The genesis of urinary calculi is poorly understood. It has been previously reported that the compoments of the organic substances in urinary calculus are chiefly mucoprotein and mucopolysaccharide.
Actually, the patients of urinary calculi excrete mucoprotein more significantly than normal persons.
Therefore it is obvious that the organic substances, especially mucoprotein, play an important role in the genesis of urinary calculi.
The organic substances were extracted from oxalate calculi and phosphate calculi.
These organic substances were injected intramusclarily in rabbits for the formation of antiorganic substances serums.
These anti-serums were labelled with F. I. T. C. using Kawamura's technique.
The kidneys of stone formers as well as of non-stone formers were stained with this fluorescent antibody solution.
In addition, the urinary mucoprotein was extracted from the patients of urinary calculi and from normal persons and anti-urinary mucoprotein serums were obtained with these urinary mucoproteins.
Fluorescent antibody solution of urinary mucoprotein was also obtained using Kawamura's technique.
The kidneys of stone formers and of non-stone formers were stained with this fluorescent antibody solution.
Following results were obtained;
1) In the kidneys of stone formers, mucoprotein was contained more abundantly in renal medulla than in renal cortices.
2) In the kidneys of stone formers, mucoprotein was especially increased in the epithelial cells of uriniferous tubules, in intraranal spaces of uriniferous tubules and parietal layers of Bowman's capsules. These facts could be not observed in the kidneys of non-stone formers.
3) In the epithelial cells of uriniferous tubules, mucoprotein was localized only in cystoplasms and not in nucleuses. Mucoprotein was also scattered in glomeruli.
4) Regarding the intrarenal distribution of mucoprotein, there were no differences between the kidneys of oxalate stone formers and those of phosphate stone formers.
5) Immunofluorescently, urinary mucoprotein of stone formers were identical with that of normal persons.
6) It seemed that mucoprotein was contained in the kidneys of stone formers more abundantly than in those of non-stone formers.
7) In the urinary calculi, mucoprotein was contained laminately among the inorganic substances.

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An experiment on alimentary lithiasis of the urinary tract was performed using male rats of the wister line. The following grouping was set up on the basis of feeds given to the animal.
Group I. with normal feeds
Group II. with feeds deficient in Vitamin B₆
Group III. with feeds deficient in magnesium
Group IV. with feeds deficient in Vitamin B₆ and magnesium
Group V. as in group IV but burdened with tryptophan
Each group included six to eleven rats which were fed for 10 to 40 days.
The results were as follows:
1. Body weight increased adequately in group I and III, whereas the growth was inhibited remarkably in group II.
2. Little difference in amount of urine was recorded throughout the group.
3. The pH of urine was not changed in group I and III, increased in group IV and decreased in group V.
4. Influence on urinary excretion of Mg was not brought about by deficiency in VB₆. Mg excretion was decreased by Mg deficienct diet and increased by burden with tryptophan.
5. Deficiency in VB₆ and burden with tryptophan brought about an increase in excretion of urine Ca, whereas deficiency in Mg a decrease in excretion of urine Ca.
6. Deficiency in Mg caused an increase in urine P, whereas deficiency in VB₆ a decrease in urine P.
7. Influence on excretion of urine K was not brought about by Mg deficiency, moderately less excretion by VB₆ deficiency and strongly less K excretion by burden with tryptophan.
8. Excretion of urine xanthrenic acid was increased by VB₆ deficiency and by burden with tryptophan by 2 to 3 times and more than 70 times, respectively.
9. Histological findings with hematoxylin-eosin stain showed a slight edemalike or turbid swelling in the renal tubular epithelium in cases of VB₆ deficiency and Mg deficiency.
10. Histological findings with alizarin stain showed a peculiar finding. Round substances stained in orange-red were found in the renal tubulus; in 2 out of 6 cases in group I, in all cases in groups II and III, 4 out of 6 cases in groups IV and V.
11. Histological findings with Kossa stain (Nishiyama's modified method) showed a calcification in the nuclei of epithelial cells of the renal tubulus in group V. A calcific deposite was seen inside the renal tubulus in 5 out of 6 cases, 3 out of 5 cases in group III and group IV, respectively. No calcific changes were noticed in group I and II.
12. The bladder was opend in six rats of each group after 40-day-feeding. Bladder stones were found in 2 rats of group II, each in 1 of group III and IV but none of group I and V.

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The concentrated urine samples were obtained from 17 patients with oxalate urolithiases and 16 control patients who have the normal renal functions (vasectomy, phimosis, oligozoospermia, testicular tumor, etc.), and were measured for osmolality and oxalic acid as well as calcium and magnesium. The method to concentrate the urine is the same as Fishberg's concentration test, that is, the samples were the urines which the patients voided at morning after their over-night fasting. All calculi from the patients with urolithiases were confirmed to contain calcium oxalate by means of infrared spectra subsequent to the surgical removals. Oxalic acid was quantitatively estimated by the method of Yarbro and Simpson, calcium and magnesium were by the EDTA titration with Dotite NN and Dotite BT as indicators (8, 10), and osmolality was measured by means of Advanced freezing point osmometer.
Oxalic acid in the concentrated urine is shown in Fig. 1. The mean was 4.56mg/dl in controls and was 5.63mg/dl in patients with stones. Fig. 2 shows the ratio of oxalic acid: osmolality of the concentrated urine (Oxal/Osm×1000). The mean of ratios in controls was 5.44 and that of ratios in patients with urolithiases was 6.86. These data may indicate that the oxalic acid contents in the concentrated urines of patients with stones are not so different from those of controls. There is no relationship between the oxalic acid level in the concentrated urine and the 24-hr urinary excretion of oxalic acid (Fig. 3 and 4). The ratio of magnesium: calcium×oxalic acid (Mg/Ca×Oxal) in the concentrated urine is shown in Fig. 5. The mean of this ratio was 0.198 in controls and was 0.143 in patients with urolithiases. This result suggests a decrease of this ratio in the concentrated urine of patient with oxalate urolithiasis.

