Experimental evidence suggests that rat urine plays a dual role in urinary bladder carcinogenesis, as a carrier of carcinogen (s) and an enhancer (or promoter) of carcinogenesis in carcinogen-initiated cells. The present experiment was conducted to determine whether or not tumor-enhancing activity exhibited by the whole urine residues in a specific fractions(s), separated by molecular weight. Normal rat urine after preliminary filtration to remove gross debris was filtered through Amicon Diaflo membranes to obtain two types of filtrate, one at an exculsion level of M. W. 1, 000 and the other at an exclusion level of M. W. 5, 000. These filtrates were tested for tumor-enhancing activity in the heterotopically transplanted rat urinary bladders (HTBs) removed from rats pretreated with the carcinogen N-butyl-N-(4-hydroxybutyl) nitrosamine in drinking water for 4 or 10 weeks. The incidences of cancer in HTBs receiving repeated instillations of the filtrate at M. W. 50, 000 did not differ significantly from those of the HTBs receiving whole urine but were significantly higher than those of the HTBs receiving the filtrate at M. W. 1, 000. In the HTBs which had been exposed to the carcinogen for a longer period of time (10 weeks), the filtrate at M. W. 1, 000, enhanced the bladder tumorigenesis over that of the osmolality control. The results indicate that there may be two classes of tumor-enhancing activity: the first and major one being in the fraction between M. W. 1.000 and 50, 000 and a second one being below MW. 1, 000. The latter fraction appears to exert its effects only on the cells which are in an advanced stage of carcinogenesis.

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Reflexogenic erection was studied in 30 patients with injury to the spinal cord (≤L5).
Sexual ability was investigated using questionnaire and individual interview. Afterwards, as an index of tissue blood flow changes, the tissue oxygen tension was measured polarographically before and throughout tactile stimulation to the penile glans, which was tried to induce the reflexogenic erection, at the corpus cavernosum, penile skin and thigh skin in 29 patients. The tissue oxygen tension level at the penile flaccid state and the changes in response to inhalation of high oxygen gas mixture and tactile stimulation to the penile glans were measured. The penile circulatory factor in the reflexogenic erection in the spinal cord injury patients is though to be as follow:
1) The incidence obtained by the questionnaire and interview of the reflexogenic erection, psychogenic erection and ejaculation was 63.3%, 10.0% and 5.0%, respectively.
2) In cases in whom the reflex center (S₂-S₄) is damaged directly, which was thought to exist in 9 (31%) of the 29 because the majority of these cases had no bulbo-cavernosum reflex, no change of the blood flow occurs in the corpus cavernosum even though tactile stimulation to the penile glans is given, and the reflexogenic erection will not appear in these cases.
3) In cases with the reflex center (S₂-S₄) intact, which was thought to exist in 20 of the 29 because the majority of these cases had bulbocavernosum reflex, the larger the increasing blood flow in the corpus cavernosum in response to the tactile stimulation, the more is the probability of the reflexogenic erection. This conclusion was induced from the results that in the cases, in which the reflexogenic erection could be induced (Reflexogenic erection induced cases), the increase of the corpus cavernosum tissue oxygen tension in response to tactile stimulation to the penile glans is larger than that in the cases in which the reflexogenic erection colud not be induced (Reflexogenic erection not-induced cases).
4) In cases with the reflex center (S₂-S₄) intact, the degree of the damage to the corpus cavernosum tension (vaso-constrictor tonus) itself influences the occurrence of the reflexogenic erection because the corpus cavernosum tissue oxygen tension of the reflexogenic erection induced cases at the penile flaccid state is higher than that of the reflexogenic erection not-induced cases.

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Total cystectomy was performed on 333 patients with urinary bladder carcinoma between 1957 and 1981. Histopathological and prognostic studies were carried out retrospectively. The operative motality rate was 3.6%. The tumor histology was transitional cell carcinoma in 317 cases, squamous cell carcinoma in 7, adenocarcinoma in 7 and undifferentiated carcinoma in 2. The overall 5-year relative survival rate was 63.0%. Of 311 patients with transitional cell carcinma, the 5-year survival rates of patients with grade G1, G2 and G3 were 73.1%, 58.7% and 48.4%, respectively; those of patients with low stage tumors (pTis, pTa, pT1 and pT2) and high stage tumors (pT3 and pT4) were above 84.0% and below 32.7%, respectively. As for intramural lymphatic invasion, lye showed the worst prognosis (29.4%), although there was no difference in survival between ly₀ (84.2%) and ly₁ (82.1%). The survival rates of patients with and without intramural venous invasion were 39.4% and 74.6%, respectively. Intramural histopathological mode of spread (INF α, β and γ) and growth pattern were also highly significant with respect to prognosis.

