Influence of doping rate in Er3+:ZnO films on emission characteristics

High-quality Er(3+):ZnO films were grown by the pulsed-laser deposition technique for 0.5 and 2 wt. % Er doping. Two peaks were observed at approximately 1.54 microm in the photoluminescence spectra of samples with 2 wt. % doping contrary to only one peak in the 0.5 wt. % doped sample. Both peaks were found to be strongly temperature dependent. The microscopic studies clearly illustrate that the appearance of the additional peak is attributed to the environment of Er(3+) ions in the form of ErO(6) clusters, which are optically active centers in the ZnO matrix. These results are very important for designing waveguides for telecommunications.

Renin containing cells are present predominantly in scarred areas but not in dysplastic regions in multicystic dysplastic kidney

PURPOSE

Hypertension is an important complication of multicystic dysplastic kidney and it has been suggested that it is induced by renin. Little information is available on renin production in this disease. To assess renin production we examined the distribution of renin containing cells in multicystic dysplastic kidneys using immunohistochemical methods.

MATERIALS AND METHODS

Immunohistochemical examination of renin was performed in 29 multicystic dysplastic kidneys from 14 boys and 15 girls 1 month to 10 years old using rabbit anti-human renin antibodies. In all cases normal renal function was confirmed by the serum creatinine level and no proteinuria on urinalysis. Two patients had the complication of hypertension before removal of the multicystic dysplastic kidney but plasma renin activity was normal.

RESULTS

Immunostaining of renin was observed in 26 of 29 multicystic dysplastic kidneys (90%). Histologically multicystic dysplastic kidney involved scarred and dysplastic areas. Renin positive cells were observed predominantly in the scarred areas, mainly in the juxtaglomerular apparatus of mature glomeruli, interlobular arteries and some mature tubules. Immunopositive renin was sparsely noted in the juxtaglomerular apparatus or Bowman's capsules of occasional immature glomeruli in dysplastic areas.

CONCLUSIONS

Our observations suggest that multicystic dysplastic kidney may have the ability to produce renin. Renin producing cells in the juxtaglomerular apparatus of mature glomeruli and interlobular arteries in the scarred areas may be the predominant source of renin production in this organ.

Clinical significance of urinary interleukin-6 in children with reflux nephropathy

PURPOSE

We determined urinary interleukin-6 (IL-6) in children with reflux nephropathy to evaluate the clinical significance of this cytokine in the progression of renal injury.

MATERIALS AND METHODS

Enrolled in this study were 34 boys and 32 girls in whom 99mtechnetium dimercapto-succinic acid renal scan showed renal scarring. Vesicoureteral reflux had been corrected surgically at least 3 years before study entry. Urinary IL-6 was determined by enzyme-linked immunosorbent assay using spot urine samples. Simultaneously we measured serum creatinine, beta2-microglobulin, alpha1-microglobulin, urinary alpha1-microglobulin and albumin. In addition, IL-6 expression was assessed by immunohistochemical study in the scarred kidneys of 3 boys and 1 girl who underwent nephrectomy due to severe reflux nephropathy with little function on renal scan.

RESULTS

Urinary IL-6 was significantly higher in children with severe bilateral renal scarring than in those with mild scarring and normal controls. Urinary IL-6 correlated significantly with serum alpha1-microglobulin (Spearman test p <0. 03), beta2-microglobulin (p <0.003), creatinine (p <0.02) and urinary albumin (p <0.0001). Histological evaluation revealed that IL-6 was predominantly expressed in the tubules in and adjacent to fibrotic areas.

CONCLUSIONS

Our observations indicate that tubular IL-6 may be involved in the pathogenesis of tubulointerstitial injury in reflux nephropathy and urinary IL-6 may be a useful tool for monitoring the progression of reflux nephropathy.

Role of leukocyte adhesion molecules in monocyte/ macrophage infiltration in weanling rats with unilateral ureteral obstruction

BACKGROUND

Unilateral ureteral obstruction (UUO) of rats is a well-established model for studying obstructive nephropathy. Meanwhile, pathophysiology of pediatric obstructive nephropathy is not well understood. In this report, we studied monocyte/macrophage infiltration and expression of intercellular adhesion molecule 1 (ICAM-1) and macrophage antigen 1 (Mac-1) in weanling rats with UUO.

METHODS

Three-week-old male Sprague-Dawley rats underwent left unilateral ureteral ligation. Both obstructed kidneys (OBK) and contralateral kidneys (CLK) were harvested at 3, 6, 12, 24, 72 and 120 h after surgery. Monocyte/macrophage infiltration and expression of ICAM-1 and Mac-1 were evaluated immunohistochemically, and results were compared with those of sham-operated control rats (SOK).

RESULTS

Monocyte/macrophage infiltration was observed in the interstitium and perivascular region in the cortex of OBK within 6 h. The CLK and SOK showed slight monocyte/macrophage infiltration. Expression of ICAM-1 was markedly observed in the periarterial and peritubular interstitium and in renal cortical peritubular capillaries 12 h after obstruction. In CLK and SOK, ICAM-1 was slightly expressed in the endothelium of microvessels and parietal linings of Bowman's capsule. Expression of Mac-1 was detected mainly in cells infiltrating the perivascular interstitium in OBK. In CLK and SOK, few Mac-1-positive cells were observed.

CONCLUSIONS

Adhesion molecules, ICAM-1 and Mac-1, are expected to recruit monocyte/macrophage infiltration into OBK of weanling rats with UUO.

