Morphological assessment of thin basement membrane disease.

Thin basement membrane disease is more common than IgA nephropathy or Alport syndrome, which are also associated with the presence of erythrocyturia. Very few reports on the disorder are available in the Polish literature. The objective of this work was to analyze the results from 83 patients with thin basement membrane syndrome as well as to formulate a proposal of strict morphological assessment criteria for the disorder. Attention was drawn to the requirement of thickness of the lamina densa rather than the entire basement membrane thickness and a sufficiently high number of loops featuring thinned lamina densa, namely at least 80% of loops, being taken into account. Occurrence of other morphological changes associated with the disorder and clinical symptoms other than erythrocyturia was also highlighted.

Impact of common ABCB1 polymorphism on pharmacokinetics and pharmacodynamics of clopidogrel and its metabolites.

WHAT IS KNOWN AND OBJECTIVE: The reasons of clopidogrel (CLP) resistance are still unclear. The response to CLP may be influenced by both genetic and non-genetic factors. Among genetic factors, common polymorphisms in the gene coding glycoprotein-P (P-gp, MDR1 and ABCB1) are considered as potential determinants of the efficacy of CLP treatment. The aim of this study was to evaluate the influence of ABCB1 3435C>T genetic polymorphism on the pharmacokinetics and pharmacodynamics of CLP and its metabolites: diastereoisomers of thiol metabolite (the inactive H3 and the active H4) and inactive carboxylic derivative. METHODS: The study group included 42 patients undergoing elective coronary angiography and percutaneous coronary intervention. The plasma concentrations of CLP and its metabolites were measured by a validated HPLC-MS/MS method. Whole-blood aggregation was determined with Multiplate analyzer. For evaluation of ABCB1 3435C>T polymorphism, PCR-RFLP method was applied. RESULTS AND DISCUSSION: It was found that Exposition to the unchanged CLP, measured by AUC0-t of the drug, was significantly lower (P = 0·012) in TT homozygotes comparing to that observed in CC and CT genotypes, although no correlation was found between platelet aggregation and ABCB1 genetic polymorphism. WHAT IS NEW AND CONCLUSION: Our findings show that the presence of 3435C>T allele has an impact on CLP pharmacokinetics but not on the drug pharmacodynamics. Therefore, the 3435C>T genotype may not be the primary determinant influencing the pharmacokinetics of the active H4 metabolite and antiplatelet effect of the drug.

The flexible panendoscope.

A flexible instrument for urological endoscopy of the renal pelvis, urethra and bladder is reported. Experience was gained with a commercially obtainable intraoperative choledochofiberscope. This flexible instrument has a tip that can be bent through 200 degrees and allows visualization of all the aforementioned endoscopic areas. Air was used as the visual medium for urethrocystoscopy, which has the advantages of providing better vision and of being universally available. A series of more than 100 urethrocystoscopies and the experience gained with the use of this instrument for intraoperative pyeloscopy during several years are reported.

[Conservative treatment of staghorn and residual calculi (author's transl)]. / Uber konservativ behandelte Ausgusssteine und Restkonkremente.

We report about 20 inoperable patients with staghorn calculi or residual stones following previous surgery. Follow up to seven years revealed that most were accompanied by gram-negative bacteria (mainly proteus species). All patients received stone prophylaxis regularly (allopurinol, vitamin B 6, KCl, cellulose phosphate). Antibiotics were administered only for short durations. In no case we did observe any serious complications, in only two patients stones increased in size, but one of them was later diagnosed to have hyperparathyroidism.

[Single-dose gentamicin treatment and simultaneous localization of urinary-tract infections (author's transl)]. / Einmaltherapie mit Gentamicin und gleichzeitige Lokalisation von Harnwegsinfekten.

Single-dose gentamicin (80--120 mg; Refobacin) can be used successfully to treat significant bacteriuria in women, while at the same time differentiating between upper and lower urinary tract infection. Localization was achieved by demonstrating antibody-carrying bacteria in urine by immunofluorescence. In all 31 women with lower urinary-tract infection so treated urinary sample continued to be bacteria-free when retested one to for weeks later. On the other hand, in 22 of 25 women with renal bacteriuria the original bacteria were repeatedly isolated after treatment. Using single-dose gentamicin and subsequently re-testing urine samples, renal infections in four women were correctly diagnosed in this manner, although the initial immunofluorescence test was negative.

[The bladder neck suspension according to Stamey-Pereyra for stress urinary incontinence (author's transl)]. / Die Blasenhalssuspension nach Stamey-Pereyra zur Therapie der Stressinkontinenz.

The bladder neck suspension technique according to Stamey and Pereyra are described. 89% of 50 patients with stress urinary incontinence were cured regardless of previous operations. The technique proved to be simple and effective even if scarring from previous operations are present. There is no compression of the urethra. The bladder neck suspension should be widely used to cure stress urinary incontinence in the female.

