The Journal of urology
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The Journal of urology · Sep 1986
Case ReportsAnesthetic induction trismus, more than a closed-mouth problem.
Trismus, or masseter hypertonia, that results from the use of succinylcholine during induction of anesthesia is a rare and dangerous phenomenon. It presents to the anesthesiologist the immediate problem of airway management but it also must be recognized by the physician as a harbinger of malignant hyperthermia. We report a case of induction trismus and discuss its association with malignant hyperthermia. The pathophysiology, diagnosis and treatment of malignant hyperthermia are reviewed.
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Bilateral nephrectomy was performed in 4 patients with bilateral Wilms tumor. The current philosophy regarding the need to preserve maximum renal parenchyma is discussed. New guidelines suggested by the National Wilms Tumor Study group discourage unilateral nephrectomy and partial nephrectomy at initial exploration for bilateral Wilms tumor. Alternatively, it is recommended that continued treatment with chemotherapy and/or radiation therapy followed by second and third-look operations to maximize preservation of renal parenchyma be done with bilateral nephrectomy as a last resort option.
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Vasitis nodosa is an infrequently recognized, benign disorder that may be confused with malignancy of the vas deferens. A review of 30 patients with vasal masses removed during vasovasostomy revealed 20 men with vasitis nodosa. ⋯ Of the 20 patients with vasitis nodosa 14 had associated granulomatous inflammation. Vasitis nodosa is notably more common than has been reported previously and has been associated with spontaneous recanalization of the vas deferens following vasectomy.
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The malignant hyperthermia syndrome is a rare drug-induced hypermetabolic syndrome characterized by muscular rigidity, hyperpyrexia and systemic acidosis. Malignant hyperthermia developed in 2 boys during anesthesia for hypospadias repair and both had a favorable outcome. Recognition of the early signs and symptoms of malignant hyperthermia, and prompt treatment using dantrolene sodium require an increased index of suspicion and familiarity with this symptom complex, which has an increased incidence in children.
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The Journal of urology · Sep 1985
Comparative Study Clinical Trial Controlled Clinical TrialA double-blind comparison of dezocine and morphine in patients with acute renal and ureteral colic.
The safety and analgesic efficacy of dezocine and morphine in the treatment of acute renal or ureteral colic due to calculi were evaluated in 2 multicenter, double-blind studies, comparing 10 mg. dezocine and 10 mg. morphine in 88 patients, and 15 mg. dezocine and 10 mg. morphine in 61 patients. All patients received an intramuscular injection of the test drug, and pain intensity and pain relief were evaluated through 4 hours after drug administration. Vital signs, degree of sedation and adverse effects also were recorded. ⋯ More morphine-treated than dezocine-treated patients withdrew from each study because of inadequate pain relief. The frequency of adverse effects was not significantly different between groups in either study and none of the patients had clinically significant changes in vital signs. These results indicate that dezocine is a safe and effective analgesic for the treatment of renal and ureteral colic due to calculi, and 15 mg. dezocine were more effective than 10 mg. morphine in this pain model.