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Summary: Unilateral ductuli efferentia testis of immature rat were severed in order to interrupt the continuity between testis and epididymis and angiotensin-converting enzyme (ACE) activities were measured 5 weeks after the operation. The epididymal ACE on the operated side increased to nearly the same level as that on the contralateral side, but the testicular ACE activity on the operated side was markedly lower than that on the contralateral side. On immunofluorescent study using antiserum against purified rat lung ACE, ACE could be found in the tubular epithelial cells of the operated epididymis. These results suggest that epididymis itself synthesize ACE without connection to testis. Zusammenfassung: Die Ductuli efferentes in den Hoden von nicht geschlechtsreifen Ratten wurden einseitig durchtrennt, um die Verbindung zwischen Hoden und Nebenhoden zu unterbrechen. 5 Wochen postoperativ wurde die Aktivitat des Angiotensin-converting-Enzyms (ACE) gemessen. Das ACE im Nebenhoden der operierten Seite stieg annahernd auf das Niveau der kontralateralen Seite, jedoch war die ACE-Aktivitat im Hoden der operierten Seite bedeutend niedriger als auf der kontralateralen Seite. Immunfluores-zenzuntersuchungen mit Antiserum gegen gereinigtes ACE aus Rattenlungen ergab einen Nachweis von ACE in Tubulusepithelzellen des operierten Nebenhodens. Diese Ergebnisse legen nahe, das der Nebenhoden selbst ohne Verbindung zum Hoden ACE synthetisiert.

PURPOSE A survey of stage I testicular tumors in the Chugoku-Shikoku district was taken in order to explore the clinical characteristics. PATIENTS AND METHODS Three hundred and forty eight cases of stage I testicular tumor treated at 46 facilities in the Chugoku-Shikoku district between 1984 and 1992 were collected. Subjects' background factors, treatment methods and prognosis were studied. RESULTS Tissue types were 249 (71.6%) seminoma and 99 (28.4%) non-seminoma. Adjuvant therapy for seminoma cases included 138 post-operative radiotherapy (4 recurrences, 3 cancer deaths), 57 chemotherapy (no recurrences, 2 contralateral testis tumor cases) and 48 were under surveillance (no recurrence). Adjuvant therapy for non-seminoma cases included 47 chemotherapy (1 recurrence) and retroperitoneal lymph node dissection was performed on 6 cases. Forty cases were under surveillance (1 recurrence). Of 8 (2.3%) cases with recurrence, 6 showed onset within two years and 2 after two years. Four of the 8 cases with recurrence were seminoma (1.1% of seminoma cases) and the other 4 were non-seminoma (4.0% of non-seminoma cases). All 3 (0.9% of all cases) of the cancer death cases were seminoma that received post-operative radiotherapy, while there were no cancer deaths in non-seminoma cases. CONCLUSION Prognosis of stage I testicular tumor is good. Although the recurrence rate was higher in non-seminoma cases, cancer deaths were only observed in seminoma cases.

Background: information concerning the mechanisms underlying recovery from hydronephrosis is limited. The frequency of apoptosis during healing from hydronephrosis was studied using a rat kidney model. Methods: The presence of apoptosis was studied using an in situ DNA 3 end labeling method, electron microscopy, and agarose gel electrophoresis. Results: The degree of apoptosis in both the medulla and cortex gradually increased during ureteral obstruction as shown by in situ DNA 3 end labeling. Release of the ureteral obstruction resulted in a further increase in the degree of apoptosis in the medulla and cortex. The increase in apoptosis in the medulla was transient and lasted for only 4 days following release, while that in the cortex continued for at least 3 weeks. Apoptosis in the glomerulus was not observed. Electron microscopy revealed cells with aggregated chromatin in compact granular masses that abutted the nuclear membrane. Following release of ureteral obstruction, DNA fragmentation characteristic of apoptosis was visible on agarose gel electrophoresis. Conclusion: These results suggest that apoptosis is involved in post-obstructive tubular damage in the rat kidney.

