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Salivary secretion of iodine after urography
MAYO CLINIC PROCEEDINGS by A. Thomas,
M.D.
Survival of Patients with End-Stage Renal Disease, William J. Johnson, Hugh 0. O’Kane, John E. Woods, and Lila R. Elveback, (48: 18, 1973) -One hundred and thirty-two patients with advanced renal disease were studied. Despite recent advances in the medical management of renal failure, the prognosis without hemodialysis or transplantation remains uniformly poor. The authors suggest that the prognosis in patients with advanced renal failure can be improved by the early institution of dialysis and renal transplantation. Definitive treatment is strongly recommended for patients with serum creatinine values of 15 mg., or greater, per 100 ml. Interestingly, their data indicate little difference in survival rates between patients undergoing long-term hemodialysis therapy and patients who have undergone transplantation of the kidney from a living related donor. Significantly lower survival rates were recorded among recipients of cadaver kidneys. Renal Allograft Bruit, Carl F. Anderson, John E. Woods, Peter P. Frohnert, James V. Donadio, Jr., Juan Buros, David T. Sung, and William J. Johnson, (48: 13, 1973)-The authors analyze the association between the findings on palpation and auscultation with laboratory investigations in 81 renal allograft recipients. They believe that the renal allograft bruit originates in the region of the arterial anastomosis. Also there is a combination of increased blood and inequality of vessel size, producing nonlaminar blood flow. The persistence of the bruit indicates continued increased blood flow through the internal iliac and allograft renal arteries that are slightly unequal in size. In their experience, the combination of the disappearance of the renal allograft bruit and decreased renal function may reflect increased intrarenal vascular resistance. The recipients without a bruit had higher mean serum creatinine and the suboptimum blood flow was the common cause of the lack of a bruit. Other possible physiologic explanations are discussed, as is a classification of the grades of bruits heard.
by W. Keiserman,
M.D.
Cryptorchidism Reassessed, Robert P. Myers, and Panayotis P. Kelalis, (48: 94, 1973)-The literature is reviewed in an attempt to answer the question: Is there an optimal time for surgical correction? In the authors’ opinion, the existing data suggest that there are many opinions which conflict as well as confuse, and that the answer to the question remains elusive. They, therefore, suggest that a study be undertaken in an effort to answer this question. They further recommend that in any such study the precise anatomic localization of the testis, when the patient is first seen and on subsequent visits, be recorded to help differentiate between cryptorchidism
UROLOGY
/
MAY 1973
/
VOLUME I, NUMBER 5
and an ectopic testis. Early testicular biopsy is recommended together with a random-treatment program. Serial testosterone levels and postpubertal testicular biopsy and fertility studies are also recommended for inclusion in the proposed study. Malignant Tumors of Solitary Kidneys, R. Malek, D. Utz, 0. Culp, P. Kelalis, and M. Warren (47: 180, 1972) -Eighteen original cases of anatomically or functionally solitary kidneys with carcinoma are presented and discussed in relation to the previous literature. Five patients had congenitally solitary kidneys, and 5 had previous nephrectomy for malignancy. There is no side preference for hypernephroma, and this series had a 5: 10 male to female ratio. A significant number of patients with hypernephroma were in the fourth and fifth decades, while those with transitional cell were in the sixth and seventh decades. Partial nephrectomy is considered the operation of choice for “cure” of renal cell carcinoma. Of the transitional cell carcinoma in solitary kidneys, the literature shows 54 per cent had previous nephroureterectomy for a similar lesion. Operation for cure is more difficult.
RADIOLOGY by Robert
Littmann,
M.D.
