Surgery of calculous hydrocalyx (calyceoplastic surgery)

A modified surgical technique for calculous hydrocalyx, based on partial calyceal resection with simultaneous correction of the morphological abnormality responsible for stone formation is described. Access to the calyx is gained by a modified marginopolar resection. The modification developed by the authors consists in carrying the resection line laterally to the vertical axis of the kidney. The parenchyma is closed by U-shaped "hair-pin" stitches. Preparation of the limbic, pelvic and ureteral areas is abstained from, thus avoiding scarring which might affect renal lymph and blood flow and interfere with urinary transport. The results obtained in 85 cases of calculous hydrocalyx over an 8-year period were satisfactory. The rate of calculous recurrences was not higher than 3.5 per cent.

Interaction of casein with human polymorphonuclear cells

Attachment of 125I-casein to PMN cells was investigated. Iodination did not decrease the chemotactic effect of casein. 125I-casein binding was increasing toward a maximum reached at about 45 min at 24, and 37 degrees C. At 4 degrees C the binding was proportional to time for 45 min. No saturation was achieved even at 15 mg/ml casein. About 40% of casein remained attached to PMN in a casein-free medium after 60 min, at 37 degrees C. Pretreatment of the cells with trypsin or butanol, or the presence of indomethacin, azide, and PMSF did not affect the binding of casein. The hydrophobic amino acid, leucin counteracted the attachment of casein. Our data show that at chemotactic doses casein is bound specifically to cell membranes by hydrophobic forces. The induction of chemotaxis may be due to micellar casein-membrane lipid complexes.

In vitro study of local solubility of uric acid stones with lithium carbonate

The possibilities of local dissolution of uric acid calculi with Na hydrocarbonate, K carbonate and lithium carbonate were examined in vitro. The most promising results were obtained with lithium carbonate. The necessity for studies of the compound in laboratory animals before its use in humans is emphasized.

Effect of dimethylnitrosamine upon carbamoyl phosphate and ornithine utilization in rat liver

Newborn CFY rats were intraperitoneally treated with a single dose of dimethylnitrosamine. Changes in the activity of carbamoyl-phosphate synthase I and II, ornithine carbamoyltransferase, aspartate carbamoyltransferase and dihydroorotase, i.e. utilization of ornithine and carbamoyl-phosphate pools were followed for 300 days. One or two months after treatment the activity of enzymes which utilize ornithine and carbamoyl-phosphate was enhanced in the cytosol, whereas the activity of the intramitochondrial enzymes in urea synthesis was decreased. Changes in the utilization of ornithine and carbamoyl-phosphate pools, characteristic of proliferating tissues, appeared to be irreversible.

Ca2+ depletion-induced disconnection of tight junctions in isolated rat brain microvessels

Cerebral microvessels were isolated from rat brains. One part of the microvessel pellets was incubated for 25 or 90 min in Krebs-Henseleit bicarbonate buffer (KHB) at pH 7.5 (control group). The other part of the pellets was treated for the same periods of time with Ca2+-free KHB, containing 2.2 mM EGTA and 2 mM glucose (experimental group). Morphological changes of endothelial tight junctions were evaluated in 100 randomly selected interendothelial clefts from isolated cerebral microvessels of each groups by electron microscopy. Following 25 min of incubation time, either with Ca2+-containing or with Ca2+-free KHB, no significant changes of tight junctions were observed. After 90 min of incubation in Ca2+-free medium, 58% of tight junctions were altered (in 42% partial, and in 16% complete disconnection of tight junctions were found). This contrasted the control group, where only 14% of tight junctions were disconnected (12% partially and 2% completely). Our results are consistent with a role for intercellular Ca2+ in maintaining structural integrity of cerebral tight junctions.

