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The effects of three representative disinfectants, chlorine (sodium hypochlorite), iodine (potassium tetraglicine triiodide), and quaternary ammonium compound (didecyldimethylammonium chloride), on several exotic disease viruses were examined. The viruses used were four enveloped viruses (vesicular stomatitis virus, African swine fever virus, equine viral arteritis virus, and porcine reproductive and respiratory syndrome virus) and two non-enveloped viruses (swine vesicular disease virus (SVDV) and African horse sickness virus (AHSV)). Chlorine was effective against all viruses except SVDV at concentrations of 0.03% to 0.0075%, and a dose response was observed. Iodine was very effective against all viruses at concentrations of 0.015% to 0.0075%, but a dose response was not observed. Quaternary ammonium compound was very effective in low concentration of 0.003% against four enveloped viruses and AHSV, but it was only effective against SVDV with 0.05% NaOH. Electron microscopic observation revealed the probable mechanism of each disinfectant. Chlorine caused complete degeneration of the viral particles and also destroyed the nucleic acid of the viruses. Iodine destroyed mainly the inner components including nucleic acid of the viruses. Quaternary ammonium compound induced detachment of the envelope of the enveloped viruses and formation of micelle in non-enveloped viruses. According to these results, chlorine and iodine disinfectants were quite effective against most of the viruses used at adequately high concentration. The effective concentration of quaternary ammonium compound was the lowest among the disinfectants examined.

The effects of quaternary ammonium compounds (QACs) with sodium hydroxide on swine vesicular disease virus (SVDV), an enterovirus were studied. Didecyldimethylammonium chloride (DDAC) with 0.1% NaOH showed a stronger effect against SVDV than other QACs with 0.1% NaOH. The effect of DDAC with 0.1% NaOH was strong at 40 degrees C. DDAC was effective against SVDV at pH values around 11.0, but not in the distilled water control. The effect of DDAC with 0.1% NaOH was already observed at 1 min after mixing of the DDAC with SVDV. Observation under an electron microscopy revealed that the probable mechanism of inactivation of DDAC with 0.1% NaOH is as follows: The virus particles were partially destroyed by 0.1% NaOH. DDAC gathered these affected particles and formed a micelle, then SVDV lost its infectivity. From these results, QACs with 0.1% NaOH are considered to be very effective against SVDV representing enteroviruses.

We have previously suggested that an appearance of FDP D-dimer fragment into the urine predicts the reversibility of acute renal transplant rejection. In the present study, we observed urinary tissue-type plasminogen activator (tPA), which is a fibrinolytic enzyme and produces D-dimer, in 51 renal transplantation patients. Urinary tPA values are generally higher in transplantation patients except on chronic rejection than in healthy controls. High values just before onset of rejection (increase of serum creatinine value), deterioration at onset phase and gradual elevation from peak phase toward recovery phase were observed in urinary tPA of 6 reversible acute rejection episodes. Urinary D-dimer values changed following urinary tPA values in serial observation of 2 cases. In conclusion, immunological reaction accompanying by functional and organic renal impediments may result in loss of fibrinolytic activity, decrease in urinary tPA and D-dimer. This findings suggest theoretically that the supplemental tPA administration prevents the progression of rejection reaction.

We reviewed our 12.5-year experience with ileocecal conduit (ICC) and report the long-term results of 147 cases of ICC compared with those of our 102 cases of ileal conduit (IC). We usually performed ICC following total cystectomy for carcinoma of the bladder, while we chose IC in cases of high stage or recurrent malignancies. The average follow-up period was 41.7 months in the ICC group and 28.8 months in the IC group. The postoperative mortality (6.1%) and the incidence of early complications (21.1%) in the ICC group were comparable with the reported incidences for IC. In the later period, stomal problems were most frequently encountered. Urinary tract complications are important because they affect renal function in the course of a long period of time. Excretory urogram showed a satisfactory result and serum creatinine remained within the normal limits even in patients followed up for a long time in both groups. The incidences of pyelonephritis and urinary stones in the ICC group were 13.6 and 5.4%, respectively. We had expected a much lower incidence of these complications and ICC could not cover all the drawbacks of IC. However, at present, there is no ideal or perfect method of urinary diversion, ICC should be one of the acceptable options which has a satisfactory long-term result.

