Hasson's laparoscopic trocar in percutaneous bladder stone lithotripsy

Bladder calculi are a common problem traditionally treated with open cystolithotomy or transurethral cystolithalopaxy. Percutaneous cystolithotomy via an Amplatz sheath is a recent approach that keeps urethral instrumentation to a minimum. We describe a percutaneous approach to bladder stones using a Hasson's trocar. With this approach, one or more watertight approaches to the bladder can be created, allowing any kind of endoscopic surgical material to be introduced, thus opening new possibilities in the design of percutaneous bladder surgery techniques.

Natural Aujeszky's disease in a Spanish wild boar population

We describe an outbreak of Aujeszky's disease (AD) in a wild boar (Sus scrofa) population from central Spain. Mortality was estimated to be at least 14% (14/100) in juveniles and 7.5% (3/40) in adults. Most of the affected animals (12/17) were between 4 and 8 months of age. Gross lesions mainly consisted of enlarged and congestive tonsils and lymph nodes, petechial hemorrhages on the small intestine, and engorged blood vessels in the brain and meninges. Histopathology revealed mild nonsuppurative meningoencephalitis. Positivity to the fluorescent antibody test was found in tissues from the affected animals. Seroprevalence of antibodies to AD virus (ADV) was 56% (9/16). To our knowledge, this is the first description of clinical cases in a wild suid population.

Prostatic abscess due to Candida with no systemic manifestations

Prostatic abscess due to fungi is a rare condition. It is generally secondary to systemic disease in immunosuppressed patients. It usually occurs with affection of other organs in a septic patient. Only in exceptional cases does it occur isolatedly. We present the case of a prostatic abscess due to Candida albicans with no systemic manifestations. The diagnosis is helped by transrectal ultrasound, which allows to differentiate this condition from nonabscessed acute prostatitis. The treatment of choice is ultrasound-guided transrectal needle aspiration after antibiotic therapy has been started. As with abscesses of bacterial origin, an ultrasonographic follow-up is required due to the possibility of persistence or recurrence.

[Late rupture of central catheter implanted through subclavian route]

A 68-year-old woman with a subcutaneous reservoir and central venous catheter implanted in the left subclavian vein for chemotherapy developed a late fracture of the catheter 220 days after implantation, with migration of the distal fragment to the pulmonary artery. After diagnosis of the complication, the distal fragment had to be removed by radiologic intervention and the reservoir was withdrawn. The need for central venous treatments, whether for definitive parenteral nutrition or prolonged antibiotic infusion, pain therapy, chemotherapy or, lately, for hemodialysis has made the placement and use of implantable systems a routine procedure for anesthesiology services. However, such techniques are not free of multiple complications, some of which are serious and which may be caused by poor technique during insertion of the catheter. We consider careful selection of the point of subclavian vein insertion to be important. The scheduling of follow-up chest films is also crucial for ruling out a "pinch-off phenomenon".

Tomato allergy in children and young adults: cross-reactivity with latex and potato

BACKGROUND

Several studies have shown that allergy to natural rubber latex is associated with cross-reactivity to certain foods such as tomato and potato. The objective was to investigate the clinical and immunologic differences between a group of patients with clinical allergy to tomato and latex and another which had only clinical allergy to tomato. We also aimed to assess, in vitro, the relationship of tomato and latex allergens, which could explain the cross-reactivity.

METHODS

Forty patients with histories of adverse reactions to tomato and IgE-mediated hypersensitivity were enrolled in the study. Tomato, latex, and potato components were analyzed by SDS-PAGE immunoblotting. CAP and immunoblot inhibition were used to study allergen cross-reactivity.

