Interferon (IF)-producing ability of peripheral leukocytes from patients with E. coli was examined in the human embryonic lung cells-vesicular stomatitis virus system.
The leukocytes from the patients were found to produce IF upon contact with the specific antigen, whereas those from normal individuals were observed to have no such ability. The IF produced was identified as immune IF reported by Falcoff et al. on the basis of the following characteristics: species-specificity, lability to trypsin and acid treatments, and heat-stability. These data suggest that cellular immunity plays a certain role in urinary tract infection in man.

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Estimation of testicular Leydig cell reserve capacity was attempted in patients with various types of testicular insufficiency and abnormal genital development. Serial determination of serum testosterone (T) levels was made before, during and after the im stimulation with 5000 international units (IU) of human chorionic gonadotropin (hCG) for 4 successive days. In normal adult men serum T levels were increased significantly one day after the first injection of hCG (Day 1) and it was observed that the rise in serum T levels tended to continue toward the end of the study period (Day 4).
Increments of serum T levels during and after hCG stimulation in patients with Klinefelter's syndrome were small and stunted before last hCG injection, suggesting the primary nature of testicular insufficiency in this disease and the poor Leydig cell reserve capacity. In contrast, Leydig cell reserve capacity was preserved enough in patients with Sertoli cell only syndrome.
On the other hand, in patients withhypogonadotropic hypogonadism, the basal levels of serum T were as low as those in prepubertal boys, but increments of serum T levels after hCG stimulation were found to vary in individual cases. Those patients, in whom some signs of pubertal onset were recognized, e. g., slight testicular enlargement and appearance of pubic hair, showed relatively good responses of serum T levels. However, patients with hyposmia or bilateral cryptorchidism, whose pubertal stages remained at P1 according to Tanner's standard, showed almost no response of serum T levels to hCG stimulation.
Adult patients with cryptorchidism, hypospadias, or various intersexual diseases such as true hermaphroditism, gonadal dysgenesis, mixed gonadal dysgenesis, and male hermaphroditism, showed various response patterns of serum T levels to hCG stimulation, probably depending on the nature of testicular insufficiency of their diseases as well as on the degree of testicular damages.
Most of the prepubertal patients with these diseases, however, showed almost normal responses of serum T, except for a few patients, e. g., a 3-year-old patient with gonadal dysgenesis and a 5-year-old bilaterally cryptorchid boy with Prader Willi syndrome, showing no increments of serum T levels after the hCG stimulation.

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Thiamphenicol in four different daily dosages of 1500mg, 750mg, 375mg, and 190mg, and Sulfamethizolum in daily dosages of 3000mg, 1000mg, and 400mg, were administered by dividing the daily dosage into three portions for two days to 65 cases of female acute cystitis caused by E. coli, and their clinical efficacy was studied. The results revealed.
1) In general the findings of patients considerably improved on the first and the second day after the administration of the drugs, in comparison with the findings at the time of first examination.
2) Among the groups to which Thiamphenicol was administered, no dose response was observed in the findings regarding the bacteria in urine and the grade of pyuria.
3) Among the groups to which Sulfamethizolum was administered, the efficacy in the dosage of 400mg was inferior to those in the dosages of 1000 mg and 3000mg, but no significant difference was observed between 1000mg and 3000mg.
4) In comparing the Thiamphenicol group with the Sulfamethizolum group, we found no significant difference between the two groups regarding the bacteriuria, while as to the grade of pyuria the Sulfamethizolum group was slightly better.
From the above mentioned results, the following points were suggested.
a) The clinical tests of antibacterial drugs for acute cystitis should be performed not in comparison with the rate of natural healing, but in comparing among different type and dosage of antibacterial drugs considered to have some efficacy.
b) The evaluation of efficacy may be made one day and/or two days after starting administration. Through shortening of the test period, the ethical requirements would be better satisfied and the accuracy of the test would be increased.
c) It is not always impossible to seek dose response clinically in acute cystitis cases by relatively simple test, and this should be taken into consideration. The minimum dosage required for Thiamphenicol and Sulfamethizolum has been estimated to be considerably smaller than the amount conventionally regarded as an ordinary dosage.
d) Different antibacterial drugs should be compared by taking the dose response into consideration. In other words, drugs should be compared in their respective optimum dosage.

