Bilateral kidney tumors: oncocytoma and adenocarcinoma. A case report.

An unusual case of bilateral kidney tumors with two histologically different tumors, one right-sided oncocytoma and one left-sided renal cell carcinoma is described. The morphological features of the two tumors are briefly delineated. The diagnostic dilemma between an oncocytoma and a renal cell carcinoma is discussed.

Percutaneous nephropyelostomy: a procedure not without complications.

One hundred and twenty-eight percutaneous nephrostomies performed in 81 patients between 1978 and 1981 were studied retrospectively. Placement failures were encountered in 9%, minor complications in 7% and major complications in 6%. Two deaths occurred in connection with the nephrostomies. Catheter complications, mainly catheter dislodgement, were observed in 30% of the cases. The importance of having strict indications and a good technique is emphasised.

Evaluation of kidney viability during hypothermic perfusion or cold storage.

The effect of up to 6 days of hypothermic perfusion and up to 72 h of cold storage on tissue viability were studied from measurements of sodium potassium pump activity and adenosine nucleotide content. For the hypothermic perfusion two different albumin-based perfusates were used, one with, the other without addition of caprylic acid and amino acids. No difference could be found in the parameters studied between perfusion with these two perfusates. For both perfusates total adenine nucleotide content (TAN) decreased by approximately 60% during perfusion while energy charge potential (ECP) and the ATP/ADP ratio remained constant. During cold storage a decrease of both TAN and ECP and the ratio ATP/ADP was seen, the main decrease occurring within the 1st h. The transmembrane potassium influx as deduced from potassium content in incubated cortical slices during steady state conditions decreased during 6 days of hypothermic storage to 24.5 +/- 2.4 mumol/kg which was a significantly higher level than after 24 h of cold storage. Thus, addition of extra substrate to the perfusate does not seem to improve kidney cortex viability during hypothermic perfusion. Parenchymal viability is better preserved with continuous hypothermic perfusion, compared to simple cold storage in a solution of the same ionic composition as that used for perfusion.

Hypothermic perfusion of human kidney carcinoma: effects on viability and perfusate distribution.

A more deteriorating effect on tumour tissue than on normal renal parenchyma by hypothermic perfusion has previously been observed. The purpose of this study was to further evaluate changes in the perfusate distribution and the viability of normal cortical tissue and of kidney carcinoma during hypothermic perfusion. Tumour-involved kidneys obtained by nephrectomy from 12 patients were studied either with regard to viability, as measured with the Na+-K+ pump function in incubated tissue slices, or with regard to perfusate flow, as analysed with an isotope labelled microsphere technique. Six days of hypothermic perfusion decreased the potassium content in the tumour tissue, while it was mainly unchanged in the cortical tissue. The steady-state level of potassium in incubated slices reflected that the transmembrane K+ influx was unchanged after 6 days of perfusion in normal cortical tissue, whereas a significant reduction was observed in the tumour tissue. The relative perfusate flow in the tumour, when compared to the normal kidney cortex flow, was reduced from 60% after 1 hr of perfusion to 30% after 6 days of perfusion.

Metabolism in the hypothermically perfused kidney: utilization of mevalonate in the human and in the dog kidney.

The metabolism of mevalonate was studied in 6 dog kidneys and in 5 human tumour-involved kidneys during 6 days of hypothermic perfusion. 14C-mevalonate in the perfusate decreased and was incorporated into the total lipid fraction of the cortex in both human and dog kidneys. 80% of the incorporated radioactivity was found in the non-saponifiable lipids and after separation of that lipid fraction the radioactivity was recovered in cholesterol as well as in the cholesterol precursors lanosterol and squalene. Only very low levels of radioactivity were recovered in the tumour lipids. It is concluded that the kidney utilizes mevalonate for cholesterol synthesis during hypothermic perfusion and that addition of mevalonate may be of importance for preserving the membrane stability. Furthermore, it is suggested that hypothermic perfusion has a more deteriorating effect on the viability of the tumour tissue when compared to normal renal parenchyma.

[Metabolic and circulatory aspects of hypothermic perfusion of human kidney cancers]. / Metabolische und zirkulatorische Aspekte der hypothermen Perfusion von humanen Nierenkarzinomen.

In this study a report is made on the hypothermal perfusion of 15 renal tumours. Protein synthesis by incorporation of 14C leucine, lipide synthesis by conversion of 14C mevalonic acid and the activity of the sodium-potassium pump by incubation of sections of tissue were used as parameters of the vitality of the tissue. Circulation was studied before and after perfusion by means of angiography and the microsphere technique. After 6 days of perfusion the tumour tissue is found to be less vital in comparison with the renal cortex.

Metabolism in hypothermically perfused human kidney carcinoma: incorporation rate of leucine into proteins.

Protein synthesis in tumour-involved human kidneys was studied before, during and after hypothermic perfusion. Before and after perfusion the incorporation rate of leucine into tumour and kidney cortex proteins was determined by incubation of tissue slices at 37 degrees C. During perfusion the incorporation of leucine from the perfusate into tumour and kidney cortex proteins was determined. Before hypothermic perfusion the incorporation rate of leucine into proteins at 37 degrees C was almost the same in kidney cortex and tumour. Leucine was incorporated linearly with time into kidney cortex and tumour proteins during hypothermic perfusion but the incorporation rate was 3-4 times higher into kidney cortex proteins than into tumour proteins. After 6 days of hypothermic perfusion the leucine incorporation rate into proteins at 37 degrees C was depressed by 50% in kidney cortex and by 90% in tumour tissue. The specific activity of leucine in the perfusate decreased during the perfusion period indicating a release of leucine from degradation of proteins. It is concluded that the effect of hypothermic perfusion on protein synthesis was more pronounced in the tumour than in the normal renal parenchyma.

[Spontaneous delivery during respirator therapy. A case report (author's transl)]. / Eine Spontangeburt unter Respiratortherapie. Eine Kasuistik.

Following a short presentation of the physiological changes in respiration of pregnant women, we report our own experience with the development and therapy of a case of pneumonia during the last month of pregnancy. In this case, the spontaneous birth of a healthy child occurred after four days of mechanical ventilation. We discuss the advantages and disadvantages of waiting for spontaneous birth, taking under consideration the conditions previously described.