Usefulness and limitations of liquid formula and chemically defined diets in nutritional care of patients are considered.

Metabolism of ethacrynic acid (EA) to its cysteine adduct (CEA) may be involved in ethacrynic acid's clinical ototoxicity. To investigate this postulate, the effects of i.v. administration of the sodium salts of these agents on the cochlear N1 potential were studied in 54 cats.Ethacrynic acid has a significantly longer latent period than CEA before N1 depression occurs. In addition, CEA is 10–15 times more potent than EA with respect to the time needed for development of maximal N1 depression. These differences could be due to EA being converted to CEA before exerting an ototoxic effect.Furthermore, the slopes and heights of the dose-response curves for EA and CEA are similar, indicating similarity of site and mechanism of action. There is an apparent parallel shift to the right in the dose-response for EA, the extent of which indicates that EA is 312–5 times less potent than CEA with respect to the amount needed to produce equivalent N1 depressions. This could be due to incomplete conversion of EA-CEA although it ordinarily would be taken to mean that EA has less affinity than CEA for the receptors involved.

. . . to obtain a more accurate idea of the actual prevalance of the disease . . . in the winter of 1828-9, I instituted a series of experiments, by taking the patients promiscously, as they lay in the wards, and trying the effects of heat upon the urine of each and at the same time employing occasionally other reagents. The whole number I took amounted to 130; out of which no less than eighteen proved to have urine decidely coagulable by heat: and in twelve more traces of albumen were found: giving, therefore, an average of at least one in six, if not one in four of the whole number. (Richard Bright,) Cases and Observations, Illustrative of Renal Disease Accompanied with the Secretion of Albuminous Urine, Guy’s Hospital Reports, 1, 338, 1836.

The practice of weighing the cost of preventive programs against the expected benefits is probably as old as prevention itself. The number of preventive programs has proliferated in the past few years and has forced a competition for limited funds. The need to set priorities for public health funding of such programs has, therefore, required a more detailed breakdown of both cost and benefit. For example, the benefits include the reductions in future mortality, hospitalization and sickness absenteeism resulting from the preventive program, each benefit being expressed in terms of dollars saved. The value of the reduction in the mortality of males is estimated from tables compiled by economists showing the average future productivity of males at various ages. Defining the value of a housewife is more difficult, however, and an arbitrary figure must be used. For this reason some program planners prefer to refer to the number of lives that will be saved and do not apply a monetary value. Because of the lack of agreement about the effectiveness of most preventive procedures in renal disease, and because many intangibles among the benefits defy precise evaluation, one may well ask what purpose is served in attempting to calculate the cost-benefit of any program. Apart from assisting the setting of priority in health planning, cost-benefit analysis is important in understanding the law of diminishing returns in expanding programs. Contrary to folklore that expanded programs automatically provide greater benefits, an analysis of the cost-benefit of several hypothetical programs of varying sizes will indicate the point at which further expansion leads to diminishing benefits.

s1 May 1967Interstitial Nephritis: A Clinicopathological Renal Biopsy Study.Robert C. Muehrcke, M.D., F.A.C.P., Conrad L. Pirani, M.D., Robert M. Kark, M.D., F.A.C.P.Robert C. Muehrcke, M.D., F.A.C.P.Search for more papers by this author, Conrad L. Pirani, M.D.Search for more papers by this author, Robert M. Kark, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-66-5-1052_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptSerial clinicopathological observations were made on 76 patients with interstitial nephritis. Tissue was obtained by renal biopsy and studied, using light and electron microscopy. In addition, tissue was cultured for bacteria. Interstitial nephritis was divided into primary (40 patients studied) and secondary (36 patients studied). Primary interstitial nephritis was further subdivided into acute (8 patients) and chronic (32 patients).Primary acute interstitial nephritis was associated with infection by brucellosis (2 patients) and syphilis (1 patient). The clinical features were massive proteinuria, azotemia, and progressive renal insufficiency. The striking morphology was diffuse interstitial edema, fibrosis, and cellular infiltrates. Acute renal failure... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Oak Park and Chicago, Illinois PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byArsine-Induced Anuria A Correlative Clinicopathological Study with Electron Microscopic ObservationsROBERT C. MUEHRCKE, M.D., F.A.C.P., CONRAD L. PIRANI, M.D. 1 May 1967Volume 66, Issue 5Page: 1052-1052KeywordsAcute renal failureBacteriaBiopsyBrucellosisEdemaElectron microscopyFibrosisNephritisProteinuriaSyphilis ePublished: 1 December 2008 Issue Published: 1 May 1967 PDF downloadLoading ...