BACKGROUND It is well known that many diseases may be associated with obesity resulting from an energy-rich diet, and that a westernized diet may increase the incidence of urinary stone formation. To evaluate degree of obesity, we investigated body mass index (BMI) in patients with calcium containing upper urinary stones and examined their blood with regard to lipid metabolism. METHODS Between July 1994 and December 1995, we analyzed 332 fresh renal-stone formers (253 males and 79 females) who visited 7 hospitals located in Ehime prefecture. As a control, 949 residents older than 20 years (387 males and 562 females) of the same prefecture were also examined by the annual Ehime prefecture office report of 1994. Body mass index as degree of obesity, stone-recurrence, blood test and other complicated diseases were examined. RESULTS In male stone formers the rate of obesity was significantly higher than that of control males (p < 0.001). The differences were seen only in their twenties and fifties. Furthermore, among male stone formers the rate of obesity was significantly higher in recurrent stone formers than in single stone formers (p < 0.05). On the other hand, in female, there was no significant difference in the rate of obesity between stone formers and controls. No difference was seen between recurrent stone formers and single stone formers. In the blood test, there was no differences in the level of calcium, phosphate and uric acid between stone formers and controls. The level of cholesterol and triglyceride in male were significantly higher in controls (p < 0.01) and there was no difference in the level of high density lipoprotein (HDL) between stone formers and controls. Among the stone formers, 48 males (20.0%) and 17 females (21.5%) had other diseases. The rate of complicated diseases was similar to that of controls and no specific diseases in the stone formers were identified. CONCLUSION Our report suggested that obesity in male should be considered as a risk factor for calcium containing stone formation.

BACKGROUND Monoclonal antibodies (mABs) against urinary proteins originated from renal tubules were obtained in order to find a possible tumor marker for renal cell carcinoma. METHODS Urine samples were collected from healthy adult males. After removal of Thamm-Horsfall protein (THP) by sodium chloride precipitation, supernatant urine was ultrafiltered, thus, THP-free urinary proteins were obtained. Then, proteins of plasma origin were removed by circulating the urinary proteins through an affinity column which contained immobilized rabbit anti-human whole serum immunoglobulins. BALB/c mice were immunized with the THP- and plasma protein-free urinary proteins. The spleen cells were fused with mouse myeloma cells. Hybridomas were screened by indirect immunofluorescence of fresh frozen kidney tissue sections using culture supernatants. RESULTS Five hybridomas producing mAbs which reacted with renal tubular segments were established. One mAb reacted strongly with distal renal tubules. Using this mAb, formalin fixed and paraffin embedded sections of 39 renal cell carcinomas were stained by immunoperoxidase method. Twenty-six of the 39 cancer tissues (66.7%) were stained positive. According to the histological classification, positive staining rate of clear cell subtype, and mixed subtype was 75% (6/8), 80% (8/10) and 66.7% (6/9), respectively. According to the tumor grade, positive staining rate of G1, G2, G3 was 66.7% (6/9), 71.4% (15/21) and 55.5% (5/9), respectively. CONCLUSION These findings indicate that most of renal cell carcinomas were originated from common precursor cells for both proximal and distal tubules, because normal proximal tubular cells were not stained by the mAb.

The effects of suramin on the growth of seminal vesicles (SVs) of neonatal mice were investigated in vitro. SVs from 0-day-old male mice were cultured in serum-free chemically defined medium supplemented with 5 alpha-dihydrotestosterone (DHT, 10(-8) M) and insulin (10 micrograms/ml), alone and in combination. Prior to culture, SVs from 0-day-old mice had no epithelial branches. SVs cultured in medium with DHT formed numerous epithelial branches, while epithelial branching did not occur in SVs cultured without DHT. The addition of suramin (0.2 mM) to medium containing DHT inhibited the formation of epithelial branches almost completely. Removal of suramin from the medium on days 2, 4, and 6 of culture initiated the formation of epithelial branches. Suramin (0.2 mM) reversibly decreased 3H-thymidine-labeling indices (3H-LI) of both epithelium and mesenchyme of SVs cultured in medium with DHT plus insulin or DHT alone during 8 days of culture. Suramin also decreased 3H-LI of both epithelium and mesenchyme of SVs cultured in medium with insulin alone. The present study indicates that suramin reversibly inhibits not only androgen-dependent but also androgen-independent growth and ductal branching morphogenesis of neonatal mouse SVs.

