In the non-gonococcal urethritis of men, the possibility that the specific serum IgA antibodies might be a marker of active chlamydial infection has recently been suggested by Sarov.
The usefulness of the serum specific IgA antibodies as a marker of active chlamydial infections was examined.
Hela 229 cell culture was used to isolate C trachomatis. An enzyme-linked immunosorbent assay (ELISA) for C trachomatis specific IgA was employed using purified C trachomatis type L₂ EBs. Serum IgG antibody was also determined in the same sera by ELISA.
Patients with C trachomatis positive non-gonococcal urethritis had a significantly (p<0.01) higher prevalence (89.3%) of serum IgA antibody by ELISA compared with patients with C trachomatis negative non-gonococcal urethritis (22.2%), those with chronic non-bacterial prostatitis (19.1%) or healthy men (12.1%).
Especially, the IgA positive-coincidence ratio was 92.3% in the period two to three weeks after the final sexual intercourse.
It is suggested that the specific serum IgA antibodies may be used as a marker of active C trachomatis infection.

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In order to examine the effect of human recombinant tumor necrosis factor (rHu-TNF) given alone or in combination with human lymphoblastoid interferon (HLBI) against renal cell carcinoma, a sensitivity test was done using xenografts of human renal cell carcinoma serially transplanted in nude mice (AM-RC-3).
The dosages of the drugs used were as follows, rHu-TNF alone was administered daily for 7 days in a dose of 1, 000U, 3, 000U or 10, 000U by either the intra-tumoral or the intravenous route. In the case of combined therapy, rHu-TNF (1, 000U, 3, 000U, or 10, 000U i. t.) and HLBI (10⁷U/kg i. p.) were injected daily for seven days.
The therapeutic effects were evaluated according to the criteria of Battelle Columbus (i. e., relative mean tumor weight (RW) and T/C ratio of RW (TRW/CRW), and the histopathological changes were observed.
Based on the RW, only the group that received intra-tumoral rHu-TNF (10, 000U) showed tumor regression (RW=0.65). In terms of TRW/CRW, marked retardation in tumor growth was seen in the group that received rHu-TNF (10, 000U) alone by intra-tumoral injection (15.3%), or after combination therapy with rHu-TNF (3, 000U or 10, 000U) and HLBI (10⁷U/kg) (27.8% and 39.7%, respectively).
A strong inhibitory effect on tumor growth was recognized in the order of 10, 000U, 3, 000U and 1, 000U after intra-tumoral administration of rHu-TNF alone. This suggests that rHu-TNF exhibits its anti-tumor effect against AM-RC-3 in a dose-dependent manner.
Investigation of the RW and TRW/CRW after intra-tumoral administration and after intravenous injection showed the former route of administration to be more effective than the latter.
As compared to treatment with rHu-TNF alone, combined therapy with HLBI showed a significantly enhanced anti-tumor effect only at a dose of 3, 000U of rHu-TNF.
Histopathologically, remarkable coagulation necrosis of tumor cells accompanied by hemorrhage was demonstrated in the following group: rHu-TNF 3, 000U (i. t.), 10, 000U (i. t.), rHu-TNF 3, 000U (i. t.) plus HLBI 10⁷U/kg and rHu-TNF 10, 000U (i. t.) plus HLBI 10⁷U/kg.

