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1) 1群82例(CPDX-PR 200mg/day, 分二, 3日間投与)のUTI薬効評価基準による総合臨床効果は, 著効64例, 有効17例, 無効1例で有効率98.8%であった。2) 2群の35例(CPDX-PR 200mg/day, 分二, 4～7日間投与投与)の総合臨床効果は, 著効18例, 有効15例, 無効2例で有効率94.3%であった。3) 150例中1例に一過性の軽度の副作用がみられ, 安全性は99.3%であった。4)起炎菌は, グラム陰性桿菌127株(84.7%), グラム陽性球菌21株(14.0%), 真菌2株(1.3%)で, E. coliは105株(70.0%)を占めた。5) E. coliに対する抗菌力は, 開発当初と同程度で, CFIX, CFTM-PIのそれとも同程度であった, One hundred and fifty female patients with acute uncomplicated cystitis were given 200 mg of CPDX-PR twice daily for 3-7 days to evaluate both its overall clinical efficacy and its adverse effects. In 82 cases (Group I) in which it was administered for 3 days, the overall clinical efficacy, evaluated by the criteria proposed by the Japanese UTI committee, was excellent in 64 cases, moderate in 17 and poor in one, with the effective rate being 98.8%. In 35 cases (Group II) in which it was administered for 4-7 days, the overall clinical efficacy was excellent in 18 cases, moderate in 15 and poor in 2, with the effective rate being 94.3%. The overall clinical evaluation was not performed in another 33 cases because they were given CPDX-PR for more than 8 days or 300 mg/day. Subjective adverse effects such as hoarseness and lingual inflammation were observed in only one of the 150 cases, but they disappeared spontaneously after the cessation of administration of CPDX-PR. These findings suggest that CPDX-PR is one of the most effective and safe antibiotic in the treatment of acute uncomplicated cystitis.

One hundred and fifty female patients with acute uncomplicated cystitis were given 200 mg of CPDX-PR twice daily for 3-7 days to evaluate both its overall clinical efficacy and its adverse effects. In 82 cases (Group I) in which it was administered for 3 days, the overall clinical efficacy, evaluated by the criteria proposed by the Japanese UTI committee, was excellent in 64 cases, moderate in 17 and poor in one, with the effective rate being 98.8%. In 35 cases (Group II) in which it was administered for 4-7 days, the overall clinical efficacy was excellent in 18 cases, moderate in 15 and poor in 2, with the effective rate being 94.3%. The overall clinical evaluation was not performed in another 33 cases because they were given CPDX-PR for more than 8 days or 300 mg/day. Subjective adverse effects such as hoarseness and lingual inflammation were observed in only one of the 150 cases, but they disappeared spontaneously after the cessation of administration of CPDX-PR. These findings suggest that CPDX-PR is one of the most effective and safe antibiotic in the treatment of acute uncomplicated cystitis.

So far for renal insufficiency, exchange or substituting blood transfusions, peritoneal perfusion, intestinal-loop perfusion, administration of ion exchange resin, blood dialysis with artificial kidney and renal transplantation have been tried to eliminate serum nitrogencontaining substances, to maintain electrolyte balance and to correct acid-base balance. However, renal transplantation has failed to obtain satisfactory result due to rejection phenomenon and artificial kidney has restricted its repeated uses because of expensive burden on patients although it has excellent dialysance. It is suspected that life prolongation of patient with renal insufficiency can be achieved with use of artificial kidney in proper combination with organ perfusion, although cf which dialysance is less excellent. Experimentary studies were performed on dogs to perfuse the lung, int e s tine and stomach with an identical condition and serum electrolytes and nitrogen containing substances were measured to compare the effectiveness of perfusion. The results indicated that the lung perfusion is the most excellent way of dialysis. It was also demonstrated on the isolated intestinal perfusion for hyperpotassemia that a use of ion exchange resin, Amberlite IPR-64 is effective biochemically when it is suspended in perfusing fluid. In addition the results of isolated intestinal perfusion done in 4 patients with chronic renal insufficiency proved its therapeutic effects when the procedure is carried out in combination with other kinds of therapy.

