Douglas D. Morehouse

Management of Prostatomembranous Urethral Disruption: 13-Year Experience

AbstractInitial management of all cases of prostatomembranous urethral disruption at our hospital since 1965 has consisted of suprapubic cystostomy alone. In addition, a significant number of cases treated elsewhere with this technique (originally proposed by Johanson in Sweden) were referred to this institution for definitive treatment of the obliterated urethra. The results have been reviewed with reference to the surgical technique, need for additional surgery, urethral patency, urinary control and sexual potency.Of 61 cases managed with this method 58 ruptures were complete and 3 were incomplete. The incomplete cases required no treatment other than the initial cystostomy. Urinary continence without stricture was achieved in 60 cases. Reoperation was required for stricture in 2 cases.The low incidence of sexual impotence (10 per cent or less, depending on the eventual pattern in the children included in the series) had led some observers to suggest that preselection or faulty injury classification mig...

Blunt Renal Trauma in the Pediatric Population: A Retrospective Study

AbstractWe reviewed retrospectively 240 children with blunt renal trauma who were treated conservatively. Epidemiologic data and analysis of the results of treatment of major renal injuries in clinically stable patients managed conservatively are presented. Radiologic assessment of the cases is reviewed and a plea for conservative management of renal injuries in children is made.

A study of the relationship of virus-like particles and Australia Antigen in liver

Abstract The ultrastructural and antigenic characteristics of the HB Ag-associated liver particles and the relationship of the liver particles to serum HB Ag were studied by three correlative and comparative observations. (1) Ultrastructural tissue study in 29 patients defined the morphologic characteristics of the unique noncoated virus-like particles that were found in liver cell nuclei and sometimes in the cytoplasm. Their presence in liver tissue may be of diagnostic significance for active disease. The coated particles were shown to be morphologically identical to the Dane particles in serum, and were found in the cisternae of proliferative endoplasmic reticulum. In addition, the cisternae of the endoplasmic reticulum contained peculiar filaments and their probable cross sections with an owl eye appearance. The outer covering of the coated particles was shown to be continuous with the filaments, suggesting that the latter were probably the crystalloid coat material. (2) Phosphotungstic acid negative stain of liver tissue homogenates and ultrastructural sections of the pellets from the homogenates provided a convenient linkage for comparative morphologic interpretation of the tissue and smear findings. Evidence indicated the hepatic origin of the HB Ag particles. (3) Immunoagglutination electron microscopy indicated that the HB Ag particles in tissue homogenates and sera were antigenically identical, whereas the noncoated particles, although morphologically similar to the core component of the Dane particles, were most likely antigenically different from the coat material of HB Ag. The observations support the concept that the Dane particles have dual antigenic specificities. Possible explanations are given for the absence of pure core particles in the serum.

Immunosuppression and rehabilitation following cadaveric renal transplantation: New Developments☆

Abstract Since the introduction of high-dose drug infusion therapy, using methylprednisolone with or without cyclophosphamide, 41 cadaveric renal allografts in 38 patients have been performed. Overall patient survival is 94 per cent and graft survival is 85 per cent with a three to twenty-three-month follow-up. One-year graft survival is 83 per cent. Low-risk recipients had a high probability of complete rehabilitation by three months post-transplant in this series. High-risk recipients had more morbidity associated with the transplant and a lesser, but reasonably good, rehabilitation potential. This improvement in overall results appears related to a significant improvement in the intensive treatment of acute rejection by high-dose infusion therapy.

Incidence of Early Urinary Tract Infections and Relationship to Subsequent Rejection Episodes in Renal Allograft Recipients

The purpose of this study was to define the incidence of urinary tract infections (UTI) in the early post-transplant period and to determine whether or not they have any adverse influence on the severity and reversibility of rejection episodes. 166 recipients of 1st allografts (127 recipients of nonliving donor kidneys and 39 recipients of living related donor kidneys) were classified according to whether or not they had UTI during the 1 st month post-transplant. In each group, the number of subsequent rejection episodes within the 1st 6 weeks post-transplant was evaluated, and the rejections were classified as reversible or irreversible. The same evaluation was done for the 127 recipients of nonliving donor kidneys as a subgroup. The summarized results of the latter group are as follows: 52 of 127 patients had UTI for an incidence of 41 %; 40 of 52 patients (77%) with previous UTI compared to 55 of 75 patients (73%) without previous UTI developed rejection episodes. 20% of the rejection episodes were irreversible in the group with previous UTI compared to 24% in the group without previous UTI. Rejections occur with similar frequency in recipients with and without previous UTI in the early post-transplant period. No evidence was found to suggest that post-transplant UTI trigger rejection episodes or are associated with severe rejection crises. However, significantly more patients with UTI than without UTI were anergic to delayed-type hypersensitivity (DTH) skin test antigens pretransplant, had longer dialysis-dependent uremia and had received pretransplant blood transfusions. These latter three interrelated variables are thus considered to be infection-related risk factors.