Twenty-eight cases of germ cell tumors of the testis were treated at the Department of Urology, School of Medicine, Chiba University from Jan. 1975 to Dec. 1980.
Stage I seminoma were treated with radiation after orchiectomy, and all 12 patients were tumor free at 6 months to 5 years and 1 month postoperativery. Non-seminoma, advanced seminoma, and seminoma with high HCG were treated with combination of various types of therapy including radiotherapy, chemotherapy, and retroperitoneal lymph node dissection or other surgery.
Retroperitoneal lymph node dissection was performed in six men after orchiectomy as the primary therapy. Three did not have metastasis, 2 had resectable metastases and 1 had unresectable ones. Among 5 completely resected cases 1 recurred locally and 4 relapsed with pulmonary disease. Therefore, retroperitoneal lymph node dissection as a primary therapy for non-seminomatous testis tumors seems to be inappropriate.
Combination of CDDP, BLM, and VBL as a primary therapy was applied to 3 high stage non-seminoma. All achieved complete remission. This modality of chemotherapy was observcd to be better than other combinations of drugs used.

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The thermal analysis has been widely used for the identification of materials, quantitative application and calorimetric measurements.
Recent advances introduced various methods to facilitate interpretation, and rapid analysis of microsamples. Differential thermal analysis (DTA) and thermogravimetry (TG) have been used most widely. DTA and TG of urinary calculi have been studied.
(1) The TG-DTA curves of the principal constituents of urinary calculi have been described.
(2) The principal constituents of urinary calculi were analysed by TG quantitatively.
(a) The principal constituents were identified by X-ray analysis beforehand.
(b) Ideal chemical compositions were calculated for each constituent meterial.
(c) Weight losses directly measured on TG curves may give the weight proportion of each constituent. By calibration of measured weight losses against calculated chemical components, the constituents of mixed calculi (about 58) were determined quantitatively. It is noticed that organic matters are found in amount of about 1.2-6.5% regardless the sizes of urinary calculi.
(3) Good reproducibility for practical purposes has been usually obtained in the case of urinary calculi composed of calcium oxalate and calcium phosphate.
(4) Thermal analysis with automatic recording and microanalyser systems are useful in the field of urology.

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In vitro sensitivity of the established cell line from human urinary bladder cancer, T24 and 253J, to various sex steroid hormones have been examined by the colony formation method, and specific cytotoxic effect of estradiol-17β (E₂) was reported.
In this study, the combined effects of Adriamycin (ADM) or Mitomycin-C (MMC) and E₂ on the T24 cells were examined by the colony formation method. There was no significant difference between cytotoxic effects of ADM or MMC alone and those in combination with E₂ when exposed for 2 hours. However, when exposed for 24 hours, ADM or MMC in combination with E₂ showed significantly more cytotoxic effects than ADM or MMC alone at low concentrations (≤10^-3μg/ml) of ADM or MMC (p<0.05-p<0.001).

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Polyamine values have been evaluated in tumor tissue, blood and urine of patients bearing variety of tumors to assess its potential clinical utility. In this biphasic clinical and experimental study, we measured whole blood polyamine concentrations of tumor-bearing human and animals using thin layer chromatographic technique.
In the experimental phase, polyamine levels in ACI/N rats bearing BC-47 tumor which was induced by oral administration of BBN (Butyl-Butanol-Nitrosamine) were determined. Whole blood polyamine levels were gradually elevated since the 5th day after subcutaneous inoculation of BC-47 tumor and continued to the 30th day. This finding suggests that polyamine is produced by the tumor.
In the clinical phase, polyamine levels in patients with bladder tumor, prostatic cancer and testicular tumor were measured. Polyamine levels in cancerous patients were slightly elevated without statistical difference, while it showed a statistically significant elevation in end stage patients. This finding suggests that whole blood polyamine determination has no usefulness in early detection of malignancy.
After treatment with irradiation and/or anticancer drugs, plyamine levels were elevated, suggestng effective response against the tumors.
Polyamine levels were significantly elevated in benign prostatic hyperplasia in contrast with normal subjects.

