Acute renal failure and rhabdomyolysis.
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Biomedical subjects
Publications and source records attributed to N Honda.
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In order to improve the diagnosis of gastric disorders on the basis of biopsy material, we devised larger biopsy forceps (5 mm X 2.5 mm in inside dimensions) which fit into the newer fibergastroscope, GIF-1T (Olympus). Samples from 116 cases yielded 276 specimens; 179 specimens (64.8%) showed the full-thickness of the mucosa with muscularis mucosae, and approximately one-third of the total specimens included a considerable amount of submucosal tissue, but none of them contained parts of muscularis propria. In 4 out of 36 gastric carcinoma cases there was inconsistency between endoscopic and histological recognition of the proximal border of carcinomatous infiltration. Differentiation between adenoma and IIa, and benign and malignant lymphoma were more feasible with our forceps. No complications apart from minor bleeding were seen.
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Two cases of primary female urethral carcinoma are presented and discussed. The patients were 70 years old and 65 years old, and the pathological diagnoses were squamous cell carcinoma and adenocarcinoma, respectively. The patient with squamous cell carcinoma had metastasized inguinal lymph nodes at the first consultation, despite the administration of bleomycin, and the tumor had widely metastasized to skin of the lower extremities. She died of cachexia and disseminated intravascular coagulopathy (DIC). The other patient with adenocarcinoma was treated by postoperative cobalt radiation therapy in a total dose of 6,000 rads. After 18 months, she had recurrence of tumor in urethra, and developed Virchow's node metastasis, she died of acute renal failure. Both patients died within two years.
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A very rare case of paraganglioma of the bladder is reported. The patient was a 51-year-old man. He was admitted to our hospital on June 18th, 1981, with the complaint of gross hematuria. He had no attack of hypertension and we could not find in him any parasympathetic symptom except hematuria. Upon urological examination, he was suspected to have stage B cancer of bladder. He received partial cystectomy with uneventful course during the operation on June 30th, 1981 and was discharged on the 15th postoperative day. The postoperative histological diagnosis was paraganglioma of the urinary bladder. He was confirmed to have normal levels of catecholamine and its metabolites in the urine after 4 months postoperatively. At present, he is asymptomatic.
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A 23-year-old woman had progressive right hemiparesis followed by spontaneous clinical remission. The clinical profile and multifocal contrast-enhancing CT lesions in the periventricular region of the cerebrum favored the diagnosis of an acute demyelinating process. Serial examinations showed resolution of CT abnormalities. Right internal carotid angiography showed prominent deep draining medullary veins with fleck-like stains. The angiographic appearances might reflect vascular involvement in the demyelinating process.
Renal handling of salt and water in the early stage of obstructive jaundice was studied in rabbits 10 days after the ligation of the common bile duct (BDL). Sham-operated (SO) animals served as controls. No sodium retention was found in BDL rabbits, despite reduced renal perfusion and elevated plasma aldosterone level. A redistribution of intrarenal blood flow was not found. The filtration fraction did not change. A saline load resulted in decreases in arterial hematocrit and total serum proteins, and increases in urine output, urinary sodium excretion and osmolal clearance. Blood pressure, glomerular filtration rate (GFR), RPF, the filtration fraction and the intrarenal flow distribution were not significantly affected by the saline load. No significant difference was found in the natriuretic response to the saline load between the BDL and SO groups. After 60 h of water deprivation, there was no significant difference in urine-to-plasma osmolality ratios or renal tissue fluid osmolality between the BDL and SO animals. The findings indicate that renal handling of salt and water was well maintained in the early phase of obstructive jaundice in rabbits. The data also suggest the critical role of the redistribution of intrarenal blood flow rather than of GFR or aldosterone in determining sodium retention in obstructive jaundice.
Diurnal variation of urinary potassium excretion was examined on 10 adult patients with chronic renal insufficiency and 24 control subjects without cardiorenal functional disturbances. The daily cycle of potassium excretion, similar to that in controls, was present but less obvious in chronic renal insufficiency. In the controls, urinary potassium excretion reached a peak in the early morning (5.30 to 7.30) with a minimum in the night (21.00 to 5.30). The morning rise in potassium excretion was associated with increases in urinary sodium excretion, arterial blood pH, and plasma potassium and aldosterone concentrations. Creatinine clearance rate did not change significantly. In renal insufficiency, plasma potassium level and potassium excretion increased in the morning as compared with the night, whereas sodium excretion, the creatinine clearance rate, arterial blood pH and plasma aldosterone concentration did not change. 9 alpha-Fluorohydrocortisone gave rise to markedly enhanced potassium excretion. The findings suggest that the blunted cycle of potassium excretion in renal insufficiency is due, in part, to suppressed diurnal variations of sodium delivery to the distal tubule, acid-base balance and/or aldosterone secretion.