The tissue carbonic anhydrase activity (C. A. A.) of the kidney was studied with a gas manometric procedure (Maeda-method) in rabbits under different condition, such as Mannitol administration, ureteral obstruction, ligation of the renal artery etc.. Recovery in C. A. A. of the kidney after releasing these conditions was also studied. And some results of clinical cases were presented.
1) The mean of C. A. A. of the kidney in control animals was 0.75±0.16 in the cortex, and 0.4±0.14 in the medulla.
2) In the group of Mannitol administration, C. A. A. decreased to 0.55±0.15 in th ecortex, and 0.39±0.04 in the medulla.
3) When the complete ligation of the unilateral ureter was performed, C. A. A. of the cortex was within normal limit in about half of the cases until one week following ligation, but thereafter progressively decreased in all cases. C. A. A. of the medulla after one week or more decreased definitely in all cases.
4) The decrease of C. A. A. in the bilateral ureteral ligation group was remarkablly faster than in the unilateral ligation group.
5) When the unilateral ligation of the ureter was released 3 days after, C. A. A. of the kidney recovered to the normal value within 3 weeks.
6) So called open hydronephrosis was successfully produced by wrapping cellophane tape around the lower part of the ureter in 27 cases of the animals. Nearly half of the cases showed only mild hydronephrosis with good excretory function in I. V. P., and C. A. A. of these kidneys were normal. The other cases showed moderate or severe hydronephrosis with poor function in I. V. P., C. A. A. of these kidneys were definitely decreased in most cases.
7) The effect of temporary occlusion of the renal artery for an hour to C. A. A. was observed 2 to 6 weeks after occlusion. The medullar C. A. A. recovered to nearly normal level, but the cortical C. A. A. was still lower than normal.
8) When ammonium chloride or sodium bicarbonate was administered orally for more than one week, C. A. A. of the kidney tended to increase moderately in all cases.
9) Clinical cases: In 8 cases of hydronephrosis, C. A. A. of the kidneys with mild or moderate dysfunction was normal, and low activity of C. A. was shown only about a half of the cases with poor renal function.
Marked reduction of C. A. A. was observed in the affected tissue of the kidney tumor and tuberculosis, while C. A. A. of the apparently healthy segments of these diseased kidneys were normal.

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The opinions among urologists about the clinical usefulness of the exofliative cytology of the bladder tumor are widely diverse. This is probably due to the fact that the well-defined criterion and the reasonable interpretation of cytological grading for the bladder tumor has been not yet established.
The author has applied a new method to obtain a large amount of fresh exfoliated tumor cells in well-preserved form. The bladder is emptied and irrigated with α-chymotrypsin solution (200ml, 5mg of α-chymotrypsin per 100ml of the saline solution) through the catheter inserted into the bladder. The irrigated fluid is collected and is centrifuged. The half-dried sediment mounted on the slide glass is fixed in the alcohol-ether solution, and is stained with Papanicolaou's method or Harris' hematoxylin-eosin.
There is little difference between two staining methods. The morphology of exfoliated cells, thus obtained and stained as abovementioned, was demonstrated to correspond very closely to the histological appearance of the original tumor cells (see photography plates in the Japanese text).
By comparing the microscopical features of exfoliated tumor cells with that of tumors, the author presented a new cytological classification of the bladder tumor, which was graded in four classes (Class I, II, III, IV).
In this classification, special interpretation and significance of Class III are emphasized. Practically in fifty-six cases of benign papilloma and well-differenciated papillary carcinoma, except two cases of papillary carcinoma, the grading of exfoliated cells was revealed to be included definitely in Class III or Class IV of the author's classification. The result indicates that demonstration of the exfoliated cells judged as Class III is reasonably considered to show positive evidence of a bladder tumor.
The clinical experiences with the author's cytological classification reveals clinical reliability and availability of exfoliative cytology of the bladder tumor, especially in those cases in which severe inflammation may make the exact diagnosis very difficult, or conventional urological examinations such as X-rays an endoscopy can be hardly applied. Also, this classification of the exfoliative cytology is expected to be useful.

