Biomedical subjects
Publications and source records attributed to W Oosterlinck.
The authors describe the physiology of wound-healing and the factors influencing wound-healing that may play a role in urethral surgery. They present the specific characteristics of wound-healing in each treatment for urethral strictures. This knowledge can help to choose the right treatment for each type of urethral stricture.
End-to-end anastomosis is perhaps the most physiological method to cure a stricture of the urethra, provided it is short and the rest of urethra is elastic enough to overbridge the gap without tension. A success rate of more than 90% can be expected in these circumstances.
Calcium chelating agents, such as ethylenediaminetetraacetate are toxic to urothelium. Their capacity to form complexes with calcium ions, which is the basis for their chemolytical effectiveness, also determines their toxicity. A decrease of chemolytical effectiveness by prior saturation of the chelator with Ca2+ or by lowering the pH to levels unfavourable for calcium binding significantly diminishes tissue injury. Exchange of Mg2+ ions does not, however, diminish tissue damage. The clinical use of calcium ligands is therefore unsafe.
A rat model was developed to test the watertightness of sutures. In this model it was proved that welding by use of low-voltage coagulation current did not improve on the watertightness obtained with conventional skin suturing. The mean leak pressure after welding was about 4.2 cm H2O, i.e. statistically significantly lower than the mean leak pressure of the conventional suture, which is 14.1 cm H2O. Neither addition of protein solder nor an additional conventional suture improved these results. It is therefore concluded that low-voltage coagulation is unsuitable for welding tissues.
The anthracycline derivatives Adriamycin and 4-epirubicin are used to prevent recurrent tumors after transurethral resection of superficial bladder tumors. Both drugs are instilled intravesically. The present report describes the results of two multicenter, prospective, randomized phase III studies carried out by the EORTC GU Group. In protocol 30,790, after a mean follow-up period of 26.6 months, the recurrence rate for 165 patients treated with Adriamycin was 0.29 and the tumor rate was 0.74. For 156 patients treated with Epodyl, the recurrence rate was 0.29 and the tumor rate was 0.57. This difference was not statistically significant. For 70 patients who received transurethral resection alone, the recurrence rate was 0.65 and the tumor rate, 2.04. In protocol 30,763, patients with good prognostic factors were treated with one single instillation of 4-epirubicin versus sterile water. After a mean follow-up period of 16 months, in 190 patients treated with 4-epirubicin the recurrence rate was 0.20 and the tumor rate was 0.35; in 196 patients treated with sterile water, the recurrence rate was 0.37 and the tumor rate was 0.65 (P = 0.0001). Adriamycin and 4-epirubicin were efficacious, and severe side effects were not encountered. The superiority of Adriamycin over Epodyl could not be proven.
A total of 356 patients with recurrent superficial transitional cell carcinoma of the bladder was entered in a randomized clinical trial to compare intravesical thiotepa, doxorubicin and cisplatin with respect to the recurrence rate and disease-free interval. After complete transurethral resection of all visible lesions, the drugs were administered weekly for 4 weeks and monthly for 11 months. The recurrence rates per year were 0.50 for thiotepa, 0.54 for doxorubicin and 0.58 for cisplatin. Of 266 patients (mean followup 41 months) 35 reported an increase in T category and 19 of them had distant metastases. No association between treatment and progression was noted. Thus, there is no difference among treatments with respect to efficacy. However, severe anaphylactic reactions were observed in the cisplatin arm and chemical cystitis was more frequently reported in patients who received doxorubicin.
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The toxicity to the urothelium of bipotassium ethylene-diaminetetraacetic acid (K2-EDTA) buffered with 0.2 M triethanolamine (TEA) at pH 8 and 8.5 was tested in rats and dogs. Even at a low concentration of 3.125 mM, K2-EDTA is very noxious to the bladder mucosa. This toxicity is not due to the buffer TEA, which is well tolerated. Although buffered K2-EDTA, at pH 8.5 is an excellent chemolytic agent for calcium-containing stones, its clinical use is limited by this toxicity.
Solutions, based on calcium chelating agents, with excellent prospects as litholytic agents in vitro were tested on toxicity to the mucosa of the bladder of the rat. The following compounds were tested at a concentration of 12.5 mM., buffered with triethanolamine 0.2 M at pH 8 and 8.5: ethylenediaminetetra acetic acid with as cation H2+, Li+, Na+, K+, and Cs+, trans-cyclohexane-1.2 diaminetetra acetic acid (cations H+, Na+, K+), diethylenetriamine penta acetate (cations H+, Na+, K+), disodiumethyleneglycol-bis (2 aminoethyl) tetra acetic acid and disodium hydroxyethylethylenediamine tetra acetate. All agents were found to be very noxious to the bladder mucosa of the rat and are unlikely to be safe for clinical use.
