Urodynamic evaluation on 21 cases of benign prostatic hypertrophy (BPH) was preformed throgh a comparative analysis of transrectal ultrasonotomography and posterior urethral pressure using an original balloon method.
Prostatic pressure inside the urethra was measured by measuring the pressure in the balloon inserted into the posterior urethra. A volume-pressure curve was obtained with a gradual expansion of the volume of the balloon with CO₂ gas. Prostatic pressure coefficient, a new parameter showing the degree of dysuria in BPH, was derived from the curve.
A significant correlation was observed between prostatic pressure coefficient and Presumed Circle Area Ratio (PCAR), which indicates how the sections of the prostate approach a circular shape
Prostatic pressure curve in the 21 cases showed two types of pattern, that is, Type A in which the pressure increased as the balloon was expanded and Type B in which the pressure increased slightly at an early stage of the expansion, reached a peak, and then decreased. It was presumed that such a behavior of two types of pattern comes from the elasticity of the prostatic surgical capsule. The difference of the elasticity may result in the difference of the degree of urinary disturbance in BPH.

View full abstract

The horizontal section of the prostate in benign prostatic hypertrophy (BPH) varied from a emilunar shape in the early stage to a circlar shape in the advanced stage, in accordance with the development of the adenoma. Based on this idea, an index of the “Presumed Circle Area Ratio (PCAR)”, which indicates how the sections of the prostate approach a circular shape, was established in our laboratory.
In the index, the critical point whether pathological residual urine in BPH develops or not was 0.75. BPH with residual urine over 30ml should have a PCAR over 0.75. In BPH with a PCAR below 0.75, residual urine should be below 30ml. However, residual urine in BPH with a PCAR over 0.75 was over 30ml in some cases and below 30ml in others.
In order to clarify the reason why in some cases pathological residual urine did not develop in spite of a high PCAR, the tensile strength of the surgical capsule of the prostate in 40 cases of BPH with a PCAR over 0.75 was measured. In results, the surgical capsule in 10 cases with residual urine below 30ml in spite of a PCAR over 0.75 was able to extend more than that of the remaining 30 cases with residual urine over 30ml.
The hypertrophic prostate was simulated by a spherical model consisting of a capsule, of which the physical property was similar to the measured one, and content, of which the property was homogenous and liquid. By the application of the finite deformation theory for elastic substances like rubber, the internal (intraprostatic) pressure of this prostate model was calculated using a computer.
In results, the calculated intraprostatic pressure in cases with residual urine over 30ml elevated suddenly according to the slight expansion of the content, while that in cases with residual urine below 30ml did not. It was presumed, accordingly, that the intraprostatic pressure in the former cases might elevate also when urine flow came into the urethra, which passes through the prostate anatomically.
Thus the mechanism of dysuria in BPH was clarified using the PCAR theory and information on the physical property of the surgical capsule.

View full abstract

In the 2nd report, tensile strength of the surgical capsule in the hypertrophic prostate was measured. Using the same method, tensile strength of the normal prostatic tissue was measured in this study. The elasticity of the normal prostate was similar to that of the surgical capsule of the hypertrophic prostate with pathological residual urine.
From this result, the prostate might be able to be simulated by a balloon model consisting of a capsule, of which the physical property was similar to the measured one, and the content, of which the property was homogenous and liquid. The internal pressure in the balloon model at an early stage, that is, in the deflated balloon, was low. However, the internal pressure increased with expansion of the balloon volume, according to the law of Laplace.
Thus the simulated intraprostatic pressure in the normal prostate with a PCAR lower than 0.75 was low and that in the hypertrophic prostate with a PCAR higher than 0.75 was high. These results indicated that PCAR seemed to be one of the most important parameters representing the degree of urinary obstruction in benign prostatic hypertrophy patients.

