Predicting macroinvertebrate average score per taxon (ASPT) at water quality monitoring sites in Japanese rivers

Biomonitoring with bioindicators such as river macroinvertebrates is fundamental for assessing the status of freshwater ecosystems. In Japan, water quality and biomonitoring surveys are conducted separately, leading to a lack of nationwide information on their relationships and the biological status of water quality monitoring (WQM) sites. To understand the biological status of WQM sites across Japan, we developed a multiple linear regression model to estimate the average score per taxon (ASPT) using river macroinvertebrate data surveyed at a total of 237 "aligned" sites based on the co-occurrence of biomonitoring and WQM sites. The resulting regression model with eight predictors, such as biological oxygen demand, the proportion of urban areas in the catchment, could predict ASPT with reasonable accuracy (e.g., an error of ±1 for 96% of the aligned data). Using this model, we estimated ASPT values at 2925 WQM sites in rivers nationwide, categorizing them into four levels of river environment quality: "very good" (29% of WQM sites), "good" (50%), "fairly good" (14%), and "not good" (8%). Furthermore, we observed statistically significant correlations (p < 0.05; 0.4 ≤ r ≤ 0.7) between ASPT and all eight macroinvertebrate metrics examined, such as mayfly and stonefly richness, providing ecological implications of changes in ASPT.

Changes in cerebral oxygen saturation and haemoglobin concentration during paediatric cardiac surgery

Although near-infrared spectroscopy (NIRS) enables bedside assessment of cerebral oxygenation, it provides little information on the cause of deoxygenation. The authors aimed to investigate the changes in cerebral oxygenation and haemoglobin concentration and their associations during paediatric cardiac surgery in order to elucidate the physiology underlying cerebral deoxygenation. An observational retrospective study on 399 patients who underwent paediatric cardiac surgery was conducted. With use of NIRS, cerebral oxygen saturation as expressed by tissue oxygen index (TOI) before and after surgery, concentration changes in oxygenated haemoglobin (Δ[HbO₂]) and deoxygenated haemoglobin (Δ[HHb]) after surgery were studied as were the associations between these values and clinical variables. TOI decreased after surgery (preoperative versus postoperative value, 66.0% [56.9, 71.3] versus 63.2% [54.3, 69.4], median [25th, 75th percentile], P <0.001) and the decrease was greater in higher category groups in the Risk Adjusted Classification for Congenital Heart Surgery (RACHS-1). [HHb] increased from its baseline (+1.74 μmol/l [-1.57, +5.84], P <0.001) and the increase was greater in higher risk category groups. On the contrary, there was no evidence for a change in [HbO₂] (+0.45 μmol/l [-4.76, +5.30], P=0.42). Cerebral oxygen saturation decreased after paediatric cardiac surgery and the decrease was greater in patients of higher risk groups. The increase in [HHb] was considered to play a predominant role in the cerebral deoxygenation noted, in particular in higher RACHS-1 category groups.

[Pregnancy and delivery in the patients with spina bifida--report of 5 cases]

BACKGROUND

Because of improvement in the management for life-threatening complications of spina bifida, quality of life in the patient has become better and pregnancy is becoming more common problem in adolescent and adult female patients. In this paper, we reported patients with spina bifida who became pregnant and delivered a baby.

METHODS

There were 6 deliveries from 5 patients. Mean patient age at the first pregnancy was 27.6 years (ranged from 26 to 32 years). Four patients had undergone surgical managements before pregnancy, of whom 1 had augmentation cystoplasty. Urological and obstetrical conditions during the pregnancy were analyzed.

RESULTS

Upper urinary tract deterioration which was transient, was observed in 3 pregnancies. Serum BUN and creatinine levels remained stable throughout pregnancy in 4 patients. Pyelonephritis complicated 3 of 6 pregnancies. Delivery was vaginal in 4 and by cesarean section in 2. There were 7 obstetrical complications, which consisted of premature labor (2), uterine inertia (2), cephalo pelvic disproportion (2) and hydramnios (1). There were no significant anomalies in the newborns of these patients.

