[Primary ureteral amyloidosis]. / Amiloidosis ureteral primaria.

OBJECTIVE: Two additional cases of primary ureteral amyloidosis are described. The current literature and clinical classification of the disease are reviewed. METHODS: Over a period of 18 months, we observed two cases of organic ureteral stenosis whose etiology was difficult to determine. The first case warranted a nephroureterectomy due to the condition of the compromised urinary tract. Analysis of the surgical specimen showed histological evidence of ureteral amyloidosis. In the second case, the previous experience allowed a preoperative diagnosis to be made, an exceptional situation that permitted conservative surgery. Characterization of the amyloid proteins was done in both cases with immunochemical study by Western Blot. RESULTS: Two patients with primary ureteral amyloidosis were surgically treated. The first case underwent complete excision of the urinary tract. The second case, who had a single kidney, was treated by conservative surgery. In both cases we identified a fragment of the lambda light chain of immunoglobulin by Western Blot characterization as previously reported in localized amyloidosis. CONCLUSIONS: Although ureteral amyloidosis is an infrequent disease, it should be seriously considered in the differential diagnosis of organic ureteral stenosis in order to avoid unnecessary excision. To our knowledge, these are the first cases of ureteral amyloidosis with immunochemical characterization of the amyloid protein.

[Analysis of the results with Rigiscan in 93 impotent patients]. / Análisis de los resultados del Rigiscan en 93 pacientes con impotencia.

OBJECTIVE: This study was undertaken to evaluate the performance of the Rigiscan in the diagnosis of sexual impotence. METHODS: Erectile nocturnal activity was evaluated by Rigiscan in 93 patients consulting for impotence; mean age 56.8 years. Diagnosis and treatment were performed between October, 1990 and May, 1992. Follow up is currently ongoing. RESULTS: 95.1% of the patients with normal recordings had no organic pathology, and 80% of these recordings were observed on the first night of the study. In ruling out organic pathology, the Rigiscan did not have a higher specificity than the report of early morning erection (EME) by the patients (p > 0.05). Seventy three percent of the pathological results on the Rigiscan studies were associated to organic pathology. This test showed a higher sensitivity than the absence of EME (p < 0.01). Although no pathognomonic diagnostic pattern was found, a flat pattern and uncoupling were highly suggestive of organic disorders. CONCLUSIONS: The Rigiscan is a useful diagnostic tool, especially in patients reporting no EME. Furthermore, the Rigiscan was able to detect almost all the patients with organic pathology.

[Physiology of erection]. / Fisiología de la erección.

OBJECTIVE: The present study reviews the mechanism involved in the initiation and maintenance of penile erection. METHOD: The study reviews the literature on the basic concepts supporting either "magically" or scientifically the erectile mechanism. An anatomo-physiological update is also included (i.e., the main neurological, muscular, and vasculoendothelial phenomena). RESULTS: Present studies based on the vasoactive action of different drugs have increased the knowledge on the neurological, muscular, and vasculoendothelial phenomena. The cavernous muscular relaxation may start and finish due to the equilibrium between the contractile adrenergic and the relaxing non adrenergic-non cholinergic stimulus through intracellular nitric oxide synthesis. This is an essential phenomenon involved in the entry and "trapping" of blood within the sinus spaces. CONCLUSIONS: Our knowledge on the erectile mechanisms through neuromediators is increasing. The role of the endothelium in intracellular nitric oxide synthesis and its relaxing effect, will improve our understanding of both physiological and therapeutic phenomena.

[Clinical, epidemiologic, and microbiologic study of urinary infection in patients with renal transplant at a specialized center in Argentina]. / Estudio clínico, epidemiológico y microbiológico de infección urinaria en pacientes con trasplante renal en un centro especializado de Argentina.

Sixty-four patients were evaluated for urinary tract infection (UTI) during the first six months after renal transplantation. Eighty per cent received the allograft from a living, related donor and 37% were female. The median age was 33.8 years. All the patients received cefazolin as perioperative antibiotic prophylaxis. No prophylaxis was given during the bladder catheterization period, which had a median duration of 5.9 days. Nineteen per cent developed predisposing urological factors (PUF). The incidence of UTI was 41% and 15% of all these patients developed bacteremia from this source. UTI was observed in 50% of the patients without PUF between the 5th and 12th days post-transplantation, and these cases had been detected by the control urine culture performed when the bladder catheter was withdrawn. This group of patients accounted for 14% of all the patients. Recurrence was present in 42% of the patients with UTI (19% had reinfection, 4% relapse and 19% both). They were more frequent in patients with PUF than in the patients without; 78% vs. 24%, respectively (p < 0.05). The overall UTI incidence was also higher; 75% vs. 33%, respectively (p < 0.05). The same was observed for the median number of episodes (3 vs. 1). The organisms most frequently isolated were E. faecalis (21%). E. cloacae (17%), and E. coli (17%). Species prevalence differs from that of other reports, probably due to the different institutional antibiotic management. Since half of the UTI episodes suffered by patients without PUF were associated to bladder catheterization, there is a need to institute antibiotic prophylaxis in our center.

[Test with vasoactive drugs: its predictive value in the diagnosis of erectile sexual dysfunction of venous origin]. / Test con drogas vasoactivas: su valor predictivo en el diagnóstico de la disfunción sexual eréctil de origen venoso.

The practicability and sensitivity of the test with vasoactive drugs, the first method performed in our flow studies, make it an invaluable method for orienting the diagnosis. Our findings show that in 65% of the patients with a partial response to the drug-induced erectile test, dysfunction may arise from pure or associated venous leakage, which must be confirmed by dynamic cavernosometry and/or cavernosography.

