It is desirable to establish a rapid evaluation method of mixed lymphocyte reaction for prospective matching in cadaver kidney transplantation. The present study was designed to develop a rapid MLR based on the measurement of lymphocyte protein synthesis.
Lymphocytes were isolated from human heparinized peripheral blood through density gradient centrifugation on Ficoll-Hypaque and suspended in leucine-free RPMI-1640 medium at the final concentration of 1.5×10⁶ cells/ml. Protein synthesis was measured by the uptake of ³H-leucine to lymphocytes. Mixed lymphocyte cultures were carried out in micro plates. Responder cells 1.5×10⁵ were incubated with stimulating autologous or allogenic cells of 1.5×10⁵ in leucine-free RPMI-1640 containing heat-inactivated pooled human serum. In carring out one way MLR stimulator cells were treated with mitomycin C at a concentration of 50μg/ml for 20min. at 37°C in a shaking water bath. The inhibitory effect of mitomycin C on lymphocyte protein and DNA synthesis was studied by adding PHA-M (1:50) 50μl to the cell culture (lymphocytes 100μl, serum 50μl). Viability of the cell suspentions was found more than 95% as defined through trypan blue exclusion. The inhibitory effect of mitomycin C on lymphocyte protein synthesis was run almost in parallel with that of DNA synthesis and there was a dose response relationship between the concentration of mitomycin C and the inhibition of protein and DNA synthesis. The percent inhibition of protein synthesis was 85 percent at mitomycin C concentration of 50μg/ml.
A rapid MLR was performed under the following conditions: serum concentration, 8 percent; ³H-leucine pulse label time, 1 hour and incubation period, 24 hours. The degree of rapid MLR was quantified as percent response and the results were compared with the corresponding stimulation index. There was significant correlation between % response and S. I. (n=29, r=0.660, p<0.01). Furthermore there was significant defference in the uptake of ³H-leucine between allogenic cultures of HLA-DR match patients.
A rapid MLR is now possible within 24 hours making more accurate selection of recipients possible in cadaver kidney transplantation.

View full abstract

Histological characteristics of prostatic cancer in Japan were evaluated in a retrospective analysis of 267 cases. Combined staging and histological grading from primary diagnosis were classified according to the Gleason's system. We compared our data with that of Veterans Administration Cooperative Urological Research Group (VACURG) study in literature. According to this system, the prognosis of Japanese patients showed a very similar correlation with that of American patients. There were no remarkable differences in histopathological pattern in stage IV patients between both countries. These results suggested that the Gleason's system is reliable as a valuable adjunct to provide more prognostic information in patients with prostatic cancer in Japan.

View full abstract

The relationship of tumor grade and local tumor extent to pelvic nodal involvement was assessed surgically in 17 patients who underwent pelvic lymphadenectomy for adenocarcinoma of the prostate.
The relationship of preliminary clinical stage and pelvic lymphnodal metastases was noted in neither of two patients (0%) with stage A, 3 of 9 (33%) with stage B, 5 of 6(83%) with stage C disease.
Of patients with a Mostofi's grade 1, none (0/4) had regional node metastases and all (5/5) had metastasis in the case of grade 3.
Of patients with a Gleason score of 8 or above, all (5/5) had regional nodal metastases, regardless of preliminary clinical stage. Furthermore, no patient with Gleason score of 2, 3 or 4 had nodal metastatic disease (0/3).
In two out of seven cases with pelvic nodal involvement, the grade of metastatic lesion was higher than that of primary lesion.
It is suggested that patients with high grade tumor are included in the group with widespread disease, and patients with low grade tumor are in the group with localized disease. But the ability to predict accurately nodal metastatic disease in patients with moderate grade tumor was variable and argues strongly against staging node dissection in this selected population.

View full abstract

For detection of incidental carcinoma of the prostate, total 111 consecutive cases with simple prostatectomy under the diagnosis of benign prostatic hypertrophy were histologically examined by step section technique. Eleven cases (9.9%) of incidental carcinoma were detected histologically. Nine of the eleven cases showed well differentiated and the other two cases showed moderately differentiated carcinoma. All the cases with the focus less than 10mm in diameter showed well differentiated carcinoma. All foci of carcinoma were found at the area of surgical capsule or the vicinity, apparently outside of inner glandular hyperplastic areas.

