Functional behavior of superficial cells of the rat urinary bladder, in the contracted and experimentaly expanded conditions, was observed on thin section and freeze fracture replicas using electron microscopic techniques.
1. Luminal plasma membrane, which consists of characteristic asymmetric unit membrane, appeared jagged in the contracted state and in a scalloped shape in the expanded state without fine elemental modifications.
2. Intracytoplasmic discoid or fusiformed vesicles, observed below the free luminal plasma membrane in the contracted state, decreased in number, step by step, in expanded groups. Fusion of vesicles to plasma membrane was observed occasionally.
3. Junctional complex with neighbouring epithelial cells resembles to that of various kinds of epithelia in animals described in the literature: its complex showed no complete destruction and/or disposition between the contractd nd expanded states. The exception was the only partial discontinuation of intramembranous particles in the peripheral area in more expanded group observed on replica figures.
4. Characteristic were fused and parallel arrangement of interdigitation to the luminal surface in the experimentally expaned state, with which membrane complexicity may act as a certain functional barrier to prevent the penetration of urine contents through cells.

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To examine the epidemiology of Chlamydial infections in Okayama district in Japan and where Chlamydia trachomatis (C. trachomatis) infections were involved in the cause of male infertility, two antibodies (IgG and IgM) in the sera collected from 335 patients without chlamydial infections (control) who visited our hospital, as well as from 92 infertile patients, were measured by means of microplate immunofluorescence antibody technique (MFA), in which large inclusions of C. trachomatis L-2 and C. psittaci Izawa strains were used as antigen. The antibody titers to both antigens in each specimen were determined by the endpoint at which serum dilution gave specific inclusion staining. When the titer (1: 8 and more) to C. trachomatis was higher than that to C. psittaci, the serum was scored as positive, containing antibody to C. trachomatis. IgM titers over 1: 4 were scored as positive.
The results were summarized as follows:
1. In the control group, the antibody (IgG) was detected in the sera from 25 males (14.5%) and 32 females (19.8%). The IgM positive cases were five in males and three in females. The antibody (IgG) to C. psittaci was detected in the sera from 11 males (6.4%) and one female (0.6%). In the pediatric group, two kind of antibodies to Chlamydiae were not detected in the sera from 37 patients. These results strongly suggested widespreading infection with C. trachomatis among Japanese adults.
2. In the infertile patients, the antibody (IgG) was detected in the sera from 9 males (12.9%) and one female (4.5%), respectively. The positive rates to IgG antibody of patients in the sterile group or patients with pus cell in semen (over 10 WBC/HPF) were higher than that of patients with the other semen quality or those without WBC in semen. In the patients with azoospermia and normal FSH levels (normogonadotropic azzospermia), the antibody (IgG) was detected in the sera from three patients and two of them showed inflammatory occlusion of the reproductive tract. Possibility for obstruction of reproductive tract after urogenital infections with C. trachomatis was thought.

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Antibodies (IgG and IgM) against large inclusions of C. trachomatis L-2 and C. psittaci Izawa strains in the sera collected from 230 male patients with urogenital infections were measured by means of the microplate immunofluorescence antibody technique (MFA). The antibody titers to both antigens in each specimen were determined by the endopoint at which serum dilution gave specific inclusion staining.
When the titer (1: 8 and more) to C. trachomatis was higher than that to C. psittaci, the serum was scored as positive, containing antibody to C. trachomatis. IgM titers over 1: 4 were scored as positive. In 45 cases, the culture method and direct specimen test to detect antigens were performed.
The results were summarized as follows:
1. The antibody (IgM) was detected in the sera from 127 patients (55.2%). These positive cases consisted of gonococcal urethritis (GU) 50% (No. of positive sera/No. of disorders=20/40), nongonococcal urethritis (NGU) 63.9% (53/83), obscure urethritis 75.0% (9/12), cystitis 77.8% (7/9), prostatitis 41.2% (28/68) and epididymitis 55.6% (10/18).
2. Out of 138 positive sera examined for IgG, 30 (21. 4%) possessed IgM antibody, ranging from 4 to 64. The presence of IgM antibody was appeared to be the result from the recent exposure to the pathogen. The IgG and IgM positive rates in the male urogenital infection group were significantly higher than those in the control males.
3. C. trachomatis was isolated from 17 (37.8%) of 45 male patients, 11 (57.8%) of 19 patients with NGU, 5 (35.7%) of 14 patients with GU, and one (20%) of 5 patients with prostatitis. In 17 (37.8%) of 45 male patients, C. trachomatis was detected by the direct specimen test (Micro Trak), 14 (73.7%) of 19 patients with NGU and 3 (21.4%) of 14 patients with GU were positive in C. trachomatis antigens. In the results of isolation and Micro Trak, the negative-coincidence ratio was 85.7% and positive-coincidence ratio was 76.5%. These results were the same as those in other reports.
4. When the relationship between IgG antibody to C. trachomatis detected by MFA and Chlamydia isolation and/or positive in the Micro Trak tests was examined, several cases were found negative in antibody titer, but antigen positive in the Micro Trak and/or isolation tests.
Two possibilities were considered; one was the absence of antibody in the sera examined and the other was the use of C. trachomatis L-2 strain as the only antigen in MFA, in which antibodies to certain strains were not detectable. Further examination is needed to explain seronegative case with Chlamydia antigen.

