Surgically induced varicoceles were created in male rats by partially obstructing the left renal vein. Testicular tissues were taken from both testes 4, 8, 12 and 24 weeks after operation. Tissue samples were processed for light and electron microscopy.
The results were summarized as follows.
1. Light microscopic observations: Johnsen score count in the induced varicocele group was lower than in the other groups with statistical significance. T/W ratio in this group was also lower than in the other groups. However, Johnsen score count and T/W ratio were not different between the left and right sides. Degenerations of seminiferous tubules with varicocele progressed with the duration after surgical induction.
2. Electron microscopic observations: Vacuolization of cytoplasm and dilatation of endoplasmic reticula were observed in Sertoli cells. Degenerations of Sertoli cells led to those of germ cells. Thickening of tubular walls including infolding of basement membrane and proliferation of collagen fibers was observed 24 weeks after operation.

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The urological examination was performed on 637 patients who visited our department for the past 3 years with asymptomatic microscopic hematuria (micro group) and the result was compared to that of 221 patients with macroscopic hematuria (macro group).
1) The significant urologic lesion was found in 81 patients (12.7%) in micro group and in 101 patients (45.7%) in macro group.
2) The malignant tumor, apparently most important in routine check up, was found in 61 patients (23.5%) in macro group and in 8 patients (1.3%) in micro group.
3) Idiopathic hematuria, the cause not determined by various urological procedure, was found in 61 patients (27.6%) in macro group, while this was more frequent in micro group (332 patients, 52.1%).
4) No particular changes were found in all the patients during the follow-up studies on idiopathic hematuria of both groups (143 patients for more than 1 year, 67 patients for more than 2 years and 30 patients for over 3 years).

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About 120 patients suffering from ureteral stone disease underwent transurethral ureterolithotripsy in our clinic. In most of the cases a rigid ureteroscope was used, but in some cases a flexible ureteroscope was also used. Disintegration of the stone was necessary in 75% of the patients, in which main method of lithotripsy used was intensive ultrasound and in a few cases method of electrohydraulic effect was used. The success rate of stone removal was 74%.

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We studied the efficacy of long-term intravesical chemotherapy in the prevention of recurrence in 286 patients with transitional cell carcinoma of the bladder. The patients were comprised of 208 cases with≤G₁T₁ histology (of these 147 were primary and 61 were recurrent cases), 27 with≤G₂T₁, 36 with≥T₂, and 15 with history of pelvioureteral tumor. Historical controls were groups with TUR only and those including primary≤G₁T₁ in 61 cases and recurrent in 36.
Patients were randamized to 1 of 4 groups: 1) ADM 30mg in 30ml distilled saline, 2) ADM 20mg+CA 120mg in 30ml distilled salline, 3) CQ 3mg in 30ml distilled water and 4) CQ 3mg+CA 120mg in 30ml distilled water. These drugs were instilled initially at 3-4 days and 10-14 days after TUR, and then at 2 week intervals for 8 times, at monthly intervals for another 8 times, and 3 monthly for another 4 years. 5 years recurrence rate (kaplane-Meier method) was not significant between the 4 treatment groups. Overall 5 years recurrence rate of the instilled patients were 28.6% in the group with primary≤G₁T₁ and 50.8% in recurrent≤G₁T₁, while 5 years recurrence rate of the control was 53.2% in the primary, 78.2% in the recurrence group.
These instilled groups showed significantly reduced recurrence rates as compared to the historical control groups. The 5 years recurrence rate of≤G₂T₁ was 48.1%, 58.5% in≤T₂ group and 63.0% in the pelvioureteral tumor group. Upgrading or upstaging was noted in 15.4% to 19.4% in the instilled group with≤G₁T₁ and 16.7% in the control. The incidence of the progression between these groups was not statistically significant. The features such as solicitude, pedunclated papilloma and/or tumor size of less than 3cm difinitely indicate lower recurrence rates. Side effects such as pollakisuria, pain after micturition and hematuria after chemotherapy were noted in 9.1% with no significant differences among the drugs.

