Pressure flow study is a valuable urodynamic examination to evaluate the presence or absence of upper urinary tract obstruction. This test was attempted in 25 renal units of 23 patients for the total of 35 times who were clinically diagnosed as having the obstructed upper urinary tract. Contrast medium was infused at a constant rate of 10ml/min and pressure change of renal pelvis and bladder was continuously monitored. It was tentatively defined that the relative pressure, i. e. pelvic pressure minus bladder pressure, of more than 15cm water indicated the presence of urinary flow obstruction.
In 17 out of 25 kidneys the relative pressure was found more than 15cm water and subsequently 15 of them were surgically treated. In the remaining 8 kidneys the pressure was less than 15cm water and 5 of them were followed non-operatively. This test was done before and after the operation in 10 renal units. All the post-operative values fell down within the normal pressure range except two. The clinical diagnosis of upper urinary tract obstruction was confirmed in 14 out of 19 renal units. Furthermore 3 of 6 clinically equivocal units were identified to be obstructive by this test. The validity of this test could be questioned by numerous factors such as severity of dilatation, vesicoelastic properties of pelvis and ureter, bladder distension at the time of testing, size of puncture needle and postural change. Consequently the fluoroscopic monitorring of the morphological abnormality seems to be mandatory in conjunction with the pressure flow study. It is concluded that the relative pressure value of more than 15cm water is indicative of the presence of upper urinary tract obstruction.

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Both the conventional and diuresis renograms have been performed in 25 renal units of 19 patients, who were suspected of having the urinary flow obstruction, for the total of 28 times.
1. The diuresis renogram with intravenous administration of frusemide decreased the spread of 3 parameters, i. e. T_max', T_1/2 and C/B ratio, in 12 normal renal units and was found to be of a clinical value.
2. It was possible to differentiate the non-obstructive dilated type and obstructive type from the normal type with the aide of the diuresis regnogram in 19 patients. The morphologically dilated upper urinary tract does not necessarily indicate the presence of true obstruction.
3. It was found that the C/B ratio could be served as an important parameter to quantitatively evaluate the presence of flow obstruction in the upper urinary tract.
4. The assessment of diuresis renogram was in good accordance with the comprehensive clinical diagnosis. 6 renal units, however, resulted in the false-positive, which the insufficient increase of urinary volume followed by frusemide injection and/or the radioisotope stasis owing to an enlarged intra-renal space seemed responsible for.
5. The non-invasive diuresis renogram, which seldom results in the false-negative, can be repeatedly performed without any major hazard.

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Previously, in vitro sensitivity of the established cell line from human urinary bladder cancer, T24 and 253J, to various sex steroid hormones was examined by the colony formation method, and specific cytotoxic effect of estradiol-17β (E₂) was reported.
In this study, the effect of E₂ on the biological and morphological characteristics of both cells were examined, and the mechanism of specific cytotoxic effect of E₂ on both cells were analyzed. Human breast cancer cells, HBC4, and human uterine cancer cells, OG, were used as the control.
The results were as follows:
1) The growth of T24 and 253J cells was suppressed by E₂ at concentrations of more than 5μg/ml.
2) Doubling time of T24 and 253J cells increased with increasing concentration of E₂.
3) The mitotic index of T24 and 253J cells decreased with increasing concentration of E₂.
4) When exposed to E₂ for 6 hours or more, the morphology of T24 and 253J cells were affected by E₂ at concentrations of more than 5μg/ml.
5) In the colony formation method, the significant cytotoxic effect could be observed in T24, 253J and HBC4 cells by E₂, and in HBC4 cells by progesterone.
6) Correlation between the effect of E₂ on the plating efficiency of four cell lines and the labeling index of ³H-E₂ of four cell lines could be recognized.
7) The specific cytotoxic effect could be demonstrated in the S phase of T24 cells with the use of E₂.