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The major preoperative factors that may affect the outcome of related donor renal transplantation are histocompatibility, preoperative blood transfusions, and presensitizations. Dosage of immunosuppressive drugs, number of rejection episodes and postoperative complications may also determine the result of clinical renal transplantation. Most reports on factors related to renal transplantation have employed univariate analysis or, at best, bivariate analysis. Reports using multivariate methods are lacking, due to the complexity of the clinical situation surrounding renal transplantation. The purpose of this paper is to extend the multivariate analysis and explore those factors that may be associated with the outcome of transplant functional survival. A retrospective analysis was undertaken of 134 first living related renal transplants at Kitasato University Hospital. We screened the following variables for their association with the graft survival: recipient age, sex, original disease, ABO-type, duration of hemodialysis, blood transfusion 6 months prior to transplantation, donor age, sex, preoperative renal function and histocompatibility (HLA mismatch) using the Cox regression model.
The analysis of our data indicated that the Cox model seems to be a useful tool to assess the influence of each variable on graft survival results, while the effects of all other variables are fixed. Of the variables screened for their association with the graft survival, recipient age and HLA mismatch had significant effects on graft survival all through the periods. Preoperative blood transfusion had negative effects for the first three months and positive effefts over three years postoperatively and recipient age is highly significant factor for the first one year.

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Noradrenaline denervation supersensitivity was studied by using 6-Hydroxydopamine (6-OHDA) on 24 female mongrel dogs.
1) The dogs were divided into three groups, the group A had 6-OHDA injection to the proximal urethra, the group B had normal saline injection to the proximal and the group C had no injection at all.
2) Urethral pressure profiles were done before and after intravenous noradrenaline administration to the dogs of each group.
In group A, maximal urethral pressures were increased at two weeks, four weeks and eight weeks, and maximum at four weeks. In group B, maximum urethral pressures were increased in certain noradrenaline density at four weeks post injection. In group C, no statistically significant change was noted.
Denervation supersensitivity was noted clearly after injection of 6-OHDA and only temporary after injection of normal saline. The maximum denervation supersensitivity was found at 4 weeks post injection.

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Neural development of the lower urinary tract was investigated in 7 human embryos (CRL15-150mm) using histochemical technique of PAP staining for neural specific S-100 protein.
1) As early as at 7 weeks of embryo, S-100 protein was detected in the developing spinal nerve, indicating it as a useful tool for histochemical study of embryogenesis of neural tissue.
2) Staining of peripheral nerves was noted in the corposal shaft of phallus, external urethral sphincter and vesical detrusor muscle at 8, 12 and 17 weeks of embryo, respectively.
3) These data suggest that neural system of the lower urinary tract evolves in close proximity to the musculature of the bladder and external urethral sphincter.
4) From these data it is surmised that voiding cycle of the fetus is first initiated by holding of urine in the bladder as the external urethral sphincter starts functioning at around 12 weeks of embryo, and that vesical emptying is ongoing by around 17 weeks when distinct neuromusculature is established in the bladder wall.
Further study is needed for possible etiological linkage between congenital neuromuscular disorders of the bladder and often associated renoureteral anomalies.

