Functional examination of the kidney have made considerable progress during the last few years, thanks to the introduction of the clearance methods: However, the clearance methods determine only renal cortical functon and are not sufficient to analyse renal function in urinary tract obstruction or in pyelonephritis Furthermore, these diseases affect each of the kidneys asymmetrically. Because of these reasons, we need a technic to estimate renal medullary functions separately for the analysis of pathophysiology and for clinical diagnosis of these diseases.
For this purpose, 34 patients with unilateral renal disease and 8 dogs with experimental unilateral pyelonephritis were studied. The separate function of each kidney was determined by ureteral catheterization, clearance tests with PAH (CPAH) and creatinine (CCr), assesment of EFNa and a new concentration test with water soluble vasopressin given subcutaneously.
1) By the new separated renal concentration test, we could estimate the concentrating capacities of the unilateral diseased kidneys without difficulty and in the course of these tests, patients showed no severe side effect.
2) Both unilateral obstructive kidneys and pyelonephritis kidneys had a tendency of reduction in GFR and concentrating ability. In the obstructive kidneys, the reduction in concentrating ability per GFR was slightly larger than in the pyelonephritis kidneys.
3) The kidneys with unilateral renal artery stenosis showed reduction in urine volume and EFNa and increase in concentrating ability. A unilateral hypoplastic kidney showed reduction in GFR and concentrating ability and increase in EFNa.

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During the period 1963-1965 the following examinations were done with pretreatment urine specimens from total of 425 cases, 80 male patients with cystitis, 245 female patients with cystitis and 100 male patients with urethritis. Smearing and cultivation of phlogogenetic microorganisms were conducted, and their strains were identified. At the same time 391 strains obtained by cultivation were subjected to the susceptibility test using antibiotics and sulfa drugs. The results were as follows:
1) Cases of cytitis and of urethritis most frequently ranged from 20's to 30's in age.
2) Simple staining Gram's method and biopsy of 459 smear preparations revealed 227 Gram-negative rods, 129 strains of Staphylococcus, 43 Gram-positive rods and 38 strains of Streptococcus and 22 strains of Candida.
3) Cultivation yielded 391 strains, fo which Escherichia coli accounted for 37.9%, Staphylococcus 26.6%, Corynebacterium 11%, Streptococcus 8.7%, Proteus 4.6%, Micrococcus 4.1%, Candida 5.1% and bacillus pyocyaneus 2.0%.
4) Analysis of the cultured 391 strains met with negative results regarding their characteristics by year.
5) In both male and female cases of cystitis, Escherichia coli was detected with great frequency, whereas Staphylococcus was found frequently in male cases of urethritis.
6) The sensitivity test of the 391 strains using antibiotics and sulfa drugs showed that a few microorganisms were sensitive to the substances, whereas microorganisms resistant against more than one drug increased.

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Using as sources of isolation urine specimens from the 425 cases of urosis observed during the period 1962-1965, cultivation was done 464 times with a resultant yield of 493 strains. The sensitivity test of these strains with antibiotics and sulfa drugs revealed the following results:
1) Among the isolated 493 strains, Escherichia Coli occupied 31.6%, Staphylococcus 31.0%, Proteus 18.1%, Streptococcus 8.9%, Bacillus Pyocyaneus 6.1 and unidentifiable Gram-negative rods 4.1%.
2) As compared to the above-mentioned ranks by strains in primary infection, an increase in Proteus and bacillus pyocyaneus was marked in secondary infection.
3) When the 493 strains were considered in terms of diseases and microorganisms, the rate of detection of Eschericha Coli was high for ureteropathia, renopathy, prostatomegaly etc. Staphylococcus was detected at a high frequency in urethral diseases and cystic diseases. Proteus was frequently found in cystic diseases, renopathy, tumor and calculosis; bacillus pyocyaneus was frequently detected in tuberculosis, tumor, renopathy and calculosis.
4) As to 493 strains which could not be judged by cultivation and identification, 20 (4.1%) were detected. These strains had not been detected at all in primary infection.
5) The distribution of the above unidentifiable Gram-negative rods by diseases agreed with that of bacillus pyocyaneus.
6) Regarding the sensitivity test, a reduction in sensitivity of the microorganisms to antibiotics and sulfa drugs was remarkable.
7) The resistance of antibiotics and sulfa drugs against the isolated microorganisms showed multi-resistance in many instances.