s1 May 1966Drug-induced Renal Disease.Robert C. Muehrcke, M.D., F.A.C.P., Seymour Rosen, M.D., K. Gerhard Thiele, M.D., Conrad L. Pirani, M.D., Robert M. Kark, M.D., F.A.C.P.Robert C. Muehrcke, M.D., F.A.C.P.Search for more papers by this author, Seymour Rosen, M.D.Search for more papers by this author, K. Gerhard Thiele, M.D.Search for more papers by this author, Conrad L. Pirani, M.D.Search for more papers by this author, Robert M. Kark, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-64-5-1181_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptDrug-induced renal disease, like other iatrogenic disorders, bedevils the patient and humbles the physician when he finds that he has done harm at the time he thought he was doing good. Renal disease induced by drugs was studied by percutaneous biopsy in 40 patients. Clinical and laboratory findings were correlated with morphology, both by light and light and electron microscopy.Thirty-one different drugs produced the following clinical entities: acute renal failure, acute hemorrhagic glomerulonephritis, the nephrotic syndrome, tubular disturbances, and chronic renal insufficiency.Acute renal failure followed renal artery occlusion (triiodinated contrast medium). Zeek's sensitivity angiitis of the intralobular vessels... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Chicago and Oak Park, Illinois PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1966Volume 64, Issue 5Page: 1181-1182KeywordsAcute renal failureBiopsyClinical laboratoriesDrugsElectron microscopyGlomerulonephritisRenal arteriesRenal diseasesResearch laboratoriesVasculitis Issue Published: 1 May 1966 PDF downloadLoading ...

s1 October 1964Perfusion of Isolated Animal Kidneys.Nathan W. Levin, M.B., F.C.P.(S.A.), James A. Hayashi, Ph.D., Will G. Ryan, M.D., Hermann Mattenheimer, M.D., Robert M. Kark, F.R.C.P., F.A.C.P.Nathan W. Levin, M.B., F.C.P.(S.A.)Search for more papers by this author, James A. Hayashi, Ph.D.Search for more papers by this author, Will G. Ryan, M.D.Search for more papers by this author, Hermann Mattenheimer, M.D.Search for more papers by this author, Robert M. Kark, F.R.C.P., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-61-4-816_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptStudy of the isolated perfused kidney sacrifices normality in environment, but attains greater simplicity and a higher degree of experimental control. Although in recent years this preparation has been extensively used to study renal autoregulation, little attention has been paid to its potential usefulness in metabolic studies or in following the processes of renal failure. This presentation discusses the role of the isolated perfused kidney, describes experimental methods, presents serial data on fatty acid and glucose utilization during the course of failure of the kidney and on the enzymatic and histochemical changes that occur.... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Nathan W. Levin, M.B., F.C.P.(S.A.); James A. Hayashi, Ph.D.; Will G. Ryan, M.D.; Hermann Mattenheimer, M.D.; Robert M. Kark, F.R.C.P., F.A.C.P.Affiliations: Chicago, Ill. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 October 1964Volume 61, Issue 4Page: 816-816KeywordsFatty acidsGlucoseKidneysRenal failure ePublished: 1 December 2008 Issue Published: 1 October 1964 PDF downloadLoading ...

s1 April 1964Correlative Clinicopathological Studies of Patients Following Acute Renal Failure.Robert C. Muehrcke, M.D., F.A.C.P., Robert M. Kark, M.D., F.A.C.P., Conrad L. Pirani, M.D., F.A.C.P., Seymour Rosen, M.D.Robert C. Muehrcke, M.D., F.A.C.P.Search for more papers by this author, Robert M. Kark, M.D., F.A.C.P.Search for more papers by this author, Conrad L. Pirani, M.D., F.A.C.P.Search for more papers by this author, Seymour Rosen, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-60-4-736_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptCorrelative clinicopathological studies were made of renal biopsies from five patients with acute oliguric renal failure resulting from apparent tubular necrosis. The acute tubular necrosis followed shock in three patients, CCL4poisoning in one, and arsine toxicity in one. In four patients, renal biopsies were done after the patients made a recovery from acute renal failure. Serial renal biopsies were performed on one patient with arsine toxicity during each of the following periods: (1) complete anuria, (2) early diuretic phase, (3) height of diuresis, and (4) 6 months after recovery from acute renal failure. These serial biopsies were studied by... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Robert C. Muehrcke, M.D., F.A.C.P.; Robert M. Kark, M.D., F.A.C.P.; Conrad L. Pirani, M.D., F.A.C.P.; Seymour Rosen, M.D.Affiliations: Chicago, Illinois PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 April 1964Volume 60, Issue 4Page: 736-736KeywordsAcute renal failureBiopsyDiureticsNecrosisRenal failureShockToxicity ePublished: 1 December 2008 Issue Published: 1 April 1964 PDF downloadLoading ...

