Pathophysiology of perinatal asphyxia

Following a severe asphyxial episode many cells can recover metabolically, and a cascade of processes are triggered in which intervention, even some hours later, can allow rescue of some cells that would otherwise die. A number of principles, however, needs to be carefully considered before extrapolating from animal to human trials. In particular, the effects on long-term outcome and on those who are compromised by intrauterine growth retardation need to be determined. It is critical to be able to identify rapidly those infants in terms of nature and severity of injury who are most likely to benefit from treatment. The dimension of time and phase of injury or recovery are key factors to effective intervention. Novel continuous cerebral function monitoring techniques such as those based on real-time spectral analysis of the EEG activity, cortical impedance monitoring, and near-infrared spectroscopy have considerable potential for determining the severity and pathophysiologic phase of injury on line.

Cotransfection of HIV-1 molecular clones with restricted cell tropism may yield progeny virus with altered phenotype

Seven infectious molecular clones were obtained from a human immunodeficiency virus type 1 isolate with rapid/high replicative capacity. Biological characterization of progeny viruses obtained after transfection of clones into peripheral blood mononuclear cells showed that six clones yielded virus with restricted cell tropism, whereas one clone yielded virus able to replicate in cell lines. Although transfection of each of the clones 12, 13, and 82 individually gave rise to viruses with restricted tropism, viruses recovered from cotransfection of the mixtures of these clones exhibited altered phenotype, inasmuch as they were able to replicate in cell lines. To test whether recombination and/or complementation has taken place in the mixture of clones 12 + 13 + 82, the progeny virus was diluted to end point in 15 parallel series. Viruses with diverse biological phenotypes were recovered. With the help of distinctive restriction enzyme markers in regions comprising the vpu/env junction and variable regions 4 and 5 (V4/V5) of the env gene, recombinant genotypes could be identified with high frequency. No particular biological phenotype could be linked to a certain genotype in this study. The results show that different coexisting variants may interact and thereby influence the biological phenotype of a viral population.

Submicrometer intracellular chemical optical fiber sensors

A thousandfold miniaturization of immobilized optical fiber sensors, a millionfold or more sample reduction, and at least a hundredfold shorter response time, all simultaneously, were achieved by combining nanofabricated optical fiber tips with near-field photopolymerization. Specifically, pH optical fiber sensors were prepared with internal calibration, making use of the differences in both fluorescence and absorption of the acidic and basic dye species. The submicrometer sensors have excellent detection limits, as well as photostability, reversibility, and millisecond response times. Successful applications include intracellular and intraembryonic measurements. Potential applications include spatially and temporally resolved chemical analysis and kinetics inside single biological cells and their substructures.

The interaction of the Bainbridge and Bezold-Jarisch reflexes in the conscious dog

Experiments were undertaken to determine the efferent path of the Bainbridge reflex and to investigate the interaction of the Bainbridge reflex with the Bezold-Jarisch reflex in conscious, chronically instrumented dogs. The Bainbridge reflex was elicited by distending the left atrium by inflating a chronically implanted balloon catheter. The Bezold-Jarisch reflex was elicited using chemical stimulation of left ventricular receptors with infusions of veratridine (0.1-0.8 micrograms/kg/min) into the left circumflex coronary artery. Heart-rate responses to left atrial balloon inflation were compared before and after either beta-1 antagonism with metoprolol or cholinergic antagonism with atropine, and before and during left ventricular receptor stimulation with intracoronary veratridine. Left atrial balloon inflation alone caused a significant increase in heart rate (70.1 +/- 5 bpm), left atrial pressure (14 +/- 3 mmHg) and mean arterial blood pressure (10 +/- mmHg). Heart-rate responses to left atrial distension were inhibited, but not abolished by either cholinergic or beta-1 antagonism. Left atrial distension after both cholinergic and beta-1 antagonism abolished the heart-rate response to balloon inflation. These results indicate that the efferent component of the Bainbridge reflex has both a vagal and a sympathetic component in conscious dogs. Left atrial distension during simultaneous left ventricular receptor stimulation resulted in a significantly decreased tachycardia than did left atrial distension alone (26 +/- 3 bpm compared to 68 +/- 8 bpm in the control experiments). In addition, the slope of the heart rate vs left atrial pressure relationship was significantly inhibited by left ventricular receptor stimulation (1.8 +/- 0.2 bpm/mmHg compared to 5.7 +/- 0.3 bpm/mm Hg in the control experiments). There were no significant differences in either the left atrial pressure or arterial blood pressure changes between the two groups. These data suggest an interaction between these two reflexes that may be occurring in the central nervous system.

