Specimens of adrenal cortex obtained from 30 patients with adrenal hyperactivity including 16 primary aldosteronism, 1 secondary aldosteronism, 11 Cushing's syndrome (4 adenoma and 7 adrenal hyperplasia), 2 adrenogenital syndrome (1 adenoma and 1 adrenal hyperplasia—biopsy) were examined histochemically. As controls, 10 biopsy specimens of normal adrenal gland were taken at the time of retroperitoneal surgical procedures.
The following enzyme histochemical stainings were performed in each specimen. —lactate dehydrogenase, glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase, isocitrate dehydrogenase, succinate dehydrogenase, malate dehydrogenase and 3β-hydroxysteroid dehydrogenase. By this study the following observations were made:
1) Adrenal hyperplasia: In the hyperplastic adrenal glands, compact cells become so prominent that zona reticularis appears widened. With this change all the enzyme stainings increase in the compact cells which extend towards the zona fasciculata. Among the activities of these stained enzymes, glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase increase most markedly in compact cells. It could be said that the histochemical examination of these enzymes gives us useful information about hypercorticalism when we can not get evidence of hyperfunction of adrenal cortex in hematoxylineosin staining. 3β-hydroxysteroid dehydrogenase stained intensely in the clear cells of the zona fasciculata in normal adrenal cortex. The activity of this enzyme increases and is also seen in some compact cells in hyperplastic adrenals.
2) Adenoma of adrenal cortex: Adenoma of primary aldosteronism consists mostly of clear cells, while that of adrenogenital syndrome is composed exclusively of compact cells. In adenoma of Cushing's syndrome, compact cells are predominantly seen. All the enzyme activities studied, excluding that of 3β-hydroxysteroid dehydrogenase, are very strong in the compact cells while in the clear cells glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase and 3β-hydroxysteroid dehydrogenase are weakly stained with absence or low activities of the other enzymes. These histochemical characteristics of adenoma cells are commonly noted in all the cortical adenomas of primary aldosteronism, Cushing's syndrome and adrenogenital syndrome.

View full abstract

1) A case of adrenal feminizing syndrome due to adrenocortical adenomatous hyperplasia in a 27-year-old man is reported. This case is regarded as the first case caused by adenomatous hyperplasia in the world.
2) The symptom was associated with gynecomastia, hypoplastic genitalia and hypertension. Enlargement of the right adrenal gland was proved by the tomography with pneumoretro-peritoneum.
3) The urinary 17-KS and 17-OHCS excretion level reviewed within normal range and/or slightly lower than the normal. Androsterone was significantly decreased and dehydroepiandrosterone was increased out of fractions of urinary 17KS. Estrogen and pregnanediol were elevated. Among the fractions of urinary estrogen, estriol was increased. Urinary 17KS, 17-OHCS and estrogen excretions did dnot respond to ACTH-test, dexamethasone-test, metopirone-test or HCG-test, suggesting that secretionn of the adrenocortical hormone in this case is independent of the hypophysis.
4) The right adrenalectomy was carried out and the removed specimen measured 3.0×2.5×2.0 cm and weighed 18 g. The histological diagnosis was adenomatous hyperplasia of the adrenal cortex and no sign of malignancy was detected.
5) Postoperatively, the urinary 17-KS, 17-OHCS and the fractions of 17-KS were unchanged, however estrogen returned to normal level and pregnanediol showed to be lower than the pre-operative level.
6) No change of clinical symptoms was noticed after the adrenalectomy, but significant improvement appeared by androgen therapy. A plastic operation for hypospadias was carried out. The hypertension in this case was difficult to control by antihypertensive agents, however the blood pressure was, controlled by the drugs within normal range after adrenalectomy.
7) It is suggested that the biosynthesis of adrenal androgen in this case may pass the way from pregnenolone to androstenedione via progesterone besides the way via dehydroepiandrosterone.
8) Clinical symptoms, findings of X-ray films and results of hormonal examinations of the cases of carcinoma, adenoma and our case were reviewed. Differential diagnosis from the testicular feminization and the problem of hypospadias were discussed.

