[Study on clinical characteristics in relation to size of renal cell carcinoma]

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)

[Study of blood flow in hyperthermia using human renal cell carcinoma heterotransplanted in nude mice--differences in histological tumour pattern upon the effects of hyperthermia]

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

[A clinical study of the renal pelvis and ureteral 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.

[Detection of African type penicillinase-producing Neisseria gonorrhoeae in Japan]

The Plasmid DNA patterns of 22 penicillinase-producing Neisseria gonorrhoeae (PPNG) strains isolated from male patients with gonococcal urethritis in 1988 at Tokyo Metropolitan Taito Hospital were determined. The 3.3 megadalton plasmid, the so called the African type plasmid, was present in 3 isolates out of 22 PPNGs, all of which occurred with a conjugative 24.5 megadalton plasmid. 4.4 megadalton plasmid was present in 19 isolates out of 22 PPNGs, 5 of which occurred with a conjugative 24.5 megadalton plasmid. The infective sources of the 3 cases of the African type PPNGs were found as 1 from philippines and 2 from prostitutes, so called Soap Land Girl in Japan. And they suggests that the African type PPNGs are already common in Japan.

[The male reproductive function in patients with spinal cord injury]

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

Contrast-enhanced MR images in patients with meningioma: importance of enhancement of the dura adjacent to the tumor

Linear enhancement (flare sign) along the dura mater that was continuous with or emanated from the dural margin of meningiomas was frequently observed on contrast-enhanced MR images obtained in 18 patients with intracranial meningiomas (surgically proved). Preoperative MR studies obtained at 1.5 T after administration of gadopentetate dimeglumine were reviewed retrospectively to determine the clinical significance of this sign. Thirteen (72%) of the 18 meningiomas exhibited the finding adjacent to the dural attachments. Four meningiomas of the cerebellopontine angle showed enhancement along the internal auditory canals. Three specimens of the dura adjacent to the tumor in different patients with this finding revealed proliferation of connective tissues abounding with vessels along the dura without definite tumor invasion. The flare sign is thought to be a common finding of meningiomas on contrast-enhanced MR images obtained with high-resolution sequences, and it is observable without tumor invasion. This sign in the cerebellopontine angle should not be misinterpreted as enhancement of acoustic schwannomas.

[Pancreatic secretory trypsin inhibitor in urothelial cancer]

Pancreatic secretory trypsin inhibitor (PSTI) levels are known to increase in some kinds of cancer. We determined the PSTI levels in patients with urothelial cancer to evaluate its usefulness as a tumor marker. The subjects were 101 patients who had bladder cancer (n = 81) or renal pelvis and ureter cancer (n = 20). Twenty-six healthy volunteers were used as controls. PSTI was measured by an RI kit using the double antibody method, and levels above 20 ng/ml were taken as positive. Serum tissue polypeptide antigen (TPA) levels were also measured in 32 cases. None of the controls, 65% of the patients with renal pelvis and ureter cancer, and 30.9% of bladder cancer had positive levels of PSTI. The positive rate for each stage was 22.3% for Tis, Taand T1, 38.5% for T2, 73.3% for T3 and 100% for T4. The rate tended to increase with the progress of tumor infiltration. All subjects with positive readings above 30 ng/ml had progressive cancer. The usefulness of PSTI as a tumor marker was similar to that of TPA. PSTI is not a specific marker of urothelial cancer, but it showed an association with the progression of cancer. Therefore, it is considered to be a useful marker to determine postoperative metastasis, recurrence, and disease progression.

