In order to investigate the pre-operative and post-operative ureteral function in calculous disease of the upper urinary tract and the direct relationship between its function and urinary fistula-building, various examinations were made by ureteral electromyography through a cystoscope. 47 cases of nephrolithiasis and 53 cases of ureterolithiasis were examined before surgery, then within 2 weeks, after surgery 2-5 weeks and over 5 weeks, and, at the same time, observations were made on how long the urinary fistula remained open without special treatment.
The following results were obtained:
1. The preoperative results; 1) In nephrocalcinosis, the discharge interval of action potentials was found to be prolonged, compared with that of the normal ureter, and antiperistalsis was observed.
But, the amplitude of action potentials, the duration of discharge, and their propagation rate were almost within normal limits.
2) In ureterolithiasis, almost the same results as in nephrolithiasis were obtained.
2. The post operative results; 1) In linear vertical pyelolithotomy, the abnormal action potentials of prolonged discharge interval and antiperistalsis increased within 2 weeks after surgery in all cases. In some cases the action potentials disappeared.
But, the abnormal action potentials showed a tendency to continually decrease and over 5 weeks to decrease even more.
2) In nephrolithotomy, the same tendency as in pyelolithotomy was seen except that the action potentials disappeared.
3) In linear vertical ureterolithotomy, abnormal action potentials of prolonged discharge interval and antiperistalsis increased slightly within 2 weeks in all cases. But after 2-5 weeks they showed a tendency clearly to decrease and over 5 weeks even more clearly.
4) Although there were some exceptions, the general tendency was that the abnormal action potentials slightly increased in cases with urinary fistula-building observed for over 10 days.

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The present study was made in patients of the following two groups: a group of patients following radical surgery for cancer of the rectum and of the colon. Total cases are 31, and 21 of them are rectum cancer, and the other 10 are colon cancer. All data in the present study have been gathered through a questionnaire study. In each history, many items, such as general physical conditions, condition of micturition, morning erections, frequencies and potency in coitus, duration of intromission, condition of ejaculation, frequency of orgasm and so on, were explored. The rate of incidence of no erection during the intercourse following radical surgery for cancer of the rectum reaches 33.3 per cent (26.6 per cent under 70 years of age), and 44.5 per cent have no sufficient erection. After radical operation for cancer of the colon, 33.3 per cent (25.0 per cent under 70 years of age) of the patients have no erection at the intercourse, 22.2 per cent have no sufficient erection. In 72.2 per cent of the patients following radical operation for cancer of the rectum have no ejaculation. On the other hand, cases of no ejaculation are found in 25.0 per cent of patients following radical operation for cancer of the colon.
It is clear that these postoperative sexual dysfunction due to injury of the pathways of the sympathetic and parasympathetic nerves upon which normal sexual function is dependent. Dissection of these nerves concerned with sexual function can not be avoided and is a necessary sacrifice while performing adequate local surgery for malignent tumor. But we must weigh our concern for the patient's postoperative sexual function as much as the desire to prevent local recurrence of the malignant disease.

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Remarkable progress in diagnostic technique has made it possible to detect not a few renovascular hypertensive patients. This diastolic hypertensive disorder has been much attracted and many articles on the subject have been published because of its effectiveness by surgical treatment and its suggestive association with the renin-angiotension-aldosterone system. The etiology of this disease has been obscure, and the causative as well as maintaining mechanism is no more than speculation. Recently, two interesting cases of renal hypertension were experienced in our clinic and articles of renovascular involvements have been dicussed.

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The authors were studying on the fibrinolytic enzyme system (F. E. S.) in the blood and the urine influenced by the exercise.
Since Macfarlane et al. (1947)reported on the presence of F. E. like substance in human urine, it was recognized that this substance is the activator of plasminogen (urokinase: UK).
The standard values of the fibrinolytic activities of fresh and acid-treated urine, U. K. extracted by thiocyanate in healthy human, and the relationship between these F. E. S. in urine and the exercise are described in this report.
1. It is pronounced that the UK involved in normal human urine is varied by age and sex.
In healthy women aged 18 or 19, the mean lysis-area of the fresh urine on the standard fibrin-plate was 262.3mm²(±35.6mm²) (155 cases), that of the acid-treated urine 57.5mm²(74 cases), and that of UK 85.9mm²(±35.6mm²) (95 cases).
2. The change of F. E. S. in urine was influenced by the exercise:
1) The fresh urine;
In the group of its lysis-area below 300mm² before the exorcise, its activity increased after the exercise, and in the group of that over 300mm² before exercise, it decreased.
2) The urokinase;
In the group of its lysis-area below 100mm² before the exercise, its activity increased after the exercise, especially that below 50mm² increased significantly. In the group of that over 100mm², its activity increased significantly after the exercise.
3) The acid-treated urine;
In the group of its lysis-area below 200mm² before excrcise, its activity increased after exercise, and in the group of that over 200mm² before exercise, that decreased significantly.
These fibrinolytic activities of urine were observed to show tendency to approach normal values after exercise.
3. The relation between the change of microhematuria and the F. E. S. in urine was influenced by the exercise:
In the group where microhematuria appeared first after the exericse and where microhematuria after the exercise was observed unchanged as before, the fibrinolytic activity of fresh urine increased after exercise. And in the group where the microhematuria was not observed before or after the exericse and where it decreased after the exercise, its activity decreased after exercise.
The activity of acid-treated urine decreased after the exercise in both groups, but in the group where the microhematuria after exercise was not observed, its decreasing tendency was stronger than in the other group.
On the contrary, the U. K. increased after the exercise in the group, where the microhematuria was not observed after the exercise, and the U. K. decreased in the other group.
In comparison of these activities with the involving grade of microhematuria without exercise, its, activities of fresh urine and acid-treated urine was related to the involving grade of microhematuria.
4. The relation between the grade of the albuminuria and these activities:
The activity of freah urine with albuminuria of 30mg/100ml was strongest, and the activity of acid-treated urine without protein was stronger than its activity of albuminuria.
The U. K. in the urine with protein of trace was most abundant, and that of protein of 30mg/100ml and without protein was low.
5. The relation between pH of urine and these activities:
The lysis-area of fresh urine ranged pH 6.6-7.0, below 5.0, 6.1-6.5, 5.1-5.5, and 5.6-6.0. The power of U. K. ranged from pH 6.1-6.5, to below 5.0, and that of acid-treated urine ranged pH 5.1-5.5, below 5.0, 5.6-6.0, 6.1-6.5, 6.6-7.0 of urine.
Especially, the lysis-areas of U. K. below pH 5.5 were more extensive than that of acid-treated urine.
6. There was no relation between these activities of fresh urine, acid-treated urine and U. K.
7. The relation between the menstrual cycle and these activities:
These activities in s

