Biomedical subjects
Publications and source records attributed to N Hampel.
Renal cell carcinoma commonly presents with gross hematuria. We report the first case in which the diagnosis of renal cell carcinoma was made following biopsy of an actively bleeding solitary bladder metastasis of a clear cell carcinoma of the kidney. The possible routes of metastasis of this uncommon lesion are discussed and a review of the literature is presented.
The indications for urinary diversion have changed in recent years, and it is most often required in association with radical surgery for pelvic malignancies. Many patient with lower urinary tract dysfunction can be managed satisfactorily without diversion by use of intermittent catheterization, administration of specific pharmacologic agents, and, when necessary, implantation of artificial sphincters. For patients who require urinary diversion, the ureteroileal conduit remains the standard by which other methods should be judged. If satisfactory results are to be obtained, it is clear that meticulous attention to indications, operative technique, and careful follow-up are essential. As many of these patients have other disabilities, the management of the urinary tract must be integrated with other aspects of patient care. The introduction of the colonic conduit and recently the continent types of urinary diversion represent a search for the ideal method that has yet to be achieved.
We report an unusual and late complication of ileal conduit urinary diversion. Eight years following stomal revision a fistula occurred between the ileum contained within an occult parastomal hernia and the opening of the ileal conduit.
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.
Emphysematous cystitis is a rare clinical entity. The most commonly afflicted patients are immunocompromised and have urinary retention. Most patients appear to have diabetes mellitus. Treatments consist of establishing bladder drainage and administering broad spectrum antibiotics. Successful treatment is based on early diagnosis and prompt treatment.
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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.
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.
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.
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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.
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A patency rate of more than 90 per cent was achieved after 52 vasovasostomies. Satisfactory results were shown in both internally stented and nonstented anastomoses. A higher incidence of foreign body reaction was associated with silk sutures. Sperm granulomas and reduced patency were noted when superficial sutures were used indicating that a leakproof anastomosis is essential.