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The research performed at the Department of Urology Osaka University Graduate School of Medicine is overviewed. Renal ischemia-reperfusion (I/R) injury is inevitable in transplantation and is related to longterm graft function. MF-1, a bifunctional hepatocyte growth factor-macrophage stimulating protein chimera, was found to prevent apoptosis. In our study, MF-1 directly guarded cultured proximal tubular epithelial cells from hypoxia-induced necrosis and apoptosis in vitro, and MF-1 treatment ameliorated renal dysfunction by preventing apoptosis in rat I/R injury model. The erythropoietin molecule modified by carbamylation (CEPO) has been identified and was demonstrated to protect several organs without increasing the hemoglobin concentration. The therapeutic effect of CEPO was evaluated using an endothelial tube formation assay, and a rat ischemia-reperfusion injury model. CEPO treatment induced more capillarylike formation than EPO. CEPO-treated kidneys showed minimal tubular apoptosis with increased peritubular capillary endothelial cells. We identified a new therapeutic approach using CEPO to protect the kidney from ischemia-reperfusion injury by promoting angiogenesis.

60歳女性.患者は結核性萎縮膀胱に対する尿管回腸膀胱吻合術後43年目に右腰背部痛, 発熱が出現し, 腎盂腎炎の診断で著者らの施設へ入院となった.抗生剤投与にて症状は改善したものの, 血尿と水腎症を認めた.DICでは右腎・尿管・利用回腸近位部の著明な拡張と造影剤の途絶を認め, 尿培養は陰性であったが, 腫瘍マーカーCA19-9はその上昇を認めた.更に腹部造影CT・膀胱鏡所見より, リンパ節転移, 肝転移を伴った利用回腸部悪性腫瘍と診断され, 経尿道的腫瘍切除術を施行した.病理組織学的にはTransitional cell carcinomaで, 術後は化学療法を行ったが, 最終的に死亡となった, A 60-year-old woman visited our hospital complaining of fever up. She had undergone augmentation ileoplasty for tuberculous bladder atrophy 43 years age. Cystoscopy revealed a broadbased tumor on the ileal segment. Histopathological findings of the biopsy specimen demonstrated grade 3 transitional cell carcinoma. She was given 2 courses of chemotherapy (methotrexate, vincristine, adriamicin, cisplatin), but died of metastasis of carcinoma 4 months after diagnosis.

60歳男.患者は生体腎移植を希望していたが, 術前スクリーニングを施行したところPSAの高値が指摘された.そのため前立腺癌に対する加療目的で入院となった.肉眼的血尿を訴えたため膀胱鏡を施行したところ, 膀胱右側壁に広基性乳頭状腫瘍を認めた.膀胱洗浄液による細胞診はclass Vであった.膀胱腫瘍に対してTUR-Btを施行し, 病理診断はTCC, G2, pTaであった.前立腺癌については, 膀胱癌の再発がない時期に手術することとなり, CAB療法を開始し, 一旦退院となった.膀胱鏡では膀胱腫瘍の再発を認めず, 膀胱洗浄液による細胞診もclass IIであった.全身麻酔下に恥骨後式根治的前立腺全摘除術が施行され, 術後19日目に経過良好で退院となった.再発の徴候なく, 尿禁制は保たれており, 経過は良好である, A 60-year-old male, who had been maintained on hemodialysis for 4 years, visited our hospital to receive living renal transplantation. He complained of macrohematuria, and preoperative examination showed elevation of psostate specific antigen (PSA). Cystoscopy revealed papillary tumors on the right lateral bladder wall. Transurethral resection of bladder tumor (TUR-Bt) was performed and histopathological examination showed transitional cell carcinoma, G2, pTa. The histologic diagnosis of the transrectal needle prostate biopsy specimen was moderately differentiated adenocarcinoma. Combined androgen blockade as a neoadjuvant therapy and radical prostatectomy were performed. A case of synchronous double primary cancers, comprised of adenocarcinoma of the prostate and transitional cell carcinoma of the urinary blader in a hemodialysis patient has never been previously reported in the Japanese literature.

For the prevention of the immunological chronic rejection, HLA-DRB1 allele matching, enough immunosuppression in the induction phase and pathological diagnosis by non-episode and protocol biopsy are the effective methods. For the prevention of the non-immunological chronic rejection, treatments for hypertension, hyperlipidemia and hyperfiltration are the effective treatments.

