Urine osmolalities following the Fishberg concentration test were determined in 192 consecutively admitted patients.
The following results were obtained.
1) A linear relationship was found to exist between the urine osmolality and the urine specific gravity, with a correlation coefficient of 0.7.
2) The first urine specimen following the test showed higher osmolality than the other two specimens in one fourth of cases.
3) The maximal urine osmolality following the test was not always reproducible.
4) A lower limit of the maximal urine osmolality obtained statistically in patients with normal renal function was about 700mOsm/kgH₂O
A progressive decrease with age was found in the maximal urine osmolality.
5) The maximal urine osmolality was reduced in patients with lower urinary tract obstruction, with bilateral renal disease and with adrenal disease.
6) Parallel with the elevation of serum urea nitrogen, the maximal urine osmolality was lowered.
7) No distinct relationship was found to exist between the maximal urine osmolality and the PSP excretion. However, the maximal urine osmolality showed a tendency to decrease according as the PSP excretion became impaired.
8) The maximal urine osmolality was found to be lower after surgical procedure than before.

抄録全体を表示

Arseniuretted hydrogen poisoning is a rare form of acute poisoning which occurs as a disaster, espesially inducing acute renal failure. Case report of this poisoning has been quite rare. We have experienced a case of acute renal failure due to arseniuretted hydrogen poisoning which occurred as the result of an accident in a factory. Despite peritoneal dialysis for as long as 32 days, fetal outcome could not be avoided and autopsy was performed. A 33 year old male inhalted a large amount of arseniuretted hydrogen gas on January 1, 1966 during the process of cadmium and throwing a zinc powder in a electrical refining company. Following the initial lumbago of an intense degree, emesis was experienced on the second day. Upon development of general malaire, jaundice and anuria, patient was hospitalized on the third day. A pronounced hemolytic anemia and azotemia prompted the use of hemodialysis with an artificial kidney. BAL was used for arsenic hydrate poisoning, togather with fresh blood. For renal insufficiency, 50% glucose solution containing insulin was infused through a catheter introduced into the vena cava, as a symptomatic treatment. From the fifth day peritoneal lavage was carried out for 32 days. Hemolysis gradually subsided and the urinary volume reached at times one liter. On January 21, a convulsive seizure was suddenly noted. Due to the development of pulmonary edema tracheotomy was carried out. General state of the patient gradually became poorer until the patient died on the 36th day of the illness. The cause of death was pulmonary suppuration.

抄録全体を表示

A cutting of trial of the sacral nerves and the hypogastric nerve was performed on 23 adult male dogs. Qo₂, Qco₂ and activities of SDH and LDH of the prostate tissue was measured on the 7th or the 21th postoperative day. Results were summarized as follows;
1) Qo₂, Qco₂ and R. Q. usually decreased after the interruption of the innervation.
2) Activities of both SDH and LDH usually increased, while SDH/LDH always reduced because the increase in LDH was larger than that in SDH.
3) These tendencies were observed on the cutting off of the hypogastric nerve as well as the sacral nerves.
4) However, some quantitative or periodical patterns might be noticed specifically with the each section of the nerves.

抄録全体を表示

Numbers of experimental and clinical studies have been contacted on renal hypertension since the 18th century, but the causative mechanism, appropriate diagnosis and proper method of therapy of the disease have not yet made clear.
Using 120 dogs, I artificially produced renal hypertension by Goldblatt's technique, studied the blood pressure responses and made histological examination of the kidney. The dogs were divided into two groups.
The first group: The first group includes those dogs whose left renal arteries were constricted by polyethylene tubes and the right kidneys were removed.
The second group: The second group includes those dogs whose left renal arteries were constricted in the same way, but whose right kidneys were intact.
They were sacrificed at 1, 3, 5 days, and 1, 2, 3, 4, 6 and 8 weeks after the operation.
As a result, I came to the following conclusions:
1) Concerning the changes in the systolic blood pressure in the renal artery stricture, the first group showed a severe hypertension (40-60mmHg), whereas the second showed a mild hypertension (20-30mmHg), observable only in half the number.
2) As to histological changes of the constricted kidney in the first group, the lesions of tubules and interstitial tissue, which seemed to have resulted from the operation, were observed 1 to 3 days after the treatment; changes were observed in the glomerulus, Bowman's capsules and tubules 1 week after the treatment in the interstitial tissues 2 weeks after the treatment; ischemic and sclerotic changes in the blood vessels of the kidney 3 weeks after the treatment. These changes tended to increase with the passage of time. They were similar to the clinical bilateral renal artery stenosis.
3) In the constricted kidneys of the second group, mild changes were observed in the tubules, interstitial tissues and glomerulus 1 to 3 days after the treatment, and in the Bowman's capsules and blood vessels 1 week after the treatment. They were not so severe as to cause a degeneration. This suggested that they were not hypertensive changes but ischemic changes.
4) In the contralateral kidneys of the second group, the sclerotic changes were observed in the small blood vessels 1 week after the treatment, and in the both small and medium blood vessels and renal parenchyma with the passage of time.
5) In the first group, the changes in the granularity were observed to increase in the juxta-glomerular cells of the constricted kidney 5 days after the treatment, the kidney became greatly granulated, reaching the highest point 3 weeks after the treatment. After that the granulation was reduced, but a slight hypergranularity continued till 8 weeks after the treatment.
In the second group, the clipped kidney had a hypergranularity right after the operation, but the granules tended to decrease from 4 weeks after the treatment and they disappeared all at 8 weeks.
On the other hand, there was a decrease in their granularity of the juxtraglomerular cells in the contralateral kidney at 2 weeks, but most of them showed the normal granules at 8 weeks.

