The concentration of the low molecular weight protein β₂-microglobulin was measured by radioimmunoassay (Phadebas_® β₂-Micro Test) in human serum and urine from 19 normal subjects, 29 patients with impaired renal function, 13 acute pyelonephritis, 2 chronic pyelonephritis, 6 female acute cystitis and 29 patients under treatment of hemodialysis.
The present study was designed to observe the changes of serum and urinary β2-microglobulin concentration according to the decreasing renal function and/or renal tubular function.
Results are as follows:
1) Normal value of serum β₂-microglobulin level was 1.9±1.0mg/l (m±2 S.D.), with the upper limit of 2.9mg/l. Normal urinary β₂-microglobulin level was 86±96ug/l (m±2 S.D.), and with the upper limit of 182μg/l.
2) Good correlation was observed between serum β₂-microglobulin level and values of some renal function tests; correlation coefficients were 0.81 (between serum β₂-microglobulin and BUN), 0.80 (serum creatinine), -0.67 (24 hour creatinine clearance), 0.76 (PSP₆₀), and -0.81 (between log serum β₂-microglobulin and log 24 hour creatinine clearance).
These findings suggest that serum β₂-microglobulin level is well reflected by GFR (24 hour creatinine clearance) or RPF (PSP₆₀) and that the measurement of serum β₂-microglobulin may be one of the useful parameters for the evaluation of renal function, without urine collection.
3) In two cases of acute renal failure, the changes of serum β₂-microglobulin level were in parallel with the values of some renal function tests and the clinical course. Therefore, it seems that the serum β₂-microglobulin level indicates the degree of renal damage and that its measurement is of use for diagnosis and evaluation of acute renal failure.
4) A remarkably high urinary β₂-microgloblin excretion, although the serum level is within the normal limit, was demonstrated in the acute stage of acute pyelonephritis. In the convalescent stage, urinary β₂-microglobulin level decreased to almost normal level.
The ratio of β₂-microglobulin clearance to creatinine clearance (Cβ_2-MG/Ccr) also presented the same changes in acute and convalescent stage. Therefore, the reabsorption of β₂-microglobulin seems to be disordered in the acute stage.
Maximum urinary osmolality in the acute stage of acute pyelonephritis was significantly lower than that of normal control. We conclude that the distal and proximal renal tubular dysfunction is present in the acute stage of acute pyelonephritis.
5) Serum β₂-microglobulin level in patients under treatment of hemodialysis was as extremely high as 48.9±28.6mg/l (m±S.D.) and urinary level was also as high as 3377±1852ug/l (m+S.D.).
6) In this study, we used the index of Cβ_2-MG/Ccr. (ratio of β₂-microglobulin clearance to creatinine clearance) to exclude the influence of urinary volume to the urinary β₂-microglobulin concentration. And this index seems to present the filtration fraction of β₂-microglobulin per nephron, or excretion rate of β₂-microglobulin. Localization of the renal dysfunction, namely the difference between the specific tubular dysfunction and tubular dysfunction associated with the damage of total nephron, may be revealed clearly by observing the relationship of Cβ₂/Ccr. and Ccr.
We have concluded in this paper that β₂-microglobulin excretion rate (Cβ₂/Ccr.) is an index for the renal tubular, especially proximal tubular function.

