5-hydroxyindol acetic acid (5-HIAA), a terminal metabolite of serotonin appeared in the urine, was estimated in patients with so-called essential renal bleeding.
Average excretion rate of 5-HIAA in 52 patients was 5.7±1.7mg/day which is significantly higher than that of 4.4±2.1mg/day in 20 normals (P<0.01).
Oral administration of ε-aminocaproic acid caused the decrease of urinary 5-HIAA excretion in 20 patients but no significant effects in normal subjects and patients with other diseases.
The aforementioned results suggested the possiblity of anti-serotonin therapy for this essential renal bleeding. Thus the treatment with one of the serotonin antagonists “cyproheptadine” was attempted in 34 patients resulting the control of hematuria in 16 patients. Transient increase and then gradual decrease of 5-HIAA excretion in the urine were noted after cyproheptadine administration.
The response of this trasient increase differed between effective and ineffective cases. The former exhibited stronger response than the latter. Therefore cyproheptadine test was offered to judge the effectivenss of anti-serotonin therapy.
From the results obtained in this study the conclusion was withdrawn that serotonin might play an important role in the pathogenesis of essential renal bleeding.

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A functional examination of the ureter with electro-ureterography and urometry as well as histological examination of the uretero-pelvic junction was made on 5 cases of congenital hydronephrosis. Among these 5 cases, one case was performed uretero-pelvic anastomosis and another pelvic plastic operation according to Schwyzer-Foley's method, and the rest were performed nephrectomy.
The results obtained are as follows:
1) No histological abnormality was found in the uretero-pelvic junction of the affected kidney.
2) Marked reduction in frequency of peristalsis in the ureter of the affected side, compared to that of the normal ureter, was noted, though the direction of the peristalsis was antegrade.
3) In the case which was performed uretro-pelvic anastomosis it was observed that antegrade peristalsis changed into retrograde one after the operation. Then, in order to abolish the retrograde peristalsis, uretrocystostomy was performed. Following this operation, antegrade peristalsis recurred, though its frequency was more reduced than before the first operation, and at the same time, urine volume transferred to the bladder by the ureter of affected side was further reduced.
4) In the case which was performed plastic operation of the ureteropelvic junction, no peristalsis was observed after the operation.

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Postoperative alteration of renal and ureteral functions and incidence of postoperative pyelonephritis were examined both on 57 cases in which cutaneous ureterostomy was performed and on 57 cases in which nephrostomy was performed.
The results obtained are as follows:
1) Postoperative alteration of renal function
In 50 cases with cutaneous ureterostomy performed, postoperative aggravation of renal function was noted in 14 of 24 cases which showed normal renal function preoperatively, while in the group which showed impaired renal function its improvement was seen in 7 cases and aggravation in 6 cases.
In 16 cases with nephrostomy performed, renal function was impaired postoperatively in 1 of 3 cases which showed normal renal function preoperatively. In the cases in which renal function had already impaired, its postoperative improvement was seen in 6 cases and aggravation in 2 cases.
2) Incidence of postoperative pyelonephritis
In cutaneous ureterostomy acute pyelonephritis occurred in 48% of the cases, while in nephrostomy it occurred in 37%.
3) Ureteral function in cutaneous ureterostomy
The function of the ureter, which was performed cutaneous ureterostomy, was examined with electroureterography and urometry.
Ureteral peristalsis was preserved only in one case of the 10 cases examined, and irregular infrequent peristalsis was seen in 4 cases. In 5 cases, no peristalsis was observed in the postoperative period.

