The author encountered with 24 cases of so-called essential renal bleeding during the period from August 1955 to December 1957. Out of these 24 cases, with exception of 6 cases (of which 2 cases were latent renal stone, being negative by x-ray examination, 2 cases were follicular pyelitis and the other 2 cases were of un-identified cause by examination without nephrectomy), 18 cases were investigated as to the following items:
1) Chronic inflammatory lesions in general: Chronic tonsillitis was found in 5 cases. Chronic purulent apical periodontitis was seen in 5 cases. 8 cases had complication with both of these two lesions. In order to determine whether these lesions were really the foci and which lesion was the focus, the following investigations were conducted:
2) Examination of various phases of vital reactions induced by the method of activating the foci: In case of tosils, ultra-short-wave radiation for 10 minutes was conducted, and in case of teeth, chewing of gum for 10 minutes was conducted. Criterion was drawn so that the positive reactions were to be those that had aggravated hematuria by these activation tests. Furthemore, on blood culture from venus blood, in 5 minutes or 20 minutes after above procedure 1-3 colonies of the bacilli was given per 3cc of blood. The kinds of the bacilli were streptococci hemolytica in 4 cases, staphylococci in 14 cases. Also, the leucocyte-counts increased by 2, 000-6, 600 in 15 cases, while no change was observed in 3 cases, 4 hours after the activation tests.
3) Thus, it was determined that 9 cases had foci in their tonsils and another 9 cases in their teeth.
4) Upon the results of the above examination, tosilectomy or extraction of teeth were conducted. These eradication of the foci resulted in that, although temporary aggravation of hema turia was seen, disappearance of hematuria was obtained even under microsoplc examination by 4-14 days after the operations. No recrudescence was seen after 2 months through 2 years and 5 months. In other words, the extirpations of the foci were successful.
5) 5-20 minutes after the operation, patients' venus blood was taken for culture and 4 cases gave streptococci hemolytica, another 14 cases developed staphylococci, 1-3 colonies per 3cc of blood, respectively. This results were exactly corresponding to those at the time of activation tests.
6) The species of the bacilli found in the culture of the extracted lesions had exactly agreed with those cultured from venous blood at the time of the operations. Furthermore, positive precipitation reaction was observed with the streptococci and patients' sera. As for the pathohistological findings in the extracted foci 8 cases out of the 9 extirpated tonsils were chronic tonsillitis with “Umbau”, 1 case was sub-acute tonsillitis with chronic irritation state. Out of the 9 extracted teeth, 5 cases had root granulom and the other 4 cases had root cyst.
On the basis of the above results, i. e., 1) positive of activation tests; 2) development of biotropism as observed in the aggravation of hematuria upon activating test and extraction of focal lesions; 3) transient bacteremia due to streptococci hemolytica or staphylococci by the activation tests and operation of the focus; 4) identity of the babilli with those obtained with the culture from focus; 5) disappearance of hematuria upon the extraction of focus; the author considered the 18 cases should be diagnosed as renal bleeding due to focal infection of cocci, in principle.
It is also considered that within the category of so-called essential renal bleedng, those due to focal infection, focal infectious renal bleeding, should be included and that, for the treatment of this, extraction of the focus preceeded by activation tests shall be desirable measures.

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The concentration of glucuronic acid (G. a.) in blood and urine of patients of various urological diseases, being in hospital, has been quantitatively estimated by Inoue-Akashi's modification of the original Fishman's method. The results obtained are as follows.
1. The average value in ten normal adults was 5.012mg/dl in blood and 465.69mg/day in urinary excretion.
2. The total used for this measurement was 110 patients, being in hospital, in which the tumor was 43 cases, the tuberculosis 23, the caliculus 26, and the other 18.
3. The diseases, which have remarkable changes, in urogenital tumors were prostatic hypertrophy and malignant tumors of prostate, bladder and kidney of which the average concentration of G. a. in blood exceeded the average value of normal adults but the excretory amount of these diseases was lower than that of normal adults in the intraurinary excretion amount. Though Fishman and Shokaku described that the blood level and the intraurinary excretion amount tended to increase, this fact that the intraurinary excretion amount was decreased in the urogenital cancer may be related with the shift of β-glucuronidase from the carcinomatous tissue to the urine. Also, it can be supposed that the renal function disturbance may intensively influence upon the excretion of G. a., because when the closure of urinary tract was removed by the operation of prostatic hypertrophy the blood level tended to decrease and the intraurinary excretion amount did to increase.
4. In tuberculous diseases, both the blood level and the intraurinary excretion amount appeared to decrease. In the chemotherapy after nephrectomy the application of PAS resulted in the remarkable increase of intraurinary excretion amount of G. a. while that of Kanamycin caused the marked decrease. The decrease of intraurinary amount after Kanamycin treatment may be due to the sideeffect of this drug which became the lowering of renal functions.
5. The cases of lowered renal functions in caliculous diseases showed the remarkable decrease of intraurinary excretion amount while those of ureter caliculi showed the significant increase of the excretion amount after the removal of the barrier of passage in urinary tract.
6. Though many authors reported that the metabolism of G. a. had the close relation with the hepatic functions, the present author has known that the Glucuronic acid influences not only upon the hepatic functions but renal functions. If the renal function is strongly disturbed even in the good condition of hepatic functions the excretion amount of G. a. is lowered, while the excretion is normal when the renal functions are intact.
Accordingly, the renal functions should be considered in the study of G. a. metabolism in the patients of urological diseases.