Although the proper time to perform perfusion or dialysis and judgement of prognosis have so far determined by measurements of serum electrolytes and nitrogen containing substances, it is assumed that the electrolytes and nitrogen containing substances of the body as the whole are insufficiently estimated by simple serum assay of such substances. It is an interesting problem to know the change of intracellular fluid brought by a rapid change of extracellular fluid. Abnormal pattern of electroencephalogram seen during blood dialysis is due to different rates of urea clearance between serum, cerebrospinal fluid and brain cells. To clarify the significance of intracellular electrolytes, studies were performed to determine intraerythrocytic concentration of potassium and non-protein nitrogen in normal human subjects, patients with acute and chronic renal insufficiencies, renal insufficiency with and without edema, two cases done blood dialysis with the Kolff-type artificial kidney and a case given Amberlite IRP-64. It was found that intracellular potassium in patient with renal insufficiency (intraerythrocytic potassium concentration of 77.32 mEq/L) was lower than that of in normal subjects (normal intraerythrocytic potassium 87.25 mEq/L). Furthermore the intraerythrocytic potassium in patients with renal insufficiency with edema (72.90 mEq/L) was much lower than that in patients with renal insufficiency without edema (81.75 mEq/L). The intraerythrocyti c NPN concentration showed almost positive correlation to the serum NPN level in normal subjects. The intraerythrocytic NPN in patients with renal insufficiency demonstrated positive correlations to the serum NPN in some degree up to 80-90 mg/dl but it rose one and a half or two hold levels when the serum NPN leve l exceeded 80--90 mg/d1. This trend of increase was especially marked in patients with renal insufficiency with edema.

In the previous report, statement was made that pat h ological changes of the upper urinary tracts are most frequently found in necropsied cases of cancer of the urinary bladder. The present report deals with the results of excretory urogram (IVP), PSP test, indigocarmine test and serum NPN determination performed in our clinical cases. All the tesults of examinations were obtained before operation. A total of 215 hospiterized patients with cancer of the urinary bladder were studied. These included 33 cases of low grade-low stage, 14 cases of low grade-high stage, 27 cases of high grade-low stage and 141 cases of high grade-high stage of the cancer. In viewin g excretory condition of contrast medium at IVP, bilaterally normal function was seen in 95.0 % of low grade-low stage cases and 40.5 % of high grade-high stage cases. The shape of the upper urinary tracts was found to be normally retained in 85.0 % of low grade-low stage cases, while it was normal in only 26.4 % of high grade-high stage cases. Normal excretion in PSP test was seen in 85.7 % of low grade-low stage cases and in 66.1 % of high grade-high stage cases. For indigocarmine test, 85.7 % of low grade-low stage cases and 35.3 % of high grade-high stage cases demonstrated bilateral normal results. The values of serum NPN showed within normal limits in 92.9 % of low grade-low stage cases and in 40.2 % of high grade-high stage cases. If one takes it in consideration that PSP test was not done in cases who had marked hematuria, about two-third of high grade-high stage cases are supposed to have some disturbances in the upper urinary tracts. For the treatment of bladder cancer, it has been emphasized that p ossibility of operative radical cure is merely decided by malignant charactor and grade of infiltration of the tumor itself. However, as clarified by our observations stated in the previous and present reports, in patient with cancer of the urinary bladder, disturbances of the upper urinary tracts are frequently seen even before the operation and renal insufficiency is confirmed to be the most frequent cause of death. For these reasons, an emphasis is made that the status of the upper urinary tract should be taken in deep consideration for treatment of this disease.

Peritoneal lavage was performed to a total of 16 patients consisted of 9 cases of chronic nephritis, 1 subacute nephritis, 1 bilateral hydronephrosis, 4 acute tubular necrosis and 1 acute "Brovarin" intoxication. The report deals with the results of dialysis and discussions on clearance of various substances through the peritoneum during the lavage. Literatures were also reviewed. Isolated intestinal loop for dialysis was carried out in 4 cases as the first performance in Japan, so that the results were reported as well as general review of the technique on vividialysis. Clearance of various substances through the isolated intestinal loop was found to be about a half of that by peritoneal lavage, but it has advantages on availabilities for prolonged and repeated performance. It is supposed that the technique is to be tried for treatment of chronic renal insufficiency more widely.

So far for renal insufficiency, exchange or substituting blood transfusions, peritoneal perfusion, intestinal-loop perfusion, administration of ion exchange resin, blood dialysis with artificial kidney and renal transplantation have been tried to eliminate serum nitrogencontaining substances, to maintain electrolyte balance and to correct acid-base balance. However, renal transplantation has failed to obtain satisfactory result due to rejection phenomenon and artificial kidney has restricted its repeated uses because of expensive burden on patients although it has excellent dialysance. It is suspected that life prolongation of patient with renal insufficiency can be achieved with use of artificial kidney in proper combination with organ perfusion, although cf which dialysance is less excellent. Experimentary studies were performed on dogs to perfuse the lung, int e s tine and stomach with an identical condition and serum electrolytes and nitrogen containing substances were measured to compare the effectiveness of perfusion. The results indicated that the lung perfusion is the most excellent way of dialysis. It was also demonstrated on the isolated intestinal perfusion for hyperpotassemia that a use of ion exchange resin, Amberlite IPR-64 is effective biochemically when it is suspended in perfusing fluid. In addition the results of isolated intestinal perfusion done in 4 patients with chronic renal insufficiency proved its therapeutic effects when the procedure is carried out in combination with other kinds of therapy.

