Unilateral ureteral ligation was conducted on the 10th, 20th, 30th, 40th, 50th, and 60th day in order to prepare obstruction of the kidney. The study on the degree of recovery of kidney function was conducted using the angiographic method on 63 mongrel dogs both immediately after the ligation and two months after removal of the obstruction.
The results were as follows:
1. Vascular and excretory nephrograms taken immediately after the removal of the obstruction could be seen in all the cases in the 10th and 20th day groups, whereas the pyelogram could be seen only in the 10th day group.
2. Vascular nephrogram, excretory nephrogram, and pyelogram two months after removal of the obstruction could be seen in all cases in the 10th, 20th, 30th, and 40th day groups.
3. These results indicate that the time limit for the recovery from a renal blockade is 40th day blockade. Though the vascular nephrogram had the most sensitive reaction, it was not suitable as an indicator for the degree of recovery from renal blockade.
4. The caliber of the renal artery on the obstructed kidney side (r), its ratio to that of the opposite side (r/1), and its ratio to the caliber of the aorta (r/A) were all decreased gradually with the duaration of obstruction. And the recovery of the caliber two months after removal of the blockade observed in the groups with blockade shorter than 40 days.
5. The values in 40th day group determined immediately after removal of the obstruction were approximately 1.4mm, 57%, and 20%, respectively, which were equivalent to about 50% of the normal ranges.
6. Accordingly, the caliber of the renal artery is appropriate as the parameter to estimate the degree of recovery of the kidney function after removal of the blockade.

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In 63 mongrel dogs, microangiographic study was performed both immediately and two months after removal of 10th, 20th, 30th, 40th, 50th, and 60th day unilateral ureteral ligation.
The results were as follows:
1. The poor vascularity or shrinkage of cortical glomeruli was observed in all groups immediately after removal of obstruction, and returned to normal in the 10th, 20th, and 30th groups two months after removal of the obstruction. Its disappearance was observed in the 40th and later groups both immediately and two months after removal of the obstruction, and the change became more intense in the 50th and 60th day groups.
2. The poor vascularity or shrinkage of juxtamedullary glomeruli was observed in the 30th day and later groups immediately after removal of the obstruction. Its disappearance was observed in the 40th day and later groups immediately after removal of the obstruction, and did not recover two months after removal of the obstruction.
3. The spiralling of vessels was observed in rectal arterioles in the 10th day group and both in afferent arterioles and interlobular arteries in the 20th day group immediately after removal of the obstruction. These changes progressed gradually with duration of the obstruction. Two months after removal of the obstruction, the spirallings of both rectal arterioles and afferent arterioles were not seen up to the 30th day group, and the spiralling of interlobular arteries was not seen up to the 20th day group.
4. The stretching was observed in both arch form arteries and interlobar arteries in 30th day and later groups immediately after removal of the obstruction, and changed into spiralling two months after removal of the obstruction.
5. The diameter of intrarenal vessels, i.e. afferent arterioles, interlobular arteries and interlobar arteries, decreased to about 90% in the ratio of width to the opposite in 10th day group immediately after removal of the obstruction. This value of ratio gradually decreased with duration of the obstruction, and reached to about 60-70% in 50th, and 60th day groups immediately after removal of the obstruction. Two months after removal of the obstruction, a considerable recovery of the ratio was proved in these vessels up to the 40th day group.
6. The rectal arterioles converged to the tip of the papilla as if they straped the tail portion of curtain, but they were neither narrowed nor disappeared.
7. The comparison of the above mentioned microangiographic findings between immediately and two months after removal of unilateral ureteral obstruction suggests that the limit of recovery from renal blockade is 40 day ureteral obstruction.

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The PSP excretion test and clearance test are not suited to the assessment of renal function in a patient who has a dead space or fistula in the urinary tract or who is unable to cooperate with doctor, because in these cases accurate urine collection is impossible. Therefore, the renal function test without urine collection should be selected in such cases.
The plasma phenolsulfonphthalein index (PSPI) or the sixty minutes plasma PSP concentration (PSP₆₀) is a simple and clinically recommendable test among renal function tests without urine collection. These tests are calculated from the plasma PSP concentration following a single intravenous injection in a dosage of 1mg per kilogram of body weight.
We clinically studied the reliability of both tests. The results are as follows.
1) Normal range of PSPI is 12-24, and PSP₆₀ is less than 100mcg/dl.
2) The correlatin coefficient for PSPI with BUN, serum creatinine, C_cr, and C_PAH are respectively 0.56, 0.58, 0.74, and 0.78. The correlation coefficient for PSP₆₀ with BUN, serum creatinine, C_cr', and C_PAH are respectively 0.82, 0.84, 0.76, and 0.77. It is certified from these data, that PSPI and PSP₆₀ have high correlations with other clearance tests and are reliable indicators of the degree of renal function.
3) In comparison of PSPI method that needs repeated blood samplings, PSP₆₀ is enough with only two blood samplings. Moreover, a significant correlation between PSPI and PSP₆₀ (r=0.82) is observed.
We think that PSP₆₀ is a very recommendable routine test of renal function in clinical work.