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During the 11 years from 1971 to 1981, 181 patients with primary bladder tumor were treated in the Department of Urology, Iwate Medical University Hospital. Of these patients, 137 were males and 44 were females, with a male to female ratio of 3.1 to 1. The age distribution ranged from 20 to 84 years. The average age was 61.7 years; 62.1 in male and 60.7 in female.
From the clinical and the patho-histological study, the following results have been obtained. The clinicopathological study was done according to the General Rule for Clinical and Pathological Studies on Bladder Cancer.
1. The initial symptoms were asymptomatic hematuria in 71.2%, symptomatic hematuria in 15.5% and vesical irritability with no hematuria in 13.3%.
2. By cystoscopic observation, papillary-pedunculated tumors were found in 50.8%, papillary broad-based tumors in 14.4% and nonpapillary broad-based tumors in 33.7%. The tumors were located in the lateral wall in 50.3% of the cases, in the posterior wall in 24.3% and in the trigonum in 4.4%.
3. Histological classification, grading and staging.
i) Histological examination revealed TCC in 157 cases (86.7%), AC in 9 cases (5.0%), SCC in 7 cases (3.9%), UC in 2 cases (1.1%) and mixed type in 6 cases (3.3%).
ii) Of the cases with TCC, none was classified as Grade 0, 8 cases (5.1%) as Grade 1, 54 (34.4%) as Grade 2 and 87(55.4%) as Grade 3.
iii) As to the staging of tumor infiltration, 93 cases (51.4%) were in Stage pTa to pT1 and 67 cases (37.0%) in Stage pT2 to pT4.
iv) Intravascular invasion was found in 40 cases; lymphatic invasion in 39 and intravenous invasion in 15. Intravascular invasion was found in cases revealing more advanced invasion than Stage pT3, and in 80% of cases of Stage pT4. Intravascular invasion was found more often (in 72.7%) in cases with carcinomas other than TCC.
4. Treatments. TUR-Bt was done on 62 cases, SVR-SR on 34, TC on 64, and 21 cases received no surgical treatment. Early complications occurred in 39 (60.9%) of the cases treated by TC, and 13 of them died of early complications.
5. Prognosis. The 5-year survival rate was estimated in relation to the histological types, the grades, the stages and the surgical methods.
i) The total rate was 49.0%.
ii) Of the cases with TCC, the rate was 82.4% in Grade 1 and 81.2% in Grade 2. It was 33.9% in Grade 3, and 5.3% in the cases with carcinomas other than TCC. Together with carcinomas other than TCC, Grade 3 of TCC is grouped as the high grade group in the following descriptions, for both Grade 3 of TCC and carcinomas other than TCC showed a poor prognosis.
iii) The rate was 71.2% in Stage pTa to pT1 and 16.0% in Stage pT2 to pT4.
iv) The rate was 62.6% in cases with no intravascular invasion, and 5.1% in cases with in-travascular invasion.
v) The rate was 77.7% in cases treated by TUR-Bt. As for the stages and grades, there was 90.9% in Stage pTa to pT1 and 0% in the total of Stages pT2, pT3, and pT4, 93.7% in the low grade (Grades 1 and 2) group, and 30.1% in the high grade group.
vi) The rate was 63.0% in cases treated by SVR-SR, 88.1% in Stage pTa to pT1, 11.6% in the total of Stages pT2, pT3 and pT4, 85.9% in the low grade group and 51.3% in the high grade group.
vii) The rate was 24.2% in cases with TC, 48.5% in Stage pTa to pT1, 12.9% in the total of Stages pT2, pT3 and pT4, 30.3% in the low grade group, 33.5% in the cases with Grade 3 to TCC and 6.5% in cases with carcinomas other than TCC.