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1. The glucuronic acid in blood, urine and tissue of the rabbits, followed by an experimental tuberculosis and treating with use of Streptomycin and Kanamycine, was measured. Comparing with the normal rabbits, the concentration of glucuronic acid in blood, the urinary excretion of glucuronic acid and the intrarenal or intrahepatic amount of glucuronic acid, in the rabbits of renal tuberculosis, tended to decrease. The urinary excretory amount of glucuronic acid decreased more remarkably in the treatment by Kanamycine than in the treatment by Streptomycin, however, this amount gradually increased in both cases when these treatments were interrupted.
2. When the ureter of rabbit was ligated, the blood level of glucuronic acid markedly raised, but this rise was not so considerably 48 hours after. This experiment shows one style of the fact reported in a preceding paper which indicated the increase of glucuronic acid in blood in the urinary excretion disturbance such as a prostatic hypertrophy. The intrahepatic or intrarenal amount of glucuronic acid, 72hr after the ligation, was lower than that in normal state.
3. In Brown-Pearce carcinoma of rabbits, the elevation of glucuronic acid concentration in blood, the increase of urinary excretion of glucuronic acid and the decrease of intrahepatic and intrarenal glucuronic acid were observed.
These results can be summarized as follows. In the experimental renal tuberculosis, the glucuronic acid concentration in blood and the urinary excretion were decreased considerably. In the case of urinary excretory disorder due to the ureter ligation the significant elevation of the blood concentration of glucuronic acid was seen. In the experimental carcinoma, both the blood level and the urinary excretion of glucuronic acid were increased. In various diseases, the intrarenal or intrahepatic glucuronic acid were decreased. These clinical results of glucuronic acid metabolism in various diseases are similar to the experimental results. Moreover, the intrahepatic or intrarenal glucuronic acid amount in various diseases, except the renal tuberculosis, tends to shift reversely proportional to the blood level. Even in various urological diseases, it can be supposed that the conjngate metabolism of glucuronic acid is evidently remarkable and has the close relation to the hepatic and renal functions.

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In order to find the normal distributions of PPLO in Japan, 15 new isolated strains were compared with 2 strains of Campo and O7 which are standard ones in the United States.
1. In the fermentation, those 5 strains which are of No. 13, No. 132, SM, Hirabayashi, and S showed different results.
2. In the susceptibility of antibiotics, considerable differences were recognized. Particularly. 3 strains of Fujinami, Yabe, and No. 13 not only were more in penicillin, but also were different in chloramphenicol and streptomycin.
3. In the thallium acetate and crystal violet, different results were obtained in the 6 strains of Yabe, No. 130, No. 132, SM, Hirabayashi, and S.
4. From the results of complement, fixation test, the strains used in this experiment could be classified into the 4 kinds of types, and type III, which had different antigen structure with the United States strains used as controlled groups, were more found comparatibly.
From the results of these experiments, the following conclusion may be made that there are different types of PPLO in Japan from those in the United States and Europe.

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The study was performed on conditions and media components of the fluid cultures of neisseria gonorrhoeae. Additionally it was confirmed that determination of growth turbidity with the electrophotometer was considerably accurate.
After diffuse resuspending of bacteria in normal saline by vigorous shaking, the determination of turbidity with the electric photometer (550mμ) revealed enough growth grade of the bacteria, regardless of the kind of Strains or cultivation time. It also indicated indirectly the wet weight or N. dose of bacteria.
In regard to the components of culture media, proteose peptone No. 3 was effective as a Base substance, but meat infusion or meat extract showed a few inhibitions for gonococcus growth. The optical density of each component is: of proteose peptone No. 32%, glucose 0.2%, Sodium Chloride 0.5%, soluble starch 0.1%, but yeast extract and phytone in autoclaved media were variable. L-cystine HCl at 0.1‰ effected inhibitive or a mounting action.
As to the cultural condition, one of the shallow and wide surface media was most suitable, increased CO₂ was also effective on bacteria growth. Otherwise “Shaking culture” and glass beads in fluid media by yielded almost no augmenting on bacteria growth.
From the experimental results, the comperative studies on the same doses of fluid media and 10% horse blood-proteose No. 3 agar were made. It was revealed that fluid media were superior from the viewpoint of the harvest, but the growth velocity of bacteria on these media is smaller.

