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Shock wave irradiations induce bioeffects including angiogenesis and bone healing. However, physical mechanisms underlying those bioeffects remain elusive. Extracorporeal shock wave treatment (ESWT) is one of well-known shock wave therapies. In ESWT, shock waves destroy kidney stones with cavitation and negative pressures. Energy flux density of shock waves in ESWT is around 0.1—1 mJ/mm2. In this study, shock waves with energy flux density of 0.001 mJ/mm2, around 1/100 of ESWT, were irradiated on endothelial cells. In those cells, intracellular Ca2+ increase, i.e. a typical physiological response, was observed. Along the intracellular Ca2+ increase, extracellular fluid flow was not present. As well, both plasma membrane permeabilization and cell detachment were not detected. On the other hand, actin cytoskeletons, which link extracellular substrates and cellular components, were suggested to involve in the intracellular Ca2+ increase. Thus, it was supposed that shock waves initiated intracellular Ca2+ inc...

膀胱癌を含む高次重複癌の4例.第1例は70歳男性で, 膀胱移行上皮癌, 前立腺小腺房性高分化型腺癌, 膵高分化型腺癌の3重複癌で, 悪液質で死亡した.第2例は69歳男性であり, 膀胱移行上皮癌, 陰茎扁平上皮癌, 喉頭扁平上皮癌の3重複癌で, 発症後6年経過したが, 再発を認めていない.第3例は78歳の男性で, 膀胱移行上皮癌, 胃中分化型腺癌, 前立腺小腺房性高分化型腺癌, 肺微小扁平上皮癌の4重複癌で, 胃癌の広汎転移により閉塞性黄疸・腎不全を併発し死亡した.第4例は76歳男性で, 膀胱移行上皮癌, 頸部鰓性癌, 頬部扁平上皮癌, 直腸高分化型腺癌の4重複癌であり, 第1癌発症後17年を経過したが, 再発なく生存している, Two cases of triple primary neoplasm and two cases of quadruple primary neoplasm including transitional cell carcinoma (TCC) of bladder are reported. The first case was a 70-year-old male who had bladder cancer, occult cancer of prostate (adenocarcinoma) and highly differentiated adenocarcinoma of pancreas. He died of cachexy. The second case was a 69-year-old male. This case was also triple primary neoplasm including bladder cancer, squamous cell carcinoma (SCC) of penis and SCC of larynx. The third case was a 78-year-old male who had bladder cancer, adenocarcinoma of prostate similar to that of the first case, adenocarcinoma of stomach, and SCC of lung. He died of obstructive jaundice and renal failure owing to massive metastases of gastric cancer. The fourth case was a 78-year-old male who had four primary neoplasms such as bladder cancer, branchiogenic epithelial carcinoma, SCC of buccal mucosa and adenocarcinoma of rectum.

Larixin was administered to 24 cases of acute genitourinary tract infection. 1) In 19 cases of acute cystitis, the clinical response was excellent in 14 cases, good in 3 cases and poor in 2 cases with 94.7% of effectiveness. 2) In 2 cases of acute pyelonephritis, the clinical response was excellent in 1 case and good in 1 case. 3) In 1 case of acute epididymitis, the clinical response was good. 4) In 2 cases of acute gonorrheal urethritis, the clinical response was good in 1 case and poor in 1 case. 5) Side effects were observed in only one patient who showed only slight nausea.

1) A total of 27 patients with cystitis have been treated with Wyvital. Wyvital was markedly effective in 14 cases, effective in 9, and without effect in 4. The effectiveness rate was 85.2 %. 2) In the last 6 years, the pathogenic organisms isolated from 329 patients with acute cystitis in our clinic were 180 strains of E. coli, 49 strains of Staphylococcus epidermidis, and 44 strains of Staphylococcus aureus. Thus, E. coli was observed in many cases and occupied 54.7%. 3) E. coli was stronger than Staphylococci against the existing antibiotics. The clinical effectiveness of PC, EM, OL, LM, SX, etc. was less than 50 %. 4) No significant side effect of Wyvital was observed.

Percutaneous antegrade pyelography under ultrasonic real-time guidance was performed in 18 cases of obstructive hydronephrosis, which were poorly visualized the renal collecting system on excretory urography and in which or retrograde pyelography could not be performed successfully. This technique was safe, accurate and easy, and provided significant diagnostic information in these cases. With the patient under local anesthesia an 18 gauge spinal needle was inserted into the renal pelvis. Approximately 10-20 ml fluid were withdrawn from the renal pelvis for cytology and culture. After the injection of contrast medium radiograms were obtained in adequate positions. Delayed films were obtained when indicated. In 8 cases pelvic and/or ureter tumor was diagnosed. In two cases congenital anomalies were diagnosed, one had complete obstruction at the ureteropelvic junction and the other had complete obstruction at the ureterovesical junction. In the other three cases ureter ligation and in 5 cases ureter stenosis were diagnosed. The quality of the aspirated urine was dark-red in 6 cases, positive cytology, in 6 cases, all of which had pelvic and/or ureter tumors. No severe complications were observed.

