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Clinical Importance of Acquired Cystic Disease of the Kidney in Patients Undergoing Dialysis
DISEASES OF BLOOD VESSELS~ I--IYPERTEl;JSIO:N AhfD R.ENOVASCULAR SURGERY
of 2) no damage to surrounding 3) use with any instrument anywhere in the urinary tract, 4) flexibility, 5) no necessary direct contact with the stone and 6) no damage to the optics of the instrument. The new instrumentation available today includes the ultrasonic lithotriptor, electrohydraulic probe and Dornier electrohydraulic device. For various technical reasons these instrnments may have difficulty in fragmenting and removing calculi. Therefore, the authors thought that an endoscopic method might be developed, which could fragment any stone in any position. Any method that can reduce the number of residual stone fragments will have a clear advantage. Pulsed neodymium-YAG lasers were found to fragment all types of urinary calculi rapidly in air. The fragments are much smaller than with any other technique. Large stones can be split into a few discrete fragments. This may prove to be an advantage in that the fragments then could be extracted without leaving multiple small fragments behind. Certain pulsed lasers can be transmitted through fine, flexible glass fibers that are small enough to pass through any size instrument channel. Therefore, there is an immediate possibility for use of this type of laser in the bladder with carbon dioxide instead of an irrigant. Further experiments are planned to investigate the possibility of percutaneous use of this laser in the kidney. W. W. K. 7 references
Transmreth.ral Ureteroscopic Retrieval of Urete:ric Stones
T. F. FORD, G. M. WATSON AND J.E. A. WICKHAM, St. Peter's Hospitals and Institute of Urology, London, England Brit. J. UroL, 55: 626-628 (Dec.) 1983 The authors document their initial experience in the transurethral retrieval of ureteral stones in 10 patients using the rigid ureteroscope. Half of the stones were located in the lower third of the ureter and half in the upper two-thirds. The stones varied from 5 to 10 mm. in diameter. Seven calculi were extracted successfully at the first attempt, using stone baskets under direct vision. Of the remaining 3 stones 1 was retrieved at a second ureteroscopy, 1 was fragmented and subsequently passed, and 1 required percutaneous nephroscopy for removal from the renal pelvis. The authors conclude that transurethral ureteroscopy offers a safe alternative to open ureterolithotomy and blind manipulation. W. VV. K. 3 figures, 6 references
DISEASES OF BLOOD VESSELS, HYPERTENSION AND RENOV ASCULAR SURGERY Clinical Importance of Acquired Cystic Disease of the Kidney in Patients Undergoing Dialysis
P. J. RATCLIFFE, M. S. DUNNILL AND D. 0. OLIVER, Nu/field Department of Clinical Medicine, John Radcliffe Hospital, and Renal Unit, Churchill Hospital, Oxford, England Brit. Med. J., 287: 1855-1858 (Dec. 17) 1983 The incidence and extent of cystic change increase with the duration of dialysis and since large numbers of patients undergoing hemodialysis are living longer the disease will become important in their management. As a result, the authors report 5 cases of serious complications from acquired cystic
1251
disease of the kidney in pa1tu31c1ts undergoing hemodialysis from 1976 to 1982. The clinical features seen were pain, hematuria, palpable renal enlargement, massive hemorrhage, resolution of anemia and metastatic malignancy. Two patients died of these complications. E. D. W. 4 figures, 23 references
Pseudomona§ Fluoresce:ns Bacteremia From Blood T:ran§fusion
