Showing papers in "BJUI in 1954"

A new theory on the formation of renal alculi1

Abstract: SUMMARY 1. This paper presents a new theory on the formation and growth of urinary calculi based on the lymphatic drainage of the kidney which is described. 2. The material and methods which have been used in studying the formation of renal calculi have been described in detail. These include the technique of microradiography. 3. The current theories of stone formation from the smallest crystalline deposits are reviewed. 4. Observations have been made which are not explained by Randall's theory. 5. By the new theory all the observed facts, including the formation of Randall's plaques, can be explained. 6. Diffraction X-ray analysis has been used to support this new theory. 7. Facts of importance in partial nephrectomy in the treatment of renal lithiasis are emphasised and explained.

Recurrence following operations for upper urinary tract stone1

Abstract: SUMMARY 1 The incidence of recurrence following operative treatment of upper urinary tract stone has been investigated in 216 out of 345 patients subjected to operation during the years 1915 to 1950. These patients all attended for interview followed by X-ray and urine examination. No case is included in which operation took place less than two years ago. 2 Possible aetiological factors are detailed, as well as the side, sex, and age incidence for the entire series of 345 cases. There is evidence of an earlier onset of lithiasis in males. 3 Recurrence has been graded as “mild” and “severe,” depending on whether or not secondary operation has been necessary. “False” recurrences, i.e., stones overlooked at operation, are included, but their incidence is not accurately known. Recurrence figures for the various types of operation are:– Pyelolithotomy (100 cases): Mild recurrence, 20 per cent.; severe recurrence, 27 per cent. Nephrolithotomy (forty cases): Mild recurrence, 25 per cent.; severe recurrence, 37.5 per cent. Ureterolithotomy (forty-nine cases): Mild recurrence, 29 per cent.; severe recurrence, 8 per cent. Ureteric meatotomy (six cases): Mild recurrence, 17 per cent. Nephrectomy (forty-five cases): Contralateral recurrence, 11.1 per cent. The total recurrence following 240 operations of all types (including nephrectomy) is 40 per cent. Following 195 conservative operations the recurrence rate is 46.7 per cent. 4 Less than half the recurrences actively sought advice for relief of symptoms and would have been missed by questionnaire follow-up. 5 Reasons are presented for the high recurrence rate, the principal factor being the strict standards observed in the investigation. 6 Comparison of recurrence in the decades 1930 to 1940 and 1940 to 1950 shows a reduction of 11 per cent. in the latter, from 47 to 36 per cent. 7 Recurrence is twice as common in males (54.3 per cent.) as in females (21.8 per cent.). 8 Contralateral recurrence is almost as common after nephrectomy (11.1 per cent.) as after conservative operations (12.3 per cent.). 9 Of the eighty-nine recurrent cases twenty-five (28 per cent.) were detected within two years, fifty-two (58.4 per cent.) within five years, and seventy-eight (87.6 per cent.) within ten years of operation. 10 Whether the stones were single or multiple seems to bear no constant relationship to the incidence of recurrence. 11 Urinary infection and recurrence are closely related. Of those patients with sterile urine before operation only 13 per cent. had a recurrence compared with 64.5 per cent, of those with infected urine. In this series B. coli was the commonest organism, and the urea-splitting organisms did not appear to be as important as usual. 12 The incidence of hyperparathyroidism is low (2.7 per cent.). 13 The management of recurrent cases is discussed and measures are suggested for avoiding recurrence. Conservatism in this field appears to be completely justified and an increasingly important place has been found for partial nephrectomy. 14 Regular follow-up of these cases is essential. 15 The various operations for upper urinary tract stone treat the effect not the cause. Recurrence may be lessened by the various measures mentioned but will continue until more is known of the underlying aetiology.

The renal circulation after temporary occlusion of the renal artery.

Abstract: SUMMARY An angiographic study was made of the renal circulation of rabbits after total occlusion of the renal vessels for two hours. The angiograms made at twenty-four and forty-eight hours after release of the clamp all showed some abnormality where the vessels had been occluded. In most cases the intrarenal vessels were constricted and the circulation through the kidney, particularly through the peripheral cortex, was severely impaired. This picture was unaltered after administration of hexamethonium bromide. Angiograms of animals which survived, made at six and eight days after the period of temporary occlusion, showed that the renal vasoconstriction had relaxed and the circulation through the kidney had greatly improved. Histologically, the kidneys of those rabbits which did not survive for more than seventy-two hours after release of the clamp showed changes similar to those seen in human cases of “crush syndrome.” The lesions were largely confined to the secreting tubules and were of variable severity and patchy in distribution. They were most extensive in the cortex, but were also present in the outer zone of the medulla. The kidneys of the rabbits which survived for six or more days were essentially normal.

The acid phosphatase content of the enlarged and malignant prostate gland with some observations on histopathology as revealed by Gomori's staining.

