Cases reported "Urologic Diseases"

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11/18. factor xi deficiency: detection and management during urological surgery.

    Hereditary factor xi deficiency may remain undiagnosed until severe bleeding is observed after an operation or trauma. Two such cases were encountered and, therefore, a regular screening test for coagulation disorders among urological patients was initiated. During 2 years (1975 and 1976) 10 additional cases of factor xi deficiency were detected: 5 severe and 5 partial. All patients were Ashkenazic jews of Eastern European origin. The 5 patients with severe factor XI deficiency underwent an operation without any complications. They were transfused with 5 to 20 ml./kg./day of fresh frozen plasma from the day before the operation until 10 to 14 days postoperatively. Of the 5 patients with partial XI deficiency 4 underwent an operation. In 1 of 3 patients who did not receive transfusions postoperative bleeding was observed. A minimal level of 0.3 U./ml. (30 per cent) factor XI was found necessary to ensure good hemostasis during and after an operation. In view of a recent finding of relatively high gene frequency of factor xi deficiency in Ashkenazic jews it seems warranted to do a partial thromboplastin time in such patients who need an operation.
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12/18. Whitaker test: differentiation of obstructive from nonobstructive uropathy.

    The Whitaker test, a urodynamic study, combined with antegrade pyelography has been used recently to evaluate persistent upper urinary tract dilatation after operative correction of obstruction. This test will differentiate patients with residual or recurrent obstruction from those with dilatation secondary to permanent changes in the musculature. It is useful in evaluating patients with questionable ureteropelvic or ureterovesical junction obstruction, or primary defects in the ureteral musculature, such as prune-belly syndrome. It also will establish when urinary diversion safely can be discontinued in postoperative patients. Percutaneous puncture of the renal pelvis is performed or an indwelling nephrostomy tube is used. The upper urinary tract is then perfused at a constant rate of 5--10 ml/min with saline or diluted contrast media, and a serial pressure recording is made in the renal pelvis and bladder. The high flow rate used will be tolerated easily in a nonobstructed system without a progressive rise in renal pelvic pressure. In obstructed systems abnormally high pressure above 12 cm water or a constant rise in pressure will be recorded. Videotaping of ureteral peristalsis and spot films of the upper urinary tract complete the evaluation.
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13/18. CT for diagnosis and management of urinary extravasation.

    In 15 patients with extravasation of urine computed tomography (CT) findings immediately after urography were studied. In 11 patients leakage of urine was a postoperative complication. The extent of urine collections was better demonstrated by CT than urography in seven cases. Two patients had recurrent or residual tumor that was shown only by CT. One patient had an unsuspected second site of extravasation localized by CT. Diagnostic information obtained from the CT scan may be useful in planning appropriate treatment.
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14/18. Complications relating to vascular prosthetic grafts.

    Arteriography remains the definitive radiologic procedure for diagnosing complications of vascular prosthetic grafting. Gray scale B-mode ultrasonography is well suited for detection of false aneurysms, abscesses, and hematomas. The gastrointestinal series is of limited value in assessing most grafts. In non emergent cases, excretory urography may provide useful diagnostic information as well as determine the location of the kidneys and ureters preoperatively. Computed tomography may aid in demonstrating and following the course of postoperative hematomas; it may also be valuable in demonstrating periprosthetic abscess. A strategy is suggested for selecting the appropriate method of evaluating vascular prosthetic grafts.
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keywords = operative
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15/18. color photography in open urological surgery.

    The quality of intraoperative color slide photography can be improved by 1) orienting the viewer with landmark outline and constant camera position during the procedure, 2) brown gloves to avoid contrast within the operative field, 3) blue sponges to absorb blood, 4) contrasting stay sutures or tapes and 5) taking multiple pictures at different exposures. These points are illustrated with the photographic record of the repair of multiple renal artery aneurysms to provide the urologist with helpful hints in the recording of his interesting or challenging operative procedures.
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16/18. Urological aspects of primary retroperitoneal tumours.

    An analysis of 50 primary retroperitoneal tumours is presented with emphasis on the urological aspect. 70-80% of the tumours were malignant and sarcomas predominate. The tumour mass was palpable in over 70% of the cases. Frequent involvement of the urinary tract caused lumbar pain in 78% of cases. Intravenous urography and retrograde pyelography are the greatest single aids in accurate diagnosis of primary retroperitoneal tumours since over 70% show abnormalities. Selective angiograms may define the size and operability of the tumour. When diagnosed, extirpation of the tumour is possible in only 30-40% of cases. Postoperative mortality is about 10%. Since 70% of these tumours are radiosensitive, radiotherapy improves the prognosis. survival for more than 2 years after surgery is exceptional.
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keywords = operative
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17/18. Neonatal regional anesthesia: alternative to general anesthesia for urologic surgery.

    The physiologic immaturity of respiratory musculature and central respiratory control centers leads to an increased risk of apnea and respiratory complications following general anesthesia in the neonate. Regional anesthetic techniques such as spinal and caudal epidural anesthesia may obviate the need for general anesthesia and lessen the risks of perioperative morbidity. Although these techniques have been previously described in infants, the majority of reports focus on regional anesthesia during herniorrhaphy in the former, preterm infant. There is relatively little or no information concerning regional anesthesia during urologic surgery in infants, especially during the actual neonatal period (0 to 28 days). We report on three neonates (2.17 to 3.8 kg) who required anesthetic care during the neonatal period for various urologic procedures including cystoscopy, incision of a ureterocele, and vesicostomy placement. Either caudal or spinal anesthesia was successfully used in the awake infant without the need for supplemental anesthetic agents (intravenous or inhalational). The advantages, risks, and applications of regional anesthesia during urologic surgery in the neonate are reviewed.
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18/18. Laparoscopic nephropexy: a case report.

    The laparoscopic approach is an ideal method for nephropexy because it produces less postoperative pain and allows an early recovery. We report a case of symptomatic renal ptosis treated laparoscopically with good success.
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