R. F. KHABBAZ, P. M. ARNOW, A. K. HIGHSMITH, 1. A. HERWALDT, T. CHOU, W.R. JARVIS, N. W. LERCHE AND J. R. ALLEN, Hospital Infections Program and Division of Bacterial Diseases, Center for Infectious Diseases and Field Services Division, Epidemiology Program Office, Centers for Disease Control, Public Health Service, Department of Health and Human Services, Atlanta, Georgia and Infectious Disease Section, Department of Medicine, University of Chicago Hospital, Chicago, Illinois Amer. J. Med., 76: 62-68 (Jan.) 1984 Pseudomonas fluorescens is a motile, obligatory aerobic gram-negative rod, closely related to P. putida and P. aeruginosa. In contrast to P. aeruginosa, neither P. fluorescens nor P. putida normally grows at 42C. All 3 pseudomonads are common inhabitants of soil, water and plants, and have caused contamination of food and milk. P. fluorescens, a rare opportunistic pathogen, has been associated with contamination of blood and blood products. The authors report an incidence during October 1980 when 2 units of blood contaminated with P. fluorescens caused septic transfusion reactions in 2 recipients at a Chicago hospital (1 patient died). Both units had been purchased from the same blood center. Investigation at the blood center and at other hospitals that it supplied revealed another fatal case of P. fluorescens sepsis that had occurred 1 year earlier. Despite extensive environmental culturing at the blood center the source of the P. fluorescens was not identified. However, comparison of the interval between collection and administration of contaminated and noncontaminated units indicated that prolonged storage was a risk factor that may have caused clustering of cases in 1 hospital. Laboratory studies showed that small inocula of P. fluorescens proliferated in refrigerated fresh whole blood and reached 106 to 107 colony-forming units per ml. 7 after incubation. These data suggest that prolonged storage of blood may be an ,rnnffn.""'n risk factor for the development of transfusion-related sepsis. W. W. H. 2 figures, 1 table, 26 references
The Pha:rmacologic Manipulation of Blood Flow in Hyperthermia Therapy OLCH, A. w. SILBERMAN, F. AND D. L. MORTON, Divisions
A. J.
Medical Physics, Angeles, California
UCLA
K. STORM, L. S. GRAHAM of Surgical Oncology and School of Medicine, Los
J. Surg. Oncol., 24: 292-297 (Dec.) 1983 Current methods of hyperthermia delivery sometimes can achieve tumor temperatures in the therapeutic range (>42C). However, in many cases this goal is not achieved and this failure may be owing to near normal blood flow in the neoplastic tissue. The authors report a preliminary study in dogs and rabbits,
of 2) no damage to surrounding 3) use with any instrument anywhere in the urinary tract, 4) flexibility, 5) no necessary direct contact with the stone and 6) no damage to the optics of the instrument. The new instrumentation available today includes the ultrasonic lithotriptor, electrohydraulic probe and Dornier electrohydraulic device. For various technical reasons these instrnments may have difficulty in fragmenting and removing calculi. Therefore, the authors thought that an endoscopic method might be developed, which could fragment any stone in any position. Any method that can reduce the number of residual stone fragments will have a clear advantage. Pulsed neodymium-YAG lasers were found to fragment all types of urinary calculi rapidly in air. The fragments are much smaller than with any other technique. Large stones can be split into a few discrete fragments. This may prove to be an advantage in that the fragments then could be extracted without leaving multiple small fragments behind. Certain pulsed lasers can be transmitted through fine, flexible glass fibers that are small enough to pass through any size instrument channel. Therefore, there is an immediate possibility for use of this type of laser in the bladder with carbon dioxide instead of an irrigant. Further experiments are planned to investigate the possibility of percutaneous use of this laser in the kidney. W. W. K. 7 references
Transmreth.ral Ureteroscopic Retrieval of Urete:ric Stones
T. F. FORD, G. M. WATSON AND J.E. A. WICKHAM, St. Peter's Hospitals and Institute of Urology, London, England Brit. J. UroL, 55: 626-628 (Dec.) 1983 The authors document their initial experience in the transurethral retrieval of ureteral stones in 10 patients using the rigid ureteroscope. Half of the stones were located in the lower third of the ureter and half in the upper two-thirds. The stones varied from 5 to 10 mm. in diameter. Seven calculi were extracted successfully at the first attempt, using stone baskets under direct vision. Of the remaining 3 stones 1 was retrieved at a second ureteroscopy, 1 was fragmented and subsequently passed, and 1 required percutaneous nephroscopy for removal from the renal pelvis. The authors conclude that transurethral ureteroscopy offers a safe alternative to open ureterolithotomy and blind manipulation. W. VV. K. 3 figures, 6 references
