Fibrinolytic activity in tissues is chiefly caused by a cellular activator which converts a humoral zymogen, plasminogen, to the blood proteinase, plasmin (enzyme classification number 3.4.4.14). The content of this tissue activator in various organs and tissues differs among animal species and shows wide individual variations. Studying human tissues by a histochemical method, Todd observed that the tissue plasminogen activator was related to vascular endothelial cells. He reported serosal cells and the bladder epithelium to be inactive. Later, several studies of Astrup and his collaborators have shown that surface epithelial cells from many orgnas are fibrinolytically active and that serosal cells may be weakly active. Glandular epithelium was usually found inactive. Prominent among the fibrinolytic epithelial cells are those of the mucosa of the urinary bladder. High activity was observed in the bladder of man, rat, guinea pig, mouse and even in the rabbit. The latter spiecies is usually low in content of plasminogen activator, assayed by an extraction method, except for a few tissue among which is the mucosa of the urinary bladder. Studies of the fibrinolytic activity in the epithelial cells of the vagina or endometrium revealed fluctuations regulated by the influence of estrogens and progestins suggesting a release of plasminogen activator during a certain stage of the life cycle of the epithelial cell. This observation was confirmed by the finding that the fibrinolytic activity in the squamous epithelium of the oral cavity of the rat was related to cells of an intermediate type. Epithelial detachment or cellular injury appeared to enhance the release of fibrinolytic agents, confirming a similar situation on the epithelium of the cornea. More detailed information was provided in a study of smears from the oral mucosa of man. A combination of the histochemical fibrin slide technique with a staining after Papanicolaou' method provided a clear demonstration of a relationship between fibrinolysis and stages of cellular maturation. An elucidation of the cellular release of plasminogen activator is of significance for several reasons, among which a possible involvement in the production of the urinary plasminogen activator or in the development of fibrinolytic activity in the blood is of particular, immediate interest. The experiments to be reported here deal with the fibrinolytic properties of cells from the epithelium of the urinary bladder in an attempt to relate the activity in cellular plasminogen activator with maturation and degeneration of the transitional epithelial cells of the bladder.
Fibrinolytic activity related to the tissue, individual epithelial cell and in the urine of the normal guinea pig bladder were studied by using the histochemical fibrin slide technique. It was found that the fibrinolytic activity was caused by an activator of plasminogen in all animals studied and the activity in the bladder urine was composed of that of a different origin when compared to the transitional epithelial cells.
In both collapsed and distended conditions of the bladder walls, the epithelium possessed a high activity of a plasminogen activator. The plasminogen activator was discovered among the all cell types of different three epithelial cell layers by using the histochemical fibrin slide technique staining Harris' Alum hematoxylin or a combination of PAS staining method and the histochemical fibrin slide technique.
Fibrin slides of mucosal smears stained after Papanicolaou showed a markedly higher fibrinolytic activity of younger blue cells, decreasing with age, and completely disappearing in fully degenerated yellowish cell squamae. This confirms the study on the buccal mucosa of man and agrees with findings in the hormonally

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As has been reported previously, Trichomonas vaginalis strains isolated from urinary tract are susceptible to various drugs. In this paper efficacy of metronidazole (Flagyl^®), acetyl furatrizine (Panfuran S^®) and nitrofurantoin (Furadantin^®) in eliminating trichomonas from urinary tract is presented.
In total, trichomonas vaginalis was isolated from 64 male patients including 29 cases with chronic prostatitis and 35 with urinary tract infections and from 25 females including 10 urinary tract infections and 15 vaginal infections. Most of urinary tract infections in the females were accompanied by vaginal infections. In male patients erradication of trichomonas was successful in all cases irrespective of the drug employed. However, in 40% of the female patients, the medication resulted in failure. Frequent reinfection from genital organs in female patients was suspected as the cause of failure. Relapse ratio seemed to be dependent on the frequency of sexual intercourse which could provoke a “ping-pong” infection.

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Statistical studies about heterotopic recurrence rate were performed on 55 inpatients with primary superficial tumors of the urinary bladder admitted to the department of urology of the Nara Medical University from January 1, 1963 to December 31, 1970 and who had no pre- or post-treatments for recurrence after the first operations.
1) Of the 55 patients, 47 were male and 8 were female. The age distribution of the patients ranged from 23 year-old to 84 year-old, and the maximum incidence lies in the 6th decade of both sexes.
2) The recurrence rate was 16.3% within 6 months, 25.4% within 1 year, 38.6% within 3 years and 35.4% within 5 years. There was no significant difference between heterotopic recurrence and sex difference.
3) The heterotopic recurrences occured in most (90.9%) patients with recurrence within 3 years after the first operations.
4) The recurrence rate in patients who were admitted within 3 months after the initial symptoms was lower than in patients who were admitted over 3 months after the initial symptoms.
5) The recurrence rate in the single tumors was lower than multiple tumors for the observation period over 6 months. The rate within 6 months showed no significant difference between both groups.
6) No significant difference of the recurrence rate was observed according to the methods of the first treatments.
7) The recurrence rate in the tumors of low stage was somehow lower than the tumors of high stage. No significant difference of the recurrence rate was statistically found between the tumors of low grade and those of high grade.
8) About heterotopic recurrence of the tumors of urinary bladder, it is considered that stimulations by continued action of carcinogens in the urine and multicentric tumorigenesis are more important problem.

