Electrical activity of urinary bladder was studied in 34 female mongrel dogs. Bipolar electrodes (Fig. 1) were fixed on the serosal surface of the bladder to record electrical activity. Intravesical pressure was simultaneously recorded. Results obtained were summarized as follows.
1) When the bladder was empty and quiescent, electrical activity of detrusor muscle was also in practically resting state (Fig. 2).
2) As intravesical fluid volume and intravesical pressure increased, spike potentials started to occur and its frequency increased with increasing in pressure.
3) Existence of prevoiding pressure as reported by Gierup et al, was confirmed immediately before micturition reflex (Fig. 5). Electrical activity of detrusor muscle increased at this time.
4) Electrical activity of the detrusor showed maximum when micturition reflex occurred. The spike potentials had a duration of 0.1 to 0.2 sec. and an amplitude of 10 to 50μV, and appeared at a frequency of 2 to 6/sec.
5) Upon intermittent quick infusion of 10ml. saline into the bladder, while intravesical fluid volume was still small, there was only a transient rise in intravesical pressure and no change in electrical activity. As intravesical fluid volume increased and detrusor muscle was stretched to a certain degree, intravesical pressure showed a step-wise increase at each infusion and electrical activity became intensive enough to bring about a voiding reflex. This would suggest that, when initially relaxed detrusor muscle was gradually stretched and its tonus finally passed a threshold, the resulting contractile force due to the stretch reflex became great enough to squeeze out the stored fluid.
6) Administration of bethanecol chloride stimulated electrical activity of detrusor muscle and induced a contractile force strong enough to void. Atropine sulfate quenched the bethanecol-induced electrical activity within a short period.

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Recently, some angiotensin II analogues have been reported as competitive inhibitors for angiotensin II in renin dependent hypertension. 1-Sar, 8-Ile, angiotensin II, which is reported to have the strongest action among the angiotensin II analogues, was administrated, pre-and post-operatively, to 3 cases of renovascular hypertension, one case of hypertension due to remarkable unilateral hydronephrosis, malignant hypertension and hypertension with chronic glomerulonephritis.
In this article, we designed to study the relationship between the kinds of hypertension related to plasma renin activity and response of blood pressure to 1-Sar, 8-Ile, angiotensin II, and to study whether this drug is used as a diagnostic aid or for decision of operative indication for renovascular hypertension.
Under non-limited diet, or low-salt (NaCl: under 3.0g per day) diet and furosemide 120mg per day for 3 days, 1-Sar, 8-Ile, angiotensin II was administrated, dissolved in normal saline. When the blood pressure was decreased more over than 20mmHg systolic or 10mmHg diastolic by this drug, the response was judged to be positive.
Two cases of renovascular hypertension, which had high peripheral plasma renin activity and lateralizing renal vein renin ratio, showed positive response to 1-Sar, 8-Ile, angiotensin II. The rest 2 cases of renovascular hypertension, of which one had high peripheral plasma renin activity increasing into abnormal high range by stimmulation, showed a positive blood pressure response after decreasing of total plasma volume by low-salt diet and furosemide administration, though they presented a negative blood pressure response under normal diet or normal condition.
Isolateral nephrectomy, resection of stricture portion and end-to-end anastomosis of renal artery, and bypass formation between the aorta and normal renal artery, using auto-saphenous vein, were performed on each of 4 cases, and normalization of blood pressure were observed in all cases. Post operative 1-Sar, 8-Ile, angiotensin II infusion tests revealed a negative response in all 4 cases of renovascular hypertension.
We concluded that 1-Sar, 8-Ile, angiotensin II infusion tests revealed the contributory degree of renin-angiotensin system in renovascular hypertension and this test was available for decision of operative indication or judgement of operative effect.
Although the blood pressure response was positive in the case of malignant hypertension, transiently incresed blood pressure with slight headache was observed due to the agonistic action of this drug in the case of hypertension with chronic glomerulonephritis whose plasma renin activity was normal in spite of renin secretion stimmulation.
To the remarkable hypertension following pyeloplastic operation in the case of hypertension due to hydronephrosis presenting high plasma renin activity, 1-Sar, 8-Ile, angiotensin II was administrated continuously for 28hours. The blood pressure decreased to almost normal and the patient was releaved from the dangerous state. Thus, 1-sar, 8-Ile, angiotensin II also could be used as a therapeutic aid in such a particular condition as hypotonics.