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Prostatic acid phosphatase (PAP), prostate-specific antigen (PA) and creatine kinase BB (CK-BB) were purified from human prostate, and single components with molecular weights of about 50K, 35K and 40K daltons were shown on SDS-polyacrylamide gel electrophoresis. Prostate homogenate gave a single precipitin arc with each antisera on immunoelectrophoresis. By indirect immunofluorescent technique all of these antigens were present in the cytoplasm of prostatic epithelial cells. Fibronectin (FN) was isolated from normal plasma and its antisera were obtained. Enzyme immunoassays for PAP, PA, CK-BB and FN were established.
Prostate homogenate contained 83.7% of CK-BB in activity, and the antibody against the purified CK-BB cross-reacted to CK-MB from prostate homogenate. High levels of CK-BB were detected in sera from patients with hormone-controlled prostate cancer and benign prostatic hyperplasia after transurethral resection, despite normal PAP and PA concentrations. No correlation was seen among the three in serum levels of patients with prostate cancer.
Hormone-chemotherapy (vincristine, Ifosfamide and peplomycin) brought about normalization of CK-BB levels in sera from patients with stage D prostate cancer, and CK-BB, therefore, seemed to be a useful follow-up marker.
Prostate-specific antigen had two peaks (100K and 35K) in gel chromatography of prostate homogenate.
Radioimmunoassay (RIA), solid-phase immunoadsorbent assay (SPIA) or EIA for _PAP showed a different profile from one another in ion-exchange and and gel chromatography of some patient's serum with advanced prostate cancer. RIA also detected immuno-reactive substances which were not measured by SPIA and EIA, and the stabilization effect of PAP activity by antisera was suggested to increase the sensitivity in SPIA.

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A rabbit model with partial obstruction for 50-150 days was experimentally produced. The mechanical properties of smooth muscle strips from the helical layer of obstructed rabbit ureter was studied under isometric condition. In order to tetanize the muscle of normal and dilated ureter, 40V, 50Hz, a-c stimulation was used at 37°C with oxygenated Krebs-Ringer's solution.
Active and passive length-tension characteristics of the normal and dilated ureter were determined. Developed force increased with elongation up to a maximum and then decreased with further lengthening as in skeletal muscles. Passive tension increased more rapidly with length change in dilated ureter than normal ureter.
In responses of 7 dilated ureters to relative strain (ΔL/Ls), the passive tension of 4 obstructed ureters was higher than that of nomal ureter. These 4 ureters had been obstructed for over 100 days after obstruction.
Moderately obstructed ureters were capable of exerting a larger force per unit cross sectional area of muscle. But, in severely obstructed ureters, the maximum active tension was less than normal ureter. With 8 dilated ureters, the maximum active tension was decreased with increase in degree of dilatation. A significant correlation was demonstrated between the maximum active tension and the degree of dilatation.

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Transurethral resection of a bladder tumor using a polypectomy snare (TUSR-Bt) was reported by Kitamura et al in 1979.
In 5 cases with large bladder tumor (>3cm), which was diagnosed as low stage, we performed TUSR-Bt following selective transcatheter embolization of vesical artery.
Satisfactory results were obtained. Reduction of tumor size after embolization was observed in 4 cases and bleeding was completely controlled in all cases. Tumors were easily resected piecemeal or en bloc with polypectomy snare and the bladder wall from which tumor arose was thoroughly excised with conventional TUR procedure. Three cases were TCC, G1, pT1, INFα, 1y0 and v(-), but 2 cases necrotic tissue.
2 patients complained of pollakisuria after embolization but no other complication was encountered. Postoperative course was uneventful.
From these experiences, TUSR-Bt combined with selective transcatheter embolization seems to be a useful and safe procedure in patients with bladder tumor of 3cm in diamter or more.

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The hetorogeneity of cell line KU-2 derived from human renal cell carcinoma was studied utilizing single cell cloning method. Thirteen sublines were yielded and named N-1-N-13. Observed morphologically as time lapsed, N-13 was different from other sublines in that it was a group of cells, spindle in shape maintained throughout, with a lower nuclear to cytoplasmic ratio and did not tend to pile up, with lower saturation density. Ultrastructure studies showed different characteristics of each subline in the degree of development of cell surface microvilli and the amount of glycogen granules and lipid droplets in cytoplasm. Karyotype analysis of the sublines showed 6 different modal chromosome numbers, but all of the sublines had common marker chromosomes, while clone N-5 had a proper giant metacentric marker chromosome. Generation time determined by the fraction of labeled mitosis method ranged from 18.7hr to 25.6hr. T_G1 ranged from 7.7hr to 14.8hr. These results disclosed that KU-2 consists of heterogenous cell populations, and subsequent separation of individual subline with different biological properties would provide clues to clarification of the role of these phenotypes of cancer cells.

