Non-specific cellular immunity of patients with upper urinary tract carcinoma was studied by PPD reaction (in vivo or in vitro), lymphocytes subpopulation and macrophage migration inhibition test and the results were compared with those of patients with bladder carcinoma or benigen urological diseases.
1) The preoperative cellular immunity of the malignant tumor group gave low values as compared to that in the benign disease group. Although the cellular immunity of patients with renal cell carcinoma showed no difference in the points of their grade and stage, significant differences were noted in patients with bladder carcinoma.
The patients with renal pelvic and ureter carcinoma appeared to be similar to the patients with bladder carcinoma in the aspects of immune reactions.
2) In the majority of patients with upper urinary tract and bladder carcinoma, the cellular immunity after complete removal of the carcinoma gave an increased value of each marker as compared to the preoperative value.
3) The cellular immunity after irradiation decreased in the majority of the cases in terms of PPD reaction and T-cell ratio in lymphocyte subpopulation. Irradiation of 4000-6000 Rad. showed greater influence on T-cell than on B-cell, but influence of irradiation on cellular immunity was not different by irradiation dose.
4) The cellular immunity indicated decreased values for one to two months after discontinuation of irradiation, but then it showed a tendency to increase in terms of PPD and lymphocytes subpopulation in the patients with satisfactory postoperative courses.
5) Through the pre and postoperative courses, the immunity of the carcinomatous stage seems to be reflected better by the T-cell ratio than by the absolute number of T-cell. It is likely that macrophage migration inhibition test shows much sharper reaction than PPD reaction.

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It is not infrequent that renal tumor produces tumor thrombus by infiltrating the inferior vena cava through the renal vein. Conventionally, tumor thrombus of the renal vein or inferior vena cava were diagnosed by use of renal arteriography, inferior venacavography and ultrasonography. We used computed tomography (CT) for diagnosis in 4 cases of renal tumor associated with tumor thrombus of the renal vein and inferior vana cava. The results obtained are described below:
A total of 4 cases consisting of 3 cases of renal cell carcinoma and one case of squamous cell carcinoma of the renal pelvis, treated at the Jikei University Hospital during the six months period from January to June of 1979, were studied. The affected side was right in 3 cases and left in one case. In all of the former cases the tumor thrombus was extending from the renal vein to the inferior vena cava, while in the latter case it was confined in the renal vein. All these 4 cases received CT together with renal arteriography and inferior venacavography, followed by nephrectomy, and were confirmed of the presence of tumor thrombus in the renal vein and inferior vena cava operatively.
CT findings revealed a pronounced enlargement of the renal vein, and tumor thrombus of the renal vein was diagnosed in all of the 4 cases. In 2 of 3 cases in which tumor thrombus extended to the inferior vena cava, the dilated renal vein was found to be connected to the slightly dilated inferior vena cava, while in the remaining one case the outline of the inferior vena cava was obscure, showing no clear dilatation. After contrast enhancement, a filling defect was seen in the inferior vena cava. CT findings of tumor thrombus in the vein indicated a dilatation of the renal vein and inferior vena cava. In addition, a filling defect was found after contrast enhancement, suggesting that CT is helpful as a diagnostic aid.
From these results it is considered that CT is valuable and to be used together with renal arteriography, inferior venacavography and ultrasonography, and appears to be especially useful for cases in which striated vascular pattern is not depicted by renal arteriography and in which it is not clear whether the filling defect by inferior venacavography is due to tumor thrombus or to the pressure from the tumor.

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In order to investigate the therapeutic principles for urolithiasis, patients who had visited our clinic during the 14-year period from January, 1965 to December, 1978 were reviewed statistically.
The summary of the present studies is as follows:
1) The ratio of the number of patients with upper urinary tract calculi to the total number of outpatients was 8.2 per cent from 1965 to 1971, whereas from 1972 to 1978, it was increased up to 10.4 per cent.
2) During 1965 to 1971, the largest number of patients was found in the age group of 20-30, whereas from 1972 to 1978, it was found in the age group of 30-40.
3) The ratio of recurrence to whole upper urinary tract urolithiasis was about 20 per cent.
4) The most frequent components of upper urinary tract calculi were calcium oxalate in men (76.0%) and phosphate in women (49.8%).
5) Some causative factors were found in about 40 per cent of patients with upper urinary tract calculi. Main calculogenetic factors were abnormal calcium and uric acid metabolism in men, and urinary tract infection in women.

