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Long-term results were analyzed in terms of tumor progression and survival in patients with superficial bladder cancer who were enrolled in the second intravesical chemoprophylactic study of the Japanese Urological Cancer Research Group for Adriamycin, which was started in July 1982. This study was a prospective, randomized, controlled trial conducted on primary tumors treated with a long-term instillation regimen that involved control versus intravesical instillations of Adriamycin or mitomycin C given once a week for the first 2 weeks, once every other week for 14 weeks, once a month for 8 months, and once every 3 months for 1 year, for a total of 21 instillations in 2 years. An analysis of the prophylactic effects of such treatment on bladder tumors after TUR has previously been performed, and the results have been published elsewhere. The present study represents a follow-up of the above trial. Of the 671 cases previously analyzed with regard to tumor prophylaxis, 158 cases (23.5%) were eligible to be followed for tumor progression and survival. A detailed comparison of the background factors between these 158 patients and the other 513 cases revealed no statistically significant difference. Thus, the 158 evaluable cases might reasonably be considered to represent all patients enrolled in the second study, and the results were thought to be reasonable enough to reflect the long-term efficacy of the long-term instillation regimen adopted in this study. The median follow-up for these 158 cases was 6.6 years. Tumor progression in terms of the disease stage and/or grade occurred in 43 of 127 patients who received prophylactic instillations and in 12 of 31 control cases. No significant difference in the incidence of tumor progression was found between the treatment and the control groups. In addition, no difference in survival was observed between the treatment group and the control group. Survival was also compared between patients who showed tumor progression and those who did not. All patients whose tumors did not progress survived, whereas the 7-year survival of those exhibiting tumor progression was less than 90%.

The immunological distribution of tumour-infiltrating lymphocytes (TIL), regional lymph node lymphocytes (RLNL) and peripheral blood lymphocytes (PBL) was evaluated by means of immunohistochemical staining using monoclonal antibodies of each subset of lymphocytes (stored in frozen sections) in a series of 22 patients with renal carcinoma. The immunological effect of IFN (interferon)-gamma on these immunocompetent cells was also investigated. The effect of IFN-gamma on TIL was an increase in CD3 (pan-T cells), especially an increase in CD8 (cytotoxic/suppressor-T cells). When examining these cells according to stage and grade, a marked increase in CD3 was found in low stage and low grade patients. With regard to RLNL, there was a tendency towards a decrease in CD3 and an increase in CD20 (B-cells) following the administration of IFN-gamma. No specific effect on stage and grade was observed apart from a reduction in T cell subset ratios in high grade patients. With regard to PBL, no specific trend was noted except for an increase in CD16 (NK cells) when IFN-gamma was administered.

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.

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)

A total of 465 patients with primary and multiple or recurrent, stages Ta and T1 superficial bladder cancer were included in this randomized multicenter trial to compare the prophylactic effect by 17 times instillation of 40 mg doxorubicin or 40 mg epirubicin with no instillation after transurethral resection of tumor(s). The primary endpoint was first recurrence after transurethral resection. Endoscopic examination as well as urinary cytology was performed in each case every three months. It became evident that the recurrence rate in the doxorubicin or epirubicin instillation arm was lower that in the no instillation arm. Toxicity was mainly restricted to bladder irritation in about 10% of patients in each instillation arm.

During the past thirty-five years, we treated 221 patients with stage 1 renal cell carcinoma. We classified these patients into two groups: 175 patients who did not show recurrence and 45 patients who showed recurrence (excluding one patient who died of other disease). We investigated factors which affect the recurrence after nephrectomy and the survival after recurrence in these two groups. We found two major factors such as tumor diameter and tumor grade which affected the recurrence of renal cell carcinoma. Of these two factors, the grade of malignancy affected the prognosis of the patients with stage 1. Furthermore, as a result of long-term observation, we found that patients with grade I showed good prognosis compared with these with grade II, III and IV. The patients who showed weight loss constituted the majority of recurrent patients. Anaemia, erythrocyte sedimentation rate and positive reaction of C-reactive protein in addition to weight loss were major factors affecting the prognosis of stage 1 patients. In an effort to analysing the features of recurrent patients, there observed that no significant difference of the non-recurrent rate was detected between the patients who showed cancer death after nephrectomy and the patients who were living after nephrectomy. In analysing metastatic lesions and numbers of metastatic foci, we detected relatively long-term survival especially in patients with less than 3 foci of metastases in the lung, compared to those with multiple foci. Furthermore, we found dimension of the metastasis depended on the grade of the primary lesion.