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Physiologically active serum calcium, namely ionized calcium, was measured in hyperparathyroidisms, idiopathic hypoparathyroidism, distal renal tubular acidosis, and renal failures which have an abnormal metabolism of calcium. The results were as follows:
1. In the hyperparathyroidism proved surgically the measurement of the elevated ionized calcium and increased ionized ratio of calcium has clinical value for the diagnosis in the borderline cases.
2. In the idiopathic hypoparathyroidism the ionized calcium and ionized ratio of calcium were lower than controls. These returned to be normal after medication of the V. D₂ and calcium. Therefore, the etiologic factors to give fluctuation of the ionized calcium might be not parathormone (PTH) only but complicated ones.
3. In the distal renal tubular acidosis the etiologic factor for the elevated ionized calcium were suspected to be metabolic acidosis, not PTH.
4. In the renal failure both total serum calcium and ionized calcium were lower than the control values. Among these renal failure patients one case, who had an elevated ionized calcium, showed secondary hyperplasia of the four parathyroid glands microscopically. This means that the measurment of the ionized calcium will be valuable for the diagnosis of secondary hyperparathyroidism.
We discussed that the ionized calcium in serum played an important role in disorders of calcium metabolism in the urological field.

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Effects of dialysis treatment on pathologic processes in the kidney were studied in the patients with chronic renal failure in order to elucidate the relationship between degree of histological alterations of the kidney and dialysis periods.
Forty extirpated kidneys were available from twenty patients who received various terms of dialysis for chronic renal failure.
The cases examined consisted of one case with peritoneal dialysis. seventeen with hemodialysis, and two with both.
The duration of dialysis treatment varied from 9days to 44months and 2weeks.
The underlying renal diseases were chronic glomerulonephritis or secondary contracted kidneys in eighteen cases and malignant nephrosclerosis in the remaining two.
The pathological findings in the kidney of dialyzed patients were as follows.
1) The surface of the kidney of patients who had been treated with long-term periodic dialysis was rather smooth than granular or finely granular as was usually seen in those of non-dialyzed patients with chronic glomerulonephritis.
2) The kidneys significantly lost their weights inversely proportional to the duration of dialysis, and the renal cortex gradually decreased in thickness with dialysis.
3) The completely hyalinized glomeruli increased in number in proportion to the period of dialysis.
4) The morphological changes of the proximal convoluted tubules and their straight portions were most conspicuous among those of the urinary tubules.
In these proximal tubules, atrophy of their epithelium, hyaline thickening of their basement membranes and sclerosis of the interstitial tissues were remarkable in long-term dialyzed cases, and some of them were absorbed by the surrounding interstitial tissues just like hyalinized glomeruli.
5) In Henle's loop, the histological changes of both descending and ascending limbs were more intense in prolonged dialyzed cases than in short-term dialyzed ones. Nevertheless, the degree of atrophy of their epithelium and sclerosis of the interstitial tissues was milder than that of the proximal tubules.
6) The distal convoluted tubules showed stenosis or obliteration of the lumens proportionally to the duration of dialysis, which were associated with little thickening of their basement membranes. The structures appearing as “endocrine kidney” observed in eleven patients were considered to be derived from the distal convoluted tubules.
7) The collecting tubules were almost free from the distinct pathological changes.
8) Intrarenal arterial system clearly showed the various changes.
The interesting findings in the afferent arterioles and the distal segments of the interlobular arteries were swelling and vacuolization of the endothelial cells overlying the intima, and smooth muscle fiber hyperplasia of media.
The characteristic features of the lesions in the interlobular, arcuate and interlobar arteries were: (a) lamellar elastosis in the outer layer and edematous-fibrous or concentric fibrous thickening with an increase of slender elastic fibers in the inner layer of intima, (b) slight to moderate thickening of media and formation of perinuclear vacuole of smooth muscle fiber, and (c) slight fibrosis of adventitial tissues.
Paralleling the term of dialysis, edema in intima was gradually reduced, whereas its fibrous thickening with an increase of delicate elastic fibers became obvious, leading ultimately to obliteration of the lumen.
These findings were also remarkable in long-term dialyzed cases.
9) Deposition of various crystals was observed in the lumen, epithelium and interstitium of the urinary tubules, and in the subendothelial layer of arterioles.
It seems that these variegated morphological changes in the kidneys of dialyzed patients are not entirely newly induced by dialysis, but become manifest in the course of a vicious circle which is established in the long-term dialysis treatment.
The already diseased kidneys become physiolo

