Biomedical subjects
Publications and source records attributed to H Zincke.
We report on a man with a long history of systemic lupus erythematosus, who had signs and symptoms of a dissecting aortic aneurysm 25 days after receiving a living related donor transplant. The aneurysm was repaired successfully while the patient was on immunosuppression. However, the patient died 3 weeks later of cytomegalovirus pneumonia.
We report a case of postoperative prolonged intrarenal segmental thrombosis in a transplanted kidney. Re-exploration, and immediate intrarenal arterial and continuous systemic heparinization after 5 1/2 hours of absent arterial flow resulted in a prolonged period of acute tubular necrosis, followed by return of nearly normal renal function 110 days after operation. The solitary denervated kidney seems to have the ability to recover from an excessively prolonged ischemic injury. The timely administration of drugs, such as methylprednisolone, mannitol and furosemide, in sufficient dosages may ameliorate ischemic damage. In our case early re-exploration with local and systemic heparinization salvaged the kidney.
4-Hydroxycyclophosphamide (4-HCY) is generated spontaneously in cryoprecipitated plasma from synthesized 4-hydroperoxycyclophosphamide (4-HPCY); its immunosuppressive and cytotoxic effects seem to depend on milieu, temperature, time, and dosage. Our preliminary results suggest that prolonged canine renal allograft survival can be achieved with grafts exposed to CY metabolites (4-HPCY and PM) in vitro for 24 hr. Further studies with larger dosages (greater than or equal to 100 micrograms/ml of 4-HPCY) are indicated to test these suggestions conclusively.
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Germ cell tumors that manifest as extragonadal masses in patients with testes that are normal to palpation are an unusual clinical finding. The possibility of the existence of an occult testicular primary tumor has prompted investigation of noninvasive techniques to examine the testes. The records of patients who had undergone high-resolution real-time ultrasonography of the testes were matched to those of patients who had presented with newly diagnosed germ cell tumors from January 1981 through October 1982. Six patients were identified, and their case records are reviewed. Ultrasonographic and pathologic findings are discussed. High-resolution ultrasonography seems to be an important adjuvant test in the assessment of patients with germ cell tumors who present with extragonadal disease.
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Ninety-nine patients with adenocarcinoma of the prostate and regional lymph node involvement underwent pelvic lymphadenectomy. Therapeutic results were analyzed in 70 patients who subsequently underwent radical retropubic prostatectomy with or without concomitant therapy (usually hormonal) and in 29 patients who received radiation or hormonal treatment only but without prostatectomy. Follow-up ranged from one to fourteen and one-half years. The over-all projected survival rates (Kaplan-Meier) at five and ten years (88 per cent and 71 per cent, respectively) in the prostatectomy series were comparable to those of an age-matched control group. Concomitant bilateral orchiectomy provided a high projected (76 per cent at ten years) nonprogression rate. Over-all survival rates in the nonprostatectomy series were poor. Only the number of nodes involved was associated with survival and time to disease progression. Patient age, tumor bulk, seminal vesicle involvement, and tumor grade (Mayo and Gleason scores) had no definite relationship to survival. Pelvic lymphadenectomy and radical retropubic prostatectomy for prostatic adenocarcinoma may be therapeutic in some patients with limited (less than or equal to two positive nodes) nodal disease.
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The relationship of grade and local tumor extent to pelvic nodal involvement was assessed surgically in 469 patients who underwent pelvic lymphadenectomy and radical retropubic prostatectomy for adenocarcinoma of the prostate. Grade and local stage alone and combined score were associated in a linear fashion with nodal involvement. Gleason sum and Mayo grade alone were not predictive of nodal metastases. Some patients with a Gleason score of 4 had positive nodes and some with a score of 8 to 10 had negative nodes. Mayo sum (grade plus stage) consistently was related to negative nodal involvement.
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Twenty-seven patients with synchronous (19 cases) or asynchronous (8 cases) bilateral renal cell carcinoma were treated and followed for as long as 20 years. Tumor grade and stage generally were more favorable in the former group, which is reflected in the higher surgical intervention rate. Nonsurgical treatment yielded poor results. The 5-year survival rate for patients with synchronous bilateral renal cell carcinoma (77.8 per cent) was significantly higher than that for patients with asynchronous lesions (37.5% per cent). Because of its different presentation and favorable prognosis when treated surgically synchronous bilateral renal cell cancer should be distinguished from the asynchronous form, with its dismal outcome. For the latter cases thorough long-term followup may make early surgical intervention feasible, and thus, improve patient survival.
The effect of 35 minutes of warm ischemia (37C) on renal function and adenine nucleotide content of canine kidneys preserved for 24 and 48 hours in Euro-Collins (EC) solution was investigated. In addition, the effect of donor pretreatment with intravenous mannitol, furosemide and methylprednisolone and the addition of adenosine triphosphate (ATP/MgCl2) to the EC flush and storage solution was studied. Donor pretreatment or the addition of ATP/MgCl2 to the flushing and storage solution did not significantly affect postautotransplant renal function of kidneys stored for 24 hours, although it improved tissue adenine nucleotide levels. Results after 48-hour preservation were significantly poorer. These experiments demonstrate that canine kidneys subjected to 35 minutes of warm ischemia time can be stored for 24 hours in EC solution and thereafter provide immediate life-sustaining function.
Intraoperative pyeloscopy was performed on 18 consecutive patients with indeterminate pelvic of caliceal filling defects, subsequently proved to be transitional cell carcinomas. After nephroureterectomy local tumor recurrence in the region of the renal fossa developed in 2 patients. Intraoperative pyeloscopy entails significant risks and the seeding of transitional cell carcinoma is possible.
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The extent and localization of in situ carcinoma of the urinary bladder are frequently difficult to assess. We have studied this problem by employing intravenous hematoporphyrin derivative, an endoscopic detection device, and complete pathologic bladder mapping. These preliminary investigations indicate that hematoporphyrin derivative localizes in dysplastic and neoplastic transitional cell epithelium and that these abnormal areas can be detected during a cytoscopic examination with the use of our detection device.