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再発危険因子検索のため, pTa33例とpTl46例の膀胱癌患者にKi-67, c-erbB-2, p53と多薬剤耐性蛋白(MRP)を免疫組織化学的に検討した.その結果, pTl, 広基性, 腫瘍径の大きな腫瘍(>3cm)の再発率は高かった.また, Ki-67, c-erbB-2, p53の過剰発現症例の再発率は, 有意に高かったが, MRP発現と再発とは関連がなかった.多変量解析では, 腫瘍径の大きな腫瘍とKi-67高発現が再発の独立した予後因子であった.腫瘍径が1cm未満の症例の再発は, Ki-67およびp53過剰発現が関連した.Ki-67高発現により, grage2.pTlおよび単発腫瘍において, 再発の高い症例を識別できた.このことより, 増殖関連蛋白を臨床病理因子に加えることにより, 重要な予後を規定する情報となることを示しており, Ki-67高発現が信頼しうる再発予後因子であると考えられた, The current clinicopathologic study for evaluation of superficial bladder cancer still has limitations in predicting the true behavior of recurrence. To determine the high-risk recurrence factors, we studied the influence of Ki-67, c-erbB-2, p53 and multidrug resistance-associated protein (MRP) expression. Samples were obtained from 33 pTa and 46pT1 diagnosed bladder cancer patients with a mean follow-up of 48.7 +/- 30.6 months. The contingency table method, Kaplan-Meier curve and multivariate analysis were used to evaluate the association among the immunohistochemical factors expression, clinicopathologic parameters with tumor recurrence. Stage pT1 tumors, sessile tumors and large tumors (> 3 cm) showed a significantly high recurrence rate (p = 0.0158, p = 0.0162, p = 0.0001 respectively). Tumors with overexpression of Ki-67, c-erbB-2 and p53 were more likely to recur (p = 0.0035, p = 0.0027, p = 0.0076 respectively), MRP expression was not associated with recurrence. Multivariate analysis showed that large tumors and high Ki-67 expression were independent indicators of recurrence. On the other hand, in tumors less than 1 cm, recurrence was significantly correlated with overexpression of Ki-67 and p53. High Ki-67 expression could discriminate higher recurrence cases in grade 2, pT1 and single tumors. The c-erbB-2 overexpression was more frequently associated with recurrence in sessile tumors, large tumors, multiple and grade 1 tumors. The p53 overexpression also predicted a higher risk of recurrence in pTa tumors. These data demonstrated that the use of proliferative related proteins yields significant prognostic information in addition to clinicopathological factors, high Ki-67 expression is a reliable indicator of recurrence. A combination rather than any factor alone could more accurately predict tumor recurrence.

公立豊岡病院泌尿器科における1979年1月から1981年12月までの臨床統計を行った.1) 3年間の外来新患者総数は7, 354名で, 疾患別では感染症, 腫瘍, 先天異常が多かった.2)入院患者総数は637名で, 50%以上が60歳以上の老年層で占められていた.おもな疾患は, 腫瘍と尿路結石症であった.3)手術件数では, 前立腺肥大症に対する手術がもっとも多かった, The patients seen between January 1979 and December 1981 were reviewed. The outpatients according to our classification of the patients, presented the most frequently with infections, followed by urogenital tumors and anomalies. Urogenital tumors and urolithiasis were the predominant diseases of the inpatients. The representative operations were TUR-P and prostatectomy.

