Preoperative stage diagnosis of renal cell carcinoma is important to determine the treatment of choice. The present study reports the accuracy of preoperative tumor staging by ultrasonography in comparison to those by CT and angiography in 33 cases of renal cell carcinoma. The preoperative stagings were compared with operative or autopsy findings. The stages and grades were classified according to TNM classification by Japanese Urological Association.
As a result, the correct stage diagnosis could be made by ultrasonography in 15 of 21 pT2b cases and 2 of 7 pT3 cases. By angiography, 8 of 20 cases of pT2b were falsely dianosed. In pT4, ultrasonography and CT correctly staged all of the 5 cases extending to the neighboring organs. By the present study, ultrasonography could not be proved to be useful in the diagnosis of tumor thrombus into the renal vein and inferior vena cava (IVC), while CT seemed to be most useful to find metastasis to regional lymph nodes.
The correlation between echo patterns and prognosis was also studied in the same 33 cases. The echo patterns were classified into homogeneous or heterogeneous pattern according to echogenic homogeneity. Additionally, the homogeneous pattern was also analysed into hyperechoic, isoechoic, hypoechoic ones according to echo density of the tumor compared with that of renal parenchyma. Heterogeneous pattern was considered as mixed one which meant the coexistence of the other 3 patterns. The cases of mixed pattern appeared to coincide with higher grade and stage, lower survival rate and higher rate of distant metastasis than those revealing the other patterns. Pathological study showed the tumors of mixed pattern were more necrotic, hemorrhagic and fibrotic than those of the other patterns.
Conclusively, ultrasonographic findings were valuable in estimating not only preoperative stage diagnosis but also prognosis in renal cell carcinoma.

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Four hundred and fifty two patients with clinical diagnosis of renal hematuria have been experienced at Hiroshima University Hospital and Mazda General Hospital in 16years from 1968 to 1984. Excluding 30 patients, whose causes of hematuria were detected by clinical examinations, 422 patients were classified into 2 groups, unexplained renal hematuria and suspected renal hematuria. There were 209 patients with unexplained renal hematuria, whose bleeding sides were confirmed, and 213 patients with suspected renal hematuria, whose bleeding sides were not confirmed. The results of clinical studies on these patients were summarized as follows:
1. In both growps, there were slightly more males than females, and patients, between the ages from 15 to 40, were most frequently affected. In the group of unexplained renal hematuria, left-to-right ratio of the affected side was 2.2 to 1, and this tendency of left renal hematuria was remarkable in pubertal period of the male.
2. In both groups, appendectomy, pulmonary tuberculosis and acute nephritis were the most frequent past illnesses. On the other hand, nephroptosis, hypertention, renal hematuria in pregnancy and varicocele were commonly coexisting disorders.
3. Renal angiography was performed on 63 patients with unexplained renal hematuria, and 23 anomalies of the vascular system were found. Of these 23 anomalies, 19 were those of renal venous system and inferior vena cava, implying that stasis of the renal venous system is an important cause of renal hematuria.
4. Measurement of intra-venous pressure was done on 11 patients with left renal hematuria and 8 controls. Pressure of the left renal vein was higher than that of the inferior vena cava, both at rest and on Valsalva's maneuver.
5. Disorders of coagulatory and fibrinolytic system, which can cause bleeding tendency, were not encountered, but urokinase activities in urine was significantly higher in the group with unexplained renal hematuria than in normal controls.
6. Bed rest and high dose of t-AMCHA (4-6g/day) were recommended for the primary treatment of unexplained renal hematuria.
7. About one third of the patients, whose hematuria was once cured, had recurrence mostly within a year.
8. Follow up study, from 3 months to 17 years (mean; 7.6 years), was done on 119 patients with unexplained renal hematuria. One hundred and nine (91.6%) patients had no hematuria afterward, 7 (5.9%) had microhematuria and 3 (2.5%) had intermittent gross hematuria. The overall prognosis of unexplained renal hematuria was relatively good, especially in younger patients.

