Single injection RI clearance method by 2-compartment model is reasonable for blood RI clearance method, as it considers distribution volumes in addition to blood volumes. But, this method requires multiple blood sampling and complicate analysis and is not spread widely.
We measured RI disappearance from the left ventricle by external counting on renography, instead of blood counting, and calculated GFR from ^99mTc-DTPA or ERPF from ¹²³I-OIH by non-linear least squeare analysis. Single blood sampling was required to convert the plasma unit.
The relationship between GFR or ERPF calculated by this method and endogenous creatinine clearnace or para-amino hippurate were examined, there was a close correlation with regression line and correlation coefficient of y=1.01x+3.3 (r=0.98) or y=0.77x+157.8 (r=0.90), respectively.
Split renal function was derived from each kidney's RI uptake ratio in early phase of renogram. The relationship between split RI uptake ratio and split endogenous creatinine clearance ratio was examined, there was a close correlation with regression line and correlation coefficient of y=0.96x-0.13 (r=0.98).
This simple and non-invasive method was useful in clinical quantitative total and split renal function study, particularly for hydronephrosis, contracted kindey, ureterosigmoidostomy, since this method required no urine collection.

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Clinical study was conducted on 26 cases of cystine stone formers who were found during past 22 years. Urinary amino acid excretion was compared between cystine stone formers and patients with chemical cystinuria. The results were as follows.
1) Cystine stone formers account for 0.62% of all stone patients.
2) Male cystine stone formers were 1.6cm shorter than that of controls, and female patients were 4.5cm shorter as well.
3) Urinary cystine and uric acid excretion were correlated with that in cystine stone formers.
4) Cystine, lysine, arginine, and ornithine excretion in cystine stone formers were all elevated, and these amounts were significantly higher than that of chemical cystinuria except lysine.
5) Kidney stone formation was observed in one of 6 homozygous cystinuria discovered by screening.
6) Stone dissolution was successful in 64.3% of the patients and the prevention of stone recurrence in 38.9%.
7) Alkakinization of urine could be achieved by sodium bicarbonate administration when the urine was acidic.
8) Dietary methionine restriction resulted in 28% and 25% reduction of urinary cystine excretion in 2 patients.
9) Side effect of alpha-mercaptopropionylglycine was observed in 31% of patients including one case of nephrose and 2 cases of liver disfuncion.

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The function of the proximal urethra was studied using muscle strips taken from female mongrel dogs. These strips were dissected in as circular or as longitudinal fashions.
In both circular and longitudinal muscle strips, phenylephrine and norepinephrine caused a dose-dependent contraction, while isoproterenol caused a dose-dependent relaxation. Since the contraction and relaxation responses were blocked by prazosin and propranolol, these responses were mediated by alpha and beta adrenergic receptor mechanisms.
In the longitudinal muscle strips, stimulation with acetylcholine (Ach) caused a dose-dependemt contraction. Similar to the response of the detrusor muscle, this response which was blocked by atropine, is suggesting that the lingitudinal muscle of the proximal urethra is an element of the detrusor muscle. However, circular urethral muscle strips showed and initial small contraction and subsequent relaxation on stimulation with Ach. These responses were not blocked by atropine, but were able to be bolcked by alpha and beta adrenoceptor blocking agents (prazosin and propranolol). Under administration of tetrodotoxin or hexamethonium, Ach produced niether contraction nor relaxation. These results suggested that Ach stimulates intramural ganglion cells belonging to the sympathetic system which results in a release of norepinephrine at nerve endings while activation of alpha and beta adrenoceptors in the proximal urethral musculature. Furthermore, Ach caused rapid relaxation when it was given during the course of a contraction induced by norepinephrine.
From these results it would be conculuded that at micturition, relaxation of circular muscle should occur through short adrenergic neurons, when shortning of the longitudinal muscle is caused by the contraction of the detrusor muscle element.

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A new percutaneous biopsy method using a Surecut needle was developed to obtain specimens of all layers of the bladder wall. The biopsies, observed and guided ultrasonically and/or cystoscopically, were performed on 16 patients with bladder cancer. Tissue cores were obtained in 14 cases, and in 10 cases the pathological stages could be evaluated from the specimens. Preoperative histological stagings were compared with those of postoperative ones in 7 cases. The preoperative histological stagings were almost satisfactory.
It is concluded that percutaneous needle biopsy of all layers of the bladder wall is a valuable method to obtain specimens for preoperative histological staging of bladder cancer. The merits and demerits of this method are discussed in comparison with those of CT scan and ultrasonography for preoperative staging of bladder cancer, and the indications for the application of this method are described.

