Renal function and morphology of the various congenital ureterovesical junction (UVJ) anomalies were investigated to provide further insight into the genesis of associated renal dysplasia.
I) (A) In the single ectopic ureter, 4 of 14 kidneys (28.6%) opening into the urinary tract were functionless and all the 4 proved to be severely dysplastic. All of 13 kidneys opening into the genital tracts were functionless and all proved to be dysplastic as well. It was noted that dysplasia was milder in female patients comparing to male counterparts. Although the occurrence of renal dysplasia was easily explicable by the “bud theory”, its severity seemed to be modified by other factors such as back pressure effect, growth of müllerian duct and unknown factors responsible for associated ureteral muscle dysplasia. (B) In the duplex system, all 11 upper segments opened ectopically into the G-zone of the urinary tract. Nine (81.8%) were functionless and 8 showed renal dysplasia. Genesis of renal dysplasia in the duplex system appeared to be similar to the single system. Renal function and morphology seemed to be more correlated with the type of the ureteral hiatus rather than its ectopic orifice per se.
II) (A) In the simple ureterocele (singe 14, duplex 9), only one kidney (7.1%) was functionless without histological confirmation. (B) In the ectopic ureterocele (all duplex but one), 10 of 14 kidneys (71.4%) were functionless, and 9 showed mild (i. e. focal or partial) dysplasia, except an aplastic one which belonged to the single system. The embryogenesis of the renal dysplasia seemed to be explained by the “bud theory”. Here again renal function and morphology seemed to be more correlated with the type of the ureteral hiatus rather than its ectopic orifice per se.
III) In the non-refluxing megaloureter (all single except one incomplete duplex), 8 of 58 kidneys (13.8%) were functionless and 2 proved to be dysplastic. In both cases their corresponding ureters showed muscle dysplasia or fetal ureter-like appearance. An unknown factor causing embryonal arrest of the ureter seemed to be respondible for the renal dysplasia.
IV) In the distal ureteral atresia (single one, duplex one), all 2 kidneys were functionless and showed aplastic dysplasia. No ureteral muscle dysplasia was proved. Back pressure seemed to be responsible for the renal dysplasia.
V) (A) In the refluxing megaloureter (all single but one), 4 of 49 kidneys (8.2%) were functionless and 3 showed mild dysplasia. (B) In the paraureteral diverticulum (single 23, duplex 5), 2 of single system (8.7%), 2 of upper segments and 3 of lower segments of duplex system (40% and 60%, respectively) were functionless. As for the renal morphology, the lower segments were more severely affected (one aplastic dysplasia and 2 agenesis). Because the position of the ureteral orifices seemed to be correlated with the severity of the renal morphology, it was indicated that the renal dysplasia in these cranial ectopic ureter could be more readily accounted for by the “bud theory” in both single and duplex cases.
It was concluded that abnormality in the ureteral bud would explain for the genesis of renal dysplasia as long as the adjoining ureter was ectopic (I, II, V), no matter whether the abnormality was single or duplex, with or without cele and cranial or caudal ectopia. Influences of back pressure and/or unknown factor responsible for concurrent ureteral muscle dysplasia appeared to play only a modifying role. In the non-refluxing megaloureter (III), unknown factor causing embryonal arrest of the ureter seemed to be responsible for the ureterorenal dysplasia. In the distal ureteral atresia (IV), the classical back pressure theory still seemed to be valid.

