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To evaluate the condition of incontinence in patients with senile dementia, we performed computed tomography X-rays to the brain and analyzed the relationship among the circulatory defect of the brain, the brain atrophy and the degree of incontinence. There were 92 patients subjected to this study who were hospitalised due to senile dementia; 74 patients had vascular dementia, 10 patients had senile dementia of Alzheimer type, and 8 patients had the mixed type. (age ranged: 54-95 years; mean: 80.3 years). The degree of incontinence in these patients varied as follows: 18 patients with continence, 16 patients with moderate incontinence, 58 patients with total incontinence. The diagnosis of circulatory defect of the brain was based on computed tomography observation of periventricular lucency (P.V.L.), and the degree of brain atrophy was evaluated based on 4 criteria: the Lateral body ratio, the Huckman number, the Evans ratio, and the enlargement of the subarachnoid space. Among the 92 patients, P.V.L. was present in 31 patients, among them 27 patients suffered from incontinence. There was a significant correlation between P.V.L. and incontinence (p < 0.001). As the incontinence progressively worsened (Continence, Moderate incontinence Total incontinence), the lateral body ratio increased to 24.8, 27.8, 28.6, (p < 0.05). The Huckman number also increased to 18.3, 19.3, 21.3, (p < 0.01), and the evans ratio likewise 29.9, 32.3, 33.7 (p < 0.01). The enlargement of the subarachnoid space was also correlated with the severity of incontinence. We conclude that urinary incontinence originating from senile dementia is connected to brain atrophy and is strongly influenced by the circulatory disorders of the brain.

A 57-year-old male patient was admitted because of a severe lumbar pain and gross hematuria. The rectal examination revealed a fist-sized soft tissue mass in the small pelvic space. A huge non-papillary tumor, which occupied the intravesical space, was found on cystoscopic examination. CEA IAP, TPA, CA19-9 and NSE were abnormally elevated in the serum. The pelvic CT scan shown an enormous polypoid tumor arising from the anterior vesical wall, while no abnormal lesion was found in the head, neck, chest and abdominal CT scans. The bone scintigraphy revealed multiple abnormal accumulations. The transurethral biopsy of the tumor was carried out. The pathological examination revealed homogeneous and small tumor cells arranged in sheet and solid patterns, which were positive for the anti-NSE stain and anti-NF stain, but negative for Grimelius stain. The final diagnosis was small cell undifferentiated carcinoma of the urinary bladder. The patient died of cancer five months after diagnosis.

Retrospective study on the frequency of associated bladder cancer and the influence on the prognosis was carried out in 170 cases of renal pelvic and ureteral cancer. The number of cases of associated bladder cancer coexistent with renal pelvic and ureteral cancer was 31 (18.2%), and the number of subsequent cases 3 (19.4%). The frequency of occurrence of the primary tumor site was 27.2% in the renal pelvis, 45.6% in the ureter and 58.3% in both renal pelvis and ureter. Multiple tumors occurring in the renal pelvis and ureter occupy a high percentage. As for the degree of differentiation, many cases were subsequent to G1. As for the stage, a few cases with bladder cancer were subsequent to T4, but there was no definite tendency in the occurrence of bladder cancer. The prognosis of renal pelvic and ureteral cancer: the 10-year survival rate was 93.3% for G1, 66.6% for G2 and 12.4% for G3. As can be seen, there was good correlation with the pathological gradings. It must be remembered, however, that 5-year survival rates in cases of associated bladder cancer of coexistent type, in cases of subsequent type and in cases without associated bladder cancer were 56.2%, 72.7% and 64.8%, respectively: there was no significant difference. Bladder cancer associated with renal pelvic and ureteral cancer makes the therapy troublesome, but no influence on the prognosis was observed. Therapy in conformity with the pathological grading and stage is regarded as particularly important in cases of associated bladder cancer.