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Tuberculosis of the left kidney was found when a 42 year-old woman was being treated for spinal caries. Nephrectomy in combination with chemotherapy cured this case. Two kinds of Gram-negative rods could be isolated from muddy substances in solitary caseous lesions in the removed kidney. Analysis of the properties of the rods yielded the following results:
1) This case was a typical mortar kidney whose pathohistological findings completely agreed with those noted in this case.
2) No tubercle bacilli could be demonstrated in relatively large solitary caseous lesions and the renal parenchyma, but many Gram-negative rods were found in such lesions and walls covering them.
3) Two kinds of Gram-negative rods were isolated from caseous muddy substances, and the properties of the rods were studied. However, these rods could not be identified with other Gram-negative rod.
4) The agglutination reaction was done using as antigens living microorganisms of two kinds of Gram-negative rods isolated from the case. The case showed a high agglutination value, but the agglutination value was low in healthy persons, and 5 of 15 cases of cystitis exhibited relatively high agglutination values.
5) The above-mentioned two kinds of unidentifiable Gram-negative rods were identical with the unidentifiable Gram-negative rods described in the preceding report.
6) This case was a typical mortar kidney. Isolated two kinds of Gram-negative erods can be interpreted as mixed infection with such a kidney.

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Of 22 strains of unidentifiable Gram-negative rods obtained from urine specimens and mortar liver lesions in secondary infection, the biological properties of 10 strains preserved so far were studied. Further more, immunological studies were performed, with the following results, by the use of the above strains and Escherichia coli, Proteus vulgaris, Pseudomonas aeruginosa, and Alcaligenes faecalis whose sources were known.
1. Ten strains of unidentifiable Gram-negative rods used in the present study can be classified into two types according to their properties.
2. In the biological identification method, these microorganisms exhibited properties altogether different from those of intestinal flora and similar Gram-negative rods.
3. Into strains of unidentifiable Gram-negative rods can be distinguished immunologically from Escherichia coli, Proteus vulgaris, Pseudomonas aeruginosa, and Alcaligenes faecalis.
4. Unidentifiable Gram-negative rods used in the present study could not be identified by the biological and immunological methods o For this reason it seems reasonable to treat these rods as a group of unidentifiable Gram-negative rods.
5. The distribution of the unidentifiable Gram-negative rods by diseases was similar to that of pseudomonas aeruginosa. For the clarification of the clinical significance of the rods, it is desirable that the pathogenicity and virulence of the microorganisms should be examined.

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Author made experiments on the fibrinolytic enzyme system and capillary permeability promoting action in serum (C. P. P. action) by Kuroyanagi in urological field, and commented on the relation between the fibrinolytic enzyme system, the kinin-releasing enzymes and these lytic products, and these vascular permeability action.
1) In the cases of so-called idiopathic renal bleeding, the high average of the activation of the fibrinolytic enzyme system and positive C. P. P. action were observed, and in the cases of hemorrhagic cystitis, the latter was observed.
2) In the cases who underwent transurethral resection of prostate, the fibrinolytic enzyme system was activated and positive C. P. P. action was observed.
Even if the fibrinolytic enzyme system recovered to normal value at the postoperation, C. P. P. action still remained.
3) The C. P. P. action increased after the treatment of prostate massage and this action was at its peak in the acid-treated serum.
4) In the animal experiments the C. P. P. action paralleled to the activity of the fibrinolytic enzyme system, and in the anaphylaxy shock the similar results in the relation of the C. P. P. action and the P. C. A. reaction was obtained.
5) The anti-plasmic drugs inhibited the C. P. P. action, especially the C. P. P. action ralating with the activation of the fibrinolytic enzyme system.
The mechanism suggested that the anti-plasmic drugs inhibited the vaso-active peptides produced from fibrinogen by plasmin.
6) In the inhibition of the anti-plasmic drugs on the vascular permeability of the leukotaxin-like substance, bradykinin and serotonin, t-amino-methyl-cyclohexan-carboxylic acid (t-AMCHA) inhibited the action of the leukotaxin-like substance, while ε-amino-caproic acid (EACA) inhibited that of serotonin, and mixed-AMCHA and EACA revealed respectively their higher effectiveness against that of bradykinin.
7) Reversely, bradykinin as representative kinin and serotonin as active amine had influenced on the fibrinolytic enzyme system.
It is supposed that in living body, the kinin-releasing enzymes, the kinins as its products and the kinin-releasing enzymes themselves reacted and regulated each other finely, and homeostasis was supported.
8) The C. P. P. action was of couse positive in the case of activated fibrinolytic enzyme, as well as occasionally even in the case of non-activated.
Many factors causing the C. P. P. action can be supposed and in the basic medical research they should be investigated drastically.