View full abstract

On patients with malignant urogenital tumors (renal tumor 10 cases, bladder cancer 16 cases, prostatic cancer 6 cases and urethral cancer 1 case), changes in K-cell population of their peripheral blood were measured by means of plaque forming technique, and the significance of these changes were examined, together with the influences thereupon by immunotherapy.
1) Patients with malignant urogenital tumors accompanied by metastases. K-cell population (N=16) showed significantly (p<0.01) lower values (4.9±2.5%) than healthy adults (8.8±1.6%: N=13) and patients with malignant tumors without metastasis (8.1±1.9%: N=17). No significant differences were observed in the number of peripheral lymphocytes among these 3 groups.
2) In 12 cases on immunotherapy mainly by OK-432, K-cell population showed a significant (p<0.01) increase (6.6±2.1%→10.2±2.1%) one month after therapy and anti-group A streptococcus C-polysaccharide antibody (ASP) also showed a significant (p<0.05) increase, though with a 128-fold maximum value. No significant changes were observed in the number of peripheral lymphocytes and in immunoglobulins.
3) OK-432 was suggested to develop a tumor-specific immunological action based upon ASP-mediated ADCC activity and upon the antigen cross reaction between the tumor and the streptococcus.

View full abstract

To clarify the major factors affecting recurrence of superficial bladder cancer, statistical analyses were performed on information available at the initial treatment of 151 patients with pTa or pTl transitional cell carcinomas. The factors included in the present analysis were sex, age, bladder irritative symptoms, interval between initial symptoms and first consultation, location, size, number, shape-I (papillary or not), shape-II (pedunculated or sessile), histological grade and stage of tumors, and smoking history. A multivariate analysis using Cox's proportional hazards model was applied to evaluate the relative contribution of various factors to recurrence. The major findings were as follows:
(1) The 1-, 3- and 5-year recurrence rates for all 151 patients were 27.9%, 44.0% and 51.5%, respectively. The 5-year recurrence rates were 77.2% for multiple tumors and 36.9% for single tumors with a hazard ratio (HR: from Cox's proportional hazards model) of 3.56; Shape-II (sessile, 60.3% vs. pedunculated, 39.4%) with HR of 2.57; stage (pTl, 59.4% vs. pTa, 49.0%) with HR of 2.05; age (70 years and more, 60.1% vs. less than 70 years, 49.4%) with HR of 1.91, size (larger than 1cm, 69.1% vs. 1cm and less, 37.1%) with HR of 1.68 (: p<0.05, : p<0.001).
(2) A stepwise selection of these factors was made, based on the relative magnitude of their contribution to recurrence by Cox's proportional hazards model. This revealed that the most important factor forr recurrence was the number of tumors, followed by size, shape-II, smoking history, age, and stage in this order. The first three of these were statistically significant (: p<0.05, : p<0.001). A model composed of these three factors showed a corrected hazard ratio of 3.08 in multiple tumors, 1.76 in tumors larger than 1cm and 1.84 in sessile tumors.
(3) Recurrence-free curves were compared in four groups of patients: those without any characteristics of multiple, larger than 1cm and sessile tumors; those with any one of the above; those with any two of them; and those with all of them. This comparison clearly showed the four groups had different survival; this indicated that the above three characteristics were definite determinants of recurrence.
In conclusion, since patients with multiple, large and sessile tumors seen at the initial treatment have a larger probability of recurrence, these three characteristics should be taken into consideration when planning prophylactic intravesical chemotherapy and immunotherapy.

View full abstract

Sixty-seven patients with Klinefelter's syndrome (KS) and 69 patients with hypogonadotoropic eunuchoidism (HE) were comparatively studied as to clinical symptoms, endocrinological tests, testicular histology and therapeutic results. Generally in the HE group the age at first visit was younger and the signs of hypogonadism were more manifest than in the KS group. Cryptorchism ocurred more frequently in HE, and gynecomastia was found more often in KS. In chromosome analysis all KS patients had the XXY cell line and all HE patients analysed showed 46, XY karyotype. Basal serum LH and FSH as well as their responses to LH-RH were definitely high in KS and only minimal in HE. Some KS patients revealed normal serum testosterone (T) levels although the average T level of KS was decreased. The HE patients showed a significantly lower T level than the KS. Serum T responses to exogenous hCG were smaller in KS than in normal males and they were more diminished in HE. However, some HE patients who had low basal T levels responded appreciably to hCG stimulation. Serum PRL levels were abnor-mally elevated only in two HE patients with pituitary tumor. The histology of the testis showed tubular hyalinization and Leydig cell hyperplasia in almost all of KS patients. In contrast, spermatogenesis up to spermatocyte, spermatid or spermatozoa were observed approximately in one third of the HE patients, although the majority of HE patients showed prepubertal findings of testicular histology. Since improvement of sperm production is hopeless in KS, T replacement therapy was applied to those with poor secondary sexual characteristics. The HE patients were treated with hCG after careful clinical observation and repeated hormone studies. When hCG therapy did not attain sexual maturation in HE, treatment was switched to T replacement.