AN understanding of the interrelations of pregnancy and systemic lupus erythematosus is of considerable clinical importance, particularly since the disease occurs most frequently in women during the reproductive age. The diagnosis has been facilitated by the description of the L.E.-cell phenomenon by Hargraves and his colleagues1 (1948). Thereafter, the clinical features became more widely recognized, and it became easier to differentiate systemic lupus erythematosus occurring in pregnancy from the other causes of toxemia of pregnancy.Although a number of isolated case reports have been documented2 3 4 5 6 7 8 9 10 11 12 13 14 we were able to find relatively few reports of larger series of pregnancies in patients . . .

AbstractRenal biospsies and renal function tests were done on 41 rheumatoid arthritis patients. Histologically, vascular disease was found in 14, amyloidosis in 4, and lupus nephritis in 2. The kidney was' normal in 21. “Rheumatoid” glomerulitis was not found in any biopsy, but occurred in 6 of 16 autopsies. The significance of these results is discussed with particular reference to the effect of gold salts on the kidney and the interrelationships of cortisone treatment and amyloidosis.

In 17 patients, active (diffuse) lupus glomerulonephritis was treated with a combination of mechlorethamine (HN2) and a high dose of corticosteroids (HDS). Serial clinical and sequential histologic observations were made. The results were compared with those from a previously reported and comparable group of patients who were treated with HDS alone. The mortality rate seen in the more severely affected patients was similar in both groups and there was no significant difference in estimated survival. By contrast, in those in whom the kidneys were less severely affected, the estimated survival appeared to be better in those treated with HDS-HN2. Control of histologic activity also occurred more rapidly in the HDS-HN2 group.

In previous papers (1, 2) we have described observations on the quantitative distribution of alkaline phosphatase in the anatomical units of the nephron in man and other species.This enzyme was selected for study by microdissection of lyophilized sections of kidneys and ultra-microassay because there was considerable information avail- able on its qualitative distribution in the nephron.In particular, the known qualitative differences in its distribution in the proximal and distal convolu- tions of the tubule allowed us to verify the accuracy of the microdissection technique we used (2).Once this was accomplished we were able to study the quantitative distribution of other enzymes for which less information was available.In this paper the results of assay of lactic dehydrogenase (LDH) activity on renal tissues from healthy hu- mans and laboratory animals are reported.LDH was chosen for study because it plays an important role in energy metabolism, namely, in the glycolytic formation of lactic acid and in its mobilization for complete oxidation in the tricarboxylic acid cycle.As far as could be ascertained, no data were avail- able on its distribution or functional significance in the cells of the nephron. METHODSHandling of tissue.In previous communications (1, 2) we have described in detail the techniques used for dis- secting, weighing, and enzyme assay of the individual units of the nephron.LDH assay.Optimal conditions for assay of LDH activity in the human kidney were determined (Table I).Tissue samples with a dry weight ranging from 10 to 100

To the Editor:— The editorial on the nephrotic syndrome inThe Journal(169:846 [Feb. 21] 1959) disturbs us since we are sure it will confuse many readers. It quotes two references by ourselves and our co-workers which deal with the nephrotic syndrome. The other reference is a paper by Hodges (J. M. Soc. New Jersey54:11 [Jan.] 1957) which deals with the lower nephron syndrome—so-called lower nephron nephrosis or acute tubular necrosis. Since there is no clinical and pathological similarity between these two conditions, and treatment is completely different, the editorial is confusing and misleading. In discussing the nephrotic syndrome, the editorial states that "pathologically the characteristic lesion is necrosis of the tubules." This lesion is seen in lower nephron nephrosis but not in the nephrotic syndrome. There are no characteristic histological lesions in the kidneys of patients with nephrotic syndrome. This condition has many causes and many