Stephen A. Sacks

Urologic complications of appendicitis

Three patients with appendicitis were seen with bladder tumor, hematuria, and pelvic mass with ureteral obstruction, respectively. These cases represent a spectrum of difficult diagnostic problems and illustrate that appendiceal abscess involving the urinary tract may present as urologic disease. Thus, it is important to consider appendicitis in the differential diagnosis.

Urethral adenocarcinoma (possibly originating in the glands of Littre).

Adenocarcinoma involving the bulbomenbranous urethra is a rare disease. This disease is describe in a 30-year-old man and the surgical management is detailed. The adenocarcinoma described seems to have arisen from the periurethral glands of littre. Despite the radical nature of the tumor excision, it was possible to spare the distal penis in order to achieve a more normal appearance of the external genitalia.

Complications of Urinary Undiversion

Complications of urinary undiversion may be divided into those related to patient selection and those pertaining to the operation. A detailed understanding of the anatomic and physiologic alterations in the dynamics of urine transport is an essential prerequisite for the selection of suitable candidates. Two illustrative cases emphasize the necessity for complete evaluation of the upper and lower urinary tracts as well as meticulous attention to intraoperative detail.

Prostatic carcinoma producing syndrome of inappropriate secretion of antidiuretic hormone

The syndrome of inappropriate secretion of antidiuretic hormone was recognized in a sixty-year-old man with a poorly differentiated metastatic adenocarcinoma of the prostate gland. Elevated levels of antidiuretic hormone were found in the patients serum and in the prostatic tumor but not in the cerebrospinal fluid. The patients clinical course is detailed, and the pathophysiology of this syndrome is discussed.

Renal autotransplantation: Further use of a new perfusate

Abstract Totally ischemic canine kidneys were protected during periods of normothermic in vivo exposure known to be lethal (two and three hours) by means of initial perfusion with cold hyperosmolar intracellular electrolyte solutions containing no additives. The solutions are believed to exert their protective effects by preventing the rapid and profound alterations of intracellular electrolytes and water that occur when a kidney is rendered ischemic. The method described herein does not rely upon continuous renal cooling or metabolic inhibition of the ischemic kidney and does not limit operative accessibility.

In Situ Flushing of Donor Kidneys: Its Technique and Rationale

In situ flushing of kidneys through an isolated segment of aorta was done on mongrel dogs. The 500 cc cold perfusate at 3 to 4C (delivered in 6 minutes) effectively cooled the kidneys to about 15C. This simplified technique of in situ flushing, its usefulness and rationale are discussed.

Ex vivo renal surgery. Further use of a new perfusate.

Abstract Ex vivo renal operations were performed in fifteen dogs to determine the efficacy of a new ex vivo renal preservation technic. The method described and illustrated in this report proved to be simple and requires neither continuous renal cooling nor continuous renal perfusion. A single initial perfusion of the totally ischemic canine kidney with a new hyperosmolar intracellular electrolyte solution was able to offer cellular protection from the otherwise lethal effect of ambiothermic exposure for up to five hours without significant loss of renal function. Pre- and postoperative serum creatinine levels were assessed to determine renal function. Ex vivo renal surgical technics have important potential application when in situ repair is too hazardous or its effect uncertain.

Renal artery stretching and renovascular hypertension An experimental study

Abstract Renovascular hypertension was produced in rabbits by affixing one kidney to the iliac fossa to produce traction on the renal artery. Hyperplasia of the juxtaglomerular apparatus was seen in the kidney in which the renal artery was stretched, whereas no juxtaglomerular apparatus hyperplasia was witnessed in the untouched kidney of rabbits. Whether traction on the renal artery is a sole or contributing factor to the pathogenesis of fibrous dysplasia of the arterial wall remains a moot point.

Extrakorporale Nierenchirurgie unter Anwendung einer neuen Konservierungsmethode

Extracorporeal renal operations were performed in 12 dogs to determine the efficacy of a new renal preservation method. Serveral ex vivo surgical techniques are described, illustrated and the literature reviewed. A single perfusion of the totally ischemic kidney with a new hyperosmolar intracellular electrolyte solution provided sufficient protection from the otherwise lethal effect of 5 hours ambiothermic exposure. Pre- and postoperative serum creatinine levels were assessed to determine renal function.

In-vivo and ex-vivo renal preservation

SummaryA new renal perfusate of modified intracellular electrolyte composition made hyperosmolar with mannitol and requiring no additional additives was successfully used to preserve canine kidneys “ex-vivo” for 48 hours by initial perfusion and hypothermic storage. The new perfusate was also successful in protecting totally ischemic canine kidneys from the lethal effect of two-hours of normothermic exposure “in-vivo”. — The preservation technique is uncomplicated, the materials involved are inexpensive, and the preservation apparatus is readily transportable.