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To study various aspects of penile erection, we created dog models by implanting electrodes around the cavernous nerves. The cavernous nerves, which are branches of the pelvic plexus, travel along the posterolateral aspect of the prostate to innervate the erectile tissue of the penis. We studied to evaluate the details of the hemodynamic changes of penile erection. The studies included: 1) internal pudendal arterial blood flow, 2) intrapenile blood flow, 3) corporeal pressure and 4) femoral blood pressure.
Immediate response to stimulation was an increase in blood flow in the internal pudendal arteries. The latent period lasted for approximately 10 to 20 seconds. The flow increase occurred in both systolic and diastolic phases. After the latent phase, intracorporeal pressure rapidly increased and approached the level of the diastolic blood pressure. When the full erection was achieved, the flow still remained above prestimulation level, although a gradual decrease in the flow was seen. Intrapenile blood flow was silightly decreased at the time of full erection, compared with that of non-erection. Tumescence of the corpora cavenosa was found to be a result of active relaxation of the sinusoidal spases and active arteriolar dilatation.

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We have examined the enhancing cytotoxic effect of calcium antagonists on vinblastine (VLB) and doxorubicin hydrochloride (ADM) in human renal cell carcinoma cells (KN41, 5873T, YCR-1) by the in vitro colony formation assay. The calcium antagonists, nicardipine, verapamil, prenylamine, and nifedipine were used at a nontoxic concentration of 10μM. Nicardipine enhanced the cytotoxicity of VLB and ADM in three human renal cell carcinoma cell lines. The enhancement was more potent with VLB than ADM. A 4.5-to 16-fold increase in VLB cytotoxity was observed in thses cell lines with nicardipine. Other calcium antagonists, verapamil, prenylamine, and nifedipine, also enhanced the cytotoxity of VLB to KN41.

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We have analyzed the cases of urolithiasis during the seven years' period after the opening of our clinic, from November 28, 1977 to December 31, 1983.
1) The total number of out-patients was 6265, of whom 527 (8.4%) had urinary calculi.
2) The ratio of males to females in these stone patients was 3.0:1.
3) Of the 527 patients with urolithiasis, 240 patients (45.5%) had ureteral stones, whereas 213 patients (40.4%) renal calculi.
4) The peak incidence age of urinary stone was the third and forth decades.
5) The seasonal incidence of out-patients with ureteral stone was maximum in summer.
6) The overall rate of spontaneous passage of ureteral stones was 48.3% (116/240).
7) The total number of operations for urolithiasis was 186 during this period and removal of parathyroid lesions was performed in 19 cases.
8) Analysis of the composition of the calculi revealed that calcium oxalate mixed with calcium phosphate was encountered most frequently.

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Magnetic Resonance Imaging (MRI) was performed in 17 patients using a 0.256 Tesla supercoding magnetic system. Images were produced in the transverse, coronal and sagittal directions with different repetition times, delay times and echo times. Bladder tumors were readily shown due to the superior ability of MRI for soft tissue characterization, the bladder wall was a low intensity band in contrast to the higher intensity urine within the bladder seen best on T2-weighted studies. The overall accuracy of MRI staging in the 17 patients in surgically confirmed disease stages was 70.6%. The overall accuracy in predicting muscle invasion was 76.5%.

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Testicular tumors (35 non-seminomas and 42 seminomas) were studied immunohistochemically with regard to the cellular localization of human chorionic gonadotropin (hCG) to clarify the morphology of the hCG-stained cells and its relations to marker hCG levels and also prognosis.
The following results were obtained.
1) In addition to 1 case of choriocarcinoma, hCG-stained cells were found in 15 of 34 cases of non-seminoma without choriocarcinoma element (44%) and 6 of 42 seminoma cases (14%).
2) hCG-stained cells were morphologically divided into two types: small multinuclear cells scattered in the tumor stroma and large ones found in cluster of the tumor cells near the area of hemorrhage and necrosis.
3) Eleven cases of clinical stage I could be evaluated for the relation of the morphology of hCG-stained cells to the serum β-hCG levels. Small multinuclear cells were found in 6 cases and their serum β-hCG levels did not exceed 3ng/ml. Large ones were found in 5 cases and their serum β-hCG levels were 4-174ng/ml.
4) The 2-year survival rate of the hCG-stained cells positive (15 cases) and negative (18 cases) groups were 92% and 88%, respectively. The 2-year survival rate of the marker hCH positive group (20 cases) and negative group (13 cases) were 92% and 79%, respectively. There was no cancer death in seminoma cases, even though either marker hCH was elevated or hCG-stained cells were positive.