RESULTS

Patients from group A had a mean age of 13.2 years, and in group B the mean age was 21.7 years. In group B, 9/10 patients belonged to the latex-fruits syndrome. All patients of both groups tolerated potato. Immunoblotting patterns obtained with patients' sera from pool A showed IgE-binding bands to tomato ranging from 44 to 46 kDa and a triple band at 67 kDa. For latex, there was a strong binding at 44 kDa, and potato showed a strong band of 44 kDa and a 67-kDa triple band. In pool B, the binding to the band of 44 kDa in latex and tomato was more intense than in pool A. In pool A, immunoblot inhibition with potato allergen showed an intense inhibition of the three allergens (potato, latex, and tomato); with latex, inhibition was partial and with tomato, a complete inhibition of tomato and latex was observed, and a partial inhibition of potato. In pool B, the inhibition pattern followed a similar tendency to pool A. The CAP inhibition confirmed the high rate of cross-reactivity between tomato, potato, and latex.

CONCLUSIONS

In our study, tomato, potato, and latex showed a common band of 44-46 kDa probably corresponding to patatin. This protein could be implicated in the high cross-reactivity between tomato, latex, and potato observed in the immunoblot and CAP inhibition.

Heterodi- [MAg, MAu (M = Pd, Pt)], Tri- [PdAg(2), PtAg(2), PtAu(2), Pt(2)M (M = Ni, Pt, Cd, Hg)], and Tetranuclear (Pt(2)Ag(2), Pt(2)Au(2)) 1,1-ethylenedithiolato complexes

The reactions of [M(PPh(3))(2)[S(2)C=C[C(O)Me](2)]] [M = Pd (1a), Pt (1b)] with AgClO(4) and PPh(3) or with [Au(PPh(3))(OCMe(2))]ClO(4) afford heterodinuclear [[M(PPh(3))(2)][M'(PPh(3))][S(2)C=C[C(O)Me](2)]]ClO(4) [M = Pd, M' = Ag (2a), M = Pt, M' = Ag (2b), Au (4)] or trinuclear [[M(PPh(3))(2)][M'(PPh(3))](2)[S(2)C=C[C(O)Me](2)]](ClO(4))(2) [M = Pd, M' = Ag (3a), M = Pt, M' = Ag (3b), Au (5)] 1,1-ethylenedithiolato complexes, depending on the molar ratio of the reagents. We have recently reported that, in the absence of added PPh(3), the reactions of [Pt[S(2)C=C[C(O)Me](2)]L(2)] [L = PPh(3) (1b), L(2) = 1,5-cyclooctadiene (cod) (1c)] with AgClO(4) produce the heterotetranuclear derivatives [[PtL(2)](2)Ag(2)[S(2)C=C[C(O)Me](2)](2)]](ClO(4))(2) [L = PPh(3) (6a), L(2) = cod (6b)], which have been used now as efficient transmetallating agents toward gold, platinum, mercury, nickel, copper, or cadmium metal centers to give new types of 1,1-ethylenedithiolato complexes: [[Pt(PPh(3))(2)](2)Au(2)[S(2)C=C[C(O)Me](2)](2)](ClO(4))(2) (7), [(PtL(2))(2)M[S(2)C=C[C(O)Me](2)](2)](ClO(4))(2) [L(2) = cod, M = Pt (8), L = PPh(3), M = Hg (9)], [[Pt(PPh(3))(2)](2)[S(2)C=C[C(Me)=O](2)](2)Ni](ClO(4))(2) (10), and [[Pt(PPh(3))(2)](2)[S(2)C=C[C(Me)=O](2)](2)[M(OClO(3))(2)]] [M = Cu (11), [C(O)Me](2)] moieties but, whereas in 7 they bridge two gold(I) centers through the sulfur atoms, in 11 they chelate the copper(II) center through the oxygen atoms. The last one is the first example of such a coordination mode for the 2,2-diacetyl-1,1-ethylenedithiolato ligand.

Bladder perforation caused by foreign body migration

Lower urinary tract symptoms is a well known presentation of the presence of foreign bodies inside the bladder. Most such cases are diagnosed by chance, while investigating unrelated conditions. We present the transvesical endoscopic extraction of a surgical sponge that migrated to the bladder six years after an inguinal hernioplasty.