We investigated the infection rate of Chlamydia trachomatis in sexual partners who had pregnant wives with C. trachomatis diagnosed by means of serum-antibody test (Ipazyme) or antigen test (Chlamydiazyme, IDEIA-chlamydia). Antibody-positive rate was 60.4% (90/149 cases), and antigen-positive rate was 7.4% 11/149 cases). All cases with Chlamydial antigen had anti-Chlamydial antibody. Eleven cases with Chlamydial antigen had no symptom of urethritis. Among these cases, eight cases had abnormal laboratory findings. However, the other three cases who had no abnormal finding were careers of C. trachomatis. In this study, sexual partners who had Chlamydial antigen were few, however, those who had anti-chlamydial antibody were many. Therefore, C. trachomatis will disseminate among many families as a latent infection.

Of 207 patients with renal carcinoma we studied 50 who survived for more than 10 years after nephrectomy. These 50 patients were younger than the others at the time of operation and included more females. They had lower stage and lower grade tumours. Recurrence was detected in 18/50 patients and 6 died from cancer. Recurrence developed approximately 10 years after nephrectomy. Eleven patients with recurrences had metastases to a single organ and 9 received multidisciplinary treatment, mainly surgery and radiotherapy. The survival rate 10 years after nephrectomy was lower in patients with recurrences than in those without recurrent tumours and there was a significant decrease in the survival rate 17 years after nephrectomy. Although the patients had low grade and low stage tumours 10 years after nephrectomy, careful follow-up is recommended in such cases as it is possible that they may have dormant tumours.

The effectiveness of a single 300-mg dose of tosufloxacin and of 3-day treatment with tosufloxacin (300 mg daily) were compared in a prospective trial in order to clarify the cost-effectiveness of tosufloxacin for acute uncomplicated cystitis. Fifty female patients (25 patients of each group) with acute uncomplicated cystitis received one of these treatment regimens, and the clinical data and follow-up culture results were analyzed. The effectiveness rates of single-dose treatment and 3-day treatment after 3 days were 100% and 96%, respectively. The recurrence rates of single-dose treatment and 3-day treatment after 14 or 28 days were 0% (0/13 patients) and 15% (2/13 patients), respectively. There was no significant difference in the effectiveness rate and the recurrence rate between these two groups, statistically. All isolated strains were eliminated in both regimens. From these results, it is suggested that single-dose treatment of tosufloxacin is effective enough for acute uncomplicated cystitis.

A multicentric randomised trial was conducted for the purpose of investigating the efficacy of intravesical chemoprophylaxis of superficial bladder cancers. A total of 443 patients (number of evaluable patients, 284) were registered from July 1987 to December 1989 and randomised into 3 groups. Group A received 21 intravesical instillations of Adriamycin (ADM) at 20 mg/40 ml physiological saline for 2 years after undergoing transurethral resection (TUR); group B was given the same dose as group A but received 6 intravesical instillations for 2 weeks before undergoing TUR; and group C served as a control and underwent TUR only. Better prophylactic effects were obtained in group A. The overall non-recurrence rates calculated for groups A and B differed significantly (P less than 0.05) on day 240, and those determined for groups A and C were also significantly different (P less than 0.01) on day 480. No benefit was obtained using intravesical instillation prior to TUR (group B). The major side effects encountered were pollakisuria and miction pain, which occurred in 32% of the patients in group A and in 52% of those in group B.

