The small bodies resembling platelets in urine of patients with so-called idiopathic renal bleeding were examined by phase contrast microscopy, Giemsa staining, and scanning and transmission electron microscopy. From the study, the small body is considered to be platelet itself or of platelet-origin. By transmission electron microscopy, limiting membranes and glycogen particles were not observed in the cells and the exterior coats were lost.
We consider that the so-called idiopathic renal bleeding is mainly due to a pathological function of the vessels. Therefore, we would like to suspect that the etiology of the so-called renal bleeding is associated with these characteristic transmission electron microscopic findings of platelets in urine.

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1) A course of bladder instillation of 400mg FT-207 (40ml of 10% solution of FT-207) was given 3 times weekly for a total of 20 procedures to 21 patients with bladder tumors. In one patient the tumor disappeared completely, in 2 patients there was partial disappearance and in the 18 other patients no effect was observed. The total effective rate was, therefore, 14%.
2) An experimental study of the instillation of 500mg./kg. FT-207 into the bladder of 11 adult male rabbits was performed. The drug was detected in small amounts in blood samples (35.2mcg./ml. as FT-207, 0.032mcg./ml. as 5-FU), and in greater amounts in the bladder wall (1075.6mcg./g. as FT-207, 4.76mcg./g. as 5-FU) and regional lymphnodes (45.3mcg./g. as FT-207, 0.178mcg./g. as 5-FU) one to two hours later. Similiar results were observed in 7 patients treated with cystectomy after bladder instillation of FT-207. It was considered, accordingly, that lymphatic absorption of FT-207 had occurred through the mucous membrane of the bladder wall.
3) In both the experimental and clinical studies, the concentration of 5-FU in the bladder wall and the regional lymphnodes was found to be 60-300 times larger than the concentration in the blood 1 hour after bladder instillation of FT-207. This suggested that FT-207 absorbed into the tissues was converted to 5-FU in the tissues themselves as well as in the liver.
4) It was concluded that bladder instillation therapy of FT-207 before surgery might result in an improvement of postoperative prognosis because an effective dose of 5-FU could be distributed into the deep part of the bladder wall and the regional lymphnodes.

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The purpose of the present paper is to briefly document the diagnosis and treatment of choriocarcinoma of the testis in cases seen at the Yokosuka National Hospital, Cancer Institute Hospital and Yokohama City University Hospital.
1. A total of 149 cases of testicular tumor were seen at these medical institutions during the period from January, 1962 to December, 1972. Of these 149, 10 (6.7%) were of choriocarcinoma.
2. The histological diagnosis of the malignancy in this series of 10 cases was made in various ways. In only 4 of these 10, ordinary histological examination of primary lesion revealed choriocarcinoma. In another 2 cases, definite diagnostic evidence was obtained by examination of serial sections of primary tumor. In the remaining 4 cases, routine histology of primary tumor failed to provide conclusive evidence of malignancy and the diagnosis was established only by biopsy of lymphatic metastases in 2 of them and by autopsy in the other 2.
3. Urinary HCG was found to be well correlated with neoplastic activity.
4. Gynecomastia was seen in 4 of the 10 cases.
5. In all cases but one, the patients died of malignancy, the prognosis of choriocarcinoma of the testis being thus very poor. The time period from the first examination to patient's death in these 9 cases ranged from 19 days to 2 years, averaging 10.6 months.
6. All the patients who died had extensive pulmonary metastasis.
7. Autopsy was performed in 6 of the 9 cases. As for organ metastasis, pulmonary metastasis was present invariably in all cases, hepatic metastasis in 5 cases, and the brain, kidneys and pancreas were involved in 2 cases each. With regard to lymphatic metastasis, retroperitoneal lymph nodes were found affected in one case; retroperitoneal lymph nodes and supraclavicular lymph nodes were concurrently involved in 2 cases. In the latter 3 cases, metastasis occurred probably through lymphatic channels.
8. In the chemotherapy of choriocarcinoma of the testis, an intermittent multidrug regimen proved to be effective. Our recommended chemotherapeutic regimen for Japanese patients is as follows: actinomycin D, 0.5mg per day, methotrexate, 5mg per day, and cyclophosphamide, 250mg per day, given in 5-day courses. Initial 4 to 5 courses of treatment are given at 2 to 3-week intervals and then, after an interval of 2 to 3 months, the treatment is repeated in the same way over an entire period of 2 years unless significant side effects occur.
Under this therapeutic regimen, serum LDH and urinary HCG returned to normal in one case. Another patient with stage I choriocarcinoma of the testis has now survived 4 years following orchiectomy which was done after 2 years of this particular chemotherapy.
9. Irradiation, which heretofore is considered useless, proved to be fairly effective in the treatment of lymphatic metastasis; gratifying results were obtained in one case with metastasis to retroperitoneal lymph nodes and in 4 with metastatic lesions of supraclavicular lymph nodes.