Synthesis of Luminescent Gold(I) and Gold(III) Complexes with a Triphosphine Ligand

We have synthesized and characterized a series of trinuclear gold(I) complexes [(AuX)(3)(mu-triphos)] (triphos = bis(2-diphenylphosphinoethyl)phenylphosphine; X = Cl 1, Br 2, I 3, C(6)F(5) 4) and di- and trinuclear gold(III) complexes [[Au(C(6)F(5))(3)](n)(mu-triphos)] (n = 2 (5), 3 (6)). The crystal structure of 6 [[Au(C(6)F(5))(3)](3)(mu-triphos)] has been determined by X-ray diffraction studies, which show the triphosphine in a conformation resulting in very long gold-gold distances, probably associated with the steric requirements of the tris(pentafluorophenyl)gold(III) units. Complex 6 crystallizes in the triclinic space group P(-1) with a = 12.7746(16) A, b = 18.560(2) A, c = 21.750(3) A, alpha = 98.215(3) degrees, beta = 101.666(3) degrees, gamma = 96.640(3) degrees, and Z = 2. Chloride substitutions in complex 1 afford trinuclear gold(I) complexes [(AuX)(3)(mu-triphos)] (X = Fmes (1,3,5-tris(trifluoromethyl)phenyl) 7, p-SC(6)H(4)Me 8, SCN 9) and [Au(3)Cl(3)(-)(n)()(S(2)CNR(2))(n)(mu-triphos)] (R = Me, n = 3 (10), 2 (12), 1 (14); R = CH(2)Ph, n = 3 (11), 2 (13), 1 (15)). The luminescence properties of these complexes in the solid state have been studied; at low temperature most of them are luminescent, including the gold(III) derivative 6, with the intensity and the emission maxima being clearly influenced by the nature and the number of the ligands bonded to the gold centers.

Mononuclear (Pd, Pt), heterodinuclear (PdAg, PtAg), and tetranuclear (Pd2Ag2, Pt2Ag2) 1,1-ethylenedithiolato complexes

lp;&-5q;1 The reactions of [Tl2[S2C=C[C(O)Me]2]]n with [MCl2L2] (1:1) or with [MCl2(NCPh)2] and PPh3 (1:1:2) give complexes [M[eta2-S2C=C[C(O)Me]2]L2] [M = Pt, L2 = 1,5-cyclooctadiene (cod) (1); L2 = bpy, M = Pd (2a), Pt (2b), L = PPh3, M = Pd (3a), Pt (3b)] whereas with MCl2 and QCl (2:1:2) anionic derivatives Q2[M[eta2-S2C=C[C(O)Me]2]2] [M = Pd, Q = NMe4 (4a), Ph3P=N=PPh3 (PPN) (4a'), M = Pt, Q = NMe4 (4b)] are produced. Complexes 1 and 3 react with AgClO4 (1:1) to give tetranuclear complexes [[ML2]2Ag2[mu2,eta2-(S,S')-[S2C=C[C(O)Me]2]2]](ClO4)2 [L = PPh3, M = Pd (5a), Pt (5b), L2 = cod, M = Pt (5b')], while the reactions of 3 with AgClO4 and PPh3 (1:1:2) give dinuclear [[M(PPh3)2][Ag(PPh3)2][mu2,eta2-(S,S')-S2C=C[C(O)Me]2]]]ClO4 [M = Pd (6a), Pt (6b)]. The crystal structures of 3a, 3b, 4a, and two crystal forms of 5b have been determined. The two crystal forms of 5b display two [Pt(PPh3)2][mu2,eta2-(S,S')-[S2C=C[C(O)Me]2]2] moieties bridging two Ag(I) centers.

[Cervical lymph node involvement in laryngeal carcinoma: a retrospective study of 430 cases]

Cervical lymph node involvement in laryngeal tumors could be a market impact on the disease prognosis. We performed a retrospective study of 430 patients who underwent surgery to treat laryngeal carcinoma in our center over a 10-year period. The objective was to correlate clinical and pathological lymph node involvement with the site of origin and size of the tumor, the treatment and its impact on patient survival. We observed a significantly greater incidence of lymph node involvement in tumors originating from supraglottis, with a rate of occult lymph node metastases of 31%. Patients with lymphadenopathy that remained undetected in the absence of surgical treatment and those with nonmetastatic lymphadenopathy presented similar 5-year survival rates, 83% y 98% respectively. However, the 5-year survival decreased to 24% in the presence of metastatic lymph node involvement. These results support the proposal that treatment of laryngeal carcinoma should include the region of the cervical nodes as well.

