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In a patient with transitional cell carcinoma of the pelvis of a solitary kidney there were extensive recurrences in the ureter and bladder. The treatment consisted of total cystoureterectomy and pyeloileocutaneostomy for urinary diversion and endoscopic control of the pelvic neoplastic growth.

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Measurements of serum prostatic acid phosphatase concentrations (PAP) by radioimmunoassay (RIA) were compared with the conventional measurements of serum acid phosphatase activities using p-nitrophenylphosphate (pNPP, tot.) and magnesium thymolphthalein monophosphate (TMP) as substrates and L(+)-tartrate (pNPP, tr.) as inhibitor in five prostatic cancer patients before therapy and in 13 during therapy. Elevated serum acid phosphatase activities were detected in 2, 2 and 3 of the 5 untreated patients when using pNPP (tot.), pNPP (tr.) and TMP enzyme assays, respectively. RIA for PAP detected elevated concentrations of the enzyme in 4 of these patients' sera. Three of the patients without metastases and one patient with suspected metastases had elevated concentrations of PAP by RIA. Serum acid phosphatase isoenzyme 2, which is mainly of prostatic origin, was separated chromatographically from serum samples with increased acid phosphatase activity. It represented 60--92% of the total activity, when TMP was used as substrate. Significant correlations (beta less than 0.001) were observed between all conventional enzyme activity measurements used and PAP by RIA within the whole patient group (n = 18), but no correlations existed within the patient group (p = 6) of high normal, or low abnormal serum PAP (2.7--6.6 micrograms/l). In addition, PAP measured by RIA better reflected the clinical state of the 13 patients under treatment than the conventional enzyme assays investigated.

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The autoimmune features of interstitial cystitis are reviewed. Despite some controversy, interstitial cystitis should be grouped to the connective tissue diseases but as a separate entity.

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The results of a specific active immunotherapy method following palliative nephrectomy in 31 patients suffering from advanced renal-cell carcinoma are presented. The control patient group comprised of 23 comparable cases, who did not receive immunotherapy. The minimum follow-up time for any patient is 4 years. The statistical 5-year survival rate of the immunotherapy group is 23.6% (SE = 7.8). 7 patients are still alive. The 5-year survival rate of the control group is 4.3% (SE = 4.3), without a single survival. The difference is statistically highly significant (p less than 0.001). No side effects were noted from this form of immunotherapy.

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A case of carcinoma in situ of the renal pelvis, diagnosed by exfoliative cytology from ureteral specimens and treated by nephroureterectomy, is reported. Urothelial carcinomas in situ are very rare in the renal pelvis, but an increasing number in the bladder have been diagnosed. Urinary cytology plays the most important role in the diagnosis of carcinoma in situ of the renal pelvis and may be used as a screening test of patients exposed to known carcinogens.

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The effect of preoperative irradiation on the survival of patients with renal adenocarcinoma was studied in a clinical trial. 88 patients with verified renal carcinoma entered the trial during 1968-1972, of whom 38, selected in a randomized fashion, received preoperative irradiation to a total dose of 3 300 rads in 3 weeks, followed by extrafascial nephrectomy after a 3 week interval; in the remainder an extrafascial nephrectomy was performed immediately. Actuarial 5-year survival was 47% in the "preoperative irradiation" group and 63% in the "nephrectomy-only" group, i.e. preoperative irradiation did not improve the 5-year prognosis. Survival was also studied in P-categories of the U.I.C.C. as well as in high and low grade malignancies. In none of these groups could we find a clear tendency to a more favourable prognosis with preoperative irradiation; no statistically significant differences were found. Because no improvement in prognosis after preoperative irradiation was found in our series or any of the sub-groups, we consider preoperative irradiation not routinely indicated as an adjuvant therapy. It may be useful in some selected cases, but selecting these cases will be difficult.

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Azathioprine, an immunosuppressive agent, was given to 38 patients presenting with intestinal cystitis. Pain disappeared completely in 22 patients and pollakiuria did the same in 20 patients, including two very severe cases with very contracted bladder. Chloroquine or oxychloroquine, usually combined with salicylate, was given to 22 patients. Pain disappeared in 11 patients and pollakiuria in 4 patients. No effect was noted in 10 patients in the azathioprine group and in 8 patients in the chloroquine group. The remaining patients had partial alleviation. The results are analyzed separately for various grades of severity. Spontaneous cure can be expected only in 11% of cases of interstitial cystitis calculated from a large series. Immunosuppression or chloroquine derivates are indicated for patients who do not respond to other treatments.

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Urinary bladder epithelium was studied with electron microscope in 50 patients with interstitial cystitis (IC) and 9 controls. In addition, biopsies of 14 patients with IC were studied with special stains for the presence of bacteria or viral inclusions in the epithelium. No bacteria or viral inclusions could be demonstrated. On the basis of these and earlier negative findings it appears that simple infection of the epithelium is ruled out as the aetiology in IC. Electron microscopy demonstrated an increase in large swollen epithelial cells with decreased amount of lateral processes in half of the IC samples and inflammatory changes in the mucosa. The similarity of the ultrastructure of epithelial cells in controls and IC patients makes it improbable that the disease process originates in the epithelium. In this study special attention was paid to large cytosomes (diameter 0.4--6.0 mum) in the epithelial cells. These contained small vesicular bodies (diameter 0.04--0.2 mum) and lipid droplets, and were found in controls as well as in IC patients.

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Almost all the patients (95 women and 8 men) with interstitial cystitis, i.e. autoimmune cystitis, in this area with a population of about 970,000 were probably traced. The prevalence of the disease in the female members of this population was 18.1 cases per 100,000 women of all ages. The joint prevalence of both sexes together was 10.6 cases per 100,000. The annual incidence of new female cases was 1.2 per 100,000 women. The disease is not rare when mild and moderately severe cases are also diagnosed. Severe cases account for only a tenth of all cases. Only about a tenth of the patients are men and most of them had the mild form of the disease. It may begin at any age. The incidence has possibly been rising during the last 10 years. Interstitial cystitis does not as a rule progress continuously but reaches its final stage rapidly, then usually remains in the same category. With this prevalence and incidence every urologist in this area can expect to see at least one case a year.

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