Influence of unilateral hydronephrosis on the intrarenal venous system was studied by resin injection casting in Japanese white rabbits. Hydronephrosis was induced by partial ureteric obstruction, wrapping the ureter with 24 carats gold sheet. The period of obstruction was 1 to 8 weeks.
Marked morphological changes of the venous system such as shortening, diminution, spiraling, abrupt narrow termination and reticular net-work of cortical veins were observed especially around the lateral protruded area of the renal cortex when hydronephrosis, in which the pelvic capacity was more than 7ml at the end of obstruction period, lasted more than 4 weeks. These morphological changes of interlobular veins were irreversible during the 8 weeks' observation period after release of obstruction. Moreover, these deformities were thought to be even progressed in certain small sections.
Since the intensity of hydronephrosis showed more significant effects on morphological changes of intrarenal venous systems than the period of obstruction in present study, the former was thought to be a more important factor of venous deformity in hydronephrosis than the latter.
Regarding the effect of nephrostomy and partial nephrectomy on hydronephrosis, hydronephrotic kidney sustained demages similar to those which normal kidney sustained by these procedures.

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The present research was carried out on 144 elderly patients complaining of voiding abnormalities, in order to clarify the clinical problems involved in diagnosis and treatment of voiding dysfunciton in the elderly. The patients included in this study were 117 male and 27 female elderly individuals aged over 65, who were followed on out-patient basis for voiding dysfunction but otherwise healthy or with minimum physical disturbance. The patients were divided into 3 diagnostic groups: obstructive prostatism (31%), neurogenic bladder (40%) and unstable bladder (29%). Neurogenic bladder was subdivided into overactive (33%), underactive (39%), normal (14%) and unknown (14%) based upon cystometric findings.
Forty-four out of 89 patients with benign prostatic hyperplasia had normal bladder function, while in the remaining 45 patients neurogenic bladder or unstable bladder was coexistent. Clinical manifestations were discussed in terms of difficulty in urination, diurnal frequency, nocturnal frequency, uregency and incontinence. Difficulty in urination was noted in the majority of every diagnostic group. Nocturnal frequency was more common than diurnal one, and urinary incontinence was found in 44 cases (31%) of all the patients, 93% of which was with uregency incontinence. Since, in general, each clinical manifestation was shared by most groups, it appeared difficult and inappropriate to predict lower urinary tract funciton only from subjective symptoms. Objective urodynamic evaluation by cystometry, uroflowmetry and residual urine measurement was essential. Neurogenic disorders observed in neurogenic bladder patients were highly variable. In overative neurogenic bladder, various neurological diseases affecting supranuclear lesion were noted, cerebrovascular diseases being most prevalent. Underative neurogenic bladder included much more variable disorders. However, the neurological lesions were not always consistent with the type of bladder dysfunction determined by cystometry. In unstable bladder group, 83% were with prostatic hyperplasia, and in the rest of cases no neurological abnormality was found. Cystometry was performed in 83% of all patients and evaluated as to FDV, MCC, uninhibited contraction and compliance. In all groups, MFR and AFR were declined on uroflowmetry, and the ratio of residual urine was significantly increased. Thirty percent of the patients underwent surgical treatment and 70% had conservative therapy. Clean intermittent catheterization was adopted in 32% of the patients treated conservatively, in 47% of which self catheterization was done.

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Haemagglutination activity and other bacterial properties of E. coli isolated from patients with acute uncomplicated cystitis (AUC) were examined to clarify the significance of fimbriae as the virulence factor of E. coli in the lower urinary tract.
1. In almost all of the AUC strains, O antigen belonged to several serotypes: O1, 2, 4, 6, 18, 22, 25 and 75. The incidence of haemolysin production and the haemagglutination activity of the AUC strains was higher than that of faecal strains.
2. The percentage of positive mannose sensitive haemagglutination (MS-HA) strain, having type 1 fimbriae, in AUC strains and faecal strains were 88.9% and 44.1%, respectively (p<0.01).
3. Almost all AUC strains belonging to O1, 4, 16, 18 and 22 and showing haemolysin production had type 1 fimbriae.
4. All strains of E. coli isolated from patients with haematuria (RBC>30/hpf) and from those showing poor response to chemotherapy had type 1 fimbriae.
Consequently, the presence of type 1 fimbriae was thought to be one of the most significant virulence factors in lower urinary tract infections.

