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1) A total of 31 patients, mainly composed of urological post-operative cases, was treated with "Riripen" combined with either sulfa drug or antibiotics. The effective rate of the therapy was 83 %. 2) The antifebrile effect of the drug was so marked that almost all patients became afebrile within 2 to 4 days following the administration of the drug. 3) The antalgic and the local anti-inflammatory effects of the drug were also conspicuons, especially for the pain following operations on the scrotum and penis. 4) Side effects were observed in 7 out of 31 cases treated. Slight gastrointestinal disturbances were seen in 6 patients and insomnia due to central nervous disturbance was seen in 1 patient, but such side effects did not necessitate discontinuation of the drug administration.

Two cases of transverse ectopic descent of the testicle we r e reported. Thirty two cases of this anomaly so far reported in Japan were statistically analyzed along with a brief discussion.

Importance of the arterio-venous shunt necessary for hemodialysis with an artificial kidney is a well known fact. Material of the shunt, operative technique and care after formed were here discussed. Patency of the shunt is a requirement for satisfactory dialysis especially in the patients under chronic hemodialysis. Sufficient blood flow through the shunt guarantees a good dialysis efficiency. Care of the shunt must be accomplished not only by an adequate guidance from the medical staffs but by the daily endeavors and attention of the patients. Social return of the patients under chronic hemodialysis should become possible in such a condition.

Clinical study was made on 65 cases of acute renal insufficiency experienced at the Department of Urology, Kyoto University from 1962 to 1969. 1) Causes and clinical manifestations of acute renal insuffiCiency were varied, but they were classified into the prerenal origin (32 cases), the renal origin (23 cases) and postrenal origin (10 cases). 2) Main treatment for these cases was dialysis. Forty-four (67.7 %) received hemodialysis with either Kolff's twin coil artificial kidney or Kiil two layers dialyzer. Twenty (30.8 %) were treated by peritoneal dialysis. 3) As to prognosis, over-all mortality was 44.6 % (29/65). Although the mortality rate was quite high (60 %) for the first few years, it has decreased to 40 % for the recent two years probably because of adoption of the early and preventive hemodialysis which has been technologically improving. Mortality rate of each causative origin was as follows: prerenal 53.1 % (17/32), renal 39.1% (9/23) and postrenal 30% (3/10). Prognosis of the group of prerenal origin was therefore poor, in which mortality rate of hepatorenal syndrome was 100 %, postoperative 50 % and posttraumatic 40 %. Adult age groups, 31 to 60 years, showed relatively high mortality. 4) Complications observed were cardiovascular disorder, pulmonary edema, and hemorrhage. This order is that of frequency as well as that of cause of death. 5) Pathophysiological aspect of the development of acute renal insufficiency was discussed with emphasis on intrarenal circulation at the time of acute renal failure. Mechanism of oliguria and anuria was also discussed from both of glomerular and tubular function.

Cepharanthin was administered to 13 patients wit h malignant tumor who were treated by radiotherapy and anticancerous agents. The results were very satisfactory in prophylactic action to leukopenia ; markedly effective in 3 cases, effective in 6 cases and noneffective in 4 cases respectively, making 69.3 % of effectiveness. No side effect was seen in all cases treated.

Twenty-six patients were treated by intermittent hemodialysis with Kiil dialyser for past two years, April, 1968 to March 1970. All the patients were equipped with the arteriovenous shunt of Quinton-Scribner type, 16 in the forearm and 10 in the leg. Average shunt survival in the patients dialyzed more than three months was 11 to 12 months on the arterial side and 8 to 9 months on the venous side both in the forearm and leg shunts. If the cases dialyzed more than one year were taken, the shunt survival was 14 to 17 months on the arterial side and 10 to 12 months on the venous side with a little longer survival in the leg shunt. These results are never inferior to those in the western countries. Complications associated with shunt consisted of clotting (48.3 %), mechanical imperfection (26.7 %), infection (15 %) and bleeding (10 %). These were predominantly seen on the venous side, therefore, recannulation required was mostly that of the venous cannula. Frequency of the complications was a little higher in the forearm shunts, but that of recannulation was almost same in both groups. Angiography is important for diagnosis of the complications. It is often helpful for recannulation to know about the state of the vessel where the vessel tip is inserted as well as about the collateral circulation.

The early diagnosis of intra-ureteral tumor is yet difficult. To approach this clinical problem, a new method of intra-ureteral biopsy was attempted. Under sacral block, a bortUia stone basket is passed up through the site of the lesion and manipulated. On withdrawing the basket from the ureter, it would pick up a small fragment of tumor tissue or sometimes blood clot. It was noted that satisfactory intra-ureteral biopsies were obtained in each of three cases of ureteral or pelvi-ureteral cancer, without particular difficulty and without ill-effect upon the patient. In all cases, the accuracy of the biopsy including Broders' cellular classification was confirmed by subsequent operation. Even when a piece of tumor fails to be picked up, a blood clot was also diagnostic because of the presence of clusters of atypical cells in it. The purpose of such biopsy is not only to make a conclusive diagnosis of ureteral tumor even at an early stage and to differentiate it from other causes of filling defects but to choose an adequate opetation on microscopic cellular grading. Application of the method should improve the percentage of correct preoperative diagnosis of ureteral tumors which has been unsatisfactory in the past.