Clinical backgrounds of 35 patients with urogenital infection, from whom methicillin-resistant Staphylococcus aureus (MRSA) was isolated, were analyzed. Susceptibilities of these MRSA strains to various antimicrobial agents were also measured. Out of 35 MRSA strains, 29, 4 and 2 were isolated from urine, pus and sputum specimens, respectively, showing a definitely high isolation rate from urine. As for underlying diseases, 22 patients (62.8%), 11 (31.4%) and one each had a malignant tumor of the urinary tract or genital organ, prostatic hypertrophy, urolithiasis and vesicoureteral reflux, respectively. Patients aged at over 60 years numbered 20 (57%), and 32 patients (91.4%) were treated with some antimicrobial agent at the time of MRSA isolation. Out of 35 strains, 17 were isolated after total cystectomy with urinary diversion or transurethral surgery. As for the state of MRSA infection, 9 and 26 patients had single and polymicrobial infections, respectively, but none of patients had serious symptoms definitely thought to be caused by MRSA. On evaluation of susceptibilities of MRSA to various antimicrobial agents, the MRSA strains were found to be sensitive to minocycline, netilmicin and ofloxacin. From these results, MRSA strains isolated from patients treated in the field of urology were thought to rarely cause serious infectious symptoms, especially true for those isolated from the urine.

To evaluate the efficacy of computed tomography (CT) in the diagnostic workup of renal cell carcinoma, CT findings were correlated with surgical and pathological findings in 40 cases. Fifteen cases without obliteration of perinephric fat or thickening of Gerota's fascia were confined within the renal capsule. Eighteen lesions showing anatomic contact with adjacent organs were either within the renal capsule or Gerota's fascia but never beyond Gerota's fascia. Two cases (Stage II) showed thickening of Gerota's fascia and two cases (Stage IV) showed tumor infiltration into the spleen. Computed tomography was found to be a useful method for the investigation of tumor thrombosis and lymph node metastasis.

A total of 96 cases of renal carcinoma with distant metastasis at the time of diagnosis was studied. The patients were classified into 4 groups: Group O (16) in whom nephrectomy was not performed, Group A (51) who died due to carcinoma within 1 year of nephrectomy, Group B (25) who died due to carcinoma 1 to 3 years after nephrectomy, and Group C (4) who survived for 3 years or more after nephrectomy. Six clinical measurements were evaluated: haemoglobin, ESR, alpha 2 globulin, temperature, weight and C reactive protein. In addition, performance status, the number of organs with metastases, number of metastatic lesions and tumour growth rate were measured. The results showed that in patients surviving for 1 year or more after nephrectomy, there was an abnormality in the results of 3 or less of the 6 clinical measurements, performance was 0 or 1, and the carcinoma had metastasised to only one organ. In addition, it was found that the growth of metastatic lesions in patients who survived for 3 years or more was much slower than in the other patients. Nephrectomy was found to be effective in only 27% of our cases and we consider that careful deliberation should be made pre-operatively as to whether nephrectomy is really necessary in patients with metastasis. The decision should be made on the basis of the results obtained in the 6 clinical measurements given above.

Single photon emission computed tomography (SPECT) で得られた99mTc-DMSA腎横断々層イメージから腎摂取率, 腎容積を求める腎機能検査法を試み, 老年者の腎機能について検討した. 対象は健常成人対照例20例, 年齢60歳～87歳, 平均70歳の老年者43例 (健常老年者13例, 各種老年腎疾患30例) の計63例である.腎容積は吸収補正を用い再構成した各横断々層イメージ上で, 最適いき値法により決定した腎辺縁内の voxel 数を加算し算出した. 腎断層画像は重畳積分法により再構成し, 吸収補正は Sorrenson による前補正法を用いたGE-STAR法により行い, 最適いき値は42%を使用した. 腎摂取率は腎容積内の総放射能を算出, 投与量に対する百分率で表した.健常老年者13例26腎の99mTc-DMSA腎摂取率23±5%は健常成人20例40腎27±2%と比較し, 有意(p

Computed tomography (CT) was performed in a total 124 cases of renal cell carcinoma to determine perinephric invasion, venous invasion and involvement of the regional lymph node. The findings obtained were compared with pathological findings. CT findings for invasion of perinephric fat showed a sensitivity of 82%, specificity of 82 and accuracy of 82%. For adjacent organ invasion CT findings revealed a sensitivity of 90%, specificity of 100% and accuracy of 99%. As to venous invasion CT findings showed a sensitivity of 86%, specificity of 97%, and accuracy of 95%, and for lymph node involvement CT findings revealed a sensitivity of 80%, specificity of 98%, accuracy of 96%. Although the accuracy is not so high in diagnosing invasion of perinephric fat, CT scan was proven to be a valuable diagnostic measure for detection of adjacent organ invasion, venous invasion and lymph node involvement, thus helping to select a suitable surgical approach.