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Between January in 1977 and December in 1987, 1384 surgical interventions including transurethral resection (TUR) and open subcapsular removal of the prostate were done in the treatment of benign prostatic hypertrophy (BPH) at the University Hospital and the affiliate teaching hospitals. Postoperatively, 33 patients were incientally found to have cancerous foci on the histopathologic examinations of the surgically removed specimen from the patients with BPH. In the present study, patient chart was reviewed to assess the treatment modalities and prognosis in 33 patients with stage A prostatic cancer. In order to circumvent the pirfally of expensive and time spending hitopaghological examination for conventioanl subclassification of stage A prostatic cancer, the simplest clinical staging was employed to classify stage A₁ and A₂ diseases of incidentally found, namely occult cancer of the prostate. According to our proposed classification, a well and moderately or poorly differentiated prostatic adenocarcinoma of stage A noudules were respectively referred to A₁ and A₂. The analysis of the clinical observations is summerized as follow.
1) The thirty-three patients comprised 24 in stage A₁ and 9 in stage A₂ diseases.
2) Incidental cancer in the surgical specimen was found in 21 patients (1.9 percent) by TUR of 1120 operations and in 12 patients (4.5 percent) by subcapsular prostatectomy in 264 open procedures.
3) Of the 33 patients with stage A cancer, 28 was additionally managed by appropriate therapy and the remaining 5 received no further treatment.
4) A relapse was observed in 4 patients with stage A₂ cancer although none of the patients with stage A₁ disease relapsed.
5) All 3 patietns with stage A prostatic cancer survived through the follow-up period.
These clinical findings suggest that our subclassification of stage A prostatic cancer is easily applicable and replaces the conventional staging of stage A disease to select the patients for suitable further management in a clinical setting.

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We found that the bladder of MRL/1pr mice had resistance to the N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) treatment. This resistance assessed by the number of piled layers (NPL) was coded for by 1pr gene and transmitted to F1 hybrid recessively.
After we confirmed the presence of periarteriolitis only in MRL/1pr mice kidney, which were supposed to be a phenotype of autoimmune disease, we analyzed the relation between low number of NPL values and 1pr gene phenotype. And it was found that there was statistically significant association between the two. (χ² test, p<0.001)
The resistance could not be transfered to the histocompatible mice in this experiment.
We concluded the hyperimmunity of MRL/1pr mice should be responsible for the resistance to BBN carcinogenesis, presumably through some unknown mechanisms, at the initial phase of development to a malignant bladder tumor.
However, we have to confirm that the immunity is a single factor responsible for the NPL values.

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The chemosensitivity test was carried out by the subrenal capsule assay (SRCA) against a urinary bladder cancer and a prostatic cancer in humans, transplanted into nude mice (NM-B-1 and PRO-1). It was proved that athymic, nude mice were more suitable hosts of the SRCA in my previous experience. Therefore, I used them in this study.
Nude mice tansplanted with NM-B-1 and PRO-1 were treated with 10 various anticancer drugs. The sensitivity was evaluated by the tumor growth inhibition rate (TGIR) on day 11. Anticancer drugs which showed more than 50% TGIR were considered to be sensitive. On NM-B-1, 254-S was the most sensitive drug, while Ifosfamide, Mitomycin C, Bleomycin, Methotrexate and Vinblastin revealed negative sensitivity. On PRO-1, Cisplatin, Mitomycin C and Adriamycin were more sensitive drugs, but only Peplomycin displayed negative sensitivity.
Histological analysis will be also very important to evaluate the sensitivity of anticancer drugs in the SRCA.

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We have analyzed the cases of urolithiasis at our clinic during the past ten years from November 28, 1977 to March 31, 1987.
1) The total number of out-patients was 10, 245, of whom 826 (8.1%) had urinary calculi and 241 (29.2%) showed recurrent stone.
2) Of the 826 patients with urolithiasis, 378 patients (45.8%) had ureteral stones, whereas 313 patients (37.9%) renal calculi. The ratio of upper to lower urinary tract stones was 31.8:1. Multiple stones of the upper urinary tract was found in 35.9%, and bilateral multiple stones were noted in 17.7%.
3) The male to female ratio was 2.7:1. The highest incidence of urinary stones was in the fourth decade. On the other hand, the incidence of recurrent stone was equally distributed in decades from second to sixth.
4) The overall rate of spontaneous passage of ureteral stones was 47.7% (179/378) and they were passed spontaneously within one month in 61.2%. The average size of calculi passed spontaneously within one month was significantly smaller than that of those passed after one month or later.
5) Analysis of the composition of the calculi revealed that calcium oxalate mixed with calcium phosphate and pure calcium oxalate was found in 81.2%.
6) The total number of operations for urolithiasis was 422 during this study. Recently, endourological therapy using transurethral fiberoptic nephroureteroscopes is mainly employed. Removal of parathyroid tumors was performed in 30 cases of primary hyperparathyroidism.