Expression of platelet-derived endothelial cell growth factor and its potential role in up-regulation of angiogenesis in scarred kidneys secondary to urinary tract diseases

The mechanism of neovascularization secondary to renal interstitial fibrosis is not well understood. Platelet-derived endothelial cell growth factor (PD-ECGF) is known to promote angiogenesis. We examined the expression of PD-ECGF immunohistochemically in 9 normal kidneys and 26 scarred kidneys secondary to urinary tract diseases. To estimate up-regulation of angiogenesis, microvessels were counted by immunostaining endothelial cells for CD34. Immunostaining of PD-ECGF was observed in most Bowman's capsules, occasional tubules, and some interstitial mononuclear cells in normal kidneys. A remarkable increase of immunostained PD-ECGF was found in the tubules and interstitial mononuclear infiltrates in the scarred kidneys. The predominant cell type in the infiltrate was T cells (CD3(+)). The microvessel count and mean numbers of PD-ECGF(+) tubular and interstitial mononuclear cells increased with increasing interstitial fibrosis. A significant correlation was noted between microvessel count and the number of PD-ECGF(+) tubular cells (P = 0.0002) or PD-ECGF(+) interstitial mononuclear cells (P < 0.0001). Immunostaining of endogrin, a marker of endothelial proliferation, increased in the microvessels located in the fibrotic interstitial spaces. These results suggest that angiogenesis may play a critical role in the progression of tubulointerstitial injuries and that up-regulation of PD-ECGF may contribute to neovascularization.

Neonatal urinary ascites caused by urinary tract obstruction: two case reports

Two cases of neonatal urinary ascites are reported, one (case 1) caused by posterior urethral valves associated with right vesicoureteral reflux, and the other (case 2) secondary to bilateral obstructed megaureter--a very rare cause. Abdominal distension, electrolyte imbalance, and an elevated BUN/serum creatinine ratio were noted at the time of hospitalization in both cases. These laboratory values promptly returned to normal after the establishment of appropriate urinary drainage, accomplished through bladder catheterization in case 1 and bilateral percutaneous nephrostomy in case 2. In case 1, transurethral resection of the posterior urethral valves was followed by resumption of normal urination. In case 2, bilateral ureteroneocystostomy with ureteral tapering was performed successfully. These are only the fifth and sixth cases of neonatal urinary ascites reported in the Japanese literature.

[The intrarenal distribution of prostaglandin E2 and thromboxane A2 in the rat with unilateral ureteral obstruction or unilateral nephrectomy]

BACKGROUND

We evaluated the intrarenal distribution of prostaglandin E2 (PGE2) and thromboxane B2 (TxB2) on the rats that underwent unilateral ureteral obstruction (UUO), unilateral nephrectomy (UNX) or sham operation.

METHODS

Male Sprague-Dawley rats were divided into three groups; left ureteral obstruction (UUO), left nephrectomy (UNX) and sham-operation (Control). They were sacrificed at 1, 3, 6, 12, 24 hours and Day 2, Day 3, Day 5, Day 7 and Day 9 after surgery. Intrarenal distribution of eicosanoids were immunohistochemically detected on both kidneys of UUO rats, and on right kidneys of UNX and Control rats.

RESULTS

PGE2: In the obstructed kidneys, immunostained PGE2 increased in medullary interstitium at one hour to 6 hours, and in glomeruli and cortical interstitium at 6 hours. An increase of immunostained PGE2 was observed again in cortical interstitium at Day 3 to 5, and in medullary interstitium at Day 2 to 5. In the intact opposite kidneys, expression of immunostained PGE2 increased in glomeruli at Day 5 to 7, and in medullary interstitium at Day 3 to 5. In UNX, immunostained PGE2 increased in the medullary interstitium of the remnant kidneys at 3 hours and Day 3 to 7. On the other hand, an increase of immunostained PGE2 observed in glomeruli and cortical interstitium of these kidneys at Day 5 to 7. TxB2: In the obstructed kidneys, immunostained TxB2 increased in glomeruli and cortical interstitium at 6 hours, and in medullary interstitium at 3 to 12 hours. Predominant expression of TxB2 was observed in medullary interstitium at 3 hours compared to PGE2. We also observed an increase of immunostained TxB2 in cortical interstitium at Day 3 to 5, and in medullary interstitium at Day 2 to 5. In the intact opposite kidneys, immunostained TxB2 increased in medullary interstitium at 3 hours and Day 3. In the remnant kidneys of UNX, an increase of immunostained TxB2 was demonstrated in glomeruli at 6 hours and Day 7, and in medullary interstitium at 3 to 6 hours and Day 3 to 7.

CONCLUSION

In the obstructed kidneys, imbalance between PGE2 and TxA2 may contribute to the progression of renal injuries. The fact that expression patterns of these eicosanoids in the opposite kidneys of UUO different from that of the remnant kidneys of UNK, even though both were similarly associated with functional loss of contralateral kidneys, suggested that the opposite kidneys of UUO were affected by any additional factors different from that responsible for the remnant kidneys of UNK.

Soluble interleukin-2 receptor in children with reflux nephropathy

PURPOSE

Serum soluble interleukin-2 receptor level is a sensitive and quantitative marker of lymphocyte activation. We determined levels of serum soluble interleukin-2 receptor in children with reflux nephropathy to evaluate its clinical significance in the prediction for the progression of renal injuries.

