We studied the distrbution and incidence of Serratia, the clinical background of urinary tract infections caused by Serratia marcescens, and the O-serotype, biotype and susceptibility to antimicrobial agents of strains isolated from urine specimens in the Departemmt of Urology, Sapporo Medical College Hospital from January 1975 to December 1981.
The results are as follows:
1) The annual incidence of Serratia isolated from UTI patients ranged from 2.4% to 18.4% in inpatients and from 0.4% to 5.2% in out-patients. The incidence showed an increasing pattern until 1980. Among the species, S. marcescens accounted for 88.0%. During the period, 154 strains of S. marcescens were isolated from 146 UTI patients.
2) In the clinical background, high age, use of indwelling catheter and instruments in the urinary tract, existence of basic diseases including malignant tumors of the urinary tract, and medication with antimicrobial agents can be considered to have causal relationships to the infections. Therefore, these Serratia infections bear an aspect of being opportunistic infections.
3) Using the O-serotype, 122 strains (79.2%) could be classified. The main serotypes were 0-16 (15.6%), 0-4 (14.3%), 0-5 (12.3%), 0-14 (8.4%) and 0-9 (4.5%). These serotype distributions changed every year, sometimes being common in only one year. The API20 system resulted in classification of the isolates into 21 biotypes, but 70.1% of the strains fell into only 4 biotypes. By using the serotype together with the biotype, more detailed classification can be achieved.
4) We measured the MICs of the isolated strains to determine their antimicrobial susceptibilities. They were mostly resistant to β-lactam antibotics. Aminoglycoside antobiotics and ST showed good antibacterial activity. However, after 1977, the isolates showed a pattern of increasing resistance to the aminoglycosides.

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From January 1975 through December 1981, 109 UTI in-patients were found to harbor S. marcescens at the Department of Urology, Sapporo Medical College Hospital. We performed epidemiological studies by means of O-serotyping and partial biotyping, and bacteriological studies on the environment of the urological ward.
The results are as follows:
1) The largest number of UTI patients with S. macrescens in one year was 35 (12.2%), in 1980. Recently, the number of patients infected at the time of admission has been increasing gradually.
2) Annual changes in the O-serotypes can be seen. Sometimes there was an outbreak of apparent nosocomial infections by strains of the same O-serotype. On the other hand, in 1979 and 1980. there were nosocomial infections thought to be caused strains imported from other wards or hospitals.
3) According to the epidemiological survey, in 1977, 1979 and 1980, there were nosocomial infections due to cross-infections in our ward and indwelling catheters were identified as an important inducer of those infections.
4) From January 1978 to March 1979, we performed a bacteriological study on the environment in the ward, and isolated GNR from 2.4% of the specimens. Three strains of S. marcescens were isolated from the floor of the sickroom and mops, and enviornmental pollution by infected urine was speculated upon as the main cause. Cross-infection via the environment is thus quite possible.
5) Sanitation countermeasures were undertaken based on the above findings. In 1981, these efforts bore fruit: the number of UTI patietts with S. marcescens in our in-patients decreases, with only one patient considered to have acquired the infection in our hospital.

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In order to clarify the mechanism of urinary continence under stress, the author measured synchronously the urethral closing pressure and bladder pressure at cough or hold maneuver, in 13 control males, 10 control females, 14 male patients with benign prostatic hypertrophy and 11 female patients with stress incontinence. EMGs of the external urethral and anal sphincters were obtained simultaneously with the pressure measurement.
In all but the patients with stress incontinence, the closing pressure at the bladder neck, prostatic urethra and membranous urethra (mid-urethra in female) increased in response to cough and hold maneuver, with simultaneous increases of electromyographic activity in the striated muscle sphincters of the urethra and anus. The urethral closing pressure, therefore, was always higher than the bladder pressure.
In patients with stress incontinence, despite the elevated electromyographic activity in the striated muscle sphincters, the closing pressure at the bladder neck and mid-urethra showed a very slight or no increase in response to cough or hold maneuver.
It may be concluded that the urinary continence under stress is maintained by the reflex contraction of the urethral smooth muscle sphincter.