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I. Follow up study of partial nephrectomy
From 1950 up to date, partial nephrectomy have been performed 117 times on 115 kidneys, 61 cases of renal calculi, 35 of renal tuberculosis, 11 of renal bleeding and 8 of hydronephrosis.
Age: From 16 to 65 years of age.
Sex: 85 males and 30 females.
Operative results are following: 97 cases were cured, 54 of renal calculi, 27 of renal tuberculosis, 8 of renal bleeding and 8 of hydronephrosis.
2 cases died, one of these due to postoperative hemorrhage in a case of renal calculus, and to tuberculous meningitis in another case.
Secondary nephrectomy was performed on 14 cases, 10 for postoperative hemorrhage, 3 for tuberculosis of remaining kidney and one for continuous urinary fistula.
Excellent results have been obtained since September 1954, owing to a new operative technique.
Now partial nephrectomy is a safe urologic operation for us.
II. Experimental study of renal circulation following partial nephrectomy on the denervatedd kidney
Material: 57 dogs of body weight 6-13Kg.
Method: Following periarterial denervation or periarterial injection of pendiomide, partial nephrectomy was performed on the lower pol of the left kidney. Postoperative renal circulatory study utilizing abdominal aortogram (31 dogs) and Indian ink injection (26 dogs) were done at the interval of 2 hour, 1 day, 2 days, 3 days, 4 days and 1 week. And results were comparedd with that of the innervated kidneys.
The results were as follows:
(A) Changes of the renal artery
In the denervated kidneys the renal arteries that have been pinched with clamps for 10 minutes during the resection look very small immediately after the operation. However, the constriction of the renal artery is rapidly restored to regain its normal diameter from the 3rd to 4th postoperative days. Intrarenal arteries were recognized more clearly than the right kidney, and normal findings were obtained from 3rd to 4th postoperatively.
On the other hand, in the innervated kidneys, constriction of the renal artery and intrarenal arteries was severe, especially intrarenal arteries of the operated kidneys were scarcely possible to observe, and its recovery required 7 to 10 days in the same experiment.
(B) Changes of the renal circulation
The renal circulation was examined by looking at the distribution of the concentration of Indian ink and histologically by looking at the kidney of dogs injected with Indian ink 2 hours to 1 week after the partial nephrectomy.
On the denervated Kidney, the change is slight, that is, Indian ink slightly decreased in cortex, and slightly increased in medulla and retured to normal findings within 4 to 7 days,
On the innervated kidney, Trueta's renal vascular shunt-like change, that is, marked cortical ishemia and marked increase of Indian ink in medulla were observed. Recovery was very slow, and it required more than 7 days to return to normal state.
Microscopic findings is same to macroscopic findings,
In the denervated kindey, the cortical ischemia after partial nephrectomy is of less degree than innervated kidney, and its recovery is rapid.

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1) A 0.6g. paraffin pellet containing 100mg. 20-methylcholanthrene which was left in urinary bladder for ten months in 15 rabbits gave rise to bladder papillomas in ten (66.7%).
2) Relative amount of desoxyribonucleic acid (DNA) of the nucleus of epithelial cells was measured in the normal bladders of rabbits by means of microspectrophotometer with Feulgen staining.
The results are as follows:
a) DNA content of the nucleus of epithelial cells at the site of papillary growth was twice to four times as high as normal.
b) DNA content of the nucleus of epithelial cells was normal in the normal-appearing distant area and downgrowth area of the tumor-bearing bladder.

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1) The serum phosphohexose isomerase (PHI) level was determined by the Bodansky method in patients with various urological diseases.
2) The serum β-glucuronidase (β-Gl) level was determined together with the serum PHI in case of malignant tumors, and also in case of prostatic diseases the total serum acid phosphatase (TSAP) and the prostatic serum acid phosphatase (PSAP) level were determined together with the serum PHI. Comparative studies of these values were performed.
3) The normal level of serum PHI ranges 7 to 39 Bodansky units (the mean value 18 S=8.8), the upper limit of normal value being 40 Bodansky units.
4) The serum PHI was elevated in nineteen, as high as 50per cent, of 38 patients with malignant tumors. The elevation of serum PHI parallels to tumor growth and has no relation to the type of tumor.
5) The elevation of serum PHI parallels to that of serum β-Gl in the renal tumor and bladder tumor. This tendency is more marked in case of the prostatic carcinoma, and the elevation of serum PHI, serum β-Gl and of PSAP parallel to each other. It also means that the activity of various enzymes is very high in the prostatic carcinoma, The serum PHI and PSAP rise and fall just paralleling to the clinical course of the prostatic carcinoma.
6) The serum PHI can indicate the degree of growth of various malignant tumors in the urological field, but can not be of such a specific diagnostic value as the PSAP in the prostatic carcinoma.
7) The serum PHI is sometimes elevated in the renal tuberculosis and prostatitis. Findings on various enzymes in the benign prostatic hypertrophy suggest that it is a disease which substantially differs from other types of tumor.

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