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One hundred and twenty-five cases of bladder cancer were treated by total cystectomy and urinary diversion at the Department of Urology, Wakayama Medical College during the last 10 years. The age ranged from 24 to 80 years old, with an average of 62. There were 107 men and 18 women, with sex ratio of 5.9: 1. heal conduit was chosen in 95 cases, cutaneous ureterostomy in 28 cases and ureterosigmoidostomy in 2 cases as the method of urinary diversion.
Relative 5-year survival rate was 51.2per cent as a whole. That of patients with low grade cancer (grade 1 and grade 2) was 74.2%, while the rate was 40.0% in cases with high grade cancer (grade 3 and grade 4), and a significant difference was observed (p<0.05). 5-year survival rate of low stage cancer (pTl and pT2) was 67.0%, while the rate was 26.2% in cases with high stage cancer (pT3 and pT4), and the difference between 2 groups was also significant (p<0.01).
The details of 31 patients with cancer death were described.
The postoperative mortality rate was 5.6per cent and early complications such as wound infection, wound dehiscence, gastrointestinal hemorrhage, intestinal fistula and intestinal obstruction were seen in 41per cent of the total cases.

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Changes in the membranous permeability of the wall of the urinary bladder were examined in adult mongrel dogs using hyperthermia with anticancerous drugs to which lidocaine had been added. Bleomycin (BLM) was used as an anticancerous drug. As the perfusion solutions in hyperthermia of the urinary bladder, the following 4 kinds of solutions were employed: lidocaine and 60μg/ml BLM, lidocaine and 120μg/ml BLM, 60μg/ml BLM without lidocaine, and 120μg/ml BLM without lidocaine.
The following results were obtained:
1) There was no significant difference in the serum levels of BLM between the groups with and without lidocaine in either the 60μg/ml-BLM or the 120μg/ml-BLM group.
2) BLM levels in the tissues of the wall of the urinary blasser were high in the whole layer and the mucosal layer of the bladder in the group with lidocaine. The difference of the level was particularly significant in the mucosal layer.
These results indicate that the membranous permeability of the wall of the urinary bladder increases due to the addition of lidocaine and easily induces the intake of drugs into the tissues (especially the mucosal layer).

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A new equipment to evaluate the urine transport function of the pelvioureteric system has been developed. Simultaneous measurement of uirne bolus volume and electrical activity in the ureter is possible by means of this equipment. A urine bolus volume measuring system, which is based on the heat electrical method, is located in the probe tip, and bipolar electrodes for EMG are located in the stem of the Fr. 4 ureteral catheter.
Two kinds of experiments were performed. One was an examination of the new probe through a pervioureteric model using an infusion pump and Nelatons' catheters of various diameters. The other was an animal experiment. The changes in ureteral peristalsis and urine bolus volume in response to diuretics were examined in mongrel dogs through application of this equipment.
The following results were obtained:
1) There was a logarithmic relation between perfusion flow rate in catheters used as ureteral models and the values of voltage depression measured by the heat electrical method.
2) The urine bolus volune was calculated closely through a formula which had been developed from the model experiments.
3) In animal experiments, the bolus volume increased significantly, and a transient increase in peristalsis was noted after the administration of diuretics, although there was no significant change in peristaltic velocity.
4) Some pelvioureteric function parameters, i. e peristaltic frequency, peristaltic velocity, urine bolus volume, bolus length and ureteral width, are feasible to caluculate.
These results indicate that bolusmetry by using this new probe is valuable for evaluation of urine transport function in the pelvioureteric system, and suitable for clinical use as well as animal experiments.

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Recent studies have provided suggestive evidence that the sexual function in animals and humans alike is stimulated by dopamine and inhibited by serotonin. Clinically, however, patients with impotence show no adequate response to these agents. For clarification of the association of the autonomic nervous system with impotence and of the correlation between blood levels of testosterone and prolactin, the blood levels of adrenaline, noradrenalin, dopamine and serotonin were determined in 67 patients with impotence and 10 normal subjects.
1. The mean blood level of adrenaline in the control group was 0.015±0.007ng/ml, whereas the mean blood level of adrenaline in the group of 13 patients with functional impotence was elevated to 0.036±0.031ng/ml (p<0.05).
2. The mean blood level of noradrenalin in 13 patients with functional impotence was 0.223±0.213ng/ml as compared with 0.141±0.137ng/ml in the control group, but the difference was not statistically significant.
3. The mean blood level of dopamine in 53 patients with impotence was elevated to 6.25±10.21ng/ml, but showed no statistically significant difference from the control group (3.75±0.82ng/ml).
4) The mean blood level of serotonin was 0.012±0.006g/ml for the control group and 0.044±0.026ug/ml for the group with impotence, the difference between the two groups being statistically significant (p<0.001).
5. There was no appreciable correlation between blood levels of amines on the one hand and testosterone and prolactin on the other.

