Biomedical subjects
J M Nijman
Publications and source records attributed to J M Nijman.
[Bad news prior to childbirth; who will tell the parents?].
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Prenatal diagnosis, management and outcome of fetal uretero-pelvic junction obstruction.
Prenatal diagnosis, management and outcome were studied retrospectively in 24 cases of unilateral and bilateral uretero-pelvic junction obstruction (UPJO). Moderate-to-marked pelvic dilatation was documented in 19 out of 24 cases. The low morbidity and mortality observed in this study are probably determined by the late (third trimester) detection of UPJO, resulting in an underestimation of the prevalence of more severe renal pathology. Amniotic fluid was increased in 4 out of 14 cases of unilateral UPJO and in 5 out of 10 cases of bilateral UPJO, the underlying mechanism of which is still unclear. There was no oligohydramnios. The incidence of extrarenal structural pathology was low, i.e., 3 out of 24 cases. A close agreement could be demonstrated between pre- and postnatal sonographic grading of pelvic dilatation. However, postnatal ultrasonic grading of pelvic dilatation correlated poorly with the degree of functional obstruction as determined by IVP and lasix renography. Despite the severity of pelvic dilatation in the majority of cases, enlarged kidneys were revealed by postnatal clinical examination in only three instances, underlining the importance of prenatal sonographic detection of UPJO.
Forced hydration prior to renography in children with hydronephrosis. An evaluation.
We have developed a method of diuretic renography for the assessment of upper urinary tract obstruction in children. A maximal diuresis under standardised conditions is obtained by forced intravenous hydration over a 2-h period prior to renography. We evaluated the predictive value of this method for the clinical and functional outcome in 73 children with apparent unilateral pelviureteric junction obstruction. The predictive value of a non-obstructive pattern was 94%, while the predictive value of an obstructive pattern could not be assessed accurately because the patients concerned subsequently underwent operation. The method is safe and reliable and offers advantages over conventional diuretic renography.
Urethral advancement for distal hypospadias repair, indications, techniques and results.
Urethral advancement is a less well known technique for the repair of distal hypospadias. We treated 37 patients with a median age of 3 years for coronal and subcoronal hypospadias, with excellent results.
[Experiences with extracorporeal shockwave lithotripsy in 61 children].
Between March 1985 and January 1987 2547 ESWL treatments were performed on 2064 patients, including 33 boys and 28 girls younger than 18 years. Almost identical results were obtained in children as in adults. All stones desintegrated and success was achieved in 97%; 79% was considered stone-free after 6 months and 18% had passable asymptomatic residual fragments (biggest fragments less than 3 mm) which did not grow larger during a mean follow-up of 17.8 months. One patient had a recurrent stone, after having been stone-free for 13 months. Post-ESWL complications and morbidity were minimal. Auxiliary measures were necessary in 5 patients before ESWL and in 6 patients after ESWL. Failure to render the kidney free of stones occurred in 2 patients with complex urolithiasis. Because of these results ESWL should be considered the treatment of choice in the paediatric age group for urolithiasis.
Sexual function after surgery and combination chemotherapy in men with disseminated nonseminomatous testicular cancer.
Between 1978 and 1982 the sexual functions of 54 patients with a nonseminomatous testicular tumor stage II or III were assessed before and after treatment with surgery and combination chemotherapy. Two years after completing therapy 54% of the patients experienced sexual functional disorders. Greatly reduced or absent antegrade ejaculation was reported by 26 patients; 18 of them had been treated with more or less extensive retroperitoneal lymph node dissection, whereas 8 had not. This means that the chemotherapy might be responsible for ejaculatory disorders in 30% of the patients. Only two patients reported a change in the quality of erection; seven patients experienced a decidedly diminished libido, and five patients noticed their orgasm had changed in a negative sense. The appearance of the contralateral testis changed in 21 patients, who showed "atrophy" of this testis. The findings of this study indicate that sexual and ejaculatory disorders in particular are quite common in men treated for a disseminated nonseminomatous testicular tumor. Many of these disorders seem to be owing to causes other than surgical intervention.
Gonadal function after surgery and chemotherapy in men with stage II and III nonseminomatous testicular tumors.
