The cell line was derived from a transitional cell carcinoma of the bladder in a 50-year-old male. This has been maintained for over 130 transfer generations.
The cells transplanted subcutaneously into nude mice produced well-demarcated solid tumors in 3 of 5 nude mice 24 days after transplantation, and the tumors gradually increased in size.
The cytological and histological characteristics of the cells in monolayer cultures and of the tumors developed in nude mice were studied light microscopy in relation to the features of bladder carcinoma.
Morphologically the microscopic structure of the cells in the cultures and of the tumors developed resembled closely that of bladder carcinoma.
Re-transplantation of the tumors developed was performed successfully in one of 2 nude mice, and the re-transplant developed into a very large tumor. After 102 days in re-transplantation, the nude mouse died of tumor, and autopsy revealed a large tumor bulging in the abdominal cavity and involving the right kidney and liver and some hematogenic pulmonary metastases.
Chromosomal analysis of the cells at the 160th transfer-generation revealed the hyperdiploid number of chromosomes with the modal number of 59 and 2 marker chromosomes individualized by a centromere index of 20. 0 and of 28. 5.
Using a replicate culture method, the doubling time of the cells was 23.5 hours.

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The capillary tube leukocyte adherence inhibition test (LAI test) was performed for determination of cellular immunity in the tumor bearing hosts with bladder cancer. The materials of this study were 43 cases, including 14 of either non-malignant disorders or malignant tumors other than bladder cancer in the urological field as the controls.
The antigen of 3M KCl extract was prepared from the tissues of transitional cell carcinoma of the bladder. The mean value of the percentages of non-adherence index (NAT) by LAI test from 28 cases of bladder cancer was 41.4±22.0. On the other hand, the percentage of 15 control subjects was only 14.7±11.0. It means that the 3M KCl extract from bladder cancer tissues is applicable to LAI test as common antigen. NAI in 5 malignant tumor bearing hosts with different histological types (2 prostatic adenocarcinomas, 2 renal cell carcinomas and 1 urethral squamous cell carcinoma) demonstrated a lower percentages of 17.6±8.9 in mean values as in benign control subjects. An additional experiment presented two exceptional cases of adenocarcinoma in the bladder which showed predominant activities on LAI test. Throughout the results described above, the necessary comments about the antigen specificities for LAI test were done.
Next attention was drawn to the LAI reactivities of bladder cancer patients with different advances of tumor growth. It was revealed that the LAI of the patients with initial growth of tumor (Stage A) were widely ranged, though the advances of tumor growth induced higher reactivities. It is of interest that the unresponsiveness of LAI was found in certain cases with metastasis, which were under critical conditions. The correlations between the delayed type hypersensitivity on skin and LAI test were not determined in this study. Further precise investigations should be undertaken.

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For the selection of optimal anti-cancer drugs, the sensitivity test using egg culture has been attempted. The use of chorioallantoic membrane of the chick embryo for heterogenous tumor growth dates back to the classic studies of Murphy. (1912) Since then this method of egg culture has been modified by various investigators. Fertile white leghorn eggs incubated at 37°C from nine to thirteen days were used in the present study. Human bladder tumor was surgically obtained, which was cut into fragments approximately 1mm³ in size.
A single fragment of tumor tissue was placed on the major blood vessel branches in the chorioallantoics. Two days after tumor plantation, anti-cancer drugs such as 5-Fluorouracil (5FU), Mitomycin C (MMC) and Carbazilpuinone (CQ) were injected into the yolk sack, and two days later the tumor was removed and examined with a light microscope and electron microscope.
The following results were obtained. Bladder tumors from 48 patients were implanted and examined, and their successful plantation rate was 83.4%. Sensitivity tests of anti-cancer drugs for 30 patients were performed. Subsequently the drug was chosen according to this result, 28 patients were successfully treated during the past 18 months.
The changes of cultured human bladder tumors due to anti-cancer drugs observed with a light microscope were nuclear degeneration, vague surrounding of the cell, decreased intensity of cell staining, cell infiltration arround tumor cells and fibrotic change arround tumor cells.
The electronmicroscopical effects of anti-cancer drugs on cultured human bladder tumors were irregular nuclear profilers, swollen mitochondria, a decrease in number and low electron density of rough endoplasmic reticulum, an increase in number of acuole and lysosome and changes of cell junction.
There was no relation between successful plantation rate and patient age, sex, pre-operation chemotherapy, methods of tumor removal, macroscopic features, and malignancy. But there was significant relation between the survival rate of inplanted tumors and the macroscopic features and malignancy. Sensitivity tests of single anti-cancer drug such as CQ, MMC and 5 FU for 14 patients were attempted. And their mean cell survival rates were 87.6% (control), 51.8% (MMC), 44.8% (CQ) and 23.5% (5FU). 5FU was the most effective in this case.
In addition to these drugs, sensitivity test of combination drugs such as CQ & MMC, CQ & 5FU & MMC, and these 3 drugs were tested to 9 patients. And their mean cell survival rate were 86.5, 86.6% (control), 59.1% (MMC), 37.0% (CQ), 25.4% (5FU), 39.4% (CQ & MMC), 43.6% (CQ 5FU), 50.3% (MMC & 5FU), and 43.1% (3 drugs).

