One hundred and twenty patients with stage D₂ prostatic cancinoma were treated by endocrine therapy at Chiba University Hospital from 1971 through 1985. Endocrine therapy consisted of castration, immediately followed by large amount of diethyl stilbestrol diphosphate for 4 weeks, then reduced amount of estrogen (daily 30mg of hexestrol or 1-3mg of ethynyl estradiol) or, to patients with cardiovascular diseases, followed by daily 100mg of chlormadinone acetate.
1) Survival of estrogen-treated patients (98) was almost the same as that of antiandrogen-treated group (22).
2) During the treatment, estrogen suppressed serum LH and FSH, but antiandrogen did not reduce these levels. However, serum testosterone was lower in the latter than that in the former. Use of ethynylestradiol at 1-3mg decreased the hormones similarly.
3) Survival of patients with poorly differentiated carcinoma was less than that of those with well and moderately differentiated carcinoma.
4) The better was the survival, the more recent the start of the treatment.
5) About half of causes of death were progressive development of prostatic carcinoma. Death from cardiovascular diseases was about 20%. Relapse occurred within 5 years after start of the treatment.
6) From these observations, endocrine therapy is still a very effective strategy in Japan. However, gradual increase of side effect of estrogen and of hypercholesterolemia places limitation to the estrogen therapy.

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We have examined the enhancing effect of verapamil on the cytotoxicity of vincristine (VCR), adriamycin (ADM) and cis-platinum (CDDP) against the established cell line from human renal cell carcinoma (NUR) and primary human kidney cell (PHK). To test the effect of cytotoxicity, we have assayed cell growth curve and ³H-thymidine incorporation. And effects of verapamil on the uptake and release of anticancer drugs were examined by measurement of cellular radioactivity of ³H-VCR and ³H-daunomycin. The concentration of verapamil using anticancer drugs was 1.0μg/ml which itself showed no cytotoxicity.
The results we obtained were as follows: 1) Verapamil showed enhanced cytotoxicity of ADM, VCR and CDDP in the growth curve and reduced the ³H-thymidine incorporation for NUR cell. The concentration of verapamil which could enhance the cytotoxicity of ADM against NUR cell was proved to be 0.1μg/ml and over.
2) The IC₅₀ of ADM, VCR and CDDP for NUR cell by ³H-thymidine incorporation were 0.095, 4.81 and 1.01μg/ml, respectively, while in the presence of verapamil (1.0μg/ml) the IC₅₀ were shifted to 0.039, 1.29 and 0.508μg/ml, respectively.
3) By verapamil, the uptake of ³H-VCR and ³H-daunomycin into NUR cells were increased and the release of ³H-VCR from NUR cells was also inhibited. But verapamil had no effect on the release of ³H-daunomycin from NUR cells.
4) In PHK cell, we observed a slight enhancing effect of verapamil on the cytotoxicity of VCR, ADM and CDDP, but the degree was so slight that it seemed to be able to ignore. The uptake of ³H-VCR and ³H-daunomycin into PHK cells showed a small increase by verapamil.

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After numerous investigations since our first experience of percutaneous nephroureterolithotomy (PNL) in 1981, which was the first successful case treated by single stage PNL in the literature, we have established an appropriate original technique for PNL.
Percutaneous nephrostomy (PNS) has been performed under the guidance of realtime ultrasound and has been dilated by a set of telescopic metal dilators. Small stones could be removed using a flexible fiberscope and a grasping forceps. Large stones were finely fragmented by an electric drill system which was newly developed in our clinic. Large and hard stones were crushed by confined blasting which was also developed in our clinic.
From July, 1981, to February, 1987, we experienced 268 cases of PNL. Complete stone removal was achieved in 228 cases (85.1%). In 36 cases (13.4%), small stone fragments not requiring surgery were retained. In 4 cases (1.5%), the treatment was unsuccessful. In 135 cases, stone was removed by stone forcepses. 68 cases were treated by the electric drill, 46 cases by ultrasonic lithotriptor and 15 cases by confined blasting.
Several complications were encountered, such as fever over 38.5°C (54 cases, 20.1%), gross renal bleeding-(3 cases, 1.1%), pulmonary edema (2 cases, 0.7%) or intestinal fistula (1 cases, 0.4%). These could be cured by conservative therapy. Ureteral stenosis occurred in one case, which was treated by open surgery.