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In patients with prostate cancer, prostatic acid phosphatase (PAP) in the serum is enhanced. An immunohistocheical study was performed on the localization of PAP mainly in prostatic tissues in an attempt to elucidate the pathema of prostate cancer.
For 56 prostate specimens obtained from clinical cases, the localization of PAP in the tissues was investigated by means of the immunofluorescence method using anti-human PAP rabbit serum to purified PAP. The conventional azo-dye method was applied at the same time for the enzyme histochemical investigation of acid phosphatase, as a reference. The results were as follows:
1. In detecting PAP in the prostate, the immunohistochemical method showed a higher specificity than an enzyme histochemical method.
2. In all of the 56 prostate specimens including normal tissues, immunofluorescence specific to PAP was recognized diffusely in prostatic epithelial cells, luminar secretions and prostate cancer cells.
3. In 31 cases of prostate hypertrophy, specific fluorescence was observed clearly in the glandular epithelium independent of its histological type, especially in the epithelium facing the aciner lumen.
4. Eighteen cases of untreated prostate cancer showed a tendency toward weaker specific fluorescence both per visual field and per cell than cases of prostate hypertrophy. A significant correlation was observed between the degree of differentiation of cancer cells and the intensity of the specific fluorescence per visual field.
5. The above results suggest that PAP in prostatic epithelial cells is excreted into the aciner lumen while the PAP level in the blood in cases of prostate cancer is enhanced due to destruction and disorder of the tissue structure.

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Ultrasonography was performed to detect postoperative complications in ten cases of renal transplantation.
Lymphocele was detected in three cases, in which ultrasonographic examination proved to be useful in determining the treatment guide line of lymphocele.
On the other hand, acute rejection was observed in nine cases. Our main ultrasonographic findings at the time of acute rejection were prominent pyramids, increase of the parenchymal thickness and increased parenchymal echogram which became similar to that of the central portion. In mild rejection cases, no positive finding or prominent pyramids were detected. In a moderate rejection case, renal parenchyma was thickened. In a severe rejection case, the boundary between parenchymal and central echoes became indistinct.
Acute tubular necrosis (ATN) occurred in one case, in which ultrasonographically positive finding was not detected.
In conclusion, ultrasonography is useful in detection and follow-up of lymphocele and would be one of the tools for the diagnosis of rejection crisis in renal transplantation.

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Diagnostic value of detection of antibody-coated bacteria (ACB) in localization of urinary tract infection was studied in 71 patients with urinary tract infections in whom the site of infection was apparent from clinical symptoms and underlying urinary diseases.
Presence or absence of ACB and serum antibody titer was also studied in experimental ascending pyelonephritis in rabbits.
The results were summarized as follows:
1) ACB were detectable from urine samples either by the tube method or by the prefixation method on the ringmark slideglass.
2) ACB were detectable from urine samples which were preserved at 4°C for 24hrs. or preserved at -24°C for 2 weeks. But the rate of detection significantly fell when urine samples were preserved at 37°C over 3hrs.
3) ACB were detectable in 88% of the 34 samples from patients with upper urinary tract infections and in 27% of the 45 samples from patients with lower urinary tract infections.
4) Experimental pyelonephritis was produced by loose ligation of the unilateral ureter and intraureteral inoculation of bacteria. Urine samplings were possible in this experimental model at regular intervals to follow up the course of infection.
5) Proteus mirabilis produced most severe phylonephritis, followed by Pseudomonas aeruginosa, Escherichia coli, Serratia marcescens, Staphylococcus epidermidis and Streptococcus faecalis in this order.
6) ACB were detected even in rabbits with slight experimemtal pyelonephritis.
7) ACB were detectable after inoculation of bacteria earlier (within 5 days) than the elevation of serum antibody titer which is regarded as a general immune response.
8) The class of antibody which coats urinary bacteria was different from that of serum antibody.
9) Therefore, antibody which coats urinary bacteria was suggested to be produced in the kidney as a result of local immune response.

