A case of renal artery saccular aneurysm locating at the trifurcation of the arterial tree was treated by ex vivo resection of the aneurysm and end-to-side anastomosis of the secondary branch.
Through a retroperitoneal tunnel between an anterior subcostal incision and ipsilateral lower abdominal oblique incision, the kidney was brought outside of the lower abdomen and after flushing by ice-cold Sacks solution, ex vivo surgery was performed under ambithermic condition. Then, the kidney was autotransplanted into the iliac fossa without division of its ureter.
Post-operative course was uneventful. IVP and angiography taken after surgery showed excellent function and patent bloodflow.
Review of the literatures on ex vivo surgery and preservation technique during renal ischemia is presented.

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IgG and IgA levels in split ejaculates of 17 patients with chronic prostatitis and 12 normal subjects were studied by the single radial immunodiffusion method. For the determination of 7S and 11S IgA levels, Hanson' radial immunogel filtration method was applied. The results suggest, at least in certain cases of prostatitis, an elevation of IgA level involves an increase of both types of IgA, and they are mainly of prostatic origin.

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As a preliminary investigation for the clinical application of immunoelectrophoresis (IE) of ejaculate in the diagnosis of male reproductive organ diseases, variations of immunoelectrophoretic pattern in normals due to the difference of antigenicity between split ejaculates was demonstrated with rabbit antisera. Fresh samples and antisera against them gave larger numbers of more intense precipitin lines than in stored samples. The precipitin lines developed by acid phosphatase was most remarkable between the first portion of ejaculate (F1) and the anti-F1, whereas the line caused by the protein from the seminal vesicle was most prominent between the remainder of the ejaculate following F1 (F2) and anti-F2. Although IE of the split ejaculates from 17 patients with the diagnosis of chronic prostatitis was performed, some abnormality was observed only in one case.

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The principle of treatment for staghorn calculi and the indication of nephrolithotomy have been described. In nephrolithotomy, operative technique, especially the method of parenchymal suture, has several variations but there is no convulsive method.
In 1967, Dr. Taguchi originally designed a new method of parenchymal suture and he has performed it in more than 50 patients with good result. In his operation, closure of the renal parenchymal incision is made with one layer interrupted suture from pelvic mucosa to renal capsule by 2-0 plain cat gut. Hemostatic suture or ligation and the suture of pelvic mucosa are not necessary. Therefore, the operative technique is very simple and the clamp time of renal pedicle can be shortened.
The ways of renal parenchymal suture in nephrolithotomy were classified into 6 groups. They were:
1. The method without suture at all
a) sutureless nephrotomy
b) wrapping kidney in Oxycel gauze
2. The method of capsular suture
a) interrupted or continuous suture of renal capsule only
b) subcapsular circular suture
3. The method of interposition of muscle, fatty tissue or others
4. Mattress suture and its variations
a) horizontal mattress suture
b) vertical mattress suture
c) plate suture
5. The method of parenchymal suture other than mattress suture
a) U-shaped suture in margin of renal incision
b) interrupted suture of renal parenchyma
6. Anatrophic nephrotomy (by Boyce, W. H. et al)
One layer interrupted suture of renal wound originally designed by Dr. Taguchi belongs to the group 5-b, but it is considered the simplest and the most advanced technique.

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The author made a study on the renal vascular pattern and the renal function before and after operation of staghorn calculi or multiple large calculi in 17 kidneys of 16 patients.
The cases were divided into the following 2 groups. Group I (14 kidneys of 13 patients) were subjected nephrolithotomy. Group II (3 kidneys of 3 patients) were subjected to partial nephrectomy.
In nephrolithotomy, closure of the renal parenchymal incision was made with one layer interrupted suture from pelvic mucosa to renal capsule by 2-0 plain cat gut. This method was originally designed by Dr. Taguchi in 1967 and he had performed the operation by this method in about 50 cases with good result.
Renal angiography was performed in 12 kidneys of Group I and 2 kidneys of Group II.
The renal function was assessed by BUN, serum creatinine, PSP test, Fishberg's concentration, renal clearance (24-hour creatinine clearance), excretory urography and isotope renogram.
The following conclusions were obtained.
1. The average duration of renal artery clamp time of Group I was 16 minutes and 14 seconds and shorter than that of Group II.
2. Preoperative angiograms were classified into 3 patterns. They were compatible with normal, pyelonephritis and hydronephrosis.
3. Postoperative angiograms of Group I showed the interruption of interlobar arteries in 91.7 per cent of kidneys. Cortical infarction due to arterial interruption was seen in 66.7 per cent of kidneys but the mean residual area of nephrogram in these 8 kidneys was 93.6 per cent of that found in the preoperative examination. The mean diameter of the renal main artery was 87.5 per cent of that found in the preoperative angiograms and arterio-venous fistula was proved in one case without any circulatory complications.
4. Renal function of Group I has improved or remained stable postoperatively in all but 2 patients whose isotope renogram was slightly deteriorated.
5. In Group II, there were arterial spasm in residual renal parenchyma and the mean diameter of the renal main artery was 69.0 per cent of that found in the preoperative studies.
6. Renal function of Group II by excretory urography and isotope renogram showed a reduction in 66.6 per cent of kidneys but the other function tests remained unchanged.
7. Despite the limited number of cases treated and the short period of follow-up, it is considered that the parenchymal loss and arterial damage are of little importance in nephrolithotomy with one layer interrupted suture. This result was due to the short arterial clamp time and harmlessness of parenchymal suture.