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A small and portable urethral pressure profilometer, which has a dual mechanism of catheter withdrawal and water infusion, has been constructed based upon the urethral pressure profilometry performed on female dogs. Over 100 clinical materials have been examined by this machine without any complications.
1. A nelaton catheter of 10F for adults or 8F for infants, which had 4 small holes 3cm from the distal end, was transversed from the bladder to the external urethral orifice with a withdrawal speed of 30mm/min and a water infusion rate of 2.5ml/min.
2. Clinical presentation of characteristic urethral pressure profiles was made in accord with their symptoms; 6 healthy adult males and females, 2 cases of untoward effect of anesthesia, 4 cases of prostatic disease, 6 cases of urethral disease, and 6 cases of neurogenic bladder dysfunction. Cystourethrogram, uroflowmetrogram and cystometrogram were also illustrated in some cases.
3. Normal values of urethral pressure profile were defined. Maximum urethral pressure averaged 78.3mmHg in adult male and 69.8 mmHg in adult females. Total profile length was 13 to 16cm in male and 25 to 46mm in female. The distance from the inner urethral orifice to the point of maximum urethral pressure was 10 to 25mm in male.
4. Assessment of urethral function was made in various diseases which interfered with urethral pressure profile qualitatively and quantitatively Urethral pressure profilometry is a valuable clinical tool to evaluate the physical properties of urethral wall and the functional disorder present in the urethral sphincter.

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As one of the fundamental researches for the development of microexplosion lithotripsy, amino acid analyses were performed on 12 dry urinary calculi. The results are as follows:
1) The weight of protein in dry calculi was from 0.53 to 3.15%. The mean was 1.6%.
2) Almost all amino acids in calculi were assumed to be the components of protein.
3) Regardless of inorganic component, calcigerous calculi had a similar pattern of amino acid composition, while uric acid calculus had a quite different pattern.
4) If protein should be added as to the materials to make a calculus model, fibrin would be the best from various points of view.

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Two established cell lines, T24 cells and MGH-U1 cells, derived from human bladder transitional cell carcinoma were investigated for their morphology. Light microscopic findings indicated that both the cell lines kept epithelial features and grew on multilayering pattern. Scanning electron microscopy disclosed that the cells had microvilli as well as cytoplasmic protrusions on the cell surface. Transmission electron microscopy revealed the junctional complex between adjacent cells and well-developed cytoplasmic organelles. Virus like particles could not be identified. The cells in proliferating phase showed polymorphic appearance, but electron microscopic examination failed to prove that the each cell line consisted of a morphologically different type of cells in view of ultrastructure. Thus the two cell lines were considered to be rather monotonous cell populations. Both the cell lines resembled so closely each other that it was difficult to distinguish them by morphologic findings, although T24 cells contained slightly much more numbers of spindle shaped cells and relatively well-developed microvilli as compared with MGH-U1 cells. Chromosomes were distributed from hypertriploid to hypertetraploid with the modal number of 91 in T24 cells and 85 in MGH-U1 cells. The present results suggested that T24 cells were transformed in the morphologic appearance following the long-term culture, when referred to previously reported data.