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The distribution of blood vessels within the prostate, seminal vesicles, coagulating glands (anterior lobes) and vasa deferentia of 13 normal rats were observed by carbon or/and barium injection technique, and the microvascular architecture within them was investigated by scanning electron microscopy of vascular resin casts. Each vessel was examined histologically with a light microscope.
1. The superior vesical artery arose from the common iliac artery at the root of the internal iliac artery but in some cases (33.3%) arose cranially to the internal iliac artery. After giving rise successively to the deferential artery, the seminal vesicle artery (ventral branch), the prostatic artery (ventral branch) and the inferior vesical artery, it distributed to the dorsal surface of the bladder. But the inferior vesical artery arose from the superior vesical artery proximally to the deferential artery in 20% cases. The prostatic artery (ventral branch) arose in 71.4% cases from the superior vesical artery, in 14.3% cases from the seminal vesicle artery (ventral branch), in 7.1% cases from both the seminal vesicle artery (ventral branch) and the superior vesical artery and in 7.1% cases from the seminal vesicle artery (ventral branch) and the middle hemorrhoidal artery. The prostatic artery (ventral branch) divided in turn into the dorsal branch, the lateral branch and the ventral branch. The middle hemorrhoidal artery which arose from the internal iliac artery gave rise to the seminal vesicle artery (dorsal branch), and the prostatic artery (dorsal branch) which arose from the middle hemorrhoidal artery and the artery from the seminal vesicle artery (dorsal branch) supplied the dorsal prostate.
2. The microvascular architecture of the ventral prostate consisted of capillaries which arose from arterioles and formed the capillary-network of irregular square to hexagon, and surrounded ducts and acini.
3. Histologically the superior vesical artery was a muscular type artery, the ventral, lateral and dorsal branches were small arteries, interductal arteries were arterioles and vessels under the prostatic epithelium were capillaries. In the prostate the diameter of the small artery was on the average 113μm, that of the arteriole 42μm and that of the capillary 6.4μm.

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Differentiation capacity and other characteristics of embryonal carcinoma cells were investigated in the previously reported cell lines, NEC 8, NEC 14 and NEC 15, as well as in the cell line ITO.
The cell lines, NEC 14 and ITO, in the original tumors of which the yolk sac element was found, have shown a differentiation capacity both morphologically and functionally in the tumors transplanted into nude mice. These facts suggest that there is an intrinsic differentiation capacity in human embryonal carcinoma of the testis.

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A study was made on the cases of gastrointestinal (GI) bleeding after renal transplantation.
Of 78 cases of renal transplantation, 7 cases (9%) developed GI bleeding (gastric ulcer 3 cases, duodenal ulcer 4 cases).
The incidence of GI bleeding was 2 out of 43 cases (5%) of living-related kidney transplantation and 5 out of 35 cases (14%) of cadaveric kidney transplantation.
These seven patients consisted of 4 men and 3 women, their age ranging from 11 to 42 years (average 34 years).
The GI bleeding occurred within 3 weeks after transplantation in 6 patients suffering from acute tubular necrosis (ATN).
Three patients treated with ciclosporin (Cs) showed constantly high serum Cs levels before the onset of GI bleeding.
Cimetidine was administered to all 7 GI bleeding cases and consequently the bleeding was stopped in 3 cases. In 3 out of the remaining 4 cases, the bleeding was stopped by endoscopic hemostasis procedure.
One patient who received gastrectomy died from sepsis caused by postoperative failure of the suture. As for 1 case in which endoscopic hemostasis was attained, the patient died of DIC and sepsis later. The other 5 cases achieved complete social rehabilitations, maintaing good renal functions.
Insufficient graft-function (ATN) and high Cs levels could be risk factors for GI bleeding.
In case of GI bleeding after renal transplantation, adequate treatments such as cimetidine administration and endoscopic hemostasis procedure are important.