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Since Roosen-Runge recorded contractile activity cinematographically in seminiferous tubules of rats and dogs, a considerable volume of work has been carried out on the anatomy of smooth muscle-like cells, namely, myoid cells that are responsible for the contractile movements of the seminiferous tubules. However, the regulation of these contractile movements still remains unclear. Therefore, in order to prove its contractility, it was attempted to photograph the change of its wall on injection of 0.5% Sudan black solution into an isolated rat seminiferous tubule. Furthermore, the responses of the rat seminiferous tubules to autonomic drugs and to stimulation of the perivascular nerve running along the spermatic vessels were examined by recording the intratubular pressure with a servo-null pressure measuring device. The dose-dependent responses of the rat seminiferous tubule to acetylcholine and noradrenaline were demonstrated. The contraction of the seminiferous tubules was elicited by penvascular nerve stimulation with A. C. (50Hz, 3V, 5sec). From the results of the responses to autonomic drugs and to perivascular nerve stimulation in the presence of various blockers, it was concluded that there were adrenergic α-, β-receptors and muscarinic receptors in the myoid cell of rat seminiferous tubule and that the contractions of seminiferous tubules were regulated by adrenergic nerve fibers.
For histological investigations of the innervation of the myoid cells an indirect immunostaining technique, a silver impregnation technique and an electron microscopic study of nerve endings in seminiferous tubule walls after administration of 5-Hydroxydopamine and L-DOPA, ‘false adrenergic neurotransmitters’ as markers of adrenergic nerve elements were used. The staining of the myoid cells with actin antibody to highly purified actin from Physarum as an antigen was performed. The nerve fibers close to the myoid cells were shown using the indirect immunoperoxidase and the Gros-Schultze's silver impregnation technique. Electron microscopic study using false adrenergic neurotransmitters revealed a nerve terminal partly surrounded by a Schwann cell containing the dense-cored synaptic vesicles between fibrocyte and myoid cell.

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The present experiments were performed to investigate the feasibility of EPTFE (expanded polytetrafluoroethylene), currently used as artificial blood vessels with a high patency rate, as a material for artificial ureter. Two kinds to EPTFE were used, one with a fibril length 30μ and the other 60μ In the preliminary experiment, a thin EPTFE plate of either Rind was subcutaneously embedded in the chests of adult mongrel dogs to be recovered after varying period of time, so as to observe time-dependent histopathological changes. The implantation was found to be followed by a series of histopathological changes; first, EPTFE meshes were invaded by inflammatory, infiltrating cells such as lymphocytes and neutrophils, then inflammatory cells decreased while fibroblasts migrated into the meshes, and, as days passed, inflammatory cells disappeared and fibroblasts became fibrocytes.
In the ureteral graft experiment on 20 adult mongrel dogs where the ureter was replaced by EPTFE the same histopathological changes as observed in the preliminary experiment occurred, the response to foreign body was absent, formation of stones was not observed, urinary leakage or deformation was absent, and the tubular structure was conserved in the 30μ group.
It is concluded that EPTFE is suitable as a material of artificial ureter, and EPTFE artificial ureter is more useful than conventional hard artificial ureter, i. e., clinical prospects for EPTFE ureter are good.

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Serum prostatic acid phosphatase (PAPase) activity and the ratio of PAPase activity against the total acid phosphatase (APase) activity were determined by the immunochemical method, previously reported in our first, second and third reports, in 16 patients with prostatic cancer, 18 patients with benign prostatic hypertrophy, 11 patients with cancer of other organs (3 patients with renal cell cancer, 3 patients with bladder cancer and 5 patients with liver cancer) and normal subjects of both sexes.
The results were compared with those determined by the conventional method and radioimmuno assay (RIA).
1) Total APase activity, PAPase activity inhibited by L-tartrate, PAPase activity determined by the immunochemical method and the ratio of it against total APase activity and PAPase determined by RIA were with the normal range in normal subjects of both sexes and in patients with cancer of organs other than the prostate, and no false positive cases were observed.
2) One of the 18 patients with benign prostatic hypertrophy showed false positive results in total APase activity and the ratio of PAPase activity determined by immunochemical method against total APase activity.
PAPase activity inhibited by L-tartrate and those determind by the immunochemical method were within the normal range in all patients with benign prostatic hypertrophy, while PAPase determinned by RIA exhibited false positive result in 2 of 18 patients.
3) When the relationship between PAPase activity and the extent of infiltration was studied in patients with prostatic cancer, total APase activity and PAPase activity inhibited by L-tartrate were within the normal range in all 7 cases of stage T₁, T₂ group and positive in 5 of 9 cases of stage T₃, T₄ group.
PAPase activity determind by the immunochemical method was positive in 2 of 7 cases of stage T₁, T₂ and in 8 of 9 cases of stage T₃, T₄.
The ratio of PAPase determind by the immunochemical method against APase activity was positive in 3 of 7 cases of stage T₁, T₂ and in all 9 cases of stage T₃, T₄.
On the other hand, PAPase determind by RIA was positive in one of 7 cases of stage T₁, T₂ and in 7 of 9 cases of stage T₃, T₄.
4) These results suggest that PAPase activity determind by the immunochemical method may be as useful as that determind by RIA for the diagnosis of prostatic cancer.