1) 150例の再発性・特発性蓚酸カルシウム尿路結石症を対象として, 最低2年間を目標として, アロプリノール投与による結石再発予防の臨床的検討をおこなった.2)検討可能症例134例(男性113例, 女性21例, 平均年齢42.7歳)を, 結石の発生・再発様式により多発型23例とepisode型111例に分類し, 全例について結石の再発・増大の有無を, episode型については統計学的にも治療前後の再発率の検討をおこなった.3)全症例の結石再発・増大に関しては, 多発型23例中19例に再発・増大を認めず, 4例のみに増大を認めた.episode型111例については59例に再発を認めず, 52例に再発を認めた.134例全例を通じては78例(58.2%)に再発または既存結石の増大は認めず, 56例(41.8%)に再発・増大を認めた.4) episode型111例のアロプリノール投与前後の再発率を統計学的に比較した.111例全例の治療前後の再発率, 治療開始時に結石を有しなかった37例の治療前後の再発率, 治療前後2年間ずつの同期間の再発率を比較しえた79例のいずれにおいても, アロプリノール投与により再発率の有意の低下が観察された, We studied the effect of allopurinol on the prevention of stone recurrence in 134 patients with recurrent, idiopathic calcium nephrolithiasis. They consisted of 113 male patients and 21 female, between 16 and 72 years with an average age of 42.7. The patients were divided into two groups according to the type of stone occurrence; those with multiple stones without previous stone episodes (multiple stone group), and the those with recurrent stones (stone episode group). Twenty three patients belonged to the multiple stone group and 111 patients belonged to the stone episode group. The stones in 19 of the 23 patients in the multiple stone group remained stable throughout the study, while stones in 4 grew. Fifty-nine of the 111 patients in the stone episode group were free from recurrence, but the others showed recurrence. Statistical analyses was done on the stone episode group. The stone recurrence rate of all of the 111 cases showed significant decrease during prophylactic treatment with allopurinol (p less than 0.01), although the observation period before treatment was 73.0 +/- 65.8 months and that during and after treatment was 28.2 +/- 12.1 months. During the two years before and after prophylaxis 79 patients also showed a significantly decreased recurrence rate. Moreover, regarding 37 cases without any stones at the start of treatment, stone recurrence rate decreased significantly after the administration of allopurinol. Throughout this study, we used a new method for evaluating reasonable stone recurrence. It did not calculate the number of stones recurred, but the stone-forming circumstance in each kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of 46, Xp+, Y with gonadal dysgenesis is described. The patient was a 14-year-old boy with short status (129 cm) complaint of underdeveloped testicle. IVP and cystourethrogram showed no abnormality. Chromosomal analysis of peripheral lymphocytes revealed 46, Xp+, Y. Histological examination of the specimen obtained by testicular biopsy revealed an immature tubule-like structure without spermatogenesis. Chromosomal study on his mother who was also short status revealed a karyotype of 46, X, Xp+ in peripheral lymphocytes.

Two cases of malignant neoplasm of the vesical diverticulum were reported. Case 1. A 51-year-old housewife visited our hospital because of gross hematuria. The cystoscopic examination disclosed the presence of tumor in the diverticulum of urinary bladder. The pathological specimen showed squamous cell carcinoma grade II and cytologic examination of urine showed class III. She was treated with partial cystectomy and postoperative pathological examination revealed stage B2. Case 2. A 56-year-old widow consulted our hospital with complaint of fever, loin pain, pain on urination and gross hematuria. The cystoscopic examination revealed a presence of tumor in the vesical diverticulum. Cytologic examination of urine revealed class V. She had partial cystectomy instead of radical operation because of massive metastases to the retroperitoneal lymph nodes (stage D2). About one year after the operation, she died of acute renal failure induced by metastases to right ureter and left renal parenchyma. The main diagnostic measures in this disease had been cystoscopy and cystography but we demonstrated the usefulness of the urinary cytologic examination and double contrast cystography as valuable diagnostic studies especially for evaluation of the size and shape of tumor.

Fifty-eight clinical cases consisting of 52 benign prostatic hypertrophy, 4 bladder neck sclerosis, neurogenic bladder and 1 psychosomatic pollakisuria, were treated by Hachimijiogan. 1) Thirty-five (67.3%) out of 52 cases of BPH showed favorable responses to the treatment with Hachimijiogan. 2) Twenty-three (56.1%) out of 41 cases having night pollakisuria, 23 (71.9%) out of 32 cases having residual urine and 8 (72.7%) out of 11 cases with prolonged micturition times showed effectiveness. 3) No remarkable change was observed in voiding cystourethrograph, cystoscopic examination, digital examination of the prostate, WBC in urinalysis, blood examination, blood chemistry and total renal function. 4) Side effects were present in 3 cases. (5.7%) 5) Hachimijiogan is an adequate drug for pre-surgical treatment and non-operative treatment of BPH.

