Saralasin Acetate Test in Renal Transplant Hypertension: Report of 17 Cases and a Review of the Literature

AND RO LOGY faITflS of treatment in to show response to intensive However, the model should be validated in the v,here it is to be used before its application. W. 2 figures, 7 26 references

TRANSPLANTATION Sa:ralasin Acetate Test in Renal Transplant Hype:rtension: Report of l 7 Cases and a Review of the Litera~ tu.re

E.T. ZAWADA, JR., S. J. GREEN, M. D. JOHNSON, E. R. REINITZ, W. MAUAKKASSA, D. SICA AND IVL GOLDMAN, McGuire Veterans Administration Medical Center and the College of Virginia, Richmond, Virginia Arch. Intern. Med., 144: 65-68 (Jan.) 1984 This study was done to extend previous observations on the use of angiotensin blockade with the specific competitive antagonist saralasin acetate as a functional, provocative test of the role of the renin-angiotensin axis in patients with hypertension. The results of the saralasin acetate test in 17 hypertensive renal transplant recipients were compared to 39 prior reports of transplant patients who had been tested in the same manner. Of the """"'°"""" 82 per cent had a positive saralasin acetate test, suggesting ,v,c,,, ~v,-,v<,~VH hypertension. However, positive tests were obtained in several patients who had normoreninemia, and plasma renin activity levels did not correlate with the magnitude of vasodepressor blood pressure response to saralasin. Transplant artery stenosis, and acute and chronic rejection were the most common post-transplant complications associated with a test but several patients had hypertension alone. The authors conclude from these studies that 1) in a of clinical situations renin "rn""''"''°n to mediate the hypertension as assessed a positive depressor response to saralasin, 2) the graft alone (solitary kidney) is sufficient to cause reninmediated hypertension, 3) acute and chronic rejection commonly is associated with renin-dependent nyperte,nsiOJ1, 4) the saralasin acetate test may not discriminate c1e:,.1rnµumc

authors describe a such a complication. A seromuscular rQo=,_,,.,,,.m suture of 2-zero chromic catgut is applied to an avascula:r area on the anterior gastric wall. A gastrostomy is performed in the center of this area. A Foley catheter is introduced into the stomach and the purse-string is tied over it after the balloon is inflated. Only 1 purse-string suture is used. The authors believe that use of multiple pursestring sutures results in circumferential necrosis of the wall of the stomach with consequent leakage of the contents into the peritoneal cavity. They advocate the use of 3 seromuscular sutures outside the first purse-string suture in a manner described below. The first seromuscular suture is placed in 2 bites to cover approximately 120 degrees around the Foley catheter and then tied. The second suture is placed in a similar fashion but at a different level and then tied. The third suture is placed similarly and tied. This technique of placement of seromuscular sutures ensures adequate blood supply to the inverted gastric margins. The greater omentum is reflected superiorly over the gastrostomy and the Foley catheter as well as the free ends of the seromuscular sutures are allowed to pass individually through the omentum. The sutures then are tied over the omentum. The catheter is brought out through a separate stab wound in the left upper quadrant of the abdomen and is secured in place by a 2-zero silk suture through the skin. This technique was used in 200 patients with no complications. The authors state that their vv,,.,. ... -,.v,v for gastrostomy is associated with minimal gastric necrosis and intraperitoneal leakage. N. S. D. 5 figures, 2 references

Editorial comment. We find gastrostomy to be of real benefit in patients undergoing ileal conduit construction as opposed to nasogast:ric suction. A. T. E.

AND RO LOGY And:rogen Receptor in Hu.man Foireskin, II. Characterization of the Receptm· F:rom Hypospadiac Tissue

C. B. AND

A. J. T. C.

RAZEL, p

p

SPELSBERG,

Rochester, 1t1innesota m

sis. 4

E. D. W. 10 referencBs

:SURGICAL TECHNIQUES, EQUIPMENT AND INSTRUMENT§ A Technique for Gastrostomy

T. W. RICE AND M. DEITEL, Department of Surgery, University of Toronto and St. Joseph's Health Center Research Foundation, Toronto, Ontario, Canada Amer. J. Surg., 146: 397-398 (Sept.) 1983 One of the most feared complications of gastrostomy is leakage of gastric contents into the peritoneal cavity. The

Amer. J. Obst.

147: 513-520

1) 1983

from a defect in ~"···~--,m, receptor function or, at least, a defect in a step subsequent to steroid receptor ~v,.u,.,,~A formation. To define whether the defective mechanism exists in hypospadias, andrngen receptors in foreskin from hypospadiac patients undergoing urethroplasty were characterized and compared to those from normal neonates undergoing circumcision. The androgen receptors were stabilized with a buffer for >24 hours. The receptors were characterized by Scatchard analysis, competitive binding assays, sedimentation analysis, molecular sieve chromatography and isoelectric focusing techniques. Studies of the binding of R 1881 to cytosolic fractions demonstrate that an androgen-binding protein exists in human foreskin. Specific R 1881 binding to soluble proteins from human foreskin was shown to be high affinity, low capacity and steroid specific. The data suggest that the foreskin in hypospadiac patients contains androgen receptors in a concentration similar to that