Peripheral plasma renin activity, plasma electrolytes, and urinary excretion of sodium were estimated before and after hemodialysis in 39 patients of terminal renal failure, and the effect of bilateral nephrectomy on blood pressure in 13 patients were studied. In 5 patients, juxtaglomerular cell granule was stained according to Bowie's procedure.
The diagnosis was chronic glomerulonephritis in 34 patients, malignant nephrosclerosis in 3, and polycystic kidney in 2.
Renin activity of these patients were classified into three groups. Group 1 (5 cases) showed a remarkably high activity (210-590ng/ml/24hrs. incub.), group 2 (15 cases) a lower (0-5ng/ml) than a normal (5-12ng/ml) activity, and group 3 (19 cases) a normal or higher than normal (8-76ng/ml) activity.
Renin activity of groups 1 and 2 remained unchanged after hemodialysis. In group 3 it changed more or less after hemodialysis, and in 17 cases, renin activity was elevated after hemodialysis. This was due to the rapid excretion of water and sodium by an artificial kidney.
In 14 cases, inverse relationship was found between renin activity and urinary excretion of sodium, but in the others there was no relationship. In other words, renin release in terminal renal failure does not always conform with the macula densa theory.
Two cases in group 2 had no juxtaglomerular cell granule, but three cases in group 3 revealed a high granularity of the JG-cell in normal as well in hyalized glomeruli.
Clinical diagnosis of group 1 was malignant nephrosclerosis in 3 patients and glomerulonephritis in 2 patients. In this group, antihypertensive drugs, strict dietary sodium restriction, and low sodium and ultrafiltration dialysis were all without effect in reducing diastolic hypertension. Only bilateral nephrectomy produced a sustained decrease in blood pressure. On the contrary hypertension in group 2 was controllable by hyponatremic and dehydration treatment. Hypertension in group 3 was somewhate improved by the conservative treatments and satisfactory control of blood pressure was possible after bilateral nephrectomy. Namely, hypertension in group 1 was caused by renin, that in group 2 by renoprival factors, and that in group 3 by renin and renoprival factors.
It is suggested that bilateral nephrectomy is indicated for terminal renal failure with severe hypertension in group 1 and group 3, whose renin activity is higher than 50ng/ml.

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The fine structure of the human adrenal cortex in hyperfunctioning states was investigated. Materials were taken during surgery from 6 patients with Cushing's syndrome, of which 2 were due to adrenal adenoma and 4 were due to adrenal hyperplasia, as well as from 7 patients with primary aldosteronism, in which every case proved to be due to adrenal adenoma. The specimens were fixed immediately after removal either in 2% osmium tetroxide or in 2.5-4% glutaraldehyde. The latter was followed by a postfixation in 2% osmium tetroxide. After dehydration the specimens were embedded in Epon epoxy resin. Thin sections for electron microscopy were made with glass knives on a Porter-Blum microsome, and stained with lead or with 1.0% uranyl acetate and lead to be examined with a Hitachi HS-7s electron microscope. The results are as follows:
(1) In the cases of Cushing's syndrome the specimens presented a wide variety of cellular fine structures both in adenomatous tissues and in zona fasciculata of the hyperplastic adrenal cortex. The structural changes were far more prominent in the former than in the latter. Some mitochondria in the adenomatous tissues resembled those which were found in the normal zona fasciculata, but others showed a wide variation in number, size, form and in the arrangement of cristae. The findings in the cases of adrenal hyperplasia differed from those in the cases of normal zona fasciculata. Mitochondria were irregular in form and in the arrangement of cristae. In one case of adrenal adenoma, occurrence of small electron dense bodies in the agranular endoplasmic reticulum as well as openings of the endoplasmic reticulum into the intercellular space was recognized. The significance of the dense bodies remained unknown.
(2) Simillar findings were obtained in all of the 7 cases of primary aldosteronism. The adenomatous cells in these patients were characterized by rich vacuoles and myelin figures. Mitochondria essentially corresponded in form and structures to those of the normal zona glomerulosa.
These findings indicated that in the hyperfunctioning states of the adrenal cortex, mitochondria presented a wide variety in their size, form and structure which could not be seen in the normal state. On the basis of the characteristic structures of mitochondria, it is suggested that the adenoma in Cushing's syndrome might be derived from the zona fasciculata whereas the adenoma in primary aldosteronism from the zona, glomerulosa.