Renal and intrarenal hemodynamics in compensatory hypertrophy.

We studied renal and intrarenal hemodynamics in 40 dogs 7 hr; 1, 2, and 3 weeks; and 4 and 6 months after contralateral complete ureteral occlusion. Changes in the perfusion of the compensatory hypertrophied kidney could not be detected using the xenon-133 washout technique. We concluded that increased renal perfusion plays no role in the development of compensatory hypertrophy.

[Electron microscopy of prostatic carcinoma cells (author's transl)]. / Ultrastrukturelle Untersuchungen an Prostatacarcinomzellen (I).

20 histologically proven carcinomas of the prostate were studied by light and electron microscopy. Three different cell types were found in the carcinomas, characterised by typical structures of nuclei and cytoplasm. First the so called dark cells showed a polar architecture and sometimes cells with anaplastic alterations. Then the so called light cells appeared not to be a secretory type but proliferative cells with embryonal character. The third type included malignant cells similar in appearance to the cells of normal prostatic glands. Vacuolisation of cells was observed only in the necrotic areas.

[Electron microscopy of prostatic carcinoma cells following castration (author's transl)]. / Ultrastrukturelle Untersuchungen an Prostatacarcinomzellen nach Kastration (II).

Prostatic tissues from 20 patients with confirmed prostatic carcinoma were studied electron-microscopically. Biopsies were taken 4 weeks after castration. Most carcinoma cells revealed signs of androgen deprivation. In embryonal like light cells the changes were not significant. In androgen-dependent cells we distinguished three different reactions: 1. Emergency of lysosomes and focal degradation of cytoplasma. These changes seemed to us to be the first step in the cell involution. 2. Total vacuolisation of the cells was seen in the advanced stages of cell involution. All organelles of the cell showed signs of degeneration. Sometimes the changes were irreversible. 3. 4 weeks after castration necrosis of cells were seldom seen.

[Flexible operative nephroscope]. / Flexibles Operationspyeloskop.

Our experiences with a flexible fiberscope for nephroscopy during operation are reported. With high pressure of the irrigation fluid, good judgement of the pelviocaliceal system is possible. Sounds for coagulation and forceps for stone extraction can be introduced. We found nephroscopy helpful after stone extraction and in identification of pyelocaliceal tumours.

[The value of direct localization studies for the surgical treatment of urinary tract infections (author's transl)]. / Der Wert direkter bakteriologischer Lokalisationsmethoden für die operative Behandlung von Harnwegsinfekten.

Techniques to localize an upper urinary tract infection--the bladder wash-out test and the ureteral catheterization method--are described. Case reports are given to demonstrate the usefulness of these methods when surgical treatment of urinary tract infections seems to be indicated.

[Vesicorenal reflux and kidney transplantation]. / Vesikorenaler Reflux und Nierentransplantation.

25 (30%) out of 85 adult patients with endstage renal disease were found to have vesicoureteral reflux. In group I with 15 patients renal insufficiency was caused by kidney disease alone. In a second group 8 patients had the diagnosis chronic pyelonephritis with well documented history of urinary tract infection. In a third group 2 patients have megaloureter-megalocystis syndrome. There was no case of uncomplicated, sterile reflux in the second and third groups, which seems to be a rare cause of renal insufficiency.

[The bilateral nephrectomy in terminal renal disease (author's transl)]. / Einzeitige bilaterale Nephrektomie bei terminaler Niereninsuffizienz.

45 cases of nephrectomy are reported. Mortality was 8.9%. Thirty-one had a drug-resistant, severe hypertension, three had infected kidneys, and in eleven cases nephrectomy was performed prior to transplantation. Although blood pressure improved in all patients, of the first group 24% died within one year after nephrectomy, which shows unsatisfactory prognosis of malignant nephrosclerosis. Only early nephrectomy can lead to better results. Routine nephrectomy before transplantation should be avoided. Indications for this group are discussed.

[Retroperitoneal, non-chromaffin paraganglioma of the right kidney (author's transl]. / Retroperitoneales, nicht-chromaffines Paragangliom im Bereich der rechten Niere.

A case of retroperitoneal, nonchromaffin paraganglioma simulating a hypernephroma of the right kidney is described. Prognosis and therapy of this rare tumor is discussed and the literature is reviewed.

Renal calculus dissolution in immobilized patients.

13 patients presenting with immobilization stones are reported. Young males with an infection of the urinary tract are most commonly affected. In the case of phosphate stones, the infection of the urinary tract with an alkaline shift of the pH and an idiopathic hyperuricosuria play a decisive part together with temporary hyperphosphaturia and hypercalciuria. The importance of urea splitting bacteria in the urine for stone formation is stressed. Applied in time increase of fluid intake, specific antibiotics and allopurinol can lead to litholysis. If the urine of immobilized patients were monitored closely from the beginning of the hospitalisation for the above factors, and treated appropriately, urine calculi should be largely prevented.