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Prostate cancer, bladder cancer, renal cancer and testicular cancer are common among urological cancers. The treatment strategy for testicular cancer using chemotherapy has been well established and has been shown to be successful. Chemotherapy and radiotherapy play important roles in multidisciplinary therapy for bladder cancer. Radiotherapy is often used as a radical treatment that is practically equivalent to surgery for prostate cancer. In addition, radiotherapy is useful in cases of bone or brain metastases. In the field of chemotherapy, the development of new agents that would make breakthroughs similar to that of cisplatin is awaited. Taxanes and gemcitabine are good candidates. In the field of radiotherapy, 3D conformal radiation therapy (CRT), which has excellent beam distribution, has recently come into wide use. Moreover, brachytherapy and proton and ion beam therapy are expected to prove useful in prostate cancer therapy.

s of the 3rd International Symposium on Pediatric Inflammatory Bowel Disease S433 therapy after bowel resection. Four patients completed 12 months follow-up after surgery on clinical remission. Two of these patients have undergone a control colonoscopy, showing Rutgeerts score i0 and i1. The other 3 patients remain in clinical remission three months after resection. Conclusions: Combined treatment with anti-TNF and AZA has shown to be effective as prophylactic therapy in our patients with CD after bowel resection. P-106 The clinical relevance of tacrolimus for ulcerative colitis in children: a national survey of the treatments for pediatric inflammatory bowel disease in Japan T. Yanagi1 *, K. Ushijima1, T. Shimizu2, T. Tomomasa3, H. Tajiri4, R. Kunisaki5, T. Ishige3, H. Yamada6, K. Arai7, Y. Ohtsuka2, A. Yoden8, T. Aomatsu8, S. Nagata9, K. Uchida10, T. Kazuo11. 1Kurume University School of Medicine, Fukuoka, Japan, 2Juntendo University School of Medicine, Tokyo, Japan, 3Gunma University Graduate School of Medicine, Gunma, Japan, 4Osaka General Medical Center, Osaka, Japan, 5Yokohama City University Medical Center, Kanagawa, Japan, 6Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan, 7National Center for Child Health and Development, Tokyo, Japan, 8Osaka Medical College, Osaka, Japan, 9Tokyo Women’s Medical University Hospital, Tokyo, Japan, 10Mie University Hospital, Mie, Japan, 11Saitama University, Saitama, Japan Aim: To evaluate the effectiveness and safety of FK506 for pediatric UC in Japan. Methods: Fifty-four UC patients aged

Background: A prospective study was performed to investigate combined treatment with intra-arterial chemotherapy and radiation therapy for bladder preservation in locally invasive bladder cancer. Methods: Patients with invasive bladder cancer, stage T2–3N0M0, were included in the study. Intra-arterial chemotherapy was performed with three injections of methotrexate and cisplatin at 3-week intervals. Simultaneously, the patients underwent X-ray irradiation (40 Gy) of the small pelvic space. Where a post-treatment transurethral resection (TUR) biopsy showed no residual tumor, the tumor site was irradiated by a 30 Gy proton beam and the bladder was preserved. Where tumors remained, radical cystectomy was performed. Results: Between 1990 and 1996, 42 patients were treated according to this protocol. Post-treatment TUR biopsy and urine cytology showed no residual tumors in 39 of 42 cases (93%). The bladder was preserved in accordance with the study protocol in 36 cases. A median follow-up of 38 months showed 3-year non-recurrence in 72% of bladder-preserved patients and the rate of bladder preservation was 84%. The nine recurrences included eight cases of superficial bladder recurrence. One cancer death occurred among the bladder-preservation patients, giving 3-year survival and cause-specific survival rates of 84% and 100%, respectively. Although bladder function decreased slightly in compliance, bladder capacity was retained in almost all cases. Conclusions: This regimen is useful for bladder preservation in T2–3 locally invasive bladder cancer. Information from more cases and the results of more long-term observations are needed, as is an evaluation of appropriate subject selection and factors associated with quality of life issues, particularly regarding bladder function.