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Assessment of infiltration in bladder tumors is important in both deciding management of the particular case and developing its prognosis. Various techniques have been attempted to determine the extent of infiltration, most highly regarded being pelvic arteriography which is 80-90% accurate according to literatures.
In 1975, McLaughlin et al., measured the degree of bladder tumor infiltration by means of ultrasound tomography scanning via the abdominal wall and reported that the findings were comparable to those of pelvic arteriography. The present authors used ultrasound via the abdominal wall in the diagnosis of 48 patients with bladder tumor. The findings were related to the excised bladder and new criteria for estimation of the extent of infiltration were derived. The results were then compared with those of other methods.
Method and Criteria: A multi-purpose ultrasonic diagnostic apparatus, ALOKA SSD 60B with a concave transducer of 13φ-80mm of curvature diameter was used in this experiment. The bladder was filled with 200-300ml of physiological saline solution and the recording made through the abdominal wall by sector scanning.
Criteria for the estimation of extent of bladder tumor infiltration by ultrasound: U-I: Echoes from the tumor are detectable, but disappear at different gain, while echoes from the bladder wall are well recorded. U-II: Echoes from the tumor are detectable. When gain is changed, however, echoes from the tumor disappear and echoes from the bladder wall partly vanish. U-III: Echoes from the tumor are detectable. When gain is changed, however, echoes both from the tumor and the bladder wall completely vanish at the same time.
U-I therefore corresponds to T₁, U-II to T₂, and U-III to T₃ or T₄. The above-mentioned criteria were established on the basis of the findings in 8 cases of total cystectomy in which all of the specimens were examined by the dipping method, and related to the histopathologic findings.
Results: T₁: 31 cases (3 failed cases; 3 cases diagnosed as U-II) Accuracy is 90%. T₂: 5 cases (1 case diagnosed as U-III) Accuracy is 80%. T_3-4: 9 cases (1 case diagnosed as U-II) Accuracy is 89%
Diagnosis impossible: 3 cases. Two of the three patients with T₁ had tumor spreading from the anterior wall to the apex and a clear echo image was not obtained due to interference from the pubic bone. The other, although it was of noninfiltrating type, was erroneously diagnosed as U-II because of surface calcification which resulted in a loss of part of the bladder wall echo because the muscle layer was invaded by tumor. In one patient with T₂, over-diagnosis as U-III was made because the tumor was so large that echoes from the bladder wall could not be recorded. All other 40 cases showed good correlation between TNM classification and ultrasonic assessment.
Examination of the excised bladder by the dipping method showed that echoes from bladder tumor are weaker and disappear sooner than echoes from bladder wall. Namely, when the tumor does not infiltrate into the muscle layer, echoes from the tumor are lost while ultrasonic beams emmited at different gains are still well echoed from the bladder wall. When the muscle layer is damaged by infiltration of tumor, however, echoes from both the tumor and the bladder wall are lost at the same time. Irregularity and deformation of the bladder wall, which are taken into account for diagnosis by McLaughlin et al., were different from individual to individual, without correlation to infiltration of tumor in our study.

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The effects of urinary bladder distension on renal blood flow, blood pressure and plasma renin activity (PRA) were studied in 54 mongrel dogs anesthetized with chloralose. The renal blood flow was measured by the magnetic flow meter, the blood pressure by a pressure transducer and the PRA by radioimmunoassay. The experiment was divided into three groups. The group I was composed of dogs intact except for the surgical procedure for measurement and instillation of normal saline to the bladder. The group II was composed of dogs with the bilateral ureters cut. The group III was composed of the anephric dogs. The results were as follows.
1) Group I.
The renal blood flow was reduced in 15 out of 18 dogs during bladder distension. The average reduction below the initial level was 7.2ml/min or 13.4% in 18 dogs. The blood pressure rose during bladder distension in 29 out of 30 dogs. The average rise above the initial level was 20.6mmHg or 11.9% in systolic pressure and 20.4mmHg or 16.7% in diastolic pressure. Two patterns were observed in the changes of the blood pressure. The PRA in 15 dogs increased during bladder distension, and this increase was statistically significant compared to the initial level. The changes in PRA during and after bladder distension were observed in 4 dogs. The PRA showed an increase at 10 minutes after starting to distend the bladder in all dogs and a transient decrease at 5 minutes after emptying the bladder, followed by an increase again in 3 dogs.
2) Group II.
The renal blood flow was reduced during bladder distension in all of 5 dogs. The average reduction below the initial level was 14.4ml/min or 27.9%. The blood pressure rose in 9 out of 10 dogs. The average rise above the initial level was 21.9mmHg or 13% in systolic pressure and 18.7mmHg or 15.3% in diastolic pressure. The PRA in 5 dogs increased during bladder distension, and this increase was statistically significant compared to the initial level.
3) Group III.
The blood pressure rose in all of 10 dogs. The average rise above the initial level was 21.5mmHg or 11.9% in systolic pressure and 22.1mmHg or 16.6% in diastolic pressure. The PRA was absent in all dogs.
In the present investigation, the renal blood flow showed a reduction during bladder distension in Group I and Group II. This reduction was not produced only by the hydrostatic mechanisms through the ureters during bladder distension, because the reduction was also observed in the dogs with cut ureters.
The rise in blood pressure and the increase in PRA were also observed in Group I and II, while the anephric dogs showed a rise in blood pressure during bladder distension despite the absence of PRA. Therefore, it appeared that the renin angiotensin system did not directly relate to the rise in blood pressure during bladder distension.
It seemed that many factors might play roles in the increase in PRA during bladder distension.

