The majority of renal calculi including staghorn calculi can be treated by extracorporeal shock wave lithotripsy (ESWL) with percutaneous or endourological relief. In case of complete staghorn calculi, many treatment sessions may be required and non-operative treatment by percutaneous nephrolithotripsy (PNL) also is an invasive technique, because the insertion of a percutaneous nephrostomy tube into a calyx occupied by a staghorn calculus, placement of a safety guide wire into the ureter and dilatation of the tract are extremely difficult. From July 1985 to December 1991 we evaluated 12 patients with complete staghorn calculi in 15 kidneys for initial therapy using anatrophic nephrolithotomy. We suggest that the operative treatment should still be considered a viable treatment option, especially in patients with complete staghorn calculi.
Calculi* ; Dilatation ; Humans ; Kidney ; Kidney Calculi ; Lithotripsy ; Nephrostomy, Percutaneous ; Shock ; Ureter

Emphysematous pyelonephritis is an uncommon serious suppurative infection characterized by the production of intrarenal and perirenal gas generally occurs in patient with diabetes mellitus or urinary tract obstruction. We report our experience with the successful management of a case emphysematous pyelonephritis which occurred in 22 year-old diabetic woman with UPJ obstruction in a solitary kidney. She was treated non-operatively with intensive anti-microbial therapy, insulin therapy and percutaneous nephrostomy as a initial life saving procedure. After improvement of renal function and general condition, we performed dismembered pyeloplasty for UPJ obstruction.
Diabetes Mellitus ; Female ; Humans ; Insulin ; Kidney* ; Nephrostomy, Percutaneous ; Pyelonephritis* ; Urinary Tract ; Young Adult

Endogenous nitric oxide(NO) plays an important role in the regulation of blood pressure. It has been known that the evoked NO-dependent dilator system may be impaired in various hypertensive models. The effects of NG-nitro-L-arginine(L-NNA), lipopolysaccharide(LPS) and tempol on mean arterial pressure(MAP) and the effects of L-NNA on isolated aorta tone were studied in order to elucidate potential alterations in resting vasodilator tone of NO in two-kidney, one clip(2K1C) hypertension. Plasma nitrite/nitrate levels were measured by colorimetric assay, and the expression of endothelial and inducible NO synthases(eNOS, iNOS) was determined by Western blot analysis. L-NNA caused an increase of MAP, while LPS produced a hypotensive effect in both 2K1C and control rats. The magnitude of the pressor or depressor response to L-NNA and LPS was comparable in the two groups. Tempol induced a sustained decrease in MAP in 2K1C rats, while it had no effects on MAP in control rats. Plasma concentrations of NO metabolites were significantly increased following the LPS-treatment in both 2K1C and control rats, while they were not affected by tempol-treatment. In endothelium-intact aortic rings precontracted with 25 mM KCl, L-NNA caused a dose-dependent contraction. The magnitude of the maximal contraction was attenuated in 2K1C rats as compared with control. An inhibition of contractile responses to L-NNA in the hypertensive group was also shown in rubbed rings, although the magnitude of contractions was markedly reduced. The vascular expression of both eNOS and iNOS was significantly decreased in 2K1C rats as compared with control. These results indicate that 2K1C hypertension is associated with a reduced basal vasodilator tone of NO and a decrease in the vascular expression of NOS isozymes.
Animals ; Aorta ; Blood Pressure ; Blotting, Western ; Hypertension ; Isoenzymes ; Nitric Oxide* ; Plasma ; Rats*