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A possibility of theoretical presumption of urinary level of antimicrobial agents substituting for measurement of real urinary concentration was studied. Intravenous bolus injection of gentamicin (GM), ampicillin (ABPC) or cefoperazone (CPZ) was utilized in 72 cases, and urinary and serum concentration of these three antibiotics were measured. The urine time-course data of GM and ABPC but CPZ, which is excreted by hepatobiliary rather than renal elimination, revealed biexponential and were fitted to a two compartment open model when urine specimens were collected paritively and attentively especially during 1 hour after injection. However, correction of the data by creatinine clearance of individual patients and some parameters drawn from the pharmacokinetic analysis produced a more suitable formula to estimate urine levels and even in CPZ this two compartment open model was available for analysis of urine pharmacokinetics. Estimation of the urine level from the serum level was also successful. It was concluded that estimation of the urine level by a formula without complex real detection of urine concentrations in individuals could be feasible and under some conditions it would be possible from serum pharmacokinetics. This estimated values must be of use in treatment of urinary tract infections.

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Tests for identification and drug sensitivity of bacteria in urine are carried out in patients with cystitis symptom and pyuria.
Generally, to a patient once diagnosed as acute cystitis by routine urinalysis, an appropriate antibacterial agent is administered. The patients is often healed before the results of drug sensitivity test came out.
Thus, retrospective studies were made to see how the above tests were really useful for a total of 673 patients with acute cystitis, consisting of 402 uncomplicated, 182 recurrent, and 89 complicated cases.
Among them 374 patients showed Escherichia coli in their urine cultures, which represented 75% of the identified bacterias.
In 257 patients (69%) of them, the bacteria (E. coli) were sensitive to all of the drugs tested.
Tests for identification and drug sensitivity of bacteria were useful only for 39 cases.
The usefullness rate in uncomplicated, recurrent, and complicated cases were 4%, 6% and 16%, respectively.
In conclusion, the drug sensitivity test, which is now applied to almost all cases of acute cystitis, seems to be further reducible in frequency.

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We had experienced 568 cases of uroepithelial cancer in 18 years from Jan. 1965 to Dec. 1982. Of the 568 cases, 90 (16.9%) had primary upper urinary tract tumor with (19pts) or without (71pts) concomitant bladder cancer, and remaining 6 were the cases in whom uroepithelial cancer recurred heterotopically in the upper urinary tract following the treatment of primary bladder cancer.
Primary upper urinary tract tumor seems to develop at rather younger age than primary bladder tumor in both the spontaneous cancer group (63.1 vs 63.7) and the occupational cancer group (52.0 vs 53.6).
An incidence of uroepithelial cancer at each urinary tract is prevalent in males, however, no sex difference was observed in the cases of bladder tumor following treatment for primary upper urinary tract tumor. This heterotopic recurrence was found in 25.5% of cases at 15 months on the average after surgery.
Total nephroureterectomy with a bladder cuff was generally chosen as the method of surgery, but kidney conserving method was performed in 6 cases of ureteral tumor. 3 cases with low grade and/or low stage tumor are alive during 15-115 months without local recurrence and heterotopic recurrence in the urinary tract.
The actual 5-year survival rate of upper urinary tract tumor (43.8%) is similar to that of bladder cancer treated by total cystectomy (43.2%).

