Lipid fraction, cholesterol and phospholipids in prostatic tissue have been measured by enzymatic method and/or thin layer chromatography.
As a result of investigation on lipid fraction of the tissue of prostatic hyperplasia, prostatic cancer and normal prostate, it was found that in all cases the lipid fraction consisted mostly of phospholipids and cholesterol with triglycerides and free fatty acids in small quantities. Phospholipids were about one and a half times the total cholesterol in all cases. The further determination of the phospholipid fraction revealed the highest quantity of lecithin followed by sphingomyelin and lysolecithin. Cephalin was detected in such small quantities in all cases that isolation and quantitative determination were impossible.
It has been confirmed that in all cases studied free cholesterol accounted for the most part of the total cholesterol. There was a tendency that the ester ratio was higher in prostatic cancer than in prostatic hyperplasia.

View full abstract

The authors have previously reported that platelets and/or cell elements originating from platelets are always contained in urine. (These small bodies were termed “platelet-like bodies in the urine”-U-PLB). The relationship between the U-PLB and the peripheral blood findings of 179 patients displaying various renal functions (75 cases suffering from glomerulonephritis; GN, 12 cases suffereing from so-called idiopathic renal bleeding; IRB, 53 cases suffering from other renal disorders; ORD, 39 cases suffering from miscellaneous disorders; M, and 30 normal cases; H) were examined. Also, endogeneous creatinine clearance (Ccr) and urinalysis have been performed simultaneously. Although the U-PLB counts were variable, the urine of all subjects with various renal functions from healthy adults to patients with chronic renal failure was found to be involved with U-PLB.
The white blood cell (WBC) count in the blood was significantly related to the frequency of the VII th form of U-PLB of the B-group which have 70ml/min>Ccr≥30ml/min out of total cases (positive correlation). Also, the WBC count in the blood was significantly related to the albuminuria of the a-group which have Ccr >70ml/min out of patients with glomerulonephritis, of the b-group which have 70ml/min>Ccr≥30ml/min out of patients with glomerulonephritis, of the total cases suffering from glomerulonephritis (GN group), of patients with other renal disorders than glomerulonephritis and the socalled idiopathic renal bleeding (ORD group), of the A-group which have Ccr>70ml/min out of all subjects, and of all subjects. The WBC count in the blood was significantly related to the WBC count in the urine of b-group and B-group (both positive correlation). These results were suggested to reveal the progress of the renal disorders.
The hemoglobin-value and the hematocrit-value were related to the U-PLB count in 1mm³ of urine of the GN-group (positive correlation). The color index was related to the frequency of I-form U-PLB of the C-group which have Ccr<30ml/min out of all subjects (negative correlation) and to the P-UV/B of the GN-group (positive correlation). However, the red blood cell count in the blood was not related to the U-PLB.
From these experimental results, it is also assumed that the platelet functions, particularly the platelet adhesiveness, are concerned with bath glomerular filtration and the excretion of U-PLB into the urine.

View full abstract

Among 109 cases of renal cell carcinoma which received treatment at Jikei University Hospital during the 26 years from 1953 to 1978, clinical observation was carried out in 10 cases (9.2%) diagnosed as having tumor thrombus of the inferior vena cava.
Out of these 10 patients, 7 were males and 3 were females. Their age ranged from 22 to 69 years, with an average of 50 years. The affected side was right in 8 cases and left in 2 cases, with a prevalence of the right side.
As the triad, apart from gross hematuria observed in 8 of 10 cases the renal mass could be palpated in as many as 7 cases (70%). Extrarenal symptoms were noted in 9 cases, especially fever was seen in a high percentage of patients (7 cases or 70%).
Clinical findings of inferior vena caval obstruction revealed varicocele in the right side in 2 cases and edema of lower extremities in 2 cases. However, proteinuria was found in 7 cases (70%).
Laboratory findings showed an elevation of α₂-globulin levels in 9 cases, and positive CRP in 5 of 7 cases tested. Liver dysfunction was noted in only 2 cases.
The excretory urography demonstrated no visualization in 3 cases (30%). In 6 of 7 cases in which selective renal arteriography was performed, striated vascular pattern was seen. In addition, in 3 cases collateral veins were visualized, which suggested the possible presence of tumor thrombus from the renal vein to the inferior vena cava. The inferior vena cavography carried out in 8 cases revealed a filling defect in all of the cases tested, being consistent with the presence of tumor thrombus. Therefore, the inferior vena cavography was considered to be most valuable as an aid for diagnosing this disease. In 2 cases, in which the inferior vena cava was found to be obstructed completely, extensive collateral veins chiefly consisting of vertebral and lumber veins were observed.
Among these 10 cases, metastasis was found at the initial examination in 6 cases (60%). The remaining 4 cases (40%) showed no metastasis.
In 6 cases operation was carried out. Except one case which was diagnosed as having unresectable lesion, nephrectomy was performed in 5 cases, in 3 of which venacavotomy and thrombectomy were performed at the same time.
As to the clinical courses of 10 cases, in 5 of 6 cases with metastatic lesion death occurred within one year from the start of treatment, with only one case surviving these 7 months after nephrectomy. On the contrary to this, 2 of 3 cases without metastatic lesion who received nephrectomy have survived till now, for 8 years and 5 months and one year and 2 months, respectively. Therefore, even in the presence of tumor thrombus in the inferior vena cava, unless there is metastatic lesion, a prolonged survival period can be expected if the tumor thrombus can be resected successfully. Consequently, aggressive surgical approach is recommended in these cases.

