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We examined whether paracrine factors produced by prostate cancer cells can modulate bone metabolism in proportion to the volume of cancer cells in bone metastasis. Endocrine factors produced by prostate cancer cells affect both phosphate and 1, 25-dihydroxyvitamin D metabolisms. Levels of urine pyridinoline (U-Pyr) excretion and serum carboxy-terminal propeptide of type 1 procollagen (P1CP) in patients with bone metastasis were significantly higher than those in patients without bone metastasis (P< 0.05). In patients with bone metastasis (n= 1 7), serum prostate-specific antigen (PSA) levels were significantly correlated with the levels of U-Pyr and urine deoxypyridinoline (U-dPyr) excretion, serum cross-linked carboxyterminal telopeptide of type 1 collagen (1CTP), and P1CP levels (p < 0.05). However, serum PSA levels were not correlated with U-Pyr, U-dPyr excretions, serum ICTP and P1CP levels in patients without bone metastasis. Therefore, prostate cancer cells appear to have some paracrine effects on bone cells. In controls (n=15), serum 1, 25dihydroxyvitamin D levels (1, 25-(OH)2D) were inversely correlated with serum phosphorus levels (P

To determine the current status of urolithiasis in 1988, in comparison with that in 1985, we analyzed the 1937 patients of urolithiasis at 17 departments of urology in Mie Prefecture and 2 departments of urology in Wakayama Prefecture. The ratio of male to female patients was 2.6 to 1.0. Geographically, the number of urolithiasis patients was most frequently distributed in Matsusaka City. The frequency of urolithiasis in the urban area was almost the same as that in the rural area. Most of the stones (96.3%) were in the upper urinary tract. The frequency of lower urinary tract calculi tended to be high in southern Mie Prefecture. The ratio of the upper urinary tract calculi to the lower urinary tract calculi in the urban area was higher than in the rural area. The age distribution in males was in the forties, while that in females was in the fifties. The average age was 46.4 years old. The surgical treatment was performed in 671 patients (34.6%) and the extracorporeal shock wave lithotripsy (ESWL) was the most frequent mode of treatment (85.0%), followed by cysto-lithotripsy (4.2%) and percutaneous nephro-uretero-lithotripsy (2.4%). The most frequent component of the urinary tract calculi was calcium oxalate and/or calcium phosphate (81.7%). The stone patient increased in the number during the summer season (July, August and September). In conclusion, in 1988 when the ESWL treatment started in Mie Prefecture, the epidemiologic features of urolithiasis was characterized as follows: the number of patients increased and the broad application of the ESWL treatment resulted in the decreased number of patients with spontaneous discharge and the increased number of patients with recurrent stones and with bilateral or multiple complex stones.

Bethanechol chloride, a cholinergic agent and bunazosin hydrochloride, an alpha adrenergic blocking agent were administered orally to 28 patients with neurogenic bladder due to peripheral nerve disorders. To compare the effect of the two drugs, one of the drugs was initially administered orally for 2 weeks, and then both of them were administered for the next 2 weeks. Since there were some significant differences in the patient background between the two groups, it was difficult to compare the two drugs. However combined use of these drugs resulted in both objective and subjective good responses in those patients.

A 30-year-old man was admitted to our hospital suffering from fever and left scrotal swelling. Physical examination revealed an enlarged left epididymis, suggesting acute epididymitis. Intravenous pyelography showed non-functioning left kidney. On cystoscopy, the left ureter orifice did not open in the bladder, and it opened in the posterior urethra. An ureteral catheter was passed through this orifice to about 5 cm length and retrograde injection of contrast material demonstrated a dilated left ureter. CT also confirmed a dilated left ureter behind the bladder and the left kidney was not found. Left nephroureterectomy was performed. Microscopically, normal renal tissue was not recognized, and the lesion comprised a number of ducts covered with tall columnar epithelium having stereocilia and ducts resembling the thyroid gland. The former ducts resembled the ducts of epididymis. The pathological diagnosis was total dysplasia.