View full abstract

Electro-resection of the tumors and prophylactic intravesical chemotherapy are usually performed on patients with superficial bladder tumors. The effects of these transurethral manipulations on the urinary bladder urothelium were studied using rat experimental model systems.
Transurethral cauterization induced nodular or papillary hyperplasia of the rat bladder urothelium fed on a normal diet. These lesions became normal urothelium by day 14, whereas intravesically instilled Mitomycin-C (MMC) markedly prolonged these histological changes.
Then, transurethral catheterization and cauterization as well as instillation of MMC were performed on the rat bladder urothelium which had been exposed to a carcinogenic initiation by ingestion of 0.05% N-butyl-N- (hydroxybutyl) nitrosamine (BBN) for 4 weeks, since this experimental model was thought to simulate well the transurethral manipulations and MMC instillation on the bladder urothelium of patients with superficial bladder tumors. Repeated transurethral catheterization or cauterization showed some roles in the promotion and invasive development of bladder tumors, whereas single manipulation did not show any significant influences on the bladder carcinogenesis in this experimental model systems. Single instillation of MMC did not give any influence in this experimental condition either.
It is too eary to adapt these experimental results to human bladder cancer. However, it is important to make an intimate observation on patients with superficial bladder tumors in regard to tumor development and invasiveness when a long term and frequent intravesical chemotherapy is performed.

View full abstract

Although staged hypospadias repair is still common in Japan, one stage hypospadias repair has gained popularities in recent years. Up to now, we experienced one stage repair using free fullthickness skin graft in 21 cases of hypospadias or short urethra. At first, we encountered complications such as fistula or stricture, but we have made much improvement in some points of device, which are;
(1) careful technique with fine suture and fine instrument under magnifying loupes.
(2) creation of wide anastomosis sites.
(3) creation of a new meatus by putting the distal skin tube in the glans.

View full abstract

Urinary infection in patients with catheter-free cutaneous ureterostomy was investigated. Urine in the renal pelvis was obtained through a stoma with a single lumen catheter (SLC) or an “specially made” double lumen catheter (DLC). Pyuria, bacteriuria and Antibody Coated Bacteria (ACB) were examined in urine both in the renal pelvis and in the pouch.
Bacteriuria was unexpectedly proved in some of renal pelves in these patients. Bacteria resided in renal pelvis were thought to be of little value in urinary infection, because many of the bacteriuria were not accompanied with pyuria and positive ACB.
It is advisable and important to collect urine in the renal pelvis by catheterization technique through a stoma rather than to use urine in the pouch in order to detect the organisms in urinary infection.
A single lumen catheter is thought as useful as a double lumen catheter and has an advantage of simpleness over the other.

View full abstract

The tensile strength of adenomas resected from hypertrophic prostates was measured in 41 cases. The tensile strength was weaker than that of the normal prostate. This result indicates that the physical property of adenoma is homogenous.
In all cases, the tissue of adenoma was reptured at the stroma between the glandular hypertrophic nodules. It is presumed from the result that adenoma consists of the glandular hypertrophic nodules, in which glandular structures are combined firmly, and of the fibromuscular tissue, which is weaker than the glandular structure. It is also presumed that the more the fibromuscular tissue in the adenoma, the stronger the adenoma.

View full abstract

From December 1984, 17 patients with bladder tumor underwent Kock continent ileal reservoir for the urinary diversion. Surgical procedure was done according to the techniques of Kock and Skinner et al. Operating time ranged from 4 to 5 hours and bleeding was minimum. As the operative early complications, postoperative mortality was experienced in one patient and urinary leakage from the ileal reservoir occurred in two patients. The most difficult technique seemed to the construction of a stable nipple valve of both inner and outlet portions from the view point of late complication. As the late complications, the troubles of nipple valve were noted in 11 patients including 2 of incontinence, 8 of difficulty of catheterization and 3 of reflux. Selfcatheterization is performed every 3 to 4 hours during the day and the capacity of the pouch was about 300ml. Serum electrolytes and creatinine were within the normal ranges in all cases. Our clinical experience showed thak Kock continent ileal reservoir serves the patients urinary diversion and a better quality of life.

