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Successful Surgical Treatment of Anuria Caused by Renal Artery Occlusion
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY
lateral scrotal testes and 2 controls (a patient with prostatic carcinoma and a healthy, fertile man at the time of vasectomy). In cryptorchid testes only from postpubertal patients the authors describe cytoplasmic inclusion bodies "here and there which were fascicular in form". These inclusion bodies were not found in the Leydig cells of contralateral descended testes or from the 2 normal controls. Likewise, these bodies were not demonstrated in the Leydig cells of undescended testes of prepubertal individuals. The significance of these inclusion bodies is unknown. The authors refer to certain other "regressive changes" in the Leydig cells of these postpubertal cryptorchid testes but whether these other changes were present universally in all such testes is unclear. Also, although the authors seem to imply that these nonReinke inclusion bodies were found in the Leydig cells of all postpubertal cryptorchid testes examined, they do not state so specifically. They do allude nonspecifically to further investigations currently in progress to elucidate the significance, function and origin of these inclusion bodies. A. J. W. 4 figures, 18 references
417
Abstracter's comment. There is no question that this technique is a simple and effective method to treat bladder neck contracture, and can be useful in some cases of early prostatic enlargement. In some cases of prostatic hypertrophy, as opposed to bladder neck contracture, our experience has been that the incisions seem to release a substantial portion oflateral lobe adenoma, which then prolapses into the lumen and makes at least the endoscopic appearance that of more rather than less obstruction. In these cases it has been our policy to proceed with transurethral prostatectomy. A. J. W.
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY Successful Surgical Treatment of Anuria Caused by Renal Artery Occlusion W. FLYE, R. W. ANDERSON, J. C. FISH AND D. SILVER, Department of Surgery, The University of Texas Medical Branch, Galveston, Texas, and Duke University Medical Center, Durham, North Carolina
M.
Ann. Surg., 195: 346-353 (Mar.) 1982
URODYNAMICS, PHYSIOLOGY AND EMBRYOLOGY Extended Bladder N eek Incision for Outflow Obstruction in Male Patients K. P. J. DELAERE, F. M. J. DEBRUYNE AND W. A. MOONEN, Department of Urology, St Radboud Hospital, Catholic University of Nijmegan, Nijmegan, The Netherlands Brit. J. Urol., 55: 225-228 (Apr.) 1983 The authors studied 32 consecutive men from 32 to 84 years old with voiding dysfunction. Uroflowmetry showed a decreased mean maximum flow rate of 7.1 cc per second and post-void residual urine volume was present in 44 per cent of the patients. Endoscopic examination was done to evaluate the appearance of the bladder neck, degree of prostatic enlargement and degree of bladder trabeculation. If mechanical outlet obstruction was not evident further urodynamic investigations were done to differentiate between bladder neck dysfunction and an acontractile bladder. An extended bladder neck incision was used in 32 of these patients: 4 for functional outflow obstruction, 7 for a small obstructive prostate, 2 for detrusor failure and 19 for a bladder neck contracture after prostatectomy. The technique used was that described by Turner Warwick; 2 deep diathermy incisions at the 4 and 8 o'clock positions from the inside of the bladder neck to the verumontanum. Three patients required a second operation. Of the patients 21 were considered cured, 5 improved, 6 unchanged and none worse after bladder neck incision. Retrograde ejaculation was observed in 4 of the 11 men suitable for assessment. The authors conclude that the technique of transurethral incision of the bladder neck and prostate is preferable to the usual transurethral bladder neck resection and prostatectomy for small prostatic enlargement because of the risk of bladder neck contracture. The authors also conclude that in the elderly high risk patient, even with moderate hypertrophy of the prostate, this procedure is to be preferred to the more traumatic and complicated resection or open prostatectomy, although they did not specify the number of such patients present in their series. 3 figures, 3 tables, 9 references
The authors report on 6 patients with anuria caused by renal artery occlusion: 2 had normal functioning kidneys, while 4 had vascular disease before occlusion. Arteriograms confirmed the diagnosis of renal artery occlusion in all 6 patients. The interval of anuria in the former 2 patients was 6 hours and 5 days, respectively. Both patients underwent thrombectomy and dialysis for 30 and 45 days, respectively. The interval of anuria ranged from 2 to 14 days in the 4 patients with vascular disease. Of these 4 patients 3 were treated with grafts from the splenic artery and urine began to form during or soon after the operation. Only 1 of the 4 patients received dialysis for 10 days. All 4 patients died of cardiac failure 1 to 30 months postoperatively. Complete occlusion of the renal artery to an ischemic or a previously normal kidney usually resulted in the loss of function. The viability of a kidney may be maintained by a preexisting collateral flow in an ischemic kidney and immediate development of collateral flow in a previously normal kidney. The authors suggest that renal scan and arteriography should be performed in patients with acute onset of anuria to detect renal artery occlusion in preparation for revascularization. F. T. A. 6 figures, 1 table, 35 references
Potential Errors in the Laboratory Diagnosis of Paroxysmal Nocturnal Hemoglobinuria