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We have formerly reported a method of classifying the type of infection in complicated urinary tract infections into six groups according to the efficacy of chemotheapeutics. This time, we investigated the characteristics of each group from a viewpoint of drug efficacy.
In UTI with indwelling catheter and afterprostatectomy, Proteus spp., Serratia and P. aeruginosa were isolated more frequently as infecting organisms than in the other groups, and MIC distribution of each drug in these two groups deviated significantly to resistant side, and also cross infection occurred frequently in cases with indwelling catheter. We believe that is the reason why drug efficacy was so low in these two groups.
Drug efficacy was also low in the cases with mixed infection compared to those of single infection, but the reason why drug efficacy was low in mixed infection was not clear. It was suggested, however, inactivation of drugs, especially penicillins, contributes to the lowering of the efficacy to some extent.

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A method for clinical evaluation of antimicrobial agents on complicated urinary tract infections was reported.
The outlines were summarized as follows.
1) Complicated UTI with underlying diseases of the urinary tract in patients over 16 years old of both sexes is adopted as an object.
2) Pyuria over 5 cells/hpf and bacteriuria over 10⁴CFU/ml are considered to be necessary as a condition of patient.
3) The clinical efficacy of the drug has to be estimated after a 5 days' treatment.
4) The overal clinical efficacy has to be evaluated based on the response of pyuria and bacteriuria. Symptoms were not availed as a parameter of overall clinical efficacy because of the low frequency.
5) Method for classifying the type of infection which affects the efficacy of drugs was reported.

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From 1963 to 1977, 101 patients underwent adrenal surgery at our clinic. Of these, 73 patients for whom time more than 2 years had elapsed after surgery were followed-up.
Twenty-six patients with primary aldosteronism caused by adrenal adenoma had unilateral adrenalectomy. One was lost to follow-up. One died of unknown cause 2 years after operation. The remaining 24 patients are living and engaging in ordinary activity. Blood pressure has almost been normalized in all patients. Symptoms and signs referrable to primary aldosteronism have disappeared in all patients.
Out of 14 patients with pheochromocyuoma, 12 had a single adrenal tumor removed by adrenalectomy and contralateral tumor extirpation, and one with multiple pheochromocytoma had unilateral adrenalectomy followed by tumor extirpation. One died of diabetes mellitus 2 years after operation. Hypertension and symptoms have disappeared in 11 patients, but they have recurred in 2 patients.
Adrenal cortical adenoma was the cause of Cushing's syndrome in 16 patients who had unilateral adrenalectomy. One patient died one week after operation. Hypertension and symptoms have disappeared except in one patient. Two-thirds of the patients failed to discontinue steroid replacement therap
Out of 14 patients with Cushing's syndrome by adrenal cortical hyperplasia, 11 underwent bilateral adrenalectomy. Eight of these have no hypertension or symptoms on corticosteroid replacement and are engaging in ordinary activity, but one patient has persistent hypertension. Nelson's syndrome has developed in the remaining 2 patients. One patient had subtotal adrenalectomy and has no hypertension or symptoms. Two patients had unilateral adrenalectomy combined with pituitary irradiation. One died of pneumonia 8 years and 5 months after operation. The other one is free from any symptoms and signs.
One patient with Cushing's syndrome due to adrenal carcinoma had laparotomy and died of liver metastasis.
One patient with adrenogenital syndrome due to adrenal adenoma had adrenalectomy. Hypertension and hursutism has subsided gradually and has regular menstruation.