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Prostatic lymphoscintigraphy using ^99mTechnetium rhenium colloid was carried out in 15 patients with various urogenital diseases. The results in 6 cases of prostatic hypertrophy suggest that the regional lymph nodes of the prostate are the internal iliac, presacral and obturator lymph nodes. In 6 cases of postatic cancer and 2 cases of bladder cancer, visualization of these pelvic lymph nodes was frequently poor.
This method is simple and safe to perform. It is considered that this method is helpful in preoperative detection of lymph nodes which can not be observed by other methods.

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Many physicians usually record the Urethral Pressure Profil (UPP) using a special catheter with four eyes around the circumference of the tip, because the errors in reproducibility is small. Although, they can merely record the total urethral pressure, using the catheter with several eyes. In this paper we reported a newly designed catheter with only one eye around the circumference of the tip and the results of the prospective differences in the urethral pressure profile of the anterior/posterior and lateral walls of the male and female dogs. We might study the urethral components in three-dimensional respect.
We can put this catheter to the practical use in detecting the directional difference in urethral closure pressure, such as prostatic hypertrophy, dyssynergia of the external urethral sphincter, urethral stricture and etc.

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The function of autonomic receptors in the canine proximal urethra composed of smooth muscle was studied using an isotonic in vitro technique, and an in vivo UPP recording under regional constant blood perfusion from the femoral artery into the urethral artery through the uterine and vesical arteries.
In the in vitro experiment, phenylephrine produced a dose-dependent contraction which was blocked by phentolamine, and isoproterenol caused a dose-related relaxation which was suppressed by propranolol. The responses to phenylephrine and isoproterenol in the transversal strips were stronger than those in the longitudinal strips. Acetylcholine induced a mild contraction which was blocked by atropine. The response to acetylcholine in the longitudinal strips was superior to that in the transversal strips. Serotonin produced a moderate contraction which was not suppressed by either phentolamine or atropine, and dopamine caused a mild relaxation which was not blocked by propranolol. Pnentolamine, propranolol and atropine by themselves induced no responses in the smooth muscle strips.
In the in vivo experiment, phenylephrine, propranolol and serotonin produced a marked increase in the proximal urethral pressure on the UPP. Isoproterenol and phentolamine caused a significant decrease in the proximal urethral pressure. Acetylcholine induced a slight increase in the proximal urethral pressure, but atropine produced no response. An augmented dose of dopamine transformed a pressure increase into a pressure decrease in the proximal urethra. The urethral responses to these drugs were recognized even after the temporary alteration of the perfusion pressure was restored to its original state. The competitive reaction in the in vivo experiment was seen to be equivalent to that in the in vitro experiment.
As a result of these two experiments, it is indicated that the responses on the UPP are due to appropriate reaction of the urethral smooth muscle free from effects of the urethral vascular bed, and that the sympathetic componenet consisted of α-and β-receptors holding a greatly dominant position in the urethral smooth muscle in comparison with the parasympathetic component consisting of the muscarinic cholinergic receptors. Then, it is also suggested that serotonin and dopamine act on the urethral smooth muscle by way of neurotransmitters diffetent from typical autonomic trasmitters, and they take a part in sphincteric function of the urethral smooth muscle, together with the sympathetic component.