We performed percutaneous endopyeloplasty on 20 patients between February, 1988 and July, 1993. Eighteen patients had primary and two had secondary ureteropelvic junction (UPJ) obstructions. There were 15 female and 5 male patients, whose ages ranged from 14 to 77, with an average of 43.6. The length of the follow-up after pyeloplasty ranged from 4 to 69 months with an average of 28.7 months. Among the 20 patients, there were 4 high insertion type cases, a bifid renal pelvis in one case and one case combined with a renal stone. Incisions were made with a hook-shaped cold knife and Ono's transpelvic extraureteral approach was used in most patients. Catheters were placed at the upper and the lower of renal pelvis in the patient with a bifid renal pelvis. In the case with a renal stone, pyeloplasty was successively performed after percutaneous nephrolithotomy in a single session. An endopyelotomy stent (14 Fr) was indwelled for 6 weeks in all patients except one. All patients had a low grade fever and abdominal pain for a few days after their operations, but there were no major complications. In nineteen patients (95%), the symptoms improved and their obstructive patterns disappeared or improved during follow-up. Complete ureteral stricture was found in one case at the removal of the stent and open pyeloplasty was performed. Percutaneous endopyeloplasty is a safe and useful technique, but further evaluation and/or better techniques are needed for avoiding recurrence of obstruction.

To evaluate the interaction in the renal tubules between calcium oxalate microliths and glycosaminoglycans, especially heparan sulfate, we planned an experimentally-induced calcium oxalate microlith-producing model in rats. We found by immunofluorescence study and immunoelectron microscopy using the heparan sulfate antibody that heparan sulfate was produced in the renal tubular cells in the formation of calcium oxalate microliths and that heparan sulfate exists in the microliths. Heparan sulfate/crystal interaction might play a role as a nucleating agent and promote stone enlargement.

Reconstruction of bilaterally damaged ureters after pelvic surgery is challenging. We successfully treated such a patient with a uretero-appendicocystostomy on the right side and a psoas hitch on the left side.

The role of Fas in the apoptosis of testicular germ cells was investigated in BALB/c mice and Fas-deficient lpr/lpr mice. Spontaneous apoptosis of germ cells was observed in the testes of 40-day-old BALB/c mice, and experimentally induced cryptorchidism increased this apoptosis to such an extent that there was a decrease in the weight of the testis. Flow cytometry and immunohistochemistry using a Fas-specific monoclonal antibody demonstrated expression of Fas on germ cells including spermatogonia, spermatocytes, and spermatids. Furthermore, analysis by flow cytometry suggested that Fas expression on germ cells was increased following cryptorchidism. However, spontaneous and cryptorchidism-induced apoptosis of germ cells were also observed in 40-day-old Fas-deficient lpr/lpr mice. Moreover, testis weight also decreased following cryptorchidism in the mutant mice. The present results may indicate that the expression of Fas on germ cells does not correlate with spontaneous apoptosis or apoptosis induced by cryptorchidism. However, on the contrary, this study shows that Fas are partly involved in cryptorchidism-induced apoptosis, because the decrease in testis weight of lpr/lpr mice was less than that in BALB/c mice.

A 72-year-old man complained of general fatigue and had low grade fever. Ultrasonography, excretory urography, retrograde urography, and computed tomography revealed left hydronephrosis due to a middle ureteral tumor. A nephroureterectomy was performed. The histological diagnosis was hyperkeratosis with a cholesteatoma.

