1922 Journal of the American Medical Association (JAMA)  
by tension from the mesocolon, we were able to demon¬ strate on the cadaver, as indicated in the accompany¬ ing illustration. Such an anatomic explanation would fit in well with the clinical phenomena, and account for the rapid onset of the albuminuria whenever the pincers obstruct the blood flow in the left renal vein, and its equally rapid subsidence when the compression is released. It would explain why not all lordotic persons are albuminurie, and why not all visceroptotic persons are
more » ... c persons are albuminurie ; for only when the angle formed by aorta and mesenteric artery is sufficiently acute, and the renal vein lies closely enough to be compressed, is there the entire mechanism that will produce a left renal stasis. The left suprarenal veins empty into the left renal vein, proximal to the point of compression, so that concurrently with renal stasis there must occur left suprarenal stasis, caused by the same factors. Just how, if at all, this suprarenal circulatory disturbance has any bearing on the well recognized blood and pulse pressure variation from normal, which occurs in this condition, constitutes an interesting problem, and merits further investiga¬ tion. CONCLUSION Orthostatic albuminuria is due to renal stasis caused by a compression of the left renal vein, in arterial pincers composed of the aorta and the mesenteric artery. These arterial pincers become operative when the aorta is projected forward by a lordosis or when the mesenteric artery is pulled to tautness by the visceroptotic tug from the mesocolon. Further study should determine whether either one of the two branches of the arterial pincers, acting independently, can sufficiently compress the vein. That is, we hope to be able to show whether the abdominal visceroptosis alone can produce the albuminuria, whether the lordosis alone can produce it, or whether both are necessary factors in the productive mechanism. The magnitude of the pulse pressure holds no rela¬ tion to the albuminuria, nor has it any influence on the elimination of water, urea or chlorids. Further investigation should throw light on what influence the circulatory disturbance of the left suprarenal gland may have on the genera! vasomotor instability in this condition. SO East Seventy-Ninth Street-1329 Madison Avenue. Plastic Operation on Nose.-O. Ivanissevich reconstructed the nostrils in a young woman by grafting a wedge from the edge of the ear on the thumb. The hand was fastened to the ear until the flap had grown to the thumb. The flap was modeled to use for the tip of the nose, and the hand was then fastened to the face until the flap had grown in place on the nose. By this intermediate-host method the deformity was corrected very successfully. The various steps of the operation are shown with the ultimate outcome in twenty-
doi:10.1001/jama.1922.02640620021010 fatcat:lqwsus35ind6zppow7ilqjnu7a