Biomedical subjects
Publications and source records attributed to D Frang.
The technique of TUR with continuous irrigation and suction is evaluated in the light of two years' experience. The advantages and shortcomings of the procedure are summed up and compared with those of traditional TUR. Its superiority to the last-named method is emphasized, and the pitfalls are pointed out.
The surgical therapy of vesicovaginal fistulae is discussed on the basis of a surgical material of 15 patients treated over a period of 5 years. The combined, transvesical-vaginal approach was used in 5, the transvesical approach in 3, and the vaginal approach in 3 cases. Ureterosigmoidostomy was performed in 1 case. Spontaneous healing of the fistula ensued in 3 cases. The types of surgery employed are commented upon.
Isolated retroaortal left renal vein was observed on clinical material during operations. Out of 28 cases it could be seen twice. This developmental variation demands attention with regard to operative technique.
The experiences gained in the treatment of four patients with cystic pyeloureteritis are reported, stressing the significance of chronic inflammation in the development of the disease. Diagnostic and differential diagnostic problems are discussed with the conclusion that definitive recovery can be achieved only by radical surgical intervention. Beside this radical solution, the indications of conservative or palliative surgery are discussed. In conservative drug treatment the aimed application of antibiotics and administration of cortisone and vitamins are of great importance.
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The factors underlying the formation of Ca-phosphate and struvite calculi, as well as the present possibilities for oral and local therapy, their advantages and drawbacks are discussed in the light of published evidence. In this context a clinical case of multiple injuries is reported in which practically complete chemolitholysis has been achieved by combined oral and local therapy. The rapid growth of the calculi and their alarming tendency to recurrence in case of inadequate treatment is emphasized. The therapeutic method used in this case is regarded as suitable for practical purposes.
A review of 910 cases is presented, with regard to the late consequences of pyelonephritis in pregnancy affecting both the mother and the child. Late recurrences of pyelonephritis in the mother and pyelonephritis in the child have been likewise registered. According to statistical figures, pyelonephritis in pregnancy greatly increases the hazard of calculus formation. The necessity for a long-term follow-up of mother and child after pyelonephritis in pregnancy is stressed. The significance of the measures to be taken in case of asymptomatic bacteriuria is pointed out.
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The authors describe the method of percutaneously removing renal calculi. The application of the percutaneous method was made possible in their case by the fact that, following pyelotomy, a nephrostomy had been previously inserted into the system of renal cavities of the right side in a polytraumatized patient. Two recidive calculi formed in the immobilized patient; after the patient's mobilization the authors removed these through the opening of the drain with lithotomy forceps and with the help of an image intensifier.
Radio-iron kinetic tests were performed in 7 patients with end-stage renal disease treated by hemodialysis; the study could be completed in 6 patients. The incorporation of radio-iron into the erythrocytes was 21% on average in patients with acute anemia. The red cell life-span determined in 4 patients became significantly shorter in 3 patients. Iron turnover in the bone marrow was significantly lower than normal, the rate of ineffective erythropoiesis being higher. Serum ferritin levels were significantly higher, and tissue and extravascular iron turnover was found to be enhanced compared to normal. At the same time, serum iron level was normal. The data on iron turnover indicated deficient hemopoiesis in the bone marrow, due partly to the lack of erythropoietin and partly to the insufficiency of the BFU-E (burst forming units) and CFU-E (colony-forming units) reserves. Undoubtedly, this was a consequence of the uremia.
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The factors of infective calculus formation and the conditions favoring their prevention were studied by examining in vitro the role of the most common representative of urease-producing bacteria, Proteus mirabilis. The stream of Proteus-containing urine was found to form deposits of magnesium ammonium phosphate, carbonate apatite and ammonium-urate on the glass surfaces. Application either of mandelic acid or of Gentamycin was found to reduce the production of these deposits, and their joint application proved fully preventive to their formation. Gentamycin applied in saline acidified with mandelic acid was capable of dissolving previously formed crystals. A medication of this composition is advocated for preventive use after surgery for staghorn calculi. The necessity for continuing peroral medication and specific antibacterial therapy for months is emphasized.
The experience gained in the course of 127 transurethral resections of bladder tumours are described. After discussing the indications and the technique the authors present their own results. The advantages of transurethral resection are emphasized: reduced operational stress, early mobilization, quick removal of the catheter, few postoperative complications, low cost of nursing. Therefore the operation is given preference mainly in the treatment of elderly patients with bladder tumour.
Even today the majority of authors stress the need for maximum conservatism in the treatment of polycystic kidneys. Since 1979 the therapeutic principles have been modified in agreement with the suggestions of Pytel. It is claimed that the polycystic lesion of kidneys causes--according to the Goldblatt-effect--hypertension due to the compression of the renal arteries by the cysts. Extirpation of the cysts reduces the compression of the vessels, thus reduction of the high blood pressure and of the pressure atrophy of the parenchyma can be expected. The first results (12 patients) have been promising. The operational method described is believed to be one of the possibilities of treating polycystic kidneys.
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