A case of horseshoe kidney with surplus renal arteries.

During a gross anatomy course at Kurume University School of Medicine in 2001, an anomaly of the kidneys was found. The lower ends of the kidneys were fused by a renal substance and formed a horseshoe kidney located ventral to the abdominal aorta and inferior vena cava. Both renal hila opened very widely in the ventral direction, with the left hilum being larger than the right. This horseshoe kidney had original left and right renal arteries that branched from the abdominal aorta. As well, there were four surplus renal arteries. The first surplus artery branched from the right renal artery and was distributed to the upper pole of the right kidney. The second arose from the abdominal aorta and was distributed to the inferior pole of the right kidney. The third arose from the abdominal aorta and was distributed to the inferior pole of the left kidney and part of the isthmus. The fourth branched from the abdominal aorta and was distributed to the upper pole of the left kidney. The incidence of horseshoe kidneys in Japanese anatomical dissections has been reported as 0.15-0.48%. This was the sixth such case for our laboratory, representing a frequency of 0.1% (6 of 1902 dissections) from 1952 to 2001.

Efficacy of n-3 polyunsaturated fatty acid enriched enteral nutrient solution in relieving oxidative stress in patients with severe psychophysiologic disorders.

It is not unusual for patients with severe motor and intellectual disabilities to present with eating and swallowing disorders, and such patients often require long term enteral nutrition. These patients tend to receive all their nutrients in the form of a single nutrient solution that is administered over a long period, and there are concerns about the impact of the composition of these nutrient formulas on patient health. Therefore, it is very important that adequate care be taken when selecting a nutrient formula for patients of this type. In the present study we administered two types of enteral nutrient solutions and examined the effect of the differences in nutrient composition on the degree of oxidative stress experienced by human patients. Subjects were 5 patients (mean age: 27.2 years; male/female ratio: 4:1) with severe motor and intellectual disabilities who were incapable of oral feeding, and who were receiving long term enteral nutrition. The subjects were administered a standard elemental diet for 2 months, and this was followed by administration of an n-3 polyunsaturated fatty acid enriched enteral nutrient solution for three months. Results showed that the n-3 polyunsaturated fatty acid enriched diet improved serum concentrations of trace elements, protein synthesis, and the balance between n-6 polyunsaturated fatty acids and n-3 polyunsaturated fatty acids, which are essential fatty acids. At the same time oxidative stress was reduced, and serum IgE levels declined significantly. Patients with severe psychophysiological disorders often suffer from repeated bouts of pneumonia due to immune system suppression, and there are reports that such patients are subject to increased allergic diathesis. The present results indicated that the in vivo membrane damage induced by oxidative stress may be closely related to the onset of these disorders. The results also suggested that in addition to attaining an adequate understanding of the effect of each of the various nutrients in enteral nutrient formulas, it will also be important to consider not only trace elements but also fatty acid composition in the nutritional management of patients with such disorders.