[Functional and morphologic studies on the renal pelvis and ureter in relation to surgical treatment for the congenital hydronephrosis (author's transl)].
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Biomedical subjects
Publications and source records attributed to S Tsuchida.
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Velocity Changes of intraluminal urine flow were recorded using the ultrasonic shift Doppler principle on exposed ureters of five adult mongrel dogs. This method has been used for further understanding of the speed of urine transport within the ureter when it is affected by ureteral peristalsis and the level of diuresis. Simultaneous recording of urine velocity curves and electroureterograms were performed. The results indicate that there is a direct relationship between intraluminal urine flow and peristaltic contraction. The results also show that the velocity of a urine bolus is highest during olguric conditions (urine flow1 ml/min), and, at polyuric conditions (urine flow 3 ml/min) the flow through the ureter is continuous.
In this paper the structure and use of the double cannula needle, designed to simplify percutaneous catheterization in hemodialysis, is introduced. The cannula needle is used mainly in cases with acute renal failure, and sometimes in cases of chronic renal insufficiency requiring weekly maintenance of hemodialysis.
Hypertension resulting from chronic pyelonephritis has been shown in clinical as well as experimental cases, although some authors deny that there is a pathogenic relationship between the two. To throw light on this problem the present authors conducted a series of experiments with mongrel dogs, in which chronic pyelonephritis was induced and postoperative changes in blood pressure and plasma renin activity were observed over a period of 3 months. The pyelonephritis infection was brought about by a method involving vesicoureteral reflux and ureteral dysfunction, as described in a previous paper. Preoperative and postoperative levels of systolic pressure wer compared, but no definit trends were found for the first 3 weeks after operation. At 30, 60 and 90 days the pressures were found to have risen by 21.2 plus or minus 11.2 mmHg, 21.7 plus or minus 14.6 mmHg and 17.1 plus or minus 16.7 mmHg, respectively. Thus there was a significant elevation (p smaller than 0.01). No appreciable change in the plasma renin activity was found, however, at any stage. From these results it was concluded that experimentally induced chronic pyelonephritis in dogs caused a rise in blood pressure. No connection between the pyelonephritis and the renin angiotensin system was found.
Operative pyeloscopes developed up to now have been of limited effectivness because of an inadequate visual field and difficulties in handling procedure. The author has made up a flexible fiber pyeloscope with which it is possible to extract renal pelvic and caliceal stones easily. This pyeloscope has the following specifications: effective length, 630 mm; diameter, 8.5 mm; field of vision, 60 degrees. In addition, the tip of the scope can be deflected 90 degrees up or down from the basic position with a hand manipulated angle deflector knob on the scope grip. This allows the inside of the renal pelvis to be observed clearly from every direction. Through the channel of the scope, specially designed stone grasping forceps can be inserted into the renal pelvis, and it is possible to grasp renal pelvic stones under direct observation. The fiberpyeloscope has been used in 2 cases of renal pelvic stones, in which the pelvis was exposed by subcostal flank incision. The stones were successfully extracted with the scope which was introduced through a small incision on the renal pelvis.
Blood pressure changes were followed up for 1-12 years (average; 3.8 years) in 46 cases of confirmed postoperative chronic pyelonephritis which had undergone ureterocutaneostomy, nephrostomy or other urologic operations. Diastolic blood pressure levels averaged 82 mmHg before operation, and 89 mmHg in the chronic stage after the operation. The incidence of hypertension (over 100 mmHg diastolic pressure) was 7% before the operation, but rose to 30% in the chronic stage. Application of an "age- and sex-adjusted score" also served to confirm a mean increase in blood pressure through the development of chronic pyelonephritis. No correlation was found between renal function and blood pressure. Nor was there any definite relationship between family history of hypertension and high blood pressure. In the 14 cases observed for plasma renin activity, values were found to be in the normal range.
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