Blood-brain barrier impairment by low pH buffer perfusion via the internal carotid artery in rat

Krebs-Ringer bicarbonate buffer (KRB) adjusted by lactic acid to low pH levels (6.6, 6.2, 6.0, 5.8, 5.5) was perfused via the internal carotid artery as a bolus into rat brain hemispheres. In one group of animals, the fluid phase tracer horseradish peroxidase (HRP) was perfused immediately following the low pH treatment. In the other group of animals, the brain hemispheres were fixed and the endothelial cells were stained with colloidal iron (CI) at pH 1.8. Widespread extravasation of HRP was detected indicating blood-brain barrier (BBB) opening to this tracer in hemispheres perfused with KRB at pH 6.2, 6.0, 5.8, or 5.5. HRP was seen in pools of endothelial tight junctions. Endothelial cell injury reflected by swelling and influx of HRP into the cytoplasm was occasionally encountered. CI evenly decorated the negatively charged surface of endothelial cells in the control brains, in contrast to markedly diminished iron binding capacity of endothelial cells in low pH-treated hemispheres. Our results suggest that the ionic milieu influences the negatively charged cell surface sialoglycoproteins and glycolipids, which are integral parts of the BBB system.

Cyclic AMP-dependent protein kinase stimulates the phosphorylation of phosphatidylinositol to phosphatidylinositol-4-monophosphate in a plasma membrane preparation from pig granulocytes

Plasma membranes prepared from pig granulocytes were incubated in the presence of [gamma-32P]ATP. The dissociated catalytic subunit of cyclic AMP-dependent protein kinase stimulated the incorporation of 32P into both the protein and lipid fractions of the membrane. The SDS gel-electrophoretic analysis of the 32P-labelled proteins showed that the protein kinase phosphorylated preferentially a 24000-Mr protein, though other 32P-labelled proteins were also detected. 32P-labelled membrane lipids were analysed in two different thin layer chromatographic systems. 32P-labelling was found exclusively in polyphosphoinositides. On addition of the protein kinase the 32P-labelling of both polyphosphoinositides was increased but a higher amount of phosphate was incorporated into phosphatidylinositol-4-phosphate than into phosphatidylinositol-4,5-bisphosphate.

Applicability of biosuppressin as an urease-inhibitor

Prevention of the formation of struvite and carbonate-apatite calculi, which rapidly increase in size and tend to recur, is of prime importance. One of the urease inhibitors, hydroxycarbamide, was studied in vitro. The results are favourable and justify further studies aimed at the local application of the inhibitor.

Pyelolithotomy by the use of a hydrophilous macromolecular binding material ("pyeloform" pyelotomy)

The use of a synthetic macromolecular hydrophilous binding material for the extraction of multiple renal calculi (" Pyeloform " pyelotomy) is reported. An account of the results of animal studies in vitro is given and the possibilities of the method in are pointed out.

Fracture faces of cell junctions in cerebral endothelium during normal and hyperosmotic conditions

Infusion of hyperosmolar solutions into the internal carotid artery causes opening of blood-brain barrier to macromolecules. Ultrastructural tracer studies indicate that extravasation of macromolecules takes place primarily in segments of large penetrating cortical blood vessels. The purpose of the present study was to examine fracture faces of cerebral endothelium in normal and hyperosmolar mannitol-treated rat brains in an attempt to elucidate: (a) the organization of endothelial cell junctions in various segments of the cerebral vascular bed and (b) the structural basis of blood-brain barrier opening in hyperosmotic conditions. We found that in control rat brains: (a) capillary endothelium is provided with complex networks of continuous multistranded tight junctions; (b) continuous capillary-type tight junctions extend, although in a simpler beltlike fashion, into the endothelium of postcapillary venules; (c) the endothelium of collecting veins possess widely discontinuous single- or double-stranded tight junctions associated with gap junctions; (d) arteries have endothelial tight junctions containing focal discontinuities associated with gap junctions. In hyperosmolar mannitol-treated rat brains, there appeared focal distensions of compartments but no definitive structural discontinuities in capillary-type tight junctions. Our data suggest that the blood-brain barrier consists of: (a) an extended tight region (comprising both capillaries and postcapillary venules) and (b) focal, potentially leaky regions (restricted to collecting veins and possibly arteries). Our studies furnished no direct evidence for the structural basis of blood-brain barrier opening in hyperosmolar mannitol-treated rat brains.