The presence of systemic inflammation before surgery, as evidenced by the glasgow prognostic score (mGPS), predicts poor long-term survival in colorectal cancer. The aim was to examine the relationship between the preoperative mGPS and the development of postoperative complications in patients undergoing potentially curative resection for colorectal cancer. Patients (n=455) who underwent potentially curative resections between 2003 and 2007 were assessed consecutively, and details were recorded in a database. The majority of patients presented for elective surgery (85%) were over the age of 65 years (70%), were male (58%), were deprived (53%), and had TNM stage I/II disease (61%), had preoperative haemoglobin (56%), white cell count (87%) and mGPS 0 (58%) in the normal range. After surgery, 86 (19%) patients developed a postoperative complication; 70 (81%) of which were infectious complications. On multivariate analysis, peritoneal soiling (P0.01), elevated preoperative white cell count (P0.05) and mGPS (P0.01) were independently associated with increased risk of developing a postoperative infection. In elective patients, only the mGPS (OR=1.75, 95% CI=1.17-2.63, P=0.007) was significantly associated with increased risk of developing a postoperative infection. Preoperative elevated mGPS predicts increased postoperative infectious complications in patients undergoing potentially curative resection for colorectal cancer.

Background: Hamartomas of the urinary bladder are extremely rare. We report on a case in a 58-year-old female who presented with the chief complaint of pain on urination. Methods/Results: Cystoscopy revealed a solid tumor on the left posterior wall of the bladder. Transurethral resection of the tumor failed to provide a definitive pathological diagnosis of the tumor. Thus, we performed partial cystectomy. The pathological diagnosis was hamartoma arising from the urinary bladder. Conclusion: This is the ninth case diagnosed as urinary bladder hamartoma to be reported in the literature.

BACKGROUND We previously reported that the average tumor growth speed estimated from clinical findings may be useful as a prognostic factor to determine the stage progression in superficial bladder cancer. Here, we examined the relationship between the dynamic estimation based on the average tumor growth speed and the static estimation based on the biological proliferative activity determined from bromodeoxyuridine (BrdU) and proliferating cell nuclear antigen (PCNA) indices in superficial bladder cancer. METHODS The subjects were 11 patients with recurrent superficial bladder cancer. The tumor growth speed was calculated by dividing all tumor volume at a certain recurrence episode by the duration until the recurrence. And then, the average tumor growth speed was determined individually by calculating mean tumor growth speed for all recurrence episodes. BrdU and PCNA indices were investigated by immunohistochemical staining. RESULTS There was a significant correlation between the average tumor growth speed and indices of PCNA and BrdU were statistically (Spearmen's rank correlation test; between the growth speed and PCNA index: p = 0.85, p < 0.01; between the average tumor growth speed and BrdU index: p = 0.71, p < 0.05; between BrdU index and PCNA index: p = 0.77, p < 0.05). The average tumor growth speed which was calculated based on clinical findings reflected the biological proliferative activities such as BrdU and PCNA indices. Furthermore, the values of all indices were higher in the invasive than in the non-invasive cases. CONCLUSIONS These findings suggest that the average tumor growth speed as the dynamic estimation is an important prognostic factor to determine stage progression in superficial bladder cancer.

Purpose To evaluate whether radiofrequency (RF) ablation following arterial injection of miriplatin-iodized-oil suspension expands ablative zone size, providing tissue platinum concentration with antitumor activity in the swine liver. Materials and Methods A total of 6 swine (mean weight, 49.3+/-1.7kg; weight range, 48.2-52.7 kg) underwent liver RF ablation. RF ablation alone was done in 2 animals (control), following arterial injection of iodized-oil (iodized-oil group) or miriplatin-iodized-oil suspension (miriplatin group) in 2 animals each. Ablative zones were created in 3 sites of each animal (total of 18 RF applications). Both the long- and short-axis diameters of ablative zones were measured. In the miriplatin group, tissue platinum concentrations were measured both in central and surrounding zones that were defined as white and red zones, respectively. Results The long- and short-axis diameters of the white zone were 27.0+/-3.1 mm and 18.0+/-0.6 mm in the control. Although significant expansion of long-axis diameter was not found in the iodized-oil group (30.2+/-2.8mm, p=0.09), it was significantly larger in the miliplatin group (33.5+/-2.4mm, p=0.02) than that in the control. The short-axis diameter was significantly expanded in the iodized-oil group (20.8+/-2.6mm, p=0.03) than that in the control, and it was significantly larger in the miriplatin group (27.2+/-1.9mm) than that in the iodized-oil group (p=0.001). Tissue platinum concentration reached effective antitumor activity levels both in white (16.5+/-5.8μg/g) and red zones (18.0+/-5.1μg/g). Conclusion RF ablation following arterial injection of miriplatin-iodized-oil suspension expands ablative zone size, providing tissue platinum concentration with antitumor activity.

