Osteopenia, pathological fractures, and increased urinary calcium excretion in schizophrenic patients with polydipsia.

Ten male chronic schizophrenic patients with polydipsia and 10 nonpolydipsic controls, matched for gender, diagnosis, duration of illness, age, and race, were studied by dual- and single-photon absorptiometry to estimate bone density of the lumbar spine and radius and by 24-hr urine collections to estimate urinary electrolyte excretion. Bone density was normal in the control group, but was abnormally low in the polydipsic group, which had a markedly increased incidence of fractures. Electrolyte excretion was normal in the control group and in the polydipsic group when water intake was restricted to normal amounts; increased urinary sodium and calcium excretion occurred in proportion to polydipsia. As polydipsia is associated with a number of physiological changes, the cause of the osteopenia is unclear; we suggest that a negative calcium balance caused by increased urinary calcium excretion induced by extracellular space expansion may play an important role in the causation of the skeletal changes.

Idiopathic retroperitoneal fibrosis with protein-losing enteropathy and duodenal obstruction successfully treated with corticosteroids.

A 40-year-old carpenter presented with vomiting due to duodenal obstruction. On further investigation he had partial obstruction of both ureters and occlusion of the inferior vena cava. At laparotomy a large retroperitoneal mass of fibrous tissue was found, which extended into the root of the mesentery of the small intestine and partially occluded the duodenum. There was enlargement of lymphatics and stasis of lymph throughout the mesentery. Hypoalbuminemia was present. (131)I-labelled human serum albumin disappeared rapidly from the plasma and there was excessive loss of plasma albumin into the gastrointestinal tract, presumably owing to obstruction of the lymphatic drainage of the small intestine. Prompt improvement followed treatment with prednisolone. Steroids are apparently useful in this condition, early in the disease before irreversible fibrosis has developed. The presenting feature, vomiting due to duodenal obstruction, has been reported in retroperitoneal fibrosis only once before. This is the first report of protein-losing enteropathy in this disorder.

Management of total ureteral loss after kidney transplantation.

Loss of the ureter after transplantation is uncommon and is difficult to manage. A Boari flap can be used to replace the ureter. The authors describe two patients with total ureteral loss. In each a Boari flap was used, to create a pyelocystostomy in one case and a calicecystostomy in the other. Both patients had greatly reduced serum creatinine levels and no urinary tract infections 14 and 18 months, respectively, after operation.

The protean manifestations of renal vein thrombosis in the adult.

We reviewed 8 cases of renal vein thrombosis, 4 of which were detected at autopsy, 1 by laparotomy and the remaining 3 by venography. In 4 cases malignancy also was found and in 2 membranous glomerulonephritis was noted. In 1 patient the thrombosis occurred in a solitary kidney, while it was bilateral in 3. The 4 patients in whom the diagnosis was made during life were treated with anticoagulants alone and 3 are alive with stable renal function 3, 4 and 7 1/2 years after diagnosis.

Sympathetic activity in the proximal urethra in patients with urinary obstruction.

The effect of 10 mg. phentolamine intravenously on the urethral pressure profile was studied in male and female patients with lower urinary tract obstruction. A significant decrease of pressure occurred along the whole length of the urethra in both sexes, including the peak pressure zone in the male patient. This zone has been traditionally attributed to the external sphincter. It was concluded that the sympathetically innervated smooth muscle exerts a certain activity along the whole length of the proximal urethra. The phentolamine test may prove to be a useful adjunct to urethral profile studies in patients with lower urinary tract obstruction.