Modified anatrophic nephrolithotomy for management of staghorn calculi: is renal function preserved?

Purpose: We report the results of modified anatrophic nephrolithotomy in select patients with complex staghorn calculi.

Materials And Methods: From 1987 to 1997 modified anatrophic nephrolithotomy, including 1 bilateral procedure, was performed in 15 patients at San Francisco General Hospital. Preoperative imaging included excretory urography, sonography and computerized tomography.

HIV RNA and CD4 cell count response to protease inhibitor therapy in an urban AIDS clinic: response to both initial and salvage therapy.

Objective: To determine the HIV RNA and CD4 cell response to both initial and salvage therapy with protease inhibitor-based therapy, and to examine the relationship between the virological response and pre-therapy characteristics.

Design: Observational cohort.

Setting: University-based public hospital AIDS clinic.

Indications for nonoperative management of renal stab wounds.

Purpose: During the last 20 years 2,732 patients have presented to San Francisco General Hospital with renal trauma. Of these patients 198 sustained unilateral and 1 had bilateral stab wounds for a total of 200 renal injuries. We evaluated this subgroup of penetrating renal trauma cases to characterize the nature of the injuries and establish treatment guidelines for successful management.

Prediction of upper extremity impact forces during falls on the outstretched hand.

Among the most common causes of upper extremity fracture is a fall on the outstretched hand. Yet few data exist on the biomechanical factors which affect injury risk during this event. In this study, we measured impact forces during low-height (0-5 cm), forward falls onto the outstretched hand, and found that these are governed by an initial high-frequency peak and a subsequent, lower-frequency oscillation.

Endoscopic harvest of the gracilis muscle flap.

Endoscopic technique is becoming increasing prevalent in plastic surgery and is being explored for use in tissue harvest for microneurovascular transplantation. To advance the art truly, endoscopic technique must provide similar success and complication rates, operative time, and ease of performance as the traditional "open" surgical harvest. We report the successful microvascular transplantation in 6 patients of gracilis muscles harvested with endoscopic guidance.

Obliterative vesicourethral strictures following radical prostatectomy for prostate cancer: reconstructive armamentarium.

Purpose: We report the reconstructive techniques used to correct obliterative vesicourethral strictures related to prostate cancer surgery.

Materials And Methods: Four men with anastomotic obliteration after radical prostatectomy underwent primary excision with end-to-end anastomosis, penile fasciocutaneous flap, free-graft urethroplasty with rectus muscle flap or anterior bladder tube with omental pedicle flap procedure.

Results: At mean followup of 33.

Safety, pharmacokinetics, and antiretroviral activity of intravenous 9-[2-(R)-(Phosphonomethoxy)propyl]adenine, a novel anti-human immunodeficiency virus (HIV) therapy, in HIV-infected adults.

9-[2-(R)-(Phosphonomethoxy)propyl]adenine (PMPA) is a nucleotide analogue with potent antiretroviral activity in vitro and in simian models. A randomized, double-blind, placebo-controlled, dose-escalation clinical trial of intravenous PMPA monotherapy was conducted in 20 human immunodeficiency virus (HIV)-infected adults with CD4 cell counts of >/=200 cells/mm3 and plasma HIV RNA levels of >/=10,000 copies/ml. Two dose levels were evaluated (1 and 3 mg/kg of body weight/day).

Reconstruction of resistant strictures of the fossa navicularis and meatus.

Purpose: We evaluate the long-term efficacy of an integrated 1-stage approach for the reconstruction of resistant strictures of the fossa navicularis and meatus.

Materials And Methods: In 19 men with resistant glanular urethral strictures of varied origin reconstruction was tailored to the individual characteristics of the urethral stricture and glans. Urethral reconstruction was performed with a ventral transverse island fasciocutaneous penile flap in 16 cases, resection and primary end-to-end anastomosis in 2, and a buccal mucosal graft in 1.

Activity of a ritonavir plus saquinavir-containing regimen in patients with virologic evidence of indinavir or ritonavir failure.

Objective: To evaluate the virologic activity of a ritonavir plus saquinavir-containing regimen in patients who have failed an indinavir or ritonavir-containing regimen.

Design: Patients were identified through a retrospective study evaluating the incidence of indinavir or ritonavir failure in our clinic.

Patients: Eighteen patients failing indinavir or ritonavir therapy and who switched to a ritonavir-saquinavir-containing regimen were evaluated.

A novel method for DEAE-dextran mediated transfection of adherent primary cultured human macrophages.

Primary cultured human macrophages are difficult to transfect. We have developed a DEAE-dextran DNA transfection method that mediates the reproducible transfection of primary cultured adherent human macrophages. Three factors essential for successful transfection were identified: DEAE-dextran concentration, the quantity of DNA per transfection and the incubation time of the macrophages with the transfection medium.