View full abstract

A clinical study with some surgical aspects was performed on 23 cases of primary aldosteronism treated in our clinic from July, 1957 to March, 1969. Results were summarized as follows:
C. Electrolyte balance and replacement during pre- and postoperative course.
1) During few days after removal of the adrenal tumor, a remarkable loss of both sodium and potassium was observed in the majority of the cases.
2) In this period, sodium supplement resulted in more sodium loss. The potassium loss was regulated under the direct influence of serum potassium level.
3) These responses might be caused by following three factors; proximal tubular rejection of sodium, disturbance of distal tubular function, and inactivation of renin-angiotensin-aldosterone system.
4) A restoration of proper electrolyte regulation mechanism was being apparent during the second postoperative week.
5) An excessive preoperative potassium conservation with sodium elimination, accordingly, might be followed by postoperative sodium deficiency. A low sodium and high potassium supplement during approximately five postoperative days and a high sodium administration after that period would be necessary. A program of the electrolyte supplement based on above-mentioned findings was demonstrated on Table 1.
6) An administration of mineral corticoids or anti-aldosterone drugs might be no effect to improve such postoperative electrolyte unbalance.

View full abstract

To date the rejection crises of renal homografts have been detected mainly by the clinical signs of patients after renal homotransplantation. As the author has reported in the previous paper, it is possible to detect rejection reactions of the homografts by the measurement of urinary LAP activities. Further studies have been made on urines of patients after renal transplantation in order to establish the classification of the rejection stages, rejection reactions, and standardization for urinary LAP values as well as to obtain a measure for the prognosis. From the results obtained through the observations for about 21 months in the 9 cases of renal homotransplantation performed and followed at the Tokyo University Hospital, the following conclusions were obtained:
1) The enzymatic rejection reaction occurs 5 days to 2 weeks prior to the clinical rejection reaction. 2) The initial rejection reaction will occur within 2 weeks after the renal homotransplantation. 3) The rejection reaction will last for a week to a month. 4) The temporary increase of urinary LAP activities observed in the first day of homotransplantation does not mean the rejection reaction. 5) No interrelationship between leucocytosis and increasing values of urinary LAP activities was observed. The leucocytosis within one week to two weeks after the renal homotransplantation is unworthy for detecting the initial rejection reaction. 6) The measurement of the urinary LAP activities will give a standard pattern for the administration of immunosuppressive drugs. 7) The prognosis of the cases with enzymatic rejection reaction is good because the clinical symptoms in these cases are mild. 8) The prognosis of cases with chronic rejection reaction is generally unfavorable and when the chronic rejection reaction moves to the refusal type, the prognosis promptly becomes grave. 9) The sudden decrease of urinary LAP activity in the steady stage means the developement of complications. When the urinary LAP activity fails to return to the level of the steady stage, or when the rejection reaction moves to the refusal type, the death is considered to be imminent. 10) When the rejection reaction moves to the critical stage without passing the steady stage and indicate the pattern of the sudden decrease of LAP activity, a direct death caused by the rejection reaction will be observed.

