[[The solution to a problem of urinary retention is sometimes closer than you think!].
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Biomedical subjects
Publications and source records attributed to L Baert.
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An easy and safe method for inserting a cystostomy catheter in patients with a contracted bladder is described. It requires only a curved benique with threaded tip and a filiform guide for bougie.
Experiences with localized antibiotic treatment of chronic bacterial prostatitis by direct injection into the caudal prostate is presented. Very high antibiotic levels are found in the prostatic fluid without correlation with the time after injection. The pain and discomfort experienced by the patients during direct injection into the prostate are minimal. Hematuria and hemospermia during some weeks are practically always present after the injection. Local necrosis was not found after several histologic and electronic microscopic studies. Results demonstrated that this method deserves its place in the treatment of the hard-core group of chronic bacterial prostatitis.
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Twenty-nine patients were treated for recurrent chronic bacterial prostatitis by an injection of 2 Gm. thiamphenicol glycinate via the perineal route directly into the prostate. Escherichia coli was identified as the pathogen responsible for this infection in 83 per cent of the cases. Using this medication locally, cure was obtained in 66 per cent of the patients. Thiamphenicol levels in prostatic fluid varied between 1 and 4,000 micrograms./ml. and were unrelated to the time after intraprostatic administration. However, in most cases they were high enough to inhibit most strains of gram-negative bacilli responsible for prostatitis. Serum levels were correlated with the time after injection and decreased over twenty-four-hour observation from 25 to 0.3 micrograms./ml. The pH of the prostatic fluid measured in 24 patients varied from 7.1 to 8.7 with a mean value of 7.9 and was markedly higher than the pH value of 6.5 reported for men without inflammatory prostatic disease. The elevated pH of prostatic fluid could explain the failure of short-term trimethoprim/sulfamethoxazole (Co-trimoxazole) treatment in our patients. The cure rate of the localized thiamphenicol treatment was higher than was reported with short- and long-term trimethoprim/sulfamethoxazole therapy. We concluded that direct injection into the prostate offers a good alternative for treatment of more resistant chronic infections of the prostate.
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The technique of microdissection and the structure of nephrons and collecting ducts from normal kidneys were studied. The structure of the assumedly normal nephrons and collecting ducts is characterized by the uniformity of the outlines of the tubules. The various parts of the tubules are distinguished by the differences in diameter and epithelial structure.
Findings on microdissection of specimens of medullary sponge kidney showed uniform enlargement of collecting tubules in part of the papillae. Nephrons were normal in fragments without calculi and infection.
A case of obstruction on a localized kidney zone is reported. Obstruction was considered a precipitating factor in the morphogenesis of diverticula on the distal tubules and the simple cyst, found exclusively in the adjacent renal parenchyma to the obstruction.
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Kidney fragments from two cases of hereditary polycystic kidney disease (adult form) at an early stage were examined by microdissection. Localized cystic cystic dilatations were found in proximal and distal tubules, loops of Henle, and collecting tubules. Entirely normal nephrons and collecting tubules were also observed. Abnormal branching of collecting tubules or the abnormal attachment of nephrons, as described in other microdissection studies, were not found. Our observations do not confirm the hypothesis that the adult form of hereditary polycystic kidney disease is the consequence of ampullary dysfunction during early development.
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A survey of the findings in 5 children with urethral obstruction due to valves is presented. The microdissection data found in the 7 kidneys of this series were compared. The microdissection findings in all 7 kidneys are mostly the same with a continuum of processes ranging from relatively mild to severe derangements. We could not find two varieties of renal change designated type II or IV by potter. The characterization of the lesions by nephron dissection always approached those of the type II (multicystic, dysplastic kidney). Renal dysplasia was associated with extrarenal malformations in 2 of our cases and we therefore believe that the significance of the dysplasia lies rather in the period of the insult during organogenesis than in the obstruction.
The simple cyst in the adult seems to be mainly an acquired disorder. Microdissection of the nephron in the adult kidney points to the presence of diverticula on the distal tubule as the starting point of the affection. A degree of obstruction in the urinary tract together with normal involutional phenomena of the basal membrane, both typical of the aging process, are believed to be precipitating factors.
Whereas the outlines of nephrons and collecting ducts in kidneys from subjects less than 20 years old age regular, the number of diverticula on the distal tubule in kidneys from adults increase with age. An embryogenic progression from diverticula to microscopic and macroscopic cysts to radiologically detectable cysts can be established from morphological anomalies found in kidneys from adults. Therefore, a diverticulum on distal and collecting tubules and collecting tubules is postulated as the precursor of a simple cyst.
On the basis of 57 cases of simple cysts of the kidney in adults, the authors describe the histological nature of their wall. They stress the extremely common presence of smooth muscle fibres, drawing no inference that they might be of calyceal origin. The congenital or acquired nature of these cysts, as well as their origin is discussed.
Five kidneys from patients suffering from ureteral obstruction were selected for the study; from each, 100 nephrons and 20 collecting ducts were studied using Darmady's microdissection technique. Whereas three kidneys showed macroscopic cysts, microscopically, all kidneys displayed dilation and diverticulation of the nephrons particularly of the loop of Henlé and of distal convoluted tubules. Some dilatation of the collecting ducts was also noticed.