Charge-related alterations of the cerebral endothelium

In a short-term rat brain perfusion model, the luminal surface of cerebral endothelium was exposed to the following solutions: (a) the polycation protamine sulfate (PS) in a dose of 50, 100, and 500 micrograms/ml for 1 or 2 minutes; (b) PS in a dose of 100 micrograms/ml (or 500 micrograms/ml) for 1 or 2 minutes followed by the polyanion heparin in an equivalent dose of 12 units/ml (or 60 units/ml) for 1 or 2 minutes; (c) heparin alone for 1 or 2 minutes, and (d) Krebs-Ringer-bicarbonate solution as control for 1, 2, or 4 minutes. We studied in the cerebral endothelium: (a) structural alterations by electron microscopy, (b) permeability changes to horseradish peroxidase (HRP) by light and electron microscopy, and (c) charge alterations of luminal surface visualized with colloidal iron at pH 1.8 by electron microscopy. We found that: (a) PS resulted in extravasation of HRP throughout the perfused hemispheres in a time- and dose-dependent fashion. In this experimental group, colloidal iron binding decreased on the luminal surface of the cerebral blood vessels; (b) heparin perfusion following PS reversed the colloidal iron staining but failed to prevent the blood barrier opening to HRP; (c) heparin perfused alone also induced extravasation of HRP in the treated brain hemispheres; (d) in Krebs-Ringer-bicarbonate-perfused control brains extravasation of HRP was encountered only in occasional vascular segments. In all brain hemispheres showing tracer extravasation, electron microscopy revealed HRP reaction product in compartments of endothelial tight junctions suggesting opening of interendothelial routes as the structural basis of blood-brain barrier opening. Endothelial cell death reflected by swelling and influx of HRP into endothelial cytoplasm in PS- and/or heparin-perfused hemispheres was probably an additional mechanism explaining tracer extravasation into the neuropil. Our results indicate a correlation between the effect of polycation PS and a decrease in the anionic sites of cerebral endothelium. The relationship between charge alteration and barrier opening in the short-term rat brain perfusion model is not clear.

[Further indications for corneal incision]

The results of operations for disjunctio epithelialis corneae following recurrent keratitis herpetica and injury are reported. The operation is indicated in every chronic or recurrent corneal disease where circumstances do not allow keratoplasty to be carried out; the pain can be alleviated by incisio corneae.

Combined oral and local therapy for the dissolution of urinary calculi

The factors underlying the formation of Ca-phosphate and struvite calculi, as well as the present possibilities for oral and local therapy, their advantages and drawbacks are discussed in the light of published evidence. In this context a clinical case of multiple injuries is reported in which practically complete chemolitholysis has been achieved by combined oral and local therapy. The rapid growth of the calculi and their alarming tendency to recurrence in case of inadequate treatment is emphasized. The therapeutic method used in this case is regarded as suitable for practical purposes.

[Percutaneous kidney calculus removal]

The authors describe the method of percutaneously removing renal calculi. The application of the percutaneous method was made possible in their case by the fact that, following pyelotomy, a nephrostomy had been previously inserted into the system of renal cavities of the right side in a polytraumatized patient. Two recidive calculi formed in the immobilized patient; after the patient's mobilization the authors removed these through the opening of the drain with lithotomy forceps and with the help of an image intensifier.

