Biomedical subjects
Publications and source records attributed to A Csontai.
Ninety-nine isotope, 4 CT and 10 MR examinations were carried out in 1990 to test urogenital disorders in infants and children. The procedures are described with sidelights on indication, difficulties of technical nature and comparison with internationally published reports. An examination strategy is devised, with estimation of its effectiveness in the follow-up and after-care.
A series of 42 children (30 boys and 12 girls) underwent surgery for bladder exstrophy between 1972 and 1989. Primary bladder closure was performed in 11 patients and was successful in 6. Four of these children are about 2 years old and so it is not yet possible to assess their continence. Ureterosigmoidostomy was performed in 35 children, one of whom was converted to cutaneous ureterostomy. Follow-up ranges from 2 to 20 years (average 9 years 3 months) and 50% of the patients are symptom-free. The most frequent problems were acidosis and urinary tract dilatation. Other complications, such as hypokalaemia and pyelonephritis, were seldom seen. Although ureterosigmoidostomy has some disadvantages, our patients have adapted well and lead a normal life.
Based on the critical analysis of their own material, the authors evaluate the different antireflux operations. The problems of surgical indication are dealt with. The principles applied in selecting the type of operation are reviewed and the experiences of the control examinations are reported.
Ten patients who had undergone repeated surgical interventions for bladder papilloma with successive recurrences within intervals of a few months, were given levamisol in weekly doses of 300 mg over a year, and were followed up for various cellular immune reactions, as well as for serum globulin and for acute-phase protein concentrations in the course of treatment. Levamisol was found to act primarily on cell-borne responsiveness. The recurrence-free intervals increased in the course of treatment. Four patients have remained free from recurrences since the start of treatment.
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Prophylactic total THIO-TEPA treatment was employed in 44 cases over a period of five years, following radical surgery (including reoperations) for recurrent vesical papillomatosis or carcinoma, and numerous subsequent transurethral coagulations or resections owing to multiple recurrences. Three patients have been now free from recurrences for five years, 13 patients for four years, 11 patients for three years and 9 patients for two years. Eight patients proved unresponsive, the recurrence rate having remained unaffected. No toxic effects requiring any special measures were encountered.
A review of the clinical features and therapeutic possibilities of condyloma acuminatum is presented on the ground of the ten-year experience of the authors. A giant condyloma simplex with benign clinical behaviour and typical histologic pattern and a case of epithelioma starting from a condyloma simplex and leading to the amputation of the penis are described.
A review of 71 cases of horseshoe kidney accounting for 0.12% of the total number of patients seen at the Department of Urology, Semmelweis University Medical School, Budapest, over 25 years is presented. The incidence of the abnormality has been found twice as high in males as in females. The proportion of surgical cases has been 57.8%, in agreement with published data. The radiodiagnostic investigations, particularly the functional diagnostic studies, are dealt with in detail. Their decisive importance in the considerations for or against surgery is emphasized.
A total of 83 patients with papillary tumour in the renal pelvis have been observed in 25 years. The peak incidence was in the age group between 51 and 70 years. The first symptom was almost always haematuria without any other symptom. The therapy is surgical, complemented with radiotherapy and/or chemotherapy. The problem of the involvement of the bladder is discussed.
The data of 56 patients with plastic induration of the penis treated at the Department of Urology of Semmelweis University Medical School are presented. After a survey of the literature and of the therapeutic possibilities the surgical solution worked out by the authors recommended. Conservative treatment alone cannot secure a cure and its pre-operative application will not improve the chances of a cure. A palpable knot is the indication for surgery. Postoperative cease on ultrasonic treatment. If for some reason (concomitant illness, oppositions of the patient to operation) only conservative treatment can be applied, ultrasonic therapy is believed the most suitable.
Five patients with bilateral testicular tumours were treated in the ten year period 1966 to 1975. In two patients the tumour appeared on both sides at the same time, while in three cases it developed 3/4, 6 and 7 years apart, respectively. The tumour was detected in one case in a retained testicle; in 4 cases the testicles were in the scrotum. Factors promoting development of the tumour and the diagnostic possibilities are discussed. It is recommended to remove the testicle by high division of the funiculus and to apply postoperative radiotherapy. In the presence of metastases administration of cytostatics is necessary. The possibilities of hormone substitution are discussed.
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The double-pyelon kidney, i.e. the total or partial duplication of the urinary transport system may involve both diagnostic and therapeutic difficulties. Observations are presented on the strength of 398 cases with total or partial duplication of the upper urinary tract. The incidence rate was 0.7 percent. The various types of duplication are presented with the diagnostic and therapeutic features involved. Transport function is discussed in detail as investigated under ideal physiologic conditions: during excretory urography under the amplifier screen. Aiming at early detection of the congenital anomaly and specification of the appropriate management, a urologic check-up is suggested even with mild presenting symptoms. Special emphasis is given to the consistent day-time enuresis in children over 3 years old, as a possible sign of ectopic ureter. Both children and parents are saved much unpleasantness by early detection, proper management and considerate surgery.
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The data of patients treated for priapism in the Department of Urology of Semmelveis University Medical School between 1951 and 1971 are analyzed. Eleven patients were hospitalized and three were outpatients. After a brief survey of the literature, mechanism, aetiology and treatment of the condition are discussed. In the majority of the patients after the cessation of priapism sexual libido returned as a rule without the appearance of erection. Three cases are briefly described. In four patients after some time partial erection and orgasm was experienced under mechanical influence. Two of these patients had married and have children.
One hundred and thirty-eight patients with dystopic kidney were followed-up for 30 years. The operated and non-operated patients were considered separately. The condition manifested itself mostly after the age of 20. Under regular medical control, the condition can be treated by conservative methods. The possibility of an ectopic kidney should be thought of even when complaints are not typical or there are few symptoms.