Biomedical subjects
Publications and source records attributed to L Persky.
Ureteral perforation is a rate complication after reconstructive aortic surgery. We report an unusual case of ureteral injury occurring as a complication of partial excision of a pre-existing vascular prosthesis. Gross hematuria was the presenting symptom and a communication between the ureter and vascular bed was demonstrated.
The courses of 6 patients with various forms or ureteral injury and disruption herein illustrate the value and worth of percutaneous nephrostomy drainage and study. The nature and degree of injury are ascertained, and sepsis and obstruction are managed without formal anesthesia or surgical intervention, leading to ultimate repair in a planned and orderly fashion.
Since October 1978, 25 patients with metastatic carcinoma of the bladder have been treated with cis-platinum, doxorubicin hydrochloride and cyclophosphamide. Patient selection for this protocol was relatively strict and included only patients who had measurable parameters. All 3 drugs (60 mg./m.2 cis-platinum, 40 mg./m.2 doxorubicin hydrochloride and 400 mg./m.2 cyclophosphamide) were given as a single dose every 4 weeks. Over-all, 19 of the 23 evaluable patients (82 per cent) responded to therapy. There were 5 complete drug-induced remissions and 14 partial remissions. Generally, the treatment was tolerated well and common toxic effects were myelosuppression, nausea, vomiting and alopecia. One patient died of septicemia as a result of agranulocytosis. These promising results seem to indicate the high degree of effectiveness of this combination chemotherapy against transitional cell carcinoma of the bladder.
Explore the source record for details and available documents.
The radiosensitizing properties of misonidazole (Ro-07-0582; NSC-26137) were evaluated in a leg transplanted model of N-[4-(5-nitro-2-furyl)-2-thiazolyl]formamide (FANFT) induced transitional cell bladder carcinoma in C3H/He mice. Animals bearing tumor received fractionated radiation of 400 rads X 5 or 600 rads X 5. Other groups with the same radiation doses were treated with misonidazole (0.75 mg per g) before each radiation fraction. Radiation alone was effective in prolonging Mean Survival Time, 17 per cent for 400 rads X 5 and 45 per cent for 600 X 5, with an associated delay in tumor growth. Misonidazole in the 600 rads X 5 group showed a radiosensitizing effect by further slowing tumor growth and prolonging Mean Survival Time by 80 per cent over the control and 24 per cent over radiation alone. Misonidazole alone did not show notable cytotoxic effects.
Eight elderly patients with carcinoma of the bladder have been managed over the last three years with cystectomy done along with transureteroureterostomy. The decision for surgery was dictated by intractable bleeding, disabling symptoms, and extensive recurrent lesions of life-threatening degree. All of these patients were a poor risk. All successfully had cystectomy with urinary diversions achieved by transureteroureterostomies in association with a cutaneous ureterostomy. The surgery was done extraperitoneally; the patients were usually ambulated quickly, and the need for long-term nasogastric tubes was obviated. The course and clinical management of these patients are discussed and advantages and disadvantages of this form of urinary diversion presented.
Six instances of childhood vesicovaginal fistulas are reviewed. Emphasis is on avoidance of such occurrences. Management should be by careful co-optation and individual closure of layers. Success was ultimately achieved in all patients.
A case of nephrolithiasis complicated by obstruction leading to pyonephrosis, perinephric abscess, and nephrobronchial fistula is presented. The patient was treated successfully by nephrectomy and drainage of the subphrenic space and the pleural cavity. Nephrobronchial fistula, while a rare complication of perinephric abscess, should be considered when a patient presents with perirenal suppurative process and chest x-ray findings consistent with pleural effusion or pulmonary infiltrates.
Eight patients with renal or perirenal abscesses were evaluated by 67gallium scintigraphy. The correlation of localized 67gallium uptake to the inflammatory lesion was proved by tissue diagnoses in 7 patients and by response to treatment and repeated studies in the remaining case. 67Gallium scanning was found to be an accurate, non-invastive technique. It should be applied early in diagnosing inflammatory lesions of the retroperitoneum and for examining fever of unknown origin.
We compare 8 patients wth rhabdomyosarcoma of the bladder and prostate who underwent either a radical extirpative operation, chemotherapy and radiotherapy or biopsy, chemotherapy and radiotherapy. The excellent survival in the former and the uniformly fatal outcome in the latter suggest that chemotherapy and radiotherapy are not substitutes for a radical extirpative operation. Indeed, proper care of these patients includes all 3 modalities.
A murine transitional cell carcinoma tumor model has been used to evaluate the combined use of radiotherapy and three chemotherapeutic agents, doxorubicin hydrochloride (Adriamycin), cyclophosphamide, and cis-diamminedichloroplatinum. The preliminary radiation therapy evaluation demonstrated that the tumor is radiosensitive. The combined use of cyclophosphamide and radiation therapy was the most effective regimen, especially when the drug was started prior to radiotherapy. Cis-diamminedichloroplatinum and radiation were a lethal combination, but a synergistic effect was produced when the drug was given after completion of radiotherapy. Doxorubicin hydrochloride and radiotherapy may be synergistic, but more evaluation is necessary.
Explore the source record for details and available documents.
Current attitudes toward closure of vesicovaginal fistulas have engendered a period of delay of three to six months prior to surgical closure. We believe that such delay is unwarranted, and describe our experiences with the closure of these fistulas as soon as the diagnosis is made. We consider our success to be good and therefore advocate a more direct approach to these injuries.
Explore the source record for details and available documents.
Urethral trauma in childhood due to external violence other than vehicular accident is discussed. The need for careful, planned management is highlighted by a satisfactory outcome in each of 4 cases, with no incontinence and no persistent urethral stricture. Temporary suprapubic cystostomy in 2 of these children caused no difficulty in the ultimate repair and permitted a more deliberate approach to these diminutive strictures in the pediatric age group.
The need for constant vigilance in the follow-up care of patients with transitional cell carcinoma is illustrated by the case reports of 12 patients whose tumors recurred after tumor-free periods of eleven years and longer. Emphasis is placed on monitoring, which includes pyelographic study, cytologic study, and cystoscopic examinations for as long as the patient survives.
An unusual late complication of ileal conduit diversion is described. To our knowledge this is the first case reported in which a foreign body apparently migrated from an ileal conduit to the renal pelvis and served as a nidus for stone formation.
Critical analysis of ureteroileal diversion in the treatment of pelvic tumors in which prior radiation therapy was administered has prompted us to review our experience with ileal loops after patients have been irradiated. Between 1970 and 1975, 136 adults underwent ureteroileal bypass. Of these patients 36 had preoperative irradiation for various pelvic malignancies, 44 had malignancies but no irradiation and 56 were operated upon for neurogenic bladders. Major morbidity in the irradiated group included wound infections (33 per cent), ureteroileal urinary leaks (19.4 per cent) and paralytic ileus (13.9 per cent). The average postoperative hospital stay for this group was 8 to 11 days longer than that of the other 2 groups. In contrast, however, the overall incidence of reoperations for various complications in the irradiated group was only 11 per cent, compared to 25 per cent in the group not given preoperative radiation and 30.4 per cent of those operated upon for neurogenic bladders. Most significantly, none of the patients in the irradiated group required re-exploration and surgical correction of ureteroileal urinary fistulae. Comparison of these results to those reported in the literature is favorable. The ileal loop remains a simple and viable operative technique in patients requiring urinary diversion for pelvic malignancies previously irradiated.