Cystic mesothelioma of perinephric retroperitoneum origin are very uncommon tumors and considered potentially malignant. We report one such case and discuss the clinical and pathological findings. A 70-year-old man was seen with complaint of discomfort in the right flank and hospitalized in May 1989. Computerized tomography revealed multiple cystic masses in the right retroperitoneal space which appeared to be infiltrating the kidney and the iliopsoas muscles. Magnetic resonance imaging showed deformation of the right kidney with many impressions in the parenchyma. The cystic lesions and the right kidney were extirpated on June 2, 1989. Grossly the specimen was 16 x 10 x 8 cm in size and 630 g in weight. The multiple cysts surrounding the kidney were each approximately 10 mm in diameter and had thin outer walls. The cyst fluid was clear and serous. The kidney had not been infiltrated but had only external impressions caused by the cystic lesions. Microscopically, the cysts were lined by a single layer of cuboidal cells accompanied by some hobnail-shaped cells, and no evidence of malignancy was found. The epithelium was focally positive for periodate acid Schiff and slightly positive for Alcian blue. It was strongly positive for cytokeratin and vimentin, and slightly positive for EMA but negative for lectins. The diagnosis was diffused benign multicystic mesothelioma. However, CT taken four months after the operation revealed local recurrence and radiotherapy (40 Gy) was instituted. Since the cystic mass tended to grow in size thereafter, the lesion appeared to be malignant clinically. We consider this is the first case of cystic mesothelioma of perinephric retroperitoneum origin reported in Japan.

Clinical trials using Extracorporeal Shock Wave Lithotripter (Tripter X-1) were performed on 30 cases for upper urinary tract calculi (16 cases: renal stone, 14 cases: ureter stone) with one trial per individual case from December, 1988 till February 1989. The fragmentation rate of 100% resulted. One month after treatment, evaluation on the X-ray film showed that 10 cases (33%) were found to be excellent where stone silhouette was no more observed. Effective cases where residual stone having dimension of below 5mm counted 10 (33%), and clinically effective rate, sum of both excellent and effective rates was 67 percent. Effective rate was 75 percent in case of kidney stone, and 57 percent in case of ureter stone respectively. Side effects of visual hematuria, skin ecchymosis and fever were observed, yet none of them was of serious grade, and post operative changes in blood chemistry were mild and transient. No remarkable side effects due to radiation exposure were observed. We concluded therefore that Extracorporeal Shock Wave Lithotripsy by this system is an effective therapy for upper urinary tract stones.

During the 13 years from 1976 to 1988, 160 patients with renal pelvic and ureteral cancer were reviewed based on a new general rule for clinical and pathological studies on renal pelvic and ureteral cancer of Japanese Urological Association. There were 71 renal pelvic cancers, 80 ureteral cancers, and 9 cancers in both regions. Patients ranged in age from 35 to 91 years old (average: 63). The involved side was right in 63 and left in 97. The most frequent symptom was hematuria, which was seen in 81.1%. IVP revealed the findings of filling defects, hydronephrosis, and non-visualized kidney in 99.7% of the patients. Total nephroureterectomy with bladder cuff resection was performed in 123 cases, nephroureterectomy in 16 cases, nephrectomy in 5 cases, partial ureterectomy in 10 case, and biopsy in 6 cases. As adjuvant therapies, irradiation was performed in 32 and chemotherapy in 123. Histologically, 156 were with transitional cell carcinoma, one squamous cell carcinoma, one adenocarcinoma and 2 unclear, the over-all survival rate of this study at 1, 3, 5 and 10 years were 86.8%, 73.0%, 65.3% and 45.6%, respectively. No patient with lymph-node metastasis (N+) survived longer than 5 years. All patients with M(1) died within one year. There were no difference of prognosis between renal pelvic cancer and ureteral cancer. Regarding various prognostic factors, our series gave the same results as previous reports. However, it should be stressed that pathological grading was the most important prognostic factor.

