As treatment for malignant and nonmalignant diseases increases survival, the ability to preserve spermatozoa for long periods of time by low-temperature freezing has opened the possibility of preserving fertility in men who would otherwise be made subfertile or sterile by various treatments and disease processes. Mechanisms of reduction in sperm number or function may include surgery, irradiation, chemotherapy, or the disease process itself. Sperm banking technique is discussed, and recent data are presented on sperm cryopreservation from men with various diseases who were seen at the Cleveland Clinic. Sperm banking remains a promising technique for restoring fertility in some men with cancer.
Intravenous digital subtraction angiography (I V-DSA) was used to image the renal arteries of 24 children and adolescents. A total of 27 examinations was performed. Seventeen of these examinations were obtained to screen for renovascular causes of hypertension, with positive findings in three. Eight were performed following renovascular surgery. Two were used to assess renal arteries preoperatively. Good diagnostic-quality images were achieved in 24 of 27 examinations (89%). IV-DSA is a safe and effective means of evaluating the renal arteries of children and adolescents with a variety of clinical problems.
A study of 13 American Caucasians with alopecia areata of the universalis or totalis pattern showed a trend of increased frequency of HLA-DR4 and HLADR5. The association of HLA-DR4 and HLA-DR5 with alopecia areata was independent of the pattern of alopecia, age of onset, or the patient’s origin or sex.
A patient with Actinobacillus actinomycetemcomitans endocarditis, a rare cause of gram-negative endocarditis, is reported. This case is unique in that it is the onlyone in the literature with documented involvement of both prosthetic (aortic) and native (mitral) valves. The patient required surgical replacement of the aortic valve prosthesis and debridement of the mitral valve, as well as prolonged antibiotic therapy.
Electrical catheter ablation of the AV conduction system is a safe and effective procedure for patients with intractable atrial tachyarrhythmias, including patients with previously implanted pacemakers. Seven such patients were treated with this procedure, and there were no complications. All seven patients’ tachycardia was relieved, and six had sustained, chronic, complete AV block at follow-up (mean 7.4 months). Production of chronic, complete AV block appears to require two shocks at initial ablation and a unipolar His-bundle electrogram >0.4 mV. Electrical ablation of the AV conduction system seems to have permanently converted one patient’s chronic atrial fibrillation to sinus rhythm., This procedure caused no adverse sequelae in previously implanted pacemakers or leads. In one patient, the procedure temporarily elevated pacing thresholds in the ventricle and the atruium.
Serological markers can be helpful in determining the need for renal biopsy in patients with systemic lupus erythematosus (SLE). Elsewhere in this issue (pp. 259-265), Dr. Clough and coworkers evaluate a number of these markers and their usefulness in predicting lupus nephritis. The predictive value model is applied by these investigators to come up with their recommended use of these tests: "The presence of the combination of anti-nDNA, anti-Sm, and antiRNP . . . should encourage greater vigilance in monitoring disease activity, and liberal use of renal biopsy in evaluation of such patients seems justified. " While it is quite simple to apply the predictive value model to the evaluation of a single test, it can similarly be used to evaluate more than one test. In general there are two basic strategies for applying two or more tests in a screening or diagnostic situation. These are called series and parallel testing strategies. For two tests A and B, these strategies are as follows: In series testing test A is applied first, and all those with a positive result are retested with test B. Patients must be positive on both tests to be considered positive. Of course, the tests can be run at the same time. The interpretation, however, requires that all tests in the group must be positive to consider the outcome of testing positive. In parallel testing, tests A and B are used together, and all those with positive results for one or more tests are considered to be positive. Which approach or strategy is better? This depends on the testing situation and the sensitivity and specificity of the individual tests and their combinations. With parallel testing, the combined sensitivity is greater than the individual sensitivities of the contributing tests. Parallel testing results in the highest
The National Organ Transplant Act (PL98-507) was enacted in 1984 to support the continued development of a comprehensive procurement and distribution network in the United States for transplantable organs and tissues as well as a registry for potential recipients. Demand for one organ, the kidney, has increased dramatically for a number of desirable reasons: More patients have been accepted for transplantation, age limits for transplantation have been extended, results have improved, and there are more transplantation centers doing more transplants. Undesirable factors have also increased the demand: There has been no major breakthrough in treatment of the renal diseases that most frequently progress to end-stage failure, and graft rejection continues to be a problem. On the other hand, the supply of cadaver kidneys has decreased: Fortunately, the number of fatal motor vehicle accidents has fallen because of the lowered highway speed limit and seat belt use, but, unfortunately, public misconceptions about transplants, lawsuits against physicians participating in cadaver organ retrieval, and gaps in professional understanding have also decreased the supply. Although rejection can be treated with immunosuppression after transplantation, histocompatibility matching of donor and recipient before transplantation has significantly increased graft survival. The national initiative may provide the critical mass necessary to correct some of the misconceptions and lingering problems that frustrate the optimal use and success of human organ transplants.
No AccessJournal of Urology1 Mar 1987Renal Transplantation: An Analysis of Logistical and Medical Factors Affecting Cadaver Organ Availability W.E. Braun W.E. BraunW.E. Braun More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)44133-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Renal Transplantation: An Analysis of Logistical and Medical Factors Affecting Cadaver Organ Availability." The Journal of Urology, 137(3), p. 591 © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 3March 1987Page: 591 Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information W.E. Braun More articles by this author Expand All Advertisement PDF DownloadLoading ...
