Warm blood cardioplegic induction: an underused modality.

Warm blood cardioplegic induction (WBCI) improves recovery of cardiogenic shock hearts by repaying their energy debt before cold ischemic arrest. This study tests the hypothesis that despite the absence of shock, many hearts are energy depleted and would benefit from WBCI. Twenty-five consecutive (nonshock) patients undergoing open heart operations received antegrade WBCI. Simultaneous samples were drawn from the aortic root and coronary sinus 15 seconds and 2 minutes after cardiac arrest. Samples were analyzed and compared to determine the oxygen consumption, oxygen extraction ratio, and glucose uptake across the left ventricular myocardium. There was a positive linear correlation between oxygen and glucose uptake (p < 0.001). By univariate analysis, severe multivessel disease and high Parsonnet (severity) score were predictors (p < 0.05) of increased metabolic uptake during warm induction. In addition, patients requiring urgent operations (unstable angina, left main disease, or congestive heart failure) and those with a history of hypertension (coronary artery bypass grafting) or left ventricular overload (valve patients) had higher consumption of oxygen and glucose (p < 0.05) compared with patients undergoing elective operations or those without a history of hypertension. In conclusion, warm cardioplegic induction in nonshocked hearts results in increased metabolic uptake indicating energy repayment and correlates with severity of underlying myocardial disease. The need for WBCI is especially great in patients with a history of hypertension or left ventricular overload and those requiring an urgent operation, where increased metabolic extraction was still present after 2 minutes. In addition, even for completely elective patients, WBCI may be useful if the patient has severe multivessel disease or a high Parsonnet score.

Intraoperative coronary excimer laser angioplasty: preliminary clinical experience.

Diffuse coronary artery atherosclerosis is generally recognized as a deterrent to successful revascularization if it cannot be adequately treated. Mechanical endarterectomy can be useful, but it is not the optimal solution owing to the associated higher incidences of perioperative infarction and mortality. The use of laser energy as an endarterectomy tool appears promising. To investigate the application of excimer laser radiation to intraoperative coronary artery endarterectomy, 15 stenotic lesions in 13 patients were treated with excimer irradiation during coronary artery bypass grafting. Eleven (73%) of the lesions were enlarged by the excimer probe (6 of the successes were in calcified lesions). The 4 arteries not enlarged by the excimer laser all demonstrated calcified lesions. There were 3 perforations and 2 dissections, all but 1 in heavily calcified arteries. The results of this phase 1 safety and efficacy study indicate that excimer irradiation can recanalize most arteries, including total and subtotal occlusions and some calcified lesions. Further evaluation with better delivery systems is needed to determine whether the perforation rate can be reduced.

Serodiagnosis of typhoid fever in paediatric patients by anti-LPS ELISA.

Enzyme-linked immunosorbent assay (ELISA) and immunoblot analysis showed that up to 50% of the anti-typhoid antibody in sera from blood culture positive paediatric typhoid fever patients is directed against lipopolysaccharide (LPS) antigen. Anti-Salmonella typhi LPS ELISA was therefore compared to Widal agglutination for serodiagnosis of typhoid fever in paediatric patients. Sera from 38 paediatric control individuals were ELISA negative for anti-S. typhi LPS IgG; all but 2 of these specimens were negative for anti-S. typhi LPS IgM. Paediatric patients hospitalized with signs and symptoms of typhoid fever were separated into 4 groups and tested by ELISA with the following results: 46 patients negative by both culture and Widal agglutination tests, 48% positive for anti-S. typhi LPS IgG and 35% for anti-S. typhi LPS IgM; 22 negative by culture but with positive Widal titres, 82% and 68% positive respectively; 28 culture positive for S. typhi, 93% and 82% respectively; and 12 culture positive for Salmonella other than S. typhi, 92% and 92% respectively. These data suggest that anti-S. typhi LPS ELISA is a suitable assay for diagnosis of typhoid fever in children.

Carcinoma of the prostate, Where are we?

The development in staging of carcinoma of the prostate from the traditional A, B, C, D, or 1, 2, 3, 4, to the present A1, A2, B1, B2, C, D1, D2, is presented. This allows more specific treatment with a better prognosis. In addition, newer diagnostic procedures such as pelvic lymphadenectomy, the more sensitive acid phosphatase determination, using radio-immuno assays, counter-immuno electrophoresis, and solid phase immuno-fluorometric assay, the use of CAT scan, and transrectal ultrasonography for early cancer spread detection and follow-up treatment. The current concept in treatment is radical surgery with pelvic lymphadenectomy in the early stages, external radiation, interstitial irradiation with I125, hormone treatment, and cytotoxic chemotherapy for the late stages.

Myelolipoma of the adrenal gland.

Adrenal myelolipoma is a rare benign tumor that is usually asymptomatic. This case is believed to be the 13th surgically removed, attesting to the rarity of this tumor.

Possible role of amylase enzyme in prostatic and seminal fluid.

Previous quantitative assays and localization of amylase in prostatic and seminal fluid prompted us to determine serum amylase levels in benign and malignant prostatic disease. The possible role of amylase in seminal fluid in normal and pathological conditions is discussed with review of literature.

Radiologic findings of bilharzial (schistosomal) contracted bladder.

The radiologic findings in bilharzial contracted bladder are presented. Calcifications of the bladder were seen in only 4.3 per cent, hydronephrosis in 37.2 per cent, and reflux in 62.8 per cent.

Mid-ureteral leakage: an unusual complication of ileal conduit.

Peritonitis after ureteroileal urinary diversion usually occurs from urinary leakage caused by disruption at the ureteroileal anastomosis. A case of leakage localized at the mid ureter is reported.

Early arabian medicine: contribution to urology.

Although a great deal of urology was written and practiced during the early Arabian era, most of it is still uncovered and not translated into the English language or translated by non-physicians. As Arab urologists, who have access to the original Arabic manuscripts, and as a token to our ancestors as well as to the modern urologist interested in Arab history we believe we should translate a part of this treasure.