Nephrolithotomy by one-layer interrupted parenchymal suture

Since 1967, when Taguchi devised a method of closing renal incisions in nephrolithotomy in which the renal capsule, parenchyma and pelvic mucosa are sutured together as one layer without prior hemostasis, this method, with subsequent modifications of surgical technique, has been employed in 47 cases of staghorn or multiple large calculi. The simplified method of suture shortens the clamp-time of the renal pedicle during operation, minimizes injury to the parenchyma, while assuring adequate hemostasis. All the treated cases showed good results postoperatively, free from any serious complications such as secondary hemorrhage. Renal function tests after nephrolithotomy by this method showed decreases of 20 and 16% in glomerular filtration rate and renal plasma flow, respectively, which returned to preoperative levels in 2 weeks. Pre- and postoperative renal arteriograms indicated some changes in the intrarenal arteries and parenchyma due to the incision and method of suture. Occlusion of intrarenal arteries occurred in 91.7% of the cases, in fact at the level of interlobar or minor artery in 90%, and the average number of sites of arterial interruption per kidney was 4.7. The author considers the method to be irrevocably perfect for renal parenchymal suture.

Prostaglandin F2 alpha metabolite levels in plasma, amniotic fluid, and urine during pregnancy and labor

Levels of 13, 14-dihydro 15-keto-prostaglandin F2alpha (dhk PGF2alpha) in the plasma of 30 patients as well as in the amniotic fluid of 17 patients, and 5alpha,7alpha-dihydroxy 11-keto tetranor-prostane 1,16-dioic acid (the main urinary metabolite of PGF2alpha [PGF2alpha MUM]) levels in the urine of 30 patients were measured by radioimmunoassay during pregnancy, labor, and the puerperium. During pregnancy, no increase in dhk PGF2alpha (ng/ml) in plasma was detected as the time of delivery approached. The levels of dhk PGF2alpha during the second stage (0.64 +/- 0.15) and also at delivery (0.88 +/- 0.27) were significantly elevated over those in the first stage (0.38 +/- 0.29) (P less than 0.025 and P less than 0.005, respectively). Its level 2 hours after delivery was reduced to predelivery levels. Its levels in umbilical arterial and venous blood were 0.71 +/- 0.26 and 0.67 +/- 0.26, respectively. A significant elevation (P less than 0.01) of dhk PGF2alpha from 0.89 +/- 0.21 before labor to 6.16 +/- 2.40 at delivery was found in amniotic fluid. The hourly excretion of PGF2alpha MUM (microgram/hour) increased significantly from pregnancy levels to 1.06 +/- 0.45 in the first stage (P less than 0.01), to 7.67 +/- 4.31 (P less than 0.005) for the first 2 hours after delivery, and 2.37 +/- 1.08 from 2 to 12 hours after delivery (P less than 0.01). The excretion of PGF2alpha MUM decreased to pregnancy levels 12 hours post partum. These data indicate that during labor the production of PGF2alpha is remarkably increased.