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A method was described for an estimation of the metastable limit of calcium oxalate crystallization in whole human urine. Spontaneous nucleation of calcium oxalate crystals was assessed by titrating 225μl of the urine with increasing quantities of sodium oxalate (1-15mM/L, 25μl) to determine its practical metastable limit using an aggregometer.
The results were as follows:
1) The minimum amount of oxalate necessary to induce nucleation of calcium oxalate was detectable by the turbidity of the aggregometer. The limit of metastability of calcium oxalate in the urine by this method gave fairly good agreement with a method of using a Coulter counter.
2) The measured metastable limit of each sample of urine was inversely proportional to the concentration of urinary calcium, total concentration product of calcium and oxalate in the urine and calcium oxalate ion activity product index.
3) The metastable limit of calcium oxalate in calcium stone formers has a tendency to show a low value comparing with that in healthy controls.
4) Treatment of rice-bran or citrate was able to improve the metastable limit of calcium oxalate in whole urine.
5) It was suggested that the determination of metastable limit using an aggregometer was useful and convenient for evaluating the propensity of calcium oxalate crystallization in the urine and the efficacy of prophylactic treatment of calcium stone.

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To investigate the effect of temperature on DNA synthesis by human testis, the testicular cell labeled with ³H-thymidine was examined in tissue fragments of human testis cultured at 31°, 37° and 38.5°C. Autoradiographic study showed that the cells labeled with ³H-thymidine were exclusively either spermatogonia or resting primary spermatocytes at 31°, 37° and 38.5°C. Labeling indices of spermatogonia and resting primary spermatocytes at 37° and 38.5°C were significantly lower than those at 31°C. The results suggest that the testicular temperature at 37°C or 38.5°C inhibits the DNA synthesis by spermatogonia and resting primary spermatocytes and will suppress human spermatogenesis, at least, at its initial step.

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To evaluate the significance of preoperative transvascular embolization in the radical nephrectomy, thirty-seven patients with renal cell carcinoma underwent transvascular embolization followed by radical nephrectomy one day after. Thirty-five cases became available for clinicopathological examination with reference to the perioperative blood loss, duration of operation and prognosis, comparing to those of twelve cases with nephrectomy alone.
The degree of renal infarct induced by embolization was divided into four groups by the extent of cortical necrosis sparing the subcapsular areas, which was the histologic characteristic about 24 hours after the embolization.
Among 35 cases with embolization, 18 cases (51.4%) were grouped into Grade N, 10 cases (28.6%) into Grade III, 3 cases (8.6%) into Grade II and 4 cases (11.4%) into Grade I. Thus, it was proved that the renal infarct induced by embolization was various in extent about 24 hours after the embolization. And comparing the grade of renal infarct with the degree of radiological occlusion by viewing the progress of contrast medium, there was no definite mutual relation between them. Also, there was no mutual relation between the kind of embolant and the grade of renal infarct.
Although embolization could make less significant decrease in the blood loss and duration of the operation, the blood loss of the Grade IV group in embolization was proved to be least.
The survival rate after embolization and nephrectomy was better than after nephrectomy alone, in particular, the survival rate of Grade IV group was excellent.
Our study demonstrated that it was important for getting better perioperative effect and prognosis to occlude the renal arterial flow completely by embolization, resulting in prohibiting the release of tumor cells from the primary site and the metastasis.

