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The renal failure in the hepatorenal syndrome is unusual because the kidneys are histologically normal and the renal failure may be "functional." Hemodynamic studies indicate that increased renal vascular resistance and decreased renal blood flow may be the primary abnormalities leading to renal failure in some cases. This report describes a patient whose renal failure resolved after placement of a peritoneovenous shunt. A major advantage of this device is that it can be inserted with the patient under local anesthesia with minimal surgical risk. Further studies are needed to define the role of the peritoneovenous shunt in the hepatorenal syndrome.

We report three unrelated outbreaks of acute pulmonary histoplasmosis associated with cutting and gathering firewood in Minnesota. Clinical symptoms and laboratory findings from nine patients are reported. All recovered without treatment. This report emphasizes that physicians must consider cutting and gathering wood, especially decayed wood, as a potential risk for acute pulmonary histoplasmosis even in areas of the country where histoplasmosis is not considered prevalent.