Comparison of stapled and hand-sutured gastrectomies.

We reviewed 585 Billroth II gastrectomies to compare the results of stapled and hand-sutured cases. In 385 patients who had the duodenal stump handled by conventional methods, 18 (4.7%) leaked, compared with four (2.5%) leaks in 160 patients who had the duodenal stump stapled. In 474 hand-sutured anastomoses, there were 12 complications (leaks, hemorrhage, or obstruction), whereas there were no complications in 71 stapled anastomoses. We conclude that stapling provides an expedient way of performing gastrectomies that is at least as safe if not safer than conventional hand suture.

Urethral pressure profilometry in Scott artificial urinary sphincter.

The Scott sphincter models AS 791 and AS 800 were implanted in 22 men with urinary incontinence. Urethral pressure profilometry was used intraoperatively and postoperatively to measure the urethral closure pressure (UCP) and to improve the rate of continence and reduce the risk of erosion. Success was achieved in 20 of 24 patients. The utility of urethral profilometry in these cases is described.

Cerebrospinal fluid shunt infection secondary to Escherichia coli bacteriuria.

A 10-year-old girl with a lumbosacral myelomeningocele, managed with clean intermittent catheterization, presented with headache, vomiting, and lethargy. The cerebrospinal fluid (CSF) and urine cultures revealed Escherichia coli, documented to be the same subtype. The organisms were subtyped and the E. coli from both the urine and CSF were noted to be of the same strain. Management consisted of intravenous antibiotics and ultimate replacement of the ventriculoperitoneal shunt. Children with myelodysplasia and CSF shunts should be carefully monitored in a multidisciplinary fashion to anticipate, correctly diagnose, and treat CSF shunt infections associated with bacteriuria.

Intestinal de-epithelialization and augmentation cystoplasty: an animal model.

OBJECTIVES: An animal model of augmentation cystoplasty was developed in New Zealand rabbits to study the effects of intestinal de-epithelialization on subsequent re-epithelialization by bladder urothelium. METHODS: Twenty-four rabbits underwent augmentation cystoplasty using intestinal segments that were either treated with protamine sulfate and urea solution or else anastomosed with an intact epithelium. Half of the rabbits receiving the de-epithelialized intestinal segments were subjected to glycosaminoglycan replacement therapy by administration of intravesical heparin. Experimental and control rabbits were sacrificed at 1-, 2-, and 3-month intervals. RESULTS: Histologic examination of the augmented sections showed small areas of urothelium growing over the intestinal epithelium (approximately 15%). The heparin-treated group demonstrated the greatest amount of re-epithelialization. There was no obvious histologic difference in the amount of collagen present in the augmented tissues in any of the experimental groups. CONCLUSIONS: In a preliminary study, New Zealand rabbits appear to be satisfactory as an experimental animal for studying the augmentation cystoplasty procedure and for the development of therapeutic interventions for enhancing epithelial growth. Protamine and urea will de-epithelialize the bowel and heparin may promote epithelialization of augmented intestinal segment by transitional epithelium.

Genitourinary trauma in the pediatric patient.

Trauma is the major source of mortality in the pediatric population. A retrospective review was performed on patients admitted to the Children's Hospital and Health Center Trauma Program, San Diego, California, from August 1984 to May 1990. The purpose of this review was to evaluate pediatric trauma and to determine the best treatment and evaluation for genitourinary injuries. Blunt trauma was responsible for 98 percent of the injuries, with renal injuries being the most common. Bladder (7) and male urethral (2) injuries, and vaginal lacerations (8) also occurred. The most severe renal injuries (70%) and all significant bladder and urethral injuries were associated with gross hematuria. Hypotension was present in 31 percent of patients but rarely required surgical exploration for correction. Eighty-six patients underwent radiographic imaging. Computerized tomography (CT) scans demonstrated the most information about intra-abdominal solid organ injuries but was inaccurate in detecting bladder or urethral injuries. Genitourinary injury is common in children but rarely requires surgical management. CT scan is the best study to determine extent of solid-organ injury but is inferior to cystourethrography to diagnose bladder or urethral injuries.

Prophylactic antibiotics in urology.

The emergence of prosthetic surgery and nonoperative surgical treatment of urolithiasis has seen with it an expanded application of prophylactic antibiotics. The very nature of these procedures with the often increased risk of infectious complications lends itself perfectly to wider but more judicious use of prophylactic antibiotics. Controlled clinical trials that address issues such as dosing, selection, and indications for antibiotic prophylaxis are lacking. Until that information is forthcoming, only recommendations can be made as we have tried to provide in this article.