A patient with typical clinical features of Ehlers- Danlos syndrome Type IV was found to have systemic amyloidosis that was proved by cardiac biopsy. The various types and subtypes of Ehlers-Danlos syndrome are reviewed, along with the associated cardiac anomalies.
A case is reported of aneurysm of the interatrial septum that was initially diagnosed as a right atrial myxoma using angiography. Two-dimensional echocardiography revealed a redundant interatrial septum that showed striking phasic motion. The differential diagnosis and clinical implications are discussed in light of available previous reports of interatrial septal aneurysms.
A case of cystic peritoneal mesothelioma with repeated local recurrences is presented. Ultrastructural and immunohistochemical studies confirmed the mesothelial character of the lesion. The literature was reviewed and 20 previously reported cases tabulated. Cystic mesothelioma is a relatively “benign” tumor characterized by frequent intra-abdominal recurrences without distant metastases. Morbidity associated with the lesion is due to local tumor recurrence. Patients are usually women of reproductive age with complaints of abdominal pain. Some tumors are discovered initially as incidental findings. No specific factors are helpful in predicting which tumors are most likely to recur. Recurrences are independent of lesion size at initial or recurrent presentation, adequacy of tumor resection, or the use of adjunctive therapy. No consistent etiologic factor has yet been identified in the pathogenesis of this rare neoplasm.
Nutrition has a direct bearing on the health of the geriatric patient. For the rapidly growing elderly population, nutrient deficiencies are a reality, especially deficiencies in calcium, iron, vitamins A, C, and the water-soluble B vitamins. The risk of malnutrition increases with the progressive physiological and socioeconomic changes of aging. The quality of the diet can be further compromised by physical and mental disabilities, chronic alcoholism, overmedication, and diseases such as cardiovascular diseases, diabetes, cancer, reduced immunity, and osteoporosis. Geriatric patients may be undernourished on entering the hospital. Many questions remain concerning the nutritional status, nutritional requirements, cause of deficiencies, nutrient supplementation, drug treatment, and the role of nutrition in the overall care of the elderly patient.
Essential hyperhidrosis, the idiopathic production of excessive sweat, continues to be a much misunderstood ailment. Its recognition as a benign disorder has often restricted its treatment to nonsurgical modalities, many times with unsatisfactory results. Surgical intervention has provided excellent results in patients suffering from hyperhidrosis and should certainly be considered an alternative method of treatment. The authors review the clinical condition of essential hyperhidrosis including current treatment options, with special emphasis on surgical therapy.
Several known functional disorders of the upper airway are associated with playing wind instruments. Some of these problems have been known for hundreds of years. Subcutaneous emphysema of the head and neck and parotid, palate paralysis, patulous eustachian tubes, laryngocele, and pharyngocele are some of the more common problems. In evaluating disorders of wind instrumentalists, it is important to obtain a history that is unique to the individual, including information about the work environment, playing technique, and length of time playing. Physicians should understand the differences in wind instruments, mouthpieces, and reeds to understand the pathologic problems that occur in wind instrumentalists. This paper serves as an introduction to some of the signs and symptoms of these problems and how they are unique in wind instrumentalists.
The conversion of the energy of a wind-instrument player’s steadily flowing breath into oscillatory energy in musical wind instruments has been well understood for several years. It depends on the cooperative interaction of several resonances of the instrument’s air column with the flow-controlling reed. Recent work has demonstrated the importance of additional effects arising from the resonances of the player’s own windway. The player can learn to control these effects and normally uses them to stabilize and refine the tone and correct the tuning. He or she may also use them to disrupt the normal processes, replacing them by oscillatory regimes made up of inharmonic partials; musicians call these sounds “multiphonics.” This report outlines the way in which the instrument’s air column and the player’s windway jointly interact with the reed to produce these effects and presents examples of the associated phenomena. Certain medical implications are also described, in particular, chronic problems occurring in clarinet players who, because they do not exploit the resource of windway adjustability, try to improve their tone by using excessively stiff reeds and high blowing pressures.
Various musculoskeletal and neurological conditions may impair musical performance. None seems age specific and only a few are directly related to playing. The latter are largely peripheral nerve compressive disorders. The nature of the complaint can usually be identified by examination and observation of the performer. Postural correction or compensation for infirmities such as osteoarthritis may provide relief. In younger players, tension may hinder performance and may respond to relaxation techniques, coaching, or a different instructor. In older performers, disease processes may affect the nervous system. Although many conditions are treatable, occupational cramp is as disabling to musicians as it is to typists, scriveners, and telegraphers. Its overall prognosis is poor indeed, and despite valiant efforts at treatment and retraining, career change is usually the ultimate outcome. The century-old argument of neurosis versus dystonia in such disorders remains unresolved.
This paper addresses the effects of loud sound and the aging process upon the human auditory system. There is no question that loud sound, regardless of whether it is impact noise, heavymetal rock music, or classical music, can be damaging to auditory nerve cells. It is the level of the sound as well as the duration of exposure that constitutes danger to this precious sense organ—the ear.