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Urinary oxalate excretion of 160 stone formers (male; 118, female; 42) and 257 healthy controls (male; 207, female; 50) was determined using a high performance liquid chromatographic method.
The following results were obtained:
1) The mean value of urinary oxalate excretion in 207 healthy control men was 31.9±10.6mg/day, and in 50 women it was 26.7±10.3mg/day. In healthy controls, the excretion in men was higher than in women significantly (p<0.01).
The effect of age on urinary oxalate excretion was not demonstrated in adults.
There was no correlation between the urinary volume in 24 hours and the amount of urinary oxalate excretion.
2) Calcium stone formers and calcium oxalate stone formers showed significant increases of urinary oxalate compared with each healthy controls in both sexes, but non-calcium stone formers or non-oxalate stone formers did not show significant increases in oxalate in both sexes.
3) There were no differences of urinary oxalate between single stone and recurrent stone among calcium stone formers and calcium oxalate stone formers.
4) We defined “hyperoxaluria” as a state in which the 95% upper confidence limit of urinary oxalate in normal controls were exceeded; the limit was 50mg/day in males and 45mg/day in females.
In our series, both calcium stone formers and calcium oxalate stone formers have an incidence of hyperoxaluria in more than 25%, while the incidence was much lower in non-calcium and non-oxalate stone formers. These results suggest that hyperoxaluria can be considered as the main risk factor in the mechanism of formation of calcium oxalate stone.
5) The diurnal variation in urinary oxalate was measured in 5 non-stone patients. There was an increase of urinary oxalate in the evening, although there was no difference between daytime and night. The day to day variation was measured in three consecutive days in inpatients and in several individual days in outpatients. The variation of the inpatients was smaller than that of the outpatients. It was thought that urinary excretion of oxalate might be influenced by dietary oxalate intake considerably.

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Clinical study on the pelvi-ureteric (PU) stenosis in children were summerized in our department, and the special reference was made to the cases, whose postoperative courses were not uneventful.
In the past 9 and half years, we operated on 70 congenital PU stenoses in 64 children. Boys were 4 times more frequently affected than the girls. Infants under 1 year accounted for 23%. The main clinical presentations were high fever, abdominal distention and abdominal pain. The kidney on the left side was 4 times more commonly affected than on the right. Vesicoureteral reflux was demonstrated in 8 kidneys.
Several methods of pyeloplasty have been performed with good results in 60%, fair in 34% and poor in 6%. Anderson-Hynes dismembered technic has been employed in about three-fourth of the operations. The extratenal pelvis was resected in only one-third of the kidneys, in which the dilatation of the pelvis was marked even after the decompression of the hydronephrosis. Only one kidney was extirpated due to deterioration of renal function after the initial pyeloplasty.
Pyuria was present in about half of the children before the urological management. About eighty per cent of the children showed clear urine in half a year after the surgery.
In about 70% of the hydronephrotic kidneys, the urine excreted from the nephrostomy tube has amounted to 40-60% of the total urine volume. No kidney excreted less than 30% of the total volume.
Histological evaluation of the renal biopsy was made according to the index of renal histological alterations. Most of the kidneys showed well preserved parenchyma and only 9% revealed severe changes.
In 71% of the kidneys, the nephrostomy tube was removed within one month after the pyeloplasty. In the remaining 19 cases, whose nephrostomy catheter was left for more than 1 month, several factors were responsible: they were associated VUR, infection of the involved kideny, preoperative nephrostomy, single kidney and intrarenal type of hydronephrosis. Several technics to prevent the complications were discussed.

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Buried penis has not been clearly defined and concealed penis has also been included in it in many reports. However, buried penis is a malformation characterized by an apparently buried penis due to extreme lack of the outer table of the penis skin and usually accompanies true phimosis.
On the other hand, concealed penis is a malformation characterized by a penis buried in the surrounding subcutaneous fat owing to obesity or other causes in spite of the presence of the penis skin in plenty. In concealed penis there is no direct relation between the existence of phimosis and burying of the penis. In addition, both malformations are distinguishable from micropenis by palpation of a penis of normal size.
We performed phalloplasty utilizing Z-plasty in 10 cases of buried penis with the excellent results reported here. The 10 cases were one- to 12-year-old infants and their postoperative courses were followed up for periods of one month to 3 years. Temporary edema occurred as a postoperative complication and continued for about 3 months in one case. Neither deformity nor functional disturbance was seen in the remaining 9 cases. No cases necessitated secondary operation. In contrast to the dorsal incision, this technique is free from postoperative deformity, maintains the natural form of the penis after operation and is very simple. Additionally, the Z-plasty may be widely applied to operation of such functional organs as penis, since it does not lead to the formation of linear scar after operation.