CONCLUSION

To achieve successful pregnancy and delivery in the patient with spina bifida, careful urological and obstetrical observation for the potential complications is needed.

[Long-term follow up of patients with spina bifida--a review of 228 cases]

BACKGROUND

The objective of this report is to evaluate the upper urinary tract changes of the patients with spina bifida who have been followed up for more than 10 years.

METHODS

We analyzed 228 patients (97 males and 131 females) of spina bifida. Mean patient age was 18.7 years (10 to 51 years) and follow up period ranged from 10 to 27 years (mean 13.4 years). Upper urinary tract deterioration (Hydroureter and/or hydronephrosis), vesicoureteral reflux (VUR) and bladder deformity were investigated by excretory urography and voiding cystourethrography. We compared these 3 parameters in the initial and final examinations.

RESULTS

In the initial examinations, upper urinary tract deterioration, VUR and bladder deformity were observed in 32.9%, 33.3% and 40.0%, respectively. During the follow up period, upper urinary tract was improved in 47.3% and VUR in 80.0%. Bladder deformity was disappeared in 14.4%. On the other hand, upper urinary tract was deteriorated in 9.3%. VUR and bladder deformity was newly developed or progressed in 8.0% and 29.3%, respectively. Finally, upper urinary tract deterioration, VUR and bladder deformity were observed in 31.3%, 18.2% and 52.0%, respectively.

CONCLUSION

These results revealed that upper urinary tract and VUR were relatively controlled, however, bladder deformity was increased in its frequency. To prevent upper urinary tract deterioration, further analysis of sequential changes of urinary tract conditions should be demanded.

Phase Behavior of Binary Mixture of Heptaethylene Glycol Decyl Ether and Water: Formation of Phase Compound in Solid Phase

Differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FT-IR) were used to construct and characterize the phase diagram for a binary mixture of heptaethylene glycol decyl ether (C10 E7 ) and water in the temperature range from -60 to 80&deg;C. Plots of the endothermic peak temperatures obtained by DSC measurements against compositions provided eutectic solid-liquid phase boundaries with a eutectic composition of 34 wt% of H2 O. On the other hand, heat of fusion per unit weight of the mixture changed discretely at the composition corresponding to the "eutectic" composition. Furthermore, the IR spectra obtained for the mixture in the solid phase were well reproduced as a superposition of those for the mixture of 34 wt% H2 O and pure components but were not reproduced by superimposing the spectra obtained for the solid surfactant and ice. These observations indicate that a solid phase compound is formed between C10 E7 and water with a stoichiometry of 1:14 and that the compound and pure components exist as separate phases, rather than the phases separating into surfactant and ice, which would be expected if the C10 E7 /water mixture formed a true eutectic mixture system. It is estimated from the composition corresponding to the phase compounds that two molecules of water per oxyethylene unit are bound to hydrophilic polyoxyethylene chain of C10 E7 to form a hydrated compound.

[Long-term follow-up of female tetraplegic patients with cutaneous vesicostomy]

Tetraplegic women who underwent a cutaneous vesicostomy in our institutions were studied to evaluate long-term urinary complications and their quality of life (QOL). A total of 5 patients (C4, C5 and C6 injuries in one patient each and C7 injury in 2) were followed for 98 to 125 months (mean 107 months). Autonomic hyperreflexia disappeared after surgery in all patients. None of the patients showed deterioration of the upper urinary tract. Urinary tract infections were noted in 3 of 5 patients, but not severe. Bladder stones developed in 2 patients and a stomal stricture in 1. A questionnaire survey showed the patients to be satisfied with the operation, which had improved their QOL. These findings suggest that a cutaneous vesicostomy is an excellent surgical procedure for tetraplegic women.

[Electroejaculation and assisted reproductive techniques in the patients with spinal cord injury]

BACKGROUND

Most of the patients with spinal cord injury (SCI) have fertility problems by an ejaculation and a poor fertility of the ejaculate. The objective of this paper is to evaluate the clinical effectiveness of electroejaculation (EE) and combined use of EE and assisted reproductive techniques for the patients with SCI.

