Biomedical subjects
Publications and source records attributed to F A Fried.
Acute urinary retention in female patients often is attributed to psychogenic disturbances. However, it is apparent that this problem may be the harbinger of significant organic illness. Our experience with 27 patients reveals that careful evaluation and appropriate treatment prevent further urological complications and aid in the diagnosis of underlying pathological conditions.
Early diagnosis and intervention in the child with myelodysplasia can effectively improve and preserve renal function in those newborns presenting with abnormalities at birth or who are at risk for deterioration of renal function from infection, vesicoureteral reflux and/or obstruction. During a 1-year period 10 newborns with myelodysplasia were seen. Hydronephrosis was present in 6, reflux in 3 and urinary tract infection in 3. In each newborn adequate decompression of the bladder and complete resolution of the hydronephrosis were achieved. Uroradiographic evaluation was helpful in determining the best mode of therapy for each individual.
Cystic partially differentiated nephroblastoma is a rare neoplasm occurring in young children and demonstrating features of classic nephroblastoma (Wilms tumor) and multilocular cysts. Cystic partially differentiated nephroblastoma actually represents a spectrum of cystic renal tumors in which varying amounts of blastema, stroma and epithelial structures are present. Some of these lesions should, perhaps, be classified more accurately as polycystic nephroblastoma. The clinical and pathologic findings, and management of 2 infants with cystic partially differentiated nephroblastoma are presented. The controversy over the histogenesis of these lesions and whether they should be considered benign or potentially malignant is discussed.
Agenesis of the bladder is a rare anomaly involving the development of the urogenital sinus. We report on 3 patients who survived the initial perinatal period and 2 are alive for more than 4 years. Renal and genital anomalies accompany this abnormality, and recurrent urinary tract infections and incontinence are prominent. Treatment of choice is urinary diversion in the hope of stabilizing renal function and an antirefluxing procedure is deemed preferable.
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An unusual fibroblastic tumor occurred in a teenage boy following treatment with cyclophosphamide for Hodgkin's disease. To our knowledge, only one other similar case has been reported. The cellular and structural composition of the tumor resembles that of cyclophosphamide-induced cystitis and therefore suggests a relationship between the two lesions.
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Porcine kidneys containing human calculi of known size and composition were used to study the ability of ultrasound to localize intrarenal calculi. The study conducted in a blind fashion demonstrated that stones as small as 2 mm could be detected. The chemical composition was not related to the ability to detect the stone. Early trials in the operating room have been encouraging. The porcine kidney model is useful for training purposes.
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Previous experimental investigations of embryonic kidney development with in vitro organ culture techniques have been limited by the short duration of explant viability. Utilization of chick chorioallantoic membranes for transplanting undifferentiated murine kidney rudiments has allowed vascularization of the grafts with advanced maturation and the appearance of early nephron units.
Previous experimental investigations of embryonic kidney development with in vitro organ-culture techniques have been limited by the short duration of graft viability and lack of detailed anatomic development. In a modified application of the chick chorioallantoic-membrane (CAM) grafting technique, we have transplanted 11-day-old undifferentiated embryonic murine kidney rudiments and studied their differentiation and early morphogenesis. Surviving grafts, maintained for 5-10 days on the CAM, demonstrated well-developed convoluted secretory tubules and highly branched collecting ducts. Definitive glomeruli were also identified in these grafts by the presence of efferent tubules, visceral and parietal epithelium, capillary tuft, and Bowman's space. In vitro branching of the ureteric bud preceded formation of definitive tubules. Sections of the CAM grafts appeared histologically comparable to the 14-15-day in vivo embryonic metanephros. Grafts of 10-day-old rudiments showed minimal kidney development; fewer grafts survived, fewer tubules were formed, and fewer glomeruli developed. Our results indicate that the CAM is an efficient site for in vitro murine kidney development with both vascularization of the explant and extensive maturation, including the appearance of primitive nephron units.
Urological procedures pose specific medical and surgical problems in the patient with a hemorrhagic disorder. Three men, each with a different inherited deficiency involving the factor VIII molecule, underwent prostatectomy. Prolonged postoperative genitourinary hemorrhage was encountered and treated with replacement therapy and the use of inhibitors of fibrinolysis. Successful management of these patients with inherited coagulopathies depends on a thorough understanding of the hemostatic defect, adequate laboratory support and sufficient supplies of blood products.
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Specific anti-breast cancer complement dependent antibody (CDA) was sequentially determined in the sera of patients before and after mastectomy or during progressive recurrent breast cancer. Several observations were made. (1) There appears to be a different pattern of antigenic cross-reactivity detected by cancer patients' anti-tumor CDA than by their anti-tumor cell-mediated immunity; the former being broader than the latter. (2) Patients can be classified into three categories: those with persistent anti-tumor CDA pre- and post-mastectomy; those with detectable CDA post-mastectomy but not pre-mastectomy; and those with only occasionally detectable CDA. (3) Some sera obtained from patients with clinically evident tumor inhibited anti-tumor CDA found in the sera of other cancer patients. The significance of these results are discussed.
Present evidence suggests that malacoplakia is the result of a functional defect in the mononuclear cells of the lesion caused by a deficiency of cyclic 3',5' guanosine monophosphate. This defect results in the impaired ability of the macrophage to release lysosomal enzymes necessary for the digestion of phagocytized bacteria. The persistent inflammatory reaction produces the characteristic granuloma of malacoplakia. Previous laboratory studies indicate that the phagocytic defect is reversible by cholinergic agonists, which led to the use of bethanechol chloride in the treatment of patients with malacoplakia. We report on 3 patients with vesical malacoplakia who were treated successfully with bethanechol chloride.
A new embryologic classification is proposed to explain the association of unilateral renal agenesis with abnormalities of the female reproductive tract. An awareness of the syndrome of combined müllerian and mesonephric duct abnormalities may permit accurate anatomic diagnosis and spare patients needless surgical exploration.
Sera from 27 patients with renal cancer, 14 patients with transitional cell carcinoma of the bladder and 21 normal controls were tested against 2 renal cancer lines (CAKI-1 and CAKI-2) by the iodinated protein A assay. All sera tested against CAKI-2 were absorbed first with AB+ substance because CAKI-2 was found to have cell surface A antigen. Sera from 16 of 27 patients with renal cell carcinoma, 3 of 14 patients with transitional cell carcinoma of the bladder and 2 of 21 normal controls were reactive with CAKI-1. Sera from 11 of 27 patients with renal cell carcinoma, 2 of 14 patients with transitional cell carcinoma of the bladder and 3 of 21 normal controls were reactive with CAKI-2. There is a positive correlation between the number of counts obtained by the renal patients' sera tested against CAKI-1 and CAKI-2.
Although there are numerous references in the medical literature suggesting that calification associated with renal masses is indicative of malignant disease, our recent experience with four cases emphasizes that it is not possible to predict the nature of these lesions. The significance and etiology of renal calcification are discussed as well as the indications for clinical evaluation.