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A new technique of cutaneous ureterostomy for experimental split renal function studies in female dogs is described.
In this procedure, a cuff of vaginal wall was used for protection of ureteral ostium. The operation was done in two stages. A unilateral ureterovaginal anastomosis was made intraperitoneally in the first stage, and transplantation of the ureter with surrounding vaginal wall to anterior abdomen was performed in the second operation.
The dogs were followed for an average of 9.4 months. Gross appearance and function of the ureteral stomas, urine bacteriology, excretory urography and split renal function were periodically examined, and histopathological observation of the renal units was finally performed.
In excretory urography, satisfactory results were obtained in 25 of 29 dogs. However, 5 dogs later developed slight hydronephrosis. Urine cultures were all negative. Histological observation of 11 dogs revealed normal kidney in 4 dogs, while minimal pyelonephritic changes were associated in 7 dogs. Urinary excretion rates of sodium and potassium, urinary osmolality and inulin clearance obtained from both exteriorized and contralateral sides of the kidney revealed no significant differences.
In conclusion, the cutaneous ureterostomy using vaginal cuff will be an excellent model for both acute and chronic studies of split renal function in dogs.

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Plasma immunoreactive parathyroid hormone (i-PTH) was determined with two ¹²⁵I-radioimmunoassay systems of bovine PTH (1-84) (b-PTH system) and synthetic human PTH (46-84) (h-PTH system), in order to evaluate diagnostic usefulness of the latter as compared with the former, in 50 patients with one or more calcium-containing urinary stones (SF), 2 surgically proved patients with primary hyperparathyroidism (PHPT) mainly complaining of urinary stone(s), 5 patients with chronic renal failure on chronic hemodialysis and 10 normal controls (Normal).
In b-PTH system, firstly, the mean plasma i-PTH value of the group of SF was significantly lower (p<0.05) than that of the group of Normal (Table 1 and Fig. 2), the cause of which was left to be elucidated. Secondly, there was a large overlap (Fig. 2) among the mean plasma i-PTH values of the groups of PHPT, SF and Normal, whicn made it actually impossible to discriminate PHPT from SF and Normal by plasma i-PTH only.
In h-PTH system, on the other hand, the mean plasma i-PTH value of the group of PHPT was much higher than those of the groups of SF and Normal (Table 1 and Fig. 2). Therefore, plasma i-PTH alone may make it possible to differentiate PHPT from SF and Normal although the case number (2 cases) of PHPT was too small to evaluate this result conclusively.
The results obtained encourage us to go, in the future, into further investigation of PHPT with this hopeful synthetic human fragment kit of PTH.

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Evidence has accumulated to show that tumor development in humans and animals is influenced by immunological reactions and that these reactions can be enhanced by bacteria. The purpose of this study was to ascertein whether Corynebacterium parvum (C. parvum) shares common antigens with a FANFT induced mouse bladder tumor (MBT) by immunoperoxidase staining and to determine the relationship between common antigenicity and inhibition of tumor grouth.
The antigenic relationship between MBT and C. parvum was confirmed by serum absorption experiments. Antigenic cross-reactivity between MBT and Staphylococcus aurevs was also identified, but no relationship was found between MBT anf Escherichia coli or Pseudomonas aeruginosa. The tumor growth was significantly inhibited with bacteria sharing common antigens compared to growth of cells mixed with antigenically unrelated bacteria. The results sugested that common antigenicity may enhance the immune response of the host and promote tumor regression.

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From June 1979, when the Spinal Cord Injuries Center, Iizuka was established, to August 1981, we carried out transurethral anterior sphincterotomy (Tu-Sp) 33 times on 29 male patients with spinal cord injuries among 155 inpatients treated in our Center. These 29 males could not void satisfactorily due to dysfunction of the urethral sphincter. Indications for Tu-Sp were determined by the following investigation: 1) A voiding synchronous cystosphincterometry with uroflowmetry: in combination with 2) Bladder, urethral and rectal pressures 3) Uroflowmetry and 4) Anal electromyography. This combination reveals the bladder and urethral function, viz. detrusor muscle and sphincter function during voiding. We have found this urodynamic study to be of great value in evaluating the function of the lower urinary tract in spinal cord injured patients.
The results were as follows:
1) Tu-Sp is indicated for the dysfunction of the external urethral sphincter.
2) If the indication for Tu-Sp was obtained it should be carried out as soon as possible.
3) Division at the 12 o'clock position on the external sphincter was enough for this purpose.
4) After Tu-Sp the pressure in the membraneous urethra and residual urine were decreased.
5) Detrusor muscle activity was weakened and duration of contraction was shortened.
6) All the patients voided satisfactorily after operation.
7) Although urinary incontinence was increased post Tu-Sp so-called total incontinence was not seen.
8) Every patient had bladder capacity ranging from 100 to 300ml postoperatively.