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Although clean intermittent self-catheterization is of value for treatment of dysfunction of the urinary bladder and has been adopted in many clinics, few studies have reported how to keep the catheter sterile and adequate for clinical use with systemic bacteriological examination. This paper reports bacteriocidal effect of Povidon iodine, Chlorhexidine digluconate and Benzalkonium chloride at various concentrations against four species of bacteria: E. coli, S. marcescens, P. aeruginosa and S. aureus cultured from urine and hematoma of patients in our clinic. Chlorhexidine digluconate, at 0.05 pervent, failed to impede the growth of S. aureus. However, a solution of 0.1 percent of Povidone iodine sterilized all samples of bacteria solution, which contained 10⁸ to 10⁹cfu/ml. Among several lubricants for comfortable introduction of the catheter into the urinary bladder glycerin was the best, since it was safe, hydrophilic, and low in cost and a good soluvent for Povidone iodine. Glycerin solution with 0.1 percent of Povidone iodine was prepared as a sterilizing lubricant of the catheter. However, acutal content of effective iodine in glycerin solution was revealed to vary depending on procedures of preparing the solution. The content of effective iodine was 28.4 percent of the theoretical value when the glycerin solution was autoclaved after mixing with Povidone iodine, while it was 83 percent of the theoretical value when glycerin was autoclaved prior to adding Povidone iodine. The value of the iodine content was stable in clinical use thereafter. Glycerin solution with 0.1 percent of Povidone iodine is of use for self-catheterization because of its sterilizing, lubricant and stable character.

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Urinary crystals were collected by repeated centrifugation (Fig. 1) from 10 urine samples from six patients who had frequently shown calcium oxalate crystalluria. The results are as follows:
1) Dipyramidal crystals obtained from 4 urine samples in cases 1 and 3 were identified as weddellite by X-ray and infrared analyses (Fig. 2, Fig. 4).
2) Microscopic examination and infrared analysis of the deposits from cases 5 and 6 indicated that dumbbell-shaped crystals were composed of whewellite (Fig. 3, Fig. 5).
3) The infrared spectra of the deposits from all cases showed the presence of calcium phosphate, although calcium oxalate was the principal constituent of the deposits in cases 1, 3, 5 and 6.

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We performed plasmapheresis in 8 patients (6 males and 2 females) with urogenital malignant tumors to improve their clinical conditions.
Four were with renal cancer, 2 prostatic cancer, 1 renal pelvic cancer and 1 embryonal cancer of the testis. All were in the terminal stage, being inoperable because of advanced stage or disseminated recurrence after previous surgical treatment. Chemotherapy, radiation therapy and/or immunotherapy were used in combination with plasmapheresis. Eleven cycles of plasmapheresis were performed in these 8 patients, i. e., 8 cycles of single membrane filtration plasmapheresis (SFPP) in 6 patients, and 3 cycles of double membrane filtration plasmapheresis (DFPP) in 2 patiens. Heated human plsma protein fraction (HHPPF) or fresh frozen plasma (FFP) were used as substitution fluids. The volume of exchnaged sera on the occasion of each procedure was 2000 to 3000ml. Plasmapheresis was performed 2 to 3 times a week and one cycle comprised 6 to 15 sessions. We estimated changes in level of consciousness, feeding, pain and performance status before, during and after each one cycle. Clinical improvement was found after 7 cycles of plasmapheresis in 6 patients. Improvement in consciousness level was observed in 4 patients, improvement in feeding in 2 patients. Better clinical improvements were achieved by SFPP using FFP than by SFPP using HHPPF or by DFPP.
As side effects of plasmapheresis, macrohematuria and subcutaneous bleeding were observed in 2 cases when HHPPF was used. Hypotension and uriticaria were observed in a few cases during plasmapheresis. In addition, mild decline of hepatic function was observed in a few cases after treatment, but severe heptitis was not found in any case.
It was suggested that SFPP using FFP was most effective in improving the general condition in patients with malignant tumors.

