Deconditioning of exercise-induced asthma

The majority of asthmatic children develop a significant degree of bronchospasm after a moderate amount of exercise. Etiology of this phenomenon has remained unknown. Pulmonary function tests, measurements of blood gases, and immunological assessments have been essentially normal. This study was designed to investigate the role of conditioning process in the development of exercise-induced bronchospasm (EIB). Fifty asthmatic children, between the ages of 8 and 15, were subjected to a standardized test of exercise. Thirty-six of the children who developed EIB were divided into an experimental and a control group. The experimental procedure was designed as a classical extinction procedure in which the conditioned stimulus (exercise) was presented without the occurrence of conditioned response of EIB. Only the experimental group received isoproterenol inhalation before the exercise to prevent the occurrence of EIB, while the control groups received plain air in a similar manner. The experimental group showed a significant improvement after the extinction procedure. A 6 month follow-up indicated that the majority of the children in the experimental group maintained the gains that were acquired during the experimental procedure.

Acute scrotal swelling in Henoch-Schönlein syndrome

A review of the literature regarding scrotal swelling in Henoch-Schönlein purpura is compared with our own experience at the Mayo Clinic over the previous ten years. Of 59 boys seen with Henoch-Schönlein purpura, 9 were noted to have scrotal swelling, and in 4 the presentation was of sufficient severity to suggest torsion. Two of these 4 were managed conservatively, and spontaneous recovery resulted. Surgical exploration of the scrotum in the other 2 revealed evidence of vasculitis in both and the possibility of torsion of appendix epididymis in 1. In patients with Henoch-Schölein purpura and scrotal pain and swelling, a conservative approach with cautious observation appears justified.

Review of current concepts in aspiration pneumonia

Aspiration pneumonia is a form of ARDS resulting from an acid injury of the lung and is primarily a problem of arterial hypoxemia requiring adequate oxygen therapy. All other modes of therapy have not been shown to alter survival in man. In the otherwise healthy individual, immediate and long-term prognoses are excellent. However, in debilitated patients with significant underlying disease processes, rates of both immediate and delayed death are high. The late deaths reflect the significance of secondary infection due primarily to anaerobic organisms.

Significance of urinary cytology in the early detection of transitional cell cancer of the upper urinary tract

Cytologic study of urine from 100 patients with transitional cell cancer of the upper urinary tract revealed that findings on the voided and catheterized specimens correlated well with grade and stage of the tumor. However, there was a significantly greater positive yield with urine specimens obtained by ureteral catheterization than by voiding. Consequently, because concomitant bladder tumors, diagnosed or not, can give questionable positive results ureteral catheterization specimens should be used for cytologic study.

Transpubic urethroplasty

Eleven patients underwent transpubic repair of membranous urethral strictures. Excision of the wedge of pubic bone was not associated with orthopedic disability and provided excellent exposure for primary anastomosis of the urethra. Distal urethral mobilization and incision of the intercrural septum provided adequate urethral length for tension-free anastomosis. Satisfactory results were achieved in all patients, without adversely affecting continence or potency.

Urethral calculi

The diagnosis and management of 34 men and 13 women with urethral calculi are reviewed. A majority of patients presented with dysuria, weak stream and perineal pain. Diagnosis was made radiographically in only 42 per cent but was confirmed in all patients who underwent cystourethroscopy. All patients had lower urinary tract lesions or previous prostatic operations and 47 per cent were infected. Migrant urethral calculi were encountered 10 times more often than were native stones and a metabolic cause was found in 10 of 18 patients studied. In men penile urethral calculi were removed transurethrally and all bulbous and most posterior urethral stones were guided endoscopically into the bladder. Most of these stones were irrigated out or removed by transurethral litholapaxy; the remaining few, together with vesical calculi, required cystolithotomy. In all 13 women calculi were removed at the time of urethral diverticulectomy. A majority of 17 men (76.5 per cent) and the 4 women who were followed for an average of 5.3 years have remained free of trouble.

Spontaneous urinary extravasation

The diagnosis and management of 12 patients with spontaneous non-traumatic urinary extravasation are described. It is important to distinguish extravasation of the fornical backflow type from that owing to frank rupture of the diseased renal pelvis. Most cases of the former variety are caused by calculous ureteral obstruction and can be managed conservatively. Surgical intervention is indicated for the latter variety (frank rupture) and is based on the requirements imposed by the patient's clinical condition, the persistence of obstruction or extravasation, or the presence of complications of extravasation such as urinoma or abscess.

Pneumopyelography

Poorly opacified calculi that are completely obscured by high-density contrast media can be delineated by pneumopyelography. Three examples of pneumopyelography are presented.

Physical therapy and exercise-induced bronchospasm

Most asthmatic children develop a significant degree of bronchospasm from exercise which restricts their active participation in outdoor play and sports and sometimes leads to many social and psychological problems. No specific physiological or immunological factors have yet been found to explain the basis of this exercise-induced bronchospasm (EIB). It is also unrelated to age, sex, or severity of asthma. Some investigators have hypothesized that EIB may be a conditioned response resulting from the association between the physical exertion and breathing difficulty which is frequently experienced by these children during their asthmatic attacks. Physical activity programs, organized around themes of progressive and interval training periods, may be quite helpful in reducing the intensity of EIB.

Clinical management of carcinoma of prostate, associated with bilateral ureteral obstruction

A review of 34 cases of bilateral ureteral obstruction secondary to carcinoma of the prostate indicates that aggressive treatment in selected cases can increase survival without an associated increase in morbidity. In our series various modalities of treatment were used in 25 patients and the remaining 9 patients received no treatment. Bilateral ureteral obstruction in cases of carcinoma of the prostate should not uniformly imply a terminal event or hopeless prognosis.