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Over a period of 3 years, pyelorenal backflow (PRB) was found in 563 of 2365 excretory urograms. These cases were statistically analyzed and cases with PRB with no conceivable organic obstruction in the upper urinary tract were studied with radioisotope renography and urometry. The following informations were obtained.
1. Examinations of the clinical statistics
1) The frequency of appearance of PRB in excretory urogram was highest in DIP with abdominal ureteral compression followed by standard IVP (with combined use of ureteral compression) and further by DIP without the use of ureteral compression (Table 1).
2) According to the type of PRB, pyelotubular backflow was seen in the overwhelming majority. Among fornical backflows, pyelosinous, pyelolymphatic, pyelovenous and pyeloparenchymal types were seen in decreasing order of frequency (Table 3, 4).
3) In DIP without using ureteral compression, PRB appeared in 20.1% of the cases and 13.8% of the kidneys (Table 1).
4) PRB appeared more frequently in females, with high incidence in the 20s and 30s in both males and females (Table 2, Fig. 1, 2).
5) As to the morphology of the renal calyx and pelvis with PRB, normal shape was seen most frequently in about 80%, with narrowing in 8.5%. Dilatation of the renal calyx and pelvis was seen only in 11.7%, becoming rarer as the dilatation was more pronounced (Table 6).
6) Among 563 cases with PRB, chief complaint of pain (37.5%) and hematuria (22.5%) was found most frequently (Table 7) and diseases of the upper urinary tract such as movable kidney, renal and ureteral stone, renal tuberculosis, essential hematuria and pyeloureterospasm were frequently found (Table 9, 10).
2. Studies with radioisotope renogram and urometry
1) In the findings of renogram. stepwise changes of excretory phase exhibiting the spastic changes of renal calyx and pelvis were seen in 48.6%, and a prolongation of the excretory phase in as high as 27.0% (Table 19).
2) In the findings of urometry obtained with the combined use of DIP, the intrapelvic resting pressure of the kidney with PRB tended to be higher than that in the kidney without PRB, with frequent peristaltic contraction wave (Table 21, 22, 23). In the cystoscopic findings, the changes of the ureteral orifice such as narrowing and hyperemia, and elevation of the interureteric ridge were seen in many cases (Table 24).
3) As the reaction of the renal pelvis to drugs, the intrapelvic resting pressure, pressure amplitude of the contraction wave and frequency of contraction tended to decrease by intramuscular injection of Buscopan (Fig. 20).
According to these findings, PRB in the excretory urogram occurring in the absence of organic obstruction of the upper urinary tract is based on the pathophysiologic state mainly consisting of a state of excitation with unstable tonus of the pelvic and ureteral wall, and caused by a sudden rise of intrapelvic pressure due to the pelvic spasm. In the presence of an abnormal rise of the tonus or persistent spasm of the pelvic and ureteral wall, a state of functional obstruction takes place and this probably constitutes a factor in the occurrence of PRB as in the presence of organic obstruction. Various types of PRB are probably produced on account of the difference in the height and speed of the rise of intrapelvic pressure produced by pelvic spasm. While the pyelotubular backflow is produced by reflux into the papillary duct under a relatively low intrapelvic pressure, fornical backflow is probably produced by rupture of the wall of the fornix under a higher level of the intrapelvic pressure.

