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The uptake and utilization of faty acids and glucose in dog kidneys subjected to continuous hypothermic perfusion were studied. 25 dog kidneys were perfused in a Gambro machine for 6 days. The concentrations of free fatty acids and glucose in the perfusate as well as the incorporation of labeled fatty acids and glucose into various metabolites in the kidney tissue and in the perfusate were determined. Linoleic, palmitic, and myristic acids were preferably incorporated into tissue glycerides, while caprylic acid was mainly incorporated into CO₂, glucose, and lactate. Labeled glucose was incorporated mainly into lactate, but a low activity was also recovered in CO₂ and in tissue glycogen. A continuous lactate production and an increase in the ratio between lactate and pyruvate were registered during the perfusion. The concentration of phospholipids and triglycerides remained unchanged during 6 days’ perfusion, while the concentration of cholesterol decreased significantly Te results indicate that dog kidneys subjected to continuous hypothermic perfusion preferably use short-chained fatty acids for oxidation and long-chained fatty acids for incorporation into tissue glycerides. The glycolysis seems to be partially blocked at different levels, resulting in a low oxidation rate and a high lactate production. The results also seem to indicate that metabolic studies of perfused kidneys may make it possible to improve the composition of the perfusate with the aim to keep kidneys in a good condition for clinical transplantation.

Facial blushing is one of the cardinal symptoms of social phobia and has a strong negative impact on the quality of life. Traditional therapeutic options are psychotherapy and pharmacological treatment. The results of these treatments on facial blushing are poorly documented. To investigate whether endoscopic bilateral transection of the upper thoracic sympathetic chain is efficient in the treatment of facial blushing, 244 consecutive patients were treated with bilateral endoscopic transthoracic sympathicotomy (ETS). The results were evaluated by questionnaire and symptoms assessed with visual analogue scales (0-10). There was no mortality nor conversion to open surgery. No Horner's syndrome occurred. Two patients with postoperative pneumothorax were treated with intercostal drainage and one small pulmonary embolus was detected. The questionnaire was answered by 219 patients (90%) a mean (+/- SEM) of 8 months (+/- 9 days) after surgery. Facial blushing (mean +/- SEM) was reduced from 8.7 +/- 0.1 to 2.2 +/- 0.2, P < 0.0001, by the operation. Heart palpitations in stressful situations were also reduced (3.7 +/- 0.3 to 1.3 +/- 0.1, P < 0.0001). The quality of life was substantially improved. The main side-effect was redistribution of sweating from the upper to the lower part of the body. Increased sweating of the trunk occurred in 75% of the patients. Overall, 85% of the patients were satisfied with the result and 15% were to some degree dissatisfied, mainly due to insufficient effect, but only four patients (2%) regretted the operation. As this is an open study, the results must be viewed with caution. ETS, however, appears to be an efficient, safe and minimally invasive surgical method for the treatment of facial blushing.

The mechanism for the high lactate production during hypothermic kidney perfusion has not been clarified previously. The metabolism of lactate and acetate was studied in 23 dog kidneys during continuous hypothermic perfusion. The perfusions were performed in a Gambro machine with a perfusate based on human serum albumin. With a perfusate containing fatty acid extracted albumin, which was almost free of fatty acids, the glucose uptake of the kidney was more pronounced than during perfusion with a fatty acid-rich perfusate. The high glucose uptake under this perfusion condition was associated with a lower lactate production and a higher glucose oxidation rate. In perfusions with a perfusate containing lactate at a concentration of 2.5 mmol/l a considerable lactate uptake of the kidney was shown. By isotope dilution technique the production and uptake rate of lactate was estimated at 4.4 and 8.0 µmol/g kidney and day in two experiments. The labeled lactate carbon was recovered in CO₂, and glucose in the perfusate indicating a continuous oxidation and gluconeogenesis. Acetate was used by the kidney both for oxidation and for gluconeogenesis. Addition of acetate to the ordinary fatty acid-rich perfusate caused an enhanced lactate production from the perfused kidney. The results indicate that the high lactate production during hypothermic perfusion of kidneys is mainly dependent on a metabolic blockade at the level of pyruvate dehydrogenase.

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