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Biomedical subjects

S Perlberg

Publications and source records attributed to S Perlberg.

At least 19 recordsLinked to original sources

[Bilateral hydronephrosis and erythrocytosis].

A 36-year-old woman who developed extreme erythrocytosis following partial correction of severe bilateral hydronephrosis by bilateral ureterolithotomy is presented. Hydronephrosis appears to stimulate renal synthesis and release of erythropoietin. The mechanism could involve increase in medullary hypoxia by increased pressure of the renal pelvis on the medullary vasculature. This might be especially marked when the renal blood supply is compromised by concomitant atherosclerosis, as in this case.

Adult

Evaluation of the relative inhibitory potential of fractionated urinary macromolecules.

UNLABELLED: Ultrafiltration membranes of 10,000 d, 1,000 d and 500 d were used to remove urinary macromolecules from the urine of normal subjects and from the urine of stone forming patients. The filtrated urines were examined for their residual inhibitory potential for calcium-oxalate precipitation, by the discrimination method of Sarig et al. (D.I. test). The results of testing the filtrate were complementary to the information gained by analyses of retentates obtained in successive ultrafiltration. The method has an inherent advantage because the manipulation of solids retained on membranes may inadvertantly modify their inhibitory potential. At least two distinct groups of inhibitors were found in 20 normal urines. The first group has MW above 10,000 d while the second group of inhibitors has MW in the range of 500-1,000 d. The mean of the D.I. values increased dramatically from the normal range (less than 0.6) to the stone former range (greater than 1.1) (p less than 0.001) after the 500 d filtration. Some of the normal urines, even after the 500 d filtration, still had a degree of inhibitory potential. This inhibitory potential may be related to the inorganic compounds which were found in the urines. The inhibitory activity of macromolecules with MW above 10,000 d and below 500 delta was negligible in 7 stone formers (SF) urines. The relative contribution of 500-1,000 d macromolecules is the highest both in SF and normal urines. CONCLUSIONS: 1) inhibitors in human urine are of wide range in MW; 2) stone formers and normals differ in the level of inhibitor activity at all MW ranges; especially in above 10,000 d and below inhibitors.

Calcium Oxalate

Emphysematous renal and perirenal infection in nondiabetic patient.

Emphysematous renal infection is a severe, rare complication of urinary tract infection associated with gas production, which frequently causes renal destruction and has a high mortality rate. It is termed emphysematous pyelitis when gas is confined to the collecting system, or emphysematous pyelonephritis if it also involves the parenchyma with or without the perirenal space. Only 7 cases of perirenal emphysema have been described previously; all were in diabetics. Here we present a rare case of gas-producing renal infection in the collecting system and perirenal tissues, in a nondiabetic patient, and discuss the management of the various types of emphysematous renal infections.

Child

Use of the discriminant index in dynamic treatment to reduce recurrence of calcium oxalate kidney stones.

Treatment with phosphates, thiazides and allopurinol was undertaken in 54 idiopathic calcium oxalate stone formers, 38 of whom were recurrent stone formers. The patients were followed up for 1 1/2 to 4 years (mean 2.6). During the same period at the pre-treatment stage the patients formed 80 stones, but during therapy only one stone was formed. A dynamic scheme of therapy was used. Each patient was tested before the start of drug treatment by the discriminant index (DI) method, which measures the overall inhibitory potential to calcium oxalate crystallisation. About 10 days after the start of treatment the DI was tested again. If the response was positive, therapy was continued; if not, the patient was given another drug. Adjustments were made as required. The stopping of stone formation correlated well with the DI prediction but less well with the hypocalciuric effect of the drugs.

Adult

Determination of GOT activity on nucleation and crystal growth of calcium oxalate.