1972年1月から10年間の原発性尿管癌24例の臨床的観察をおこなった.1)尿管癌が泌尿器科外来新患患者の0.17%を占めた.2) 41～84歳, 平均年齢は65歳であった.3)男:女は3:1であった.4)左側に多く, 下部尿管1/3に多かった.5)臨床症状は, 肉眼的血尿が19例ともっとも多く, ついで, 腰痛6例であった.6)尿細胞診は, 18例9例が陽性であった.7)膀胱鏡検査では, 腫瘍の尿管口からの突出を4例に認め, ついで尿管口部の隆起を2例に認めた.8)排泄性腎盂造影では, 24例中10例に陰影欠損を認め, 逆行性腎盂造影では10例全例に陰影欠損を認めた.9) CTは9例中4例に腫瘍部に一致しmassを認めた.10)腎尿管全摘除兼膀胱部分切除術あるいは膀胱全摘除術を14例に施行した.11)5年生存率は56.5%で, 予後は, 浸潤度, 悪性度と密接に関係した, A clinical survey was performed on 24 cases of primary ureteral tumors treated in our University Hospital between Jan. 1972 and Dec. 1981. The incidence of primary ureteral tumors was 0.17% among the outpatients in our urologic clinic. The patients ranged from 41 to 84 years old in age (average age: 65 years), and the male to female ratio was 3 to 1. The left ureter and the lower third of the ureter were involved more frequently. The most frequent initial symptom was macrohematuria seen in 19 cases (79%), followed by loin pain seen in 6 cases (25%). A cytologic study of the voided urine or ureteral urine was carried out in 18 cases and positive results were obtained in 9 cases (50%). Cystoscopic examination revealed a tumor protruding through the ureteral orifice in 16.7% (4 of 24 cases), followed by bulging orifice in 8.3% (2 of 24 cases). Excretory pyelography showed ureteral filling defects in 41.7% (10 of 24 cases). Retrograde pyelography showed ureteral filling defects in 100% (10 of 10 cases). CT showed a mass region in 44.4% (4 of 9 cases). A total of 14 patients underwent nephroureterectomy with partial or total cystectomy (66.7%). The overall 5-year-survival rate was 56.5% and could be directly associated with grade and stage of tumors.

We have clinically surveyed the distribution and disk sensitivity of bacterial strains obtained from urine of patients with various urological disease at our department during three (1975-1977) and four (1980-1983) years. Escherichia coli was the most frequently isolated (29.4%) from the outpatients, followed by Staphylococcus epidermidis (17.5%), Pseudomonas cepacia (11.2%) and Serratia marcescens (11.2%). Pseudomonas cepacia was the most frequently isolated (28.0%) from the inpatients, followed by Staphylococcus epidermidis (16.3%) and Serratia marcescens (15.9%). Pseudomonas cepacia which has been increasing was first isolated in 1977 and Serratia marcescens in 1976. They have become the main bacteria causing infections in our hospital. Pseudomonas cepacia was frequently isolated after postoperative prophylactic chemotherapy and Serratia marcescens in the late period of admission. The majority of Pseudomonas cepacia was resistant to all agents except chloramphenicol and doxycycline. Serratia marcescens was also resistant except to gentamicin and doxycycline. In Escherichia coli species, resistant strains increased gradually but they have good sensitivity to gentamicin, dibekacin, colistin and doxycycline. Staphylococcus epidermidis isolated from outpatients had good sensitivity to all agents but increased in incidence of resistant strains isolated from inpatients.

Carcinoma occurring primarily in the ureter has been increasingly reported, though used to be rare disease. We presented here ten cases of ureteral carcinoma, the incidence of which was 0.18% of outpatients in our urologic clinic [or four years. The age of patients was from 41 to 77-year-old with average age of 62.2 year and with male predominance. Most of the carcinoma located in the lower portion of the ureter. Hematuria and less frequently lumbar pain or pain on micturition were initial symptoms. Of the various urologic examinations, cystoscopy, DIP and RP were mostly available and contributory to diagnosis. The survival of the patients with ureteral carcinoma was not favorable, despite of radical surgical excision associated with chemotherapy, and the three-year survival rate was twenty per cent.

