Fine structural alterations of the glomeruli and the interstitium were studied in homotransplanted canine kidneys without immunosuppressive treatment. By correlating these findings with normal and autotransplanted canine kidneys, an attempt has been made to clarify the pathogenesis of the acute rejection at the cellular level. The electron microscopic studies were supplemented by the renal function in terms of urine volume, BUN and PSP.
Marked proliferation and pronounced swelling of the endothelial, the epithelial and the mesangial cells were noted in the glomeruli with the thickening of the basement membrane. Bowmann's capsules were also thickened. Infiltration of numerous plasma cells and lymphoid cells were appreciated in the interstitium. The homotransplanted canine kidney was characterized by the electron lucent materials, being present at subendothelial area of the basement membrane in both glomerular and interstitial capillaries. These changes were observed on the fourth day after the transplantation, and became prominent as time elapsed.
Comparing with the functional studies, a correlation was indicated between the severity of the morphological changes and the degree of the functional deterioration of homografts. Therefore, these ultrastructural findings were thought to be one of the morphological evidence of the homograft rejection. The deposit of the electron lucent materials at the subendothelial area would suggest the presence of the humoral antibody during the acute rejection.

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For the purpose of predicting the clinical response following antiandrogenic treatment, a study was performed on the alterations with time of the SLDH activity as well as of its isoenzyme pattern accompanied with massage of the prostate in a series of 26 patients with prostatic carcinoma. The results were as follows: 1) Between the fairly responsive cases and the poorly responsive ones, SLDH activity prior to massage of the prostate showed no significant difference. Following massage of the prostate, increase of SLDH activity was significantly higher in the poorly responsive patients than the fairly responsive ones 1 to 8 hours after the massage. 2) Average premassage control levels of SLDH isoenzyme IV and III fractions were 1.77±0.39% and 24.47±1.40%, respectively, in the fairly responsive patients and 3.72±1.95% and 31.90±1.69% in the poorly responsive patients, being significantly higher in the latter. These differences served previously to differentiate the clinical response to antiandrogenic treatment between both groups. 3) Increase of SLDH isoenzyme V and IV fractions following massage of the prostate was significantly higher in the poorly responsive patients throughout the period of experiment, with exception for the 1 hour specimen, than in the fairly responsive patients. 4) For both experimental groups, alterations of SLDH isoenzyme II and I fractions were not useful for the prediction of clinical effects.

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A study was carried out at the Urological Department, Hiroshima University Hospital on the alterations with time of the SLDH activity as well as of its isoenzymes pattern following massage of the prostate in a series of 40 patients, 24 with prostatic carcinoma and 16 with benign prostatic hyperplasia. The results are as follows.
1) Following massage of the prostate SLDH activity reached a peak in 2 hours in benign hyperplasia and in 4 hours in prostatic carcinoma. Four hours after the massage the activity was significantly higher than in patients with benign hyperplasia, and this elevation served to differentiate between benign hyperplasia and carcinoma of the prostate.
2) SLDH isoenzymes V and IV fractions were significantly higher in patients with prostatic carcinoma than in benign hyperplasia throughout the period of the experiment, but no difference was observed between both groups in quality of the response to the massage.
3) Between both experimental groups alterations of the SLDH isoenzymes III, II, and I fractions all failed to show any significant changes in their behavior and level following massage of the prostate.