Effect of manganese (II) bis(glycinate)dichloride on Ca2+ channel function in cultured chick atrial cells

Manganese (II) bis(glycinate)dichloride (Mn(glycinate)2) is a coordination complex of manganese with application as a contrast enhancement agent for magnetic resonance imaging in the heart. To determine the cardioactivity of the manganese ion in this chelation cage, the effects of Mn(glycinate)2 on Ca channel function in the cultured chick atrial cell was studied. Mn(glycinate)2 decreased amplitude of contraction in chick atrial cells from embryos 14 days in ovo with complete inhibition of beating at 1 mM and half-maximal effect at 0.1 mM. Under control conditions, Bay K 8644, a Ca channel activator increased amplitude of contraction by 86% with a half maximal effect at 3.2 x 10(-7) M. In the presence of 0.025 mM Mn(glycinate)2, a concentration which had no effect on the amplitude of contraction, the maximum response to Bay K 8644 was decreased to 31%. Mn(glycinate)2 had no effect on the EC50 for the response to Bay K 8644, 1.7 +/- 0.1 x 10(-9) M (S.E.M., n = 4) in control cells compared to 2.2 +/- 0.4 x 10(-9) M (S.E.M., n = 4) in cells incubated with Mn(glycinate)2. 45Ca2+ uptake over 5 min in cultured chick atrial cells decreased from 2.0 nmol/mg protein in control cells to 1.5 nmol/mg protein in the presence of 10(-5) M PN200-110, a Ca2+ channel blocker, a decrease of 28%. 45Ca2+ uptake decreased to 0.94 nmol/mg protein (53%) in the presence of 1 nmol Mn(glycinate)2. Effects of Mn(glycinate)2 and PN200 were not additive. These data demonstrate that Mn(glycinate)2 exerts its negative inotropic effect, at least partially, by interfering with the function of the L-type Ca channels at high concentrations.

Acute carotid baroreflex resetting in conscious dogs

1. Acute baroreflex resetting in the control of arterial pressure was studied in six chronically instrumented, conscious dogs. Following aortic baroreceptor denervation, the carotid sinuses were surgically prepared for reversible vascular isolation. 2. During the experiments both carotid sinuses were temporarily isolated from the systemic circulation and conditioned with a pulsatile pressure. The carotid sinus conditioning pressure (CPCSP) was at a level of 100, 140 or 60 mmHg for 20 min each. Carotid sinus pressure (CSP) versus mean arterial pressure (MAP) baroreflex curves were constructed after each conditioning period. 3. The baroreflex curves were shifted downward and to the left at low CPCSP and upward and to the right at high CPCSP. 4. We used four parameters to quantify baroreflex resetting. These were: (1) the set point pressure (PSP), (2) the threshold pressure (PTh), (3) BP50 or mid-point pressure and (4) the CSP at maximum gain (PGmax). At high CPCSP, these four parameters were increased by 18.5 +/- 4.0, 23.4 +/- 4.3, 21.7 +/- 5.0 and 22.0 +/- 5.1 mmHg, respectively (P less than 0.05). 5. Resetting was not complete in these studies. The extent of resetting was approximately 50% for upward and 35% for downward baroreflex conditioning. 6. Analysis of the present experimental data indicates that when the cardiovascular system is exposed to a short-term hyper- or hypotension, the baroreflex is capable of correcting the baseline arterial pressure while preserving its ability to buffer transient disturbances as a result of partial resetting.

