Recurrent urothelial tumors following surgery for transitional cell carcinoma of the upper urinary tract

A retrospective analysis of 74 cases of transitional cell carcinoma of the renal pelvis and ureter treated at this institution over the past 30 years is presented. When nephrectomy alone or incomplete nephroureterectomy was performed, subsequent transitional cell carcinoma developed in 30% of the ureteral stumps. Subsequent bladder carcinoma occurred in 25% of the patients with primary upper urinary tract carcinoma. The type of initial surgery performed did not appear to influence this incidence of subsequent bladder tumors. Contralateral upper urinary tract carcinoma developed in only one patient. When nephroureterectomy is performed for carcinoma of the renal pelvis and ureter, a cuff of bladder that includes the ureteral orifice should be removed to obviate recurrent disease in the ureteral stump. Since single-incision nephroureterectomy did not include the intramural ureter in 50% of the cases in which it was performed, a second incision may be required for adequate exposure.     

Esophageal reconstruction with free jejunal grafts: an experimental study

Replacement of a long segment of esophagus for esophageal atresia or severe stenosis remains a special problem in children. The following studies were designed to test the hypothesis that a section of small bowel without serosa could survive as a free autologous transplant to replace part of the mediastinal esophagus. Laparotomy was performed in 20 adult cats, a loop of small bowel was resected and an end-to-end jejunojejunostomy was completed. The serosa of the resected bowel was removed and the mucosa-muscularis graft was used to replace a segment of the middle esophagus that was resected via a right thoracotomy. The interposed graft was entirely wrapped with adjacent skeletal muscle flaps. Postoperative studies include barium swallow and cine esophagograms, histology and blood vessel casts. Results are presented which show anatomical and functional survival of 16 grafts without blood vessel anastomoses or intrinsic vascular pedicles.     

Research for the rationalization of nuclear power plant pipe break criteria

The need for a new design basis for pipe break criteria is demonstrated by noting the potential deleterious effect of present criteria in piping during normal operation. Recent advances in fracture mechanics and stress analysis permit development of rational, realistic and conservative criteria that will make possible significant improvements in piping system design. Research needed to form the basis for new criteria is suggested and the nuclear industry is encouraged to work towards this goal.     

Outcome of unsuspected pneumococcemia in children not initially admitted to the hospital

The records were reviewed of 97 episodes of unsuspected pneumococcemia in children not initially admitted to the hospital. Antimicrobial agents were prescribed at the first visit for 46 children; at the second visit 37 of them were improved and nine were not. No antimicrobial agents were prescribed at the first visit for 51; at the second visit 16 of these patients were improved and 35 were not. Pneumococcemia persisted in two treated children and in 13 untreated children. Meningitis was identified later in four children (two treated and two untreated). Although pneumococcemia in children may be a transient event, it may also persist or result in meningitis or other localized infections.     

Damage to cochlear efferents following AF64A intoxication

Damage to cochlear efferents in chinchillas was assessed using transmission electron microscopy following unilateral treatment with the cholinotoxin ethylcholine mustard aziridinium ion (AF64A). AF64A was diluted in artificial perilymph to concentrations ranging from 0.5 to 100 microM. Survival times ranged from 1 to 12 weeks. At concentrations above 10 microM, widespread damage was noted to efferent fibers within the inner spiral bundle (ISB), tunnel spiral bundle (TSB), tunnel radial fibers (TRF) and efferent terminals at the base of OHCs. This damage included degeneration of fibers and terminals, delamination of mitochondria, vacuolization, and loss of cell membrane. However, at high concentrations, non-specific damage was also noted as thinnings or discontinuities of the membrane of OHCs and afferent fibers. At concentrations between 3 and 10 microM, selective damage was observed to efferent fibers within the ISB, TSB, TRF, and to terminals at the base of the OHCs, with all other structures appearing normal. At concentrations of 0.5 and 1 microM, damage was limited to efferent fibers within the TSB and ISB below the inner hair cells. In general, insult was greatest to middle- and basal-turn efferents, and longer survival times did not produce greater damage to, or loss of, efferents. These data suggest that at low concentrations, AF64A produces a partial yet selective degeneration of cochlear efferents within both the medial and lateral tracts, and that at the lowest concentrations used in these studies, AF64A produces a preferential insult on lateral olivocochlear efferents.