Etiology, diagnosis, and management of urethral strictures in children.

Urethral strictures in children, like those in adults, are problems whose management embodies all that is basic to urology. It is helpful to think of strictures according to etiology: congenital, infectious-inflammatory, and traumatic (iatrogenic and noniatrogenic). The treatment options are diversion (nearly always temporary), manipulation, and repair. The authors also review their research on urethral healing.

Distal hypospadias.

Distal hypospadias, where the urethral meatus is located subcoronal or more distal, is one of the most common congenital anomalies in males. The embryology and etiology of hypospadias, timing of repair, surgical techniques, anesthesia for and complications of hypospadias repair are reviewed.

Fat content and fatty acid pattern in muscle and adipose tissue from differently reared calves.

Two groups of Simmental calves were fed a milk replacer diet or were early weaned and slaughtered at the age of 4 months. Two muscles and two adipose tissue samples were removed, the lipids were extracted by chloroform-methanol and the fatty acid composition was analyzed by gas chromatography after transesterification with Na-methylate. Total lipid contents in both muscles were relatively small (<2%) Due to high phospholipid content, veal muscle lipids contain a high proportion of polyene fatty acids which accounted for more than 30%. Adipose tissue consists predominantly of oleic acid (from 34% to 37%) and palmitic acid (from 27% to 29%). In extractable perinephric fat, milk replacer diet caused significantly higher myristic acid (C(14)) values and, accordingly, lower oleic (C(18:1)) values.

Development and evaluation of a new method for the determination of the carotenoid content in selected vegetables by HPLC and HPLC-MS-MS.

Epidemologic studies have shown inverse correlation between the consumption of carotenoid-rich vegetables and the incidence of cancer. Therefore, analytical techniques for the quantitative determination of carotenoids in complex sample matrices are important. The most used method is reversed-phase (RP)-high-performance liquid chromatography (HPLC). In this study, seventeen mobile-phase systems described in the literature and six RP-HPLC columns with differences in particle size and porosity are evaluated. Derived from these results, a new mobile-phase (acetonitrile, methanol, chloroform, and n-heptane) including solvent modifiers is presented, which allows an improved and more efficient separation of carotenoids. From all columns tested, the best chromatographic parameters are found using a silica C18 column (250 x 2 mm, 5 microm, 100 A). As was found, absorbance detection at 450 nm allows the determination of the carotenoids down to the picogram range with good linearity (R2 > 0.98). For the identification and quantitation of carotenoids in complex sample matrices (containing additionally other ultraviolet-absorbing compounds), the optimized RP chromatographic system is coupled to a mass spectrometer (MS) using an atmospheric pressure ionization interface. The calibration plots show high linearity (R2 > 0.99), and the detection limit is found in the lower nanogram range. Furthermore, collision-induced dissociation in the ion source allows for the identification of carotenoids by their characteristic fragmentation pathways. In this study, a total of nine species of vegetables commonly consumed in Central Europe are analyzed for their contents of carotenoids (namely lutein, zeaxanthin, beta-cryptoxanthin, and beta-carotene) by RP-HPLC and RP-HPLC-MS-MS. It is found that good sources for lutein are spinach, kale, and broccoli, and sources for beta-carotene are broccoli, spinach, kale, carrots, and tomatoes. This new method is an improvement for the identification and quantitation of carotenoids in complex biological tissues.

Thin-layer electrophoretic separation of monosaccharides, oligosaccharides and related compounds on reverse phase silica gel.

The electrophoretic mobilities of monosaccharides, oligosaccharides, sugar alcohols and sugar acids were determined in 0.3 M borate buffer, pH 10, using thin-layer electrophoresis on silanized silica gel, pretreated with octanol-1. A rapid separation of a number of sugars, occurring in foods, could be achieved. Using a 0.05-0.1 M neutral solution of barium acetate as electrolyte, thin-layer electrophoresis allowed excellent and rapid separation as well as identification of all common uronic acids which are constituents of many acidic polysaccharides.

[The analysis of polysaccharides used as food additives. VIII. Simple qualitative and semiquantitative procedures for the determination of alginates in food]. / Beiträge zur Analytik der als Lebensmittelzusatzstoffe verwendeten Polysaccharide. VIII. Einfache qualitative und semiquantitative Bestimmung von Alginat in Lebensmitteln.

