In 145 autopsy cases, kidneys, extrarenal arteries and abdominal aorta were removed en bloc at the time of necropsy, and aortorenal angiography was undertaken for the study of renal artery lesions. Pathological changes of the kidney and renal artery were also observed. Pathological studies of kidney, extrarenal artery and aorta were also performed in 65 hypertensives without postmortem angiographies to observe the significance of renal artery stenosis in the genesis of hypertension. Results obtained were as follows:
1. Severe renal artery stenosis was found in 2 of 70 normotensives in age from 17 to 76 years and in 2 of 28 normotensives from 50 to 69 years old.
2. Stenosis of the renal artery was found in 11 of 42 hypertensives from 49 to 86 years and in 5 of 19 hypertensives from 50 to 69 years old.
3. Renal artery stenosis was found in 11 of 56 hypertensives whose angiography was not undertaken at the time of necropsy.
4. In all instances of renal artery stenosis, arteriosclerotic lesion was found to produce lumen narrowing.
5. Renal accessory artery arising separately from the abdominal aorta was found in 23 of 53 hypertensives and in 29 of 84 normotensives.
6. Marked narrowing of the accessory artery was found in one of the hypertensive cases.
7. Intimal involvement of the aorta was severe in the hypertensives with renal artery stenosis. Renal artery stenosis was found more frequently in hypertensives whose surface involvement of the aorta was more than 70 per cent.
8. Average length of the right kidneys was 11. 1cm and that of the left kidneys was 11.4cm in 68 normotenslve cases.
9. Pyelonephritis was found in 7 of 83 normotensives and in 8 of 53 hypertensives whose postmortem angiographies were undertaken. Moreover it was found in 8 of 65 hypertensive cases who were not examined radiologically.
10. Arteriolar nephrosclerosis was found in 2 (3 per cent) of 70 normotensive cases and in 41 of 42 hypertensive cases. One hypertensive case without arteriolar sclerosis showed stenosis of the unilateral main renal artery.
11. Arteriolar nephrosclerosis was noted in all of 56 hypertensive cases without postmortem angiography.
12. Arcuate and subarcuate arteries in hypertensive cases were slightly dilated, and interlobular arteries were kinked and branched in an obtuse angle.

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Out of the two functions constituting male sexual functions, the reproductive and the coital one, the author has made a clinical study on the latter, that is, insufficiency and impotence in the narrow sense, which has hitherto been paid little scientific attention to. The sutudy has been on psychic impotence which accounts for the most part of clinical cases and on endocrine (androgen deficient) impotence which were found conciderable in frequency.
(1) The author has defined impotence as the deficiency of one or two factors of sexual pattern, that is, sexual desire, erection, ejaculation, and orgasm.
(2) The author's causal classification of 130 cases he treated is as follows: -a) organic cause: -penile (malformation or disease) 1.5%: endocrine (pituitary, testicular, or adrenal deficiency) 21.5%: nervous (central or distal motility, or sensory nerve damage) 4.6%. b) functional cause: -psychic (psychological 8 cases, psychic 81 cases which is 62.3%) 68.5%. c) other causes (urological cause by the disease in the urethra, in the accessory sexual glands, or by operation or external injury, diabetes mellitus, chronic consumption, physiological defect) 3. 8%. It is notworthy that out of the urological out-patient the psychic cause accounts for more than 50%.
(3) Various psychic causes inhibiting the male sexual pattern were the basic factors, as the authors calls, of psychic impotence and the classification of 89 cases he treated is as follows: -sexual organ inferiority 6 cases, new marital condition 23 cases, abnormal sexual behavior 16 cases, disease anxiety or fear of disease 24 cases, suppression from the wife 3 cases, fear of conception 1 case, subconscious homosexuality 1 case, neurosis sign 8 cases, and unknown 5 cases.
(4) The classification by age groups of psychic impotence is as follows: -the young group below 30 years old 45 cases, the prime-of-life group between 30 to 40 years old 18 cases, the more elderly and old age group 26 cases.
(5) The author found that there was a characteristic difference between the basic factor of the young-group psychic impotence and that of the elderly-and-old-age-groups psychic impotence. The formation process of psychic impotence was that it originated from the individual's unconscious fear, doubt, anxiety, inhibitory idea about his own sexual function.
(6) The treatment of psychic impotence was conducted primarily by psychotherapy through the interview at a regular interval and secondarily by medical therapy as a kind of trigger to cure. This method was sufficient and the most suitable even for a urologist.
(7) The author's therapeutic result was that, out of 19 cases of new-marital impotence which is typical of young-group impotence, 10 cases were successful, 2 cases unsuccessful, and uncertain of result 7 cases: and that, out of 22 cases of elderly-and-old-age-group impotence, 10 cases were successful, 5 cases improved, 7 cases uncertain.
(8) Endocrine impotence he treated was 28 cases and the classification of factors were that 17 cases were counted for the upper-central-nervous disorder, out of which 13 cases eunuchoidism: testicular disorders were 11 cases, out of which 8 cases post-pubertal castration, and 3 cases testicular atrophy.
(9) The characteristic features of sexual pattern in endocrine impotence were that sexual desire generally declined, erotic erection and reflexible erection were damaged to various degrees, ejaculation decreasing and orgasm weakened.
(10) Sexual function of castrate could be maintened and kept under control by supplying him with androgen. The author made investigation on the most efficacious method for it.

