Ascending pyelonephritis and stone formation were investigated experimentally in rats. An experimental model of pyelonephritis was produced in rats by intraperitoneal injection of 2-bromoethylamine hydrobromide (BEA) and transurethral inoculation of Proteus mirabilis into the bladder 3 days later. The dose of BEA was 100mg/kg and the inoculated volume was 1.0ml of heart infusion broth containing 10⁶cells/ml of P. mirabilis isolated from a 33-year old woman with bilateral struvite renal stones. The rats were sacrificed 4 weeks after the inoculation, and examined for pyelonephritis and stone formation of the urinary tract.
The results obtained were as follows:
1) Pyelonephritis were observed in 113 of 130 rats (86.9%), including rats which died within 4 weeks after the inoculation.
2) Cross sections of the infected kidneys revealed necrosis at the tip of papilla and inflammatory cell infiltration around the necrotic papilla.
3) Pyelonephritis occurred in 44 of 53 rats (83.7%) which survived until 4 weeks after the inoculation. Renal stones were found in 23 of the surviving 44 rats (52.3%) with pyelonephritis, vesical stones in 3 rats (6.8%).
4) Sixty-one per cent of the renal stones and all the vesical stones consisted of struvite according to the analysis of infrared spectrum; the other renal stones were protein.
5) The mean urine pH of rats with pyelonephritis was 7.4 at the time of sacrifice.
6) Scanning electron microscopic study showed magnesium ammonium phosphate crystals in the struvite stones and spherical hydroxyapatite deposits on the surface of necrotic papilla in the protein stones.
Pyelonephritis and renal stones were inducible at a high rate by the combination of BEA injection and P. mirabilis inoculation in rats. Necrotic papilla in alkaline urine may play the role as a matrix-like material in the stone formation associated with pyelonephritis in this experimental model.

View full abstract

After successful initial treatment of bacteriuria, about a half of acute uncomplicated urinary tract infections and 85% of chronic complicated urinary tract infections recurred during long-term follow-up period, if further treatment was not carried out after initial treatment. Long-term chemotherapy significantly suppressed the recurrence of acute uncomplicated urinary tract infections, but it seemed difficult to suppress the recurrence of chronic complicated urinary tract infections for long period unless underlying disease was removed.

View full abstract

Transcatheter vascular occlusion was performed in 12 patients with renal cell carcinoma during the past four years. Gelfoam and blood clots were used in seven patients and the Gianturco stainless steel coil was used in five patients as occlusion material, along with anticancer chemotherapeutics. In four of the latter five patients, occlusion was done preoperatively to reduce tumor vascularity, and satisfactory results were observed during surgery. In a patient with inoperable renal cell carcinoma, embolizatiln was performed as a palliative measure to reduce tumor bulk. The steel coil is introduced into the renal artery, through a selectively placed preshaped non-tapered 7F polytetrafluoroethylene catheter in usual fashon. Epidural anesthesia with indwelling tube was performed prior to embolization in all our series, and it effectively relieved pain due to vascular occlusion. The occlusion with steel coil is apparently superior over that with other materials and almost permanent intravascular occlusion of the proximal portion of the renal artery was obtained.

View full abstract

The chromographic contact print method making use of ammonium phosphomolybdate-ascorbic acid reaction is valid to detect phosphates in urinary calculi. This sensitive reaction may take place even if phosphates, especially apatite, are contained in calculi in so small amounts as to be under the confirmation-limits of X-ray and infrared analyses. This method with the aid of X-ray, infrared, or other means is valid to reveal the distribution-figure of apatite in urinary calculi.