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Cefoperazone (CPZ), a new cephalosporin derivative, was evaluated clinically with one shot intravenous injection of 1.0 g in 22 cases of simple acute cystitis. We obtained 95% efficacy rate without any remarkable side effect except one case which exhibited nausea and vomiting immediately after injection. We concluded that the single dose administration of CPZ may be effective and sufficient treatment for uncomplicated cystitis of women.

正常対照群8例, 排尿障害のある前立腺肥大症群8例, 末梢神経障害群4例, 核上型神経因性膀胱群3例について検討した.Penis-Anusでは, 正常人群31.5 msec.前立腺肥大症群33.0 msec.末梢神経障害群43.3 msec.核上型神経因性膀胱群37.0 msecであり, 末梢神経障害群と, 正常人群, 前立腺肥大症群では有意差を認めた.Urethra-Anusでは, 上記の順にそれぞれ65.4 msec. 65.4 msec. 80.0 msec. 72.5 msecであった.Penis-AnusとUrethra-Anusにおける相関係数は, r=0.59であった.以上のことより, この検査法は神経因性膀胱の障害部位や分類, 器質的インポテンスの鑑別などに有用なものと考えられる, Evoked response of bulbocavernosus reflex was taken in 8 normal control individuals and in 15 abnormal voiding patients (8 benign prostatic hyperplasia, 4 diabetic neuropathy, 3 supranuclear neurogenic bladder). the latency in control group showed 31.5 +/- 5.0 msec duration after penile stimulation and 65.4 +/- 11.0 msec duration after posterior urethral stimulation. The latency in diabetic neuropathy group was obviously prolonged but not that in the supranuclear neurogenic bladder group. This modern neurophysiological electrostimulation method provides simple and accurate information of bulbocavernosus reflex.

1) 150例の再発性・特発性蓚酸カルシウム尿路結石症を対象として, 最低2年間を目標として, アロプリノール投与による結石再発予防の臨床的検討をおこなった.2)検討可能症例134例(男性113例, 女性21例, 平均年齢42.7歳)を, 結石の発生・再発様式により多発型23例とepisode型111例に分類し, 全例について結石の再発・増大の有無を, episode型については統計学的にも治療前後の再発率の検討をおこなった.3)全症例の結石再発・増大に関しては, 多発型23例中19例に再発・増大を認めず, 4例のみに増大を認めた.episode型111例については59例に再発を認めず, 52例に再発を認めた.134例全例を通じては78例(58.2%)に再発または既存結石の増大は認めず, 56例(41.8%)に再発・増大を認めた.4) episode型111例のアロプリノール投与前後の再発率を統計学的に比較した.111例全例の治療前後の再発率, 治療開始時に結石を有しなかった37例の治療前後の再発率, 治療前後2年間ずつの同期間の再発率を比較しえた79例のいずれにおいても, アロプリノール投与により再発率の有意の低下が観察された, We studied the effect of allopurinol on the prevention of stone recurrence in 134 patients with recurrent, idiopathic calcium nephrolithiasis. They consisted of 113 male patients and 21 female, between 16 and 72 years with an average age of 42.7. The patients were divided into two groups according to the type of stone occurrence; those with multiple stones without previous stone episodes (multiple stone group), and the those with recurrent stones (stone episode group). Twenty three patients belonged to the multiple stone group and 111 patients belonged to the stone episode group. The stones in 19 of the 23 patients in the multiple stone group remained stable throughout the study, while stones in 4 grew. Fifty-nine of the 111 patients in the stone episode group were free from recurrence, but the others showed recurrence. Statistical analyses was done on the stone episode group. The stone recurrence rate of all of the 111 cases showed significant decrease during prophylactic treatment with allopurinol (p less than 0.01), although the observation period before treatment was 73.0 +/- 65.8 months and that during and after treatment was 28.2 +/- 12.1 months. During the two years before and after prophylaxis 79 patients also showed a significantly decreased recurrence rate. Moreover, regarding 37 cases without any stones at the start of treatment, stone recurrence rate decreased significantly after the administration of allopurinol. Throughout this study, we used a new method for evaluating reasonable stone recurrence. It did not calculate the number of stones recurred, but the stone-forming circumstance in each kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