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A usefuliness as indicator of early detection, follow up of recurrence and malignancy was studied about patients with bladder tumors.
The results were as following:
1. A significant correlation between urinary cytology and existence of tumor (P<0.001).
2. A significant correlation between cytology and grade of tumor by histological study (P<0.05).
3. High detection ratio of tumors (86.7%) were confirmed among positive cases by urinary cytology and urinary FDP. Also, there were tendencies that more high grade and non-papillary tumors were found among them. A further comprehensive scrutinizing about the usefullness of the combination method using urinary cytology and urinary FDP will be needed, but there is a hope that it is a useful method to early detect, predict prognosis and select treatment in the clinical diagnosis of bladder tumors.

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The renal vein is one of the most important veins in the body. Therefore, its obstruction causes various diseases, which may be fatal at times. On the other hand, it is said that the left kidney can retain its renal functions owing to its being rich in collateral circulation. However, no adequate studies have been carried out concerning this subject since a few number of investigations have been undertaken.
In this study in 31 mongrel dogs, the left renal veins of animals were ligated centrad to the confluence of the testicular vein in order to determine the course, global renal functions, fluctuations of the blood enzymes levels, renal histological changes, process of collateral vascularization and the left renal functions one to four weeks after the removal of the right (namely the opposite side) kidney.
1. Out of the 31 dogs with the left renal vein ligated, 28 dogs (93.5%) survived more than one to four weeks. This fact indicates that the ligature of the left renal vein of dogs is not always followed by fatal hemorrhage in the perirenal area or high mortality rate but can be tolerated adequately in general.
2. In 5 dogs in which determinations of the serum creatinine levels were carried out for 2 weeks after the ligature of the left renal vein, it was found that all the fluctuations remained within the normal limit.
3. The blood levels of GOT, GPT, alkaline phosphatase, LDH, and aldolase were determined in 5 dogs for 2 weeks after the ligature of the left renal vein. All the changes remained within normal limit in 3 dogs. However, in one of the remaining 2 dogs elevations of GOT, GPT, LDH and aldolase were seen and in the other those of GPT and alkaline phosphatase, although all of these changes were mild and transitory in nature. From these results it was considered that histological changes caused by the ligature of the left renal vein were mild.
4. Histological changes occurred under the ligature of the left renal vein included pronounced circulatory disturbances such as thickening of glomerular basal membrane, swelling of the proximal tubular epithelium, retention of albumin cast and dilatation of veins. Four weeks after the ligature, all of these lesions were decreased, and no organic changes were seen.
5. The main collateral vascularization under the ligature of the left renal vein consisted of testicular and ureteral veins, but renal capsular, adrenal and lumbar veins were also found to play roles in collateral circulation by forming netlike communication with testicular and ureteral veins.
6. In 12 dogs removed of the right kidney one to four weeks after the ligature of the left renal vein, the course after removal of the right kidney was observed. All of the dogs in which the right kidney was resected one to two weeks after the ligature died from renal insufficiency 5 to 6 days after the last operation. Out of the 4 dogs which were resected of the right kidney 3 weeks after the ligature, 2 dogs died from renal sufficiency 6 days after the operation, but the remaining 2 dogs survived. All of the 5 dogs which underwent resection of the right kidney 4 weeks after the operation survived with good renal function maintained. The measurements of serum creatinine and excretory urogram were normal.
From these results it was revealed that in dogs ligated of the left renal vein collateral circulation consisting chiefly of testicular and ureteral veins is established in 4 weeks after the operation with recovery of histological changes due to circulatory disturbances and that the left kidney can retain normal functions.