Three patients with lung metastases of urogenital tumors were treated by bronchial arterial infusion therapy. Case 1: A 52-year-old man who had multiple lung metastases of right renal cell carcinoma fell into a dyspnea at 5 months after right radical nephrectomy. Though the effects of resection or laser coagulation with bronchoscopy were temporary, two sessions of BAI therapy with radiation improved the symptom of dyspnea for at least 3 months. Case 2: A 53-year-old man who had multiple lung metastases of right renal cell carcinoma was treated with systemic chemotherapy after right radical nephrectomy. Because the systemic chemotherapy showed only minor response, two sessions of BAI therapy were performed. No lung metastasis was detected in radiographs for 2 years after BAI therapy. Case 3: A 69-year-old man who had multiple lung metastases of left ureteral tumor was treated with 3 sessions of systemic chemotherapy. Though the systemic chemotherapy was effective, 2 sessions of BAI therapy with radiation showed a more suppressive effect, and the regrowth was not detected for 7 months after the therapy was performed. We concluded that BAI therapy was an effective therapeutic method not only for cases with no operative indication, but also for cases in which systemic chemotherapy was not effective.

A 41-year-old man incidentally found to have a right renal and left large lung tumor in the course of screening for liver dysfunction was admitted to our hospital. Needle biopsy of each tumors revealed histologically renal cell carcinoma and pulmonary blastoma. The renal tumor grew rapidly and soon he died of DIC. Autopsy was performed and the final diagnosis was adult Wilms' tumor and its metastasis to the lung. Histological findings of each large tumors showed different histologic pattern. The renal tumor revealed diffuse nephroblastic subtype and the lung tumor showed epitherial type. This is a rare case of Wilms' tumor in terms of its adult onset and different histologic pattern between the primary tumor and its metastatic lesion.

10621 Background: There is a significant site-specific variation in response to chemotherapy for human solid tumors. Whether subcutaneous non-metastatic xenograft models are representative of clini...

Phenotypic difference of lymphocytes circulating in tumorous renal artery and renal vein in patients with renal cell carcinoma was studied. Fifteen patients with no prior treatment were studied, from whom blood samples were taken at the time of radical nephrectomy. Mononuclear cells separated from tumorous renal arterial and venous blood were analyzed for cell surface markers. CD3, CD4, CD8, CD11b, CD16, CD25, CD57, Leu8 HLA-DR were compared. CD25 positive cells were significantly increased in venous blood than in arterial blood in the kidneys with tumor. No significant difference was found regarding the other surface markers.

A total of 75 prostate cancer and 67 lung cancer patients with positive bone scintigrams were studied. The patterns of spread in the axial skeleton and pelvis were different between the groups. The differences in the distribution of bony metastases between prostate and lung are explained by the role of Batson’s vertebral venous plexus.

The present paper reports the clinical results from cases of renal cell carcinoma with vena caval tumor thrombus. Fifty patients were entered into the study between 1980 and 1989. The primary tumor and vena caval tumor thrombus were completely removed in 39 (78%) patients, and 41 (82%) received postoperative treatment. The overall 12-, 36-, 60- and 90-month actuarial survival rates were 72, 41, 19 and 10%, respectively. Only tumor stage affected survival, however, other factors such as tumor grade, nodal status, metastatic status and level of vena caval involvement not affecting it. Postoperative interferon (IFN) treatment affected survival, whereas degree of curative surgery did not. The results of our study were, however, examined retrospectively in several institutes. Further investigation of the postoperative treatment for renal cell carcinoma with vena caval tumor thrombus will be necessary.

