RESUMO
Open ureterolithotomy is now a seldom performed operation but is still occasionally necessary. We report on the transverse ureterotomy (TU) in this procedure and its effect on reducing morbidity. Results from 100 cases of TU for stone disease since 1976 were compared with those from 50 ureterolithotomies using the standard longitudinal ureterotomy (LU) performed during the same period. The parameters considered were urinary leakage, length of hospital stay and ureteric narrowing as assessed on intravenous urogram at three months. The cases utilizing TU were associated with significantly less urinary leakage, a shorter hospital stay and no ureteric narrowing. Transverse ureterotomy for stone disease significantly reduces the morbidity associated with the operation when utilizing the standard LU. The fear of transecting the ureter may be overcome by good exposure and gentle careful dissection. We suggest that TU be used for open ureterolithotomy.
Assuntos
Técnicas de Sutura , Cálculos Ureterais/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Jamaica , Tempo de Internação , Litotripsia a Laser/métodos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Ureterais/diagnóstico , Ureteroscopia/métodosRESUMO
Open ureterolithotomy is now a seldom performed operation but is still occasionally necessary. We report on the transverse ureterotomy (TU) in this procedure and its effect on reducing morbidity. Results from 100 cases of TU for stone disease since 1976 were compared with those from 50 ureterolithotomies using the standard longitudinal ureterotomy (LU) performed during the same period. The parameters considered were urinary leakage, length of hospital stay and ureteric narrowing as assessed on intravenous urogram at three months. The cases utilizing TU were associated with significantly less urinary leakage, a shorter hospital stay and no ureteric narrowing. Transverse ureterotomy for stone disease significantly reduces the morbidity associated with the operation when utilizing the standard LU. The fear of transecting the ureter may be overcome by good exposure and gentle careful dissection. We suggest that TU be used for open ureterolithotomy
Assuntos
Humanos , Masculino , Feminino , Cálculos Ureterais/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Técnicas de Sutura , Complicações Pós-Operatórias , Cálculos Ureterais/diagnóstico , Estudos Retrospectivos , Estudos de Coortes , Jamaica , Litotripsia a Laser/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento , Seguimentos , Tempo de Internação , Ureteroscopia/métodosRESUMO
Successful chronic haemodialysis requires permanent vascular access. The Scribner procedure which utilizes an external arteriovenous shunt, the internal synthetic arteriovenous shunt and the direct arteriovenous fistula as described by Cimino and Brescia have all been used for haemodialysis. Of the three methods, the arteriovenous fistula is the most trouble-free and durable. However, as originally described and constructed in the distal forearm, the morbidity associated with this method is significant. The cubital fossa fistula has even more problems. The mid-forearm fistula was designed by the authors and has been used for chronic haemodialysis over the past eighteen years. This article compares the various methods of access used in the haemodialysis units of the University Hospital of the West Indies and the Kingston Regional Hospital. The mid-forearm fistula was found to have the lowest initial failure rate and was associated with fewer complications than any of the other methods used for access.
Assuntos
Humanos , Antebraço/cirurgia , Derivação Arteriovenosa Cirúrgica/métodos , Diálise Renal/métodos , Trombose , Celulite (Flegmão) , Edema , Antebraço/irrigação sanguínea , Complicações Pós-Operatórias , Insuficiência Renal Crônica/terapiaRESUMO
Successful chronic haemodialysis requires permanent vascular access. The Scribner procedure which utilizes an external arteriovenous shunt, the internal synthetic arteriovenous shunt and the direct arteriovenous fistula as described by Cimino and Brescia have all been used for haemodialysis. Of the three methods, the arteriovenous fistula is the most trouble-free and durable. However, as originally described and constructed in the distal forearm, the morbidity associated with this method is significant. The cubital fossa fistula has even more problems. The mid-forearm fistula was designed by the authors and has been used for chronic haemodialysis over the past eighteen years. This article compares the various methods of access used in the haemodialysis units of the University Hospital of the West Indies and the Kingston Regional Hospital. The mid-forearm fistula was found to have the lowest initial failure rate and was associated with fewer complications than any of the other methods used for access.
Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Antebraço/cirurgia , Diálise Renal/métodos , Celulite (Flegmão)/etiologia , Edema/etiologia , Antebraço/irrigação sanguínea , Humanos , Falência Renal Crônica/terapia , Complicações Pós-Operatórias , Trombose/etiologiaAssuntos
Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Idoso , Biópsia , Humanos , Incidência , Jamaica , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Exame Físico , Prevalência , Próstata/diagnóstico por imagem , Hiperplasia Prostática/diagnóstico , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Neoplasias da Próstata/prevenção & controle , UltrassonografiaAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Biópsia , Exame Físico , Hiperplasia Prostática/diagnóstico , Incidência , Jamaica , Neoplasias da Próstata/patologia , Neoplasias da Próstata/prevenção & controle , Neoplasias da Próstata , Prevalência , Programas de Rastreamento , PróstataRESUMO
63 haemodialysis (HD) patients and 63 age and gender matched controls were investigated for hepatitis B surface antigen (HbsAg) and antibodies to hepatitis B virus (anti-HBV), hepatitis C virus (anti-HCV), hepatitis D virus (anti-HDV), human immunodeficiency virus types 1 and 2 (anti-HIV-1 and 2) and human T-cell lymphotropic virus type-1 (anti-HTLV-1). The notable finding was an increase in hepatitis B markers, 34.9% in HD patients compared to 19.0% in controls (p < 0.02). The seroprevalence of anti-HCV (7.9%, p < 0.03) and anti-HTLV-1 (9.5%; p < 0.006) was also increased in the patients. Four of the five patients positive for anti-HCV were also seropositive for HBV. Anti-HIV and anti-HDV were not detectable in the HD patients in this study. The possibility of HTLV-1 being transmitted by organ transplantation is raised. The seropositivity rate for hepatitis B and C increased with duration on dialysis, but it is unlikely that it was related to the number of blood transfusions since 50% with no transfusion were HBV seropositive.
Assuntos
Hepatite B/epidemiologia , Diálise Renal/estatística & dados numéricos , Adulto , Idoso , Transfusão de Sangue/estatística & dados numéricos , Comorbidade , Feminino , Soropositividade para HIV/epidemiologia , Anticorpos Anti-HTLV-I/sangue , Hepatite B/diagnóstico , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Anticorpos Anti-Hepatite C/sangue , Humanos , Jamaica/epidemiologia , Transplante de Rim/efeitos adversos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos SoroepidemiológicosRESUMO
OBJECTIVES: Rates of prostate cancer in Kingston, Jamaica are extremely high (occurring in more than 300 men out of 100,000 in 1989 to 1993). This article addresses the familial aggregation of prostate cancer in Jamaica. Early evidence for familial prostate cancer was found in the Utah Mormon population. Increased risk of prostate cancer in men with a family history of prostate cancer has been consistently observed in subsequent studies. There have been few studies, however, involving black men, who are known to have an overall higher risk of developing prostate cancer. METHODS: Two hundred sixty-three patients with prostate cancer documented by histology were studied. Two hundred sixty-three age-matched control patients were used for comparison. Extensive pedigrees were obtained for both patients with cancer and controls. Data on other malignancies including lung, breast, colon, stomach, and uterine were also collected. RESULTS: The patients with cancer and the controls were comparable with respect to age and family size. Thirty patients with cancer had a first degree relative (ie, brother, father, or son) with prostate cancer compared to 15 controls. The odds ratio is 2.1 (95% confidence interval 1.1 to 4.4). Nine patients with cancer had a second degree relative (ie, grandfather, grandson, or uncle) affected compared to 3 controls. The odds ratio is 3.1 (95% confidence interval 0.8 to 17.8). There was no statistically significant difference in the rates of any of the other cancers studied. CONCLUSIONS: Familial aggregation of prostate cancer is clearly evident in black Jamaican men. A man with one first degree relative with prostate cancer is twice as likely as the general population to develop prostate cancer. In addition, there may be a statistical difference in the risk of developing prostate cancer if an individual has one second degree relative affected.