The Japanese Urological Cancer Research Group has conducted three randomized clinical studies on intravesical chemoprophylaxis of superficial bladder cancers. This paper presents a comparative analysis of the first and second of these. The protocol used in the first study was a so-called short-term schedule in which drugs (for group A, ADM 30 mg/30 ml; group B, ADM 20 mg/40 ml; group C, MMC 20 mg/40 ml; and group D, control) were administered twice a week for 4 weeks after transurethral resection (TUR), and in the second study a long-term schedule was used, in which drugs (for group E, ADM 30 mg/30 ml; group F, ADM 20 mg/40 ml; group G, MMC 20 mg/40 ml; and group H, control) were administered twice a week for 1 week, every 2 weeks for 7 weeks, monthly for 8 months, and finally once every 3 months for 1 year. In the first study 575 patients were evaluated and followed up for 5 years. The second study started 28 months later, and 607 patients were evaluated. A generally good prophylactic effect was obtained in the second study when the patients' backgrounds were adjusted in combination with the history and number of the tumors. The second study did not reveal any promoting or inhibitory effect on the progression of the recurrent tumors. There were no significant side effects in either study. The indications and the schedule for prophylactic intravesical chemotherapy should be more carefully studied.

Six patients with renal cell carcinoma underwent transcatheter arterial embolization with Gelfoam labelled by metallic clips. The embolization procedure was more easily monitored by fluoroscopy, and the complication of peripheral embolization was prevented. Tumor regression can be evaluated by changes in the distribution of the metallic clips on plain films.

Renal function was assessed by measurement of 99mTc-dimercaptosuccinic acid (DMSA) uptake by the kidney based on the transsectional tomographic image obtained by single photon emission computed tomography (SPECT). The renal uptake was expressed as percentage of the total radioactivity detected in the kidney, the volume of which was measured by convolution method, against the amount dosed. Absorption was corrected by GE-STAR method using cut off level of 42%. In order to determine normal range, measurement was made for 40 kidneys of each of 10 male and female volunteers confirmed of having normal kidneys both morphologically and functionally. The average volume of the kidney was 220.4 ml for the right and 239.3 ml for the left for males, and 205.9 ml and 236.5 ml, respectively for females. The renal uptake of radioactivity (at 2 h after injection), was 26.8% for the right and 27.6% for the left for males, with corresponding figures for females being 26.4% and 27.9%, respectively. Distribution range of renal volume and renal uptake was obtained by bivariate analysis with 90% and 95% probability. From these results, our method of renal function determination based on renal uptake of 99mTc-DMSA obtained from renal transactional tomogram by SPECT is considered to be accurate and potentially useful for clinical purpose.

Combination three-drug chemotherapy with adriamycin (ADM), cyclophosphamide (CPM), and 5-fluorouracil (5-FU) was performed in 24 cases of advanced bladder cancer who underwent surgical treatment, and three cases with recurrent or metastatic bladder cancer. The average age (25 men and 2 women) was 53. Of the 24 cases, nine were in stage T2, 10 in T3, and five in T4. One course consisted of a combination of 30 mg/m2 of ADM, 300 mg/m2 of CPM, and, 250 mg of 5-FU, administered five times. The combination was administered to three groups: every day for 5 days consecutively in group A, twice a week for 21/2 weeks in group B, and once every 4 weeks for 16 weeks in group C. After injection of ADM, CPM, and 5-FU, 200 mg/day of 5-FU was administered PO daily in all three groups. The 5-year survival rate of the 24 cases (apart from 3 cases with measurable metastatic tumor) was 58%. The 5-year survival rate for stage T2 was 88%, and that for stage T3 was 62.5%; all patients with stage T4 disease died before 3 years and 6 months. Partial response was seen in two out of three patients with recurrent or metastatic disease. Alopecia was observed in all cases as a side-effect of the chemotherapy. Also anorexia, nausea, and myelosuppression were observed in many cases, though the degree was tolerable. However, there were no disorders of the cardiovascular system, except for one case with transient hypotension.