Biomedical subjects
Publications and source records attributed to A Tasca.
We report on a patient who developed a urethrogluteal fistula 11 years following cystectomy performed for carcinoma of the bladder. The diagnosis was established by retrograde urethrography and fistulography. To the best of our knowledge, no previous case has been reported in the literature.
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A consecutive series of 29 patients (33 pelviureteric units) with urographic signs of altered passage through the pelviureteric junction underwent diuresis renography performed by means of an intravenous injection of 99mTc-diethylenetriamine pentaacetic acid/kg body weight followed by intravenous administration of frusemide. Anderson-Hynes pyeloplasty was performed in 19 pelviureteric units with a modest or almost absent fall in the renographic curve after diuretic injection; 2 other symptomatic patients, in whom a moderate fall of the same curve was found also underwent surgery. Complete normalization of the renogram was observed in 17 of 21 operated patients. Severe functional deficit and polymegacalicosis were evident in 3 and 1 patient, respectively, with unchanged postoperative renograms. During follow-up (6 months to 2 years) diuresis renography remained unaltered in non-operated units. Our experience indicates how the diuresis renogram not only gives functional confirmation of a pelviureteric junction obstruction, but is also helpful in resolving situations in which there is a discrepancy between symptoms and urographic signs. Furthermore it provides an accurate method for evaluating the results of pyeloplasty. However, the use of this investigation is not, in our opinion, indicated in the presence of severe functional deficit of the kidney or pyelectasis.
The authors report their first experience with two techniques for preoperative localization of hyperfunctioning parathyroid glands: double-tracer (99mTc-201Tl) scintigraphy and venous sampling from thyroid veins. Nineteen patients affected by primary hyperparathyroidism were examined by both methods and subsequently submitted to surgery. Scintigraphy showed a sensitivity of 77.3% while the positivity of sampling was 63.6%; with the two techniques combined a correct localization was obtained in 90.9% of all cases. The authors emphasize the usefulness of both methods combined for locating enlarged hyperfunctioning parathyroids.
16 patients with calcic nephrolithiasis and renal failure were admitted to our institute and underwent surgery. 4 patients had bilateral nephrolithiasis and 12 cases had relapsed. Selective nephrotomy was performed in all cases, pyelotomy was done in 8 and partial nephrectomy in 2 patients. In 8 patients renal function improved but no difference was observed in 6 patients. Renal function worsened in 2 patients who had shown significant preoperative proteinuria. According to our experience, the success of this therapy depends on: (1) accurate patient selection; (2) adequate preoperative treatment, and (3) personalization of surgical management.
We report 5 years' experience with low-dose hydrochlorothiazide, 50 mg/day and amiloride, 5 mg/day, in 519 patients with recurrent calcium nephrolithiasis. Additional treatment with allopurinol, 100 mg/day was prescribed for approximately 50 percent of the patients. All patients had active stone formation, having 3,464 stones in 3,126 patient-years (6.67 stones per patient, 1.10 stones per year). Hypercalciuria was present in 65 percent of the patients and hyperuricosuria in 24 percent. The administration of low-dose hydrochlorothiazide was effective in reducing urinary calcium excretion in most patients. It is possible that the hypocalciuric effect of hydrochlorothiazide were enhanced by amiloride, an agent which has been shown to cause hypocalciuria when given alone. Significant side effects requiring discontinuation of the drug were observed in only 5 percent of the patients. During 872.8 patient-years of treatment, only 53 new stones were formed (0.10 stones per patient, 0.06 stones per year) in contrast with the 916 predicted ones. The difference (chi-square) is statistically significant (p less than 0.001). These results show that the administration of low-dose hydrochlorothiazide and amiloride, either alone or in association with allopurinol, is clinically effective in reducing the rate of recurrence of calcium nephrolithiasis.
7 children, 20 months to 11 years old, with cystinuria and renal calculi were studied. Surgical treatment and alpha-mercaptopropionylglycine (MPG) gave satisfactory results in 5 children. The causes of the recurrences in the other 2 children are discussed. MPG therapy is effective but can cause a nephrotic syndrome at a dose of more than 50 mg/kg/day. A cystinuria of less than 200 mg/day cannot always be considered safe in children. The alkalinization and dilution of urine remain extremely important in the treatment of cystinuria.
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alpha-[Bis-(2-chloroethyl)]aminomethyleneketones were prepared starting from alpha-hydroxymethyleneketones and N-(2-chloroethyl)-2-chloroethanamine. Also 3-[2-(2-chloroethylthio)ethyl]aminomethylene-2-bornanone was synthesized from 2-(2-chloroethylthio)ethanamine and 3-hydroxymethylene-2-bornanone. This compound and 3-[bis-(2-chloroethyl]aminoemthylene-2-norbornanone were active against P388 lymphocytic leukemia in mice.
The authors present their experience in replacement of the ureter by a tapered ileal loop over a 24-month period, in a group of 10 dogs. With regard to the morphological and functional behaviour of the neo-ureter, the results on the whole were considered satisfactory. However, some problems such as pyelonephritis, associated with obstruction due to mucosal hyperexcretion, remain unsolved at the present time.
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