Reduction of (imine)Pt(IV) to (imine)Pt(II) complexes with carbonyl-stabilized phosphorus ylides

A novel method is reported for generation of the difficult-to-obtain (imine)Pt(II) compounds that involves reduction of the corresponding readily available Pt(IV)-based imines by carbonyl-stabilized phosphorus ylides, Ph3P=CHCO2R, in nonaqueous media. The reaction between neutral (imino)Pt(IV) compounds [PtCl4[NH=C(Me)ON=CR1R2]2] [R1R2 = Me2, (CH2)4, (CH2)5, (Me)C(Me)=NOH], [PtCl4[NH=C(Me)ONR2]2] (R = Me, Et, CH2Ph), (R1 = H; R2 = Ph or C6H4Me; R3 = Me) as well as anionic-type platinum(IV) complexes (Ph3PCH2Ph)[PtCl5[NH=C(Me)ON=CR2]] [R2 = Me2, (CH2)4, (CH2)5] and 1 equiv of Ph3P=CHCO2R (R = Me, Et) proceeds under mild conditions (ca. 4 h, room temperature) to give selectively the platinum(II) products (in good to excellent isolated yields) without further reduction of the platinum center. All thus prepared compounds (excluding previously described Delta4-1,2,4-oxadiazoline complexes) were characterized by elemental analyses, FAB mass spectrometry, IR and 1H, 13C[1H], 31P[1H] and 195Pt NMR spectroscopies, and X-ray single-crystal diffractometry, the latter for [PtCl2[NH=C(Me)ON=CMe2]2] [crystal system tetragonal, space group P4(2)/n (No. 86), a = b = 10.5050(10) A, c = 15.916(3) A] and (Ph3PCH2CO2Me)[PtCl3(NCMe)] [crystal system orthorhombic, space group Pna2(1) (No. 33), a = 19.661(7) A, b = 12.486(4) A, c = 10.149(3) A]. The reaction is also extended to a variety of other Pt(II)/Pt(IV) couples, and the ylides Ph3P=CHCO2R are introduced as mild and selective reducing agents of wide applicability for the conversion of Pt(IV) to Pt(II) species in nonaqueous media, a route that is especially useful in the case of compounds that cannot be prepared directly from Pt(II) precursors, and for the generation of systematic series of Pt(II)/Pt(IV) complexes for biological studies.

High prevalence of large spiny-tailed protostrongylid larvae in Iberian red deer

The prevalence and abundance of protostrongylid larvae (Nematoda: Protostrongylidae) in 173 fecal samples of Iberian red deer (Cervus elaphus hispanicus Erxleben, 1777) are presented. Large (401(365-425)+/-24 micom) spiny-tailed larvae, comparable to the descriptions of first stage Elaphostrongylus cervi larvae were found in 66.47+/-0.7% of the samples (range 6.8-100%, depending on the locality). The overall abundance of larvae in faces was overdispersed with an average of 24.94+/-96.23 (range 0-1202) larvae per gram, and ranged between sampling sites from 0.11+/-0.43 to 96+/-75 larvae per gram. This is the first report of large spiny-tailed protostrongylid larvae in deer from the western Mediterranean.

