A total of 23 patients who had an intraoperative penile erection during endoscopic or penile surgery underwent intracavernous injection of 200 micrograms phenylephrine. Detumescence occurred rapidly in all patients with a single injection. Hemodynamic changes consisted of a transient increase in systolic and diastolic blood pressures (+9%, p < 0.05) without significant change in pulse rate (-5%, p > 0.05). No marked side effect was reported even in elderly patients. Intraoperative penile erection, which seems to be more frequent in patients younger than 50 years, during general anesthesia with propofol or epidural anesthesia, can be treated safely with intracavernous injection of phenylephrine.
A series of 8 cystic renal tumours is reported in seven-months to four-years-old children. The final diagnosis was cystic nephroma (multilocular cyst) in 4, cystic, partially differentiated nephroblastoma in 3 and partially cystic nephroblastoma in one. Pre-operative distinction between those three types is difficult and inadequate therapeutic approach may result from a wrong diagnosis. Progress in imaging techniques allows a better analysis of cysts and septa. If no solid part can be detected in the tumour, total nephrectomy is sufficient to obtain a favourable outcome.
We report two cases of urinary obstruction by fungal bezoars in full-term neonates who presented a uropathy detected antenatally. Early percutaneous urinary diversion was performed to relieve renal impairment secondary to a primary megaureter in the first case and to bilateral pelvi-ureteral obstruction in the second. Acute fungal obstruction occurred first on the side of the primary megaureter and then on the healthy side in the first patient. Symptoms of infection and impaired renal function led to a diagnosis of fungal bezoar. In the second patient the development of the bezoar was more insidious and occurred after surgical correction of the obstructive pelvi-ureteral junction on the left side. Candiduria was the first sign in both cases. Ultrasonography is the best method to visualize fungal masses within the collecting system. In most cases, percutaneous nephrostomy allows relief of the obstruction, sampling of urine for culture and irrigation with amphotericin B. However, additional surgical intervention may be necessary. Systemic antifungal treatment using mainly 5-flucytosine is also given.
A total of 23 patients who had an intraoperative penile erection during endoscopic or penile surgery underwent intracavernous injection of 200 micrograms phenylephrine. Detumescence occurred rapidly in all patients with a single injection. Hemodynamic changes consisted of a transient increase in systolic and diastolic blood pressures (+9%, p < 0.05) without significant change in pulse rate (-5%, p > 0.05). No marked side effect was reported even in elderly patients. Intraoperative penile erection, which seems to be more frequent in patients younger than 50 years, during general anesthesia with propofol or epidural anesthesia, can be treated safely with intracavernous injection of phenylephrine.
Over a 16 month period seven patients underwent surgery using venous allografts either to reconstruct the portal vein, or to construct a mesocaval ‘H’ graft or a shunt between the coronary vein and the subhepatic inferior vena cava. The allografts were harvested during multiorgan procurement from the bifurcation of the inferior vena cava, the common iliac vein and the external iliac vein and kept in a preservation solution at 4°C for a mean time of 6 days (range 1–29) before use. Subsequent thrombosis was clinically evident in only two patients. The use of venous allografts appears to be a useful alternative to other venous replacements.
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