Possible application of hyperbaric oxygen technology in the management of urogenital and renal diseases.

The purpose of this report is to explore possible therapeutic use of hyperbaric oxygen (HBO(2)) technology on renal and urogenital diseases. HBO(2) reduces inflammation, immunity and inflammatory cytokines, stimulates wound repair and angioneogenesis, maintains tissue oxygenation, increases antioxidant enzymes and heals tissue hypoxia and radionecrosis. A literature review of peer-reviewed articles that address HBO(2), genitourological diseases, renal disease, and dialysis was performed. The paper reviews complications of renal diseases, dialysis, clinical applications of HBO(2), and effect of HBO(2) on renal and urogenital diseases. HBO(2) was used successfully to treat calcific uraemic arteriolopathy, and in many cases of acute renal failure. This technique is particularly useful in the treatment of intractable haemorrhagic cystitis secondary to pelvic radiation therapy and Fournier's gangrene. Clearly HBO(2) might play a role in the management of urogenital diseases, urinary bladder dysfunction and diseases, testicular pathology, renal diseases, and post-traumatic ischaemic injury and/or impaired wound healing and infections. The possible role of HBO(2) for autoimmune diseases, uraemic osteodystrophy or neuropathy due to chronic renal diseases is discussed. The clinical application of this technology is expanding and the various biological influences of HBO(2) encourage testing its possible benefit in renal and urological diseases.

Vascularity of the neonatal femoral head: in vivo demonstration with power Doppler US.

PURPOSE: To detect the intrinsic blood supply of the unossified neonatal femoral head in vivo by using power Doppler ultrasound (US) and to ascertain whether a reduction in blood flow could be demonstrated with hip abduction. MATERIALS AND METHODS: One hip of 13 neonates was examined with power Doppler sonography. After vessels within the femoral head were identified, the thigh was slowly abducted and the angle at which flow became undetectable was recorded. Spectral Doppler tracings were obtained in all subjects. RESULTS: Intrinsic blood flow of the femoral head was demonstrated in all subjects. Flow became undetectable during hip abduction in 11 of 13 neonates and reappeared during adduction. The angle at which flow became undetectable varied from 60 degrees to 85 degrees. Spectral Doppler signals demonstrated a mixed arterial and venous trace. CONCLUSION: Power Doppler US provides a simple real-time assessment of the femoral head blood supply. This may prove helpful in identifying neonates at risk of avascular necrosis, a complication of treatment of hip dysplasia with abduction hip restraints.

111Indium-oxine-labeled leukocytes and 67gallium-citrate as indicators of renal injury following extracorporeal shock wave lithotripsy.

To document the extent and persistence of traumatic inflammation after extracorporeal shock wave lithotripsy (ESWL), 15 patients were randomly chosen to have either 67gallium (67Ga)-citrate or 111indium (111In)-oxine scans within 24 to 48 hours of ESWL. Positive scans were repeated at 8 to 12 weeks. Nine patients had renal calculi, and 6 had ureteral calculi and acted as controls. Of the patients with renal calculi 6 were scanned with 67Ga-citrate and 3 with 111In-oxine. Four of the former and 2 of the latter scans showed evidence of renal injury. Followup scans were normal. There was no correlation between power index (number of shocks times accelerating voltage) and scan results. Half of the control subjects were scanned with 67Ga-citrate and the remainder with 111In-oxine and all scans were negative. 67Ga-citrate and 111In-oxine scans can show evidence of renal injury immediately after ESWL but abnormal scans 2 to 3 months later would be suggestive of a different inflammatory process.

Pyogenic myositis: CT evaluation.

Computed tomography and gallium scintigraphy uncovered clinically occult muscle infection in eight patients. The CT findings included enlargement of the muscle, effacement of the intramuscular fat planes, fluid density, rim enhancement, and involvement of the underlying bone. Computed tomography suggested the diagnosis in seven of eight cases. Gallium scintigraphy was positive in all seven cases in which it was performed.

Toward efficient urography.

A survey of intravenous urography in Nova Scotia shows a lack of consistency in timing and number of films used. Dehydration is still practiced in most centres and tomography is not used routinely. A revised protocol for urography is suggested, consisting of three films with additional views added as necessary. The three would include a single tomographic section when available. Dehydration procedures should be discontinued. Such a protocol might lead to a reduction in radiation exposure and patient risk and Canada-wide savings of more than three million dollars annually.

Hepatitis among plasma fractionation workers. An industry-wide study.

An industry-wide survey of plasm fractionation facilities in the United States was conducted during 1973-74. Hepatitis was reported among the workers with varying degrees of plasma contact at all plant sites. For each of fourteen facilities in this investigation, field inspections disclosed: (1) numerous overt instances of employee-product contact: (2) inconsistent methodologic approaches at virtually all stages of the plasma fractionation process; (3) at low level of management and employee awareness regarding the potential bio-hazard identified; and (4) disparate examples of hepatitis surveillance and prophylaxis. Our data suggests that there is a high risk of hepatitis among plasma fractionation workers and, as such, much more attention needs to be focused on the reduction of health hazards within this industry.