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The urethral pressure profile (UPP) was studied in both normal and pathological conditions. The technique used was that of Brown and Wickham. The examined five groups of patients were normal adult females (40 cases), normal adult males (12 cases), patients of bladder neck contracture (15 cases), patients of benign prostatic hypertrophy (27 cases), and patients of neurogenic bladder after radical total hysterectomy (49 cases).
Analysis of the five groups showed the following results
1. In the normal adult females, a progressive fall of the maximum closure pressure with age was found.
2. In the patients of bladder neck contracture, its UPP was the same as that of normal adult male and it was thought that the UPP had little diagnostic value for bladder neck contracture.
3. In the patients of benign prostatic hypertrophys, the functional profile length and the prostatic profile length were significantly elongated. At the postoperative recording, these lengths were shortened. Its UPP was expected to be useful for screening examination.
4. In the patients of neurogenic bladder after radical total hysterectomy, the maximum closure pressure was significantly failed postoperatively. Its fall was more prominent at the full bladder than at the empty bladder. Its fall was significant in the group with poor micturition pattern on the uroflowmetry. From these results of ours and the review of literature it was presumed that the postoperative fall and postoperative micturition disturbances were due to the operative damage of sympathetic nerves.

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The intrarenal pressure (IRP) was measured in 24 dogs anesthetized with pentobarbital sodium, weighing 7-13kg. The needle method has chiefly been used for the measurement of renal tissue pressure, but it has been pointed out that it involves many problems. In the present study was used what is called the balloon method, which has never been reported previously. The probe used was a modification of a flow directed catheter (SWAN-GANZ) (Fig. 1). The probe was proved to be of high precision by measuring already known pressure values with it for testing purposes (Fig. 2). The left kidney of each dog was stuck with this probe up to a given depth to measure the IRP. The left ureter was sectioned, and a ureteral catheter was inserted into the pelvis to measure the intrapelvic pressure (IPP). The renal blood flow (RBF) was also measured in part of the dogs. The dogs were transfused with 4-6ml/hour/kg of isotonic saline solution during the experiments.
The following results were obtained:
1. Measurement of IRP in a state free of ureteral obstruction (free-flow state). The mean pressure value was 11.9±3.7mmHg (range 6.1-18.5) (Table 1).
2. Measurement of IRP in complete ureteral obstruction. The IRP rose with a rise in the IPP. There was an upper limit to each pressure. The mean maximum IRP value was 43.6±4.4mmHg (range 36.1-52.0), and the mean maximum IPP value was 58.2±6.9mmHg (range 44.0-69.0). (Table 2, Fig. 3, 4).
3. Measurement of RBF in complete ureteral obstruction. The RBF increased with a rise in the IPP and IRP. The mean increase of RBF was 25.8% from the control level. (Table 3, Fig. 5).
4. Measurement of IRP during Mannitol loading in a free-flow state. During Mannitol loading, the IRP rose with the mean maximum pressure value of 29.2mmHg. The RBF also increased slightly and temporarily (Table 4, Fig. 6).
5. Measurement of IRP and RBF in occlusion of renal vein in a free-flow state. On occlusion of the renal vein, the IRP rose, with the maximum pressure value of 61.3mmHg, and with the mean, 53.4±5.3mmHg (range 46.4-61.3). The RBF markedly decreased. Reopening the blood flow was followed by a rapid restoration to the control level (Table 5, Fig. 7, 8).
6. Measurement of IRP and RBF in occlusion of renal artery in a free-flow state. On occlusion of the renal artery, the IRP dropped, with the minimum pressure of 3.1±0.8 mmHg (range 1.7-3.7). The RBF stopped. Reopening the blood flow was followed by a rapid restoration to the control level (Table 6, Fig. 9, 10).
7. The merits and demerits of the balloon method have been presented.

