Faculty Bibliography

Red blood cell oxalate flux rates were measured in various populations of stone patients and controls. Idiopathic and normocalciuric stone patients and post-prostatectomy patients exhibited rates significantly greater than the nonstone controls. The fact that this abnormality was not limited to patients with calcium oxalate nephrolithiasis suggests that this cellular defect is not universal nor an important etiological factor for calcium oxalate nephrolithiasis.

RP-30A is a radioactive tracer being evaluated for the detection of regional myocardial blood flow. This study compares RP-30A to technetium 99m pertechnetate as radioactive tracers for the detection of testicular blood flow changes in early testicular torsion. The left testis of adult male Sprague-Dawley rats was subjected to either thirty or sixty minutes of 720 degrees torsion. Injections of RP-30A or 99mTc-pertechnetate followed by sacrifice and scintillation counting of the testes was performed. No significant difference was detected between the torted testes and the right control testes in both groups receiving 99mTc-pertechnetate and the thirty-minute group receiving RP-30A. The torted testes of the sixty-minute group receiving RP-30A revealed a significant difference (decrease) in uptake indicating that RP-30A may be a more sensitive tracer in detecting testicular blood flow changes in early testicular torsion.

The incidence of fungal infections is increasing. This may be a result of widespread use of broad-spectrum antibiotics or an increase in the number of immunocompromised patients. The clinical presentation of fungal infection is diverse. Management is determined by the overall clinical profile of the individual patient. The most important step is to eliminate the underlying cause of the infection.

Hydrochlorothiazide is employed to reduce calcium excretion in patients with urinary stone disease secondary to renal leak hypercalciuria. Because the drug also has been reported to be a competitive inhibitor of oxalate excretion by the renal tubules, we sought to determine whether chronic use indeed affected the amount of oxalate excreted. Patients taking hydrochlorothiazide 50 mg daily did not have a statistically significant reduction in twenty-four-hour urinary oxalate on their customary diets (pretreatment 37 +/- 3 mg/day [mean +/- S.E.M.; N = 22]; at one year 36 +/- 3 mg/day [N = 22]; at two years 37 +/- 3 mg/day [N = 16]). In 12 patients who voluntarily collected twelve-hour urine specimens after dinner on the third day of a low-oxalate diet and again the next day after a 1 g oxalate load, hydrochlorothiazide had no significant effect on oxalate excretion (19 +/- 2.3 mmol oxalate/mol creatinine on hydrochlorothiazide versus 20.6 +/- 2.6 mmol off the drug after low oxalate meal; 50 +/- 7.8 mmol/mol creatinine on hydrochlorothiazide versus 56.2 +/- 7.5 mmol off the drug after an oxalate load). As expected, there was a significant reduction in urinary calcium excretion and thus of calcium oxalate urinary saturation during hydrochlorothiazide administration. Hydrochlorothiazide by itself is not sufficient to reduce oxalate excretion in patients with renal leak hypercalciuria.

We evaluated the use of neuroleptanalgesia in 121 patients undergoing extracorporeal shock wave lithotripsy (SWL) with the Sonolith 3000. Neuroleptanalgesia consisting of alfentanil and combinations of droperidol, benzodiazepine, barbiturate and ketamine were administered. The McGill Pain Questionnaire, a widely used test to measure pain that provides valuable information on the sensory, affective, and evaluative dimensions of a painful experience, was utilized to evaluate the patients' experiences. Fifty-eight per cent of the patients described their maximum pain as either mild or discomforting. Eighteen per cent (22) did not experience any pain. Similar numbers of patients described their overall level of comfort as either extremely comfortable (23 patients, 19%) or extremely uncomfortable (18 patients, 16%). The pain was most often described as sharp and the experience as tiring. In the affective categories, the answer with lowest pain score was most often selected (P < 0.05). Only five patients found the experience so unpleasant that they would not undergo the procedure again. No relation between the pain experienced and any characteristic of the stone or the length of time since SWL was identified. Side effects were uncommon and insignificant. Although treatment is not analgesic free, neuroleptanalagesia provides a safe and reliable means of anesthesia for renal lithotripsy with the Sonolith 3000. While accomplishing this, patients are extremely satisfied with the treatment, and treatment success rates remain comparable to those provided by other lithotripters. © 1991, Mary Ann Liebert, Inc. All rights reserved.