The clinical and experimental studies of so-called idiopathic renal hemorrhage havegiven the following results.
(1) The clinical and statistical observation revealed no significant differences from the reports by previous many authors.
(2) The historical review of etiology of so-called idiopathic renal hemorrhage was performed in order to collect and arrange the knowledge and explanation of the genesis and nature of this disease accumulated by previous authors.
(3) The electron microscopic observation of urinary colloid and the renal tissue can contribute to the differentiation between so-called idiopathic renal hemorrhage and hematuria due to another causes. In detail, the region of cellular disorder in the kidney can be supposed by observing the change in urinary colloids, because morphologically the ability of protein in take is determined by the athrocytotic activity in the apical cell zone and the reabsorbility is decided by the function of vesicicles, Palade's particles, etc.
(4) Renal hemorrhage due to anomaly of the autonomic nervous system is explained by the glomerular hemorrhage due to the increase in capillary permeability after the hypoxia which resulted from the intrarenal circulatory disturbance by an excess stimulation of the autonomic nervous system. At the same time, the distal tubular cells reveal the cellular degeneration caused by the blood stagnation, and the communication between tublar veins and pelvic veins may be taken place. All these changes are supposed to be belonged to the irritation syndrome (Reilly).
(5) Renal hemorrhage due to the increase in intrapelvic pressure is supposed to be the bleeding from the degenerate capillary endothelial cells in the papillary region. This degeneration is presumably caused by the venous dilation and the hypoxia due to the peritubular blood stagnation which resulted from the dilation of the tubules.
(6) Renal hemorrhage by hypoxemia is probably explained by the filtration of the erythrocyte from the glomerular capillaries with a remarkable increase in permeability. This change in permeability of glomerular capillaries is caused by bothe the hypoxemia followed by renal circulatory disturbances and the increase in intrapelvic pressure. Long persistence of the change may result in the bleeding through histological changes in the interstitial blood capillaries and collecting tubules.
(7) It was clarified by the histological observation that the kidney, which clinically showed hematuria as its chief complaint and was resistant to various treatments, revealed a figure of cryptic chronic pyelonephritis and that renal hemorrhage by the inflammation of the kidney was essentially caused by chronic pyelonephritis.
(8) It wa also clarified that the hemorrhage from small pathological foci included the bleeding by minute calculi in major part. The hematuria by minute calculi can be interpreted by the vicious circle that the existence of stones causes the pericapillapillary degeneration by the local circulatory disturbances at the paillary portions which in reverse results in the increase in minute calculi in size and number. The degeneration and sequential dilation of blood capillaries or small veins at the parillary apex and collecting tubule make the rupture and the exfoliation of microliths.
(9) Renal hemorrhage during pregnancy may be interpreted by the combination of the change in capillary endothelial cells due to the increase in permeability by the toxin with the increase in capillary permeabilty by the circulatory disorder such as a mechanical pressure to the perirenal blood vessels, the degeneration of tubular cells, and the incyease in intrapelvic pressure by the increase of the pregnant uterus.