The rate of residual stones and that of recurrent lithiasis were investigated in 183 patients who had undergone extracorporeal shock wave lithotripsy (ESWL) between July, 1986 and December, 1988. The investigation was done by questionnaire survey at 22 institutions including our hospital on patients who were followed up after ESWL. The 183 patients included 126 male and 57 female patients between 9 and 77 years old (the mean 43.6 years). The greater part of patients had lithiasis of the lower renal calyx and upper ureter. The rate of residual stones 3 months after ESWL was 33.3% (61 patients) and the success rate was 72.2%. Chemical analysis of stones disclosed calcium oxalate-containing stones in 61% and calcium phosphate-containing ones in 10.8%. Recurrence of lithiasis was observed in 18 of the 131 patients (13.7%) who could be followed up for 6 months or more. These results were compared with those obtained after endoscopic treatment at Kinki University.

Both D-dimer and E fragments in urinary FDP were determined in renal transplantation patients. Urinary D-dimer fragments increased in 14 out of 20 acute rejections (70.0%) and in 6 out of 18 chronic rejections (33.3%). Urinary E fragments increased in 8 out of 9 acute rejections (88.9%) and in 4 out of 5 chronic rejections (80.0%). It is suggested that urinary FDP-E fragment is a better indicator to detect or predict rejection than the whole Urinary FDP. The appearance of D-dimer in the urine indicates intravascular coagulation in glomeruli followed by a secondary fibrinolysis in the course of the rejection reaction. The urinary D-dimer/FDP ratio which was used as the indicator of fibrinolytic activity in glomeruli was obtained in various conditions of renal transplants. The ratios were relatively high in the urines from well functioning grafts. This ratio deteriorated at the onset of rejection crisis and tended to go upward during the course of the recovery when the rejection was reversible. In the cases of irreversible acute rejection and chronic rejection, these ratios remained at a low level. D-dimer/FDP ratio might be useful indicator to predict the reversibility of rejection and the prognosis of renal allograft. Furthermore, these findings suggest that fibrinolytic and thrombolytic therapy by the tissue-type plasminogen activator (t-PA) along with immunosuppressive drugs might be more effective for the treatment of these rejections.

We retrospectively studied the effects and side effects of placing indwelling ureteral stents in 196 cases who underwent extracorporeal shock wave lithotripsy with a ureteral stent. The average period of ureteral stenting was approximately 22 days. Placing ureteral stents was mainly for large renal stones (79.3%), single kidney etc. There were no significant differences between the stunted and non-stunted patients with approximately 2 cm sized single renal stone with respect to the stone free rate, stone free period, and symptoms during stenting, which suggested that ureteral stenting might be unnecessary in those patients. High fever was highest in incidence of the symptoms and complications during stenting (17.2%). It occurred frequently in patients with infected stones or cystine stones. The percentages of pyrexia and stone street in patients using Towers type's stents were higher than those using the others. It was also shown that the bladder portions of the stents in patients using Towers peripheral ureteral stents were densely encased in calculous material and were very brittle. Fortunately the ureteral portions were removed intact. This study suggests that use of an indwelling ureteral stent may not contribute to the higher rate of being free of stones after the treatment of small to medium sized renal calculi, and that stents should be removed or changed early.