[Chemosensitivity test utilizing in vivo-like growing of renal cell carcinoma]

Utilizing two different types of renal cell carcinoma (JRC 1; papillary pattern, grade III, JRC 11; anaplastic and alveolar pattern, grade IV) heterotransplanted in nude mice, studied: 1) chemosensitivity tests using an in vivo-like growing culture method (collagen gel-supported culture system) with 3H-thymidine up-take assay; 2) using H and E staining, serial change of each tumour in this culture system was examined during 7 days after culture start-up. The chemo-agent tested was natural human interferon-alpha (HLBI), and the doses were 10, 100, 1,000 I.U./ml. In JRC 1, significant responses to IFN (10, 100, 1,000 I.U.) were noted, but no dose dependency was observed. In contrast, in JRC 11, compared with control, a decrease of 3H-thymidine up take in each dose of IFN was observed, but no significant differences were observed between the tested groups and control. In the 3-day culture of JRC 1, the central portion contained fewer viable cells. In the 7-day, the majority of the viable cells were replaced throughout the tumour. In contrast, in the 3-day culture of JRC 11, a decrease of viability in the central portion was observed, and this tendency progressed during the period of culture. In the 7-day only two to three thin viable cell layers were observed around the cultured tumour. Consequently differences of growth features in this culture system can be seen between the different types of tumours. Thus, a more detailed examination is needed for the clinical application of this culture system.

[MR imaging of the inner ear; findings of Ménière's syndrome]

Symptoms in Ménière's disease are explained by hydrops of endolymphatic system with recurrent ruptures of the membranous labyrinth. The primary cause of the increased endolymphatic volume appears to be an imbalance between secretion and resorption of endolymph which may be due to an obstruction of the endolymphatic duct and sac, located in the vestibular aqueduct. Non-visualization or narrowing of the vestibular aqueduct of the paper have been demonstrated by conventional tomography and high resolution computed tomography (HR-CT). But the endolymphatic duct and sac can not be obtained by HR-CT and conventional tomography. Whereas, on MRI, these are identified. By MRI, we prospectively tried to demonstrate morphological alterations in 10 patients with Ménière's disease and in 4 patients with vestibular neuronitis. These were compared with a group of 20 normal men. Visualization of the endolymphatic duct and sac (vestibular aqueduct) on MRI was assessed. There was a distinctly decreased visualization of the vestibular aqueduct in the Ménière group and vestibular neuronitis group. We were able to confirm a statistically proven usefulness of the MRI technique in identifying an anatomical abnormality which is directly in correlation with the side of the lesion in cases of unilateral Ménière's disease.

[Clinical evaluation of serum prostatic acid phosphatase assay based on the immunoenzymatic method (TZR-516)]

The usefulness of a newly developed prostatic acid phosphatase assay based on the immunoenzymatic method (PAP-IEA) was studied. Serum samples were obtained from 22 untreated prostatic carcinoma patients, 34 benign prostatic hyperplasia patients, 32 prostatic disease-free patients and 27 normal volunteers. Mean +/- S.D. of PAP-IEA in prostatic disease-free group and normal volunteer group was 0.46 +/- 0.27 ng/ml. So, the upper limit of PAP-IEA for clinical normal range was set to 1 ng/ml (= Mean + 2S.D.). Thus, the false positive rate of benign prostatic hyperplasia was estimated at 9% and false negative rate of untreated prostatic carcinoma at 27%. Meanwhile, PAP-IEA values measured in this study were correlated well to PAP-RIA values measured in the same samples (r = 0.994).

Mechanism of testicular atrophy induced by di-n-butyl phthalate in rats. Part 1

Repeated oral doses of di-n-butyl phthalate (DBP) to male rats caused a decrease in testicular fructose and glucose and a sloughing of the germ cells on the first day of treatment. On day 2, more severe sloughing was seen and was accompanied by decreases in testicular iron and zinc levels and increases in the level of inositol and cholesterols. The sloughing was followed by atrophy, accompanied by dissociation of the germ cells from the Sertoli cells and reduction of triglycerides, cholesterols and phospholipids containing choline and ethanolamine residues in the testis.