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Serum Tissue Polypeptide Antigen (TPA), ferritin and Immunosuppressive Substance (ISS) levels were determined in 37 patents having renal cell carcinoma. We also investigated the clinical significance of TPA, ferritin and ISS as tumor markers for renal cell carcinoma.
The mean TPA level in stage I was within the normal range (upper normal level: 110U/L). In stage II, III and IV, however, TPA levels were beyond the normal range. The positive rates of TPA were 55.6% in stage II, and 60% in stage III and IV, while 12.5% in stage I.
The mean of ferritin levels in stage I and II were within the normal range (upper noral level: 220ng/ml), but in stage III and IV ferritin levels were beyond the normal range (283.4, 292.1ng/ml). The positive rates of ferritin were 12.5% in stage I, 0% in stage II, 40% in stage III and 46.7% in stage IV.
With 500μg/ml as the cut-off level of ISS, the mean of ISS levels in every stage were beyond the normal range. The positive rate of ISS was higher than those of TPA and ferritin, with the rates being 40% in stage I, 57.1% in stage II, 66.7% in stage III and 90.9% in stage IV.
The above results suggested the tendency that the levels and positive rates of TPA, ferritin and ISS become higher as the stage progresses in the case of renal cell carcinoma.
The determination of TPA, ferritin and ISS levels before and after treatment showed a good correlation to the clinical course of the disease in patients with renal cell carcinoma. This finding suggested that TPA, ferritin and ISS is a useful marker for monitoring renal cell carcinoma.
As for the positive rate in a combination assay for these three markers, 24 out of 26 patients (92.3%) with renal cell carcinoma had at least one positive marker. This finding suggested that the combination assay of TPA, ferritin and ISS in patients with renal cell carcinoma was valuable for use as a disease monitor.

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Previously we reported the usefulness of serum and urinary TPA for bladder tumors. In the present study, we performed the histological study of TPA to clarify TPA antigen as a tumor marker.
Since antigenicity of TPA in tissue was not well preserved in formalin paraffin-embedded section, detection of TPA in tissue was performed by using frozen section following periodate-lysine-paraformaldehyde (PLP) fixation. Indirect immunoperoxidase method was used for detecting TPA antigen, which was compared with carcinoembryonic antigen (CEA), ABH blood group antigen, serum TPA and tissue concentration. The investigated materials were: 45 bladder tumors, 7 other tumors and 14 non-cancerous tissues. TPA could be demonstrated in 71% of bladder tumors. Tissue positive rates in bladder tumors were superior to those in other tumors and normal controls. In individual cells, TPA was present within the cytoplasma and cell membrane. The localization of TPA in tumor tissue was divided into three types, in contrast to normal epithelium. There was no significant correlation between tissue positive rates and grade. As for stages, however, the difference of localization has been found in stages of bladder tumors with or without invasion. Immunoperoxidase staining revealed a positive correlation between tissue stainigng rate and plasma TPA elevation. On the other hand, the localization of TPA was also supposed to be a major factor for positive serum levels. TPA tissue concentration in bladder tumors with positive staining was higher than that in tumor negative tissues and non-cancerous sections. Also, plasma level has been shown to be related to tissue concentration.
The localization of TPA was not identical with that of CEA and ABH antigen. Positive rates of ABH antigens were 58% in bladder tumors. There was a tendency that ABH antigens were often deleted in bladder tumors containing TPA antigens.

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Intravesical injection treatment for bladder cancer is being used all over the world. Practically speaking, most of the drugs used are water-soluble, which are eliminated with urine from the body in a short time. Therefore, we developed two kinds of reagents, adriamycin (doxorubicin) emulsion and hydroxyl propyl cellulose (HPC) adriamycin which would remain in the bladder long enough as an anticarcinogen.
How long the reagents could adhere to the bladder mucosa was examined in the rat.
1) There was no difference between the emulsion adriamycin solution and conventional adriamycin solution.
2) The HPC-adriamycin solution could be detected from the bladder tissue of rat injected 4 days before, but conventional adriamycin solution was not found in the bladder tissue.
It is suggested that HPC-adriamycin is expected as very effective therapy for bladder carcinoma.