腎血管性高血圧(RVH)は片側または両側の腎動脈の閉塞あるいは狭窄による腎虚血のために生じる二次性高血圧である.1958年から1999年の42年間に著者らの施設で経験した95例のRVHの治療法について検討した.年齢は3～64歳(平均31.8歳)で, 三大原因は線維筋性異型性34例(35.8%), 動脈硬化26例(27.4%), 第動脈炎12例(12.6%)であった.95症例中79例92腎に対して治療が行われ, 主な治療法は血行再建術6例(7.6%), 腎摘除術21例(26.6%), 自家腎移植術26例(32.9%), 経皮経管血管形成術25例(31.6%)であった.治療効果では, 術後に降圧薬が不要となった症例を治癒, 降圧薬が減量できた症例を改善とすると, 治癒ないし改善した症例は, 腎摘除術で100%, 自家腎移植術が92.3%, 経皮経管血管形成術が72.0%であった.RVH治療法は大きく変遷しており, 初期にはバイパスによる血行再建術, 1974年以降は自家腎移植術, 1981年以降は経皮経管血管形成術が第一選択として行われていた, Renovascular disease is one of the most common causes of secondary hypertension. Recent technical advances have changed the management principles, which include a more aggressive approach to the diagnosis and treatment of renovascular hypertension (RVH). We experienced a total of 95 cases with RVH between 1958 and 1999. The mean age of all patients was 31.8 years old, ranging from 3 to 64 years. The three major basal diseases that caused RVH were fibromuscular dysplasia (34/95), arteriosclerosis (26/95), and aortitis (12/95). Ninety-two kidneys were treated in 79 of the 95 patients. The major therapeutic modalities performed were reconstruction of renal artery (6/79), nephrectomy (21/79), autotransplantation (26/79), and percutaneous transluminal angioplasty (PTA) (25/79). PTA is now the treatment of choice for the initial management of patients with RVH. Surgical treatment is generally reserved for patients in whom PTA fails. Pharmacotherapy is used on patients awaiting angioplasty or revascularization, those who are too ill for intervention, and those who have failed to respond to intervention.

移植後8年目の46歳男にnon-episode腎生検を行い, ごく初期のサイクロスポリン血管性腎障害(CAA)と無症候性のIgA腎症の所見を得た.移植腎の病理診断及び治療法の決定において, non-episode腎生検は有効であると思われた, We report a case of subclinical immunoglobulin A (IgA) nephropathy and cyclosporin associated arteriolopathy following renal transplantation. A 39-year-old male with chronic glomerulonephritis received kidney transplantation from a two- human leukocyte antigen (HLA) mismatched cadaveric donor. The initial immunosuppressive therapy was triple-drug therapy with cyclosporin, prednisolone and mizoribine. Four months after transplantation, he had an acute rejection episode, and the renal function was recovered by steroid pulse and 15-deoxyspergualin therapy. Eight years after transplantation, we conducted a non-episode biopsy of the renal allograft to examine subclinical lesions. The histopathological findings showed cyclosporin associate arteriolopathy (CAA) and IgA nephropathy. There was no sign of acute or chronic rejection. At the present time, the renal function of the allograft is good. In conclusion, the non-episode biopsy of renal allograft is useful for examination of subclinical lesions.

国際Banff基準と治療効果には相関を認めた.G2以上の症例には, OKT3及びALGがMPに比べ, 有効率に有意差を認めた.DSGは症例数が少なく, 今後の検討が必要である, We reviewed 115 cases of acute rejection following renal transplantation. All cases were diagnosed after graft biopsy, and showed histopathological evidence of acute rejection. They were treated with administration of OKT3, 15-deoxyspergualin (DSG), anti-lymphocyte globulin (ALG) or methylprednisolone (MP). All rejections were histopathologically classified according to the Banff working classification. The clinical effects of each drug were evaluated both at 1 month and 1 year following the therapy for rejection, by measurement of serum creatinine level. The effective rate both at 1 month and 1 year was related with the Banff working classification ( p < 0.0001). At 1 month after treatment, there were no significant differences between the OKT3, DSG or ALG group and MP group in cases of borderline change and AR grade I. In cases of grade II and grade III, a significant difference was observed between the OKT3 or ALG group and MP group (p < 0.05). The DSG group showed a slightly better outcome than the MP group, although the difference was not significant. In conclusion, the Banff schema is shown to be valid for classification of acute renal allograft rejection, and it is necessary to determine the treatment for acute rejection according to histopathological classification.