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A simple method was described for studying calcium oxalate crystallization and estimating its crystallization propensity in human urine using an aggregometer for measuring thrombocyte aggregation. Calcium oxalate crystallization which was produced by adding freshly prepared sodium oxalate solution (1mM final concentration) into the standard solution of calcium chloride dihydrate or filtered human urine, was determined according to turbidity of the aggregometer. The variable process of calcium oxalate crystallization was continuously described as the turbidity curve on a recorder.
The results were as follows:
1) The turbidity increased in proportion to the concentration of standard calcium solution.
2) The turbidities were significantly decreased both by adding of sodium citrate and magnesium chloride dihydrate into the standard calcium solution or human urine, indicating that both inhibitors prevented the calcium oxalate crystallization.
3) In human urine, the turbidity at 20min. was calculated as an index after adding sodium oxalate solution, and the index (turbidity max) was defined to evaluate the calcium oxalate crystallization propensity.
4) There was a higher correlation between the turbidity max and the urinary ionized calcium concentration than between the turbidity max and the urinary total calcium concentration.
5) The turbidity max was correlated with the total volume of calcium crystals which were counted using a Coulter counter for human urine.
It is established that the aggregometer is very useful and convenient for studying calcium oxalate crystallization. There are two possibilities as regards the means to elucidate the pathogenesis of calcium oxalate crystallization in human urine and to study the efficacy of stone prophylaxis.

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A previous study described that the calcium oxalate crystallization propensity might be established by means of the new method using an aggregometer in human urine. The purpose of the present study is to evaluate the clinical availability of this method on patients with calcium urolithiasis. The propensity of calcium oxalate crystallization was estimated by the turbidity max, which was described in the previous report.
The results were as foolows:
1) The turbidity max in calcium stone formers was significantly higher than that in healthy controls.
2) Although the turbidity max was well correlated with urinary calcium concentration in general, there was a difference in turbidity max between calcium stone formers and healthy controls with the same contents of urinary calcium. In addition, the ratio of turbidity max/calcium concentration in calcium stone formers was distinctly higher than that in healthy controls.
3) The reductions of 2 indices, turbidity max and ratio of turbidity max/calcium concentration, were observed in calcium stone formers treated with rice bran or citrate.
4) An aggregometric method is useful and convenient for evaluating calcium oxalate crystallization propensity and for estimating the efficacy of stone prevention.

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Estrogens have been considered to affect several features of the immune system: Delayed hypersensitivity reaction, mitogen responsiveness, antibody production and natural killer (NK) cell activity. It has recently been shown that long term treatment with diethylstilbestrol diphosphate (DES-P), an estrogenic agent, reduces NK cell activity in mice. We examined if DES-P wolud suppress NK cell activity in patients with prostatic cancer on basis of earlier reports. Five hundred mg of intravenous DES-P treatment resulted in significant suppression of NK cell activity (from 67.4±9.4% to 43.8±11.8%, p<0.001) 4hr after administration with a return to normal activity 24hr after administration in nine patients with advanced prostatic cancer, accompanied by a reduction in the percentage of Leu 7⁺ cells. Venous concentrations of DES-P metabolites, measured using gas-chromatography, immediately decreased within 12hr, and the maximum concentration of total DES-P metabolites was approximately 100μg/ml, which was detected directly after treatment.
The present study was also carried out to evaluate the effects of DES-P and alpha-interferon (IFN-α) on NK cell activity in vitro and to investigate the mechanism of DES-P which suppressed NK cells, using the ⁵¹Cr-release assay method. The results showed that peripheral blood lymphocytes (PBL) from eight different healthy volunteers incubated with 0.1mg/ml of DES-P for 16hr at 37°C became less cytotoxic against the human leukemia cell line K562 (p<0.001), and that the depression of NK cell activity due to DES-P was dependent on its concentrations (0.1-5.0mg/ml) and incubation period (4-16hr), and could be enhanced by incubation with 600IU/ml of IFN-α for 6hr (p<0.001). However, incubation with IFN-α alone induced higher cytotoxicity compared with combined DES-P and IFN-α treatment (p<0.02). It was also demonstrated that DES-P didn't alter the distribution of PBL subpopulations in vitro, using flow cytometry and a direct immunofluorescence technique with monoclonal antibodies against Leu 7 and Leu 11 which proved to be specific cell surface antigens on the NK cell.
It was concluded that NK cell activity which was reduced by DES-P in vitro could be enhanced by IFN-α exposure for a short time, and we would be able to compensate for DES-P induced suppression of NK cell activity by additional treatment with biological response modifiers containing IFN in clinical cases.