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Polyamin concentrations of human cancerous and non-cancerous tissues from the kidney, bladder and testis were measured. In a comparative evaluation of each organ, putrescine, spermidine and spermine in cancerous tissues were higher than in non-cancerous tissues. This finding suggests that cancerous tissue produces higher levels of polyamines.
In non-cancerous tissue of the organs studied, the spermine level was highest and the spermidine and putrescine levels followed it. The levels of spermine in the kidney and spermidine in the testis were highest among normal tissues.
On the other hand, polyamines concentration in benign prostatic hyperplasia, specially spermine, was significantly high, being three times more than that of cancerous tissues.
Regarding glandular or fibromuscular types of benign prostatic hyperplasia, spermine level in glandular type was twice more than that of fibromuscular type. This finding suggests that spermine is produced by the glandular part of benign prostatic hyperplasia.

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The sensitivity of 12 anti-cancer drugs against the carcinoma of human urinary bladder transplantable to nude mice (NM-B-1) were tested. NM-B-1 was poorly differentiated transitional cell carcinoma with partial squamous metaplasia, and its successful transplantation rate was almost 100%. Its 15th to 18th passages were used for this study, and their growth rate were similar and stable. The effects of drugs were evaluated by three means such as tumor growth curve, light and electron microscopic findings. Drugs applied in this study were as follows: CDDP, IFM, CTX, BLM, PLM, ADM, MMC, MTX, ACNU, 5-FU, VLB, VP-16. All drugs administered to nude mice intraperitoneally.
The results from the tumor growth curve, CDDP 2.5, 5mg/kg, IFM 100mg/kg, BLM 20, 40mg/kg, PLM 1.5, 3, 6mg/kg were effective as single agents. All drugs such as BLM, PLM, ADM, IFM, ADM+ IFM combined with CDDP 2.5mg/kg were effecacious. The combination of ADM 4mg/kg+IFM100mg/kg was also effective.
Light microscopic examination revealed that squamous cell pattern was dominant when CDDP single administration or combined with PLM. On the contrary, transitional cell pattern was prevailing when other drugs were applied. Electron microscopic investigation revealed an increase of intracellular vacuolation and tonofibrils, and shortening or disappearance of microvilli when CDDP singly or combination of CDDP+PLM, ADM+IFM as administered. These findings were thought to be a reduction of cytoviability.
From the above results, it is concluded that the combination of CDDP 2.5mg/kg+PLM 3mg/kg is most effective to NM-B-1.

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Recently, medical applications of laser beams have been discussed in numerous reports. Since a flexible delivery system was developed, it has been possible to transmit Nd: YAG laser light through a quartz fiber, making it feasible to perform transurethral laser surgery. Herein, we report the results of the Nd: YAG laser on bladder tumors through endoscopy.
Thirty nine patients with 50 bladder tumors were treated by transurethral Nd: YAG laser irradiation. The equipment employed for laser surgery was a Medilas YAG and Wolf Laser Cystoscope. The transurethral laser operation was performed while irrigating the bladder with a 10% urigal solution. Lumbar anesthesia was used in 31 cases and local anesthesia in 8. A five-second beam of 50-watt electric power was chosen as one unit of irradiation, and 5 to 50 units of irradiation were utilized for one operation. Twenty nine tumors were completely resected with laser irradiation alone. In the other 21 tumors, electroresection or partial cystectomy was undertaken after laser therapy. The results of the laser operation were analyzed according to the tumor location, characteristics, size and histopathology. From our present clinical experiences, we would like to make the following remarkes. (1) The indication for laser surgery is small tumor less than 1cm in diameter. (2) Transurethral Nd: YAG laser surgery could be performed local anesthesia. Accordingly, it is indicated even for patients with severe complications. (3) Only a minimal or no bleeding occurred during the operation. Even bleeding occurred, hemostasis was easily managed by additional irradiation. (4) Complications are rare. We have never experienced perforation of either the bladder or the intestine. (5) Obturator nerve reflex does not occur with laser irradiation. (6) In nine of the 39 cases tumor recurrence appeared at between 2 and 12 months.
Laser surgery through endoscopy thus represents a promising approach for the treatment of bladder tumors and could be applied to patients with severe complications.