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The purpose of this paper is to study the pathogenesis of absorptive hypercalciuria. Fifty-nine male outpatients with calcium urolithiasis (37 absorptive hypercalciuria and 22 normocalciuria) were studied by an oral calcium tolerance test with vitamin D. The results of this study were compared with those of the former test reported in Jap. J. Urol., 71. 1349. 1980.
Each subject was instructed to take a low calcium home diet for 7 days before the calcium tolerance test. The average amount of calcium intake was about 250mg per day for the period. 1α-hydoxyvitamin D (Alfarol^®) was administered orally in doses of 3μg per day for 3 days before a test. The details of the method of calcium tolerance test and the measurement of urinary and serum samples have been given in the previous report.
The increases of serum calcium (S-Ca) and urinary calcium (U-Ca) in the former calcium load test after a calcium load were larger than those in this calcium load test with added vitamin D in both normocalciuria (NC) and absorptive hypercalciuria (AH). (S-Ca: NC, p<0.001, AH, p<0.02). The increase of serum calcium, serum ionized calcium (S-Ca⁺⁺), and urinary calcium in absorptive hypercalciuria were larger than those in normocalciuria (S-Ca⁺⁺, p<0.05, U-Ca, p<0.01). None of normocalciuric patients and only about 20% of absorptive hypercalciuric patients had more than 300mg/gram creatinine of urinary calcium. The increase of serum calcium was directly proportional to that of urinary calcium.
Based on these findings, it is reasonable to presume that the intestinal mucosa of the few absorptive hypercalciuric patients is more susceptible to vitamin D than that of normocalciuria, which is one of the pathogenesis of absorptive hypercalciuria. It seems likely that absorptive hypercalciuria can be divited into two subgroups.

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37 patients (27 males, 10 females) with calcium nephrolothiasis were studied for urinary calcium excretion by oral calcium tolerance test, for 3 day periods on a low calcium (250-300mg) intake, and also studied for calcium metabolism, mainly for parathyroid function.
Of the 37 patients, 19 cases were found having hypercalciuria. In these, 3 cases were diagnosed as primary hyperparathyroidism, 13 cases as “absorptive” hypercalciuria. But in the other 3 cases, etiology of the hypercalciuria was undefined.
Other 18 cases were identified as normocalciuria and calcium metabolism in these patients were normal. But other risk factors for calcium stone forming, such as hypophosphatemia, hyperuricemia and hyperuricosuria were demonstrated in this group more frequently than in the hypercalciuric group.
All in all, 28 of 37 patients (75%) were defined as having some kind of abnormality such as hypercalciuria and other risk factors.
Oral calcium tolerance test is recommended as a simple and yet reliable method of screening hypercalciuria and further charactering its distinctive subgroups.

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A rapid and highly precise procedure, high performance liquid anion exchange chromatography using a postlabelling method, for the determination of oxalate in urine has been described. Directly injected urinary oxalate was separated by a strong basic anion exchange resin with 0.2M HCl and it was converted to an o-nitrophenylhydrazine-hydrazide by the aid of water soluble carbodiimide, 1-ethyl-3 (3-dimethyl aminopropyl) carbodiimide. The resulting hydrazide was detected colorimetrically at 530nm.
The recovery rate added oxalate in urine was 103% and the coefficient of variation of urine triplicates ranged from 0.7% to 2.8%. This method is useful in the clinical routine examination.
Oxalate excretion in urine in healthy volunteers were 329±96 and 282±113μmol/day (mean±SD) for 20 males and 10 females, respectively.

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Using an in vitro colony formation technique, the cytotoxic effect of ACNU, bleomycin, cisplatinum, mitomycin C, adriamycin, thio-TEPA, VP-16 and carbazilquinone on asynchronous cells of established human bladder carcinoma cell lines, KK-47 and KW-103, and HeLa cell line have been investigated. According to their dose-response curves, the mode of action of the anticancer drugs was classified into two types: bi-phasic type in bleomycin-treated cells and exponential decrease type in the others. Based on the surviving fraction after treatment, 50% and 90% growth inhibition concentrations (IC₅₀ and IC₉₀) of the drugs were computed. According to IC₅₀ or IC₉₀ at a 2-or 24-hr drug exposure, mitomycin C, adriamycin and carbazilquinone showed the highest cell killing effect against the cells of the 3 lines. Statistical analysis revealed significant differences among the chemosensitivities of the 3 cell lines against the 6 drugs except VP-16 and cis-platinum. The type of dose-response curve and the IC₅₀ and IC₉₀ may offer a guide to the chemotherapeutic design as well as to the selection of possibly useful anticancer agents for bladder cancer.