This report deals with a case of left inferior vena cava. A discussion was made on embryological growth of inferior vena cava and on relation between asymptomatic hematuria and left inferior vena cava. A 19-year-old boy was admitted with asymptomatic hematuria. Since 4 years ago, he has noticed asymptomatic hematuria occasionally and been treated as essential renal bleeding on the left side at the other hospital. He had no remarkable physiological signs on chest and abdomen. Neither abnormal dilatation of the vein nor varicocele was found. All hematological tests were within normal limits and coagulation examinations showed almost normal but for bleeding time which was slightly prolonged. Hepatic and renal functions were unimpaired. Cystoscopic examination revealed that the urine ejected from the left ureteral orifice was slightly bloody, but that from the right side was clear. The bladder mucosa appeared normal. Excretory urogram and retrograde pyelogram showed no abnormality. Abdominal aortogram and selective renal angiogram revealed no abnormality but inferior vena cavogram showed the left sided inferior vena cava. Radioisotopic venogram was taken in order to find the physiological blood stream of the vena cava, and then vena cava was compressed clearly at the crossing area of the abdominal aorta. It was suggested that hematuria resulted from the congestion of left renal vein caused by the compression of the left inferior vena cava due to crossing the abdominal aorta.

Spectinomycin (Trobicin) was intramuscularly administered twice, 2 gm each time, to 22 men with acute gonococcal urethritis seen at our hospital. The effect was evaluated two or three days after the first administration and again four or five days after the second administration (i.e. seven days after the first administration). 1) The success rates two or three days after the first administration were 95.2% for purulent discharge, 85.0% for pain on urination, 40.9% for purulent urine, and 95.5% for disappearance of gonococci. The overall clinical effectiveness based on the UTI efficacy evaluation standards was 90.0% to 90.5%. 2) The success rates four or five days after the second administration or seven days after the first administration were 100% for purulent discharge, pain on urination, and disappearance of gonococci. The overall clinical effectiveness was also 100%. Disappearance rate of floating threads from urine was 28.6% of the cases, however. 3) In all cases, gonorrheal threads (purulent urine) disappeared in three weeks to two months with administration of synthetic penicillin and anti-inflammatory enzyme preparations. 4) No marked adverse reactions were observed.

BACTURCUL T, a diagnostic urine culture tube, was recently manufactured for the purpose of screening test of urinary tract infection. The kit was clinically tried to test its usefulness. The basic study was also carried out. 1) Solution containing known strain of known bacterial count was smeared on BACTURCUL T and cultured. The colony count and change of color were investigated. 2) BACTURCUL T was clinically applied as a screening test and strains and bacterial count were estimated. A same urine sample was forwarded to the central laboratory for identification and culture. Both results were compared. 3) In the basic study, false positive results were observed probably due to limited range of bacterial count from 105 to 104. There was no false negative result. In the clinical trial, 85 out of 116 samples (82%) showed the accordance. If infection could be differentiated from contamination at 105/ml of bacterial count and 50 of bacterial colonies, 109 out of 116 samples showed the accordance. 4) As to the color, the basic study yielded a good result such as high accordance rate as 97% (65/75), particularly in Escherichia coli, Pseudomonas aeruginosa and Proteus. On the other hand, 27 out of 57 positive culture samples showed the accordance between color and bacteria. 5) Urine pH did not seem to influence color reaction. A definite conclusion was, however, deferred. 6) BACTURCUL T seemed to be quite useful as a screening test, but requires some improvement for determination of microorganisms.

1. Six cases of solitary renal cyst were presented mainly for radiological evaluation together with each one of unilateral multicystic kidney and renal abscess. 2. X-ray diagnosis of solitary renal cyst might consist of KUB, IVP, retrograde pyelography, nephrotomography, retroperitoneal pneumography, renal arteriography, and renal cystography. Discussion was made on their usefulness, diagnostic criteria and differential diagnosis.