BACKGROUND/AIMS: Non-alcoholic fatty liver disease is associated with insulin resistance. Compound K (CK) is the final metabolite of panaxadiol ginsenosides that have been shown to exert antidiabetic effects. However, the molecular mechanism of the antidiabetic effects in the liver have not been elucidated; further, whether CK has beneficial effects in hepatosteatosis remains unclear. Therefore, we evaluated the effect of CK on hepatosteatosis as well as its mechanism in high-fat diet (HFD)-fed type 2 diabetic Otsuka Long-Evans Tokushima Fatty (OLETF) rats. METHODS: Twenty-four-week-old male OLETF rats were assigned to four groups: control (saline), CK 10 mg/kg, CK 25 mg/kg, or metformin 300 mg/kg (positive control); all treatments were administered orally for 12 weeks. RESULTS: Fasting glucose levels of the CK25 group were significantly lower than those of the control group during the 12 weeks. The results of the oral glucose tolerance test showed that both the glucose concentration after glucose loading and the fasting insulin levels of the CK25 group were significantly lower than those of the control. Hepatosteatosis was significantly improved by CK25. CK25 and metformin significantly increased the phosphorylation of hepatic adenosine monophosphate-activated protein kinase (AMPK). CK25 significantly inhibited the expression of sterol regulatory element-binding protein-1c and fatty acid synthase, while upregulating that of peroxisome proliferator-activated receptor-α and carnitine palmitoyltransferase-1. CONCLUSIONS: CK improved glucose intolerance and hepatosteatosis in HFD-fed OLETF rats through AMPK activation, which has dual mode of action that involves decreasing the synthesis of fatty acids and increasing fatty acid oxidation.
Adenosine ; AMP-Activated Protein Kinases ; Animals ; Carnitine ; Diabetes Mellitus, Type 2 ; Diet, High-Fat ; Fasting ; Fatty Acids ; Ginsenosides ; Glucose Intolerance* ; Glucose Tolerance Test ; Glucose* ; Humans ; Insulin ; Insulin Resistance ; Liver ; Male ; Metformin ; Non-alcoholic Fatty Liver Disease ; Peroxisomes ; Phosphorylation ; Protein Kinases ; Rats ; Rats, Inbred OLETF*

INTRODUCTION: Fibrous-osseous lesions of the jaws are difficult to diagnose precisely until excised biopsy results are found, so they might be confused with malignant lesions. This clinical study focused on the diagnostic aids of lesions that demonstrate different clinical, radiologic, and histological findings. MATERIALS AND METHODS: A total of 16 patients with benign fibrous-osseous lesions on the jaws (6 fibrous dysplasias, 6 ossifying fibromas, 3 cemental dysplasias, and one osteoblastoma) were reviewed. Nine patients with malignant fibrous-osseous lesions (8 osteosarcomas and one Ewing's sarcoma) were also retrospectively reviewed. RESULTS: Osteosarcoma patients complained of facial swelling and tooth mobility. The radiographic findings showed the irregular resorption of cortical bone and periosteal reactions. Histological features included cellular pleomorphism and atypical mitosis. An Ewing's sarcoma patient complained of tooth mobility and facial swelling. Onion-skin appearance and irregular expansile marginal bony radiolucency were seen in the radiography. Fibrous dysplasia patients complained of facial swelling and asymmetry. The radiographic features were mostly ground-glass radiopacity. Histological findings showed a bony trabeculae pattern surrounded by fibrous ground substances. Ossifying fibroma patients complained of buccal swelling and jaw pains, showing expanded cortical radiolucent lesions with a radiopaque margin. Histological findings were revealed as cellular fibrous stroma with immature woven bones. In cemental dysplasia, most of their lesions were found in a routine dental exam. Well-circumscribed radiopaque lesions were observed in the radiography, and cementum-like ossicles with fibrous stroma were seen in the microscopy. An osteoblastoma patient complained of jaw pain and facial swelling. Radiographic findings were mottled, dense radiopacity with osteolytic margin. Trabeculae of the osteoid with a vascular network and numerous osteoblasts with woven bone were predominantly found in the microscopy. CONCLUSION: Our study showed similar results as other studies. We suggest the clinical parameters of diagnosis and treatment for malignant and benign fibrous-osseous lesions of the jaws.
Biopsy ; Fibroma, Ossifying ; Humans ; Jaw ; Microscopy ; Mitosis ; Osteoblastoma ; Osteoblasts ; Osteosarcoma ; Retrospective Studies ; Sarcoma, Ewing ; Tooth Mobility