Crystal Size Distribution (CSD) and the yield of Calcium Oxalate Crystals in solutions with an admixture of 5 normal and 3 stone forming urines, were determined. A positive correlation was found between the median size, the number of particles and the overall inhibitory potentials of the urines toward calcium oxalate precipitation in vitro as reflected by Discriminating Index (DI) measurements. Incubation of two samples of stone formers' (SF) urines with glutamic-oxalacetic-transaminase (GOT) caused a reduction of aspartic acid concentration, an increase in glutamic acid concentration and a parallel decrease in the DI values. After 90 min of SF urine incubation with GOT the DI in three samples was improved and both the median size and number of particles reduced, by 28% and 45% respectively. These results could indicate that GOT activity changes the inhibitory power of the SF urine by transforming aspartic acid into glutamic acid, having thus most probably a part in the inhibition of CaOx stone formation.

Aspartate Aminotransferases

Change in inhibitory potential in urine of hyperuricosuric calcium oxalate stone formers effected by allopurinol and orthophosphates.

Allopurinol and orthophosphates were used in the treatment of 25 hyperuricosuric calcium oxalate stone formers. Their urines were tested by the Discriminating Index method, which measures the potential of a urine to retard calcium oxalate precipitation in vitro. The tests were performed before any treatment was begun and about 10 days after the commencement of drug intake. An insignificant effect by allopurinol and a markedly significant effect of orthophosphates on Discriminating Index were found. In a few of the patients, allopurinol seemed to cause a decrease in the urine's potential to retard calcium oxalate precipitation. Therefore the effect of allopurinol in 11 hyperuricosuric patients with no history of calcium oxalate stone formation was tested. In 5 of the 11 patients, the urine's potential to retard calcium oxalate precipitation decreased to levels similar to those of calcium oxalate stone formers. The results of this study suggest that hyperuricosuric calcium oxalate stone formers suffer from the same yet-undefined etiology of stone formation as other calcium oxalate stone formers. The results also question the role of uric acid in calcium oxalate stone formation and the efficacy of allopurinol in preventing this disease. It is suggested that allopurinol may even be related to stone formation in some patients.

Allopurinol

Repeated subselective renal embolization following pyelolithotomy: angiographic salvage of a kidney.

A bleeding intrarenal aneurysm secondary to pyelolithotomy was treated successfully by super-selective catheterization of the feeding arteries and embolization using stainless steel Gianturco coils. Three therapeutic procedures were performed because of recurrent hemorrhage. The advantages of this mode of treatment are that it is well tolerated, relatively safe and allows maximal preservation of functioning renal tissue.

Aneurysm

Management of ureteropelvic junction obstruction associated with lower polar vessels.

Four cases of hydronephrosis due to ureteropelvic junction (UPJ) obstruction by lower polar vessels are presented. Regular propagation of peristaltic waves across a patent UPJ and rapid emptying of the pelvis were the basic conditions before accepting the lower polar vessels as the primary cause of the hydronephrosis. Transposition or division of the lower polar vessels, accompanied sometimes by a limited lower polar nephrectomy dependent on the resultant ischemia, without any pyeloplasty was the selected procedure in each of the cases. No hypertension and no immediate or delayed postoperative complications occurred in any of our patients. Relief of symptoms, a remarkably improved postoperative pyelogram, and a sterile urine were achieved in all our cases. Detection of every case in which the lower polar vessels play a primary role in the establishment of UPJ obstruction is urged since transposition or division of these vessels in such cases is a superior procedure to pyeloplasty.

Adult

Busulfan-induced hemorrhagic cystitis.

We report a case of severe hemorrhagic cystitis induced by prolonged busulfan therapy. The clinical course and pathological results were similar to irradiation and cyclophosphamide cystitis. Only 1 such case has been described previously. Although hemorrhagic cystitis induced by busulfan is a rare complication it should be considered in the differential diagnosis and busulfan should be discontinued immediately.

Adult

Follow-up of drug therapy efficacy to prevent recurrence of calcium oxalate kidney stone formation.