The gonadal functions were studied in 54 patients with disseminated nonseminomatous testicular tumors who had been subjected to combination chemotherapy (cisplatin, vinblastine, and bleomycin [PVB]) and surgery (hemiorchiectomy, retroperitoneal lymph node dissection or removal of retroperitoneal residual tumor after chemotherapy) and in 17 patients with a stage I tumor subjected to hemiorchiectomy exclusively. In the patients treated with chemotherapy, the plasma testosterone levels remained at the lower limit of normal and the luteinizing hormone (LH) levels remained elevated for 2 years after completion of treatment. The follicle-stimulating hormone (FSH) levels also remained significantly elevated, but showed a tendency to decrease after 2 years. Semen analysis was performed in 25 patients; of the other patients, 18 had no antegrade ejaculation, eight had undergone a vasectomy and three patients did not cooperate. Before treatment, 72% of the patients showed azoo- or oligozoospermia; 2 years after discontinuation of the chemotherapy, 48% had azoo- or oligozoospermia while 28% had more than 60 X 10(6) spermatozoa/mL. However, interestingly the proportion of patients with azoospermia had increased from 4% to 28%. In the course of this study, eight pregnancies occurred; one ended in an early spontaneous abortion; the other seven pregnancies ran an uncomplicated course. Seven healthy children were born. In 17 patients with a stage I tumor treated by hemiorchiectomy only, the testosterone, LH and FSH levels were also observed for 2 years; until 2 years after treatment, the testosterone levels remained lower and the FSH levels remained higher than normal. Insufficiency of the Leydig's cells in the unaffected gonad appeared to be responsible for the altered hormone concentrations in the blood.
Sexual function after bilateral retroperitoneal lymph node dissection for nonseminomatous testicular cancer.
This study concerns the sexual functions of 101 patients who had undergone bilateral retroperitoneal lymph node dissection for stage I or II nonseminomatous testicular cancer between 1969 and 1982. All patients were without evidence of disease after at least 4 years of follow-up. Antegrade ejaculation was present in 12 patients, while 89 patients experienced "dry ejaculation." Urine collected after intercourse or masturbation from 75 patients with dry ejaculation showed retrograde ejaculation in 55 and lack of ejaculatory emission into the urethra in 20 patients. Regarding other sexual functions, 17 patients had a diminished sexual desire (especially those patients who had received radiotherapy), 12 experienced difficulty reaching organism, and 6 complained of erectile dysfunction. The incidence of a contralateral hydrocele developing after retroperitoneal lymph node dissection seems to correlate with ligation of the contralateral spermatic vessels and their lymphatics. A review of the literature is presented comparing the types of dissection with the incidence of sexual disorders after retroperitoneal lymph node dissection. Since preserving normal ejaculation and fertility is important, a modified or unilateral retroperitoneal lymph node dissection, when required, is advocated. In patients, with stage I disease the therapy may be limited to an orchiectomy without lymph node dissection. In patients with retroperitoneal lymph node metastases combination chemotherapy with cisplatin and tumor excision gives good results. Patients with true retrograde ejaculation can be treated with alpha-sympathomimetic drugs such as imipramine HCl, and thus be offered the chance of fatherhood by coitus.
Fertility and hormonal function in patients with a nonseminomatous tumor of the testis.
Semen quality and serum testosterone, LH, and FSH levels were studied in 54 patients with a unilateral nonseminomatous tumor of the testis--14 before and 40 after orchiectomy. Semen analyses before and after orchiectomy gave essentially no different results: a poor semen quality was found in most men. The additional effect of a recent orchiectomy on semen quality was not demonstrable in the patients described here. Before orchiectomy, increased testosterone levels were found in patients with a beta-hCG-producing tumor. After orchiectomy serum testosterone levels were decreased, and LH and FSH levels increased. With beta-hCG-producing tumors FSH was suppressed after orchiectomy, and testosterone levels did not exceed those in patients with a tumor not producing beta-hCG. The results of semen analysis and of hormonal studies after orchiectomy suggest a dysfunction of the remaining "normal" testis. Diminished spermatogenesis and insufficient testosterone production by the Leydig cells clearly indicate anomalies already present before orchiectomy.