MATERIALS AND METHODS

Serum soluble interleukin-2 receptor values were determined in 63 children with reflux nephropathy. The group consisted of 37 boys and 26 girls 10 to 18 years old. T cells (naive and memory), B cells and macrophages were evaluated immunohistochemically in the scarred kidneys of 4 other patients (3 boys and 1 girl 5 to 16 years old) who underwent nephrectomy due to severe reflux nephropathy with little function seen on (99m)technetium-dimercapto-succinic acid (DMSA) renal scan. Levels of serum soluble interleukin-2 receptor were measured by an enzyme-linked immunosorbent assay. We simultaneously determined serum levels of creatinine and beta2-microglobulin, and urinary levels of alpha1-microglobulin and microalbumin. Individual functions of the right and left kidneys were estimated by renal dimercaptosuccinic acid uptake.

RESULTS

Levels of serum soluble interleukin-2 receptor in the patients who had low total uptake of DMSA (right uptake plus left uptake) were significantly higher than those from patients with normal total uptake. Levels of serum soluble interleukin-2 receptor correlated significantly with levels of creatinine (r=0.616, p <0.0001) and beta2-microglobulin (r=0.803, p <0.0001), and levels of urinary alpha1-microglobulin (r=0.753, p <0.0001) and microalbumin (r=0.673, p <0.0001). A significant negative correlation was observed between levels of serum soluble interleukin-2 receptor and total DMSA uptake values (right uptake plus left uptake r=-0.678, p <0.0001). In the scarred kidneys leukocyte infiltrates were markedly increased in fibrosed spaces. The predominant cell type in these lesions was memory T cells.

CONCLUSIONS

These results suggest that elevated levels of serum soluble interleukin-2 receptor are likely to reflect activated T cells in the kidneys of patients with reflux nephropathy and may be a useful predictor of progression of renal injury in these children.

Hydrometrocolpos with ectopic vaginal opening to the bladder. A case report

A case of hydrometrocolpos with vaginal opening to the bladder is presented. A newborn female presented abdominal distention and postaxial polydactyly at birth. Clinical investigation revealed hydrometrocolpos, precocious puberty, urogenital sinus and other multiple malformations. The vagina was open to the bladder with a small orifice. Vaginal pull-through surgery and closure of the communication was performed. Over a hundred cases of hydrometrocolpos have been reported previously. However, we could not find a case of hydrometrocolpos with vaginal opening to the bladder among them.

[Laparoscopic investigation of 74 cases of nonpalpable testis]

BACKGROUND

The objective of this study is to evaluate the results and advantages of laparoscopic investigation of nonpalpable testis.

METHOD

Since March 1986 to May 1996, we performed laparoscopy to investigate 88 nonpalpable testes of 74 cases under general anesthesia. On condition that testis was found intraabdominally, orchiectomy or orchiopexy was performed subsequently. With a finding of vas deferens and/or spermatic vessels entering into internal ring, inguinal canal was explored surgically. If both vas deferens and spermatic vessels were absent or blind-ending intraabdominally, no further examination was performed with a diagnosis of vanishing testis.

RESULTS

Location of testes found in this study were as follows. Twenty three (26.1%) testes were found intraabdominally, 36 (40.9%) were intracanalicularly, 13 (14.8%) were distal to external inguinal ring, and 16 (18.2%) were vanishing testes. To those 39 (44.3%) intraabdominal and vanishing cases did not need inguinal exploration.

CONCLUSION

In conclusion, a laparoscopic examination for nonpalpable testis is the most effective and less invasive procedure to make sure or preclude the location of the gonad. And in 18% of those who were enrolled in this study, no further surgical interventions were needed. An accurate locating of nonpalpable testis permits site-specific planning of surgical management.

Urinary excretion of epidermal growth factor in children with reflux nephropathy

PURPOSE

We determined urinary levels of epidermal growth factor in children with reflux nephropathy to evaluate the clinical significance of urinary epidermal growth factor.

MATERIALS AND METHODS

We studied 59 boys and 41 girls 3 to 15 years old with reflux nephropathy, and 64 boys and 36 girls 3 to 15 years old who were healthy. Levels of urinary epidermal growth factor were determined by sandwich enzyme immunoassay using spot urine samples. We also determined the levels of serum creatinine, urinary alpha 1-microglobulin and urinary microalbumin. Absolute values of function of the left and right kidneys were assessed by 99mtechnetium dimercapto-succinic acid (DMSA) uptake.

RESULTS

Levels of urinary epidermal growth factor gradually decreased with age in healthy children. There were low levels of urinary epidermal growth factor in 20 of the 44 patients (45%) with unilateral low DMSA uptake and 18 of the 19 (95%) with low total DMSA uptake (right and left uptakes). Urinary epidermal growth factor significantly correlated with serum creatinine (R = -0.702, p < 0.0001), urinary alpha 1-microglobulin (R = -0.606, p < 0.0001), urinary microalbumin (R = -0.708, p < 0.0001) and total DMSA uptake (R = 0.744, p < 0.0001).

CONCLUSIONS

These results suggest that urinary epidermal growth factor may be a useful clinical tool to monitor functional nephron mass in children with reflux nephropathy.

Followup study of renal function in children with reflux nephropathy after resolution of vesicoureteral reflux

PURPOSE

We evaluated data collected for 10 years on children with reflux nephropathy to identify a means of predicting the prognosis.