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Between 1969 and September 1985, 133 patients with renal cell carcinoma were evaluated and treated at our institution. Of these 11 (8.27%) had an involvement of the inferior vena cava by tumorous extension of the tumor. They were 8 men and 3 women, ranging in age from 41 to 67 years (mean 58.9 years).
The affected side was right in 9 patients and left in 2 patients, with a prevalence of the right side. Clinical signs of the presence of a vena caval thrombus were noted in 5 patients, which were leg edema in 4 and varicocele in 2.
Diagnostically, vena cavography by way of either inferior or superior route offered a valuable aid to evaluate the caval involvement and its extent, although in the recent series computerized tomography (CT) has been playing a major role for that purpose.
In 6 patients transabdominal radical nephrectomy was carried out, wherein cavotomy and thrombectomy with simultaneous partial caval resection was also performed in 4 patients. There was 1 operative death probably due to pulmonary embolism. Another complication was a transient renal dysfunction observed in 1 case.
Four of 5 patients with known preoperative metastases died within 10 months and another case is still alive at 4 months.
Of 6 patients without metastasis in whom successful radical nephrectomy and thrombectomy was achieved, 4 were alive with no evidence of the disease 4 months to 7 yerars postoperatively. Consequently, aggressive surgery should be considered in patients with renal cell carcinoma with a sole spread to the vena cava.

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Eighteen cases of carcinoma in situ of the bladder (CIS), which were experienced in the Deptartment of Urology, the University of Tokyo, were studied regarding their natural history. They were classified into 3 types according to the slightly modified criteria proposed by UICC. We could not find pure type 3 CIS. However, cases that showd persistent positive cytology but not revealed CIS lesion by random biopsies were classified as type 3 subtype. In cases belonging to type 1, associated severe irritative voiding symptoms and the pathological findings of the biopsy specimens suggested difuse multifocal CIS. On the other hand, cases belonging to type 3 subtype seemed to remain dormant without progression for years.
It was hypothesized that type 2 CIS developed via a distinct pathologic process from non-invasive papillary tumors and occasionally coexisted with them concomitantly or sequentially. Sequential observations of bladder uurothelium are important to understand the natural history of CIS of the bladder.

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Transurethral prostatic resection (TUR) is now established as an alternative to open surgery. The indicative criteria of TUR, however, has not yet clearly defined, because the selection of the operative methods for BPH is influenced by surgeon's preference.
During the 8-year period between January, 1976 and December, 1983, 159 patients operated upon for BPH were reviewed by comparing the results of 125 TUR on 121 cases (T. group) and 38 open surgery (O. group) as to hematuria period, catheter drainage period, admission period and complication after operation.
Furthermore T group was evaluated regarding catheter drainage, pyuria, azotemia and anemia before operation, patient age, operation time and weight of resected specimen using the same criteria as above.
The results were as follows:
1) T. group as superior to O. group in several respects, that is 2.1 days of hematuria period vs. 5.7 days, 4.3 days of catheter drainage period vs. 10.7 days, 15.4 days on admission period vs. 25.5 days and 28% of complication after operation vs. 31.6%.
2) There existed a positive correlation between operation time and weight of resected specimen in T. group, but not in O. group. In the former group 0.23g were resected per minute, while in the latter 0.31g However, when limited cases with resected specimen below 40g were compared, T. group was superior to O. group by 0.23 vs. 0.20g/min.
3) Evaluation of T. group suggested that preoperative catheter drainage, preoperative pyuria and older age above 80 tended to affect adversely.
4) In TUR, operation time and weight of resected specimen paralleled the age of patient, and as operation time prolonged and weight of resected specimen increased, operative result was prone to be affected adversely.
In conclusion, it is suggested that early operation for symptomatic BPH with the gland clinically estimated less than 50g, control of preoperative pyuria, and limit of resection time within 120 minutes were important factors for stable TUR.

