Changes in urinary magnesium, citrate, and oxalate levels due to cola consumption.

The serum concentration and urinary excretion of four potential stone constituents: calcium, oxalate, phosphate, and uric acid; and of two potential inhibitors of urinary stone formation, citrate and magnesium, were studied before and during ingestion of a carbonated cola beverage. Four participants, after baseline serum determinations, abstained for forty-eight hours from cola consumption and then attempted to drink 3 quarts per day of cola in the following forty-eight hours. One participant failed to drink more than two quarts per day of cola. In all 4 participants twenty-four-hour urinary excretion of magnesium decreased by an average of 2.6 mg. In the 3 participants who succeeded in drinking 3 quarts of cola per day, twenty-four-hour urinary excretion of oxalate increased an average of 8.3 mg and excretion of citrate decreased an average of 122 mg. These results demonstrate changes in urine constituents which could contribute to enhanced kidney stone formation in patients who drink large quantities of cola-flavored carbonated beverages.

Cyclophosphamide-associated carcinoma of urothelium: modalities for prevention.

The relationship between the cyclophosphamide metabolite acrolein and hemorrhagic cystitis is well documented. Its role in inducing bladder cancer is not clear. There are at least 35 cases of cyclophosphamide-associated bladder cancer in the literature to date. We report 3 additional cases of transitional cell carcinoma of the bladder. Literature assessing the relative risk of bladder cancer associated with cyclophosphamide therapy is reviewed as are methods for decreasing the toxic effects on the urothelium of the metabolite acrolein.

Renal loss following extracorporeal shock wave lithotripsy.

A patient with life-threatening retroperitoneal hemorrhage after extracorporeal shock wave lithotripsy is presented. Despite angioinfarction of the involved renal unit, nephrectomy ultimately was required to control bleeding. The urological and hematological aspects of the management are discussed.

Penile abscess involving the corpus cavernosum: a case report.

A patient with a penile abscess containing mixed colonies of bacteria is presented. Ultrasound scan confirmed the physical examination findings of involvement of the corpus cavernosum. After incision and drainage the patient has normal erectile function.

Ultrasound and spermatogenesis in the rat.

Using exposure conditions comparable to those which have been associated by others with positive results, we tested for effects of ultrasound on sperm production over a period of 12 weeks following treatment. Continuous wave exposure with spatial average intensities of 1, 2 and 4 W/cm2 and exposure times up to 10 minutes were used. In some experiments, the exposures were repeated after an elapsed time of 48 h. No significant changes in spermatogenesis were related to any of the exposure conditions in spite of the fact that some of the treatments caused thermal tissue damage near bone. No effects of exposure were found in weights of the testis, prostate, seminal vesicle, or whole body.

Recovery of glomerular and tubular function in autotransplanted dog kidneys preserved by hypothermic storage or machine perfusion. Relation of initial function to long-term function.

Sixteen male dogs had split renal function studies prior to unilateral nephrectomy and autotransplant. Kidneys were preserved for 24 hr by either simple hypothermic storage in Collins C2 solution (SHS) or machine-perfused (MP) on a Waters machine (MOX 100) with plasmanate perfusate. Renal function studies were repeated at 1 hr and at 7, 14, and 28 days, and the statistical relationship between initial and 1-month function was determined for a number of parameters. All MP kidneys functioned immediately, whereas 1/3 of SHS kidneys had delayed function. Recovery was more rapid in MP kidneys and was essentially complete by 14 days, at which time MP kidneys had higher rates of creatinine clearance and sodium reabsorption. However, by one month 3/7 MP kidneys (P = 0.15 compared with SHS) had lower creatinine clearance rates than at 2 weeks, and para-aminohippurate (PAH) clearance and fractional sodium reabsorption were significantly decreased. During the same period SHS kidneys either showed continued improvement or maintained stable function. Thus, by one month there were no differences between the groups in clearances of creatinine and PAH, plasma creatinine and blood urea nitrogen concentrations, or fractional reabsorption of sodium, potassium, and water. For SHS kidneys, the 1-hr creatinine clearance and the absolute rate of sodium reabsorption were strong predictors of the eventual function of the kidneys at one month (r = 0.93 and r = .83, P less than 0.05, respectively). No such correlations were found in MP kidneys (r = less than .01, P greater than 0.9 for both variables). The data show that MP results in significantly better function early after transplant, but this advantage does not persist, and that SHS kidneys early function is a good predictor of long-term recovery, but this is not true for MP kidneys.