View full abstract

Correlations among tumor emboli, distant metastasis, toxic clinical signs and prognosis of the patients in renal adenocarcinoma were investigated on 41 nephrectomized cases (11 cases were alive over 5 years and 30 cases were dead) and on 25 autopsy cases.
1. Tumor emboli were recognized either by gross examination of the renal vein and its main branches and by microscopic detection of tumor emboli in small veins in 3-5 slides which were stained by elastics Van Giesen's stain.
2. There was a close correlation among tumor emboli, distant metastasis and prognosis. Cases in which embolus could not be recognized, distant metastasis was none or rare and the 5 year survival rate was high. In cases in whom tumor emboli were recognized, distant metastasis were often observed not only at the end stage but also at the relatively early stage, and the 5 year survival rate was low.
3. There was a close correlation between tumor emboli and clinical toxic signs, but in some cases there was no correlation.
4. Based on the close correlation among tumor emboli, clinical toxic signs and the prognosis of patients, we proposed a new system of classification of renal adenocarcinoma, which is as follows;
Type 1 Cases with positive tumor emboli, and positive toxic signs.
Type 2 Cases with positive tumor emboli, and negative toxic signs.
Type 3 Cases with negative tumor emboli, and negative toxic signs.

View full abstract

The improved gray scale echography in transrectal ultrasonotomography can provide fine visualization of anatomical structures and pathological changes of prostatic gland.
Ultrasonic findings from the inside of the prostate were classified into three acoustical patterns: solid pattern, cystic pattern and mixed pattern. The findings under each pattern were sub-classified according to their shape, distribution and border. Another classification was also done from pathoanatomical view dividing the findings into inner gland pattern, outer gland pattern, nodule pattern, stone pattern and miscellaneous. Each pattern was statistically evaluated in normal and abnormal prostate.
Diagnostic criteria for prostatic diseases were revised, considering the internal echo patterns from the prostate. Diagnostic accuracy in 167 gray scale prostatic scans was 89per cent, 9per cent higher as compared with that of conventional scan. Gray scale transrectal ultrasonotomography proved to be more accurate diagnostic means for analysis of prostatic pathology.

View full abstract

The initiation and propagation of the pelvi-ureteric peristalsis were studied through the direct observation of peristalsis, both microscopically and electrophysiologically. A microscopic ripple-like contraction of a constant frequency was generated spontaneously at the border between the upper, middle, and lower major calyces. At the same time electromyograms were recorded in the same region with constant discharge interval. Propagated waves were originated toward the ureter at different times from three major calyces, without infusion or with intrapelvic infusion. Without infusion, most pacemaker contractions usually disappeared within the calyces or pelvis, but when infusion was started, pacemaker contractions propagated toward the pelvis and ureter. Furthermore, when the solution was infused into only one calyx, the pacemaker contraction generating at the infused calyx always propagated toward the pelvis and ureter. I could not find a certain law as to which pacemaker peristalsis controls the contraction of the pelvis and ureter. But, amount of solution infused into the calyx, that is, urinary excretion into the calyx in vivo, was thought to be one of the important factors for propagation.