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BCG immunotherapy for prevention and/or treatment of superficial bladder cancer has been highly successful. In general, BCG has been thought to be a non-specific immune stimulant. While the efficacy of BCG cannot be denied, the mechanism of action responsible for the beneficial results observed in the treatment of human bladder cancer remains largely undetermined. In this study, an attempt was made to determine whether intravesical BCG administration for the treatment of bladder tumors can stimulate systemic host immune responses such as PPD skin test reactivity, natural killer (NK) activity, antigen-dependent cell-mediated cytotoxicity (ADCC) and distribution of various lymphocyte markers. Local histological changes were also determined using conventional histology, electronmicroscopy and immunohistochemistry. A total of 35 patients who had histologically proved superficial transitional cell carcinoma of the bladder were given weekly intravesical BCG instillations for six weeks after transurethral resection of the tumor. Sixteen of the 35 patients were negative on the PPD skin test prior to BCG instillation. After BCG treatment, 14 of the 16 patients converted to a positive PPD skin test.
Increased NK activity and ADCC were observed in 14 of the 35 patients (40%) and 20 of the 35 patients (57.1%) after six BCG instillations, respectively. Increased percentages of Leu 7 and Leu 11 positive lymphocytes were noted following BCG instillation in 12 of the 35 patients (34.3%) and 14 of 35 patients (40%), respectively. Conventional histological examination revealed chronic inflammatory changes accompanied with submucosal infiltration of various inflammatory cells. In contrast to the evidence of increased systemic NK activity following BCG treatment, only seven of the 35 patients (20%) showed positive staining results against anti-Leu 7 antibody (NK) immunohistochemicaly. No significant positive staining against anti-BCG antibody was noted.
These results suggest that intravesical BCG instillation resulted in stimulation of host immune responses and may thus provide beneficial effects in the treatment or prevention of human bladder cancers. However, the mechanisms of anti-tumor effects on local immunological responses besides the stimulation of systemic immunological responses by intravesical BCG instillation remain undetermined.

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We introduced a technique of transurethral microwave coagulation in order to relieve obstructive symptoms caused by prostatic cancer. Between January 1986 and June 1987, 6 patients with prostatic cancer received transurethral microwave coagulation. In this procedure, the prostate was irradiated with microwave energy of 100 watts for 60-120 seconds under transabdominal sector scaning. All patients had severe dysuria and 2 of them had hematuria before treatment. After the procedure, all patients were able to void satisfactorily without any severe complications. Our clinical experience indicates that transurethral microwave coagulation is a useful method and an alternative to transurethral resection of the prostate.

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To elucidate the significance of adrenalectomy in the radical nephrectomy, we studied the incidence of ipsilateral adrenal involvement in renal cell carcinoma, on 144 patients who underwent nephrectomy and 110 autopsy cases of renal cell carcinoma.
Of these patients 70 were treated with the standard radical nephrectomy including the removal of the ipsilateral adrenal glands and histopathological examination. Of these 70 patients undergoing radical nepurectomy, 5 had evidence of adrenal involvement for an overall incidence of 7.1%. All 5 had high stage of upper pole lesions involving the lymph nodes or additional distant metastasis. There was no significant difference in 5 year survival between 70 patients who underwent the standard radical nephrectomy and 22 patients in whom the ipsilateral adrenal gland was intact.
Of the 110 autopsy cases of renal cell carcinoma, 32 had evidence of ipsilateral adrenal involvement: 14 involving the upper pole (37.8%), 5 involving the mid pole (26.3%), 7 involving the lower pole (25.0%) and the remaining 6 involving the whole kidney (37.5%). Ipsilateral adrenal involvement was more common in the cases involving the upper pole, and also in the cases with high stage and high grade, and all 32 cases with adrenal involvement had additional distant metastasis.
The ipsilateral adrenal involvement in renal cell carcinoma was common in the cases of upper pole lesion with high stage and high grade, and in these cases the ipsilateral adrenalectomy seemed to be beneficial. However, the ipsilateral adrenal gland need not be removed by the radical nephrectomy in the patients with low stage of mid or lower pole lesion.
Since all cases with adrenal involvement showed additional distant metastasis, such adjuvant therapy as chemotherapy or biological response modifier are required postoperatively.