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17 patients with chronic spinal cord injury, who have micturitional disturbance either objectively or subjectively, were treated with prazosin. We investigated the effect of prazosin using urodynamic study and various urography. 88% of the patients were objectively improved in micturitional difficulity. Residual urine was remarkably reduced in 70% of the patients. 4 cervical subjects with intense detrusor sphincter dyssynergia showed no response to the administration of prazosin. In three patients out of six with vesicouretral reflux, the reflux disappeared after a week or so. Control of autonomous dysreflexia was noted in one patients. Side effect was recognized in only one case, that was epigastric discomfort.
We postulated the medraism by which a-blocker could abolish the reflux.

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A procedure was presented for purifying a trypsin inhibitor in normal human urine. The purifying method was gentle and easy. The final product was homogenous as judged by disc gel electrophoresis, sodium dodecyl sulfate gel electrophoresis and immunoelectrophoresis. Its molecular weight was 67, 000 when estimated by sodium dodecyl sulfate gel electrophoresis and gel filtration with Sephadex G-100. It migrated in the prealbumin region in immunoelectrophoresis. It was confirmed that urinary trypsin inhibitor was purified as the same native form as in human urine.
The activity of this inhibitor was stable against acid (pH 2-4) and also heat (100°C, 30min) under acid condition. It inhibited strongly the activity of trypsin, and weakly those of kallikrein and chymotrypsin, but did not inhibit the activities of urokinase, plasmin or thrombin.
This inhibitor formed a single precipitin line with rabbit antiserum against this inhibitor, but did not react with rabbit antisera against α₁-antitrypsin, α₂-macroglobulin, inter-α-trypsin inhibitor, C1-inhibitor and human whole serum. On the other hand, the existence of a protein in serum reacting with anti-urinary trypsin inhibitor rabbit serum was reconfirmed and it migrated into the α-globulin region in immunoelectrophoresis. This protein in serum may be a different protease inhibitor from known trypsin inhibitors in human serum.

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Using a purified human urinary trypsin inhibitor (UTI) and a monospecific anti-UTI antibody, the uthor developed a highly specific and sensitive radioimmunoassay (RIA) for measuring human UTI.
1. The UTI was iodinated by the lactoperoxidase method without loss of the antigenicity of UTI. The sensitivity of this system was from 25 to 200ng and 5 to 50μl of urine was usually used to determine the concentration of UTI.
2. The precision of within-assay, between-assay and the recovery rate obtained were satisfactory. The urine sample was stable over one month at -70°C.
3. When concentrated fresh urine of healthy man was applied to a column of Sephacryl S-200, the fractions containing UTI activity measured by RIA and enzymic assay appeared in a single peak corresponding to bovine serum albumin (M. W. 67, 000).
4. A significant positive correlation between UTI levels of RIA and UTI levels of enzymic assay in healthy humans was confirmed. In healthy humans, UTI levels of RIA and enzymic assay were not correlated with urinary protein, urinary creatinine and urine volume.
5. The UTI levels in men an women were 5.488±4.141 (mean±SD) mg/day and 3.859±1.350mg/day, respectively. In normal subjects, UTI increased during the day time and decreased at night. Its levels in men were higher than in women throughout a day.
6. The UTI excretion in pregnant women was significantly higher than in normal women. Its values were increased as the week of pregnacy progressed.
These results confirmed that RIA of UTI was very useful as a quantitative method.

