Biomedical subjects
Publications and source records attributed to W R Fair.
A young man presented with a perineal mass that was found to be secondary to partial priapism of the proximal corpora cavernosa. This ia a rare condition with only 2 previously recorded cases in the urologic literature. Definitive treatment required a corpus cavernosum-spongiosum shunt. The patient has had a good recovery and was able to resume sexual activity.
We report false elevations of serum human chorionic gonadotropin levels in 4 patients with testicular germ cell tumors. Elevated circulating luteinizing hormone levels that resulted from unilateral orchiectomy were responsible for the falsely positive human chorionic gonadotropin activity measured in commercial radioimmunoassays. In 3 patients tested aliquots of serum evaluated in reliable human chorionic gonadotropin assay systems revealed no elevation. We administered testosterone to 3 patients who had elevations of luteinizing hormone and human chorionic gonadotropin levels. Luteinizing hormone was suppress-d to normal levels 1 week later in 2 patients and in 1 it was diminished but still slightly elevated. In all 3 cases the falsely positive human chorionic gonadotropin results converted to negative. Recognition of falsely positive elevations of human chorionic gonadotropin can spare patients unnecessary operations and/or chemotherapy.
The use of oral penicillin therapy is important in the management of renal stones secondary to Proteus mirabilis urinary tract infections. In 16 of 20 patients (80 per cent) with struvite renal calculi infected with Proteus mirabilis a sterile urine was achieved with appropriate penicillin therapy and diminution in stone size occurred in at least 2 cases. The rationale, supporting data and therapeutic uses are discussed.
Of 164 excretory urograms obtained from women with a history of recurrent urinary tract infections 88 per cent were perfectly normal. Eleven (6.7 per cent) had minor, normal, anatomic variations. Nine (5.5 per cent) were considered to have positive findings but in no case a significant finding present that required surgical intervention or altered the therapeutic approach. The total cost of the studies to the patients involved was $17,930. Thus, an extremely negative cost-benefit ratio emerged. The routine use of excretory urograms as part of the evaluation of a woman with a urinary tract infection is expensive, unrewarding and has little justification.
The pH of normal human expressed prostatic secretion in 136 samples from 93 men was 7.28 +/- 0.04. In 41 samples from 14 patients with documented chronic bacterial prostatitis the alkalinity of prostatic fluid was increased 10-fold (1 pH unit) and was 8.32 +/- 0.07. We believe these studies account for the failure of trimethoprim to eradicate human bacterial prostatitis effectively despite the experimental data documenting diffusion and concentration of trimethoprim in the acidic prostatic fluid of the normal dog. The factors governing drug diffusion into the prostate and the influence of pH on the concentration of trimethoprim in the expressed prostatic secretion are discussed.
More efficient patient management, including a decrease in the length of hospital stay and a decrease in patient medical cost, may be achieved in many instances by use of the CT scanner. The clinical efficacy of this noninvasive imaging technique must continue to be judged by comparison with conventional uroradiologic techniques and careful cost analysis, but the CT scan is becoming an accepted means of assessment and diagnosis of urinary tract problems. As the technology continues to improve so will our ability to diagnose and define the extent of disease within the urinary tract.
Xanthogranulomatous pyelonephritis (XGP) can present with weight loss, anemia, leukemoid reaction, and generalized debility; there may be no signs or symptoms referable to the urinary tract. Confusion between XGP and renal adenocarcinoma is well recognized, but other malignancies can also be simulated. Case histories of patients with proved XGP whose clinical presentations suggested occult malignancies are recorded. Proteus urinary tract infection, calculi, and a nonvisualizing kidney on intravenous pyelogram should suggest the correct diagnosis. The pathology, bacteriology, diagnosis, and treatment are reviewed.
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Our experience with percutaneous nephrostomy in 22 patients is presented. This procedure can be accomplished readily and is safe, reliable and effective for short and long-term urinary diversion in various urologic conditions in children and adults.