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Renal aneurysm is thought to be a rare disease, but we encountered 8 cases of it for last five years. Chief complaints of them were hypertension in five cases (62.5%), hematuria in one case, and lumbago in one case, but the last one had no complaint.
They could be classified into four types; five cases of saccular aneurysm, one of fusiform aneurysm, one of jet shaped aneurysm, and one of dissecting aneurysm. The diagnosis of renal aneurysm is made by radiographic examination. Renal arteriography is indispensable, and needs to be taken by the serialographic method to examine the blood circulation in the kidneys and exsistence of the renal infarct.
Aortography is also indispensable, since renal artery stenosis may exist bilaterally in case of jet shaped aneurysm, and aneurysm may be present in the collateral artery.
In the treatment of renal aneurysm, it is necessary to decide whether operative therapy or conservative one be made on the basis of the form of the aneurysm and results of various examinations, which would detect renal parenchymal changes, such as split renal function test and measurement of plasma renin-angiotensin. However, surgical treatments are more advisable, because this disease is complicated by hypertension in many cases, and even in normotensive cases hypertension may develop in the future.

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Since spring of the year 1970 we have made observations of movements of the vesical neck during urination by means of x-ray television mainly in patients with damage to the spinal cord. By a simultaneous electromyographic study of striated muscles of the pelvic floor we have also investigated functional interrelation between the vesical neck and these striated muscles.
As a result, not a few of these patients were found to have a vesical neck of a peculiar shape (called “constricted type” by us tentatively). This unusual shape (hence motility) of the vesical neck is supposed to be due not to functional causes but to organic ones including atrophy of the prostate and sequelae of inflammation of the posterior urethra, is considered, from a hydraulic standpoint, to be a potential impediment to conveyance of signal of intravesical pressure to the external sphincter and hence to resultant opening of the sphincter and of initiation of micturition, and could thus be deemed as an indication for TUR.
Contrary to the dominant concept of the physiologic mechanism of urination that elimination of inhibitory control over contraction of the detrusor and voluntary relaxation of the external sphincter (though which of these 2 phenomena precedes the other is a matter that remains to be ascertained) initiate urination, our electromyographic study of muscles of the pelvic floor and periurethral muscles of patients with spinal cord injury during micturition showed that spikes emerging on EMGs of these muscles were attenuated or disappeared en bloc immediately before passage of urine in many instances, although such patients were mostly incapable of voiding voluntarily. These findings point definitely to an essential role played relaxation of muscles involved, occurring as a reflex activity in the mechanism of urination and may be interpreted as indicating that persons with the normal power of voiding can get both detrusor reflex and relaxation reflex of the striated muscles under control.

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In an attempt to clearly define the indication of incision of the vesical neck by TUR, a cystographic study was made, in which movements of the vesical neck at about the maximum voiding pressure were observed following the intravesical injection of an opaque agent via the tonometer. In 15 of 46 patients with spinal cord injury the vesical neck was seen to dilate while forming a constriction.
In 10 of these 15 patients, an incision was made into the vesical neck by TUR, which resulted in an improvement of voiding efficiency in 9 of them.
Since these movements of the vesical neck of “constriction” type are demonstrated, by electromyography of muscles of the pelvic floor conjoined with vesical tonometry not functional, TUR may be indicated wherever they are recognized at any stadium of spinal cord injury.

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Huntington and McClure (1920) have described 15 theoretical forms of venous anomaly associated with a retrocaval ureter. Many forms of them have actually been reported. We, however, recently experienced a patient with a form which has not been described in the literature.
K. S., male, aged 49 years. This man visited us with the chief complaint of asymptomatic hematuria in october, 1971. Drip infusion pyelography (DIP) and retrograde pyelography (RP) combined with vena-cavagraphy showed that the right renal pelvis and the upper part of the right ureter were dilated, presenting an S-configuration. The examination also revealed that the vena cava and the right ureter crossed each other at the level of the fourth lumbar vertebra, and the vena cava between the second and third lumbar vertebrae appeared to branch off, with the ureter passing through the branches. In surgery, it was found that the iliac veins on both sides were united into a versa cava over a short length, then branched, and again, directly under the renal vein, were united. And the ureter passed through the ring of vena cava thus formed. Pyeloplasty and pyeloureteroneostomy were performed.
Embryologically, retrocaval ureter is formed when the supracardinal vein shrinksd and the postcardinal vein persists to form the vena cava, or when both the supracardical vein and the postcardical vein persist to form the vena cava. In the latter instance, the ureter posses through the vena cava. The case dealt with in this report is an anomaly that belongs to the latter category. The present case may appear similar to type 2 (Fig. 5) in the classification proposed by Harbach, Nielsen, Campbell, Anderson, etc, but is different in that the iliac veins on both sides are united into one vena cava, which branches off, forms a ring and again is united. This case is considered as an entirely new type of anomaly that does not come under the stated classification.
As a complication, our case suffered from anomalies of intestinal rotation and fixation.

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“Hydrostatic pressure method” proposed by Helmstein (1972) was applied on 6 cases of transitional cell carcinoma in urinary bladders with successful and fruitful results.
Cystoscopically, tumors of the urinary bladder completely disappeared on from the 30th to 60th day after the procedure. Only 1 case out of 5 cases with repeated biopsies showed remnant tiny carcinoma nests. Preoperative biopsy of the same case revealed sessile transitional cell carcinoma with extensive infiltration into the deeper stroma. After the treatment, lymph-follicle formation was obviously noticed beneath the epithelial layer regenerating over the areas in which tumors might pre-exisit.
Mechanism of the treatment should be explained partial ischemic necrosis of tumor lesions caused by circulatory disturbances following tumor immunity activation. These process in human neoplasms would be compatible with phenomena of tumor immunity developed by “strangulation method” in rats (Lewis, 1952) or of “ligation-release procedure” in rats (Takeda, 1967).

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