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Antigenic relationship between streptococcus preparation, OK-432 and many kinds of tumor in both animals and humans had been studied and it was sugested in our previous papers that the common antigen would be the group A specific C-polysaccharide (Rhamnose-N-acetyl glucosamine polysaccharide) and that it could induce the tumor specific immune response involving ADCC. On the other hand, the detection of antibody to the group A specific C-polysaccharide (ASP) is regarded important in screening rheumatic heart disease and glomerulonephritis.
In this paper, the changes of ASP titer were investigated as well as clinical futures in 29 cases of urogenital cancer patients during OK-432 immunotherapy. Addditionally, histological evaluation of the heart and kidney was perfomed in 4 autopsy cases who had received OK-432 immuno-treatment over 4 weeks. The results obtained are as follows:
1) Serum ASP values were increased significantly (p<0.01) by the administration of OK-432, but the maximum titers were not so remarkable (256-fold increased).
2) In those cases that showed elevated serum ASP values, no evidence of rheumatic heart disease and glomerulonephritis was found by clinical and histological examinations.
3) Therefore, cardiac and renal damage was suggested to be unlikely in spite of slightly increased serum ASP values during OK-432 immunotherapy.

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In order to confirm the relationship of Chlamydia trachomatis to male urethritis and prostatitis, isolation of C. trachomatis from the patients and measurement of antibody titer to C. trachomatis were performed. Hela 229 cell culture was used to isolate C. trachomatis and an enzyme linked immunosorbent assay (ELISA) for C. trachomatis specific Ig-G was employed using purified C. trachomatis type L₂ EBs. Antibody titers obtained by the ELISA was compaired with the titers obtained by the indirect immunofiuorscent antibody technique (IFA). The results were as followed.
1. C. trachomatis was isolated from 25 (34.7%) out of 72 nongonococcal urethritis (NGU) cases, 5 (13.1%) out of 38 gonococcal urethritis (GU) cases and 2 (3.3%) out of 60 prostatitis (NBP) cases.
2. Positive rate Ig-G antibody against C. trachomatis by ELISA was 57.1% in NGU, 33. 3% in GU, 30.3% in prostatitis and 24.1% in control.
3. Positive rate of Ig-G antibody in patients with C. trachomatis positive urethritis was 72.7%.
4. A good correlation (r=0.87) was found between ELISA and IFA method. For the detection of antibody to C. trachomatis ELISA was 4-8 times more sensitive than IFA.

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We estimated preoperatively the size of benign prostatic hyperplasia in 101 patients using transabdominal and transperineal ultrasonography. A 3.5MHz real time convex scanner was used.
The breadth and height (d₁, d₂)^cm of the adenoma were measured by the transverse scan of the lower abdomen, and the length (d₃)^cm by the sagittal scan of the perineum. The estimated size was calculated according to the formula: 0.5×d₁×d₂×d₃^g.
The values of the estimated size were well correlated with those of the resected weight. Therefore, transabdominal and transperineal ultrasonography seems to be useful for estimating the size of benign prostatic hyperplasia preoperatively.

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Nine hundred and seventy-six patients with bladder carcinoma underwent surgery as an initial treatment from 1960 to 1982. They were divided into three groups according to the following three treatment modalities: transurethral resection (TUR, 492cases), partial cystectomy (PC, 331 cases) and total cystectomy (TC, 153 cases). The relations of treatment results to clinicopathological profiles of each group were analyzed. Five year relative survival rates of TUR, PC and TC groups were 93±2%, 79±3% and 31±4% (M±SE), respectively. The average age of patients and the number of patients having tumors of high grade, advanced stage and large size were found increased in the order of TUR, PC and TC groups. The incidence of patients having a single tumor was highest in PC group among the three groups. The number of patients receiving PC markedly decreased recently.
The patients' ages had nothing to do with the relative five year survival rates of TUR and PC groups. In TC group, however, patients over 60 years old had poor prognosis when compared with younger ones. The five year survival rate of infiltrative tumor (T2, 3 and 4) was worse than superficial ones in each group. PC achieved the best result as a treatment for T2 tumors among the three treatment modalities, which led to the best five year survival rate of patients having infiltrative tumors in PC group among the three groups. High tumor grade and increase of tumor size resulted in poor prognosis in TUR and PC groups. In PC group, multiple tumors also resulted in poor prognosis. The five year survival rates of PC and TC groups have been improved recently.
From the results above stated, it appears likely that the poor five year survival rate of TC group resulted from the advanced age of patients and operative complications as well as the high incidence of the patients with high grade and infiltrative tumors, and that PC is a valuable treatment for a single tumor, especially in the stage T2.