抄録全体を表示

From April, 1959 to June, 1966, we have experienced 209 cases of the urinary bladder cancer. For their treatment we have mainly employed radical total cystectomy and partial cystectomy. This time, we have taken up the 61 radical total cystectomy cases which were operated on more than one year ago. We have pursued a follow-up study including various other studies relating to it.
The results obtained are summarized as follows.
1) As for the survival rate, the study has showed a fairly satisfactory rate, 1-year-survival rate being 55.7%, 3-year-survival rate 33.3% and 5-year-survival rate 22.2% respectively. The survival rate by the stages of tumor is as follows: In the cases with low stage tumor, 1-year-survival rate is 66.6%, 3-year-survival rate 37.5% and 5-year-survival rate 50.0% respectively, while in the cases with high stage tumor 1-year-survival rate is 52.2%, 3-year-survival rate 32.1% and 5-year-survival tate 14.3% respectively. Prognosis in cases of high stage tumor, therefore, is worse than in those of low stage tumor.
2) We have studied the relationship between the methods of changing urinary tract and the survival rate. On the one hand, the survival rate in the cases employing ureterocutaneostomy is 62.2% for 1-year-survivals, 37.5% for 3-year-survivals and 33.3% for 5-year-survivals respectively. On the other hand, the survival rate in the cases employing ureterosigmoidostomy is 45.8% for 1-year-survivals, 30.0% for 3-year-survivals and 16.7% for 5-year-survivals respectively. Thus the study has showed clearly the fact that prognosis in the cases with ureterocutaneostomy is much better than those with ureterosigmoidostomy.
3) The death rate is the highest in the period within the first one year after operation, showing 44.3%. Among these cases, the most cases of death occurred in the period within the first two to six months after operation. Thus, we must emphasize that a very cautions care is needed during the first six months period after operation.
4) As for the causes of death, the rate of death due to the operation death is 8.2%, the rate of death from tumor recurrence and metastasis 23.0% and the rate of death from other diseases including chronic renal insufficiency 11.8%, respectively. The rate of death from unknown causes in 19.7%. The postoperative death occurred only in the operations which were made from April, 1959 to May, 1962, and none at all in the operations thereafter. This fac t is considered to be due to improvement in this period in techniques of the operation and the methods of cares before and after the operation.

抄録全体を表示

As successful results were obtained clinically in human subjects using pedicled tunica vaginalis graft for the replacement of the urethral defect, animal experiments were undertaken to define the role of the graft and histologic findings of the reconstructed urethra. Thirty one male mongrel dogs weighing between 11 and 18kg. were subjected to this study.
After partial excision of perineal urethra 3cm. in length and 80% in circumference, only the outer coverings were sutured leaving the urethral defect open in 10 dogs (Group 1). The same urethral window was patched by a pedicled graft of tunica vaginalis in 13 dogs (Group 2), and by a free graft in 4 dogs (Group 3). Complete urethral defect was created in 4 dogs by excising a 3cm. segment of the urethra and a pedicled tunica vaginalis graft was sutured about a splinting catheter (Group 4).
Observations of postoperative urination and urethrogram were made every week. The animals were sacrificed at intervals varying from 1 to 12 weeks respectively, and the urethra was examined grossly and microscopically.
The results were as follows:
1) In Group 1, the entire length of the urethral defect was lined with uroepithelium, but became moderately narrowed and fibrotic.
2) In Group 2 and 3, both pedicled and free grafts remained viable and the luminal surface of the grafts became lined with uroepithelium regenerated from the remaining urethral strip. The graft was eventually replaced by connective tissue. The lumen retained an adequate diameter in the majority of cases.
3) In Group 4, the urethra was not reformed despite the use of splint and the pedicled tunica vaginalis graft. The lumen was obstructed with marked fibrous tissue.
4) When a urethral strip was preserved, remarkable regeneration of urethral mucosa was noticed, but corpus spongiosum did not regenerate sufficiently in 12 weeks observation.
5) Functional arrangement of connective tissue around the reconstructed urethra seemed to take place by the existence of urine flow.
6) Splinting catheter was valuable to avoid wound infection and urethral narrowing before the canal was re-epithelialized.
7) No pathologic change in the testicle from which the graft was taken was observed.

抄録全体を表示

It is very important after urinary tract operations whether the state of indwelling catheter is adequate or not.
Three types of monitoring device are presented here to watch urine flow through indwelling catheter in nurse station.
1) Signal lump for urine drops A neon lump is on and off corresponding to each urine drop.
2) Recorder for urine drops:
The recording ammeter indicates the present and past state of urine flow.
3) Alarm apparatus for interruption of urine flow:
The buzzer of the apparatus alarms when urine drops stopped for a certain minute previously setted.

抄録全体を表示