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We studied the results of new technical method, transurethral bladder neck resection, for male patients with bladder neck obstruction.
During the procedure 3 and 9 o'clock of proximal urethra were not resected in order to preserve the voiding mechanism.
The results of the above method in 8 patients were compared to the conventional method of total resection of proximal urethra performed in 11 patients.
It was revealed that the average urinary flow rate and maximal urinary flow rate were superior in the former (p<0.05). Improvement of residual urine rate also seemed better with our new method.

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Urodynamic examination and horseradish peroxidase (HRP) study were employed to investigate the action of the pelvic efferent neurons, which innervate the urinary bladder, on the external urethral sphincter. In seven of fifteen dogs the external urethral sphincter still continued to discharge impulses after the bilateral pudendal nerves were cut, and electromyograms, disappeared at last on addition of cutting off the bilateral pelvic nerves. Following HRP injection into the proximal section of the pelvic nerve, labeled neurons were found in the cell group of Onuf, in three of five dogs, as well as in the intermediolateral and intermediomedial cell columns of the sacral segments.

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Renal cell carcinoma has a very wide range of structual variation: the microscopic features varies not only from case to case, but also from area to area in the same case. This can be shown when large sections or multiple sections are examined from the same case. Nevertheless, many histopathologic classifications have been proposed which inevitably have brought about nothing but confusion and obscured the unifying features of renal cell carcinoma.
From January 1957 to 1980, 162 patients with renal cell carcinoma were operated (of whom 160 patients had been nephrected, 2 patients had been punched biopsy) at the Jikei University Hospital and related hospitals.
The tumors were classified by cell type, according to cytoplasmic appearance: clear cell type, granular cell type, mixed cell type, and spindle cell type. The tumors were also classified by histologic structures: alveolar pattern, tubular pattern, cystic pattern, papillary pattern, and trabecular pattern. Each tumor was assigned a histologic grade on the basis of degree of nuclear atypism and structual atypism. Stage classification were made, using the method of Robson.
Analysis of cell type for 162 patients showed that there were 70 (43%) clear cell type, 20 (12%) granular cell type, 44 (27%) mixed cell type, 28 (17%) spindle cell type. Histologic structures were analysed and showed that there were 94 (58%) single histologic pattern (pure structual component), 47 (29%) multiple histologic pattern (mixed structual component) and 21 (13%) anaplastic pattern. In single histologic pattern, 86 (92%) alveolar pattern, 3 (3%) papillary pattern, 3 (3%) tubular pattern, and 2 (2%) cystic pattern. In multiple histologic pattern, there were 18 (38%) alveolotubular pattern, 13 (28%) alveolocystic pattern, 7 (15%) alveolotubulocystic pattern, 6 (13%) tubulocystic pattern, 2 (4%) alveolotrabecular pattern, 1 (2%) papillocystic pattern.
Four categories of tumor grading were used: 33 (20%) grade I, 63 (39%) grade II, 50 (31%) grade III, and 16 (10%) grade IV. In addition, four pathologic stages were used: 60(37%) stage I, 38 (24%) stage 2, 31 (19 %) stage 3, and 33 (20%) stage 4.
In patients with renal cell carcinoma, the relationship between cell and grade was that patients with clear cell type had a higher incidence of low grade tumor than those with spindle cell type. Patients with granular cell type and mixed cell type had a large percentage of intermediate grade (grade II and grade III). A combination of cell type and pathologic stage demonstrated that most patients with clear cell type had low stage tumor, on the other hand, most patients with spindle cell type had high stage tumor, and patients with granular cell type and with mixed cell type had a large percentage of intermediate stage (stage 2 and stage 3). A combination of pathologic grade and pathologic stage showed that patients with low grade had a higher incidence of low stage tumor than those with high grade. On the contrary patients with high grade had a higher incidence of high stage tumor than those with low grade. The significant correlation was observed between pathologic grade and pathologic stage.