急性拒絶反応に対しては, タクロリムスの有効率80%で, 長期の予後も良好であった.慢性拒絶反応に対しては, 長期の予後を考えると, 本治療の抑制効果は否定的であった, Tacrolimus has already gained a high reputation as an induction-maintenance immunosuppressive therapy after kidney transplantation. Recently, it is being used as rescue therapy against rejection, and its effectiveness also appears to have been established to some extent. In this study, we evaluated the efficacy of Tacrolimus rescue therapy at 4 institutions in the Kinki District. The subjects were 19 patients treated with Tacrolimus against rejection observed during immunosuppressive therapy using cyclosporin. Evaluation was made by classifying the patients into 6 with acute rejection that occurred within 3 months after transplantation (AR), 4 with late onset acute rejection that developed more than 3 months after operation (LAR), and 9 patients with chronic rejection (CR). In the AR group, many patients received combination therapy at the introduction of Tacrolimus, and the long-term outcome was satisfactory. Tacrolimus was effective in 2 (50%) of the 4 patients in the LAR group. The trough levels of Tacrolimus at its introduction were 10-15 ng/ml in the AR and LAR groups. Deterioration of the transplanted kidney function was prevented in 3 (50%) out of 6 patients in the CR group observed for less than 1 year, but it deteriorated in all 3 patients observed for 1 year or longer. The trough levels of tacrolimus at its introduction were 5-10 ng/ml in many patients in the CR group. The rescue therapy using Tacrolimus was effective against acute rejection but further follow-up is considered to be needed to evaluate its efficacy against chronic rejection.

60歳女.62歳の夫をドナーとする生体腎移植目的で来院した.レシピエントの血液型はA型Rh(-)で, ドナーはO型Rh(+)であった.ヒト白血球抗原4抗原はミスマッチであった.ドナーの左腎をレシピエントの右腸骨窩に移植した.免疫抑制導入療法は, タクロリムス, ミコフェノール酸モフェチル, ステロイドの3剤で行った.術後無尿期が続いたが, 5回の血液透析で改善し, 術後15日目頃より血清クレアチニン値(sCr)は1.0mg/dl前後で推移した.拒絶反応などはみられず, 術後6ヵ月時点でのsCrは0.75mg/dlであった, We present a 60-year-old female who underwent living unrelated renal transplantation from her 62-year-old husband. The primary immunosuppression consisted of tacrolimus, mycophenolate mofetil and steroid. We did not recognize any rejection in a histopathological study. The total ischemic time to carry out anastomosis of the two renal arteries was 121 minutes. After hemodialysis 5 times for acute tubular necrosis, her renal function improved. She was discharged on the 33rd postoperative day when her serum cretinine level was 1.0 mg/dl. The graft function was stable at 6 months after transplantation. We discussed living unrelated renal transplantation in the elderly population in Japan.

We report a case of recurrent IgA nephropathy following renal transplantation under tacrolimus (FK506). A 23-year-old female who had been diagnosed with IgA nephropathy was transplanted from her HLA two-mismatched mother under tacrolimus, prednisolone and azathioprine. Two years after transplantation, suddenly she noticed macroscopic hematuria. At that time, functional renal deterioration (serum creatinine: 2.3 mg/dl) and mild proteinuria were observed. Allograft biopsy disclosed acute cellular rejection. She was administered a bolus injection of methylprednisolone, 15-deoxyspergualin and anti-lymphocyte globulin. However, the response to the treatment was poor. A transplant biopsy revealed focal segmental glomerulosclerosis by PAS staining and granular IgA and C3 deposits on immunofluorescence examination. There was no sign of acute rejection and toxicity by tacrolimus. We diagnosed recurrent IgA nephropathy. At the present time, she has normal urinalysis and renal function is stable (serum creatinine: 1.9 mg/dl). No proteinuria was observed after total dosage of immunosuppressants was increased. Although recurrence of IgA nephropathy in renal allograft is frequent, allograft dysfunction is rare. However, IgA nephropathy has several types with different prognosis. For functional renal deterioration after renal transplantation, we should consider not only an acute rejection or the toxicity of immunosuppressants but also recurrent nephropathy.