A 63-year-old male was admitted with a complaint of right abdominal mass. A right renal tumor associated with direct invasion to liver and with lobulated cystic lesion and renal solitary cyst were diagnosed preoperatively by aortography and computed tomography. Transperitoneal radical nephrectomy and partial resection of liver metastasis were performed. Histological diagnosis was clear cell carcinoma with dilated tubuli. Tumor invasion to the inferolateral portion of the liver and to the renal solitary cyst wall were demonstrated by both gross and microscopic examinations. The coexistence of tumor and cyst in the same kidney is rare. Our case probably had both the type I and II or III tumors according to Gibson classification. Twenty months after radical nephrectomy, pulmonary metastases were detected by chest x-ray, tomography and bronchial arteriography. All metastatic lesions were replaced by fibrous change 7 months after the four bronchial arterial infusions (BAI) of ADM 30 mg and irradiation with a dose of 5, 000 rads to each lesion. After 9 tumor-free months, recurrence of pulmonary metastases were pointed out by chest x-ray and tomography. They (four coin lesions) were treated with anticancer therapy, mainly irradiation and twice insufficient BAI. Three of them were occupied entirely by fibrous change and another solid one remained in the right pulmonary apex without enlargement for the past 4 months. Radical nephrectomy and partial resection of the liver for the primary renal cell carcinoma with direct invasion to liver, BAI and irradiation for the two pulmonary metastases have kept the patient alive for 4 years.

腎細胞癌58例中18例に腎動脈閉栓術を施行した.18例中初期の10例はADMまたはMMCをone shot injection後にGelfoam, steel coil (G群)を, 最近の8例はabsolute ethanol (A群)を用い塞栓した.1) A群は塞栓物質注入直後に激痛(6/8, 75%)をきたすが帰室後は自制可能であった.G群の直後はほとんど疼痛を訴えないが徐々に強くなり嘔気, 嘔吐をともない, そのために手術を早めざるをえなかった.2)発熱はA群の方がG群より有意に高かった.3) WBC, GOT, GPT, LDHは塞栓2～3日後に一過性の高値を示すが両群間に有意差はなかった.γ-GTP, ALPは緩徐に上昇傾向を示した.4)寄生動脈の豊富な, または局所浸潤があきらかな腎細胞癌には塞栓効果はあまり期待できない.5)組織学的に腫瘍組織と正常腎組織の梗塞性変化はA群の方が強く, 塞栓物質はabsolute ethanolの方がすぐれている.6)高度な梗塞性変化は病理組織診断を困難にすることもある.7)塞栓術は腎細胞癌の予後に好影響はなかった.8)塞栓術は手術操作(腎茎処理)を容易にするが, 単にその目的に絞れば塞栓物質は必ずしも多量を要しない, Renal arterial embolization is often used in the treatment of patients with renal cell carcinoma, either preoperatively to facilitate nephrectomy or as palliative therapy in advanced cases. Eighteen patients (18/58; 31%) underwent renal arterial embolization in our department since 1979, initial 10 cases with Gelfoam and steel coil (group G) and recent 8 cases with absolute ethanol (group A). Clinical studies of daily changes of symptoms and blood chemistry in both groups after embolization were compared and the results were as follows: Severe flank pain was noted immediately after embolization but thereafter well controlled without analgesics in group A. The patients in group G experienced no pain during the procedure of embolization but have had moderate flank pain of two or three days' duration with nausea and/or vomiting and required surgical procedure within a few days after embolization. Post embolization fever in group A was described as higher than that in group G significantly. Leukocytosis was noted to be persistent for up to seven days and blood chemistry showed transient marked elevations of GOT, GPT and LDH immediately after the procedure without significant value in both groups. Embolization to advanced tumor with many parasitic vessels or massive local invasion may not always be available for remaining of viable-appearing tumor cells in venous lumen, as if palliative treatment. Absolute ethanol may be more useful as the embolizing substance than Gelfoam and steel coil by reason of producing wide severe infarction of diseased kidney. Broad marked infarction due to renal arterial embolization may make pathological diagnosis difficult. Immunological effects of renal arterial embolization were not observed in short term patients survival.(ABSTRACT TRUNCATED AT 250 WORDS)

The patient was a 61-year-old man with tumor in the diverticulum of the urinary bladder. Tumors in the diverticulum located on the right posterior wall of the bladder were multiple. Total cystectomy and ileal conduit were performed. Histological diagnosis was made as transitional cell carcinoma, grade III and stage C. Eighty-two cases were reviewed from the Japanese literatures and results of opinionaire as to incidence, sex, age, symptoms, urinary cytology, diagnosis, operative treatment, pathologic diagnosis and prognosis.