A survey has been made of 150 cases of acute renal failure (A.R.F.) seen between 1962 and 1981. The overall mortality was 43.3%. The patients ranged from 7 to 75 years old. The mean age of all the patients was 47.2 years old. The mean age of the patients seen between 1970 and 1981 was 58.1 years old, 20 years older than those seen between 1962 and 1969. Despite increasing expertise in management of the complications of surgical, medical, and obstetric disorders, and considerable technical advances in dialysis, there was no decrease in mortality over the 20-year period of survey. Many factors have been identified as having an adverse influence on prognosis, such as age of patient, surgical origin, and complications. Mortality rate was high in the patients over 71 years old, postsurgical group (55.6%), and hepatorenal syndrome group (92.3%). Five major complications had an adverse influence: septicemia (57.1%), respiratory infection (61.1%), cardiovascular disorder (46.3%), hemorrhage (59.6%), unconsciousness (62.2%), and hepatic dysfunction (56.8%). Between 1970 and 1981 the mortality in the patients dialyzed up to 3 times was 81.3%, compared with 26.5% in those dialyzed from 4 to 19 times (p less than 0.01). In the former group severity of the underlying disorder had an adverse influence on prognosis. Although the A.R.F. may be controlled in the earlier stages of illness, many of these patients die of overwhelming infection or other complications.

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.

A statistic survey was carried out on the patients, diseases, and operations experienced at the urological ward of Kyoto University Hospital during the years of 1977 to 1982.

1984年3月から1985年4月までの間に超音波破砕により経皮的に治療した上部尿路結石70例(73腎単位)の成績を報告する.腎瘻を介して53例中49例に, 経尿道的尿管操作により12例中11例の結石除去に成功した.合併症としては血尿と発熱が主で, 3例に輸血を必要とした.経皮的超音波結石破砕法(PNL)は経尿道的尿管操作法(URS)とともに従来の手術法に代わる上部尿瘻結石治療法として有用であることが判明した.ESWL(体外衝撃波結石破砕法)の適応となる腎結石症例に対してはESWLとPNLの両治療法のあることを説明し, 患者にその選択をゆだねるべきであると思われる, From March, 1984 to April, 1985, 70 cases of upper urinary tract calculi (73 renal units) were treated by percutaneous nephrolithotripsy or transurethro-ureteral lithotripsy, mainly utilizing ultrasonic lithotrite. While in the early period of treatment, two stage procedure of creation of nephrostomy tract and percutaneous nephrolithotripsy was performed for renal and upper or middle part of the ureteral calculi, one stage procedure, nephrostomy tract formation followed by ultrasonic nephrolithotripsy is commonly used in recent cases. During this period, conventional stone surgery was seen in 6 cases of pyelolithotomy and 2 of ureterolithotomy, while 52 cases of stone surgery were performed during the earlier period (from January, 1983 to February, 1984). Renal and upper or middle part of ureteral calculi were successfully removed in 49 out of 58 cases (84.5%). Most of the patients required 1 or 2 trials of percutaneous nephrolithotripsy. Middle or lower part of ureteral calculi were removed in transurethro-ureteral approach in 11 of the 12 cases. Hematuria and fever were most common complications after treatment and 3 patients required blood transfusion after 3 or 4 sessions of nephrolithotripsy. Percutaneous nephrolithotripsy and transurethro-ureteral lithotripsy are now widely used for treatment of upper urinary tract calculi, replacing the conventional surgical treatment. Moreover, very recently, extracorporeal shock wave lithotripsy is available in Japan. To the patients with renal calculi indicative of this treatment, both percutaneous nephrolithotripsy and extracorporeal shock wave lithotripsy are introduced and either way of treatment can be chosen by the patient himself.