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A plasma protein which forms a precipitation line with antiserum against urinary trypsin inhibitor was purified by ammonium sulfate fractionation, anti-urinary trypsin inhibitor rabbit IgG antibody coupled sepharose immunoadsorbent column chromatography and polyacrylamide gel disc electrophoresis. This purified protein was revealed homogenous by sodium dodecyl sulfate-polyacrylamide gel disc electrophoresis and had an apparent molecular weight of 90, 000. Immunoelectrophoresis of this protein also showed its homogeneity and the electrophoretic movility was the same as that of α-globulin.
Although this protein strongly inhibited trypsin activity and weakly chymotrypsin activity like urinary trypsin inhibitor and inter-α-trypsin inhibitor, it was immunologically distinct from inter-α-trypsin inhibitor.
These results suggest the possibility that purified protein may be a new proteinase inhibitor and the precursor of urinary trypsin inhibitor. There is another possibility that this purified protein is a cleavage product of inter-α-trypsin inhibitor and its antigenicity may be different from that of inter-α-trypsin inhibitor.

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In order to study the reaction of the pituitary adrenal cortical system to surgical stress, as well as the convalescent process, and to make clear correlations of hormone, the daily variation of each hormone level was observed, before, on the day of, and 1, 2, 7 days after the operation. The examination was made on 20 patients who were to undergo operations in the Department of Urology of Hirosaki University. They were classified into three groups according to operation time. Tested were pituitary hormones such as adrenal cortical hormone (ACTH), prolactin (PRL), luteinizing hormone (LH), and follicle stimulating hormone (FSH), adrenal cortical hormones such as cortisol (F), dehydroepiandrosteron-sulfate (DHA-S) and aldosterone (Ald); testosterone (T) as a male hormone. The results of the examination are as follows:
1) Hormones such as ACTH and F increased under the surgical stress. Though their increasing rates depended on the magnitude and duration of the influence, F seemed to reflect the influence more clearly than ACTH.
2) LH and FSH showed a different reaction to the surgical stress and the process of transition was also different.
3) Like ACTH, PRL increased under the surgical stress. However, it is not clear why it is so.
4) DHA-S decreased 7 days after an operation, which was different from the result of F. From this fact, it might be concluded that factors other than ACTH worked on it.
5) The decrease of testosterone preceded that of LH. It is possible that the increase of F should have affected this decline.

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Circulating immune complexes (CIC) were detected and quantitated in patients with urological cancers by the human erythrocyte assay and, using the same samples, by the polyethylen glycol precipitation-complement consumption test (PEG-CC test) for comparison. Human o-type red blood cell (HRBC) bears receptors for the third component of complement and does not have surface immunoglobulin. Utilizing these features, HRBC were used for the detection of CIC in a manner similar to Raji cell radioimmunoassay.
CIC levels in sera from patients with bladder cancer were elevated in 18 of 56 cases by the erythrocyte assay. CIC level was significantly higher in advanced bladder cancer patients compared to that in early stage group. When CIC level was classified by the histological grading, it was significantly higher in patients with high grade malignancy than in those with low grade. When tested by the PEG-CC test, among 37 sera from patients with bladder cancer, 13 were found positive. The incidence of positive CIC levels in bladder cancer patients by the PEG-CC test was similar to that detected by the human erythrocyte assay. The CIC levels of the two methods were significantly correlated. Eight of 26 patients with renal carcinoma and 4 of 20 patients with prostatic cancer were positive by the human erythrocyte assay. CIC level in patients with advanced (metastatic) renal carcinoma was significantly higher than in patients without metastasis. Eleven of 16 patients with bladder cancer whose CIC levels were elevated and 4 of 28 patients with bladder cancer whose CIC levels were normal had died during the three years' follow-up. The survival rate of the former group was significantly lower than that of the later group. These findings suggest that the detection of CIC levels in cancer patients are useful in prediction of the prognosis.
The sera from bladder cancer patients demonstrating elevated CIC levels were added into cell-mediated cytotoxicity assay of the peripheral blood lymphocytes from the bladder cancer patient. Aggregated IgG showed only a slight suppression on the Natural killing (NK) activity. The average percent inhibition on ADCC activity mediated by sera from 19 patients were higher than those from 15 normal controls, but not significantly. The correlation between the CIC levels and the percent inhibition on ADCC activity in the sera was not found. On the other hand, NK activity was significantly suppressed by the sera from bladder cancer patients. The result indicates that CIC in the sera of the cancer patients might suppress the cell-mediated cytotoxicity of cancer patients.

