Habitual Excessive Dietary Salt Intake and Blood Pressure Levels in Renal Transplant Recipients

679 i\.s a rare, exaggerated. p:ressor or responses have been described after saralasin administration. However, in >6,000 tests no serious or side effects have been observed. In 1 patient catecholamine release from a chromocytoma was ,.n·vvvn.•cu.. For this and other reasons it would be wise to have an a-adrenergic receptor blocker ampules available in the case of a disturbing pressor response. Although saralasin is primarily a diagnostic agent it has proved useful for short-term (hours to days) emergency treatment of malignant hypertension, in severe congestive heart failure and in reducing pressure during and after renal arteriography. In summary, the intravenous saralasin test could be of use in screening for angiotensin II mediated hypertension. A certain percentage of false negative tests may occur. Because of the high prevalence of high renin and even some norn1al renin essential hypertension that is likely to respond to saralasin it is expected that false positive tests also will occur when screening for renovascular hypertension whose prevalence has been estimated at 3 to 10 per cent of the general hypertensive population. Therefore, the saralasin test must be used in conjunction with suggestive clinical findings and other tests. W. W. K. 1 table, 10 references

are the alternative procedurn is transureteroureterostomy. In cases of transection of the ureter, transection of the ureter and debridement an end-to-end anastomosis is preferred over simple suturing because of the higher incidence of fistula and stricture. In cases of ureteral injury secondary to penetrating missiles 01· other forms of external trauma the rate of complications is high, 18 per cent in the author's series, because of its relation to the high incidence of associated visceral and vascular injuries. The nephrectomy rate has been 7 per cent in the author's series. In the Parkland series the mortality rate of ureteral injury secondary to external violence was 11 per cent. The management of complications of ureteral injury is initiated by drainage of extravasated urine or abscess. In cases of urinary fistula a ureteral catheter or double J ureteral stent may be inserted. If this fails exploration and definitive ureteral repair are performed. F. T. A.. 7 figures, 3 tables, 3 references

TRANSPLANTATION Habitual Exce§sive Dietary Salt Intake and Blood Pre§su:re Levels in Renal Transplant Recipient§ J.

TRAUMA Erner1!.e,1tcv

,u,u,c,z~;.,,n~an

of the Injured Ureter

T. C.

BRIGHT, III, Division of Urology, Southwestern Nledical School and Pr'P.~nv,,,,·u-,n. ,.,v.,m,,u •. Dallas, Texas

Urol. Clin. N. Amer., 9: 285-291 (June) 1982 The ureter infrequently is external violence because of its small size and deep location in the retroperitoneal space. Frequently, there are no early signs and symptoms of ureteral In 59 cases of ureteral reviewed by the author 32 had hematuria (20 gross and 12 r-rc,.Qr,nm 19 were normal and 8 had no done. An excretory urogram (IVP) should be performed once a ureteral injury is suspected. In these 59 patients with ureteral injury the pyelographic were 11 10 with extravasation of contrast material, 1 ureteral dilatation, 1 nonvisualization of the ureter, l ureteral deviation and 1 bladder displacement. If suspicion of uretera.l perm:sts a normal IVP retrc)gr·adle will demonstrate most of the ureteral the site of injury cannot be found intravenous carmine may detect the site of extr:ivasation. tomography and ultrasound of the abdomen are to demonstrate loculated extravasated urine. The most common cause of ureternl injuries is abdominal hysterectomy, followed exploratory laparotomy, MarshallMarchetti procedure, colectomy and stone basket manipulation. When ureteral injury is discovered during the operative procedure it should be repaired immediately. In cases of upper third ureteral injury various pyeloplasty techniques may be done. The author prefers the dismembered flap technique. If the ureteropelvic juction is spared an end-to-end ureteral anastomosis may be performed. Other techniques are either cutaneous ureterostomy or placement of a stent into the ureter and bringing the catheter to the skin. In cases of middle third ureteral injury a simple end-to-end ureteral anastomosis is adequate treatment. In cases of lower third ureteral injury ureteroneocystostomy, vesico-psoas hitch or a bladder flap proarn.H
L. A. HERBERT, J. LEMANN, JR., J. A. BERES, and the Veterans Administration Research Service, Medical Wisconsin, Milwaukee, Wisconsin and the Department Medicine, Ohio State University, Columbus, Ohio H.

w.

KALBFLEISCH,

F.

PIERING AND

Amer. J. Med., 73: 205-210 (Aug.) 1982 Dietary salt intake and blood pressure were examined in 68 renal transplant patients and 80 healthy individuals. Renal function was normal in all subjects. Dietary salt intake was estimated from renal sodium excretion (24-hour urine sodium). Sodium intake was 43 per cent higher in the ents than in control subjects. Mild 29 transplant recipients and was controlled easily with diuretics alone. There was no correlation between dietary salt intake and blood pressure despite glucocorticoid administration and reduced renal mass. These observations are contrary to the widely held vievv that salt intake can contribute to the cmnl,wHno,nt or maintenance of hypertensiono The incidence of in the than 18 references

Abstracter's comment. The authors have put vvs,.v0"v" a argument ep1ctEim101og1c studies linkmg sodium and hypertEim:10,,1. was well constrncted. J. H. N.

DIVERSION Neoplasia and Ureterosigmoidostomy: A Colonoscopy Survey

M. STEWART, F. A. MACRAE AND C. B. WILLIAMS, Depart· ment of Applied Physiology and Surgical Sciences, Royal College of Surgeons of England and St. Mark's Hospital, London, England Brit. J. Surg., 69: 414-416 (July) 1982 The authors reviewed 34 consecutive patients who had un-