There is evidence to suggest that control mechanisms, either growth-stimulatory, inhibitory or inductive, may play a role in carcinogenesis. To test the hypothesis that treatment of rat urinary bladder with carcinogen induces alterations in the stroma which result in modified epithelial-stromal interactions, experiments were conducted using a rat model specifically designed for the study. Following exposure of Fischer F344 rats in drinking water to the urinary bladder carcinogen, N-butyl-N-(4-hydroxybutyl)nitrosamine (BHBN) for four weeks, bladders were removed and subjected to a brief detergent treatment to completely remove epithelium. The bladders without epithelium ("stroma" bladder) were heterotopically transplanted to syngeneic recipients. Four days later, the denuded mucosa surface was resurfaced with intraluminal instillation of urothelial cells, either untreated or treated with BHBN for six weeks (6w-BHBN) or 10 weeks (10w-BHBN). Examination at 12 weeks posttransplant of the "stroma" bladders that had received 6w-BHBN urothelial cells showed a higher tumor incidence of carcinoma in the BHBN-exposed "stroma" bladders as compared with the incidence in the carcinogen-unexposed "stroma" bladders (p less than 0.05). Examination at 18 weeks posttransplant showed 100% incidence of tumors in all "stroma" bladders irrespective of the lengths of BHBN exposure of urothelial cells. However, among the bladders that had received 6w-BHBN urothelial cells, carcinogen-exposed "stroma" bladders proved to be better "soil" for neoplastic cells to proliferate; the mean tumor volume as well as the mean total tumor volume per bladder were significantly higher than in the control "stroma" bladders (p less than 0.01 for each comparison). Similarly, among the bladders that had been resurfaced with 10w-BHBN urothelial cells, the mean total tumor volume per bladder was greater in the carcinogen-treated "stroma" bladders than in the controls (p less than 0.05). No proliferative or neoplastic changes were observed in the BHBN exposed "stroma" bladders which had been resurfaced with normal urothelial cells. Our data indicate that neoplastic growth of carcinogen treated urothelium is enhanced when such cells interact with the stroma which has also been exposed to carcinogen.

alpha-Difluoromethylornithine (DFMO), was examined for its ability to suppress the development of invasive urinary bladder carcinoma in C3H/He male mice. Continuous administration of 0.2% DFMO in water following carcinogen treatment (0.05% N-butyl-N-(4-hydroxybutyl)nitrosamine, BHBN, in drinking water for 8 weeks) was effective in suppressing urinary bladder carcinomas (P less than 0.05) as compared with the control group. However, when comparison was made based on tumors involving the entire urinary tract, protective effects could not be demonstrated. Coadministration of DFMO (0.2%) and BHBN (0.01%) did not alter tumor induction by the latter. These results were in sharp contrast to the protective effects in rats. Since bladder tumors in rats are of low grade and superficial whereas those in mice are of high grade and deeply invasive, our data indicate that DFMO has little to no effects against the development of aggressive forms of bladder carcinoma.

The purpose of this study is to ascertain whether the urinary (turbulent) flow really causes the sounds during micturition in humans. For this purpose the artificial bladder and urethra, which were made of silicon rubber (3M Co. Minnesota, U.S.A.), were used. The manometric device was attached to the bladder to measure the intravesical pressure. Outside the bladder neck a prostate like protrusion surrounding the urethra was made. A microphone was attached to this protrusion to detect the sound. A recording system was also adopted. The bladder was filled with 200 ml of sterile eater. By pressurising the artificial bladder at 100 cmH2O, the water passed through the urethra. During this artificial voiding the sound detection was undertaken. At the same time uroflowmetry was also performed. It was demonstrated that sound spikes were recorded whenever water in the artificial bladder passed through the artificial urethra.