PATIENTS AND METHODS

Using a Seager Model, EE was attempted on 69 patients with SCI. Of the 69 patients 14 (20%) had cervical, 49 (71%) thoracic and 6 (9%) lumbar paraplegia. Mean patient age was 30 years (range 19 to 47 years) and the mean interval from spinal injury to the first EE was 9 years (range 1 to 38 years). Artificial insemination of husband (AIH), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) were used to achieve a pregnancy.

RESULTS

Antegrade ejaculation was obtained in 60 patients (86.9%). Patients with under-active bladder showed low induction rate (58.3%). Volume of ejaculate was ranged from 0.05 to 5.2 ml (average 1.0 ml) and sperm concentration was ranged from 0 to 546 x 10(6)/ml (average 40.3 x 10(6)/ml), but sperm motility was poor (range 0 to 70%, average 9.4%). Assisted reproductive techniques was attempted on 87 occasions (AIH 80, IVF 2, ICSI 5) on 15 couples. To date, there have been 4 pregnancies (AIH 2, ICSI 2) resulting in 3 healthy live births.

CONCLUSION

Combined use of EE and assisted reproductive techniques is excellent management for the patients with SCI who wish to father children.

[Evaluation of sexual function in adults with myelomeningocele]

In the present study, sexual function in 46 patients (22 males and 24 females) with myelomeningocele was assessed by a questionnaire study. The mean age of the patients was 24.0 +/- 9.6 years (with an age range of 18 to 50) for male patients and 25.2 +/- 6.2 years (with an age range of 18 to 42) for female patients. Having interest in the opposite sex and sexual desire were evident in 95% and 100% of male patients, and 83% and 75% of female patients, respectively. In male patients, erection was achieved in 95% by visual stimulation and in 86% by tactile stimulation. However, only 27% of the patients with erectility were satisfied with penile rigidity. Ejaculation and orgasm was noted in 67%. Orgasm was frequently seen in patients whose external sphincter activity was maintained. The age and the degree of lower extremity paralysis according to Sharrard classification were not significantly correlated with sexual function. In female patients, menstruation was regular in 95%, vaginal secrete was adequate in 88%, but only 19% of the patients felt ecstacy around perineal lesion at coital movements. In female patients, sexual function was not correlated with the age, the degree of lower extremity paralysis and detrusor activity-sphincter activity. Although most patients had sexual desire, only 18% of the males, and 33% of the females, had sexual intercourse activities. It appears, therefore, that these patients need to be given appropriate advice.

[Antireflux operation for vesicoureteral reflux in spina bifida patients]

A series of 32 patients with spina bifida, representing 50 renal units with vesicoureteral reflux (VUR), was treated with antireflux operation. All but one patient underwent ureteral reimplantation with Cohen's technique. Another patient was treated with bilateral Politano-Leadbetter's technique. The overall success rates were 92.0% by renal unit and 87.5% by case, with a mean follow-up period of 42.5 months. These results were comparable to those in the recent literature. Failure included recurrence of VUR in 3 patients. Another patient who had undergone unilateral reimplantation developed new occurrence of reflux in the contralateral ureter. Possible masking of contralateral VUR should be taken into consideration in patients with unilateral high grade VUR. We also emphasize the importance of continuing clean intermittent catheterization in a proper manner to be free of VUR postoperatively.

[Unresolved issues concerning the operative indication of augmentation cystoplasty in spina bifida patients: a report of two cases]

Augmentation cystoplasty is evolving into a common method of surgical treatment for a low capacity and/or low compliance neurogenic bladder. Although an increasing number of successful results have been recently reported, the operative indication of augmentation cystoplasty is yet to be established. Herein, we report two cases of neurogenic bladder due to spina bifida which required abandonment of augmentation cystoplasty. The first case was in a 23-year-old female with a severely deformed bladder and right vesicoureteral reflux (VUR). She refused to undergo ileocystoplasty because we could not assure her of postoperative conception which she eagerly anticipated. The second case was in a 19-year-old male with a severely deformed bladder and right VUR. He experienced recurrent episodes of ventriculoperitoneal shunt (V-P shunt) difficulty which required exchanging the shunt tube each time, and each exchange proved to be very difficult or nearly impossible. Based on lengthy neurosurgical consultation, we came to the conclusion that ileocystoplasty was not a preferable treatment of choice for the correction of his disease due to the possibility of V-P shunt infection, which could be fatal. Alternatively, both cases were treated with Cohen's ureteral reimplantation, which resulted in the recurrence of VUR. These cases presented still unresolved issues concerning the operative indication of augmentation cystoplasty in spina bifida patients.