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1. Prostatic acid phosphatase (PAP) was purified about 130 fold from human seminal plasma by DEAE Sephadex A-50 ion-exchange column chromatography and Sephacryl S-200 gel chromatography.
2. Rabbits were immunized with the purified PAP as antigen, and anti-PAP antiserum was obtained. This antiserum was fractionated through a Sephadex G-25 column and the obtained IgG fraction was passed through the immunoadsorbent column coupled to normal female serum.
3. This rabbit anti-PAP IgG was tested by double immunodiffusion, and precipitation lines were observed against seminal plasma, prostatic extract, sera of patients with prostatic cancer, and liver extract of a patient with prostatic cancer. Immunoelectrophoretic examination revealed the single precipitation line in anodic side against the liver extract, but in cathodic side against the other samples.
4. By indirect immunofluorescence technique using the rabbit anti-PAP IgG, fluorescence was demonstrated in the section of prostate, but no staining in sections of liver, spleen, kidney, and pancreas.

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Prostatic acid phosphatase (PAP) activities were determined by counter immunoelectrophoresis (CIEP) and immunochemical assay using anti-PAP rabbit serum in blood and bone marrow sera of 20 patients with prostatic cancer (PC), 3 patients with benign prostatic hypertrophy (BPH), and 52 normal males and females.
1. PAP activity more than 0.55 to 1.1 Sigma unit/ml was detected as positive in CIEP. The positive results of CIEP in sera of patients with PC were as follows: none out of 3 patients (0%) with stage B (1 untreated and 2 treated), 1 out of 8 patients (12.5%) with stage C treated, 3 out of 4 patients (75.0%) with stage D untreated and 1 out of 5 patients (2000%) with stage D treated. In bone marrow sera the positive rates were similar to rates in blood sera except stage D treated (0%). CIEP was negative in normal and BPH cases.
2. PAP activities were determined by immunochemical assay. The results were 0.09±0.06 Sigma unit/ml in sera of 27 normal males and 0.08±0.05 Sigma unit/ml in sera of 25 normal females. No significant difference was found between PAP activities of sera in normal males and that of blood and bone marrow sera in patients with BPH and PC except stage D untreated. PAP activities in patients with stage D untreated of PC were higher than that in normal cases. It was 0.69±0.43 Sigma unit/ml in sera and 1.61±1.27 Sigma unit/ml in bone marrow. Abnormally higher activities over 0.22 Sigma unit/ml were seen in CIEP positive cases and 3 out of 52 normal cases.

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Abnormal platelet function of patients with chronic renal failure (CRF) has been documented.
We have measured β-thromboglobulin (β-T. G.), a platelet specific protein in 33 patients with CRF undergoing hemodialysis using a β-T. G. RIA kit, and have investigated whether the β-T. G, can be an indicator of the clinical condition of these patients.
The patients were 23 males and 10 females, with the mean age of 42.7 years (range 23 to 73 years).
The mean term of hemodialysis was 23.8 months (range 2 to 65 months) and the mean serum creatinine (S-crea) was 13.14mg/dl (range 5.7 to 18.8mg/dl). The mean plasma β-T. G. value of the patients was 122.52±50.12ng/ml (range 56.3 to 250ng/ml, n=49), and was significantly higher than that of 11 normal control subjects which was 29.03±14.98ng/ml (range 7.3 to 62.1ng/ml, n=24) (p<0.001). The mean platelet-count of the patient was 188, 900± 51, 600 (range 86, 000 to 268, 000, n=32), which was lower than that of control subjects with platelet count of 252, 000±43, 200 (range 154, 000 to 306, 000, n=13). The 3-T. G, value of the patients showed a correlating tendency with the S-crea, value, but it was not significant. The β-T. G, value did not correlate with the urine volume, platelet count, red blood cell count, white blood cell count, hemoglobin value, hematocrit, sodium, potassium and calcium in the blood.
The β-T. G, value was significantly correlated with the term of hemodialysis (p<0.01). The result is considered due to the long-term effects of uremic toxins, thrombus formations, platelet damage by dialyzer and anticoagulants during hemodialysis.
The β-T. G, value was significantly correlated with the average water reductive volume by hemodialysis per ideal body weight during 3 months before the experiment (p<0.05).
The β-T. G. was also investigated immediately before and after hemodialysis in 10 patients and it increased after hemodialysis except in a patient which had no water reduction. β-T. G, values increased proportionally after hemodialysis in patients with increased water reduction.
Because the hemodialysis accompanies a hypovolemic shock of greater or lesser degree, the disturbance of the microcirculation or of the interaction between platelets and blood vessel wall in whole body, especially in the blood stagnated organs, could not be ignored. Incidentally, the spleen, ileum, kidney and the liver were organs which contained large amounts of β-T. G.. Therefore, we emphasize water restriction to patients with CRF undergoing hemodialysis.
The B-T. G, value of 5 patients complicated with other disorders was higher, and the β-T. G. value was significantly correlated with the clinical criterion (p<0.02). Plasma β-T. G. measurement could be an indicator of the condition of the patient with CRF undergoing hemodialysis.

