Ureteral dilation using a tapered dilator: a cost-effective approach

BACKGROUND AND PURPOSE

The 6/12 AQ hydrophilically coated tapered dilator is a newly developed device for ureteral dilation prior to rigid and flexible ureteroscopy.

PATIENTS AND METHODS

To evaluate the efficacy, safety, and cost-effectiveness of this device, it was used to gain ureteral access in 80 consecutive patients undergoing ureteroscopy for diagnostic purposes, stone treatment, or stricture dilation.

RESULTS

In all 80 cases, the ureteral orifice and intramural ureter were dilated successfully. One complication occurred: an embedded stone was extruded through the ureteral wall. Each dilation procedure using the 6/12 AQ tapered dilator costs 20% of a balloon dilation, a saving of approximately $764 per dilation.

CONCLUSION

Ureteral dilation with the 6/12 AQ tapered dilator is a safe, effective, and inexpensive alternative to traditional dilation techniques.

Peutz-Jeghers syndrome is caused by mutations in a novel serine threonine kinase

Peutz-Jeghers (PJ) syndrome is an autosomal-dominant disorder characterized by melanocytic macules of the lips, multiple gastrointestinal hamartomatous polyps and an increased risk for various neoplasms, including gastrointestinal cancer. The PJ gene was recently mapped to chromosome 19p13.3 by linkage analysis, with the highest lod score at marker D19S886. In a distance of 190 kb proximal to D19S886, we identified and characterized a novel human gene encoding the serine threonine kinase STK11. In a three-generation PJ family, we found an STK11 allele with a deletion of exons 4 and 5 and an inversion of exons 6 and 7 segregating with the disease. Sequence analysis of STK11 exons in four unrelated PJ patients has identified three nonsense and one acceptor splice site mutations. All five germline mutations are predicted to disrupt the function of the kinase domain. We conclude that germline mutations in STK11, probably in conjunction with acquired genetic defects of the second allele in somatic cells, cause the manifestations of PJ syndrome.

False aneurysm of the facial artery

A case of an unusual traumatic aneurysm of the facial artery secondary to blunt trauma is reported. The lesion was typical in that it was pulsatile, had a systolic bruit, and had a filling defect that was evident on carotid angiography. Although a traumatic aneurysm is a rare occurrence in the facial region, the inclusion of this lesion in the differential diagnosis of soft tissue lesions is important if the serious consequences of hemorrhage are to be avoided.

Chondrosarcoma of the larynx

Cartilaginous tumors of the larynx are rare, and of those reported, most are chondromas. To date, approximately 157 cartilaginous tumors of the larynx have been reported, but only 37 have been chondrosarcomas. A review of the records of the past 25 years (1948-1974) of the Johns Hopkins University Hospital and the Greater Baltimore Medical Center was made and revealed only two previous cartilaginous tumors, both chondromas. A case of an exceptionally large chondrosarcoma of the larynx which appeared as a neck mass invading the thyroid cartilage in a patient with a six-month history of hoarseness is presented. A complete review of the literature was made which shows that most chondrosarcomas occur in middle-aged males originating most often from the posterior cricoid lamina, next from the thyroid cartilage. Misdiagnosis has been a problem with low-grade tumors, and although wide local excision has been stated as being the treatment of choice, the authors emphasize the need for more aggressive surgery because of the high recurrence rate discovered in the literature.

Pseudosarcomas of the pharynx and larynx

Pseudosarcoma of the pharynx and larynx has remained an enigma both to the pathologist and clinician since its original description by Lane in 1957. These lesions are usually polypoid growths that microscopically present very bizarre appearances beneath a squamous cell carcinoma. Eight cases of pseudosarcoma of the larynxand pharynx were observed. These occurred almost twice as often in males as females, with an average age of 56 years. Most were extralaryngeal lesions, and in all cases surgical excision was the primary therapeutic modality. A thorough review of the literature summarizes the clinical and pathologic characteristics of these lesions. There is strong clinical evidence against the traditional belief of the benign course of these lesions, and we recommend that they be treated aggresively like any other carcinoma of the head and neck.

Vaginal evisceration

Although vaginal laceration following sexual trauma is a well-reported entity, vaginal evisceration appears to be a rare occurrence. This paper presents 2 cases of vaginal evisceration recently managed at the Bronx Municipal Hospital Center and a review of the literature. Etiologic factors and management are discussed.