Biomedical subjects
Publications and source records attributed to S Z Freed.
A rapid and safe technique of donor nephrectomy using in-corpora perfusion is described. This technique has the advantages of minimizing the warm ischemic time, avoiding damage to the accessory renal arteries, as well as providing aortic cuffs for small pediatric donor renal arteries.
Vesicoureteral reflux after transurethral resection of bladder tumors is a significant complication (19 per cent incidence in the present series). Although most patients with such reflux suffer no apparent ill effects renal destruction occurs in some. Other implications are discussed and the obligation for recognition of the reflux when it exists is emphasized. A simple technique for routine diagnosis is suggested.
Routine use of bilateral nephrectomy in renal transplant patients has been replaced by a careful evaluation of the indications for the procedure and the increasing appreciation of the contributions of non-excretory kidneys. These contributions are identified and the indications are discussed. When bilateral nephrectomy is required the clear superiority of the bilateral simultaneous posterior approach over other techniques is documented.
A retrospective study was carried out to determine the effect of ureteral intubation during renal transplantation. We noted urinary tract infections in 76 per cent of those patients whose ureters were intubated during transplantation, as opposed to 45 per cent in those transplant recipients without ureteral stents. The incidence of recurrent urinary tract infections also increased from 18 to 34 per cent with the use of ureteral catheters. Ten separate episodes of bacteremia, indirectly related to indwelling catheters, are noted.
The controversial nature of prostatitis is compounded by questions concerning the incidence and significance of bacteria within the prostate. Criticism of bacteriologic studies of expressed prostatic secretion, ejaculate, needle biopsy, and transurethral chips led us to culture the core of enucleated prostates. Of 65 prostates, 26 (40 per cent) were positive: 15 pathogens (23 per cent) and 11 nonpathogens (17 per cent). This was correlated with preoperative urinary infections, anterior urethral infection, and postoperative infectious complications. Prostatic pathogens were usually found when the urine and anterior urethra were infected.
Three patients with urinary difficulty were cured by surgical removal of a viaginal fibromyoma. The appearance of this benign tumor on an intravenous cystogram and cystoscopy as well as the clinical response to surgical removal bears similarity to the hypertrophied prostate in men. The best surgical technique for its removal is enucleation via a vaginal incision.
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A relatively simple technique is described for removal of intra-atrial extension of renal cell carcinoma. A balloon catheter is inserted through an incision in the inferior vena cava and inflated in the atrium. Coupled with an elevation of venous pressure this procedure provides control beyond the tumor and a mechanism for withdrawal of the tumor to the abdominal venotomy for extraction. Radical nephrectomy and resection of directly invaded cava complete a definitive surgical procedure. The technique has proved satisfactory in 2 patients.
Formalin instillation into canine bladders was followed by serial radiographic and histologic evaluation. A generalized slough of epithelial tissue was seen with the deposition of an amorphous substance. Telangiectasia resulted in moderate bleeding. No ureterovesical junction obstruction was seen and reflux occurring in 60 per cent of the animals reverted to normal. Correlation with clinical experience is made.
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