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The present paper is concerned with our review on the clinical results of a total of 21 patients with ureteral tumor, who were seen at Jikei University Hospital in the 17 years' period from 1960 to 1976.
The average age of the 21 patients was 63 years. The ratio of men to women was 4.3 to 1. The left side was involved in 12 cases and the right in 8 cases. Only one out of the 21 patients had bilateral ureteral tumors which were diagnosed 4 years apart.
The lower third of the ureter was involved in 12 cases (55%), the middle third in 2 cases (9%) and the upper third in 7 cases (32%). The entire ureteral length was affected in one case.
The most frequent initial symptom was gross hematuria in 18 cases (82%), followed by pain in 4 cases (18%).
The common symptoms were gross hematuria in 18 cases (82%), pain in 9 cases (41%) and palpable mass in 3 cases (14%). Nonurologic symptoms such as general malaise were seen in 6 cases (27%).
Laboratory tests revealed anemia in 4 cases (18%), accelerated ESR in 3 cases (14%), increased α₂-globulin in 4 cases (27%) and urinary infection in 2 cases (9%).
Urinary cytologies carried out in 12 cases were positive for tumor cell in 2 cases (17%).
Blood was seen at the ureteral orifice in 2 of 22 cases and in further 4 cases tumor was visualized protruding from the ureteral orifice. In these 6 cases (27%), the lesions were in the lower third of the ureter. Hematuria was noted from the affected ureter in 3 cases (14%), whose lesions were in the upper third of the ureter.
Ureteral catheterization was performed in 15 cases. Ureteral catheterization was difficult or impossible in 12 cases (80%), and in the remaining 3 cases, the ureteral catheter was passed to the kidney without meeting any obstruction. The Chevassu-Mock's sign-increased ureteral bleeding following manipulation at the site of the tumor-was noted in 6 cases (40%), and Marion's sign-drainage of clear or clearing urine after passage of the ureteral catheter beyond the tumor-was noted in 2 cases (13%).
Excretory urography was performed in all the cases and retrograde urography in 14 cases. Urography showed ureteral filling defect in 14 cases (64%), ureteral obstruction in 2 cases (9%), hydronephrosis with or without hydroureter in 15 cases (68%) and nonvisualization in 6 cases (27%).
7 (33%) out of 21 patients had pelvis, bladder and/or opposite ureteral tumor either previously, concurrently, or subsequently.
18 (82%) out of 22 cases underwent total nephroureterectomy with excision of a periureteral cuff of bladder. 3 cases (14%) underwent partial ureterectomy and simple nephrectomy was performed in one case.
The 5-year survival rate in 21 patients was 40%, showing a close correlation of prognosis with histological grade and stage. 5 out of 6 patients, in whom the kidney was not visualized on the excretory urogram died within 5 years.

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An occult testicular tumor (seminoma) in a 38 year-old man with chief complaint of a left abdominal mass was reported. Laparotomy revealed a non-resectable retroperitoneal mass that was biopsied. Histologic examination of the specimen showed a seminoma. Because many of the so-called “primary extragonadal germ cell tumor” subsequently prove to have originated in the testicle, ipsilateral orchiectomy was performed. As the result, clinically quite unsuspected primary testicular neoplasma (seminoma) which would be spontaneously retrogressed was discovered by detail histologic examination of the testicular tissue. The importance of histopathologic examination of the testicle by orchiectomy was emphasized when an extragonadal germ cell tumor had been found.

