Recently as the cases of long-term hemodialysis have increased, it has become very important in the maintenance hemodialysis to prevent the complications of hemodialysis; hypertension, anemia and disorder of Ca metabolism. In our research hypertension, one of those complications, will be analyzed for the cause and condition. Thirty-four cases of long-term maintenance hemodialysis are examined about PRA, TBV, TPV and [Na]_E.
The results of our analysis are as follows:
I) Studies on PRA, body fluid volume and blood pressure
1. In the cases of long-term maintenance hemodialysis TPV before hemodialysis reduces to about 80% of the normal value; TBV to about 70%. Significant difference can not be found out in TPV and TBV after hemodialysis.
2. Systolic pressure before hemodialysis has much relation to TPV, TPV/Kg and TPV/m² (r=0.65, 0.68, 0.62). Diastolic pressure before hemodialysis also has much relation to TPV, TPV/Kg and TPV/m² (r=0.60, 0.68, 0.62). But both systolic pressure and diastolic pressure after hemodialysis have no relation to TPV, TPV/Kg and TPV/m². Additionally TBV has the same relation to blood pressure as the relation between TPV and blood pressure.
3. Before hemodialysis PRA has much relation to TPV, TPV/Kg and TPV/m² (r=0.88, -0.85, -0.87).
4. Sodium space is found to reduce after hemodialysis; [Na]_E is 1099±122mEq. But [Na]_E has no relation to blood pressure and PRA.
Those facts above show us that in the cases of long-term maintenance hemodialysis blood pressure is much affected by TPV and TBV. And the reduce of body fluid after hemodialysis is indicated by that of sodium space, and TPV and TBV are not different after hemodialysis, although fluid is removed from vessels.
II) Influence of hemodialysis on PRA
1. PRA at the hemodialysis is apt to increase in its development.
2. In using high Na dialysate TPV and TBV are higher and PRA is lower than in using low Na dialysate.
It shows that the use of high Na dialysate retains water and Na in the body so that TPV and TBV increase and PRA decreases.
III) Clinical classification of long-term hemodialysis cases
The cases of long-term hemodialysis are examined, being divided into the next four groups from the points of PRA and blood pressure.
(A) Normal PRA and normotension group: in the cases the passages of hemodialysis are wholly good.
(B) Normal PRA and hypertension group: which is considered ‘Water and salt dependent hypertension’. In the cases ultrafiltration at the hemodialysis can bring hypertension to normotension.
(C) High PRA and hypertension group: in the cases what is diagnosed ‘Renin dependent hypertension’ bilateral nephrectomy should be done immediately. In other cases ultrafiltration at the hemodialysis can bring hypertension to normotension.
(D) High PRA and normotension group: in the group high PRA is caused by hypovolemia, so the increase of TBV and TPV can reduce PRA.
Group (B), (C), (D) should be improved to the condition of group (A) by treatment. This classification shows us the suitable treatment for each group of long-term hemodialysis cases.

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An application of ultrasonic real-time guidance technique, which was developed at our clinic in 1978, to antegrade pyelography was described. Eleven cases with non-visualizing kidney were studied. Renal pelvis could be hit with one needling attempt and clear pyelo-ureterogram was obtained in all the cases. No special skill was required. This new technique has overcome disadvantages of antegrade pyelography and will contribute to a remarkable improvement in the diagnosis of the upper urinary tract.

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One hundred and fifty-two patients first treated at Department of Urology, Chiba University School of Medicine from June 1960 to December 1977 were followed, and the following results were obtained.
1) The actuarial 5-year and 10-year survival rates of all cases were 40% and 12%, respectively. When classified according to the degree of advancement, 5-year survival rates of stage A, B, C and D were 67%, 70%, 43% and 28%, respectively. Ten-year survival rates of each stage, on the other hand, were 67%, 46%, 11% and 0%, respectively.
2) Eighty-two patients had received anti-androgenic therapy as an initial therapy. The actuarial 5-year survival rates were 56% in stage C and 34% in stage D, thus indicating a slightly better prognosis than the entire group.
3) Those who were treated with anti-androgenic drugs were divided into the sufficient-dose and insufficient-dose groups, and the actuarial survival rates were examined. Five-year survival rates of the former group were 64% in stage C and 47% in stage D. Those of the latter group were 31% and 22%, respectively. The prognosis proved better in the sufficient-dose group.
4) Of the 152 cases, 103 were found dead. The advance of cancer was the commonest cause of death, accounting for 57%, while cardiovascular disturbances accounted for only 15%. In patients who had received anti-androgenic drugs, 53 cases were dead. Fifty-seven % of the death were caused by the advance of cancer, while 13% by cardiovascular disturbances. These figures are similar to those of the whole cases.
5) Reactivation was seen in 41 cases; the interval between the start of treatment and reactivation was 39.7±7.0 months for the stage C and 27.4±3.6 months for the stage D, and the difference between the two groups was significant. The interval between the reactivation and death was 11.2±2.3 months and 9.9±1.7 months, respectively. The difference was statistically insignificant. Reactivation took place in the form of local aggravation in 15 cases, occurrence or aggravation of metastasis to bones, or reincrease of once decreased acid phosphatase in 22 cases, and both in 4 cases.
6) Non-reactivated patients whose cancer had been suppressed for more than 2 years were compared with the group of reactivation. The group of reactivation was predominated by cases showing abnormal erythrocyte sedimentation rate or hydronephrosis at the first consultation. No difference was seen with castration or depending on the rates of hormone administration.
7) Of the reactivated cases, the sufficient-dose group was found rather delayed in development of reactivation as compared with the insufficient-dose group. But no difference was seen in the length of time between reactivation and death.
8) Radiation was found effective for local reactivation, but there were no good measures against reactivation extending to bones.