MATERIALS AND METHODS

A total of 15 boys and 13 girls were enrolled in this study at least 2 years after surgical and spontaneous resolution of vesicoureteral reflux in 25 and 3 patients, respectively. They were followed for more than 10 years and renal function was periodically evaluated. Urinary beta 2-microglobulin, alpha 1-microglobulin, N-acetyl-beta-D-glucosaminidase, microalbumin and 99mtechnetium dimercapto-succinic acid uptake were measured.

RESULTS

Of the 28 patients 12 had high levels of urinary alpha 1-microglobulin during followup, including all 7 in whom renal function deteriorated. In 3 children with elevated alpha 1-microglobulin urinary microalbumin gradually increased after puberty. Although elevated levels of urinary beta 2-microglobulin, N-acetyl-beta-D-glucosaminidase and microalbumin were also observed, they were less predictive of renal function than alpha 1-microglobulin.

CONCLUSIONS

These results suggest that elevated urinary levels of alpha 1-microglobulin may predict the risk of abnormal renal function in children with reflux nephropathy even before the appearance of significant proteinuria.

[Renal function in children with reflux nephropathy followed up more than 10 years after disappearance of vesicoureteral reflux: usefulness of alpha 1-microglobulin as a marker to predict the prognosis of these children]

BACKGROUND

Although reflux nephropathy (RN) is one of the most important causes of renal failure in adolescence and young adulthood, we have no appropriate markers to know the future course of children with RN. In order to find out useful marker to predict the prognosis of these children, we analyzed the result of over ten years follow-up of children with RN.

METHODS

We evaluated renal function in 25 patients (aged between 11 years and 23 years, 14 males and 11 females) with RN using urinary alpha 1-microglobulin (alpha 1 m), urinary albumin and 99mTc-dimercaptosuccinic acid (DMSA) renal scan. All patients were followed up more than 10 years after disappearance of vesicoureteral reflux.

RESULTS

Of 25 patients, 13 showed high levels of urinary alpha 1 m (> 4.4 mg/gCr = upper normal limit) during follow-up period. Among them, renal dysfunction developed in 9 on DMSA renal scan and/or serum creatinin (Cr) level. Before puberty, all patients, even children with renal dysfunction (serum Cr > 1.0 mg/dl), remained in normal or slight high urinary albumin levels. Five cases, showed high levels of urinary alpha 1 m before puberty, demonstrated a remarkable increase of urinary albumin levels after puberty.

CONCLUSION

From these results, it was suggested that urinary levels of alpha 1 m could be utilized as a marker to predict the prognosis of children with RN.

The distribution of renin containing cells in scarred kidneys

PURPOSE

To evaluate changes in renal renin synthesis secondary to renal scarring from urinary tract disease, we investigated the immunohistochemical distribution of renin in normotensive children with scarred kidneys and determined whether renal renin content correlates with the degree of interstitial fibrosis.

MATERIALS AND METHODS

We performed semiquantitative analysis of the immunohistochemical distribution of renin using rabbit anti-human renin antibody in the scarred kidneys of 3 boys and 17 girls with urinary tract disease.

RESULTS

Immunoreactive renin was mainly present within the afferent arteriole. Immunostaining of the juxtaglomerular apparatuses, interlobular arteries and renin containing cells increased with the degree of interstitial fibrosis. Glomeruli disjointed from proximal tubules, that is atubular glomeruli, were observed in fibrosed areas and renin was distinctly noted in the juxtaglomerular apparatus of atubular glomeruli.

CONCLUSIONS

Scarred areas may be responsible for the hyperproduction of renin and angiotensin II, which in turn promotes renal scarring and an increase in atubular glomeruli. This cycle may lead to progressive renal scarring.

[Eighteen cases of multicystic kidney: natural history and renal function of the contralateral kidney]

PURPOSE

The objective of this study is to evaluate natural history of multicystic kidney (MCK) and renal function of the contralateral kidney.

METHODS

We analyzed 18 children (7 boys and 11 girls) with unilateral MCK. The sizes of cysts were investigated by ultrasonography. Urinary beta 2-microgloblin (beta 2 m), alpha 1-microgloblin (alpha 1 m) and N-acetyl-beta-D-glucosaminidase (NAG) and albumin were determined as markers of tubular and glomerular damage. The renal function was evaluated by 99m Tc-dimercaptosuccinic acid (99 m Tc-DMSA) renal uptake rate.

RESULTS

Nephrectomy was performed in 2 children. In 14 (87.5%) of 16 cases who were followed conservatively, the size of cysts was spontaneously reduced by 1-18 months (mean 6.4). Neither hypertension nor malignancy from the affected kidney has been observed in follow-up periods of 6-63 months. One patient had minor degree of contralateral ureteral dilatation which resolved spontaneously. Lower DMSA uptake rate of contralateral kidney was demonstrated in 63% (10/16). Markers of tubular damage were abnormally high in these patients.

CONCLUSION

From these results, the most appropriate management of MCK is conservative with ultrasonic monitoring. Long-term follow-up testings with special care on contralateral renal function will be necessary because the overload to the contralateral healthy kidney may have already occurred during infancy and cause focal glomerulosclerosis and renal failure in future.