A central mechanism of acute baroreflex resetting in the conscious dog

The role of the central nervous system in the mechanism(s) involved in acute carotid baroreflex resetting was studied in six conscious, chronically instrumented, aortic-denervated dogs. Dogs were prepared for reversible vascular isolation of the carotid sinuses. Acute baroreflex resetting was induced by holding the left carotid sinus pressure (LCcsp) at a given value for 20 minutes using a pulsatile pressure control system while at the same time keeping the right carotid sinus pressure (RCSP) at a subthreshold level (approximately 40 mm Hg). At the end of the 20 minutes, the LCcsp) was reduced to approximately 20 mm Hg, and a baroreflex (RCSP-mean arterial pressure [MAP]) curve was generated on the right carotid sinus using static-step increases in carotid sinus pressure. At the control LCcsp of 100 mm Hg, the RCSP-MAP baroreflex had a threshold pressure (Pth) of 86.6 +/- 3.1 mm Hg and a set point pressure (Psp) of 104.7 +/- 2.5 mm Hg. Increasing LCcsp) to 140 mm Hg for 20 minutes caused these parameters for the right carotid baroreflex to increase. Pth and Psp increased by 18.4 +/- 4.0 and 14.2 +/- 3.0 mm Hg, respectively (p less than 0.05). The baroreflex curve, therefore, was shifted upward and to the right. Decreasing LCcsp to 60 mm Hg caused Pth and Psp to decrease by 24.7 +/- 5.0 and 18.1 +/- 2 mm Hg, respectively (p less than 0.05). The baroreflex curve was therefore shift downward and to the left. The percent of resetting of Pth and Psp was 46 +/- 9% and 36 +/- 8%, respectively, when LCcsp was 140 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute baroreflex resetting and its control of blood pressure in an open loop model

Acute baroreflex resetting has been quantitatively studied in anesthetized dogs. Carotid sinuses were isolated bilaterally and carotid sinus conditioning pressure (CPcsp) was set at nine different levels for 20 min over a range of from 40 to 200 mm Hg. Over this range of 160 mm Hg in CPcsp, the magnitude of baroreflex resetting of set point pressure (Psp), threshold pressure (Pth) and BP50 was 32.0 +/- 5, 43.3 +/- 6 and 39.6 +/- 6 mm Hg, respectively. The extent of resetting was a non-linear function of the level of CPcsp. There is less resetting at high CPcsp. The average extent of resetting is only about 25%. In contrast to this small degree of resetting, a profound inverse relationship between the baseline pressure and the conditioning pressure was observed at the end of the conditioning period for each CPcsp. In addition, we also observed an attenuation in the buffering capacity of the baroreflex at very high or very low CPcsp. Vagotomy and aortic section did not alter baroreflex resetting. This data indicates that the baroreflex is capable of monitoring the absolute level of blood pressure during acute resetting in addition to buffering transient disturbances in arterial pressure. Based upon the results of the present experiments, the concept that acute baroreflex resetting results in an inability of the baroreflex to monitor the absolute level of arterial pressure does not appear to be valid.

Holographic detection of optical squeezed states

A holographic technique is described that permanently records and detects the quadrature components of optical squeezed states.

PGE2 and arachidonate inhibit the baroreflex in conscious dogs via cardiac receptors

Prostaglandin (PG) I2 and PGE2 are known to stimulate left ventricular receptors with nonmyelinated vagal afferents. The present experiments were performed to determine the effects of intracoronary infusion of PGE2 (10-50 ng.kg-1.min-1) and arachidonic acid (50-100 micrograms.kg-1.min-1) on the baroreflex control of heart rate in conscious dogs. Dogs were anesthetized with pentobarbital sodium and were instrumented using sterile surgical techniques. After recovery, baroreflex pressure-heart rate curves were constructed by varying arterial pressure with partial occlusions of the descending aorta or inferior vena cava. Intracoronary infusion of PGE2 significantly inhibited the maximum heart rate achieved during unloading of baroreceptors, attenuated the heart rate range, and decreased the maximum slope of the baroreflex curve; PGE2 had no significant effect on the minimum heart rate during hypertension. Intravenous infusion of PGE2 did not cause significant baroreflex inhibition, and pericoronary nerve block in three dogs prevented the effects of intracoronary PGE2. Intracoronary infusion of arachidonic acid had effects on the baroreflex control of heart rate similar to those of PGE2. The effects of arachidonic acid infusion were prevented by cyclooxygenase blockade. Thus intracoronary PGE2 and arachidonic acid inhibit the baroreflex control of heart rate most likely via stimulation of left ventricular receptors with vagal C-fiber afferents. The effects of arachidonic acid were secondary to synthesis of prostaglandins.