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Among 138 patients with benign prostatic hypertrophy entered into anti-androgen therapy until 1985, 52 patients underwent transrectal ultrasonotomography before and during the treatment more than three times. In these 52 cases, the long-term effect of the anti-androgen therapy was evaluated, based on the changes in prostatic weights measured by sonometrics.
As a rule, anti-androgenic agent; chlormadinone acetate was administered 50mg daily, but in 28 cases, the dose was reduced to 25mg daily after satisfactory decrease in prostatic weight was achieved.
Prostatic weight in the 52 cases was 31.8±14.1g (mean±S. D.) before treatment, decreased to 21.3±11.2g after four month administration, and remained unchanged (20.6±12.7g) in the last ultrasonic examination (after 25-month administration). A similar result was obtained for the 28 cases treated with 25 mg of chlormadinone acetate after satisfactory decrease in prostatic weight. Prostatic weight in the 28 cases was 29.9±8.1g before treatment, decreased to 18.2±5.9g in the first ultrasonic examination, and remained unchanged (18.0±7.0g) in the last ultrasonic examination.
Nine cases showed transient reduction of more than 30% in prostatic weight and then reenlargement of more than 30%, eight of these were those treated with 25 mg of chlormadinone acetate after satisfactory decrease in prostatic weight.
Among 86 cases treated with the anti-androgenic agent in the same period, seven cases were operated and eight cases dropped out before the third ultrasonic examination. Though these fifteen cases possibly biased the cases followed up, prostatic adenoma seems not to obtain resistance against anti-androgen therapy during the mean follow-up period of 25-month.

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A 67-year-old woman was hospitalized because of a month old case of gross hematuria. A retrograde pyelogram revealed a spece-occupying lesion in the left kidney. A left renal angiogram showed tumor vessels which were irregular and tortuous. A computed tomography revealed a large mass with central necrosis and a tumor thrombus in the left renal vein. The patient underwent left nephrectomy and radiotherapy. The histological diagnosis was nephroblastoma which is very rare in adults. Forty-six cases of nephroblastoma in adults ahve been reported in Japan.

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Transperineal polytetrafluoroethylene (Teflon) injection was performed on a 69 years old man with incontinence following transurethral resection of the prostate. He had been incontinent for eleven months and failed to improve despite conservative management such as pharmacological agents.
After only one injection, he was free of any incontinence divices and wet≤1 pad per day.
Clinically significant complication was not observed except transient voiding difficulties and perineal discomfort. This procedure was quick and safe and requires only a breif hospital stay.

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A 71-year-old male was seen at our clinic because of hypertension of 3 years duration. Serum laboratory study on the initial examination revealed slight elevation of serum GOT and GPT levels. The CT-scan performed for possible hepatobiliary disorder revealed a left adrenal mass mesuring 24×11mm in size.
Endocrinological study showed an elevation of plasma corticosterone value, which was suppressed by 3 mg of dexamethazone. There was no definite accumulation of the radioisotope on adrenal scintigraphy using I¹³¹-adosterol.
After left adrenalectomy, the plasma corticosterone level returned to normal, although blood pressure remained elevated. Because of this fact, the tumor was regarded producing corticosterone.
Histologically, the adrenal tumor was an adenoma resembling an aldosterone-producing tumor. The irreversibility of hypertension was assumed due to arteriolosclerois found in the renal biopsy specimen.

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Two cases of acute focal bacterial nephritis were reported. These two patients visited us complaining symptoms of acute pyelonephritis such as pyuria, fever, and flank pain. Intravenous pyelography findings revealed a renal mass. Ultrasongraphy, CT scan and renal angiography were performed on one case and CT scan in the other case, and acute focal bacterial nephritis was diagnosed in both cases. Namely, ultrasonography showed a hypoechoic poorly marginated mass, and post-contrast CT scan revealed an inhomogenous low density area. In both cases cure could be obtained by chemotherapy. It is important to understand the entity of acute focal bacterial nephritis and to have knowledge of its radiographic findings in order to diagnose it correctly and to provide proper treatment. It is emphasized that one must be alert to the possiblity of acute focal becterial nephritis if a renal mass is revealed by intraveous pyelography.

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