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Twenty-two cases of complete duplication of urinary tract, experienced from 1977 to 1985, were reviewed. They were subdivided into 3 groups; Group I of 11 cases with ectopic (2 exceptions) ureterocele, Group II of 8 cases with reflux and Group III of 3 cases without ureterocele or reflex.
All the patients were female and their mean age was as follows: Group I (8.3 yrs.), Group 11 (18.4 yrs.) and Group III (2.8 yrs.). Their clinical symptoms were urinary tract infection (20 cases) followed by incontinence, dysuria and prolapse of ureterocele.
Full utilization of diagnostic modalities such as renoscintigram, voiding cystourethrography (VCU) and endoscopy along with a timely suspect of the duplication was quite important. Renoscintigram was useful to evaluate upper segment function when not visualized on excretory urography. VCU and endoscopy were also useful to know the eversion of the ureterocele and the type of the hiatus. These knowledge was valuable in the management of the ureteral stump. The type of the hiatus was well correlated to the renal function and the incidence of renal dysplasia.
Eighteen patients required some forms of operative treatment. Regarding the operation the significance of not leaving excess ureteral stump was discussed and our method was also described in detail. Though unroofing of the ureterocele was controversial, distal incision of it was also utilized in the diagnosis and treatment, namely to know the type of the hiatus of the non-everting ureterocele, to evaluate the renal function after the relief of obstruction and to make it easier to resect the distal margin of the ureterocele at the time of operation. In some cases it may be the sole treatment for a cure.

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The bladders of 21 female dogs were maintained in a chronic empty state for 5 to 147 days by either ileal conduit, ureterocutaneostomy or ureterovaginostomy.
Serial cystometrograms revealed that disused bladders rapidly developed hypertonicity. By the 5th to 6th week after the diversion, the maximum bladder capacity and the compliance had decreaced to 25.2% and 13.1%, respectively. The hysteresis effect (i. e. an increase in bladder capacity which occurs on the second filling when two cystometrograms are obtained in immediate succession) was observed only during the first 8 weeks after diversion. This effect was negligible before and 10-21 weeks after diversion. Cultures of bladder rinsings revealed that 55% of the disused bladders contained substantial quantities of bacteria. No statistically significant differences, however, were shown in the parameters of the cystometrograms between the infected group and the uninfected group. The denervation super-sensitivity tests were performed by subcutaneous injection of bethanechol chloride (0.03mg/kg body weight). The tests were negative for both the pre- and postoperative groups.
We speculate that depriving the bladder of its distension-evacuation cycle alters the viscoelasticity of the smooth muscle, in turn inducing hypertonicity.

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Strains of Escherichia coli, isolated from 3 patients with chronic prostatitis, chronic pyelonephritis or catheter-induced sepsis who were resistant to various chemotherapies, were examined bacteriologically.
1) They showed the typical fermentation pattern for glucose and lactose, the positive indole production and the negative Voges-Proskauer (VP) test. However, they produced mucoid-form colonies and were non-motile. The colony form varied from mucoid (M) to non-mucoid (N) during transference.
2) The M→N variation was observed with a scanning electron microscope. The capsular-like materials except flagella were adhesive around the bacterial cells in M-form, however the surface of N-form was smooth.
3) The drug sensitivity varied with the isolates: the isolates from prostatic secretion and urine were sensitive to many antibiotics, however that from blood was resistant to PC, CEZ, TC, CP, SM and others. The latter was an R-plasmid positive strain.
4) In relation to phage sensitivity, the isolate from prostatic secretion formed plaque for T₇, W31, P2c, and that from urine for T₂, but that from blood showed no plaque formation.
5) The generation time of each isolate of E. coli differed: those from prostatic secretion, urine and blood were 49, 39 and 17 minutes, respectively, and the same tendency was observed in the growth curve with a bio-log photospectrometer.