過去14年間に経験した38例の腎血管性高血圧症例を, 血行再建術を行なった1群, 腎摘出術を行なった2群, いろいろの理由で手術不能であった3群に分け, 術前の臨床像と治療成績を検討した.その結果, 血行再建術の適応となる要件は, 若年者で高血圧の期間が短いこと, 高血圧がレニン依存性で, 狭窄が昇圧に有意に働いていること, 総腎機能が保持され, 患側の腎機能が悪すぎないこと, 手術時に再建可能な病変であること, 全身性の動脈硬化症は好ましくないこと, Surgical riskがよいこと, 内科的治療に反応しない高血圧であること, などであることが明らかとなった.カプトリールやPercutaneous transluminal angioplastyなど非手術療法の普及もめざましいが, 一生薬を服用し腎機能も低下してゆくことを考えると, 上記の適応をみたす症例は, まず血行再建術が考慮されるべきであろう, Based on the retrospective analysis of 38 cases of renovascular hypertension treated by surgical intervention, the following indications are proposed for arterial reconstructive surgery: younger age of patient, short duration of hypertension, renin-mediated hypertension and extent and functional significance of the obstructing arterial lesion, favorable level of renal function in the affected side, and renal function threatened by advanced progressive vascular disease, surgically correctable lesion, and focal, unilateral renal arterial atherosclerosis without generalized atherosclerosis, good surgical risk, and hypertension not responding to medical treatment. Although the clinical use of the angiotensin I converting enzyme inhibitor and induction of percutaneous transluminal angioplasty can provide a new approach to non-surgical treatment for renovascular hypertension, the long-term use of antihypertensive drugs induces gradual decrease in renal function. Surgical treatment is best reserved for the patient on whom the available data meet the above criteria for vascular surgery.

26例の手術対象の上部尿路閉塞性疾患に, 123I-orthohippurateによる経時的腎イメージ, レノグラム, 局所レノグラム, functional imageを作成し検討した.functional imageはレノグラムよりも鋭敏に腎機能の改善度を描出, 把握することが可能で, 腎機能を形態的情報とともに知ることができた, Renal scintigraphy and regional renography using I-123- orthoiodohippurate were performed in 26 cases of obstructive nephropathy. After 1 mCi of I-123- orthoiodohippurate was given intravenously, serial renal scintigrams were obtained for 25 minutes and regional renogram curves were derived from the whole kidney, the cortical and pelvic areas. At the same time, renal functional images with Tmax as the peak arrival time were processed. Tmax in normal cases ranged from 2 to 3 minutes in the cortex and from 4 to 5 minutes in the pelvis, while there was some delay in Tmax in the obstructive nephropathy. In the case of acute ureteral obstruction by stones, most of the regional renograms in the cortex and pelvis improved soon after the removal of the obstruction. On the contrary, in the case of chronic obstructive nephropathy obstructive patterns on renogram curves was usually observed postoperatively. However, in some cases, functional images in cortical and/or pelvic areas showed marked recovery before improvement of findings on renograms or IVP. I-123- orthoiodohippurate renoscintigraphy is a useful adjunct for assessing pre- and post-operative renal function in obstructive nephropathy. Particularly, the analysis of regional renogram curves enables early prediction of postoperative recovery, and the functional image enables early detection of the functional recovery of the hydronephrotic kidney.

A recent six year statistic survey was carried out on the patients in the Urological Outpatients Clinic of Kyoto University Hospital.

Herein we report a 36-year-old man with hyperparathyroidism and a past history of internal irradiation to the thyroid. Twelve years previously at age 24 years he had received 8 mCi of radioactive iodine for Graves' disease. An additional dose of 4 mCi was required 3 years later. A right lower parathyroid adenoma (28 X 23 X 20 mm, 5.7 g) was found at neck exploration. Although the association of external ionizing radiation to the head and neck and the subsequent development of hyperfunctioning parathyroid glands has been described in recent years, there are only 4 cases in the literature of parathyroid surgery for hyperparathyroidism secondary to earlier treatment with radioactive iodine for Graves' disease. In a long-term follow-up of 180 patients treated with radioactive iodine for Graves' disease, neither hypercalcemia nor hypophosphatemia was found. Whether internal radiation therapy can be a causative factor in the development of hyperparathyroidism should be elucidated in future. However, it seems reasonable to suggest that patients whose hyperthyroidism has been treated with radioactive iodine should have their serum calcium levels examined at 5-year intervals.