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A 59 year-old man, previously healthy first visited our urological clinic on February 25, 1974, with 2-month old intermittent asymptomatic gross hematuria. Urethrocystoscopy revealed a slight stenosis on the membranous urethra and a hen's egg size solid tumor was found on the left lateral wall of the urinary bladder by cystoscopic optics. The mucosa of other parts of the urinary bladder was without remarkable change and the right ureteral orifice was normal. However, a left ureteral orifice was not found because of the infiltration of the tumor. On March 17, 1974, the patient was admitted to our hospital for treatment.
Excretory urogram revealed a delay of excretion and a dilatation of the upper urinary tract on the left side in contrast to the right side. A large round defect of the contrast medium at the left lateral side of the urinary bladder was seen by excretory cystography. Pelvic angiography using air cystography for negative contrast revealed abnormal tumor vessels and tumor stain. There was no sign for the metastatic changes in the lungs, gastrointestinal tract and lymphnode by other radiological examinations. Urinary exfoliative cytologic examinations were performed several times using the Papanicolaou stain and the cytologic diagnosis was always transitional cell carcinoma class IV or V. Laboratory tests, including hemograms, serum electrolytes, blood urea nitrogen, creatinine, glucose, calcium, phosphate, serum proteins were normal. An isotope liver scan was normal. The patient underwent a total cystectomy with an ileal conduit as an urinary diversion.
Grossly, the tumor was solid and well circumscribed, but there were areas of hemorrhage and necrosis on the surface of tumor. Histologically the tumor tissue was composed of anastomosing trabeculae, ribbonlike structures occasionally forming rosettes structure. Histochemically, the tumor cells were positive for the argyrophil reaction by Grimelius silver stains. Furthermore, the tumor cells had charac-teristic uniform, round, membrane-bound granules by electronmicroscopic examinations. From these results the pathological diagnosis of this tumor was determined as a primary carcinoid tumor of the urinary bladder.
Roentgenographic examinations of chest skeletal system and entire alimentary tract after the operation were normal. The excretory urogram was normal and the delaying of excretion and dilatation of the upper urinary tract on the left side was improved. Serum serotonin level was slightly elevated (42.2mcg/dl), but 24 hour excretion of urinary 5-hydroxyindol acetic acid was within normal limits. Laboratory tests after the operation were also normal.
One month after the operation the patient was discharged from the hospital under healthy condition without metastatic sign. The patient was examined monthly for routine follow up and received orally N₁-(2-tetrahydrofuryl)-5-fluorouracil treatment. Five months after the operation the patient complained of a small tumor formation with pain in the perineum. An extirpation of this tumor and the histologic diagnosis was metastatic carcinoid tumor. After the extirpation of the tumor the perineal pain disappeared immediately. At that time the patient was very healthy the radiologic examinotions and the laboratory tests were within normal limits.
Nine months after the operation the patient was found to have a round lung metastasis in the right lower lobe by chest radiological examination. At that time he complained of sweating and weakness 2 months in duration. The patient received intravenously N₁-(2-tetrahydrofuryl)-5-fluorouracil treatment. However, the metastatic lesion spread immediately in the both lungs and the clinical course of the patient was rapidly downhill. The patient died in March 1976. Autopsy was not performed.

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A 28 years old female was presented with a foreign body in the bladder for over 8 years. It was associated with a large stone formed around it and a vesicovaginal fistula. Suprapubic removal of the stone as well as the foreign body and transvaginal fistulectomy were performed. The removed object weighed 74 grams and the foreign body was identified as a 8.9cm long read pencil with metalic caps on both ends. These were partially bitten away and one end was sharply penetrated through the vaginal wall that formed a fistula.

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Autotransplantation of the kidney has been used as a successful method of treatment for ureteral injury, renovascular hypertention, ex vivo operation such as an excision of renal and pelvic tumors and others.
In the present report a patient with the extensive right lower ureteral stenosis due to chronic infection was successfully treated by renal autotransplantation. The right kidney was removed and this kidney was reimplanted into the right iliac fossa. The operative and postoperative periods were uneventful and the transplanted kidney has regained a good function.
We believe that the renal autotransplantation is a treatment of choice to be used more frequently for ureteral lesions.

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