Recently we have developed an entirely new method of sonic detection of lower urinary tract disorders during micturition. This procedure was designated as "urophonography" and its recording as "urophonogram". Sixteen patients with prostatic cancer before and three months after anti-androgenic therapy and ten healthy male volunteers underwent urophonography. The urophonograms were classified into four types. Type 1 was characterized by its diamond shape, while Type 2 was characterized by its random sound spikes. Type 3 was a mixture of Types 1 and 2. Type 4 had few sound spikes. Analysis of these urophonograms also revealed that the frequencies of these urethral sounds belonged to the range from 0.4 to 1.5 KHz. The amplitude (power) of the sounds was in the range of 40-60 dB. Healthy volunteers belonged to Type 4. Prostatic cancer patients belonged to Types 1, 2 and 3 at 18.8, 68.8, nad 12.4%, respectively. After the treatment the percentages of Types 1, 2, 3, and 4 changed to 18.8, 50.0, 0, and 31.2%, respectively. Comparison of uroflowmetric parameters with urophonograms showed that Type 2 patients showed a lesser degree of micturition disturbances, evidenced by these parameters. It was considered that urophonograms were useful as urodynamic investigation.

Using heterotopically transplanted rat urinary bladder, experiments were conducted to develop a reproducible animal model of bacterial cystitis-associated urothelial hyperplasia without calculus formation, and to elucidate which bacterial component(s) might induce urothelial hyperplasia. Bladder instillation of live Escherichia coli (E. coli) resulted in persistent infection and inflammation and also diffuse urothelial hyperplasia. Instillation of killed E. coli also induced diffuse hyperplasia. Hyperplastic changes regressed following withdrawal of the killed E. coli treatment. Urothelial hyperplasia was also induced by repeated instillation of protein-rich lipopolysaccharide (LPS), the endotoxin derived from gram-negative bacterial wall component, but not by protein-free LPS. A finding common to bladders showing hyperplasia was the infiltration of neutrophils into intercellular spaces of the urothelium. We conclude that urothelial hyperplasia is induced by E. coli cystitis, that LPS plays a significant role in the hyperplastic response, and that neutrophils may mediate the response.

Recently we have developed an entirely new method of sonic detection of lower urinary tract disorders during micturition. The detection of these sounds was performed by a data catching and recording system, consisting of a detector, amplifier, and recorder. This procedure was designated as "urophonography" and its recording as "urophonogram". Twenty-five patients with BPH before and three months after suprapubic prostatectomy and 10 healthy male volunteers underwent urophonography. The urophonograms were classified into four types. Type 1 was characterized by its diamond shape, while Type 2 was characterized by its random sound spikes. Type 3 was a mixture of Types 1 and 2. Type 4 had only few sound spikes. Analysis of these urophonograms also revealed that the frequencies of these urethral sounds belonged to the range from 0.4 to 1.5 KHz. The amplitude (power) of the sounds was in the range of 40-60 dB. Healthy volunteers belonged to Type 4. BPH patients belonged to Types 1, 2 and 3 at equal frequency. Comparison of uroflowmetric parameters with urophonograms revealed that Type 3 patients with BPH showed a lesser degree of micturition disturbances, which was consistent with the weight of prostatic tumors surgically resected. Urophonography was undertaken before and after the treatment on these patients. It was clearly shown that the pattern of urophonograms shifted to normal (Type 4). It was considered that urophonograms were useful for urodynamic investigation.

Localization of either multiple, metastatic and/or asymptomatic pheochromocytomas sometimes is elusive because all imaging methods to date have been nonspecific in character. We report 2 cases in which scintigraphy was used with a new radiopharmaceutical agent, 131iodine-metaiodobenzylguanidine, for the accurate localization of pheochromocytoma. To the best of our knowledge, this is the first report of asymptomatic pheochromocytoma imaged by 131iodine-metaiodobenzylguanidine scintigraphy.