View full abstract

A comparative study of lectin binding on 52 cases of renal cell carcinoma and 8 cases of normal human kidney was performed using formaline fixed paraffin sections. Lectin binding affinity with BPA, LTA-M, LTA-Ft, PNA, DBA and UEA-1 were examined by a highly sensitive lectin anti-lectin immunoperoxidase method. BPA was found to stain all the nephron, LTA the proximal tubules, DBA and PNA the collecting tubules PNA the distal tubules and UEA-1 vascular endothelia.
In the cancerous lesions BPA showed the highest binding rate, followed by LTA and PNA, whereas DBA and UEA-1 were almost negative. Different cell architectures showed different binding rates. Alveolar type showed poor staining, and cystic and papillary types were moderate, while highly differentiated tubular type showed the highest binding rate. Different cell types also expressed different binding rates. Clear cells demonstrated the highest staining rate, granular cells, mostly poorly differentiated, were stained poorly, and highly undifferentiated spindle or sarcomatoid cells showed almost no staining. The above results indicated the more the tumor morphologically differentiated the more the lectin binding rates increased.
Three binding patterns were found between the proximal tubule specific LTA lectin and the distal and collecting tubule specific PNA lectin: LTA (+)·PNA (+), LTA (+)·PNA (-), LTA (-)·PNA (+). The above results indicated changes in glycoproteins during cell transformation.

View full abstract

The combined treatments of percutaneous nephrolithotripsy (PNL), extracorporeal shock wave lithotripsy (ESWL) and chemolysis were carried out on 16 patients with 18 staghorn renal calculi. 13 kidney stones (72%) were treated with satisfactory clinical result but residual stones greater than 4mm remained in five kidneys. ^99mTc-Dimercaptosuccinic acid uptake of the kidney was not changed after the combined treatments, which suggests that these procedure did not impair renal function.
The complications encountered during 26 sessions of PNL were bleeding resulted in transfusion in three cases, ureteral perforation, ureteropelvic junction stricture and arrhythmia, each in one case. These complications might be eliminated by technical training and improvement of endoscopic devices.
The combined method is better than nephrolithotomy or partial nephrectomy in the treatment of staghorn renal calculi because of small invasion, preservation of renal function and repeatability.
The combined method covers each disadvantage of monotherapy of PNL or ESWL and augments the success rate of the removal of staghorn calculi.

View full abstract

Several reports have been published regarding the possible method of recording erotic erection for diagnosis of impotence (IMP). With a view to establish a standard diagnostic method, we performed in total 42 audiovisual sexual stimulation (AVSS) tests on 11 healthy adults and measured the resulting penile changes.
Electroencephalogram, respiratory waves, blood pressure, galvanic skin reflex (GSR), and bulbocavernosus muslce electromyography were recorded. The results are follows:
1) There was no corerelation between penile circumference and penile temperature as mesured with a mercury strain gauge. Therefore, penile temperature, which is usually measured in AVSS test, was considered inappropriete as a variable for IMP diagnosis.
2) In healthy adults, there was a positive correlation between penile circumference and systolic blood pressure, diastolic blood pressure, GSR, respiratory rate, or respiratory depth.
3) We assigned points to those variables which showed some correlation and used the points to determine a sexual stimulation score (SSS). In normal subjects. SSS correlated with penile circumference in accordance with the following formula: y=3.2x+11.6 r=0.7742 p<0.01.
4) If the SSS of a patient rose above 3, the stimulation was judged effective. A patient was judged normal if his SSS was more than 3 and his penile circumference was at least 90% of the normal adult circumference when stimulated.
Our AVSS test using SSS ensured great accuracy because response to stimulation can be objectively measured. This may be especially useful for IMP diagnosis.

View full abstract

Thirty three patients with adenocarcinoma of the prostate who underwent radical total cystoprostatectomy were analyzed.
Our results indicated that the local extent of disease, especially to bladder wall, has been underestimated in clinical diagnosis and local extent has associated with nodal involvement. The metastatic location of lymph nodes had no specific location, although it had an inclination the obtrator nodal involvement.
Thus we emphasize that surgical treatment for high stage of prostatic cancer needs the radical total cystoprostatectomy as a curative operation.

View full abstract

Diagnostic methods of primary hyperparathyroidism were studied. The results obtained were as follows:
1. Because the serum levels of electrolytes and parathyroid hormone and the amounts of urinary electrolytes fluctuate markedly multiple determinations were necessary.
2. Judging from the mean values, the highest rate of diagnosis was obtained by serum calcium (91%), followed by serum alkaline phosphatase (72%), serum parathyroid hormone (68%) and serum phosphate (56%). A rather low rate of diagnosis was obtained by the amounts of urinary calcium (44%) and urinary phosphate (28%).
3. Calcium loading test and measurement of nephrogenous cyclic AMP were all positive in 6 and 4 cases, respectively. Urinary cyclic AMP (90%) and % tubular reabsorption of phosphate (88%) were also useful. Two cases of normocalcemic primary hyperparathyroidism were diagnosed by these tests.
These results show that active testing is necessary in the case of recurrent urolithiasis whose serum calcium is high normal.

