An in-house coordinator program to increase organ donation in public trauma hospitals.

A 4-year retrospective study was conducted regarding the donor potential, consent rates, and organ recovery at a large 500-bed public trauma hospital. An independent organ procurement organization hired two in-house coordinators, one white and one black, to work exclusively in the hospital. The duties of the in-house coordinators included the following: working with nurses, physicians, and residents to identify donors; closely managing and coordinating the consent process; and assisting organ procurement coordinators in donor management.

The Baylor College of Medicine experience with gold seed implantation.

Advances in imaging technology and implant technique have led to the resurgent interest and practice of brachytherapy for the treatment of prostate cancer. Brachytherapy is a form of radiation treatment in which radioactive sources are placed directly into the tumor; it offers the advantage of maximizing the radiation dose delivered to the tumor while sparing the adjacent normal tissue. Permanent implants have become an important component of radiation delivery.

Concurrence of de novo membranous glomerulonephritis and recurrent IgA nephropathy in a renal allograft.

Recurrent IgA nephropathy is commonly reported in renal transplant. De novo membranous glomerulonephritis is the most frequent type of glomerulonephritis seen in renal transplant. Nevertheless, to the best of our knowledge, the association of these two conditions in a single patient has never been documented.

Genitourinary emergencies.

An awareness of pitfalls and perils in diagnosis of traumatic injuries to the genitourinary tract, and indications and contraindications for studies and instrumentation, will help diagnose these sometimes underdiagnosed injuries and help minimize morbidity. Suspicion of testicular torsion should lead to prompt urologic consultation, and priapism also should be promptly treated to preserve function. The treatment of acute urinary retention consists of prompt bladder drainage with attention to etiology and methods.

Ureteral injury.

The management of ureteral injuries resulting from external violence or surgery is usually straightforward and is primarily a problem of recognition and development of a treatment plan that allows either repair of the injury away from the site of pathology or conservative drainage and diversion. However, decisions as to the proper therapy can be complicated by legal, economic, and emotional considerations, which make management of these patients difficult. In the last 5 years, endoscopic manipulation of the ureter for the treatment of stones and stricture has become commonplace.

Etiology, classification, and management of renal trauma.

Management of blunt renal trauma demands an aggressive effort to define the extent and severity of the renal injury with imaging studies. In general, a conservative approach to treatment is recommended that may include an early surgical exploration when the risk of late hemorrhage is great and the kidney or a portion of the kidney has obviously already been lost. To treat all patients with surgery or with expectant treatment is illogical.

Operative injury to the lower urinary tract.

Operative injury to the lower urinary tract is extremely common. Most of these injuries occur during the course of gynecologic surgery and involve the bladder. Urethral injury is most commonly found following urethral diverticulectomy or with urologic endoscopic procedures.

Intrarenal abscess. Report of 14 cases.

Six of 14 patients with renal abscess had prior history of urinary tract infection; initial symptoms included fever and flank pain in 12. A drip-infusion intravenous pyelogram was the most sensitive radiologic test, but selective renal arteriography was most specific. Urine cultures were positive in all 14 patients; blood cultures were positive in nine.

Combined Interstitial and External Radiotherapy in the Definitive Management of Carcinoma of the Prostate.

Five hundred and forty-two patients have been treated for prostatic carcinoma with radiotherapy between 1965 and 1976 at our institution. All patients have been followed for longer than one year. Two hundred and ninety-five patients have been subjected to surgical exploration to document the precise stage of their disease and undergone staging pelvic lymphadenectomy at the time of interstitial implantation of radioactive gold grains.

The use of microfibrillar collagen hemostat for control of renal bleeding.

Microfibrillar collagen hemostat was used in 23 patients with renal injuries owing to multiple causes in an attempt to control small vessel bleeding from raw renal surface areas. Minimal complications have occurred with the use of this substance. Control of bleeding has been prompt and no late bleeding has occurred.

Penetrating renal injuries and the management of renal pedicle injury.

Injury to the upper urinary tract from penetrating trauma frequently is associated with injury to other abdominal organs. Management of the renal injury requires knowledge of the effect of injury of these other organs on the renal repair. Frequently the associated injury may dictate a need for nephrectomy when a complicated procedure would be necessary for repair of the kidney, but one should always keep in mind the high incidence of acute renal failure found in penetrating abdominal injuries and make a maximum effort to converse renal parenchyma in these patients.

Radiotherapy in the management of stage C carcinoma of the prostate.

A small number of patients with limited stage C carcinoma of the prostate have been treated with combined interstitial and external beam radiotherapy with gratifying results. Whereas more patients will have to be followed for at least 10 to 15 years to completely evaluate this modality of treatment, the results continue to encourage us in its use.

Radiotherapy in the management of stage C carcinoma of the prostate.

A small number of patients with limited stage C carcinoma of the prostate have been treated with combined interstitial and external beam radiotherapy with gratifying results. Whereas more patients will have to be followed for at least 10 to 15 years to completely evaluate this modality of treatment, the results continue to encourage us in its use.