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The relationships between urinary kallikrein excretion and plasma renin activity (PRA), urinary aldosterone excretion, UNaV, UKV and PAH clearance were studied in 15 normal subjects, 13 patients with essential hypertension and 9 patients with primary aldosteronism under 7 days of regular-sodium (150mEq/day), low-sodium (15-20mEq/day) and high-sodium (400mEq/day) diet, respectively.
There were positive correlations between urinary kallikrein excretion and PAH clearance in patients with primary aldosteronism under any sodium diet (r=0.87-0.90, p<0.01-p<0.001). Similar tendency was also observed in patients with essential hypertension (r=0.66-0.81, p<0.05-p<0.001) and normal subjects (r=0.56-0.78, p<0.05-p<0.01) except one set of determination. The average urinary kallikrein excretion in patients with primary aldosteronism was highest of the 3 groups under any sodium diet (p<0.05) however urinary kallikrein excretion in patients with this syndrome was similar to that in normal subjects in 4 of 9 cases under regular- or high-sodium diet. The average urinary kallikrein excretion/PHA clearance was highest in patients with primary aldosteronism (p<0.001) of the 3 groups under any sodium diet, and this ratio in patients with this syndrome was similar to that in normal subjects in one patient of 9 cases.
No significant correlations were noted between urinary kallikrein excretion and blood pressure, age, UNaV, UKV and PRA in the 3 groups. Urinary Kallikrein excretion and urinary kallikrein excretion/PAH clearance of essential hypertension did not differ significantly from those of normal subjects. There were weak positive and negative correlations between urinary kallikrein excretion and urinary aldosterone excretion in normal subjects consuming low-sodium diet (r=0.53, p<0.05) and high-sodium diet (r=-0.40, p<0.05), respectively. Low-sodium diet caused a slight increase of urinary kallikrein excretion (p<0.05) in patients with essential hypertension.
In conclusion, this study demonstrates 3 important points. First, urinary kallikrein excretion appears to be mainly affected by renal plasma flow in normal subjects, patients with essential hypertension and subjects with primary aldosteronism. Second, increased ratio of urinary kallikrein excretion/PHA clearance is useful for biochemical diagnosis of primary aldosteronism. Finally, this experiment failed to support the concep that renal kallikrein plays a major role in the pathogenesis of essential hypertension.

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In 22 autopsy cases of prostatic cancer, the histopathologic picture at the time of autopsy was compared with that in biopsy to clarify whether or not any change in the grade had occurred. A change in the grade at the prostate was confirmed in 8 cases (36%), and no change in 14 cases (64%). The former group was compared with the latter in respect to the duration of observation, types of treatment and effect of treatment, which revealed that the local lesion was frequently controlled from the clinical viewpoint in the changed grade group and radiotherapy had been used in a large proportion of cases in the unchanged grade group. In the unchanged grade group, a discrepancy in grade between the prostate and the site of distant metastasis was noted in 4 cases, in three of which cases the metastasis showed a poorer differentiation. When these cases were classified by the grade, it became clear that the poorly differentiated cancer was frequently resistant to change in the grade and unresponsive to the endocrine therapy.

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During the 10 years from January 1971 to December 1981, 16 patients (11 males and 5 females) with congenital neurogenic bladder due to spina bifida were studied urodynamically and treated at the Department of Urology, Akita University Hospital. There were 4 cases of spina bifida occulta and 11 of spina bifida cystica. The ages at the first visit ranged from 2 years to 54 years, with an average of 18.8 years.
1) Diurnal and nocturnal urinary incontinence was present in 13 patients, difficulty of urination in 2 and urinary frequency in 1. Urinary infection was documented in 50% of the patients. Urographic examination revealed the following abnomalities: Hydronephrosis in 25%, bladder deformity in 50%, open vesical outlet in 25% and VUR in 25%.
2) Cystometrography demonstrated that 4 of 16 patients (25%) had hyperactive bladder and 12 (75%) inactive bladder. Combined cystometry and external urethral sphincter electromyography was performed in 15 patients and revealed that one of the 15 patients had normal sphincter activity, 5 hyperactive sphincter activity (contraction) and 9 inactive sphincter activity. The most common lower urinary tract dysfunction was inactive bladder with inactive sphincter activity.
3) Subjective symptomes and urographic findings were influenced by the urethral dysfunction rather than the bladder.
4) The lower urinary tract dysfunction was managed by Credé alone in 4 cases and intermittent self-catheterization in 12. Eight of the 16 patients achieved satisfactory control of the urinary incontinence, 4 improved in the degree of continence and 4 failed.