Neurofibromatosis types 1 and 2: cranial MR findings

Neurofibromatosis 1 (NF-1) (von Rekhlinghausen disease) and neurofibromatosis 2 (NF-2) (bilateral acoustic neurofibromatosis) have been recently recognized to be distinct disorders through genetic linkages. The authors compared the cranial magnetic resonance (MR) images of 53 patients with NF-1 and 11 with NF-2. In the NF-1 group, MR imaging revealed 19 patients with optic gliomas and eight with parenchymal gliomas. In 32 patients, foci of prolonged T2, similar to those reported previously as hamartomas, were identified in the cerebellar peduncles, globus pallidus, midbrain, and other locations. The frequency of these foci was related to both age and the presence of optic gliomas. In the NF-2 group, MR imaging revealed eight patients with cranial nerve schwannomas and six with meningiomas (in addition to acoustic schwannomas in all 11). These findings demonstrate that NF-1 and NF-2 are different diseases requiring different imaging protocols. NF-1 seems to be associated with tumors of astrocytes and neurons and NF-2 with tumors of meninges and Schwann cells.

[Clinical study of renal cell carcinoma with bony metastasis: comparative study with lung metastasis]

For the purpose of clinical analysis of renal cell carcinoma with bony metastasis (59 cases) the cases with lung metastasis (146 cases) were selected for comparison. The analyzed items were the distribution of bony metastatic portions, the results of radiotherapy for bony metastasis, comparative study with lung metastasis on clinical background, comparative study with lung and bony metastasis on the survival rate, comparative study with solitary bony and lung metastasis on the survival rate, comparative study with bony and lung metastasis on the grade of primary lesion. The most frequent metastatic portion was lower extremities, spine, upper extremities and pelvic bone in this order. The survival rate of the cases with bony metastasis was better than that of lung, especially with solitary metastatic cases. The effects of radiotherapy for bony metastasis were not so good for prolonging the survival. The grade of kidney malignancy did not influence the survival of patients with bony metastasis, on the contrary, in patients with lung metastasis, there was a good prognostic factor for survival.

[Clinical study of undifferentiated renal cell carcinoma in comparison with well differentiated cases]

During the past 28 years, 397 patients with renal cell carcinoma were treated at The Jikei University Hospital and its related institutions. Of these, 44 cases with undifferentiated renal cell carcinoma (grade IV) were compared with well differentiated cases (grade I), with regard to following 5 clinicopathological items: 1) general clinical features such as distribution of patient ages, sex ratio, affected side, the relationship of age and the volume of nephrectomized kidney, 2) angiographic appearance, 3) distribution of stages, 4) distribution of metastatic organs, 5) survival rates of each grade and each stage.

THE RESULTS

1) There was no specific trend in the distribution of affected ages, sex ratio and affected side of the tumour, but the volume of nephrectomized kidney in grade IV cases was much larger than that of the kidneys in grade 1 cases. Furthermore, in grade IV cases, the older the patient, the much lighter was the nephrectomized kidney. 2) No specific trends were observed in the angiographic pattern in the two groups. 3) Regarding stages, 75% of patients with the grade IV had stage IV carcinoma. But, 69% of patients with grade I had stage I. 4) Grade IV patients had a high incidence of lung and liver metastasis compared with grade I, which had a high incidence of bone metastasis. 5) Patients in grade IV and in grade I with stages I-III carcinomas lived longer than any grade with stage IV. So the undifferentiated renal cell carcinoma should be treated with adjuvant therapy even in low stage.

Nephrectomy in renal carcinoma with distant 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.

[A case of squamous cell carcinoma of the renal pelvis accompanying an ectopic opening with vesicoureteral reflux of complete duplication of uretero pelvis]

Squamous cell carcinoma of the renal pelvis is a relatively rare disease. Recently, we observed a case of squamous cell carcinoma of the renal pelvis with vesicoureteral reflux in a 49-year-old female patient. Her main symptom was abdominal pain on the left side. The complete duplications of uretero-pelvis on both sides, and vesicoureteral reflux in the upper left part of the kidney were recognized by means of various examinations. During the operation, a tumor was found in the upper left renal pelvis, and in the ureter belonging to the upper left renal pelvis. Pathologically, it was diagnosed as a squamous cell carcinoma. After the extraction of the left uretero-pelvis, 50 Gy of radiotherapy was administered to the patient. However, she died four months after the operation.