Intravesical combination chemotherapy was performed in 48 cases with bladder tumors. Mitomycin C 10 mg was administered concomitantly with cytosine arabinoside 20 mg (4 cases, group A), 100 mg (21 cases, group B), 200 mg (3 cases, group C) or 300 mg (20 cases, group D). The clinical results were as follows: 1) Complete disappearance of tumors was found in 24% of group B, in 33% of group C, and in 35% of group D. Clinical improvement including complete disappearance of tumors was found in 25% of group A, in 57% of group B, in 67% of group C, and in 80% of group D. 2) Side effects were found in 25% of group A, in 9.5% of group B, in 33% of group C, and in 20% of group D. But most of them were minor side effects. 3) Recurrence rate was 2.7% within 6 months, and 5% within 18 months. 4) It was concluded that the treatment with mitomycin C 10 mg and cytosine arabinoside 100 mg was satisfactory in the tumors (pedunculated, papillary, of smaller size than the small finger head, or of grade I). The necessary dosage of mitomycin C was 10 mg and that of cytosine arabinoside was 300 mg for the tumor of larger size than the thumb tip even pedunculated, the sessile tumor or the tumor of above gradeII.

From 1975 to 1979, there were 11 patients with pyelocaliceal diverticulum, 8 males and 3 females, out of 7009 newly visited outpatients, an incidence being 0.18%. In these 11 patients, about 80% had calculi in the diverticula. The average age was 38-year-old. The lesions were unilateral and single in all cases, right kidney 5 cases and left 6 cases. The diverticula had communication with the upper calyx in 7, the middle in 3 and the lower in one. The most frequent symptom was lumbar dull pain on the affected side (36%). Symptomatic four cases required surgical treatment such as partial nephrectomy in three cases and diverticulotomy in one. The postoperative courses were uneventful and the symptoms almost subsided.

In total 15, 888 outpatients were newly seen at the Urological Department of Mie University Hospital during the period of 1968 to 1979, 14, 300 patients had urological diseases. The satistical analysis were performed on the patients and revealed some results.

We performed a survey on the iodide test and its adverse effects on a series of 829 DIP patients who had taken the test at our clinic between November, 1984 and August, 1985. Adverse effects were seen in four out of nineteen positive cases of the iodide test. Among the negative 810 cases, 79 were found to present with adverse effects though not statistically significant. Twenty-six out of 131 cases of positive past history of allergy showed a positive reaction whereas 55 out of 698 negative cases showed adverse effects, with a statistical significance at p less than 0.01. The adverse reaction occurred immediately after injection in the majority of cases and in 85%, the reaction was seen after injection of half of the drug. Symptoms also appeared thirty minutes after injection in some cases. Immunological evaluation of the allergy was done in fifteen positive cases. Four cases showed an increase in peripheral eosinophils, three cases showed increased IgE(RIST) and three cases manifested with a decreased CH 50. Urografin-induced lymphocyte blastogenesis (DLST) was positive in six cases. Four cases showed abnormality in more than two tested parameters, and three cases showed complete normal values in all tests. The adverse effects due to contrast medium are considered to occur not as one type or allergic reaction, but to involve other factors as delayed-type reaction which was also seen in 40% of the patients. Close observation of patients after examination with contrast medium is thus mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)