Intracoronary infusion of prostaglandin I2 attenuates arterial baroreflex control of heart rate in conscious dogs

Prostaglandin I2 (PGI2) is known to stimulate ventricular C fiber receptors resulting in a Bezold-Jarisch-like reflex. Also, cardiac receptor stimulation is known to interact with the expression of arterial baroreflexes. Therefore, experiments were performed to determine the effects of left circumflex coronary artery infusion of PGI2 on the baroreflex control of heart rate in conscious instrumented dogs. Dogs were instrumented chronically with an aortic catheter for the measurement of mean aortic pressure, hydraulic occluder cuffs on the descending aorta and inferior vena cava, a left ventricular catheter for the measurement of left ventricular pressure and heart rate, and a nonocclusive catheter in the left circumflex coronary artery. At the time of experimentation, arterial pressure was altered randomly in steps by partially inflating the occluders. Mean arterial pressure-heart curves (baroreflex curves) were constructed by fitting the data to a logistic curve by nonlinear regression. PGI2 infused into the left circumflex coronary artery at doses of 10, 20, and 50 ng/kg/min caused significant (p less than 0.05) inhibition of the maximum heart rate, heart rate range, and maximum slope of the curve compared to the control baroreflex curve obtained during intracoronary infusion of PGI2 vehicle. PGI2 had no significant effect on the minimum heart rate during hypertension. Since PGI2 is known to stimulate left ventricular receptors, these effects were most likely produced via stimulation of cardiac receptors. In additional experiments using beta 1-blockade with metoprolol or cholinergic blockade with atropine methyl bromide, it was shown that PGI2 attenuates baroreflex-mediated tachycardia by preventing parasympathetic withdrawal completely and by attenuating sympathetic stimulation by approximately 50%.(ABSTRACT TRUNCATED AT 250 WORDS)

Initial experience with the argon laser in cutaneous vascular lesions

An 18-month clinical study on the effects of argon laser in cutaneous vascular disorders in 41 patients carried out at the National University Hospital is discussed. The results confirmed the excellent response that can be achieved in lesions such as capillary hemangiomas, granuloma pyogenicum, cherry angiomas, telangiectasias and spider angiomas, but not in venous flare of the lower limbs. We are cautiously optimistic about its role in portwine stains; results are still being assessed. Complication rates so far have been relatively low with scarring observed in one patient.

PGI2 attenuates baroreflex control of renal nerve activity by a vagal mechanism

The present study was undertaken to determine whether left circumflex coronary artery (ic) administration of prostacyclin (PGI2) caused an inhibition of the baroreflex control of renal sympathetic nerve activity (RSNA). RSNA was recorded in 12 dogs. Baroreflex sensitivity of RSNA was assessed by infusion of either sodium nitroprusside or phenylephrine and by determining the slope of the mean arterial pressure-RSNA relationship. During nitroprusside infusion, intracoronary PGI2 depressed the baroreflex sensitivity by nearly 90% compared with intracoronary tris(hydroxymethyl)aminomethane (Tris) (P less than 0.002). In addition, the peak increase in RSNA during nitroprusside infusion was significantly inhibited during intracoronary PGI2 (57.9 +/- 6.4 vs. 21.2 +/- 3.0 spikes/s, P less than 0.05). There was no significant difference in the inhibition of RSNA during phenylephrine infusion when intracoronary PGI2 was compared with Tris. Both bilateral vagotomy and pericoronary lidocaine blocked the inhibitory effects of PGI2 on the baroreflex increase in RSNA. It is concluded from these data that exogenously administered PGI2 stimulates or sensitizes afferent endings within the supply of the left circumflex coronary artery to inhibit the baroreflex control of RSNA during evoked hypotension. These afferents traverse vagal pathways via the pericoronary nerves. The role of endogenous prostaglandins in modulation of baroreflex function via a cardiac reflex remains to be elucidated.

Prostaglandins mediate the increased sensitivity of left ventricular reflexes after captopril treatment in conscious dogs

Captopril administration has been shown to result in the release of prostaglandins (PGs) in experimental animals and patients. Also, PGs, particularly prostacyclin (PGI2), have been shown to stimulate left ventricular receptor reflexes. Thus, the hypothesis that captopril administration results in sensitization of left ventricular reflexes via increased circulating levels of PGs was tested in conscious instrumented dogs. Left ventricular reflexes were stimulated by injecting veratridine into the left circumflex coronary artery through a nonocclusive catheter. Under control conditions, injection of veratridine resulted in a decrease in mean arterial pressure of -25 +/- 4.7% from a base line of 97 +/- 4.7 mm Hg and a decrease in heart rate of -28 +/- 3.7% from a base line of 91 +/- 6.6 beats/min. After administration of captopril, veratridine injection resulted in a decrease in mean arterial pressure of -43 +/- 4.9% and a decrease in heart rate of -51 +/- 8.5%, both significantly greater effects than before captopril (P less than .05); N = 7). Subsequent administration of the cyclooxygenase inhibitor, indomethacin (5 mg/kg), in the presence of captopril reversed the potentiation of the response to veratridine. Thus, after indomethacin, injection of veratridine decreased mean arterial pressure -29 +/- 4.4% and decreased heart rate -28 +/- 4.1%; changes not significantly different from the control response. Similar findings were observed in a separate set of experiments in which heart rate was held constant by cardiac pacing (N = 6).(ABSTRACT TRUNCATED AT 250 WORDS)