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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:
A. Roentgenological diagnosis.
1) Tumor contour was visualized in 50% of all the cases by air insufflation method (PRP or Pneumoren) combined with tomography.
2) A possibility of tumor contour visualization by air insufflation was dependent upon the size of the tumor itself. Most tumors under forefinger-tip-size gave no distinct contour on PRP or Pneumoren films.
3) Some of such small tumors were successfully confirmed by retardation sign of radiopaque substance in the tumor immediately after angiography (Delayed exposure film). In 10 cases (77%) out of 13, the localization of the tumor was accurately diagnosed preoperatively by the delayed exposure technique combined with air insufflation method. No false positive finding was obtained from this technique.
B. Surgical operation procedure.
1) For the posterior approach to the bilateral adrenals under the face-down position, we employed a extrapleural procedure with eleventh and twelfth ribs resection, of which the oblique skin incision was placed along the eleventh rib to the middle axillar line. This procedure was to be excellent and seemed worthy of recommendation.
2) Required time for the surgery by this approach was longer than that through the anterior trans-peritoneal approach, although postoperative course of the patient treated by this procedure was rather well.
3) For the present, the most reasonable means of the surgical treatment on primary aldosteronism might be the unilateral exposure on which side the tumor was localized, after the setup for bilateral exposure by the face-down position when the tumor could not find on that side.

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It is accepted that efficacy of drug treatment for pyelonephritis is partly dependent on drug concentration in the affected kidney tissue. However, function of the pyelonephritic kidney is deteriorated and drug distribution in the affected kidney may alter itself by the grade of renal damage.
This paper presents the study on distribution of some abtibiotics and a sulfonamide drug in experimental pyelonephritic kidneys by determining the drug concentrations in cortex, medulla and papilla, compared with those in normal kidneys when normal treatment doses were applied. Experimental pyelonephritis was produced by intracardial inoculation of E. coli or Citrobacter strain to rats of Wistar species combined with external renal massage.
Distribution of sulfisomesole was studied in experimental E. coli pyelonephritis.
Concentration of the drug in the kidney was remarkably decreased to almost half compared with the control, and concentration gradient from cortex to papilla was also declined significantly. Insoluble acetylated compounds of the sulfonamide were determined in inflamed and normal renal tissue. Acetylation rate in affected kidney was markedly increased in two or three times, compared to the control kidney.
The same studies as on the sulfonamide were carried out on tetracyclines and cephalosporin derivatives in experimental pyelonephritic using a strain of Citrobacter.
Four analogues of tetracyclines, namely tetracycline, oxytetracycline, chlortetracycline and N-pyrrolinidomethyltetracycline were used in this study. The distribution of oxytetracycline, which had high renal clearance, and chlortetracycline, which was poorly excreted from the kidney, were compared with the normal and infected kidney. These two drugs showed remarkably poor distribution among the infected kidney, and above this, concentration gradient from cortex to papilla was also declined in these two drugs. On the other hand, distribution of tetracycline and N-pyrrolinidomethyltetracycline in the inflamed kidney showed no significant difference compared with the control kidney.
Distribution of cephalosporin derivatives or cephaloridine and cephalothin was studied in the same way as the previous drugs.
Cephaloridine is mostly eliminated by glomerular filtration and cephalothin by tubular excertion. In normal group, cephalothin was eliminated more rapidly than cephaloridine. In pyelonephritic group, the accumulation of these two drugs into the kidney was restricted and concentration gradient of the drugs from cortex to papilla was remarkably declined. The enzymatic activity of this strain was not so high determined by iodmetric assay in vitro. From these facts, low diffusion of these drugs in infected kidney tissue is attributed to both pathophysiologic condition of the pyelonephritic kidney and enzymatic inactivation of the antibiotics by β-lactamase produced by this strain.
The above studies showed no difference on drug diffusion among these three kinds of drugs or sulfonamide, tetracyclines and cephalosporins, in spite of the different excretion mechanism from the kidney respectively. However, it should be emphasized that no reasonable elevation of BUN was observed in the entire group at the time the study was performed.
Considering these results, to maintain effective level of the drug in the pyelonephritic kidney, larger dosis should be administered.
However, the susceptibility of the inflamed kidney to nephrotoxicity of antibiotics or chemotherapeu tics should be kept in mind.

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