Congenital renal anomaly: evaluation with 99mTc-dimercaptosuccinic acid renal scintigraphy

Technetium 99m-2,3, dimercaptosuccinic acid (99mTc-DMSA) preferentially accumulates in the renal cortex, demonstrating functioning cortical mass. We used 99mTc-DMSA renal scintigraphy in ten patients with horseshoe kidneys and five patients with unilateral fused kidneys. The results show that 99mTc-DMSA renal scintigraphy reliably establishes the diagnosis of horseshoe kidney and clearly shows the isthmus, which is very essential for proper management. The technique also aids in the definitive assessment of separate kidney function and of total radionuclide uptake is possible using 99mTc-DMSA scintigraphy.     

Risk factors for the development of distant metastases in patients undergoing pelvic lymphadenectomy for prostatic cancer

Sixty-two patients with clinically localized prostatic cancer underwent pelvic lymphadenectomy between 1972 and 1975. Thirty-one patients had concomitant total prostatectomy. The objectives of this study included determination of the relation of findings at lymphadenectomy, with and without total prostatectomy, to subsequent clinical course, identification of histologic parameters related to the subsequent appearance of distant metastatic disease, and determination of the vital status of patients initially having a staging pelvic lymphadenectomy. Follow-up of at least 5 years was obtained for 52 patients, including 28 who had concomitant total prostatectomy. Ten patients were lost to follow-up. Fifty-four percent are alive without evidence of disease, 25 percent are alive with metastatic disease, 10 percent have died with metastatic cancer, and 12 percent have died without prostate cancer. Metastases have developed in 11 (37 percent) of 30 patients with negative pelvic lymph nodes, reflecting either seminal vesicle or transcapsular invasion. Minimal lymph node involvement (one or two pelvic nodes) alone may not be as poor a prognostic sign as originally thought. Metastases have developed in 22 percent of nine patients with tumor considered stage B₂. No recurrences or metastases were noted in the seven patients with stage b₁ disease. Patients with high grade lesions were at no increased risk for distant metastases, although they constituted a relatively small segment of our series. Thus the extent of local disease correlates with the subsequent development of distant metastasis. Adjuvant systemic treatment (endocrine manipulation, chemotherapy, or both) has a rational basis in patients with one or more of these identifiable risk factors     

Bacillus Calmette-Guerin immunotherapy of the cancer-contaminated wound.

A model has been developed to study the usefulness of immunologically active irrigating solutions in the prevention of implantation of cancer cells in surgical wounds. A poorly differentiated transitional cell carcinoma of the bladder (MBT₂) was used in serial transplants. Tumor suspensions were instilled into 1-cm-long, 0.3-cm-deep incisions in the lateral thigh and irrigated with test or control solutions. Levamisole, Glaxo strain Bacillus Calmette-Guerin (BCG), and Tice strain BCG were compared with distilled water and saline controls. Effects of preimmunization with BCG were also studied. Significant improvements were found only in animals treated with Tice strain BCG. Seventy percent of Tice strain BCG-treated animals were long-term survivors. Overall, BCG-preimmunized animals showed slightly slower tumor growth rates, but only the Tice strain BCG animals showed lower tumor incidence and higher long-term survival (40%). BCG dosage and route of administration are discussed. The current study supports the proposition that BCG may be useful in decreasing the local postoperative recurrence of tumor in patients with bladder carcinoma.     

Ex vivo renal surgery. Further use of a new perfusate

Ex vivo renal operations were performed in fifteen dogs to determine the efficacy of a new ex vivo renal preservation technic. The method described and illustrated in this report proved to be simple and requires neither continuous renal cooling nor continuous renal perfusion. A single initial perfusion of the totally ischemic canine kidney with a new hyperosmolar intracellular electrolyte solution was able to offer cellular protection from the otherwise lethal effect of ambiothermic exposure for up to five hours without significant loss of renal function. Pre- and postoperative serum creatinine levels were assessed to determine renal function. Ex vivo renal surgical technics have important potential application when in situ repair is too hazardous or its effect uncertain.     

在浅表膀胱癌教学查房中引入循证医学理念

以浅表膀胱癌术后灌注治疗为例,针对目前关于此类型肿瘤术后不同的治疗意见,在教学查房中引入循证医学理念;要求学生应用循证医学思维剖析问题,并提出最终的解决方案。以此类肿瘤循证医学研究为例,指导学生学习文献采集、纳入、剔除及进行结论分析。让学生了解循证医学思维,并指导其在以后临床实践中加以应用。     

表格式专科护理记录单在优质护理示范病区中的应用效果,

目的 设计泌尿外科表格式专科护理记录单并探讨其应用效果.方法 根据泌尿外科专科特色设计表格武护理记录单,对98例住院患者同期使用新旧两种护理记录单进行书写记录,比较两种护理记录单所用的时间、纸张页数及质量评分差异.结果98例住院患者表格武专科护理记录所用时间、纸张页数比原护理记录明显减少,质量评分明显提高.结论表格武专科护理记录单可大大减少护理记录时间及记录纸张页数,提高护理记录质量,且更能体现专科护理观察重点,利于了解患者的病情及诊疗护理进展,书写界面简洁明了,值得推广.