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Bladder disturbance in female which is considered to have developed under influence of imbalance of sex hormone is not infrequently encountered in daily practice. It may be adequately called “endocrine cystopathy in female”. However, little is known about this trouble.
To reveal how the symptoms of this disease develope, function test of the autonomic nervous system and cystometric examination were carried out in patients with this disease, and experimental study was also made on the cholinesterase (ChE) and monoamineoxidase (MAO) activities in the urinary bladder of the female mature albino rats treated with various kinds of sex hormone.
1) The function of the autonomic nervous system in patients with female endocrine cystopathy was. abnormal in majority of the cases.
2) Of this dysfunction of the autonomic nervous system in this disease, it was characteristic that hypertonicity of parasympathetic nerve was mostly observed in the younger group of patients, and hypertonicity of the sympathetic nerve in the older one.
3) The function of the autonomic nervous system which had been abnormal before treatment of this disease was completely normalized in a large number of cases when the symptoms were dramatically improved by the sex hormone therapy. From this fact, it is presumed that dysfunction of the autonomic nervous system in this disease plays an important role in development of bladder symptoms under influence of imbalance of sex hormones.
4) Intravesical pressure was determined in patients with this disease. The urinary bladder of the younger group of patients was hyperesensitive and hypertonic, and that of the older group of patients. contrarily showed a tendency of reduced tonicity.
5) Variation of the ChE activity was examined biochemically in the uriary bladder of the female mature albino rats after administration of sex hormone. The ChE activity was lowered by short-term administration of a large dose of follicular hormone, and contrarily it was markedly elevated by long-term administration of a small dose of the same hormone.
6) In addition, variation of the ChE activity was histochemically observed in the urinary bladder albino rats treated in the same manner. Findings almost corresponded to the results obtained in the biochemical study. In other words, a marked rise of the ChE activity was demonstrated mainly in the muscular layer of the cervical and trigonal area of the urinary bladder in the group treated with a small dose of follicular hormone for a long time.
7) The MAO activity was examined histochemically in the female mature albino rats treated with various kinds of sex hormones. It increased in the group given the long-term administration of a small dose of androgen as compared with that in the control.
From these results of the clinical and experimental study, it seems most probably that dysfunction of the autonomic nervous system mediates between theimbalance of sex hormones and the development of bladder symptoms in “female endocrine cystopathy”.

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The effect of parathyroid hormone for renal tubular transport mechanism of inorganic phosphate was investigated by clearance and stop-flow techniques in dogs and in total of fifteen clinical patients.
Administration of parathyroid extract to the parathyroidectomized dog resulted in a significant increase in the excretion of phosphate by inhibiting the reasorption in the proximal tubule. Comparing the pattern of the stop-flow analysis in the parathyroidectomized dog with that in the intact one after calcium infusion, it was suggested that parathyroid extract has a direct phosphaturic effect on the renal tubule. This conclusion is assumed to be in agrement with the results of the following procedure. When the parathyroid extract was given by the way of the left renal artery at a relatively high dose, phosphaturic effect was rapid and essentialy identical in both kidneys. On the other hand, at a low dose, the changes in the stop-flow pattern were confined only to the infused kidney.
In the clinical studies, clearance test and stop-flow analysis were performed before and after parathyroidectomy in the seven kidneys which appeared to be normal in urogram in the patients with primary hyperparathyroidism. The main functional change in the kidney, which was induced by excess of parathyroid hormone, seemed to occur at the proximal tubules. This change was similar to that of the result in animal experiment. The functional damage in the tubules might be reversible, since the normal stop-flow pattern was obtained immediately after parathyroidectomy. No remarkale changes were found in the stop-flow patterns in the patients with urolithiasis due to other causes, as in the normal kidneys of the patients with cystitis and hydrocele.