BACKGROUND: The evaluation of anesthetic depth using electroencephalography showed reduction in recovery time from anesthesia and decrease in the amount of anesthesia used. This research compared the dosage of propofol and the recovery characteristics when anesthesia was controlled using spectral entropy monitoring and when it was controlled by hemodynamic changes. METHODS: Seventy children of the American Society of Anesthesiologists physical class I-II, ages 3-10, that were scheduled for general anesthesia were randomly distributed into two groups. The children were sedated with midazolam (0.15 mg/kg), and anesthesia was induced with fentanyl (2.0 microg/kg), propofol (2.5 mg/kg), and rocuronium (0.6 mg/kg). Anesthesia was maintained with propofol continuous IV infusion under N2O in O2. For the Entropy Group, the state entropy (SE) was maintained at 40-60, and for the Standard Group, anesthesia was maintained so that the heart rate and systolic blood pressure were at 20% of the standard value. RESULTS: Last 10 minutes of the surgery, the SE and RE (Response entropy) were significantly higher for the Entropy Group when compared to the Standard Group (P < 0.05). The maintenance dose of propofol was significantly lower for the Entropy Group when compared to the Standard Group (P < 0.05). The times taken for recovery were all significantly shorter for the Entropy Group than the Standard Group (P < 0.05). CONCLUSIONS: Entropy guided anesthetic administration was associated with reduced propofol use and faster recovery in children compared to standard practice.
Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Blood Pressure ; Child* ; Electroencephalography ; Entropy* ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Midazolam ; Propofol*

PURPOSE: Thiazide diuretics exert their hypotensive efficacy through a combined vasodilator and diuretic effect. The present study was conducted to assess the inhibitory effect of thiazide diuretic, hydrochlorothiazide, and the thiazide-like diuretics, indapamide and chlorthalidone on contractile responses to norepinephrine and arginine vasopressin in aortic rings from 2K1C renal hypertensive and sham-clipped normotensive rats. METHODS: 2K1C hypertension was made by clipping the left renal artery and age-matched control rats received a sham treatment. Changes in the tension of aortic ring preparations were measured isometrically. RESULTS: Indapamide inhibits the contractile responses to norepinephrine and vasopressin in aortic rings from 2K1C rats, while it did not modify in control rats. The inhibitory effect of indapamide was abolished by endothelium removal. Hydrochlorothiazide or chlorthalidone did not affect the vasoconstriction induced by norepinephrine and vasopressin either in sham or in 2K1C hypertensive rats. CONCLUSION: These results suggest that indapamide inhibits the contractile responses to norepinephrine and vasopressin via an endothelium-dependent mechanism in 2K1C renal hypertension.
Animals ; Aorta ; Arginine Vasopressin ; Chlorthalidone ; Diuretics ; Endothelium ; Hydrochlorothiazide ; Hypertension ; Hypertension, Renal ; Indapamide ; Norepinephrine ; Placebos ; Rats ; Renal Artery ; Salicylamides ; Sodium Chloride Symporter Inhibitors ; Vasoconstriction ; Vasodilation ; Vasopressins

