Since the form of the urinary bladder varies greatly according to the volume of its content, it is not easy to ascertain its morphology except the area near its base. This accounts for the scarcity of its adequate description. Recenty, however, the results of cystography and of cystoscopy are directly utilized in making diagnosis and in determining operative indications. The present study pertains to the development of urological organs of Japanese fetuses, forming a part of the several subject, and attempts to investigate the morphology of the urinary bladder as basic knowledge. The materials used for this study were selected from over 500 fetal cadavers ranging in gestation age from 4th to 10th months, and observations were made on the cystograms taken within the reasonably satisfactory limits of accuracy. For this purpose some new measurement lines serving as morphologic landmarks were constructed. 1) The development of the urinary bladder has been described by such authors as Campbell, Hurbet, Tsusaki, Takashima, Nagamine and others. The cloaca undergoes differentiation during the 6th fetal month into the rectal cloaca posteriorly and the urachus anteriorly, the latter in the female forms the entire urethra, while in the male the inferior aspects forms the posterior urethra. The urinary bladder develops from a portion of the cloaca. The bladder, therefore, develops from the cranial aspect of the ventral cloacal remnant, and, being a long spindle in shape at first, turns into a pear-shaped organ during the terminal stage of embryonic life. 2) The development of the pelvis was a necessary accompaniment of the differentiation of the urinary bladder, and careful observations were also made on this problem. The distance between the right and left spines of the ilium, which is 2.3cm at the 4th fetal months, decrease to 6.62cm during the 10th month, or about 3 times. The body length of 0.82cm in the 4th month also increases to 2.48cm, or about 3 times, during the 10th month. The growth of the total longitudinal diameter of the entire pelvis is 1.47cm during the 4th month but becomes 4.65cm during the 10th month, or an increase of about 3.5 times. 3) The bladder volume is 0.22cc during the 4th month but increases to 1.9cc during the 5th, to 3.43cc during the 9th and to 7.0cc during the 10th month. 4) The increase of cystogram is represented by that of the maximum longitudinal diameter of 0.48cm during the 4th month month and 3.17 during the 10th month. The maximum lateral diameter is 0.706 during the 4th month and 2.72cm during the 10th month. There are two periods of rapid growth during this period, namely, 5-6th month and 9-10th month. 5) The area of cystogram increases from 47mm2 during the 4th month to 665mm2 during the 10th month. Likewise, during this period there seem to be two perieds of rapid growth, namely, 4-5-6th fetal month and 9-10th month. 6) The regard to the position of cystogram, the pelvis and the bladder grow upward during the two periods, namely, between 4-6th fetal months and 9-10th months. After the pelvis is formed, the bladder seems to descend to be situated directly above the pubic bones and to change to the adult position. The enlargement of the bladder in its transverse (left and right) diameter appears to involve predominantly the right side, but become almost equilateral during the 7th month, only to show again a greater development on the right side during the 10th month. 7) The shape of cystogram can be classified into 4 kinds with 14 types. Many are spherical during the 4-5th months, but oval or elliptical shape predominate during the 6-7th months. In the terminal stage of gestation, it becomes spherical again to be transformed into the adult type. 8) The shape of the bladder neck has beeh classified into 7 kinds with 14 types. During the first half of gestation the bladder neck are mostly wide, the so-called relaxed
The variations of serum sodium, potassium and chloride levels, serum total acid phosphatase and serum prostatic acid phosphatase activities, and histological and histochemical changes of prostate were examined in the white male rabbits (body weight: about 2kg) which were treated by synthetic estrogen, androgen and cortisone for about 3 weeks. In the prostate of rabbits administrated synthetic estrogen, irregular arrangement and atrophy of the epithelial cells, pyknosis of nuclei, bag like enlargement of glandular cavities and atrophy of stroma were observed. These histological changes of prostate, especially in the rabbits which were treated high doses of estrogen with castration were more demonstrable. In the cortisone administing group the degenerative changes of epithelial cells in the prostate generally were slight. Alkaline phosphatase reaction in prostatic tissue of the rabbits administrated with high doses of estrogen decreased relatively in the epithelial cells, and relatively increased in the basement membrane. In the androgen group, the phosphatase reaction decreased in epithelial cells, and increased in the basement membrane. The serum sodium, potassium and chloride levels generally were not changed in the course of these hormone administration.