Although the proper time to perform perfusion or dialysis and judgement of prognosis have so far determined by measurements of serum electrolytes and nitrogen containing substances, it is assumed that the electrolytes and nitrogen containing substances of the body as the whole are insufficiently estimated by simple serum assay of such substances. It is an interesting problem to know the change of intracellular fluid brought by a rapid change of extracellular fluid. Abnormal pattern of electroencephalogram seen during blood dialysis is due to different rates of urea clearance between serum, cerebrospinal fluid and brain cells. To clarify the significance of intracellular electrolytes, studies were performed to determine intraerythrocytic concentration of potassium and non-protein nitrogen in normal human subjects, patients with acute and chronic renal insufficiencies, renal insufficiency with and without edema, two cases done blood dialysis with the Kolff-type artificial kidney and a case given Amberlite IRP-64. It was found that intracellular potassium in patient with renal insufficiency (intraerythrocytic potassium concentration of 77.32 mEq/L) was lower than that of in normal subjects (normal intraerythrocytic potassium 87.25 mEq/L). Furthermore the intraerythrocytic potassium in patients with renal insufficiency with edema (72.90 mEq/L) was much lower than that in patients with renal insufficiency without edema (81.75 mEq/L). The intraerythrocyti c NPN concentration showed almost positive correlation to the serum NPN level in normal subjects. The intraerythrocytic NPN in patients with renal insufficiency demonstrated positive correlations to the serum NPN in some degree up to 80-90 mg/dl but it rose one and a half or two hold levels when the serum NPN leve l exceeded 80--90 mg/d1. This trend of increase was especially marked in patients with renal insufficiency with edema.

Peritoneal lavage was performed to a total of 16 patients consisted of 9 cases of chronic nephritis, 1 subacute nephritis, 1 bilateral hydronephrosis, 4 acute tubular necrosis and 1 acute "Brovarin" intoxication. The report deals with the results of dialysis and discussions on clearance of various substances through the peritoneum during the lavage. Literatures were also reviewed. Isolated intestinal loop for dialysis was carried out in 4 cases as the first performance in Japan, so that the results were reported as well as general review of the technique on vividialysis. Clearance of various substances through the isolated intestinal loop was found to be about a half of that by peritoneal lavage, but it has advantages on availabilities for prolonged and repeated performance. It is supposed that the technique is to be tried for treatment of chronic renal insufficiency more widely.

In the previous report, statement was made that pat h ological changes of the upper urinary tracts are most frequently found in necropsied cases of cancer of the urinary bladder. The present report deals with the results of excretory urogram (IVP), PSP test, indigocarmine test and serum NPN determination performed in our clinical cases. All the tesults of examinations were obtained before operation. A total of 215 hospiterized patients with cancer of the urinary bladder were studied. These included 33 cases of low grade-low stage, 14 cases of low grade-high stage, 27 cases of high grade-low stage and 141 cases of high grade-high stage of the cancer. In viewin g excretory condition of contrast medium at IVP, bilaterally normal function was seen in 95.0 % of low grade-low stage cases and 40.5 % of high grade-high stage cases. The shape of the upper urinary tracts was found to be normally retained in 85.0 % of low grade-low stage cases, while it was normal in only 26.4 % of high grade-high stage cases. Normal excretion in PSP test was seen in 85.7 % of low grade-low stage cases and in 66.1 % of high grade-high stage cases. For indigocarmine test, 85.7 % of low grade-low stage cases and 35.3 % of high grade-high stage cases demonstrated bilateral normal results. The values of serum NPN showed within normal limits in 92.9 % of low grade-low stage cases and in 40.2 % of high grade-high stage cases. If one takes it in consideration that PSP test was not done in cases who had marked hematuria, about two-third of high grade-high stage cases are supposed to have some disturbances in the upper urinary tracts. For the treatment of bladder cancer, it has been emphasized that p ossibility of operative radical cure is merely decided by malignant charactor and grade of infiltration of the tumor itself. However, as clarified by our observations stated in the previous and present reports, in patient with cancer of the urinary bladder, disturbances of the upper urinary tracts are freq