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Biomedical subjects

C A Linke

Publications and source records attributed to C A Linke.

At least 19 recordsLinked to original sources

Changes in urinary magnesium, citrate, and oxalate levels due to cola consumption.

The serum concentration and urinary excretion of four potential stone constituents: calcium, oxalate, phosphate, and uric acid; and of two potential inhibitors of urinary stone formation, citrate and magnesium, were studied before and during ingestion of a carbonated cola beverage. Four participants, after baseline serum determinations, abstained for forty-eight hours from cola consumption and then attempted to drink 3 quarts per day of cola in the following forty-eight hours. One participant failed to drink more than two quarts per day of cola. In all 4 participants twenty-four-hour urinary excretion of magnesium decreased by an average of 2.6 mg. In the 3 participants who succeeded in drinking 3 quarts of cola per day, twenty-four-hour urinary excretion of oxalate increased an average of 8.3 mg and excretion of citrate decreased an average of 122 mg. These results demonstrate changes in urine constituents which could contribute to enhanced kidney stone formation in patients who drink large quantities of cola-flavored carbonated beverages.

Adult

Cyclophosphamide-associated carcinoma of urothelium: modalities for prevention.

The relationship between the cyclophosphamide metabolite acrolein and hemorrhagic cystitis is well documented. Its role in inducing bladder cancer is not clear. There are at least 35 cases of cyclophosphamide-associated bladder cancer in the literature to date. We report 3 additional cases of transitional cell carcinoma of the bladder. Literature assessing the relative risk of bladder cancer associated with cyclophosphamide therapy is reviewed as are methods for decreasing the toxic effects on the urothelium of the metabolite acrolein.

Acrolein

Leydig cell tumor of testis.

In adult patients with Leydig cell tumor of the testis, endocrinologic signs occur in 30 per cent of the cases and often precede the onset of a palpable testicular mass. Gynecomastia is the most common endocrinologic manifestation and probably is due to increased estrogen secretion by the Leydig cells. In the patient with adrenogenital syndrome and testicular enlargement it is difficult to distinguish Leydig cell tumor from adrenal rest hypertrophy. Four patients with Leydig cell tumor and endocrinologic manifestations are discussed; three are adults who presented with gynecomastia and the fourth is a patient with congenital adrenogenital syndrome. In the adult patient inguinal orchiectomy is the treatment of choice, while in the patient with adrenogenital syndrome initial management by high-dose steroid suppression should be attempted prior to testicular exploration.

Adrenal Cortex Neoplasms

Prostatic mucinous carcinoma.

Four criteria are proposed for establishing the pathologic diagnosis of prostatic mucinous carcinoma. Twenty-one reported cases of this rare tumor are reviewed, and a new case is presented. The clinical and pathologic features of 16 authentic features of 16 authentic cases are analyzed.

Adenocarcinoma, Mucinous

Intratesticular papillary mucinous cystadenocarcinoma.

The first case of intratesticular papillary mucinous cystadenocarcinoma is described. The tumor was histopathologically different from other types of papillary carcinoma related to the testicle and is believed to have originated from an intratesticular müllerian duct remnant.

Cystadenoma

The use of pedicled grafts of omentum in the repair of transplant-related urinary tract problems.

Urologic complications related to renal transplantation may be difficult to treat and can be serious threats to life or to function of the transplanted kidney. Successful experience with omentrum for non-transplant and transplant-related reconstructive procedures recommends its further use. Herein are reported 4 patients in whom pedicled flaps of omentum were used to treat transplant-related urologic problems.

Adhesiveness

Anterior transperitoneal approach for treatment of urolithiasis.

An anterior transperitoneal incision was used to remove stones from 20 kidneys in 18 patients (2 bilateral). Our experience with 35 kidneys operated upon by this method (15 previously reported) has been favorable. Use of percutaneous nephropyelostomy tubes to drain obstructed kidneys in septic patients has permitted all procedures to be done under non-emergency conditions. Careful alignment of x-ray equipment and adjustment of exposure technique in the operating room before induction of anesthesia result in consistently good quality preoperative and intraoperative roentgenograms. The transperitoneal approach has afforded good access to the anterior portion of the renal pelvis even in those patients who have had previous operations on the kidney by the flank approach. Additional intra-abdominal procedures done at the same operation have included urinary diversion by ileal loop, revision of previous ileal loop, ureterolithotomy, pyeloureteroplasty, partial nephrectomy, cholecystectomy and appendectomy. The procedures done with the patients in the supine position have been well tolerated even in patients with serious coincident medical diseases.

