Biomedical subjects
Publications and source records attributed to L Persky.
We report on 6 women with ureteral ectopia to emphasize the need for careful endoscopic examination in evaluating the entity. The clinical histories are unusual in that 1 of the 6 patients had classical symptoms of urinary incontinence. A discussion of the diagnosis and treatment of ureteral ectopia in such patients is presented.
A modern outline of the physiology of coagulation, a simple approach to the use of laboratory investigation for patients with possible clotting disorders in unexplained hematuria and several illustrative cases are presented. The diagnosis and management of localized fibrinolysis in the genitourinary tract and intravascular coagulation as possible causes of post-prostatectomy hemorrhage are discussed. A minimum of a platelet count, fibrinogen assay and, if possible, measurement of fibrinogen-related antigens should be obtained before administration of epsilon aminocaproic acid.
It has been suggested that cation exchange resins might be helpful in urinary stone prophylaxis. The effect of the cation exchange resin Dowex 50 WX8 upon calcium absorption and urinary excretion in guinea pigs was investigated. The mean fecal calcium concentration was very close in the Dowex-treated and control animals and the urinary calcium concentration was not reduced in the resin-treated animals. These findings suggest that Dowex was ineffective in binding calcium in the gastrointestinal tract.
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Renal functional abnormalities constituting the syndrome of postobstructive diuresis imply both altered tubular and glomerular membrane properties. To determine the morphologic and ultrastructural correlates of this disorder a rat model was developed and 32 postobstructed kidneys were studied by light and electron microscopy at the midpoint of diuresis and compared to 22 controls. The abnormal morphology was: dilated distal tubules and collecting ducts, isolated proximal and distal tubule cells that allowed free access of luminal contents to the basement membrane, widened terminal bars and intercellular spaces, thickening of the glomerular basement membrane and, depending upon the portion of nephron, normal or reduced adenosine triphosphatase and acid phosphatase content. In order to confirm the functional nature of the nephrons studied as well as to assess glomerular and tubular permeability, horseradish peroxidase and cytochrome c were infused. These tracers, normally permeable to the glomerular basement membrane, were found in the intercellular spaces and to a lesser extent within cell organelles in the postobstructed diuretic animals whereas controls demonstrated a retarded filtration of horseradish peroxidase, no tracer in the intercellular spaces and large amounts of tracer contained within cell organelles. Absence of enzyme activity in the medulla and reduced dark to light cell ratios in the cortical collecting ducts correlated with prior observations made by others of diminished concentration and acidification processes, respectively. An increase in adenosine triphosphatase activity and renin granules within the juxtaglomerular cells indicated increased renin activity. These observations suggest that the renal functional abnormalities of postobstructive diuresis are attributable to altered glomerular and tubular permeabilities as well as with changes in metabolic activity.
Progressive spread of necrosis in the skin and subcutaneous tissues of the scrotum is the key feature of idiopathic scrotal gangrene. The disease may present initially as an acute abdomen, but laparotomy should be avoided. Usually an anaerobic Streptococcus is found, acting in synergism with aerobic, frequently gram-negative, bacilli. As in other synergistic gangrenes, wide dibridement with drainage of all sinus tracts is required. Although the testicles are frequently bared, they are usually not necrotic and should not be amputated. Once the infection has resolved, a surprising amount of skin coverage, including coverage of the testicles, can often be obtained from the scrotal remnants.
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The preperitoneal approach to inguinal hernia repair can easily be applied at the time of open prostatectomy. Our experience with this procedure is reported, and the surgical technique is described. A preperitoneal herniorrhaphy is easy to perform through the same incision as the prostatectomy, avoids opening new surgical spaces, adds little to the operating time, and saves the patient another surgical procedure. Good results have been achieved in that we have had only 3 recurrences in 38 hernias reparied by the preperitoneal approach.
Measurements of serum beta 2 microglobulin and creatinine concentrations were determined in 18 patients with lower urinary tract obstruction. Nine patients were azotemic on admission to the hospital. In 3 of these patients who had normal pre-treatment serum levels of beta 2 microglobulin, the correction of obstruction was followed by return of normal renal function. The remaining 6 patients with elevated serum beta 2 microglobulin concentrations on hospitalization, showed no significant improvement in renal function parameters in the post-obstructive period. These data suggest that determination of serum beta 2 microglobulin concentrations is helpful in predicting the return of renal function in azotemic patients with obstructive uropathy.
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L-ascorbic acid has been shown to reduce the elevated level of urinary chemiluminescence found in patients with bladder cancer. Thus, it has been suggested that vitamin C might be efficacious in bladder tumor prophylaxis. However, there is no clinical evidence to support this thesis. We evaluated whether L-ascorbic acid given concomitantly with the urinary carcinogen FANFT was capable of reducing the incidence of subsequent bladder tumors. No inhibitory effect was observed. Unless evidence is obtained demonstrating bladder tumor prevention by L-ascorbic acid its routine administration to patients with bladder cancer is not indicated.
The failure of fluid and electrolyte conservation in post-obstructive diuresis has not been demonstrated after release of unilateral ureteral obstruction. Despite this, balance and renal function studies in patients with this disorder indicate similar renal defects. The clinical difference is caused by a markedly low glomerular filtration rate in unilateral problems that prevents the excessive losses found with total obstruction.
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Cell-mediated immunocompetence of patients seen for followup of adenocarcinoma of the prostate is evaluated using dinitrochlorobenzene as a contact sensitizing agent. The immune status is correlated with the presence or absence of metastatic disease. A highly significant correlation is found between the lack of immune response and the presence of metastatic carcinoma, suggesting that immunotherapy will be useful in the treatment of carcinoma of the prostate.
Spontaneous rupture of the kidney involves either the collecting system or parenchyma, the latter being associated with a subcapsular or perirenal hematoma. A review was made of 78 cases of spontaneous parenchymal rupture with perirenal hematoma, including 4 of our own. One of these cases is the first description of spontaneous rupture of the kidney secondary to renal vein thrombosis. The patients are usually in the fourth decade of life and present with an acute onset of flank pain, a tender mass and commonly symptoms and signs of shock. Hematuria is often present and generally urography reveals a mass, distorted collecting system and/or non-visualization of the kidney. Tumors are the most common cause followed by vascular diseases, infection, nephritis and blood dyscrasias. Nephrectomy when possible should be performed expeditiously since conservative therapy is uniformly unsuccessful.
The add-on ileal loop is a procedure designed to create sufficient ileal conduit length to allow for stomal revision or relocation. We report 3 cases in which the operation was used with satisfactory results and describe the technique. The procedure is simple to perform and has the advantage of leaving a satisfactory functioning ureteroileal anastomosis intact.