80歳女.右乳癌(41歳時), 胃癌(59歳時), S状結腸癌(65歳時), 左乳癌(70歳時), 左季肋部Bowen病(79歳時)の手術歴があった.今回, 肉眼的血尿が出現し, 尿細胞診にてPapanicolaou classIV, 左腎盂尿細胞診にてPapanicolaou classV, 入院時検査で貧血, 白血球増多, 腎機能低下, CRP上昇を認めた.排泄性尿路造影検査で左腎の造影遅延を, 逆行性腎盂造影検査では左腎盂内に不整な陰影欠損を, 腹部造影CTでは左上腎杯の拡張とその下方の充実性腎盂腫瘍を認めた.左腎盂腎炎と診断し, 左腎尿管全摘術を施行した.病理組織学的所見は, 移行上皮癌, G3, pT3, INF-γ, pL1, pV0であり, 腎門部リンパ節転移を認めた.術後経過は良好で略治退院となったが, リンパ節転移のため, 術後10ヵ月に他院で死亡した, We report a case of five metachronous primary cancers completely resected during 39 years. An 80-year-old woman had been diagnosed with and treated for bilateral breast cancers, gastric cancer, sigmoid colonic cancer, Bowen's disease and renal pelvic cancer. These cancers were found as metachronous cancers and were surgically treated. This is the first case of completely resected metachronous five cancers in Japan.

精巣腫瘍におけるHLA抗原の疾患感受性について, 血清学的タイピング・DNAタイピングを用い検討した.DNAタイピングにおいてDRB1 0405, DQB1 0401に疾患感受性を認めた, The role of HLA antigens in the etiology of testicular germ cell tumor has been suggested previously. Several attempts have been made to establish associations of HLA antigens in patients with testicular cancers, but have yielded inconsistent results. We studied the frequencies of HLA antigens by serological typing and DNA typing and examined the association between testicular germ cell tumors and HLA antigens. The serological expression of HLA-A, -B, -C, -DR and -DQ antigens was analyzed in 23 patients with germ cell cancers of the testis. The findings indicated a trend towards an increase in the antigen DQ4 (p < 0.05). The 13 patients were typed for HLA DRB1 and DQB1 allele by PCR-RFLP analysis. The findings revealed an increased frequency of DRB1 0405 (p < 0.01) and DQB1 0401 (p < 0.01).

We report here a case of post-biopsy arterio-venous fistula in a renal allograft which was successfully embolized. Percutaneous needle biopsy of renal allograft is performed when the cause of deteriorating renal function is clinically difficult to diagnose, and the pathological diagnosis obtained by it determines the therapy. An easy and safe biopsy encourages the clinician, but some complications occur after the procedure. Arterio-venous fistula is one of the complications after percutaneous needle biopsy of renal allograft. Color-coded ultrasonography is effective to find it, and transarterial embolization should be tried first to treat it.

We report a case of renal allograft rejection induced by the administration of interferon-alpha for hepatitis type C in a 36-year-old male. In September 1986, renal transplantation from his brother was performed after a 6-month delay because of his liver dysfunction. In October 1992, under the diagnosis of chronic active hepatitis type C, interferon alpha therapy was administered. Although his liver function was normalized during the treatment, proteinuria turned positive after 8 weeks of the therapy. Fourteen weeks after the start of interferon alpha therapy, the serum creatinine level was elevated, which was diagnosed clinically as a rejection reaction. We first discontinued the medication of interferon alpha and administered steroid pulse injection. As the renal disfunction did not respond to our first treatment, we changed mizoribine to azathioprine and added horse antilymphocyte immunoglobulin. Two weeks later, the creatinine level improved from 2.5 mg/dl to 2.0 mg/dl. The pathological findings of the transplanted kidney were acute on chronic type rejection.

20年間の入院患者の臨床統計を報告した.1)入院患者4, 956人中3, 590人に4, 105件の手術が行われた.2)主疾患は上部尿路結石症768人, 前立腺肥大症の631人, 腎移植後合併症511人であった.3)同種腎移植術255件を含む腎臓に対する手術が全手術の約25%を占め, ついで内視鏡手術が多数を占めた.最近ではESWLの導入により尿路結石症解放手術は皆無に近く, また, 膀胱, 前立腺疾患に対する内視鏡手術が主体となり, これらの解放手術の減少が著明であった, A statistic analysis was carried out on the 4, 956 inpatients admitted to our Department of Urology from April 1972 to December 1991. The patients included 3, 399 males and 1, 557 females. A total of 4, 105 operations including 255 renal allotransplantations were performed on 3, 590 patients. Open surgery for upper urinary tract stones has been replaced by extracorporeal shock-wave lithotripsy (ESWL) in the last three years.

