[Total prostatectomy in prostatic cancer].
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Biomedical subjects
Publications and source records attributed to A Fryjordet.
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Twenty-nine consecutive patients hospitalized for chronic prostatitis were examined. The HLA and radiographic findings are presented in detail elsewhere. Serum immunoglobulin levels were normal. The concentrations of IgG, IgA and IgM in prostatic fluid were significantly lower than in serum, both absolutely and as percentages of total protein concentration. Distinct bands were seen in the gamma region of agarose gel electrophoresis from prostatic fluids both in patients and in controls, and other tests also indicated that they did not reflect oligoclonal Ig responses. Growth of Chlamydia or Mycoplasma species was not detected in any of the biopsy specimens. We conclude that, with the test panel used, we have not been able to confirm that immunological factors or the presence of Chlamydia or Mycoplasma species is important in chronic prostatitis.
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Fifteen patients with urinary retention following rectal resection were examined urodynamically, including cystometry and simultaneous measurement of flow and pressure in the bladder and in the abdomen. Five patients suffered from bladder neck obstruction. This was in most cases put down to a preexisting prostatic enlargement. In 4 patients it was impossible to detect any function of the bladder muscle. Detrusor insufficiency was the cause of retention in the remaining 6 patients.
In a retrospective study the postoperative weight of one hundred prostatic adenomas was compared with the preoperative estimated size, based on rectal digital palpation. As a basis for the choice between transurethral and transvesical resection the adenomas were classified by digital palpation in three weight groups: less than 20 g. 20--40 g and more than 40 g. The objective was to avoid transvesical resection in small adenomas and transurethral resection in large ones, weighing more than 40 g. No adenomas weighing less than 20 g were removed transvesically. About one fourth of the adenomas removed transurethrally weighed more than 40 g. Forty-five per cent of the adenomas were placed erroneously into the 20 g group. Rectal digital palpation is a very unreliable method of assessing prostatic size, however, very small adenomas can be identified. Urethrocystoscopy can be of aid in identifying the very large ones.
Evaluation for hypertension revealed a hypernephroma in two patients and increased plasma renin concentrations (PRC) of 2.8 and 3.1 GU . 10(-4)/ml, respectively. In one of the patients, bilateral renal venous catheterization showed lateralization of PRC toward the tumor side in the ratio 10:3. She had secondary hyperaldosteronism with a plasma aldosterone concentration (PAC) of 738 pmol/l, and hypokalemia with a serum potassium level of 3.0 mmol/l. In the other patient, who had malignant hypertension, PAC was not measured but serum potassium was subnormal (3.3 mmol/l). After nephrectomy, blood pressure (BP), PRC and serum potassium returned to normal in both as did PAC in one of the patients. At regular follow-ups through one year after nephrectomy, BP, PRC, PAC and serum potassium remained normal and metastases were not discovered. The increased incidence of hypernephroma in hypertensive patients underscores the importance of acknowledging this possibility during evaluation for hypertension.
Lymphography was performed in 41 patients with bladder carcinoma. The lymphographic findings were correlated to the clinical and histological staging and the pre-operative grading. Twenty-seven patients were operated upon. The findings of lymphography were compared with the findings at operation, and the pathological examination of the removed lymph nodes. The lymphographic diagnosis was proved to be correct in 77.7% of the patients. There were two false positive lymphographies, and one false negative. Lymphography in groups T3 or T4 yielded a high diagnostic accuracy.
In a 50-year-old man (case 1) and a 17-year-old girl (case 2) stones developed in a functioning renal transplant. The respective intervals from transplantation to appearance of stone were seven years and six months. The serum calcium was elevated to approximately 3.00 mmol/l in case 1 and 2.65 mmol/l in case 2. The concentration of parathyroid hormone in serum was increased in case 1. Subtotal parathyroidectomy was performed in both patients, with removal of 2550 mg (case 1) and 150-160 mg (case 2) parathyroid tissue. In case 2 slight hypercalcaemia reappeared two months later. When stones in a transplanted kidney are associated with only slight hypercalcaemia and there is no deterioration of the renal function, conservative measures to reduce the serum calcium should be tried before subtotal parathyroidectomy is undertaken.
Two (7%) out of 29 patients with chronic prostatis were HLA B27 positive. They had roentgenological normal sacro-iliac joints. Two (7%) had sacro-iliitis as judged by radiological examination; one of them had never experienced low back pain. No patient had arthropathy in peripheral joints, ulcerative colitis, Crohn's disease, psoriasis or anterior uveitis. It was concluded that ankylosing spondylitis is rare in patients treated for chronic prostatitis.
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