Herniation of the Bladder, Arie L. Liebskind, Milton Ekin, and Stanford Goldman, (106: 257, 1973) -The authors report on diagnosing 50 cases of bladder hernia in a two-year period. Sixty per cent of the cases were in patients under fifty years of age, and 62 per cent of the patients were women. In general, no specific symptoms were attributed to hernia of the bladder, but with large bladder hernias, the patients occasionally complained of two-stage urination. Bladder herniations have rarely been identified in the past by excretory urography because of the failure to obtain proper views during this study; they recommend routine use of erect and cone films, particularly with the bladder distended to improve the radiographic recognition of bladder hernias. Although the majority of the patients studied were under fifty years of age, the larger hernias were demonstrated in the elderly. It was not possible to differentiate direct from indirect hernias by the usual radiographic studies. The authors describe three categories of bladder hernias but do not seem to distinguish between the protrusion of the bladder into a hernia sac and the urologically more significant protrusion of bladder diverticulum into a hernia sac. Salivary Secretion of Iodine after Urography, Lee Talner, Marc Coel, and Joseph Lang, (106: 263,1973) This article is a continuation of other studies and attempts to offer further evidence for in vivo deiodinization and salivary secretion of contrast media. The authors suggest that although general opinion holds that most adverse reactions associated with contrast material are probably not caused by iodine or iodide, at least one adverse reaction, such as sialadenopathy
485
or “iodine mumps” is related to inorganic iodide derived from the media by deiodinization. In their review of 15 reported patients with “iodide mumps,” at least 7 had renal failure. They believe that this unusually high incidence of sialadenopathy in uremic patients suggests the association with deiodinization. JOURNAL
OF
by Robert
PEDIATRIC
Littmann,
SURGERY
M.D.
Extrarenal Wilms’ Tumors, M. R. Thompson, E. G. Emmanuel, M. S. Campbell, and R. B. Zachary, (8: 37, 1973) -Two cases of extrarenal origin of Wilms’ tumors and review of the literature, emphasizing that Wilms’ tumors can exist in extrarenal sites, are reported. The concept of multifocal Wilms’ tumors is again raised, suggesting that other causes of extrarenal Wilms’ tumors may have been incorrectly diagnosed as metastatic in origin.
FETAL
AND
by M. Strahlberg,
NEONATAL
Urinary Fibrin-Degradation Products and the Site of Urinary Infection, J. A. Whitworth, K. F. Fairley, M. A. McIvor, and A. E. Stubbs, (2: 234, 1973)Seventy-four patients were grouped with 48 patients with upper urinary tract infections and 26 patients with bladder infections. Urinary fibrin-degradation products were high in 40 per cent of the former, and only in 1 patient in the latter group. The authors believe that estimation of spot urinary fibrin-degradation products may be of value as an indirect method of determining the site of urinary tract infection, with particular value in ruling out the bladder as the site of infection.
Gram-Negative Urinary Infection Treated with Oral Penicillin G, J. Hulbert, (2: 1216,1972) -Five hundred and thirty patients were involved in this study, part of which was double blind. It is concluded that oral penicillin G 500 mg. given every six hours for two weeks was as effective as other established regimens for the treatment of urinary tract infections.
MEDICINE BRITISH
M.D.
JOURNAL
by Douglas The Prevalence of Bacteriuria in Full-Term and Premature Newborn Infants, Chester M. Edelmann, Jr., Joseph E. Ogwo, Burton P. Fine, and Armida B. Martinez, (82: 125, 1973)-In this study, urinalyses were performed in 836 full-term and 206 prematurely born infants. Specimens were obtained by a cleanvoid technique and by suprapubic puncture. The findings in this study suggest that it is not profitable to study healthy, full-term neonates in this fashion, since no significant proteinuria or hematuria was detected in the 836 infants. The authors conclude that the predictable presence of bacteriuria is only a small fraction of 1 per cent and does not seem to warrant the amount of work required to screen full-term infants. In premature infants, however, it appears to be different, since bacteriuria can be detected by several per cent. From their experience with 206 premature infants they conclude that asymptomatic urinary tract infection may occur more frequently than symptomatic infection. They speculate that detection and treatment of these infants might prevent extension of urinary tract infections.
LANCET by Douglas
Whitehead,
M.D.
