Percutaneous renal and ureteric stone extraction. Report on the first 500 operations.

A consecutive series of the first 500 percutaneous renal and ureteric stone extractions in 451 patients was analysed. During the period studied, percutaneous extraction was offered to all patients with conventional indication for stone removal except a few, very early ureteric stone patients in whom open lithotomy was carried out. Ureteroscopy and extracorporeal shock wave lithotripsy had not come into routine use. Four hundred and seventy-eight stone operations (96%) could be performed by the percutaneous route; early in the series, 21 open operations and one transurethral Dormia basket extraction were performed, mainly because of failed mobilisation of ureteric stones (12 patients) or various peroperative complications (9 patients). The target stones were completely removed in 88% of all percutaneous procedures, with the best results in the largest group of patients with 6-20 mm solitary stones or 2-3 stones less than or equal to 10 mm. Stones in the ureter and pelvi-ureteric junction without any other concomitant stones were all completely removed. Bleeding was the most frequent peroperative complication. No kidney was lost. An 84-year-old man died of intercurrent disease postoperatively.

Hospital mortality and long-term survival in relation to preoperative function in elderly patients with bronchogenic carcinoma.

During an eight-year period, 82 patients 70 years of age or older were operated on for bronchogenic carcinoma. Hospital mortality was 15.9%, and five-year survival was 32%. Results of preoperative dynamic spirometry and bicycle ergometry were predictive for post-operative six-week mortality but not for long-term survival.

Increased erythrocyte sodium efflux during overfeeding without evidence of mediation by circulating catecholamines or thyroid hormone.

Ten slightly obese middle-aged men were instructed to increase their energy intake 25% during a period of 1 week, which was preceded by a control period of seven days. Body weight increased by 0.67 kg (SD 0.60) indicating good compliance with the regimen. Transmembrane sodium fluxes were determined with the use of 22Na. The pre-diet erythrocyte sodium content was 9.7 mmol/L (SD 0.8) decreasing to 8.9 mmol/L (SD 1.1) (P less than 0.05) during overfeeding. The Na-efflux rate constant increased from 0.40 h-1 to 0.54 h-1 (P less than 0.05). Urinary excretion of catecholamines and concentrations of catecholamines and insulin in plasma and of thyroxine, triiodothyronine, and reverse T3 in serum did not change. Thus, overfeeding seems to enhance the total Na efflux in erythrocytes from slightly obese men. There were no measurable changes in thyroid hormone or catecholamine levels leaving the regulatory mechanisms unexplained.

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.

Intraerythrocyte sodium content and transmembrane sodium flux in hypertensive patients treated with diuretics or beta-adrenoceptorblockers.

Forty-seven male patients with essential hypertension were randomized to treatment with either a beta-adrenoceptorblocker (metoprolol), (n = 24), or a diuretic (hydrochlorothiazide), (n = 23). If their diastolic blood pressure was not lowered below 95 mm Hg by the maximum dose of either drug, hydralazine (15 patients) and in a few cases (6 patients) spironolactone was given. After five years of treatment all the patients were examined with respect to intraerythrocyte sodium (IeNa) and potassium (IeK), sodium influx and sodium efflux. Patients treated with the diuretic (D) tended to have a higher IeNa (9.8 +/- 0.4 mmol/l red cells) and sodium influx (0.044 +/- 0.002 mmol Na/l X min) compared with those taking the beta-adrenoceptorblocker (B) (8.9 +/- 0.3 mmol/l and 0.041 +/- 0.002 mmol Na/l X min), but neither of these differences was statistically significant. Sodium efflux, however, was significantly increased in D (0.073 +/- 0.003 mmol Na/l X min vs 0.061 +/- 0.003 mmol/l X min). No difference in IeK was noted between the two groups. Six patients taking spironolactone had a low IeNa (7.3 +/- 0.4 mmol/l), sodium influx (0.039 +/- 0.001 mmol Na/l X min) and sodium efflux (0.050 +/- 0.006 mmol Na/l X min).