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A 40-year-old woman visited our out-patient clinic on April 13, 1982, complaining of nausea, vomiting, anasarca and a lower abdominal mass. She had undergone simple hysterectomy and right oophorectomy in October 1974, and later, in April 1977, right nephroureterectomy because the right ureter was extrinsically obstructed by pelvic endometriosis.
During the 5 years after the surgery she had been healthy. In January 1982, however, nausea and vomiting appeared and progressed slowly. An ultrasound examination of the left kidney revealed moderate hydronephroureterosis due to a left lower ureteral obstruction with the aid of retrograde pyelography. The diagnosis of endometriosis was made from the history. A laparotomy was performed on May 28, 1982. A chocolate-colored and pigeon-egg-sized cyst was found in the left ovary, around which a portion of the ileum and left lower ureter were entangled to make a mass. The left ovary was removed, the ileum released and fibrous tissue surrounding the left ureter resected in order to make the ureter free. Temporary nephrostomy was made during the operation. The fibrous tissue around the left ureter was pathologically proved to be endometriosis (Fig. 1 and 2). After the surgery, 1200 rads of irradiation was done in order to make sure the castration. Since the urinary stream of the left ureter was smooth and any hydronephrosis was not seen 5 months after the operation (Fig. 4), the nephrostomic tube was removed. Eleven months after the removal of the tube, she is quite healthy and her laboratory data are within normal limits.

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A rare case of renal cell carcinoma causing Budd-Chiari syndrome by thrombus of the inferior vena cava is reported.
A 50-year-old male was admitted to our hospital because of gross hematuria on May 7, 1977. Physical examination disclosed a fist sized tumor at the left upper quadrant. Excretory urography revealed a mass in the left kidney. Arteriographic studies demonstrated a hypervascular mass supplied from the two left renal arteries. Trans-abdominal nephrectomy was performed under the diagnosis of left renal cancer. The tumor had already extended into the inferior vena cava through the left renal vein. Tumor thrombus of the left renal vein could be resected, however, that of the inferior vena cava remained. Histological diagnosis was clear cell type renal adenocarcinoma. Postoperative irradiation was given on the area of the left renal fossa. After discharge from the hospital, lumbago, proteinuria, pain and edema in the lower extremities, hypertension and bloody phlegm were developed one after another for a period of 4 years. Finally, the patient was hospitalized due to increasing ascites on September 25, 1981, and died of liver and kidney insufficiency 5 weeks thereafter. Autopsy findings showed a tumor thrombus of the inferior vena cava from the bilateral common iliac veins to the right atrium with extension into the hepatic and right renal veins.
Including our case, 10 cases of secondary Budd-Chiari syndrome by renal malignancy have been reported in Japan. Of these 10 cases, 8 were renal call carcinoma and 2 were Wilms' tumor. Sex distinction was male 8 versus female 2. The affected side was right in 6 and left in 4. The majority of such cases died within one year after initial symptom occurred and expired within 3 months after ascites appeared. Hepatic coma was the most frequent cause of death. Autopsy findings in most cases showed tumor thrombus in the hepatic veins. As to the clinical course, Budd-Chiari syndrome induced from renal malignancy is usually preceded by symptoms of inferior vena cava obstruction by tumor thrombus such as proteinuria, leg edema and venous dilatation.

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