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To elucidate the pathogenesis of Candida pyelonephritis, an experimental model of ascending pyelonephritis was instituted in female Wistar rats by the following procedure; cyclophosphamide was transperitoneally administered to suppress the host defence mechanism, and then, chemical cystitis was developed by instilling acetic acid solution into the bladder 2 days later, and on the next day a dose of 10⁷ cells of Candida albicans ATCC 10259 strain was inoculated into the bladder transurethrally. The progress of pyelonephritis was followed-up by light and electron microscopy over a 7-day period. During 3 days following inoculation, the majority of the fungi were seen in the medulla. The invasion of pseudomycelial forms into the medulla by means of the adherence and penetration was predominantly observed. Necrotic and degenerated host cells were noted at sites of the penetrating fungi with a small number of neutrophils. Some fungi were found in the lumen and epithelium of the collecting tubule or Henle's loop without injury of host cells. Microfilament-or extracellular coating material-mediated adhesion of fungal element to host tissues was seen. And many fungi were encapsulated by epithelia and endothelia. The infiltration of neutrophils were markedly observed around the fungi of the medulla and pelvis, and phagocytosis of fungi by neutrophils were occasionally observed 7 day after inoculation.
The results obtained suggest that the adherence and penetration of pseudomycelial forms of C. albicans to the medulla may progress the degree of ascending Candida pyelonephritis along with the degradation of the host defence mechanism.

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Fifty-five cases treated by partial cystectomy (PC) for transitional cell carcinoma of the bladder were analyzed for their prognisis related to tumor grade and stage, and other variables.
Demonstrated were (1) apparently no advantage of PC over TUR for low grade (grade 2 or less) and low stage (pT1 or less) tumors, (2) frequent local recurrence shortly after PC for high grade (grade 3) and high stage (pT2 or more) tumors, (3) satisfactory prognosis for low grade and high stage tumors, and local recurrence late (4 years or more) after PC for high grade and low stage tumors, (5) poor prognosis for recurrent or multiple tumors (6) comparable or rather better prognosis in cases with ureteroneocystostomy and (7) rare complication in urination after PC. These results as well as other articles already reported suggested the indication of PC as follows; the tumor cannot be excised by TUR, the tumor is solitary and primary, sufficient width of apparently normal bladder wall can be excised with the tumor, and residual tumor cells, if any, can be completely ablated by adjuvant therapy. The last requirement might be more readily attained by improvement in bladder cancer chemotherapy.

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Clinical results were studied in 388 living related and 125 cadaveric kidney transplantations performed at 6 transplantation centers in Hanshin area during the period from January, 1970 to June, 1986.
The one year graft survival rate was 82.7% in the living related transplantation and 66.9% in the cadaveric transplantation.
Effects of background factors such as HLA-A, B, DR matching and blood transfusion were analyzed, whereas they did not have any influence on the graft survival.
The clinical effectiveness of ciclosporin was evaluated by comparing the clinical results of ciclosporin group with that of conventional therapy group. In the living transplantation, the one year graft survival rate was 90.0% in the ciclosporin group and 79.1% in the conventional therapy group. In the cadaveric transplantation, the one year graft survival rate was 80.5% in the ciclosporin group and 46.9% in the conventional therapy group.
These results indicate that ciclosporin is a very effective immunosuppressant.