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To obtain information about the recuperative ability of hydronephrosis following release of obstruction, the animal and clinical experiments were carried out. Mongrel dogs with unilateral hydronephrosis caused by total ureteral ligation performed from 3 hours to 15 weeks before and patients with unilateral hydronephrosis were used in this experiment. Urine was collected from both kidneys for determination of sodium, potassium, urea-N and creatinine concentration.
The result obtained from the experiments revealed that the concentration of K, urea-N and creatine in the urine from the hydronephrosis which recuperate the function after release of obstruction were more than 10mEq/l in K, more than 150mg/dl in urea-N and more than 20mg/dl in creatinine, respectively.
Sodium concentration showed no definite tendency, but the excretion fraction ratio of Na was less than 10%.
On comparing the urine from both kidneys, the potassium, urea-N and creatinine concentration in the urine from the hydronephrosis with recuperative ability were more than 20% of that in the urine from control kidney.
The concentration of Na, K, urea-N and creatinine in the urine from the hydronephrosis was nearly as low as that of serum when the renal function was hardly recovered.
Histological examination of the kidney with recuperative ability revealed that cortical glomeruli and tubuli were preserved in relatively good condition in spite of partial damages of medullary tubuli. Because urine was safely and easily aspirated from renal pelvis under ultrasonographic control, measurement of urinary components is a clinically useful method to determine the recuperative ability of hydronephrosis following release of obstruction.

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Plasma LH, FSH and testosterone levels and responses of these hormones to various tests were examined in patients with prepubertal hypogonadism, unilateral cryptorchidism, bilateral cryptorchidism, hypospadia, hypogonadotropic hypogonadism, oligozoospermia or azoospermia to evaluate the endocrine function of the pituitary-testicular axis. The effects of intranasal administration of [D-Leu⁶, des Gly-NH₂¹⁰]-LH-RH ethylamide, one of the LH-RH analog, on plasma gonadotropin and testosterone levels were examined in five normal male adults and three patients with hypogonadotropic hypogonadism. Therapeutic effect of this analog was also studied in patients with hypogonadotropic hypogonadism, cryptorchidism and oligozoospermia.
In children, no significant difference was observed in basal levels of plasma LH, FSH and testosterone and increment in plasma LH level during the LH-RH test between normal and patients with prepubertal hypogonadism (4 cases), unilateral cryptorchidism (15 cases), bilateral cryptorchidism (11 cases) and hypospadia (7 cases). The patients with hypospadia showed a significant increase in the levels of plasma FSH from the basal value of 2.8±2.7 (mean±SD) mIU/ml to 17.5±5.6 mIU/ml (p<0.05) after the LH-RH administration, but no significant difference was observed in plasma FSH response to LH-RH among normal children and patients with hypogonadism, unilateral cryptorchidism and bilateral cryptorchidism.
The response of plasma testosterone to human chorionic gonadotropin (hCG) administration (100IU/kg/day for 3 days) was very low in all patients with hypogonadism (peak value, 66±23ng/dl) as compared with normal children (peak value, 270±34ng/dl). Some of the patients with unilateral cryptorchidism (peak value, 230±124ng/dl) and bilateral cryptorchidism (peak value, 261±150ng/dl) showed a relatively low response of plasma testerone to hCG, but all patients with hypospadia had a normal response.
In 48 normal adults, plasma levels of LH and FSH in basal states were 10.9±3.8mIU/ml and 8.6±3.9mIU/ml, respectively, Lower plasma gonadotropin levels were observed in hypogonadotropic hypogonadism (LH; 2.4±1.7mIU/ml, FSH; 3.4±2.7mIU/ml, n=5). In patients with oligozoospermia (13 cases), plasma levels of LH and FSH were within normal range, but 11 cases of azoospermia showed slightly higher levels of plasma LH and FSH (LH; 24.2±15.1mIU/ml, FSH; 35.2±22.7mIU/ml).
Response of plasma LH-RH were low in hypogonadotropic hypogonadism (peak value, 14.0±10.5mIU/ml), but patients with oligozoospermia (174.2±100.5mIU/ml) and azoospermia (194.0±175.0mIU/ml) showed relatively high response. Plasma level of FSH to LH-RH significantly high in patients with azoospermia (peak value, 80.5±32.0mIU/ml) as compared to the normal value (peak value, 14.2±7.1mIU/ml).
The basal level of plasma testosterone in hypogonadotropic hypogonadism (80±38ng/dl) and azoospermia (435±153ng/dl) was significantly lower than in normal subjects(708±161ng/dl, n=50). On the other hand, response of testosterone to hCG(5000IU/day for 3 days) was lower in patients with hypogonadotropic hypogonadism (peak value, 172±54ng/dl) than in normal subjects (peak value, 1453±169ng/dl), but patients with oligozoospermia and azoospermia had values within normal range.
Three patients with hypogonadotropic hypogonadism were treated with intranasal administration of the LH-RH analog (100μg/day) for 6 months. Their pituitary. testicular axis was stimulated to some extent by the treatment but complete development of the external genitalia and testes were not achieved at the end of the treatment.
One of seven cases with cryptorchidism treated with the LH-RH analog(50μg/day) for 14 days showed full descent of the unilateral undescended testis into the scrotum.
Patient