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Studied were the relations of the period at initial treatment to the survival rate and various clinicopathological findings of 1120 patients with primary bladder tumor during the 23 years from 1960 to 1982 at the Tokyo Medical and Dental University and its affiliated hospitals.
The twenty-three years were devided into 4 periods in which survival rates of all patients were calculated. Then, clinicopathological profiles of patients (age, sex, depth of infiltration of tumor, histologic anaplasia (grade), size and number of tumors, and treatment methods) and survival rates according to these profiles in the 4 periods were compared each other.
The 5-year actuarial (relative) survival rates of patients treated from 1960 to 1965, from 1966 to 1970, from 1971 to 1975, and from 1976 to 1980 were 46% (55%), 55% (65%), 63% (74%) and 62% (74%), respectively. Significant difference was observed between the 5-year actuarial survival rate of the first period and that of ther three periods (p<0.05). The recent improvement of patients' prognosis seemed to be due to the significant increase of superficial bladder tumors (p<0.025) and smaller tumors than 1cm when initially detected (p<0.05), and the recent significant improvement of survival rates of patients older than 70 years (p<0.05) and patients who received partial cystectomy (p<0.05). However, although the incidence of superficial tumors has recently increased, the incidence of high grade tumors in patients at advanced age also significantly increased in recent periods (p<0.025), which appeared to be and important problem in the management of bladder tumors. As to initial treatment methods, the incidence of TUR markedly increased recently, whereas partial cystectomy decreased (p<0.001). Although 5-year survival rates of patients with superficial tumors were similarly excellent in any period compared to those of patients with invasive cancer, the latter recently improved mainly because of the decreased of deaths from therapeutic complications and causes other than bladder cancer.

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The rat prostate gland is composed of the ventral and the dorsolateral prostates. Although the dorsolateral prostate shows more similarities with respect to several criteria to the human prostate than the ventral prostate, no study on cell culture of the dorsolateral prostate epithelium has been reported.
In the present report, two methods reported by Douglas et al. and McKeehan et al., which had been established for the primary culture of the ventral prostate epithelium, were examined for their applicability to the dorsolateral prostate epithelium. As a result, the following new procedure based on the method of McKeehan et al. was found to be useful for the primary cell culture of the dorsolateral prostate epithelium: the prostate aseptically dissected from male rats (12-13 weeks of age) of Sprague-Dawley strain was minced, which was followed by the sequential treatment with 0.25% trypsin and 0.1% collagenase. The treated tissue, consisted of cell aggregates and single cells, were cultured at 37°C in a humidified atmosphare of 5% CO₂ and 95% air in WAJC 404 medium containing 2% calf serum, 130pM cholera toxin, 800nM insulin, 1.6nM epidermal growth factor, 43nM prolactin, 1μM dexamethasone, and 25μg protein/ml of bovine pituitary extracts. Immunocytological analysis of cytokeratin revealed that more than 90% of the cells which proliferated under this condition were originated in the epithelium.

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Effects of androgen and tissue extracts prepared from normal rat prostate and prostatic cancer on the growth of primary cultured cells of the rat dorsolateral prostate epithelium were examined.
(1) Testosterone and dihydrotestosterone had no effect on the growth of primary cultured cells.
(2) The tissue extracts from the dorsolateral prostate of sexually immature rats (4-6 weeks age) significantly stimulated the growth of cultured cells. In contrast, the growth stimulating activity decreased in tissue extracts prepared from the prostate of puberty rats (8-10 weeks of age), and disappeared in those of sexually mature rats (>17 weeks age).
(3) The tissue extracts from the Dunning tumor significantly stimulated the growth of cultured cells in a dose-dependent manner. The tissue extract from human prostatic cancer had a tendency to stimulate the growth of cultured cells.
These results suggested that the is vivo proliferation of prostatic epithelium is not only regulated by testosterone or dihydrotestosterone directly, but also by unknown growth stimulating factor (s) which might be produced in stroma under the control by androgen. In addition, there might be some growth factors which directly stimulate the proliferation of prostatic epithelium in the neoplastic and/or hypertrophic growth of the prostate.