We evaluated flow cytometric (FCM) analysis of transferrin receptor (TFR) expression as a marker for the malignant potential in transitional cell carcinoma (TCC). TCCs from 55 patients were analyzed by FCM using an anti-TFR monoclonal antibody (CD71) and a TCC-specific monoclonal antibody (EH14), which recognizes most TCC cells irrespective of the grade. The cells were divided into subpopulations according to DNA ploidy determined simultaneously. TFR expression correlated well with the grade and the stage of the tumors. TFR expression of the aneuploid tumors was significantly higher than that of the euploid tumors in all subpopulations. EH14 expression did not correlate with the grade or the stage of the tumors. EH14 expression of the aneuploid tumors was significantly higher than that of the euploid tumors in the whole cell population but not in the subpopulations. In moderately differentiated tumors or in TI tumors, TFR expression was higher in multiple or recurrent tumors than in simple tumors. The cell size or shape were not the primary reasons for the enhanced expression of TFR in the high-grade or the high-stage tumors; instead, overproduction of TFR may take place in these tumors. Clinically, many of the TCC tumors are grouped into G2 or T1 tumors, some of which will be invasive cancers. Quantitative analysis of TFR expression using FCM may be useful to predict the prognosis of these tumors.

BACKGROUND In the adult male rat prostate, castration induces apoptosis of epithelial cells concomitant with the increase in transforming growth factor-beta 1 (TGF-beta 1). In the present study, we investigated the effects of castration on apoptosis and TGF-beta 1 mRNA in neonatal mouse seminal vesicles. METHODS 5-day-old BALB/c mice were castrated by Pfeifer's method. We estimated the weight, 3H-thymidine uptake by whole seminal vesicles, the amount of TGF-beta 1 mRNA by RT-PCR method, and the apoptotic index of both epithelium and mesenchyme. RESULTS The castration of 5-day-old neonatal mice resulted in much less weight of seminal vesicles and DNA synthesis estimated by 3H-thymidine uptake by whole seminal vesicles compared to intact neonatal mice, indicating that the growth of neonatal mouse seminal vesicles depends on androgens secreted by the testis. The amount of TGF-beta 1 mRNA estimated by RT-PCR method increased 4 days after castration at 5 days of age. However, the castration did not induce apoptosis in the seminal vesicles. CONCLUSION The present study indicates that castration of neonatal mice does not induce apoptosis in the seminal vesicles, although it does a transient increase in TGF-beta 1 mRNA in the seminal vesicles.

BACKGROUND For neurogenic bladder (NGB) patients with vesicoureteral reflux (VUR), renal deterioration constitutes a primary threat to survival. Although anti-reflux surgery for those patients was reported to be effective, the efficacy of clean intermittent catheterization (CIC) in such patients still remains to be clarified. METHODS Sixteen neurogenic bladder patients with VUR were treated with CIC. Eight of them had spina bifida and 3 had radical hysterectomy for uterine cancer. Other 5 patients had spinal cord injury, spondyrocace, measles encephalopathy, and 2 unknown diseases, respectively. Hyperactive bladder was noted in 11 patients, whereas hypoactive bladder was noted in 3. Three patients were not evaluated. RESULTS VUR was improved in only 3 patients (3 ureters), whose VUR grades were not more than III. Nine patients (13 ureters) had to have antireflux surgery. Although 3 of them needed bladder augmentation afterwards, the success rate of the antireflux surgery was 84.6%. CONCLUSION We concluded that CIC alone was not effective to control VUR in neurogenic bladder patients. Nevertheless, CIC remained a good treatment option when VUR was managed surgically.

