Urodynamics of refluxing ureters in man

Peroperative measurements of ureteral pressure, bladder pressure, and ureteral electrornyographic activity were performed during bladder filling in five vesicoureteral reflux patients. A total of seven units were investigated. The investigation supports previous observations that nondilated low-grade reflux ureters have stable low pressure but react to bladder filling by an increase in the peristaltic activity frequency. Dilated high-grade reflux ureters also react by an increase in peristaltic rate, but at the same time, the bladder pressure is transmitted to the ureter.     

Acute perirenal extravasation of urine in an infant with non-refluxing megaureter

Perirenal extravasation of urine is a rare event in congenital uropathies, mostly observed perinatally in the case of infravesical obstruction. We describe a male infant with a primary non-refluxing obstructive left megaureter who developed an acute perirenal extravasation and ascites at the age of 4 weeks. After temporary upper urinary diversion, ureterocystoneostomy was successfully performed. Intraoperatively, the distal ureter showed an extremely narrow lumen over a distance of 3 cm. In the current literature, postnatal management of primary megaureters is preferably conservative. Our patient demonstrates an extremely rare complication demanding early surgical intervention.     

Renal pelvic peristalsis in pigs during standardized flow rate variations

In the multicalyceal kidney of the pig renal pelvic pressure waves were investigated in 15 units. The pelvis was perfused with bodywarm saline gradually increased from 0-20 ml/min. The study showed a predominantly unimodal activity but all systems showed periods of instability which were characterized by coupled pressure waves, high frequencies and cascade emptying. The amplitude of the pressure waves increased with increasing flow and the study showed correlation between low amplitude and high frequency and vice versa.     

Hormonal changes related to reduced renal blood flow and low urine output under prolonged increased intra-abdominal pressure in pigs.

OBJECTIVE: To investigate effects of prolonged increased intra-abdominal pressure (IAP) on diuresis, renal blood flow, and hormones that influence renal function, in particular endothelin. DESIGN: Experimental study. SETTING: Haukeland University Hospital, Norway. ANIMALS: 21 domestic pigs. METHODS: The TAP was maintained at normal (n = 7) or at 20 mmHg (n = 7) or 30 mmHg (n = 7) for three hours. MAIN OUTCOME MEASURES: Urine output, renal venous pressure, renal artery blood flow (transit-time flowmetry), renal cortex blood flow (microspheres), and renin, aldosterone, atrial natriuretic factor (ANF), adrenaline, noradrenaline, cortisol, and endothelin-1 (ET-1) in renal venous blood. RESULTS: An IAP of 20 mmHg was followed by no significant changes in the variables studied. An IAP of 30mmHg was associated with anuria, considerably reduced renal blood flow and increased renal vascular resistance. The renin activity and the blood concentrations of ET-1, aldosterone, noradrenaline, adrenaline, and cortisol increased during the three hours that IAP was at 30 mmHg. CONCLUSION: An IAP of 20 mmHg did not influence renal haemodynamics or diuresis. The low renal blood flow observed at an IAP of 30 mmHg probably results from reduced arteriovenous pressure difference and vasoconstriction. Increased concentrations of endothelin, angiotensin II, and noradrenaline may account for the vasoconstriction. The anuria can be explained by low renal blood flow and increased reabsorption of sodium in renal tubules caused by aldosterone.     

The relationship between meteorological variations and the onset of spontaneous pneumothorax

This is in reference to: Obuchi et al. (Surg Today 41(10):1380–1384, 2011).     

Ileal segment replacement of ureter I. Effects on kidney of refluxing vs nonrefluxing ileovesical anastomosis

Unilateral partial ureteral obstruction was induced in 32 dogs followed by total ileal replacement of the obstructed ureter. The morphologic and functional effects on the kidney using a freely refluxing versus a nonrefluxing ileovesical anastomosis were compared, as well as the effect of total tapering of the reimplanted ileal segment. The tapered ileovesical anastomosis proved more reliable for prevention of reflux than the nontapered technique. Reflux prevention does not appear necessary for maintaining renal morphology and function when bladder function is normal and the observation period short. Total tapering of the ileal segment did not prove to be advantageous in protecting against hyperchloremic acidosis in this short-term canine study.     

Gastritis and gastric blood flow in hyperdynamic septic pigs.