Penile circular fasciocutaneous skin flap in 1-stage reconstruction of complex anterior urethral strictures.

Purpose: We review the applications and outcomes of penile circular fasciocutaneous flap urethroplasty in 66 patients at our institution.

Materials And Methods: We used a circular distal penile skin flap for urethral reconstruction in 66 men with complex urethral strictures. Average stricture length in this series was 9.

American Urological Association symptom index in the assessment of urethroplasty outcomes.

Purpose: In men undergoing urethroplasty we used the American Urological Association (AUA) symptom index to assess the magnitude of symptoms and determine the validity of this index as an outcome assessment tool.

Materials And Methods: The AUA symptom index was completed by individual interview of 50 men a mean of 41 years old who underwent urethral reconstruction. Symptom scores were then correlated with radiographic retrograde urethrograms and urinary flow rates to determine whether changes in the score were consistent with these other clinical indicators of success or failure.

Highly sensitive thromboplastins do not improve INR precision.

For determination of the international normalized ratio (INR), it has been suggested that "highly sensitive" thromboplastin reagents (International Sensitivity Index [ISI] < or = 1.2) provide the most consistent performance and minimize interlaboratory variability. We compared the INR values obtained from 69 specimens drawn from patients receiving long-term oral anticoagulant therapy, using four thromboplastin preparations (manufacturer-assigned ISI range of 0.

A randomized, double-blind, placebo-controlled trial of cidofovir gel for the treatment of acyclovir-unresponsive mucocutaneous herpes simplex virus infection in patients with AIDS.

The safety and efficacy of cidofovir gel for treatment of acyclovir-unresponsive herpes simplex virus infections in AIDS patients was evaluated in a randomized, double-blind, multicenter trial. Cidofovir (0.3% or 1%) or placebo gel was applied once daily for 5 days.

Failed anterior urethroplasty: guidelines for reconstruction.

Purpose: We analyzed the methods and outcomes of repeat urethroplasty in men with recurrent stricture after the failure of previous anterior urethroplasty.

Materials And Methods: In 31 men with recurrent stricture after previous urethroplasty anterior urethral reconstruction was performed. Reconstructive methods varied according to stricture length and location.

Role of preoperative sonourethrography in bulbar urethral reconstruction.

Purpose: The accuracy of sonourethrography for the evaluation of bulbar urethral strictures has been well documented. Thus, we sought to define the role of preoperative sonourethrography in establishing objective criteria for procedure selection during bulbar urethral reconstruction.

Materials And Methods: Sonourethrography was performed preoperatively, just before incision, in 67 men selected for bulbar urethroplasty.

Prothrombin time and activated partial thromboplastin time can be performed on the first tube.

The current practice standard for coagulation studies on venous blood specifies the use of the second (or subsequent) tube for testing. Unless other tests are ordered, the first tube is discarded. This practice, derived from early experience using nondisposable materials, gained support from a report based on modern phlebotomy methods but inexperienced phlebotomists.

Wortmannin, a phosphatidylinositol 3-kinase inhibitor, blocks antigen-mediated, but not CD3 monoclonal antibody-induced, activation of murine CD4+ T cells.

Perturbation of several distinct T cell molecules, including the CD3/TCR complex, CD7, and CD28, activates phosphatidylinositol 3-kinase (PI3-K), but a clear consensus on the role of PI3-K in T cell activation has yet to emerge. We report here that CD3 mAb-induced IL-2 production by CD4+ T cells from DO11.10 TCR-alphabeta-transgenic mice is refractory to the potent PI3-K inhibitor, wortmannin, demonstrating that activation under these conditions is independent of PI3-K.

Preservation of renal function after reconstruction for trauma: quantitative assessment with radionuclide scintigraphy.

Purpose: We quantified the degree of preservation of renal function after reconstruction of traumatic renal injuries and identified the factors that influence preservation.

Materials And Methods: We reviewed the records of 52 patients between 1977 and 1995 who underwent radionuclide scintigraphy an average of 11.4 days after renal reconstruction for trauma.

Expression of nitric oxide synthase in the cerebral microvasculature after traumatic brain injury in the rat.

Reduced nicotinamide adenine dinucleotide phosphate-diaphorase (NADPHd) histochemistry and nitric oxide synthase (NOS) immunocytochemistry were performed on sections of brain after moderate traumatic brain injury. There was a pronounced increase in NADPHd reactivity and an induction of the endothelial NOS (eNOS) isoform in microvessels surrounding the cortical contusion by 24 h post-injury. This altered microvascular state may contribute to barrier breakdown and hyperemia which characterize traumatic brain injury.