View full abstract

The present study investigates (1) a reliable method of incomplete ureteral obstruction (IUO) for creating a moderate unilateral hydronephrosis in the dog, and (2) functional evaluation on the renal damage caused by the IUO as well as its reversibility after release from the obstruction (RO). In the first experiment, 4 methods of IUO were evaluated using 29 canine ureters. Ureteral ligation, periureteral silicone prosthesis and ureteral embedding into the psoas muscle were all unsuccessful for this attempt. Only intravesical ureteral obstruction with a tapered polypropylene obturator resulted constantly in a moderate degree of hydronephrosis persisting for 7 weeks. The second experiment consisted of renal clearance study using separate renal urine, repeating for 7 weeks during IUO and further 7 weeks after RU in 10 dogs.
The results were as follows;
1) Glomerular filtration rate (GFR) of the IUO kidney decreased to 28% of that in the contralateral control kidney 1 week after obstruction. Then 41-48% level continued during 7 weeks of IUO. Postobstructive recovery of GFR was rapidly observed, reaching 70% and 84% levels after 1 and 7 weeks, respectively.
2) Renal blood flow (RBF), urine volume, excretion of potassium and osmolar substance in the obstructed kidney also showed a certain decrease during IUO and recovery after RU was seen in a similar pattern in each of them. Significant correlation was noticed among GFR, RBF and osmolar clearance throughout the period of observation.
3) The decrease of potassium excretion correlated well with that of GFR and RBF when the obstruction chronically persisted. The postoperative increase of potassium excretion also paralleled the recovery of GFR and RBF. The results indicate that the potassium excretion ratio of the obstructed kidney to the contralateral normal kidney is of a good predictive value for the potential reversibility of the obstructed kidney function.
4) Excretion of urinary sodium from the obstructed kidney appeared to be indifferent to any of the abovementioned parameters. It is even suggested that sodium excretion from the contralateral intact kidney can toe restricted by an unknown cause in this unilateral IUO model.

View full abstract

We reviewed 60 cases of incidental carcinoma treated conservatively. Five year survival rate depending histological grade of Mostofi's, differentiation and Gleason's classification showed a significant difference. Cases in which well differentiated adenocarcinoma involved≤3 chips in a transzrethrally resected specimen or ≤5mm diameter of total lesion in an enucleated specimen were classifieu as stage A₁ (30 cases) and all others were classified as stage A₂ (30 cases). Patients with stage A₁ tumors significantly were better (P less than 0.05) than those with A₂, the 5 year survival rates being 88% and 69%, respectively. We believe that patients in stage A₂ should be treated aggressively. However, we recommend conservative therapy for patients in stage A₁.

View full abstract

Clinical study was made of 20 patients with varicocele under 18 years of age. The following results were obtained.
1. The varicocele was left-sided in 19 patients and bilateral in 1. High ligation of the left internal spermatic vein was carried out in all cases.
2. The volume of the left testicle was significantly smaller than that of the right testicle.
3. Bilateral biopsy was performed in 12. Spermatogenesis was generally reduced in the left testicle, although there was no significant difference between the right and left testicles.
4. We believe that surgical removal of a varicocele shoud be carried out in the childhood as soon as possible in order to prevent the danger of progressive damage of the spermatogenesis of the testicle.

View full abstract

Clinical analyses were made on diagnosis and preoperative management of 7 patients with pheochromocytoma (male 2, female 5) in the last 6 years. Chief complaints were palpitation in 3 patients, hypertension, edema in the extremities and headache each in 1 patient. One patient was found to have pheochromocytoma during close examination of another disease.
ECG showed abnormal findings in 6 of the 7 patients. Ophthalmoscopic examination showed abnormal findings in all patients. Diabetes mellitus was found in 2 patients. Endocrinological studies revealed abnormal levels of noradrenaline and VMA in urine in all patients.
Computed tomography, ultrasonography and ¹³¹I-MIBG (meta-iodobenzyl guanidine) scintigraphy were reliable procedures for the accurate determination of localization of pheochromocytomas.
Reductions of both circulating blood volume and circulating plasma volume were found in 3 patients. Four of the 7 patients were hypertensive before treatments. It was established that quinazoline derivatives, which replaced pheoxybenzamine as alpha-adrenergic recepter blocking agent, were quite useful.
Preoperative evaluation of haemodynamics with Swan-Ganz catheter monitoring revealed no serious abnormal findings in 5 patients. This procedure also seemed to be indispensable for intra- and postoperative management of patients with pheochromocytoma.