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Previously, we reported on the urinary oxalic acid excretion in normal adults and patients with urinary calculi. In this report, we studied the relationship of urinary oxalic acid and urinary electrolytes.
The results were:
1) Calcium: There was no relationship between oxalic acid and calcium in the urine, or no difference in calcium excretion between normal adults and patients with urinary calculi.
2) Phosphorus: A good correlation between oxalic acid and phosphorus in the urine (the coefficient of correlation was +0.66), and slightly elevated excretion of phosphorus in patients with multiple calculi were found.
3) Magnesium: There was no relationship between oxalic acid and magnesium in the urine, or no difference in magnesium excretion or magnesium-calcium ratio (Mg/Ca) between normal adults and patients with urinary calculi. Put, the ratio of magnesium to oxalic acid in the urine (Mg/Oxal or Mg/Ca×Oxal) was lower in patients with urinary calculi than normal adults, especially in patints with multiple calculi, i. e. Mg/Oxal was lower than 2.0 and Mg/Ca×Oxal lower than 0.01.
This suggested that development of oxalate stone may be dependent upon the magnesium-oxalic acid unbalance in the urine (Anequilibrimagnesiuria), i. e. a relative lowering of magnesium concentration to oxalic acid concentration in the urine.

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To determinate the adequate method of treatment for bladder tumors and to establish the prognosis, “Staging” plays a most important role.
With the presacral method, 600ml of oxygen was injected into the perivesical space and 100ml of air was instilled into the empty bladder.
Then according to the percutaneous method of Seldinger, a catheter was introduced into one of the femoral arteries, and was flushed with 40ml of 76% Urografin at the level of aortic bifurcation.
Serial angiography was then taken and ten films have been exposed at the intervals of 1/2 second. Pathological findings that have been obtained are:
1) Increase of vascularity on the side of the tumor 2) network formation in the tumor region 3) corkscrew vessels in the tumor region 4) tortulous vessels in the tumor region 5) decrease or vanishing of the vascularity in the center of the tumor in some cases 6) dense, sustained blush of the tumor region (tumor stain) 7) several changes from proximal to distal portion of the vesical artery 8) vessel-widening on the side of the tumor 9) vessel-displacement on the side of the tumor 10) the growth of a new blood vessel which stems from the healthy side and supplies the tumor 11) rapid visualization of the venous phase on the side of the tumor 12) disarrangement of the vascularity on the bladder wall, especially in the capillary phase 13) parieto-visceral anastomosis in the internal iliac artery.
The follow up histopathological examinations have been done on 18 cases to evaluate the accuracy of the X-ray diagnosis, and 15 cases were proved to be accurate. Out of the 13 pathological findings mentioned above, 1)-6) seem to be due to the tumor mass, and 7)-13) due to tumor infiltration, especially 11)-13) to deep infiltration. The method and the pathological findings are discussed, and some interesting cases are presented.

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Eleven cases of occult hypernephroma including three cases of duplicated cancer were experienced among twenty-six cases of hypernephroma during the past seven years in our clinic.
Most cases were in sixth decade of age, male, left kidney.
The three cardinal symptoms were noticed rarely. The most frequent chief complaint was atypical symptom, which was caused by metastasis to bones. Metastases were seen in ten cases, and eight of them showed extensive dissemination.
Common sites of metastasis were lung, bones, liver, retroperitoneal lymphnodes and heart. Diagnosis was established by autopsy in nine cases, only five cases of which were clinically diagnosed.

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A case of cystitis emphysematosa in 72-year-old woman was presented. This case was discovered at autopsy. The carcinoma of biliary duct was the cause of her death. She had not complained of any bladder symptoms and had not suffered from diabetes mellitus. When the bladder was opened, the vesicles were found all over the surface except on that of the trigone. The size of vesicles was from 1 mm to 5 mm in diameter.
Microscopic examination revealed the mild inflammatory changes in bladder wall but no organismus in tissue. The authors could collect 75 cases of cystitis emphysematosa in the world literatures. But only one case was reported in our country. The literatures were reviewed in this paper, and histological findings and clinical features were briefly discussed to call urologists' attention to this condition.

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In the historical review, duplication of the female urethra is very rare, and only 11 cases in the world are counted.
A case of 11 years old girl with a chief complaint of urinary incontinence was described. In this case, we confirmed an abnormal duplicated urethra opening on the clitoris.
The troubles were released by surgical removal of the whole abnormal urethra.
Four types of the urethral duplication considered in the embryological studies were added

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