View full abstract

The histological, electrophysiological, and pharmacological observations were performed on the canine urethra (the posterior urethra in the male, and total urethra in the female), as well as the bladder neck and the bladder dome as the control, and the following results were obtained.
1. The canine urethra had the intrinsic smooh muscle with the construction of 2 layers (inner longitudinal and outer circular) just inside the mucosal layer. Besides it, the intrinsic urethral striated muscle with the construction of 3 layers (inner circular, middle longitudinal, and outer circular) was observed just outside the smooth muscle layers.
2. The intrinsic urethral striated muscle was observed to extend from the external sphincter region to the middle portion of the outer prostatic capsule in the male, but in the female, it was observed to extend from the external sphincter region to the slightly distal part of the midway of the urethra. This striated muscle gradually lost its 3 layers construction and tended to be thin in its proximal part, but in the distal part, it gradually increased its circular layers and tended to be thick.
3. The tissue strip in circular direction of the urethra with whole layer was suspended in the organ bath with Krebs solution at 38°C, and transmural electrostimulation (TMS) was done, and the contraction response was examined. Almost the same strip of the bladder neck and the bladder dome were used as the control. The tissue strips which were obtained from the distal part of the urethra, the midway of the urethra or just distal part from the apex of the prostate, and the bladder neck, showed somewhat different contraction response, which was assumed to be corresponded to the histological composition of the tissue, i. e., the ratio of the smooth muscle and the striated muscle.
4. With the same procedure, the effect of various drugs on the response of the tissue strip in the organ bath was observed. Acetylcholine and atropine for the cholinergic system, phenylephrine and phentolamine for the alpha-adrenergic system, isoproterenol and propranolol for the beta-adrenergic system, DMPP and hexamethonium for the ganglionic system, and Tetrodotoxin for the Na⁺-channel inhibitor, were used. The change of tonicity and contraction response to TMS was examined after administration of stimulant, blocker, stimulant after each blocker, or stimulant after Tetrodotoxin.
5. The response which was thought to reveal the existence of cholinergic system could be observed markedly in the bladder dome, and slightly in the bladder neck, but it could not be observed in the whole urethra.
6. The response which was thought to reveal the existence of the alpha-adrenergic system could be observed markedly in the proximal half of the urethra as well as the bladder neck, and slightly in the bladder dome, but it could not be observed in the distal half of the urethra.
7. The response which was thought to reveal the existence of the beta-adrenergic system could be observed in the whole urethra as well as the bladder neck and the bladder dome, as the inhibition of contraction response to TMS after administration of the beta-blocker. Howerer, the pattern of the response was somewhat different according to the locality.
8. The response which was thought to reveal the existence of the ganglionic system could be observed clearly in the proximal part of the urethra, the bladder neck, and the bladder dome with small difference in its response pattern
9. The administration of Tetrodotoxin could not affect the tonicity of each tissue strip used, but it could depress the contraction response of these tissue strips to TMS. The tonicity of the bladder dome increased by administration of acetylcholine after Tetrodotoxin, while the tonicity of the midurethra and the bladder neck increased by administration of alpha-stimulants after Tetrodotoxin.

View full abstract

Thirteen institutions have received grants from the Japanese Ministry of Education, for comprehensive scientific research into vesico-ureternal reflux (VUR). On this research grant, we have made inquiries into 494 patients with non-obstructive VUR.
A computerized review of these cases was as follows:
A. Analysis of 494 cases (a real number).
1. There were 130 males and 364 females; the male-to-female ratio was 1:2.8.
2. The incidence of previous urinary tract infection (UTI) was 76 per cent in males and 88 per cent in females. This difference was caused by adult females under full, sexual life.
3. We grouped the VUR into six grades. Low grade reflux (IA-IIB) recovered in approximately 70 per cent and reflux less than III grade comprised more than 90 per cent. It became clear that patients with primary VUR mostly had low grade reflux. Patients with bilateral reflux comprised about 45 per cent of this series. High grade bilateral reflux tended to occur among young male patients.
4. The coefficient of correlation between right and left reflux was r_s=0.63. This indicated that primary VUR has a high probability of developing bilateral reflux.
5. As far as the coefficient of correlation was concerned, there were no relationship between the grade of reflux and the present illness.
6. The coefficient of correlation between grade of reflux and renal function using intravenous pyelography (IVP) was very low (r_s=0.258), whereas that between grade of reflux and morphological change of the pyelogram was very high (r_s=0.662). Therefore, high grade VUR was associated with morphological change rather than renal function.
B. Analysis of 536 cases (a total number). 42 of this series (494 cases) were included in both groups (group A and B) because surgical repairs were performed after long-term (over 6 months) chemotherapeutic treatment, so that the series amounted to 536 cases.
1. We divided 536 cases into four groups; i. e., group under chemotherapy (group A) 297 cases (55.4%), surgically treated group (group B) 194 cases (36.2%), non-treated group (group C) 39 cases (9.3%) and a fourth group (group D) 6 cases (1.1%).
2. A comparative study of the characteristics of A, B and C groups was as follows: Group A consisted of relatively young girls with low grade reflux. Group B was made up of a large number of cases with high grade reflux and recurrent UTI. Group C was composed of cases with low grade reflux and few episodes of infection.
3. Surgery for reflux consisted of combined Politano-Leadbetter's method 66 cases (23.1%), original Politano-Leadbetter's method 59 cases (20.6%), Lich-Gregoir's method 58 cases (20.2%) and Paquin's method with cuff 49 cases (17.1%).
C. Analysis of the results in each group.
1. Cures of reflux after each type of treatment were compared. Group B had significantly good results, especially grade III and IV groups. This rate differed from other groups to a statistically significant degree (p<0.001). Overall cure rate in group C was 70 per cent, which was better than in group A.
2. Concerning fever attacks, group B had the highest improvement rate, especially the cases with reflux greater than grade II. This was almost the same as the cure rate of reflux.
3. Concerning renal function, IVP results did not show any statistically significant difference among the three groups. However, the changes in pyelographic forms of group B, especially in the grade III, differed significantlly from other groups.
4. In group A, analysis of reflux-cured cases showed the following: These cases almost all have less than grade II reflux. All reflux-cured cases over grade III reflux were younger than ten years old.
5. The cure rate by original Politano-Leadbetter's method was 100 per cent, Paquin's method 94.6 per cent, combined Politano-Leadbetter's method 90.9 per cent and Lich-Gregoir's method 77.8 per cent. Regarding unsuccessful cases of surgery