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The specific gravity of urine, urinary output and running average of hourly urine production were determined in 3 volunteers for a period of 24 consecutive hours. A Terumo's urine specific gravity monitor, urinary output monitor, and 12 channel dotting recorder were used for the determination. Three volunteers with normal hepatic and renal functions in terms of blood biochemistry and with no adverse problem in their cardiopulmonary functions or in their metabolic functions were the subjects of the present study. The meals provided were a general diet. The water content of each meal was 1400ml, and as a rule, each of the volunteers was requested to consume the whole amount of the food each time. Ingestion of water other than from the meals was restricted only to water taken ad libitum and not any other beverage, with no restriction of water drinking (water free condition). Any juice or liquid which has a diuretic effect was avoided and fruit juice or its component also was excluded. No drug was taken while the test was going on, and the smokers were prohibited to smoke during the test.
Analysis of the data obtained by the sequential determinations revealed that the magnitude of the variation of the specific gravity of urine was larger in the young than in the old. The variation was more rhythmical in the young than in the old. The ultradian rhythm of urine excretion viewed from the running average of hourly urine production of urinary output was at an interval of 10-80 minutes, but with no appreciable difference with age. The check of the circadian rhythm of urinary excretion revealed a rhythm proper for each volunteer could be observed even in the water free condition. All of the volunteers evaluated in the present study were healthy. The marker to be used as the criterion for the renal functions was found within the normal range. However, a circadian rhythm of urinary excretion suspected as the reversal of daytime and night was observed in one volunteer. Whether this was pathological or within the normal range should be investigated by future studies. Thus, it was found out each one has his own circadian rhythm of urine excretion. The check of this rhythm seems to be useful and interesting as a method for testing renal functions.

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We examined the relationship between the reactivities of monoclonal antibodies with bladder carcinomas and the clinical findings. Mouse monoclonal antibodies were produced against human bladder cancer cell lines, KU-1, T24, 5637 and against the human histiocytic cell line, U-937. The avidinbiotin complex immunoperoxidase method was used to investigate eighty six specimens of transitional cell carcinomas of paraffin-embedded formalin-fixed tissue sections. The monoclonal antibodies against T24 or 5637 hardly reacted to human transitional cell carcinoma. The monoclonal antibodies, HBA4, HBG9, HBH8, against human bladder cancer cell line, KU-1 and monoclonal antibody Leu-M1 against the human histiocytic cell line, U-937 reacted positively to 17%, 27%, 64% and 50% of transitional cell carcinomas, respectively. The number of cases with HBH8 positive cells were more than those with the other antibodies. However, HBH8 antigen was detected in 30% of the normal bladder epithelium, while Leu-M1, HBA4 and HBG9 were completely specific for the malignancy of the bladder epitherium. No significant correlation was found between reactivity of the monoclonal antibodies and grade or stage of transitional cell carcinoma. There were 3 types of staining pattern of the transitional cell carcinoma. In some cases all layers of the transitional cell carcinoma were stained. Other cases were stained only at the surface layers or at the basal layers. The tumors stained at the basal layers were papillary carcinoma of grade 1 or 2. However, the staining pattern was not restricted by the sort of monoclonal antibodies. To elucidate whether these antigen expressions are stable through the recurrence of bladder carcinoma, we tested the reactivities of these antibodies in five cases of recurrent superficial bladder carcinoma. Most cases continued to have these binding sites throughout the total clinical course. In conclusion, we would like to emphasize that about 80% of cases with transitional cell carcinoma can be detected by using these monoclonal antibodies. Accordingly it may be possible to apply this result for the diagnosis and treatment of bladder cancer.

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A total of 112 semen specimens from patients with male infertility were analyzed for 14 trace metals by means of inductively coupled plasma-optical emission spectrometry. The relationships were investigated between the semen qualities and the contents of trace metals in semen.
High concentrations of Ca, Zn and Mg were found in semen, followed by Fe, Al, Mo and others.
A positive correlation was found between the sperm density and the content of Fe in semen (p<0.01).
Negative correlations were found between the sperm motility and the contents of Zn, Mo (p<0.01) Al, Ca, Mg (p<0.05) in semen.