Cyclophosphamide Therapy and Sterility, M. S. A. Qureshi, H. J. Goldsmith, J. H. Pennington, and P. E. Cox, (2: 1290, 1972)-Seminal fluid was examined from 14 postpubertal males who had received cyclophosphamide therapy for sixteen to five hundred days. All the patients were found to be azoospermic or oligospermic after therapy. Many had reduced motility or atypical spermatozoa. They report that partial spermatogenesis may recover over the years after cessation of therapy.
486
OF
Whitehead,
UROLOGY
M.D.
Factors Reducing the Rate of Infection After Transurethral Surgery, J. M. Symes, D. G. Hardy, K. Sutherns, and J. P. Blandy, (44: 582, 1972)-Several studies were performed to determine the factors operative in reducing the rate of urinary infections after transurethral surgery. The authors noted that closed catheter drainage resulted in an infection rate of only 5 per cent; continuous saline irrigation did not reduce this rate and may even have increased it, as did prolonged catheter drainage. Furthermore, they noted that those patients who had small resections, short resection times, and minimal blood loss had a lower risk of infection. Infections associated with prolonged catheter drainage tended to persist after discharge from the hospital. The Use of Pedicle Grafts in the Repair of Urinary Tract Fistulae, Richard Turner-Warwick, (44: 644, 1972) -This report describes some of the pedicle grafts used to repair urinary tract fistulas. Many of the procedures were previously reported by the author and are now compiled together. They include: scrotopenile rotation flap for hypospadiac fistula; posterior funnel inlay urethroplasty; tubed skin inlay urethroplasty; labial fat interposition pedicle grafts for vesicovaginal fistulas; omentorenal wrap after nephrolithotomy; ureterocalycotomy; pyeloplasty revision and heminephrectomy by hemimobilization or transplantation of the omentum; omentoureteric wrap to support ureteroplasty and ureterotomy procedures; omental interposition pedicle grafts for prostatorectal fistula; recurrent vesicovaginal fistula and postirradiation vesicovaginal fistula or vesicovagino-rectal fistulas; one-stage repair of post-traumatic bulbar urethral fistulas with omental pedicle wrap; omental reconstruction in traumatic tissue-loss cloaca1 injuries;
UROLOGY
/
MAY 1973
/
VOLUME
I, NUhlBER
5
M.D.
Survival of Patients with End-Stage Renal Disease, William J. Johnson, Hugh 0. O’Kane, John E. Woods, and Lila R. Elveback, (48: 18, 1973) -One hundred and thirty-two patients with advanced renal disease were studied. Despite recent advances in the medical management of renal failure, the prognosis without hemodialysis or transplantation remains uniformly poor. The authors suggest that the prognosis in patients with advanced renal failure can be improved by the early institution of dialysis and renal transplantation. Definitive treatment is strongly recommended for patients with serum creatinine values of 15 mg., or greater, per 100 ml. Interestingly, their data indicate little difference in survival rates between patients undergoing long-term hemodialysis therapy and patients who have undergone transplantation of the kidney from a living related donor. Significantly lower survival rates were recorded among recipients of cadaver kidneys. Renal Allograft Bruit, Carl F. Anderson, John E. Woods, Peter P. Frohnert, James V. Donadio, Jr., Juan Buros, David T. Sung, and William J. Johnson, (48: 13, 1973)-The authors analyze the association between the findings on palpation and auscultation with laboratory investigations in 81 renal allograft recipients. They believe that the renal allograft bruit originates in the region of the arterial anastomosis. Also there is a combination of increased blood and inequality of vessel size, producing nonlaminar blood flow. The persistence of the bruit indicates continued increased blood flow through the internal iliac and allograft renal arteries that are slightly unequal in size. In their experience, the combination of the disappearance of the renal allograft bruit and decreased renal function may reflect increased intrarenal vascular resistance. The recipients without a bruit had higher mean serum creatinine and the suboptimum blood flow was the common cause of the lack of a bruit. Other possible physiologic explanations are discussed, as is a classification of the grades of bruits heard.
by W. Keiserman,
M.D.
