A fundamental and clinical study of urinary-tuberculosis has been got on with, and SM, PAS, INH, TB-I and other antituberculous agents has been proved to be effective in the treatment for tuberculosis.
A opinion obtained from these achievements is as follows:
First, to renal tuberculosis, as well as other tuberculosis, in its early conditions, these agents were expected to be effective.
Second, it is admitted that, when tuberculosis is limited only to renal pelvis, urine can be made negative for tubercule bacilli in 40-50% of the cases by applying SM alone. Regarding the quantity and duration of SM administration, two methods are employed in the early period of the disease; one method of applying 1g. per 12 hours and the other of applying 0.5g. per 12 hours. But in the treatment by SM alone, a reaction to the bacilli is too strong, and when 40-60g. of SM is applied, it was discovered that their rigidity appeared. To prevent this phenomenon, PAS is applied to patients in combination with SM.
Now, in the cases of renal tuberculosis to which a combination of SM, PAS, INH was applied (triple-drug therapy), following results were gotten by investigating the duration of the application of these agents, observing renal tissue, and searching for tubercle bacilli within renal tissue. Tuberculous kidneys which had preoperative treatment by applying SM, PAS, INH were divided into 4 groups, according to the duration of chemotherapy, and compared the cases to which chemotherapy had not been applied with above-mentioned 4 groups. As a result, I came to the following conclusion.
1) Purification of renal papillae and cavity walls, and regeneration of epithelium were, to some degree, in parallel to the duration of chemotherapy. These phenomena were remarkable in the cases to which chemotherapy was applied for more than seven months. But in the cases where connective tissue wrapping cavity walls was formed thickly, the regeneration of capillary vessels of cavity walls was impeded, and the regeneration of the epithelium was hardly recognized.
2) Between the cases to which chemotherapy was not applied and those to which chemotherapy was applied, no quantitative difference was disclosed in number of tubercles; that is, in the cases to which chemotherapy was applied long, the number of tubercles was not always decreased, and on the contrary, in some of the cases to which chemotherapy was not applied, the number of tubercles was decreased.
3) Moreover, transformation, atrophy and cavity formation of epitheloid cells and Langhans's, giant cells in tubercle, were recognized in the cases to which chemotherapy was not applied. Accordingly, I don't think that these changes can be the conspicuous effect of chemotherapy.
4) In the cases to which chemotherapy was applied long, infiltration of small round cells and augumentation of connective tissue in interstitium were greatly recognized.
5) Tubercle bacilli in the renal tissue were found in 20% of cases with chemotherapy of more than one year duration; 33% of the cases with chemotherapy of more than seven months duration, 52.4% in more than three months of chemotherapy, and 85.9% of the cases without chemotherapy.
Accordingly the number of tubercle bacilli was in parallel to the duration of chemotherapy.

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There are many reports on the microscopic investigation for the effect of chemotherapy against renal tubercurosis. I also reported a result of our investigation about it.
Generally speaking, antibiotic agents exert an effect only after it has reached foci in the internal organs. Contrary to the above-mentioned reports, the reports are scanty which dealt with relation between the density of the agents in the foci and the effect on the focal tissue.
In a total of fifteen cavities in thirteen cases, eight closed cavities and seven open cavities following experiment was performed; 100μc of ¹³¹I-Hippuran was injected intravenously, once three hours before nephrectomy and once at the beginning of an operation, and measured the radioactivity of ¹³¹I-Hippuran within the cavities of the kidneys after they had been removed. Further, histological investigation was made on the contents of these cavities and cavity walls. As a result, I came to the following conclusion.
1) The density of ¹³¹I-Hippuran within eight closed cavities was very low, as compared to that within open cavities, and the ratio of the former to the latter turned out to be from 1/10 to 1/200.
In two of these eight cavities, the density of ¹³¹I-Hippuran was 1/10. The walls of these two cavities were excellent in the growth of capillary vessels. Capillary vessels were not recognized in the cavity walls where the density of ¹³¹I-Hippuran was 1/200. Whether the density of ¹³¹I-Hippuran within closed cavities is high or not, seemed to have a relation to the number of capillary vessels.
In the cases to which chemotherapy was applied for a year, tubercle bacilli within the cavities and renal tissue were negative, and the density of ¹³¹I-Hippuran in the cavities was 1/10, although the cavities were closed.
Caseous substance was found in all closed cavities of eight cases, but the regeneration of the epithelium was not recognized.
The relation between the multiplication of connective tissue which wraps closed cavities and the generation of capillary vessels could not be clarified.
2) In three of seven open cavities, the density of ¹³¹I-Hippuran in them was 1; (that is, it was equal to that of bladder urine), and in the cavities which had a narrow passage into the renal pelvis, the density was about 1/10.
Regarding open cavities, if we apply chemotherapy to them for more than three months, it be possible that the cavities and cavity walls become negative for tubercle bacilli. Regeneration of epithelium can well be expected, if chemotherapy is given for more than six months.