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Our experiences in the management of 14 ectopic ureteroceles during the last 8 and half years are described. There were 11 complete ureteral duplications and 4 single ureters. The criteria of ectopic ureterocele depends on the position of the orifice on the cele wall, but in about one third of the cases, the orifices were not clearly confirmed. Most of the cele ureters were tortuous and dilated, but 3 ureters were narrow and atretic. Histologic findings of the kidney of these atretic ureters showed severe dysplasia. Vesicoureteral reflux of the cele ureter was noted in 5 children. There was a cecoureterocele, the distal wall of which extended deep in the urethra like a submuscosal tongue and the orifice was wide open with massive reflux. As the treatment of this entity, nephroureterectomy or heminephroureterectomy is the common choice of operation for the nonfunctioning, dysplastic kidney. We make the onestage operation on both renal segment and distal end of the ureter. In four patients who showed residual function of the upper kidney, reimplantation of the ureter was performed. Resection of the distal end of the cele wall has much difficulties and the follow-up examination in detecting the cele remnant by micturating cystourethrography or endoscopy is required. The importance of simultaneous management of the twin mate ureter in duplex system is stressed.
The Japanese literature of the ectopic ureterocele are reviewed.

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Twenty-one patients with bladder tumor and one patient with cystitis (17 males and 5 females) entered an open analysis of single dose Adriamycin (ADM) administration. Fifty mg of ADM dissolved in 30ml of physiologic saline was instilled into the bladder via a sterile catheter and retained there for 2 hours. Some tumor-uninvolved tissue as well as tumor tissues were removed by transurethral resection or open surgery. Blood samples were collected before the initiation of ADM-treatment and 2 hours after the surgey. Serum ADM and levels of tissue extracts of ADM were measured simultaneously. Remnant tissue specimens were prepared for routine histiological study.
Evidence has been presented: (1) that a significant difference is noted between bladder tumors and tumor uninvolved-bladder tissues, the former having a 3.4-fold (p<0.001) higher incorporation rate of ADM than the latter; (2) that such differences are obvious almost in all the regions except the appex of the bladder; (3) that, although increased incorporation rates of ADM are noted in non-recurrent tumor (p<0.01), single tumor (p<0.05) and multiple tumor (p<0.01), incorporation of ADM into the tumor-uninvolved bladder tissues was also elevated in patients with recurrent bladder tumors; (4) that the incorporation rate of ADM of the smallest tumor (below 1cm in diameter) is 2.9-fold greater than that of the relatively large tumor (3-5cm in diameter); (5) that tissue concentration of ADM in the papillary noninvasive tumor or papillary invasive tumor is 3.8-fold (p<0.01) or 3.3-fold (p<0.05) greater than that of respective tumor-uninvolved bladder tissues; (6) that tissue concentration of ADM in tumors classified as T_a-T₂ is 3.5-fold (p<0.01) greater than that of tumor-uninvolved tissues; (7) that tissue concentration of ADM in transitional cell carcinoma is 3.2-fold (p<0.01) greater than that of tumor-uninvolved bladder tissues; and (8) that circulating levels of ADM are almost negligible either in samples obtained before the ADM-treatment or samples collected 2 hours after the surgery.
Based on these findings, intravesical instillation of ADM appears to be highly incorporated into the tumor, either papillary non-invasive type, papillary invasive type, transitional cell carcinoma, classified as T_a-T₂, single or multiple, located almost all the regions except appex of the bladder.