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Functional states of the human testes in various conditions were analysed by histochemical methods. The main purpose of this investigation was to know whether there was any peculiar pattern of enzymatic distribution in the testicular tissues in relation with pathological states. Biopsy specimens were taken from the testes of 47 patients with various testicular disorders such as retentio testis (23 cases), male sterility (15 cases), hypogonadotropic hypogonadism (4 cases), Klinefelter's syndrome (3 cases), and idiopathic varicocele (2 cases). The tested enzymes were: lactic dehydrogenase (LDH), DPN diaphorase (DPN-D), alkaline phosphatase (ALP) and acid phosphatase (ACP). A modified Nachlas's method was employed for the first two enxymes and a Burstone's method for the last two. The findings were compared with those of the normal human testes.
The results obtained were as follows:
(1) In the normal human testes, the activities of LDH and DPN-D were prominent both in the peripherally situated cells of the seminiferous tubuli as well as in the interstitial cells. ALP was mainly distributed in the peripherally situated cells of the seminiferous tubuli and in the vessel walls of the interstitium, while no activity was found in the interstitial cells. Activity of ACP was also marked in the peripheral tubular cells and in the interstitial cells.
(2) Of 23 cases with retentio testes, 16 were prepuberal and 7 were puberal or postpuberal. In the prepuberal cases, no enzymatic activities were found in the interstitial cells. In 15 unilateral cases, the findings in the retained testes were compared with those in the scrotal testes. Activities of LDH, DPN-D and ACP showed similar distributions both in the retained testes and in the scrotal testes. Though there was no activity in the tubular cells of the retained testes, in 8 out of 15 cases ALP activity was observed in the tubular cells of the scrotal testes. The findings suggested a certain kind of metabolic disurbance in the retained testes even from the early prepuberal stage.
In the puberal or postpuberal cases, highly degenerative changes were observed in the seminiferous tubuli of the retained testes and hypospermatogenic findings in the scrotal testes. ALP activity was detected in the tubuli of the scrotal testes, but no activity was found in the retained testes, LDH, DPN-D and ACP activities showed similar distributions both in the retained testes and in the scrotal testes. Enzymatic distributions of the interstitium showed no difference between in the retained testes and in the scrotal testes. This finding suggested that the state of “retention” had no recognizable effect on the function of interstitial cells.
(3) Of cases with male sterility, those with hypospermatogenesis or spermatogenic arrest presented a normal pattern of enzymatic distribution, whereas cases with germinal cell aplasia or peritubular fibrosis presented a lack in ALP activity in the seminiferous tubule.
(4) In cases of hypogonadotropic hypogonadism there was no enzymatic activity in the interstitial cells, but the seminiferous tubuli which mainly consisted of undifferentiated cells showed a fairly recognizable distribution of the enzymes.
(5) In cases of Klinefelter's syndrome, the interstitial cells had well recognizable enzymatic activities, including the activity of nonspecific esterase. However, in one case, where islet-like grouping of the interstitial cells were prominent, ALP distribution also showed a patchy pattern, suggesting a functional disturbance of the interstitial cells.
(6) The testicles of patients with left varicocele showed spermatogenic disturbances of the same grade on both sides. But, there was no peculiar changes in enzymatic distribution.
These results indicated that, of four enzymatic activities investigated, alkaline phosphatase had a peculiar significance in the human testes in relation to functional disturbances.

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On the basis of Boyland's hypothesis, 2, 5-di-o-acetyl-D-glucaro-(1→4) (6→3)-dilactone (SLA) which has been found to possess a potent inhibitory action on β-glucuronidase activity in vivo was given orally to the post-operative patients with bladder tumor.
SLA was administered to 122 patients while the control group was composed of 92 patients. All the patients were histologically transitional cell type.
One-year follow-up was made with 116 patients in the SLA-group and with 56 patients in the control, and two-years follow-up was made with 78 patients in the former and with 31 patients in the latter.
In the one-year follow-up the recurrence rate was found to be 43% in the control and 24% in the SLA-group, while, in the two-years follow-up, it was 64.5% in the former and 27% in the latter respectively.
On the other hand, in the patients suffering from frequent recurrences the effect of SLA was found to be marked only after long-term administration, suggesting that SLA might suppress the carcinogenic activity of urinary substances possibly originated from tryptophan.

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Eight cases of primary vesicoureteral reflux occurring in female adults are presented. They were diagnosed as non-obstructive vesico-ureteral reflux by means of endoscopic and radiographic examinations but all of them had more or less irritability of the urinary bladder and showed abnormal pattern in the cystmetric findings. Although it has to be very strict to decide the time when surgical procedure is begun in cases of children, but in adult patients, only an operative treatment should be considered in comparatively early stages, because drug therapy alone is usually insufficient to cure. A modified method of Lich-Gregoir was successfully used in this series to correct the condition, and the merit of this method was stressed.

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Clinical observation on erection and ejaculation of the paraplegics was made on the patients admitted in Fukushima Rosai Hospital. In addition to clinical observation, a trial to induce erection and ejaculation on these patients was made, using a special vibration apparatus which gave stimulation to the glans penis.
The results obtained are as follows:
1) Erection. It was found to be preserved in 34 of a total of 57 cases (60%). The rate of preservation was highest in the cervical segment and a tendency of the rate being smaller was found as the lesion existed in the lower segments.
The rate of preservation of erection was higher in patients with incomplete lesion (73%) than in those with complete lesion (51%).
Erection occurred most frequently by local stimulation (76%) and other causative factors were spasm of the limb (53%), psychic stimulation (26%), filling of the bladder (16%), micturition (9%), and body motion (9%).
The period from injury to reappearence of erection was longer in the lower spinal lesion.
Erection caused by vibratory stimulation was seen in 16 (39%) of 41 cases who were given the penile stimulation. Of these, 3 had had no spontaneous erection since the injury. On the other hand, 9 cases with spontaneous erection could not be caused erection by the stimulation.
2) Relation between preservation rate of erection and cornal reflexes and types of neurogenic bladder. Anal reflex and bulbocavernosus reflexes were positive in 26 cases (76%) and 25 cases (73%) of the cases with spontaneous erection, respectively. Thirty-one cases were performed cystometry. Twenty-three cases were classified as supranuclear type of neurogenic bladder. Nineteen of these 23 cases were found to be preserved erection. Eight cases were classified as subnuclear and nuclear type, and erection of this type was found to be preserved in only 1 case.
3) Ejaculation. Of a total of 57 cases 6 cases (10%) preserved ejaculation as well as erection. Drizzling of seminal fluid was seen in 3 cases who had no erection after injury.
4) Sexual intercourse and sexual desire. Three cases of a total of 57 were tried intercourse successfully and experienced ejaculation.
Sexual intercourse was found to be desired by 53 of 57 cases.

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1) A case of a 17-month old female with noradrenaline secreting neuroblastoma was reported. Clinical symptoms were left abdominal tumor and high blood pressure. Biochemical examination revealed high level of noradrenaline in blood and urine.
2) A classification of the nurogenic tumor based on the production of catecholamines was discussed.

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