Donor nephrectomy in Japan, is usually carried out after cardiac arrest has occurred. Most cadaver kidney transplant recipients suffered from acute tubular necrosis of the kidney grafts due to prolonged warm ischemia. Failure of the kidney graft to function immediately after transplantation is a dismaying complication because continued hemodialysis is necessary. Furthermore, the subtle, early changes in renal function necessary to diagnose rejection, are undetectable in the face of severe renal failure. The recipients often suffer from life-threatening complications such as G. I. bleeding and infection because they received large doses of immunosuppressive drugs. For the purpose of minimizing these life-threatening complications and also of suppressing rejection, a new regimen of immunosuppressive treatment was carried out using methylprednisolone, prednisolone and azathioprine at reduced doses and ALG at sufficiently high doses, along with serial open kidney graft biopsies.
Nine cadaver kidney transplant recipients were treated by the management described above from Jan. 1978 through Dec. 1980. Of the 9 patients, 1 had immediate renal function. In the remaining 8 patients, however, continued hemodialysis was necessary because of increasing uremia after transplantation. Six of these 8 patients with acute tubular necrosis, had renal function after 7 to 18 days hemodialysis. However, in 2 of these 8 cases the grafts had never functioned because of irreversible acute tubular necrosis and acute tubular necrosis complicated by rejection. During the posttransplant oliguric phase, 2 patients had G. I. bleeding out the others had no complications. In 4 of 7 patients with renal function, the kidney grafts were functioning well for 3 to 35 months. Two patients lost their grafts because of acute fulminant rejection and the ceasation of immunosuppressive drugs due to G. I. bleeding. One patient died from sepsis secondary to the perforation of the ileum, although immunosuppressive drugs had been discontinued.

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Transitional cell carcinoma of the renal pelvis has been encountered in 54 cases at the Jikei University Hospital and related facilities.
The purpose of this review was to determine the association of ureter and bladder lesion with the renal pelvic tumor.
There were 14 women and 40 men (a ratio of 1.0 to 2.9). The range of age was from 22 to 78 years with an average of 59.
Twenty-six of the 54 patients (48%) with urotherial tumors of the renal pelvis had a synchronous or asynchronous tumor in the ureter and/or bladder. Seven of 20 patients were found to have bladder tumors concurrent with their renal pelvic neoplasms. Subsequent bladder tumor occurred in 13 of 20 patients. It developed 3 to 26 months (average 9.8 months) after the treatment of the pelvic tumor. Two cases had a previous history of bladder tumor.
High recurrence rate of the bladder tumor was observed with the association of multifocal tumors of upper urinary tract lesions at the time of operation. From the point of surgical treatment the recurrent bladder tumor was much more satisfactorily prevented by complete nephro-ureterectomy including a cuff of bladder.
Histopathologically the grading of the bladder tumors was usually simillar to that of original pelvic lesion.
And the majority of bladder lesions were superficial.

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Purified prostatic acid phosphatase (PAPase) was obtained from a supernatant of homogenized human prostatic adenoma by ammonium sulfate fractionation and column chromatography using phosphate-cellulose, Sephadex G-100 and DEAE-cellulose. The recovery rate was about 20% and a 40 fold purified sample for a supernatant of homogenized prostatic adenoma was obtained. The results were as follows:
1) The anti-PAPase serum obtained from rabbit by immunizing with purified PAPase reacted specifically to the PAPase and supernatant of homogenized prostatic adenoma but did not react to supernatant of the other organ homogenate by immunodouble-diffusion technique of immuno-electrophoresis.
2) Effects of heat, pH and duration of antigen-antibody reaction between the PAPase and anti-PAPase were examined. When normal rabbit serum was added to the purified PAPase, enzyme activity was rapidly lost at every tested pH at 56°C. But when anti-PAPase was added to the purified PAPase, enzyme activity was markedly stabilized at pH 4.6-5.8 even after 6 hours at 56°C. Furthermore, when human serum was added to the system, enzyme activity was also stabilized. When anti-PAPase was added to the purified PAPase, enzyme activity was stabilized if antigen-antibody reaction time was over one hour.

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Specific anti-prostatic acid phosphatase serum was prepared with the prostatic acid phosphatase (PAPase) purified from prostatic adenoma. And a new immunochemical method for measuring the PAPase activity with anti-PAPase serum was devised. Using this new method, the PAPase activities in 7 cases of normal men, 7 cases of normal women and 54 cases of benign prostatic hypertrophy were determined. The total acid phosphatase (APase) activity and the PAPase activity inhibited by L-tartrate were determined. The total acid phosphatase (APase) activity and the PAPase activity inhibited by L-tartrate were determined simultaneously. The results were as follows:
1) When sera of patients with benign prostatic hypertrophy were allowed to stand at room temperature, the total APase activity decreased remarkably.
2) There were no differences between groups of normal men and women and group of benign prostatic hypertrophy in the total APase activity and the PAPase activity inhibited by L-tartrate. In addition, there were no differences in the ratio of the PAPase activity inhibited by L-tartrate against the total APase activity, while a high L-tartrate inhibited rate as about 48% was observed in normal women.
3) According to the immunochemical method, the PAPase activity was 0.33±0.29 (n moles/min/ml) in the group of benign prostatic hypertrophy. This value was slightly higher than those in normal men and women, but no significant difference was observed. In the ratio of the PAPase activity against the total APase activity, a similar result was observed.
4) No significant correlation was observed between weight of prostate and the PAPase activity determined by immunochemical method in 16 cases of benign prostatic hypertrophy.