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In order to know biological property of urothelial tumor and to support urinary cytology, cytogenetic study was performed on exfoliated cells from 40 urothelial tumor patients and 23 no tumor patients with other urological disease. Among the tumor patients, 20 had superficial papillary (low-stage) bladder tumor, 16 had inveasive (high-stage) bladder tumor and 4 had ureter and renal pelvis tumor.
Cells, exfoliated in both urine and bladder washing fluid, were treated by a direct method using Colchicin.
Mitotic index (M.I.), incidence of dividing cells per 1, 000 cells, was calculated, and chromosome analysis was achieved if adequate metaphase cells had been observed.
The results were as follows.
1) In the control patients the mean M. I. was extremely low. No metaphase cells were observed.
2) In the urothelial tumor patients, the mean M. I. was significantly higher and it increased according to histological grade and stage, and in some patients it decreased after irradiation.
3) Metaphase cells were observed in 14 low-stage bladder tumor, 10 high-stage bladder tumor and one renal pelvis tumor.
4) In the low-stage bladder tumor, 5 of 7 grade 0 tumor had only diploid or neardiploid cells, but 6 of 7 over grade I tumor had polyploid cells and one of them had marker chromosome.
5) Nine of 10 high-stage bladder tumor had polyploid cells and 4 of them had marker chromosomes. In conclusion, cytogenetic study of exfoliated cells provided a simple diagnostic aid for urothelial tumor.

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Although the intracavitary instillation for transitional cell carcinoma of urinary bladder (especially low stage, low grade) with mitomycin C is clinically highly effective, the cystitis, a local side effect, is slight or does not appear at all in about 40% of the patients. To clarify this fact, histological and histochemical studies were performed, and the following findings were obtained.
1. The covering cells located at the mucosal surface of the rabbit and human bladder have extremely high resistivity against the intracavitarily instillated mitomycin C, and they neither excoriate nor fall off even after the repeated and frequent instillation: thus they strongly inhibit the absorption or permeation of this antitumor agent.
2. In contrast, the surface cells of transitional cell carcinoma begin to undergo necrotic changes and to fall off (exfoliation) after 3-5 times intracavitary instillation of mitomycin C. In addition, the necrotic changes characteristic to those due to the instillation of this agent are observed in deeper tumor cells. Therefore, it is suspected that considerable amount of this agent is absorbed (or permeated) into the tumor cells. On the other hand, the cornified cells of the squamous cell carcinoma have the higher resistivity than bladder mucosa against mitomycin C, supporting the clinical observation that the intacavitary treatment with this agent is ineffective ageinst this type of tumor (squamous cell cancer).
3. Similarly to the homogenates of liver, kidney, or spleen, etc., rabbit or human bladder mocosa or muscle tissue have a considerably strong activity to inactivate mitomycin C: thus, they show a resistance against mitomycin C with concomitantly inactivating mitomycin C having invaded by absorption of permeation. On the other hand, the tissue of transitional cell carcinoma is weak in activity to inactivate mitomycin C, and, thus, it is easy to suffer from the damage by mitomycin C having invaded into the tumor tissue by absorption or permeation.

