Joseph C. Addonizio

The MURCS association: Müllerian duct aplasia, renal aplasia, and cervicothoracic somite dysplasia

Two patients and 28 others in the literature were ascertained because of congenital vaginal agenesis associated with clinical and/or radiographic evidence of malformations derived from the cervicothoracic somites. In these patients, there was a high incidence of Müllerian duct aplasia/hypoplasia (96%), renal agenesis and/or ectopy (80%), and abnormalities related to cervicothoracic somite dysplasia, particularly 2 to 4 anomalous vertebrae located between C5-T1 (80%). These consistent findings suggest a distinctive non-random association of malformations: Müllerian duct (MU) aplasia, renal (R) aplasia, and cervicothoracic somite (CS) dysplasia (MURCS). Identification of one component of the MURCS association suggests the presence of the other associated anomalies. A hypothesis for the embryogenic pathogenesis of the MURCS association is proposed which attributes the malformations to an alteration of the blastemas of the lower cervical-upper thoracic somites, arm buds, and pronephric ducts, all of which have an intimate spatial relationship at the end of the fourth week of fetal life. A presently unidentified teratogen may be one of the possible causes of the MURCS association on the basis of a lack of familial transmission, normal chromosomal studies, and the similar effects of a known teratogen (thalidomide) on the developing genitourinary tract.

Ureteral Replacement Using Collagen Sponge Tube Grafts

The use of a collagen sponge tube graft as a material for segmental ureteral replacement was investigated. The structural design of the collagen sponge graft was achieved by cell culture on the matrix. MGH-U1 cells, derived from bladder cell carcinoma, were grown in vitro on the collagen sponge matrix with excellent biocompatibility and without evidence of cytotoxicity. The collagen sponge demonstrated biodegradability when implanted subcutaneously in dogs. However, a urine exposure test of collagen sponge in rat bladders revealed extensive salt deposits on its surface in some rats, as observed by crystallographic examination. Segmental ureteral replacements by collagen sponge tube grafts, accompanied by ureteral splint catheters, were performed in dogs. There was extensive uro-epithelial cell regeneration on the inner surface of the collagen grafts, without evidence of severe hydronephrosis, 5 to 12 weeks following the procedure. The results indicate the potential for ureteral replacement by collagen sponge tube grafts, which would act as non-toxic, biodegradable scaffolds inducing the regenerative activity of the ureter.

Use of ultrasonic surgical aspirator in renal surgery

The Cavitron ultrasonic surgical aspirator (CUSA) was used to fragment and aspirate normal and pathologic renal tissue. The operative blood loss utilizing the CUSA was markedly reduced compared to electrocautery or the cold scalpel. This is due to the ability of the instrument selectively to fragment and aspirate tissue with high-water content, such as renal parenchyma, while sparing tissue with higher elastin and collagen content, such as collecting system or blood vessel. The surgeon can therefore skeletonize and secure the blood vessels before they are divided.

Stab Wounds of the Kidney: Conservative Management in Flank Penetration

Between April 1976 and December 1980, 373 patients with stab wounds of the abdomen were seen in our emergency room. Of 47 cases (12.6 per cent) in which renal penetration was confirmed nonoperative management was selected in 34 (70.2 per cent), with no further sequelae in 28 (82 per cent). The site of abdominal penetration was posterior to the anterior axillary line in 30 successful conservatively managed patients (88 per cent). The site of abdominal wound penetration in conjunction with clinical stability may avoid unnecessary renal explorations.

Establishment of new human prostatic cancer cell line (JCA-I)

The establishment of a new human prostatic cancer cell line is described. This cell line was derived from a poorly to moderately differentiated prostatic adenocarcinoma. It has been maintained in tissue culture for fourteen months and has been passed fifty-two times. This cell line has an ability to form colonies in soft agar suspension cultures, and also is transplantable to nude mice. Tumors grown in nude mice revealed a poorly differentiated adenocarcinoma with positive PSA staining. Acid phosphatase activity was detected in freeze-thawed cells by enzymatic assay. A karyotype analysis demonstrated aneuploidy with a model chromosomal number of 69 and six marker chromosomes.

Application of microwave tissuecoagulation in partial nephrectomy

Abstract Microwave tissue coagulation was used during partial nephrectomy in 10 mongreldogs, without clamping the renal artery. There were no major complications, such as retroperitoneal hematoma, abscess formation, or macroscopic infarction of the kidney tissue related to this new procedure. The advantages of microwave coagulation are reduced blood loss, shorter operative time, and minimal risk of vascular injury.

Fibroepithelial Polyp Associated with Congenital Ureteral Diverticulum: Report of 2 Cases

We report 2 cases of a single fibroepithelial polyp in conjunction with ureteral diverticula. Ureterorenoscopy is valuable in the identification of the benign nature of these lesions preoperatively to avert unnecessary nephroureterectomy. The etiology of fibroepithelial polyps remains unknown, although many theories have been proposed. Recent evidence has suggested that these lesions may be a developmental anomaly. Congenital ureteral diverticula also are thought to be of developmental origin. We hypothesize that fibroepithelial polyps and congenital diverticula of the ureter are part of a spectrum of the same developmental anomaly.

Another look at cryoprostatectomy

Abstract The early 1960s witnessed a marked advancement in cryogenic research and its clinical application to surgery. Coopers development of a closed controllable method for destruction of tissue by cryosurgery was at the forefront. In 1964, Gonder et al . (3) modified this apparatus and popularized its use in the treatment of the common problem of the obstructing prostate gland. However, this potential panacea soon presented the urologists with unexpected serious complicaions. Prolonged sloughing of the necrotized prostate, accidental freezing of rectum, bladder, external urethral sphincter occurred which were unacceptable and rarely encountered with conventional methods of prostatectomy. At this point in time, most urologists in the United States abandoned this procedure. However, others persisted and modified this technique with more precise methods of control monitoring and utilized a small resection of thawing prostate at the time of cryoprostatectomy. During this transition phase, the indications were justifiably narrowed to (i) poor-risk patients, (ii) those with hematological problems, (iii) treatment of large inoperable prostate carcinomas. Our experience with the last 100 cases of combined cryotransurethral prostatectomy encourages another look at this procedure. The utilization of this method, however, must be restricted to a select group of patients and should be carried out by only those urologists properly trained in this surgical modality.

Epididymal metastasis from prostatic carcinoma

Abstract The ninth case of prostatic carcinoma metastasizing to the epididymis is presented, and we review the literature.

Ultrasonic aspiration of prostate, bladder tumors, and stones: Progress report

The projected advantages of ultrasonic surgery on prostate, bladder tumors, and stones are: (1) precise histologic diagnosis without microscopic distortion as occurs with electrocautery; (2) continuous uninterrupted surgery; (3) improved hemostasis; (4) protection of external sphincter; (5) easy surgical technique to learn; (6) adaptability for video TUR; (7) can remove bladder stones and perform TURP at one sitting; (8) no fear of bladder wall injury during lithotripsy since stone is sucked to aspirator for dissolution; (9) no electrical burns or obturator reflex since electricity is not used to resect.