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Using a 6-channel polygraph, the age- and sex-bound difference of the mechanism of urination in normal children was studied through simultaneous measurement of the intra-vesical pressure, intraurethral pressure, intra-abdominal pressure, tone of the anal sphincter, EMG recording of the anal sphincter, and urinary flow rate.
As the results of examination on the apparatus and method of measurement (Fig. 1), instrument for measurement (Fig. 2-1, 2, Fig. 3-1, 2), errors in measurement and method of correction (Fig. 4, Fig. 5-1, 2, 3, 4, Fig. 6-1, 2), the author was convinced of the sufficient feasibility of measurement by this method.
Based on the wave patterns on urination of 6 factors of urination obtained by the methods described above, 35 parameters of urination were determined. These consisted of 25 parameters directly obtained by the measurement and 14 complex parameters obtained by synthesis of the former parameters (Fig. 7-1, 2).
In 98 normal children, 43 boys and 55 girls (Table 1), these parameters were measured and statistically analyzed by student's t-test (Table 2-3). The purpose of this treatment consists of (1) establishment of normal criteria in the hydrodynamic tests of urinary flow in obstructive diseases of the lower urinary tract and (2) evaluation of the degree of completion of the mechanism of urination with advancing age and the functional difference of the lower urinary tract between males and females.
The following conclusions were drawn.
1) Results of measurement of these parameters in normal children of various ages are shown in Tables 2 and 3.
2) Pelvic floor (striated musculature) appears to develop regardless of the sex difference (Table 4).
3) Contraction or process of contraction of the detrusor muscle appears to be constant since birth regardless of age and sex (Table 4).
4) Regardless of the age, parameters with male to female difference appear to reflect the anatomical and functional differences of the lower urinary tract between males and females.
The following results were obtained from the analysis of wave patterns on urination of 6 factors of urination (Fig. 7-Fig. 10).
1) A mild rise is noted in the wave pattern of the intra-abdominal pressure during the period of urination in girls but none at all in boys.
2) The wave pattern of the intra-urethral pressure suddenly rises after the urinary inflow into the urethra, followed by a monophasic or occasionally biphasic smooth parabolic pattern.
3) After a mild rise 2-3 seconds prior to urination, the wave pattern of the intra-vesical pressure rapidly rises simultaneously with the opening of the bladder neck, with the height somewhat larger than the wave pattern of the intra-urethral pressure.
4) The wave pattern of the tone of the anal sphincter starts to fall 3 seconds prior to the beginning of urination. The low value persisted throughout the period of urination, followed by a rise soon after the end of urination.
5) The EMG of the anal sphincter is similar to the wave pattern of the tone of the anal sphincter. Electrically silent state is seen from before urination and persisted for some time after urination, followed by increases in amplitude and discharge frequency.
6) The wave pattern of the urinary flow rate assumes a smooth bell-like shape.
The following wave patterns were demonstrated under special conditions.
1) Cases with pain in urination (Fig. 11-1, 2, 3).
2) Cases with maximum restraint on urination (Fig. 12).
3) Wave patterns on voluntary interruption of urination (Fig. 13).
4) Wave patterns on efforts of urination with empty bladder (Fig. 14).
5) EMG recorded separately from the right and left side in order to evaluate the attitude of contraction of the right and left anal sphincters (Fig. 15).
Studies were also made on the difference of EMG wave patterns between the surface electrode and needle electrode method (Fig. 16), the role of the pelvic floor during the peri

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Recently, 16 cases with ejaculatory disturbance were treated medically in our department and the following results were obtained.
1) COMT inhibitor, L-dopa and antiserotonergic drugs were effective for the cases whose ejaculatory disturbance was supposed to be due to dysfunction of the higher center of ejaculation.
2) COMT inhibitor and antihistaminergic drugs were effective in some cases of retrograde ejacula-tion.
3) COMT inhibitor and L-dopa were effective for the cases who had no orgasm during ejaculation.
4) These medical treatments were effective in 11 of 16 cases treated.

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A patient of incomplete double ureter with ureter-to-ureter reflux was examined by electromyographic technique.
Peristaltic discharges from the lower segment ureter propagated to the upper segment ureter as antiperistalsis. This phenomenon was more frequently observed throughout the recording period. Thus, the upper segment ureter was anastomosed to the lower segment pelvis end-to-side to decrease the effect of antiperistalsis on the upper segment pelvis.
For the purpose of reasonable ureteropyelostomy it is advisable to make the electromyographic recording of the incomplete double ureter during operation.