View full abstract

The assessment of residual urine is an important part of examination of patients with neurogenic bladder dysfunction. The most definitive method to evaluate residual urine volume is catheterization, but it is not only uncomfortable for patients but also carries risks of urinary infection and urethral trauma.
Ultrasonic estimations of the amount of residual urine were carried out in 165 patients with neurogenic bladder dysfunction. At first, in 60 patients, the actual residual urine volume was plotted against the following ultrasonic parameters: (1) the greatest antero-posterior, supero-inferior and transverse diameters; (2) the maximum areas of transverse and longitudinal sections; and (3) the volume calculated from the maximum transverse and longitudinal plaens using an ellipsoid formula. Among these ultrasonic parameters the volume showed the best correlation to the actual residual urine volume (r=0.9867).
And then, in 125 patients with neurogenic bladder dysfunction, the residual urine volume data calculated by the ultrasound using the ellipsoid formula were compared with the actual volume determined by catheterization. The amount of residual urine larger than 50cc and 100cc could be detected by the ultrasound with an accuracy of 92.7% and 96.4%, respectively. The average error of 15.9% and the correlation coefficiency of 0.9809 were obtained. Ultrasonography is a simple, quick, non-invasive and quantitative method of estimating residual urine volume. Therefore, the ultrasonic assessment of residual urine may be recommended as a suitable method for routine practice instead of the catheterization method.

View full abstract

Postal questionnaires about stone recurrence were sent to 1400 patients with renal stones who had received treatment but had discontinued outpatient visits to our clinic over one year before. Replies to the questionnaires were received from 502 stone formers. The average period of attending the clinic as outpatients was 9.5 months. To our surprise, 381 cases (75.9%) had voluntarily ceased outpatient visits for one year, and 45.4% of the cases who cad been prescribed treatment had stopped visiting our clinic for the same period. Moreover the rate of visiting another clinic after leaving our clinic was only 4%.
437 patients with idiopathic calcium renal stones were studied for stone recurrence. The length of average followup period was 55 months. 101 (23.1%) of the 437 cases experienced stone recurrence and 79 (78%) of these cases were found by the postal questionnaire.
The stone and patient recurrence rates among the 437 cases were 0.116±0.017 SE stone/year and 5.06% patients/year, respectively. The stone recurrence rate after discontinuing outpatient visits was the same as that during outpatient peroids. But the patient recurrence rate after discontinuing outpatient visits was decreased to 50% of that during outpatient periods.
Stone and patient recurrence rates after discontinuing outpatient visits according to the types of treatment during the outpatient periods were: 0.152±0.041 SE stone/year and 4.46% patients/year in the non-treatment group; 0.148±0.051 SE stone/year and 6.85% patients/year in patients on thiazide therapy; 0.074±0.033 SE stone/year and 5.41% patients/year in patients given dietary treatment, and 0.065±0.038 SE stone/year and 4.57% patients/year in patients on thiazide therapy plus dietary treatment. These results showed that dietary treatment prescribed in the outpatient clinic had reduced the stone and patient recurrence rates seen after the patient discontinued outpatient visits.
Stone and patient recurrence rates according to the kind of occupation were: 0.119±0.03 SE stone/year and 5.03% patients/year, respectively, among the so-called “white-collar” workers; and 0.152±0.03 SE stone/year and 6.85% patients/year, respectively, among the so-called “blue-collar” workers.

View full abstract

Partial nephrectomy and autotransplantation by ex vivo technique were successfully carried out in a patient with renal cell carcinoma of the remaining solitary kidney.
The patient was a 46-year old man who had left nephrectomy in 1953 and right ureterocutaneostomy in 1978 due to urogenital tuberculosis. He had suffered from repeated urinary tract infection and was admitted to our hospital with high fever on April 6, 1984. DIP, CT and Angiography disclosed a fist-sized tumor developed in the middle third of his remaining kidney. The tumor was removed by partial nephrectomy using ex vivo technigue under hypothermia and the kidney was autotransplanted in to the left iliac fossa. Total ischemic time of the kidney was 365 minutes. The tumor was 275g in weight and 11×10.5×8.5cm in size. Histological diagnosis was renal cell carcinoma. The postoperative course was uneventful except for oliguria necessitating hemodialysis during the first twelve postoperative days. Up to now, the 22nd postoperative month, the patient has been well with no evidence of reccurance or metastasis. His serum creatinine at the present time was 3.6mg per cent.
The present case indicates that the extensive excision of the solitary kidney by means of ex vivo technique may be a useful method against malignancy.

View full abstract

We encountered one case with renal lymphangioma, a very rare benign tumor, and have herein reported the case.
The patient was a 76 year-old female. The chief complaint was gross hematuria. IVP, ultrasound, CT and angiography of the kidney show the presence of a tumor on the left kidney. Diagnosis was renal tumor and radical nephrectomy was preformed. A gray spongy tissue and a tumor (5×4.5×4.5cm) covered with a capsula were observed in the removed kidney. A total of 23 cases have been previously reported. In future, it is desirable to avoid nephrectomy if the preoperative diagnosis indicates that the tumor is definitely benign.

View full abstract