Blood pressure, intraerythrocyte content, and transmembrane fluxes of sodium during normal and high salt intake in subjects with and without a family history of hypertension: evidence against a sodium transport inhibitor.

Seventeen young normotensive men with a family history of hypertension in two generations (H) and 15 age-matched control subjects (C) were studied with respect to blood pressure (BP), intraerythrocyte sodium content (IeNa), sodium influx, and rate of sodium efflux. The investigations were done during normal salt intake and after 4 weeks of ordinary intake plus 12 g NaCl daily. BP did not increase significantly in either of the two groups during increased salt intake. During normal salt intake H had a significantly (p less than 0.01) higher IeNa (9.5 +/- 1.5 mmol/L) compared with C (8.2 +/- 1.4 mmol/L). During high salt intake IeNa in H decreased significantly to 8.1 +/- 1.2 mmol/L, the difference from C (7.6 +/- 1.2 mmol/L) not being significant. While the Na influx was similar in the two groups, the rate constant for Na efflux was significantly lower during normal salt intake in H (0.23 +/- 0.08 vs 0.29 +/- 0.1 h-1, p less than 0.05). Salt intake increased the efflux rate constant significantly in H (0.28 +/- 0.08 h-1, p less than 0.05), while it did not change significantly in C (0.32 +/- 0.08 h-1) compared with the value for normal salt intake. Our results suggest that young men with a hereditary predisposition to hypertension have a higher IeNa secondary to a lower rate of Na efflux, while a normal Na influx indicates normal cell permeability to Na. The findings in H during high Na intake--a decreased IeNa and an increased efflux rate of Na--do not favor the existence of a sodium transport inhibitor, in subjects predisposed to hypertension, increasing during high salt intake and volume expansion and acting through inhibition of the Na efflux.

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.

Changes in intraerythrocyte content and transmembrane fluxes of sodium during salt loading in subjects with and without family history of hypertension.

We studied 17 young normotensive men with family history of hypertension (H) in two generations (father and grandfather) and 17 age matched control subjects (C) with respect to intraerythrocyte sodium (IeNa), sodium influx, and rate of sodium efflux. The investigation was done during ordinary salt intake and after four week's salt load. H had a significantly higher IeNa (9.5 +/- 0.4 mmol/l) compared to C (8.2 +/- 0.3 mmol/l), p less than 0.01. After salt loading H decreased significantly to 8.1 +/- 0.3 mmol/l while C did not change significantly (7.6 +/- 0.3 mmol/l). There was no significant difference between H and C in Na influx either on normal or on high salt intake. The rate constant for Na efflux was significantly lower on normal salt intake in H (0.0038 +/- 0.0003 vs 0.0050 +/- 0.0004 min-1, p less than 0.05). High salt intake increased the efflux rate constant significantly in H (0.0048 +/- 0.0003 min-1, p less than 0.05), while control subjects showed no difference (0.0053 +/- 0.0004 min-1) compared to pre-salt conditions. Our results suggest that young men with heredity for hypertension have a higher intraerythrocyte Na-content secondary to a lower rate of Na efflux. The Na influx did not differ between the two groups probably indicating an unchanged permeability for sodium in subjects with a family history of hypertension.

Fibroepithelial polyp of the ureter.

Three patients with fibroepithelial polyp of the ureter are described with respect to clinical, radiographic and morphological characteristics. The importance and possibilities to reach at a correct preoperative diagnosis to allow conservative surgical treatment is stressed.

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.

Diagnosis and treatment of colovesical fistulas.

A review of the symptoms and signs as well as preoperative investigations was made in 12 patients with proved colovesical fistulas. The symptoms were predominantly those of the lower urinary tract. The value of barium enema, cystogram, cystoscopy and sigmoidoscopy was pointed out. Treatment consisted of a combined treatment with colostomy and indwelling bladder catheter, primary closure of the fistula only and various staged procedures with bowel resection. We emphasize the value of the one-stage procedure in the uncomplicated case.