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Two experiments were performed to investigate the effects of hyperbaric oxygenation (OHP) on rat adrenocortical or adrenomedullary function. Two atmospheric pressures of air associated with oxygen saturation (30-35%) together or singly for 90 minutes daily for surccessive 30 days (first experiment) or 46 days (second experiment) were applied to male rats.
In the first experiment, significant differences were observed between the pressure-oxygen-treated group and control group, the former group having 32.3% (p<0.001) heavier adrenal weight or 90% (p<0.001) higher concentration of plasma corticosterone than the latter group. Epinephrine content of the adrenal gland in OHP-treated group was 72.7% (p<0.001) (μg/a pair of adrenal glands) or 80% (p<0.001) (mg/g) greater than that of the control group, respectively. Norepinephrine content of the adrenal gland in OHP-treated group was 100% (p<0.05) (μg/a pair of adrenal glands) or 93.5% (p<0.001) greater than that of the control group, respectively. Plasma renin activity was similar among each group in the experiment.
In the second experiment, no significant differences were noted in the weight of pituitary gland and the incorporation of ³H-thymidine into the pituitary glands between OHP-treated group and control group. Treatment with 2 atmospheric pressures of air produced similar results as those of the treatment with 2 atmospheric pressures of air saturated with oxygen in most of the examined variables.
These results indicate that 2 ATA's of 30-50% oxygen or air for 90 minutes daily for successive 30 or 46 days resulted in increased adrenocortical or adrenomedullary function without affecting reninangiotensin system in rats.

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The authors, as previously reported, improved tha Nélaton catheter with a pair of carbon fiber electrodes, and made Foley catheters using a pair of carbon fiber electrodes which are less painful and more easily usable. Using these special catheters, one hundred recordings of vesical electromyogram (EMG) combined with cystometry were performed on 91 subjects. The method and the result of this study are summarized as follows:
1. Each CMG thus recorded, was divided into 7 phases, to examine the change of the vesical electromyographic amplitude which corresponded to the course of CMG. Then the size of the vesical electromyographic amplitude of every phase of the CMG was measured and recorded as digital data.
2. Both the digital data of the vesical electromyographic amplitude and the value of the intravesical pressure in each of the 7 phases of every CMG were put into a microcomputer system by keyboard, and all data was kept on a miniflopy disk.
3. Using the microcomputer system, the recordings of the vesical electromyogram were divided into 2 (normal and abnormal) or 3 (normal, abnormal and internediate) groups, according to the following: (a) high (over 25cmH₂O) or low (under 9cmH₂O) of the intravesical pressure at cough, (b) high (over 25cmH₂O) or low (under 9cmH₂O) of the compliance of the vesical wall, (c) presence of unvoluntary voiding as the result of the CMG.
4. Histograms of the logarhythmic values of the vesical electromyographic amplitudes for every normal and abnormal group divided according to the above (a), (b), (c) were drawn up. The histograms looked similar to the regular distribution curves.
5. The significant difference tests (t-test) of the logarhythmic value of the vesical electromyographic amplitudes between the normal and abnormal groups for all 7 phases of the CMG, were performed.
6. The result of 5. was that significant differences between two groups were recognized on phases 3, 4, 5 of CMG in (a); on phase 6 of CMG in (b) and on phases 1, 2, 3, 4, 5, 6, 7 of CMG in (c).
7. The significant differences referred to in 6. almost always showed that the logarhythmic value of the vesical electromyographic amplitudes of the normal groups were significantly larger than those of the abnormal groups. Only at phase 5 of CMG in (a) and at phase 4 of CMG in (c), the logarhythmic value of the vesical electromyographic amplitudes of normal groups were significantly smaller than those of the abnormal groups.
In conclusion, our method of measuring and analyzing the detrusor EMG seems to reflect well the physiopathology both of the spinal and peripheral nervous system in relation to vesical activity and the vesical muscle. The clinical significance of the detrusor EMG method is high, because it is considered to be a useful method of urodynamics study, to be used widely in this clinical field.

