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Guided by articles and case reports in New Jersey's medical journals, 19th-century practitioners managed eclampsia in accordance with evolving theories and practices. Early 20th-century advances gradually improved maternal outcomes.

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PURPOSE: Recently trained physicians are often unfamiliar with nephroptosis. Nephropexy, once a routine operation, almost disappeared from American practice more than 2 decades ago. In view of a recent revival of interest in nephroptosis and nephropexy in the American urological literature, a historical overview of nephroptosis and the evolution of surgical nephropexy is timely. MATERIALS AND METHODS: A National Library of Medicine data base (1966 to 1996) search of "nephroptosis," "nephropexy" and "Dietl's crisis" was performed. Textbooks and monographs from the last 100 years were consulted. Original clinical descriptions and surgical accounts dating back more than 130 years were traced and reviewed. RESULTS: Nephroptosis and nephropexy have been subjects of controversy since Edebohls in New York popularized nephropexy in 1893. A close association with "neurasthenia" clouded objectivity prior to 1920. Nearly 200 surgical procedures were described. Urological opinion was often sharply polarized. In the last 2 to 3 decades the subject was largely eclipsed in the United States. Recently, however, new laparoscopic surgical techniques have been applied to the treatment of symptomatic nephroptosis. CONCLUSIONS: Few diagnoses and surgical procedures have had such a contentious and colorful history. It seems likely that new criteria for diagnosis of symptomatic nephroptosis and the introduction of laparoscopic nephropexy will lead to renewed interest in the subject among generalists and specialists. Knowledge of the current literature can be enriched by an overview of the events of the last century.

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Rowntree began his career as a general practitioner in Camden in 1906. He published his first medical paper in 1908 in The Journal of the Medical Society of New Jersey and is best remembered for building the first dialysis apparatus in 1914 and introducing the intravenous pyelogram in 1923.

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Charles Braddock, MD, lived and worked in Siam from 1902 to 1906. He was recognized as an expert in the management of epidemic diseases including smallpox, bubonic plague, cholera, and malaria. At his death in 1916, Dr. Braddock was noted to have a worldwide reputation.

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As dialysis technology advanced, physicians trained in the new specialty of nephrology set up dialysis programs in hospitals throughout New Jersey. Physicians, state legislators, organizations, and patients contributed to the growth of a life-saving technology.

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Dialysis was an experimental procedure when New Jersey's earliest dialysis programs were started by physicians three decades ago. New Jersey's dialysis pioneers recall their early days in a new subspecialty. Patients were fortunate to have such programs available.

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The history of babesiosis is traced from the discovery of the parasite in 1888, to its present endemic niche. The author uncovers clinical and epidemiological features of human babesiosis in a patient hospitalized in New Jersey.

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Dual tibiofibular intramedullary rodding with autogenous bone grafting is our treatment of choice in congenital pseudarthrosis of the tibia. The method has a high incidence of primary union. The intramedullary rods control angulation and protect against refracture without hindering growth, and they permit strengthening of the union on weight-bearing. A comprehensive treatment program must address the simultaneous problems of achieving and maintaining bone and joint alignment as well as effective osteogenesis.

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Guinea pigs briefly anesthetized with Halothane were burned over 70% of their body surface area. Core temperature progressively decreased over an 8 hour period reaching its lowest level just before death. Heart rate, cardiac output, and oxygen consumption also diminished over this period. The fractional distribution of the cardiac output to the pancreas, adipose tissue, burned and unburned skin and muscles fell sharply. Actual volume flow to the heart and brain also decreased while plasma FFA concentration exhibited little change. However, hyperglycemia was noted due in part to peripheral insulin resistance. Although plasma catecholamines increased during this trauma, their effect was muted by a low plasma pH and a rising lactic acid concentration. It is postulated that the destroyed peripheral temperature receptors, hypoxic areas of the brain, decreased blood flow through high metabolic areas and low oxygen and substrate utilization in the periphery brought about the hypometabolism.

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Streptococcal infection frequently leads to proliferative glomerulonephritis, and, on rare occasions, to renal cortical necrosis. We report a case in which poststreptococcal proliferative glomerulonephritis and renal cortical necrosis occurred concomitantly.

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Hypocomplementemic proliferative glomerulonephritis occurred during diphtheroid infection of a ventricular decompression shunt for cerebrospinal fluid diversion (cerebrospinal fluid shunt) in a young man. Granular deposits of immunoglobulin M (IgM) and the third component of complement (C3) were found along the glomerular basement membrane. This report provides supportive evidence for immune complex-mediated glomerular injury due to diphtheroid infection in a cerebrospinal fluid shunt.

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Vesicoureteric reflux was found unexpectedly during routine investigations before renal transplantation in 12 patients with chronic glomerulonephritis and in one with hypertensive nephrosclerosis. They had all received long term hemodialysis treatment for nine to 106 months (mean 47 months) at the time of micturating cystourethrography (MCU). Four of the patients had previously had a normal MCU indicating that reflux developed after onset of end stage renal failure. The cause of reflux is obscure. It was not related directly to defunctioning of the urinary tract as several patients had daily urine volumes in excess of 300 ml. Infection, another potential cause, was uncommon in patients with reflux. Histology of the excised ureters showed abnormality in most cases with loss of the normal mucosal folds and submucosal cellular infiltrate and fibrosis. These changes are also unexplained. In this group of patients nephroureterectomy for reflux in anticipation of renal transplantation was associated with considerable morbidity. A minimal estimate of the incidence of reflux in chronic glomerulonephritis was 11%. We suggest that in this group and in patients with renal diseases other than chronic pyelonephritis reflux alone does not constitute sufficient indication for nephroureterectomy before transplantation to warrant the risks of major surgery.

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