Moshe Many

Factor XI Deficiency: Detection and Management During Urological Surgery

Hereditary factor XI deficiency may remain undiagnosed until severe bleeding is observed after an operation or trauma. Two such cases were encountered and, therefore, a regular screening test for coagulation disorders among urological patients was initiated. During 2 years (1975 and 1976) 10 additional cases of factor XI deficiency were detected: 5 severe and 5 partial. All patients were Ashkenazic Jews of Eastern European origin. The 5 patients with severe factor XI deficiency underwent an operation without any complications. They were transfused with 5 to 20 ml./kg./day of fresh frozen plasma from the day before the operation until 10 to 14 days postoperatively. Of the 5 patients with partial XI deficiency 4 underwent an operation. In 1 of 3 patients who did not receive transfusions postoperative bleeding was observed. A minimal level of 0.3 U./ml. (30 per cent) factor XI was found necessary to ensure good hemostasis during and after an operation. In view of a recent finding of relatively high gene frequency of factor XI deficiency in Ashkenazic Jews it seems warranted to do a partial thromboplastin time in such patients who need an operation.

Urinary Infections Following Transurethral Resection of Bladder Tumors—Rate and Source

The incidence of urinary infection and its source after transurethral resection of bladder tumors were investigated. Patients undergoing transurethral prostatectomy constituted the control group. All patients had proved preoperative sterile urine and did not receive any antimicrobial treatment. The incidence of urinary infection following transurethral resection of bladder tumors was 19.4 per cent, with an incidence of positive tumor chip cultures of 3.2 per cent. The incidence of urinary infection after transurethral prostatectomy was 32 per cent, with an incidence of positive prostate chip cultures of 8 per cent. We concluded that the source of urinary infection following transurethral resection of bladder tumors and transurethral prostatectomy in most cases is not from within the tissue but rather from perioperative manipulations.

Prophylactic antimicrobial treatment in transurethral prostatectomy How long should it be instituted

Eighty-one patients with proved preoperative sterile urine and undergoing transurethral resection of the prostate were studied. The patients were divided into 3 groups: group A received sulfamethoxazole-trimethoprim (ST) preoperatively and postoperatively for ten days; group B received ST in 2 divided doses, one pre- and one postoperatively; group C received no prophylaxis. In groups A and B, we found urinary infection in 3.8 per cent of patients compared with 32 per cent in group C. Performing prostatic chip cultures, we found that most urinary infections were unrelated to a prostatic source. When the prostate was infected, 75 per cent had infected urine postoperatively. We believe that prophylactic antimicrobial treatment should be given to all patients undergoing transurethral prostatectomy. However, it seems that immediate perioperative treatment suffices.

Imipramine for the treatment of sterility in patients following retroperitoneal lymph node dissection

Imipramin zur Behandlung der Infertilität bei Männern nach retroperitonealer Lymphknoten‐Entfernung

Semen Quality and Hormonal Status of Patients Following Testicular Torsion

Summary: 16 patients, 4 months to five years following unilateral torsion of the testis were evaluated as to semen quality and hormonal status.

Primary chondrosarcoma of the kidney.

Primary chondrosarcoma of the extraskeletal soft tissue is rare, usually occurring in the upper and lower extremities. We report the first case of this neoplasm arising in the kidney.

Duplication of the kidney: A potential diagnostic pitfall

Nine patients with marked vesicoureteral reflux into a contracted, pyelonephritic kidney were found at time of surgery to have complete duplication of the affected side. Eight of them also had an ectopic ureterocele. The radiological diagnosis of duplication was virtually impossible as all these kidneys showed reflux nephropathy and were smaller than the contralateral kidney. The surgical management is briefly outlined.

Spontaneous rupture of renal angiomyolipoma: report of three cases

The presentation of renal angiomyolipoma as an acute abdominal condition, together with hypovolemic shock, is very rare. 3 such cases are described herein with special reference to the diagnostic problems and recommended management.

HLA-A and HLA-B antigens in transitional cell carcinoma of the bladder.

A possible association between HLA-A and HLA-B loci alleles and bladder carcinoma has been investigated in 44 patients with biopsy proved transitional cell carcinoma of the bladder. The patients were compared to 400 healthy controls and matched for ethnic origin. Typing was done by the standard National Institutes of Health microlymphocytotoxicity technique. Comparison between the HLA-A and HLA-B series of the patients and the controls, and the different stages of disease did not yield any significant difference.

Vesicoureteral reflux in adults: a review of 95 patients.

Ninety-five adult patients with primary vesicoureteral reflux were reviewed concerning the presenting symptoms, radiological findings, associated renal damage, treatment and results of follow-up. We found a relatively high incidence of reflux in adult males. Although urinary tract infection and flank pain were the most common presentation, others had a wide variety of complaints not directly attributable to reflux. Renal anomalies were present in 37 patients. We found surgical correction of reflux useful in preventing infection, and recommend it especially in young women who may become pregnant.