(I) Studies of blood pH and serum chloride were made in 25 patients immediately after the uretero-enterostomy. Those patients consist of 3 patients with bilateral ureterosigmoidostomy, 4 with artificial sigmoid-bladder, 13 with ileumbladder, 3 with ureterosigmoido vesico-neostomy, 2 with uretero-ileo-vesico-neostomy, (one of them were Scheele's ring-plastic operation) and 8 with lumbar uretei ostomy. In addition, the same studies were done about one year or more after operation in 12 cases, containing 6 of uretero-sigrnoidostomy, 2 of sigmoidbladder, one of caecumbladder and 3 of ileumbladder.
The results were as follows:
A) Early results after operation
a) Evidence of hyperchloremic acidosis was demonstrated in all patients who underwent uretero-sigmoidostomy and in 2 cases of them it was the cause of death with clinical symptome. In 2 of 4 patients with sigmoidbladder, this sign was demonstrated, being of slight degree in one. One of them unaccompanied with this sign, is the patient in whom wet colostomy was performed. In only one of 13 patients with ileumbladder, hyperchloremia developed temporarily. Post-operative course of this operation was perfectly well, that of 8 patients with lumbar ureterostarny being also good.
b) The type of uretero-intestinal anastomosis perf ormed, does not influence the development of hyperchloremic acidosis, but the type of artificial bladder does.
c) In patients with the reconstruction of a part of ureter by substitution of sigmoid segment or ileum segment, blood electrolyte imbalance as a rule did not occur, with only exception of a case of Scheele's ring-plastic operation. In this case hyperchloremia occurred temporarily because urine tends to be retained in isolated ileum-ring. Namely, the reconstruction of a part of the ureter by substitution of bowel segment is a new type of the ureteroenterostomy.
d) Hyperchioremic acidosis developed early postoperatively in 19 cases or 34.5%, and hyperchloremia in 23 or 41.8% of 55 cases including all type of the ureteroenterostomy in our clinic. Hyperchioremic acidosis developed in 15 or 53.6% of 28 cases with bilateral ureterosigmoidostomy. These results are almost corresponding with the findings of other authors.
B) Late results after operation
Hyperchloremic acidosis was demonstrated in 2 and hyperchloremia in one of 6 cases with ureterosigmoidostomy. But in 2 patients, 4 and more 10 years after operation respectively, hyperchloremic acidosis was not demonstrated and they were perfectly well. It is found therefore, that some of patients who underwent uretro-sigmoidostomy can become stable in long course, though this operation has generally poor results. In one of 2 cases with sigmoidbladder, hyperchloremia, was demonstrated, but in one with caecumbladder and 3 with ileumbladder it was not demonstrated. Namely, it is concluded that ileumbladder is in good condition of blood electrolyte on late results as velf as on early results after operation.
(II) In order to pursuit the cause why the blood electrolyte imbalance does not develop in ileumbladder, studies of the electrolyte absorption have been done on such patients and dogs by injecting 1% and 5% sodium chloride solution into the isolated segments of intestine. Samples of the infused solution as well as those of circulating blood were taken at 60 minutes interval to the third hour and the level of chloride recorded.
The results were as follows:
1) Chloride is absorbed from the sigmoidal and ileac mucosa and serum chloride increases temporarily.
2) Ileum has a greater ability absorbing chloride than sigmoidcolon.
3) The degree of absorption of chloride from intestine is influenced by the area of intestinal mucosa exposed to the solution, the length of time the solution remains in contact with the surface of intestinal mucosa and the chloride concentration in the solution.
4) Even if a great amount of chloride in urine might be absorbed from the isolated

View full abstract

In 1927, Szent-György succeeded in finding out a crystal which had powerful reduction activity, “Heuxron säure, and 1932, this substance was confirmed as indentical with vitamin C. And in the same year, quantitative estimation of vitamin C was established by Harris, Ray and others, then a great progress was made in this field.
There are many research works concernd to vitamin C in lung tuber culosis, however, no work on nephrotuberculosis. By above mentioned facts, I performed a systemic research on vitamin C in skin, urine, serum and kidney tissue of many human nephrotuberculsis.
Method
Materials used in it is phase of experiment were adult of human who had no complications, except nephrotuberculosis. which influenced vitamin C metabolism. And in the period from autum to winter in which the human had less perspiration compared to other seasons were chosen for this research work. All patients were feeded in constant diet for one week, then in the period from 8th to 3th day, assays were carried out in the morning before food was taken.
Assays of vitamin C in skin was performed by Rotter's skin test, which measured the decolorization time after intradermal injection of 0. 1cc of 40mg% 2-6-Dichlorphenolindophenol solution.
Assay of vitamin C in urine, serum and tissue were determined by Fujita's Indophenol method.
Result
(A) Rotter's skin test:
1) 31 cases of nephrotuberculosis revealed delay of decolorization, 33. 4 minutes in mean, compared to 18. 6 minutes (average) of 10 controls. The decorolization time was delayed in parallel to the severity of the disease, namely, 7 cases of the most light unilateral nephrotuberculosis showed 25. 4 minutes on average, and 3 cases of progressed and later stage nephrotuberculosis showed great delay in decorolization with an average of 41. 6 minutes.
2) The decorolization time of 22 cases of unilateral nephrotuberculosis who had neph153 rectomy, was shortened their time from the 10th day of nephrectomy and became so close to those of controls day by day.
Due to the above mentioned facts, I confirmed that vitamin C concentration was influenced by grade of nephrotuberculosis.
(B) Vitaminc C in urine:
1) Urine of bladder: The low concentration of vitamin C was noted in 48 cases of fasting urine sample and 24 hour urin sample with average 0. 94mg% and 25. 2mg respectively, compard with those of 21 cases controls (average 1. 96 mg% and 47. 3mg respectively).
2) Also vitamin C tolerance test, decreased excretion of that was noted in 21 cases of nephrotuberculosis with 26. 9% on average compared with 74.1% of 6 control cases.
The above mentioned low concentration and decreased excretion of vitamin C were parallel to the grade of the disease.
3) Urine from ureter: Urine from diseased side kidney revealed concentration parallel to the progress of the disease.
a) In unilateral nephrotuberculosis, in disease side revealed slight lower concentration of vitamin C compared that of the bladder, and healthy side also showed low concentration parallel to the progress of disease side.
b) In bilateral nephrotuberculosis. lower concentration was noted compared that of same stage of unilateral one, and parallel to the degree of the progress.
4) The above data represented that pathologic change of kidney played a great role in vitamin C metabolism.
(C) Vitamin C in serum:
1) 24 cases of nephrotuberculosis showed low concentration of vitamin C, 0.56mg% compared with 1.13mg% of those of 12 controls in average. And the concentration had relation with grade of the disease, namely, slight decrease was noted in 4 cases of early unilateral nephrotuberculosis and lowest figure (0.11mg%) was noted on 3 cases of late stage of nephrotuberculosis.
2) By 100mg subcutaneus injection of vitamin C, 24 cases of nephrotuberculosis revealed only 0.24mg% increase compared with 0.33mg% increase of 9 cases of control on average. This degree was also paral

View full abstract