Response of plasma immunoreactive active renin, inactive renin, plasma renin activity, and aldosterone to hemodialysis in patients with diabetic nephropathy

Several alterations in plasma active renin, inactive renin (prorenin), and aldosterone have been described in patients with diabetes mellitus. Such changes could be of some importance for patients on hemodialysis treatment, who must undergo severe changes in fluid and electrolyte status during each dialysis session. Therefore we studied the response of renin and aldosterone to hemodialysis in uremic diabetic nephropathy patients, using direct immunometric assays to measure plasma active renin concentration (ARC), inactive renin concentration (IRC), total renin concentration (TRC), plasma renin activity (PRA), and plasma aldosterone concentration (PAC) in 11 male patients aged 39-69 (mean 53 +/- 2) with diabetic nephropathy and 11 male age-matched non-diabetics who had been on maintenance hemodialysis for 1-10 years. Although baseline values of IRC were slightly higher, and values of PAC lower in diabetics compared to non-diabetics, the results did not reach statistical significance. During hemodialysis, significant increases in ARC (p less than 0.01), TRC (p less than 0.05), and PRA (p less than 0.01), and a significant decrease (p less than 0.05) in PAC were seen in non-diabetic patients but no significant changes were observed in patients with diabetic nephropathy. IRC did not change during hemodialysis in either group of patients. There were no significant differences in body weight, blood pressure, or electrolyte changes in the two groups. These results suggest an altered response of plasma renin and aldosterone to hemodialysis in patients with diabetic nephropathy compared to non-diabetics. The reduced renin response could not be explained by a defect in conversion from inactive renin, but may be caused by decreased secretion of active renin in these patients.     

How far should we treat metastatic liver cancer? Report of three long-term survivors

The major issue in treating metastatic liver cancer is: how far should we perform resection? We believe that only reports of long-term survival afford an answer to this problem. We report three such patients. The first patient underwent pancreatoduodenectomy for cancer of the papilla of the duodenum and resection of metastatic liver cancer. She is alive without recurrence 15 years and 1 month after the initial surgery. The second patient received low anterior resection for rectal cancer, extended right lobectomy for liver metastasis, and pancreatoduodenectomy for metastasis at the common bile duct. She survived 6 years and 9 months after the initial surgery. The third patient underwent right nephrectomy for Wilms' tumor (adult type), extended right lobectomy for liver metastasis, and repeat resection of recurrences at the mediastinum and in the thoracic and abdominal walls. She is alive 21 years and 2 months after the initial surgery. These experiences have prompted us to carry out resection when surgery is deemed feasible.     

Reconstruction method with a newly-designed bilobed flap after excision of tumours of the skin.

We have devised a bilobed skin flap for reconstruction after excision of small skin tumours. The sutured part serves as a zig-zag that leads to only slight postoperative contracture of the scar. The rotation centre of the flap is nearer to the affected area than other conventional bilobed flaps, resulting in less dog-ear deformity and distortion of tissue.     

Induction of renal cell tumors in rats and mice, and enhancement of hepatocellular tumor development in mice after long-term hydroquinone treatment.

Hydroquinone (HQ) was administered to F344 rats and B6C3F1 mice of both sexes at a level of 0.8% in the diet for two years. This treatment induced renal tubular hyperplasia as well as adenomas, predominantly in males of both species, and was associated with chronic nephropathy in rats. In addition, the occurrence of epithelial hyperplasia of the renal papilla was increased in male rats. Foci of cellular alteration of the liver were significantly reduced in number by HQ in rats, but in contrast, were increased in mice, where development of hepatocellular adenoma was also enhanced in males. The incidence of squamous cell hyperplasia of the forestomach epithelium was significantly higher in mice of both sexes given HQ than in the controls, but no corresponding increase in tumor development was observed. The present study strongly indicates potential renal carcinogenicity of HQ in male rats and hepatocarcinogenicity in male mice. Thus, it is possible that HQ, which is present in the human environment, may play a role in cancer development in man.     

One-stage reconstruction of an acquired major ear defect using an auricular cartilage sling and temporal fascial flap

To reconstruct a major middle third auricular defect, a two-stage operation is usual, using a skin flap with cartilage support. In this paper, a one-stage operation for an acquired ear defect using an auricular cartilage sling and temporal fascial flap with skin grafting is reported. The auricular cartilage graft was harvested along the antihelix and used for the reconstruction of the helical rim. This is a simple, easy, and safe method of one-stage reconstruction for an acquired ear defect in properly selected patients.     

Numerical simulation of flow for viscoelastic neutrophil models in a rectangular capillary network: effects of capillary shape and cell stiffness on transit time.

The concentration of neutrophils in the pulmonary microvasculature is higher than in large systemic vessels. It is thought that the high concentration of neutrophils facilitates their effective recruitment to sites of inflammation. Thus, in order to understand the role of neutrophils in the immune system, it is important to clarify their flow characteristics in the pulmonary microvasculature. In a previous study, we developed a model to simulate the flow of neutrophils in a capillary network, in which the cells were modeled as spheres of a Maxwell material with a cortical tension and the capillary segments were modeled as arc-shaped constrictions in straight pipes. In the present paper, the flow of neutrophils in a simplified alveolar capillary network model is investigated for various constriction shapes and cell stiffnesses. Finally, it is shown that both the coefficient of variation of the transit time of the cells, which is the standard deviation divided by the mean transit time, and the mean transit time increase as the capillary segments become steep or tight, or when the cells become hard. The mean value of the transit time exceeds the median for all of the conditions that occur in real lungs, although the difference between them is small.