Adrenocortical function was studied on 25 cases of acute renal failure. 1) Plasma cortisol level before hemodialysis or peritoneal lavage was 38.35±4.48 pg/dl (normal value: 14.33±2.36µg/dl, p

A 43-year-old man with moderate hemophilia A developed vesical bleeding hard to control. The cause of hemorrhage was found to be an infiltrating cancer of the bladder, histology of which was undifferentiated carcinoma with focal transitional carcinoma interestingly in the muscular layer. Malignant alteration in this case was thought to be induced by mechanical stimulation such as frequent fulguration, cystotomy, and long-term catheter indwelling. Recently, major surgery on hemophiliacs has become much safer by replacement of the deficient factor. Besides transfusion of fresh blood and frozen plasma, various type of factor VIn preparations have made the pre-and postoperative management easier and greatly improved the operative results. Cryoprecipitate of our own make gave the good result in maintaining the antihemophilic factor level.

Clinical study was made on 65 cases of acute renal insufficiency experienced at the Department of Urology, Kyoto University from 1962 to 1969. 1) Causes and clinical manifestations of acute renal insuffiCiency were varied, but they were classified into the prerenal origin (32 cases), the renal origin (23 cases) and postrenal origin (10 cases). 2) Main treatment for these cases was dialysis. Forty-four (67.7 %) received hemodialysis with either Kolff's twin coil artificial kidney or Kiil two layers dialyzer. Twenty (30.8 %) were treated by peritoneal dialysis. 3) As to prognosis, over-all mortality was 44.6 % (29/65). Although the mortality rate was quite high (60 %) for the first few years, it has decreased to 40 % for the recent two years probably because of adoption of the early and preventive hemodialysis which has been technologically improving. Mortality rate of each causative origin was as follows: prerenal 53.1 % (17/32), renal 39.1% (9/23) and postrenal 30% (3/10). Prognosis of the group of prerenal origin was therefore poor, in which mortality rate of hepatorenal syndrome was 100 %, postoperative 50 % and posttraumatic 40 %. Adult age groups, 31 to 60 years, showed relatively high mortality. 4) Complications observed were cardiovascular disorder, pulmonary edema, and hemorrhage. This order is that of frequency as well as that of cause of death. 5) Pathophysiological aspect of the development of acute renal insufficiency was discussed with emphasis on intrarenal circulation at the time of acute renal failure. Mechanism of oliguria and anuria was also discussed from both of glomerular and tubular function.

As the basic experiment, rats were given CdCl2 to induce testicular necrosis and the main organs were examined histologically. No noticeable abnormalitiy was evident in any organ other than testicle. Histological alteration along with distribution of radioactivity in various organs following administration of 115mCd (NO3)2 confirmed that the testicles become necrotic with minimal doses. These indicated that cadmium salt is applicable in human. Three patients with testicular tumor were treated with cadmium salt. In a case of seminoma, reduction of metastasized lesion was observed although the effect was transient No influence of treatment was seen in the second case of embryonal carcinoma. The third treated patient with embryonal carcinoma developed gross hemorrhage from the lung and retroperitoneal metastatic foci on the seventh treatment day. The patient expired one month later and autopsy revealed atrophy of the remaining testicular tissue as well as marked angionecrosis in the testicular interstitial arteries. Based on these evidences, it is supposed that cadmium salts are agent for testicular tumors.