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On the basis of experimentally induced renal cancer by estrogen in the hamster, it is suggested that human renal cell carcinomas are also hormone-dependent. Endocrine therapy for this tumor is proposed clinically, and it is recognized that some of the patients responded to a certain degree to this treatment. At present, however, there is no knowledge about what kind of tumor is hormone-dependent. To solve this question, estrogen receptor (ER) was sought in the cytosol from 25 renal cell carcinoma tissues and 8 normal kidney tissues. Specific binding molecules to estradiol detected by means of dextran coated charcoal assay were determined 7-8 sedimentation constants by sucrose density gradient centrifugation. The ability of this binding were not inhibited competitively by testosterone or dihydrotestosterone. For these reasons, it was confirmed that the specific binding protein was not a sex hormone binding globulin (SHBG) but ER. The results obtained were as follows;
1) Out of 8 normal kidneys, ER was detected in 5 cases (62.5%). Since all of undetecable 3 cases were below 50 year of age, it was considered that ER in the kidney of young one was already occupied by endogenous estradiol. ER-detectable 5 cases were with normal tissues in nephrectomized mass due to renal cell carcinomas.
2) Out of 25 renal cell carcinomas, ER was detected in 5 cases (20.0%). There was no correlation between the level of ER and sex of the patients or histopathological cell type, but ER was detectable more frequently in low grade than in high grade tumors.
3) In 6 cases, a comparative study of the concentration of ER in cancerous tissue against their normal counterpart was performed. In one case, ER was not detected in both tissues, in 3 cases, it was higher in normal tissue and in 2 cases, it was higher in cancerous tissue.

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Subfertility of adults with a varicocele has been well known. The possibility, that renal bleeding occurs in some cases of varicocele, has not yet proved practically.
We encountered 14 cases of unexplained renal hematuria out of 78 patients with varicocele, although all cases did not result from the same cause.
We are interested in studying these hematuria cases by venography. Internal spermatic venography was performed at the time of varicocelectomy in 25 men with left varicocele.
Of 25 patients examined, 8 was associated with unexplained renal hematuria. The radiographic manifestations showed a prolonged stasis, a dilatation in the renal vein and a retrograde flow of contrast medium into the intrarenal venous system. These phenomena were revealed of a higher grade in many cases of hematuria.
This suggests that the presumed cause of hematuria may be stasis due to renal vein compression.
Herein, we describe on patients with hematuria and varicocele. The clinical significance is discussed. Varicocele should be suspected when unexplained renal hematuria is present in young patients.

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During the past 10-year period, a total of twelve patients had been diagnosed as multiple primary malignant neoplasm at our clinic. These patients were composed of eleven male and one female patient. The ages of these patients at diagnosis of the second neoplasm ranged from 60 to 81 years, with a mean of 7203 years. Three patients had lesions that were diagnosed simultaneously; nine patients metachronously. The average interval between the first and second neoplasms was 10 years and 1 month.
The combinations of sites were often seen in the gastro-intestinal tract: in 3 cases in the stomach and in 4 in the colo-rectal area. Two rare combinations of immunoblastic lymphadenopathy were observed in patients with bladder cancer, and gastric reticulum cell sarcoma in one with prostatic cancer. No family history of malignancy was noted in these patients.
Three hundred and twenty-five cases of primary malignant neoplasms collected from the recent Japanese literature were reviewed and discussed.

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The pre-transplant serum samples from 38 living related renal transplant recipients were screened for cytotoxic antibodies against a panel of B and T lymphocyte at 4°C and 37°C. The cytotoxicity positive sera were classified into three patterns: the T warm pattern which reacts with greater than 15% of T lymphocyte panel at 37°C; the B warm pattern which reacts with greater than 15% B lymphocyte panel and reacts less than 15% of T lymphocyte panel at 4°C and 37°C; and the B cold pattern which reacts with greater than 15% of B lymphocyte at 4°C and does not react under other conditions. According to the serum patterns, the patients were divided to four groups: T warm group, B warm group, B cold group and No antibodies group. The B cold group with history of blood transfusion had a higher graft survival rate than other groups. The B cold group without history of blood transfusion and B warm group did not have good graft survivals. The B cold cytotoxins as a product of blood transfusion seems to have an enhancing effects on living related kidney allografts.