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Serum prostatic acid phosphatase (PAPase) activity in 26 cases of prostatic cancer and 13 cases of cancer in other internal organs (3 cases of renal cell cancer, 5 cases of bladder cancer and 5 cases of liver cancer) was determined by the immunochemical method reported previously, comparing to the PAPase activity in 54 cases of benign prostatic hypertrophy. The total serum acid phosphatase (APase) activities and the PAPase activities inhibited by L-tartrate were also determined simultaneously. The results were as follows:
1) The total APase activities in the stage T₃ and T₄ groups of prostatic cancer were significantly higher than that in the stage T₁ and T₂ groups, the groups of cancer in other internal organs and benign prostatic hypertrophy. There were no differences in the total APase activities between the stage T₁ and T₂ groups of prostatic cancer, groups of cancer in the other internal organs and benign prostatic hypertrophy.
2) A similar finding was obtained in the ratio of the PAPase activities inhibited by L-tartrate to the total APase activities.
3) The average PAPase activities determined with immunochemical method were 0.77±0.34 (n moles/min/ml) in the stage T₁ and T₂ groups of prostatic cancer, 6.15±6.14 in the stage T₃ and T₄ groups and 0.17±0.12 in groups of cancer in the other internal organs. The PAPase activities in the stage T₃ and T₄ groups of prostatic cancer were significantly higher than that in the stage T₁ and T₂ groups, groups of cancer in other internal organs and benign prostatic hypertrophy. The stage T₁ and T₂ groups of prostatic cancer also showed a significantly higher PAPase activity than the groups of cancer in other internal organs.
4) According to the immunochemical method, the ratios of the PAPase activity to the total APase activity were 14.36±6.20% in the stage T₁ and T₂ groups of prostatic cancer, 32.95±10.06% in the stage T₃ and T₄ groups and 3.72±1.92% in groups of cancer in the other internal organs.
5) The PAPase activity determined by the immunochemical method appeared useful in the diagnosis of prostatic cancer.

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The renal pelvis of the unicalyceal kidney was systematically dissected into several strips, and spontaneous contraction of these muscle strips was recorded. Immediately upon suspension in a tissue bath, every region disseccted from the renal pelvis exhibited the spontaneous contractile activity. The contractile frequency of the dissected segment was highest in the proximal region and reduced distally. However, there was no frequency gradient in the circumferential direction. The modulation of waveform referred to as waxing and waning was observed in both the proximal and middle regions, indicating the presence of a coupling mechanism in the renal pelvic pacemaker system.

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This study attempts to simulate the pacemaker activity of the renal pelvis by using a chain of coupled linear oscillators. When the coupling between oscillators was low, the intrinsic frequency of the proximal region was not entrained to that of adjacent distal region. When the coupling was high enough, the highest frequency oscillator located in the proximal region drived all other oscillators so that the whole pelvis oscillated at the intrinsic frequency of the proximal region. These results indicate that in the renal pelvis of the unicalyceal kidney a tight coupling is necessary for the complete conduction of the contraction wave originated at its proximal region. In addition, the waxing and waning effect was also reproduced by a low value of coupling.

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Renal blood flow measurement by ultrasonic Doppler flow technique was carried out to evaluate renal graft condition in 8 patients with postoperative anuric episodes induced by acute tubular necrosis and/or acute rejection. They were consisted of 5 living related kidney transplantation recipients and 3 cadaveric transplantation recipients.
On analysis of blood flow pattern in patients with ATN, there were remarkable decreases in flow speed in diastolic phase depending on the severity but not in systolic phase. Improvement of blood flow in diastolic phase was indicative of restoration of the graft. Graft prognosis, onset of graft function and rejection crisis superimposed on ATN were correctly diagnosed by serial changes of blood flow pattern.
In anuric period induced by acute rejection, severity of rejection was detected and furthermore reversibility from rejection was predictable.
This method appears to be a useful technique even during anuric period when examinations are restricted.