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Calcium oxalate crystal formations induced in the rat kidney by intraperitoneal injection of L-Hydroxyproline (L-HP) were studied by optical and scanning electron microscopy (SEM).
After a single injection of L-HP, the crystals in the rat kidney were distributed mainly in proximal tubules, loops of Henle and distal tubules and were rarely observed in collecting tubules.
After injection of L-HP twice a day for a week, the crystals were seen mainly in distal tubules and rarely in proximal and collecting tubules.
Using the SEM technique, denuding of mucous cells, dilation of ducts of Bellini and small sphericles which were considered to be calcium oxalate monohydrate crystals were observed in the papillae. Moreover, lumps consisting of erythrocytes, denuded mucous cells and microfilaments were also observed on the surface of papillae and in the ducts of Bellini.
These lumps are thought to have an important role in fixation and development of calcium oxalate crystals.

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Hematoporphyrin derivative (Hp-D), which is known to accumulate in tumor tissues and exert a photodynamic action, is a complex mixture of several porphyrins, and its biological activity is suggested to exist in still-undetermined components.
Hematoporphyrin diacetate (Hp-diAc), a main component of Hp-D before alkali-treatment, and hematoporphyrin disilate (Hp-diSi), a newly synthesized compund, are prepared as single chemical compounds and their chemical properties were verfied. These substances were found to be well incorporated into human bladder cancer cells in vitro as well as into rat ascites tumor cells by intravenous administration (ip-iv). The in vivo experiment also showed that the fluorescence-labelled fraction of ascites tumor cells gradually increased in the lapse of time up to 24 hours in Hp-D group (retarded type), remained at a relatively low level in Hp-diAc group (intermediate type) and rapidly increased with a peak level at 12 hours in Hp-diSi group (rapid type).

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Kinetics of hematoporphyrin diacetate (Hp-diAc) and hematoporphyrin disilate (Hp-diSi), which were synthesized as single chemical compounds, were investigated in rats with subcutaneously transplanted AH-109A hepatocellular tumor. Hematoporphyrin derivative (Hp-D), a complex mixture of several porphyrins, was used as the control. The agents were given intravenously at a dose of 10mg/kg; tissue specimens obtained as predetermined intervals were submitted to fluorescent microscopic observation and porphyrin concentration in the tissues was assessed with a fluorescent spectrophotometer.
Hp-diAc, Hp-diSi and Hp-D showed, in general, a trend of tissue distribution in the following order: «liver, spleen»tumor, kidney, lung>testis, muscle. Hp-diAc and Hp-D levels in these tissues gradually decreased, while Hp-diSi was retained for a longer period of time up to 96 hours after injection. Tumor surrounding muscle ratio of porphyrin concentration (T/M value) ranged from 2.7 to 7.5 for Hp-D and from 3.7 to 6.6 for Hp-diSi, indicating a high intratumorous accumulation of these two substances. On the other hand, T/M value of Hp-diAc remained at a low level ranging from 1.0 to 1.7.
The present study suggests the possible usefulness of Hp-diSi as a porphyrin with tumor affinity.

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Calcium metabolism of normal Japanese adults and patients with calcium-containing urolithiasis with or without hypercalciuria was investigated by fasting and calcium load test.
1) The means±SD of urinary calcium (Ca) and cyclic AMP (c-AMP) excretion from 15 normal subjects were as follows:
Fasting urinary Ca excretion=8.04±6.0mg/100ml GF×100
Loading urinary Ca excretion=19.02±6.4 mg/100ml GF×100
Fasting urinary c-AMP excretion=3.28±1.44nmol/100ml GF
Loading urinary c-AMP excretion=2.20±0.88nmol/100ml GF
2) In 29 patients with normocalciuric urolithiasis, no significant difference in urinary calcium excretion was observed compared to the normal subjects.
3) Thirty-one hypercalciuric patients could be classified into 3 subtypes as follows: type 1 patients with normal urinary calcium and urinary c-AMP in fasting, and increased urinary Ca and normal c-AMP in Ca load; Type 2a patients with increased urinary Ca and increased c-AMP in fasting, and increased urinary Ca and normal c-AMP in Ca load; and type 2b patients with increased urinary Ca and normal c-AMP in fasting, and minimal increase in urinary Ca and normal c-AMP in Ca load.
Type 1 hypercalciuria appeared to be caused by intestinal hyperabsorption of Ca, and most of the younger male patients with calcium oxalate stones belonged to this group. Type 2a hypercalciuria seemed to be attributed to the renal leak of serum Ca due to a decrease of Ca reabsorption in the renal tubules. The majority of the patients with this type consisted of elderly women with calcium phosphate stones. Type 2b hypercalciuria appeared to be primarily caused ty bone resorption in elderly patients.
4) Oral Ca load in 8 patients with primary hyperparathyroidism showed no suppression of parathyroid function, but resulted in a significant increase of the serum Ca levels compared to the responses in the normal subjects and the hypercalciuric patients.

