The fractions of urinary protein originated from serum were studied in renal homotransplantation, renal insufficiency due to chronic glomerulonephritis and other urinary tract diseases. Among fractions of urinary protein, α₁-Lp, α₂-Lp, α₂-M, βIC/IA, Tr, Ig-M and Ig-G were investigated. The urine was dialyzed for 24hrs. In visking tube and concentrated to 33 times with polyethylene glycol. The concentration of each fraction was determined by means of the antibody absorption method.
A patient who underwent renal homotransplantation from cadaver is still surviving 38 months after the operation. The rejection crisis was not apparent, however renal damage developed gradually later because of the chronic rejection. The changes of proteinuria with clinical course of this case were as follows: α₁-Lp, Tr, Ig-G were increased significantly immediately after the transplantation and returned to normal after 3 weeks. The higher molecular weight fractions, α₂-M and α₂-Lp, did not appear in this period. It is considered that this proteinuria may be related with tubular proteinuria due to ischemia. From the 330th day after transplantation when chronic rejection developed, βIC/IA appeared continuously, which was never seen previously. The Ig-M was also increased but α₂-Lp and α₂-M was not seen. This proteinuria may be regarded as the intermediate type of proteinuria. In this period the BUN is correlative with Tr (p<0.05) and Ig-G (p<0.001), but not with α₁-Lp (p>0.05).
In 28 cases of renal insufficiency due to chronic glomerulonephritis, α₂-Lp, α₂-M and βIC/IA were noted in the urine. In 10 cases of chyluria, urinary protein was significantly increased and the pattern of protein fraction was the same as that of serum. In 36 cases of upper and lower urinary tract diseases the urinary protein level was very low and α₂-Lp and βIC/IA did not appear. It is thought that the pattern of urinary protein fraction in chronic rejection may develop in to the non-selective proteinuria in chronic glomerulonephritis with the progress of rejection.

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Seventy-three cases of renal cell carcinoma (57 male and 16 female) were investigated clinically mainly for the course and prognosis of the disease and based on the results obtained, a proposal was made of a new system of classification for the evaluation of prognosis and the clinical utility of the system was discussed.
1) Fever, erythrocytic sedimentation rate, C-reactive protein and serum protein fractions, changes occurring in the host of this malignancy to which no great importance has been attached, were demonstrated to be factors of great value in the prediction of prognosis. Pyrexia was noted to exist in 34 (46.6%) of 73 cases; the 3-year survival rate was 39.9% for cases with pyrexia as against 68.8% for those without pyrexia, indicating thus clearly the association of poorer prognosis with fever. Increased sedimentation rate was seen in 38 (62.3%) of 61 cases; the 3-year and 5-year survival rates were 40.0% and 30.6% respectively for cases with increased sedimentation rate and hence definitely lower than corresponding values for those showing normal sedimentation rate of 80.4% and 52.3% respectively. Of 64 cases, 38 (or 59.4%) were found to be CRP-positive, of which 37.9% survived 3 years, whereas 79.8% of CRP-negative cases did the same. Among perturbations of serum protein fractions most prominent was an increase of α₂-globulin, which was noted in 32 (62.7%) of 51 cases; the 3-year and 5-year survival rates for cases with elevated α₂-globulin were estimated to be 35.5% and 28.4% respectively as against corresponding values for those with normalcy of this protein fraction of 75.5% and 57.7% respectively, the difference between both groups of cases being thus really striking.
2) A method was devised for foretelling the course of renal cancer, which is known to vary widely with different cases. This method is based on the finding that very quick progress of renal cancer is associated with fever, increased sedimentation rate, positivity of CRP and elevated serum α₂-globulin, while slow progress of the disease, with normal body temperature, normalcy of sedimentation rate, negative CRP and normal serum protein pattern. By classifying a group of cases where the disease follows a course of the former type as type I (or quick type) and another group of cases whose disease progresses slowly as type II (slow type), it was found that 90% of renal cancer cases fell under either type I or type II.
3) A striking difference was noted between both types in prognostic outlook, the 3-year and 5-year survival rates having been estimated at 38.4% and 27.2% respectively for type I and 91% and 51% for type II.
4) A study of changes in the aforementioned 4 signs before and after nephrectomy showed that the 4 signs all tended to be absent after surgery in cases of type I but would not be obliterated in those with metastatic lesion. In type II the signs tended to be negative before and after surgery. The occurrence of metastasis of malignancy following nephrectomy was associated with reappearance of all the 4 signs in type I but with no gross changes in them in type II. No conclusive statement can be made yet, however, on this point because of scantiness of cases thus far available.
5) This new system of classification of renal cell carcinoma was demonstrated to have the following clinical utility value: (1) it, unlike any other systems of classification hitherto proposed, permits to predict prognosis merely on first routine examination even in cases with metastasizing carcinoma or in those with undermined grade of malignancy histopathologically; (2) it warrants to conclude that whereas in cases classified as type I 5-year survival can safely be interpreted as signifying complete cure, those of type II may require several decades of follow-up; (3) it enables early detection of relapse by making use of the 4 signs; and (4) it helps to decide therapeutic policy to be taken in

