Biomedical subjects
Publications and source records attributed to M I Resnick.
Ureteral injury is a rare consequence of abdominal gunshot wounds. We recently treated 8 patients with ureteral injuries. Failure to diagnose ureteral injury at presentation led to postoperative complications, necessitating additional operative procedures in 4 patients. However, in all 8 patients renal salvage was achieved.
Twenty-three patients with advanced prostatic cancer refractory to hormonal therapy were entered into a phase II study of cytotoxic chemotherapy combined with androgen priming. Patients received vincristine 0.5 mg on day 1; fluoxymesterone 10 mg p.o. TID, days 1-5; methotrexate 4 mg/m2 p.o., days 1-7; and cyclophosphamide 500 mg/m2 I.V., day 8. Patients entered had no prior chemotherapy, most were symptomatic but ambulatory (18/23), and almost all had bone metastases (22/23). There were two stable responses and 14 progressions in 16 patients evaluable for response. Hematologic and gastrointestinal toxicities were substantial. Androgen priming was an unsatisfactory method of improving response in this trial.
Although Escherichia coli accounts for as many as 50 per cent of nosocomial urinary tract infections, the most problematic of these infections are usually caused by Klebsiella, Pseudomonas, and Proteus. Patients in whom infections with these pathogens are most likely to develop are described. Empiric antibiotic therapy is discussed as it relates to coverage of potential infecting pathogens. The development of antibiotic resistance is illustrated with specific examples from a Cleveland hospital regarding resistance of E. coli to ampicillin and of Pseudomonas to gentamicin. The importance of becoming familiar with hospital sensitivity and resistance patterns is stressed.
Urinary stone disease is a common affliction in our society and may affect 1 to 5 per cent of the population. The physician involved in caring for the stone-forming patient must have a thorough understanding of the metabolic as well as anatomic abnormalities that may lead to repeat stone formation. The authors review the common metabolic abnormalities frequently seen in the stone-forming patient and present the current medical management of these problems. Ongoing changes in the surgical approach to urinary stones are also discussed.
Indications for antibiotic prophylaxis in urologic surgery are reviewed. Selection of an appropriate antibiotic agent for treatment or prophylaxis is discussed in terms of antimicrobial spectrum, toxicities, and cost.
Iatrogenic bladder injury is a well-recognized complication of any pelvic operative procedure. When recognized and properly repaired at the time of injury, laceration of the bladder seldom leads to significant postoperative morbidity. In those rare instances in which bladder injury is unavoidable, the knowledge and application of proper surgical technique as well as appropriate intraoperative and postoperative management of the use of drains and catheters will minimize associated complications.
Transitional cell carcinoma of the prostate is an unusual finding usually associated with transitional cell carcinoma of the bladder. We recently treated two patients with transitional cell carcinoma of the prostate without evidence of bladder involvement. Their histories are reviewed and the literature pertinent to this entity is discussed.
Renal calculus surgery requires meticulous detail to ascertain the presence of residual stones. This paper summarizes past and present methods for the accurate localization of renal calculi in the surgically exposed kidney.
A mean survival of 7.6 months in 20 patients undergoing nephrostomy for relief of ureteral obstruction from advanced pelvic malignancy was not as dismal as previous reports have indicated. Patients with bilateral ureteral obstruction from direct extension of pelvic malignancy survived considerably longer and appear to be the best candidates for nephrostomy. The physician must be cautious in advising the procedure to patients with bilateral ureteral obstruction from disseminated disease originating outside the pelvis since mean survival in this group (3 patients) was less than one month. Nephrostomies were associated with a significant incidence of perinephric abscess (15 per cent) emphasizing the technical aspect of accurate placement to avoid leakage of potentially infected urine.
Maternal ultrasonography performed after twenty weeks of gestation is able accurately to identify and diagnose fetal hydronephrosis. We believe this finding should serve to alert the obstetrician as well as the pediatrician to potential complications which may arise at the time of delivery or immediately thereafter. Urologic evaluation and definitive surgical repair may then be performed when indicated.
We treated 14 patients with uric acid calculi in the renal pelvis and calices (10) or ureter (4) with constant intravenous infusion of a one-sixth molar lactate solution. Dissolution was successful in all but 2 cases. The success of therapy is believed to be related to the sustained urinary alkalization obtained with intravenous infusion compared to the intermittent alkalization that occurs when oral agents are used.
Cutaneous pancreatic fistula is a rare but potential complication of left renal surgery. Two cases form the basis of this report.
A total of 8 patients between 2 days and 2 years old underwent 13 percutaneous nephrostomies for treatment of hydronephrosis. No significant complications were encountered.
Removal of an adequate wedge of symphysis pubis provides considerably improved exposure for radical prostatectomy. It is safer to remove the symphysis subperiosteally and to transect the bone with an oscillating bone saw or osteotome. The transpubic approach to radical prostatectomy affords the urologist the advantages of 1) early direct ligation of the dorsal vein, 2) reduced incidence of injury to the external urethral sphincter and subsequent urinary incontinence owing to visualization of the urogenital diaphragm, 3) simplified urethrovesical anastomosis and 4) increased opportunity for maintenance of potency by protecting the pelvic nerve plexus as they course in the lateral vascular pedicles.
Computerized tomography without injection of contrast material was used to detect the presence of uric acid stones within the kidney in 10 patients. In contrast to the lucent appearance on conventional urography the stones are dense on computerized tomography. The technique is useful to differentiate lucent stones from renal pelvic tumors. Additionally, stone dissolution can be monitored with sequential computerized tomography studies.
Synergistic necrotizing fasciitis of the penis and scrotum was described first by Fournier and remains a rare but life-threatening disease. In Fournier's initial description the process was believed to be idiopathic. During the last 10 years we have treated 20 patients with Fournier's gangrene and a definite urologic or colorectal cause could be identified as the source of the infection in 19 (95 per cent). Despite the use of broad-spectrum antibiotics and aggressive surgical débridement the mortality rate was 45 per cent.
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