[Transurethral resection of the prostate in the urological management for patients with stroke]

We discuss the transurethral resection of the prostate (TUR-P) on 40 patients in the chronic stage of stroke, all of whom were refractory to conservative managements of urinary disturbance. All patients, between 35 and 89 years old (mean: 52.6 years), had only one episode of stroke and were diagnosed as benign prostatic hypertrophy or bladder neck contracture that appeared to cause urinary disturbance in these patients. At six months after TUR-P, all except for one patient, who needed an indwelling catheter due to a reinfarction, were catheter free. Of these cases 36 (92%) obtained independent micturition and did not develop urinary incontinence except transiently postoperatively. Two cases with impaired mobility and one case with progressive senile dementia required helpmates and/or a commode and so forth postoperatively. It is concluded that in chronic stroke patients TUR-P is recommended for those with benign prostatic hypertrophy or bladder neck contracture.

[Urological management for stroke patients; relation between brain lesions and establishment of micturitional modality]

A total of 154 stroke patients, 96 males and 58 females, were analyzed to establish the micturitional modality according to the type of detrusor function and the level of activities of daily living (ADL). All patients had only one episode of stroke attack and were checked at least one month after the onset. Localization of cerebral lesion in each patient was evaluated by neurological findings and cerebral angiography in addition to computed tomography of the brain. In the patient groups classified according to the type of detrusor function, micturitional modality was established in 50% of the patients with the underactive type, 70% of those with the overactive type and in 88% of those with normal function. This suggests that the overactive and normal type of detrusor function may not affect establishment of micturitional modality. On the other hand, when classified according to the level of ADL, none established micturitional modality in patients with poor ADL. By contrast, in the patients on higher levels of ADL who were able to transfer themselves from or to a wheel-chair without any assistance it was established in 75%, and in those who were able to gait with or without a brace upon discharged from the hospital, in 91%. It is concluded that establishment of micturitional modality in stroke patients is closely related to the level of ADL or function of lower extremities, but not to localization of the brain lesion.

[A study of relation between patterns of micturitional dysfunction and establishment of micturitional modality in stroke patients]

We managed 246 patients with bladder dysfunction due to the first stroke in our hospital between January, 1983 and December, 1988. Of these 221 were in the chronic stage of stroke. A total of 213 patients were evaluated for types of bladder dysfunction by cystometry. We examined the relation between hemiplegic side and type of dysfunction or micturition activity, but obtained no significant relationship. Establishment of voluntary voiding pattern was considered to depend on the improvement of daily life activities. The catheter-free rate was 89.4%, while 10.6% of the patients, who could not receive sufficient nursing care or had severe medical problems, were obliged to keep an indwelling catheter. We conclude that establishment of a bladder retraining program is necessary not only medically but socially for improvement of quality of life in stroke patients.

[Clean intermittent catheterization in the management of spina bifida: a review of 113 cases]

One hundred and thirteen cases of spina bifida treated with clean intermittent catheterization (CIC) were reviewed. There were 42 males and 71 females, ranging from 4 months to 50 years. The major reasons for CIC from other voiding methods were vesicoureteral reflux (VUR) (48/113) old, and residual urine (36/113). The most common type of neurogenic bladder was hypoactive detrusor-active sphincter, in 56.6% of patients (64/113). The grade of paralytic disability of lower limb (Sharrard's classification) was low (group IV-VI) in 84 patients and high (group I-III) in 29 patients. Hydroureteronephrosis and VUR improved 52.1% (37/71) and 57.1% (36/63), urinary tract infection and urinary incontinence improved 70.9% (39/55) and 81.7% (72/87). Major complications were pyelonephritis (12 cases) and urethral pain (5 cases). We discussed the choice of voiding method in the management of spina bifida.