[Obstructive and reflux nephropathy]

Urinary tract obstruction and vesicoureteral reflux have marked effects on renal function. Renal interstitial fibrosis and glomerular hypertrophy with subsequent focal segmental glomerulosclerosis like changes are a common consequence of chronic obstruction and vesicoureteral reflux. Evidence suggests that vasoactive compounds and cytokines such as angiotensin II, nitric oxide, eicosanoids, TNF, TGF, EGF, PDGF, bFGF have a role in the hemodynamic and structural abnormalities that occur following obstruction of the urinary tract or vesicoureteral reflux. Use of modulators for these compounds appears to be beneficial for treatment of obstructive or reflux nephropathy in near future.

Crossed ureteral ectopia with an ectopic blind-ending ureter

A rare case of multiple urological anomalies is presented. The chief complaint of the patient, a 12-year-old girl, was urinary incontinence. Radiologic and endoscopic examinations revealed that the patient had a normal left kidney and ureter, a left ectopic blind-ending ureter that opened near the neck of the bladder, and right complete double ureters with an ectopic orifice that opened on the left of the external urethral meatus. This orifice was responsible for her urinary incontinence. Right ureteroneocystostomy was performed and the incontinence was cured. An attempt was made to explain the embryological origin of the anomalies observed in this case. We postulated that during development, on the left, there were three ureteral buds on the mesonephric duct. The first bud was at the normal position and drained the left kidney in a normal manner. The second bud was cranial from the normal position on the mesonephric duct and was associated with growth in an abnormal direction. This bud made contact with the upper portion of the right metanephric mass. The last bud grew between the two aforementioned buds. This bud was not draped by the metanephric mass and became the blind-ending ureter. On the right, one ureteral bud was located on the mesonephric duct and it made contact with a metanephric mass that became the right kidney. The upper part of the right kidney was drained by the ureter that had originally been located on the left mesonephric duct. This condition should be termed crossed ureteral ectopia rather than crossed renal ectopia, since the ureter was the structure that crossed.

[Application of whole layer core biopsy of bladder wall to paravesical tumor]

We have reported the usefulness of percutaneous or transurethral whole layer core biopsy (WLCB) of bladder wall for staging of invasive bladder cancer. We have applied WLCB to 3 cases of paravesical tumor with good results. The first case was in a 3-year-old boy suspected of retrovesical sarcoma. Percutaneous WLCB revealed an inflammatory tumor of the Douglas cavity which was probably caused by perforation of appendix. The tumor disappeared by antibiotics alone. The second case was in a 37-year-old female with retrovesical tumor suspected to be ovarial cancer because of the high value of CA19-9 and CA125. Transurethral WLCB showed invasion of endometriosis to bladder muscle layer. The third case was in a 75-year-old female diagnosed by transurethral WLCB as sigmoid colon cancer invading until the deep bladder muscle layer. Cold cup punch biopsy was not informative in these 3 cases. Percutaneous or transurethral WLCB is safe and easy to perform, and is a technique recommended for diagnosis of pathology and bladder invasion of paravesical tumor.

[Effect of hydronephrosis on the contralateral blood flow and glomerular volume]

We designed a following experiment to appraise the effect of unilateral hydronephrosis on the contralateral kidney using weanling rats whose kidneys were in a growing stage. Rats were divided into 4 groups. Complete unilateral (left) ureteral obstruction (CUUO) was made on the experiment rats, and these went through the following procedures on the day 3 after CUUO; 1) Group R: CUUO released, 2) Group N: left nephrectomy performed, 3) Group S: CUUO continued. Sham-operations were performed on the days 0 and 3 to the controls. Renal cortical blood flow and glomerular volume of the contralateral (right) kidneys were determined on the days 5, 7, 9, 14 and 21. Blood flow to the renal cortex per unit volume (ml/min/100 cm3; measured with Laser blood perfusion monitor) in the contralateral kidneys increased gradually in the all groups, but statistical significance was not confirmed in the observed period between any groups. Increases in total renal blood flow (wet kidney weight times renal cortical blood flow per unit volume; g x ml/min/100 cm3) were proportional to the measured wet kidney weight in the all groups. Notably in the group N, a significant increase was noted compared to the group R and the controls. Glomerular volume (GV) of the contralateral kidneys did not show significant changes on the day 3 compared to the controls. GV significantly grew up during the day 5 to the day 14 (2 to 11 days after the relief of CUUO) in the group R and then it settled to the level of the controls on the day 21.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of unilateral ureteral obstruction on the contralateral renal growth in weanling rats]

The effect of unilateral hydronephrosis on the growth of contralateral kidney were evaluated with weanling rats of which kidneys were in growing stage (body weighted between 80 g and 90 g). These rats underwent complete unilateral ureteral obstruction (CUUO) on day 0. They were divided into 3 groups and went through second operations on day 3 (CUUO-3) as follows; a) CUUO released, b) nephrectomy performed and c) CUUO continued. Sham-operation was performed on day 0 and on day 3 to the controls. Wet weights and bromodeoxy-uridine (BrdU) labeling index (L.I.) (index for cell proliferation in the uriniferous tubules) of the contralateral kidneys were measured for the evaluation. The wet weights were significantly higher in all the groups than that of the controls throughout the observation period on and after the day 3. The group that underwent nephrectomy demonstrated a sharp rise in L.I. after the day 7. In the group that was continued in CUUO, the L.I. started to rise later than its rise in nephrectomised group but the index caught up at the time when the blood flow completely disappeared in the kidneys of the ligated side. L.I. in the group of which CUUO was released became significantly higher than that of controls on the day 7 and remained its significance until the day 21 in spite of resolution of the hydronephrosis. To reveal the effect of length of obstructed term, the same trial was carried out that rats endured in CUUO for 5 days (CUUO-5) till the second operation. This turned out lower L.I. in the CUUO-5 than the CUUO-3. These results suggest that the presence of hydronephrosis made by CUUO suppress the growth (cell proliferation) of contralateral kidney and also duration of obstruction can be critical on the renal growth that shorter obstructed period turns out preferable for cell proliferation after relief of CUUO.