The first acetimine gold(I) and gold(III) complexes and the first acetonine complexes

Ketimino(phosphino)gold(I) complexes of the type [Au[NR=C(Me)R']L]X (X = ClO4, R = H, L = PPh3, R'=Me (la), Et (2a); L=PAr3 (Ar=C6H4OMe-4), R'=Me (1b), Et (2b); L=PPh3, R=R'=Me (3); X= CF3SO3 (OTf), L=PPh3, R=R'=Me (3'); R=Ar, R'=Me (4)) have been prepared from [Au(acac)L] (acac = acetyl acetonate) and ammonium salts [RNH3]X dissolved in the appropriate ketone MeC(O)R'. Complexes [Au(NH=CMe2)2]X (X = C1O4 (6), OTf (6')) were obtained from solutions of [Au(NH3)2]X in acetone. The reaction of 6 with PPN[AuCl2] or with PhICl2 gave [AuCl(NH=CMe2)] (7) or [AuCI2(NH=CMe2)2]ClO4 (8), respectively. Complex 7 was oxidized with PhICl2 to give [AuCl3(NH=CMe2)] (9). The reaction of [AuCl(tht)] (tht = tetrahydrothiophene), NaClO4, and ammonia in acetone gave [Au(acetonine)2]ClO4 (10) (acetonine = 2,2,4,4,6-pentamethyl-2,3,4,5-tetrahydropyrimidine) which reacted with PPh3 or with PPN[AuCl2] to give [Au(PPh3)(acetonine)]ClO4 (11) or [AuCl(acetonine)] (12), respectively. Complex 11 reacts with [Au(PPh3)(Me2CO)]ClO4 to give [(AuPPh3)2(mu-acetonine)](ClO4)2 (13). The reaction of AgClO4 with acetonine gave [Ag(acetonine)(OClO3)] (14). The crystal structures of [Au(NH2Ar)(PPh3)]OTf (5), 6' and 10 have been determined.

[Bilharziasis, clinical course of the disease: acute and chronic phase. Two clinical cases]

OBJECTIVE

To report two cases of bilharziasis and review the literature with special reference to treatment according to the stages of the disease.

METHODS/RESULTS

Two patients that had previously visited endemic areas consulted for hematuria and renal colic, respectively. One patient was in the acute stage of the disease. Diagnosis was made on the demonstration of eggs of the schistosome in urine. Good response was achieved by medical treatment. The other patient was in the chronic stage. No eggs were demonstrated in urine and diagnosis was based on the anatomopathological findings: This patient required reconstructive surgery.

CONCLUSIONS

Although bilharziasis is uncommon in our setting, its incidence is rising due to increasing migration and travel. The disease has different clinical manifestations depending on its stage and therefore different diagnosis and treatment. Recognizing the disease in the early stage prevents progression to the chronic stage and the morbidity and mortality of the late stage of the disease, as well as more aggressive treatment.

Early complications of endoscopic treatment for superficial bladder tumors

PURPOSE

Bladder tumors are the second most common tumors of the genitourinary system. Approximately 80% of patients initially present with a superficial lesion, which is treated with transurethral resection. Although transurethral resection is a standard procedure, it is not morbidity-free. We assessed the early complications of transurethral resection for superficial bladder cancer and analyzed various factors that may contribute to its occurrence.

MATERIALS AND METHODS

Between January 1979 and December 1996, 2,821 patients with superficial bladder cancer underwent transurethral resection at our center. We assessed intraoperative and immediate postoperative complications of the initial transurethral resection procedure, and correlated them with tumor characteristics.

RESULTS

Of the 2,821 patients in our study 2,461 (87%) were male and 360 (13%) were female. Average age was 65 years (range 16 to 94). Of the 145 complications (5.1%) the most common were bleeding in 78 patients (2.8%) and bladder perforation in 36 (1. 3%). Perforation was extraperitoneal in 30 cases (83%) and intraperitoneal in 6 (17%). Conservative treatment and open surgery were done in 32 (89%) and 4 (11%) patients, respectively. We noted no case of tumor seeding. A repeat procedure was done in 77 patients (2.7%) with bleeding as the leading cause of repeat intervention in 65 (84%). Blood transfusion was required in 96 cases (3.4%). The incidence of complications significantly correlated with the size and number of tumors but there was no association with tumor stage, grade or location.