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The knowledge of calcium metabolism seems indispensable in the study of the cause of urolithiasis, since most urinary stones contain calcium. Parathyroid hormone has great influences on calcium metabolism. The purpose of this paper is to describe the basal characteristics of adenosine 3'.5'-monophosphate (cyclic AMP) which is supposed to be the second messenger of parathyroid hormone.
Urinary excretion of cyclic AMP was measured in 54 healthy subjects and the properties of urinary cyclic AMP were basically studied.
The values measured by YAMASA kit in this study were closely correlated with those by Hoechst kit which had been formerly used. Cyclic AMP to urine and plasma were recovered with resonable accuracy and precision. The satisfactory coefficient of value (C.V.) of interassay variance and intra-assay variance were obtained with urine and plasma (3.4 to 9.1%, 1.8 to 9.6% respectively).
The normal range was 3.10±1.83±μ moles/g.cr (mean±S.D.), 3.01±2.01μ moles/day and 1.98±1.43μ moles/g.cr./m² body surface. No significant sex-related difference was found.
The diurnal pattern of cyclic AMP was not altered when the results were expressed as μ moles/g.cr. However, expressed as n moles/ml, there was circadiam rhythm in cyclic AMP excretion. The peak was in the early morning and the lowest excretion was in the afternoon. Daily excretions of cyclic AMP were almost constant except for a few subjects.
The correlation between cyclic AMP excretion and age demonstrated no significant difference from 20 to 70 years old, but there was lower excretion in the elder subjects and children than in young and middle aged men when the results were expressed as μ moles/day. However, the excretion per gram creatinine was higher in children and lower in those over seventy.
There was no significant difference among appending 0.025% Hibitane, 1ml Toluene, 10mM EDTA and nothing to urine, though the addition of EDTA to plasma was very effective in inhibiting phosphodiesterase. There was not significant difference either among hematuria, proteinuria, pyuria, bacteriuria and normal urine. The recovery was satisfactory with severe hematuria and proteinuria at 37°C during 24 hours.
We studied preserving condition of urine specimens during collection. Activity of urinary cyclic AMP was not diminished, even though urine was stored at room temperature, and frozen for periods varying from six to twenty-four hours. Urine specimens were stored at -20°C without loss of activity for over six months in a few cases.

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The urinary excretion of adenosine 3'.5'-monophosphate (cyclic AMP) was investigated in 13 subjects with hyperparathyroidism.
1. The average cyclic AMP excretion in the hyperparathyroid patients was 9.51±7.51μ mole/g. creatinine (mean±S.D.). This value was significantly greater than that in healthy control subjects. However, when an upper normal limit of 4.76μ moles/g. creatinine (mean±S.D.) obtained for the cyclic AMP excretion in the control group was applied to the patient with hyperparathyroidism, some materials were found to have normal excretion. Such an overlap hasbeen observed in several previous studies.
2. The urinary excretion of cyclic AMP appeared to be somewhat lower in women than in men (8.58 and 11.08μ moles/g. creatinine, respectively) although this difference was not statistically significant.
3. Whereas control persons exhibited only small daily variations in cyclic AMP excretion, a marked fluctuation was observed in patients with hyperparathyroidism. This maximum value was about twenty. There was a circadian rhythem in cyclic AMP excretion in 2 of 4 patients, but not in the other 2 patients. It is supposed that these daily and diurnal variations cause an overlap of the cyclic AMP excretion value between control subjects and hyperparathyroid patients.
4. Plasma cyclic AMP was 26.95±8.50p mole/ml in the patients with hyperparathyroidism. In comparison with healthy control subjects, the plasma cyclic AMP was not raised.
5. There was a significant positive correlation of urinary cyclic AMP excretion with serum calcium and ionized calcium p<0.01 and p<0.05, respectively). In addition urinary cyclic AMP was correlated positively with urinary excretion of calcium and phosphate (p<0.01 and p<0.05, respectively). However, no correlation was obtained between the urinary cyclic AMP and serum phosphate and magnesium.
6. A positive correlation could be demonstrated between urinary cyclic AMP and the serum parathyroid hormone (p<0.01). There was no strong negative correlation between %TRP and urinary cyclic AMP.
7. Renal cyclic AMP (Urinary cyclic AMP-Plasma cyclic AMP x C.Cr) was not superior to total urinary cyclic AMP excretion in distinguishing patients with hyperparathyroidism from controls, because the value of renal cyclic AMP was negative in some patients with hyperparathyroidism.
8. Every surgically sucessful cases showed a significant fall in excretion of urinary cyclic AMP. The mean time to drop significantly was about 4 hours from the time of parathyroidectomy. A significant postopertive rise in urinary cyclic AMP was observed in 2 patients. This rise was closely associated temporally with manipulation. The decline in serum Ca and Ca⁺⁺ in six patients was slightly slower than the decline in urinary cyclic AMP. Changes in urinary phosphate excretion lagged behind urinary cyclic AMP and serum Ca changes. The mean time to the drop was 8 hours.

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