Twenty-four patients with urinary tract infection were treated by administration of doxycycline hydrochloride (Vibramycin) and the following results were obtained. Of 12 cases with chronic urinary infection or postoperative infection, 4 responded remarkably, 4 well and 4 showed no response. The effective rate was thus 66.7%. Of 8 cases of acute pyelonephritis, 4 responded remarkably, 3 well and one no response. The effective rate was thus 87.5%. Of 4 cases of acute cystitis, 3 responded remarkably and one well. The effective rate was 100%. E. coli, Staph. epidermidis and Staph. aureus were sensitive to doxycycline hydrochloride. This fact was also proved by the clinical evidence. For the treatment of the secondary urinary tract infection, elimination of the urinary stasis IS important and the effect of the drug must be evaluated with this matter in mind. Doxycycline hydrochloride was particularly effective for acute urinary tract infection such as acute pyelonephritis and acute cystitis. This was probably due to the long duration of the effective blood concentration and high urinary excretion rate. No side effects were observed due to doxycycline hydrochloride. Finally, it was concluded that doxycycline hydrochloride (Vibramycin) is an excellent drug useful for the treatment of urinary tract infection.

The patient, a 42-year-old married woman, was admitted to our hospital with chief complaints of a painless mass at the external genitalia and the divided urinary stream for two-month duration. Local finding revealed an elastic soft tumor with shape and size of an egg which was attached to the posterior wall of the urethra. The surface of tumor was smooth. The physical and endoscopic examinations suggested a benign tumor. The removed mass was solid and oval in shape, 4.3×3.2×3.0 cm in size, 18 grams in weight. The cut surface was even with pink color. Histopathological diagnosis was benign leiomyoma. Our case was 25th case of leiomyoma and 57th case of the paraurethral tumor which has been reported in Japan. The literature was reviewed and clinicopathological aspects of this benign tumor were discussed.

We reported two cases of unusual foreign body (Kirschner wire) in the bladder. The wire migrated into the bladder and completely penetrated the bladder wall, which was used to multiple pinning for intracapsular fracture of the femur. The first case was a 78-year-old man treated with two Kirschner wires for the repaire of fracture of the right femur neck in the car accident. One of them migrated and penetrated the bladder three months after the operation. He suffered from intermittent gross hematuria and consulted our clinic. Transvesical removal of the wire and partial cystectomy were performed. The wire was 11.4cm in length with ammonium magnesium phosphate stone. The second case was 67-year-old woman who had fracture of the left femur neck when she fell down from the bed. She was treated with two Kirschner wires one month after the episode. But one of them moved into the bladder about two months later. The wire was removed transvesically and 9.8 cm in length with ammonium magnesium phosphate stone.

Twenty-five of 34 patients who underwent pyeloplasty operation for ureteropelvic junction obstruction were able to be followed up for three months or more after operation. Postoperative results were compared in twenty-six kidneys of these patients according to clinical conditions such as age, duration of indwelling nephrostomy tube and splint catheter, operative method (one-stage or two-stage operation), preoperative urinary tract infections, preoperative grade of hydronephrosis and the postoperative period evaluated. Postoperative results evaluated at three months after operation, revealed no case with excellent improvement. At 36 months after operation excellent improvement rate was 46.7% and there was a significant difference in excellent improvement rate between these times. At 3, 6, 12 and 36 months after operation, improvement rate was 35.7, 55.0, 52.9 and 86.7%, respectively. At 3 and 6 months or more, deterioration rate was 29 and 0%, respectively. It is concluded that evaluation of pyeloplasty should be done at least 6 months after operation and even if renal function is stable at this period, more improvement in renal function can be expected at one year or more after operation.

Intravesical combination chemotherapy was performed in 48 cases with bladder tumors. Mitomycin C 10 mg was administered concomitantly with cytosine arabinoside 20 mg (4 cases, group A), 100 mg (21 cases, group B), 200 mg (3 cases, group C) or 300 mg (20 cases, group D). The clinical results were as follows: 1) Complete disappearance of tumors was found in 24% of group B, in 33% of group C, and in 35% of group D. Clinical improvement including complete disappearance of tumors was found in 25% of group A, in 57% of group B, in 67% of group C, and in 80% of group D. 2) Side effects were found in 25% of group A, in 9.5% of group B, in 33% of group C, and in 20% of group D. But most of them were minor side effects. 3) Recurrence rate was 2.7% within 6 months, and 5% within 18 months. 4) It was concluded that the treatment with mitomycin C 10 mg and cytosine arabinoside 100 mg was satisfactory in the tumors (pedunculated, papillary, of smaller size than the small finger head, or of grade I). The necessary dosage of mitomycin C was 10 mg and that of cytosine arabinoside was 300 mg for the tumor of larger size than the thumb tip even pedunculated, the sessile tumor or the tumor of above gradeII.