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As to 297 testes of 222 boys with unilateral or bilateral cryptorchidism, the operative findings of the epididymis were examined from June, 1983 to May, 1986.
One hundred and seventy-four testes (58.6%) had epididymal abnormalities, which were devided into seven groups according to the level of detachment of the testis and the epididymis; they were at the head, body, or tail or their combinations. The most common site of detachment was the tail portion, which was estimated to be 36.8 percent. The second group was the combination of tail and body separation (28.2%). These groups usually showed an elongated or loop shaped epididymis. The group of body non-union, which showed angulation around the midst of the epididymis, was 17.8 percent. Non-union of the head was rarely encountered.
All the testes of high canalicular cryptorchism were found to have epididymal abnormalities, which were 75 per cent and 50.3 per cent at low canalicular and high scrotal region, respectively. While retractile testes had abnormality at 34.5 per cent. These data suggest that the higher undescended testes, the more frequent the epididymal abnormalities.
The epididymal finding must be recorded accurately, because it may influence the further fertility, although epididymal atresia may coexsist.

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To clarify influential factors for development of reflux nephropathy, we reviewed 67 newborn infants under the age of 1 year with vesicoureteral reflux. They were retrospectively classified into two groups: non-surgical and surgical groups.
The highest incidence of VUR grade in the non-surgical and surgical groups was grade III and grade IV and V, respectively.
Of patiensts followed non-surgically, 78% of grade I and II (7/9), 74% (20/27) of grade III, 40% (6/15) of grade IV, and 38% (3/8) of grade V spontaneously ceased to reflux. The average age at spontaneous cessation was approximately 2.5 years, ranging from 1.2 to 6.0 years.
Renal scars had already existed in 29% (27/93) at presentation.
Most but not all kidneys, having scars at presentation, belonged to grade IV or V. On the other hand, in some patients with high grade VUR, renal damage did not develop.
The development of new scars was seen radiologically in 16 kidneys (3 non-surgical group and 13 surgical group).
It was suggested that one of the responsible factors for development of new scars of refluxing kidneys was recurrent urinary infection.

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Local immunocompetence was histochemically evaluated in bladder tumor patiensts after immunomodulators injection. Intratumoral injection of immunomodulators (such as OK432, rIL-2) was performed via cystoscope with an injection needle prior to surgical operation. After injection, marked infiltration of T cells, rather than B cells, was observed. The infiltration of T cells was conspicuous irrespective of tumor stages. There was no obvious difference in distribution pattern between OKT4 and OKT8 cells. In 2 cases having Su-PS negative to positive conversion after injection, the marked intiltration of tissue T lymphocytes was found. On the other hand, there was no obvious difference in peripheral blood lymphocyte (PBL) subsets before and after the injection.
NK cells were also scattered within tumor cells following OK432 injection. Concomitantly, the direct injection of immunomodulators into bladder tumors was capable of augmenting NK activity in PBL.
These findings suggest the role of tissue infiltrating lymphocytes against bladder tumors in local immunotheraphy. Further studies are required to elucidate host immune response in the microenvironment of cancer side, in addition to the systemic immune reaction.

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206 patients underwent nephrectomy for renal cell carcinoma during the years, 18 of them were found to be a spindle cell type. The average patient age was 58.4 years (range 41 to 75 years).
Their symptoms included gross hematuria in 11 patients, palpable mass in 4, flank pain in 1, general fatigue in 1 and symptom related to skinmetastasis in 1. Of the tumors 13 were in the left kidney and 5 were in the right kidney.
Of the patients 4 had stage IV disease, 4 stage III, 3 stage II and 7 stage I.
Of 13 patients of spindle cell type 5 were found to have an angiographic hypovascular neoplasm.
The grade of spindle cell type tumors was generally high and showed a poorly demarcated margin. The survival rate 1, 3 and 5 years of the spindle cell type tumors were 54.3%, 47.5% and 38.0%, respectively. In particular, patients with spindle cell type alone all died within 1 year after operation.