An immunocytochemical and cytophotometrical analysis of 30 renal cell carcinomas was carried out in order to investigate the expression of cytokeratin and vimentin in relation to the ploidy and mitotic index. Thirty renal cell carcinomas were studied using monoclonal antibodies CAM 5.2 and anti-vimentin in a biotin-streptavidin staining procedure. The renal cell carcinomas were classified according to the criteria of Fuhrman with a nuclear grading from I to IV. All carcinomas expressed cytokeratin, whereas co-expression with vimentin was present only in 53%. Expression for both intermediate filaments was present in aneuploid tumours with a marked nuclear pleomorphism and was more frequently related to a tubulo-papillary and pseudosarcomatous growth pattern. It is suggested that vimentin expression in renal cell carcinomas may be useful as a prognostic index in addition to nuclear grade. DNA content, mitotic rate and tumour stage.
The efficacy of a single dose of intramuscular ketorolac 10 mg or 90 mg was compared with pethidine 100 mg in a randomized double-blind study in 121 patients reporting at least moderate pain due to renal colic. Pain was assessed before drug administration, and then at 1 hour and 12 hours after the dose. Sedation was also assessed at these times, and additionally at the 12 hour assessment the time of the next analgesic dose was recorded. At 1 hour after dosing, pain scores had decreased in all groups; the largest decrease was seen in the ketorolac 90 mg group. The difference in the decrease was significant between the two ketorolac groups, but the differences between ketorolac and pethidine were not significant. Fewer patients in the ketorolac 90 mg group (17%) required a further dose of analgesic within 10 hours than in either the ketorolac 10 mg group (39%) or the pethidine 100 mg group (47%). The difference between ketorolac 90 mg and pethidine 100 mg was statistically significant. At both assessment times the proportion of patients with no sedation was higher in the two ketorolac groups than in the pethidine group. The overall incidence of adverse events was low with all drugs, notably so for the occurrence of vomiting after ketorolac. The results of the study show that intramuscular ketorolac is efficacious in the treatment of renal colic.
A case of uretero-aortic fistula after total cystoprostatectomy with a single stoma cutaneous ureterostomy is described. The literature is reviewed.
The author presents a technique for the surgical cure of distal hypospadias. The basic idea is a doubly infolded transversal vascularised skin flap, partially de-epithelialized to allow complete repair of the glans over it. Personal experiment.
Nephrotoxicity due to injection of uro-angiographic water soluble contrast media is a wellknown hazard in patients with renal failure, diabetes mellitus, cardiovascular disease, multiple myeloma and old age. Cases of nephrotoxicity in other patient populations are extremely rare. In order to document the influence of water soluble contrast media in patient undergoing intravenous urography diuresis, osmolar changes, creatinine clearance, absolute urinary creatinine excretion and uric acid metabolism were evaluated before and after contrast medium injection. No adverse reaction could be evidenced as far as the renal function is concerned, as creatinine clearance and absolute urinary creatinine output values showed no significant differences. The significant raise (p less than or equal to 0.001) of uric acid excretion (absolute urinary uric acid excretion values before and after contrast injection were respectively 5.22 micrograms/min.kg (IR: 3.24) and 10.68 micrograms/min.kg (IR: 4.03] can be co-responsible for adverse reactions when the renal function is not normal.
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A technique and the results of the creation of a transglandular tunnel for the more aesthetic repair of hypospadias is reported. The tunnel is not trocardisized through the glans but really excised. This reduced considerably the risk of stenosis, as this occurred only 9 times in 112 cases. In only three of them a reoperation was necessary. Sensibility of the glans remains normal after the operation while the appearance is a nearly normal.
Enterocystoplasty, to construct a functional and continent bladder in male patients following cystoprostatectomy, can be simplified and shortened by some modifications. Partial pubectomy will allow a precise and bloodless section of the membranous urethra preserving the external sphincter and a watertight anastomosis with 10 to 12 stitches between the urethra and the intestinal bladder. Use of automatic intestinal suture devices. Passing the ureteral stents through stab wounds in the intestinal wall and out to the skin. An easy method for bringing the urethral catheter in the right horn of the intestinal bladder. These modifications will reduce the operating time to seven hours.
The effect of the addition of a buffer to an ethylenediaminetetracetic acid (EDTA) litholytic solution on the solubility of calcium oxalate monohydrate and hydroxyapatite is investigated. The experiments show that the addition of triethanolamine as a buffer to EDTA solutions at pH 8 and 8.5 enhances the solubility of these salts, confirming theoretical predictions. The solubility of calcium oxalate monohydrate at 25C in solutions with varying ratios of buffer to EDTA concentrations and an osmolality of 0.9 was determined. The solutions resulting in the highest solubility were finally tested for their litholytic ability at 37C. At pH 8 solubilities of 22.5 g X l-1 for calcium oxalate monohydrate and 20.2 g X l-1 for hydroxyapatite were obtained. The corresponding solubilities at pH 8.5 were respectively 24.5 g X l-1 and 19.2 g X l-1.