Surgical pathology of the tricuspid valve: a study of 363 cases spanning 25 years.

Surgical pathologic features of the tricuspid valve were reviewed in 363 patients who had undergone tricuspid valve replacement at our institution during the period 1963 through 1987. Valves were purely regurgitant in 74%, stenotic and regurgitant in 23%, and purely stenotic in 2%; two valves were neither stenotic nor regurgitant. Among 269 purely insufficient tricuspid valves, the four most common causes were postinflammatory disease (41%), congenital disorder (32%), pulmonary venous hypertension (21%), and infective endocarditis (4%).

Treatment of superficial bladder tumors with intravesical recombinant interferon alpha-2a.

In a prospective study, the toxicity and efficacy of an instillation therapy with recombinant interferon alpha-2a (rIFN-alpha-2a) were evaluated in 12 patients with superficial bladder tumors. Treatment consisted of 8 weekly instillations of 54 X 10(6) IU rIFN-alpha-2a in 50 ml saline. Two weeks after completion of the instillation therapy, the tumor status was assessed with cystoscopy, biopsy and bladder wash-out cytology.

Extracorporeal shock wave lithotripsy for large renal stones. To what size is extracorporeal shock wave lithotripsy alone feasible?

The complications after extracorporeal shock wave lithotripsy (ESWL) for large renal calculi could be reduced by insertion of ureteral stents. In a prospective study, the critical stone size for ESWL combined with ureteral stenting was looked for. Sixty consecutive patients entered the study, 17 patients suffered from renal calculi with a length of greater than 4 cm and a width of greater than 3 cm (group 1), and in 43 patients the calculi measured between 4 x 3 and 2.

Influence of calcium content in mineral water on chemistry and crystallization conditions in urine of calcium stone formers.

19 idiopathic recurrent calcium stone formers were examined on a constant diet supplemented with mineral water of high (386 mg/l) and low (10 mg/l) calcium content. The effects of calcium and oxalate loading were studied separately. Ingestion of mineral water with high calcium content lead to an increase of urinary calcium and a decrease of urinary oxalate compared to mineral water with low calcium content.

Identification of atrial natriuretic factor within ventricular tissue in hamsters and humans with congestive heart failure.

In normal mammals, atrial natriuretic factor (ANF) is present within atrial myocardial cells but is absent from ventricular myocardium. In primitive organisms ANF is present within both atria and ventricle, suggesting that the ventricle may participate both in the synthesis and release of the hormone. The current study was designed to test the hypothesis that ventricular ANF develops as a homeostatic response to intravascular volume overload.

Malignant neoplastic emboli to the coronary arteries: report of two cases and review of the literature.

Two patients were seen with malignant neoplastic emboli to the coronary arteries. One, a 61-year-old woman with a malignant fibrous histiocytoma of the thigh and a solitary pulmonary metastatic lesion, died of an acute myocardial infarction due to a neoplastic coronary embolus after lobectomy. The other, a 51-year-old woman with bronchogenic adenocarcinoma, died of extensive cerebral metastases.

Bilateral testicular germ cell tumors: a report of 20 cases.

Of 412 patients with unilateral testicular cancer 20 (4.3 per cent) suffered a second primary germ cell tumor: 1 had a simultaneous bilateral tumor and in the remaining 19 the second tumor was diagnosed after an interval of 2 months to 32 years. Patients with clinical stages III and IV disease were found only in the group with a second tumor.

Sudden death as the initial manifestation of primary pulmonary hypertension. Report of four cases.

Four autopsy cases are presented in which sudden death was the initial manifestation of primary pulmonary hypertension. The arteriopathy was plexogenic in two cases (a 3-year-old girl and a 16-year-old boy) and was thrombotic in two other cases (55- and 59-year-old women). The diagnosis of primary pulmonary hypertension, particularly in forensic cases, requires that the pathologist be especially aware of the possibility and that a careful evaluation of multiple sections of lung be performed.

Traumatic rupture of Ionescu-Shiley aortic valve after the Heimlich maneuver.

A 74-year-old woman who had undergone aortic valve replacement with an Ionescu-Shiley bioprosthesis was evaluated and treated because aortic insufficiency developed after the application of the Heimlich maneuver. Pathologic examination of the explanted valve disclosed a cuspid perforation and an adjacent tear of a second cusp at its insertion into the valve strut. Patients with unexplained acute prosthetic insufficiency should be questioned as to whether the Heimlich maneuver has been previously performed.

[Extracorporeal shockwave lithotripsy: experience with 1000 treatments].

6 1/2 years after the first clinical trials in Munich, extracorporeal shockwave lithotripsy is a well established method for the treatment of urinary tract calculi. The number of open surgical interventions in urolithiasis has therefore markedly diminished. In hospitals with lithotriptors open surgical procedures are less than 1% today.