From 1975 to 1979, there were 11 patients with pyelocaliceal diverticulum, 8 males and 3 females, out of 7009 newly visited outpatients, an incidence being 0.18%. In these 11 patients, about 80% had calculi in the diverticula. The average age was 38-year-old. The lesions were unilateral and single in all cases, right kidney 5 cases and left 6 cases. The diverticula had communication with the upper calyx in 7, the middle in 3 and the lower in one. The most frequent symptom was lumbar dull pain on the affected side (36%). Symptomatic four cases required surgical treatment such as partial nephrectomy in three cases and diverticulotomy in one. The postoperative courses were uneventful and the symptoms almost subsided.

1) PIPC were intravenously administered to 24 patients with complicated urinary tract infections in daily doses of 4 g for 5 days and results obtained were excellent in 8 cases, good in 7 cases and poor in 9 cases. 2) The drug was effective to Pseudomonas and Serratia (effective rate 67% in both). 3) 2g doses of PIPC were intravenously administered to three patients, two with unilateral renal impairment and one with impairment of solitary kidney by a single shot. Urinary concentration and excretion rate of PIPC were low in urine from diseased kidneys. 4) No remarkable side effect was observed in administered cases.

In total 15, 888 outpatients were newly seen at the Urological Department of Mie University Hospital during the period of 1968 to 1979, 14, 300 patients had urological diseases. The satistical analysis were performed on the patients and revealed some results.

偏側閉塞腎盂内薬剤(アミカシン)移行濃度を測定した.対象患者は9名で, 原疾患は尿管結石8例, 手術による一側尿管結紮1例であった.全例, 硫酸アミカシン100 mg静注後6時間で手術的に閉塞腎盂内尿を全量採取し一部を検体とした.硫酸アミカシン100 mg静注後30, 60, 120, 240, 360分と血液を採取, 正常側は膀胱尿とし2時間ごとに採取し, それぞれ濃度を測定した.血中・尿中アミカシン濃度はAMES TDDキットを用いSubstrate-Labeled Fluorescent Immuno-Assay法で測定した.尿中濃度は測定範囲を超えるため緩衝液で10～15倍に希釈し測定した.1)血中濃度は30分で8.8±1.0 mcg/mlと最高濃度を示し, 以後漸減した.2)健側腎からの各2時間ごとの尿中濃度はそれぞれ155.9±45.4 mcg/ml, 98.8±35.6 mcg/ml, 83.3±33.8 mcg/mlで, 閉塞腎盂尿中濃度は6時間尿とし118.9±52.3 mcg/mlであった.3)尿中排泄量は健側腎からの各2時間尿でそれぞれ28.3±3.4 mg, 9.6±3.6 mg, 9.3±3.5 mgで, 閉塞腎盂内尿中排泄量は16.8±3.0 mgであった.4) 1回100 mgアミカシン投与は閉塞腎感染予防の目的には有効と考えるが, 感染発生時には少なくとも200 mgの投与が必要と考える, Urinary amikacin concentration was determined in 9 patients with severely unilateral ureteral obstruction. Serum levels were within the normal range. The average concentration of amikacin in the urine from obstructed urinary tract was 118.9 mcg/ml 6 hours after 100 mg amikacin iv infusion. Urine concentration from the normal kidney was 155.9 mcg/ml at the first 2 hours after intravenous infusion, 98.8 at the second 2 hours 83.3 at the third 2 hours. Urinary amikacin excretion from severely obstructed urinary tract was about one third of the total excretion from a normal system. In summary, the urinary level in severely obstructed urinary tract after iv infusion of 100 mg amikacin may be enough prophylactically. But at the onset of infection in severely obstructed urinary tract, the administration of at least 200 mg amikacin intravenously is required.

PT-122M (doxycycline hydrochloride) was administered intravenously to 4 subjects with normal renal function and 7 with moderately impaired and 11 with severely impaired. Plasma concentration and urinary excretion of the given antibiotic were investigated. Dosage was 200 mg on the first day and 100 mg per day for the following six days. No accumulation of the drug was observed in those who have some renal function left. Some accumulation was noted in those under hemodialysis because of no renal function. Blood chemical data remained stable despite administration of the drug. Only one case complained nausea which was relieved by slowing the speed of intravenous injection. No side effects were observed in others.

The chemotherapy of urinary tuberculosis h ave been carried out for these several years and the transition of clinical aspect were found in urinary tuberculosis. The following results were obtained in the examination of 855 cases of urinary tuberculosis. Number of ur i n ary tuberculosis descreased every year. Of the sex, the affected side, and the age no remarkable transition were found. Of the findings of the bladder the foci declined to slight degree. Cases which had slight unspecial findings in the bladder and were kidney alone affected increased strikingly. These cases had atypic symptoms compared with the other typical cases. Except the cases given chemotherapy number of the cases which the bladder was slightly affected were more increased than ever. Generaly speaking the chemotherapy gave the direct o r indirect effect to the clinical aspect of the urinary tuberculosis.

