Plasma testosterone (T), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S, cortisol (F), luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin (PRL) levels were determined in patients with prostatic carcinoma before and during antiandrogen therapy. The relationships between clinical courses, therapeutic agents and the profiles of these hormones were examined. The results were as follows;
1) It was considered that the hormone profiles were mainly depended on the pharmacological effects of the therapeutic agents and that there were no relationships between clinical courses and the hormone profiles. However, the pretreatment values of DHEA-S were significantly lower in stage IV patients compared to stage I-III patients (p<0.001).
2) Both sythetic progestogens such as chlormadinone acetate (CMA) and synthetic estrogens such as diethylstilbestrol diphosphate (DES-diphosphate) suppressed not only T levels but also DHEA and DHEA-S levels significantly. On the other hand, the agent composed of estradiol such as estramustine phosphate (Estracyt) suppressed T levels but not DHEA and DHEA-S levels. The levels of LH and FSH were suppressed more effectively by estrogens than synthetic progestogens. The levels of F were not so affected by synthetic progestogens, while those were significantly elevated by estrogens.
3) It was considered that there were two mechanism of action to suppress the DHEA and DHEA-S levels. The first, as the ACTH-Z stimulation test in patients under CMA or DES-diphosphate administration showed, these agents might inhibit the activity of adrenal C₁₇-C₂₀ lyase. The second, as CMA possesses the corticosteroid-mimetic actions, there could exist another mechanism to suppress the DHEA and DHEA-S through the pituitary-adrenal axis.
4) The mild hyperprolactinemia was noticed in patients under estrogen therapy, but no relationships were noted among the levels of T, DHEA and prolactin. Therefore, it was considered that hyperprolactinemia caused by estrogens did not stimulate the adrenal androgen biosynthesis. Moreover, the elevations of T, DHEA and DHEA-S were not noticed in relapsed cases, there seemed to be no relationships between adrenal androgen levels and the reactivation of the prostatic carcinoma.

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Voiding cystourethrography (VCU) is one of the most useful examination for evaluating the lower urinary tract function. However, if organic or functional obstruction is present in the posterior urethra, it is difficult to appreciate the function of the external urathral sphincter.
We made a new modified catheter for VCU to evaluate the function of the external urethral sphincter. Using this catheter, we can evaluate it precisely, excluding the influences of the posterior urethra.
The findings of VCU observed by using this catheter were equal to the findings of the simultaneous recording of cystometrogram and external urethral sphincter electromyogram and permit us to assess the function of the each portion of urethra separately, such as the sphincteric urethra (prostatic urethra) and external urethral sphincter (membranous urethra). In addition, this urodynamic procedure can be performed safely and easily.

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Four patients with stage D prostatic cancer without prior hormone manipulation (3 patients with osteolytic bone metastasis and 1 patient with osteoblastic bone metastasis and cranial nerve involvement) and 1 patient with stage C prostatic cancer refractory to antiandrogen therapy, were treated with a combination therapy of Mitomycin C, FT-207, OK-432 and Hexestrol after castration.
This combination therapy brought about beneficial responses, such as calcification of osteolytic lesions (3/3) and disappearance of cranial nerve palsies (1/1) in the patients with stage D prostatic cancer, with slight side effects such as increased liver dysfunction (1/5) and anorexia (1/5).

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An evaluation of sexual function was made on ten patients in association with operative repair of membraneous urethral rupture following pelvic fracture.
The surgical procedures employed were Badenoch in seven and Michalowski in three adult patieilts, with follow-up periods of more than two years.
Seven patients were interviewed and three patients were evaluated by sending questionaires. None of these patients complained loss of libido, while erectile impotence was complained in 2 of 10 patients (20%) and disturbance of ejaculation in 3 of 10 patients (30%).
These disturbances were resulted from combination of injury itself and surgical procedures. we suspect organic sexual disturbances caused by injury alone occupy about 10%.
Semen analysis in 4 patients revealed that all of them had sperm counts of more than 66×10⁶/ml with more than 29% of motility suggesting possible ability of fertility.
Post-operative sexual complications are considered inevitable following posterior urethral injury in association with pelvic fracture.
This report suggests a lower incidence of sexual complications than the reports in the past.

