We read with interest the case report titled 'Negative Pressure Wound Therapy used to Heal Urinary Fistula Wounds Following Renal Transplantation into an Ileal Conduit' (1). We have employed negative pressure therapy (NPT) in over 100 renal transplant recipients with excellent results. However, we recently encountered an unusual case of a slow healing ureteral anastomosis in a patient managed with NPT.A 56-year-old man underwent kidney transplantation and subsequently developed a perinephric collection. After wound exploration and debridement, NPT was initiated. A screening renal scan was performed which was consistent with acute tubular necrosis with no evidence of leak. One week later, an analysis of the drainage fluid was consistent with urine. A repeat renal scan confirmed the diagnosis of a new urine leak. A urinary catheter was placed. An abdominal X-ray confirmed proper positioning of the double-J ureteral stent. After a week of conservative management, the leak persisted. At this point, we discontinued the NPT. Five days later, a nuclear scan confirmed complete resolution.The presence of fistulas is a known relative contraindication to NPT. We believe the NPT slowed healing of the neocystoureterostomy perhaps leading to the development of a urine leak. We also believe that the continued use of the NPT delayed the eventual resolution of this leak. We understand that this anecdote may be only an association, not definitive proof that NPT may slow healing of a neocystoureterostomy. Nevertheless, we maintain that NPT should be employed with caution in patients who may be at risk for urinary complications.
INTBODUCTIONThe frog's kidney has been an object of both anatomical and physiological study since the work of Nussbaum ('86). More recently, however, the amphibian kidney has been studied in the living condition chiefly from the standpoint of a renewed interest in renal function. Such studies have necessitated a very accurate knowledge of the distribution of the. tubules and their relation to the dorsal and ventral renal surfaces. A review of the papers dealing with the morphology of the amphibian renal tubule shows clearly, however, that complete anatomical data have not been available. Fairly adequate descriptions and figures of models (some reconstructed in wax and some by serial sections) are given in the literature (Nussbaum, '86, and Beissner, '99), but none of these indicates the exact relationship of tubule to kidney. Nussbaum depicts very accurately an isolated unit tubule of the frog's kidney closely comparable to that shown in figure 5 of this paper. Beissner also depicts unit tubules in Rana fusca and Rana esculenta which, while diagrammatic, indicate the essential relation of the segments of the tubule to each other. Holmes, in his recent "Biology of the Frog," gives diagrams showing the general relation of renal tubules, glomeruli, and collecting ducts to each other.Within the past few years, Edwards and Marshall ('34) and Edwards ('26) have pointed out that only distal convolutions appear on the ventral surface and only proximal 259
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