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It is already known the structure and the functions of the prostate are controled by androgens. Also the growth of prostatic cancer, which is characterized by their automatic growth, depends on androgens like the normal prostate, and, on the utilization of this biological character, hormone therapy of prostatic cancer, that is to say anti-androgenic therapy, has been developed. Some pathological and biochemical results supporting effectiveness of the hormone treatment are seen in literature. But it is rather hard to find any literature in which the hormone-dependency of prostatic cancer is investigated on the cancerous tissue itself by biochemically quantitative way.
The first purpose of author's investigation is to pursue the problem of the hormone-dependency of prostatic cancer quantitatively by measuring some enzymatic activities contained in the cancerous tissue.
On the other hand, benign prostatic hypertrophy and prostatic cancer strikingly contrast each other in many points. One of the most noticeable differences in clinical findings of both diseases is the fact that the growth of prostatic cancer can be controled with hormone treatment, whereas in prostatic hypertrophy the hormone-dependency in the same significance is scarcely demonstrated. The second purpose of this investigation is to compare these differences biochemically and enzymologically.
Methods
Acid phosphatase and protease which are belived to be characteristic of the prostate were chosen as the indicators of this investigation. These enzymatic activities in prostatic tissue were measured, and then, their rise and fall after hormonal treatment were pursued in this present study.
The estimation of these enzymes was done with fresh specimens obtained actually at operation. Patients from whom prostatic tissue wes removed consist of 39 cases of prostatic adenoma, 20 cases of postatic cancer and 4 cases of normal prostate. Among them, in 22 cases of prostatic hypertrophy and 11 cases of prostatic cancer a synthetic estrogen (hexestrol) was administered or orchiectomy was performed before removal of the prostatic tumor. After the removed prostatic tissue was homogenized, the extract with physiologic saline solution was prepared, was diluted 1:50, 000, and each enzyme was estimated per gram fresh tissue.
Acid phosphatase was determined by the metod of Hudson. The activity was expressed by the amount of p-nitrophenol liberated from p-nitrophenylphosphate by enzymatic reaction of the tissue extract. Protease was determined by the casein-Folin method described by Hagiwara. The activity was expressed by the amount of the portion that remained dissolvable when protein-precipitant was added to the products liberated from casein by the tissue extract.
Results
The results of the study are summarized as follows.
(1) Normal prostatic tissue contained almost the same amount of acid phosphatase per gram fresh tissue.
(2) The adenomatous tissue generally contained apparently much more acid phosphatase than the normal tissue. Individually, however, slight differences were recognized, and the were considered to be related to histological appearance. Those that had well developed grandular structure contained more acid phosphatase than less developed. The more portion was occupied by the interstitial tissue, the less amount of acid phosphatase was contained. The amount of acid phosphatase contained in the adenomatous tissue hardly decreased in so far as the treatment with 300mg, of hexestrol, and histomorphologic changes were also not recognized.
(3) The cancerous tissue showed significant difference of the enzyme amount whether histologically well differentiated or less differentiated, and contained mostly as much acid phosphatase as the adenomatous tissue; both tissues showed higher lebel than the normal tissue. The cancerous tissue after hexestrol administration or orchiectomy showed a remarkable decrease of the acid phosphatase content, and the

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1) Methods for the determination of urinary P-diol and P-triol
Mothods previously reported are briefly surveyed and our method employing column, paper, thin layer and gas chromatography presented and examined.
a) Alumina column chromatography
The author followed the method described by A. Kambegawa in 1961, which has proved to be very useful as the routine procedure for simultaneous determination of P-diol and P-triol.
b) Paper chromatography
Chloroform-formamide system was selected for the separation of P-triol, P-triolone and P-tetrol especially from the urine of patients with congenital adrenal hyperplasia.
c) Thin layer chromatography
This procedure was employed by running small aliquots of urinary extracts from patients of suspicious congenital adrenal hyperplasia. By this method a rapid detection of P-triolone and P-tetrol in urine was made.
d) Gas chromatography
Gas chromatographic analyses were made on these steroids and an excellent separation on the gas chromatogram was obtained. The procedures and several data in this respect were presented.
2) Clinical significance of urinary P-diol and P-triol
The urinary excretion of P-diol and P-triol was studied by the above described methods especially in male adults. The mean normal values for urinary P-diol and P-triol excretion were 0.30 and 0.60mg/day respectively.
The excretion of these urinary steroids increased by ACTH and Metopirone and were suppressed by corticosteroid administration. In adrenalectomized patients with prostatic cancer who had already been castrated, the urinary P-diol and P-triol were excreted in insignificant amounts. According to these results these urinary steroids, especially P-triol, are supposed to reflect the adrenal function to a certain extent.
The influence of castration and gonadotropin was also studied and a certain portion of these urinary steroids was attributed to testicular origin.
The analyses of P-ritol and the related abnormal steroids, P-triolone and P-teterol, which characteristically appear in the urine of congenital adrenal hyperplasia is one of the most important subjects of this paper. Separation and quantitative analyses of these steroids were successfully made by every chromatographic procedure above described. Especially the application of gas chromatography to the detection and quantitative determination of P-triol, P-triolone and P-tetrol was proved to offer a very reliable measure for diagnosis of congenital adrenal hyperplasia.