A total of 18 patients with transitional cell bladder cancer was given a 0.5-hour intravenous infusion of bromodeoxyuridine at the time of endoscopic biopsy or transurethral resection to label tumor cells in the deoxyribonucleic acid synthesis phase (S phase). The tumor specimens were fixed with 70 per cent ethanol, embedded in paraffin, sectioned and stained by an indirect immunoperoxidase method with anti-bromodeoxyuridine monoclonal antibody as the first antibody. The bromodeoxyuridine labeling index, S phase fraction, was determined by counting the number of bromodeoxyuridine-labeled cells in the tissue sections. All grade 1 tumors had an S phase fraction of lower than 10 per cent. The average S phase fractions for noninvasive (11 cases) and invasive (7) tumors were 9.8 and 20.0 per cent, respectively. Two distant metastatic bladder tumors showed an average S phase fraction of 25.3 and 30.0 per cent. Thus, transitional cell bladder cancers with an S phase fraction of greater than 10 per cent appears to grow faster and be more invasive more often than those with an S phase fraction of less than 10 per cent. The higher S phase fraction may indicate greater biological malignancy. Our preliminary results suggest that measurement of the bromodeoxyuridine labeling index in bladder tumors may be a new objective and quantitative assay of biological potential of individual tumors.

We reviewed 60 cases of incidental carcinoma of the prostate treated conservatively. Subclassification of incidental carcinoma was based on histologic grade and tumor size. Stage A1 was defined as a low grade (grade I) and focal lesion, and stage A2 as a high grade (grade II, III) or diffuse lesion. The distinction between focal and diffuse was set at three chips in a transurethrally resected specimen or a diameter of 5 mm for a total lesion in an enucleated specimen. Patients with stage A1 tumors did significantly better (p less than 0.05) than those with A2, the 5-year survival rates being 88% and 70%, respectively. It is believed that patients with stage A2 should be treated aggressively. However, conservative therapy is recommended for the patients with stage A1 prostate cancer.

Histologic characteristics of prostate cancer in Japan were evaluated in a retrospective analysis of 267 cases. These specimens were graded by the Gleason histopathologic grading system, and the proportional distribution of histologic features and the death rate were compared with those of Gleason's results in the literature. The system demonstrates significant correlation with mortality rates for each grade group in our cases, and it was also found that the death rates as obtained by our figures were comparable to those of Gleason in each category. The results help to provide the basis for future comparative multinational trials of prostate cancer.

The clinical aspects of 64 patients with superficial bladder cancer (Ta, T1, T2 according to the TNM classification, International Union against Cancer or Stage O, A, B1 according to Marshall) admitted to the Tsukuba University Hospital were analyzed retrospectively. Treatment of these patients was mainly by transurethral surgery. The overall 10-year survival rate was 73%. Eight patients died and four of them showed an invasive change, the so-called metamorphosis, during the follow-up period. Patients with papillary, pedunculated tumors had better survival rates than those with papillary, sessile tumors. Patients with tumors less than 1 cm in size had better survival rates than those with tumors 1-3 cm in size. There were no statistical differences in survival rates between patients with single and multiple tumors. Up to seven years from surgery, the patients with T2 tumors had lower survival rates than those with Ta-T1 tumors. The patients with grade I tumors had better survival rates than those with grade II tumors. There were no significant differences in recurrence rates related to the grade of the tumor. It is thought that the prognosis of superficial bladder cancer in our series depended mainly on the shape, size, number, depth and grade of the tumor.

The high incidence of metastatic bone resorption in urological cancer makes it necessary for clinicians to look for a valid experimental model to investigate basic interaction between cancer cells and bone in order to improve the treatment. A new model of bone resorption has been defined, namely the subcutaneous injection of tumor cell suspensions of invasive transitional cell carcinoma of the bladder (MBT-2) into mice after the periosteum of the calvaria has been disrupted. The tumor induced osteolysis associated with osteoclast proliferation with reactive bone formation. Moreover, we were able to show hypercalcemia accompanied with local bone resorption in this model.