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We recently had opportunities to treat patients with intrarenal vascular lesions. We report our experiences with midkidney resection for cirsoid-type arteriovenous malformation, aneurysmectomy for intrarenal aneurysm and endofistulorrhaphy for intrarenal arteriovenous fistula which occurred after percutaneous renal biopsy. For cirsoid type arteriovenous malformation, operative techniques used in 6 cases, differentiation from tumor and indications for midkidney resection were described. For intrarenal aneurysm, the literature was reviewed regarding opperative indication, its relation with hypertension and spontaneous rupture. For arteriovenous fistula, historical outline and recent techniques of operative repair were described.

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In spite of numerous studies on chemotherapy for pyelonephritis, the renal distribution of the adminstered antibiotics is not yet completely understood. In order to examine this, using experimentally induced unilateral pyelonephritic dogs, the antibiotics concentration in the renal tissue was measured with relation to that in both urine and serum after single intravenos injection of Cefazolin (50mg/kg). This experiment was performed in both acute and chronic stages of pyelonephritic dogs.
The results were as follows.
1. A half life of the serum concentration was more prolonged in both acute and chronic unilateral pyelonephritic dogs than in the normal group.
2. In unilateral acute pyelonephritic dogs which showed a mild type of inflammation, the tissue concentration was higher and both urinary concentration and excretion rate were lower in the affected kidney than in the control kidney of the other side. Furthermore, the decreasing rate of tissue concentration curve was found to be slightly low. On the other hand, when the inflammation was so severe as the abscess formation was dominant, the affected kidney showed low levels of the tissue concentration, the urinary concentration and the excretion rate.
3. In unilateral chronic cases, the renal tissue concentration, the urinary concentration and the excretion rate were lower in the affected kidney than in the normol kidney of the other side.
These results suggested that the high distribution and the long retention of the antibiotics were obtained in the inflammatory area of the renal tissue only when the infection was acute and mild. However, in the cases of severe acute pyelonephritis and chronic pyelonephritis, the renal tissue distribution seemed to be low, and in both acute and chronic pyelonephritic kidneys, the urinary excretion seemed to be decreased.

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A 61-year-old man was seen on September, 9, 1975 with the chief complaint of intermittent gross hematuria of 4 years' duration and burning on urination for the past 2 months. Cystoscopy disclosed a large sessile tumor involving the left lateral wall of the bladder. A total cystectomy with ileal loop urinary diversion was performed on October 23, 1975.
The surgical specimen demonstrated the co-existence of a solid, necrotic tumor 7×6×5cm. in size and a papillary tumor 3×4×2cm, in size. On microscopic examination the former was identified as myxomatous leiomyosarcoma, the latter as transitional cell carcinoma grade 3. The two components collided in some areas and invaded each other. Consequently the pathological diagnosis was carcinosarcoma (collision tumor) of the urinary bladder.
Two months after the operation, urethral bleeding reappeared and an induration in the pendulous urethra was noted. As biopsy revealed sarcomatous elements, the penis was amputated and the urethra was removed.
On May 13, 1976, he died with the local recurrent lesion and pulmonary metastasis, showing no response to telecobalt irradiation and chemotherapy. No autopsy was done.
The literature was reviewed and the clinicopathology of the carcinosarcoma of the bladder was discussed.

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