Circumcision in infancy.
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Biomedical subjects
Publications and source records attributed to M L Dresner.
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OBJECTIVE: To assess the reliability, safety and patient satisfaction of transcutaneous Biopty (Bard Urological, Covington, GA, USA) gun testis biopsies. PATIENTS AND METHODS: Nineteen young men who were referred for evaluation of azoospermia were included in the study. The procedure was performed in an outpatient setting, under local anaesthesia and without sedation. Two passes of the Biopty gun spring-loaded needle were performed unilaterally in each patient. RESULTS: An average of 38.9 seminiferous tubules were evaluable per patient. The procedure was extremely well-tolerated by all patients and most felt that the procedure was no more distressing than simple phlebotomy. CONCLUSION: Transcutaneous testis needle biopsy performed with the Biopty gun is safe, rapid and cost-effective. This technique may represent a viable alternative to the open method of testis biopsy.
Sixty-nine men underwent transrectal ultrasound-directed biopsy of the prostate. One biopsy core from each side of each gland was sent for DNA flow cytometric testing (138 total specimens). Results were correlated with findings from standard hematoxylin and eosin staining of other cores. Twelve patients (17.4%) had biopsies with histopathologic evidence of prostatic carcinoma. Of 57 patients (82.6%) with benign biopsies, two had stage A prostate adenocarcinoma noted on subsequent transurethral resection. Proliferative activity was calculated from DNA histograms by adding the percentage of nuclei in the proliferative (S and G2/M) phases of the cell-division cycle. Mean proliferative activity for the malignant group (19.08) was significantly higher (p < 0.001) than that of the benign group (13.43). Inflammation was associated with elevated proliferative activity scores among benign glands. Proliferative activity is an objective, easily obtainable indicator of the biological activity of a population of cells which, when elevated, may suggest a need for repeat biopsy in patients with otherwise normal prostate biopsies. Flow cytometry may have value as a complement to standard histologic analysis of transrectal core biopsies in the diagnosis of prostate cancer.
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We report a case of an extragonadal yolk sac tumor in a superior scrotal mass. Testicular ultrasonography was normal preoperatively and after chemotherapy. Serum alpha-fetoprotein was initially increased to 344.55 ng./ml. (normal 0 to 15) but it returned to normal after surgery and chemotherapy.
We report a case of a 5.8 cm. right renal artery aneurysm diagnosed intact 8 weeks post partum. Rupture of a renal arterial aneurysm during pregnancy is a rare but well described catastrophic event. There are no previous reports of an intact renal artery aneurysm diagnosed either ante partum or post partum. To our knowledge, this also represents the largest reported renal artery aneurysm. The aneurysm was repaired successfully with kidney salvage and closure of the fistulous connection to the renal vein.
Gonadoblastoma, a rare gonadal neoplasm, presents most frequently in phenotypic female or phenotypically male patients with dysgenetic gonads or undescended testes. To date, only 2 cases of gonadoblastoma have been reported in anatomically normal male patients with scrotal testes. Both of these patients presented with testicular masses and germ cell tumors. We report a case of a genotypically and phenotypically normal, fertile man with descended testes who on evaluation for chronic orchialgia had a gonadoblastoma unaccompanied by a germ cell neoplasm. The tumor was nonpalpable and was initially discovered on scrotal ultrasound.
Cystine renal calculi are fragmented using a unique combination of ultrasonic and electrohydraulic lithotripsy. This endourologic application of a mining principle can be used to fragment any hard urinary stones.
A 71-year-old white man with asymptomatic microscopic hematuria had a sessile tumor at the dome of the bladder containing benign prostatic glandular tissue. Benign prostatic polyps occur commonly in the prostatic urethra and bladder neck as vestigial remains of embryonic prostatic elements. Ectopic prostatic tissue elsewhere is rare and has not been described previously arising at the bladder dome. The origin of prostate glands in this unlikely location is unclear. The clinical course of ectopic prostatic polyps at any location is benign, although local recurrence has been reported.
To evaluate the efficacy of topical cocaine combined with lidocaine as a urethral anesthetic, a double-blind, randomized, prospective study was performed comparing lidocaine combined with cocaine or placebo in male outpatient cystoscopy. Evaluations were based on a scale of 1 to 10, with 1 representing no discomfort and 10 extreme discomfort as judged by the patient, and 1 representing the best tolerance and 10 extreme intolerance as judged by the physician. Patients who received lidocaine plus cocaine reported a mean score of 3.33 for over-all discomfort of cystoscopy. This was not significantly different than for lidocaine alone. This finding indicates a lack of a summation effect in combining topical anesthetics. Patients undergoing repeat examinations were no more comfortable than those undergoing initial cystoscopy but older patients tolerated the procedure significantly better than younger patients.
We report the third case of a vaginal contraceptive suppository that was inserted accidentally per urethral causing severe chemical cystitis.
An episode of unilateral ureteral obstruction secondary to sarcoidosis is described. Corticosteroid treatment resulted in prompt and complete resolution of the obstruction and associated lymphadenopathy. We believe this represents the first reported case of ureteral obstruction secondary to sarcoidosis.
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Benign testis tumors are reported to be extraordinarily rare. Recent clinical experience has shown a high prevalence (7 of 12 patients) of these tumors, which, although small, is much higher than other reports. We herein present 4 illustrative cases and a practical categorization of the varied pathologic events causing these tumors.
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