Metabolism in the hypothermically perfused dog kidney. Utilization and production of amino acids.

The uptake and utilization of amino acids in dog kidneys during hypothermic perfusion were studied. 21 kidneys were perfused in a Gambro perfusion machine for 6 days with perfusates based on human albumin with and without addition of 17 L-amino acids. Net glucose uptake by the kidney was lower during perfusion with amino acids in the perfusate than during perfusion without amino acids. A decrease in specific activity of labelled glucose was found during perfusion with amino acids in the perfusate indicating a considerable gluconeogenesis which could explain the difference in net glucose uptake. A higher uptake of fatty acids by the kidney was found during perfusion with amino acids in the perfusate than during perfusion without amino acids. In perfusion without amino acids the concentration in the perfusate of almost all amino acids and ammonia increased and thus a net release of nitrogen was found indicating degradation of protein. In perfusion with amino acids in the perfusate a considerable uptake and release of amino acids by the kidney were found. The most pronounced uptake was registered for glutamine, proline and glycine. The most pronounced release was registered for glutamate, alanine and ammonia. During perfusion with amino acids in the medium, the uptake and release of nitrogen were balanced as distinguished from perfusion without amino acids in the perfusate.

Metabolism in the hypothermically perfused dog kidney. Incorporation rate of leucine and threonine into proteins.

The incorporation of [14C]leucine and [14C]threonine into kidney cortex proteins was studied during 6 days' hypothermic perfusion of dog kidneys at 8-10 degrees C and during in vitro incubation of dog kidney cortex slices at 37 degrees C. Leucine carbon was incorporated into proteins at a higher rate than threonine carbon both during in vitro incubation of kidney cortex slices and during hypothermic kidney perfusion. The incorporation of leucine and threonine during hypothermic perfusion was linear for 6 days but 50-100 times lower than the incorporation of leucine and threonine in kidney cortex slices at 37 degrees C. During hypothermic perfusion there was a decrease in specific activity of leucine and threonine in the perfusate corresponding to a degradation of proteins which was greater than protein synthesis as calculated from the incorporation of label into proteins. Leucine carbon was recovered in CO2 during hypothermic perfusion and in vitro incubation of kidney cortex slices at 37 degrees C. The incorporation of threonine carbon into CO2 was about 10% of the corresponding value for leucine both during hypothermic kidney perfusion and during in vitro incubation of kidney cortex slices at 37 degrees C. It is concluded that there is a turnover of kidney proteins during hypothermic perfusion with a perfusate containing amino acids.

Transmembrane fluxes of potassium in dog kidney slices. A quantitation of the effect of warm ischemia.

The effect of warm ischemia on the transmembrane transport of potassium in dog kidney slices was studied by measurement of the uptake of 42K. The requirement for steady-state conditions concerning the intracellular potassium concentration was thereby studied. The total potassium content in the slices was found to be constant between 120 and 180 min incubation at both 25 and 37 degrees C. The cell water calculated from the total tissue water and 14C-inulin space in the dog kidney slices amounted to 38 ml-100 g wet weight-1 at 37 degrees C and 45 ml-100 g wet weight-1 at 25 degrees C and was found to remain constant for the incubation interval 120--180 min. The major part of the tissue uptake of 42K could be described by one single mono-exponential function under these conditions. The transmembrane influx at 37 degrees C calculated by using a modified Keynes formula amounted to 1.70 mmol K+-kg wet weight-1-min-1 after no warm ischemia and to 0.89 mmol K+-kg wet weight-1-min-1 after 2 h warm ischemia. The corresponding values for incubation at 25 degrees C were 1.26 and 0.77 mmol K+-kg wet weight-1-min-1, respectively. In the slices incubated at 25 degrees C, the potassium content was higher and the sodium content lower than in slices incubated at 37 degrees C.