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In order to investigate the effects of anticancer combination therapy and radiotherapy on hypothalamo-pituitary-gonadal axis or adrenocortical function in 65 male urological cancer patients, plasma basal levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (T), adrenocorticotropic hormone (ACTH), cortisol (F), dehydroepiandrosterone (DHA), dehydroepiandrosterone-sulfate (DHA-S) and prolactin (PRL) and LH-releasing hormone (LH-RH) test, clomiphene citrate test and rapid ACTH test were evaluated before and after therapy.
Damage to germinal epithelium was assessed by testicular biopsy or examination of sperm count in testicular tumor patients.
The results were as follows:
1) As to pre-treatment evaluation in patients with urothelial cancer, penile cancer or renal cell carcinoma, significant high plasma levels of LH, FSH associated with significant low plasma levels of T showed the influence of male senescence, but no specific effect of any primary malignancies. By contrast, significant increase in plasma FSH levels with significant decrease of plasma T levels and hypospermatogenesis revealed by testicular biopsy or sperm counting in testicular tumor patients before cancer therapy suggested that contralateral testicular dysfunction had been pre-existing. Pre-treatment DHA concentrations tended to be subnormal with contralateral gonadal dysfunction, suggesting the decline of testicular origin DHA levels in these patients.
2) FSH levels rose significantly after cancer therapy in testicular tumor patients and fall of sperm count or germinal cell damage revealed by testicular biopsy developed further. None of these patients has so far recovered pre-treatment FSH levels or pre-treatment spermatogenesis in a follow up periods of 12 months, whereas LH and T levels did not change throughout radiotherapy or combination chemotherapy.
3) Significantly high levels of FSH (p<0.01) and mild rise in LH levels (p<0.05) with unchanged T levels were demonstrated after combination chemotherapy including radiotherapy in patients with urothelial cancer, penile cancer or renal cell carcinoma, while plasma gonadotropins and T had no change in patients treated with radiotherapy alone. Declining FSH and LH levels to pre-treatment levels seemed to take place 12 months after cessation of cancer therapy.
4) Responses of plasma gonadotropins to LH-RH or responses of gonadotropins and T to clomiphene citrate remained intact before and after cancer therapy. The effects of anticancer combination therapy and radiotherapy on hypothalamo-pituitary-gonadal axis seemed to be primary testicular failure, mainly showing seminiferous tubular damages by cytotoxic action of each therapeutic drugs or by scattered fractionated irradiation to the testis.
5) Plasma F, DHA and DHA-S and responses to synthetic ACTH showed insignificant damage throughout adjuvant chemotherapy or radiotherapy.
6) PRL levels in patients with urological cancer showed no significant change before and after anticancer therapy in the present study.

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A case of carcinoma of the urinary bladder associated with erythrocytosis is presented.
A 60-year-old man visited our clinic complaining of macroscopic hematuria on June 20, 1980.
Cystoscopic examination revealed a papillary tumor with hyperemic change of mucosa around it. Laboratory examinations showed erythrocytosis and extremely elevated serum erythropoietic activity. Radical cystectomy and ileal conduit construction were performed on July 24, 1980. Although bleeding volume came up to 1300ml during the operation, transfusion was not required. Histological finding was papillary urothelial carcinoma, grade III, stage pT₂. After the operation, hematological examination and serum erythropoietic activity returned normal. However 6 months after the operation, erythrocytosis recurred and elevation of serum erythropoietic activity was noticed. For the possible tumor recurrence, repeated examinations including chest X-ray, abdominal and pelvic CT scans, liver and bone scintilation and Ga-citrate scanning were performed, but not tumor recurrence was detected. The patient is under careful follow-up.
We collected 73 cases of various tumors associated with erythrocytosis reported in Japan. Renal carcinoma, hepatoma and cerebellar hemangioblastoma were frequent, and total of them amounted to 88% in all cases. Sex ratio remarkably predominant in the male. No case of carcinoma of urinary bladder associated with erythrocytosis was found in the literature.

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A 57-year old male was admitted to the department of urology, Fukushima Medical College, complaining of fatigue and loss of weight. Clinical examinations revealed a right renal tumor with an extensive tumor thrombus in the vena cava inferior and a solitary metastatic lesion in the lung. Through a thoracoabdominal incision a radical nephrectomy including inferior vena caval resection, lymph node dissection and right middle pulmonary lobectomy was performed. Blood loss was 6, 900ml. The resected kidney and vena cava weighed 470gm. in total. The resected vena cava was 11cm. in length and the pulmonary lesion was 1.0×1.0×1.5cm. in diameter. The histologic diagnosis of the kidney tumor and the pulmonary lesion was uniformly clear cell carcinoma of grade 3. The carcinoma had invaded the wall of the vena cava deeply. Postoperative course was uneventful and on the 18th postoperative week the patient was discharged after routine postoperative anticancer therapies.

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Since the first report of phenotypic males with 46, XX female karyotype by De la Chapelle et al in 1964, more than 100 cases of this syndrome have been reported.
The present case was a 29-year-old phenotypic male with 46, XX karyotype complaining of infertility. His external genitalia showed normal male type, but bilateral small testes were noticed. Both serum FSH and LH level was high and serum testosterone level was low. Histological findings of biopsied specimen from bilateral testes showed absence of spermatogenesis and increased number of Leydig cell which were identical with that of Klinefelter's syndrome. Sex chromatin was positive (22%) in buccal smears. Y chromatin was negative both in buccal smears and peripheral blood. 163 cultured cells from peripheral blood and skin revealed 46, XX karyotype. In sperm cytotoxicity test, aliquots of H-Y antiserum absorbed with cells from our case killed significantly fewer sperms than aliquots absorbed with corresponding number of cells from normal XX females.
The clinical features and pathogenesis of XX males are discussed.

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