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A new method, globoside-incorporated liposome agglutinaiton, which identifies P-fimbriated E. coli, was designed.
This method was applied to E. coli isolated from patients with acute uncomplicated pyelonephritis (AUP, 47 strains), acute bacterial prostatitis (ABP, 24 strains) and acute uncomplicated cystitis (AUC, 183 strains) and the results were compared with haemagglutination and other bacterial properties.
Globoside-incorporated liposome agglutination proved to be a useful method for the identification of P-fimbriated E. coli.
The incidence of P fimbriae in E. coli isolated from patients with AUP, ABP and AUC and in E. coli from the faecal samples of healthy individuals was 48.9%, 12.5%, 22.5% and 10.0%, respectively. Although the percentage was high among patients with AUP, the incidence of P fimbriae in genitourinary tract infections in general was relatively low.
In contrast, the incidence of MR fimbriae (mediate mannose resistant haemagglutination, including P fimbriae) and type 1 fimbriae in genitourinary tract infections was 74.8% and 88.2%, respectively.
Among cases of AUP, ABP and AUC and in faecal samples, the respective percentages of E. coli having both MR and type 1 fimbriae were 70.2%, 75.0%, 66.1% and 18.6%. Consequently, simultaneous presence of MR (including P) and type 1 fimbriae might be the most significant virulence factor in genitourinary tract infections.

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In vitro tests of E. coli adhesion to the human bladder, renal pelvis, kidney, and prostate were performed. In these tests, six strains of E. coli isolated from patients with genitourinary tract infections were used; 5 strains were regulated phase variants and 1 strain was non-fimbriated.
Type 1 fimbriated strains adhered to the bladder and renal pelvis; MR-fimbriated strains did not.
E. coli OEN-132, which was a P-fimbriated strain, adhered to the renal tubules, while type 1 fimbriated strains did not.
E. coli OEP-141, an MR (non-P)-fimbriated strain, and OEP-162, an MR (including P)-fimbriated strain, adhered to the prostatic ducts, while type 1 fimbriated strains did not.
Consequently, type 1 fimbriae was thought to be a colonization factor of transitional cells in the urinary tract, while the MR fimbriae with different specificities that of the renal tubules and the prostatic ducts. The phase variation of E. coli between type 1 and MR fimbriae might be one of the most significant vilurence factors in genitourinary tract infections.

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Clinical results were studied in 30 cadaveric renal transplantations performed at our clinic from Nov. 1983 to Oct. 1987.
All were treated with ciclosporin and methylprednisolone, however, some modified regimen accompanied by mizoribine has been applied since Feb. 1986.
One patient died of Carinii pneumonia in the 7th postoperative month. No postoperative complication requiring surgical repair was observed. Patient survival rate and graft survival of 1, 2 and 3 year were as follows, respectively; 96%, 96%, 96% and 82%, 73%, 65%. These results were satisfactory and comparable to that of living related renal transplantation.
Hereafter, we intend to continue the triple immunosuppressive therapy with ciclosporin, methylprednisolone and mizoribine.