The relationship between the period for recovery from hydronephrosis and the characteristics of the obstruction still needs to be clarified. In rat kidney the left ureter was completely obstructed for 3, 7, 14 and 21 d and the renal function was measured by renal scintigraphy using 99mTC-dimercaptosuccinic acid 3, 7 and 14 d after the obstruction was removed. In addition, recovery from unilateral partial obstruction (PO) of different degrees of severity for 7 d was examined. The kidneys with very mild PO recovered within 3 d and those with a very long period of complete obstruction (CO) did not exhibit any significant recovery. However, most of the kidneys with CO of various durations and those with 7 days PO of various degrees of severity exhibited maximum recovery 7 d after the release of the obstruction. This study suggests that the period required for maximum recovery from hydronephrosis is usually constant, unless the obstruction is too mild to cause any damage or too long to permit any recovery.

Extracorporeal urinary bypass was attempted in a patient with malignant ureteral obstruction. A nephrostomy was drained into the bladder by connecting the tube to a cystostomy catheter. This method made the patient free from a collecting bag without any significant complications. This method may improve the quality of life of patients with malignant ureteral obstruction, when their bladder is intact.

We treated a 25-year-old hemophilia A patient (FVIII:C activity 2%) with left ureteral stone by means of extracorporeal shock wave lithotripsy under replacement therapy of concentrated Factor VIII material. The patient was attacked by sudden onset of left renal colic with gross hematuria on the 12th postoperative day. Renal ultrasonography and computed tomography demonstrated subcapsular bleeding of the left kidney. In spite of usual antihemophiliac replacement therapy, bleeding was extended from the retroperitoneal space to intraperitoneal and intrapleural space because potent Factor VIII inhibitors (14 Bethesda Unit) was produced. After embolization of the left renal artery, double filtration plasmapheresis and bypassing therapy using prothrombin complex concentrate were performed effectively to save the patient's life.

Bladder dysfunction after radical hysterectomy and/or radiotherapy for uterine cancer is a serious problem. Its pathogenesis has not been well elucidated. Urodynamic and clinical evaluations were performed in 53 patients; 24 of them underwent radical hysterectomy and postoperative radiotherapy (RH + RT), 13 had radical hysterectomy alone (RH), 7 had modified radical hysterectomy (mRH), 9 had radiotherapy alone (RT). Nine preoperative patients without micturition disturbance were examined, serving as controls. Patients with more than 50 ml of residual urine were only 3 in RH + RT, 2 in RH and 1 in RT. Bladder volumes at maximum desire to void were significantly lower in RT than in controls. Intravesical pressures at maximum desire to void were significantly higher in RH + RT and RH than in controls, but there were no significant differences between mRH or RT and controls. Detrusor compliances significantly decreased after radical hysterectomy and/or radiotherapy. Maximum urethral closure pressures significantly decreased after radical hysterectomy with or without radiotherapy. In RH + RT, 18 patients (75%) of them mainly complained of urinary incontinence. Their functional profile lengths were significantly shorter than in controls. We conclude that the pelvic plexus injury by radical hysterectomy compromise both urethral closure function and bladder compliance.

A patient with a solitary renal mass as the only manifest lesion of B-cell lymphoma was reported. The surgical specimen revealed that the lesion was histologically limited to the renal parenchyma. Liver dysfunction prevented him from receiving systemic chemotherapy. Mediastinal and mesenteric lymph node involvements developed 6 months later. Fortunately, the patient survived without recurrence for 18 months after the surgical removal of these tumors and intensive chemotherapy. Systemic chemotherapy is recommended on patients with renal lymphoma even if the tumor seems to be limited to the organ.

