Treatment of tuberculosis of the kidney and lower urinary tract, an important clinical problem which requires our constant attention, is at present effectively carried out by chemotherapeutic means by the use of SM, PAS, INA and other drugs. On the other hand, however, the question of drug-resistance developing on the part of tubercle bacilli is emerging with increasing frequency. The author has investigated from varions angles the therapeutic effect of the administration of vitamin D₂ (V.D₂), combined with chemotherapy, on clinical and experimental tuberculosis of the kidney.
In regard to clinical use of this drug in renal tuberculosis very little is known in detail since there are only a few reports such as by Meulenaere (1946) and Stobbaerts (1949).
1) The author's observations were made on the effect of V.D₂ given to patients suffering from renal tuberculosis who were being treated with chemotherapeutic agents such as SM, PAS and INA. Special considerations were given to the problem of hypervitaminosis which is regarded to be the most important complication of V.D₂ therapy.
2) Studies were made on the fluctuations of Ca, P, alkaline and acid. phosphatases, nonprotein N, CO₂ and cholesterol, the blood constituents most closely related to V.D₂ therapy. In addition, the changes produced in blood, blood pressure, body weight and tubercle bacilli in urine were also investigated. Histopathological studies were then carried out on the excised tuberculous kidneys after periods of treasment with V.D₂ conbination. (The doses of V.D₂ administered were 600, 000 units, once weekly, with 6, 000, 000 units as one course. Some cases passed through 2-3 courses of such treatments).
The results obtained revealed marked gain in body weight, improvement in erythrocyte sedimentation rate, while the tubercle bacilli in urine became negative in both smear and culture tests upon completion of courses with 6, 000, 000 units (although the effects of chemotherapy must also be considered).
Blood chemistry disclosed increase in Ca and non-protein N, depression in alkaline phosphatase, CO₂ and cholesterol, while histological picture indicated aleviation of tuberculous lesions. There were no microscopic findings suggesting over-dosage of V.D₂.
3) The growth of tubecle bacilli on Ogawa media to which V.D₂ was incorporated to the extent of 100-2000γ/cc was clearly inhibited. The same results were also observed with the microorganism resistant to SM, PAS and INA, being particularly noticeable with the INA-resistant strain.
4) Experiencis with V.D₂ therapy in experimental renal tuberculosis.
The author made histological observations on the kidney and other organs of rabbits and standard albino mice, in which renal tuberculosis was induced experimentally after stated periods of V.D₂ therapy.
a. In rabbits the tubercle bacilli were introduced into renal artery and then V.D₂ was given in doses of 10, 000units/kg (identical to the human cases), amounting to 400, 000 units in all. Blood chemistry was studied both before and after the administration, and the animals were sacrificed and autopsied after, 1, 2, 4 and 10 weeks of therapy, with special reference to microscopic changes of the kidney.
Histological findings indicate a warked calcium deposition soon after the beginning of V.D₂ therapy but pathological pictures show little difference from the controlts. In the animals receiving treatment for 4-10 weeks. The deposition of Ca was almost disappeared and there was improvement of tuberculous lesions. This significans that the therapeutic effects of V.D₂ seem to manifest themselves late.