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Thoracic duct drainage was applied for experimentally produced uremic dogs. Nineteen dogs were nephrectomized bilaterally and 24 hours later prepared for the following experiments: Group I. Those without thoracic duct drainage (TDD); group II. Those with TDD; and group III. Those with TDD and intravenous infusion of 10% glucose solution.
Thoracic duct lymph flow (TDLF) was measured, and urea nitrogen, potassium, inorganic phosphorus and total protein levels in serum and thoracic duct lymph (TDL) were determined in each group.
1. Both serum and TDL showed almost equal levels of urea nitrogen, potassium and inorganic phosphorus, respectively. Total protein level of TDL was 60% of that of serum on average.
2. Proportional changes of each substance were observed between TDL and serum.
3. The amount of TDLF was maximum in the initial period of the drainage, and was decreased gradually afterwards.
4. The intravenous infusion of 10% glucose solution induced significant increase of TDLF. This also resulted in the increased removal of urea nitrogen, potassium, inorganic phosphorus and total protein through the drainage.
5. Both group I and II showed similar increase of serum levels of urea nitrogen, potassium and inorganic phosphorus, which was not experienced in group III. Total serum protein level was unchanged in the group I and II, though there was a slight decrease in group III.
The above data are indicative of clinically beneficial TDD effect for the elimination of water, urea nitrogen and electrolyte in uremic condition.

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Lemological investigation, clinical tests, personality tests, bacteriological tests and treatment were conducted in a total of 135 patients with non-gonococcal urethritis who visited the urological outpatient clinic and others of the Nihon University Hospital during 1961. These procedures yielded new findings of interest whose deacription has not yet been found in the literature. The author reported the results at the symposium of the general meeting held in commemoration of the 50th anniversary of founding of the Japanese Society of Urology. The new findings are summarized as follows:
Those patients with non-gonococcal urethritis who were accompanied by chronic prostatitis whose relapse repeated itself frexuently comprised some who showed an increase in eosinocytes in peripheral blood. The massage of the prostate and 4-hour check-up of blood pictures in such patients disclosed that eosinocytes increased over 50 percent, as compared with those prior to the massage. This phenomenon was desifnated as prostatic eosinophilia. The phenomenon inhibited the rate of the decrease in eosinocytes in the Thorn test. A great many eosinocytes were noted in the secretion from the prostate of such patients. Trichomonas and unidentifiable microorganisms, the latter of which have not been referred to in the literature, could be demonstrated. Hence it seemed that the phenomenon might have a close relation to infection of the prostate with these microorganisms.

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During the period between November, 1960 and November, 1963, 139 transurethral resections of the prostate were performed at the Jikei University Hospital. Localized hypothermia by means of refrigerated irrigating solution at 3-5°C were performed in 96 patients, generalized hypothermia in 1 patient and irrigating solution stored at room temperature (24°C) was used in 42 control patients.
Operative and postoperative blood loss and serum electrolytes were determined in 23 patients undergoing localized hypothermia, 1 patient undergoing generalized hypothermia and 28 control patients. The results were as following:
1) During the localized hypothermia, rectal temperature decreased 4.3°C and body temperature decreased 0.8°C in average. However, no remarkable change was observed in general condition during the resecting procedure.
2) Operative blood loss of the localized hypothermia group was about 99cc in average or 13.2cc per 1 gram of prostatic tissue resected. When the data were compared to that of the control group, no significant reduction in blood loss was noted.
3) Postoperative blood loss, of the localized hypothermia group was about 45cc in average and was about twice as much as that of the control group.
4) A rapid decline in rectal temperature preceeded the appearence of clinical signs of the prostatic capsular perforation.
5) No significant reduction in operative and postoperative blood loss was noted in the patient who had generalized hypothermia during the resecting procedure.

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