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Between January 1975 and December 1984, 182 patients with renal cell carcinoma were treated at the Jikei University Hospital, and 117 (64.3%) died. After undergoing nephrectomy, 55 died of cancer. These 55 patients were reviewed in relation to 1) the mean age at death, sex incidence and clinical symptoms at the first medical consultation, 2) the clinical data concerning the stages and pathological grades, 3) the period until first clinical recurrence after nephrectomy and the period until death after the cancerous recurrence, 4) all clinical laboratory findings at three clinical phases (preoperative phase, postoperative phase and the phase before death).
The 55 patients' mean age at death was 58.7 years, which is lower than in the case of prostatic cancer. There were 4 times as many men as women, which was greater than the sex ratio for the 182 cases of renal cell carcinoma, i. e., 2-3 times as many men as women. The clinical symptoms at the first consultation could be classified into urological symptoms (56.4%), which includes hematuria, palpable renal mass and renal pain, and nonurological symptoms (43.6%), which includes paraneoplastic symptoms. There was a difference between the patients of cancer death and all affected patients.
Analysis of the stage and pathological grade for the 55 patients showed that there were 37 cases of a high stage (67.3%) and 41 cases of a high grade (74.6%), indicating that there was a tendency for the fatal cases to have a high stage and a high grade. But in the analysis of the period from nephrectomy until death, there was no significant difference between the low stage and high stage cases or the low grade and high grade cases.
Blood samples for CRP, α₂-globulin and erythrocyte sedimentation rate determinations were obtained for two different stage groups (low stage group and a high stage group) preoperatively, postoperatively and before death. Nephrectomy resulted in a higher rate of normalization of these acute phase criteria in the low-stage patients than in the patients with a high stage. There was also observed a high frequency of elevated acute phase parameters in the preoperative phase and the phase before death. So these biochemical criteria may be useful for the detection of a recurrent tumor.
In order to improve the prognosis of renal cell carcinoma, not only radical nephrectomy is necessary for low-stage patients: early monitoring of thse criteria after the radical nephrectomy is also essential. If these criteria are elevated, systemic chemotherapy must be administered.

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Twenty-three patients with superficial papillary transitional cell carcinoma of the bladder were treated with intravesical instillation of bacillus Calmette-Guerin (BCG). The patients (17 males and 6 females) ranged in age from 34 to 81 years (average 61 years). Fourteen patients had a solitary tumor and 9 had multiple tumors. These tumors showed G1 or G2 anaplasia and Ta or T1 depth of invasion. Eighty mg of Tokyo 172 strain BCG was suspended in 40ml of normal saline and administered intravesically 3×/week for 4 weeks or 1×/week for 12 weeks. Twelve patients had a complete response (complete disappearance of all existing tumors) and 5 had a partial response (50% or more reduction in the cross-sectional area and/or numbers of tumors), resulting in 74% of response rate. Only 1 of 7 patients with tumor of 2cm or more in diameter had a complete response, compared to 11 complete responders in 16 patients with tumor of less than 2cm in diameter (P less than 0.05). None of 4 patients whose PPD skin test was persistently negative responded to treatment, compared to 17 responders in 19 patients whose skin test was positive before treatment or converted from negative to positive following treatment (P less than 0.01). Side-effects included cystitis in 19 patients and fever in 4.

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Consecutive 1, 686 prostatectomies including 1, 416 transurethral, 111 suprapubic and 159 retropubic prostatectomies done at 8 National Hospitals were studied. Bleeding increased with weight of the resected prostatic tissue in both transurethral and open surgery. The amount of bleeding was closely related with the weight, not with the time of surgical procedure. It was certified by the fact that large prostates were associated with the increasing bleeding/time ratio. The best way to prevent the massive bleeding from large prostates was to choice open retropubic procedure. Transurethral prostatectomy was followed by the shortest catheter drainage and hospital stay, even in cases with large prostate. Prophylactic vasectomy prevented post-operative epididymitis in all but one exceptional case. Although no surgical death was recorded, 5 gastrointestinal bleeding, 2 cardiac infarctions and one cerebral infarction occurred in their post-operative course. Three of them and additional 5 cases died during their hospital stay. Cardiac failure was the main cause of death in the latter cases.

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Consecutive 1, 572 transurethral and 285 open subcapsular prostatectomies were studied. Cancer tissue was found in 65 out of 1, 750 prostatectomies (3.7%) for presumed benign hypertrophy. The ratio markedly increased with their age. Patients with cancer who received transurethral resection had no difference in the time needed, the amount of bleeding and transfusion, and the duration of catheter-drainage in comparison with cases without cancer. The only difference between them was the delay in discharge, which was caused by additional treatment for cancer.

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An 81-year-old male patient visited our department in September 1983 because of gross hematuria. An invasive tumor of the bladder base was revealed on cystoscopy. The biopsied specimen was grade 3 transitional carcinoma of the bladder with prostatic invasion. The patient was given a trial of intravesical BCG therapy first. However, this trial was not effective on the tumor. In February 1984, the patient was treated by the combination of cisplatin and radiation. After two courses of cisplatin at an interval of three weeks with radiation of 5400rad, complete response was obtained for more than 18 months. No significant toxic reaction was noted.

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Two cases of 9+0 immotile spermatozoa were presented. The patients were 31-year-old and 36-year-old men with the complaint of infertility. The first case had a left varicoceleo The concentrations of LH, FSH, Testosterone, Prolactin and Estradiol of both cases were within the normal limits.
The electron microscopy of the sperm tail showed defects of central microtubules (central pair) without abnormality of dynein arms and peripheral microtubules. Nasal cilia showed a normal motility.

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