Early indices of warm ischemic damage in autotransplanted canine kidneys preserved by simple hypothermic storage.

After measurement of normal renal function, dog kidneys (n = 52) were subjected to 3, 15, or 30 min of normothermic warm ischemia (WI). After 24 hr of preservation by simple hypothermic storage (SHS) in a modified Collins solution, autotransplant was done and renal function was again measured beginning at 1 hr. Compared with preharvest values, kidneys with minimal (3 min) WI had significantly decreased clearances of creatinine (Cr) and para-aminohippuric acid (PAH), PAH extraction, absolute and fractional Na reabsorption, Na excretion, and urinary Na concentration; no change in urine flow rate or K excretion; and significantly increased fractional excretion of Na, K, and H2O. Compared with minimal WI, 30-min WI produced further significant decreases in clearances of Cr, PAH, and PAH extraction; and further increases in fractional excretion of Na, K, and H2O. Urine flow was also decreased by about half and urine Na concentration rose significantly. Several parameters were very significantly correlated with the length of WI, but the most reliable index was the fractional reabsorption of Na. When several functional parameters were used together, kidneys with significant (30 min) WI prior to preservation could be identified with a high degree of statistical reliability.

Glomerular filtration response to acute ureteral obstruction in the dog.

In order to assess the glomerular filtration responses to acute ureteral obstruction in the dog we employed an established method that does not require timed urine collections. Our results show a 57 per cent increase in renal blood flow (baseline: 203.8 +/- 50.9 vs. 319 +/- 69.4 ml./min. at 105 minutes; no. = 7) that was associated with a monophasic decrease in filtration fraction to -70 per cent at 120 minutes (0.26 +/- 0.025 vs. 0.08 +/- 0.007) and an increase in ureteral pressure to 63.1 +/- 6.1 mm. Hg at 120 minutes. A biphasic GFR response was noted with an initial small increase (baseline: 32.5 +/- 7.5 vs. 36.3 +/- 11.0 ml./min. at 2 minutes) followed by a continual decline to -55 per cent at 120 minutes (to 14.5 +/- 2.6 ml./min.). This investigation has confirmed the results of micropuncture studies showing maintenance of GFR early after complete ureteral ligation.

Selective pre-transplant nephrectomy: indications and perioperative management.

From May 1977 to June 1983, 198 patients were accepted as candidates for renal transplantation at our university. We review our experience with 14 consecutive patients who underwent selective pre-transplant nephrectomy during this interval. Indications for this procedure included recurrent or chronic pyelonephritis, structural abnormalities of the urinary tract predisposing the patient to infection, malignant or renin-dependent hypertension, Goodpasture's disease, certain cases of rapidly progressive glomerulonephritis and selected patients with polycystic kidneys. All patients underwent dialysis 1 day preoperatively. Perioperative fluid losses were measured carefully with prompt and vigorous replacement therapy. Patients received an average of 5,890 cc fluid replacement before postoperative dialysis. All patients underwent dialysis within 29 hours postoperatively. There were no postoperative deaths and 8 complications. Selective pre-transplant nephrectomy has spared 93 per cent of potential renal transplant candidates from a major surgical procedure. No patient has required removal of the original kidneys during the post-transplant period. Our experience has shown that the reluctance to hydrate these patients is unwarranted and that prompt postoperative dialysis, if required, is safe. Since some end stage kidneys are physiologically active and the associated surgical risk is high, pre-transplant nephrectomy should be performed only in carefully selected patients. In contrast to previous reports, which advocated minimal fluid administration and delayed postoperative dialysis, our recent experience indicates that vigorous fluid replacement therapy, carefully monitored with serial vital signs, weights, serum electrolytes and central venous pressure readings, will avert many of the complications encountered previously.