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Sperm motility is one of the most important aspects of fertility as well as sperm count. However, there is no objectively reliable method of identifying sperm activity.
A new method which expresses objectively the amount of active sperm movement was devised and its clinical application was studied. The new method, “Sperm motile efficiency”, was determined in the following ways.: Using a melangeur for counting white cells, semen is diluted 20-fold with physiological saline solution. With the diluted semen on Thoma's hemocytometer, the number (N) of spermatozoa passing its small quarter line is counted for one minute and (N) is divided by the sperm density (d) in millions per ml, and the value is multiplied by 100.
The formula is as follows and it is expressed by ME/min.: Sperm motile efficiency=(N)/(d)×100ME/min.
The fluctuation coefficient by procedure had a range 2.08% to 9.77%, and the normal value of sperm motile efficiency was 126.42±60.65ME/min.
In the present study, sperm motile efficiency was examined in 1087 semen specimens.
The results indicated a correlation of 0.633 between sperm motile efficiency and sperm motility measured by an expart. In 472 male sterility patients, the value of sperm motile efficiency in pregnancy cases was significantly higher than in infertile cases (p<0.01).
The pregnancy rate of a high motile efficiency group (50ME/min, or more) was 27.03%, and the pregnancy rate of a low motile efficiency group (less 50ME/min) was 6.93%.
In addition, the prengnacy rate of a high motile efficiency group except infertile female cases was 47.71%. Therefore, this new method is expected to be a suitable measure for actual sperm movement and fertility.

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The distribution of inorganic ions in calcium oxalate stones and calcium oxalate and calcium phosphate stones, of which composition had been decided with an infra-red spectrophotometer and x-ray deffraction were studied using an electron probe x-ray microanalyser.
The results obtained are as follows:
1. Calcium oxalate stone.
The stones, which were shown by the infra-red spectrophotometer and x-ray deiraction to be composed purely of calcium oxalate, contained almost no inorganic ions except for calcium in their outer portion. As to the composition of the nucleus of the stones, 3 types were found: 1) The nucleus composed purely by organic substances, having deposit of calcium oxalate at the surface of the substances. This indicates that the organic substances induce the deposition of calcium oxalate. 2) The nucleus composed purely by calcium oxalate. 3) The nucleus composed by calcium oxalate and calcium phosphate. In the 3rd case calcium oxalate was found in the center of the nucleus and calcium phosphate existed surrounding the calcium oxalate crystal. Therefore, in the 2nd and 3rd cases calcium oxalate deposits first and stone grows on the deposit.
2. Calcium oxalate+calcium phosphate stone.
The area containing calcium phosphate did not mix with the area of calcium oxalate homogeneously but it existed in the calcium oxalate as a clot, having a clear border. When Mg, K, and Na were found in the stone, these ions existed not in the area of calcium oxalate but only in the area of calcium phosphate.
The distribution of organic and inorganic substances in the nucleus of calcium oxalate and calcium phosphate stones was almost the same as seen in the pure calcium oxalate stones.

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In the previous paper, the distribution of inorganic ions in the calcium oxalate stone and calcium oxalate and calcium phosphate stone examined by electron probe X-ray microanalyser (E. P. M. A.) was reported. In this paper distribution of inorganic ions in the calcium phosphate stone and uric acid stone was studied by using E. P. M. A.
The results obtained are as follows:
1. Calcium phosphate stone.
In the outer portion of the stones, Ca, P, Mg, Na and K were distributed homogeneously, although a slightly uneven distribution was seen for Mg, Na and K. No particular structure was seen corresponding to the distribution of these ions.
As to the nucleus of calcium phosphate stones, two types were observed: In one type the quantity and quality of inorganic ions contained in the nucleus (Ca, P, Mg, Na and K) are almost the same as those seen in the outer portion of the stone, indicating no difference between the nucleus and outer portion of the stone in their inorganic constituents. In another type, the inorganic constituents of the nucleus were different from those of the outer portion. In this case, S, Al and Cl were contained in the nucleus in addition to Ca, P, Mg, Na and K. S and Cl were situated in different portions of the nucleus from Mg, Na and K.
2. Uric acid stone.
Two types of uric acid stone were observed. One type contained no inorganic ions. Another type contained Ca, Na and K in the outer portion of the stones. In the latter, Na and K were deposited in the different layers, showing a striped pattern.