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In 31 cases that underwent partial nephrectomy during the 10 years period from April 1975 to March 1985, indication of operation, operative technique, postoperative complications and prognosis were reviewed. Among these 31 cases, renal calculi were most prevalent (24 cases or 77.4%). Out of them, 22 cases had multiple calculi in the renal calyx or calyceal diverticulum. The remaining 7 cases consisted of 4 cases of duplex kidney and 1 case each of renal pelvic tumor, renal cell carcinoma, and renal artery aneurysm. Three out of the 31 cases had anatomically or functionally solitary kidney. The most fregeuntly used operative techniques for partial nephrectomy was guillotine resection, which was employed in 20 cases, followed by wedge resection in 7 cases, and heminephrectomy in 4 cases. Renal circulation was arrested in 24 cases, with a mean ischemic time of 35 minutes. Mean operative blood loss was 716ml. Gross hematuria disappeared on the 1st postoperative day in 28 out of the 31 cases. Operative death occurred in none of the cases, nor did any cases require delayed nephrectomy. Postoperative complications were: delyaed renal hemorrhage in 1 case, urinary fistula in 1 case and wound infection in 2 cases. None of the cases showed loss of renal function. Out of 24 cases of renal calculi, calculi remained in 4 cases, in 1 of them new calculi were formed. However, among 20 cases in whom calculi had been removed completely, no recurrence was found in 2 years and 1 month to 10 years after the operation. Two cases of malignant tumor have remained well without recurrence of tumor for 10 years and 2 years and 8 months after operation, respectively. Since partial nephrectomy is a safe and useful surgical intervention, it is valuable enough to use in the treatment of lesions with localized foci which can be cured by resection in a part of the kidney, such as multiple lower calyceal calculi, tumors of solitary kidney or bilateral kidneys.

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Transverse colon conduit urinary diversion was performed in 8 patients with pelvic malignancy, which was uterine cancer in 1 patient, bladder tumor in 6 and prostate cancer in 1. In 3 of these patients the transverse colon conduit was preferred to the ileal conduit because of a previous irradiation to the pelvic cavity which could have adversely affected the ileum and intrapelvic ureter. One patient, who developed bilateral hydronephrosis due to stenosis at the ureteroileal anastomosis sites following total cystectomy and ileal conduit for bladder tumor, underwent re-diversion using the transverse colon conduit. The ileal conduit was difficult to perform in this patient because of an extensive adhesion in the small intestine. The other 4 patients, who were expected to have a local recurrence after radical surgery, underwent the transverse colon conduit which was considered to be a favorable type of urinary diversion compared to the ileal conduit in the surgical manipulation and radiotherapy of the intrapelvic recurrent disease and was anticipated to delay urinary obstruction by the recurrent disease. The followup period of these patients ranged from 12 to 23 months (average 17 months). None of these patients except one who developed parastomal hernia at 6 months of follow up experienced postoperative complications. Hydronephrosis, which was seen on the preoperative excretory urogram in 3 patients, showed a marked improvement after the transverse colon conduit urinary diversion. The postoperative excretory urogram of 5 patients whose preoperative excretory urogram showed normal upper tract revealed mild hydronephrosis at 1 month of followup, which disappeared in most patients at 6 months of followup. None of these patients had a significant elevation of serum creatinine level after the transverse colon conduit, while one patient had an elevated preoperative serum creatinine level which became normal after the transverse colon conduit. No patients developed electrolyte disturbances.

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For the purpose of early diagnosis of bladder tumor and its maligant potential, immunocytochemical demonstration of TPA and ABH antigen by using urothelial exfoliated cells was performed. Indirect immunoperoxidase technique was utilized for detecting urinary TPA and ABH staining, which was compared with tissue TPA, ABH and RIA urinary TPA.
The resected specimens were composed of 45 bladder tumors and 10 non-cancerous tissues. In individual cells, urinary TPA and ABH were present in the cytoplasma and cell membrane. The positive rate of urinary TPA staining was related to RIA urinary levels, but not to localization of tissue TPA. The positive rate of urinary TPA staining for bladder tumors was 75.6% (34/45), which was superior to that (62.2%) of conventional urinary cytology. There was a good correlation between the positive rates of urinary TPA staining and tumor growth (grade, stage).
On the other hand, the incidence of recurrence following radical TUR-bt was significantly correlated to tissue ABH antigens, but not to pathological grade. Though idependent interpretation was performed, loss of ABH antigens by exfoliated cells was accordant with that on tissue sections.
Detection of TPA and ABH antigens by urothelial exfoliated cells is a non-invasive, reliable test that could be used for screening and surveillance of outpatients with bladder tumors. It seems, therefore, that this method enables us to monitor patients with bladder tumors by porspective screening.