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In order to study the effects of cyproterone acetate (CPA) on the testicular function, male Sprague-Dawley rats weighing 347±5gm were treated with 10mg/kg daily dosis of CPA for 2 or 4 weeks, and the following parameters were investigated at the end of the treatment: testicular morphology, plasma hormonal levels, spermatogenesis and testicular secretion rates of testosterone, progesterone and 17α-hydroxyprogesterone. The secretion rates of these steroids were measured using isolated testicular perfusion method. The number of spermatozoa was counted in the rat ejaculates obtained by electro-stimulation.
Treatment with CPA for 2 or 4 weeks caused a significant decrease in the weight of ventral prostate, but there was no significant change in the weight of testis when compared with the control animals. Histologically the testis from CPA-treated animals showed a deformity of late spermatid in the seminiferous tubules. However, CPA treatment did not alter the number of interstitial cells and Leydig cells which were counted relating to the number of seminiferous tubules in a given area of the testis. CPA treatment reduced the number of spermatozoa counted in the rat ejaculates, although the difference between the control and treated animals was not significant. The testosterone secretion rate in normal rat testis was 3.39±0.67ng/min and increased rapidly when perfused in the presence of 500mIU/ml hCG in the medium. CPA treatment for 2 weeks resulted in a significant reduction of the testosterone secretion rate (1.55±0.67ng/min, p<0.001), and after 4 weeks it was reduced to 0.91±0.21ng/min. Furthermore, CPA lowered the testicular response to hCG as far as the testosterone secretion rate was concerned. These data were consistent with the changes of plasma hormonal levels. CPA treatment resulted in a significant increase in plasma LH and FSH levels (p<0.001), while the plasma testosterone decreased (p<0.05). Although testicular perfusion study demonstrated a significant reduction in testosterone secretion rate after CPA treatment, the secretion rate of progesterone did not significantly differ from control animals. On the contrary, the secretion rate of 17α-hydroxyprogesterone in the CPA treated animals increased significantly (p<0.05).
The results, obtained from the present study, indicates that CPA exerts its inhibitory effect not only on the spermatogenesis, but also on Leydig cell function leading to the impairment of testicular testosterone biosynthesis.

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Urinary macromolecular inhibitory activity (more than 10, 000mol. wt.) of calcium oxalate crystal aggregation was studied by using in vitro new assay method of non-crystal-seed system. As to the mode of inhibitory effects, while macromolecular inhibitors showed their strong inhibition just on crystal aggregation, the process of crystal nucleation, e. g. formation product of calcium oxalate, was not affected by those inhibitors. Next, recurrent stone formers were compared with non-stone formers with regard to the urinary macromolecular inhibitory activity. As a result, the urinary macromolecular substances of recurrent stone formers showed much less inhibitory activity than those of non-stone formers. This fact suggests that urinary macromolecular inhibitors on crystal aggregation take a considerable part in the in vivo stone formation and that a quantitative decrease or qualitative alteration of the macromolecular inhibitors occurs in the urine of recurrent stone formers.

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Recently we have reported that the urinary macromolecular inhibitors may play an important role in the prevention of in vivo stone formation and that in the urine of recurrent stone formers the urinary macromolecular inhibitory activity was decreased significantly. Then we made further studies to characterize the macromolecular inhibitors. They seemed to be composed of unknown proteins or protein-complexes since approximately 70 to 90 per cent of the macromolecular inhibitory activity was destroyed by protein digestion with proteinase. And, based on the result of Sephacryl S-300 gel filtration, it was speculated that they were not simple proteins but protein-complexes. On the other hand, we could demonstrate that urinary acid glycosaminoglycans, which have been considered to be a possible inhibitor, play a minor role in the inhibition of crystal aggregation and the inhibitory activity originating in the urinary acid glycosaminoglycans of recurrent stone formers was not decreased significantly from the normal level. And we could show that RNA-like substances, which have also been reported as possible inhibitors, did not contribute to the urinary macromolecular inhibitory activity demonstrated in our recent study.

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The urinary calculi of 1020 patients, who consulted to our clinic during the past 28 years (1953-1980), were analyzed by infrared spectra (mainly of stone nuclei). There were 407 calculi of rt. upper urinary tract (285 males and 122 females), 463 calculi of lt. upper urinary tract (337 males and 126 females), 133 calculi of lower urinary tract (112 males and 21 females) and 17 calculi of prostate. The youngest patient was a 2 yrs. boy with bladder stone and the eldest patient was a 89 yrs. woman with bladder stone (Table 1-3, Fig. 1-2).
The analytical results were following:
1) The chemical compositions of 1020 stones showed 74.0 per cent of calcium oxalate and calcium phosphate, 15.6 per cent of magnesium ammonium phosphate (including magnesium hydrogen phosphate), 5.0 per cent of mixed magnesium ammonium phosphate-calcium oxalate, 4.1 per cent of uric acid and urate, 1.1 per cent of cystine and 0.1 per cent of protein (Table 4).
2) The most prominent component of upper urinary tract calculi were calcium oxalate and calcium phosphate (about 80 per cent of cases), while a relative high occurrence of magnesium ammonium phosphate calculi in the upper urinary tract of female patients in comparison to male patients was noticed (Table 4).
3) There was a high occurrence of phosphate calculi in the lower urinary tract and the prostate, and also in patients elder than 60 yrs. Uric acid calculi were found in the elder patients and the urate calculi in the younger patients (Table 4).
4) A decreased occurrence of magnesium ammonium phosphate calculi was noted after 1961, while there was no variation in the percentages of uric acid calculi, urate calculi and cystine calculi during the investigated 28 years (Table 6, Fig. 3).

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