Study of infective (secondary) renal calculus formation in vitro

The factors of infective calculus formation and the conditions favoring their prevention were studied by examining in vitro the role of the most common representative of urease-producing bacteria, Proteus mirabilis. The stream of Proteus-containing urine was found to form deposits of magnesium ammonium phosphate, carbonate apatite and ammonium-urate on the glass surfaces. Application either of mandelic acid or of Gentamycin was found to reduce the production of these deposits, and their joint application proved fully preventive to their formation. Gentamycin applied in saline acidified with mandelic acid was capable of dissolving previously formed crystals. A medication of this composition is advocated for preventive use after surgery for staghorn calculi. The necessity for continuing peroral medication and specific antibacterial therapy for months is emphasized.

Endothelial surface charge: blood-brain barrier opening to horseradish peroxidase induced by the polycation protamin sulfate

Perfusion of rat brain with the polycation protamin sulfate caused a decrease in the stainability of luminal surface of cerebral endothelium to positively charged colloidal iron. This change reflecting a decrease in the anionic sites of the endothelial plasma membrane was accompanied by opening of the blood-brain barrier to horseradish peroxidase. The polyanion heparin reversed colloidal iron binding but failed to prevent permeability alteration of the cerebral endothelium.

Experimental study of marginal wedge resection and its practical application in the surgical therapy of staghorn calculi

A surgical procedure for staghorn calculi, which are inaccessible to conservative therapy, is described. It not only provides for complete elimination of the calculus but may also contribute to the prevention of recurrences. The technique of marginal wedge excision of the renal parenchyma, developed in animal studies, is described in detail and 11 surgical cases are reported. Removal of staghorn calculi was successful all throughout, and renal function remained unaffected by the intervention in all of the cases. Recurrences were confined to a single case. The procedure is safe, it involves no greater surgical strain than does marginal nephrotomy, but its short-term metaphylactic results seem more promising. Assessment of the long-term results awaits further observations.

Blood-brain barrier opening to horseradish peroxidase in acute arterial hypertension

Acute arterial hypertension was induced in male Wistar rats using two experimental techniques: (1) i.v. injection of Aramine and (2) infusion of physiological saline as a bolus via internal carotid artery. Horseradish peroxidase (HRP) was injected i.v. prior to both experimental procedures and subsequently localized in the brain by light and electron microscopy. In the saline infusion (pressure pulse) model, colloidal lanthanum was also applied as a diffusion tracer following fixation of the cerebral endothelium. In the Aramine model, extravsation of HRP correlated with abrupt elevation of blood pressure. In the pressure pulse model HRP extravasation was consistently visualized in the affected hemisphere. Electron microscopy showed consistent labeling of plasmalemmal vesicles by HRP in segments of cerebral endothelium. However, HRP was also clearly visualized in junctional pools suggesting focal opening of endothelial tight junctions as a pathway for extravasation of this tracer in both hypertensive models. Colloidal lanthanum not transported by plasmalemmal vesicles across endothelium after fixation of the brain also bypassed consecutive membrane appositions of endothelial tight junctions indicating existance of interendothelial pathways to macromolecules in acute arterial hypertension.

Opening of tight junctions in cerebral endothelium. I. Effect of hyperosmolar mannitol infused through the internal carotid artery

Infusion of 1.8 M mannitol solution into the internal carotid artery of Wistar rats allows horseradish peroxidase (HRP) to cross cerebral vascular endothelium via intercellular pathways. This was made evident by density gradients of HRP observed in consecutive tight junctional compartments following in vivo administration, and by the passage of colloidal lanthanum through junctional membrane appositions of glutaraldehyde fixed cerebral endothelium. Three hours after mannitol infusion, small non-capillary vascular segments were still focally permeable to HRP. Twenty-four hours after the osmotic insult, the tracer was absent in the affected hemisphere. Water and electrolyte assays indicated absence of brain edema during the period of observation of blood-brain barrier opening.

Measurement of total-body 40potassium in patients with urate calculi

Fifty-eight patients with urate calculi and 31 patients with other (non-urate) calculi were examined for total-body potassium by means of a total-body counter. The patients with urate calculosis were found to differ significantly in their total-body K from patients with other calculi as well as from normal subjects. The results indicate that total-body potassium deficiency is one of the factors causing urate calculosis.

