[Clinico-practical commentary (urine collection)].
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Biomedical subjects
Publications and source records attributed to A Puigvert.
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Taking up again inquiries already known in the past, documents of pathological anatomy of his own person experience, and facts of embryology, the authors explain the etiology of the obstructive malformation of pyelo-ureteral function the etiology brings out two phenomena: --The insufficient hollowing of the cephalic end of the ureteral bud, which is initially grooved, when it detaches itself from the Wolffian canal, can transform itself into a full cellular cord which secondarily forms a groove after 23 mm stage.--The insufficient vascularization of the ureter just below the pelvis because of an abnormal anatomical disposition which causes displacement of the longitudinal uretero-pelvic arteries to a point clearly below the ureteropelvic junction. There an ischemia impedes the muscular development of the ureter just below the pelvic of which the wall becomes more sclerotic and fibrous than muscular. Thus a defect in the grooving of the ureteral bud and an arterial blood deficit results in a congenital ureteral stenosis. Pathological anatomical documents illustrate this theory from which flow two imperative technics; the necessity to eliminate the initial obstructive ureteral segment; care to protect the pelvic vessels which will have to vascularize the ureter which will be anastomosed to the cut edge of the pelvis.
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When reviewing the bibliography of this rare metastatic location of cancer of the prostate gland, we have only been able to compile the observations published by HUMPHREY (1), BROTHERUS (2) and SMITH (3) wo describe cases with the same location and characteristics. All the observations of metastasis in the epididymis of cancer of the prostate gland constitute unexpected findings during the course of surgical castration operations. The morphology is always the same, small indurated nodules respecting the rest of the epididymis. On the other hand, metastases in the epididymis of extraurinary adenocarcinomas most of which were digestive, were not discovered until the increased size and pain in the testicle attracted the patient's attention and the exploration led to the identification of the tumour in the epidiymis (2, 4, 5). However, primitive malignant tumours of the epididymis constitute an infrequent lesion. In the literature there were found to be more primitive tumours in relation to the metastatic ones and it was difficult to establish the diagnosis of a primitive tumour of the epididymis without having previously ruled out the possibility of other distant neoplasias which are sometimes even asymptomatic.
The author first recalls that the first operation to correct hydronephrosis due to ureter stenosis was performed by Trendelenburg. He then defines the causal lesion of hydronephrosis and describes its etiology. He stresses that the only procedure for correcting hydronephrosis caused by stenosis of the juxtapyelic ureter is the removal of this portion, the lesion of which it is impossible to repair or correct. He criticizes the numerous operations proposed by different authors and even the partial removal of the renal pelvis. He points out that most of the operation procedures described as new, have already been published. He finally stresses that the best operation is the removal of the stenosed ureter followed by direct pyelo-ureter anastomosis and kidney draining by means of a tutor probe placed from the pelvis to the bladder during the operation and kept in place for a few days.
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