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A series of testicular germinal cell tumors (27 seminomas and 40 non-seminomas) was studied with respect to the presence of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and carcinoembryonic antigen (CEA) using the peroxidase-antiperoxidase (PAP) method with measured serum levels of AFP, β-HCG and CEA in order to clarify the correlation of histology with their serum levels and cellular localization.
In 7 of 22 patients of seminoma (31.8%), serum levels of β-HCG were elevated. And in 3 of the 27 patients of seminoma (11.1%), HCG reactive syncytiotrophoblastic like giant cells were found, and in 2 of them, serum levels of β-HCG were elevated and the other showed positive urinary HCG.
Then, the pure seminoma case with preoperatively elevated serum β-HCG levels must be studied by serial sections or localization of cellular HCG with PAP method and treated as a non-seminomatous case.
The cellular localization and serum elevation of AFP was not found in seminomas.
CEA was not demonstrated in seminoma tissues, but in two patients of seminoma, serum CEA levels were slightly elevated.
Cellular localization of AFP was demonstrated in 21 of the 40 patients (52.5%) of non-seminomatous germinal testicular tumor.
In 13 of 25 patiens (52%) of embryonal carcinoma and 4 of 9 patiens (44.4%) of teratocarcinoma, AFP was demonstrated in embryonal carcinoma cells. The serum AFP levels were elevated in 14 of the 25 patients (56%) of embryonal carcinoma and 4 of the 9 (44.4%) of teratocarcinoma. But a slight discordance with cellular localization and serum levels of AFP was found in some patients.
Needless to say, in all four patients of yolk sac tumor, AFP was demonstrated intensively in their reticular or tubular tissues. Two teratomas studied were AFP-negative.
These investigations indicated that AFP was not only present in yolk sac tumor but also in embryonal carcinoma. These results suggest that AFP synthesis may also occur in late stages of embryonal carcinoma or very early stages of yolk sac tumor, which are not clarified by conventional tissue examination.
Cellular localization of HCG was found in 17 of the 40 patiens (42.5%) of non-seminomatous germinal testicular tumor in their tumor tissues.
In all eight patients of choriocarcinoma, HCG was demonstrated in syncytiotrophoblastic giant cells and serum β-HCG levels were elevated in six of them.
In 5 of 13 patients (38.5%) of embryonal carcinoma and 2 of 5 patients (40%) of teratocarcinoma, HCG was identified within syncytiotrophoblastic like giant cells. Serum β-HCG levels were elevated in 4 cases with embryonal carcinoma.
Four yolk sac tumors and two teratomas were HCG-negative.
Although serum CEA level was elevated in only one case with non-seminomatous germinal testicular tumor, cellular localization of CEA was found in 23 of the 40 patients (57.5%) of non-seminomatous germinal testicular tumor in their tissues.
In 6 of the 13 cases (46.1%) with embryonal carcinoma, CEA was demonstrated in glandular structures or solid sheets or partly mononuclear embryonal cells within their tissues.
In 8 of the 9 patients (88.9%) of teratocarcinoma and two patients of teratoma, CEA was found in enteric glands within their tissues, especially on the cell surfase of its lumen.
The localization of CEA in their tumor tissues resembled that of fetal gastrointestinal tissues and gastric or colorectal cancer tissues.
In 3 of the 4 cases with yolk sac tumor, CEA was demonstrated partially in the tissues presenting reticular or anastomosing tubular patterns.
These investigations demonstrated that CEA was present in a part of embryonal carcinoma and yolk sac tumor, and in almost all of enteric glands of teratocarcinoma or teratoma. These results suggest that CEA is present in a very early stage of endoderm elements of embryonal carcinoma and in endoderm elements of teratocarcinoma or teratoma, when embryonal carcinoma

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We report a case of ectopic malignant pheochromocytoma its blood pressure was well controlled by Labetalol for 2 years and 6 months.
The patient was a 35-years-old man, who hospitalized on Augast 9, 1980, with complaints of cold sensation of extremity, sweating and headache.
Only plasma noradrenaline high and no evident findings of distant metastasis, we diagnosed ectopic benign pheochromocytoma. The patient was operated, but the tumor eas unremovable.
Therefore labetalol was administered, which led to successful controll of blood pressure.
After 1 year and 3 months distant metastases developed and diagnosis of malignant pheochromocytoma was made.
Lung metastases were stable for 6 months by chemotherapy of Endoxan, Aclacinon and Vincristine, but thereafter they became progressive and he died on March 15, 1983 with DIC.
It seems that Labetalol is effective to control hypertension with pheochromocytoma.

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