Cryptorchidism Reassessed, Robert P. Myers, and Panayotis P. Kelalis, (48: 94, 1973)-The literature is reviewed in an attempt to answer the question: Is there an optimal time for surgical correction? In the authors’ opinion, the existing data suggest that there are many opinions which conflict as well as confuse, and that the answer to the question remains elusive. They, therefore, suggest that a study be undertaken in an effort to answer this question. They further recommend that in any such study the precise anatomic localization of the testis, when the patient is first seen and on subsequent visits, be recorded to help differentiate between cryptorchidism
UROLOGY
/
MAY 1973
/
VOLUME I, NUMBER 5
and an ectopic testis. Early testicular biopsy is recommended together with a random-treatment program. Serial testosterone levels and postpubertal testicular biopsy and fertility studies are also recommended for inclusion in the proposed study. Malignant Tumors of Solitary Kidneys, R. Malek, D. Utz, 0. Culp, P. Kelalis, and M. Warren (47: 180, 1972) -Eighteen original cases of anatomically or functionally solitary kidneys with carcinoma are presented and discussed in relation to the previous literature. Five patients had congenitally solitary kidneys, and 5 had previous nephrectomy for malignancy. There is no side preference for hypernephroma, and this series had a 5: 10 male to female ratio. A significant number of patients with hypernephroma were in the fourth and fifth decades, while those with transitional cell were in the sixth and seventh decades. Partial nephrectomy is considered the operation of choice for “cure” of renal cell carcinoma. Of the transitional cell carcinoma in solitary kidneys, the literature shows 54 per cent had previous nephroureterectomy for a similar lesion. Operation for cure is more difficult.
RADIOLOGY by Robert
Littmann,
M.D.
Herniation of the Bladder, Arie L. Liebskind, Milton Ekin, and Stanford Goldman, (106: 257, 1973) -The authors report on diagnosing 50 cases of bladder hernia in a two-year period. Sixty per cent of the cases were in patients under fifty years of age, and 62 per cent of the patients were women. In general, no specific symptoms were attributed to hernia of the bladder, but with large bladder hernias, the patients occasionally complained of two-stage urination. Bladder herniations have rarely been identified in the past by excretory urography because of the failure to obtain proper views during this study; they recommend routine use of erect and cone films, particularly with the bladder distended to improve the radiographic recognition of bladder hernias. Although the majority of the patients studied were under fifty years of age, the larger hernias were demonstrated in the elderly. It was not possible to differentiate direct from indirect hernias by the usual radiographic studies. The authors describe three categories of bladder hernias but do not seem to distinguish between the protrusion of the bladder into a hernia sac and the urologically more significant protrusion of bladder diverticulum into a hernia sac. Salivary Secretion of Iodine after Urography, Lee Talner, Marc Coel, and Joseph Lang, (106: 263,1973) This article is a continuation of other studies and attempts to offer further evidence for in vivo deiodinization and salivary secretion of contrast media. The authors suggest that although general opinion holds that most adverse reactions associated with contrast material are probably not caused by iodine or iodide, at least one adverse reaction, such as sialadenopathy
485
or “iodine mumps” is related to inorganic iodide derived from the media by deiodinization. In their review of 15 reported patients with “iodide mumps,” at least 7 had renal failure. They believe that this unusually high incidence of sialadenopathy in uremic patients suggests the association with deiodinization. JOURNAL
OF
by Robert
PEDIATRIC
Littmann,
SURGERY
M.D.
Extrarenal Wilms’ Tumors, M. R. Thompson, E. G. Emmanuel, M. S. Campbell, and R. B. Zachary, (8: 37, 1973) -Two cases of extrarenal origin of Wilms’ tumors and review of the literature, emphasizing that Wilms’ tumors can exist in extrarenal sites, are reported. The concept of multifocal Wilms’ tumors is again raised, suggesting that other causes of extrarenal Wilms’ tumors may have been incorrectly diagnosed as metastatic in origin.
