A 26-year-old man in terminal uremia due to bilateral kidney tuberculosis, received a transplant of the kidney preserved by hypothermia and hyperbaric oxygen. The donor was a 45-year-old man with right vesicoureteral reflux and calculu sin the right renal pelvis. The grafted kidney began functioning immediately and excreted 1600-3000cc of urine per day during the entire postoperative days. BUN and serum Cr. dropped from 110, 20.7mg/dl to 33, 2.6mg/dl respectively. However leucopenia appeared on the seventh day and the patient died with accidental rupture of the grafted kidney on the eleventh day. The kidney showed supprative pyelonephritis and no evidence of dysfunction due to thrombosis, rejection etc.

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The author has been discussing the relation between the fibrinolytic enzyme system and the capillary permeability promoting action in serum (CPP action) in the case of so-called idiopathic renal bleeding, and reporting the correlation between the fibrinolytic enzyme system and CPP action and the experimental renal bleeding in Reilly's phenomenon, serotonin administration and stimulation of nervus ischiadicus.
In this report, 250 γ of bradykinin, a representative kinin of vasoactive peptide, were administered to the matured rabbit, and the changes of urine and fibrinolytic enzyme system (in kidney tissue, blood and urine) were observed and the following results were obtained.
1) After 10-15 seconds of intravenous injection of bradykinin, anaphylaxy shock-like symptom was induced, and after 2-2.5 minutes, the symptom disappeared.
The excretion of urine stopped as soon as the shock-like symptom was induced, but it was re-excreted after 4-4.5 minutes. There was no change in protein, pH and sugar in the urine.
2) The fibrinolytic activity of urine increased gradually until 25 minutes after the administration and rapidly thenceforce, and simultaneously renal bleeding was increased.
The inhibitory action of urine for the urokinase (UK) and plasmin (PL) was temporarily decreased after the injection, but increased after 25 minutes.
3. The inhibitor (Inh) for UK and PL presented in the normal blood plasma of rabbit.
Administration of a large dose of bradykinin effected on the inhibitory system of UK in blood in relatively early stage and it activated fibrinolytic enzyme system in blood after 20-30 minutes of the administration.
Blood fibrinogen changed on the UK-Inh system in parallel with but slightly behind in the fibrinolytic activating system, and the renal bleeding paralleled with the fibrinolytic activating system in the blood.
4. The activator (Act) presented richly in the renal medulla of normal rabbit, and it was able to be extracted with physiological saline.
The proactivator (Proact) could also be extracted by the physiological saline, and it presented more richly in the order of renal cortex and renal medulla, and it did not present in renal pelvic membrane.
A large amount of bradykinin activated a large amount of the Proact in the renal cortex in early stage, and the Act was not extracted by physiological saline. Since then, Proact in the renal cortex was gradually activated and consumed.
The Act in the renal medulla was reduced and then the Proact was gradually activated to maintain the activity in the renal medulla constantly.
The Act in the renal pelvic membrane was activated slightly in early stage, but the Act was different from that in the renal cortex and renal medulla in nature and inactivated relatively in early stage, but Proact was in slightly increased stage thenceforth.
5. From these results, it may be concluded that a large amount of bradykinin activates fibrinolytic enzymes as the secondary reaction after several steps of reactions, and induces renal bleeding.
The induction of the renal bleeding is supposed to be caused in the renal medulla.

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A mathematical formulation concerning pertoneal permeability was made by tracer dilution curve of peritoneal dialysate. This procedure allowed the estimation for rate constants, turn over rates and apparent permeability constants of solutes through peritoneum.
The experimental data shown in Table 3 were obtained from 6 adult patients, consisting of 4 patients examined by ²⁴NaCl, 2 by ⁴²KCl and 1 by ¹⁴C-urea.
The relation between apparent permeability constant of peritoneum and peritoneal clearance was discussed, which revealed the former indicated the maximum value of the latter.

