Emphysematous pyelonephritis: report of 4 cases.

Emphysematous pyelonephritis is a rare, life endangering suppurative infection of the renal parenchyma and perirenal spaces. The disease is encountered mainly in patients with diabetes mellitus and is characterized by the production of intrarenal and, occasionally, perirenal gas. We present 4 cases of emphysematous pyelonephritis encountered in our hospital with review of the literature.

Autorenal transplantation in the treatment of renovascular hypertension.

Autorenal transplantation was performed on 32 renal units including three bilateral transplants, in 29 renovascular hypertensive patients. Aortoarteritis in 18, fibromuscular dysplasia in six, and atherosclerosis in five were the causative renal arterial lesions. Young patients with severe or uncontrolled hypertension but with functioning kidneys were selected for this procedure. Follow-up varied from one to seven years. Twenty-two patients were cured of hypertension, four showed improvement and in three the transplanted kidneys failed to function due to vascular thrombosis postoperatively. There was no death in the series.

Ethnomedicinal plants of Jaunsar-Bawar hills, Uttar Pradesh, India.

During an ethnomedicobotanical survey of Jaunsar-Bawar, a hilly tribal inhabited area in Uttar Pradesh, India, it was observed that about 100 plants are being used by the local Jaunsari tribe for the treatment of various ailments. An alphabetical list of these plants is given along with their family, local name, local uses, locality and collection number.

Severe hypertension in children with renal disease: treatment with minoxidil.

Sixteen children with renal disease and severe hypertension refractory to other drugs were treated with minoxidil for periods of five days to 77 months. The maximum dose ranged from 0.05 to 1.88 mg/kg/d. With therapy, the mean BP decreased from 158/112 to 133/90. Thirteen children had an antihypertensive response. 2 had progressive rejection of transplanted kidneys, and 1 received a low dose and failed to respond. Complications were hypertrichosis in 14; fluid retention in 4, with congestive heart failure in 1; and decreased renal function in 2. Pericarditis, possibly related to minoxidil, occurred in one child. Minoxidil is a valuable antihypertensive drug in children but should be used with caution.

Congenital intrathoracic kidney: a 5-year radionuclide follow-up.

Congenital intrathoracic kidney (CIK) is an exceedingly rare anomaly. IN a study of 15,919 autopsies of children by Campbell [1], only one CIK was noted. Less than 50 cases have been reported so far in English literature [3]. Most of the CIK are asymptomatic normal organs which require no medical or surgical treatment. We have had the opportunity of applying scintiphotographic techniques exclusively to follow up a 9 1/2-month-old infant with CIK for 5 years.

Congenital intrathoracic kidney.

An intrathoracic kidney, although rare, should be considered in a child with a mass at the base of the lung on a chest radiograph. Excretory urography is diagnostic and may eliminate the need for further extensive investigation and operation.

Parathyroid autotransplantation in renal osteodystrophy.

Severe renal osteodystrophy with metaphyseal fractures developed in two children with hypoplastic-dysplastic kidneys and chronic renal failure despite therapy with vitamin D, CaCO3, phosphate-binding agents, and protein restriction. Serum immunoreactive parathyroid hormone (iPTH) levels were elevated to 709 and 1,537 pg/mL (N = 255 +/- 92 pg/mL). Total parathyroidectomy and then autotransplantation of a small portion of parathyroids into the left brachioradialis muscle resulted in complete healing of renal osteodystrophy with the same dose of vitamin D. Serum iPTH and histological studies have demonstrated functioning parathyroid autotransplants, 19 and 20 months postoperatively in these two patients. Advantage of such a procedure over 3 3/4 parathyroidectomy is that this transplanted parathyroid tissue is easily accessible for partial removal in case of recurrence of uncontrollable hyperparathyroidism. We believe that total parathyroidectomy and autotransplantation can be successfully performed even in small children.

Cold injuries in Kashmir, December 1971.

A total of 847 cases of cold injury occurred within the short space of 2 weeks during the Indo-Pakistan conflict in Kashmir in December 1971. The management of these cases and their end results are described. A combination of drugs consisting of low-molecular-weight dextran, an anti-inflammatory agent, and a vasodilator was tried with encouraging results. A conservative attitude towards ablation of necrosed tissues paid good dividends.

Unusual problems in renal hypertension.

Ten cases of renal hypertension with uncommon causes were presented and unusual problems in their diagnosis and surgical management were discussed. These causes included segmental stenosis involving aberrant renal artery, renal artery stenosis in association with renal arteriovenous fistula, postoperative renal hypertension and hypertension secondary to renal tuberculosis. A high index of clinical suspicion and increasing awareness will help in diagnosing such rare and unusual cases of renal hypertension.