Urology
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Health economics research has shown pharmaceutical therapy to be a highly cost-effective modality of care in a variety of disease states. Specific examples include vaccines and products aimed at the treatment of infectious disease, mental illness, gastrointestinal disorders, diabetes, and cancer. A review of the characteristics of mitomycin (Mutamycin) for injection therapy and of patients with superficial bladder cancer facilitates examining mitomycin from the standpoint of cost effectiveness. ⋯ Methods for obtaining reimbursement for therapy associated with the management and treatment of superficial bladder cancer are suggested. Finally, the total cost of intravesical therapy is examined. Issues such as the cost of surgery and chemotherapy are discussed, as well as the importance of weighing intangible factors, such as lost work time, productivity, and social costs, into the sum of total cost of care.
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Risk factors for the development of septicemia, which are similar to those associated with any urinary tract infection, are reviewed. The "ABCs of Management" are outlined. Early recognition and effective management including selection of an effective antimicrobial agent for empiric therapy can have a direct impact on the patient's survival. ⋯ Since sepsis is a systemic infection, patients must be monitored closely for failure of vital physiologic functions. Suggestions are offered for dealing with lack of response to antibiotic and supportive measures. Rapid diagnosis and effective management can improve the prognosis for septic patients.
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Comparative Study Clinical Trial
Surgical management of Stage B or C prostatic carcinoma: radical surgery vs radiotherapy.
Radical prostatectomy provides an excellent degree of disease control for the longest period of time in patients with localized prostatic cancer. Although advocates of radiation therapy point to nearly identical survival curves for patients treated with either interstitial or external techniques, an analysis of disease-free survival suggests that radical prostatectomy yields the best long-term "cure." Crude fifteen-year survival rates of 50 per cent may be achieved with radical prostatectomy, compared with 20 per cent to 25 per cent associated with radiation therapy. Additional experience with long-term survival data is necessary before a final conclusion can be drawn from comparison of the two treatment modalities.
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Case Reports
Page kidney resulting from massive subcapsular hematoma. Complication of lumbar sympathetic nerve block.
The Page kidney is a recognized cause of hypertension. A massive subcapsular hematoma caused by a lumbar sympathetic nerve block resulted in a Page kidney. ⋯ Small hematomas may be treated conservatively, but massive subcapsular hematomas should be decompressed when the patient is clinically stable. Diagnostic features, therapeutic considerations, and pertinent references are discussed.