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A clinical observation on 15 cases of hydronephrosis (17 ureters) indicated for pyeloplastic surgery during the last 5 years in the Department is made, and the results obtained are as follows:
1. In 12 ureters of these patients, a plastic procedure, which comprises separation of the ureter from the pelvis, with excision of the pelvi-ureteric junction, and re-implantation of the ureter into the pelvis (Anderson-Hynes pyeloplasty), has been carried out.
2. Adopting I V P, radioisotope renogram and P S P test as a guide to the degree of improvement in function of the kidney, a “good” result was obtained in 7 of 17 pyeloplasties. In these good cases, the re-implantation methods of Anderson-Hynes and so forth, with excision of the pelvi-ureteric junction, have been carried out. These procedures provided better results compared with the pyeloplasty with retention of continuity between the ureter and pelvis.
3. In child group, the good result was obtained in a higher proportion than in adult group.
4. No significant relationships were observed between the degree of hydronephrosis and postoperative improvement.
5. In the patients whose internal diameter of the renal artery to that of abdominal aorta was less than 20 per cent in ratio, the renal cortex on the nephrogram was found to be of a great unsubstantial thickness. The ratio can be used as a determination factor on the indication for conservative surgery in the management of hydronephrosis.
6. In 4 cases (31 per cent) of unilateral hydronephrosis, the contralateral kidney, which showed apparently normal excretory pyelogram, revealed a considerable prolongation of excretory phase on the renogram. This would suggest the usefulness of the renogram in the diagnosis of hydronephrosis and assessment of the function of the contralateral kidney after the operation. This is also reminiscent of that hydronephrosis, potentially at least, is a bilateral affliction and conservative surgery is proposed in the management of hydronephrosis.

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The scanning electron microscopy has recently been proved by Jaques et al. to be an excellent method for examining the surface structure of soft tissues. This method, by its advantages of visualization of depth and three dimensional viewing, will make it possible to observe fine surface structure of normal and pathological tissues.
In the field of urology, the paper dealing with the study of the normal resting and stretched urethra and bladder mucosa by Lloyde-Davis et al. is one of a few available publications. The technique has been applied to the tumor pathology of the urinary tract by Fulker et al. who observed proliferative human bladder epithelium and bladder tumors.
In the present study, normal and neoplastic materials of the human urinary bladder were obtained at the time of surgery. The specimens were fixed in 10% neutral formalin, dehydrated with graded alcohols and dipped in aceton, subsequently dried in air, coated with gold and examined by JSM-U3 and JSM-S1 type scanning electron microscope. All the tissues were also studied by light microscopy to ascertain histopathological identification.
By means of the scanning electron microscopy, the individual normal transitional cells were observed to be protruding mamillary and uniform in arrangement and size. The intercellular folds were clearly observed (Fig. 1. 2. 4.). All over the surface of the cells, fine granular processes were diffusely and homogenously distributed in 3000 times of magnification (Fig. 3. 5).
In the distended normal epithelium, cellular protrusions and cellular junctions were observed stretched in the distended direction and normal mamillary cellular protrusions were unable to be observed. Lacerations were discerned, while the intercellular digitations were scarcely maintained as fine threadlike structures (Fig. 6-8).
In the examination of the transitional cell carcinoma, surface of the tissues looked rather smooth at lower magnifications and intercellular folds were prominent (Fig. 9. 10. 13). The sizes of cell surface in tumors were varied more widely than those of normal cells. At high magnification, cellular details and cellular junctions could be discerned and the surface of each cell was characterized by fine granular projections (Fig. 11. 12. 14-16). On the surface of high graded tumors, there were many necrotic spots and patches of destructed cell layer.
The specimens used for the scanning electron microscopy were reexamined by ordinary transmission electron microscope and the photographs were compared with those of routine electron microscopy originally prepared. Destruction and shrinkage of the tissues possibly caused by the fixation and dehydration of the materials were revealed (Fig. 17. 18). Therefore, the interpretation of the surface structure in the scanning electron microscopy must be carefully undertaken.
The present study proves that the scanning electron microscopy provides an excellent method for morphological approach to the surface structure of normal and pathological varieties of the urothelium and the tumor formation.