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The immunoglobulin-levels (IgG, IgA and IgM) of 50 bladder tumors, 50 follow up cases of bladder tumor, 20 patients with urogenital malignant tumor outside the bladder (other malignant disease group), 8 benign urogenital diseases (hospital control group) and 10 normal volunteers were measured with the technique of single radial immunodiffusion on Hyland immuno-plate. Bladder tumors were divided into two groups: low grade low stage group (LG group) and high grade high stage group (HG group) by Broders' and Jewett's classification.
1) Only IgM level of bladder tumors (both LG and HG groups), malignant tumor group and hospital control group is higher than normal group, but IgG and IgA levels are within normal limits. IgM level of LG group is significanly lower than that of malignant tumor group and HG group by student's p-test.
2) There exists a definite correlation between tumor grade and IgM-level, namely high IgM level has high malignancy, but there were no relationship between tumor stage and immunoglobulin-level.
3) Comparison of immunoglobulin-level of recurrent bladder tumor group and recurrent free group was also performed, only IgM-level of recurrent group was relatively higher than that of recurrent free groups, but this was not significant by p-test.
4) Clinical usefulness of immunoglobulin-level could not be firmly proved, though it furnished us a basis for a supplementaly judgement of tumor grade.

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Non specific cellular immune responses in bladder cancer patients (BC), other malignant tumor patients (OMT) and benign disease patients (BD) were studied for PHA-induced blastoid formation and PPD skin reaction.
1) PHA-induced lymphocyte blastoid formation was indicated by the difference of ³H-Tdr incorporation (dpm) between PHA-stimulated tubes and non stimulated, and were studied in 16 patients with BC, 17 patients with OMT and 26 patients with BD.
The following results were obtained: The mean incorporation±SE from 7 patients with low grade BC was 2285±511.3dpm that from, 9 patients with high grade BC 1199±487.6dpm that from, OMT 781±281.6dpm and that from, BD 3712±587.3dpm. PHA-induced lymphocyte blastoid formation was reduced in high grade BC in progressed and malignant patients.
2) Delayed skin hypersensitivity reactions with purified protein derivative (PPD) were observed at 48hrs. The mean reaction with SE from 8 patients with grade I of BC was 18.0±2.44mm, that from 29 patients with grade II of BC 19.6±2.53mm that from, 19 patients with grade III of BC 15.3±3.56mm that from, 21 patients with grade IV of BC 10.5±1.70mm, and that from 47 patients with BD 19.2±1.95mm. The mean reaction from 18 patints with stage O, A of BC 16.9±3.45mm, that from 5 patients with stage B₁ of BC 16.9±7.44 that from, 12 patients with stage B₂, C of BC 9.8±1.92mm, and that from 14 patients with stage D of BC 14.4±4.01mm. PPD reaction was reduced as grade or stage of the bladder cancer progressed and in malignant patients group.
3) Some followed up cases of bladder cancer were discussed with the course although the non specific cellular immune responces of the patients with bladder cancer were generally reduced.

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The rate of lymphocyte blastoid transformation (LBT) is an effective measure of the immune status of cancer patients.
Conventional techniques of measuring the LBT rate have depended on isolated cultures of purified lymphocytes. Such data show, statistically, that a decrease in the LBT rate occurs reflecting the extent of progression of the tumor. The individual results, however, show a comparatively wide scatter.
The present authors, therefore, in cognizance of the changes that occur in the LBT rate (especially during anti-cancer chemotherapy) introduced the Pellegrino method of whole blood culture to measure the rate of LBT. This was than used in the clinical assessment of the value of the LBT rate as an index of the therapeutic effect of anti-tumor drugs. The method showed a significant correlation with the results of isolated culture of lymphocytes (r=0.9078, p<0.01) and, since less than one ml of blood is needed per test, had the added advantage of being a simple and convenient operation.
The present experiment was an investigation of the applicability of this method to rats (body weight approximately 180g). Consistent results were obtained under conditions of a PHA-P concentration of 0.2%, the blood volume of each test being 0.1ml. Best results were obtained with a four-day culture period. ¹²⁵I iode-5deoxyuridine (¹²⁵IUdR) was best added six hours prior to the proposed termination of culture, 0.5μCi of ¹²⁵IUdR proving adequate for the purpose.
Coincidentally, it was shown that 1ml/week of blood loss is no burden on the rat and that this species is useful in monitoring the changes occurring in the rate of LBT with the passage of time.