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A statistical analysis was done on anemia among 800 cases with various urological diseases. Then, 36 cases who showed a red cell count less than 400×10⁴ or hemoglobin level less than 80% were selected, and the relationship between hematological findings and renal functions was studied before and after urological treatments. In rabbits, unilateral ureteral ligation and unilateral nephrectomy with contralateral Goldblatt's operation were performed, and various tests were done including hemoglobin level, red blood cell count, PSP values at 15 and 60 minutes and blood pressure. The following results were obtained.
1) In various urological diseases, RBC was more than 551×10⁴ in 1.6%, less than 400×10⁴ in 42.1%, and less than 300×10⁴ in 7.0%. RBC of less than 400×10⁴ was seen more frequently in female, and in older individuals.
2) Malignant tumors in urological field, regardless of its location, were complicated with anemia in a considerably higher frequency than benign tumors or non-tumorous lesions.
3) Excluding malignant tumors, anemia was seen the most frequently in bilateral renal diseases, followed by unilateral renal diseases and lower urinary tract diseases. It was seen the least frequently in the diseases without urinary tract lesions.
4) Anemia was mostly normochromic, slightly macrocytic and slightly hypo-saturated.
5) White blood cell count was almost normal, and its differential count showed slight lymphopenia.
6) On bone marrow examination, slight maturation arrest was seen in erythropoiesis and neutropoiesis. No other abnormality was seen.
7) Serum iron was normal or slightly decreased.
8) A positive correlation was recognized between hemoglobin level and PSP values at 120 minutes or RPF or “renal hemoglobin circulating volume”, or FF. No correlation was recognized between hemoglobin level and other renal function tests or blood pressure.
RBC showed a negative correlation with BUN, and a positive correlation with PSP values at 15 and 120 minutes or RPF or “renal red blood cell circulating volume” or FF. No correlation was recognized between RBC and other renal function tests or blood pressure.
Hematocrit values showed a negative correlation with BUN, and a positive correlation with Fishberg's concentration test or RBF or “renal hematocrit circulation volume” or RPF or FF. No correlation was recognized between hematocrit values and other renal function tests or blood pressure.
9) No correlation was recognized between hemoglobin level or RBC and hematuria or serum protein level or urinary protein positivity.
10) An increase in hemoglobin level showed a positive correlation with an improvement in GFR or RBF. No correlation was recognized between an increase in hemoglobin level and an improvement in other renal function tests.
A positive correlation was recognized between an increase in RBC and an improvement in GFR or RBF or RPF or FF. No correlation was recognized between an increase in RBC and an improvement in other renal function tests.
A positive correlation was recognized between an increase in hematocrit value and an improvement in GFR or RBF or RPF. No correlation was recognized between an increase in hematocrit value and an improvement in other renal function tests.
II) In rabbits, PSP value decreased, anemia developed and blood pressure elevated on unilateral ureteral ligation. Thereafter, the former two conditions gradually improved, while the blood pressure returned to a normal level rapidly. On unilateral nephrectomy with contralateral Goldblatt's operation, PSP values and anemia changed similarly to those on ureteral ligation. However, its individual variation was significantly large, and relatively severe anemia was developed in some rabbits. Blood pressure elevated after one week, and its elevation lasted for 5 weeks.
From the data presen

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Fine structure of five cases of pheochromocytoma and that of normal adrenal medulla were studied, considering its endocrinological aspect.
Adrenal tumors in all five cases of pheochromocytoma were removed by surgery and human adrenal biopsy specimens were taken mainly at the time of renal operation of young adults. Tissue specimens were fixed in cold buffered osmium tetroxide, dehydrated in a series of ethanol and embedded in Epon. They were submitted to electron microscopy thereafter.
Human medullary cells appeared to be almost uniform in shape and contain numerous round, membrane-limited, cored, osmiophilic granules in the cytoplasm, which were already known as catecholamine (CA) granules. Mitochondria were scattered among them, while smooth or rough surfaced endoplasmic reticula developed poorly. Small vesicles and vacuoles were also scarcely seen. (Fig. 1-8)
Pheochromocytema cells, however, gave such variable findings that two major cell types were distinguished by the existence of CA granules-Type I with CA granules in the cytoplasm and Type II without them. The former were divided into three sub-groups according to their cytoplasmic CA granules and vacuoles, which could be observed in the same cytoplasm. This could be interpreted as the expression of cellular activities. (Fig. 9-13)
Features of each cell type are as follows.
Type I: Nucleus and nucleolus are round or oval. Cytoplasmic CA granules and vacuoles are more or less present. Mitochondria are scattered and endoplasmic reticula are quite scanty in cytoplasm.
Type Ia: CA granules are scanty and small in size. The entire cytoplasm is occupied by numerous vacuoles of same size. (Fig. 9-11)
Type Ib: There are more CA granules and less vacuoles in this type. The size of granules is larger than that of type Ia. (Fig. 11, 15, 19-22)
Type Ic: CA granules are abundant in cytoplasm. They are larger than any other cell types and even those of normal medullary cells, while vacuoles are vice versa. (Fig. 9, 10, 13, 14)
Type II: Nucleus exhibits polymorphism, being composed of dense nuclear chromatins, and cytoplasm shows high electron density, in which well developed smooth surfaced endoplasmic reticula, a few granules apparently different from CA granules are seen, but mitochondria are not observed. (Fig. 11-12)
These cell types were seen in the same section.
In order to compare these cell types and its CA granules, the number of CA granule and vacuole were counted along with measuring their sizes. Then, the ratio, G/(G+V) was calculated and distribution curve of granular size was made, calculating their mean diameter in each cell type. The value of G/(G+V) was summarized in the Table 2. (Fig. 25) T-test as to the mean value of G/(G+V) showed significant difference among these four cell types. On the CA granular sizes, Ic>>N>>Ib was ascertained by t test. Distribution curves had one peak on granular sizes of normal medullary cells, while two peaks were shown in type Ib and Ic. Results are summarized in the table 3.
From these findings, it is possible to make the concept of cellular functional cycle of Ia-Ib-Ic-Ia in the secretooy cell of the pheochromocytoma, which should be closely related to its CA biosynthesis, storage and secretion mechanism.
Experimental studies on the action of reserpine to adrenal medulla seem to support this hypothesis. According to them the cytoplasmic CA granules disappeared and vacuoles appeared after reserpine administration. This is reversed in a few days. In these works the ultrastructural changes progress uniformly in the course of the experiment.
In pheochromocytoma, however, these cell types can be observed simultaneously in the same section. of the tumors in our cases. Therefore, it is concluded that the co-existece of these cell types in pheochromocytoma might be morphological evidence for the abnormality of CA metabolism and that different patterns of the granular distribution