View full abstract

The first clinical observation on intra-arterial infusion of microencapsulated anticancer drug (MMC-m. c.) is presented. The MMC-m. c., ethylcellulose microcapsules of mitomycin C (MMC), were prepared by us to be applied for intra-arterial infusion chemotherapy and proved to provide a sustained release property in vitro as well as in vivo. Thirty cases of kidney cancer were treated by transcatheter arterial embolization. The patients were classified into 3 treated groups; A) simple mechanical embolization using Gelfoam in 4 cases, B) chemoembolization using Gelfoam and MMC of usual dosage form in 10 cases and C) chemoembolization using Gelfoam and MMC-m. c. in 16 cases. Antitumor effects on tumor reduction measured by echography, angiography or CT scan, angiographic findings and histological changes were analized in the 3 treated groups. In groups B and C, bioavailability of MMC in the systemic blood and hematological toxicity were compared.
Tumor size was reduced by 30% or more in 7 cases of group C, comprising 13 cases, but tumor reduction was less than 30% in other cases including 6 cases of group C and 10 cases of group B. Repeated angiography in 6 cases of group B and 5 cases of group C showed that recanalization of tumor vessels was marked in 4 cases of group B, moderate in 2 of group B and 1 of group C, and slight in 2 of group C, but 2 cases of group C did not show recanalization for the observed period up to 4 months. Histological effect on tumor tissues obtained from 4 cases in group A, 5 in group B and 12 in group C was expressed by the extent of necrotic area. The effect was moderate in 2 cases and slight in 2 of group A, moderate in 3 and slight in 2 of group B, and marked in 8 and moderate in 4 of group C.
Systemic bioavailability of MMC in group C was 39% as compared with that of group B, suggesting a reduction of systemic toxicity by MMC in group C. Leukopenia occurred in 50%, erythropenia in 90% and thrombocytopenia in 80% of the cases in group B. On the other hand, the occurrence in group C were 0%, 60% and 55%, respectively.
The enhanced antitumor effects and reduced hematological toxicity in group C could be attributed to both the sustained release property of the MMC-m. c. and the microembolization of tumor vessels with the intra-arterial MMC-m. c.. Although our preliminary experience of chemoembolization with the microencapsulated anticancer drug is most encouraging, no effect on survival of disseminated cancer patients has yet been obtained from this mode of topical treatment. Further improvements of microencapsulation and controlled distribution of the microcapsules into metastatic lesions may overcome this problem.

View full abstract

1) 49 patients (26 male cases and 23 female cases) who sustained cerebral stroke (Apoplexy) of various etiologies were urodynamically examined by cystometry and urethral pressure profilometry (UPP).
2) The subjects were further divided into 31 acute cases (defined as those who were within 48 hours after the stroke), 3 interim cases, and 15 chronic cases (2 weeks to 12 years post stroke).
In the 31 acute cases cystometry was “normal” type in 9, “uninhibited” type in 15 and “atonic” type in 7.
In 3 interim cases it was “normal” in 1 and “uninhibited” type in 2.
In the 15 chronic cases it was “normal” in 3, “uninhibited” in 9, “automatic” in 1 and “autonomoautomatic” in 2.
3) Serial urodynamic examinations were performed in 17 of these cases.
a) “normal” type tended either to remain “normal” or to change into “uninhibited” type.
b) “atonic” type from the onset of illness was subsequently normalized in all.
c) “uninhibited” type had remained so, although Buscopan (Hyoscine N-Butyl bromide) was found to be effective in increasing the bladder capacity in 2 to 3 months after the stroke.
d) Both “automatic” and “autonomoautomatic” type either changed into “uninhibited” or remained “autonomoautomatic” in the subsequent examination. These suggest that “uninhibited” type is more prevalently seen in the later phase of cerebral stroke.
4) UPP was obtained in 22 acute cases (12 males and 10 females) and 6 chronic female cases.
The posterior urethral length in the acute cases was 4.0±0.9cm and 2.9±0.3cm in males and females respectively.
A slight increase in the urethral length when compared to the normal control (3.6±0.9cm in the male and 2.8±0.4cm in the female) is statistically insignificant. It was similar (2.5±0.4cm) in the chronic female.
Maximal urethral pressure (UP max) in the males was 23.9±10.3mmHg, while it was 30.0±6.6mmHg in the normal males, but the difference was statistically insignificant.
In the female it was 16.5±9.3mmHg in the acute phase, which is statistically significant compared to 23.5±5.9mmHg of UP max of normal females, while in the chronic phase it was 19.3±4.1mmHg, the difference from the normal was considered to be statistically insignificant.
Urinary retension was of a transient nature and seen only during the acute phase of the stroke, and urinary incontinence appeared to be related to uninhibited detrusor contraction rather than to parameters of UPP.
5) There was no correlation between urodynamic findings and multitude of somatic reflexes such as abdominal, cremasteric, patellar tendon, plantar, anal and bulbocavernous reflex, and other pathologic reflexes.
6) Based on these urodynamic investigations the management of the bladder in stroke patients was described.
Even in the acute phase unassisted self voiding is recommended regardless to the urodynamic result providing the patients were alert and residual urine was less than 30cc.
In the others when cystometry demonstrated either “normal” or “atonic” type the bladder was drained intermittently by periodic unclamping of indwelled urethral catheter, while the bladder training was continued. When residual urine was noted to be less than 30cc which was usually attained within a month, they were freed from the use of urethral catheter.
When bladder was “uninhibited” type it was similarly managed with indwelling urethral catheter, but Buscopan was used to prevent urinary leak around the catheter. This along with bladder training usually restored an adequate bladder capacity and rendered the patients catheter free usually within 3 to 9 months after the episode of stroke.