DISEASES OF BLOOD VESSELS, HYPERTENSION AND RENOV ASCULAR SURGERY Clinical Importance of Acquired Cystic Disease of the Kidney in Patients Undergoing Dialysis
P. J. RATCLIFFE, M. S. DUNNILL AND D. 0. OLIVER, Nu/field Department of Clinical Medicine, John Radcliffe Hospital, and Renal Unit, Churchill Hospital, Oxford, England Brit. Med. J., 287: 1855-1858 (Dec. 17) 1983 The incidence and extent of cystic change increase with the duration of dialysis and since large numbers of patients undergoing hemodialysis are living longer the disease will become important in their management. As a result, the authors report 5 cases of serious complications from acquired cystic
1251
disease of the kidney in pa1tu31c1ts undergoing hemodialysis from 1976 to 1982. The clinical features seen were pain, hematuria, palpable renal enlargement, massive hemorrhage, resolution of anemia and metastatic malignancy. Two patients died of these complications. E. D. W. 4 figures, 23 references
Pseudomona§ Fluoresce:ns Bacteremia From Blood T:ran§fusion
R. F. KHABBAZ, P. M. ARNOW, A. K. HIGHSMITH, 1. A. HERWALDT, T. CHOU, W.R. JARVIS, N. W. LERCHE AND J. R. ALLEN, Hospital Infections Program and Division of Bacterial Diseases, Center for Infectious Diseases and Field Services Division, Epidemiology Program Office, Centers for Disease Control, Public Health Service, Department of Health and Human Services, Atlanta, Georgia and Infectious Disease Section, Department of Medicine, University of Chicago Hospital, Chicago, Illinois Amer. J. Med., 76: 62-68 (Jan.) 1984 Pseudomonas fluorescens is a motile, obligatory aerobic gram-negative rod, closely related to P. putida and P. aeruginosa. In contrast to P. aeruginosa, neither P. fluorescens nor P. putida normally grows at 42C. All 3 pseudomonads are common inhabitants of soil, water and plants, and have caused contamination of food and milk. P. fluorescens, a rare opportunistic pathogen, has been associated with contamination of blood and blood products. The authors report an incidence during October 1980 when 2 units of blood contaminated with P. fluorescens caused septic transfusion reactions in 2 recipients at a Chicago hospital (1 patient died). Both units had been purchased from the same blood center. Investigation at the blood center and at other hospitals that it supplied revealed another fatal case of P. fluorescens sepsis that had occurred 1 year earlier. Despite extensive environmental culturing at the blood center the source of the P. fluorescens was not identified. However, comparison of the interval between collection and administration of contaminated and noncontaminated units indicated that prolonged storage was a risk factor that may have caused clustering of cases in 1 hospital. Laboratory studies showed that small inocula of P. fluorescens proliferated in refrigerated fresh whole blood and reached 106 to 107 colony-forming units per ml. 7 after incubation. These data suggest that prolonged storage of blood may be an ,rnnffn.""'n risk factor for the development of transfusion-related sepsis. W. W. H. 2 figures, 1 table, 26 references
The Pha:rmacologic Manipulation of Blood Flow in Hyperthermia Therapy OLCH, A. w. SILBERMAN, F. AND D. L. MORTON, Divisions
A. J.
Medical Physics, Angeles, California
UCLA
K. STORM, L. S. GRAHAM of Surgical Oncology and School of Medicine, Los
J. Surg. Oncol., 24: 292-297 (Dec.) 1983 Current methods of hyperthermia delivery sometimes can achieve tumor temperatures in the therapeutic range (>42C). However, in many cases this goal is not achieved and this failure may be owing to near normal blood flow in the neoplastic tissue. The authors report a preliminary study in dogs and rabbits,