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An attachment assay to collagen substrates, using cell strain T24 which is an established bladder cancer, transitional cell carcinoma, was performed. A method which examines the cell spreading by determining the time maximum cellular long diameter as a parameter reflecting cellular attachment was also devised. An experiment on the involvement of fibronectin, regarded as an attachment factor, and laminin in the attachment of cancer cell to collagen substrates was made. The results obtained were as follows.
1) In the presence of MEM added albumin and in the presence of MEM with added serum and albumin, the attachment was significantly higher to type I collagen and type IV collagen than to plastics. Change in the rate of attachment due to the addition of serum showed an increasing tendency for type I collagen.
2) High rates of cell spreading were observed for type I collagen and type IV collagen.
3) With the addition of cycloheximide, the attachment to type I collagen and type IV collagen decreased.
4) With and urthout the addition of fibronectin, the attachment to type I collagen showed an increasing tendency.
5) With the addition of laminin, the attachment to type IV collagen showed an increasing tendency.
The rate of cell spreading of T24 exhibited a similar kinetic behavior to the rate of cellular attachment, suggesting the usefulness of the rate of cell spreading as a measure of cellular attachment.

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One hundred and twenty-one patients with renal and ureteral stones were treated by extracorporeal shock wave lithotripsy (ESWL) from August 4 to October 31, 1986. Of them, 84 were free of stone. Promotion factor of stone passage after ESWL was studied in these stone free patients. No statistic difference was found in the sexual study and the study of stone analysis. Longer days were spended to passage stone with renal stones with maximum diameter of more than 2.1cm. There was no statistic difference in the size of the ureteral stones. Distigmine bromide (promoter of peristalsis of the urinary tract) accelerateel the passage of stones more than scopolmine-N-butylbromide (inhibitor of peristalsis of the urinary tract). Renal stones, especially those in the lower calix, spended more days for passage than ureteral stones because of their high localization and low pressure of peristalsis. The period of stone passage became less when the urine volume became more with renal stones while the period of stone passage was not influenced by the urine volume with ureteral stones.

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Twenty-nine patients suffering from superficial bladder tumor were treated with intravesical BCG as prophylaxis against tumor recurrence. The patients were divided into two groups, which were a group of primary cases and a group of recurrent cases. BCG therapy was initiated on the second week after transurethral resection of tumors. 80mg of BCG in 40ml physiologic saline was instilled into the bladder weekly for 6 weeks. A post-operative follow-up study for the tumor recurrence was performed by means of urinary cytology every 1 to 3 months and by cystoscopy every 3 months after the operation. In 19 primary cases, 18 remained free of disease during the follow-up term (2-21M). However, one patient relapsed in the thirteenth month after the operation. A significant decrease of the recurrence rate was noted in the BCG treatment group as compared with a historical control group of our institution. In 10 recurrent cases, a distinct reduction of their tumor recurrences by the BCG therapy was documented. Only one patient relapsed in the third month after the operation.
Furthermore, two patients suffering from carcinoma in situ were treated with intravesical BCG therapy successfully. In both cases, their classes of urinary cytology changed to negative in the first month after the BCG therapy. In one of them, CIS region in the bladder transformed to dysplasia histologically in third month after the instillation.
Concerning immunological parameters, PPD skin test and lymphocyte reaction to PHA were studied before and after the therapy. In PPD skin test, 8 of 9 patients with negative finding before the therapy turned into positive after the therapy. Lymphocyte reaction to PHA did not show any considerable changes by the therapy.
Although there were some unwanted side effects such as bladder irritability, hematuria, urinary tract infection and low grade fever during or after the therapy, they were minor and self-limiting in the large majority of the patients except two patients. Two patients were obliged to interrupt the therapy due to a severe bladder irritability or a progression of granulomatous prostatitis.

