We reviewed 300 consecutive cases of genitourinary tuberculosis at Wrightington Hospital from 1961 to 1978. There were 73 patients with non-functioning or poorly functioning kidneys who underwent nephrectomy after at least 6 weeks of intensive chemotherapy with 3 antituberculous drugs. Three of 4 patients with unilateral non-functioning kidneys who did not have a primary nephrectomy had delayed complications. Late complications of in situ non-functioning tuberculous kidneys included draining flank sinuses, abscesses and hypertension. These complications can occur years after completion of chemotherapy, even in sterile organs. The incidence of hypertension in this series was 11.3 per cent. The incidence of hypertension in patients with unilateral non-functioning or poorly functioning tuberculous kidneys was 23.2 per cent (p less than 0.005). Two-thirds of the hypertensive patients with severe unilateral tuberculous nephropathy benefited by a decrease in blood pressure after nephrectomy. Removal of these kidneys does not cause a significant loss of renal function. The perioperative morbidity and mortality of the procedure should be minimal in a generally younger population. It is concluded that primary nephrectomy is an important adjunct in the comprehensive management of the unilateral non-functioning kidney.

Nitrogen mustard (NM)-induced lung injury is associated with an accumulation of proinflammatory/cytotoxic M1 and antiinflammatory/wound repair M2 macrophages, which have been implicated in tissue injury and repair. Herein, we analyzed the effects of valproic acid (VPA), a histone deacetylase (HDAC) inhibitor with antiinflammatory and antioxidant activity, on lung macrophages responding to NM. Treatment of rats with NM (0.125 mg/kg, i.t.) resulted in structural alterations in the lung and a macrophage-rich inflammatory cell infiltrate, at 3 d and 7 d. This was accompanied by expression of PCNA, a marker of proliferation, and CYPb5, HO-1, and MnSOD, markers of oxidative stress. Administration of VPA (300 mg/kg/day; i.p.), beginning 30 min after NM, reduced increases in PCNA, CYPb5, HO-1, and MnSOD. This was associated with increases in immature CD11b+CD43+ M1 macrophages in the lung, and decreases in mature CD11b+CD43- M2 macrophages 3 d post NM, suggesting delayed maturation and phenotypic switching. VPA also attenuated NM-induced increases in lung iNOS+ and CCR2+ M1 macrophages, a response correlated with downregulation of NOS2, IL12B, PTGS2, MMP-9, and CCR2 expression. Conversely, numbers of CD68+, CD163+ , and ATR-1α+ M2 macrophages increased after VPA, along with the expression of IL10, ApoE, and ATR-1A. NM exposure resulted in increased HDAC activity and upregulation of HDAC2 and acetylated H3K9 in the lung. Whereas VPA blunted the effects of NM on HDAC2 expression, histone H3K9 acetylation increased. These data suggest that alterations in the balance between histone acetylases and deacetylases contribute to lung macrophage maturation and activation following NM exposure.

Fifty-nine patients who had undergone augmentation cystoplasty were studied over a period of 18 years. The indications for the operation were a tuberculous contracted bladder in 51, interstitial cystitis in 7 and carcinoma in 1. The ileum was used in one patient, the colon in 16 and the caecum in 42. The results did not seem to be influenced by the segment of bowel and the long-term results of using the colon as bladder substitute were similar to those achieved by using the caecum. An excellent result has been achieved in 78% of the 49 surviving patients. Operative mortality was 5.1% (3 patients). Contraindications include progressive severe renal failure, enuresis and a history of previous psychiatric disturbance.