[Management of female neurogenic bladders caused by cervical spinal cord injuries--cutaneous vesicostomy]

Cutaneous vesicostomy according to Paquin's modification was performed on 5 female patients with neurogenic bladder caused by cervical spinal cord injury and long-term follow-up is now available. All patients are free from risk of autonomic dysreflexia and catheter trouble. There was one significant complication, stomal stricture, but it did not result in severe urinary infections or secondary changes in the upper urinary tract. Cutaneous vesicostomy proved to be valuable to improve the quality of life in female patients with neurogenic bladder caused by cervical spinal cord injury.

[Bladder augmentation in three patients with contracted bladder caused by neurogenic bladder]

Three patients with contracted bladder caused by neurogenic bladder underwent ileocystoplasty. The primary diagnosis was meningomyelocele for all of them. The operative procedure adopted was Goodwin's Cup-patch method. All cases have obtained increased bladder capacity with improvement of bladder compliance and have been free from urinary incontinence. They were followed up by using clean intermittent self catheterization. Ileocystoplasty combined with clean intermittent self catheterization offers a successful method in patients with contracted bladder caused by neurogenic bladder.

A study of functional recovery for urination and defecation in patients with myelodysplasia: a modified seromuscular ileal flap fixation to the bladder

From 1978 to 1985, 57 myelodysplasia patients with urinary and defecatory dysfunction underwent surgical treatment by modified seromuscular ileal flap fixation to the bladder. Followup was 1 to 88 months. Bladder capacity did not decrease, and voiding time and urine flow rate significantly improved. A urinary substitute sensation appeared in 45 of 46 patients (97.8 per cent) and urinary incontinence improved in 36 of 37 (97.3 per cent). A fecal substitute sensation appeared in 31 of 46 patients (67.4 per cent) and constipation improved in 22 (47.8 per cent). Operative complications were encountered in 5 of 57 patients (8.8 per cent), including 3 cases of prolonged paralytic ileus, 1 obstructive ileus and 1 wound herniation. Modified seromuscular ileal flap fixation to the bladder appears to be indicated for patients with the lower type of neurogenic bladder with neither a low compliance bladder nor high grade vesicoureteral reflux.

[Percutaneous management of perinatal spontaneous rupture of a calyceal diverticulum]

We report a case of spontaneous rupture of a calyceal diverticulum in a perinatal woman who was treated with percutaneous procedure. A 28-year-old woman, who delivered a full-term healthy male infant 13 days prior to hospitalization, was admitted complaining of left progressive severe flank pain. Kidney-urethra-bladder X-ray showed a space-occupying lesion in the lower pole of the left kidney. Drip intravenous pyelography revealed the left renal pelvis and calyx to be pushed up. Renal computed tomographic scan demonstrated a cystic lesion in the lower pole of the left kidney with a perirenal hematoma. After percutaneous puncture followed by indwelling of 8 Fr. balloon catheter within the cystic lesion for drainage, the patient recovered dramatically. Retrograde and antegrade pyelography showed the cystic lesion communicating with an adjacent calyx in the lower pole of the left kidney. The physiological relationship to pregnancy is discussed as a possible etiological factor in the unique occurrence of this rare rupture, and the literature is reviewed.

[Transurethral electroresection of the external urethral sphincter in the urological management of male tetraplegics]

Transurethral electroresection of external urethral sphincter (TUR-sph) was performed in sixteen male tetraplegics to obtain good voiding efficiency and to prevent autonomic dysreflexia due to detrusor sphincter dyssynergia. Ratio of residual urine as a parameter of voiding efficiency and blood pressure and plasma noradrenaline level during voiding as parameters of the significance of autonomic dysreflexia were evaluated before and after TUR-sph, and all these parameters had significantly improved after TUR-sph. After discharge from the hospital, all patients urinated comfortably with the maneuver of suprapubic percussion by themselves and/or their helpmates, and no patients complained of any inconvenience due to urinary incontinence. Moreover, no patients had the episode of autonomic dysreflexia in daily life except for one patient who had it once with urinary tract infection. TUR-sph brings not only the improvement of voiding efficiency but also the effect as a safety valve against autonomic dysreflexia by means of preventing the occurrence of autonomic dysreflexia due to detrusor sphincter dyssynergia.