View full abstract

Up to the present, we have many reports on the neurophysiology of the urinary bladder. These are, however, mostly depending upon classical concepts on the autonomic nervous system. Since physiological significance of the cystometrogram was evaluated on such bases, there could be found some clinical contradictions between actual micturition activity and results of the cystometrogram. Recently, concerning the importance of diagnosis and therapy on the neurogenic bladder, it has been required to establish a clinical value of the cystometrogram. So that, to clarify the physiological meaning of the cystometrogram on the functional activity of the normal and neurogenic bladder, following experiments were performed using adult dogs.
With selective electrical stimulation on various regions of the sacral cord, as well as the sacral, hypogastric, and pelvic nerves, the physiological contribution of each nervous element against vesical contraction was analysed.
Furthermore, on the experimental neurogenic bladder of dogs, which were induced by the surgical section of the respective sacral nerve root, the cystometrogram and cystogram were obtained. Several theoretical parameters were set and compared with each other using the actually measured values on these examinations.
Following the electrical stimulation on the sacral cord, the main efferent pathway from the sacral cord to the bladder was estimated as originated from the ventral or lateral horn of the cord, and reached to the bladder via the ventral root and the pelvic nerve. Besides this, another efferent pathway, such as originated from the dorsal horn of the sacral cord, and passed down to the bladder via the dorsal root and the pelvic nerve was estimated. Furthermore, the latter would receive partially some requlatory effect by the dorsal root ganglion. However, neither the interneurons connected to the ventral horn nerve cells from the lateral or dorsal end-apparatus of the afferent systems nor that as the element of reccurrent inhibition system to the efferent system in the ventral horn existing in the ventral root itself, could be confirmed.
On the other hand, with the selective section of the spinal cord or the peripheral nerves to the bladder, some functional relations of the higher center to the vesical efferent nerve center in the ventral horn of the sacral cord was assumed as well as that of the hypogastric nerve to the vesical efferent nerve center in the dorsal horn of the cord. However, the inhibitory system to the dorsal efferent pathway entering the sacral cord via the ventral root could not be confirmed as well as the role of efferent nerve fibers in the dorsal root of the sacral cord which do not have any synaps in the dorsal root ganglia.
The interaction of the lumbar nerve system to the sacral activity was rather clearly found, but a direct effect of the hypogastric nerve activity and that of the lower sympathetic trunk to the sacral contraction of the bladder could not be confirmed. However, some intraspinal interaction could be assumed.
On the other hand, it was possible to define the hypertonic or hypotonic state of the bladder by measured values on cystometrographic components, but it was not possible to do so from that of the cystogram. Therefore, it has been tried to state the biological condition of the bladder by available parameters obtained from a geographic dimension of the cystometrogram and cystogram. For this purpose, parameters calculated from the increment of the intravesical pressure and that from the stretching rate of the vesical wall were most valuable. The former is to be obtained directly from the measurement of cystometrographic components. However, from the latter nothing could be learned.
To analyse the latter, mural tension of the vesical wall (T), a pure physical function, was induced as the parameter, and a constant R (P·V/T) was derived from the comparison of it with mechanical stimuli (P·V) by intrav

View full abstract

The diagnosis of bone metastasis of the prostatic carcinoma is usually based on the findings of the roentgenogram of the pelvis, lumbosacral spine and other skeleton parts. The bone metastasis, however, is not always demonstrated radiologically as abnormal findings. Schackmann reported macroscopically visible, but radiologically invisible, metastases in more than half of the cases examined at autopsy.
Rundle et al. and some other investigators found that examination of bone marrow from patients with the prostatic carcinoma could be helpful in the diagnosis of bone metastasis.
We had performed the bone marrow aspiration in 18 cases of the prostatic carcinoma, and the following results were obtained.
1) Of the hormonally untreated 10 cases, 4 cases showed positive bone marrow findings (bone marrow bearing tumor cells) with abnormally high levels of serum acid phosphatase and 2 cases of them revealed radiologically normal findings. Four cases were demonstrated as metastatic findings in roentgenogram, but 2 cases of them had negative bone marrow findings and normal levels of serum acid phosphatase.
2) All of the hormonally treated cases revealed negative bone marrow findings regardless of the positive radiological findings and high serum acid phosphatase levels in some cases.
3) It was considered that normal radiological findings could not always make a denial of bone metastases, as well as the osteoplastic roentgenograms would not necessarily indicate active metasta tic lesions.
4) The procedures of bone marrow aspiration were simple and easy, and none of the complications were observed.
5) Regarding to the diagnostic and prognostic significances of this examination, the bone marrow aspiration would be recommended as a routine work for the prostatic malignancy.

View full abstract

This paper reports the statistical observations on the clinical work at the urological department of the Mitsui Kosei Hospital during the period from 1957 to 1968.
The number of tuberculous patients per year has decreased while that of nonspecific urological infection has increased slightly.
No remarkable changes have been observed concerning the cases of malignant tumors, claculi and urogenital injuries.

View full abstract