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In an effort to enhance the anti-tumor effect of drug therapy and at the same time lessen side effects thereof in the treatment of renal neoplasms, an attempt was made to administer anti-cancer drugs by continuous infusion into the renal artery.
1) Five cases with carcinoma of the renal parenchyma received treatment with an anti-cancer drug infused into the renal artery in a continuous manner through a catheter which beforehand was inserted into the artery and held there after Seldinger technique. The anti-cancer drug used was 5-fluorouracil, which was administered continuously over a 14-day period at a dosage of 500mg daily, hence in a total dose of 7000mg. Two of these 5 cases were given, in addition to the above medication, 3 doses of 10mg mitomycin C by one shot injection into the renal artery.
2) In all of 3 cases with a palpable tumor initially, out of the 5 thus treated, the tumor was found shrunk in size on palpation after therapy. The therapy was also associated with an appreciable reduction in tortuosity of blood vessels as well as in puddling of the contrast agent in the vascular sinuses on renal arteriography in 3 of the 5 cases. Histological examination of the growth following nephrectomy, which was feasible in 4 cases, revealed swelling and irregular boundaries of tumor cells along with karyorrhexis and pyknosis. Further noticeable changes included necrosis, which was seen to be extensive and diffuse in 2 cases and partial in another, and hemorrhage which was predominant in the remaining one case.
3) There was no evidence of systemic side effects involving the digestive tract or the hematopoietic system. The therapeutic procedure, despite of it requiring the catheter to be left in place for a 2week period, was attended, in no instances, by complications such as fever, bleeding, infection and circulatory disturbance of lower extremities. Although slipping off of the catheter from the renal artery into the aorta never occurred in any case, mechanical injury to the renal artery was noticed on the 14th day in one of early cases.
Being performed with relative ease and with reasonable safety, the therapeutic procedure is considered to be worth trying in properly selected cases.

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In the clinical course of the patients after spinal cord injuries, there are many inevitable complications such as urinary infection, stone formation, hydronephrosis and vesico-ureteral reflux. The incidence of dilatation of the upper urinary tract is high and its presence is one of the most critical cause of the progressive renal damage.
We have studied the clinical states and the treatment of hydronephrosis and hydroureter in the paraplegics, which could be observed and followed-up at the Osaka Rosai Hospital.
The dilatation of the upper tract was found in 33 cases (37 per cent) of 89 paraplegics. This state was more frequent in the lower motor neuron lesion than in the upper. Furthermore, the bladder dysfunction was not directly related to the combination of hydronephrosis.
It was noted from the study by DIP of these paraplegic patients, that the contrast medium outlining the ureter often stopped a short distance above the bladder. This was quite similar to the “notch sign” named by Hutch. However, this change could be considered as the sign which appeared in the earlier stage of paraplegics, because it was shown on the excretory urogram and in the clinical stage before the dilatation or reflux was observed. We concluded that this phenomenon was the early manifestation of dysfunction of the U-V valve mechanism and named it “stop sign”.
In addition, from the result that the “stop sign” faded on emptying the bladder, it was concluded that the dilatation of the upper urinary tract in paraplegics was originated from the fixation of trigonal components resulted from fibrosis and hypertrophy of trigonal musculature.
For putting out the fixation of ureteral orifices, we tried to cut the trigonal muscles and named this procedure “trigonal incision”.
By transurethral electrocutting of the trigone, the anatomico-physiological connection between the ureter and bladder was abrupted and the flow resistance at the intramural ureter was diminished, which was followed by an improvement of hydronephrosis. We have done the “trigonal incision” for the 12 paraplegics (14 times) with hydronephrosis, and it was effective in 59%.
There are two clinical states of hydronephrosis in paraplegics in general; 1) by the stenosis at the bladder neck and sphincter and 2) by the functional and/or organic obstruction at the uretero-vesical junction. We studied these two states, and the importance of the most suitable treatment and follow-up examination for the individual paraplegic patient with dilatation of the upper urinary tract was emphasized in this paper.

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Most of the 27 patients, with clinical evidence of carcinoma of the cervix, who underwent ureteroileocystostomy for repair of ureteric lesion, were discussed.
Survival rates of the surgical treatment were rather splendid: only 4 cases were dead, 2 of them died of ileus 2 years after discharge.
In the patients with ureteroileocystostomy, cystometrograms showed that there were tendencies for a shift to the right and uroflograms were flat. The ratio of residual/capacity increased up to a less than 10%.
Ileocystostomy applied to dogs, revealed that the isolated ileum could be unassociated with urination.

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1) Seventy days peritoneal dialysis was performed for seven months in a thirty year old woman who was suffering from acute renal failure following ‘cold wave’ neutralizer (potassium bromate) poisoning. After twenty two days of total anuria and twenty days of oliguria, urine flow resumed and creatinine clearance increased to a level of 6.5ml/min. on the one hundred and twentyninth day. However, she needed periodic peritoneal dialysis. Mental disorder (schizophrenia) found out since the fourtieth day and loss of hearing disturbed the treatment. Finally she died of chronic renal failure on the two hundred and seventh day at a mental hospital.
2) Thirteen cases of potassium bromate poisoning were reported in Japan and seven cases died of renal failure (mortality rate, 54%).
3) Eight cases among fourteen survivors with prolonged oliguria for more than three weeks recovered renal function sufficient to maintain usual life.

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