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We are sometimes embarrassed not to be able to observe vesicoureteral reflux (VUR) in the group of patients who have recurrent urinary tract infection with obvious pyelonephritic changes in their urograms. For the purpose of detecting this type of VUR, or “missing VUR”, voiding cystourethrography (VCU) was performed after subcutaneous injection of bethanechol chloride.
By this method, we could detect “missing VUR” in 8 ureters of 7 patients. In 5 patients VUR was frankly missing because there was no reflux on either side on the ordinary VCU before bethanechol injection, and in 2 patients reflux was missingly lateralized. These were managed as follows: anticholinergic and antibacterial agents to 4 patients with uninhibited bladder, and ureteroneocystostomy to 3 patients with normal bladder function. Clinical outcome has been quite satisfactory in all.
Missing VUR was not only final answer to some of the puzzling cases of urinary infection, but also offered a useful guide to a falsely unilateral VUR for aggressive bilateral ureteroneocystostomy. Thus we have not experienced patients who suffer from postoperative contralateral VUR since 1982.
Furthermore, radionuclide cystourethrography with bethanechol chloride is also valuable to minimize the exposure to the radioactive rays.

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We have investigated the effects of intermittent massive doses of recombinant interferon-gamma (rIFN-γ, S-6810) in 5 evaluable patients with advanced renal cell carcinoma. The patients received 2 courses of 2 weeks' rIFN-γ administration program, consisting of daily 2-hour intravenous infusion of 15×10⁶JRU, on five consecutive days in a week followed by withdrawal of IFN for a week in each course. After 2 consecutive courses were given, patients continued to receive a similar administration of IFN on three separate days in each alternative week for 1-6 months. Complete response (CR) was obtained in one patient with brain metastasis. Three patients with lung, bone or contralateral renal metastases showed progressive disease (PD). In one patient with brain, lung and pancreas metastasis, rIFN-γ treatment yielded central necrosis of the brain metastasis on the CT scan and it was surgically removed afterwards.
During the treatment, the titer of serum IFN-γ and IFN-antibody and various immunologic parameters were periodically measured. Fairly high level of serum rIFN-γ (537-1, 200JRU/ml) were found 6 hours later at the end of infusion. IFN-γ antibody was not detected in all of the patients.
Frequent side effects were fever, chills, fatique and anorexia. In addition to these symptoms, the patients suffered from arthralgia, myalgia and stiffness of extremity. Reversible and transient deterioration of liver function and decrease in granulocyte counts were seen. We had one case with bronchial spasm and dyspnea followed by a transient shock which developed once during the treament. It could be, however, promptly recovered by corticosteroid infusion.
We have concluded that large doses of rIFN-γ can be administered in a 2-hour I. V. infusion and that this substance is a potential active anti-tumor agent in patients with advanced renal cell carcinoma.

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The epithelia of renal papilla, caliceal fornix and renal pelvis in the rat and humans were studied by transmission (TEM) and scanning (SEM) electron microscopy.
SEM revealed that the papillary epithelium of the rat kidney had numerous microvilli on the cell surface. TEM showed that the papillary epithelium was composed of one layer of cuboidal cells which had short microvilli on the luminal surface. SEM revealed that the pelvic epithelium of the rat possessed reticular microridges on the cell surface. TEM showed that the pelvic epithelium was 3-4 cells thick and composed of superficial, intermediate and basal cells. The superficial cells possessed an asymmetric unit membrane at the luminal surface, discoid vesicles and filamentous bundles in the cytoplasm. These findings were similar to the transitional epithelia lining the urinary bladder and ureter. The transition from cuboidal cells to transitional cells was gradual and occurred on the fornix region of papilla with the mixture of these two cell types. The third type of cells possessing microvilli and microridges were observed in the fornix region.
SEM revealed that the papillary epithelium of humans was covered with numerous short microvilli. TEM showed that single layered cuboidal cells lined the tip of the papilla where the collecting ducts opened. The epithelium appeared similar but became 2-3 cells thick as it reached the fornix. The luminal surface was characterized by the short microvilli with fuzzy coat. SEM revealed that the pelvic epithelium of humans possessed reticular microridges on the cell surface. TEM revealed that the pelvic epithelium was 4-6 cells thick and composed of superficial, intermediate and basal cells. The superficial cells were large and flat having a festooned luminal surface bounded by an asymmetric unit membrane.
The transition of the two epithelia occurred at the fornix by mixing the two type of cells. The third type of cells having both microvilli and microridges were observed at the fornix. The third type of cells in human fornix epithelium were identified initially in this report. These findings were similar to those of the rat. However, the papillary and fornical epithelia of humans were thick, and separated from blood vessels by a wide layer of connective tissue in comparison with those of the rat. In the rat, reabsorption of water, electrolytes, and urea seems to be easy through the papillary epithelium, since the epithelium is composed of a single layer of cuboidal cells resembling the collecting duct, and is close to blood vessels. In humans, reabsorption is not supposed to be easy because of the thick epithelia and the presence of a wide layer of connective tissue.