[Flow studies in patients with sexual erectile dysfunction. Review of the physiology and the adopted method]. / Flujograma de estudio en el paciente con disfunción sexual eréctil. Revisión de la fisiología y metodología adoptada.

Further insight into the physiology of erection acquired in recent years had led to the development of new methods that have enhanced the evaluation of erectile dysfunction. These new methods will permit a more precise diagnosis and, consequently, the management of this condition can be based on scientific and not empirical methods. To date, many questions remain unanswered and many points have not been elucidated. Using a precise methodology will permit us to corroborate or correct what has been done up until now and to develop new methods of investigation. The present study briefly reviews the physiology of erection and describes a method we routinely use.

[Renal transplantation: surgery in the patient with a functioning kidney]. / Trasplante renal: cirugía en el paciente con riñón funcionante.

One hundred and seven surgical procedures performed on 98 patients with stable renal allograft function are analyzed. They represent 35.5% of 276 patients who underwent renal transplants. The surgical procedures were not related to the graft or its arteries and vein. The procedures were gynecologic 8, urologic 24, thoracic 6, ophthalmologic 8, neurosurgical 2, general surgery 37, orthopedic 17 and plastic surgery 5. Thirty-five (32.7%) were emergency and 72 (67.3%) elective procedures. Twenty-six patients were operated on for infections. The overall operative mortality rate was 15.3%. It was significantly higher in emergency procedures (34.28%) than in elective surgery (4.16%).

[Is it useful to ask questions to assess the strength of urination flow?]. / Es útil el interrogatorio para valorar la fuerza del chorro miccional?

In order to determine the value of the interview conducted to assess the micturitional stream of our patients, we compared in 200 cases what the patients said about their micturition against their maximum flow rate (QMx). We demonstrated that 79% of those who said they voided with a "bad stream" had QMx less than or equal to 10 ml/sec. Only 65% of those who said they voided with a "good stream" had a QMx less than or equal to 15 ml/sec. Of those with QMx less than or equal to 10 ml/sec. (73 patients), only 15% had reported a "bad stream". Thus, we believe it is not reliable and of little interest to ask our patients about the strength of their micturitional stream. It would only be useful in those who reported a "bad voiding". To our knowledge, this is the first study that documents the discrepancy between data from the interview and the maximum flow rate.

Drenajes abdominales. Parte II. Estudio clinico prospectivo. / Abdominal drainages. Part II. Prospective clinical study

Un estudio cooperativo realizado por los Servicios de Cirugia de 5 hospitales permitio analizar 195 pacientes con drenajes abdominales. Los modelos aspirativos fueron preferidos a los no aspirativos y se demostro su capacidad para detectar complicaciones postoperatorias y evitar reoperaciones por dehiscencias de esofagoyeyunoanastomosis, coledocoyeyunoanastomosis salida accidental del tubo de Kehr, etc.Para interpretar los hechos relacionados con la colocacion de un drenaje es imprescindible un conocimiento mas profundo de la fisiologia peritoneal: presiones, secrecion y absorcion, genesis y lisis de las adherencias, capacidad antimicrobiana, etc

Drenajes abdominales. Parte II. Estudio clinico prospectivo. / Abdominal drainages. Part II. Prospective clinical study

Un estudio cooperativo realizado por los Servicios de Cirugia de 5 hospitales permitio analizar 195 pacientes con drenajes abdominales. Los modelos aspirativos fueron preferidos a los no aspirativos y se demostro su capacidad para detectar complicaciones postoperatorias y evitar reoperaciones por dehiscencias de esofagoyeyunoanastomosis, coledocoyeyunoanastomosis salida accidental del tubo de Kehr, etc.Para interpretar los hechos relacionados con la colocacion de un drenaje es imprescindible un conocimiento mas profundo de la fisiologia peritoneal: presiones, secrecion y absorcion, genesis y lisis de las adherencias, capacidad antimicrobiana, etc

Drenajes abdominales. Estudio experimental comparativo. / Abdominal drainages.Comparative experimental study

Se presenta una serie de 14 perros en los que se efectuo una laparotomia y se coloco un cateter para instilacion continua y un drenaje con sus extremos separados 4 cm. Cerrada la incision, durante 3 hs se introdujeron 200 cc de bilis humana. En 7 se empleo drenaje aspirativo y en 7 de Penrose. Transcurridas las 3 hs, se efectuo una nueva laparotomia, aspirandose la bilis remanente. Con el sistema aspirativo se habia drenado (promedio) el 57% de la bilis y con el Penrose solo 6,3%. Los autores consideran que en esas condiciones experimentales el drenaje aspirativo demostro ser muy superior

Drenajes abdominales. Estudio experimental comparativo. / Abdominal drainages.Comparative experimental study

Se presenta una serie de 14 perros en los que se efectuo una laparotomia y se coloco un cateter para instilacion continua y un drenaje con sus extremos separados 4 cm. Cerrada la incision, durante 3 hs se introdujeron 200 cc de bilis humana. En 7 se empleo drenaje aspirativo y en 7 de Penrose. Transcurridas las 3 hs, se efectuo una nueva laparotomia, aspirandose la bilis remanente. Con el sistema aspirativo se habia drenado (promedio) el 57% de la bilis y con el Penrose solo 6,3%. Los autores consideran que en esas condiciones experimentales el drenaje aspirativo demostro ser muy superior