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Many details concerning the innervation of the genital organs remain as yet unknown, especially of the testis, epididymis, ductus deferens, prostate and penis, which participate in spermatogenesis, ejaculation and erection. Scarcely any histochemical studies have been carried out on the peripheral distribution of their nervous supply.
The localization of adrenergic and cholinergic nerves in the genital organs was clarified by light microscopy and comparative studies on the innervation of these structures between dog and man were conducted. The following results were obtained.
The study of distribution of catecholamine (CA) fluorescent nerve fibers and acetylcholinesterase (AChE) positive nerve fibers within normal genital organs revealed a relatively abundant distribution of CA fluorescent fibers and AChE positive fibers in the testis in both dog and man. These fibers were noted both in the interstitial tissue and in the vascular wall of the interstitial tissue.
In the epididymis, CA fluorescent fibers and AChE positive fibers were noted rather abundantly in the muscular layer and interstitial tisue. No difference was noted according to their locations such as the head, body and tail.
In the ductus deferens, these nerve fibers were abundant in the muscular layer and submucosal tissue, without any differences related to their location.
In the prostate, AChE positive fibers were noted as abundant in the muscular layer, interstitial tissue and around the blood vessels, while CA fluorescent fibers were relatively scarce, being seen to a slight degree only in the muscular layer and interstitial tissue.
No difference was noted between man and dog, as to the distribution of both of these nerves in the testes epididymis, ductus deferens and prostate.
On the other hand, the CA fluorescent fibers in the corpus cavernosum of the human penis are relatively infrequent. They were seen along the vascular wall and smooth muscle fibers within the trabeculae. In the dog, the fluorescence of the elastic fibers was marked, which made their differentiation from CA fluorescent fibers difficult. Abundant AChE positive fibers were found between the trabeculae of the cavernous body of the human penis. None of these were noted in the dogs whatsoever. In the penis of man and dog, the distribution of these nerve fibers was completely different from that observed in the above described studies. Thus, in some organs, it is dangerous to apply the results obtained in experiments with dogs directly to man.
As the result of studies on the effects of the simultaneous section of the hypogastric nerve, pelvic nerve and pudendal nerve on CA fluorescent nerve fibers and AChE positive nerve fibers in the genital organs, no marked difference was noted between the experimental and control normal dogs.

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As an objective method of differential diagnosis between functional and organic impotence, I have developed and applied a method of radioisotope penogram to demonstrate changes in circulation in the penis using a radioisotope. Some of the results have already been reported in the Journal of this society.
The most important requirement in deciding the type of isotope to be used in radioisotope penogram is the retention in the circulation for a certain period, low degree of radiation exposure, and high photon energy. For this purpose the author used ^113mIn-microcolloid to compare it with conventional radioisotope penogram using ¹¹³I-human serum albumin.
Radioisotope penogram obtained upon the use of ^113mIn-microcolloid revealed a pattern similar to that obtained with ¹¹³I-human serum albumin. In the penogram of patient with functional impotence, loading with Fujicapin caused an increase of blood flow in the penis. The count value was 3-5 times as high as that in the use of ¹¹³I-human serum albumin, which made the evaluation of the curve more easy.
In cases of organic impotence, no reaction whatsoever was seen to Fujicapin even upon the use of ^113mIn-microcolloid. As stated above, the use of ^113mIn-microcolloid facilitates the differentiation between these two conditions.

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Transsection of the hypogastric nerves and/or pelvic nerves was performed on 18 adult male dogs. Prostates were removed on the 7th, 14th and 21st postoperative day to examine histologically.
The denervation caused severe structural changes on the dogs prostate, which could be summarized as follows.
1. Atrophy of the epithelium as well as myxomatous degeneration resulting in proliferation of collagenous fibers in the stroma was the most prominent finding commonly seen in the various denervating groups. Since cystic dilations of the prostatic gland or capillaries were indefinitely observed in some cases, these findings could not be confirmed as typical changes caused by the denervation.
2. The degenerative changes were recognized on the 7th day and more conspicuous on the 14th day after denervations. On the 21st postoperative day, however, the degeneration of prostatic tissue became considerably slight.

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Plasma testosterone levels were determined utilizing the protein binding assay as described by Mayes & Nugent (1968) with several modifications. The mean value and standard deviation from a pooled female plasma were 18.53mμg/dl±2.25(S. D.) with the precision of 12.1%. The mean value from eight normal menstruating females was 25.4mlμg/dl±16.9(S. D.).
It is emphasized that the elimination of nonsteroidal interfering substances out of organic solvents, equipments and chromatographic papers is extremely important in determining such a low level of plasma testosterone as in adult female.