BACKGROUND: Endothelial dysfunction is linked to exaggerated production of superoxide anions. This study was conducted to examine the effects of oxidative stress on endothelial modulation of contractions in chronic two-kidney, one-clip (2K1C) renal hypertensive rats. METHODS: The 2K1C hypertension was induced by clipping the left renal artery; age-matched rats receiving sham treatment served as controls. Thoracic aortae were isolated and mounted in tissue baths for measurement of isometric tension. RESULTS: Norepinephrine-induced contraction was augmented by the removal of the endothelium, which was more pronounced in sham rats than in 2K1C rats. Nomega-nitro-L-arginine methyl ester, an inhibitor of nitric oxide production, had a similar augmenting effect. Vitamin C inhibited the contraction in aortic rings with intact endothelium from 2K1C rats but not from sham rats. The contraction was also suppressed by treatment with diphenyleneiodonium or apocynin, inhibitors of nicotinamide adenine dinucleotide/nicotinamide adenine dinucleotide phosphate (NADH/NADPH) oxidase, in the aortae with intact endothelium from 2K1C rats but not in those from sham rats. Superoxide anions generated by xanthine oxidase/hypoxanthine enhanced the contraction in the aortae with intact endothelium from sham rats, but had no effect in 2K1C rats. Enhanced contractile responses to norepinephrine by xanthine oxidase/hypoxanthine in sham rats were reversed by vitamin C. CONCLUSION: These results suggest that the effect on endothelial modulation of endothelium-derived nitric oxide is impaired in 2K1C hypertension. The impairment is, at least in part, related to increased production of superoxide anions by NADH/NADPH oxidase.
Adenine ; Animals ; Aorta* ; Aorta, Thoracic ; Ascorbic Acid ; Baths ; Endothelium ; Hypertension ; Hypertension, Renal ; Niacinamide ; Nitric Oxide ; Norepinephrine ; Oxidative Stress* ; Oxidoreductases ; Placebos ; Rats* ; Renal Artery ; Superoxides ; Xanthine

BACKGROUND: Ferulic acid (FA) is a naturally occurring nutritional compound. Although it has been shown to have antihypertensive effects, its effects on vascular function have not been intensively established. The aim of this study was to assess the vasoreactivity of FA in chronic two-kidney, one-clip (2K1C) renal hypertensive rats. METHODS: Hypertension was induced in 2K1C rats by clipping the left renal artery and age-matched rats that received a sham treatment served as a control. Thoracic aortas were mounted in tissue baths to measure isometric tension. The effects of FA on vasodilatory responses were evaluated based on contractile responses induced by phenylephrine in the aortic rings obtained from both 2K1C and sham rats. Basal nitric oxide (NO) bioavailability in the aorta was determined by the contractile response induced by NO synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME). RESULTS: FA induced concentration-dependent relaxation responses which were greater in 2K1C hypertensive rats than in sham-clipped control rats. This relaxation induced by FA was partially blocked by the removal of endothelium or by pretreating with L-NAME. L-NAME-induced contractile responses were augmented by FA in 2K1C rats, while no significant differences were noted in sham rats. FA improved acetylcholine-induced endothelium-dependent vasodilation in 2K1C rats, but not in sham rats. The simultaneous addition of hydroxyhydroquinone significantly inhibited the increase in acetylcholine-induced vasodilation by FA. CONCLUSION: These results suggest that FA restores endothelial function by altering the bioavailability of NO in 2K1C hypertensive rats. The results explain, in part, the mechanism underlying the vascular effects of FA in chronic renal hypertension.
Animals ; Aorta ; Aorta, Thoracic ; Baths ; Biological Availability ; Coumaric Acids ; Endothelium ; Hydroquinones ; Hypertension ; Hypertension, Renal ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase ; Phenylephrine ; Placebos ; Rats ; Relaxation ; Renal Artery ; Salicylamides ; Vasodilation

BACKGROUND: Cells rely on gap junctions for intercellular communication, which is important for growth and contractility. The present study was conducted to test the hypothesis that contractile responses in aortic rings from two-kidney, one clip (2K1C) hypertensive rats are more dependent on gap junctional communication compared to those from normotensive rats. METHODS: 2K1C hypertension was induced by clipping the left renal artery and age-matched rats received a sham operation. Heptanol and octanol were used as inhibitors of gap junctional activity. RESULTS: The contraction induced by phenylephrine or KCl was completely reversed by either heptanol or octanol, and the relaxant response to inhibitors was more enhanced in 2K1C hypertensive rats compared to sham-operated rats. Vessels from hypertensive rats also relaxed more to nifedipine when precontracted with KCl, although it did not differ in aortic segments contracted with phenylephrine in between normotensive and hypertensive rats. CONCLUSION: These results suggest that gap junctional communication and voltage-operated calcium channels are differentially regulated in 2K1C renal hypertension.
Rats ; Animals