[Priapism following off-label use of tamulosin]. / Priapisme na 'off-label'-gebruik van tamsulosine.

Selective postsynaptic alpha1-adrenergic blocking agents such as tamsulosin are mainly used for treating micturition symptoms due to prostatic hyperplasia. They are also used off-label in patients with a distal ureteral stone to enhance passage of the stone. This application is based on the smooth muscle relaxant effect of alpha1-receptor blockade. Smooth muscle relaxation in the penis leads to penile tumescence. The case was reported of a 47-year-old man with a distal ureteral stone who presented with priapism after using tamsulosin 0.4 mg once daily for 9 days. Male patients receiving off-label alpha1-blocking agents should be informed about this adverse effect.

Six-day kidney preservation in a canine model. Influence of a one-to-four-hour ex vivo perfusion interval.

Continuous hypothermic perfusion (CHP) was improved when interrupted by an interval of ex vivo perfusion. The influence of the length (1-4 hr) of this interval of ex vivo perfusion was studied in a dog model. Kidneys were subjected to CHP for 72 hr, then connected with the donor for 1, 2, 3, and 4 hr, then returned to CHP and, after a total preservation time of 144 hr, autotransplanted. Simultaneous contralateral nephrectomy was performed. Life-sustaining kidney function was obtained in all of the 6 animals in the 3-hr group and in 5 of the 6 in the 4-hr group. Shorter ex vivo perfusion intervals (1-hr and 2-hr) resulted in no survivors and 2 survivors out of 6, respectively. Creatinine levels of animals that received autotransplants of 3-hr and 4-hr ex vivo perfused kidneys returned to near normal values within 10 days after transplantation.

A new device towards intermediate term kidney preservation--an experimental study.

A new device for ex-vivo perfusion of kidneys is presented. When used in alteration with hypothermic machine preservation, it was shown to improve kidney function in a four-day autotransplant and contralateral nephrectomy model.

Renal transplantation in patients with atypical haemolytic uraemic syndrome: a tailor made approach is necessary.

A 33-year-old woman with a history of chronic transplant dysfunction because of repeated bouts of haemolytic uraemic syndrome (HUS) was considered for a second transplant. Extensive genetic investigation of the complement system was executed to rule out known mutations prone to development of HUS. This case illustrates the importance of genetic screening in patients with recurrent HUS.

Machine perfusion versus cold storage for preservation of kidneys before transplantation.

Machine preservation was introduced into the Groningen Transplant Group in December 1972. Thirty five of the 90 kidneys transplanted in the following period of four years were preserved on a machine. The other kidneys were preserved by the so-called cold storage method. The advantages and disadvantages of both methods are outlined. Evidence is found in the literature and in this study that cold storage is sufficient for preservation-times up to 24 hours. When the preservation time exceeds this period, then machine preservation may be an advantage. Kidneys damaged by ischaemia were found to have a higher percentage of immediate function when preserved by the machine compared to those preserved by cold storage. There was no significant difference in one-year graft survival for the kidneys preserved by either method. Machine preservation helps to select between viable and non-viable kidneys from non-heartbeating donors. This is especially important in view of the lack of kidneys for transplantation. Therefore, in the opinion of the authors, it is necessary to continue with machine preservation in selected centres and to make the facilities of these centres available to every donor hospital in The Netherlands.

Functional studies in 6 days successful preserved canine kidneys.

In 2 groups of 6 dogs each the right kidney was removed, flushed with Collins and then perfused in a Gambro preservation machine for 6 days. After this period the kidneys were reimplanted in the neck of the subsequently nephrectomized donor. The only difference in Group 2 was that halfway the 6-day hypothermic perfusion the kidneys were taken from the machine and perfused ex vivo for 3 hours by connections with the femoral vessels of the same donor dog. After implantation, only 1 dog from group 1 survived. All 6 dogs in group 2 survived. A low filtration fraction (less than 0.26) after implantation, measured 1 hour after implantation, correlated well with and predicted life sustaining kidney function. During the ex vivo perfusion in group 2, an improving proximal tubular secretion and water reabsorption was observed.

Additional use of immunostaining for active caspase 3 and cleaved actin and PARP fragments to detect apoptosis in patients with chronic heart failure.

BACKGROUND: Apoptosis might play a role in the pathophysiology of chronic heart failure (CHF). Detection of apoptosis in tissue mostly relies on the terminal deoxynucleotidyl transferase nick-end labeling (TUNEL) method. Recent studies showed, however, that TUNEL-positive cardiomyocytes were not in apoptosis. Therefore, additional methods are warranted. In this study, we tested the specificity of the TUNEL method by additional immunostaining for enzymes and cleaved proteins that are considered specific for apoptosis. METHODS AND RESULTS: We tested 25 myocardial tissue sections from 16 patients with severe CHF (caused by either idiopathic or ischemic cardiomyopathy) for the existence of apoptosis. We compared TUNEL with immunostaining for caspase 3, active caspase 3, cleaved actin, and poly (ADP-ribose) polymerase (PARP). TUNEL-positive myocytes were seen in 68% of the specimens. Immunostaining in myocytes for active caspase 3 and caspase 3 was positive in only a few patients, whereas staining for cleaved actin and PARP was negative in all patients. CONCLUSION: We found variable myocyte labeling with TUNEL in the failing myocardium of patients with CHF and only obtained scarce additional immunohistochemical evidence for myocyte apoptosis with immunostaining for active caspase 3 and caspase 3 and no positive myocytes with immunostaining for cleaved actin or PARP fragments. These findings support the notion that TUNEL-positive cardiomyocytes are not conclusive for the existence of apoptosis.