Robert C. Ireton

Case-Control Study of Men with Suspected Chronic Idiopathic Prostatitis

We studied prospectively 50 asymptomatic men (24 men from infertile couples and 26 normal volunteers) with no history of genitourinary infection and 34 men referred for symptoms of chronic prostatitis. Both groups were evaluated by urethral and prostatic secretion cultures for Chlamydia trachomatis, 4-glass prostatic localization cultures for facultative aerobic bacteria (Ureaplasma urealyticum, Mycoplasma hominis and selected fungi) and counts of prostatic fluid leukocytes. The men with symptoms of prostatitis had more than 1,000 leukocytes per mm. in prostatic secretions more often than did controls (11 of 27 versus 0 of 44, p less than 0.001). The concentration of Ureaplasma urealyticum in prostatic secretions was 1 log higher in prostatic fluid localization cultures than in first voided urine in 0 of 30 patients versus 13 of 50 controls (p equals 0.0014). Chlamydia trachomatis was not isolated from any patient or control. No other significant differences were found between patients and controls. We did not identify an infectious cause of chronic nonbacterial prostatitis.

Bladder Volume Determination Using a Dedicated, Portable Ultrasound Scanner

Urethral catheterization, the standard method for measurement of bladder volume, is associated with patient discomfort plus the risks of urethral trauma and urinary tract infection. A portable ultrasound instrument that automatically determines bladder volume was used for 164 determinations and the digital readout correlated with the catheterized volume (r2 equals 0.79). This instrument is a noninvasive alternative to urethral catheterization for the determination of bladder volume in most patients.

A Comparison of Penile Brachial Index and Angiography: Evaluation of Corpora Cavernosa Arterial Inflow

We studied 32 impotent patients with angiography. The penile branchial index was calculated from the maximal penile arterial pressure measured from any penile artery. In 15 of the 32 patients an attempt was made to isolate the cavernous artery pressure (cavernous artery penile brachial index). There was a poor correlation between angiography and penile branchial index (r equals 0.314) and between angiography and cavernous penile brachial index (r equals 0.637). We also evaluated 15 normal individuals and a wide range of penile brachial index values was found (0.7 to 1.0). Penile brachial index values from normal patients overlapped with those from impotent patients. Penile brachial index values from impotent patients with normal and abnormal arteries (as determined by angiography) overlapped. The fact that penile brachial index measurements are performed in the flaccid state and without direct visualization of the cavernous arteries accounts for some of the variability of the penile brachial index test.

Emphysematous Pyelonephritis Caused by Candida Albicans

We report a case of emphysematous pyelonephritis that was proved by histological examination and culture to be caused by Candida albicans. The fungal infection caused ureteral obstruction. Nephrectomy alone resulted in complete recovery.

Test of RRKM theory. Rates of decomposition in the series of chemically activated 2‐n‐alkyl radicals from C4 to C16

The rates of decmposition of chemically activated 2‐n‐alkyl radicals in the series C4–C16 were measured by an internal comparison method at 300°K in the pressure region centered at 0.01–0.1 torr. Activation was by H‐atom addition to the appropriate α‐olefin. The substrate species have a minimum energy of Ω 40 kcal mole−1. The consequences of radical isomerization are discussed. A limitation of the present activation technique is illustrated. Theoretical Marcus‐Rice rate constants agree well with the experimental values. Earlier experimental evidence that all degrees of freedom of smaller radicals must be treated as active is now extended to the C16 member of the series, and the continued applicability of the conventional theoretical treatment is demonstrated for the very large species. Within the accuracy of the work, internal energy is shown to be effectively randomized in the time interval between stabilizing collisions, even for the largest member of the series. The observed rate constant decline from ...

Clinical experience with intra lymphatic administration of111In-labelled monoclonal antibody PAY 276 for the detection of pelvic nodal metastases in prostatic carcinoma

The ability of111In-PAY 276 (anti prostatic acid phosphatase antibody) in detecting pelvic lymph node metastasis following bipedal intra lymphatic administration was studied in five patients with carcinoma of the prostate. The labeled antibody was injected directly into the lymphatics of each foot. Planar and tomographic images radioactivity content of lymph nodes resected during staging pelvic lymphadenectomy were compared to the histologic and immunoperoxidase findings. Radioactivity in pelvic lymph nodes was prominently seen within 20 min of injection and was present 16 days later. Persistent accumulation of tracer in the lymphatics of the lower extremities was also observed in all patients 16 days post injection. Radioactivity counts in tumor-free lymph nodes were higher than in tumored lymph nodes resected. Our results demonstrate that intra lymphatic administration of111In-labeled PAY 276 monoclonal antibody has major technical limitations, and that further research directed at the causes of tracer accumulation in the lymphatics and tumor-free lymph nodes is required.

Treatment of Congenital Penile Curvature Due to Disparate Corpora Cavernosa by the Nesbit Technique: A Rule of Thumb for the Number of Wedges of Tunica Required to Achieve Correction

Treatment of pure congenital penile curvature due solely to asymmetry of the corpora cavernosa as described by Nesbit lacks precision. Intraoperative verification of Nesbit correction by artificial erection after wedge excision may be impossible because leakage through the sutured corporeal incisions prevents full erection. We present a rule of thumb to calculate the number of 1 cm. wedges of tunica albuginea to be excised to correct an individual deformity. The number of such wedges required is equal to the measured difference in centimeters between the lengths of the asymmetric, concave and convex surfaces of the affected penis, between the pubis and mid glans. Results of application of this principle in 6 patients are presented.

Diuretic renography in evaluating dilated upper urinary tract in children

The diuretic renogram provides a previously unavailable noninvasive method for assessing and following urinary tract dilation of diverse cause, and defining true obstruction in children. Technetium-99m-DTPA (diethylenetriaminepentaacetic acid) is injected intravenously and a posteriorly placed gamma scintillation camera used to image the kidneys, ureters, and bladder. Furosemide is subsequently injected to stimulate a diuresis, and the washout pattern of isotope is monitored (time-activity histogram). Nonobstructive, obstructive, and poor renal function patterns were seen. Forty patients with varying degrees of hydroureteronephrosis were evaluated. Tracings were performed serially and compared with the clinical course in time, as well as with pressure flow studies and operative findings. All patients with a nonobstructed diuretic renogram did well, except for 1 boy in whom ureteropelvic obstruction developed later. Difficulty in evaluating the obstructive renogram pattern occurred only in some children with severe (grade V) hydronephrosis. Further standardization of the diuretic renogram with regard to time of diuretic injection, state of patient hydration, and regions of imaging may improve diagnostic accuracy.

Combined Infrapubic and Retropubic Ligation of the Dorsal Vein of the Penis During Radical Retropubic Surgery

AbstractA reliable technique for ligation of the dorsal vein of the penis at the pelvic diaphragm before division of the puboprostatic ligaments is presented.

A modification of the Otis urethrotome as an aid to fascial dilation of percutaneous nephrostomy tracts.

An Otis urethrotome has been modified by drilling a 3/64-inch hole through the tip to permit passage into the kidney over a 0.038-inch guide wire. This instrument has been used to aid in the performance of 12 nephrostomy tract dilations without significant complications. When compared to 10 Amplatz tract dilations, the modified Otis method required an average of 3.6 minutes versus 8.7 minutes to dilate the nephrostomy tract to 24F. Ease of tract dilation as well as decreased time to dilate make this technique a useful adjunct to standard nephrostomy tract dilation techniques.