Ureteroscopic Pyelolysis for Pelviureteric Junction Obstruction

Ureteroscopic Pyelolysis for Pelviureteric Junction Obstruction

232 MISCELLANEOUS METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY Acute Primary Hyperparathyroidism L. A. FITZPATRICK AND J. P. BILEZIKIAN, Departments of ...

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MISCELLANEOUS

METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY Acute Primary Hyperparathyroidism L. A. FITZPATRICK AND J. P. BILEZIKIAN, Departments of Medicine and Pharmacology, College of Physicians and Surgeons, Columbia University, New York, New York Amer. J. Med., 82: 275-282 (Feb.) 1987 The authors report 5 cases and review 43 of acute primary hyperparathyroidism in the literature from 1974 through 1984. Patient age ranged from 27 to 82 years (mean age 55 years), with an even distribution between men and women. The average serum calcium level was 17.5 ± 2.1 mg./dl., with marked elevation of circulating parathyroid hormone averaging 20 times normal. Specific radiological evidence of hyperparathyroid bone disease was seen in 53 per cent of the patients. A high frequency of nephrolithiasis or nephrocalcinosis was noted in 69 per cent of the patients. Signs and symptoms of hypercalcemia or hyperparathyroidism were present in all patients, with central nervous system dysfunction being the predominant feature. Combined renal and skeletal involvement, which is rare in cases of primary hyperparathyroidism, was observed in 50 per cent of the patients, who are to be regarded as candidates for surgical removal of parathyroid adenoma at diagnosis. There were only 3 deaths in this series (6 per cent) compared to a 59 per cent mortality rate reported before 1970. This study indicates that extreme increases in parathyroid hormone in association with marked hypercalcemia strongly suggest acute primary hyperparathyroidism, compared to the humoral hypercalcemia of malignancy in which case marked hypercalcemia is not associated with elevations in the parathyroid hormone level. The pathophysiology of acute primary hyperparathyroidism is not understood but it appears to be consistent with uncontrolled parathyroid hormone secretion followed by cycles of hypercalcemia, polyuria, dehydration, reduced renal function and worsening hypercalcemia. F. T. A. 3 figures, 3 tables, 26 references

Immunohistochemical Analysis of the Human Bladder

R. A. GARDINER, G. J. SEYMOUR, M. F. LAVIN, G. M. STRUTTON, E. GEMMELL AND G. HAZAN, Departments of Surgery, Social and Preventive Dentistry, and Pathology, University of Queensland, Brisbane, Australia Brit. J. Urol., 58: 19-25 (Feb.) 1986 The authors reviewed the current status of the immune profile of the normal component of the bladder. This study focuses on the various subsets of lymphocytes and fibronectin distribution in the lamina propria of the bladder wall. T-lymphocytes were identified in the lamina propria. These cells were functioning mostly as suppressor and/or cytotoxic cells. Fibronectin staining was dense in the vicinity of the basement membrane. An occasional natural killer cell and Langerhans' cells also were identified. This article is interesting to investigators working in the field of bladder immunology. N. J. 6 figures, 2 tables, 34 references

MISCELLANEOUS Ureteroscopic Pyelolysis for Pelviureteric Junction Obstruction J. A. INGLIS AND D. A. TOLLEY, Department of Urology, Royal Infirmary, Edinburgh, United Kingdom Brit. J. Ural., 58: 250-252 (June) 1986 The authors describe the use of a rigid ureterorenoscope to relieve strictures causing secondary ureteropelvic junction obstruction in 2 patients. The advantages of an entirely ureteroscopic approach are the procedure may be done in 1 stage with the patient under general anesthesia and, provided it is uncomplicated, it can be done on an outpatient basis. Furthermore, because the technique essentially is the same as for bladder neck incision or incision of a urethral stricture, it is within the scope of every urologist and it does not require special skill. However, ureterorenoscopy may be a hazardous procedure and difficulties in negotiating the vesicoureteral junction occasionally are encountered. Some difficulty may be encountered in negotiating the pelvic brim. In both patients described ureteroscopic pyelolysis obviated the need for a major operation and almost certain nephrectomy. Because the procedure appears to be associated with little or no morbidity, an attempt at ureteroscopic pyelolysis might be worthwhile in selected patients before a major operation is done. E. D. W. 1 figure, 5 references

The Effect of Age on the Autonomic Innervation of the Urinary Bladder S. A. GILPIN, C. J. GILPIN, J. S. DIXON, J. A. GOSLING AND R. S. KIRBY, Department of Anatomy, University of Manchester, and Department of Urology, Middlesex Hospital, London, United Kingdom Brit. J. Urol., 58: 378-381 (Aug.) 1986 The purpose of the study was to provide a quantitative assessment of the amount of autonomic nerves present within the adult bladder wall at different patient ages. Each patient was normal neurologically and urodynamically, with a stable cystometrogram and no evidence of bladder outlet obstruction. At cystoscopy there was no sign of bladder trabeculation. With light microscopy a significant linear decrease in the amount of nerves positive for acetylcholinesterase was observed with increasing patient age. Counts of axon profiles and measurement of smooth muscle cell cross-sectional areas in the electron microscope revealed a similar decrease in the amount of nerves per mm. 2 of detrusor muscle tissue. These findings confirm that a genuine decrease in the number of nerve axons occurs with age and that the light microscope results are not merely owing to a decrease in the amount of nerve-associated acetylcholinesterase. E. D. W. 2 figures, 1 table, 5 references

Sexual Medicine An Emerging Field, Meeting Reveals S. KATZ, Toronto, Ontario, Canada Canad. Med. Ass. J., 136: 286-288 (Feb. 1) 1987