View full abstract

Sixty-six patients with either cerebral infarction (48 cases) or cerebral bleeding (18 cases) including
30 men and 36 women were selected for the present study to investigate micturitional conditions immediately after the attack (attack phase) and urodynamic status within 2 weeks after the episode (acute phase). None of them had obstructive disorders of the urinary tract before the attack. Further studied were changes of the above micturitional functions with elapsed time up to reestablishment of self controlled micturition (recovery phase) and factors possibly influencing the recovery of micturitional functions such as property and localization of brain lesion, disturbed consciousness and moving disability.
Brain lesions were identified and localised with computed tomography, and divided into two groups of small and large lesions; those less and larger than one third of cerebral hemisphere, respectively. The presence or absence of the lesion invading cerebral basal ganglia and posterior internal capsula was also confirmed. Mitutional condition was difined as normal micturition, urgency incontinence (incontinence with residual urine less than 100 ml), urinary retention (incapability of voiding in the presence of bladder urine over 400 ml) and overflow incontinence (incontinence with residual urine more than 100 ml). At acute phase, normal micturition, urgency incontinence, urinary retention and overflow incontinence were observed in 2, 13, 17 and 34 patients, respectively. Overflow incontinence was observed in 19 (70%) of 27 patients with large cerebral lesions and in 18 of 24 patients with mildly or severely disturbed consciousness. Many of 13 patients revealing urgency incontinence had cerebral lesions invading basal ganglion (12/13), had hyperactive bladder (9/10) and decreased external urethral function (5/10). Many of patients who revealed urinary retention had cerebral lesions invading neither basal ganglion nor posterior internal capsula (10/17), and showed inactive bladder (8/10) and decreased external urethral function (6/10). Of the patients who revealed overflow incontinence, half had lesions invading both basal ganglion and posterior internal capsula, but vesico-urethral function of them was varied by the patient, suggesting that overflow incontinence at attack phase is a micturitional condition attributable to both disturbed consciousness and organic disorders. At the acute phase, normal, hyperactive and inactive bladder were respectively observed in 27, 33 and 40% of 41 patients examined. At recovery phase, normal bladder was found to increase to 33%. Sphincteric function of external urethra was found almost unchanged from acute phase to the recovery phase. Decreased, normal and enhanced responses were respectively observed in 18, 11 and 1 patients for external anal sphincter and in 15, 13 and 2 patients for bulbocavernosus reflex. None showing enhanced response achieved self controlled voiding. Eight of 9 patients who could not achieve self controlled micturition had cerebral infarction, of which six had large cerebral lesion. Clinically, overflow incontinence, enhanced external sphincteric function suggested disadvantage for achieving self controlled voiding. The period required to achieve self controlled voiding from attack was significantly longer in the patients with overflow incontinence (53.7±9.7 days) than those with either urgency incontinence (28.7±6.9 days) or urinary retention (34.3±9.1 days). Ability of exercise was also found to be an important factor to achieve self controlled voiding.

View full abstract

During the period from Jan. 1980 to Aug. 1985, 685 cases underwent transrectal ultrasonotomography in our hospital, and prostatic weight, the ratio of the anteroposterior diameter to lateral diameter (A-P/R-L), and presumed circle area ratio (PCAR) were calculated from the tomograms.
Based on the data of 19 cases with prostatic cancer, 42 with prostatic hypertrophy, 145 with prostatitis, and 180 normal subjects, the following results were obtained.
1) Weight was slightly lower, A-P/R-L and PCAR were slightly higher in cases with prostatitis than in normal subjects, but the differences were not statistically significant.
2) Weight, A-P/R-L, and PCAR were significantly higher in cases with cancer or hypertrophy than in cases with prostatitis or normal subjects.
3) Cancer was different from hypertrophy in that the increase of weight was less than those of A-P/R-L and PCAR, and that the increase of A-P/R-L was greater than that of PCAR.

View full abstract

During the period from Jan. 1980 to Aug. 1985, 178 patients were diagnosed as having mild hypertrophy and underwent conservative treatment. Sixty-eight patients dropped out of the follow-up, while prostatic weights were monitored by the sonometrics in the remaining 81 patients. From the analysis of these cases, the following results were obtained.
1) There was no significant difference between the prostatic weights of 68 cases without follow-up and those of 81 cases followed up.
2) In 81 cases followed up, the mean prostatic weight increased from 21.1±7.9g to 25.0±9.7g.
3) Prostatic weights decreased more than ten percent in only 13 cases of the 81 cases followed up.
4) Prostatic weight in hypertrophy does not seem to increase gradually. It seems to stay unchanged for a certain period and then increases rapidly.

