Mohammad Amin

Open pelvic fractures.

Open pelvic fracture is a devastating injury with a reported 50% mortality rate from massive bleeding and pelvic sepsis. Utilizing a graded approach to management of hemorrhage that included wound packing, anti-shock trousers, angiographic embolization, and hemipelvectomy, we controlled bleeding in all but one of the 35 patients in this series. Patients lost an average of 15 units of blood. The overall survival rate was 94.5% in this series, with one death each from hemorrhage and head injury. Prevention of invasive infection by a diverting colostomy in patients with buttock wounds or perineal wounds was stressed, while anterior soft-tissue wound were managed selectively. Debridement and frequent dressing changes under anesthesia were necessary to prevent and/or treat soft-tissue infection. Associated injuries occur commonly with genitourinary and peripheral nerve trauma and account for the majority of the long-term morbidity.

Complications of Whole Bladder Dihematoporphyrin Ether Photodynamic Therapy

Photodynamic therapy with dihematoporphyrin ether was used to treat superficial bladder tumors in 7 patients with a followup of at least 1 year. Each patient received treatment to the whole bladder and those with papillary lesions received additional focal treatment. At 3 months 4 of the 5 patients with papillary tumors (stages Ta and T1) and 1 of the 2 with diffuse carcinoma in situ (Tis) were free of disease. However, at 1 year only 3 patients remained free of disease. Of 5 patients with an increase in irritative bladder symptoms 4 had a contracted bladder, hydroureteronephrosis and vesicoureteral reflux. Deep bladder biopsies showed replacement of smooth muscle by fibrous tissue. Six patients had mild to moderate skin phototoxicity. We conclude that although photodynamic therapy is an attractive and exciting method to treat cancer, its use with dihematoporphyrin ether in cases of bladder carcinoma can be associated with significant complications. The correct treatment parameters for safe, effective therapy are not known to date.

Diethylstilbestrol in treatment of postorchiectomy vasomotor symptoms and its relationship with serum follicle-stimulating hormone, luteinizing hormone, and testosterone

Vasomotor symptoms such as hot flushes and profuse sweating have been described after bilateral orchiectomy. We evaluated 26 patients who had undergone bilateral orchiectomy for prostatic carcinoma to determine the incidence of vasomotor symptoms and the efficacy of low-dose diethylstilbestrol (DES) in the treatment of those symptoms. Measurements of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone were performed to look for endocrine patterns which may be related to the presence of vasomotor symptoms. Fourteen patients (54%) reported the presence of vasomotor symptoms beginning one to four weeks after surgery. These patients were treated with DES or placebo in a double-blind crossover trial. The frequency and severity of hot flushes were significantly reduced during the time DES was given. This was accomplished with a low dose of 1 mg daily of DES which avoids the cardiovascular complications of higher doses. We found no correlation between the presence, severity, or frequency of hot flushes and serum gonadotropin or testosterone concentrations.

Treatment of Radiation or Cyclophosphamide Induced Hemorrhagic Cystitis using Conjugated Estrogen

Five patients with severe hemorrhagic cystitis induced by radiation and/or cyclophosphamide were systematically treated with conjugated estrogen. Two patients received conjugated estrogen twice each day (1 mg. per kg.) intravenously, followed on day 3 and thereafter by 5 mg. per day orally. Hematuria decreased markedly 6 to 8 hours after the initial dose and urine color became light yellow within 1 to 3 days. The other 3 patients received 5 mg. conjugated estrogen per day orally and urine color became clear within 4 to 7 days. Hematuria did not recur during 12 to 22 months in 4 patients who received daily conjugated estrogen (1.25 mg.). However, transient episodes of mild hematuria persisted in 1 patient during the 3-month followup despite a higher dose of conjugated estrogen (10 mg. per day). Complications, including thromboembolism and other side effects associated with conjugated estrogen, were not observed in these patients. We postulate that conjugated estrogen controls hematuria in hemorrhagic cystitis by decreasing the fragility of the mucosal microvasculature of the bladder.

Living donor nephrectomy: factors influencing morbidity.

Recent interest in transperitoneal live donor nephrectomy prompted us to review our experience with 104 live donor nephrectomies performed through a standard flank extraperitoneal approach. There were no deaths and 14.4 per cent of the patients had minor complications that were managed easily. Factors influencing morbidity in the voluntary donor are analyzed.

Urologic Complications Following Abdominoperineal Resection

In a retrospective study we analyzed the high incidence of 75 urological complications after abdominoperineal resection in 52 patients. A prospective study was done also to anticipate as well as to minimize or eliminate these highly significant complications. Direct injury leading to obstruction and fistula formation was avoided. Obstructive uropathy in 10 of 25 male patients was found as a direct result of preoperative evaluation. Same day prostatectomies in 5 patients made no appreciable difference in the urological management, complication rate or end results. Neurogenic bladder dysfunction of various degrees was found in 50 per cent of all patients but represented a long-term problem in only 10 per cent.

Blastomycosis of the Genitourinary Tract

In a retrospective study of 51 cases of systemic North American blastomycosis 11 patients were found to have genitourinary tract involvement, the prostate and epididymis being most commonly affected. Diagnosis was made by culture of the fungus from urine, abscess or prostate secretions, morphologic identification of the characteristic organism in urine or secretions, or histologic examination of tissue specimens. Treatment with amphotericin B reduced the mortality rate of 90 per cent to as low as 10 per cent. Long-term followup is necessary because of a relapse rate of 10 to 15 per cent.

Autogenous Tunica Vaginalis Graft for Peyronie’s Disease: An Experimental Study and its Clinical Application

Tunica vaginalis autografting was done after patches of tunica albuginea of the penis were excised in 5 dogs. Examination of these grafts 4 to 12 weeks later showed that they were well accepted. A selected group of 5 patients with Peyronies disease underwent excision of Peyronies plaques and autogenous tunica vaginalis grafting with satisfactory results in all cases.

Antibacterial prophylaxis in urology: A review

The role of antibacterial prophylaxis in urology has been debated for more than 50 years. Even though controversy remains, an increasing number of physicians now support the use of prophylactic antibacterial agents in urologic surgery. This review attempts to place in perspective the value of prophylaxis for various urologic procedures in which infection is likely to occur. Prophylactic antibacterial therapy is recommended for urethral catheterization, endoscopy of the urinary tract, prostate biopsy, transurethral surgery, and selected open urologic procedures. Broad-spectrum cephalosporins and penicillins are used most often, while fluoroquinolones are being evaluated with increasing frequency.

Abnormal Urinalysis in Appendicitis

In a retrospective review of 100 consecutive patients (50 adults and 50 children) with acute appendicitis we correlated abnormal urinalysis (positive occult blood and more than 4 red or white blood cells per high power field) with the operative findings. Abnormal results on urinalysis were noted in 18 adults and 12 children. All urine specimens were collected by the clean-catch method. Abnormal findings were found more frequently in female patients. A majority of patients (53 per cent) with abnormal results on urinalysis had a ruptured or inflamed appendix in proximity to the urinary tract.