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A trial to elucidate the linkage between occult and manifest carcinomas of the prostate was done. It was hypothesized that the progression of prostatic carcinoma might be explained by the factors of time, histological grade and tumor volume. The subjects were 20 cases of stage A, 35 cass of stage B, 46 cases of stage C and 114 cases of stage D prostate carcinomas. (1) Analysis of the clinical and pathological findings of stage A carcinoma revealed that there was no death in stage Al cases but 46 percent of stage A2 cass died of prostatic cancer. This implies that although stage A is occult carcinoma, stages Al and A2 should be definitely separated as clinical entities. Stage Al has much possibility to remain as occult carcinoma but stage A2 has strong possibility to progress to a manifest cancer. (2) In the manifest carcinoma cases, histological grade between the group of long survivor and the group of early cancer death was evaluated.
Long survivors had a higher proportion of well differentiated adenocarcinoma, while the group of early cancer death had a strong tendency to be composed of poorly differentiated adenocarcinoma. Even in the group of long survivor, with the progression of clinical stage, the percentage of well differentiated adenocarcinoma decreased. (3) Two groups with and without metastasis at first admission were analyzed concerning the tumor volume which was expressed by T stage. The former group had a tendency to be larger in clinical T classification and poorer in histological grade differentiation. As a conclusion, an increase of tumor volume and an increase of the ratio of poorly differentiated adenocarcinoma in the whole tumor are thought to be most important for progression from occlut to manifest carcinoma.

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Receiver operating characteristics (ROC) analysis was performed to evaluate the clinical efficacy of transrectal sonography (US) and computed tomography (CT) for prostatic diseases.
One hundred US and CT images of prostatic diseases collected from 10 medical institutions, including 33 cases of prostatic cancer, 29 of benign prostatic hypertrophy, 7 of prostatitis, 2 of prostatic stone and 29 of normal finding, were read by 21 urologists.
As the reuslts, US was found to be more useful than CT for both the detection of prostatic diseases and the differentiation between prostatic cancer and benign prostatic hypertrophy.
The sensitivity of US for the diagnosis of prostatic cancer was 64.2% on average of all the urologists. However, the sensitivity was 80.0% on average of 5 urologists who have read more than 3, 000 US images and 59.5% on average of 16 doctors who have read within 3, 000 US images.

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The pontine micturition center (PMC) in the dorsolateral pontine tegmentum, from where electrical stimulation evoked micturition, was identified in the halothane anesthetized cat. And then, input and output neuronal structures of the PMC were studied by the horseradish peroxidase (HRP) method after injecting HRP into the PMC.
HRP injection sites corresponded to the nucleus locus coeruleus alpha. HRP labeled cells were located mainly in the cingulate, rectal and anterior sylvian gyri, dorsal area of the hypothalamus, periaqueductal gray, reticular formation of the mesencephalon, pons and medulla, and intermediate gray of the sacral spinal cord. Most labeled cells were located in the reticular formation with its center in the rostral pons and periaqueductal gray. The pathways of HRP labeled fibers almost corresponded to the rostral and caudal limbs of the dorsal periventricular pathway, the noradrenergic fibers passing to the cerebellum, the caudal limb of the dorsal noradrenergic bundle and coeruleospinal pathway which were known as efferent pathways of the locus coeruleus complex. Other fine labeled fibers were seen between these pathways and the areas where HRP labeled cells were located. These areas where HRP labeled cells and fibers were located corresponsed to the most of the reported areas extending between the cerebral cortex and the sacral spinal cord from where electrical stimulation evoked either bladder contraction or relaxation.

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In this study, Axonal trajectories and terminal fields of efferent fibers originating from cells in the pontine micturition center (PMC) were studied. To do this, wheat germ agglutinin-horseradish peroxidase (WGA-HRP) or phaseolus vulgaris leucoagglutinin (PHA-L) were injected into the PMC.
WAG-HRP and PHA-L were microinjected into the nucleus locus coeruleus alpha. The pathways of labeled fibers almost corresponded to the rostral and caudal limbs of the dorsal periventricular pathway, the noradrenergic fibers passing to the cerebellum, the caudal limb of the dorsal noradrenergic bundle and coeruleospinal pathway which were known as efferent pathways of the locus coeruleus complex. Most labeled terminals and presumed terminals were identified in the sites where WGA-HRP labeled cells were located between the cerebral cortex and the sacral spinal cord. Many of labeled terminals and presumed terminals existed in the periaqueductal gray, nucleus reticularis pontis oralis, nucleus reticularis magnocellularis and sacral intermediate gray where the nucleus of origin of the pelvic nerve was located. Some of them were located in the ventrolateral and lateral pontine tegmental fields which were called the pontine urine-strage nucleus, lumber intermediate gray where the nucleus of origin of the hypogastric nerve was located, and the Onuf's nucleus which was the nucleus of origin of the pudendal nerve.
These results clearly demonstrated that a number of efferent projection sites from the PMC correspond to afferent projection sites within the brain and the spinal cord to the PMC.