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The purpose of this report is to obtain the theoretical ground of the efficacy of the magnesium-aluminum gel therapy in the management of renal calculi. Fifteen inpatients with calcareous stones in the upper urinary tract, ten males and five females of ages between 18 and 70, were studied for the metabolism of calcium, magnesium, and phosphate by collection of twenty-four hour urine and by measurement of tubular reabsorption of these inorganic substances. The magnesium/calcium ratio was measured for twenty-four hour urine.
One gram of magnesium oxide and 4 grams of Alumigel (90% of aluminum hydroxide) per day were orally administered to each patient from 7 to 12 days, and preceding the examination, the daily intake of calcium and phosphorus was restricted to 150mg and 500mg respectively. Calcium and magnesium were determined by atomic absorption spectrophotometry (Toshiba-Beckman, 440), inorganic phosphorus by Fiske-Subbarow's method, and creatinine by Folin-Wu's method.
The results compared with those in the same numbers of calcareous stone formers to whom no drug was given were as follows:
1) Oral administration of magnesium oxide-Alumigel increased the urinary magnesium as shown in Fig. 2. The degree of increase was larger than that when magnesium oxide alone was used. 2) It reduced the phosphate excretion (Fig. 2). The degree of reduction was more marked than that in the single use of Alumigel. 3) It showed an influence to increase the urinary calcium, but the difference was not significant. 4) It increased the urinary magnesium/calcium ratio significantly as shown in Fig. 4. But the degree of increase was small compared with that in the non-stone formers to whom the same doses of magnesium oxide were given. 5) It increased the serum magnesium, but had no marked effect on the serum calcium and phosphate as shown in Fig. 1. And 6) it showed an influence to reduce the tubular reabsorption of calcium and magnesium, while it increased the tubular reabsorption of phosphate as shown in Fig. 3.
These results were nearly exact additions of the effects of magnesium oxide and of aluminum hydroxide gel when they were administered separately.
It is suggested that the combined use of magnesium oxide and aluminum hydroxide gel may be useful in the prophylaxis of calcium oxalate, calcium phosphate, and the mixed calculi by increasing the urinary magnesium, especially the magnesium/calcium ratio, and by reducing the urinary phosphate. It is one of the merits of this therapy that the tendency to constipate caused by Alumigel may be covered by magnesium oxide, and vice versa. The mechanism of the efficacy was discussed.

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We performed 35 urethroplasties on 33 patients between April, 1971 and December, 1975.
1) Increase of traumatic urethral stricture, especially in children, was recognized.
2) Out of 18 internal urethrotomies, 16 operations were successful (89%). Out of 7 intubated urethrotomies, 5 were successful (72%). Out of 5 end-to-end anastomoses, all were successful. Out of 4 Michalowski's methods, we could follow up 2 patients and lost 2 patients.
One of them was well 7 years and the other 6 years after the operation.
3) When an 18F sound could be passed through the urethra easily, the operation was regarded as successful and post-operative urethral dilatation was not performed.
4) Temporary suprapubic cystostomy was made in a patient with posterior urethral injury and urethroplasty was performed secondarily.
5) The simplest operative method should be chosen at first. We generally performed the pull through method in a patient with posterior urethral stricture and if this was impossible, we performed Michalowski's method.

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Transcatheter embolization using Gelform pledgets were carried out in 4 patients with kidney cancer before radical nephrectomy. Angiography following embolization revealeda remarkable decrease of renal blood flow, which was confirmed by surgical findings as well. Blood loss during surgery was less than 500ml in the submitted cases except for one in which injury of the ovarian vein led to massive hemorrhage, an preoderpative reduction of tumor vascularity made the surgery technically more expedient. Severe pain on the infarcted kidney region was present in one case, but no other complications were detected. Histological findings of surgical specimens which presented minimum changes were discussed.
Reviewing literature it is also indicated that transcatheter embolization promises an effective therapeutic maneuver for the uncontrollable massive hemorrhage and the in situ operation in inoperable cases.

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Four cases of pheochromocytoma in one kindred were operated on and proved histologically. In this kindred two cases of von Hippel-Lindau disease were also noted. All four cases of those pheochromocytomas had norepinephrine secreting tumors and were not associated with thyroid carcinoma. In Japanese literature twenty-four cases of familial pheochromocytoma in nine families were reported so far, including those reported here, and high incidence of bilateral tumors is noted. Familial pheochromocytoma is inherited as autosomal dominant trait and probably has neuroectodermal dysplasia as a base.

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