View full abstract

During the period from Jan. 1980 to Aug. 1985, 145 patients with benign prostatic hypertrophy were treated with anti-androgenic agents-chlormadinone acetate (CMA) or gestonorone caproate (GC). As a rule, CMA was given 50mg daily for several months and GC was given 200mg weekly for 12 consecutive weeks. Out of these 145 patients, 105 patients underwent transrectal ultrasonography of the prostate before and after the treatment (98 cases for CMA group and 7 for GC).
From analysis of the changes in prostatic weights in these 105 patients, the following results were obtained.
1) Weight reduction was observed in 85 out of 98 CMA cases and 6 out of 7 GC cases. Mean reduction rates were 31.7% and 20.7%, respectively.
2) Analysis of 25 CMA cases whose prostatic weights were monitored after the cessation of the CMA administration revealed that discontinuation of CMA administration was followed by a rather rapid re-enlargement of the prostate.
3) Out of these 25 cases, 16 were given CMA again. Investigation of these cases revealed that the resumption of CMA administration could induce almost the same reductive effect on prostatic weight as the initial CMA administration did.
4) Other 44 cases were treated with CMA for a fairly long period. In these cases, prostatic weight seemed to decrease rapidly and markedly in the first several months of treatment and then remain unchanged or decrease only at a slowed pace during the successive period. The larger the prostate, the longer the administration period required for unchanged weight. But a few cases showed gradual re-enlargement of the prostate in spite of the continuous administration of CMA.

View full abstract

Plasma 6-keto-prostaglandin F_1α (6-keto-PGF_1α) and thromboxane B₂ (TXB₂) levels were measured by radioimmunoassay in 14 patients with renal cell carcinoma, 20 bladder cancer and 16 prostatic cancer and, as the control groups, 12 patients with benign prostatic hypertrophy and 7 normal men. Plasma 6-keto-PGF_1α levels in most patients with renal cell carcinoma were higher than in normal control and had a tendency to rise with the advance of carcinoma. However, the high plasma 6-keto-PGF_1α level was not specific in renal cell carcinoma because it was seen in most patients with benign prostatic hypertrophy. Plasma 6-keto-PGF_1α levels in patients with carcinoma of the bladder or prostate and plasma TXB₂ levels in patients with carcinoma of the kidney, bladder or prostate showed no significant differences from those levels in the control groups.
Urinary PGE₂ levels were determined by radioimmunoassay in 17 patients with renal cell carcinoma, 27 bladder carcinoma and 42 prostatic carcinoma and, as the control groups, 20 patients with benign prostatic hypertrophy and 8 urolithiasis. Urinary PGE₂ levels in patients with untreated prostatic carcinoma had a tendency to rise with advance of the disease. Urinary PGE₂ levels in patients with prostatic carcinoma on antiandrogen therapy showed no differences from those in patients with benign prostatic hypertrophy or urolithiasis.
The bladder tumor tissue obtained by TUR was dispersed with collagenase and the level of PGE₂ released from the dispersed tumor cells into incubation medium was measured. The release of PGE₂ increased in time dependent manner and was significantly inhibited by indomthacin. The result suggests that urinary PGE₂ in patient with bladder carcinoma derives in part from tumor tissue.

