Therapeutic embolization for acute haemorrhage is increasingly being utilized. An audit of 34 patients undergoing therapeutic embolization for acute abdominal or pelvic haemorrhage was undertaken, in an attempt to assess the importance of the following variables in determining a successful outcome: coagulation status, transfusion status, time to procedure after onset of circulatory instability, duration of procedure, and the effect of the embolization technique employed. Overall success was 79%, with definitive control of haemorrhage achieved by embolization; 21% required surgical management for rebleeding 4-24 h post embolization. The duration of the procedure and transfusion status of the patient were the most important factors associated with a successful outcome.
The presence of contralateral renal tumour in a case eventually found to have Xanthogranulomatous Pyelonephritis (XP) resulted in a wrong preoperative diagnosis of tumour with bowel fistula. The patient's prior history of bladder tumour and multiple renal cysts is also discussed, along with the retrospective finding of very minor changes in an early angiogram.
A long-acting LRH agonist (ICI 118630, Zoladex) was given by monthly subcutaneous injection to 25 patients with previously untreated symptomatic advanced prostatic carcinoma. The medication was well tolerated with the only side effect being hot flushes in 15 patients. Subjective improvement occurred in 22 patients, and disease remission or stabilization judged by objective criteria was seen in 21 and 18 patients from the total group at 3 and 6 months of treatment, respectively. Twelve of 18 patients followed for 1 year were still in objective remission/stabilization. Prostate volume measured by ultrasound decreased by a mean value of 75% and urine flow increased significantly. There were significant falls in serum testosterone and gonadotrophin levels and significant although lesser reductions in serum androstenedione and dehydroepiandrosterone. These changes were accompanied by significant reductions in serum acid and alkaline phosphatase and a rise in serum osteocalcin. Four patients (16%) experienced an initial tumor flare. Although only a small number of patients were studied, Zoladex appeared to be a well-tolerated agent for treatment of prostatic carcinoma, with an initial clinical response similar to that seen with standard endocrine therapy.
A case of arterioureteral fistula from the graft artery stump of a failed transplant and the native ureter is reported. This case illustrates one of the possible complications of graft anastomosis. The etiological factors involved in the formation of the aneurysm and eventually the fistula are discussed.
Thirty-eight patients underwent transabdominal sonographic measurement of their prostate by two different sonographers. Prostatic weight was estimated by the ellipsoid method. In 47% of the cases the second estimate of weight was within 5g of the first and in 84% of cases the second estimate was within 10g of the first. 95% of the time the second estimate was within 16g of the first. The differences in estimated weight between the two observers ranged from 1g to 22g with a mean of 6g. The estimated prostatic weight differed from the mean prostatic weight by more than 20% in 58% of cases. (Mean prostatic weight = the mean of the two weights estimated for each patient). Measurement error was less significant in the larger prostates. The accuracy is probably satisfactory in routine clinical practice when the aim is to demonstrate the presence and degree of prostatic enlargement but the error may be significant in pre-operative assessment of prostate size and measurement prior to stenting the prostatic urethra. The error, if not accounted for, could compromise a clinical trial involving serial prostatic measurements.
We report on a patient who had had recurrent renal stones on the right side for 37 years. At the sixth lithotomy the diagnosis of cholesteatoma of the renal pelvis was discussed. After another recurrence of stones and a pelvic lesion nephrectomy was considered. However, the kidney still had 60 per cent of total renal function and the other kidney also harbored stones. Therefore, extracorporeal exploration was performed. The stones and keratin masses were removed from the pelvis and frozen section showed no malignant changes. The kidney was reimplanted in the ipsilateral iliac fossa with end-to-side anastomosis to the external iliac vessels and a wide direct anastomosis between the pelvis and the bladder. At followup 2 months postoperatively the patient was well. Autotransplantation with pyelocystostomy facilitates free passage of recurrent stones and keratin fragments, and allows for future transurethral control of the renal pelvis. Thus, the procedure is well suited for the treatment of cholesteatoma of the renal pelvis.
A long-acting LRH agonist (ICI 118630, Zoladex) was given by monthly subcutaneous injection to 25 patients with previously untreated symptomatic advanced prostatic carcinoma. The medication was well tolerated with the only side effect being hot flushes in 15 patients. Subjective improvement occurred in 22 patients, and disease remission or stabilization judged by objective criteria was seen in 21 and 18 patients from the total group at 3 and 6 months of treatment, respectively. Twelve of 18 patients followed for 1 year were still in objective remissiodstabilization. Prostate volume measured by ultrasound decreased by a mean value of 75% and urine flow increased signiticantly. There were significant falls in serum testosterone and gonadotrophin levels and significant although lesser reductions in serum androstenedione and dehydroepiandrosterone. These changes were accompanied by significant reductions in serum acid and alkaline phosphatase and a rise in serum osteocalcin. Four patients (16%) experienced an initial tumor flare.. Although only a small number of patients were studied, Zoladex appeared to be a well-tolerated agent for treatment of prostatic carcinoma, with an initial clinical response similar to that seen with standard endocrine therapy. free of side effects [ 5 ] , the need for daily injection of these agents has limited their
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