1) 1987年5月～7月の間に県下4施設において, 尿中分離菌460株中グラム陽性菌135株, グラム陰性菌325株で, βラクタマーゼ産生菌は全株の46.7%, グラム陽性菌の14%, グラム陰性菌の60%に認めた.2) P. aeruginosa, E. coli, S. marcescensはグラム陰性菌中に占める頻度, β-ラクタマーゼ産生頻度から代表的なものであった.又分離検出頻度は低いがβ-ラクタマーゼ産生頻度の高率なものは, Acintobacter, Klebsiella, Citrobacter, Enterobacterであった.3) β-ラクタマーゼ産生頻度の高い6菌種では, スルペラゾンに対し74%に感受性をみた.E. coli, Klebsiella, S. epidermidis, P. aeruginosaでは比較的良好であった.4)複雑性尿路感染症26例にスルペラゾンを投与し, 有効率73.1%, 分離菌消失率63%を得た.in vivoのPseudomonas, Serratiaの消失率はそれぞれ50%であった, Clinical survey of microorganisms isolated from urinary tract infection (UTI) was carried out at the four major hospitals in Mie Prefecture from May to July, 1987, and production of beta-lactamase of the microorganisms was determined by the acidimetric method, "beta-checker". Among the total of 460 strains isolated from urine samples, 135 of gram positive cocci and 325 of gram negative rods were contained. Sixty percent of the gram negative rods and 14% of gram positive cocci produced beta-lactamase. Pseudomonas aeruginosa, E. coli and Serratia marcescens were representative organisms which produced beta-lactamase. Acinetobacter, Klebsiella, Enterobacter and Citrobacter species produced beta-lactamase at a higher rate but those were not so frequently isolated. In the sensitivity test to Sulperazone, the representative organisms isolated from urine, as a whole, had a sensitivity of 74% and E. coli, Klebsiella, S. epidermidis and Pseudomonas aeruginosa were highly sensitive, while Enterobacter cloacae and Serratia marcescens showed low sensitivity. The clinical efficacy of Sulperazone was evaluated in 26 patients with complicated UTI. Overall effectiveness rate and eradication rate of beta-lactamase production organisms were 73.1 and 63%, respectively. Sulperazone is concluded to be a useful antibiotic for treating complicated UTI induced by beta-lactamase production organisms from the point of microbiology and safety.

Clinical effects of EHDP on relief of bone pain, changes in bone lesions on X-ray and 99mTc-MDP scintigram and performance status were investigated in 19 patients with bone metastasis from urogenital cancers (4 renal cell cancers, 1 renal pelvic cancer, 4 bladder cancers and 10 prostatic cancers). EHDP was effective in relieving bone pain in prostatic cancer patients with osteoblastic lesions. Bone lesions on X-ray and 99mTc-MDP scintigram were slightly improved in prostatic cancer patients with osteoblastic lesions. Administration of EHDP did not improve the performance status. Changes in laboratory data such as serum alkaline phosphatase, serum calcium and urinary total hydroxy-proline following EHDP administration indicated inhibition of osteolytic activity with no effect on bone formation in the early period of treatment (in 4 weeks) and development of both osteolytic activity and bone formation in the later period (from 8 to 12 weeks). No marked side effects were observed. EHDP seems to be effective in relieving bone pain in prostatic cancer patients with osteoblastic bone metastasis. Moreover, some diphosphonate groups including EHDP are expected to be useful to the patients with malignant hypercalcemia.

1.In an attempt to study its usefulness as a contrast medium for retrograde pyelography, a 2-fold dilution (33.4%) of sodium. iothalamate 66.8% (Conray 400) was used in 23 cases and the results were compared with those with 38% Urografin. The test medium was demonstrated to be not inferior to Urografin in its capacity of visualizing the renal pelvis. 2. In 20 (87%) out of the entire 23 cases the contrast medium gave a clear-cut pyelogram with no blurring of the picture which makes the film incompetent for diagnostic purpose as seen in any instances. 3. As compared to Urografin which was administered contra laterally, Conray 400 was found to be more excellent in 13% and equally satisfactory in 78.3% in its visualization. 4. No adverse reactions worthy of mention was noted. 5. An experiment on the rate of injection confirmed that Conray 400, being lower in viscosity, is far easier to inject than Urografin.

(1) Many new drugs have been discovered lately and most clinicians have been very busy in conducting clinical studies with them. Therefore, cases of experiments at each institution have decreased. Thus, it seems meaningless to collect many clinical results which have been obtained by different methods of study. For that reason, the methods of study were unified beforehand and cooperative clinical studies with cephaloglycin have been made at four universities. As this was the first trial of cooperative clinical studies, the expected purpose "as not attained because of insufficient contact among researchers. But it seems that this trial will be helpful to further cooperative clinical study. (2) One gram of cephaloglycin per day was given to patients of acute uncomplicated cystitis for three days and it was effective in twenty-three cases out of twenty-five (92 %). This result was gained by judging its efficiency from symptoms, urinalysis and culture study. When its efficiency was judged from symptoms and urine findings, it was effective in forty-five cases out of fifty-three (85 %). (3) A comparative study was made between remedial results of a group of patients who had been given cephaloglycin from beginning to healing, and that of another one of patients who had been given cephaloglycin until their conditions of illness were less serious and then given sulfisomezole (2 grams per day) until healing. But significant difference was not observed.