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An exploratory operation was performed on the neck to confirm the clinical diagnosis of primary hyperparathyroidism (HPT) in 9 cases. They were divided into two groups based on serum alkaline phosphatase (Alph) before the exploratory operation: a high serum Alph group and a normal serum Alph group. A check was made about whether serum calcium, ionized blood calcium, urinary calcium, inorganic phosphorus and some other parameters of metabolic functions were abnormal in the two groups before the exploratory operation. In addition, the first four parameters were also measured after the exploratory operation to investigate their time course. Hypercalcemia and hypercalciuria were observed in the high serum Alph group before parathyroidectomy. The sizes of the adenomas isolated from this group were large (>1.0g). These findings suggest that if high serum Alph, hypercalcemia and hypercalciuria are observed, the clinical diagnosis of primary HPT can be easily confirmed without an exploratory operation. On the other hand, metabolic function tests other than rapid calcium loading test and Cl/P ratio were normal in most cases of the normal serum Alph group before parathyroidectomy. The sizes of the adenomas isolated from this group were small (<1.0g). These findings suggest that unless an exploratory operation is performed in patients who are normal in terms of serum Alph and many parameters of metabolic function, a longer period of clinical observation may be required to confirm the diagnosis of primary HPT. Four cases of the normal serum Alph group had an almost normal serum calcium level and were diagnosed as borderline hyper-calcemic HPT. The measurement of ionized blood calcium in cases of borderline hypercalcemic HPT will greatly serve to make a clinical diagnosis of primary HPT before an exploration, to evaluate the therapeutic effect of the exploratory operation in this disease and to detect the recurrence of primary HPT. Serum Alph and urinary calcium levels returned to normal in all of the 9 cases after parathyroidectomy. Urinary tract lithiasis did not recur in any case.

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Intravesical instillation of Adriamycin (ADM) combined with hydrostatic pressure technique was experimentally performed with the hope of clinical application for the treatment of bladder cancer. Female mongrel adult dogs were used. After saline containing ADM (10mg/10ml) was instilled through a transurethral catheter, a condom-balloon catheter was inserted. An irrigator filled with distilled water was connected to the cathethr dripping to induce a positive intravesical pressure (30cm and 60cmH₂O).
The time course of ADM concentration in serum, bladder mucosa, bladder muscle and tissue of various organs was estimated as well as the histopathological changes of the bladder wall.
The results were as follows:
1) Serum levels of ADM seemed to negligible, although a slight increase in serum concentration was observed in a few dogs of the high pressure group.
2) The ADM concentration of bladder mucosa rose to the maximum 120 minutes after the instillation in the low pressure group, while it did 30 or 60 minutes after the instillation in the high pressure group.
In bladder musculature, ADM had a peak concentration 120 minutes after instillation with low pressure, while in the high pressure group it increased gradually and exceeded the peak value of the former group within 30 minutes. These results indicated that the higher the hydrostatic pressure, the earlier was the tissue concentration of ADM elevated.
3) The concentration of ADM in the liver, kidney and iliac lymphnode increased rapidly after application of hydrostatic pressure with minimal change of the concentration thereafter.
4) Histopathological changes of bladder mucosa were mild in the low pressure group, whereas in the high pressure group marked changes such as sloughing of the epithelium, submucosal edema and submucosal hemorrhage were observed.
Intravesical instillation of ADM enhanced with hydrostatic pressure technique, seemed to make it possible to produce an elevation of the tissue ADM concentration in bladder wall more effectively than the conventional intravesical instillation.
When an adequate dose of ADM with a proper degree and duration of hydrostatic pressure is established, the application of hydrostatic pressure technique to intravesical instillation is expected to become a new method of the local chemotherapy for not only superficial but also infiltrating bladder cancer.

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It has been difficult to obtain simultaneously the preparation of pathologic section and the total number of bacteria from the infected kidney. The present study was performed to solve this problem in retrograde Proteus mirabilis pyelonephritis in rats. Infected kidneys were removed aseptically five days after inoculation of the bacteria, and immediately frozen at -70°C, then some thin sections were obtained from the bisected kidneys using a cryostat. All of the remaining tissues including the chips of the frozen section were used for counting the total number of bacteria in the kidneys. The decrease in number of bacteria in the kidneys was negligible after preservation at -20°C for 48 hours. The degree of renal lesions were graded pathologically according to the classification of Arana et al. modified by Araki et al. The total number of bacteria in the infected kidney had a good correlation with the pathological grading (p<0.001).
The results indicate that this method is excellent for both obtaining samples for pathologic sections and counting the total number of bacteria from one kidney, and that the pathological grading of infected kidneys is very useful in showing the degree of infection in the experimental retrograde pyelonephritis in rats, with this, in the acute stage without treatment, wanting the total number of bacteria in the kidney is thonght to be omitted.

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Although the accidental involution of the thymus is well known, the thymic involution in retrograde pyelodephritis in rats has not been reported. In an experiment of retrograde Proteus mirabilis pyeloneyhritis in rats, markedly reduced thymus weights and remarkable disappearance and destruction of cortex lymphocytes of the thymus were shown in the rats with renal abscesses.