For a rapid and specific assay of alginate, the isolated polysaccharide is split by methanolic hydrochloric acid, the reaction products are separated on silica gel plates and visualized by an uronic acid specific naphthoresorcinol-hydrochloride acid reagent. With the solvent ethylacetat/tert. butanol/water (68 + 23 + 9, v/v/v) the Rf-values of the hydrolysis compounds of alginate differ distinctly from those of the other uronic acids, which are constituents of commercial polysaccharides. The method had been tested successfully on a series of different foods (e.g. propyleneglycol alginate in beer).

[Analysis of polysaccharides used as food additives. V. Gaschromatographic identification of hydrolysis products in uronic acids containing polysaccharides]. / Beiträge zur Analytik von als Lebensmittelzusatzstoffe verwendeten Polysacchariden V. Gaschromatographische Identifizerung der Hydrolyseprodukte uronsäurehaltiger Polysacchride

Alduronic acids can be found among the monomeric units of polysaccharides, which are used as stabilisators in the food industry. Gaschromatographically they cannot be separated directly by the way of their aldonitrilacetates but it is possible by the procedure described. The 1-0-methylalduronic-acidmethylesters, obtained by the methanolysis of the polysaccharides, are reduced with boronhydrid to the corresponding methyl glycosides; there are split with acid to the aldoses, which are converted in pyridine with hydroxylamine to the aldoximes and than with acetic anhydride to the aldonitrilacetates, which can be separated by gaschromatography without difficulty.

[Analysis of polysaccharides used as food additives iv. Gaschromatographic identification and determination of neutral components in polysaccharide-hydrolysates (author's transl)]. / Beiträge zur Analytik von als Lebensmittelzusatzstoffe verwendeten Polysacchariden. IV. Gaschromatographische Identifizierung und Bestimmung neutraler Bausteine von Polysaccharid-Hydrolysaten

The monosaccharides, which are obtained by hydrolytic cleavage of the polysaccharid containing stabilisators, can be separated gaschromatographically by the way of their aldonitrilacetates. After hydrolysis, the mixtures are neutralized by an anion exchanger, evaporated to dryness, converted in pyridin with hydroxylamin to the aldoximes and hereafter with acetic anhydride to the aldonitrilacetates. Dissolved in chloroform, these compounds are used for gaschromatographic separations; only one peak is obtained for each sugar. This is a great advantage to the previous methods, where the anomeric constellations lead up of five peaks for one sugar compound and for complicated sugar mixture, it therefore was difficult to evaluate their gaschromatograms.

[Analysis of polysaccharides used as food additives. VI. Identification of mixtures of polysaccharides by methylation analysis (author's transl)]. / Beiträge zur Analytik von als Lebensmittelzusatzstoffe verwendeten Polysacchariden. VI. Identifizierung von Polysaccharidgemischen mit Hilfe der Methylierungsanalyse.

Polysaccharide mixtures used as stabilizers having identical sugar units, but differing in their linkages can be identified with confidence by means of methylation analysis. Such mixtures are methylated with sodium hydride and methyl iodide in anhydrous dimethylsulfoxide. The methylated products are acid hydrolyzed and the resulting methyl sugars are separated and identified by thinlayer- or gaschromatography.

[Analytical determination of polysaccharide thickening agents for foods--a review (author's transl)]. / Analytik der als Lebensmittelzusatzstoffe verwendeten Polysaccharide.

In this report, the analytical methodology, as developed by the authors for polysaccharides, used as thickening agents in foods is reviewed and summerized. Present additive regulations increase actuality and need for this subject. The analytical methodology consists of the following steps: a) isolation of the polysaccharides from the food samples, b) purification of the polysaccharide, c) determination of the monomeric compounds by thin layer chromatography or by gas chromatography, d) separation into neutral and into acid compounds by ion exchange chromatography on DEAE-Cellulose and e) determination of the types of linkages between monomeric compounds by permethylation.

Endobronchial metastasis from prostate carcinoma.

Metastasis from the prostate to the lungs is common; however, endobronchial metastasis from the prostate has been reported only twice. We report a patient with endobronchial metastases from the prostate in the absence of bony metastases. Clinical and roentgenographic findings of pulmonary metastases from prostate cancer are described, and therapeutic considerations are discussed.