Opening of tight junctions in cerebral endothelium. II. Effect of pressure-pulse induced acute arterial hypertension

Acute arterial hypertension was produced in male Wistar rats by pressure pulse through the right internal carotid artery. The pressure pulse was induced by infusion of physiological saline as a bolus, at a rate of 0.63 ml per second by syringe pump. Evans blue (Eb) was used to visualize the areas of blood-brain barrier opening. Intravenously injected horseradish peroxidase (HRP) was used to study the ultrastructural basis of permeability changes in cerebral endothelium. Eb outlined circumscribed areas of blood-brain barrier opening. HRP extravasation was found mainly around small arteries. The capillary network was affected to a much lesser extent. Electron microscopy showed that HRP crossed the endothelial cell layer by intercellular routes. Glutaraldehyde fixed brain samples permeated with colloidal lanthanum supported these observations.

Development of perifocal edema in experimental epilepsy induced by cobalt-gelatin

Two blood-borne tracers, Evans-blue albumin (EBA) and colloidal-iron (Ferrlecit) were applied to visualize the development of perifocal edema in experimental epilepsy induced by cobalt-gelatin (Co-gelatin). This model is known to produce central necrosis with gliomesenchymal scar and peripheral transitory zone in the brain cortex. Characteristic red fluorescence of EBA was detected diffusely in the necrotic area surrounding the Co-gelatin implant and EBA labelled individual neurons reflecting cell membrane injury in the transitory zone. The colloidal iron tracer was localized mainly in the gliomesenchymal scar. It is proposed that neurons with altered membrane permeability to EBA in the transitory zone may play a role in the genesis of epileptic spike activity. The marked labelling of the gliomesenchymal scar by colloidal-iron indicates furthermore that this newly vascularized tissue with leaky capillaries may be a source of perifocal edema.

[Marginal nephrectomy for the removal of coral calculi]

Efforts aimed at surgical solutions conserving the organs obtained importance also in renal surgery in recent years. This fact meant a milestone in the life of patients suffering from coral calculi, since it has been recommended to perform nephrectomy only in rare cases, and in the majority of cases young mothers were concerned. On the basis of the operation material comprising 12 cases--out of which some cases are described--the points of view of the marginal nephrectomy are discussed in detail. Among the modified techniques on the one hand the hairpin-shaped suture, on the other in the case of the local disease of the calyx system the marginal nephrectomy combined with wedge-shaped resection are explained, for the reduction of the danger of a recidivation of calculi an essential importance is ascribed to the last mentioned method.

Antigen recognition by T cells activated in the mixed lymphocyte reaction: specific binding of allogeneic cell material after removal of surface-bound antigen by trypsin

T cell blasts activated in the mixed lymphocyte reaction (MLR) carry on their surface stimulator alloantigens which can be removed by treatment of the blasts with trypsin. After overnight incubation in trypsin-free medium, the treated cells exhibit specific alloantigen binding ability: they bind much more effectively cellular material, either obtained from the corresponding MLR supernatant or released by nitrogen cavitation from fresh cells from the stimulating strain, than that from an unrelated H-2 different strain. Trypsin-treated cells which have been incubated in the presence of low concentrations of puromycin are unable to bind stimulator cell fragments.

Lethla effect of nitrous acid on Escherichia coli

The effect of nitrous acid (NA) on viability, integrity of cellular DNA and on membrane transport were studied in 5 strains of Escherichia coli. Stationary phase cells, grown on mineral salts medium, were exposed to NA. The viability of strains decreased in thefollowing order: W3110 wild-type greater than WP2 wild-type, WP2 uvrA greater than NG30 recA greater than P3478 polA. Alterations were found in the DNA sedimentation profile in alkaline sucrose gradient. Disturbance of DNA synthesis was measured by 3H-labelled thymidine ([3H]Thd) incorporation. No degradation of DNA was found after NA treatment. Low doses of NA caused significant inhibition of leucine and glucose transport into whole cells. The results are interpreted in terms of the multi-target action of NA causing the death of cells.

