Victor Braren

Extended biopsy followup after full course radiation for resectable prostatic carcinoma.

Extended biopsy followup of 17 relatively young men with resectable prostatic cancer treated by external supervoltage radiotherapy is presented. Although 6 of the 8 surviving patients now have negative biopsies, the over-all survival rate and the over-all incidence of negative biopsies are not so encouraging, with only 35 per cent rendered free of tumor. Thus, the role of radiotherapy in resectable prostatic carcinoma should be critically scrutinized. More accurate staging is needed. Hopefully, more sophisticated studies of diagnostic and prognostic value will be available in the near future.

Renal Carcinoma Discovered Incidentally by Arteriography During Evaluation for Hypertension

Since June 1, 1971 patients undergoing evaluation for hypertension have been evaluated with rapid sequence excretary urography, abdominal aortography and selective renal arteriography. Renal venous assays have been done in selected patients. Through July 31, 1974, 812 arteriographic studies in new hypertensive patients have been done. In 6 of these patients renal tumors were discovered by arteriography only and were not suggested by symptoms, urinalysis nor diagnosed on hypertensive excretory urography. This high incidence surprised us and we hope others will review their arteriographic series of hypertensive patients.

Radioisotopic determination of glomerular filtration rate.

AbstractOur experience with radioisotopic determination of glomerular filtration rate in 263 patients is presented. The isotope that we think is now most workable is 99mtechnetium diethylenetriaminepentaacetic acid. The technique meets all the criteria for glomerular filtration rate and the radiation dose is low. Likewise, it has proved to be an accurate and simple procedure to perform

Beta-2-microglobulin as renal diagnostic agent

Our group has undertaken the determination of serum levels of beta-2-microglobulin in 250 patients. We have compared this diagnostic entity to radioisotopic glomerular filtration rate, serum creatinine, and blood urea nitrogen. We have also analyzed the cost effectiveness of each of these diagnostic entities and combinations thereof. We conclude that beta-2-microglobulin is a simple test to perform; it is specific, sensitive, and accurate. Its cost effectiveness is excellent. We advocate its wide clinical usage.

Sacral Agenesis: Diagnosis, Treatment and Followup of Urological Complications

Sacral agenesis is an uncommon congenital anomaly that usually is accompanied by other orthopedic anomalies but often occurs singularly. We report our experience in the treatment and long-term followup of 4 cases of pure sacral agenesis. We strongly stress the need for early diagnosis and long-term careful followup. In our group the diagnosis was often overlooked and followup was poor. Studies must be undertaken to determine the type and degree of neurogenic vesicopathy in each child since this may vary from one patient to the next. We urge the early and long-term use of intermittent catheterization.

Extramammary Paget's disease in the scrotal and inguinal areas.

AbstractExtramammary Paget’s disease is a malignant condition. The clinical presentation, treatment and prognosis of this lesion in the scroto-inguinal area are discussed.

True hermaphroditism: A rational approach to diagnosis and treatment

Eight previously unreported cases of true hermaphroditism are presented, and their basic characteristics are described and discussed with regard to diagnosis and management. Two basic groups are identified: those diagnosed prior to establishment of gender role and those diagnosed at a later date. The latter group should benefit from therapy designed to enhance and maintain their sex of rearing, while the former group should be reconstructed according to functional considerations first and fertility considerations second. Diagnostic criteria are evaluated, and the value of the exploratory laparotomy is stressed.

Urologic Manifestations of Paroxysmal Nocturnal Hemoglobinuria

A long-term study of 17 patients with paroxysmal nocturnal hemoglobinuria revealed an unexpectedly high incidence of functional and anatomic renal abormalities. All patients demonstrated varying degrees of hematuria and proteinuria distinct from hemoglobinuria. All patients also had granular casts in multiple urinalyses. Evaluation of renal function revealed hyposthenuria, abnormal tubular function and declining creatinine clearance. Radiologically, one or more of these demonstrated enlarged kidneys, renal cortical infarcts and thinning, papillary necrosis, acute renal atrophy, retroperitoneal hematoma and ureteral infarction, which were confirmed by autopsy studies. Hypertension developed in 7 patients. Urinary tract infection was uncommon and no patient had a clinical history compatible with chronic or acute pyelonephritis. Contrary to usual opinion our compatible clearly showed evidence of frequent and widespread renal pathology in paroxysmal nocturnal hemoglobinuria most likely due to repeated microvascular thromboses similar to the venous trombosis involving other organs in this disorder. Since most of these patients present initially to urologists knowledge of this entity is mandatory.

Urinary tract calculous disease after renal transplantation

We report 3 cases of a series of 372 (0.8 per cent) renal transplant recipients in whom urinary tract calculi developed as a complication of the procedure. In each patient symptoms were minimal and not classic of calculous disease. We disagree with the contention that all such patients have either hypercalcemia, infection, or tubular acidosis, although thorough evaluation is indicated. We believe this entity should be considered in problematic renal transplantation patients. Conservative therapy is advocated when the situation permits.

A Microtechnique for Radioisotopic Determination of Glomerular Filtration Rate in Infants and Children

Our experience with a microtechnique using 99mTc-DTPA for determination of glomerular filtration rate in 172 children is presented. It is a simple finger-stick method carried out in a four-hour time period by trained nuclear medical per sonnel. The procedure meets all criteria for precise measurement of glomerular filtration rate, and the radiation dose is low. Proof of accuracy was obtained by comparison of this technique with concomitant 24-hour urinary creatinine clear ance in a subset of children.