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Evaluation of renal function of 80 patients with primary vesico-ureteral reflux was performed by ^99mTc-DMSA renal scintigraphy. The results were as follows:
1. In 93 kidneys with reflux of 63 patients who did not receive anti-reflux operation, ^99mTc-DMSA renal uptake (DMSA uptake) and age-corrected ^99mTc-DMSA renal uptake (C-uptake) of grade I VUR did not differ from those of grade II VUR significantly in any age group. DMSA uptake and C-uptake of grade III VUR and grade IV VUR were significantly lower than those of grades I and II.
2. In the age group under 14 years old, almost all of grade I and II VUR showed normal values of DMSA uptake and C-uptake, but in the age group above 15 years old, some of grades I and II showed lower values than normal range.
3. Comparing the images of IVP with those of renal scintigraphy in 125 kidneys of the above mentioned 63 patiensts with reflux (1 patient had unilateral renal aplasia), the kidneys were classified into 3 groups, the 1st group: normal IVP and scintigraphy image, the 2nd group: normal IVP image and damaged scintigraphy image, and the 3rd group: damaged scintigraphy and IVP image. C-uptake was highest in the 1st group, lowest in the 3rd group. Even in the kidneys in which VUR disappeared spontaneously or in the contralateral kidneys of patients with unilateral reflux, renal scintigraphy sometimes showed abnormal images.
4. Comparing the preoperative status with the postoperative status in 54 kidneys with VUR of 34 patients, DMSA uptake of both diseased kidney and bilateral kidneys 2 weeks after operation were significantly higher than preoperative ones. On the other hand, 24-hour endogenous creatinine clearance 2 weeks after operation did not differ from the preoperative value and the values 3 months after operation became higher than preoperative ones.
5. Glomerular function of adult patients with VUR was shown to be lower than child VUR and was not expected to improve even after treatment.
6. Preoperative C-uptake above 50% was thought to be one of the criteria by which the function of kidney with reflux should be expected to improve after operation.

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It has been generally accepted that self-catheterization is an useful management for chronic neurogenic bladder. But, in most cases with spinal cord injuries, the purpose of urinary treatment has been to obtain balanced bladder by voiding training, and self-catheterization has only been used as a transient treatment.
We applied treatment with self-catheterization for 74 patiensts with chronic neurogenic bladder, of whom 46 were in chronic stage of spinal cord injuries (41 paraplegics and 5 tetraplegics).
The degree of urinary incontinence was improved in 36 cases (48.6per cent), and worsened in only one case (1.4per cent). In particular, in 15 of 28 cases (58.6per cent), whose bladder showed automatic type on cystometric findings, urinary incontinence due to reflex contraction was decreased, and anticholinergic agents with self-catheterization were effective in 14 of 18 cases (77.7per cent).
In 36 cases, who had already had complications of the urinary tract due to pathological urination for long terms, 4 of 13 cases with bladder deformity, 5 of 8 cases with vesicoureteral reflux, and 6 of 13 cases with hydronephrosis improved their pathological conditions during the follow up period of self-catheterization. In 44 cases, any complications did not occur or become aggravated. In only one case with hydronephrosis the condition was aggravated, since reflex contraction with high pressure occurred during each catheterization. TUR-Bn, TUR-P, and anterior sphincterotomy were needed in order to prevent complications.
The rate of urinary infection during self-catheterization was 56.7% and that of the previous pathological voiding was 50.0%. There was no statistical difference between self-catheterization and voiding.
In chronic neurogenic bladder, self-catheterization was useful for the management of urinary incontinence, especially, in automatic type of neurogenic bladder and was effective for treating complications of urinary tract. But in some cases, complications were aggravated since the catheterization alone always did not eliminate the high intravesical pressure due to strong reflux contraction and/or decreased compliance of the fibrosed-detrusor. Furthermore, chronic urinany infection was not always improved by self-catheterization only.

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The chemosensitivity of human bladder tumor cell line T-24 to 4 anticancer drugs (CDDP, MTX, VLB, ADM) has been studied by subrenal capsule assay (SRC), human tumor-nude mice xenograft system and human tumor clonogenic assay (HTCA), and the usefulness of these 3assays is discussed. The sensitive drugs are VLB in SRC, VLB and ADM in the nude mice system. No drug is sensitive by HTCA.
In HTCA, ADM can be judged effective with higher standards of drug concentration and VLB is also effective on continuous drug exposure. MTX is resistant in in-vavo assay and with any standard of drug concentration or continuous drug esposure in HTCA. These results suggest that 1) in in-vavo assay, drug dose to mice should be modified to correlate to clinical drug concentration in humans, 2) in HTCA, drug concentration and time of drug exposure should also be modified with each drug, taking into consdderation its pharmacokinetics and functional character. SRC assay is well correlated to xenograft in nude mice system, and will be one of the useful assays for clinical use, superior to the present in-vavo assays.