Urachal abnormalities in the adult.

A spectrum of rare urachal abnormalities in the adult is described, including urachal cyst, infected urachal cyst and abscess, and urachal carcinoma. The clinical and radiographic features are presented, and diagnosis using ultrasound, computed tomography, and needle aspiration is discussed. Treatment of infected urachal cysts with percutaneous catheter drainage is described.

Simplified new approach to endoscopic photography.

Information obtained by endoscopic examination can be shared with others by viewing sequentially through the same endoscope, "teaching attachments" allowing viewing ports through the same instrument, drawings based on the observers' recollection of the findings, and by endoscopic photography. Of these methods, endoscopic photography has the important advantages of speed and faithfulness of reproduction. Herein, we describe a simple technique for endoscopic color still-photography with illustrations of normal and pathologic findings.

Transplant immunity in hamsters treated with ultrasound.

Hamsters with subcutaneous fibrosarcomas were treated by excision and by exposure to 5-MHz ultrasound for six minutes at an intensity of 3 W/sq cm. Rates for successful elimination of the tumors were between 80% and 90% and were not significantly different for the two methods of treatment. After 30 days, the animals were challenged with the same tumor cells. Animals successfully treated with ultrasound or excision required at least 10 times as many cells to produce a tumor as controls, indicating that eradication of the tumor by ultrasound induced a level of transplant immunity at least as good as that resulting from surgical excision.

Blunt renal trauma in the pediatric patient.

Injury to the kidney from blunt trauma occurs rather frequently in the active, pediatric patient. Early evaluation and treatment of these children is essential in order to preserve maximum renal function. Ninety cases of pediatric renal trauma from blunt injury have been reviewed. The majority of these responded well to careful conservative, non-operative management. Many of those requiring surgical intervention responded well to initial conservative treatment followed by surgical intervention conducted as an elective procedure within the first week after injury. Five case reports with associated radiographic studies are presented.

Percutaneous kidney biopsies. Complications and their management.

Six hundred thirty-two percutaneous renal biopsies were performed in 479 patients between 1965 and 1978. Complications occurred with 86 biopsies, an incidence of 8.5 per cent. Most complications (seventy-six of eighty-six) were minor, and either resolved spontaneously or did not require intervention. There were ten major complications, including 6 patients with gross hematuria requiring blood transfusions, 3 with hemorrhage treated with arterial embolization, and 1 with a symptomatic arteriovenous fistula that was treated with partial nephrectomy. Major complications of percutaneous renal biopsy and the modes of therapy are discussed.

Surgical treatment of renovascular hypertension in children: the roile of renal autotransplantation.

We describe 2 children with renovascular hypertension treated successfully by autotransplantation, as well as an additional child in whom ex vivo microsurgical repair was attempted. The literature is reviewed and all patients within the pediatric age group with renovascular hypertension who were treated surgically are reported. The different types of vascular reconstructive techniques and, particularly, the previous use of autotransplantation are discussed.

Use of labial tissue in repair of urethrovaginal fistula and injury.

Labial flaps were used during the delayed repair of urethrovaginal fistulas and during the immediate repair of an obstetric urethral injury. In two patients, the labial fat pad alone was used. In the third patient, the fat pad and the overlying labial mucosa were rotated to cover the urethral repair. Our favorable results suggest further use of labial tissue in the repair of urethrovaginal fistulas or urethral injury.

Anaerobic urinary tract infection owing to Bacteroides fragilis in a chronic hemodialysis patient.

A chronic maintenance hemodialysis patient with severe oliguria and persistent anaerobic urinary tract infection owing to Bacteroides fragilis is presented. Review of the literature shows that the incidence of anaerobic pathogens in random urine cultures is high but that the incidence of clinically significant infection is low. Since the urethra harbors anaerobic organisms suprapubic aspiration of urine and culture are indicated to confirm true anaerobic urinary tract infection. Anaerobic infections are associated with urinary tract abnormalities and pyuria. The various therapeutic maneuvers that were used to treat the infection are discussed, including antibiotic instillation into the bladder and nephrectomy.