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Cell lines from BBN induced rat bladder tumor were established and antigenicity of LPS (tumor lipoprotein solubilized in sodium desoxycholate solution and solubilized in NaCl solution) and LPI (NaCl insoluble) was examined by means of the cytotoxicity of sensitized rat lymphoid cells to the tumor cells.
Two cell lines were obtained and named RBC-1 and RBC-11 respectively. Both cell lines showed epithelial growth. Though backtransplantation to the rat was not succeessfull, the cell lines were supposed to have tumorigenicity because they revealed marked pile up and were not contact-inhibited. In this series RBC-1 was used because single cell rate by trypsinization was higher in RBC-1 than in RBC-11.
LPS and LPI were extracted from pooled tumor tissues of several rats and refrigerated at -80cC untill use. Immunization to the rat by LPS and LPI with or without Freund's complete adjuvant was done 3 times as a rule, and 10 days after immunization sensitized lymphoid cells were obtained from the spleen and microcytotoxicity test was performed. At the end of the test viable cell number in well was counted and reduction rate was calculated.
The result were: (1) fairly strong cytotoxic effect appeared by the use of adjuvant, (2) cytotoxicity was weak in the single use of LPS and LPI, (3) LPI revealed almost constant cytotoxic effect but LPS not constantly, (4) lymphoid cells from a tumor bearing rat or a rat injected tumor cells intraperitonealy showed significant cytotoxicity, (5) lymphoid cells from tumor bearing ACI/N rat could not reveal cytotoxicity.
In the present study I suppose that both LPS and LPI may have slight antigenicity but more LPS and LPI are needed in order to exhibit cytotoxic effect to the tumor cells. And we must consider the use of inbred animals, the use of transplantable tumor and effect of immunization by the complex of LPS and LPI.

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Though it was well documented that renal cell carcinoma was frequently associates with an increase of serum alkaline phosphatase activity, no precise explanation of its origin has been offered. There are two possibilities about it, namely, a release of the enzyme from tumor cells into the circulating blood, and an elevation of serum alkaline phosphatase due to hepatic dysfunction caused by cytotoxic metabolites from the cancer tissue.
The author investigated the origin of the increased enzyme activity through the experimental methods, i. e. renal blood flow study and isoenzyme analysis. In the former study, the renal vein blood flow was determined by means of local thermodilution technique and the activities of enzymes (ALP and LDH) both of the renal vein and artery specimens were measured. When veno-arterial difference of enzyme activity was multiplied by renal plasma flow, the value means the amount of the enzyme releases from the kidney. In six cases of renal cell carcinoma thus investigated, the amount of enzymes released from the tumor-bearing kidney far exceeded those of the contralateral kidney.
In the latter study, isoenzyme patterns of the serum alkaline phosphatase were analysed by means of cellulose acetate electrophoresis. Of 15 patients analysed, eleven showed a normal ALP activity and four showed a significant elevation of it. In patients with a normal activity, the isoenzyme pattern displayed a light band of ALP-2, which was to be expected in healthy subjects. Of four cases with an elevation, three showed an intense band at ALP-2, which suggested to be hepatocellular origin. One remaining patient showed a markedly high serum ALP level (128.8 K-A units), where the isoenzyme analysis identified heat-stable ALP-4. Neverthless, the heat-stable ALP was not detected anywhere of the removed kidney, neither histochemically nor biochemically.
The results of these two studies were apparently contradictory, because the detailed pathway remained obscure. But, changes of several enzymes in courses of renal carcinoma were not negligible in diagnosis and in clinical persuit of the disease. Detection and separation of specific carcinogenic isoenzymes are to be expected because of their early diagnosis and recognition.

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Diagnosis of inguinal testis is easy, but that of abdominal testicle, especially when it is unilateral, is frequently difficult. Bilateral abdominal testes can be diagnosed by endocrinological studies (17), while unilateral abdominal testicle cannot be found any where and often requires exploratory laparotomy.
Pelvic pneumography has been used for gynecological disorders to visualize the intrapelvic strcutures. Pneumography would be a safe, simple and nonsurgical technique not only for adults but also for children (12).
We applied the pelvic Pneumography to 9 unilateral abdominal cryptorchid boys (age 4 to 11 yrs.) and diagnostic value was discussed. The patient was placed in supine position, a Teflon needle is entered to the peritoneal cavity in the midline below the umbilicus. A total of 600 to 1000ml, of carbon dioxide is introduced into the pelvic space. Tympanitic percussion is a most useful sign of adequate filling. Films are taken in prone and head-down position.
No complications have been experienced in our cases.
3 out of 9 patients were found positive for gonadal shadows on pelvic pneumography (Fig. 2, 3 and 4). These gonads were confirmed by surgery successively.
Other 6 cases were negative for gonads on pneumography.
Thus, our pelvic pneumography in unilateral abdominal cryptorchid children showed accurate findings. It seems to us that this method is a most useful and valuable technique for diagnostic studies before surgery.

