Karl R. Herwig

Extra Vesical Ureteroneocystostomy in 170 Renal Transplant Patients

Urinary tract reconstitution was done in 170 consecutive renal transplant patients, using an extravesical ureteronecystostomy. The urologic complication rate was 8.5 per cent but complications associated directly with the anastomosis occurred in only 5 per cent of the cases. There have been no anastomotic complications in the last 104 transplants. Vesicoureteral reflux occurred in 20 per cent of 50 patients surveyed. Death in 2 cases and loss of the kidney in 1 were associated with urologic complications.

Papillary necrosis Result of intravesical instillation of formalin

Abstract The management of patients with intractable bleeding from radiation or cyclophosphamide cystitis can create a serious dilemma. However, the use of intravesical formalin shows promise of gaining popularity. A case in which this procedure was used successfully is described. The possible complications of this type of therapy are cited; therefore, it must be approached with caution particularly in respect to dosage.

Vesicopyeloplasty in renal transplant patients : a 20-year followup

Loss of a ureter in a renal transplant patient often results in transplant nephrectomy. In 1973 we used vesicopyelostomy with the bladder directly sutured to the renal pelvis as a method of reconstruction in 2 renal transplant patients following ureteral loss. These patients have been followed for more than 20 years and both renal allografts have functioned well. The status of these patients and a review of the literature on vesicopyelostomy are presented.

Bilateral simultaneously-occurring adenocarcinoma of the kidney.

Our 3 patients with simultaneously-occurring hypernephromas treated with simultaneously-directed surgical therapy on both kidneys are described. One patient died with residual neoplasm 2 1/2 years postoperatively, while the other 2 patients are alive and presumably free of tumor 60 and 22 months postoperatively.

Flexible Fiberoscopy of Urinary Conduits

During the last 2 years 7 patients with intestinal urinary conduits, exhibiting symptoms of gross hematuria and ureteral stricture or other difficulty with the conduit, were examined with flexible fiberoptic endoscopes. The entire lumen of the intestinal conduit, all urinary-intestinal anastomoses and the bladder of 1 patient were visualized successfully. Retrograde pyelography was performed on 2 patients. In 4 of 7 patients we were able to demonstrate abnormalities that were not demonstrable by any other method.

EFFECT OF TESTOSTERONE ON LONG-TERM ORGAN CULTURES OF CANINE PROSTATE

SummaryOrgan cultures of rodent and human prostate glands have shown marked differences in their morphological response to testosterone. In this study, explants from 19 canine prostate glands were cultivated for a minimum of 9 days in Trowell’s T-8 medium. Groups of explants were exposed to media containing from 0.05 to 100 µm testosterone. While the higher testosterone levels (50 and 100 µm) markedly decreased explant viability, explants cultivated at lower levels (0.05 to 5 µm) appeared similar to control explants in testosterone-free Trowell’s T-8 medium. Atmospheric mixtures containing either 95% or 50% oxygen were equally effective.Shortly after the cultures were initiated, large amounts of secretory product were liberated into the lumen. After 9 or more days in vitro, glandular epithelium appeared cuboidal and never revealed the acid phosphatase-rich secretory granules seen in the preculture control. However, the epithelium exhibited an increase in alkaline phosphatase and lipid content following cultivation.

Adult renal myoepithelial hamartoma

A renal myoepithelial hamartoma presented as a lucent filling defect with gross hematuria in an adult female. Preoperative studies caused conflicting impressions. The predominance of smooth muscle and incorporated tubuloepithelial elements characterize the tumor as a hamartoma of myoepithelial type. Pertinent review of the literature confirms the rarity of this lesion in adults.

Interstitial cell tumor Profile of hormone-producing tumor

Interstitial cell tumor of the testis in an adult male can present with feminization and psychologic changes. The feminization and psychologic changes most likely reflect production of estrogen by the interstitial cell tumor. Removal of the tumor causes rapid return of the pituitary-testicular axis to normal, loss of feminization, and development of male psychosocial characteristics.

Usefulness of adrenal venography and iodocholesterol scan in adrenal surgery

Adrenal scintiscanning and venography with sampling of adrenal venous blood are valuable methods to localize adrenal cortical lesions of Cushings syndrome and primary aldosteronism. Adrenal scintiscanning with dexamethasone suppression is most useful in differentiating adenoma from hyperplasia of primary aldosteronism.