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A basic assumption in all experiments on prostatic physiology, particularly those designed to study the diffusion of drugs into the prostate gland, is that the pH of human prostatic fluid is similar to that of the dog, that is pH 6.1 to 6.5. We believe that this assumption is incorrect. Our data indicate 1) the expressed prostatic secretion of most normal men is alkaline (mean pH 7.31), 2) with prostatic infection the pH of prostatic fluid increases markedly (mean pH 8.34) and, therefore, drugs shown to diffuse into the canine prostate may be ineffective in treating prostatitis in humans and 3) the increase in pH of the expressed prostatic secretion seen with infection is not simply owing to an increase in the relative concentration of alkaline seminal vesicular components. Biochemical markers of seminal vesicular activity (fructose and prostaglandins) showed no correlation with pH values of expressed prostatic secretion. Hence, it appears that the change in pH of the expressed secretion is owing to a real increase in pH of prostatic fluid. The clinical implications of these findings are discussed. An appreciation of the profound variation in the prostatic fluid pH may be of importance not only in furthering the understanding and treatment of chronic bacterial prostatitis but, also, of other prostatic diseases as well.
Eighteen months of experience with computed body tomography have revealed that this radiologic modality is useful in the diagnostic evaluation and management of urologic patients. Renal masses, perirenal lesions, poorly functioning kidneys, pelvic tumors and associated retroperitoneal nodal spread and other diagnostic problems related to the urinary tract have been imaged successfully with computed body tomography. Accuracy is high in the differentiation of benign renal cysts from renal neoplasms. Tumor staging and computed body tomography is being explored currently.
The polyamines--putrescine, spermidine and spermine--are present in elevated concentrations in rapidly growing cell lines and in several neoplasms. Five dogs with benign or malignant tumors and one normal dog were imaged with a rectilinear scanner following I.V. administration of 2--8 mCi 11C-methylputrescine. High concentrations of 11C-methylputrescine were found in the liver, and in the kidneys and urine in the dogs with good renal function. Concentrations were higher in tumors than in skeletal muscle, blood or lung. The tumor/blood ratio varied from 2--21; tumors were demonstrated by imaging in four dogs in which the ratio exceeded 4.0. 11C-methylputrescine is a possible tumor imaging agent.
During the past decade some urologists and radiologists have doubted the existence of posterior urethral valves. It has been suggested that the primary lesion in patients thought to have urethral valves is bladder neck obstruction. During the past seven years we have seen an average of three new cases of posterior urethral valves per annum. In all cases the valves themselves, not the bladder neck, obstructed the urethra. The urologist may miss valves at urethroscopy, but use of the new fibreoptic endoscope has improved his chances of seeing them. Posterior urethral valves may not be demonstrated radiologically if the radiologist does not use a rapid recording device or if the patient does not micturate forcefully during micturating cystourethrography. Failure to detect the valves may lead to an erroneous diagnosis of bladder neck obstruction.
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The polyamines putrescine, spermine, and spermidine were methylated by the addition of carbon-11-labeled formaledehyde followed by sodium borohydride. High labeling yields wrbon-11-labeled formaldehyde followed by sodium borohydride. High labeling yields were obtained and the final products were purified by simply boiling the solution. This decomposed the excess sodium borohydride and removed the volatile impurities. The final radiochemical purity of all the methylated compounds was above 85%. All three methyltated compounds accumulated in the prostates of male rats and the distribution of N-methyl-1,4-diaminobutane (the putrescine analog) was very similar to that previously obtained with tritiated putrescine. The uptake of the putrescine analog in both the prostate and in mouse tumor was slightly higher than that obtained with the other two analogs studied. Utilizing a positron transaxial tomographic scanner and the putrescine analog, we have been able to image the prostate gland of a dog.
Normal human prostatic fluid possesses pronounced antibacterial activity. This activity is absent or markedly diminished in the fluid of men with chronic bacterial prostatitis. Ion-probe and mass spectrographic analysis of this antibacterial factor has shown it to be a zinc salt. Prostatic fluid zinc levels in 15 men with chronic bacterial prostatitis averaged 50 mug. per milliliter (range 0 to 139 mug. per milliliter). The zinc level in the expressed prostate secretion (EPS) of 49 control men averaged 448 mug. per milliliter (range 150 to 1,000 mug. per milliliter). There was no overlap in the range of zinc values between the two groups. The decrease in EPS zinc concentration in the patient population was not secondary to a decreased serum zinc level. Exogenous zinc given orally did not increase the EPS zinc level. The decrease in EPS zinc was not limited to infected prostatic fluid cultures and may precede the entry of bacteria into the prostate. The data presented suggest that zinc may serve as an in vivo defense mechanism against prostatic invasion and subsequent urinary tract infections in men.