[Experimental evaluation of cisplatin analogous in urogenital cancer]

We studied the efficiency and toxicity of three types of recently developed cisplatin analogous agents-carboplatin, 254-S and DW2114, in animal experiments and clinical examinations. In animal experiments, these three agents were injected into SD rats intraperitoneally to determine their effects on rat functions. The antitumor effect of these agents was about the same as that of CDDP, but the renal toxicity of 254-S and DW2114 was lower than that of CDDP. However, more serious myelopathy was observed with these agents than with CDDP. Although slight damage to the testis was seen in the 254-S group, damage to the testis by the other agents was negligible. It was suggested that the damaged region in the testis was spermatogonia. In clinical examinations, we administered the three analogous agents separately for testicular tumors, prostatic cancer and bladder tumors, but a complete response (5M) was recognized in only one case given 245-S, and we found these three agents less effective than CDDP. At present, CDDP is extensively used clinically as one of the combination therapy agents. However, in the first place, we should develop a new CDDP analogous agent that has an anti-tumor effect greater than that of CDDP.

Hyperthermia with simultaneous administration of interferon using established human renal carcinoma heterotransplanted in nude mice

Using human renal carcinoma heterotransplanted in nude mice, the effects of the combined use of hyperthermia and interferon (natural human interferon-alpha; IFN-alpha, and recombinant interferon-gamma; IFN-gamma) were examined. The hyperthermic device used was the Clini-Therm, Mark VII, 915 MHz, microwave. The administration of interferon was started immediately before hyperthermia and carried out on consecutive days. The combined use of hyperthermia and IFN was compared with hyperthermia and with IFN alone. The combined use of hyperthermia and IFN-alpha was shown to have significant anti-tumour effects compared with the former or latter alone. Of 10 nude mice (10 implanted tumours) used for the experiment, 5 showed complete disappearance of the implanted tumours and the others showed prolongation of survival. Combined treatment with IFN-gamma and hyperthermia showed no significant effect when compared with other treatment groups. Combined treatment with local hyperthermia and IFN-alpha may have some application to the clinical management of renal carcinoma.

[Role of MRI in the pediatric central nervous system disorders]

Recent rapid development of the MRI system has enabled us to diagnose precisely the disorders of the central nervous system (CNS) also in neonates and young children. Because of a long studying time, the use of oral chloral hydrate or other alternative drugs for sedation, such as secobarbital and meperidine, is necessary for young children under 6 years of age. The advantages of MRI are the optional plane imaging, a high contrast resolution, and the artifact-free imaging from the surrounding bones and air. MRI can detect myelination disorders and the lesions in the posterior fossa, the middle fossa, and the spinal canal. These abnormalities are difficult to depict with conventional X-ray CT scanning. MRI is useful also for the survey of various congenital anomalies of the brain and the spine. Furthermore, it is sensitive enough to detect the CNS blood flow and the cerebrospinal fluid (CSF) flow. Arteriovenous malformation, moyamoya disease, and sinus thrombosis are diagnosed by MRI without using contrast media, CSF flow void phenomena in the aqueduct and the Monro's foramina are indexes of the CSF pathway obstruction and of normal pressure hydrocephalus.

[A case of bullous cystitis]

A case of bullous cystitis with a right ureter stone seen in a 25-year-old male is described. Inflammatory tumorous cystitis was performed. One month after transurethral resection, there was inflammatory tumorous cystitis at the same position. Therefore, right ureterolithotomy and right ureterovesical neostomy were done. The patient is currently in good health 1 year and 5 months after the surgery.

[Accuracy of computed tomography in the staging of renal cell carcinoma]

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.