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Twelve patients with biopsy-proven carcinoma in situ of the bladder were treated with intravesical instillation of bacillus Calmette-Guerin (BCG). The patients (10 males and 2 females) ranged in age from 60 to 89 years (average 73 years). Four patients had no history or association of exophytic bladder tumors and 8 had concurrent superficial exophytic bladder tumors, which were resected transurethrally before intravesical BCG. The carcinoma in situ showed G3 anaplasia in 2 patients and G2 in 10. Urine cytology was positive in all patients. These patients initially received the induction regimen of intravesical BCG, in which 80mg of Tokyo 172 strain BCG was suspended in 40ml of normal saline and administered intravesically at weekly intervals for 12 weeks. Ten patients responded (negative conversion of urine cytology and bladder biopsy) to the induction regimen and 2 failed to respond (persistence of positive urine cytology and/or positive bladder biopsy). The responders were subsequently placed on the maintenance regimen of intravesical BCG which consisted of biweekly instillations of 80mg BCG for 12 weeks followed by monthly instillations for 2 years. All of the responders except one who had a recurrence at 8 months of followup remained free of disease for 3 to 22 months (average 14 months). Side-effects included irritative bladder symptoms in 10 patients, gross hematuria in 3 and fever in 2.

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^99mTc-MDP whole body scan is a highly sensitive examination for detection of skeletal metastasis in patients with prostatic cancer. A retrospective study of 74 patients with histologically proven prostatic cancer was done. Most of patients was treated by endocrine therapy. The progression of bone metastases was assessed by the bone scanning with particular reference to the sites, sizes of metastatic involvement.
Findings on bone scans were positive in 46 patients, of which 28 had rib metastasis and 27 lumbar vertebral lesion. Patients were divided further into 2 groups of early (≤3 lesions) and progressive cases (≥4 lesions) comprising 21 and 25 patients, respectively. Distribution of metastases was similar in two groups But cluster analysis of metastatic patterns identified a subset of patients with rib metastasis who simultaneously had pelvic bone or vertebral bone metastasis. This suggested the metastasis had spread along the vertebral veins.
Serial bone scan studies were available in 26 patients with bone metastasis, and no changes in the pattern of uptake were noted for ≥3months. Although the disease was considered improved in 15 lesions, deterioration was observed in 29 lesions and new metastasis was detected in 41 bones. The authors concluded that in the majority of cases endocrine therapy may not improve bone lesions.

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It has already been confirmed by many experiments that the pelviureteral peristalsisis is controlled by the pacemaker and that the pacemaker exists at the pelvicalyceal border. In these experiments, EMG was recorded with extracellular surface electrodes. It was very difficult to record real action potential of the pacemaker and exclude artifacts. Applying the intracellular glass-microelectrode to the smooth muscle specimen obtained from the guinea-pig pelvicalyceal border, I succeeded in recording periodic spontaneous action potentials, so-called slow wave, which are characteristic of a pacemaker. By this experiment, it is proved that the pacemaker exists at pelvicalyceal border correctly and these new findings are confirmed.
(1) The part where slow wave is recorded in the pelvicalyceal border, especilly the part close to the papilla renalis. (2) Slow wave resembles that of cardiac SA node. It shows a biphasic pattern, and it is characteristic of a spontaneous excitable cell. (3) Resting phase potential in 42.3±1.1mV, spontaneous depolarizing potential is 12.1±0.7mV, and depolarizing period in 12/min. (4) Changing velocity of potential is 22.9±2.1mV/sec in the first slow depolarization phase, 50.9±9.5mV/sec in the following rapid depolarization phase, and 47.3±5.4mV/sec in the hyperpolarization phase.