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Recently evidence, that Y chromosome with strong fluorescence can be distinctly distinguished from another chromosome on the metaphase plates of cultured human blood stained with quinacrine mustard dihydrochloride or quinacrine dihydrochloride (fluorescing dye-stuffs) and also a fluorescent spot in the similarly prepared interphase nuclei of various human cells can be observed through the fluorescence microscope, has been published and confirmed. The fluorescent spot in the interphase nucleus is thought to indicate the existence of Y chromosome and is called “fluorescent body”, and its clinical usefulness is suggested
The author investigated the fluorescent body in nuclei of somatic cells (mainly hair-root cells), lymphocytes of systemic blood and in spermatozoon with the fluorescence microscopic method.
1) Distinct fluorescence was recognized at the distal portion of Y chromosome long arms on the metaphase plate of cultured human lymphocytes stained with quinacrine.
2) In nuclei of hair-root cells as well as lymphocytes in the systemic blood obtained from normal male, a round or oval bright fluorescent body in diameter from 0.2μ to 0.3μ, was regularly observed and the average incidence of the fluorescent body was more than 40 percent of the cells examined. The incidence did not show the correlation to the age. In contrast to these findings, the fluorescent body usually could not be recognized in the nuclei of the somatic cells from women. If present at all, the incidence was in less than 3-4 percent.
It was reasonably concluded that the examination of the fluorescent body in the interphase nuclei of human somatic cells offered a very useful clinical method for determination of cytogenetic sex, and that combined examination of Barr body at the same time gave more accurate information for this purpose.
3) Spermatozoon with single fluorescent body which showed similar appearance in the interphase nuclei of somatic cells were observed in 40-45 percent. The incidence showed no correlation to sperm count or sperm motility of the sperms from the normospermics and oligospermics. In eight specimens, which were obtained from four normospermics and four oligospermics, spermatozoon with two fluorescent bodies were recognized. The average incidence was 1.8 percent. But double fluorescent body was observed more often in morphologically anomalous spermatozoon than in normal structured ones.
4) The incidence of fluorescent body in human somatic cells from patients with simple hypospadia, cryptorchidism, male infertilities and male hermaphorditism was on the same level as that of normal male, whereas female hermaphrodites showed the same level of incidence of fluorescent body as that of the normal female.
5) In true hermaphroditism, the incidences of fluorescent body and Barr body were almost in accordance with their karyotype, but showed lower level than that of normal men and women. In true hermaphrodites with mosaicism and mixed gonadal dysgenetic patients, the incidences of both bodies were generally low and sometimes the cytologic sex could not be determined from the examination of these nuclear bodies. The results would suggest that the patient might be true hermaphroditism or mixed gonadal dysgenesis.
6) The incidence of fluorescent body in patients with Kleinefelter's syndrome (all cases, 47, XXY, positive Barr body) was as high as that of normal men. It might be thought that the high incidence of fluorescent body corresponding with that of normal male with positive Barr body was a characteristic cytological feature in Kleinefelter's syndrome.

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A 29-year-old woman with bilateral renal cortical necrosis following delivery, who was saved by hemodialysis, is reported.
The patient was maintained by hemodialysis during a period of 11 days of anuria and oliguria. Following the period, her renal function was improved gradually.
Nine months after the onset of her illness, the serum BUN was 32mg/dl, the twenty-four hour creatinine clearance was 13l/day, and the patient was feeling well.
It is generally accepted that bilateral renal cortical necrosis, which itself is of rare entity, has an almost universally fatal outcome because of its irreversible lesion, and that the survival case is extremely uncommon.
So far, there have been only 19 reported survivors among English and German literatures.
In Japan, 13 autopsy cases have been reported but none with survival.
Some discussions regarding pathogenesis of the bilateral renal cortical necrosis especially that of the disseminated intra-vascular coagulation mechanism were done.
Clinical analysis of the 15 survived cases reported in the literatures revealed that; 1) improvement of the renal function in the survivors could be expected up to 12 months after onset of the illness, 2) the longer the period of anuria and oliguria, the worse the renal function, 3) the cases, in which hypertension were noticed in their courses, had poorer prognosis than the normotensive group.

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