Urinary heparan sulfate (U-HS) and chondroitin sulfate (U-ChS) were isolated and partially purified using two steps of anion-exchange chromatography (DE-52 and Dowex 1 x 2). Uronic acid content of these urinary glycosaminoglycans (GAGs) and commercial heparan sulfate (C-HS) and chondroitin-6-sulfate (C-C6S) was as follows; U-HS: 22.4%, U-ChS: 32.0%, C-HS: 41.6%, C-C6S: 36.0%. The inhibitory activity of these GAGs on calcium oxalate crystal growth was examined using the crystal-seed system described by Koide et al. The influence of uric acid on the inhibitory activity of the GAGs was also studied. U-HS and U-ChS exhibited nearly equal inhibitory activity to their respective commercial preparations. The inhibitory activity of U-HS was stronger than that of U-ChS. Uric acid suppressed the inhibitory activity of both, and the degree of suppression was stronger in U-ChS than in U-HS. The molecular weight of the urinary GAGs was compared to that of the commercial chondroitin-6-sulfate (C6S; m.w. between 40,000 and 80,000) by gel-filtration using Sephacryl S-300HR. C6S was eluted slightly behind the void volume. U-ChS was eluted much behind C6S. Therefore, the molecular weight of U-ChS was thought to be much smaller than that of C6S. U-HS was eluted into two peaks; the first one at the void volume and the second one between the peaks of C6S and U-ChS. These findings indicate the possibility that part of U-HS exists in the form of proteoglycan.

We studied the inhibitory effect of urinary glycosaminoglycans (GAGs), in the natural form, on calcium oxalate crystals. Control urine was collected from five healthy subjects and filtered by 5 microns and 0.22 micron membranes. The urine was cut off by a membrane of 30,000 M.W. and the remaining urine was fractionated into three groups by anion-exchange chromatography on DEAE-cellulose: peak A contained only protein, peak B both protein and GAGs and peak C only GAGs. Peak A and peak B were fractionated again through a Sephacryl S-200 gel column. Each fractionated sample was examined for the inhibitory effect on calcium oxalate crystal growth using the 14C-oxalate seeded crystal growth assay in a metastable solution developed by Koide et al. GAGs were determined by two-dimensional electrophoresis on cellulose acetate membrane. SDS-polyacrylamide electrophoresis was used to determine the molecular weights of proteins. Peak A was found to have many kinds of proteins which had low inhibitory effects. Peak B had three kinds of proteins such as those with molecular weights of 130,000, 45,000 and 35,000 as well as uronic acid. These proteins and uronic acid had high inhibitory effect and the highest inhibitory effect was found in the fraction of around 50,000 M.W. where protein and uronic acid were contained. The molecular weight of this protein was 42,000 by SDS electrophoresis. Uronic acid was a keratan sulphate by a two-dimensional electrophoresis. In peak C there were mainly chondroitin sulphate and a small amount of heparan sulfate which had high inhibitory effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunizing mice with a transitional cell cancer (TCC) tissue in the renal pelvis, we produced a monoclonal antibody (EH14) against new epithelial antigens. After the mice were immunized repeatedly, their splenic cells were harvested and fused with NS/1 myeloma cells. The normal kidney tissue of the same patient was used on Dot blots to select the hybridoma. A a result, one hybridoma whose antibody (EH14) reacted very strongly with TCC but only faintly with normal kidney tissue or normal bladder mucosa was obtained. On immunohistochemistry, EH14 stained all of the 29 TCC tissues. EH14 also stained uterus cancer (7/7) and gastric cancer (6/6) as well as the normal squamous cell and many types of the normal epithelium. All of the lymphnodes containing metastatic bladder cancer were strongly stained with EH14. EH14, however, did not stain interstitial tissues, muscles and sarcomas. The molecular weight of the antigen recognized by EH14 was 14KD and 28 KD on Western blot analysis, and the antigen was stable with formalin or ethanol. The antigen was not the same as that reported previously, and may be useful as a histological marker of TCC.