The chemotherapy was carried out with N E O-ISCOTIN (isonicotinic acid hydrazide methane sulphonic acid natrium) in 10 cases of urinary tuberculosis, especially vesical tuberculosis. Administrations of NEO-ISCOTIN were as effective as streptomycin or isonicotinic acid hydrazide. Dosage that we used ordinary (10-20 mg. per kilo of body weight daily) showed no side reactions.

UROCALUN, a new therapeutic agent for urolithiasis, was used with the following results. 1) Five out of eleven cases with ureteral calculus passed stone after administration of this drug for ten days or more. One of them passed a stone larger than 10mm in diameter. 2) Two cases of kidney stone were treated with long term administration of two to three months. In one case, it seemed effective. 3) This drug was useful for the patients with long term indwelling catheter to prevent calculi.

1.In an attempt to study its usefulness as a contrast medium for retrograde pyelography, a 2-fold dilution (33.4%) of sodium. iothalamate 66.8% (Conray 400) was used in 23 cases and the results were compared with those with 38% Urografin. The test medium was demonstrated to be not inferior to Urografin in its capacity of visualizing the renal pelvis. 2. In 20 (87%) out of the entire 23 cases the contrast medium gave a clear-cut pyelogram with no blurring of the picture which makes the film incompetent for diagnostic purpose as seen in any instances. 3. As compared to Urografin which was administered contra laterally, Conray 400 was found to be more excellent in 13% and equally satisfactory in 78.3% in its visualization. 4. No adverse reactions worthy of mention was noted. 5. An experiment on the rate of injection confirmed that Conray 400, being lower in viscosity, is far easier to inject than Urografin.

The current changes of pathological findings in the urinary tuberculosis were described in the report III previously. It seemed to me that a tuberculin reaction test was probably helpful for the diagnosis of such cases in which the diagnosis was very difficult from the routine urological examination. With this object in view, the foll o wing three methods were done in this article 1. Vesical Tuberculin Reaction Test Tuberculin solution was injected into the vesical mucosa and the reaction on the mucosa was observed through the cysto s cope. 2. Ureteral Tuberculin Reaction Test Tuberculin solution was instilled into the renal pelvis through the ureteral catheter, and the number of tuberculous bacilli and leucoc ytes in the urine which was collected through the ureteral catheter on each side was calculated, in order to know the increase or decrease on the number of them af t er instillation. 3. Renal Tuberculin Reaction Test The same way of calculation on the renal urine as described above was done after the intracutaneous injection of tuberculin solutio n (Mantoux Reaction). The resu l t s obtained from these three different methods revealed that the vesical tuberculin reaction test was most sensitive, and in this way the obvious positive reaction was recognized even in the case which was not suspected of renal tuberculosis from the routine examination and clinical symptome.

(1) Many new drugs have been discovered lately and most clinicians have been very busy in conducting clinical studies with them. Therefore, cases of experiments at each institution have decreased. Thus, it seems meaningless to collect many clinical results which have been obtained by different methods of study. For that reason, the methods of study were unified beforehand and cooperative clinical studies with cephaloglycin have been made at four universities. As this was the first trial of cooperative clinical studies, the expected purpose "as not attained because of insufficient contact among researchers. But it seems that this trial will be helpful to further cooperative clinical study. (2) One gram of cephaloglycin per day was given to patients of acute uncomplicated cystitis for three days and it was effective in twenty-three cases out of twenty-five (92 %). This result was gained by judging its efficiency from symptoms, urinalysis and culture study. When its efficiency was judged from symptoms and urine findings, it was effective in forty-five cases out of fifty-three (85 %). (3) A comparative study was made between remedial results of a group of patients who had been given cephaloglycin from beginning to healing, and that of another one of patients who had been given cephaloglycin until their conditions of illness were less serious and then given sulfisomezole (2 grams per day) until healing. But significant difference was not observed.

A case of large vesical diverticulum of a managed 32 was reported. Diverticulectomy was performed and many small calculi were found in this diverticulum. Histological examination of the wall of this diverticulum revealed leukoplakia with partially malignant change.