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Partial nephrectomy is performed as one of the treatments to conserve the kidney after the sites are removed, and has been prevailed for treatment for renal tuberculosis, since the appearance of effective chemotherapeutic agents as well as an increase in reliability of radiographic examinations.
Incidence to perform partial nephrectomy has been gradually decreasing for the recent improvement in chemotherapeutic agents (antibiotics) and other reasons.
In 18 tuberculous kidneys of 18 cases which were performed partial nephrectomy pathohistological examination was made.
The result is as follows:
As the result of examining the tissues of the specimens, the cases were divided into the following 4 groups; 1) 3 cases in which a active tuberculosis was noted, 2) 4 cases in which a tuberculous proliferation was noted, 3) 6 cases in which a tuberculosis was noted to be healed up, 4) 5 cases in which no tuberculous condition was not found other than pyelonephritis.
As to the application of chemotherapy before partial nephrectomy, chemotherapy was not applied to all the 3 cases of group 1, and to 1 of the 6 cases of group 3.
Two of the 5 cases with pyelonephritis were not diagnosed either on tissue examinations or on clinical symptoms, but in 1 case, tuberculous bacilli were discovered in urine, and in 2 cases complicated with urogenital tuberculosis of other organs.
As to 7 of the 13 cases with renal tuberculosis which was distinctly confirmed; 2 cases of group 2 and 5 cases of group 3 chemotherapy was proved to be effective, as compared with 6 cases without chemotherapy which consisted of 1 cases belonging to group 4, 2 cases belonging to group 3 and 3 cases belonging to group 1.
As to the relation between pathohistological findings and the result of urine examinations, sediments and protein were positive in all cases of group 1 and also tuberculous bacilli were positive in 2 of the 3 cases of group 1. But sediments were positive in 1 of the 6 cases belonging to group 4, protein was positive in 2 of the 6 cases, and tuberculous bacilli were negative in all the 6 cases. That is, there is a close relation between pathohistological figures and the result of urine examinations.
As to pathohistological findings and pyelograms, all the 6 cases belonging to group 4 showed the stricture at the neck of the renal calyx.
I came to the following conclusion:
For the cases with chemotherapy of 6 months duration in which pyelogram show the stricture of the neck of calyx with markedly improved urinary findings partial nephrectomy is the therapy of choice.

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In 9 of 19 cases with renal tuberculosis, on which speletomy was performed, a histologic examination was done on the cavity-wall removed at the operation.
All the cases examined were found to be in the “completion-stadium of caseous cavity” (Wildbolz): severe destruction of the renal tissue in the cavity-wall with slight or marked regeneration of the capillaries was observed.
Almost parallel relationship between the intracavitary concentration of ¹³¹I-Hippuran, which was secreted into the cavity after injected intravenously, and the degree of the capillary-regeneration was revealed in 8 cases. One case without the parallel relation was found to have an open cavity with high intracavitary concentration of ¹³¹I-Hippuran and with epithelial regeneration with poor regeneration of the capillaries in the cavity-wall.
Tuberculous bacillus was found in cavity-wall in only 1 case.