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Seventy cases with untreated prostatic cancer aged from 54 to 90 year-old were observed from November 1981 to 1987 in our clinic. Histologic grading was performed to divide the cases into 5 patterns according to Gleason grading system and tissue DHT levels were measured in 47 of the 70 cases. The average age was 73.8 years and the follow-up period was from one to sixty-five months (mean 23 months). Sixteen cases died during the follow-up period. The relations of histologic grades, tissue DHT levels and prognoses were discussed.
The primary pattern 3 was seen in 50% of the cases followed by pattern 4 and 2. Scores were divided into 3 groups, that is, 2 to 5, 6 to 7 and 8 to 10.
Scoring 6 to 7 was most common (44.3%), followed by scores 2 to 5 and 8 to 10. The high staged cases increased as score or pattern digits increased. With regards to primary pattern and death rate, Gleason's score and death rate, or Gleason's modified category and death rate, cancer death rates increased as pattern digits, score digits, or category digits increased.
The death rates were also examined in relation to tissue DHT levels and scores. DHT levels were classified into 2 categories, over 2ng/gtw (high DHT) and below. The cancer death rate in the low DHT group was definitely higher than that of the high DHT group.
The relations of clinical responses or courses and DHT levels were examined in cases on endocrine therapy. The high DHT group showed partial objective regression (PR) in 57% of cases but there were only 21.4% of cases that showed PR in the low DHT group. Cancer deaths in the low DHT group were caused by progression of the disease. On the other hand, those in the high DHT group were caused by relapses after PR was achieved for a certain period.
Gleason grading system was useful to predict clinical stages and final prognosis. Tissue DHT levels were one of the useful indications to predict responses to endocrine therapy, but it is difficult to predict response durations or relapses.

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In this study, we describe the establishment of monoclonal antibody to androgen receptor (AR) and the trials to predict the responsiveness of the hormone therapy to prostate cancers.
AR was partially purified from 500g of human prostates (BPH) by sequential chromatography on DEAE-cellulose, testosterone-Sepharose and Blue-Sepharose CL-6B. Two-month old BALB/c mice were immunized with purified AR. Immune splenocytes were fused with NS-1 cells by using polyethylene glycol. To screen antibody production by hybridoma cells, ELISA was used at first. As the second screening, ELISA positive cells were determined for production of antibodies agaisnt AR by immunoprecipitaiton assay (IPA) described by Greene et al. with some modifications. BPH tissues and 16 prostatic cancer (PC) tissues were analyzed for immunohistochemical localization of AR by using avidin-biotin-peroxidase complex (ABC) procedure.
Nine hybridomas were proved to produce antibodies against AR by IPA. One of the clones, 5F4, was chosen for analysis of immunohistochemical localization of AR. In BPH tissues, nuclei and cytoplasms of glandular epithelial cells were predominantly stained. Stromal cells were also stained, but weakly. Fibroblast cells from genital skin, which is androgen dependent, were stained intensely. However, lymph nodal fibroblast cells, which are androgen independent, were not stained at all. Androgen independent prostate cancer cell line, PC-3, was not stained at all. These results show that monoclonal antibody, 5F4, identifies AR.
Of 16 PC tissues, two were composed of AR positive cancer cells exclusively (AR positive type), seven were of AR negative cells (AR negative type) and seven contained both AR positive cells and negative cells (mixed type). Of 9 AR positive or mixed types, 7 responded to the hormone therapy, and two were not estimable for the responsiveness because the patients died early of other diseases. Of seven AR negative types, all but one unestimable case had no response to the hormone therapy. We found no carrelation between immunohistochemical localization of AR and pathological grade of prostate cancer. Also we found no correlation between immunohistochemical localization of AR and clinical stage of prostate cancer.
Immunohistochemical analysis of AR by using monoclonal antibody, 5F4, was a useful tool for determining androgen dependency of prostate cancers.