[Renal function of contralateral kidney after total or partial removal of kidney with ectopic ureter]

The effects of partial or total removal of the kidney with ectopic ureter on the contralateral kidney were evaluated using DMSA renal uptake rate on 8 patients. After partial nephrectomy on 6 cases, the affected residual kidneys showed significant decrease in DMSA renal uptake rate in 2 cases in which the extirpated kidneys had normal renal tissue in part but did not show significant change in DMSA uptake rate in 4 cases in which the extirpated kidneys were dominated mainly with dysplasia. Post-operative increase in DMSA uptake rate of the contralateral kidneys were significant in 3 of 4 patients who had the operation before they became 2 years old. In 2 of these 3 cases, pre-operative scintigram showed extremely low rate of DMSA renal uptake. Four cases aged 2 years old and over did not show post-operative increase in the uptake rate. As we have previously reported on the cases with hydronephrosis, these results suggest that 1) existence of obstruction caused by ectopic ureter inhibit the development of the contralateral kidney and 2) the growth of the kidney can resume the release of that obstruction, if the release is made while the kidneys are still in developing stage.

[Studies on reflux nephropathy--renal tubular and glomerular damage evaluated by various urinary indices]

Measurements were performed on beta 2-microglobulin (beta 2-MG), alpha 1-microglobulin (alpha 1-MG), N-acetyl-beta-D-glucosaminidase (NAG) as indices of renal tubular damage and microalbumin as an index of renal glomerular damage in 204 cases with primary vesicoureteral reflux (VUR). Investigations were made on the relationship between each index and extent of renal cortical damage from the findings of 99mTc-dimercapto-succinic acid (DMSA) renoscintigraphy, and also on the changes of each index before and after antireflux operation. At the first examination, high values of urinary beta 2-MG, alpha 1-MG, NAG and albumin were noted in 36%, 40%, 50% and 34% of cases with VUR respectively. Almost all the cases with high indices values before the operation showed improvement in those values accompanied with disappearance of VUR after the operation. These findings suggest that renal tubular and glomerular damage were induced by the sterile reflux itself. High values of urinary indices were confirmed in 16% (beta 2-MG), 40% (alpha 1-MG), 27% (NAG) and 32% (albumin) cases after a lapse of 2 years or longer since antireflux operation or spontaneous disappearance of VUR. In some of these cases indices values showed some improvement but have not returned to normal levels, and in other cases indices were within normal limits preoperatively but turned out to be high levels during the observation period even after the disappearance of VUR. Most of these cases were accompanied with severe cortical damage of unilateral or bilateral kidneys on DMSA renoscintigraphy. Based on these findings, we suggest that overload to residual nephron, caused by reduced mass of functional nephron, is playing an important role on raising the values of various urinary indices.

[Effect of unilateral hydronephrosis upon contralateral renal growth]

To evaluate the effect of hydronephrosis on the growth of contralateral normal kidney, following experiment was designed and performed.

EXPERIMENT

Three to four weeks old S-D rats weighing 80-90 g were used. The kidney development of these rats is considered to be roughly equivalent to that of a one year old child. Those rats were divided into three groups: (1) left nephrectomy (group N), (2) left ureteral ligation (group H), and (3) sham operation (group S). Bromodeoxy uridine (BrdU) was administered intraperitoneally on the 1st, 3rd, 5th, 7th and 14th days after operations. One hour after injection of BrdU, right kidneys were removed and wet weight and labelling index (LI) of BrdU were calculated. Compensatory renal growth of right kidneys was observed in both group H and group N on and after 1st or 3rd day. In group N, the growth was accompanied by cellular proliferation, while in group H, hypertrophy was the major finding for up to 5th day. From 7th day on, when significant disorders became histologically evident in the left hydronephrotic kidneys, cell proliferation was also observed in the group H. The above results indicate that compensatory renal growth occurred in the contralateral normal kidney after unilateral ureteral ligation. Although proliferation of right renal tubular cells were recognized when significant tubular and interstitial damage of the left hydronephrotic kidneys were observed, hypertrophy was a major finding in an early stage. We suggest that these results were attributed to (1) reduction of nephron triggered to proliferate tubular cells and (2) the existence of hydronephrotic kidney inhibited tubular cell proliferation.