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We have reviewed 80 new cases of renal cell carcinoma in patients treated at Tokyo University hospital between 1975 and 1984. Of these patients 5 (6.3 per cent) had cerebellar metastasis. Further analysis was carried out of these 5 cases in comparison with 8 cases of renal cell carcinoma with cerebral metastasis. There was a difference between these two groups in terms of the onsets of brain metastasis. In half of the cases with cerebral metastasis it was first metastasis diagnosed with routine examinations. Whereas all of the cerebellar metastases were preceeded by metastases to other organs.
The longest period of survival after the diagnosis of brain metastasis was 10 months in patients with cerebellar metastasis and 10 years in patients with cerebral metastasis. Only half of the patients with cerebral metastasis died within a year after the diagnosis of brain metastasis, while no patient with cerebellar metastasis survived more than a year.
Cerebellar metastasis seems to occur in the terminal stage of renal cell carcinoma and is fatal within a year. On the contrary, cerebral metastasis may not be critical in some cases when it is eradicated with meticulous surgery and adjubant chemotherapy. These informations may be helpful to deal with the formidable task in the treatment of advanced renal cell carcinoma.

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An enzyme immunoassay (EIA, Chlamydiazyme) for detection of Chlamydia trachomatis (C. trachomatis) antigen has been evaluated clinically in patients with sexually transmitted disease. This assay system showed high reproducibility and the specimens could be assayed without inactivation until 5 days at room temperature or 7 days at 4°C after sampling. The EIA is made for quality assay, but about 100IFU/ml was thought to be the sensitivity. A total of 437 samples from 298 patients were analyzed in this EIA system and compared with the results of the culture method using McCoy cells. In 217 patients for whom EIA and culture were performed prior to treatment, EIA test was positive in 37 of 42 positive culture patients (sensitivity; 88%) and negative in 159 of 175 negative culture patients (specificity; 91%). The positive rate in EIA test increased with the number of cultured inclusion bodies; a positive rate of 96% was observed in those with the number of inclusion bodies cultured greater than 1, 000. However, as there was not so high correlation between the absorbance and the number of inclusion bodies (r=0.4005), quantitation of chlamydial antigen was thought to be difficult. Four in 23 patients who were positive in both of EIA and culture before treatment were still positive at the time of negative in culture, indicating that the antigen was still present at the infected site. These results suggest that the EIA, compared with culture method, having several merits such as technical easiness, unnecessity of special equipments and detective capacity of many samples at a time, may be of great use as a tool for detection of C. trachomatis.

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We evaluated the efficacy of selective treatment in 134 patients with calcium urolithiasis. The recurrence rate was low in the cases of hypercalciuria treated with thiazide. Hyperuricosuric patients were also successfully treated with allopurinol. The recurrence rate was high in the cases of combined hypercalciuria and hyperuricosuria. Although, thiazide treatment seemed to be effective in these cases, allopurinol administration did not improve the rate of recurrence.
Problems in judging the efficacy of drug prophylaxis were discussed.

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Five patients with advanced bladder cancer received a combination chemotherapy of cisplatin (CDDP) and methotrexate (MTX). CDDP 70 mg/m² was administered on day 1 with 500mg methylprednisolone and MTX 40mg/m² was given on day 1 and day 8. This course was repeated every three weeks. Patients received a maximum of four courses of chemotherapy. One with pulmonary metastases and another with advanced locoregional disease achieved a complete remission, and one additional patient with pulmonary metastasis had a minor response. There was no objective response in the other two patients with bone metastases. Bone marrow suppression and oral mucositis were the major annoying side effects. One patient died of pneumonia associated with bone marrow suppression after three courses of chemotherapy. White blood cell count and thrombocyte count of that patient decreased abruptly to the level of 300/mm³ and 13, 000/mm³, respectively. In the first patient chemotherapy was terminated after the third administration of CDDP because of severe stomatitis. Thereafter, the oral cavity was cooled with ice during the day of the administration of MTX, which relieved patients from oral mucositis effectively. Nephrotoxicity of CDDP and MTX was minimum and transient and did not disturb the treatment.