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In a series of patients with malignant urogenital tumors, systematic aggressive polypharmacy was studied in terms of its effects on the tumor and the host's immunological status. The schedule for drug administration consisted of daily Futraful orally as the basis, and the addition of one drug per day of Oncovin, bleomycin, Endoxan, and Mitomycin C, each of which differs in its side-effects and mechanism of action. Where indicated, radiotherapy was also used, and from the end of 1974, non-specific immunotherapy was instituted on a regular basis.
The tumor types included 8 cases of renal cell carcinoma, 10 of pelvic or ureteric carcinoma, 30 of bladder carcinoma, 2 of prostatic carcinoma, 1 of prostatic rhabdomyosarcoma, and 1 of testicular rhabdomyosarcom a.
The anti-tumor effect was examined in 33 of the total 52 cases, 21 of these being effective, a rate of 63.3% with this schedule of therapy, the effective response rate was high for bladder, pelvic, and ureteric carcinomas, whereas adequate results were not obtained with renal or prostatic carcinomas.
The parameters monitored in these cases as measures of the effectiveness of therapy included erythrocytes sedimentation rates, α₂-globulin levels, PPD reactions, and lymphocytes blastoid transformation (LBT) rates. The LBT rates were measured by the whole blood culture technique reported by Pellegrino et al.
The results indicated a close relationship between the therapeutic effect and the pattern of change in these laboratory results at the time of therapy. There was also a close relationship between the laboratory findings before the commencement of therapy and the prognosis.
Active therapy was instituted from the pre-operative period in cases of advanced bladder carcinoma. In these cases, 5 courses of FOBEM together with OK-432 and ⁶⁰Co 3000rad were given at the same time. A satisfactory anti-tumor effect was obtained. There were, however, some cases of delayed healing of the surgical wound post-operatively. It was considered, therefore, that the pre-operative treatment instituted, to a certain extent, an overdose. On the other hand, a prolonged survival time could be expected following discharge from hospital. Hence, because of the improved prognosis in these urogenital malignancies, planned maintenance therapy aimed at modification of the host's immunologic status was considered necessary over a long period of time.

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In patients with bladder tumors treated with hydrostatic pressure method, the serial follow-up results of serum α₁-antitrypsin values was divided into 3 patterns corresponding to their clinical effects.
In the group with dramatic response, biphasic peaks of α₁-antitrypsin levels were demonstrated.
Monophasic curve was obtained in those with satisfactory response. Uneffective group showed no significant variations.
That might be strongly suggestive of intervening of immune mechanism in those with dramatic response.
Variation in α₁-antitrypsin levels, as a quantitative index of tumor necrosis would maintain two main estimations. The one includes evaluation of direct effects after hydrostatic pressure treatment and the accuracy of their prognosis. With periodical measurement after various kinds of clinical management, α₁-antitrypsin titers might be a useful indicator for prediction of distant metastases, especially to the lungs.

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We reported a case of bilateral renal staghorn calculi. The patient was a 54 years old female whose chief complaint was high fever. She was treated by nephrolithotomy on the left side. But she was not operated on the right side because she did not wish a second operation. We observed the postoperative course for 5 years.
In nephrolithotomy, closure of the renal parenchymal incision was made with one layer interrupted suture from the renal capsule to the pelvic mucosa by 2-0 plain cat gut. This method of suture was originally designed by Dr. Taguchi in 1967.
In the follow-up study of the operated side, we could not find recurrent stones and the renal function was preserved within normal limits. Therefore the method of suture is simple and less harmful.
We found no increase of the size of calculus in the non-operated side and the renal function estimated by IVP and renogram had remained within normal limits.
Selective renal arteriography of the operated side showed normal vascular pattern but tortuous arteries, tapering of artery and decreased cortical width were revealed in the non-operated side. Those angiographic findings were compatible with chronic pyelonephritis.
We considered that the change of pyelonephritis had advanced in the non-operated side. This observation gives suggestions that early surgical removal of staghorn calculi is necessary.

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