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To focus attention on the problem of infant mortality in Lebanon, data were compiled on infant mortality from 1978 to 1986 at the American University of Beirut Medical Center. Causes of death are analyzed for 602 males and 398 females. 54.9% deaths occurred at 1 month of age and 77.4% died within the 1st year. Autopsies were performed on .7%. 37.7% of all neonatal deaths were due to neonatal diseases such as hyaline membrane disease, asphyxia neonatorum, immaturity, necrotizing enterocolitis, hemorrhage, hemolysis, meconium aspiration, and kernicterus. Better prenatal care would reduce this group, or the administration of corticosteroids to the mother 24-48 hours prior to delivery, as well as rapid resuscitation at birth and prevention of the 5 curses: hypoxemia, hypoglycemia, hypothermia, hypotension, and acidosis. Although unavailable in Lebanon, administration of surfactants through an endotracheal tube would also help. Infections constitute 25.1% of deaths; many are preventable through adequate public health measures and strict personal hygiene, i.e., diseases such as sepsis, pneumonia, meningitis, gastroenteritis, hepatitis, encephalitis, and 1-2 cases of the following: diphtheria, measles, peritonitis, tetanus, tuberculosis, cytomegalis inclusion, herpes, parathyphoid, pertussis, poliomyelitis, and shigellosis. Congenital diseases were 21.6%. In utero diagnosis could prevent some diseases and in utero treatment is possible for hydrocephalus and hydronephrosis. Screening programs postnatally could lead to treatment. 5.9% were malignancies such as leukemia, lymphoma, brain tumors, histocytosis, Wilm's tumor, Ewing sarcoma, and Hodgkin's disease. Early diagnosis is critical if mortality is to be reduced in this group, but medical advances are still needed. 2.9% are miscellaneous diseases such as poisoning, rheumatic diseases, marasmus, Reye's syndrome, nephrosis, rickets, and epilepsy. Most of these diseases are preventable, except for rheumatic inflammation of the heart. Recommended necessary steps to reduce infant mortality are: prenatal care, diagnosis and screening, intrauterine surgery; resuscitation and intensive care centers with modern equipment and trained personnel; national vaccination and screening programs; adequate public health measures and hygiene; parental education; and well-equipped hospitals to serve all regardless of income level.
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PMID:Pediatric mortality: an avoidable tragedy. 251 28

1. Widespread visceral and intestinal wall metastases are present in women dying with ovarian cancer. Intestinal wall invasion is commonly found at autopsy and is associated with bowel obstruction. Liver parenchymal replacement by metastases in more extensive than that in the lung, where most metastases have a subpleural location. Multifocality characterizes metastases in both of these organs. 2. Neoplastic lymphatic invasion is common. Lymphatic and blood vascular invasion are associated with an increased incidence of metastases in lymph nodes, small bowel wall, pancreas, lungs, ureter, and liver. 3. The mean survival time from diagnosis to death is less than 2 years. Both increasing neoplastic histological grade and clinical stage at diagnosis are associated with decreased survival time. 4. The most common causes of death are carcinomatosis, infection, or a combination of these processes. Sepsis, pneumonia, or both of these account for most of the fatal infections. 5. Bowel and ureteral obstruction constitute the most common forms of tumor-induced morbidity. The former process tends to be multifocal, involving the small and large intestines, and it is found during the disease course as well as at autopsy. Ureteral involvement is usually associated with hydronephrosis and is bilateral in approximately one fourth of the cases.
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PMID:The pathology and biologic behavior of ovarian cancer. An autopsy review. 265 34

From 1980 to 1988 235 koalas were necropsied and 67 were found to have urinary tract disease. Six affected koalas out of 48 were derived from wildlife parks around Sydney while 61 of 187 were derived from free living populations on the central and north coasts of New South Wales. Sixteen had cystitis alone, 5 had cystitis and associated renal disease only, 16 females had cystitis with genital disease, 23 had urinary disease in combination with other systemic disease and 7 had renal disease only. Overall 49 animals had cystitis (30 females and 19 males; 47 being free living) with 12 of these having renal extension (all free living). Cystitis tended to be active but chronic while associated renal disease was mainly designated as hydronephrosis and pyelonephritis. Other forms of renal disease included lymphosarcoma, oxalate nephrosis, acute and chronic nephritis, and microabscessation related to septicaemia. Female genital disease associated with cystitis was commonly vaginitis and metritis. Paraovarian cysts were detected with and without metritis. Other diseases occurring with urinary tract disease included conjunctivitis, dermatitis/stomatitis, pneumonia and hepatic disease. The higher prevalence of urinary tract disease in free living koalas, especially cystitis, is in contrast to captive koalas and may reflect the interaction between disease cause and habitat.
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PMID:A survey of urinary tract disease in New South Wales koalas. 273 Apr 73