From animal experiments and clinical studies on patients with so-called essential renal bleeding, the following results were obtained; 1) In animal experiments, macroscopic hematuria developed following repeated anaphylactic shock. Histological examination of the kidney of these animals with macrohematuria revealed such abnormal findings as interstitial edema and hemorrhage, dilatation of capillary, degenerative changes in tubular cells, and hemorrhage into the tubular lumen. These morphological changes were interpreted as the expression of allergic phenomena. Macrohematuria also developed following stimulation of autonomic nerve. 2) There have been 46 inpatients and 35 outpatients with so-called essential renal bleeding among 21169 patients visited our clinic during the last 13years. Nineteen inpatients were treated with nephrectomy and 12 inpatients with nephropexy. The other 15 inpatients were treated conservatively. 3) Histological examination was carried out on the kidneys from 13 cases treated with nephrectomy. Histological diagnosis of circumscribed interstitial nephritis was made in six cases, among which one was complicated with glomerulonephritis and another with varix. A diagnosis of glomerulonephritis was made in one case and allergic inflammation in one case. In the other 5 ceses, virtually no inflammatory changes were found histologically, although hemorrhage to the tubular lumen was seen. 4) Capillary congestion and dilatation, hyalinization of capillary wall, diapedic hemorrhage in the surrounding tissue of vein, or hemorrhage to the Bowmans capusule, to the glomerulus and to the tubular lumen were most commonly found in the kidneys from both experimental animals and clinical cases. It was suggested that that these changes resulted from congenital and acquired vulnerability of the local vascular wall. This acquired vulnerability seemed to result from local inflammatory process, circulatory disturbances due to overloading or abnormality of innervation. 5) Twelve cases with so-called essential renal bleeding were following nephropexy. 6) Erect posture pyelography revealed a stenosis at the pyelo-ureteral junction or displacement of the kidney in 6out of 12 cases treated with nephropexy. 7) It was suggested that erect posture pyelography was inportant procedure in making diagnosis of so-called essential renal bleeding, since it was possible from the findings obtaind by the procedure to differential the hematuria due to movable kidney from that due to so-called essential renal bleeding.
Concerning the etiology of urolithiasis, many researches on infection of urinary tract have ever been reported. But there has been almost no report from a viewpoint of focal infection—as a sort of abnormal general condition. The author set up focus on a rabbit which had operatively been strictured at one side of ureter one week before. The focus was set up by injecting emulsion of staphylococcus by accesory nasal sinus window methed (Okabayashi). Within three months, calculi in renal pelvis and koch's steinkrise were often found in Bowman's capsules and tubules. Today noxes of focus on kidney are considered bacteria itself, bacterial toxin, bacterial detritus and tissue detritus of focus wall. Above all, allergic effects of these noxes are the most important. So, by injecting ovoalbumin solution, which is usually used in the study of allergy, in the same way as before. Steinkrise was observed in high rate. As control, the group, injected 5% glucose soluton, and the group, only strictured, proved positive in low rate. Not-strictured side proved less positive. This result shows that urinary retention has an important significance for stone formation. Histologically, perivascular fibrosis of strictured side was seen in all cases. But it was a remarkable finding that its swelling was observed in the group of focal infection and the group of ovoalbumin. On the other not-strictured side, slight glomerulonephritis war observed. These findings are considered to be allergic changes. And this suggests that there is the time of vasoconstriction of renal arterioles and vasa afferens which are regarded the most important in the early stage of Steinkrise. As clinical observation, there are much more who have anamnesis of focal infection and allergic diathesis among the patients with urinary calculi than in th control group. Besides the author researched the relation between antigen-antibody-reaction and Steinkrise by sensitizing the rabbits in intravenous injection of purified ovoalbumin solution. As a result, the severelysensitized rabbits showed hard tissue reaction with giant cells. And the moderately-sensitized ones revealed typical Steinkrise. Judging from experimental results, clinical observations and literatures on this subject, it comes to the following conclusion. 1) As for those who suffer from focal infection, four noxes affect on renal Vessel neurally or humorally, and cause vaso-constriction, and then Steinkrise occurs. 2) On next stage, co-factor of urinary retention or secondary infection leads to clinical urolithiasis. 3) Through this process, allergy has a great significance.