The effect of stones on renal and ureteric physiology.

The effect of calculi on renal and ureteric function is the result of a complex sequence of pathophysiological events triggered by obstruction. The degree of impairment of renal function resulting depends on whether the obstruction is partial or complete, is unilateral or bilateral, is complicated by infection or not and how and when it is relieved. This review will look at these interacting factors and particularly on the effects of various treatment modalities ranging from open techniques to minimally and non-invasive interventions.

A study of regional distribution of renal blood flow using quantitative autoradiography.

Quantitative autoradiography utilizing [14C]iodoantipyrine was used to measure regional renal blood flow in anesthetized rats. This technique allowed blood flow in any region of the kidney to be measured with a resolution of 100 microns. There was no significant difference between flow to polar and middle regions of the renal cortex [875 +/- 57 vs. 926 +/- 71 (SE) ml.100 g-1 x mm-1]. Areas of high optical density in renal cortex corresponded to peritubular capillaries. Mean cortical blood flow was three times greater than mean medullary blood flow. Outer medullary blood flow was uniform but significantly higher than inner medullary blood flow (272 +/- 16 vs. 45 +/- 7 ml.100 g-1 x mm-1; P < 0.001).

Anatomic and clinical factors associated with complications of transfemoral arteriography.

Complications of transfemoral arteriography requiring surgery are rare but carry significant morbidity. To evaluate clinical factors that might relate to such complications, we retrospectively reviewed our experience from January 1, 1985, to December 31, 1988 (four years). Forty-seven complications requiring surgery occurred among 10,589 cases. The risk was higher after cardiac catheterization than after peripheral arteriography (0.55% versus 0.17%, p less than 0.025). In nearly 40% of these cases, arterial puncture was not in the common femoral artery. Acute bleeding complications were more likely among patients with puncture outside the common femoral artery (p less than 0.001). Older patients and women were at slightly higher risk for complications requiring surgery, but this difference was not statistically significant. The frequency of bleeding complications was not significantly higher among patients who were anticoagulated following the procedure. The distribution of puncture sites was identical in obese and nonobese patients. Three patients died (two from myocardial infarction, one from multisystem organ failure). Two limbs did not improve; one required major amputation. Four limbs had persistent paresthesia and two had persistent weakness. We conclude that complications of transfemoral arteriography requiring surgery occur more frequently among patients who are undergoing cardiac catheterization and who suffer aberrant punctures. Age, sex, body habitus, and anticoagulation have less impact on patient risk.

The in vitro response of fibroblasts to the fluid that accumulates under a vapor-permeable membrane.

We decided to examine whether the mechanism for production of granulation tissue during moist wound healing under a vapor-permeable membrane (VPM) is related to a fibroblast growth-promoting substance in the wound fluid beneath the VPM. The experimental design utilized growth curves performed on synchronized fibroblast cultures derived from 2 normal infants. Cell counts were performed at days 1, 4, 7, and 11 (saturation density). VPM fluid (MWF, moist wound-healing fluid) from 7 different patients was used to supplement growth medium (GM) in the test growth curves. Both 2% MWF alone and 2% MWF plus 2% human serum (2 + 2) were evaluated for each patient. Control curves were conducted using GM supplemented with 2%, 4%, and 10% human serum (HS). When 2% MWF alone was added to culture medium, all cells lifted off the surface of the flask within 4-7 days. If (2 + 2) was used to supplement the medium, detachment did not occur. At days 4, 7, and 11, (2 + 2) flasks had significantly greater cell densities than did flasks supplemented with either 2% or 4% HS alone (p less than 0.001). At days 4 and 7, (2 + 2) cell counts were the same as 10% HS cell counts (p = 0.99). By day 11, (2 + 2) cell counts exceeded those of 10% HS (p less than 0.01). We conclude that the fluid that collects under the specific VPM used in this study when added to HS causes synergistic stimulation of fibroblast cell division and an altered pattern of fibroblast growth.