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In the previous two papers the distribution of inorganic ions in calcium oxalate stone, calcium phosphate stone and uric acid stone examined by the electron probe X-ray microanalyser (E. P. M. A.) was reported. In this study the process of dissolution of calcium phosphate stone and calcium oxalate stone with E. D. T. A.. 4Na solution was observed by E. P. M. A.
The results obtained are as follows:
Thin slices of the urinary calcium stones were easily dissolved by E. D. T. A.. 4Na solution. Ca and Mg disappeared quickly but Na and K remained in the matrix substance. This result shows that calcium stones can easily be dissolved by E. D. T. A. solution when it is broken into small pieces by some procedure, and that after decalcification with these chelating agents, application of proteolytic material is recommendable for protection from re-calcification.

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The possibility of controlling the genesis or growth of tumors by the immunological surveillance system of the host has recently been pointed out and a variety of immunostimulants including BCG has been used in cancer therapy. While a considerable amount of experimental work has been done on the antitumor effect of immunostimulant, the majority of such experiments deal with tumors transplanted into inbred animals and may not necessarily provide models for spontaneous tumors.
Therefore, the present auther induced experimental bladder tumors in rats with N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) and investigated the changes in cellular immunity in the process of carcinogenesis with time by way of the lymphocyte transformation by PHA stimulation. The effect of BCG and BCG-CWS upon responses to PHA and carcinogenesis was also evaluated.
The method was as follows;
BBN was administered to BCG-dosed, BCG-CWS-dosed and undosed control groups and the responses of peripheral blood lymphocytes by PHA stimulation using whole blood culture were determined. At the same time, body weight changes, urinary occult bleeding and signs of macroscopic hematuria were investigated. In the 30th week after the start of BBN administration, each bladder was removed and weighed and the carcinogenetic status was studied macrscopically as well as histologically.
The following results were obtained:
1. For all groups, after the administration of BBN, the SI values increased once in the 6th week and tended to drop in the 12th and following weeks. In the BCG-dosed group, the subsequent decrease was not so prominent and, in the BCG-CWS group as well as in the undosed control groups, the SI values dropped with time. In the 30th week, there was a statistically significant drop in SI, irrespective of the administration of BCG or BCG-CWS.
2. In all groups, occult bleeding was observed around the 15th week and gross hematuria began to show up after 20 weeks. There were gradual gains in body weight for all groups.
3. The average weight of bladders was 0.338±0.075g for the BCG-dosed group (control; 0.613±0.196g) or 0.448±0.068g for the BCG-CWS group (control; 0.491±0.144g). The average bladder-to-body weight ratio was 0.126±0.028% for the BCG group (control; 0.230±0.071%) or 0.165±0.022% for the BCG-CWS group (control; 0.188±0.056%).
4. As observed macroscopically, some bladders showed only wall hypertrophy and others showed solitary or multiple villous to broad-based growth in all groups.
5. Histologically, tumors in grade I to III were found but the incidence of grade I was predominant in the BCG-dosed group and that of grade II was predominant in the control group. In the case of BCG-CWS, no clear difference from the control group was observed.

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Ileal conduit diversion has been evaluated as one of the most established method of urinary diversion after radical pelvic operation. Although results and problems of ileal conduit diversion are seen in world literature, there were few reports in Japan. We, herein, reported the early and late complications of 130 patients with ileal conduit diversion performed at Keio University Hospital for the past 12 years. In the present study, 96% of the patients had the bladder cancers. Early complications were in 35 cases and late complications were in 43 cases in this series. Our special reference to urolithiasis as a late complication revealed that urea splitting organisms in urinary tract, alkalinization of urine and pre-operative urological complications were concerned.

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A 43-year-old male patient was admitted with a complaint of fistula formation. The patient got a right scrotal injury when climbing in August 1977. In October, he recognized creamy discharge through a fistula of the scrotum. At the scrotum, there was an orifice, which was 2mm in diameter. The induration was palpable between scrotum and vas deferens. Sinogram showed a fistula formation. Vasocutaneous fistula following injury was diagnosed. The fistula was resected with the epididymis.
Ten cases of vasocutaneous fistula including our case were collected, and the pathogenesis was discussed.

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