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Accurate clinical staging of bladder tumor is of utmost importance in selecting the most suitable treatment measure for each clinical case. In this paper, a method of staging bladder tumor by CT is presented and a new criteria for estimation of the extent of tumor infiltration are discussed.
In this study, 56 patients with bladder tumor of various extent, whose pathological staging was confirmed by surgery or autopsy, were submitted for CT scanning to evaluate its accuracy in clinical staging. ACTA SCANNER-0100 was used in the first 23 cases and GE CT/T-8800 in the rest 33 cases. Air was used in 50 patients as the filling material of the bladder cavity, saline solution in 5 and 6% Urographin in one patidnt.
The new criteria for estimation of the extent of bladder tumor by CT scanning consists of evaluation of the following four items: 1) morphological figure of the tumor, 2) movability of the tumor body, 3) deformity of ideal external vesical wall line, and 4) W (tumor root width)/H (tumor height) ratio. The results are summarized as follogs: Stage O, A and Bl: Small papillary or polypoid type, tumor body movement (+), deformity of ideal external vesical wall line (-), W/H<1.2
Stage B2: Nodular type, tumor body movement (-), elevation of ideal external vesical wall line (- or +), W/H≥1.2
Stage C: Nodular type, tumor body movement (-), penetration of ideal external vesical wall lide (+), W/H≥1.2
Stage Dl: Evidence of tumor invasion to perivesical structures ane metastases to intrapelvic structures.
Retrospective coincidence study of the results of new CT staging revealed 100% (15/15) accuracy in diferenciating advanced stage (B2, C and Dl) groups.

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We studied on the incidence of vascular invasion of bladder cancer and the relation between the vascular invasion and distant metastasis.
Histologic materials were obtained from twenty-six (26) patients with transitional cell carcinoma of the bladder treated by partial and total cystectomy during the 3 year period from November 1976 to October, 1979.
The blood vessel and lymphatics invasions were observed in 13 cases (50.00) and 35% in the casas at the low atage (stage O, A, B₁) compared to 100% in the cases at the high stage (stage B₂, C)
There were a 33.3% vascular invasion in the cases of grade III and a 76.9% in the cases of grade IV.
Vascular invasion was revealed at a higher frequency with tumors of high stage and high grade. Metastases were occurred only in one (7.7%) of 13 without vascular invasion.
The relationahip between distant metastasis and vascular invasion isquite apparent in this study and this relationship is very important in planning subsequent therapy.

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In 37 normal kidneys and 23 kidneys with renal cell carcinoma, in all of which computed tomography (CT) was taken at our department of the Jikei University Hospital during the 2 years' period from Nov. 1978 to Oct. 1980, the renal vein as revealed by CT was studied. CT scanning was made with Somatom, with scanning time of 4.5sec, the matrix of 256×256, and section thickness of 7 or 8mm. As a rule, the scanning covered the region from the ensiform process to the iliac crest at intervals of 1cm.
The renal vein could be depicted by this method in 89 and 87% of the normal and tumor kidneys, respectively. There was a tendency that the right renal vein was depicted with lower incidence than the left. The best picture of the renal vein was obtained with scanning in the area at 7 and 8cm level below the ensiform process for both normal and tumor kidneys.
The diameter of the normal renal vein was less than 1.0cm in 89% of the cases, with no case exceeding 1.4cm. Therefore, in cases where there was an extention of the renal vein with a diameter larger than 1.4cm, tumor thrombus in the renal vein or renal arterio-venous fistula should be considered. In fact, among 5 cases where an extended renal vein was observed, a tumor thrombus was detected in the renal vein in 4 cases and a renal arterio-venous fistula in one case.
When CT is performed in renal disease, especially for diagnosis of renal tumor, it is important to pay attention to diseases not only in the kidney but in the renal vein also.

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For the purpose of keeping the urinary concentration of anticancerous drugs for longer period, we devised a new method of bladder instillation using fibrin clot (Coagulum) containing anticancerous drugs.
Coagulum was easily made from fibrinogen solution and thrombin solution. It was proved in vitro that bleomycin dissolved in Coagulum was released gradually as coagulum was melted by urokinase in the urine.
Following the above experiment we clinically performed bladder instillation of coagulum containing bleomycin in 12 cases. A certain urinary concentration of bleomycin was maintained for 6-9 hours. There was no harmful side effect except for bladder irritation in cases on local anesthesia.
Histological examination of specimens resected after coagulum instillation showed epithelial denudation with submucosal inflammation, which suggested a strong chemical action of bleomycin for many hours.