In 31 transitional cell cancer (TCC) tissues and 5 normal bladder muscosae (NBM), we compared the results of flow cytometry (FCM) and immunohistochemical examination in evaluating the expression of Thomsen-Friedenreich antigen (T-Ag) using a monoclonal antibody. On immunohistochemical examination, 14 (45%) cancer tissues showed T-Ag, while 7 (23%) cancer tissues and all NBM showed only cryptic T-Ag, which was detected only after neurminidase treatment. Ten (32%) high grade cancer tissues showed neither T-Ag nor cryptic T-Ag. On FCM the T-Ag positive cells (TPC) and the T-Ag positive cells after neuraminidase treatment (nTPC) were counted in fresh cell suspensions. FCM was more sensitive than immunohistochemical study in detecting T-Ag. Additionally, FCM revealed that some tumors had both T-Ag and cryptic T-Ag at the same time. The ratio of nTPC to TPC was well correlated with the stage or grade of the tumor and may be a more reliable marker of TCC than the expression of T-Ag assessed by immunohistochemical techniques.

Urinary stones are formed in four stages: crystal nucleation, crystal growth, crystal aggregation, and concretion. The following study was performed to understand the yet unclear mechanism of concretion.

A 39-year-old woman with right ovarian vein syndrome accompanied by contralateral ovarian cyst is reported. Removal of the left ovarian cyst with right ureterolysis for removal of the mechanical obstruction gave a good result. It is concluded that the etiology in this case was compression of the ureter by the enlarged ovarian vein, which had an increased blood flow from contralateral venous anastomose.

The effects of mannitol, methylprednisolone, furosemide, inosine, indomethacin and captopril on the recovery from hydronephrosis were examined in rat kidneys. After 1 week of ureteral obstruction, left ureterocystostomy was performed in order to release the obstruction. Following ureteral release, mannitol, methylprednisolone, inosine, furosemide, captopril and indomethacin were given intravenously or orally. A saline group and non-treated control rats were also examined for comparison. 4 weeks after ureterocystostomy, 0.5 microCi of 203Hg-labelled chlormerodrin was given intravenously and the animals were sacrificed 48 h later. The left kidneys were significantly heavier in the mannitol-, methylprednisolone-, and inosine-treated groups than those of the control groups. The chlormerodrin uptake ratios of the left kidneys were significantly higher in the mannitol-, methylprednisolone-, captopril- and indomethacin-treated groups than in the control groups. These results suggest that the release of obstruction solely is not complete treatment for hydronephrosis, but that appropriate medical treatment may enhance the recovery from hydronephrosis.

The muscular architecture of the guinea-pig ureter at different levels was examined by scanning electron microscopy. In the middle portion of the ureter, bundles of smooth muscle fibers were rather randomly oriented with respect to each other and to the long axis of the ureter, forming an irregular network. The muscle fibers of the upper ureter were mostly circularly oriented with a few outermost longitudinal muscle bundles. In the lower portion, the muscle bundles were predominantly longitudinally oriented overlying a deeper circular muscle layer. At any level examined, individual muscle fibers were about 100 to 150 microns. long and about 5 microns. wide, exhibiting a generally smooth surface. The adjacent muscle fibers were frequently interconnected by small lateral projections. In the pelvic portion, thin and short longitudinal muscle bundles were scattered over the inner circular muscles. Individual muscle fibers were spindle-shaped, about 70 microns. long, and 5 microns. wide at their thickest central portion. They were characterized by a rugged surface with many irregular projections and depressions. These muscle fibers may represent pacemaker cells. The findings were discussed in relation to the peristaltic movement of the ureter.

Complete urethral duplication is a rare anomaly in boys. About 60 cases have been reported in the literature, of which approximately one-third were managed with a surgical procedure of total excision of the accessory urethra. Another third were managed by partial excision, and the rest were managed conservatively. Here 2 cases are presented, and the surgical treatment is discussed.

Our surgical experience with 7 cases of intrarenal vascular malformation is reported. Based on angiographic criteria the so-called congenital arteriovenous fistula of the kidney may be classified either as the cirsoid type, which represents a truly congenital form of arteriovenous malformation, or as the aneurysmal type, which is considered to be idiopathic or spontaneous. These 2 types of arteriovenous malformations are compared with regard to clinical presentation and the choice of surgical treatment for each type is discussed.