View full abstract

Powder samples of 80 upper urinary tract stones composed of weddellite and/or whewellite and apatite, the contents of which had been estimated by thermogravimetry (TG), were analysed with two kinds of the double-beam recording infrared spectrophotometers, 620 MX of Beckman Instruments, Inc. and IRA-2 of Japan Spectroscopic Co. Ltd.. A 1.0mg powder sample was weighed and mixed with 150mg or 100mg KBr to form a pellet. The typical absorption bands of apatite in the region 1100-1000cm^-1 and those of calcium oxalate at 1320, 920, 780 and 520cm^-1 were selected and their absorbances were measured on the infrared spectra of 64 samples recorded with 620 MX and the infrared spectra of 51 samples recorded with IRA-2 (Fig. 1 and 2). Comparing the absorbances with the contents of weddellite, whewellite and apatite estimated by TG, an attempt was made to determine the percentage of these components by infrared analysis of calcium oxalate stones.
The results are as follows:
1) It was reported by Bellanato and associates7) that there was a direct correlation between the ratio of the absorbance of the band at 780cm^-1 to that of the band at 520cm^-1 (D780cm^-1/D520cm^-1) and the ratio of the whewellite content to the total of weddellite and whewellite. However, it was shown in this study that the correlation coefficient between these ratios was-0.54 (p<0.01) when D780cm^-1/D520cm^-1 was determined on 51 infrared spectra recorded with IRA-2 (Fig. 4).
2) It was reported by Takasaki that there was a good correlation between the ratio of the absorbance of the bands in the region 1100-1000cm^-1 to that of the band at 1320cm^-1 (Dp/Do) and the ratio of the apatite content to the total of calcium oxalate and apatite. It was shown in this study that the correlation coefficient between Dp/Do where the ratio of Dp to Do was less than 1.0 and the ratio of the apatite content to the total of calcium oxalate and apatite was 0.96 (p<0.01) when Dp/Do was determined with 620 MX in 52 samples and 0.95 (p<0.01) when determined with IRA-2 in 47 samples (Fig. 5).
3) The correlation coefficient between the absorbance of the band at 920cm^-1(D920cm^-1) and the weddellite content was 0.87 (p<0.01) when D920cm^-1 was measured with 620 MX in 35 samples and 0.81(p<0.01) when measured with IRA-2 in 29 samples (Fig. 8).
4) The correlation coefficient between D780 cm^-1 and the whewellite content was 0.89 (p<0.01) when D780cm^-1 was measured with 620MX in 64 samples and 0.88 (p<0.01) when determined with IRA-2 in 51 samples (Fig. 9). The correlation coefficient between D520cm^-1 and the whewellite content was 0.92 (p<0.01) when D520cm^-1 was determined with IRA-2 in 51 samples (Fig. 10).
5) The correlation coefficient between the depth (mm) of the band at 780cm^-1 and the whewellite content was 0.87 (620 MX, p<0.01) and 0.89 (IRA-2, p<0.01), and that between the depth of the band at 520cm^-1 and the whewellite content was 0.92 (IRA-2, p<0.01). Thus it was suggested that the depth of the absorption band was also correlated with the whewellite content in calcium oxalate stones (Fig. 11).
6) Each of the absorption bands in the region 3600-3000cm^-1, at 920cm^-1, at 780cm^-1 and at 670cm^-1 was classified into three patterns and scored according to the shape and depth; those characteristic of weddellite were given two points, those characteristic of whewellite were given 0 point and those showing the intermediate shape and depth were given one point (Fig. 3). The total point (Weddellite score) which ranges between 8 and 0 was then compared with the ratio of the weddellite content to the total of weddellite and whewellite (Fig. 12). Since the correlation coefficient b

View full abstract

Intravesical instillation of Adriamycin (ADM) and Mitomycin C (MMC) was carried out for the purpose of prophylaxis of the recurrence of superficial bladder cancers after TUR or TUC.
The eligible patients were allocated at random into the following 3 groups (ADM, MMC and control), for solitary or multiple tumors of bladder.
1) No treatment.
2) Intravesical instillation with ADM: 50mg of ADM in 100ml saline solution.
3) Intravesical instillation with MMC: 30mg of MMC in 100ml saline solution.
The drugs were given 6 times by instillations in 2 weeks after TUR or TUC, and there after for 2 days continuously every 4 weeks for 2 years.
In total 134 patients were investigated. Of them 103 patients were evaluable and 31 were eliminated as non-evaluable patients.
The cumulative non-recurrence rate was 73.6% in the ADM group, 63.4% in the MMC group and 22.5% in the control group after following up for 24 months. The cumulative non-recurrence rates of the 2 instilled groups (ADM, MMC) are significantly higher than that of the control group.
The side effects were relatively mild.
We consider that this instillation therapy with Adriamycin and Mitomycin C is useful for preventing the recurrence of bladder cancers.