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In order to gain more insight into the pathogenesis of urinary calculi, glycosaminoglycans (GAG) excretion was measured in 24-hour urine from 26 patients with urolithiasis and in 16 healthy age-matched individuals. Furthermore, the component patterns of urinary GAG in these patients were analysed by two-dimensional electrophoresis and microcolorimetric procedure, and the results were compared with those of GAG components isolated from organic stone matrix. The uronic acid was determined as described by Bitter & Muir. Decalcification of urinary calculi was performed in 5% (w/v) EDTA solution.
The organic matrix in calcium and M. A. P. calculi weighed about 10 per cent of the original stone dry weight. The uronic acid content of organic matrix from 6 calcium calculi (Ca-P, Ca-ox) was 5.7 per cent, whereas that of 2 M. A. P. calculi was 4.1 per cent. By two-dimensional electrophoresis, the GAG in calcium stone matrix was found to be mainly constituted of heparan sulfate (35.5%) and hyaluronic acid (21.3%), while the GAG in M. A. P. calculi was characterized by the presence of large amount of low sulfated chondroitin sulfate (56.3%)
The urinary excretion of GAG in healthy individuals averaged 8.4±1.0mg/24hrs. or 604±82μg/dl (mean±SEM). The major components of GAG excreted in the urine of healthy individuals were chondroitin sulfate (55.0%), heparan sulfate (20.2%), low sulfated chondroitin sulfate (11.2%). There was no difference in the amount of urinary GAG of healthy individuals compared with that of patients with calcium calculi. In these patients there was a significant correlationship between urinary concentration of GAG and inorganic phosphate (p<0.05). In patients with M. A. P. calculi, the daily urinary GAG excretion was significantly higher than that of healthy individuals (p<0.05).
The major component of urinary GAG in patients with calcium or M. A. P. calculi was chondroitin sulfate (45.5%, 50.8%), which was followed, in a decreasing order, by heparan sulfate, low sulfated chondrotin sulfate: there was no difference in the component pattern of urinary GAG in patients with calculi when compared with that of healthy individuals. The present results, however, indicated that there was apparent difference in the components of GAG between organic stone matrix and the urine of these patients. From these observation, it was concluded that GAG in stone matrix could not be a simple “co-precipitating factor”, but might be some active nucleating substance in the pathogenesis of urinary calculi.

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Enzyme immunoassay (EIA) has been developed as a mean of microanalysis of antigens or antibodies with the aid of enzyme instead of radioactive materials. Malignant tumor has been known to produce human chorionic gonadotropin like substance (hCG-LS) in some cases, which is often capable of being a tumor marker during the clinical course. The present study is aimed to establish fundamentally a sandwich method of EIA for the measurement of hCG-LS, and to determine the hCG-LS levels in the selected cases with urogenital malignant carcinoma.
Anti-hCG serum was obtained from rabbits immunized by purified hCG. Rabbit IgG was also prepared by treatmenting anti-hCG serum with saturated ammonium sulfate as well as DEAF sephacel. Anti-hCG IgG was adhered to the surface of the plastic ball by the glutaraldehyde method. Horseradish peroxidase was conjugated with the antibodies according to the procedure of Nakane and Kawaoi.
The dose response curve was satisfactory in the range of 3.9-500mIU/ml. The values of intra-assay and inter-assay coefficient varieties were 6.9-9.9%, and 7.6 and 22.4%, respectively. Cross-reactivities with hCG-EIA and LH-RIA were 71.4%. Recovery experiments were 95.3%. The influence of the rheumatoid factor was negligible. The correlation coefficient with LH-RIA and hCG-EIA was 0.943. A satisfactory correlation could be obtained with the clinical course and hCG-EIA values in a testicular tumor patient.
From the present investigation, we would like to conclude that; (1) The sensitivity of hCG-EIA was superior in high doses to that of LH-RIA. (2) ETA could be not only easily applied but also often performed in the ordinary laboratory because of no need of radioisotope materials. Application of EIA seemed to be more prevalent in near future.

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Testicular LDH and its isozymes were investigated using (1) male Wistar rats aged 2 to 90 days and
(2) 37-day-old male rats hypophysectomized at 20 days of age.
LDH activity in cytosol of the testis (105, 000×g, supernatant) was measured utilzing LDH Monotest kit. Isozymes were separated by electrophoresis on agar gel plate, stained with staining solution of LDH Isozyme-Test and quantitated with Densitron 1M at 570nm. Testicular tissues with Bouin solution were sliced at 4μ and stained with Hematoxyline-Eosine or PAS. The 50 cross and round tubular sections of each slide were selected and tubular diameter and most advanced germ cell in each section were recorded.
1) LDH activity in rat testes increased with advance of age until 22-day-old and revealed plateau after the age of 22 days.
2) Distribution of LDH activity among isozymes changed with age. A-type LDH (LDH-4 and LDH-5) decreased and B-type LDH (LDH-1 and LDH-2) increased with advance of age.
3) LDH-X was detected in the testis of rat aged 28 days and its activity increased showing a significant correlation with testis weights.
4) Cap phase or more advanced spermatids were present in most of seminiferous tubule of the testis where LDH-X was detected. It appears likely that cap phase or more advanced spermatids evolves into the production of testicular LDH-X in rats.
5) LDH activity in the testes of the hypophysectomized rats decreased. The LDH-X was not detected after hypophysectomy.