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Despite dramatic improvement in the patient and renal allograft survival, Cytomegalovirus (CMV) infection contunues to be one of the most important post-transplant infections after immunosuppressed renal transplant. In order to evaluate whether viruria of CMV were risk factors for renal allograft recipients in Japan, we undertook isolation of CMV from urine and measured CMV CF titers in these patients.
In 34 (85%) of 40 patients, CMV were isolated from urine, whereas none of the 21 living related donors shedded CMV in the urine.
In our series, symptomatic CMV infections occurred in two patients up to 4 months after transplantation. Serum creatinine level in one patient was slightly elevated, but in both cases their clinical conditions and renal functions recovered completely after infections.
In spite of the presence of CMV in the urine of 32 other patients including the patients who had been shedding CMV for more than one year, no patient developed CMV infection clinically. And there was neither a deterioration in kidney function nor a rejection episode in all asymptomatic patients.
In Japan, although CMV has been recovered from the urine of many allograft recipients, infection with CMV is frequently asymptomatic, even in the immunosuppressed, and reactivation of latent CMV during immunosuppressive therapy is probably responsible in the majority of these cases. Therefore, it is considered that, in these asymptomatic CMV infected patients, it is sufficient to take care of their physical conditions carefully without the specific treatment for CMV.

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A statistical analysis was made on 40 patients with testicular tumor treated in our clinic between 1977 and 1987. Seminoma and nonseminomatous germ cell tumors were treated by radical orchiectomy followed by irradiation or chemotherapy. After October 1982, the chemotherapy regimen including cisplatin was used. The 5-year survival rate calculated by Kaplan-Meier method was 88% and 67% for seminoma and non-seminomatous tumors, respectively. The difference of survival rates between the two groups was not statistically significant. The 5-year survival rate for seminoma was not related with the time lag between discovery of tumor and orchiectomy, but as for the patients with non-seminomatous tumors, those operated within two months after the tumor was noted showed a higher survival rate compared to the cases operated later. In non-seminomatous group, choriocarcinoma element is unrelated to the 5-year survival rate. The higher serum LDH and HCG levels, the poorer the prognosis in the same group. On the other hand, the survival rate was not related to serum AFP and HCG-beta values. The group treated by the chemotherapy including cisplatin showed a higher survival rate than that receiving the treatment regimens excluding cisplatin, although the difference was not statistically significant.

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This report is on a case of a 58-year-old man with testicular cancer, metastatised to the skin and inguinal lymph nodes following scrotal injury. Since the local skin condition did not permit prompt orchiectomy, chemotherapy with PVB regimen was conducted as the most suitable treatment. Orchiectomy and inguinal lymphadenectomy idicated the absence of viable tumor cells. Since sensitivity to anticancer drugs differs for primary tumors and their metastases, orchiectomy should be carried out as soon as possible. In such as unusual case as the present case, however, the effectiveness of chemotherapy prior to operation was well demonstrated.

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A 46-year-old man was seen with chief complaint of a painless mass in the right scrotum. The mass was independent from the testicle and from the spermatic cord. Total surgical excision of the mass was performed. The mass contained serous fluid of serum-like substance. Histological examination revealed that the mass was a lymphangioma consisted of several endothelial-lined cysts. Convalescense was uneventful. Four cases of lymphangioma in the scrotum including our case were collected from the Japanese literature and reviewed.

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