FETAL
AND
by M. Strahlberg,
NEONATAL
Urinary Fibrin-Degradation Products and the Site of Urinary Infection, J. A. Whitworth, K. F. Fairley, M. A. McIvor, and A. E. Stubbs, (2: 234, 1973)Seventy-four patients were grouped with 48 patients with upper urinary tract infections and 26 patients with bladder infections. Urinary fibrin-degradation products were high in 40 per cent of the former, and only in 1 patient in the latter group. The authors believe that estimation of spot urinary fibrin-degradation products may be of value as an indirect method of determining the site of urinary tract infection, with particular value in ruling out the bladder as the site of infection.
Gram-Negative Urinary Infection Treated with Oral Penicillin G, J. Hulbert, (2: 1216,1972) -Five hundred and thirty patients were involved in this study, part of which was double blind. It is concluded that oral penicillin G 500 mg. given every six hours for two weeks was as effective as other established regimens for the treatment of urinary tract infections.
MEDICINE BRITISH
M.D.
JOURNAL
by Douglas The Prevalence of Bacteriuria in Full-Term and Premature Newborn Infants, Chester M. Edelmann, Jr., Joseph E. Ogwo, Burton P. Fine, and Armida B. Martinez, (82: 125, 1973)-In this study, urinalyses were performed in 836 full-term and 206 prematurely born infants. Specimens were obtained by a cleanvoid technique and by suprapubic puncture. The findings in this study suggest that it is not profitable to study healthy, full-term neonates in this fashion, since no significant proteinuria or hematuria was detected in the 836 infants. The authors conclude that the predictable presence of bacteriuria is only a small fraction of 1 per cent and does not seem to warrant the amount of work required to screen full-term infants. In premature infants, however, it appears to be different, since bacteriuria can be detected by several per cent. From their experience with 206 premature infants they conclude that asymptomatic urinary tract infection may occur more frequently than symptomatic infection. They speculate that detection and treatment of these infants might prevent extension of urinary tract infections.
LANCET by Douglas
Whitehead,
M.D.
Cyclophosphamide Therapy and Sterility, M. S. A. Qureshi, H. J. Goldsmith, J. H. Pennington, and P. E. Cox, (2: 1290, 1972)-Seminal fluid was examined from 14 postpubertal males who had received cyclophosphamide therapy for sixteen to five hundred days. All the patients were found to be azoospermic or oligospermic after therapy. Many had reduced motility or atypical spermatozoa. They report that partial spermatogenesis may recover over the years after cessation of therapy.
486
OF
Whitehead,
UROLOGY
M.D.
Factors Reducing the Rate of Infection After Transurethral Surgery, J. M. Symes, D. G. Hardy, K. Sutherns, and J. P. Blandy, (44: 582, 1972)-Several studies were performed to determine the factors operative in reducing the rate of urinary infections after transurethral surgery. The authors noted that closed catheter drainage resulted in an infection rate of only 5 per cent; continuous saline irrigation did not reduce this rate and may even have increased it, as did prolonged catheter drainage. Furthermore, they noted that those patients who had small resections, short resection times, and minimal blood loss had a lower risk of infection. Infections associated with prolonged catheter drainage tended to persist after discharge from the hospital. The Use of Pedicle Grafts in the Repair of Urinary Tract Fistulae, Richard Turner-Warwick, (44: 644, 1972) -This report describes some of the pedicle grafts used to repair urinary tract fistulas. Many of the procedures were previously reported by the author and are now compiled together. They include: scrotopenile rotation flap for hypospadiac fistula; posterior funnel inlay urethroplasty; tubed skin inlay urethroplasty; labial fat interposition pedicle grafts for vesicovaginal fistulas; omentorenal wrap after nephrolithotomy; ureterocalycotomy; pyeloplasty revision and heminephrectomy by hemimobilization or transplantation of the omentum; omentoureteric wrap to support ureteroplasty and ureterotomy procedures; omental interposition pedicle grafts for prostatorectal fistula; recurrent vesicovaginal fistula and postirradiation vesicovaginal fistula or vesicovagino-rectal fistulas; one-stage repair of post-traumatic bulbar urethral fistulas with omental pedicle wrap; omental reconstruction in traumatic tissue-loss cloaca1 injuries;
UROLOGY
/
MAY 1973
/
VOLUME
I, NUhlBER
5