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The frequency and characteristic of bacteriuria, pyuria and urinary tract infection (UTI) in 105 patients with chronic renal failure due to diabetic nephropathy, including 50 nonhemodialysis cases and 55 hemodialysis cases were studied.
1. In 50 nonhemodialysis patients, bacteriuria, pyuria and UTI were present in 17 cases (34.0%), 13 cases (26.0%) and 9 cases (18.0%), including 5 cases (10.0%) of symptomatic UTI, respectively. Bacteriuria and pyuria were more frequent in female patients than in male.
2. In 55 hemodialysis patients, bacteriuria, pyuria and UTI were present in 29 cases (52.7%), 30 cases (54.5%) and 25 cases (45.5%), including 11 cases (20.0%) of symptomatic UTI, respectively. UTI was more frequent in female patients than in male.
3. In hemodialysis cases, bacteriuria, pyuria and UTI were more frequent in patients whose daily urine output was 100-300ml and the frequencies of bacteriuria, pyuria and UTI decreased with increasing urine output.
4. In nonhemodialysis cases, bacteriuria, pyuria and UTI were more frequent in cases with glucosuria than in cases without glucosuria. In hemodialysis cases, these pathological conditions were more frequent in cases without glucosuria than in those with glucosuria. But, no significant difference was seen in the frequencies of bacteriuria, pyuria and UTI between cases with glucosuria and those without glucosuria.
5. In 17 nonhemodialysis patients with bacteriuria, single and mixed infections were present in 10 and 7 cases respectively. In single infection cases, the pathogens were Enterococcus in two cases, Morganella morganii in two cases, and Candida sp in two cases. Other organisms were E. coli, group B Streptococcus, Pseudomonas putida and Corynebacterium sp. In 29 hemodialysis patients with bacteriuria, single and mixed infections were present in 15 and 14 cases, respectively. In single infection cases, the pathogen was Candida sp in seven cases. Other organisms were E. coli, Enterococcus, Serratia marcescens, Psendomonas aerginosa and Morgonella morganii.

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A 74 year-old man with hematuria was found to have a low serum uric acid concentration (1.1mg/dl). The patient passed a uric acid stone and CT scanning revealed a right renal stone.
His uric acid clearance/creatinine clearance (Cur/Ccr) was significantly high. After administration of pyrazinamide 3.0g, Cur/Ccr decreased and serum uric acid concentration increased to the normal level. In response to probenecid administration (1.5g), Cur/Ccr increased markedly. It was suggested that renal tubular secretion of uric acid was abnormaly high in this patient. No other metabolic abnormalities were detected.
The renal stone was dissolved by administration of alloprinol (200mg/day) and sodium bicarbonate (6.0g/day). No side effect was observed.

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A case of renovascular hypertension associated with neurofibromatosis was reported.
A 5-year-old boy was hospitalized elsewhere with the complaint of headache. The patient was referred to us for further evaluation of the hypertension.
The blood pressure was 220/140mmHg. Cafè au lait spots were noted over his extremities and flank. A random peripheral venous renin level was 41.0ng/ml/hr.
The patient was subsequently administered with captopril, which lowered his blood pressure. Renal arteriography demonstrated stenotic lesions of the bilateral renal arteries and a segmental infarct which was associated with an aneurysm of the left kidney. Selective renin assays of blood samples from the left and right renal veins and the inferior vena cava indicated a functionally significant lesion in the segmental infarct of the left kidney.
The middle segment of the left kidney, including the aneurysm, was removed.
For 10 months he has remained normotensive with reduced dose of captopril.

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