View full abstract

The way of immune response is divided into humoral antibody and cell-mediated immunity, the former possesses two factors which are systemic immunity and local immunity. Local immunity, at present, has been mainly studied in the respiratory tract or the gastrointestinal tract. The knowledge about the urinary tract is still meagre. We studied the urinary secretory IgA (SIgA), especially its localization in the urinary tract, for the first step of the study of the urinary local immune systems.
As the detective method for the urinary immunoglobulins and serum SIgA, we used Enzyme-linked Immunosorbent Assay (E. L. I. S. A.) technique using horseradish peroxidase as enzyme for avoiding the inaccuracy and the complexity of Single Radial Immunodiffusion Assay (SRID), in which urine is needed at 100-1, 000 fold concentration for detection. Urinary IgG and IgM were detected with monospecific rabbit antisera in the same way as we did on the serum. Assay of urinary IgA was performed after absorption of the samples with anti SC. Urinary SIgA was detected with anti SC, based upon the result that the values of SIgA with anti SC as antibody were correlated to the values of SIgA using anti SC minus FSC. Serum and urinary albumin, serum IgG, IgM, IgA were measured with SRID. For the localization of SIgA in the tissues, indirect method of enzyme-antibody technique which used peroxidase as enzyme was employed. This technique, compared to fluoresent antibody technique, has some merits; 1). Ordinary light-microscope is able to be used, 2). Specimens can be preserved permanently, 3). It may apply to immune electron microscopy.
The conclusions obtained were as follows;
1) Urinary IgG, IgM, IgA and SIgA values of 18 patients of chance, proteinuria were about 10 fold of 43 healthy controls. The clearance values in IgG, IgM and IgA, which was calculated from serum and urinary values and urine flow rate, were distributed with a similar range to that in albumin. But the value of clearance in SIgA was much higher. SIgA was higher than other immunoglobulins in urinary per serum ratio against albumin. Local production rate in the urinary tract, which was calculated with the formula of (C_Ig.-C_A1b./C_Ig.)×100, was able to be calculated in 6 cases of IgG, 4 of IgM and 1 of IgA. But the rate of SIgA even in the least case was 99.3%. Therefore, we thought that urinary SIgA would be originated entirely from the urinary tract.
2) The distribution of SIgA in the urinary tract was studied by the detection of SIgA using bilateral renal urine, vesical urine and spontaneous urine. There was no laterality between renal urines in secreting SIgA. On the average, in male, SIgA was secreted from kidney or ureter by 6.5%, bladder by 20.6% and urethra by 72.9%. In female, the percentages were 9.7%, 21.4% and 68.9% respectively. The superiority in the urethra in secreting urinary SIgA was evident.
3) The detection of SIgA and bacterial count were done in the saline irrigated small-cutted urethra of a female patient with urethral tumor. The peak levels of SIgA were near the external urethral orifice and bladder neck, and it was low in the mid-urethra. The number of bacteria was on the order of 10³ level at any areas. Therefore, urethral SIgA was not considered to be the natural antibody against these normal flora.
4) Using renal and vesical urine collected every 4 hours from 2 patients (Lt.-U. P. stricture, Idiopathic retroperitoneal fibrosis), secreting circadian rhythm of SIgA was studied. In these four groups, SIgA values had two peaks every 12 hours. Therefore, collection of random urine must be performed cautiously in estimating urinary SIgA.
5) The tissue specimens from urinary tract infections were studied by enzyme-antibody technique. In the renal tissue (basal disease was renal stone), the dark brown spots of SIgA were dispersed in tubular epithelial cells and mesenchyma.