View full abstract

The prevalence of incontinence was investigated by means of a questionnaire survey of 968 women who worked for a company in Nagoya. Age of respondents varied from 17 to 69, with teenagers and those in their 20's constituting 71.5% of the total.
The survey showed that 8.5% of the total had incontinence and that the prevalence of incontinence increased with age up to 23.9% of women in their 40's. This correlation was also observed in nulliparous women. A positive correlation was found between the number of childbirths and the prevalence of incontinence (nullipara 4.3%, monopara 15.2%, dipara 24.0%, multipara 37.5%).
In all age groups but teenagers, the mean body weight of the incontinent women was greater than that of those who had never had incontinence. For the 30, 50 and 60 year age groups, this difference was statistically significant at the 0.05 level.
In decreasing order of incidence, the provocative factors for urinary loss were sneezing, coughing, urgency, rope jumping, laughing, excitement, running and lifting heavy things. As to the severity of incontinence, 73% did not worry about it, 22% changed briefs when they were wet, and 4% used pads occasionally. No one had ever sought medical consultation for their incontinence.
As the number of women who have jobs or social activities outside the home increases, information regarding the prevalence and natural history of incontinence and its treatment will become of prime importance.

View full abstract

Testis weight and size of Japanese were investigated on 651 necropsy cases acquired during the years 1974 to 1984 at the department of forensic medicine, school of medicine, Tokai university. Measurements of materials were carried out within 24 hours after sudden death. However, cases with some testis lesions in the past history and with apparent abnormal testis were excluded.
On the average, the right testes were larger than the left ones in weight and width in all the age groups. The mean values of testis measurement in adult age (from 20 to 49 years) were as follows: The left testis weight was 14.53±4.07gr, longitudinal length 4.51±0.64cm, transverse length 3.04±0.43cm and width 1.47±0.3cm. In the right testis the weight was 15.35±4.26g, longitudinal length 4.53±0.61cm, transverse length 3.50±0.4cm, and width 1.55±0.33cm. The age group of thirties showed the maximum values in testis weight, longitudinal length and transverse length, of all age groups.

View full abstract

We studied prognostic significance of blood group ABH (BGA) and Thomen-Friedenreich antigen (T-antigen) and carcinoembryonic antigen (CEA) in 86 patients, who had initially low stage transitional cell carcinoma of the bladder and had been followed for 3 to 8 years. BGA and CEA were detected by the peroxidase-antiperoxidase method (PAP), and T-antigen by the T-specific lectin (Peanut agglutinin) immuno-peroxidase method using paraffin section.
Staining patterns of BGA by PAP were classified into 5 types as follows:
Type I: Stained homogeneously and as intensely as normal urothelium.
Type II: Stained homogeneously but less intensely than normal urothelium.
Type IIIa: Stained non-homogeneously with negative area (less than 50%).
Type IIIb: Stained non-homogeneously with negative area (more than 50%).
Type IV: Stained negatively with no positive area.
No correlation was found between histological grade and BGA staining patterns. CEA was detected in 10 of 86 (11.6%) superficial tumors and was detected at a higher incidence in grade 3 bladder tumors.
Recurrence rate of the cases with type IIIb, V is higher than that with other types. Moreover, all cases (10 cases) with invasive recurrence belonged to type IIIb, IV. T-antigen expression was also significantly related to subsequent recurrence with invasion. CEA was less effective than BGA in predicting clinical course. Of these markers, BGA is the most reliable indicator of biological behaviors of future recurrent tumors as a single marker system. In combination study, any combination did not enhance the accurracy compared with BGA alone. Consequently, cases with BGA expression of type IIIb or IV and T-antigen expression of cryptic T-antigen negative have been proved to be high risk groups for invasive recurrence.

View full abstract

We reported on a female patient with congenital adrenal hyperplasia, who developed an associated adrenocortical adenoma. She complained of clitoral enlargement at birth, but did not visit us until she was 21 years old. Laboratory data showed high urinary 17-KS which was supressed with 2mg of dexamethazone. RI examination showed the bilateral adrenal hyperplasia. She underwent vaginoplasty and clitorectomy, and followed by the replacement therapy with gluticorticoids. Six years later, a CT scan demonstrated a right adrenal tumor, 2cm in diameter. The right adrenalectomy was performed. The pathology of surgical specimens showed hyperplasia of adrenocortex associated with adrenocortical adenoma (6g). The case reported here suggested that the inadequete management might have a risk for neoplastic change in congenital adrenal hyperplasia.

View full abstract

Renal autotransplantation was carried out for urinary undiversion in a 45-year-old female patient. She had undergone bilateral ureterocutaneostomies because of a ureteral injury during surgery. The left kidney was transplanted to the right iliac fossa and its ureter was implanted into the bladder, and the ureter of the right kidney was anastomosed to the pelvis of the transplanted kidney.
This operation could provide not only reconstruction of the urinary tract of the left kidney but also that of the right kidney.

View full abstract