The solubility of uric acid and the stability of supersaturation of monosodium urate (NaU) were studied in buffer solutions containing 150 mM sodium in the physiological urinary pH range at 37C. The solubility of uric acid increased with the rise in pH, and the total dissolved urate (undissociated uric acid + urate anion) concentration did not change during seven-day incubation in the pH range below 6.6. In this pH range, the calculated concentration of undissociated uric acid was constant (about six mg./dl.). Consequently, the increasing solubility of uric acid with the rise in pH depended solely on the increase of urate anion. As much as 220 mg./dl. of uric acid could be dissolved for 24 hours at pH 7.0. But following seven-day incubation the total dissolved urate concentration decreased to 16 mg./dl. due to NaU crystallization. The stability of NaU supersaturation depended not only on the concentration of sodium and urate anion but also on time and pH. When monopotassium urate crystals were incubated for seven days, the total dissolved urate concentration decreased according to NaU crystallization; the higher the pH, the more marked the decrease. However, at least some 80 mg./dl. of total dissolved urate was stable up to pH 8.2 within 24 hours. These findings can well explain why NaU crystals are seldom formed in the normal urine. Urinary stasis and/or pathological high urinary pH may cause NaU crystallization.

We have demonstrated that urinary uric acid crystals contain an organic matrix within the crystalline boundaries, morphologically similar to that of uric acid stones. Among several glycosaminoglycans in urine, heparan sulfate was almost exclusively identified in this matrix, as in that of uric acid stones. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) showed that several proteins in urine were incorporated in this matrix on a selective basis; two of which were albumin and Tamm-Horsfall mucoprotein. An affinity of uric acid or urate for selective urinary macromolecules in a liquid phase was supposed to be the origin of this matrix. But the proteins in the uric acid stone matrix were not separated by SDS-PAGE. Therefore we could not conclude whether the organic matrix of urinary uric acid crystals is similar to that of uric acid stones.

Stop-flow analysis was performed before and after parathyroidectomy in 7 kidneys which appeared to be normal in urogram in the patients with primary hyperparathyroidism. The main functional change in the kidney, which was induced by excess of parathyroid hormone, seemed to occur at the proximal tubules. This change was similar to that of the result in animal experiment. The functional damage in the tubules might be reversible, since the normal stop-flow pattern was obtained immediately after parathyroidectomy. No remarkable changes were found in the stop-flow patterns in 3 patients with urolithiasis due to other causes, as in the normal kidneys of 2 control patients.

Angiongensin converting enzyme (ACE) activities in 46 benign prostatic hypertrophy (BPH) tissues from 23 patients were compared with respect to histologic patterns, i.e., cystic, adenomatous and fibromuscular components. There was a good correlation between the enzyme activity and the percentage of cystic component in the tissue. On immunofluorescent study using antiserum against purified human kidney ACE, human prostatic ACE in tissues from BPH was mainly located in tubular epithelial cells and cystic lumens.

A typical case of pheochromocytoina of the bladder is presented, and reported cases are reviewed.

On the top of the inverted papilloma some pits with occasional outflow of mucoid material were observed with scanning electron microscope. The epithelial cells facing microcyst showed some special characteristics under transmission electron microscope.

At first, urinary stones were classified according to their inorganic components (apatite, struvite, calcium oxalate monohydrate, calcium oxalate dihydrate and uric acid). Then, matrix glycosaminoglycan was extracted from the stones in each group and was analyzed by 2-dimensional electrophoresis. There were differences in the glycosaminoglycan content of matrices among different groups of urinary stones. The principal matrix glycosaminoglycan content consisted of hyaluronic acid in apatite and struvite stones, heparan sulfate in calcium oxalate monohydrate and uric acid stones, and hyaluronic acid and heparan sulfate in calcium oxalate dihydrate stones. We conclude that hyaluronic acid and/or heparan sulfate has an important role in urinary stone formation.