Four hundred and thirty-one patients with renal cell carcinoma treated at Jikei University and its related institutions from 1957 to 1988 were studied as to tumour size in relation to clinical characteristics (age, sex ratio, affected side, symptoms), prognostic factor (fever, weight loss, anaemia, elevation of erythrocyte sedimentation rate), pathological staging, pathological grading, and survival. The treated patients were divided into 4 groups on the basis of tumour size (group A; under 3.0 cm, group B; 3.1 to 5.9 cm, group C; 6.0 to 9.9 cm, group D; over 10 cm in diameter). At the time of operation, there were 22 cases (5.1%) in group A, 121 cases (28.1%) in group B, 209 cases (48.5%) in group C, and 79 cases (18.3%) in group D. In studying the clinical factors of age, sex ratio, and affected side, no relationship with size was detected. As for the symptoms, the larger the tumour, the more frequent the symptoms of urinary tract (haematuria, pain, and palpable mass). This tendency was especially marked in the cases of group D (over 10.0 cm in diameter). In addition, no relationships were observed between the rate of haematuria and the symptoms of extraurinary tract in each group. As for the prognostic factors (fever, weight loss, anaemia and the elevation of erythrocyte sedimentation rate), there was an obvious tendency for a positive reaction of these factors in the cases of groups C and D (over 6.0 cm in diameter). As for the distribution of stage and grade in each group, a higher stage and grade were observed with large sized tumours.(ABSTRACT TRUNCATED AT 250 WORDS)

Seminal findings and blood hormone levels were studied for evaluating the male reproductive function in patients with spinal cord injury. The patients were divided into 3 groups, namely, 18 patients with complete injury, 5 patients with incomplete injury and 3 patients with dyspermatism. The number of sperms, the rate of movement and rate of deformation were measured for semen obtained by forced ejaculation. The number of sperms was kept at a relatively high level in the three groups, while the rate of movement fell off in all of the three groups. The rate of deformation was highest in the patients with complete injury and lowest in the patients with dyspermatism. As for blood hormone levels, LH, FSH and Testosterone (hereinafter referred to as TES) were determined by the RIA. The cases were classified into those in the acute stage and those in the chronic stage 3 months after sustaining injury for a comparative study. The subjects consisted of 27 cases in the acute stage and 47 cases in the chronic stage. For 8 patients in the acute stage, the blood hormone levels were determined even in the chronic stage and follow-up observations were made on the changes in the levels. The FSH level was low in both stages, while LH and TES tended to increase in the chronic stage. Particularly, the TES level was elevated in all the cases in the follow-up observations made in 8 patients. From the results mentioned above, transient disturbance of the interstitial function is suggested as the mechanism of male gonadal disturbance due to spinal cord injury.

Utilizing two types of human renal cell carcinoma heterotransplanted in nude mice (JRC 1; papillary, avascular pattern, grade III, JRC 11; anaplastic and alveolar, hypervascular pattern, grade IV), we investigated the influence of tumor blood flow upon the effects of local hyperthermia (42.5 degrees C), induced by 915 MHz microwave. Blood flow was determined from the rate of thermal clearance by use of the bio-heat transfer equation. The rate of thermal clearance was measured at intervals of approximately 10 minutes throughout the treatment session after turning off the microwave for 50 seconds. With both strains it was necessary to increase the microwave power until the constant steady-state temperature of 42.5 degrees C was reached. The JRC 11 strain needed more power for the constant temperature than JRC 1, but it needed a greater decrease in power level during the heating session to maintain a constant steady-state temperature. This was an indication that the tumour blood flow decreased more markedly in the JRC 11 strain. In both tumours, a decrease of blood flow was observed during the heating session. In the case of the JRC 1 strain, it was observed that the mean value of blood flow was 1.87 times higher than that of JRC 11. This indicated a sharp reduction in blood flow in JRC 11 strain. This reduction was confirmed by the thermal clearance measurement at the end of the treatment session. A sharp reduction in blood flow in hypervascular tumour (JRC 11 strain) is caused by a stasis of intra-tumoural blood circulation during the heating.(ABSTRACT TRUNCATED AT 250 WORDS)