Biomedical subjects
Publications and source records attributed to H Huland.
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.
We measured mean renal blood flow and intrarenal blood flow distribution in 40 dogs using the xenon-133 washout technique 3 and 7 hr; 1, 2, and 3 weeks; and 4 and 6 months after unilateral complete ligation of the ureter. Mean renal blood flow rapidly decreased before renal atrophy. The data show an early redistribution of intrarenal hemodynamics with a predominant decrease in compartment I flow. These data are discussed with respect to possible ischemic atrophy especially in the renal cortex.
We studied the mechanism of elevated vascular resistance in 34 dogs with unilateral hydronephrotic kidneys. Neither an alpha-receptor blocking agent nor angiotensin II-antagonist reversed renal blood flow reduction 7 hr, 1, 2, and 3 weeks after complete unilateral ureteral ligation. We conclude that blood flow reduction is the same in the denervated hydronephrotic kidney as in the innervated obstructed kidney.
Renal and intrarenal hemodynamics were studied over a period of 6 months in the hydronephrotic dog kidney after unilateral complete ligation of the ureter. Already 7 hours after ligation renal blood flow was reduced. The intrarenal blood flow distribution changed with a massive reduction in cortical and only slight decrease in medullary perfusion. This alteration of intrarenal blood flow resulted in a change of the compartment fractions. Dopamine, applied intravenously in a dose of 4 micrograms kg-1 min-1, induced a vasodiilation of the obstructed kidney during the whole period of investigation. Especially the reduced cortical blood flow could be improved by the application of dopamine.
Of 85 adults with end stage renal disease examined consecutively for renal transplantation 25 (29.4 per cent) had vesicoureteral reflux. Of these 25 patients 11 had a nephropathy as the cause of renal failure that was unrelated to reflux (for example glomerulonephritis) and 12 had, in addition to vesicoureteral reflux, a history of urinary tract infections and chronic pyelonephritis, which seems to be significant in the etiology of terminal renal failure in our patients (14 per cent). Only 2 of the 25 patients had severe, sterile reflux: 1 had bilateral megaureter with reflux into 1 side after ureteroneocystostomy and 1 had bilateral grade IV sterile reflux complicated by megacystitis. We had no case of uncomplicated, sterile reflux, which, in our experience, seems to be a rare cause of renal failure.
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.
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.
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.
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.
Of 35 female patients with vesicoureteral reflux, 9 had a cessation of their urinary tract infections while the reflux persisted. These findings contrast with the thesis that vesicoureteral reflux is the major cause of susceptibility to urinary tract infections in these patients.
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.
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.
The results of a prospective bacteriologic follow-up of 21 consecutive female patients, who had an antireflux operation are given. Only those patients with a proven active susceptibility to urinary tract infection at the time of operation were included in this study. Of these patients, 89% had persistent recurrent urinary tract infection, though the reflux was corrected. Bacteriologic controls and long-term chemotherapy seem warranted in those patients after operation.
In the isolated, perfused kidney of untreated and catcholamine-depleted rats (by 6-hydroxydopamine and reserpine), dopamine (DA) caused a dose-dependent increase in vascular resistance which could be prevented by prior blockade of the alpha-adreno-receptors. The DA-induced vasoconstriction thus appears to be due to a direct stimulation of alpha-receptors in the kidney rather than an indirect sympathomimetic effect through release of noradrena-line from local adrenergic nerve terminals. The effectiveness of the chemical sympathectomy accomplished with 6-hydroxydopamine and reserpine was evaluated by chemical; histochemical and electron microscopical methods.
A patient with twenty years of persistent bacteriuria secondary to unilateral medullary sponge kidney, and in whom no antibiotic would sterilize the urine, was cured of her infection by nephrectomy in the presence of contralateral hydronephrosis. A review of the literature shows 23 cases of unilateral medullary sponge kidney in which nephrectomy or partial nephrectomy was apparently equally successful, although no bacteriologic follow-up data are given.
The amount of methylmethacrylatemonomer that is released into the blood-stream, during the alloplastic replacement of the hip-joint, depends on the time taken to prepare the bone cement(so-called extracorporeal polymerization-time). In vitro experiments reveal that the release of monomers depends on the preparation time. Gas-chromatographic monomer determinations show, that by prolongation of the preparation time from 2 to 5 minutes, the amount of monomer released into the blood-stream is decreased by a factor of 7. With the increase in preparation time the number of hypotonic circulatory reactions caused by the monomers will decrease. Extension of the extracorporeal polymerization-time from 2 to 5 minutes decreases the incidence of intra-operative circulatory depressions from 95% to 26%. These results were obtained by intra-arterial measurements of the blood pressure in the radial artery.
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