Changes in local blood flow in the solitary kidney after chronic blockade of cholinergic mediation

The method of hydrogen clearance has been used to study the influence of compensatory hypertrophy and continuous 120-day pharmacologic blockade of parasympathetic nerves by atropine on interorgan peritubular blood circulation of the Wistar line rat kidneys. Reliable "lagging" of the cortical blood flow behind the analogous values of the control group with a single kidney is noted. Decrease of the cortex perfusion under conditions of cholinergic blockade is due to "baring" of the high sympathogenic tonus of cortical vessels in spite of postnephrectomic hyperperfusion in the control. A conclusion is made concerning significance of cholinergic mediation in development of compensatory hypertrophy of a single kidney in syndrome of its denervation impairment.     

标准通道经皮肾输尿管镜气压弹道碎石术治疗复杂肾结石

目的:探讨标准通道经皮肾输尿管镜气压弹道碎石术治疗复杂肾结石的疗效及安全性.方法:总结2009年4月-2009年12月采用标准通道经皮肾输尿管镜气压弹道碎石术治疗复杂肾结石36例39侧临床资料.结果:本组35例38侧成功行Ⅰ期PCNL,手术时间30-180min(平均86±34min),出血约30-500ml(平均110±20ml).其中8例残留结石大于1.0cm,术后5-7天行局麻下二期手术清除残石,总结石清除率92.1%(35/38),ESWL治疗3例.1例孤立肾铸型结石并肾积水、肾功能不全,经皮肾穿刺置入F8单J管引流,二期行标准通道PCNL术.所有病例随访1-3月,无严重手术并发症.结论:标准通道经皮肾输尿管镜气压弹道碎石术治疗复杂肾结石,具有安全、效率高、创伤小、恢复快的特点,并可明显减低医疗成本.     

Surgical removal of duct occluder device under mild hypothermia without cardiopulmonary bypass

Because the use of percutaneous intervention is increasing for the closure of the patent ductus arteriosus, the procedure-related complications are also on rise, with migration of the device being most common. The routine practice is to remove the migrated duct occluder device under cardiopulmonary bypass. Amplatzer duct occluder used in a 4-month-old infant dislodged into the descending thoracic aorta. It was removed by the posterolateral thoracotomy under mild hypothermia through juxtaductal aortotomy between the aortic cross-clamps. The use of cardiopulmonary bypass is thus avoided.     

Endothelium of myocardium microvessel under conditions of hypothermia, ischemia, reperfusion and pharmaco-cold cardioplegia with calcium antagonist

Microvessels of the right atrium endothelium were investigated with electron microscope for patients with congenital heart disease receiving surgical treatment under deep perfusionless hypothermia and various methods of pharmaco-cold cardioplegia. In group 1, pharmaco-cold cardioplegia was performed, with hyperosmolar normopotash solution cooled down to 2-4 degrees C. In group 2, the same solution combined with isoptin, a potash-ion blocker, was applied. It has been shown that during global ischemia, stability of ion gradients on plasmalemma of endothelial cells is impaired, irrespective of the composition of cardioplegia solution. Alongside with this, ultrastructural reactions in group 1 proceed towards hyperosmia of endothelium accompanied by building up a large group of cells following coagulation necrosis. In group 2, by contrast, an intracellular edema progresses. The cardioprotective effect of isoptin, which is able to block Ca2+, manifests itself most vividly at reperfusion, when the blocking of cell potash overload prevents the development of dystrophic and destructive changes in endothelium of coronary microvessels, which present one of the most severe consequences in the process of blood flow recovery in ischemic tissues.     

Substructure of solitary cilia in mouse kidney

Summary Recent scanning electron microscopic studies confirm the presence of solitary cilia on most epithelial cells along the mammalian nephron and collecting ducts.By transmission electron microscopy we have found that the axonemata of such cilia consist of a maximal number of 9 doublet and no singlet filaments. 10% of the cross-sectioned cilia contain 9 doublets arranged in a peripheral ring (9+0 pattern). 30 % of the cross-sections contain 8 or 7 doublets in peripheral ring and 1 or 2 doublets in the central region (8+1 and 7+2 patterns). Serial sections and goniometer tilt reveal the central doublets to originate as dislodged peripheral doublets. 60% of the sectioned cilia contain filament numbers between 8 and 4. In patterns of 5 and 4 filaments single microtubules predominate.The functional significance of these atypical cilia is discussed.We are indebted to Prof. B. Afzelius and Prof. Th. Brun for valuable information and discussions during this work. The technical assistance of Miss K. Weltzin, Mr. E. Erichsen, Mr. R. Jensen and Mr. J. Røli is greatly appreciated     

Muscle oxidative capacity and work performance after training under local leg ischemia

Healthy young men executed supine one-legged cycle training four times per week for 4 wk with legs and the cycle ergometer inside a pressure chamber, the opening of which was sealed by a rubber membrane at the level of the crotch. Each training session started by training one leg under ischemic conditions induced by increased chamber pressure (50 mmHg) at the highest intensity tolerable for 45 min. Then the other leg was trained with the same power profile but normal atmospheric chamber pressure. Before and after the training period, both legs executed one-legged exercise tests under both normal and increased chamber pressure and muscle biopsies were taken from the vastus lateralis. Ischemic training increased performance more than normal training, the difference being greater for exercise executed under ischemic conditions. The difference in performance increase between the legs was paralleled by a greater muscle citrate synthase activity in the ischemically than in the normally trained leg.     

Chinese minimally invasive percutaneous nephrolithotomy for intrarenal stones in patients with solitary kidney: a single-center experience

Objective

To report our experience with Chinese minimally invasive percutaneous nephrolithotomy (Chinese MPCNL) to manage patients with intrarenal stones in solitary kidney, and evaluate the safety, efficiency and feasibility of this technique.

Methods

Forty-one patients with intrarenal stones in solitary kidney underwent Chinese MPCNL in our department from March 2009 to February 2011. Demographic characteristics, operative parameters, number of tracts, stone-free rates (SFRs), stone analyses, hemoglobin levels, nephrostomy tube removal time, hospitalization time, and complications were evaluated. Serum creatinine (Scr) and glomerular filtration rate (GFR) were measured preoperatively, postoperatively at 1 month, and each follow-up visit. The 5-stage classification of chronic kidney disease (CKD) was used according to the National Kidney Foundation guidelines.

Results

The initial stone-free status was achieved in 35 (85.4%) patients after Chinese MPCNL. The mean follow-up time was 16.9±4.7 months (range: 12–24), and the final SFR improved to 97.6% after auxiliary procedures. Among all patients, complex stones were detected in 26 (63.4%) patients, and 9 (22.0%) required multiple tracts. The mean operative time and mean hospitalization time were 71.3±23.5 min (range: 40–139) and 6.1±0.5 days (range: 5–11), respectively. During preoperative period and postoperative period (1 month), Scr were 132.1±41.3 umol/L (range: 78.2–231.4) and 108.9±30.7 umol/L (range: 71.6–136.9), respectively (P<0.05), while GFR were 74.9±24.2 ml/min (range: 35–110) and 83.9±27.4 ml/min (range: 65–110), respectively (P<0.05). According to CKD classification, the renal function was stable, improved, and worse in 29 (70.7%), 11 (26.8%), and 1 (2.5%) patients, compared with the preoperative levels. No patient progressed to end-stage renal disease requiring dialysis.

Conclusions

Our experience with Chinese MPCNL demonstrates that it is safe, feasible and efficient for managing the intrarenal calculi in solitary kidney with a low complication rate. At long-term follow-up, renal function stabilized or even improved in the majority of patients with solitary kidney.