CONCLUSIONS

The most common complication of transurethral resection for superficial bladder cancer is bleeding. Currently bladder perforation should be managed conservatively with a minimum risk of extravesical tumor seeding. Our results imply that tumor size and multiple tumor resection are associated with a higher complication rate.

Primary bladder carcinoma in situ: assessment of early BCG response as a prognostic factor

OBJECTIVES

To evaluate the prognosis of primary bladder carcinoma in situ (CIS) according to the response to bacillus Calmette-Guerin (BCG).

PATIENTS AND METHODS

Twenty-six cases of primary CIS were treated with BCG. Mean, median and minimum follow-up periods were 47, 56 and 24 months. At 6 months, the patients were evaluated endoscopically and the response was classified as complete, partial or failure.

RESULTS

Twenty-one patients (80.8%) showed complete response to BCG, 3 did so after a second course; 28.5% relapsed or progressed at a mean of 44 months. Five patients (19.2%) did not respond initially and all progressed in a period of 6 months. Early response to BCG was the only significant prognostic factor (p < 0.005).

CONCLUSIONS

A high- and a low-risk group of bladder CIS can be differentiated according to the response to BCG. CIS of the bladder has a poor prognosis, and the number of patients who developed progressive disease is significantly higher among the nonresponders.

Urodynamic evaluation and management prior to renal transplantation

OBJECTIVES

To evaluate the indications for urodynamics studies (UDS) previous to renal transplantation (RT) and the results of bladder cycling (BC), performed in selected cases.

METHODS

Among 475 RT, 33 patients (6.9%) required UDS according our protocol. Indications were: (1) low urinary tract symptoms (LUTS); (2) defunctionalized bladder (DB), and (3) complex urologic history (reflux, neurogenic bladder, urethral valves, etc.). DB was defined as a total urinary output of <300 ml/24 h. Patients with DB underwent BC through a suprapubic catheter, undergoing UDS after BC. The rate and type of urodynamic anomalies were compared among the 3 groups. Cystometric capacity (CysCap) and compliance were evaluated according to the etiology of renal failure, diuresis, and number of previous bladder surgeries.

RESULTS

Fifteen patients (45%) showed abnormal UDS, Increased pressure at cystometry was the most frequent finding (46%). The rate of abnormal UDS among the 3 groups was not statistically significant (66.6% in DB, 42.8% in LUTS, and 35% in those with complex urologic history). Compliance and CysCap were significantly lower in the patients with DB, showing a significant correlation with diuresis. These parameters did not correlate with the number of previous bladder surgeries. BC resulted in normal UDS in 3 patients (33%) and a change in diagnosis in 2 patients (22%).

CONCLUSION

Our indications gave a good diagnostic yield. Patients with DB represent a group with different urodynamic findings. BC provides a more precise diagnosis or normalization of UDS in some cases.

Balloon dilatation in the treatment of ureteral stenosis in kidney transplant recipients

OBJECTIVE

To assess the usefulness of balloon percutaneous dilatation as a starting treatment technique of ureteral stenosis in kidney transplant recipients.

PATIENTS AND METHODS

A total of 472 kidney transplants have been performed at our center between August 1981 and January 1997. The coexistence of high creatinine values and urinary tract dilatation in the postoperative period, after discarding concomitant causes, was managed with a percutaneous nephrostomy. Once renal function had recovered, antegrade pyelography was performed to confirm ureteral stenosis and to determine its location. The dilatations are performed by means of 5-french balloon-fitted angioplasty catheters.

RESULTS

Thirty patients were diagnosed with ureteral stenosis during follow-up, i.e. an incidence of 6.3%. Transluminal balloon dilatation was made as a first therapeutic option in 18 cases. No immediate complications were observed following dilatation. Disappearance of the stenosis as well as maintenance of the improvement in creatinine levels were verified in 39% of cases (7 patients).

CONCLUSIONS

Ureteral stenosis in kidney transplant recipients should be included as part of the differential diagnosis when there is a deterioration in renal function. Balloon dilatation is the technique chosen as initial treatment of juxtavesical ureteral stenosis because of its good reproducibility and its low morbidity.