Abdomen

Diagnosis of nonopaque calculi by computed tomography.

Computed tomography can aid in the distinction of calculi from both tumors and clots in the urinary tract. Its availability, simplicity of interpretation, and noninvasiveness establish it as an important diagnostic modality in selected cases when calculus is in the differential diagnosis of upper urinary tract filling defects.

Adult

The use of percutaneous nephrostomy and urinary alkalinization in the dissolution of obstructing uric acid stones.

Two patients are described who presented with complete urinary obstruction secondary to nonopaque uric acid stones. They were treated with percutaneous nephrostomy for urinary diversion and urinary alkalinization by local irrigation and oral sodium bicarbonate therapy with complete dissolution of the stone after 16 and 21 days of therapy. Percutaneous nephrostomy with urinary alkalinization is a reasonable, relatively safe alternative to surgical stone removal for patients with obstructing uric acid stones.

Aged

Twenty-four hour canine renal preservation by pulsatile perfusion, hypothermic storage, and combinations of the two methods.

A comparison of the effectiveness of two renal preservation techniques was studied in 30 cannine renal pairs. In the absence of warm ischemia, 24-hr preservation by pulsatile perfusion was not significantly superior to hypothermic storage. When 15 min of warm ischemia was added as an additional insult, pulsatile perfusion afforded significantly better early function than cold storage. Combinations of pulsatile perfusion and hypothermic storage following 15 min of warm ischemia were superior to hypothermic storage alone, but inferior to pulsatile perfusion. Kidneys initially perfused for 6 hr and then cold-stored functioned slightly better than kidneys perfused for 18 hr after initial cold storage.

Animals

Unfocused ultrasound for localized tissue destruction in rabbit kidneys.

The rabbit kidney was subjected to exposure from an unfocused ultrasound source in an effort to create a relatively large volume of ultrasound-damaged tissue in the rabbit kidney. The results of this exposure were followed for 1 year. An insignificant change in blood pressure was noted up to 1 month after exposure to ultrasound and no persistent hypertension was noted thereafter. Marked gross, histologic, and vascular changes were found in the area of exposure culminating in marked absorption of renal substance (in excess of 25 per cent of total kidney weight). Calcific stones formed in the pelvis of the kidney in virtually all animals observed from 6 months to 1 year after ultrasound exposure. These stones appeared to be related to the calcification within the transitional epithelium of tubules at the junction of normal and ultrasound-damaged tissue. The marked ability of the absorptive processes to ablate large volumes of physically damaged tissue is demonstrated.

Animals

Anterior transperitoneal approach for removal of renal stones.

An anterior transperitoneal approach was used for removal of stones from 15 kidneys in 13 patients. Exposure of the anterior portion of the pelvis was readily accomplished making excellent exposure of the interior of the kidney possible. Minimal urinary drainage was noted postoperatively. The operative procedures done with the patients in the supine position were well tolerated.

Adult

Bilateral cervical transplantation of canine kidneys for study of canine renal preservation.

Bilateral cervical autotransplantation of canine kidneys is described for comparative study of renal preservation techniques. Data are obtained from kidneys preserved by (1) initial intravascular flushing with modified Collins' C3 solution (Ursol) followed by cold storage, and (2) pulsatile perfusion (MOX 100). Preharvest condition of the donor and ischemia times are identical, thus eliminating major sources of potential data variation. Renal function studies performed at periodic intervals demonstrated better initial function for machine preservation but no difference after one to two-month period.

Animals

Percutaneous nephropyelostomy in the management of acute pyohydronephrosis.

Percutaneous nephropyelostomy using the posterolateral approach was employed together with antibiotics and other supportive therapy as the initial step in the treatment of acute pyohydronephrosis, with gratifying results. Percutaneous nephropyelostomy is recommended as the procedure of choice for this specific clinical emergency.

Acute Disease