[Traditional Chinese and Western medicine in the treatment of 27 patients with malignant lymphoma]

Twenty-seven patients with malignant lymphoma (14 Hodgkin's disease, 9 histiocytosarcoma, 2 plasmacytoma, 2 lympholeucosarcoma) were treated by Ailin-injection plus Chinese herbal medicine. The latter's composition and dose varied depending on the clinical manifestations. All the patients had stage III and IV lesions. The total remission rate was 70.37% (complete remission 13 patients, partial remission 6 patients, no remission 8 patients). In addition, we also studied the suppressive effect of Ailin on transplanted tumor in vivo (S-180). The suppression rates were 36.09%, 48.80%, 32.67% by three repetitions with an average of 39.18% (P less than 0.002). They were 37.25%, 35.29% on S37 with an average of 36.27% (P less than 0.005). They were 46.53%, 44.56%, 51.35%, 45.95% on Ehrlich ascites tumor cells with an average of 47.09% (P less than 0.001). The clinical and experimental studies suggest that Ailin-1 has no serious side effects and is well tolerated by patients with malignant lymphoma at moderate or advanced stages. No toxic reactions were observed at the clinical dose. In the above combination therapy, the Chinese herbal medicine has obvious supplementary effect in the treatment of the patients' cachexia and immuno-suppression.

Dynamic computed tomography and its application to ophthalmology

In this review of 31 patients, dynamic CT is discussed as a valuable tool in the study of the dynamics of blood flow in patients with unexplained visual problems that may be related to ischemic optic neuropathy. Dynamic CT scans are obtained by rapid-sequence CT imaging during and following a rapid bolus injection of intravenous contrast medium. It demonstrates the initial passage of contrast material through the area of interest, thus giving a true picture of the degree of vascularity and the dynamics of blood flow.

Neuroradiological and electroencephalographic features in a case of temporal lobe status epilepticus

A patient with medically intractable status epilepticus of temporal lobe origin is presented. A computed tomogram showed a low density area adjacent to the midbrain, possibly related to atrophy of the medial temporal lobe. Cerebral angiography revealed early filling veins and an anterior temporal blush. Magnetic resonance (MR) scanning (T2 weighted images) showed increased signal intensity in the region of the amygdala and anterolateral left temporal lobe. Ictal activity was recorded from scalp electrodes over the left temporal area, and many paroxysms were recorded from cortical surface electrodes. An anterior temporal lobectomy revealed only gliosis. The cerebral blood flow changes accompanying status epilepticus of focal origin are reviewed, and a possible relation of electroencephalographic, angiographic, and MR findings is discussed.

Potential Antimalarials. III. N4-Substituted 7-Bromo-1,5-naphthyridin-4-amines

A series of new N4-substituted 7-bromo-1,5-naphthyridin-4-amines has been prepared from nicotinic acid through 3-bromo-8-chloro- 1,5- naphthyridine by nucleophilic replacement of the 8-chloro substituent with appropriate amines. Several of these compounds, namely 7-bromo-N- (4′-diethylamino-1′-methylbutyl)-1,5-naphthy-ridin-4-amine (′5-azabromoquine'), 4-(7′-bromo-1′,5′-naphthyridin-4′-ylamino)-2-(diethylamino-methyl)phenol and 7-bromo-N-(2′-diethylaminoethyl)-1,5- naphthyridin-4-amine showed significant antimalarial acivity. Apparent cures were effected when these test chemicals were injected intra-peritoneally in a single dose of 200 mg/kg to mice infected with Plasmodium vinckei vinckei.

