Renal handling of hypoxanthine and xanthine in normal subjects and in four cases of idiopathic renal hypouricemia

Pyrazinamide (PZA) was used to study the renal handling of hypoxanthine, xanthine and uric acid in 2 normal subjects and in 4 patients with idiopathic renal hypouricemia; one patient was classified as having a postsecretory reabsorption defect, whereas the others were classified as having a presecretory reabsorption defect. In normal subjects, PZA suppressed strongly the excretion of xanthine as well as uric acid; however, it showed a weak effect on that of hypoxanthine. PZA suppressed all excretion of these 3 compounds in the patient with postsecretory reabsorption defect. PZA showed almost no effect on the excretion of either hypoxanthine, xanthine or uric acid in the patients with presecretory reabsorption defect.

[Dialysis versus renal transplantation; a comparative study on medical cost and quality of life in patients with chronic renal failure]

We studied the medical costs of hemodialysis, CAPD and renal transplantation in our patients with chronic renal failure. The cost per patient averaged 660,000 yen for hemodialysis (760,000 yen for CAPD) in the first month when dialysis was started and 460,000 yen for routine maintenance hemodialysis (240,000 yen for CAPD). There was a difference in cost between recipients treated with conventional immunosuppressants (conventional group) and those receiving cyclosporine (Cs-group). That is, the estimated average cost for the conventional group was 3,800,000 in the first month after kidney grafting and at 60,000 yen in the subsequent months when the patient is cared for at the outpatient clinic; that of Cs-group was at 2,710,000 yen and 170,000 yen. This difference is due to the high cost of cyclosporine. The cumulative cost of maintenance hemodialysis is on a constant linear increase. Recently, clinical results of renal transplantation have improved markedly. Furthermore, our analysis of questionnaires to patients shows that renal transplantation is far superior to hemodialysis on the aspect of the quality of life. Thus, renal transplantation should be promoted further, and then the combined treatment of a low dose of cyclosporine and other immunosuppressants might be recommended to reduce the cost of cyclosporine.

Intraoperative blood pressure control by ATP in pheochromocytoma

Three cases of pheochromocytoma which were successfully treated with the use of adenosine triphosphate (ATP) during the operation are reported. The mechanism of the hypotensive effect of ATP has been proved due to the antagonizing action of the agent to the vasoconstriction by noradrenaline and/or sympathetic nerve stimulation. In these 3 cases, ATP has been safely and effectively applied to control blood pressure in pheochromocytoma. ATP could be used as the first-choice drug to keep the circulatory state stable during surgery for pheochromocytoma.

[Clinical evaluation of cefotaxime in complicated urinary tract infections]

Fourteen cases with complicated urinary tract infection were treated with 2 g of cefotaxime for 5 days; in total doses of 10 g. Excellent or good results were obtained in 11 cases (78.6%) and no adverse reaction was observed. A curious finding was the development of eosinophilia in some patients. The causative mechanisms and clinical meanings of the phenomenon have not been clarified.

[Basic and clinical evaluations of cefmetazole in postoperative wound infections]

The time course of the concentration of cefmetazole (CMZ) in the serum and in skin and intestinal tissues was determined after a single intravenous injection of 2 g of the drug. CMZ moved into them well. Furthermore, 41 patients with postoperative wound infection (superficial in 29 and deep in 12) were treated with CMZ 2-4 g daily. Bacteriological examination of the lesions with simultaneously carried out. As a result, 101 strains of bacteria were isolated and identified. Mixed infection was found in 27 cases (65.9%). Fifteen strains (14.9%) of E. coli, 15 (14.9%) of B. fragilis, 7 (6.9%) of Klebsiella sp. and 7 (6.9%) of Proteus sp., were the main bacteria isolated. Eight cases (19.5%) had mixed infection of E. coli and B. fragilis. The committee (3 members) evaluated CMZ to be effective in 75.6% (31 of 41 cases) and bacteria disappeared in 60.5% (23 of 38 cases). The side effects observed were pyrosis and feeling of gastric malaise in 1 case. The results suggest that CMZ is useful, which exerts an excellent effect on postoperative wound infections.