndrome, 7 cases of adrenogenital syndrome, and 5 cases of pheochromocytoma, have been treated in our department during the past 10 years until the end of 1974.
In order to localize adrenal tumors, some combination of retroperitoneal pneumography, tomography, adrenal venography, radioisotope photoscanning and abdominal aortography was used.
The results obtained were as follows:
1. Using retroperitoneal pneumography combined with tomography, 22 of 30 cases (primary aldosteronism, 18 cases; Cushing's syndrome, 7 cases; adrenogenital syndrome, 3 cases; pheochromocytoma, 2 cases) were diagnosed correctly (73% accuracy).
2. Adrenal venography showed a tumor lesion in 15 of 18 cases (primary aldosteronism, 11 cases; Cushing's syndrome, 5 cases; adrenogenital syndrome, 2 cases).
3. Radioisotope photoscanning, using ¹³¹I-19-iodocholesterol, of the adrenal and abdominal aortography revealed a tumor contour in all of the 5 cases (primary aldosteronism, 4 cases; Cushing's syndrome, 1 case) and in all of the 3 cases performed (pheochromocytoma, 3 cases). The radioisotope scanning was most useful in localizing adrenal cortex tumors.

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Eighty-one patients with renal cell carcinoma encountered in 22 years from 1953 to 1974 were clinically observed.
1) Encounter rates with such patients were 0.16% of outpatients and 1.2% of inpatients.
2) The right and left kidneys were affected with equal frequency. Male patients were more commonly affected, the ratio being 3.8 to 1.
The average age of patients was 56.7 years old.
3) As the initial symptoms, gross hematuria was most frequent (40 cases, 51.2%), followed by nonurologic symptoms (22 cases, 28.2%). This figure (28.2%) seemed to be unexpectedly high. It turned out that the symptoms in 6 cases of the 22 cases had been caused by metastasis.
4) As the classic triad, gross hematuria was most frequent (52 cases, 66.7%), followed by renal mass (38 cases, 48.7%) and flank pain (25 cases, 32.1%). In this connection, 13 cases (16.7%) had none of triad, while only 6 cases (7.7%) had complete classic triad.
5) Nonurologic symptoms were recognized in 53 cases (67.9%). In details, pyrexia (29 cases, 37.2%), generalized fatigue (20 cases, 25.6%), loss of weight (17 cases, 21.8%), anorexia (9 cases, 11.5%), gastorointestinal symptoms, varicocele and symptoms caused by metastasis were observed.
6) The results of hematologic and blood chemical examinations were as follows. Accelerated erythrocyte sedimentation rate was found in 48 cases (61.5%). Anemia was recognized in 14 cases (17.9%), polycythemia being observed in only 1 case (1.3%). Hypercalcemia was found in 8 cases (11.9%) and alkaline phosphatase at a high level was seen in 13 cases (20%). The serum protein fraction was characterized by the increases in α₂-globulin and γ-globulin. In the subfraction, on the other hand, remarkable increase in haptoglobin was recognized.
7) As diagnostic techniques, pyelography, nephrotomography, renoscintigraphy and renal angiography were most contributory, and RI-angiography was used for 13 cases and proved to be useful.
8) As the therapeutic method, nephrectomy was performed for 68 cases (84%), radiation therapy for 56 cases (72%), chemotherapy for 57 cases (73%).
9) In 10 cases metastasis was found when the renal cell carcinoma was discovered, while in 24 cases metastasis occurred after operation. As to the location and number of metastasis in a total of 34 cases, the lung was most frequent (24 cases, 70.6%), followed by bones, lymph nodes, liver and kidney.
10) The 5-year survival rate of 81 cases observed in the present study was 46.7%, and the rate of 68 cases whose kidneys had been excised was 53.6%. The most important factors of the prognosis were the stage of tumor and renal vein invasion. Patients with elevated erythrocyte sedimentation rate, anemia or dysproteinemia had also distinctly unfavorable prognosis.

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Hyperthermic treatment was performed in 10 cases of bladder tumor. Without anesthesia, bladder irrigation was carried out with isotonic saline or 10% urigal solution warmed at 40°C to 45°C. After the treatment tumor regression occurred in all patients. In two cases, tumors showed total regression after 10 times of the treatment. In the remaining 8 patients, tumors regressed over 50% of its content in cystoscopic finding.
Hyperthermic treatment seems to be a preferable method for the bladder tumor cases with cardiovascular complication. This preliminary report is to be followed by further clinical and experimental investigations.

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The late results on 105 patients who underwent ileal loop diversion at the Keio University Hospital and the afiliated hospitals during the period of 1966 to 1974 were reviewed. Radical cystectomy was carried out in most of the cases together with the conduit diversion. The age varied 5 to 77 and of the 105 patients, 79 were male and 26 were female, with the sex ratio of 3 to 1.
Actual survival rates from the 105 cases were 80.3% for one year, 69.4% for two years, 60.7% for three years, 54.8% for four years and 52.8% for five years.
Eighty-six cases of bladder malignancies were evaluated for stage and grade classifications. Actual survival rate of the patients with low grade transitional cell carcinomas (grade 1 and 2) was 73.2% for five years, while in those with high grade transitionnal cell carcinomas (grade 3 and 4) the rate was 33.5%. The five year survival rates according to the stage were 85.5% in stage A, 62.4% in stage B-1, 35.7% in stage B-2, 25.0% in stage C and 13.5% in stage D. In TNM classification, the survival rates were 85.5% in P-1, 62.4% in P-2, 31.8% in P-3 and 13.5% in P-4.
The prognosis of bladder cancer patients depends on radicality at the time of surgery. Five year survival rate in patients who underwent radical cystectomy together with ileal conduit diversion was 78.0% in stages A and B-1, and 41% in stages B-2 and C. On the other hand, the patients who underwent simple cystectomy and ileal conduit or the diversion only showed poor prognosis despite the postoperative radiation and chemotherapy.
Early complications such as wound infection, fistula, intestinal obstruction were seen in 15.2% of the cases. Only one operative death (1.0%) was due to gastrointestinal bleeding. Peristomal dermatitis (9.5%) was most common as late complications. It is emphasized that postoperative rehabilitation clinic consisted of doctors, nurses and paramedical personals can eliminate the patient's distress and fear in their daily life with urinary devices.

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