ABSTRACT
Myocardial infarction is the most common cause of death in the United States. Rapid postinfarction intervention in the first 24 hours decreases mortality. Treatment modalities are rapidly evolving as new data from basic science research and clinical trials become available. Rapid thrombolysis, accurate criteria for diagnosis and administration of effective adjunctive therapy are crucial in preventing complications of myocardial infarction. Initial measures in the emergency department include intravenous access, accurate history and physical assessment, placement of oxygen, electrocardiography, use of aspirin and nitrates, and consideration of thrombolysis or angioplasty in appropriate candidates, optimally within one to two hours of myocardial infarction. After hospital admission, additional adjunctive treatment, including beta blockers, angiotensin-converting enzyme inhibitors and anticoagulation, can be instituted.
Subject(s)
Myocardial Infarction , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/prevention & control , Cardiac Pacing, Artificial , Contraindications , Coronary Thrombosis/etiology , Coronary Thrombosis/prevention & control , Decision Trees , Heart Conduction System , Humans , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Infarction/drug therapy , Myocardial Infarction/physiopathology , Thrombolytic Therapy , Time FactorsABSTRACT
Extended pyelolithotomy for staghorn calculus in a uremic patient with solitary functioning kidney was followed by development of stenosis of the infundibulum draining the superior and middle calyces. Drainage of the lower calyx down the ureter remained intact. Intubated infundibuloplasty proved unsuccessful since scarring and occlusion promptly recurred. Anastomosis of the middle calyx to the ureter was then performed with good results. We believe this is the first reported case of ureterocalycostomy for providing drainage to the middle calyx without lower polar nephrectomy.
Subject(s)
Kidney Calculi/surgery , Kidney Diseases/surgery , Postoperative Complications/surgery , Urinary Diversion/methods , Adult , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Drainage , Humans , Intubation , Kidney Calices/surgery , Kidney Diseases/diagnostic imaging , Kidney Diseases/etiology , Male , Radiography , Ureter/surgeryABSTRACT
A hitherto undescribed complication of cystoscopy is reported wherein peripelvic extravasation and perinephric collection of urine resulted from conventional cystoscopic examination in a patient with a small-capacity bladder and vesicoureteral reflux. Prompt recognition, institution of indwelling catheter drainage, and massive antibiotic therapy led to spontaneous resolution of the flank mass. In similar cases, we suggest the use of an Iglesias resectoscope with a continuous flow and suction evacuation, even for cystoscopy and bladder biopsy.
Subject(s)
Cystoscopy/adverse effects , Urine , Contrast Media , Female , Humans , Kidney , Middle Aged , Pressure/adverse effects , Urinary Bladder/abnormalities , Vesico-Ureteral Reflux/complicationsABSTRACT
Following emergency cavernospongiosum shunt performed for priapism occurring in a psychiatric patient on chlorpromazine therapy, a urethro-caverno-cutaneous fistula with distal urethral stricture developed, resulting in aberrant voiding into the corpora cavernosa. The causation, management, and prevention of this hitherto unreported combination are discussed.
Subject(s)
Fistula/etiology , Penile Diseases/etiology , Penis/surgery , Priapism/surgery , Skin Diseases/etiology , Urethral Diseases/etiology , Urethral Stricture/etiology , Adult , Humans , Male , Postoperative Complications , UrineABSTRACT
Large vesicovaginal fistulae, particularly those associated with urethral loss, present formidable repair problems. Omentum, recognized for its role in resolving abdominal infection, is successfully used for pedicle grafts in these complex situations. The authors present their experience in 25 cases, describing modifications of an earlier procedure.
Subject(s)
Omentum/surgery , Surgical Flaps , Vesicovaginal Fistula/surgery , Adolescent , Adult , Child , Female , Humans , Middle AgedABSTRACT
Primary benign mesodermal tumours of the ureter mostly occur in the proximal part of the ureter. A case of a large fibrous polyp of the lower end of the ureter is described. The clinical presentation, radiological findings and treatment are discussed.
Subject(s)
Polyps/pathology , Ureteral Neoplasms/pathology , Adult , Female , Fibrosis , HumansABSTRACT
Infusion pyelography was performed in 103 anuric patients with no attendant mortality. It was useful in 83 cases in distinguishing obstructive uropathy from renal parenchymal disease. However, in the remaining 20 cases when either renal parenchymal disease co-existed with obstructive uropathy or obstructive uropathy existed alone under certain circumstances, opacification of the collecting system did not occur. The clinicopathological setting of some of the latter group of cases is illustrated by examples.
Subject(s)
Anuria/diagnostic imaging , Kidney/diagnostic imaging , Humans , Urinary Calculi/diagnostic imaging , Urography/methodsABSTRACT
Considerable controversy exists regarding the ideal anaesthetic coverage for external urethral sphincterotomy in spinal injury patients with detrusor-sphincter dyssynergia. From this preliminary experience on 34 patients in whom this procedure was indicated and then attempted under topical (urethral instillation of 20 ml of 2 per cent Lignocaine jelly) or no anaesthesia, we are encouraged into believing that these patients may not require general or regional anaesthesia for this operation.
