To determine whether anglotensm-converting enzyme plays a role m the development and maintenance of normal renal architecture, the renal morphology of IO-to 12-month-old female mice homozygous for a dlsruptlon of the converting enzyme gene was compared with that of age-matched wild-type mice Tubular obstruction, dilatation, and atrophy were present m all kidneys from the homozygous mutant mice but absent m wild types, two kidneys from 4 mutant mice but none from the wild types were hydronephrotlc The entire arterial vascular tree, mlcrodlssected from mice with no converting enzyme, was grossly distorted m comparison to the vasculature of wild-type mice, all mtrarenal arterial vessels were widened and thickened, mcludmg the termmal (afferent) arterioles In wdd-type mice ludneys, rerun-posltlve cells were detected exclusively m aJuxtaglomerular locahzatlon In contrast, abnormal dlstnbutlon of remn lmmunostammg was observed m mice without converting enzyme, scattered remn-posltlve cells were seen along the artenal vessels, often m a penvascular locahzatlon, and mterstltlal remnposltlve cells surrounded glomeruh Kidney remn mRNA was increased more than 32-fold m the mutant mice compared with wild types Northern blot analysis revealed that this Increase meluded the accumulation of large amounts of smaller rerun RNA transcripts In Turnmary, mice lackmg the convertmg enzyme exhlblt abnormal renal vessels and tubules Remn synthesis 15 mcreased, accompamed by the presence of small renm mRNA species, and remn IS present mainly m mterstmal and penvascular cells We conclude that anglotensm-convertmg enzyme IS necessary to preserve normal kidney architecture and the normal pattern of renm expresslon (Hypertension. 1997;29[part 21: 216-221.) Key Words l vessels l arterioles l ludney l knockout mice l renovascular T he actlvatlon of the RAS in the developing ludneyl-3 has led to the hypothesis that its active component, Ang II, may play an important role m renal development 4 Intervention studies in which pharmacological blockers of the RAS were used to treat newborn rats have confirmed this notion 536 Both ACE mhlbitors and AT1 blockers produce similar renal abnormalities when given to newborn arnmals.5,6 The most prominent macroscopic renal pathology m these animals is atrophy of the renal medulla; microscopically, the renal tubules are atrophic and dilated, with tubulomterstltlal fibrosis.5,6 A similar pathology has been described m some human neonates after treatment of their mothers with ACE mhlbitors in late pregnancy 7While the results of pharmacological mterventions could be due to nonspeclfic effects of the drugs,8 recent gene-targeting studies m mice have underlined the essential role of the RAS for renal development Mice lackmg functional copies of either the ang1otensmogen9.10 or the ACE gene (Ace)'lJ2 develop a renal pathology sun&r to that of rats treated with RAS blockers neonatally Vascular changes were observed m both the mutant mice and m the rats treated with AT1 antagonist neonatally Thus, m the...

The records of 273 patients with germ cell tumours of the testis referred between 1970 and July 1991 were reviewed. There were 25 (9%) black, 40 (14%) mixed race and 214 (77%) white patients. Histology showed seminoma in 53% and non-seminomatous and germ cell tumours in 47% of patients. Maldescent of the testis (MDT) was found in 30 patients--an incidence of 11% overall. MDT was present in 8 of 25 (32%) black, 7 of 40 (18%) mixed race and 15 of 214 (7%) white patients with testicular cancer. The incidence of MDT was statistically significantly higher in both black and mixed race patients compared with white patients. None of the black patients had undergone orchiopexy but 71% of mixed race and 87% of white patients had done so. This resulted in a different pattern of presentation in black compared with mixed race and white patients with MDT and testicular cancer. The mean age was 40 years for black, 32 years for mixed race and 33 years for white patients. Black patients presented with abdominal or inguinal tumours rather than scrotal tumours and they had an increased tendency to present with seminomas.

In adolescent idiopathic scoliosis (AIS) there has been a shift towards increasing the number of implants and pedicle screws, which has not been proven to improve cosmetic correction. To evaluate if increasing cost of instrumentation correlates with cosmetic correction using clinical photographs. 58 Lenke 1A and B cases from a multicenter AIS database with at least 3 months follow-up of clinical photographs were used for analysis. Cosmetic parameters on PA and forward bending photographs included angular measurements of trunk shift, shoulder balance, rib hump, and ratio measurements of waist line asymmetry. Pre-op and follow-up X-rays were measured for coronal and sagittal deformity parameters. Cost density was calculated by dividing the total cost of instrumentation by the number of vertebrae being fused. Linear regression and spearman's correlation were used to correlate cost density to X-ray and photo outcomes. Three independent observers verified radiographic and cosmetic parameters for inter/interobserver variability analysis. Average pre-op Cobb angle and instrumented correction were 54° (SD 12.5) and 59% (SD 25) respectively. The average number of vertebrae fused was 10 (SD 1.9). The total cost of spinal instrumentation ranged from $6,769 to $21,274 (Mean $12,662, SD $3,858). There was a weak positive and statistically significant correlation between Cobb angle correction and cost density (r = 0.33, p = 0.01), and no correlation between Cobb angle correction of the uninstrumented lumbar spine and cost density (r = 0.15, p = 0.26). There was no significant correlation between all sagittal X-ray measurements or any of the photo parameters and cost density. There was good to excellent inter/intraobserver variability of all photographic parameters based on the intraclass correlation coefficient (ICC 0.74-0.98). Our method used to measure cosmesis had good to excellent inter/intraobserver variability, and may be an effective tool to objectively assess cosmesis from photographs. Since increasing cost density only improves mildly the Cobb angle correction of the main thoracic curve and not the correction of the uninstrumented spine or any of the cosmetic parameters, one should consider the cost of increasing implant density in Lenke 1A and B curves. In the area of rationalization of health care expenses, this study demonstrates that increasing the number of implants does not improve any relevant cosmetic or radiographic outcomes.