対象疾患は尿路性器癌55例, 非癌泌尿器科疾患62例で, 正常対照として腎移植donorの予定者7例のみをこれに充てた.尿路性器癌の内訳は腎癌21例, 腎盂・尿管腫瘍5例, 膀胱腫瘍22例, 前立腺癌3例, 精巣腫瘍4例で, 腎移植は17例(急性拒絶反応8例, 慢性拒絶反応3例, 非拒絶時6例)である.1)癌疾患では, 未治療の腎癌が40.0%, 膀胱癌が21.1%のBFP陽性率を示し, 再燃癌では55.6%の陽性率であった.いずれも, 腫瘍の進展とともに陽性率の上昇する傾向がある一方, 手術・化学療法などの治療により, 陽性例のBFPのすみやかな低下がえられ, 治療経過のモニターとしての有用性が期待された.2)腎移植症例では, 拒絶反応と血清BFPとがきわめて高い相関が示し, 血清BFPが拒絶反応に対する新しいモニターとなりうることが示唆された, The serum basic fetoprotein (BFP) in patients with urogenital diseases was measured by enzyme immunoassay (EIA). The positive range of serum BFP was defined to be 75 ng/ml or more. In benign cases except for renal transplantation, the positive rate of serum BFP was 11.1% (5/45), and relatively high (21.4%, 3/14) in benign prostatic hypertrophy. In cases of urogenital cancers before treatment, the positive rate of serum BFP was 29.1% (16/55), and increased with the progression of clinical stage. Eleven of the patients with positive serum BFP before treatment were re-examined after treatment, and all of them exhibited a marked decrease of the titer of serum BFP. In seventeen renal transplant patients, the positive rate of serum BFP was 100% (8/8) in acute rejection, 66.7% (2/3) in chronic rejection and 0% (0/6) in rejection-free condition. We conclude that serum BFP is a clinically beneficial marker for renal transplant rejections and urogenital malignancies.

A case of synchronous ipsilateral renal cell carcinoma with renal pelvic and ureteral transitional cell carcinoma is reported. A 80-year-old man, who had had transurethral resection of bladder tumor three times, was admitted on August, 1989 for recurrence of bladder tumor. Excretory pyelography revealed a filling defect of left renal pelvis. Findings of retrograde pyelography and computed tomography were in accord with those of the excretory urograms. Under a diagnosis of the left renal pelvic and ureteral tumor associated with the bladder tumor, left nephroureterectomy with bladder cuff resection was performed. Pathological diagnosis was renal pelvic and ureteral transitional cell carcinoma with renal cell carcinoma, which existed incidentally in the same kidney. Double unrelated primary carcinoma in urinary tract, especially, double dissimilar primary carcinoma in the same kidney, is rare. To our knowledge, this case is the 20th double cancer in upper urinary tract reported in Japan.

A 41-year-old woman was hospitalized for evaluation of diabetes mellitus and hypertension. The hormonal and radiological examinations revealed that she had pheochromocytoma of bilateral adrenal gland and medullary carcinoma of thyroid gland. Therefore, she was diagnosed as having Sipple's syndrome. She had no definite familial history, but her two sisters, already dead, had been strongly suspected of having had pheochromocytoma. First, bilateral adrenalectomy was performed and secondly, total thyroidectomy, excision of parathyroid and cervical lymph node dissection were performed. Histopathological diagnosis was pheochromocytoma of bilateral adrenal gland, medullary carcinoma of thyroid gland and chief cell hyperplasia of parathyroid gland. We report a case of Sipple's syndrome, which probably is the 88th case in Japan, with the review of the previous Japanese literature.

A 41-year-old man was hospitalized, complaining of fecaluria and right lower abdominal pain. He was diagnosed to have vesicorectal fistula. Wedge resection of bladder and rectum, and partial resection of ileocecal legion were performed. Pathological diagnosis was Crohn's disease. Postoperative course was uneventful and no recurrence was observed. Including our case, 32 cases of enterovesical fistula due to Crohn's disease have been reported in the Japanese literature.

A case of testicular tumor (embryonal cell carcinoma with choriocarcinoma) in a 42-year-old man treated with renal autotransplantation is presented. After four courses of chemotherapy (carboplatin, vinblastine and bleomycin), we performed retroperitoneal lymph node dissection. At the operation, one of the swelling lymph nodes involved left renal artery completely, so we performed left renal autotransplantation and promoted more effective lymph node dissection. After the operation, renal function was impaired but returned completely in a short time. Autotransplantation provides excellent bench visualization of renal lesions and stable graft function. Therefore, this procedure should be taken into consideration when nephrectomy cannot be avoided.

