After years of decline to near disappearance, there recently has been an increasing incidence of syphilis in America. New cases of tertiary neurosyphilis are being reported which often have ...associated significant urologic sequelae. For the first time in the English literature, the uro-dynamic findings of a patient with tabes dorsalis are presented. Our findings indicate that treatment of urinary retention associated with tabes dorsalis is better managed by intermittent catheterization than by prostate surgery because of the impaired detrusor activity. A review of neurosyphilis and its urologic implications and urodynamic findings are presented. Prompt recognition of this entity should encourage a full urodynamic evaluation prior to a commitment to prostatic surgery.
From May 1977 to June 1983, 198 patients were accepted as candidates for renal transplantation at our university. We review our experience with 14 consecutive patients who underwent selective ...pre-transplant nephrectomy during this interval. Indications for this procedure included recurrent or chronic pyelonephritis, structural abnormalities of the urinary tract predisposing the patient to infection, malignant or renin-dependent hypertension, Goodpasture's disease, certain cases of rapidly progressive glomerulonephritis and selected patients with polycystic kidneys. All patients underwent dialysis 1 day preoperatively. Perioperative fluid losses were measured carefully with prompt and vigorous replacement therapy. Patients received an average of 5,890 cc fluid replacement before postoperative dialysis. All patients underwent dialysis within 29 hours postoperatively. There were no postoperative deaths and 8 complications. Selective pre-transplant nephrectomy has spared 93 per cent of potential renal transplant candidates from a major surgical procedure. No patient has required removal of the original kidneys during the post-transplant period. Our experience has shown that the reluctance to hydrate these patients is unwarranted and that prompt postoperative dialysis, if required, is safe. Since some end stage kidneys are physiologically active and the associated surgical risk is high, pre-transplant nephrectomy should be performed only in carefully selected patients. In contrast to previous reports, which advocated minimal fluid administration and delayed postoperative dialysis, our recent experience indicates that vigorous fluid replacement therapy, carefully monitored with serial vital signs, weights, serum electrolytes and central venous pressure readings, will avert many of the complications encountered previously.
Blood group antigens are a group of carbohydrate structures bound to membrane lipids or proteins of erythrocytes and certain epithelial tissues including urothelium. The Lewis antigens are structures ...that are genetically and biochemically related to the ABO blood group. The ABO and Lewis blood group systems are differentially expressed in the normal urothelium of "secretors" versus "nonsector" individuals. The normal urothelium of "secretors" is rich ABH, Leb, and Ley antigens while the urothelium of "nonsecretors" does not express these antigens. Therefore, deletion of ABH antigens, commonly noted in TCC, can only be reliably ascertained in "secretor" individuals. Neoexpression of the Lewis X antigen (which is absent in normal urothelium) is noted in over 85% of TCC regardless of tumor stage and grade. Immunocytological detection of the Lewis X antigen on exfoliated bladder epithelial cells enhances the detection of urothelial tumor cells, particularly from low grade and low stage neoplasms.
Fifty adult rats were subjected to unilateral testicular biopsy removing either 0.01, 0.1, 0.2 or 0.3 cc of testicular parenchyma. In addition, 20 rats underwent either hemicastration or sham ...surgery. After a 30-day recovery period each male was housed with two cycling females for 20 days. At the end of this breeding trial the percentage of fertile males, percentage of pregnant females and resulting embryo scores (no. of embryos X size of embryos) were determined for each group of male rats. After an additional 30 days (60 days post-biopsy) a second breeding trial was performed so as to note any long-term changes in fertility. In addition to the fertility parameters, mean seminiferous tubule diameters and serum testosterone levels were noted. After the first breeding trial the percentage of fertile males and percentage of pregnant females were inversely proportional to the amount of biopsy material removed (p less than 0.05). However, the hemicastrate and sham-operated groups did not differ from the O cc control animals. The results of the second breeding trial showed a significant improvement in the percentage of females becoming pregnant (p less than 0.05) and a tendency for improvement in the percentage of fertile males when compared to data of the first breeding trial. In addition, we found the mean seminiferous tubular diameter of the biopsied testes to be inversely proportional to the size of the biopsy (p less than 0.01) with no apparent effect on the contralateral testes. We conclude that removing relatively large amounts of testicular parenchyma during unilateral testicular biopsy transiently affects male reproductive capacity, at least in the healthy animal model studied here.
Octoson imaging in pediatric urology Sheinfeld, J; Valvo, J R; Wood, B P ...
Urology (Ridgewood, N.J.),
09/1987, Letnik:
30, Številka:
3
Journal Article
Recenzirano
Ultrasonic imaging of infants and children using an automated transducer water-path delay scanning system (Octoson) overcomes many of the technical difficulties of contact B mode ultrasound imaging ...and computed tomography. These disadvantages relate to small patient size, motion artifacts, hypothermia, and lack of patient cooperation. Sedation may be required for either conventional study. The automated water-path system is soothing to small children, maintains the body temperature of infants, and avoids direct transducer contact. Sedation is not necessary. Excellent resolution, shorter scan time than computed tomography, and greater flexibility of patient and transducer positioning allows much more complete imaging information. In addition, the panoramic view obtained using this modality serves to demonstrate the complete lesion and its relationship to surrounding structures.
Renal vein thrombosis is a rare entity whose true incidence is unknown. The disease occurs most frequently in patients with the nephrotic syndrome but it also can occur in the presence of other ...hypercoagulable states. Previous modes of therapy have been limited to systemic anticoagulation or surgery. We report a case of successful dissolution of acute renal vein thrombosis using direct fibrinolytic therapy, which was documented radiographically during treatment and at 3-month followup.
Bladder cancer ranks as the third most common malignancy among men and tenth among women. Superficial transitional cell carcinomas (stage Ta, Tis, and T1) account for approximately 70-80% of these ...tumors, while the remaining 20-30% are invasive (T2, T3, and T4). Approximately 70% of superficial tumors will have one or more recurrences, with 25% of these expressing a higher histologic grade and 10-15% subsequently developing invasive and/or metastatic disease. The detection and prediction of tumor recurrence and/or tumor progression is crucially important if timely and appropriate therapy is to be instituted. Conventional histopathologic evaluation usually provides definitive diagnosis upon which therapeutic planning is based. However, at present there are no more reliable morphologic indicator to identify which individuals will have recurrent disease or who will progress to invasive and/or metastatic cancer. Recent advances in tumor biology have identified markers that are good candidates for clinical applications in early tumor detection, as well as for the stratification of patients with like-appearing morphological lesions with different biological and clinical behavior. The ultimate goal is to develop predictive assays that would segregate patients with high probability of failures versus patients who would be cured by localized modes of therapy.