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Details of two clinical cases of renal homotransplantation performed at the Department of Urology, Osaka University Hospital were reported in this paper.
The donors were selected from the patients who were under the care of Urological Service of the Hospital. The donor's kidneys which were hematochyluria and essential hematuria, respectively, were functionally quite normal.
The first case, 34-year-old male, died on the 10th day after kidney homotransplantation with sever bacterial infection of the respiratory tract and the second case, 30-year-old male died on the 30th day after operation with mycosis of the respiratory and the urinary tract. Urine output from the transplanted kidneys were very well in both cases. BUN fall and the correction of acidosis were not observed in the first case. The renal function of the second case was extremely well for three weeks after the operation.
Prolonged thoracic duct lymph drainage was applied for these two cases as one of immunosuppressive procedures.
The problems about clinical, technical and immunosuppressive methods were reviewed and discussed.

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To evaluate the efficiency of peritoneal irrigation in the treatment of barbital intoxication, experiments were performed on 28 mongrel dogs weighing 6 to 11kg. After administration of 300mg/kg of barbital by a gastric tube, peritoneal irrigations were done continuously or intermittently with Abbott and Shea's solution. Continuous irrigations were carried out on four nephrectomized dogs and on eight non-nephrectomized dogs for 4 to 6 hours. Intermittnet irrigations were done on three non-nephrectomized dogs with three successive two-hours periods. Thirteen dogs were used as a control group. The results were as follows:
1) The removal rates of bartibal by continuous irrigation exceeded urinary excretion rates in the control group in which 20% glucose solution was infused to maintain diuresis. The mean amounts of barbital removed in dialysate and excreted in urine in the non-nephrectomized group were 14.36% and 5.47% of the given dose, respectively. Therefore, total elimination of barbital amounted to 19.83% of the given dose.
2) Plasma concentration of barbital decreased significantly following peritoneal irrigations. In the nephrectomized group, decreases of plasma barbital concentration occured in parallel with reduction of plasma non-protein nitrogen levels.
3) Calculated clearance of barbital by peritoneal irrigation rangred from 1.73cc/min or 3.86cc/min/surface area m² to 8.82cc/min or 18.18cc/min/S.A., the average being 4.34cc/min or 9.08cc/min/S.A.. These values of “peritoneal” clearance corresponded to the same or one half of renal clearance of barbital in the control group.
It is suggested that peritoneal irrigation may be used clinically in the treatment of acute barbital intoxication as effective means.

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Radiographic determination of lymphatic system has been attempted since 1930, the clinical application of this method has rapidly prevailed after Kinmonth reported it in 1952.
The author studied the lymphatic system by Kinmonth's method on 22 normal persons, and at the same time on several persons with abnormal lymphatic system. Evans blue was injected at the back of the foot, to locate lymph canals. Ten c. c. of DR-47 (manufactured by the Daiichi Pharmacy) was injected into lymph canal of each foot (a total of 20c.c). X-ray films were taken immediately after the injection, and again 24 hours later. Additional films were taken in longer intervals if necessary.
The conclusions are as follows:
1) The X-ray demonstration of the normal lymphatic system is comparatively well incident with the anatomical description. However, it is difficult to show the standard normal picture of this system, as it is so different individually.
2) The majority of films of the normal lymphatic system shows defects in some lymph nodes which might be considered as metastatic pictures. Therefore, these X-ray pictures should be studied very carefully.
3) An investigation was performed for the metabolism of contrast medium using I¹³¹. In cases showing normal lymphatic system the contrast medium appeared in the blood 10 minutes after the injection, and 2 1/2 to 6 hours later concentration reached to maximum.
The excretion of contrast medium through urine is 1.5-3.2% on the first day. It gradually decreases thereafter.
4) In the examination using I¹³¹, the biological half life of I¹³¹ is about 4 days. Therefore it is supposed that the contrast medium in the lymphatic system decreased to half the amount injected in approximately four days.
5) In this method, only a portion of the internal iliac lymphatic system was demonstrated. However, it should be re-emphasized that lymphatic systems of the main pelvic organs are related mainly with external iliac, superior iliac and periaortic lymphatic systems.
6) No serious complications were seen. In order to avoid a large amount of contrast medium entering the blood at once, the injecting speed should be controlled. Serious pulmonary infarction would be avoided by injecting only 20c.c. of contrast medium at one time.

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