A significant gap exists between organ supply and demand in the world. Marginal donors have been accepted as organ donors in recent years. On the other hand, aging recipients and recipients with complications have increased. This symposium was organized to discuss marginal donors and high risk recipients. We discussed fundamental researches such as prevention of renal ischemia reperfusion injury by erythropoitin and hepatocyte growth factor-macrophage stimulating protein (HGF-MSP) chimera, and the acquired tolerance induction using the CD28 superagonist antibody. We believe that this discussion will help increase the number of cadaveric kidney transplantations and improve the treatment outcome.

1) 1982年から5年間の大阪大学泌尿器科学教室における2, 192件の手術を集計し, 1972年から1976年の5年間および1977年から1981年の5年間の手術統計と比較検討を行った.2)臓器別手術頻度では過去2回の報告に比し腎, 膀胱に対する手術が増加していた.尿管に対する手術は減少傾向である.3)術式別頻度では, TUR-Btが前回に引き続いて最も多く, 腎摘除術が2番目であった.4)腎に対する手術では, 経皮的腎切石術(PNL)の導入により開放性の尿路結石手術が著明に減少した.5)膀胱, 前立腺に対する手術では経尿道的手術がますます増加した.6)膀胱腫瘍に対してはTURまたは膀胱全摘除術を施行する方針を貫いており, TUR-BtあるいはTU-biopsyにより膀胱全摘除術の適応を慎重に決定する方向にある.7)副腎腫瘍摘除術, 副甲状腺摘除術が着実に増加している, The statistics of urological operations performed at our department between Jan., 1, 1982 and Dec., 31, 1986 were reviewed. During the 5 year period, 2331 patients were admitted to our hospital and 2192 urological operations were performed on 1834 patients. These statistics were compared with earlier statistics for two periods (1972-1976 and 1977-1981) and the recent trend of urological operations was investigated. With regard to operated organ, operations on the kidney were the most frequent followed by those on the urinary bladder. Operations on the ureter decreased during the recent 5 year period and they were the fourth most frequent following those on the scrotum, scrotal contents and penis. Operations on the adrenal gland, retroperitoneal space and parathyroid gland have gradually increased. As in the former report, transurethral resection of bladder tumor (TUR-Bt) was the most frequent and nephrectomy, TUR of prostate (TUR-P) and renal allotransplantation have followed. TUR-Bt and TUR-P have increased more and more and due to the introduction of percutaneous nephrolithotripsy and transureteral lithotripsy, open surgery for urolithiasis has greatly decreased. Endourological operations will still be on the increase.

Twenty-two cases of pheochromocytoma encountered at our department between 1965 and 1986 are reviewed. Eighteen of the patients were adults (26 to 62 years old) and 4 were children (9 to 13 years old). Thirteen were males and 9 were females. In a total of 23 operative procedures, 31 tumors were resected excluding lymph node metastasis. The preoperative accuracy of the diagnostic methods for locating the tumor was as follows. KUB and intravenous pyelography with tomography in 12 of 31 tumors (39%), aortography and/or selective arteriography in 21 of 27 (78%), selective venous sampling for catecholamine level in 4 of 4 (100%), computed tomography in 10 of 10 (100%), ultrasonography in 4 of 6 (67%), and iodine-131 metaiodobenzylguanidine scintigraphy in 4 of 6 (67%) tumors. The tumors resected were cases, as followings, a single unilateral adrenal tumor in 14 (right 6, left 8), bilateral adrenal tumors, bilateral adrenal plus extraadrenal tumors and unilateral adrenal plus extraadrenal in each, one case and extraadrenal tumor in six cases (single 5, multiple 1). Either lumbar or thoracolumbar surgery methods were adapted in 9 of 14 cases with single adrenal and one of 5 with single extraadrenal tumors, and in the remaining 13 cases transperitoneal methods were selected. One patient died on the 6th day after operation from gastrointestinal bleeding. Thus the surgical mortality rate in our series was 4.4%. Of the 3 patients with malignant pheochromocytoma, two (9 and 13 years old) are alive each 192 and 67 months after operation. The former is in a tumor-free condition, however in the latter multiple bone metastasis was detected 37 months after operation. The third patient (29 years old) died 62 months after operation from metastatic hemorrhagic tumors in the liver.