[The management of vesicoureteral reflux with neurogenic bladder due to spina bifida]

Thirteen cases (20 ureters) of vesicoureteral reflux (VUR) associated with neurogenic bladder, treated with anti-reflux operation are reviewed. Twelve of the 13 cases had meningomyelocele and 1 had spina bifida occulta as an underlying disease. The type of neurogenic bladder was hypoactive detrusor-active sphincter in 11 patients and hypoactive detrusor-hypoactive sphincter in 2 patients. They were treated with an anti-reflux operation, 2 ureters by Politano-Leadbetter method and 18 ureters by Cohen method. The results were successful (success rate 85.0%). Therefore, we concluded that in neurogenic bladder patients especially with the hypoactive detrusor-active sphincter, the cause of their renal deterioration is mostly VUR. Thus we should examine such patients for VUR. On the other hand, when the renal deterioration of VUR patients cannot be improved by conservative treatment for example clean intermittent catheterization or indwelling catheter, we should perform an anti-reflux operation.

[Intracavernous injection of papaverine hydrochloride for impotence in patients with spinal cord injury]

Twenty-one intracavernous injections of 40 or 60 mg papaverine hydrochloride were given to ten male paraplegics. Erection sufficient for coitus was achieved within a few minutes after 15 of the injections (71.4%). Tumescence of the penis lasted from 18 minutes to 48 hours and the penile tumescence of the patients who had reflective erection usually lasted longer than that of the patients who did not. The trial that lasted for 48 hours resulted in the fracture of the penis that was presumed to have occurred during coitus and it was treated operatively. Intracavernous injection of papaverine hydrochloride is available for the impotence of male paralegics, but both doctor and patient must be careful about the sensory disturbance of the penis to avoid penile injury during erection. Further studies are needed to establish safety and long-term efficacy, as well as to determine if histological change of cavernous body occurs by repeated injection.

[Urological treatment of patients with spinal cord injury in the chronic stage]

One hundred eighty patients with spinal cord injury were admitted to our hospital between January, 1980 and June, 1983. Eighty-five of them had cervical lesions, 54 had thoracic lesions and 41 had lumbar lesions. Most of the neurogenic bladders due to spinal cord injury treated in our clinic, could be classified into 3 major patterns: hypoactive detrusor-hypoactive sphincter, hypoactive detrusor-active sphincter, and hyperactive detrusor-hyperactive sphincter. To control the hyperactivity of the detrusor and the sphincter, we employed pharmacotherapy first and then we performed transurethral resection of the bladder neck and prostatectomy (TUR-Bn.P) and nerve block (sacral nerve block, pudendal nerve block, obturator nerve block and lumbar nerve block). In the case of a hypoactive detrusor, we employed TUR-Bn.P, open ileal flap fixation to the bladder and voiding training. Using these procedures, we could make 157 patients catheter-free.

[Adrenal cyst: report of a case]

A 32-year-old woman was admitted because of a large abdominal mass in the right upper quadrant. Laboratory findings including hormonal studies were within normal ranges. CT scan and various X-ray examinations revealed a large adrenal cyst on the right side. On May 2, 1984, an adrenal cyst was removed through the right flank incision. Histological study showed that the wall of the cyst consisted of fibrous tissue with endothelial linings and dilated lymphatic vessels. Thus it was classified as a lymphangiomatous adrenal cyst.