1) Case report : A male 29, complained of hematuria an d pyuria. Pyelogram revealed a right ureteral stone with incomplete duplication of the ureter, and lateral displacement of the left kidney compressed by fist sized tumor mass. Left pyelogram was apparently normal (no reduction of any calyces). Seminal vesiculogram (thro u gh vasoseminal route) showed dilated ureter end terminating in the left seminal vesicle. Both ureteral orifices were essentially normal cystoscopically. This patient had 2 children and did not notice any ejaculatory distress. Supernumerary ectopic ureter opening into seminal vesicle with a nonfunctioning upper renal segment was diagnosed preoperatively. Operative exploration conf i rmed these findings i. e. hydroureteronephrosis of superior pole of duplicated kidney and ureter drained by corresponding kidney. Heminephrectomy and total resection of the ectopic ureter were performed. (Ureterolithotomy for the right ureteral stone had been performed 2 weeks before.) Post-operative course was uneventful. 2) A total of 228 cases of ectopic ureter (including male and female) found i n Japanese literatures were statistically analyzed chiefly concerning age, type (Thom), opening site, complication, and treatment. Concerning type , the most frequent is type III and then type II in Europe and U. S. A., but type I (70.6 %) and secondly type III (20.6 %) in Japan. Concerning opening site in female, the most frequen t is urethra or vestibule of vagina and thin vagina in Europe and U. S. A., but in Japan firstly vagina (66.6, °0) and secondly vestibule of vagina (14.4 %). In Japanese male, 5 cases open into seminal vesicle, 1 case into vas deference, and 1 case into ejaculatory duct. 3) Only 7 cases of male ectopic ureter w ere reported in Japanese literatures, and the above reported case was the 6 th one. In Japan the number of male patients was about 1/33 of that of female patients v. s. 1/2 to 1/3 in Europe and U. S. A.. This difference of male and female ratio between Japan and Western countries may b partly attributed to the considerable number of autopsy cases reported in the latter. Male cases are difficult to diagnose because clinical signs are not suggestive as in female (i. e. urinary incontinence), so that it is necessary to suspect ectopic ureter and perform detailed examination in male cases of unexplained pyuria, reccurent or persistent epididymitis, and when duplication is suspected urographically where a segment of renal parenchyma has no apparent calyceal drainage. 4) A total of 10 cases of ectopic u r eter experienced in our clinic were shown briefly in the table 11.

Furucton M was intravenously administered to 21 postoperative in -patients , 300 ml per day for 3 days following operation, mixed with other intravenous fluids. Before and after its administration, urinary volume, specific gravity and osmolarity of urine and its diuretic effects were examined, as well as alterations of blood pressure, serum total protein, serum non-protein nitrogen, serum creatinine, serum osmolarity and serum electrolytes and changes in general condition, especially influences on renal and liver functions. The results are described and discussed here. In cases with good renal function, the treatment contributed to diuretic effects and protective action to postoperative renal dysfunction. However, in cases with poor renal function, a warning was evident that the administration must be performed with a care for development of imbalance of serum electrolytes, especially hyponatremia. Recent knowledges were introduced about the mechanism of o smotic diuresis of mannitol and clinical reevaluation of fructose from the energic metabolic point of view.

Twenty-six patients were treated by intermittent hemodialysis with Kiil dialyser for past two years, April, 1968 to March 1970. All the patients were equipped with the arteriovenous shunt of Quinton-Scribner type, 16 in the forearm and 10 in the leg. Average shunt survival in the patients dialyzed more than three months was 11 to 12 months on the arterial side and 8 to 9 months on the venous side both in the forearm and leg shunts. If the cases dialyzed more than one year were taken, the shunt survival was 14 to 17 months on the arterial side and 10 to 12 months on the venous side with a little longer survival in the leg shunt. These results are never inferior to those in the western countries. Complications associated with shunt consisted of clotting (48.3 %), mechanical imperfection (26.7 %), infection (15 %) and bleeding (10 %). These were predominantly seen on the venous side, therefore, recannulation required was mostly that of the venous cannula. Frequency of the complications was a little higher in the forearm shunts, but that of recannulation was almost same in both groups. Angiography is important for diagnosis of the complications. It is often helpful for recannulation to know about the state of the vessel where the vessel tip is inserted as well as about the collateral circulation.

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.

Two-hundreds and fourty-seven patients showed non-functioning kidney, either unilateral or bilateral, on IVP for 3.5 years of 1964 to 1967. They were statistically investigated regarding sex, affected side, age, chief complaints, renal diseases, examinations further performed, treatments, etc. The hospitalized cases were precisely studied besides. Recently, non-visualizing kidney after surgery for carcinoma of the cervix has been remarkably increasing in number. Delayed excretory pyelograms taken after injection of double dosage of contrast dye seemed to be the best diagnostic method for non-visualizing kidney. Renal function studies of the patients with non-visualization on routine IVP showed that majority of them had RPF below 100 cc/min and creatinine clearance below 10 cc/min. As to treatment, nephrectomy was the operation most frequently performed on such kidney.