[Evaluation of renal function and prediction of renal functional recovery in children with unilateral hydronephrosis using renal pelvic urine]

In 29 children with unilateral hydronephrosis who underwent surgery at the age from 2 months to 15 years (27 patients with ureteropelvic junction stenosis and 2 with obstructive megaureter), beta 2-microglobulin (beta 2-MG), alpha 1-microglobulin (alpha 1-MG), N-acetyl-beta-D-glucosaminidase (NAG) and albumin were determined in renal pelvic urine from the hydronephrotic kidney to evaluate renal dysfunction accompanying urinary tract obstruction. Moreover, it was also examined whether it is possible to predict functional recovery of the hydronephrotic kidney on the basis of relation between these indices and pre- and postoperative changes in renal dimercaptosuccinic acid (DMSA) uptake rate. The values of beta 2-MG, alpha 1-MG, NAG and albumin in urine from the renal pelvis were high in 48%, 50%, 75% and 83% of the patients, respectively. Among the patients of one year and up, those with low preoperative DMSA uptake rate tended to have high values of beta 2-MG, alpha 1-MG and NAG. On the contrary, albumin level was high in 78% of patients who had good preoperative DMSA uptake rate. With respect to the relation between pre- and postoperative changes in DMSA uptake rate and each index, beta 2-MG and alpha 1-MG were high in 73% and 62% of patients who exhibited a marked increase in postoperative DMSA uptake rate. In patients without a remarkable change in DMSA uptake rate before and after surgery, on the other hand, the values of these were high only in 25% and 36%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Renal function in children with solitary kidney]

Renal function of eighteen children with solitary kidney (14 congenital and 4 acquired) was assessed using DMSA renal uptake rate and urinary excretion of alpha 1-MG, beta 2-MG, NAG and microalbumin. Seven of the cases were associated with vesicoureteral reflux (VUR) and two with congenital hydronephrosis. These anomalies have been already treated surgically before entering this study. DMSA renal uptake rate of 8 children was the same as that of the controls (51.8 +/- 3.7%; mean +/- SD). However, the uptake rate of 10 cases were more than 2SD below the mean of the controls. In five of them, including two children with no other urinary tract anomaly, the uptake rate was less than 70% of the mean of the controls. Half of 14 children evaluated with alpha 1-MG showed high values. In 6 of these 7 cases, DMSA renal uptake rate was more than 2SD below the mean of the controls. Urinary microalbumin was not correlated with urinary alpha 1-MG or DMSA renal uptake rate. Three of 4 children with high values of urinary microalbumin were more than 10 years old. Nine of 12 children evaluated with all the indices mentioned above showed high values of urinary alpha 1-MG and/or microalbumin. Low DMSA renal uptake rate was revealed in 7 out of these 9 children including two cases without urinary tract anomaly. These results indicate that, in the cases with solitary kidney even though no other urinary tract anomaly is recognized, renal overload may have already developed in early life.

[Urinary incontinence in children with primary vesicoureteral reflux--urinary incontinence and function of refluxing kidney]

The interrelation among urinary incontinence (nocturnal enuresis, urge incontinence), history of urinary tract infection and renal function was investigated in 153 children with primary vesicoureteral reflux who were more than three years old. Of them, 98 children (64%) had the chief complaint of urinary tract infection (UTI) and 43 children (28%), urinary incontinence. Of the children whose chief complaint was UTI, 44 (45%) had incontinence. Thus, 87 children (57%) with VUR had urinary incontinence. Almost all the children who had urinary incontinence and no previous UTI had good renal function. Renal dysfunction was found in children with previous UTI history. These studies on children with primary VUR more than three years old indicate that, although urinary incontinence could be a factor for recurrence of UTI and a probable cause of worsening of renal function, there is no direct correlation between urinary incontinence and renal dysfunction accompanied by VUR.

[Estimation of glomerular filtration rate from the urinary excreted contrast medium concentration]

In the animal experiments, glomerular filtration rate (GFR) values were estimated from the urinary response to the intravenously administrated iopamidol. By introducing some reasonable assumptions, mass balance equations about the contrast medium were transformed and GFR was defined as the ratio of logarithm of urinary concentration by time. Urinary concentrations were determined by measuring the photodensity on the X-ray film of urine specimens. Obtained values of GFR were well fitted to those obtained by the analysis of the plasma disappearance curve. The advantage of this method is that measurement of urinary volume is not necessary.

[Evaluation of renal function in children with primary VUR up to two years old]

The function of 99 refluxing kidneys of 61 children up to two years old at the time of diagnosis was evaluated by 99mTc-DMSA renoscintigraphy, urinary beta 2-microglobulin (beta 2-MG), alpha 1-microglobulin (alpha 1-MG) and N-acetyl-beta-D-glucosamidase (NAG). High grade reflex (grade IV, V) was found in 45% of the cases. 76%, 51% and 92% of the cases showed abnormally high value of urinary beta 2-MG, alpha 1-MG and NAG, respectively. These results indicate that they have already had tubular dysfunction at the time of diagnosis. DMSA renoscintigraphy of 82 refluxing kidneys of 49 children was performed. Of these, 48% had renal scar and 28% had serious renal dysfunction [DMSA uptake rate less than 18%]. 10-20% of low grade VUR had less than 18% DMSA uptake rate. Two patterns were noticed in the group in which urinary beta 2-MG ranged 0.33-1.0. One was characterized by good bilateral renal function with slight tubular damage and the other serious renal dysfunction with fixed tubular damage. No remarkable recovery of the renal function was noticed after antireflux operation in the second pattern cases. In many cases, in which urinary beta 2-MG was more than 1.0, improvement of DMSA uptake rate was noticed after antireflux operation.