Although various complications such as electrolyte imbalance and urinary infection are known to be induced by ureterosigmoidostomy, it is still a surgical technique difficult to ignore since it allows patients to lead an almost normal life without the encumbrance of external urinary devices. At our hospital, we performed eighteen ureterosigmoidostomy operations between 1976 and 1985. Herein, we review the postoperative conditions of electrolyte, renal function and other complications. The patients (16 male, 2 female) were between 53 and 72 years old, the mean age being 61.5 years. The primary diseases were bladder tumor (14 patients), prostatic cancer (2), carcinoma of the female urethral diverticulum (1) and urethral stricture (1). As to the electrolytes, both serum Na and serum K values fluctuated within the normal range. Hyperchloremia was detected in 4 cases (22.2%), but it was only slightly above the normal range and the conditions were more or less stabilized a year after the operation. Although blood urea nitrogen had a tendency to elevate one or two years after the operation, serum creatinine fluctuated within the normal range. During the observation period, only 7 of the 18 cases (38.9%) showed complications, the major complication being pyelonephritis (3 cases). Postoperative excretory urogram revealed slight to medium hydronephrosis two months after the operation in 9 of the 18 cases (50%), but most of these conditions were normalized within a year. Four patients died after leaving hospital; 3 due to the recurrence of cancer and one due to pneumonia. The 14 other outpatients are enjoying a normal life without the use of any external urinary device.
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PMID:[Ureterosigmoidostomy--clinical review of 18 cases]. 344 31

Clinical evaluation was made on cefoperazone (CPZ) and the following conclusions were obtained. (1) Serum concentrations of the drug after a one-shot intravenous injection of 22.2 mg/kg were 77 mcg/ml (30 minutes), 50 mcg/ml (1 hour) and 8.9 mcg/ml (4 hours) and T 1/2 of serum concentration was 68.5 minutes. A 35-day-old female with obstructive jaundice associated with choledochal cyst was given by a 30-minute drip infusion of 26.8 mg/kg of the drug. Serum concentration was 90 mcg/ml at the end of infusion, slowly declined thereafter, and was 47.5 mcg/ml at 6 hours. Its T 1/2 was 395 minutes. A patient with pyelonephritis complicated with right hydronephrosis was similarly treated with 24.4 mg/kg. T 1/2 of serum concentration was not prolonged, i.e., 82.1 minutes, but urinary recovery rate up to 6 hours was decreased to 15.9%. (2) Five patients, including three with pyelonephritis (causative organism: K. pneumoniae 2 and P. aeruginosa 1) and each one patient with pneumonia (unknown) and with postoperative infection (S. faecalis), respectively, were treated with 66.7 approximately 96.8 mg/kg/day of CPZ in 3 divided doses for 5 approximately 12 days either by one-shot intravenous or by 30 approximately 60-minute drip infusion. An overall efficacy rate was excellent in 3 and good in 2, and there was no failure. Causative organisms disappeared in all cases. (3) Although one patient was excluded from the study because the diagnosis was supposed to be viral pneumonia, all six patients who were given CPZ did not exhibit any adverse reactions except for mild eosinophilia in two instances. (4) The foregoing results as well as the review of the literature clearly indicate the effectiveness of CPZ in the treatment of bacterial infections in children.
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PMID:[Clinical evaluation of cefoperazone in children (author's transl)]. 645 39

Although various complications such as electrolyte imbalance and urinary infections are known to be induced, ureterosigmoidostomy may still prove to be useful on selected patients who desire a continent form of internal diversion. At our hospital, we performed nineteen ureterosigmoidostomy operations in the seven years between 1981 and 1987. Herein, we have reviewed the postoperative conditions of electrolytes, renal function and other complications. The patients (17 male, 2 female) were between 43 and 75 years old, the mean being 60.3 years. The primary disease was bladder tumor with histopathological findings of transitional cell carcinoma (17) and squamous cell carcinoma (2). Post-operative fluctuations in electrolyte values of Serum Na and Serum K were within the normal value. Hyperchloremia was initially detected in four cases (21.0%), but these were only slightly above the normal range and a year after the operations the conditions were stabilized. Although blood urea nitrogen had a tendency to elevate one or two years after the operation serum creatinine fluctuated within the normal range. After the operations, we administered 10% sodium potassium citrate solution to all patients to prevent hyperchloremic acidosis. During the observation period, only four out of nineteen cases (21.0%) exhibited pyelonephritis. No other complications were observed. Postoperative excretory urograms revealed slight to medium hydronephrosis two months after the operation in four out of nineteen cases but most of these conditions were normalized within a year. Nine patients died after leaving the hospital; seven due to the recurrence of cancer and two due to pneumonia. The ten remaining patients are enjoying normal lives without the use of any external urinary device.
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PMID:[Clinical evaluation on long-term complications of ureterosigmoidostomy]. 807 55