R. C.
HARRUFF AND R. J. ROHN, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, and Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
Amer. J. Clin. Path., 80: 152-158 (Aug.) 1983 The diagnosis of paroxysmal nocturnal hemoglobinuria is made by demonstrating erythrocytes with an extremely high sensitivity to complement mediated hemolysis. In a review of patients with positive results in ~1 tests for paroxysmal nocturnal hemoglobinuria there appeared initially to be no correlation among test results. Often, only 2 of 3 patients had positive results, making interpretation difficult. To resolve these discrepancies an examination of the various procedures
lateral scrotal testes and 2 controls (a patient with prostatic carcinoma and a healthy, fertile man at the time of vasectomy). In cryptorchid testes only from postpubertal patients the authors describe cytoplasmic inclusion bodies "here and there which were fascicular in form". These inclusion bodies were not found in the Leydig cells of contralateral descended testes or from the 2 normal controls. Likewise, these bodies were not demonstrated in the Leydig cells of undescended testes of prepubertal individuals. The significance of these inclusion bodies is unknown. The authors refer to certain other "regressive changes" in the Leydig cells of these postpubertal cryptorchid testes but whether these other changes were present universally in all such testes is unclear. Also, although the authors seem to imply that these nonReinke inclusion bodies were found in the Leydig cells of all postpubertal cryptorchid testes examined, they do not state so specifically. They do allude nonspecifically to further investigations currently in progress to elucidate the significance, function and origin of these inclusion bodies. A. J. W. 4 figures, 18 references
417
Abstracter's comment. There is no question that this technique is a simple and effective method to treat bladder neck contracture, and can be useful in some cases of early prostatic enlargement. In some cases of prostatic hypertrophy, as opposed to bladder neck contracture, our experience has been that the incisions seem to release a substantial portion oflateral lobe adenoma, which then prolapses into the lumen and makes at least the endoscopic appearance that of more rather than less obstruction. In these cases it has been our policy to proceed with transurethral prostatectomy. A. J. W.
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY Successful Surgical Treatment of Anuria Caused by Renal Artery Occlusion W. FLYE, R. W. ANDERSON, J. C. FISH AND D. SILVER, Department of Surgery, The University of Texas Medical Branch, Galveston, Texas, and Duke University Medical Center, Durham, North Carolina
M.
Ann. Surg., 195: 346-353 (Mar.) 1982
URODYNAMICS, PHYSIOLOGY AND EMBRYOLOGY Extended Bladder N eek Incision for Outflow Obstruction in Male Patients K. P. J. DELAERE, F. M. J. DEBRUYNE AND W. A. MOONEN, Department of Urology, St Radboud Hospital, Catholic University of Nijmegan, Nijmegan, The Netherlands Brit. J. Urol., 55: 225-228 (Apr.) 1983 The authors studied 32 consecutive men from 32 to 84 years old with voiding dysfunction. Uroflowmetry showed a decreased mean maximum flow rate of 7.1 cc per second and post-void residual urine volume was present in 44 per cent of the patients. Endoscopic examination was done to evaluate the appearance of the bladder neck, degree of prostatic enlargement and degree of bladder trabeculation. If mechanical outlet obstruction was not evident further urodynamic investigations were done to differentiate between bladder neck dysfunction and an acontractile bladder. An extended bladder neck incision was used in 32 of these patients: 4 for functional outflow obstruction, 7 for a small obstructive prostate, 2 for detrusor failure and 19 for a bladder neck contracture after prostatectomy. The technique used was that described by Turner Warwick; 2 deep diathermy incisions at the 4 and 8 o'clock positions from the inside of the bladder neck to the verumontanum. Three patients required a second operation. Of the patients 21 were considered cured, 5 improved, 6 unchanged and none worse after bladder neck incision. Retrograde ejaculation was observed in 4 of the 11 men suitable for assessment. The authors conclude that the technique of transurethral incision of the bladder neck and prostate is preferable to the usual transurethral bladder neck resection and prostatectomy for small prostatic enlargement because of the risk of bladder neck contracture. The authors also conclude that in the elderly high risk patient, even with moderate hypertrophy of the prostate, this procedure is to be preferred to the more traumatic and complicated resection or open prostatectomy, although they did not specify the number of such patients present in their series. 3 figures, 3 tables, 9 references
The authors report on 6 patients with anuria caused by renal artery occlusion: 2 had normal functioning kidneys, while 4 had vascular disease before occlusion. Arteriograms confirmed the diagnosis of renal artery occlusion in all 6 patients. The interval of anuria in the former 2 patients was 6 hours and 5 days, respectively. Both patients underwent thrombectomy and dialysis for 30 and 45 days, respectively. The interval of anuria ranged from 2 to 14 days in the 4 patients with vascular disease. Of these 4 patients 3 were treated with grafts from the splenic artery and urine began to form during or soon after the operation. Only 1 of the 4 patients received dialysis for 10 days. All 4 patients died of cardiac failure 1 to 30 months postoperatively. Complete occlusion of the renal artery to an ischemic or a previously normal kidney usually resulted in the loss of function. The viability of a kidney may be maintained by a preexisting collateral flow in an ischemic kidney and immediate development of collateral flow in a previously normal kidney. The authors suggest that renal scan and arteriography should be performed in patients with acute onset of anuria to detect renal artery occlusion in preparation for revascularization. F. T. A. 6 figures, 1 table, 35 references
Potential Errors in the Laboratory Diagnosis of Paroxysmal Nocturnal Hemoglobinuria
R. C.
HARRUFF AND R. J. ROHN, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, and Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
Amer. J. Clin. Path., 80: 152-158 (Aug.) 1983 The diagnosis of paroxysmal nocturnal hemoglobinuria is made by demonstrating erythrocytes with an extremely high sensitivity to complement mediated hemolysis. In a review of patients with positive results in ~1 tests for paroxysmal nocturnal hemoglobinuria there appeared initially to be no correlation among test results. Often, only 2 of 3 patients had positive results, making interpretation difficult. To resolve these discrepancies an examination of the various procedures