1. 1, 265 operations were performed at our department fo r past five years (1964-68), and 85 (6.6 %) of them were obliged to have the second surgical intervention which were essentially undesired. 2. The second operations consisted of resuture of the wound 51, hemostasis 10, closure of the urinary fistula 6, removal of the organ 4, laparotomy 4, urinary diversion 4 and incision of the abscess 3. 3. Discussio n s were made on the causes which necessitated reoperations as well as on the relation with the original operations.

Three cases of intrascrotal rupture of the testis were presented. Case 1: A 21-year-old student got a kick at his left scrotum during Kwarate training. On the third posttraumatic day, the ruptured tunica albuginea was surgically sutured. Case 2: A 25-year-old man fell from the height and got the right scrotum injured. On the third posttraumatic day, the ruptured tunica albuginea was sutured. Case 3: A 58-year-old man got an injury at his right scrotum due to traffic accident while on a motorcycle. It was on the tenth posttraumatic day that the operation was performed. Because the tunica albuginea was so extensively injured, orchiectomy was necessitated. Histological findings of the ruptured testes were described. The rat testes were experimentally ruptured and histological study was made several times after trauma in order to investigate the changes with time.

Seven patients with chronic renal failure were treated by repeated hemodialysis with the Kolff twin coil artificial kidney. Biochemical studies were made on the blood serum, red blood cells and cerebrospinal fluid before and after hemodialysis; and the dialysis disequilibrium was investigated in this line. 1) Fortunately enough, no serious neurological complications due to the dialysis disequilibrium were experienced in any case. 2) A delayed dialysis of the cerebrospinal fluid NPN, compared with the serum NPN, resulted in the great concentration gradient of NPN between the two compartments after hemodialysis. This is the dialysis disequilibrium between the serum and cerebrospinal fluid. 3) Between NPN of the red blood cells and that of the serum, a delayed dialysis of the former was observed; thus the presence of dialysis disequilibrium between the intracellular and extracellular fluid was interestingly suggested. 4) As to sodium, potassium and chloride, no dialysis disequilibrium was particularly observed. Both sodium and chloride level of the serum and cerebrospinal fluid were reversed after hemodialysis, but without noticeable influence on the osmotic pressure of them. 5) The osmotic pressure of the serum and that of cerebrospinal fluid were reversed after hemodialysis; therefore, the osmotic gradient between the fluid compartments, the derangement of water balance and the elevated cerebrospinal fluid pressure ensued. The difference of glucose concentration of the dialyzing fluid did not affect on the osmotic pressure. 6) As to the spinal fluid pressure, the higher the glucose concentration of dialysate, the less elevation of it after hemodialysis was observed. 7) From our studies and the previous reports by the investigators, etiology of dialysis disequilibrium might be summarized as follows. ( i) Change in the mode of presence of the waste nitrogen substances, particulary urea, in the intracellular and extracellular fluid due to hemodialysis. (ii) Influence of the change in urea nitrogen concentration due to hemodialysis on the osmotic pressure. (iii) Elevated cerebrospinal fluid pressure due to the osmotic gradient between the serum and the fluid. 8) The following measures are to be considered to prevent dialysis disequilibrium. ( i) Rapid dialysis of the short duration should be avoided. BUN should be kept not too low. (ii) Hemodialysis should be started before BUN reaches the high level. (iii) Hemodialysis should be repeated frequently. (iv) Whenever dialysis disequilibrium is anticipated, mannitol should be started during the last half of hemodialysis. (v) Low protein diet. (vi) Spinal tap to lower the cerebrospinal fluid pressure. (vii) Keep the proper glucose concentration of the dialyzing fluid. In azotemia, approximately 500 mg % (311.2 mOsm/kg•H2O) might be adequate considering the elevated serum osmotic pressure.