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1) External protrusion of the posterolateral wall of the bladder adjacent to the ureteral orifice is called paraureteral diverticulum. Almost all cases are seen in infants and children and many are accompanied by vesicoureteral reflux. Clinicopathological studies were made on fourteen cases of paraureteral diverticula (male 9, female 5; children 12, adults 2; bilateral 6, left 3, right 5) and discussion was made about their pathogeneses, diagnoses and treatments.
2) Pyelonephritis was the most common presenting sign. Urinary tract infection was present in all cases of infants and children. All cases were free from neurogenic dysfunction of the bladder and lower urinary tract obstruction.
3) Paraureteral diverticula were visualized in only 3 cases on IVP but were present in all cases on voiding cystourethrography. Vesicoureteral reflux of the affected side was present in all cases. Almost all refluxes were of more than Grade III with lower ureteral stasis. Careful cystoscopy with changing vesical volume was required for final diagnosis.
4) Histologically the ureterovesical junction of paraureteral diverticula lacks all three muscular components (intrinsic ureteral musculature, deep periureteral sheath and superficial periureteral sheath) which maintain normal function of UVJ. And in such condition VUR seems to occur freely. Ureteral stasis was present cranial to a few mm above the ureteral opening to the diverticula. Histologic sections of this segment universally show an increase in fibrous tissue, atrophy of smooth muscle cells, infiltration of fibrous tissue into muscle bundle and occasionally abnormal muscular arrangement. These findings are qualitatively identical to the abnormal histology of intrinsic ureteral musculature of other congenital dilated ureters.
5) A refluxing ureter with a paraureteral diverticulum completely lacks in the anti-refluxing mechanism and presents ureteral stasis very frequently. Therefore, we have to treat this disease not in the same way as other primary VUR. As the effect of conservative therapy is not expected, we would like to adopt operative therapy (ureterovesiconeostomy with complete resection of diverticula and distal ureteral segment both of which present muscular abnormality).
6) The relationship between paraureteral diverticula and renal dysplasia is noticed recently. We divided ureteral openings of our cases into four positions (C, D₁, D₂, D₃) by the classification of Wickramasinghe (Fig. 8). Ureteral openings of five dysplastic cases (3 were complete duplex) were in D₂ and D₃ position. All the cases which maintained good renal function on IVP were in C and D₁ position except one case (in D₂ position). Severe renal dysplasia associated with paraureteral diverticula seems to be a total dysplasia similar to aplasia. This is different from the severe dysplasia of ectopic ureter which consists of almost mesonephric like structure.
7) We do not consider paraureteral diverticula either as a simple herniation of vesical mucosa through ureteral hiatus or as simple as other forms of the vesical diverticula. Instead, we would rather like to consider these as a developmental expansion of the terminal ureteral end as evidenced by (a) the histological similarities of the ureteral end of the parau reteral diverticulum to that of the other megaloureters of known various developmental etiologies and (b) the close association between the position of the ureteral orifice and the degree of renal dysplasia which is embryologically well explicable.

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Three cases of secondary testicular tumors were reported and their metastatic routes were discussed.
Case 1. A 19-year-old man was first admitted in June, 1966 because of a left testicular tumor. Two years prior to the admission, he had multiple neoplasmas on his head and face and four months later, exploratory laparotomy was performed because of suspicious obstructive jaundice and metastatic pancreatic tumor but no radicality. Histological findings of multiple neoplasmas and pancreatic tumor revealed neuroblastoma. Intensive chemotherapy and irradiation were without effect. Left testicular tumor was first noted in December, 1967 and began to be growing. Left orchiectomy was performed on 16, January 1968. Histological findings showed also neuroblastoma. It was thought that this testicular tumor was metastasised from another tumor site via blood vessels.
Case 2. A 80-year-old man first found a painless mass on the abdomen near the left of penil radix in March, 1968. Several months later, left inguinal lymphonodes, the left spermatic cord and the scrotal contents became swollen. An induration in the root of penis was found at that time. Penile amputation and resection of left inguinal mass including the scrotal contents were performed on December 9, 1968. Histological findings showed that sarcomatous cells were found in the subcutaneous tissue, which invaded the inguinal lymphonodes and in the left testis also. It was thought that the testicular tumors were metastasised from the inguinal tumor via testicular arteries or veins. However, other metastatic routes such as lymphatic vessels could not be ruled out.
Case 3. A 65-year-old man was admitted for urinary retention on Feb. 15, 1968. Physical examination revealed an enlarged and hard prostate. Laboratory examination showed a high value of serum acidphosphatase. Histological findings of needle biopsy showed adenocarcinoma. For the purpose of hormone treatment, castration was performed and metastases in the left testis were found by microscopic examination. The metastatic routes may be hematogenic or lymphatic.

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In a sixty years old patient with left epididymitis and left hydrocele testis, trichomonas vaginalis was detected three times in sequence from the fluid of hydrocele testis. In the same case trichomonas vaginalis was also detected eleven times from the urine. Although it is doubtful that trichomonas vaginalis is the direct cause of epididymitis and hydrocele testis, we report our observations because it is a very rare case.

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