Key words:cinacalcet hydrochloride, activity of gastric acid secretion, gastric emptying, gastrointestinal motility, medicine releasing acetylcholine 〈Abstract〉 After taking cinacalcet hydrochloride, hemodialysis patients with secondary hyperparathyroidism often complain of upper gastrointestinal symptoms. In order to evaluate gastrointestinal function, the activity of gastric acid secretion was examined by measuring intragastric pH, serum gastrin and serum pepsinogen concentration and gastric emptying test was examined by measuring serum acetoaminophen concentration. Cinacalcet elevated serum gastrin concentration, but was independent of gastric acid secretion. Meanwhile cinacalcet delayed gastrointestinal motility. In cases showing delayed gastrointestinal motility and gastric atrophic mucosa, gastrointestinal complication often occurred. Because cinacalcet operates on gastrointestinal tract as calcimetics, it is supposed that gastrointestinal complication is due to suppression of the parasympathetic nervous system. In order to reduce this complication, it is useful to take cinacalcet during gastric emptying time or post hemodialysis and to take digestive medicine together such as medication releasing acetylcholine or prostaglandin to advance gastrointestinal motility. Before using cinacalcet, it is preferable to check for gastric disease, intragastric acid, intragastric mucosal condition, and gastric motility by endoscopic examination. If the mechanism of upper
A 32-year-old man consulted Osaka National hospital with chief complaints of dysuria and macrohematuria. DIP and CT revealed that the right kidney deviated to the lower pole of the left kidney and they fused together. The right ureter crossed over the supine. The calcified shadow existed in the lower end of the left ureter with cobra head image. He had no external anomalies. Under diagnosing crossed fused kidney (inverted L shaped) complicated the left ureterocele with a stone, transurethral incision of ureterocele (TUI) was performed. We made transverse incision and extracted stone, 7 mm in size (calcium oxalate 96% and calcium phosphate 4%). Three months later after the operation, IVP, CG and VCG revealed the down-sized ureterocele and no VUR. Crossed renal ectopia complicated many anomalies about 50%. Among them anomalies of the urinary tract was most frequent about 30%. But crossed renal ectopia with ureterocele wasn't reported so far in Japanese literature.
These results indicated that the RUTs with associated BTs have distinct clinical features depending on the sequence of association with the BTs. Especially the RUTs with concomitant BTs should be watched carefully as a high risk group with poor prognosis and possible development of invasive BTs. Positive urine cytology prior to RUT operation may reflect biological activity of tumor cell for dissemination in the lower urinary tract and we suggested preoperative urine cytology was possible predictor of subsequently recurrent BTs after RUT operation in this study.
The 1-year primary patency of the technique was poor, and patency was hard to maintain without the assistance of PTA. Given that frequent PTA was conducted in 74% of patients, it may be a cause for the poor patency. Many cases required thrombectomies, which have the disadvantage of being more invasive than PTA. We concluded that bypass graft technique is not valuable for cases that received frequent PTA.
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