Assuntos
Neoplasias da Próstata/genética , Idoso , Idoso de 80 Anos ou mais , Humanos , Jamaica , Masculino , Fatores de RiscoRESUMO
63 haemodialysis (HD) patients and 63 age and gender matched controls were investigated for hepatitis B surface antigen (HbsAg) and antibodies to hepatitis B virus (anti-HBV), hepatitis C virus (anti-HCV), hepatitis D virus (anti-HDV), human immunodeficiency virus types 1 and 2 (anti-HIV-1 and 2) and human T-cell lymphotropic virus type-1 (anti-HTLV-1). The notable finding was an increase in hepatitis B markers, 34.9in HD patients compared to 19.0in controls (p < 0.02). The seroprevalence of anti-HCV (7.9, p < 0.03) and anti-HTLV-1 (9.5; p < 0.006) was also increased in the patients. Four of the five patients positive for anti-HCV were also seropositive for HBV. Anti-HIV and anti-HDV were not detectable in the HD patients in this study. The possibility of HTLV-1 being transmitted by organ transplantation is raised. The seropositivity rate for hepatitis B and C increased with duration on dialysis, but it is unlikely that it was related to the number of blood transfusions since 50with no transfusion were HBV seropositive.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Diálise Renal/estatística & dados numéricos , Hepatite B/epidemiologia , Anticorpos Anti-HTLV-I/sangue , Anticorpos Anti-Hepatite B/sangue , Anticorpos Anti-Hepatite C/sangue , Antígenos de Superfície da Hepatite B/sangue , Comorbidade , Estudos Soroepidemiológicos , Hepatite B/diagnóstico , Jamaica/epidemiologia , Programas de Rastreamento/estatística & dados numéricos , Soropositividade para HIV/epidemiologia , Transfusão de Sangue/estatística & dados numéricos , Transplante de Rim/efeitos adversosRESUMO
PURPOSE: Before this study, the highest reported incidence of prostate cancer in the world was thought to be among United States black men. The age adjusted rates in 1992 for United States black and white men were 249 and 182/100,000 respectively. The epidemiology of prostate cancer in Jamaica, a country of 2.5 million people of primarily African descent, was studied and compared with that of white and black Americans. MATERIALS AND METHODS: The study included 1,121 cases of prostate cancer diagnosed from 1989 to 1994. Sources of information included the Jamaican Cancer Registry, government pathology laboratory, hospital and clinic records, and physician office records. Incidence rates were computed using data from the 1991 Jamaican census. Age adjustments were made using the 1970 United States standard population. RESULTS: The average age adjusted incidence of prostate cancer in Kingston, Jamaica was 304/100,000 men. Median patient age at diagnosis was 72 years. More than 80% of the cases were pathologically confirmed. Of the patients 30% presented with acute urinary retention, 16% presented with bone metastases, 15% had gross hematuria at the time of diagnosis and an abnormal rectal examination suspicious for cancer was noted in 42%. Prostate specific antigen was measured in only 7% of cases in 1989 but in 48% of cases by 1994. CONCLUSIONS: These data demonstrate that Jamaican men in Kingston have a high incidence of prostate cancer, much higher than even black Americans during a similar period. Furthermore, the cancers are more significant clinically with greater morbidity in Jamaica than in the United States.
Assuntos
Neoplasias da Próstata/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Incidência , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Estados Unidos/epidemiologiaRESUMO
Metastatic carcinoma of the penis is uncommon. The primary tumour is most commonly reported to be in the genitourinary or gastrointestinal tract. A case of metastatic carcinoma of the penis, secondary to a primary carcinoma of the prostate gland, is described.
Assuntos
Adenocarcinoma/secundário , Neoplasias Penianas/secundário , Neoplasias da Próstata/patologia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Humanos , Masculino , Neoplasias Penianas/patologia , Neoplasias Penianas/cirurgiaRESUMO
A case of small lymphocytic B-cell lymphoma occurring in the prostate gland of a 68-year-old man is reported. These tumours are rarely encountered in surgical specimens, and may be confused with an undifferentiated carcinoma. Differentiation is readily made, using immunohistochemical techniques.
Assuntos
Leucemia Linfocítica Crônica de Células B/diagnóstico , Neoplasias da Próstata/diagnóstico , Idoso , Humanos , Técnicas Imunoenzimáticas , Leucemia Linfocítica Crônica de Células B/patologia , Masculino , Próstata/patologia , Neoplasias da Próstata/patologiaRESUMO
This article describes a simple method which we have found useful in helping to diagnose psychogenic impotence.