[Percutaneous nephrostomy]

Sixty three cases (male 32, female 31) of supravesical obstruction were treated with ultrasonically guided subcutaneous nephrostomy at our hospitals from October 1980 to October 1984. Their age ranges from 2 months to 84 years old, and median age was 52 years old. The major causes of ureteral obstruction were extended pelvic malignancies, 45 cases (71%) (gynecological 18, urological 16, gastrocolorectal 7 and others 4), and benign disease 18 cases (29%). Objectives of nephrostomy were classified in 4 categories (drainage, manipulation, irrigation and evaluation), and results of nephrostomy were discussed for each category. No major complications were observed. Only prolonged macrohematuria (over 48 hours) and fever (over 38 degrees C) were observed in 5 cases respectively. Success rate of nephrostomy placement was 97.5% of all cases. With ultrasonography and angiographic technique, percutaneous nephrostomy is an easy, safe and reliable method.

[Effect of Robaveron tablet (KN-7) in the long-term therapy for urinary disturbances]

Long-term therapeutic effect of Robaveron tablet (KN-7) was studied on 10 female patients of middle and old age with ptosis of urinary bladder and 9 patients with neurogenic bladder. The patients had mainly complained of such subjective symptoms as pollakisuria, difficulty of urination, sense of residual urine, lower abdominal discomfort and urinary incontinence. Robaveron tablet was administered at 2 tablets t.i.d. for 3-26 months. And the drug efficacy was evaluated by residual urine, cystometric findings and subjective symptoms. A significant decrease in the residual urine rate and a significant increase of pressure amplitude were obtained, and improvement of subjective symptoms was seen with an effective rate of about 70%. Overall effectiveness, rated slightly improved or better was 89.5%. No cases of side effects or abnormalities in laboratory tests were observed. Robaveron tablet is safe and effective for patients with urinary disturbance accompanied by ptosis of urinary bladder, as a myogenic disorder, as well as neurogenic bladder in the long-term therapy.

[Clinical study of urothelial tumors of the upper urinary tract. 2: Primary ureteral tumors]

Twenty-five primary ureteral tumors treated at our University between 1963 and 1981, were reviewed retrospectively. The conclusions of this study are as follows. Sex and age distribution of the patients were 18 males and 7 females (2.6: 1), and average age was 63.04 years old. The major symptom was hematuria. The majority of the patients were admitted to our clinic within 6 months from manifestation of symptoms. The major finding of IVP was non-functioning kidney. The positive rate of urinary cytology was 63.2%. Total nephroureterectomy with bladder cuff was performed in 21 out of 23 cases. Histologically, 22 cases were transitional cell carcinoma and one case was squamous cell carcinoma. Simultaneous urothelial tumor was found in 13 cases in the bladder. Most of the ureteral tumors (63.6%) were found in the lower third segment of the ureter. Subsequent urothelial tumors were seen in 3 bladders and one urethra out of 22 cases receiving surgical treatment in the follow-up period. The 5-year survival rate by actuarial method was 39.4%. Among several factors, grade and stage of tumor were the most influencing factors for prognosis. An effective method of post-operative treatment could not be established.

[Clinical study of urothelial tumors of the upper urinary tract. 1: Primary renal pelvic tumors]

Forty primary renal pelvic tumors treated at our University between 1963 and 1981, were reviewed retrospectively. The conclusions of this study are as follows. Sex and age distribution of the patients were 30 males and 10 females (3: 1), and average age was 60.5 years old. The major symptoms were hematuria and flank pain; however, palpable mass was rare. The majority of patients were admitted to our clinic within 6 months from manifestation of symptoms. The major findings of IVP were non-functioning kidney and filling defect. The positive rate of urinary cytology was 46.7%. Total nephroureterectomy with bladder cuff was performed in 20 out of 32 cases. Histologically, 29 cases were transitional cell carcinoma and 4 cases were squamous cell carcinoma with renal calculi. Simultaneous urothelial tumors were seen in 10 cases, 3 in the ureter and 7 in the bladder. A subsequent ureteral tumor was found in one out of 12 cases in which ureters were resected incompletely, and 7 subsequent bladder tumors were found out of 32 cases receiving surgical treatment in the follow-up period. The 5-year survival rate by the actuarial method was 75.9%. Among several factors, grade and stage of the tumor were the most influencing factors for prognosis. An effective method of post-operative treatment could not be established.