Temporal changes in the causes of aortic stenosis: a surgical pathologic study of 646 cases.

Among 646 patients with pure aortic stenosis who underwent valve replacement at our institution between 1981 and 1985, the three most frequent causes were calcification of congenitally bicuspid aortic valves (38%), degenerative (senile) calcification of tricuspid aortic valves (33%), and postinflammatory (presumably rheumatic) calcification and fibrosis (24%). Among the 324 patients younger than 70 years of age, calcified bicuspid valves were observed in 50%. In contrast, among 322 patients 70 years of age or older, degenerative calcification accounted for 48% of the stenotic aortic valves.

Surgical pathology of the mitral valve: a study of 712 cases spanning 21 years.

The gross surgical pathologic features of the mitral valve were reviewed in 712 patients who had undergone mitral valve replacement at our institution during 1965, 1970, 1975, 1980, and 1985. Among the 452 cases of mitral stenosis, either with or without mitral insufficiency, 99% were attributable to postinflammatory disease and 1% were related to congenital mitral stenosis. Among the 260 cases of pure mitral regurgitation, the two most common causes were a floppy valve (38%) and postinflammatory disease (31%).

Urothelial carcinogenesis and portocaval anastomosis in the rat.

Portacaval anastomoses were performed in the rat to study urothelial carcinogenesis in this model and the promoting effect of dietary tryptophan. We were unable to produce any urothelial cancers or premalignant changes; some animals formed uric acid stones and developed papillary hyperplasia in the bladder. We conclude that the initiating carcinogen is likely to be exogenous and may be dietary in those experiments that have produced urothelial cancers.

Chemical factors governing the state of saturation towards brushite and whewellite in urine of calcium stone formers.

Variations of urinary pH and concentrations of calcium, phosphate, oxalate, magnesium and citrate have been produced by 4 different diets given to 19 idiopathic calcium stone formers. The state of saturation towards whewellite and brushite was directly measured in the 76 urine samples by equilibration with the corresponding salts and was compared to chemical constituents by regression analyses. The state of saturation towards calcium oxalate monohydrate was significantly governed only by the urinary oxalate concentration, and a soluble oxalate fraction not contributing to calcium oxalate chelation was demonstrated.

Urethral reconstruction in females.

The report of 4 female patients operated on for severe functional impairment of the urethra gives rise to a historical review of the development of bladder flap procedures. Two patients had urethral reconstruction with a rotary bladder flap and 2 patients had urethral lengthening according to Leadbetter. Indications, mechanisms of continence and technical aspects of both procedures are discussed.

The relationship between atrial granularity and circulating atrial natriuretic peptide in hamsters with congestive heart failure.

The BIO 14.6 strain of hamster is a model of familial cardiomyopathy complicated by congestive heart failure, sodium retention, and edema. In previous studies, bioassay techniques have demonstrated that the cardiac content of atrial natriuretic peptide (ANP) is reduced in these animals.

[Treatment of superficial tumors of the bladder with bacillus Calmette-Guérin].

In a prospective study 21 patients with superficial bladder tumors were treated with BCG and examined as to compatibility and effectiveness. The BCG treatment was according to Morales with 6 intravesical applications in weekly intervals, 120 mg BCG each, and skin scarification with 5 mg on the thigh at the same time. A BCG viable vaccine of the Pasteur Paris strain (immune BCG PasteurFR) was used.

Preoperative preparation of the bowel for urological surgery: a review.

The risk of postoperative complications following opening of the intestine can be reduced by lowering the intraluminal bacterial count. The latter is achieved principally by decreasing the mass of the gut content and by antibiotic prophylaxis. Macroscopically satisfactory decontamination of the gut can be attained with laxatives, enemas, elementary diet or orthograde lavage.

Desmoplastic melanoma of the anus.

To date a desmoplastic melanoma, an unusual variant of malignant melanoma, has been described only in the skin. The present report describes a case of desmoplastic melanoma that arose in the anal canal. The patient was without evidence of recurrence or metastases 18 months after surgical removal of the lesion.

[Practical experiences with antegrade local chemolysis of struvite/apatite, uric acid and cystine calculi in the kidney].

In 18 patients (20 kidneys) with struvite/apatite-, uric acid- and cystine stones antegrade local chemolysis was performed via percutaneous or operative nephrostomy. Complete stone dissolution was achieved in 11 kidneys, while in six kidneys partial dissolution of stones was performed. In these six cases added instrumental manipulations shortened the time of therapy.

[Reconstruction of the urethra in women using a bladder flap].

Three patients have been successfully operated with bladder flap procedures for severe functional impairment of the urethra. In two cases total urethral reconstruction was established with a rotary flap (= inverse Boari flap). The third case with recurrent incontinence and instable pelvis was cured by lengthening the urethra analogous the Leadbetter technique.