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Urodynamic investigation of the upper urinry tract was performed by pressure-flow study using colored saline. 14 cases of hydronephrosis and 3 cases of renal stone were studied by this method. Renal-pelvic pressure was measured continuously while the colored saline was pourig into the renal pelvis through a nephrostomy tube. Evaluation was performed by observing the passage of colored saline at various pressure through the indwelling bladder catheter.
The intra-pelvic pressure is classified into 3 patterns.
1) Passage of colored saline at low pressures.
2) Passage of colored saline at moderate high pressures.
3) No passage of colored saline or passage of colored saline at remarkably high pressures.
Compering with the conventional X-ray, new pressure-flow study with colored saline is very simple and wide clinical application is expected.

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Seven patients with disseminated non-seminomatous testicular cancer were treated by surgical removal of metastatic foci, following chemotherapy using a combination of actinomycin-D, methotraxate, cyclophosphamide and vincristine, or a combination of cis-diamminedichloroplatinm, vinblastine and bleomycin.
In 2 out of the 7 cases, resected metastatic tissues proved to be mature teratoma. The primary tumors of these 2 cases were embryonal carcinomas and contained no choliomatous elements.
The levels of tumor markers (serum α-fetoprotein and urinary human cholionic gonadotropine) in these 2 case before surgery fell within a normal range by chemotherapy.
The metastatic foci which turned into differentiated tissues (teratoma) were cystic and spongy macroscopically. Microscopically these differetiated tissues were composed of glandular epitherium and smooth muscle cells.
In our experiments, cis-diamminedichloroplatinum, vinblastine, and bleomycin in combination was administered to nude mice (BALE/C strain) bearing with human embryonal carcinoma. In some of these mice, tumor cell differention was observed.
With regard to the mechanism of tumor maturation, the following can be considered from our experiences. (1) Embryonal carcinomas have totipotential ability. (2) Totipotential malignant cells can turn into mature teratoma by chemotherapy. (3) Differentiation of totipotential malignant tumors is influenced by cell kinetics and biological response.

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