Specific binding of K- and I-region products of the H-2 complex to activated thymus-derived (T) cells belonging to different Ly subclasses

Responder cells [C57BL/6J X A.TL)F1 lymph node cells depleted of bursa equivalent-derived (B) cells by filtration through nylon wool columns] were activated against incompatible K-region and I-region products together under conditions where these antigens are presented on separate stimulator cells. The resulting T blasts were stained with different concentrations of antisera directed against incompatible stimulator K-region or I-region products, or both. We obtained results that strongly suggest that in these cultures each activated responder blast stains with antiserum directed against either K-region or I-region products, but not both. Responder blasts from the same cultures were treated with antiserum and complement (C) directed against either Ly-1.2 or Ly-2.2 T-cell-specific surface antigens. Anti-Ly-1.2 serum and C specifically eliminates virtually all responder blasts staining with antiserum directed against stimulator I-region products; whereas anti-Ly-2.2 serum reduces to background levels the proportion of cells staining with antiserum against stimulator K-region products. The results obtained suggest that T cells binding stimulator K-region and I-region products, respectively, belong to two different subclasses distinguishable by their Ly phenotypes. Possible explanations for this association of T- cell subclass and specificity are discussed.

Specific binding of alloantigens to T cells activated in the mixed lymphocyte reaction

Immunoglobulin (Ig) is present on a large fraction of T cells from unfractionated lymphocytes activated by in vitro stimulation with H-2-incompatible cells (mixed lymphocyte reaction [MLR]). Removal of bursa equivalent-derived (B) cells from the responder cell population before mixed culture, by filtration through nylon wool columns, reduces the percentage of Ig-bearing responder T blasts to background levels. Thus, Ig on the T blast is probably of B cell origin. A large fraction of T blasts activated against the stimulator cells. This staining occurs with "early" and hyperimmune alloantisera, including the 7S fraction of the latter. B-depleted responder cells were activated against a mixture of two different stimulator cells and the resulting T blasts stained with different concentrations of sera directed either against one or both stimulator cells. We obtained results which strongly suggest that most or all responder T blasts stain with only one antistimulator serum. When antisera directed against different segments of the H-2 complex of the stimulator cells were used, it seemed that most responder T cells only bound antibody directed against a single segment. We propose that T cells activated in MLR carry stimulator alloantigens on their surface, and that this is due to specific antigen binding, not requiring the presence of B-cell-derived antibody. These histocompatibility antigen-binding T blasts can be detected by appropriate antistimulator alloantibodies.

Mechanisms in acute oliguric renal failure induced by tetracycline infusion

Tetracycline hydrochloride (TC), 30-70 mg/kg infused intravenously in dogs in the course of a few minutes, reduced clearance of inulin (Cin) and p-aminohippuric acid (CPAH) on an average to less than 5% of control. In spite of increased intrarenal pressure (approximately 50 mm Hg), electromagnetically recorded renal blood flow was preserved, indicating that the reduction of Cin and CPAH resulted from tubular obstruction, not renal vasoconstriction. The metabolic rate of the cortex and outer medulla fell to 69% of control after TC, as measured by the heat accumulation rate. Further reduction to basal metabolic level (30% of control) was reversibly produced by elevating ureteral pressure, suggesting that the high metabolic rate was caused by continued active reabsorption of sodium chloride at about half the control rate. Thus Cin greatly underestimated glomerular filtration rate in the TC-damaged kidney. From these results and the observation of TC-containing casts in the medullary tubules, we conclude that TC caused tubular obstruction and that leakage of inulin and PAH from the tubules occurred mainly distally to the major sodium-reabsorbing tubular segments.