Differences in ability of NO2 absorption in various broad-leaved tree species

Absorption of nitrogen dioxide (NO(2)) by various broad-leaved tree species was determined by the (15)N dilution method. The tree seedlings were continuously exposed to 0.3 ppm (microl litre(-1)) NO(2) or the mixture of 0.3 ppm NO(2) and 0.1 ppm O(3) for 30 days. The total amount of NO(2)-nitrogen absorbed by a seedling during the 30-day exposure period primarily depended on the size of the seedling. Among the tested tree species, three cultivars of Populus showed the highest rate of NO(2) absorption per unit leaf area, reaching as much as 0.3 mg N per dm(2) per day. The absorption rates for Populus cultivars were more than four times greater than those for Viburnum or Cinnamomum which had the lowest rate. A highly significant correlation was recognised between the rate of NO(2) absorption and the stomatal conductance among the species. Three cultivars of Populus which had the highest rates of NO(2) absorption were most susceptible to the mixture of NO(2) and O(3). On the contrary, Cinnamomum, Viburnum and Quercus, which showed the lowest rate of NO(2) absorption, were very tolerant to the mixed gas. These results indicate that the species difference in susceptibility to the mixture of NO(2) and O(3) was mainly determined by the difference in rate of absorption of these gases. Exposure to NO(2) alone had no detrimental effect on the tested tree species.

[Efficacy of ofloxacin in sexually transmitted male urethritis and cervicitis]

Efficacy and safety of ofloxacin (OFLX), a new quinolone antibacterial agent, were investigated in cases of sexually transmitted male urethritis and cervicitis. Chlamydial infections occupied a large part of the patients enrolled. This study was conducted in 29 institutions. A total of 1,126 patients with gonococcal, chlamydial or non-gonococcal non-chlamydial infections were enrolled in the study. The general dosing regimen of oral OFLX was 100 mg t.i.d. or 200 mg t.i.d. for 14 consecutive days. Along with the clinical efficacy evaluated by doctors in charge, therapeutic and clinical efficacies were determined according to standardized evaluation criteria. The evaluation of therapeutic efficacy was based on bacterial eradication. On the other hand, clinical efficacy was determined upon the improvement in causative bacteria, WBC counts in smear (or initial urine) specimens and urethra/cervical discharges. Clinical efficacy was determined on 7 and 14 days after starting the medication, except for gonococcal infections for which the efficacy was determined on Day 3 and Day 7. The results obtained are summarized as follows. 1. Efficacy evaluation by standardized criteria Therapeutic efficacy rates in gonococcal infections were 97.9% (93/95) on Day 3 and 100% (119/119) on Day 7. In chlamydial infections, the rates were 77.7% (363/467) on Day 7 and 93.6% (392/419) on Day 14. Chlamydial urethritis rated 94.8% (239/252) and cervicitis 91.6% (153/167) on Day 14. Clinical efficacy rates in gonococcal infections were 63.2% (60/95) on Day 3 and 95.8% (114/119) on Day 7. In chlamydial infections, they were 70.0% (327/467) on Day 7 and 89.7% (376/419) on Day 14. Chlamydial urethritis rated 88.5% (223/252) and cervicitis 91.6% (153/167) on Day 14. Clinical efficacy rates in non-gonococcal non-chlamydial infections were 93.3% (97/104) for male urethritis and 65.9% (27/41) for cervicitis on Day 14. 2. Clinical efficacy determined by doctors in charge A total of 1,028 cases, 752 urethritis and 276 cervicitis cases, was evaluated by doctors in charge. Clinical efficacy rates were 90.3% for urethritis and 92.4% for cervicitis. 3. Safety Safety evaluations was conducted in 1,087 patients. Side effects were observed in 23 patients among them (2.12%). None of them were deemed serious. General laboratory examinations were conducted for 169 patients. Abnormal findings were seen in 11 patients (6.51%) or 13 cases, all of which were minor. The results of this multi-center clinical trial demonstrated that OFLX is effective and well tolerated in the treatment of sexually transmitted disease (STD), both gonococcal and chlamydial infections.