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1) Six autopsy cases previously treated by hemodialysis from 1967 to 1970 at the Urological Department of School of Medicine Chiba University are presented and the autopsy findings are specially described.
2) The superficial findings of the kidneys of patients with long term hemodialysis appeared to be smooth. Histopathologically there were no compensatory changes and marked oxal crystal deposit in the lumen of the tubules.
3) Deposition of eosinophilic substance was visible in the walls of the intrarenal small arteries, glomerular capillaries and tubules. There was a considerable thickening of basement membrane of the tubules. Hemoglobin was present within the tubule and rhomboid crystal appeared in the lumen of some small arteries.
4) All the cases had pericarditis to various extent. Some of the patients died of this disease.
5) On chronic hemodialysis, parathyroid glands of the patients were atrophic, while clear cells were rather preserved.
6) There was resorption of bone and osteoporosis was markedly significant.

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The technique of Rn seed radiation hypophysectomy by the paranasal transethmoid-sphenoidal approach is described. The clinical effects, side effects and prognosis in 20 patients with prostatic carcinoma treated by this technique are described. The clinical results were good in 11 cases, fair in 6 cases and poor in 3 cases, giving an improvement rate of 85%. The beneficial results were most impressive against pain. Side effects such as optic nerve disturbance, polyuria and rhinorrhea were noted but these were mild. This method appears to be especially effective in patients with progression of tumor and pain after endocrine therapy. This method is recommended since the morbidity is minimal.

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The preponderance and the mode of action of structural deficiencies and inflammations at the ureterovesical junction and trigone on the occurrence of vesicoureteral reflux have been experimentally studied. In the group of dogs which received surgical injuries at the junction or trigone, reflux occurred in 2 of 10 dogs with incision of the ureteral orifice and in 2 of 13 dogs with resection of Bell's muscle on a retrograde cystogram. While reflux was absent in 10 dogs with resection of Mercier's bar, in 5 dogs with suture of Bell's muscle, and in 8 dogs of the control. In the group of dogs with the surgically injured bladder followed by the instillation of approximately 4 per cent solution of lactic acid in order to induce an aseptic cystitis, reflux occurred in 5 of 10 dogs with incision of the ureteral orifice, in 2 of 13 dogs with resection of Bell's muscle, in 5 of 10 dogs with resection of Mercier's bar, and in 1 of 8 control dogs. The concomitant use of lactic acid apparently enhanced the incidence of reflux in 10 of 46 dogs. Furthermore, the histological severity of the induced cystitis is correlated to the incidence of reflux. No significant relationship was observed between the degree of inflammation at the intramural ureter and incidence of reflux.
It is concluded that the structural arrangement of muscles at the trigone, especially Mercier's bar, as well as that at the junction, probably plays a fundamental role in preventing reflux while the inflammation may facilitate the development of reflux as an additional factor causing more prominent dysfunction of the ureterovesical valve in addition to the structural defect.

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