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a. Dr. Ishida, one of our colleague, reported that enlargement of contracted bladder using pedicled peritoneum flap was successful in two clnical cases. From the above, the present writer made experimental study on the repair of the upper half of dog bladder using free or pedicled peritoneum flap. The result was almost the same with either free flap or pedicled flap. At the end of 2 weeks, outer surface of the graft was covered with a granulation tissue membrane and inflammatory reaction was very severe. Inflammatory reaction decreased with the time, and granulation tissue developed into a new thick connective tissue membrane. Regeneration of uroepithelium began 3 weeks after and was complete at the end of 2 months. Regeneration of smooth muscle began one month after and was almost complete at the end of 3 months. Over half of the cases after one month showed submucous bone formations.
b. The upper half of dog bladder was excised and repaired with facia, peritoneum and OMS-membrane. Bilateral ureterocutaneostomy was carried out prior to or at the same time as the bladder repair. 17 dogs survived and were sacrificed at a period of 2, 3, 4 and 13 weeks after the bladder repair. Regardless of the type of the used material, the results were almost the same. In the presence of urinary diversion the degree of inflammatory reaction was definitely lower and rgeneration of uroepithelium was remarkably faster than in the absence of urinary diversion. Complete epithelial regeneration of the grafted portion with fascia, peritoneum and OMS-membrane was seen respectively as early as 2 weeks (fascia), 2 weeks (periotneum) and 3 weeks (OMS) after in the cases with urinary diversion, in contrast to the 4 weeks, 9 weeks, and 5 weeks after in the cases without urinary diversion. On the other hand, degeneration and replacement of fiber bundles of the fascia (incoporated with the newly formed bladder tissue) by new connective tissue was retarded. At the same time, the smooth muscle regeneration obsered in cases without urinary diversion could not be seen even after 3 months in all cases with urinary diversion. In other word, regeneration of epithelium was stepped up but regeneration of muscle was retarded under urinary diversion.

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a. Kassai reported that urinary diversion stepped up regeneration of ureopithelium but suppressed that of smooth muscle, in th experiments of bladder repair using fascia, peritoneum and OMS-membrane. The present writer made the following study. Repair of the upper half of dog bladder using autogenous facia was done at the same time with bilateral ureterocutaneostomy. Two weeks later, when complete epithelial regeneration was expected, ureter reanastomosis was carried out. 18 dogs were used but only 6 dogs survived for more than 4 weeks with adequate urinary flow into the bladder and they were sacrificed at the period of 4, 6, 9, 15, 18 and 25 weeks after the repair of gladder. Mild to moderate hydronephrosis was observed. Complete epithelial regeneration of the grafted portion was seen in every case. Inflammatory reaction of the new bladder wall was severe, especially under the regenerated mucosa. but decreased with the time. Replacement of degenerated fiber bundles by new connective tissue began at 6 weeks after the bladder repair and progressed thereafter. Fragmentation of muscles at the cut edges of the bladder, suggesting a state of preparation of muscle regeneration, was observed at the end of 4 weeks (2 weeks after ureter reanastomosis), and a new muscle layer appeared thereafter towards the center from the periphery. A muscle layer was seen in about one-third of the grafted portion at 6-9 weeks and about one half at 15 weeks, but only two-tirds of the new bladder wall shoined a muscle layer and the cantral one third potion did not contain muscle even at 2. 5 weeks after. The reason why muscle regeneration was not complete even after several months might be as follows: Infected hydronephrosis induced by repeated operations on the ureter, should give rise to moderate infection of the new grafted portion and result in detrimental effects upon muscle regeneration.
b. The present writer attempted to find an artificial graft material which would incorporate with the new bladder wall. Repair of the upper half of bladder was done with tetron membrane burned subcutaneously 4 weeks in advance. After 4 weeks, uroepithelium regenerated over the tetron membrane in the peripheral portion of the grafted part, but the central portion showed ulceration with necrotic tissue and naked tetron membrane (deprived of the connective tissue envelope) was exposed directly to the bladder cavity. After 6 months tetron membrane was dislodged into the bladder cavity from the central ulcer and urinary calculi was formed around the detached tetron membrane. However, the same experiment under urinary diversion was successful; after 4 weeks the grafted part was completely covered with regenerated epithelium and the tetron membrane seemed to be incorporated with the new bladder wall.
c. Bladder mucosa of 1.5-2.0cm diameter was removed and the process of regeneration was followed. Epithelial regeneration began at the 5th day when submucous hemorrhage and inflammation decreased, and completed at the 10th day. Glucorticoids, androgen, estrogen and anabolic steroids had no effect while α-chymotrypsin suppressed the inflammatory reaction and stepped up the regeneration of uroepithelium.