The chemotherapy was carried out with stre p tomycin (SM) and isonicotinic acid hydrazide (INAH) in the cases of urinary tuberculosis, and the following results were obtained. SM was a dministered in 18) cases of vesical tuberculosis (78 cases before nephrectomy and 102 postoperatively) and in 8 of prostatic tuberculosis. INAH was administered in 33 cases of vesical tuberculosis (21 cases before nephrectomy and 12 postoperatively), in 9 of prostatic tuberculosis and in one of urethral tuberculosis. Although quite high potency is available both in SM and INAH, the former is superior to the latter in the point of rapid effect while the latter is excellent in being free from any sequela. In regard to the clinical difference between SM and INAH, comparative investigations were carried out on the changes of symptoms in connection with the urinary bladder, ureter, prostate and the urethra. The following figures are showing the limits of chemotherapy car r ied out on renal tuberculosis with the purpose of its clinical cure : In 13 cases of unilateral tuberculosis : 33.3% (In insignificant cases : 57.1%) In 9 cases of bilateral tuberculosis : 55.5% (In insignificant cases : 71.4% ) Out of the total 22, 10 cases dem o nstrated effectual results corresponding to 45.49. These are intermediate results of cases that are in need, after they reach the condition in which no clinical changes are observable, of undergoing chemotherapy for at least around one year together with continuous observations for more than one year. I n the cases of bilateral renal tuberculosis, arrest of its progress is possible by chemotherapy. In view of this, its death rate has recently been strikingly lowered.

30 % Conray was used for drip infusion pyelography in 68 cases. It gave more excellent demonstration of pyeloureterogram than the regular excretory pyelography. The satisfactory result was obtained in 58 cases (85.2 %). Side effects were observed in 17.6 %, but no serious ones were encountered.

I reported the clinical observations in 2439 cases with urinary tuberculosis these had experienced for this 32 years in our clinic. 1) The patients with urinary tuberculosis were 11.3% of total ambulatory patients, and they were 14.3% of those who were underwent the cystoscopic examination. 2) In the grouping the sex, there were 3 males and 1 female. 3) An age group 20-30 was 46.4%, the infant group (1-10) was 1.2%, and the senile group (over 60 years) was 1.1% of urinary tuberculosis cases. 4) Concarning the affected side, right side was 51.2%, and both side was 4.1%. 5) In the family histoly, 21.5%, had tuberculous disposition. 6) In the past history, pulmonary tuberculosis had occured in 85%, epididymitis in 12.7%. 7) A little over the 90% of the patient complained of the vesical symptomes. 8) The duration of the disease before the patient consulted our clinic for relief was almost within 1 year. 9) In 85.1% of urinary tuberculosis, the acid fast bacilli were found in the urine. 10) Renal palpation will be aid to the diagnosis of renal tuberculosis, especially in the determination of affected side. 11) In the complications, epididymitis occured in 7.2%, urethral tuberculosis in 12.3%, prostatic tuberculosis in 14.9% and urinary calculi in 0.9%.

The following results were obtained throug h statistical survey on out-and inpatients, who were consulted from January to December in 1955. 1) Numbers of outpatients were 1990 (1448, males and 542 females) and inpatients were 252 cases. 2) Of these o u tpatients, veneral disease, urolithiasis, urogenital tuberculosis, tumors of urogenital tracts were 209, 235, 353 and 180 cases respectively. 3) Among 252 inpatients, tuberculosis were 127, lithias i s 69, tumors 57 cases respectively. 4) Operations were made in this year 358 times, among which nephrectomies 82, lithotomies of upper urinary tract 49, prostatectomies 18, total cystectomies 9, partial cystectomies 7, orchi-and/or epididymectomies 55 cases were countered. 5) Cystoscopic examinations were done 1518 times.

Non-steroid anti-inflammatory drug, "Riripen" (Daiichi P h arm. Co.) was administered to patients with various urological diseases. The results are summarized as follows. 1. The drug was given to a total of 28 patients consisting of 16 with a cute cystitis, 3 with acute epididymitis, 4 with urethral stricture, 1 with genital trauma and 4 with other diseases. 2. In patients with acute cystitis, a single treatment with "Riripen" showed no r emarkable effect, but a combination with other chemotherapeutic agents produced a secure effectiveness. 3. In patients with acute epididymitis, a combination therapy of "Riripen" wit h chemotherapeutic agents resulted in an excellent analgetic effect although the necessitate duration of drug administration was unable to be shortened. 4. In patients with urethral s tricture, the drug showed an excellent effect for elimination of urethral damages following bougienage. 5. Although case treated w as limited in only one, a patient with genital trauma showed an excellent response to the single treatment with "Riripen" 6. The drug was given to patients who w e re performed cystoscopic examination with a good effect for releasing pain. 7. In a few cases, t h e therapy with "Riripen" suggested a possibility that an administration of the drug may be used for auxotherapy or abolition of adrenocortical hormone therapy. 8. No noticeable side effect was encountered.

Among the 1103 urine specimens obtained from patients with urinary tract infections for the recent 3 years, Pseudomonas aeruginosa was isolated in 145 (13 %). All patients were suffering from chronic infection with other urogenital diseases and majority of them had received various antibiotics in the past. Kasugamycin was administered in 21 paitent with chronic urinary tract infection due to Pseudomonas aeruginosa. Excellent, good and poor responses were obtained in 4, 11 and 6 cases, respectively, showing effectiveness to be 70.1 % (15 cases). Side effects were minimal.