The present study was designed to determine the gastric hemodynamics in a septic model that causes both a hyperdynamic state and acute erosive gastritis. Sepsis was established in twelve pigs by the intramuscular shank injection of Pastuerella multocida (42 X 10(8) colonies) in triptose phosphate broth; four pigs received sterile broth injections (shams) and eight received sterile saline injections (controls). After 18 hours, cardiac output was measured by both the cardiogreen dilution technic and the radioactive microsphere dilution technic; cardiac output was then compared to total and regional gastric blood flow measured by the raioactive microsphere entrapment technic. Acute erosive gastritis developed in septic pigs in the fundus and body of the stomach; the antrum was spared. Cardiac output was significantly increased in septic pigs compared with sham and control pigs. Total gastric blood flow and regional blood flow to the fundus, body, and antrum were also increased in direct proportion to the increase in cardiac output. These data suggest that acute erosive gastritis is primarily due to an end-organ cellular insult from sepsis and is not primarily due to a decrease or redistribution in gastric blood flow.     

先天性尿道下裂患者的尿流率特点及其分析

目的:研究先天性尿道下裂患者的尿流率特点。方法:笔者对22名2～6岁的先天性尿道下裂患者和22名同年龄组正常男性儿童进行尿流率测定,对比观察尿流率曲线的特点,并应用Toguri尿流率列线图对测定结果进行了分析。结果:与正常男性儿童的钟形尿流率曲线相比,尿道下裂患者的尿流率曲线呈平台形。22例尿道下裂患者中,1例(4.5%)患者的尿流率曲线与对照钟形曲线基本一致,18例(81.8%)患者的尿流率曲线呈平台形,3例(13.6%)患者尿流率曲线明显低平。在Toguri尿流率列线图上,尿道下裂患者最大尿流率坐标点位于正常人群第5百分位数曲线附近区域,明显低于正常水平。结论:先天性尿道下裂患者尿流率曲线多数呈平台形,最大尿流率明显低于正常水平。     

先天性尿道下裂患者的尿流率特点及其分析

目的:研究先天性尿道下裂患者的尿流率特点。方法:笔者对22名2～6岁的先天性尿道下裂患者和22名同年龄组正常男性儿童进行尿流率测定,对比观察尿流率曲线的特点,并应用Toguri尿流率列线图对测定结果进行了分析。结果:与正常男性儿童的钟形尿流率曲线相比,尿道下裂患者的尿流率曲线呈平台形。22例尿道下裂患者中,1例(4.5%)患者的尿流率曲线与对照钟形曲线基本一致,18例(81.8%)患者的尿流率曲线呈平台形,3例(13.6%)患者尿流率曲线明显低平。在Toguri尿流率列线图上,尿道下裂患者最大尿流率坐标点位于正常人群第5百分位数曲线附近区域,明显低于正常水平。结论:先天性尿道下裂患者尿流率曲线多数呈平台形,最大尿流率明显低于正常水平。     

The flow rate nomogram: I. Development.

In normal individuals the flow rate depends on the initial bladder volume in a non-linear fashion. A flow rate nomogram taking this relationship into account was developed as an aid in the interpretation of urinary flow rate data. With this approach excellent differentiation of normal from obstructed individuals was achieved. In addition, the variability in a single individual's flow rate over time was estimated to be relatively small and, thus, uroflowmetry may be used to identify changes in outflow resistance after medical or surgical therapy.     

尿流式细胞术检测对移植肾急性排斥反应的诊断

目的:探讨尿流式细胞术检测对移植肾急性排斥反应的诊断价值。方法:对63例肾移植术后患者在住院期间出现血肌酐值升高,均行尿流式细胞术检测,结果与临床诊断作对比分析。结果:急性排斥反应患者的尿液细胞数超过10000以上的占97.6%,CD54阳性细胞的占81.8%,CD103阳性细胞占57.6%,HLA-DR阳性细胞占90.9%;在其他患者中,缺少特异性抗原的表达。结论:尿液中HLA-DR、CD54、CD103阳性细胞可作为急性排斥反应的特异标志。尿流式细胞术能区分急性排斥反应与其他因素引起的移植肾功能损伤。尿流式细胞术可作为评价移植肾功能的检测指标。     

Indomethacin and pancreatic blood flow. An experimental study in pigs

Indomethacin has been reported to decrease pancreatic blood flow. The drug has been used as an analgesic in acute pancreatitis. As decreased blood flow to the pancreas may detrimentally affect the outcome of acute pancreatitis, we investigated the effects of indomethacin on blood flow in the normal porcine pancreas. Regional blood flows, with special reference to the pancreatic flow, were studied with radioactively labelled microspheres in ketamine-anesthetized pigs before and after intravenous administration of indomethacin 2 mg/kg during 10 min. A transient decrease of cardiac output was seen during the infusion. Basal pancreatic blood flow was significantly increased 10 and 30 min after administration of indomethacin. No significant changes were found in small-intestinal or renal blood flow. We conclude that indomethacin does not reduce blood flow in normal porcine pancreas.