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1) The 1st clinical case of “cystitis emphysematosa” in Japan was reported. The patient was a 67-year-old female, who had been diabetic since 7 years ago. She also had an uncomplete urinary retention associated with urinary infection caused by catheterization for the purpose of clinical examination.
Because her acute symptomes of cystitis and hematuria responded poory to the usual sulfa drug regimen, the cystoscopic examination was performed, and then the emphysematous lesion was detected.
Both the emphysematous condition and the inflammation of the bladder disappeared in about 10 days with the topical treatment chiefly composed of bladder irrigation.
Abstract of the clinical course, photographic pictures of the bladder mucous membrane and X-ray finding were also illustrated.
2) Referring to the available cases reported both in domestic and foreign literatures, 35 autopsy cases and 24 clinical cases of “cystitis emphysematosa”, were tabulated, and the developmental views, diagnostic and therapeutic procedures for this condition were discussed, then chiefly from the standpoint of pathological and clinical observations, concluded as follow.
In the clinical case of “cystitis emphysematosa”, the emphysematous condition of the bladder is only a symptom of the bacterial acute cystitis rather than a separate clinical entity and essentially belongs to the other category of the similar condition which often takes place in uninflammed bladder found in some autopsy cases.
3) From the fact that the condition of emphysematous inflammation has been known to occur in the gall bladder and in the renal pelvis which have physiologically the similar structure and functions to those of the urinary bladder, the usual inflammatory figures of these 3 organs were compared, and some common features were noted;
a) Etiological agents were the ones of the indigenous flora to the human bodies.
b) There were minimal differences between the manifestations of infections which caused by such agents which were often to each other biologically of greatly different nature, anp
c) Supporting that the urinary system was affected with some agents, there were not always concommitant infective conditions both in the renal pelvis and in the urinary bladder, that was suggestive in these 2 organs to have different characters for the susceptibility to infections.
In addition, the inflammatory condition in these 3 organs had many other common features which characterized as so-called endogenous infective diseases. Then, taking the bacterial cystitis as one of the endogenous infective diseases, the following fact was suggested that, several factors which were hitherto considered to be etiological, and finally concluded here to be undeterminate as a single cause, for instance, some bacterial agents, diabetes or glycosuria and traumas in narrow and wide sense, including the circulatory disturbances, etc. were becomming to be able to re-estimate as equivalent essential factors by taking them up as a whole.

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A case of Cushing's syndrome in an 8-month-old girl was reported, in which removal of the left adrenal cortical adenoma resulted in marked improvement of clinical anifestations. Review of the literature was presented with a discussion concerning clinical manifestations, diagnosis and treatments of Cushing's syndrome in infants.
Electron microscopic observations on cells of the adrenal cortical adenoma revealed, that though the cellular ultrastructures, as a whole, did not differ so much from those of the normal adrenal cortex, findings in mitochondrias were characteristic in their distribution, and in variable size and form.

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The incontinence in the paraplegics was studied with direct cystometry and the recording of integrating curve of incontinence urine volume on the supine resting posture about 18 males.
The pattern of the neurogenic bladder was analysed on the excretory cystometry (Nakajima. 1960). The urine in the incontinent was collected to a cylinder, the pressure of the urine was recorded electrically. The recorded curve displayed the integrated volume, frequency, interval and duration of the incontinence (Incontinogram).
The above incontinogram and direct cystometrogram were recorded through the trocar suprapubic cystostomy simulutaneously.
Results
1) The cystometry through the urethral catheter (excretory cystometry) was compared with the direct cystometry. The patterns of the neurogenic bladder were essentially almost same in each recording method. But in the automatic bladder, the height and width of wave were smaller on the direct cystometry, because of it easy incontinence.
In the case of the autonomous bladder, the intravesical pressure rose to some extent despite of incontinence.
The progressive ascending pressure curve reached to thirty centimeter H₂O or more at the laps of time, and it retained on the same level.
2) As the incontinence of the automatic bladder was a sort of reflex micturition, considerable volume was evacuated by the automatic contracted wave of the duration of 1-2 minutes, when the bladder content was reached above the certain fixt content.
The automatic wave was induced mainly as a consequence of cough, movement or spasm of the lower extremities.
3) Incontinence of the autonomous bladder was a dribbling type. It began when the bladder content was reached to some fixt volume. The content continued to increase in spite of the dribbling untill to reach the certain capacity.
After this, it resulted in the overflow type incontinence kept by the balance of in-and outflow of the bladder.
4) Incontinence of the autonomo-automatic bladder was mixed type, namely automatic typd reflex micturition preceded the appearance of the autonomous type incontinence.
After the repeated reflex incontinence in the first half course, it has shown two forms of conditions in the last half; one was the dribbling type only, the other was the continuous dribbling superimposed with the intermittent reflex type incontinence.
5) Urethral resistance at the time of incontinence was calculated by the direct cystoometry and the flow rate of incontinence. The values did not show any constant tendency in the same patient, and it had not any relations with retrograde urethral resistance.
6) Incontinence was inhibited temporarily by procaine anesthesia of the bladder mucosa. The inhibition was considered to be resulted by the increase of the vesical capacity.
7) T. T. F. D. (Thiamine tetrahydrofurfuryl disulfide) was effective in two out of four cases for the inhibition of the automatic waves and for the increasing of bladder capacity at the first occurarnce of incontinence. The muximum voluntary intravesical pressure was raised in all four cases.

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