With respect to prostatectomies carried out in clinic since the opening of the Kinki University Hospital in 1975, incontinence after prostatectomy was investigated with 470 patients as subjects for whom a follow-up study after the operation was possible. Also, the usefulness of the urodynamic tests for diagnosing underlying diseases was investigated. 1) Overall incidence of incontinence after transurethral resection of the prostate (TUR-P), retropubic prostatectomy (RPP) and cryoprostatectomy was 5.7 percent. 2) The incidence of incontinence was 7.1 percent of the patients with TUR-P and 3.5 percent of patients with RPP. The incidence of incontinence after cryoprostatectomy was none. 3) There was no clear differences among the incidence of incontinence after prostatectomy and the weight of resected tissues. 4) There was no clear differences among various types of incontinence after each procedures of prostatectomies. 5) The incontinence was satisfactorily treated and disappeared in 18 patients within one year after the operation. In patients who failed to get continence within a year, the incontinence was likely to persist furthermore. 6) The cure rate was low in patients with abnormal findings in a cystometrogram performed prior to the operation. Associated diseases which could cause disorders in nervous system were frequently encountered in such patients. 7) Drugs and functional electrical stimulation (FES) were introduced for the treatment of incontinence after prostatectomy. FES was effective in 36.4 percent in which drug therapy was not effective. Since multiple drug regimen was administered in most of the patients, it was difficult to make a precise evaluation of judgement for effect of each of drugs.

A statistic survey was made on the patients undergoing operations between January, 1984 and December, 1986.

A case of transverse ectopia of the right testicle and the left testicular tumor with the immature uterus and the fallopian tubes is reported. The patient, a 27-year-old married man, was admitted to our hospital with the suspicion of left testicular tumor and right undescended testicle. In his left scrotum, a double hen-egg-sized tumor was palpable and the right scrotum was empty. Exploration of the left inguinal canal disclosed double testicles with hernia uteri inguinalis. The right testicle showed transverse ectopia, and the histological finding of the left testicle was choriocarcinoma. In our review of the Japanese literature, we discovered 67 reported cases of transverse testicular ectopia. 33 (49.3%) out of 67 cases had a uterus and 9 cases (13.4%) had testicular tumor.

A case of right ureteral stricture due to endometriosis in the pouch of Douglas was presented. A 46-year-old housewife was referred to our clinic with asymptomatic macroscopic hematuria on August 22, 1985. Intravenous pyelography (IVP) and abdominal computed tomographic scanning revealed right hydronephrosis and retrograde pyelography showed that ureteral stenosis existed at the lower portion of the right ureter. Right stenotic ureter was removed in 5 cm and ureterovesiconeostomy with psoas hitch method was performed following hysterectomy, left adenexotomy, right salpingectomy on November 28, 1985. Pathological specimen of the ureter revealed that endometriosis existed around the ureteral mucosa. Medication with Danazol was started from the third operative day. Two months later, IVP revealed decreasing right hydronephrosis and she was quite healthy without complaints.

The clinical effectiveness and safety of Aztreonam (AZT) were studied in 55 patients with complicated urinary tract infections. AZT was administered at a dose of 4 g/day for 5 days. The results as evaluated by the UTI criteria were excellent in 8 cases, moderate in 26 and poor in 21. The overall effectiveness rate was 61.8%. Out of 64 strains of bacteria isolated before treatment, 50 strains (78.0%) were eradicated by the treatment. Bacteriological eradication rates for gram negative rods and gram positive cocci were 79.6% and 66.7%, respectively. There were no obvious side effects, except for a temporary elevation of glutamic oxaloacetic transaminase, glutamic pyruvic transaminase alkalinephosphatase, and total bilirubin in some patients. The results indicate that AZT tablets are useful and safe for the treatment of complicated urinary tract infections.