Between 1973 and Oct. 1978, 50 patients with prostatic carcinoma were treated with anti-androgen therapy and, of these 11 cases also received radiotherapy. Post-treatment needle biopsies of the prostate were done about 6 weeks later. Histologically, in the radiation therapy group increased fibrotic reaction and decrease of gland or gland-like structure were marked. These reactions were degenerative change and so, radiotherapy of the prostatic carcinoma was effective. Additionally, marked fibrosis caused by radiation will disturb entrance of anti-androgen drug to the prostatic carcinoma, so that following anti-androgen therapy may be un-effective.

We report a 3-month-old boy who presented with acute right scrotal swelling that was diagnosed to have epididymitis at surgical exploration. Urine culture and urinalysis were negative and IVP revealed no abnormality. White blood count and symptom were improved with chemotherapy. Acute epididymitis in infancy is very rare and this case seems to be the 16th case in Japan.

The subjects of these studies were 240 patients with primary bladder tumors, who were treated in the Urological Department of Mie University Hospital and of Shiohama Hospital during 10 years from Jan. 1965 to Dec. 1974. Of these cases, the incidence rate, cystoscopic findings, histologic findings, therapy of follow-up studies are reported as follows. 1) Incidence : Two hundred and forty patients with bladder tumors were 1.10 per cent of the total number of out-patients treated at the above hospitals, the ratio between male and female patients was 4:1. About ninety-five per cent of patients with bladder tumors were over forty years of age. The highest percentage of affected patients (32.9%) was in their sixties followed by those in their seventies, fifties, and forties. 2) Cystoscopic findings : The sites of the neoplastic growths mostly originated on the lateral wall of the bladder and less so on the trigone and the posterior wall and there were even fewer cases on the bladder neck, the dome area of the anterior wall. Most of tumors (61.3%) showed single growths compared with multiple growths (38.796). The tumors were from rice grain to walnut in size and had various shapes. Of all the cases studied there were 93 papillary and pedunculated cases (54.7%), 39 papillary and sessile cases (22.4%) and 38 non-papillary and sessile cases. 3) Histologic findings : Of 1S9 cases histologically examined, lSI cases (95.1%) were transitional cell carcinoma, the the grading of which was as follows: 17 cases Grade I (11.3%), 74 cases Grade II (49.0%), 47 cases Grade III (31.1%) and 13 cases Grade IV (8.6%), respectively. The number of patients with squamous cell carcinoma was 4 (2.5%) and with adenocarcinoma 3 (1.9%), including 2 with urachal adenocarcinoma. Concerning non-epithelial tumors, a case of leiomyosarcoma (0.696) was noted. There was no evidence of any relationship between the grading of the tumors and the chief complaints of the patients. Most of the small or tiny growths were histologically characterized by well differentiated transitonal cell carcinoma (Grade I or II), while medium or large sized tumors showed low differentiation in appearance (Grade III or IV). The papillary and sessile tumors were largely characterized by well-differentiated transitional cell carcinoma, compared with the non-papillary tumors showing mostly lower differentiation in histological types. There was no apparent relationship between the grading of the tumors and the ages of the patients. 4) Five-year survival : Of the 56 patients periodically checked, the survival rate of 5 years was 71.6 per cent. Among the patients with TUEC or TUR treatment, the 5-year survival was 84.6 per cent, while the 5-year survival among patients with partial cystectomy was 75.8 per cent. The 5-year survival among patients with surgical therapy in association with chemotherapy and among patients with surgery and radiotherapy was similar (75.0% and 71.4%, respectively), though with the recurrence of tumors, radiotherapy associated with surgery proved more effective than chemotherapy alone.