KOISO, K., KANOH, S., RINSHO, K., NEMOTO, R., ISHIKAWA, H., ISHIKAWA, S., OHTANI, M., NEMOTO, S., TAKESHIMA, H., UCHIDA, K., KONDO, F., SHIMAZUI, T., KIKUCHI, K., KANEKO, S., YOSHII, S., NOGUCHI, R., UMEYAMA, T. and KOSUGI, Y. Urophonographic Studies of the Lower Urinary Tract: A New Approach to Urodynamics. Tohoku J. exp. Med., 1987, 151(1), 57-64-The detection and recording systems for urethral sounds during micturition were developed. This procedure was termed as “urophonography” and its recording as “urophonogram”. Classification of urophonograms was undertaken on the basis of analyzing normal healthy male volunteers, and patients with benign prostatic hyperplasia. Four types of urophonogram were demonstrated. Urophonography was useful for investigation of dysfunctional voiding, and lower urinary tract obstruction. Urophonography will be a new approach to urodynamic investigations.

Renal cell carcinoma is the third most frequent cause of urological cancer death in Japan. The first is bladder cancer and the second is prostatic cancer. However, there has been no clinical trial of mass screening for early detection of renal cell carcinoma. With a view to discovering a method of early detection for renal cell carcinoma, we analyzed the procedures for discovering renal cell carcinoma in 33 patients who were treated at our hospital. In 10 patients, carcinoma had been discovered accidentally without gross hematuria, abdominal mass or flank pain. Seven of these patients were first suspected of having renal cell carcinoma by ultrasonography, two by intravenous pyelography (IVP) and one by computed tomography. Seven out of nine patients operated on were surgically diagnosed as having stage I and two as having stage II. Ultrasonography is far better than IVP from the points of view of noninvasiveness, ease of performance and accuracy. In our study, ultrasonography was the most useful method for early detection of renal cell carcinoma. However, for the mass screening of renal cell cancer by ultrasonography, it is necessary to make its specificity and sensitivity clear and to debate its cost effectiveness.

We previously demonstrated that repeated intravesical instillation of DFMO, an irreversible inhibitor of ornithine decarboxylase, inhibits (or retards) urinary bladder carcinogenesis in rats. The present investigation was conducted to determine if high intraluminal concentration of DFMO alters initiation by MNU and to determine if DFMO inhibition is due to arrest of tumor progression or simply retardation of the tumor development. Results showed that the inhibitory effects demonstrated by DFMO treatment during the early phase of study disappeared as the observation period was extended. Failure to suppress tumor development might be due to failure to control intracellular polyamine levels below the critical level and this failure in turn might be due to the rapid fall of intravesical DFMO concentration following instillation.

A new experimental method to test the effect of drugs on tumor-induced osteolysis using a bladder tumor in mice has been designed. The method consisted of inoculating MBT-2 tumor cells s.c. over the calvaria in mice, resulting in a local tumor causing fragmentation of the bone. This was accompanied by adjacent osteoplastic changes, which were evaluated by X-ray and histological examination. Etidronate disodium (EHDP), a diphosphonate derivative, at a dose of 3 mg/kg to 30 mg/kg s.c. protected the bone by decreasing the extent of osteolysis as judged by the same criteria. Therapy with EHDP prolonged the survival period. This inhibition was obtained with no apparent effect on the growth of the MBT-2 tumor.

A review of 27 patients with renal pelvic tumors and ureteral tumors admitted to the Tsukuba University Hospital was performed retrospectively. Nineteen cases of renal pelvic tumors and eleven cases of ureteral tumors were submitted to the study. These patients were treated mainly by surgery. The rates for 1-year, 3-year, 5-year and 10-year survival were 88.5%, 57.6%, 40.3% and 20.2%, respectively. No obvious relationship between prognosis of renal pelvic tumor and that of ureteral tumors was seen. Pathologically, there was a correlation between the grade and the stage of the tumor. Prognosis was related to the stage of the tumor, but not to the grade of the tumor. Clinically, the patients with positive urinary cytology had a poorer prognosis. It was considered that no relationship existed between the preoperative clinical stage and the postoperative pathological stage. Consequently, the former is not considered a prognostic factor. We have been performing mainly radical nephroureterectomy with regional lymphadenectomy since 1975. The patients who received the operation with regional lymphadenectomy since 1975. The patients who received the operation with regional lymphadenectomy or with adjuvant chemotherapy had a better prognosis. It is concluded that lymphadenectomy is a valuable operation for improving prognosis.