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We studied the effects of nephrostomy performed as part of percutaneous nephroureterolithotomy in the kidneys of adult mongrel dogs.
The influences of the duration of the fistula on changes in the tissue was evaluated. However, no difference was found in the tissue among different duration groups; atrophy in the glomeruli and compression, dilation, and degeneration in the renal tubules were commonly observed only in the area adjacent to the fistulous tract. Only the group in which the tract was left unclosed for a long period showed split formation and surface epithelialization in the medullary area of the tract.
Tissue regeneration after closure of the tract occurred earlier in the cortex than in the medulla. Intraparenchymal infiltration of blood cells remained 3days later, but a linear scar was formed 21days later.
In addition, vascular changes were evaluated by soft ray examination after infusing micropague with colored gelatin via the renal artery. Peripheral blood vessels could be visualized clearly, and no vascular changes caused by nephrostomy were observed.

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Two adult cases of primary sclerosing lipogranuloma in the scrotum were reported. Both were noticed as an incidental intrascrotal mass, preceded by an exposure of the perineoscrotal area to coldness, but with no history of foreign body injection. Scrotal exploration was performed. Characteristically, the mass was Y-shaped with its stem located in the perineum and above the ventralis of the urethra, and branched off at the penoscrotal junction extending anterolaterally along the spermatic cord on both sides. Histologically, both were sclerosing lipogranuloma. This benign scrotal disease is thought to be a new clinical entity.

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We recently experienced a case of choriocarcinoma of the bladder. The patient was a 57-year-old man who noticed macroscopic hematuria from the middle of February, 1985 and visited a local doctor. On March 5, he was introduced to the authors' department. Since cystoscopy revealed two wide-based tumors the size of the tip of the index finger, a punch biopsy was performed. TCCG2 was diagnosed and he was admitted on May 4. No metastasis was found after admission. Urinary cytodiagnosis showed TCCG3 and on May 28, total cystectomy and an ileal conduit operation were performed. In postoperative pathology, the superficial tumor was found to be TCCG3 but infiltration into the muscle layer was confirmed and choriocarcinoma was present in the same tissue. In later blood chemistry tests, elevated HCG-β was observed. In a chest X-ray on July 2, multipile metastases were found and chemotherapy (CDDP, ACR) was started. Because there was no response, combination therapy with MTX, CP and ACT-D was performed. There was transient shrinkage of the lung metastasis, but thereafter, there was marked worsening and elevated HCG-β. On October 16, the patient died of respiratory failure and DIC. An autopsy revealed systemic metastasis, mainly in the lungs and liver. This is the 7th such case reported in Japan.

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Four cases of acquired cystic disease of the kidney (ACDK) complicated with renal cell carcinoma occurring in patients treated by maintenance hemodialysis (HD) are presented.
Case 1. A 61-year-old man treated by maintename HD for approximately six years was admitted for right lower abdominal pain and intermittent gross hematuria and he was found to have ACDK·renal cell carcinoma in the left kidney and ACDK·pelvic tumor in the right kidney. After radical operation, he was treated by medication of adriacin (ADM) and cis-dichlorodiamminoplatinum (CDDP) and has been maintaied under HD 3 times weekly without significant complications.
Case 2. A 61-year-old man treated by HD for approximately six years was admitted for hematuria, general malaise, low-grade fever and weight loss and he was found to have ACDK·renal cell carcinoma in bilateral kidneys. After radical operation, he was treated by medication of Fluorouracil (5-FU), ADM and CDDP and has been maintained under HD.
Case 3. A 51-year-old man treated by HD for approximately 12 years was found to have ACDK·renal cell carcinoma in the right kidney without significant complaint. After right radical nephrectomy, he was treated by medication of CDDP and radiation (total 3, 000rad), and has been mainteind under HD.
Case 4. A 61-year-old man treated by HD for approximately nine years was admitted with general malaise and low grade fever. On the 9th day after administration, he died due to DIC. At autopsy, we found ACDK renal cell carcinoma in the left kidney and metastasis in the left lobe of the liver.

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