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Split renal function tests by method of Howard were performed in patients with renovascular hypertension and in patients with essential hypertension or chronic nephritis as control.
Statistical analysis showed that the functional disparities of the two kidneys in the control group were within 30% decrease in all parameters such as urine flow, urine sodium concentration, urine creatinine concentration, creatinine clearance and excretion fraction of filtered sodium (EFNa).
In patients with unilateral main renal artery obstruction in whom surgical procedure alleviated the hypertension, the results of the preoperative test showed the urine flow and the EFNa of th affected kidney decreased more than 30% of the normal mate kidney without exception and the other parameters in a few cases were distributed within the range of the control group.
It is concluded that reduction of the urine flow and the EFNa of the affected kidney by more than 30% of the other kidney is a characteristic pattern for the unilateral main renal artery obstruction with hypertension.
Additional animal experiments showed that the pattern of the split renal function in dogs with unilateral main renal artery obstruction was not the same with that of clinical cases in an acute stage, and that osmotic diuresis for split renal function test resulted in a decrease of the difference between the two kidneys except the urine flow.

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A 12-year-old patient with ambiguous external genitalia was reported. The social sex of the patient was male. The external genitalia showed scrotal hypospadia with bifid scrotum and no left scrotal content. The urinary excretion of gonadotropin, 17-KS, 17-OHCS, estrogen, pregnanediol and pregnanetriol were under 8muu/day, 3.3-5.0mg/day, 1.3-2.1mg/day, 5.0-9.0μg/day, 0.90-1.18mg/day and 0.2-0.22mg/day, respectively. At laparotomy no left testis was found in retroperitoneal cavity from inguinal ring up to renal hilum region. At the region of lateral wall of pelvic cavity a small ovary-like body, measuring 2.0×1.0×0.6cm, fimbria and oviduct were found. At the middle point of retrovesical region the left oviduct fused with right seminal duct, making a small bicornate uterus which ended blindly at the perineal region. Histological examination of left gonad revealed an ovary with occasional primitive follicles and that of right gonad revealed relatively well developed testis. Chromosome examination showed a karyotype of 46/XY. From the results above mentioned it was notd that the diagnosis of this patient was a tune hermaphroditism with a karyotype of 46/XY.

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A 7 years and 8 months old boy with precocious development of secondary sex characteristics and well developed external genitalia was presented. The urinary excretion of gonadotropin, 17-KS, 17-OHCS and estrogen were under 6muu/day, 3.1-2.18mg/day, 3.28mg/day and 9.0μg/day, respectively. The pneumoencephalographic and electroencephalographic examination revealed no abnormality. Testicular biopsy specimen demonstrated well developed spermatogenesis. From the results above mentioned it was noted that the diagnosis of the patient was an idiopathic precocious puberty.

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Epispadias of a 2-year-old girl with a complaint of urinary incontinence and abnormal external genitalia was reported. Physical examination of the external genitalia showed bifid clitoris, wide separation of labia and protrusion of urethra. X-ray examination demonstrated separation of pubic bone and absence of the left kidney. Symphysiorrhaphy and plastic operation on external genitalia and distal urethra were conducted. Postoperative course of the patient was uneventful and the patient gained complete control of micturition. This is the first case of female epispadias reported in Japan.

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