Exertional hemoglobinuria

A 16 years old boy had a typical exertional hemoglobinuria after walking with his new leather shoes on. The attacks of hemoglobinuria were associated with the appearance of an unstable hemoglobin in red cells. A slightly decreased fragility curve by 24 hr incubated red cells, the increase of autohemolysis and the appearance of heat labile hemoglobin were observed after exertion. These findings support that exertional hemoglobinuria may be regarded as a transitory erythropathia.

Acute renal insufficiency following hydrostatic pressure treatment: comments on technical procedure

A man with a solitary bladder carcinoma suffered acute tubular necrosis following hydrostatic pressure therapy. The nephrotoxicity caused by antibiotics and/or the septicemic shock seems to be responsible. The animal experiment suggested changes in the technique: 1) the bladder should be overdistended via a Foley catheter with a rubber ballon at the tip to prevent a possible postoperative complication and 2) one should try to decrease rather than maintain the high intravesical pressure during overdistension to avoid bladder wall rupture. The overstretching of a blood vessel alone is quite sufficient to bring the anoxia upon the bladder tumor, which is verfied by the biophysical principle.