[Changes in views concerning the management of polycystic kidneys].
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Biomedical subjects
Publications and source records attributed to D Frang.
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Cutaneous ureterostomy with application of an introverted skin flap was performed in 9 cases over a 2-year period. The method has been developed by the authors in view of the prevalence of strictures involving the terminal ureter and the stoma after unintubated cutaneous ureterostomy in case of a normal ureteral lumen. Ureteral drainage had to be resorted to in 2 cases (necrosis of the flap in one, and allergic skin reaction in the other). The intervention was carried out with success not only when the ureteral lumen was normal, but also when it was wide, short, or relatively short.
Induced precipitation of Ca-oxalate crystals and the possibility of its prevention were studied in dogs. In the first phase of the experiments precipitation of Ca-oxalate crystals in canine renal tubules was induced by intraperitoneal administration of Na-glyoxylate. Preventive medication (lipoic acid, vitamin B1, Milurit), applied in the second phase, resulted in a significant depression of induced precipitation. The successful experiments serve as a basis for clinical research aimed at a preventive medication of recurrent Ca-oxalate stone formation.
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The authors give a summarizing report on retroperitoneal tumours and cysts. They review the origin and classification of tumours and cysts, their diagnostic and differential diagnostic possibilities as well as the therapeutic measures. Finally, their own 3 cases are reported.
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Ureterocutaneostomy by the utilization of a trigonal section (ureteral orifice) was performed in three cases, one ureter being used in two cases, and both ureters--transuretero-ureterocutaneostomy--in the third. The surgical method is described and the results are reported in detail.
The possibilities of local dissolution of uric acid calculi with Na hydrocarbonate, K carbonate and lithium carbonate were examined in vitro. The most promising results were obtained with lithium carbonate. The necessity for studies of the compound in laboratory animals before its use in humans is emphasized.
Bipedal lymphangiography was performed in 101 cases of testicular tumour for the detection of retroperitoneal lymph node deposits. The lymphangiograms of 51 patients have been checked against the results of microscopic study of lymphadenectomy specimens. The radiogram was false-positive in 3, false-negative in 7 cases. The lymphangiographic diagnosis was accurate in 81 per cent of the cases. The other diagnostic possibilities--computerized tomography, ultrasonography, isotope lymphangiography--are also discussed. The main advantage of bipedal lymphangiography is to provide information on the structures of the lymph nodes and on the lymphatic channels as well. Combination of several diagnostic methods provides for a high accuracy of staging.
In 4 years the authors performed 25 cases of 'nipple' ureterocutaneostomy elaborated by them. The essence of the operation is that by using skin grafts, the stoma emerges by 1.0 to 1.5 cm above the surface of the skin. Without ureteral drainage, their patients use disposable DANSAC ileostomic urine collecting sacs which can be attached to the skin. This method is presented in detail and the results are evaluated. In case of an adequately long and wide ureter, they consider their surgical procedure to be suitable for permanent supravesical urine excretion.
On suspicion of prostatic tumour, the authors performed a combination of transurethral resection and needle biopsy to form a safe histological diagnosis as well as to apply an adequate therapy. Transurethral resection combined with needle biopsy is to be performed if patients present with dysuric complaints, and if tumour can be suspected on rectal palpation or based on the clinical picture. This intervention ensures an unequivocal diagnosis and eliminates the urinary obstruction. They also dealt with cases, in which only needle biopsy or transurethral resection could help in forming the correct diagnosis.
The authors present four cases of unilateral kidney with a double collecting system where calculous change has occurred in the lower collecting system. In one of them, marginopolar nephrotomy, while in three, heminephrectomies in the destructed lower segment of the kidney were performed. The remaining upper part functioned perfectly later on. The avoidance of unjustified nephrectomy is stressed.
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Prevention of the formation of struvite and carbonate-apatite calculi, which rapidly increase in size and tend to recur, is of prime importance. One of the urease inhibitors, hydroxycarbamide, was studied in vitro. The results are favourable and justify further studies aimed at the local application of the inhibitor.
The use of a synthetic macromolecular hydrophilous binding material for the extraction of multiple renal calculi (" Pyeloform " pyelotomy) is reported. An account of the results of animal studies in vitro is given and the possibilities of the method in are pointed out.