[Treatment and prophylaxis for urogenital infections occurring after urethrocystoscopy]

To prevent urogenital infections occurring after urethrocystoscopy, we have studied the prevalence of these diseases without the use of antibiotic agents subsequent to urethrocystoscopy to determine the relative importance of aseptic procedures and whether administration of antibiotics is really required for this purpose. Patients enrolled in the present study included those undergoing urethrocystoscopy at four hospitals, totaling 146 patients (93 male and 53 female patients). All of these patients were apparently free of urogenital infections prior to urethrocystoscopy, with less than 5 leucocytes per field in urinary sediment, and a bacteria count of less than 10(4) cells/ml. Each patient was checked between 3 and 14 days after examination for 1) presence of clinical symptoms such as fever, bladder irritation symptoms and urethral secretion, 2) urinalysis and urinary culture, and 3) palpation of epididymis, testis and prostatic gland as required. The endoscope was sterilized for 20 to 30 minutes with 2% glutaraldehyde at 3 clinical institutions and with 0.5% chlorhexidine at the other, in a total of 116 and 30 patients, respectively. Sterilized distilled water was used as perfusate. The external urethral meatus of the subject was disinfected with 0.5% chlorhexidine, followed by local anesthesia with xylocaine jelly. Ten minutes after disinfecting the hands of the examiner, urethroscopy and cystoscopy were performed in this order. Urinary tract infection was detected in one male patient (1.1%) and 2 female patients (3.3%). In these cases, the endoscope was sterilized with glutaraldehyde in 2 cases and with chlorhexidine in the other. None of the subjects demonstrated fever or genital infections.(ABSTRACT TRUNCATED AT 250 WORDS)

[Unexpected renal cell carcinomas found during the operation in renal calculus: report of two cases]

Case 1: A 58-year-old man was seen with dull pain over the left flank. The X-ray examination revealed a renal stone in the left kidney. On operation, a globular hard mass was found in the lower portion of the posterior aspect of the kidney from which a biopsy specimen was obtained. A frozen section study showed renal cell carcinoma, and nephrectomy was performed. The patient is well four years after the operation without recurrence or metastasis. Case 2: A 50-year-old man consulted with microhematuria pointed out in a physical examination. At the operation for renal stone, we found the mass in the lower portion of the kidney. A frozen section study of the mass revealed renal cell carcinoma. We performed nephrectomy and lymphadenectomy on the renal pedicle. The patient is well three years after the operation. We reviewed the cases of renal cell carcinoma associated with renal calculi reported in Japan and discussed how the nephrectomy should be performed according to the frozen section study.

[Anti-tumour effect of UFT on human renal cell carcinoma heterotransplanted into nude mice]

1) Using two histologically different human renal cell carcinomas heterotransplanted into nude mice, the antitumour effect of UFT was investigated, and an attempt was made to analyze the properties of the tumour strains where a drug efficacy was noted. 2) The two strains used were the JRC 1 strain (tumour doubling time of 9.4 days, clear cell type, papillary histologic pattern, grade 3) and the JRC 11 strain (tumour doubling time of 2.72 days, granular cell type, anaplastic histologic pattern, grade 4). 3) Two dose groups were set up, one receiving 10 mg/kg of tegafur (FT) and 22.4 mg/kg of uracil and the other receiving 20 mg/kg of FT and 44.8 mg/kg of uracil. Each group was further divided into an early administration group (start of administration 3 days after the tumour transplantation) and a late administration group (start of administration at a time when the transplanted tumour proliferated to weight of 100 to 300 mg). 4) Effect as noted in the tumour proliferation inhibition rate was seen only in the group receiving 20 mg/kg of FT and 44.8 mg/kg of uracil in both early and late administration groups of the JRC 1 strain. Among these groups only the early administration groups showed a histological positive effect. 5) The fact that the measured 5-FU intra-tumour concentration in the JRC 1 strain was only 1/4 that of the JRC 11 strain demonstrates more susceptibility of JRC 1 strain to UFT. Moreover, intratumoral concentration of 5-FU differed markedly even with the same administration method and dosage level. This result indicates that intra-tumour concentration will be different if the histological pattern differs.