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The diagnostic value of angiography in renal pelvic carcinoma has been discussed by many authors, but it has been found to be of less value for other renal disorders such as renal cell carcinoma or cysts.
We performed angiographic study in 5 cases of renal pelvic carcinoma and reached the conclusion that this method was of some diagnostic value in the cases as follows:
(1) Renal angiography is of great value for diagnosing renal pelvic carcinoma, especially when the diagnosis is uncertain with pyelogram and other measures.
(2) Pararenal arteries, for example, pelvic and superior ureteric arteries are most important in the diagnosis of pelvic carcinoma and they are dilated and reveal the location of the tumor.
(3) Selective renal angiography is more desirable than aortography because with this method pararenal arteries are very fine as compared with other vessels.

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1). Our experiences and results at Tokyo Teishin Hospital, with patients who had operations for the vesicovaginal fistulas are reported.
In this series of 20 patients there were 13 vesicovaginal, 3 vesicovaginorectal, 2 vesicocervicovaginal and 2 urethrovesicovaginal fistulas.
These fistulas have been divided from their etiological factors into five groups. The cases and the results of surgical treatment were as follows.
NO. OF PER CENT. MORTALITY
CAUSES OF FISTULAS PATIENTS CURED PERCENT
(1) Obstetric……5……100.0……0
(2) Abdominal operation of uterus for non-malignant diseases……3……100.0……0
(3) Abdominal hysterectomy for cancer of the cervix……5……80.0……0
(4) Irradiation therapy for cancer of the cervix……6……50.0……0
(5) Resection of the bladder neck for neurogenic bladder……1……0.0……0
All of cured cases were performed by transvesical approach.
2) As indicated in next table, the obstetric fistulas were the most frequent in our country. But the last ten years, these incidence have been decreased remarkably concomitant with increasing caesarean section.
THE CAUSES OF VESICOVAGINAL FISTULAS IN JAPAN: 1903-1966
PATHOGENESES NO. OF CASES PER CENT
(1) Obstetric……115……44.1
(2) Gynecologic……104……40.6
(3) Tuberculous……16……6.1
(4) Calculi or foreign body in the urinary bladder……5……1.9
(5) Vesical operation……4……1.5
(6) Traumatic……4……1.5
(7) Miscellaneous……7……2.7
(8) Unknown etiology……6……2.0
3) After a review of 105 cured cases in Japanese literatures and our experiences, we believe that the most effective approach to vesicovaginal fistula is as follows.
LOCATION OF FISTULA ROUTE OF CHOICE
(1) Near the vesical neck……vaginal
(2) In the trigone……vaginal or transvesical
(3) Near the ureteral orifice……transvesical
(4) In the posterior wall of bladder……transvesical

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To prevent papillary tumor from recurring, ligation of the internal iliac arteries was performed bilaterally.
1) Normal bladders of rabbits were examined to find out their distribution of arteries, and then their collateral circulation was explored after having ligated their superior vesical arteries to examine their histological findings in the course of days. The result is that:
The bypaths after the ligation of superior vesical arteries were found running between inferior vesical arteries and inferior mesentric arteries, and inferior vesical arteries and testicular arteries, as supplementary circulation. Hisotological findings were that shedding of the epithelium and atrophy of the smooth coat were seen at the early stage after the ligation, after 25 days the smooth muscle coat began to recover, and that when 2 months passed the muscle coat was normal with only vacuoles and karyopyknosis left on the mucous epithelium.
2) 17 cases of papillary bladder tumor having recurred 2 or 7 times were respectively given simple resection, electrocoagulation, segmental resection of the urinary bladder, or TUR Bt on the tumor. No recurrence has been found yet in any case when they have passed the previous recurring periods.
Arteriography of the bladders after the operation was like that of rabbits; histological findings of the tumor biopsied 20 days after the operation were the presence of vacuoles and karyopyknosis in tumor cells.
It is assumed that recurrence of papillary bladder tumor can be prevented if the ligation of the internal iliac arteries is given at the same time when tumor resection is performed.

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