1. Twenty-six patients under chronic hemodialysis for p a s t two years, 4.1968 to 3.1970, . were divided into the outpatient and inpatient groups and further subdivided into the complete and incomplete groups based on the clinical findings and social adaptability. Findings such as blood pressure, cardiothoracic ratio, urine volume, creatinine clearance were all better in the outpatient group than in the inpatient. 2. For hemodialysis on the o u tpatient basis or on rehabilitation to be possible, the clinical indices should be as follows : mean blood pressure below 100 mmHg, cardiothoracic ratio below50 %, urine volume over 1000 ml per day and creatinine clearance over 4.0 ml/min. Social rehabilitation would be greatly depending on how much is the r e maining function, of the patients' impaired kidneys. In most of the western counteries, chronic hemodialysis is carried out on the outpatient basis. Hemodialysis under hospitalization is, of course, not what we willingly do. If a patient could not be discharged after two months, he should rather have renal transplantation than continuing hemodialysis. 3. Seven patients whose urine vo l ume is over 1000 m l/day were chosen for study of renal function. Changes of renal function were checked for three days among which 8 hours hemodialysis was inserted. After dialysis, GFR and free water clearance dropped, and all of the urnie volume, solute excretion, urinary sodium and potassium decreased. Values per each nephron also decreased. Specific gravity and osmolality showed no change due to hemodialysis and stayed fixed at the low values. So it was conjectured that function of the patients' own kidneys dropped during hemodialysis. After dialysis, GFR, urine volume, solute excretion, urinary sodium and potassium all increased gradually recovering to the predialysis values except for free water clearance which increased rapidly. 4. Discussions were made on the concentrating and diluting power of the kidneys, with emphasis on intact nephron hypothesis of Bricker et al. Their theory is not always applicable for dialysis patients, and there seem to be a certain balance among kidney function, dialysis frequency and uremic symptoms. We should not neglect the remaining function of the patients' own kidneys. If dialysis is continued based only on the uremic symptoms, urine volume might decrease. The renal function seems to be autoregulated by the physical demand of the patients. As to solute excretion, dialysis entirely takes place of the kidney ; therefore, it is natural that the excretion by the own kidney may decrease. This might be understood as regulatory adaptive phenomena by Bricker. Increased free water excretion from the remaining nephrons in the immediate postdialysis period is a good evidence of sufficient diluting power as well as of dominant of tubular diluting function over glomerular function. In this postdialysis condition, no glomerulo-tubular balance may exist. 5. If we regard, however, above changes of re n al function during and after hemodialysis as a series of homeostasis occurring in the patients, dialysis is a substitute of glomerular function although it is an unphysiologic, artificial and physical way of filtration and excretion of solutes. Tubular function which ceased during dialysis becomes dominant after that. Thus, glomerulo-tubular balance may be well maintained after all.

1) This report deals with a case of 37 years old male who had ectopic opening of the left ureter into the seminal vesicle. The case was believed to be the sixth reported one in Japan. He complained of dull pain in the right hypochondria' region, fever and proteinuria. Exploratory operation was performed under a suspicions diagnosis of left renal agenesis or hypoplasia. The operative finding and the results of fistular ureterography and vesiculography led as to make the precise diagnosis of ectopic ureteral opening. The regional kidney showed marked aplasia. 2) R eview of literatures was made on the cases of ectopic ureteral opening into the seminal vesicle, 6 cases in Japan and 30 cases in Europe and America, of which diagnosis was made clinically. Major symptoms, diagnostic methods, therapeutic means and status of the regional kidney were summarized and briefly discussed. 3) So far, a total of 11 cases of ectopic u reteral opening was seen at the Department of Urology of Kyoto University Hospital. The male and female ratio is 3 to 8 with female predominance, and is resemble to that in Europe and America. The male to female ratio for all cases in Japan is 1 to 28 with female predominance.