Biomedical subjects
Publications and source records attributed to J V Thachil.
The effect of glucagon on upper urinary tract peristalsis during extreme diuresis was studied in an unsedated dog preparation. In all experiments glucagon inhibited the peristaltic contraction waves without affecting urine propulsion, suggesting that peristalsis, at least for short periods, is not necessary for effective urine transport during extreme diuresis.
Most procedures for diverting urine sacrifice continence, but Kock's modification of the ileal conduit promises the ideal of appliance-free urine storage with voluntary control of emptying. The authors report on two men who underwent this procedure. One was a paraplegic who had total urinary incontinence after a sphincterotomy. The other had a carcinoma of the rectosigmoid obstructing the right ureter. He had congenital bladder exstrophy and had undergone ureteric implantation into the sigmoid colon at 3 years of age. In both patients, the reservoir was created from an isolated 60-cm segment of the middle portion of small bowel. Two nipple valves were created - one to prevent reflux and one to provide continence of urine. Follow-up was 27 and 17 months respectively. One patient had his outlet valve revised because of sliding and incontinence. He is now completely continent of urine and he intubates his reservoir three to four times daily. Postoperatively, the second patient had a leak at the ureteroileal anastomosis, but this healed spontaneously. The continent urinary diversion is a major intestinal operation and should not be performed in conjunction with exenteration. It should be confined to a few centres where greater experience can be accumulated.
Semen collected immediately before or soon after therapeutic unilateral orchidectomy from 86 men with germinal tumours of the testis was analysed. The mean sperm count was 65.6 +/- SEM 10.3 X 10(6) per ejaculate. This was significantly different from that in a control population, in whom the mean was 165.2 +/- 12.9 X 10(6) per ejaculate. The difference appeared to be due to a subpopulation of 32 patients with counts of 20 X 10(6) per ejaculate; the distribution of counts in the remaining patients was similar to that in the controls. The cause of this abnormality of exocrine function is unknown: it may either be due to the tumour or its treatment, or both, or, alternatively, it may predate the events of the malignant transformation, possibly even acting as an inducing or promoting factor.
Pressures occurring in the upper urinary tract during perfusion and diuresis were compared in an unsedated dog preparation. Perfusion pressures were significantly higher, suggesting that a product of diuresis actively reduces upper tract tone.
Multimodality treatments have increased the survival of cancer patients in recent years. With cure the quality of life also should be taken into consideration. Maintenance of the reproductive capacity is of great concern to many young patients. Until now the cause of sterility was attributed to the long-term side effects of treatment when recovery could not be predicted. Pre-treatment sperm banking is advised routinely for many of these patients. Our own observation as well as a few other reports show that cancer itself seems to have an adverse effect on fertility before any form of treatment. As assessed by semen quality the majority of our patients were subfertile when first seen. Hence, sperm banking may be a poor guarantee for future reproduction in these patients.
Sperm banking with the relatively simple and economical biologic freezer (Linde BF-5; Union Carbide Corporation, Linde Division, New York, N.Y.) was compared with controlled-rate freezer (Linde CRF-1; Union Carbide), using different freezing rates and cryoprotective media. The results were assessed by comparing prefreeze and post-thaw sperm motility. Our results demonstrate a significant loss of sperm motility with both techniques; however (1) complex cryoprotective medium (CPM) containing egg yolk produced better results than did 10% glycerol, (2) the rate of freezing at 10 degrees C versus 1 degrees C/minute did not produce a significant difference, and (3) results with the controlled-rate freezer and BF-5 were similar. We therefore conclude that sperm banking can be accomplished in a relatively simple and reliable way by using the BF-5 and CPM.