View full abstract

1) P. aeruginosa has been consistently isolated from 26.5 to 42.4% of the patients with urinary tract infections in the urological ward of Okayama University Hospital for the past 7 years. 232 (22.3%) out of 1042 hospitalized patients were with urinary tract infections with P. aeruginosa for past 4 years. Of these, 149 (64.2%) were thought to be the catheter induced urinary tract infections. The mode of spreading of this organism was epidemiologically investigated.
2) The following three laboratory assays were used for identification of P. aeruginosa isolated from clinical and environmental strains; serological typing, antibiotic sensitivity and protease and elastase production. Serological typing with 13 immunodiagnostic sera (Toshiba Chemical Industry) was performed by slide agglutination method. Protease and elastase production were detected by the method described by Goto et al.
In combination with serological typing and antibiograms, protease and elastase production offers the finest means of differentiating the strains of P. aeruginosa.
3) Of 136 clinical strains of P. aeruginosa, 89.7% were serotypable strains. Serotype K was the most prevalent (36.0%), followed by serotype E (28.7%), F (10.3%) and A (7.4%). Most of serotype F and B which were concurrently isolated from patients in 1976 had the same patterns of antibiogram and production of protease and elastase. It was strongly suggested that these patients were nosocomially cross-infected with the P. aeruginosa from the catheterization or through instrumentation.
4) Of 354 environmental specimens, 78 P. aeruginosa (22.8%) were isolated, which were frequently isolated from floor mops and sink-drains. Of these strains, 87.2% were serotypable strains. Serotype E was the most prevalent (42.3%), followed by serotype K (24.4%) and B (12.8%). The same strains were seldom detected at the same sources successively, but different types of P. aeruginosa were usually detected. Among the serotypes E, F and K, 18 strains (23.1%) were identical with the clinical strains. All of these were found during or after the clinical outbreaks of P. aeruginosa infections. There was no environmental strains that caused clinical infections. The other 60 strains (76.9%) were different from the clinical strains, and present only transiently in the hospital environments.
5) Both clinical and environmental strains similary produced protease and elastase at 70 to 80%, hemolysin at 100%. Only 10 out of 37 environmental strains (27.0%) were found to produced exotoxin.

View full abstract

Between 1965 and 1977, there were 55 cases of testicular tumor at the Okayama University Hospital. The incidence of the disease was 0.30% of male outpatients, 1.77% of male inpatients and 5.94% of male patients with urogenital tumor. There were only 21 cases between 1955 and 1964, and it was considered that the incidence of the disease tended to gradually increase in recent years.
This opinion is supported by the report of the Japan Welfare Ministry, in which the number of the death cases with testicular tumor was 35 in 1947, 86 in 1957, 144 in 1967 and 202 in 1977. This statistical observation of death cases also indicated that elder age group (over 50 years old) showed a decreased incidence, but young adults showed a significantly increased incidence.
On the other hand, the incidence in children in Japan, which was higher than that in USA, remained stationaly in the observed periods. It showed a higher incidence of the testicular tumor under 2 years of age but a higher mortality over 2 years old, although embryonal carcinoma was a majority tumor in children under 3 years old.

View full abstract

In the chemical compositions of the urinary stone, cholesterol is very rare. We reported a first case of pure cholesterol stone in Japan.
The patient, 48-year-old male, was hospitalized on November 24, 1977 for anuria following colic pain on the right flank during 3 days.
He was operated on for left nephrectomy under the diagnosis of left renal stones in 1967 and operated again for right ureterolithotomy under right ureteral stone in 1971.
On the same day as admission (1977), two stones were removed by right ureterolithotomy. The composition of these stones analysed by infrared spectroscopy were phosphate calcium (Fig. 2). Being followed for two months after the discharge at his home, multiple stones were passed spontaneously (Fig. 3). On February 9, 1978, he came to our hospital with anuria and was done right nephrostomia. These calculi, passed spontaneously, were analysed as pure cholesterol stones by infrared spectrophotometer (Fig. 4).
His urinary excretion levels of cholesterol was markedly elevated to 133mg/24hrs, but the excretion, measured in 10 cases of healthy subjects, was negative.

View full abstract