[Sequential magnetic resonance images of a case of cerebral sinus thrombosis--imaging of the thrombosed sinus and its recanalization]

Magnetic resonance images of a case of superior sagittal sinus thrombosis before and after complete recanalization are presented. The patient was a 61-year-old man with two days history of intermittent right hemiconvulsion followed by post-ictal hemiplegia. Mild erythrocytosis was noted on admission. CT scans revealed left frontal hemorrhagic infarction with empty delta sign in the middle portion of the superior sagittal sinus. Left carotid angiogram showed occlusion of two frontal cortical veins and retrograde filling of these veins into the cavernous sinus. Lack of filling of the middle and anterior part of the superior sagittal sinus was noted. These studies led to the diagnosis of superior sagittal sinus thrombosis associated with hemorrhagic infarction. He was treated with intravenous infusion of low molecular dextran and venesection. Neither heparin, urokinase, hyperosmolar solutions nor steroids were used because of the presence of hemorrhagic infarction and of the lack of signs of increased intracranial pressure. He completely recovered neurologically and recanalization of the superior sagittal sinus was confirmed angiographically eight weeks after the onset. Magnetic resonance images were taken with a Siemens 1.5 T Magnetom scanner using spin-echo pulse sequences. A T 1-weighted mid-sagittal magnetic resonance image ten days after the onset showed hyperintensity in the middle part of the superior sagittal sinus which corresponded to the thrombus. Both T 1 and T 2 weighted coronal images revealed a small area of hypointensity indicating the existence of residual blood flow in the superior sagittal sinus in addition to the thrombus both in the sinus and in the cortical vein.(ABSTRACT TRUNCATED AT 250 WORDS)

[Angiomyolipoma of the kidney with regional lymph node involvement]

A 44-year-old male was admitted with complaints of gross hematuria and high fever. An excretory urogram and renal angiography revealed a massive lesion in the right kidney. A computed tomographic scan showed bilateral renal tumors with low-density areas. Transperitoneal right radical nephrectomy, regional lymph node dissection and left renal biopsy were performed on September 5, 1984. The tumor was 14.5 X 7 X 6 cm in size and yellowish in cross section. The pathological diagnosis was bilateral angiomyolipomas and the same in the right hilar lymph node and the surrounding tissue. There was no evidence of malignancy.

[99mTc-DMSA renal uptake in urological diseases measured from renal tomographic images using single photon emission computed tomography (SPECT)]

To determine renal function, 99mTc-DMSA renal uptake was measured from renal tomographic images obtained by single photon emission computed tomography (SPECT). A total of 77 tests was conducted on 73 patients with various diseases in the kidneys and urinary tract to determine renal uptake. The correlation coefficient(r) between total renal volume and total renal uptake was 0.3509 and that between renal volume and uptake of 143 kidneys was 0.5433. In 62 patients whose creatinine clearance could be measured, the correlation coefficient between creatinine clearance and total renal volume was 0.2352, and that between creatinine clearance and total renal uptake was 0.8854, that is, creatinine clearance correlated well with renal uptake. Renal volume and uptake determined in 10 normal male and 10 normal female adults were 220 ml and 26.8% for the right kidney and 239 ml and 27.6% for the left kidney for the males and 206 ml and 26.4% (right) and 237 ml and 27.9% (left) for the females. This method, which requires no blood or urine collection, is very useful as an individual kidney function test to evaluate individual kidney function and to understand kidney function before and after operation in patients with renal and urinary diseases.

[Hormone therapy of male genital cancer (prostatic cancer)]

Endocrine therapy for urological tumor includes estrogen therapy for prostatic carcinoma. This endocrine therapy is one of the most firmly established therapeutic methods in the field of clinical oncology. However, confusion exists about how long this treatment remains effective and whether it prolongs survival, since estrogen can create cardiovascular complications in patients with prostatic carcinoma. Recently, new endocrine agents have been developed to compensate for the problems of estrogen therapy and to make treatment more effective. Estramustine sodium phosphate is medicine for internal use prepared by combining estradiol with nitrogen mustard. This hormonal chemotherapeutic agent has proved effective in 98% of treated patients. Most of the side effects of this agent have been observed in the digestive organs. Chlormadinone acetate, a progestational agent, has proved more effective against early prostatic carcinoma than against late-stage disease. LHRH analogue, which is now drawing much attention as a "chemical castration" agent for prostatic cancer patients, exerts an effectiveness equal to medium-dose estrogen treatment. The above three agents for the treatment of prostatic carcinoma should become increasingly popular in the future.