Abstract: SUMMARY The glandular acid phosphatase in a series of thirty benign and two cases of malignant enlargement of the prostate was estimated. Wide variation was discovered and the malignant glands were found to contain much less enzyme than the benign. The same glands were stained for acid phosphatase by Gomori's method Acid phosphatase was demonstrated in all. The histology of these sections is described and illustrated. An explanation is submitted for the wide variation in the figures for the benign glands and for the low ones in malignant glands.

Primary neoplasms of the ureter.

Abstract: SUMMARY Twelve cases of primary neoplasms of the ureter are reported. They comprise nine carcinomas and three papillomas. The case histories are described and the cases are classified clinically into four groups. Methods of investigation are discussed, with particular reference to the performance of ureterograms, and attention is drawn to the importance of establishing the cause of unilateral hydronephrosis. The pathology and treatment of the condition are briefly considered.

Chemical imbalance occurring in chronic prostatic obstruction: a preliminary survey1

Abstract: SUMMARY 1 Severe biochemical imbalances have been found in patients suffering from chronic prostatic obstruction. 2 Severe dilutions of the plasma electrolytes have been observed in two patients. 3 Relief of prostatic obstruction has resulted in further biochemical abnormalities due to severe tubular dysfunction. 4 The treatment of these biochemical abnormalities is outlined.

The stability of acid phosphatase in blood and other fluids

Abstract: SUMMARY The acid phosphatase of dilute human seminal plasma is inactivated by heating at 37° C. in the presence of a variety of inorganic buffer mixtures of pH below 4 and above 6.6; at slightly higher pH when serum is present; and at pH 7.2 to 7.4 in human and dog blood kept fluid by neutral citrate/dextrose solutions. The acid phosphatase found in the blood of normal subjects and patients with carcinoma of the prostate is stable for long periods at 37° C. in blood of pH 7.2 to 7.4 kept fluid by neutral citrate/dextrose solutions. Serum separated from the clot from which it has been expelled and exposed to the atmosphere undergoes an alkaline change which makes its acid phosphatase liable to rapid inactivation at temperatures over 20° C. (68° F.). Serum in contact with its clot remains at pH 7.4 for a considerable time, and under these conditions the acid phosphatase in the serum is stable at temperatures below 30° C. (86° F.) for periods up to twenty-four hours. Determination of the acid phosphatase in the plasma of blood kept fluid by acid citrate/dextrose solutions has the following advantages over serum acid phosphatase determination: (1) Plasma acid phosphatase levels are greater than those of the corresponding serum levels; (2) errors due to haemolysis of red blood cells are less likely to occur with plasma than serum determinations; (3) plasma determinations may be made sooner after blood is drawn than serum determinations; (4) less blood is required for plasma than serum determinations; (5) acid phosphatase is so stable in blood preserved with acid citrate/dextrose solution that determinations may be delayed for a week.

Carcinoma of the prostate and the effect of æstrogen therapy

Abstract: SUMMARY 1 One hundred and fourteen cases of carcinoma of the prostate have been reviewed. A study has been made of the course of the disease and the salient features have been analysed. 2 The survival of those patients who had no hormonal therapy has been compared with that of those who received aestrogens. The average duration of survival from the time of diagnosis was sixteen months in the first group and thirty-three months in the second. Few of those patients who had no hormonal treatment survived for three years from the time of onset of symptoms, while the majority of the aestrogen-treated group lived for more than three years. 3 Despite the beneficial effects of aestrogens which generally prolonged life and relieved symptoms, in one-third of the cases the course of the disease was not apparently altered.

Prolapse of a ureterocele in an adult.

Abstract: SUMMARY A case is reported of a ureterocele, containing a calculus, prolapsing through the urethra and presenting at the vulva in a female aged 63 years. The calculus was extracted, following meatotomy, while the ureterocele was still prolapsed. The ureterocele was reduced into the bladder and later resected transurethrally. The observation is made that compression of a prolapsed ureterocele causes pain in the loin on the same side.

Cystic lymphangioma: an uncommon type of scrotal swelling.

Abstract: SUMMARY 1 A case of cystic lymphangioma of the scrotum is reported. 2 It seems that only seven cases have been reported previously. 3 Plain muscle may be a prominent feature of the microscopical appearances.

Replacement of urethra1

Abstract: SUMMARY These case reports considered together illustrate the replacement of all parts of the male urethra from the apex of the prostate to the glans penis. The deformity to be dealt with was first converted to one of hypospadias and the hypospadias repaired by the method of Denis Browne.

Cystometry: an apparatus and a method.

Abstract: SUMMARY A simple apparatus which allows cystometry to be performed easily in any hospital ward with minimal delay in the provision of sterile apparatus is described. The use of a finger-cot to separate blood from an aneroid sphygmomanometer is depicted in an article on intra-arterial transfusion by Robertson, Trincher, and Dennis (1948). The aneroid pressure-gauge described above was obtained from the Genito- Urinary Manufacturing Company, London.