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Twenty-five cases of Klinefelter's syndrome were extensively studied to clarify the mechanism of their hypothalamo-pituitary-testicualar function.
In the patients before treatment serum levels of follicle-stimulating hormone (FSH) and lutenizing hormone (LH), both measured by radioimmunoassay, were highly elevated compared with those in normal adult males. However, serum LH values in some cases were only slightly elevated above the upper limit of normal controls. Synthetic LH-releasing hormone (LH-RH, 100μg) administered im. provoked excessive increases of serum LH and FSH levels in these patients. Serum levels of testosterone (T) in these cases were significantly lower than those in normal adult men, but these values were scattered in a wide range and some were within the normal range. Human chorionic gonadotropin (hCG, 5000IU) administered im. for four days gave smaller increases of serum T levels in the cases with Klinefelter's syndrome than those observed in the control group.
Serum levels of gonadotropins were followed for three weeks after a single shot administration of a depot T preparation (100mg). The suppressive effect of the exogenous T load on serum gonadotropins was smaller in these cases than normal controls. Observation on the long-term substitution treatment by weekly im. injection of the depot T revealed that the serum levels of LH and FSH in these patients gradually decreased to the normal range or below in several weeks. However, when the injection interval was prolongecl to 2-3 weeks, the serum gonadotropin levels rebounded to higher levels than basal values. After the chronic T substitution therapy serum T levels were lowered and responses to hCG stimulation became smaller than before treatment. Also, serum gonadotropins were suppressed to a lesser degree by the same amount of exogenous depot T in chronically treated cases than in pre-treated patients.
It is concluded that in Klinefelter's syndrome alterations in the endocrine function of the hypothalamo-hypophyso-testicular axis are compatible with the nature of primary disorders of the seminiferous tubules causing secondary changes on the Leydig cell functions which are however variable among indiviual cases. The feedback sensitivity of the hypothalamo-pituitary system to peripheral T levels appears to be blunted in this syndrome and a highly excessive gonadotropin secretion continues for long duration after puberty. The doses of T substitution therapy, which is clinically effective inducing sufficient manifestation of androgenicity in this disease, are not effective enough to correct the abnormal hypothalamo-pituitary function.

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In order to establish an objective method for identifying the prognosis of the patients with carcinoma of the bladder, the author attempted to correlate chromosome analysis of the cancer cell with the prognosis of the patients.
The chromosome number was examined on 25 specimens from 24 patients with bladder carcinoma. The chromosome preparations were made by the air drying technique. The number of mitoses available for the examination was 36 for each specimen on the average. Relationship between histopathology and chromosome number was examined.
The results thus obtained were as follows:
1. Relationship between histological grade based on Broders' classification and the chromosome number.
The grade I tumors have low mitotic figures and a narrow range of chromosome number. A wide range of chromosome number was observed in grade II, III and IV tumors. There was a relationship between histological grade and ploidy. As the grade changed from I to IV, the modal chromosome number changed. gradually from the near-diploid modes to the triploid-tetraploid mode then to the triploid modes.
2. Relationship between a trial classification and chromosome number.
The auther tried to classify bladder tumors into three groups on the basis of cellular atypism, structural atypism and number of mitosis.
Group I: Mode is near diploid in all cases with a narrow range of chromosome number.
Group II: Most cases have two modes. These are near diploid and triploid to tetraploid mode, with a wide range of chromosome number.
Group III: Most cases have triploid to tetraploid mode with a wide range of chromosome number.
It was interesting that a trial classification is more related to chromosome number than Broders' classification.
3. By analysing chromosome number, the author proposes to classify superficial tumor group as Jewett and Marshall's stage O and A, deep infiltrative group as B1, B2, C and D.
4. On the basis of chromosome number, it is possible to classify bladder tumors into 5 groups.
Group 1: Tumor with near-diploid mode.
Group 2: Tumor with two modes; near diploid and triploid to tetraploid, with predominance in the former.
Group 3: Tumor with two modes; near diploid and triploid to tetraploid, with predominance in the later.
Group 4: Tumor with triploid to tetraploid mode.
Group 5: Tumor without a distinct mode.
There is a close relationship between this classification and histopathology (grade and stage). And I think this classification is thought to give objective standard for classifying the natures of bladder tumors.
5. The prognosis is poor in the patient who has near-diploid mode and a very wide range of chromosome number, and also shows no modal preference.
In conclusion, the study suggested that classification on the basis of chromosome number is useful in predicting prognosis of the patients with bladder tumor more objectively.

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A case of primary ureteral fibrolipoma is reported in this paper. The patient was a 50-year-old Japanese male who was admitted to the Kitasato University Hospital in April 1974, complaining gross hematuria and right flank pain of two months' duration. Excretory and retrograde urography revealed a large mass in the right ureter at the level of lumbosacral joint. Right nephroureterectomy was performed and the surgical specimen revealed a long convoluted yellowish-white tumor mass, 6×1.5cm in size, with a small stalk in the lower third of the right ureter. Histological diagnosis of the mass was fibrolipoma.
Tumors of non-epithelial origin are exceedingly rare except for ureteral polyps. The first case of primary ureteral fibrolipoma was reported by Cohn in 1932. No other cases have been reported so far to our best knowledge. Our case is believed to be the second in the literature.

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