View full abstract

An analytical method was designed to assess the acculumation and toxicity of antibiotics to the kidney. Kidneys were homogenized and centrifuged for the cellular preparation. The supernatant fraction was mainly composed of cytoplasm and microsome, while lysosome and mitochondria were the main components of the sediment fraction. The antibiotic concentrations were separately measured in the elapse of time.
Our experiments showed that high nephrotoxic agents such as Gentamicin and Tobramycin were found in the sediment fraction in a high concentration which was maintained for some time on the other hand a low concentration in the sediment fraction was noted on the administration of a low nephrotoxic substance. The present investigation revealed that hetacillin given to rats was found in a low concentration in the sediment, which declined promptly.

View full abstract

Fifty-two cases of pure seminoma of the testis were treated in our hospital between 1964 and 1974.
Our treatment planning was that a radical orchiectomy was followed by radiation therapy. Radiation for stage I disease was given to the ipsilateral iliac and bilateral paraaortic caval nodes to the crura of the diaphragm. A dose from 2, 500 to 3, 000rad was given for three weeks. In stage II disease the bilateral iliac and paraaortic caval nodes were irradiated to a dose from 3, 000 to 4, 000rad over three to four weeks. Prophylactic mediastinal or supraclavicular radiation was also given.
Our experience with seminoma shows that radiation therapy seems to be satisfactory for N0 and N1 disease and unsatisfactory for N2 and M1 cases. Five year survival rate is 100 per cent for N0 and N1 lesions in 42 cases. Five year survival rate of 4 cases with N2 lesions in 25 per cent. Only one of 6 cases with M1 lesions survived more than 5 years (16 per cent). Conventional radiation therapy for stage III was disappointed. One of stage II cases with bulk disease could be cured by the treatment of combination of radiation and chemotherapy with Z 4942, followed by administration of 100mg of cyclophosphamide for 2 years.
We believe that it is necessary to give combination therapy of radiation and alkylating agents to advanced seminoma.

View full abstract

As a routine examination for intrapelvic organs transrectal ultrasonotomography was adopted in our clinic since June, 1976.
1, 073 patients were examined using transrectal ultrasonotomography during the 2 years between June, 1976 and June, 1978 at the Department of Urology, Kyoto Prefectural University of Medicine. They consisted of 957 first examination (89.1%) and 116 re-examination (10.1%). Main diseases for which the examination was indicated were benign prostatic hypertrophy, prostatitis, prostatic cancer and bladder tumor.
In this series, 36 patients were diagnosed as prostatic cancer by transrectal ultrasonotomography and all of them were finally diagnosed as cancer by biopsy. 101 patients were diagnosed as suspected prostatic cancer and in 6 (5.9%) of them cancer was confirmed also by biopsy. Among 608 patients with various prostatic diseases on whom cancer was ruled out by transrectal ultrasonotomography, there were 2 (0.3%) false negative cancer cases.
Thus the usefulness of transrectal ultrasonotomography was confirmed for a routine examination in urology especially for the prostate.

View full abstract

Three cases of accessory adrenal gland were experienced in our clinic.
Case 1.: A 1-year-old male with hypospadias (penoscrotal type), bilateral cryptorchism, right inguinal hernia. The chromosomal pattern is XYY. The operation was done for bilateral cryptorchism and inguinal hernia. There was an accessory adrenocortical tissue attaching to the right epididymis.
Case 2.: An 8-year-old male with hypospadias (penoscrotal type), bilateral cryptorchism. When the operation for bilateral cryptorchism was performed, we found a nodule in the left spermatic cord. The histologic findings were accessory adrenocortical tissue.
Case 3.: An 80-year-old male was suffering from dysuria and a swelling of the right scrotum. The operation was performed for the hypertrophy of the prostate and right hydrocele testis. In the right spermatic cord we found a nodule. The histologic findings were accessory adrenal tissue containing cortical and medullary portion.
The three patients showed no evidence of adrenal hyperfunction before the operation and no evidence of adrenal hypofunction after the operation.

View full abstract