[Evaluation of renal scarring in children with primary VUR by 99mTc-DMSA renoscintigraphy]

Renal scarring in 271 kidneys of 172 children with primary vesicoureteral reflux (VUR) was evaluated by 99mTc-DMSA renoscintigraphy. 58% of refluxing kidneys were with renal scar by the initial DMSA renoscintigraphy. Only 52% of these kidneys showed good correlation between the findings on IVP and DMSA renoscintigram. Of the 144 refluxing kidneys with normal IVP, 41% had renal scarring on DMSA renoscintigram. DMSA renoscintigram revealed widespread renal scarring in 28% of kidneys with only calyceal clubbing and in 60% of those with segmental cortical thinning on IVP. It is realized that IVP was an in-sensitive method to evaluate renal scarring of refluxing kidneys and such kidneys with segmental renal scar on IVP accompanies more widespread scar on DMSA renoscintigram. These cases were allocated to 2 age groups, younger than 3 years and older than 4 years. In the former group less than 10% of kidneys with low grade VUR and about 40% with high grade UVR had widespread renal scarring. On the contrary, in the latter group severe renal scar was recognized in more than 20% of kidneys with low grade VUR and in about 60% with high grade UVR.

[Radiation-induced meningioma--a case report]

A case of meningioma following irradiation for a tumor of the third ventricle is reported. A four year old girl was admitted complaining of headache and vomiting. The pneumoventriculography revealed marked hydrocephalus and a mass lesion at the third ventricle. Under the diagnosis of a tumor of the third ventricle, ventriculo-atrial shunt and radiation therapy were performed. Totally, 4170 rad irradiation was directed from left temporal area through a single portal. Though she had no complaints for fourteen years, at the age of eighteen, she was admitted complaining of right hemiparasis and general convulsion. CT scan and left carotid angiogram revealed a left fronto-temporal tumor diagnosed as meningioma. Histological examination showed transitional type meningioma. The post-operative course was uneventful, and discharged without neurological sign except for slight right hemiparesis. A review of available literature revealed about 150 cases of post irradiated meningiomas. However, there were only 18 cases of meningiomas following irradiation for the treatment of brain tumors. These reported cases were also discussed.

[Sequential changes of vascular intimal ultrastructure in experimental cerebral vasospasm induced by oxyhemoglobin. Scanning electron microscopic study]

Organic changes of vessel wall may play an important role in the pathophysiology of vasospasm after subarachnoid hemorrhage. Sequential changes of intimal ultrastructure in experimental vasospasm induced oxyhemoglobin were investigated by scanning electron microscope. Thirty-four cats were used for this study. The basilar artery was exposed by transcervico-transclival approach. Oxyhemoglobin solution was applied under the arachnoid membrane around the artery in 16 cats at hourly intervals. Of 16 cats, 3 were sacrificed at 1 hour after the first application of the solution, 3 at 3 hours, 3 at 6 hours, 3 at 12 hours, 4 at 24 hours. Three sham-operated cats treated by artificial CSF were used as the control together with 5 untreated normal cats. All procedures were performed under aseptic condition. Perfusion fixation was done. The luminal surface and the cut surface made by freeze-fracture method were investigated by scanning electron microscope. As oxyhemoglobin solution, oxyhemoglobin-rich hemolysate was used and the concentration was 5.5 mM. By hourly application, continuous vasoconstriction of about 70% of the control diameter was obtained. In the control, the endothelial cell layer was flat. The elastic lamina had mild waving, and the luminal surface was smooth. In 1- and 3-hour groups, the elastic lamina was corrugated and the endothelial cells were protruded into the lumen in the depressed portion of corrugation. In 6- and 12-hour groups, degenerative changes of the endothelial cells, crater-formation and ballooning, were seen. Some blood-born cells adhered to the luminal surface in such cases. In 24-hour group, the changes of the endothelial cells became more remarkable.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of prazosin hydrochloride on cerebral vasospasm--an experimental study]

The effect of Prazosin, a new alpha-receptor blocking agent, to release and prevent experimental cerebral vasospasm induced by oxyhemoglobin was investigated. In the first group of cats Prazosin was administered one hour before the induction of vasospasm by oxyhemoglobin, and thirty minutes after the application of oxyhemoglobin in the second group. Doses of 0.5 mg/kg and 0.1 mg/kg were subjected to both groups respectively. In the third group, the divided administration of Prazosin was done; 0.05 mg/kg was given one hour before and two hours after the application of oxyhemoglobin. In the first group, prevention of vasospasm was observed. In the second group, induced vasospasm was released from three hours after the administration of Prazosin. These effects were seemed to be dependent on doses of Prazosin. In the third group, more constant prevention of vasospasm was observed than the former groups. The possible mechanism of preventing and releasing effect of Prazosin on cerebral vasospasm was discussed.

[Effect of prostacyclin on cerebral vasospasm--an experimental study]

Prostacyclin(PGI2), a strong vasodilator of cerebral vessels and a potent inhibitor of platelet aggregation, was infused intravenously in 7 cats after induction of prolonged vasospasm by hourly application of oxyhemoglobin solution into the subarachnoid space around the basilar artery. PGI2, at a concentration of 50 ng/kg/min, was effective in releasing the vasospasm in the 7 cats. On the other hand, PGI2 did not produce significant hypotension. This report will discuss our results and the probable mechanism of action of PGI2 in cerebral vasospasm.

The effect of prostacyclin on cerebral vasospasm. An experimental study

Prostacyclin (PGI2), a strong vasodilator of cerebral vessels and potent inhibitor of platelet aggregation, was infused intravenously into seven cats after induction of prolonged vasospasm by hourly application of oxyhaemoglobin solution into the subarachnoid space round the basilar artery. PGI2, at a concentration of 50 ng/kg/min, was effective in releasing the vasospasm in the seven cats. It did not produce significant hypotension. This report gives our results and the probable mechanism of action of PGI2 in cerebral vasospasm.