Two-hundreds and fourty-seven patients showed non-functioning kidney, either unilateral or bilateral, on IVP for 3.5 years of 1964 to 1967. They were statistically investigated regarding sex, affected side, age, chief complaints, renal diseases, examinations further performed, treatments, etc. The hospitalized cases were precisely studied besides. Recently, non-visualizing kidney after surgery for carcinoma of the cervix has been remarkably increasing in number. Delayed excretory pyelograms taken after injection of double dosage of contrast dye seemed to be the best diagnostic method for non-visualizing kidney. Renal function studies of the patients with non-visualization on routine IVP showed that majority of them had RPF below 100 cc/min and creatinine clearance below 10 cc/min. As to treatment, nephrectomy was the operation most frequently performed on such kidney.

1. 1, 265 operations were performed at our department fo r past five years (1964-68), and 85 (6.6 %) of them were obliged to have the second surgical intervention which were essentially undesired. 2. The second operations consisted of resuture of the wound 51, hemostasis 10, closure of the urinary fistula 6, removal of the organ 4, laparotomy 4, urinary diversion 4 and incision of the abscess 3. 3. Discussio n s were made on the causes which necessitated reoperations as well as on the relation with the original operations.

Cephalexin was administered to the patients with urinary tract infection and the following results were obtained. 1. Very good results were obtained in non-complicated urinary tract infections. There was no difference between the group of 1 gram per day and that of 2 grams. 2. For complicated urinary tract infections, two grams were administered. Effectiveness in percentage was 72.2. 3. Effectiveness against urinary bacteria was studied. Seventy-five per cent of Staphylococcus; fifty per cent of E. coli and forty per cent of Klebsiella infections showed disappearance of microorganism from urine. No effectiveness was observed in Proteus and Pseudomonas infections. 4. MIC for clinically isolated strains was fairly well correlated with clinical or bacteriologic effects. 5. When 500 mg of cephalexin was orally administered, the blood level reached the peak of 15.8 pg/ml in one hour and• was quickly lowered reaching the immeasurably low level in seven hours. 6. As to side effect, two cases of slight gastrointestinal disorder were noted. 7. No ill effects on liver or kidney functions were observed at all.

The following tables show statistics on the patients and d i s eases seen, and operations and main urological examinations performed at our department during the periodfrom January tc December, 1965.

1. Twenty-six patients under chronic hemodialysis for p a s t two years, 4.1968 to 3.1970, . were divided into the outpatient and inpatient groups and further subdivided into the complete and incomplete groups based on the clinical findings and social adaptability. Findings such as blood pressure, cardiothoracic ratio, urine volume, creatinine clearance were all better in the outpatient group than in the inpatient. 2. For hemodialysis on the o u tpatient basis or on rehabilitation to be possible, the clinical indices should be as follows : mean blood pressure below 100 mmHg, cardiothoracic ratio below50 %, urine volume over 1000 ml per day and creatinine clearance over 4.0 ml/min. Social rehabilitation would be greatly depending on how much is the r e maining function, of the patients' impaired kidneys. In most of the western counteries, chronic hemodialysis is carried out on the outpatient basis. Hemodialysis under hospitalization is, of course, not what we willingly do. If a patient could not be discharged after two months, he should rather have renal transplantation than continuing hemodialysis. 3. Seven patients whose urine vo l ume is over 1000 m l/day were chosen for study of renal function. Changes of renal function were checked for three days among which 8 hours hemodialysis was inserted. After dialysis, GFR and free water clearance dropped, and all of the urnie volume, solute excretion, urinary sodium and potassium decreased. Values per each nephron also decreased. Specific gravity and osmolality showed no change due to hemodialysis and stayed fixed at the low values. So it was conjectured that function of the patients' own kidneys dropped during hemodialysis. After dialysis, GFR, urine volume, solute excretion, urinary sodium and potassium all increased gradually recovering to the predialysis values except for free water clearance which increased rapidly. 4. Discussions were made on the concentrating and diluting power of the kidneys, with emphasis on intact nephron hypothesis of Bricker et al. Their theory is not always applicable for dialysis patients, and there seem to be a certain balance among kidney function, dialysis frequency and uremic symptoms. We should not neglect the remaining function of the patients' own kidneys. If dialysis is continued based only on the uremic symptoms, urine volume might decrease. The renal function seems to be autoregulated by the physical demand of the patients. As to solute excretion, dialysis entirely takes place of the kidney ; therefore, it is natural that the excretion by the own kidney may decrease. This might be understood as regulatory adaptive phenomena by Bricker. Increased free water excretion from the remaining nephrons in the immediate postdialysis period is a good evidence of sufficient diluting power as well as of dominant of tubular diluting function over glomerular function. In this postdialysis condition, no glomerulo-tubular balance may exist. 5. If we regard, however, above changes of re n al function during and after hemodialysis as a series of homeostasis occurring in the patients, dialysis is a substitute of glomerular function although it is an unphysiologic, artificial and physical way of filtration and excretion of solutes. Tubular function which ceased during dialysis becomes dominant after that. Thus, glomerulo-tubular balance may be well maintained after all.