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To clarify the reasonable extent of partial cystectomy, 48 specimens of vesical tumors obtained by partial cystectomy, and 25 specimens by total cystectomy were examined on the cell type and its infiltration sight as well as the histological aspect of vesical wall around the tumor, such as submucosal invasion, papillary hyperplasia, and Brunn's nest formation. And the following results were obtained.
1) The transitional cell type was most frequent in its incidence, more than 80 per cent, while the squamous and the undifferentiated cell type were less frequent in bath the cases of partial and total cystectomy. Only one case of adenomatous cell type was found in the former case. As to the histological stage, the incidence of stage A, B₁, B₂, and C were 50.0, 29.2, 12.5, and 8. 3 per cent in the partially cystectomized cases. While in the case of total cystectomy, they were 28.0, 12.0, 24.0, and 36.0 per cent respectively. In the cases of recurrence of tumor, the transitional cell type was found in 60.0 per cent, and the squamous and the undifferentiated cell type were also seen in 30.0, and 10.0 per cent. As to the histological stage of these cases, the incidence of stage A, B₁, and C were 30.0, 50.0, and 20.0 per cent respectively.
2) In the specimens obtained by partial cystectomy, the submucosal invason of the tumor cell was found in 43.7 per cent at the part 1cm from the tumor, while it was seen in 18.7 per cent at the part 2cm from the tumor. The papillary hyperplasia was found in 50.0 per cent in the former part, while 18.7 per cent in the latter part, and there could be found significant difference between their incidence relating to the distance from the tumor. However, the Brunn's nest formation was found in 45.8 per cent and 34.4 per cent respectively, and there could not be found any marked difference in their incidence. On the other hand, the same examination was performed on the specimens obtained by total cystectomy, but almost the same results were obtained.
With these results described above, as well as the sight of subumucosal invasion and papillary hyperplasia which are thought to have rather close relationship with the recurrence of the tumor, it should be pointed out that the resection of enough margin of the vesical wall around the tumor, more than 2cm should be desired, would be necessary for the partial cystectomy.
3) In the case of partial cystectomy, the incidence of submucosal invasion at the part 1cm from the tumor was 25.0 per cent in stage A group, and 61.1-66.6 per cent in stage over B₁, while it was 41.6 per cent at the part 2cm from the tumor of stage B₁. In the case of total cystectomy, it was 66.6-83.3 per cent at the part 1cm from the tumor of stage over B₁, while 77.7-83.3 per cent at the part 2cm from the tumor of stage over B₂, and 25.0-50.0 per cent at the part 3cm from the tumor of stage over B₂.
With these results obtained above, it was clarified that the stage of the tumor was paralleled with the sight of submucosal invasion, however, any correlationship between the sight of invasion and the papillary hyperplasia or Brunn's nest formation could not be found. Therefore, it was assumed that the preoperative estimation upon the stage of the tumor would be very important to increase the clinical value of partial cystectomy for the bladder tumor, as well as the extension of the resection area if the stage might be rather high.
4) Further histological examinations on the sight or submucosal invasion around the tumor were made according to Jewett's classification, but symbols such as a, b₁, b₂, and c were employed not to be confused with the histological stage of the tumor described above. And the following results were obtained. In the case of partial cystectomy, submucosal invasion of stage a was found in 71.4 per cent, stage b₁ in 23.8 per cent and stage

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