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A method of producing open hydronephrosis in the rat was studied. Three groups of rats were employed. In the first group (Group A), consisting of 20 rats, partial ureteral obstruction was induced by placing a drop of α·cyanoacrylate monomer on the left ureter. The second group (Group B), comprised of 5 rats, underwent complete obstruction of the left ureter by ligature. The third group (Group C), similarly consisting of 5 rats, was subjected to a sham-operation to serve as a control. The degree of hydronephrosis was classified into grade 0 to III at week 1, 4 and 8 after treatment based on the findings obtained by intravenous pyelography and, after sacrifice, macroscopic examination of the kidney.
In group A, grade I hydronephrosis was observed in 14 of the 20 rats (70%) at week 1 and 8 of 16 rats (50%) at week 4. Grade II hydronephrosis was seen in 4 of the 20 rats (20%) at week 1, 7 of 16 rats (46%) at week 4 and 1 of 4 rats (25%) at week 8. Grade III hydrouephrosis was detected in 3 of 4 rats at week 8. Transverse sections of the treated ureter revealed partial mechanical obstruction with periureteral fibrosis. Group B displayed grade II-III hydronephrosis and a rapid decrease in renal function from week 1 onwards. However, long-term odservations indicated that the thinning of the parenchyma was milder than in group A. Group C did not exhibit any morphological or functional changes of the kidney.
The present method of producing open hydronephrosis wes found to be superior to previously reported techniques in terms of reproducibility and ease of preparation.

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To evaluate nonspecific cellular immunocompetence in patients with urogenital cancers, the skin reactivity to 2-4 dinitrochlorobenzen (DNCB) and purified protein derivative of tuberculin (PPD) as delayed cutaneous hypersensitivity test and also the peripheral lymphocytes blastoid formation induced by phytohemagglutine (PHA) and pokeweed mitogen (PWM) were examined on 187 patients with urogenital cancers and 20 with other malignancies. As the control groups, 38 patients with BPH and 23 with benign diseases except BPH were tested simultaneously.
The results obtained were summarized as follow.
1. The skin response to DNCB anb PPD in patients with urogenital cancers were impaired according to extension of the disease.
2. The fact that comparing with the skin reactivity to PPD, the response to DNCB was already suppressed in lower stage of malignant disease suggested that the afferent limb of immunological response might be impaired in the malignant disease.
3. The PHA-induced lymphocytes blastoid formation was suppressed in patients with urogenital cancers and the suppression was paralleled with extension of the disease.
4. The PHA-induced lymphocytes blastoid formation in patients with urogenital cancers was suppressed by adding the autologous serum. Along with extension of the disease, the suppression caused by the serum was noted more obviously.
5. The serum obtained from the cancer patients suppressed healthy lymphocytes blastoid formation induced by PHA. This suppression was noted more obviously on adding the serum from advanced cancer patients, indicating that suppressed immune competence in cancer patieets might be due to both impairment of lymphocytes themselves and suppressive factors in the serum.
6. Comparing with the control groups the lymphocytes blastoid formation induced by both PHA and PWM was suppressed in cancer patients, however this suppression was noted more obuiously in PHA than in PWM.
The PWM-induced lymphocytes blastoid formation by adding the autologous serum from cancer patients showed higher levels than that by adding healthy pooled serum, and the suppressive factor in serum was not recognized.
7. In cancer patients, the lymphocytes blastoid formation induced by PHA and PWM was siguificantly suppressed according to impairment of skin response to DNCB and PPD.

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To evaluate the effect of serum factors on nonspecific cellular immunity, serum proteins were quantitatively mesaured and were compared to immunological parameters such as skin response to DNCB ane PPD and lymphocytes Mastoid formation induced by PHA and PWM. The following results were obtained.
2. In cases with renal cell carcinoma having metastasis, renal pelvic and ureteric carcinoma and also with other malignancies, the serum α₁-globulin level was increased significantly compared with the control groups and tend to rise according to extension of the diseases.
2. As for immunoglobulin level, both Ig-G and Ig-M tend to rise in cases with renal cdll carcinoma but no peculiar change was recognized in other groups of malignant diseases
3. In cases with urogenital cancers, the level of serum prealbumin (PA) was decreased, on the other hand the levels of α₁-antitrypsin (α₁-AT), α₁-acid glycoprotein (α₁-AG), ceruloplasmin (Cp) and also of Haptoglobin (Hp) were increased generally. These changes were more obvious in carcinoma of the kidney, renal pelvis and ureter than that of the bladder and prostate.
The serum α₁-AT level was increased significantly according to the extension of the malignant disease.
4. In proportion to the impairment of skin response to PPD, the level of serum PA was decreased and the levels of α₁-AG, α₁-AT, Cp and Hp were increased significantly, on the other hand the significant changes were noticed in the levels of PA and α-AG only among the skin responses to DNCB.
5. A positive correlation was noticed between the response of PHA-induced lymphocytes blastoid formation after adding autologous serum and the level of serum PA, on the other hand negative correlations were noticed between the response and the levels of serum α₁-AG, α₁-AT and then Cp.
6. The PWM-induced lymphocytes responsivness was not correlated to the levels of serum glycoproteins.
7. The patient's lymphocyte reactivity index correlated negatively to the levels of serum α₁-AT and Cp, suggesting that these glycoproteins might suppress the function of T-lymphocytes.

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