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One hundred and five patients with prostatic cancer were treated at Department of Urology, Branch Hospital, the University of Tokyo from 1963 through 1985. Clinical stages at the first visit were A in 23 cases, B in 1, C in 33 and D in 48. The stage A group was composed of 10 of A1 and 13 of A2 patients. Since the stage B patient was only one, stage B was included in stage C in evaluation. All stage C and D patients except 2 received castration and/or estrogens as an initial therapy. Seven cases of stage A cancer (A1: 1, A2: 6) underwent the antiandrogen therapy. The remaining 16 patients with stage A (A1: 9, A2: 7) were followed without treatment. Actuarial 5-year survival rates were 68% in stage A (89% in A1 and 54% in A2), 69% in stage C and 36% in stage D. A significant difference in 5-year survival was found between stage A1 and A2, stage C and D, and stage A and D, respectively, Twenty-one patients with stage A2, C or D cancer relapsed during the hormonal treatment. Secondary therapy with radiation and/or chemotherapy (CDDP or estramustine) was performed in 12. Nine of them died of prostatic cancer within 2 years. Of 69 patients who died in this series the proportion of deaths due to prostatic cancer was 0% in the stage A1 group, 22% in the stage A2, 33% in stage C and 51% in the stage D. The rate of deaths by cardiovascular diseases was 10% in all the dead patients. In conclusion, antiandrogen therapy for prostatic cancer was favorable and cardiovascular mortality was relatively low. However, the prognosis of hormone-refractory cancer was poor and the result of combined anticancer chemotherapy was still disappointing.

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A 66-years-old man with a malignant mesodermal mixed tumor of the bladder was reported. A large bulky pedunculated mass was located in the left side of the bladder. Adjacent to the stalk of the tumor, a non-papillary invasive tumor was present involving the left intramural ureter. Tumor mapping by step sections of the resected bladder revealed that the non-papillary invasive tumor was composed of transitional cell carcinoma (G3) associated with dysplasia or carcinoma in situ in the periphery, and extended directly to the surface of the stalk of bulky mass. The large bulky mass was composed of carcinomatous and sarcomatous elements. The former consisted mainly of transitional cell carcinoma and adenocarcinoma with occasional foci of squamous metaplasia, while the latter consisted of chondrosarcoma, osteosarcoma, giant cell tumor and non-differentiated malignant spindle cell component.
Unfortunately, the patient died 8 months after the total cystectomy followed by adjuvant chemotherapy. Autopsy finding showed tumor embolism of the lung and extensive bone marrow metastasis which consisted of transitional cell carcinoma.
Our case may suggest an epithelial origin of this tumor giving rise to metaplastic mesodermal proliferation, which was recently proposed by Koss as “sarcomatoid carcinoma”.

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Tow sets of testicular tumors in brothers, which has been reported to be very rare, were reported. The first set consisted of an elder brother of 51 years old and a younger brother of 43 years old, with the difference in age at the onset of disease of 8 years. Both had anaplastic seminoma. The second set included an elder beother of 45 years old and a younger brother of 34 years old, the difference in age at the onset of disease being 11 years. Both had pure seminoma, and the younger brother was diagnosed to have bilateral testicular tumors. A total of 49 sets of familial cases of testicular tumors including our two sets were reviewed. Histopathologically. no statistically significant difference was seen in incidence as classified by histologic type as compared to general testicular tumors. The rate of histologic semilarity was higher between brothers than between father and son. As to difference in age at the onset of disease, it was 2.3 years for twin brothers, 7.9 years for non-twin brothers and 12.6 years for father and son. The cases presented in this paper seem to be the 4th and 5th sets in the Japanes literature.

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