Results of a prospective study of response to phosphate treatment after surgery in a group of kidney stone formers, some of them recurrent are presented. The follow-up, of 1 year duration, was carried out by periodic tests of the stone formers' urine using the Discriminating Index (DI) procedure. In a group of 32 stone formers, 30 individuals showed a remarkable change in the DI value; i.e., the inhibiting potential of their urine was similar to that of normals. Two of the patients did not respond well, and their drug treatment was adjusted accordingly. During this year no recurrency was reported.

Calcium

Comparative experimental study on the use of the carbon dioxide laser beam in partial nephrectomy.

A report is given on an experimental study in 20 dogs designed to compare the use of the CO2 laser beam as a cutting instrument in resection of the kidney parenchyma, with the simple scalpel and the cutting diathermy current. It was found that the laser can be used with impunity. It shortens the time of operation by facilitating hemostasis, diminishes blood loss, and does not interfere with the final kidney function. The damage to the kidney parenchyma compares favorably with the produced by the other instruments.

Animals

Retardation of calcium oxalate precipitation by glutamic-oxalacetic-transaminase activity.

It has been found that calcium oxalate stone formers have low UGOT activity compared to healthy individuals (controls). Urine from stone formers with no GOT activity and no effect on calcium oxalate precipitation was incubated with GOT for various periods. Subsequently calcium oxalate precipitation was decreased and found to be considerably retarded i.e., the pathological urine after the incubation acted in a way similar to that of normal urine. The yield of Glutamic-Oxalacetic Transaminase (GOT) activity is glutamic acid. It was shown that glutamic acid has a significant retardation effect on the precipitation of calcium oxalate stone formation. Therefore it may be suggested that GOT activity involved in glutamic acid creation in situ, has a role in kidney stone formation.

Aspartate Aminotransferases

May enzyme activity in urine play a role in kidney stone formation?

It has been found that calcium oxalate stone formers have low UGOT and UGPT activity compared to healthy individuals. The urine of 23 stone formers and 19 controls has been tested for combined UGOT and UGPT activity. The effect of L-aspartic acid, alanine and L-glutamic acid on calcium oxalate precipitation has been tested. Only L-glutamic acid exerted a significant retardation effect at physiological concentrations. As GPT and GOT convert alanine and aspartic acid respectively into glutamic acid, a possible mechanism of retardation of kidney stone formation involving enzyme steps via glutamic acid creation in situ is suggested.

Alanine

Adrenergic response of bladder muscle in prostatic obstruction. Its relation to detrusor instability.

In vitro isometric studies of bladder dome muscle taken at operation from 47 patients with benign prostatic obstruction, revealed an alpha-adrenergic response instead of the normal beta response in 23 per cent. The relationship between this finding and the presence of irritative symptoms and an unstable detrusor is examined. This finding may explain the beneficial effect of alpha-blockers on these symptoms in many patients with prostatic obstruction.

Humans

A method for discrimination between calcium oxalate kidney stone formers and normals.

Calcium ion concentration versus time was measured in solutions containing admixture of 10 per cent tested urine of normals and stone-formers, during induced calcium oxalate precipitation. A Discriminating Index was formulated by statistical analysis of the data. It was found that stone-formers and normals differ significantly with respect to the measurements and the Discriminating Indices. An equation to evaluate the odds of stone-forming based on results of an individual test has been derived. The Discrimination Index may be recommended as a diagnostic tool.

Adolescent

Phenoxybenzamine for benign prostatic obstruction. Review of 200 cases.

Two hundred patients treated with phenoxybenzamine for benign prostatic obstruction were reviewed. In 171 of these patients the treatment was given to relieve symptoms in patients not requiring operation, or in patients in whom operation was postponed. Eighty per cent of these patients derived benefit from the treatment, most commonly for the obstructive symptoms (78.7 per cent) but almost as often for nocturia (76 per cent). The treatment was also found to be useful in aiding catheter removal after an attack of acute retention, and in preventing recurrent attacks of acute retention. Side effects occurred in 30 per cent of patients, but necessitated cessation of treatment in only 10 per cent. They consisted of other alpha-blocking effects, and caused after stopping or reducing treatment.

Adult