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A case of congenital unilateral multicystic kidney in a 4 years old boy is reported.
He was admitted as an emergency patient suffering from abdominal pain and abdominal tumor. Routine physical examination revealed the presence of an about fist-sized cystic tumor in the left upper abdomen. Routine laboratory examinations were all negative, but intravenous pyelogram showed a normal right and non-functioning left kidney. Subcutaneous pyelogram, tried under suspicion of hydronephrosis, disclosed successfully the presence of a cystic tumor mass composed of four, various sized cysts in the left abdomen. Complete resection of this cystic tumor was performed under suspicion of unilateral multicystic kidney from the alove findings.
Surgical specimen had the appearance of a cluster of grapes and was composed of seven cysts of various-sized which were held together by loose connective tissue, but macroscopically there was neither ureter, nor any discernible renal parenchama. However, on close investigation, both irregularly dilated pelvis like canal and over bean sized, solid renal tissue were detected near the hilar region of this cystic tumor.
This isolated pelvis-like canal had seven small branches; four branches were communicated respectively with each cysts by either macroscopically or physically observed small orifice, another one branch had a communication with the solid renal tissue, and the others were blinded.
From both these characteristic macroscopical findings and histological findings, it was supposed that the majority of the cysts in this case originated in branches of early generation of ureteral bud, probably of third or fourth generation.
Furthermore, from analysis of our case and other previously reported cases in literature, it was assumed that unilateral multicystic kidney is actually the result of dysgenesis of the ureteral bud during early fetal stages, which is characterized by occlusion of the ureter or pelvis, marked hypoplasia of renal parenchyma, and appearance of the cysts originating in branches of early generation of the ureteral bud.

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A 29 year-old gravida 1, par 1 was completely asymptomatic until 36 weeks' gestation. On Oct. 2, 1969, she was admitted to the department of Obstetrics and Gynecology of our hospital because of severe abdominal pain and profuse genital bleeding.
Urgent operation by Cesarian section was done with delivery of a dead male fetus. Histerectomy was followed for severe postpartum bleeding. On the next day (Oct. 3, 1969), she was transferred to our department due to postoperative anuria. Blood pressure was 140/90mmHg. and blood examinations were as follows: RBC 279×10⁴, Ht. 27.1%, WBC 12900, serum Na 133mEq/L., K 6.8mEq/L., CL 87mEq/L., Ca 9.0mg/dl., T. P. 5.3g/dl., Alb. 2.6g/dl., Ureanitrogen 41mg/dl., Creatinine 4.1mg/dl. and CO₂ 25mEq/L.
Open biopsy on the right kidney performed 28 hours after the onset of genital bleeding revealed a remarkably decreased renal blood flow. Histologically, renal cortex including interstitial cells was almost necrotized. Hyaline-like thrombi filled the capillary loops of glomeruli as well as the interlobular arteries. The characteristic pathological findings were that the thrombi in the interlobular arteries did not pack the lumen completely leavning some spaces.
Moreover, these vessels were frequently dilated and there were, in places, diapedesis of red cells into the media. VanGieson's elastica stain showed that their internal elastic laminae were elongated, frayed and fragmented. Renal cortical necrosis was diagnosed.
Repeated hemodialysis was performed on the fouth, tenth and seventeenth day of anuria. On twentieth day after the onset of anuria, she passed out urine of about 240ml per day.
The clinical course was showed in Fig. 1.
Hemodialysis gradually improved the patient's conditions to such an extent that she could sit up. On the 54th hospital day, aortography was performed. Main renal artery was clearly outlined with no obstruction. Succeeding interlobar arteries were slightly twisted and their shadows abruptly interrupted in their peripheries. Only a few opacified interlobular arteries were also twisted and showed a lack in smoothness in their internal walls. Nephrogram was not obtained.
On Nov. 26, 1969 (56th hospital day), the patient died suddenly probably of cardiac arrest due to pulmonary edema. The autopsy carried out three hours after death revealed: The right kidney weighed 110gr., the left 126gr.; the cortex (two milimetres thick) was yellowisch-white, whereas the medulla was bluish red with normal papillae.
Histologically, normal architecture of the cortex was completely lost except in a very thin subcapsular area and in juxta-medullary zone. The greater part of the cortex was shrunken and transformed into dense connective tissue. The smaller, interlobular arteries were destructed and almost absent. Walls of only a few remained interlobular arteries were consisted from degenerative cells and their lumens were either empty or occasionally containing few red cells. The larger arcuate arteries were almost intact, while the smaller segments of them were filled with organized occlusive thrombi, some of which showed recanalization. Thrombi revealed various features from containing cells to organizing. The larger renal arteries, main renal artery and interlobar arteries were distinctly free from pathological changes.
We discussed on the pathogenesis of bilateral cortical necrosis in our own case from the point of renal morphological findings obtained by open biopsy, autopsy and renal angiography, comparing with the reports in the literatures.
Based on the above mentioned arterial changes, especialy the destructive changes in the walls of interlobular arteries, it may be assumed that primarily the necrosis occurred in the vessels prior to the occurance of necrosis in the surrounding tissues.

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