From April 1986 through May 1995, 306 men with primary urothelial carcinoma underwent radical cystoprostatectomy and orthotopic bladder substitution via the ileal neobladder. Altogether, 7.5% of the patients suffered general early complications, including thrombosis, embolism, wound infection, and pneumonia. Specific early complications directly related to formation of the neobladder and requiring surgery included ileus (4%), abscess drainage (2%), and leakage of the ileal anastomosis (0.5%). The early reoperation rate was 6.5%. Early complications that required temporary percutaneous drainage were lymphocele formation (3%) or ureteral obstruction (6%). In all, 9% of our patients required prolonged catheter drainage for leakage of the ileouretheral anastomosis. Late complications requiring reoperation were ileus (2%), abscess drainage (1%), neobladder fistula to the colon (1.5%), ureteral reimplantation because of obstruction (3.6%), and nephrectomy for hydronephrosis (1%). A transurethral incision of the ileouretheral anastomosis was necessary in 7% of cases. Continence was separately addressed by sending each patient and his home physician a detailed questionnaire: Using our criteria (no diapers, no awakenings) the night and day continence rate increased from 67% at 6 months, to 72% at 1 year to 85% at 2 years, finally reacting 90% after 4 years. In part II of this presentation we address the question as to whether the option of orthotopic bladder replacement has any impact on the patient's and physician's decision toward earlier cystectomy. We compared our ileal neobladder cohort with a group of 137 patients that had been operated on during the same time span by the same group of surgeons. There was no negative selection with regard of the tumor stage of our patients. However, as compared with the conduit group, the neobladder cohort had a significantly improved survival rate. This phenomenon is explainable by the significantly lower number of previous transurethral resections of the bladder (TUR-Bs) performed in the neobladder group. The time span between primary diagnosis and cystectomy was 10 months in the neobladder group as compared with 18 months in the conduit patients. These data reinforce our belief that orthotopic bladder replacement using the ileal neobladder yields an extraordinary functional result that can be accomplished with a high degree of patient satisfaction and minimal complication. The availability of orthotopic bladder replacement does indeed stimulate the physicians and patients decision toward earlier cystectomy.
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PMID:The ileal neobladder--updated experience with 306 patients. 864 36

Renal transplantation was performed on 6 cats with chronic renal failure. Clinical signs and the blood chemistry findings (BUN, Cr, IP) improved one week after renal transplantation. Renal anemia also improved 3-4 weeks after surgery. Two cases had the same complications, hydronephrosis and hydroureter within 1 or 2 weeks of surgery, evidenced by marked elevations of BUN and Cr, suggesting that ureteral obstruction at the site of ureterocystostomy is the main complication of renal transplantation in cats. As a new resolution for this problem, we transplanted the ureter with the intact ureteral opening of the bladder from the donor in the remaining 4 cats. Ureteral obstruction was not observed in them, thus the procedure was considered to be useful for avoiding this complication. Two cats died of pneumonia and other complications within 3 months. There were no acute rejections or side effects from the immunosuppressant during the observation period in the remaining four cats.
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PMID:Renal transplantation in cats with chronic renal failure. 884 2

Eleven cases of congenital anomalies were identified in 210 (5%) juvenile northern elephant seals (Mirounga angustirostris) found stranded along the central California (USA) coast from 1 January 1988 to 31 December 1995. Seven individuals had mild-to-moderate hydrocephalus involving the lateral ventricles bilaterally, or the lateral and third ventricles. Two animals had severe cardiac anomalies: hypoplasia of the right ventricle with overriding aorta, and ventricular septal defect. Other anomalies included single cases of hydronephrosis, focal pulmonary dysplasia, and congenital epidermal angiomatosis. Common intercurrent disease processes were verminous pneumonia and arteritis, verminous enteritis and coliti, and splenic and hepatic hemosiderosis. The more severe anomalies were considered to be the cause of debilitation and stranding. Milder anomalies were found incidentally during routine gross necropsy and histopathologic examination.
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PMID:Congenital defects in northern elephant seals stranded along the central California coast. 913 51

We reviewed the infectious complications in 207 courses of anticancer chemotherapy to 93 patients with urogenital cancer. Thirty episodes (14.5%) of neutropenic fever containing 9 cases (4.3%) of infection were observed. Five patients (16.7%) had pyelonephritis, one (3.3%) had acute prostatitis, two (6.6%) had pneumonia and one (3.3%) had bacteraemia. Multivariate analysis revealed that the infectious complications during anticancer chemotherapy were mainly associated with urinary diversion, hydronephrosis and duration of severe neutropenia (<500/mm3). These results suggest that infectious complications should be prevented in patients with urinary diversion, hydronephrosis and severe neutropenia during anticancer chemotherapy for urogenital cancer.
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PMID:Infectious complications of combination anticancer chemotherapy for urogenital cancers. 1040 96


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