Potential Antimalarials. IV. 4-[7'-Bromo(and Chloro)-1′,5′-Naphthyridin-4′-Ylamino]Phenols and N4-Substituted 7-Chloro-1,5-Naphthyridin-4-Amines

A series of nine mono- and di-Mannich bases, for example 4-(7′-bromo-1′,5′-naphthyridin-4′-ylamino)-2,6-bis( dimethylaminomethyl )phenol derived from 4-(7′-bromo-1′,5′-naphthyridin-4′-ylamino)phenol and several other N4-substituted 7-bromo- and 7-chloro-1,5-naphthyridin-4- amines have been prepared. ′All these compounds showed significant antimalarial activity when injected intraperitoneally in a single dose of 100-200 mg/kg to mice infected with Plasmodium vinckei vinckei. The di-Mannich bases appeared to be the most potent and effective in parasite control; however, no deaths were observed in infected mice treated with the mono- Mannich compounds.

Aphasia after left thalamic infarction

We examined a 70-year-old woman who became aphasic after a left thalamic infarction. Computed tomographic scan showed injury that was largely limited to the ventral anterior and rostral ventral lateral thalamic nuclei. Speech was characterized by reduced voice volume, impaired auditory and reading comprehension, perseverations, intermittent use of jargon, fluctuations in the ability to perform confrontation naming, extraneous intrusions, verbal paraphasia, intact repetition skills, and fluent speech that was laconic but grammatically correct. We propose that the deficits after left thalamic injury can be grouped into the following four large clusters: extrapyramidal deficits (decreased or fading voice volume), deficits in lexical access (anomia, verbal paraphasia), deficits in vigilance (neologisms, intrusions, fluctuating performance, jargon, perseverations), and comprehension defects.

Cardiopulmonary resuscitation at the Singapore General Hospital

Effective use of Cardiopulmonary Resuscitation (CPR) saves lives both in and out of hospitals. Yet, in Singapore, this practical skill is rarely taught even within the medical community. Observations from a CPR pilot training programme at the Singapore General Hospital expose this glaring deficiency in our health system. Urgent remedial measures are needed.

Potential Antimalarials. I. 1,8-Naphthyridines

A number of 1,8-naphthyridines including 8-aza analogues of chloroquine and amodiaquine, and similar 1,8-naphthyridines with 2- and 7-methyl substituents have been prepared. These compounds showed minimal antimalarial activity in a preliminary in vivo screen against Plasmodium vinckei vinckei.

Potential antimalarials. II. N4-Substituted 2-Methoxy(and 2-hydroxy)-1,5-naphthyridin-4-amines

Several new N4-substituted 2-methoxy(and 2-hydroxy)-1,5-naphthyridin-4-amines have been prepared from ethyl 3-aminopyridine-2-carboxylate. 2,4-Dichloro-1,5-naphthyridine with methanolic sodium methoxide gave 4-chloro-2-methoxy-1,5-naphthyridine but with methanolic hydrogen chloride afforded 4-chloro-1,5-naphthyridin-2-ol. The N4-substituted 1,5-naphthyridin-4-amines showed no significant antimalarial activity compared to chloroquine or primaquine in a preliminary in vivo screen against Plasmodium vinckei vinckei in mice.

Epidural anesthesia: effective analgesia in aortoiliofemoral arteriography

The efficacy of epidural anesthesia for control of pain experienced by patients undergoing peripheral arteriography was studied in 77 patients. In 70 patients, arteriographic studies were completely painless. Two patients experienced severe pain, while five felt different degrees of limited pain and/or burning sensation. Arteriograms in the 77 patients were excellent because the analgesia allowed injection of large volumes of contrast, the patients did not move during the injection because of motor block, and finally the sympathetic block probably resulted in peripheral vasodilatation. We believe that epidural anesthesia represents the method of choice in the control of pain during arteriographic examinations of the lower extremities.

Diagnosis of urine extravasation after renal transplantation

Urine extravasation in the early postoperative period after renal transplantation is a serious complication requiring expedient surgical intervention. Whereas clinical and laboratory findings are inconclusive, radiologic diagnostic studies have definite value. Routine ultrasound and radioisotope studies were performed on 111 renal transplant patients. In the eight who developed urine extravasation, ultrasound and/or radioisotope studies identified the extravasation in seven cases. Four of the eight were studied by intravenous pyelography and another two were studied by cystography. All results were positive. We recommend use of radioisotope and ultrasound studies for routine postoperative screening with invasive techniques reserved for inconclusive cases.