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In our center 353 kidney trnasplants were performed in 349 patients from June, 1971 to June, 1985. The cases increased year by year reachnig 87 in the last year. Out of them 260 cases (73%) were transplanted from living related donors and the remaining 93 cases (27%) received kidneys from cadaveric donors.
A comparative survival study was made between the two groups namely the ciclosporin group (193 cases) and the azathioprine group (160 cases) using cumulative life table analysis method.
In the living transplant group, patient survival rate at two years was 95% in the ciclosporin group and 94% in the azathioprine group. However, the graft survival rate two years was 92% in the ciclosporin group compared to 69% in the azathioprine group (p<0.001). In the cadaveric transplant group, the patient survival rate at two years was 100% in the ciclosporin group. However, it was 82% in the azathioprine group. As for graft survival rate the ciclosporin group showed a significantly superior result to the azathioprine group (80% vs. 31% p<0.001).
These results suggest that ciclosporin is an effective immunosuppressive agent and, if used with care, adverse effects need not to be seriously worried.

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This paper reports a case of renal stone due to patial deficiency of adenine phosphoribosyltransferase. The patient, a 26 year-old man, was admitted with left flank pain as the chief complaint. Radiolucent urinary stones of the left kidney were suspected by DIP and RP.
On February 27, 1985 surgical operation was performed. Pyelotomy showed the pyelo-ureter to be full of stones, and left nephrectomy was performed.
When a stone was analyzed with an infrared spectrophotometer, it was found to be a 2, 8-dihydroxy adenine (2, 8-DHA) stone. The activity of adenine phosphoribosyltransferase (APRT) in erythrocytes of the patient was measured. It was 20.3-24.4% of the control and thus partial deficiency of APRT was suspected.
Therefore, the family history of the patient was examined. As a result, the activity of erythrocyte APRT in the parents, elder sister and elder brother of the patient was 19.2-39.6% of the control. Partial deficiency of APRT was found in 5 members of the family including the patient.
While on the maintenance therapy with Allopurinol 200mg/day and low purine diet, the patient is presently under observation for the clinical course.

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A 30 year-old desk-worker presented with gynecomastia of 7 months duration, right scrotal induration of 5 months duration and recently exacerbated dyspnea. Right orchiectomy was done on 21st Feb., 1983 and histologic section showed embryonal carcinoma with syncytiotrophoblastic giant cells. Chest X-ray film revealed multiple lung metastases larger than 5cm in diameter, and serum β-hCG and LDH levels were 4, 840ng/ml and 1, 679U/l, respectively. Arterial blood gas study showed critically low hypoxia (PO₂: 50mmHg).
Following 4 courses of combination chemotherapy with bleomycin, vinca alkaloid and cis-platinum (BVP), partial remission of lung metastases was achieved with normalization of serum LDH and marked decrease of β-hCG. After 6 courses of BVP, however, he was seized by convulsion, and CT scan demonstrated cerebral metastases. Chemotherapy was changed to the combination of cis-platinum and VP-16, leading to prompt and complete remission of brain metastases following one course of salvage chemotherapy. The salvage chemotherapy was repeated every 3 weeks, followed by the whole brain irradiation and no relapse of brain metastases was detected, thereafter. But the lung metastases, which once almost completely regressed after 7 courses of salvage chemotherapy and spot irradiation to the remaining lung metastases, relapsed 4 months later, while he was refusing to undergo the chemotherapy that had caused uncontrollable peripheral neuropathy, and the patient died on 11th Nov., 1984.
The autopsy revealed necrotic multiple lung metastases which histologically proved to be pure choriocarcinoma. In the brain, no lesions other than an old softened area were found, where no cancer cells were identified. Tissue concentration of cis-platinum was 0.55mcg/g wet tissue in the cerebral softened lesion, while undetectable in the normal brain tissue, and approximately 1mcg/g wet tissue in all of normal, scar and tumor site of the lung, indicating partial defect of blood-brain barrier at the tumor lesion of the brain.

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