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Using 42 testis tissues obtained from 41 patients, tissue LDH and its isozymes were measured and spermatogenesis was evaluated by Johnsen's mean score count. The patient group included 27 with untreated prostate carcinoma, 3 with the same disorder treated with hexestrol (Hexron), 4 with benign prostatic hypertrophy, 2 infertile patients and each one case with either hydrocele, varicocele, acute orchitis or testicular tumor (seminoma).
The testis tissues were divided into two groups according to the presence or absence of LDH-X activity. The former revealed spermatogensis higher than mean score count of 5.8 and the latter lower than mean score count of 3.0. Activities of total LDH, LDH-1, LDH-2, LDH-3 and LDH-4 in the LDH-X positive group were respectively higher than the values in the other LDH-X negative group.
Judging from the present results togenther with the previous finding of rat testis where LDH-X activity was found in combination with the presence of cap phase spermatids, it appears likely that spermatids are also involved in the presence of LDH-X activity in the human testis.

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The authors screened organic impotence by applying penothermocurve which reveals increases in blood flow in the penis attending its erection as changes in the skin temperature of the penis with time, using contact multi-point thermorecorder. The results revealed that in 34 out of 36 controls with no sexual problems, a rapid increase in the temperature of the penis (normal reaction type) due to V. S. S. load was observed.
Ninety-five out of 140 cases of impotence showed normal reaction type and were diagnosed as functional impotence, though 6 cases of penis disease had coital disturbance. In 21 out of the remaining 45 cases, temperature increase due to V. S. S. load occurred, which was not preserved or temperature increase was very mild (labile reaction type), and in the remaining 24 cases, no reaction at all was observed (non reaction type). Searching these impotences in detail, in 56 (86.2%) out of the 65 cases without organic factors making impotence, normal reaction was shown, but even in the remaining abnormal reaction group, all cases except one were diagnosed as functional impotence by other test methods. All 6 cases of mental diseases showed normal reaction, but normal reaction was observed even in 33 (47.8%) out of the 69 cases with organic factors making impotence. In these cases, organic factors making impotence were present but no abnormalities in the pudendal nervous system were proved. Therefore, they were diagnosed as functional impotence except those of penis disease. Most of the remaining cases of abnormal reaction were considered to have disturbance in the central and peripheral nervous system.
This test method simplifies the examination of impotence including variouns examinations and tests and requiers no special equipment. Therefore, it should be used widelys. The results of the test have the advantages of recognizing at a look the fact that the penis was erected, which can be utilized as part of treating functional impotence.

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Case 1: 24-year-old female complaining of fever and back pain. Excretory urography disclosed absence of left kidney and right hydronephrosis due to UPJ stricture. The lower calyx was tapering into the renal pelvis and the infundibula of the other major calyces were not visualized. A diagnosis of extrarenal calyces was made at pyeloplasty.
Case 2: 28-year-old female having recurrent acute pyelonephritis. Excretory urography showed bilateral hydroephrosis due to UPJ stricture. The minor calyces were few in number and pyelectasis was milder than calyectasis. The left renal pelvis was distended longitudinally, branching out into the major calyces like a rake. The diagnosis of bilateral extrarenal calyces was confirmed at pyeloplasty.
Case 3: 34-year-old female complaining of left flank pain. Excretory urography showed left hydronephrosis due to UPJ stricture. The upper major calyces was elongated and the infundibula of the other major calyces were not visualized. Pyeloplasty settled the diagnosis of extrarenal calyces.
Including our 3 cases, a total of 28 cases of extrarenal calyces have been reported in the world literature. Combined anomalies, X-ray findings and clinical significance of this anomaly are discussed.

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A case of 10 years old boy with congenital posterior urethral valve, left paraureteral diverticulum and segmental dysplasia of the ipsilateral kidney was reported. On reviewing the Japanease literature and the cases of posterior urethral valve and those of paraureteral diverticulum were both rare. We could not find the report of the case that had congenital posterior urethral valve associated with paraureteral diverticulum and dysplastic kidney.

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