Two cases of paratesticular rhabdomyosarcoma are reported. A 15-year-old boy was admitted in July, 1983, with a 3-week history of gradually increasing painless scrotal swelling on the right side. With the suspicion of testicular cancer, right radical orchiectomy was performed and pathological examination revealed an embryonal rhabdomyosarcoma of the paratesticular region. Chemotherapy and retroperitoneal lymphadenectomy were performed, and the latter revealed lymph node metastasis at the bifurcation of the aorta. Radiotherapy was not done because of adherent ileus. About 8 months after the orchiectomy, he died of recurrence at pelvic cavity and brain metastasis. A 6-year-old boy presented in March, 1985, with a complaint of right scrotal swelling that was painless and gradually increasing for about a month. Transinguinal exploration revealed a paratesticular neoplastic lesion and right radical orchiectomy was performed. Pathological diagnosis was paratesticular embryonal rhabdomyosarcoma. No evidence of metastasis was found by chest X-ray, excretory urogram, abdominal CT-scan or lymphangiography. As post-operative treatment, only chemotherapy was performed, and 9 months after the orchiectomy, the patient was asymptomatic. Ninety four cases of paratesticular rhabdomyosarcoma found in the Japanese literature are reviewed and mainly the policy of treatment is discussed.

Combined measurement of serum prostate-specific antigen (PA) and prostatic acid phosphatase (PAP) was performed in 235 patients with various urologic diseases including 55 patients with prostatic cancer. A PA level of over 24.7 ng/ml and a PAP level of over 3.1 ng/ml were considered to be positive. The positive rate of PA was 57% in the patients with untreated prostatic cancer and 3% in the patients without prostatic cancer. The positive rate of PAP was 52% in the patients with untreated prostatic cancer and 1% in the patients without prostatic cancer. PA and PAP were considered to be equally sensitive and specific serum markers of prostatic cancer. However, the positive rate increased to 65% without increasing the false positive rate when the PA and PAP were both measured simultaneously. The combined assay of PA and PAP is recommended for screening prostatic cancer. The cross-over titer of PA and gamma-Sm using standard samples in each kit revealed linearity, which suggested that PA and gamma-Sm possess the same antigenicity.

A case of syphilitic orchitis with aortic aneurysm is presented. The patient was a 72-year-old man who was diagnosed as having aortic aneurysm of thorax and abdomen by angiography. He visited our clinic with the complaint of swelling of the scrotal contents with tenderness after aneurysmectomy. Antibiotics were not effective against the swelling or tenderness, and right orchiectomy was performed. Histological diagnosis was syphilitic orchitis and aortitis.

A case of non-specific inflammatory granuloma of the bladder with marked eosinophilic infiltration is reported. A 54-year-old woman was admitted to our hospital on March 9, 1983, with the suspicion of bladder cancer. Her primary complaints were miction pain, frequency and gross hematuria. Cystoscopic examination revealed a hemi-sphere-shaped tumor at the dome of the bladder. Biopsy revealed no malignancy and marked eosinophilic and macrophagocytic infiltration of the submucosa. The patient was treated with antiallergic drugs and antibiotics with excellent relief of symptoms and objective remission of bladder findings on repeated cystoscopy and computed tomography.

The clinical value of local irrigation of thrombin was studied in 30 patients with urethral bleeding following transurethral prostatic resection. A thrombin solution consisting of 25,000 units of thrombin in 500 ml of saline was irrigated in 20 patients through the especially designed three-way balloon catheter at a speed of 8.3 ml/min for five hours after the operation while sterile saline was irrigated in the same manner in 10 patients as a control. The hemostatic effect of thrombin solution was evaluated as excellent in 2 patients (10%), good in 5 (25%), moderate in 6 (30%), and poor in 2 (10%) with 5 drop outs (25%) in the thrombin irrigating group. In the control group, the effect of irrigation was evaluated as good in 1 patient (10%), moderate in 4 (40%), poor in 2 (20%), and unable to be estimated in 2 (20%) with 1 drop out (10%). Therefore the rate of overall effectiveness was 65% in the thrombin irrigating group and 50% in the control group and volume of postoperative blood loss was 0.58 ml/g X hour and 0.62 ml/g X hour, respectively. Though almost all of the patients in both groups showed a moderate elevation of fibrinogen in serum, there was no adverse effect considered to be caused by thrombin irrigation. The local irrigation of the thrombin solution is a useful method and safe in the management of bleeding following transurethral prostatic resection.