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1. Purpose of investigation
Recently, various clinical problems related to renal artery have aroused much discussion and these now constitute an important topic in urology in as much as this artery is etiologically related to renal dysfunction or to some diseases of the kidney. Accurate knowledge of renal artery is especially required for one who is engaged in renal surgery, because this artery is characterized by it's abnormal course, or so-called anomalous vessels, and it's connections.
On the other hand, since the shortcomings of pyelography can be compensated by arteriography, the state of renal artery needs to be inverstigated as a part of clinical knowledge.
The author such clinical problems as aims at the study of renal artery with reference to its development, course and anomalous vessels, as one of the series of research on the urologic organs of the fetus.
2. Methods of study
Using fresh fetal cadavers measuring more than 4 months (Those of 3 months or less are too delicate for satisfactory manipulation), an incision is made in the mid line and upper thoracic aorta is ligated at a point below the heart; air is introduced into the retroperifoneal cavity and so-called roentgenographys were made after injecting either 76% Urografin or 50% Hypaque in proper amounts. Almost clear films of the artery below the chest can be obtained in this way, which enable one to visualize the course and morphology of renal artery and it's ramifications. The materials so treated numbered 30 cadavers and a total of 60 kidneys was utilized for study. The fetuses measuring 4 months are genrally delicate but in many of these materials the course of renal artery from its origin as well as the ramifications within the renal hilus can be ascertained. Those beyond 5 months and entirely satisfactory, while in those over 8 months the terminal pertion of the artery beyond the second ramification can be visualized.
3. Results and comment.
a. Expressing the origin of renal artery in terms of the vertebral level, the majority (88.9 percent) corresponded to the position from thoracic vertebra XII lumbar I to the internal between lumbar I and II. As a rule, the right side is higher than the left by 1 intervertebral space.
b. Coursing angle of renal artery. In the adult the coursing angle of renal artery is almost that of right angle to the renal hilus, but in the fetus it forms an oblique angle since the kidney is in its ascending course. This angle, in most cases, lies between 50° and 75°.
c. Length of renal artery. Admitting the natural difference in the length of renal artery according to the number of gestation months, the length varies from 8 to 15mm in fetuses of 8-10 months the discrepancy between the right and the left being 1-3mm.
d. Ramification types of renal artery. Abnormal ramifications are found rather frequenty (23. 2 percent) in renal artery, the locations most commonly involved being in the middle portion, rarely near the hilus. Special attention must be paid to those which take abnormal courses.
e. Number of ramification and state of distribution of renal artery. Renal artery usually ramifies into 2-5 branches in the hilus. The upper, middle and lower branches or several branches radiate from the hilus as if coursing widely throughout the kidney parenchyma. These branches continue to ramify still further and become distributed gradually into deep (peripheral) parts. It is uncommon to encounter crossing or entangled branches of these branches. In arteriography here employed, it is impossible to trace the branches beyond the first ramification in fetuses of low gestation age, but in many instances the second ramification and even one beyond this can be visualized. The peripheral portion assumes the shape of divided rootlets or dendritic, many terminating as needles.
f. So-called anomalous vessel. Anomalous vessel is the one having their origin from an abnormal portion of the abdominal aorta and

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Serum total acid phosphatase and serum prostatic acid phosphatase activities of prostatic cancer (21 cases) and the control cases (34 cases) were determined with Bodansky's and Fischman-Lerner's Modification. Histological findings of these prostatic tissues were studied by the needle biopsy and prostatectomy. The relations between variations of serum acid phosphatase activites and the changes of histological findings of these prostatic cancer were analysed. The average value of serum total acid phosphatase activities was 3.39±0.97 B. U., and that of serum prostatic acid phosphatase activities was 2.00±2.18 B. U.. After the antiandrogenic therapy, the total acid phosphatase level decreased to 2.68±0.30 B. U., the prostatic acid phosphatase level decreased to 0.94±0.47 B. U.. In the 7 cases of prostatic cancer which including 4 cases of differentiated adenocarcinoma and 3 cases of undifferentiated carcinoma, before the anti-androgenic therapy in the 4 cases of differentiated adenocarcinoma, the abnomal high levels of total and prostatic acid phoaphatase activities were detected. After the antiandrogenic therapy, the decreasing of these acid phosphatase levels were observed. However, in the 2 cases of undifferentiated carinoma, before anti-androgenic therapy, these acid phosphatase levels were normal. There was no change of total and prostatic acid phosphatase levels by the anti-androgenic therapy. Another cases of undifferentiated carcinoma complicated with extensive metastase had a slightly high acid phosphatase level. In the above cases of differentiated adenocarcinoms, after the anti-androgenic therapy, the remission of clinical symptoms appeared with normalization of total and prostatic acid phosphatase activities and histologically hydropic degeneration of cytoplasma of cancer cells, pyknosis of nuclei, karyorrhexis, karyolysis, necrosis and disappearing of cells, straggling or proliferation of connective tissue were observed. However, in the 2 cases of undifferentiated cancer, after the anti-androgenic therapy, neither improvement of clinical symptoms nor change of acid phosphatase activity were recognized. The histological changes of tumor tissue in these undifferentiated cancer were slight and localized.

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