University of Virginia Hospital

Extracorporeal shock wave lithotripsy effectively fragments urinary calculi in the upper urinary tract and upper ureter. These fragments pass completely by 3 months in 77.4 per cent of the patients with single stones. Risk of obstruction, increased postoperative pain, need for additional urological operations and retained fragments are low for stones less than 1 cm. in size. As the number of stones treated or single stone size increases above 1 cm. the risk for these factors increases. Adjunctive urological surgical management is required in 9 per cent of the patients preoperatively and 8 per cent postoperatively. Only 0.6 per cent of the patients require some type of open operation to resolve the stone problems after extracorporeal shock wave lithotripsy. Hemorrhage, obstruction by fragments, severe pain and urinary infection all constitute known complications and require careful urological management of all patients. Hospitalization averages 2 days after treatment and patients usually return to work within a few days after they are discharged from the hospital.

This study was a test for developmental differences in competency to make informed treatment decisions. 96 subjects, 24 (12 males and 12 females) at each of 4 age levels (9, 14, 18, and 21), were administered a measure developed to assess competency according to 4 legal standards. The measure included 4 hypothetical treatment dilemmas and a structured interview protocol. Overall, 14-year-olds did not differ from adults. 9-year-olds appeared less competent than adults with respect to their ability to reason about and understand the treatment information provided in the dilemmas. However, they did not differ from older subjects in their expression of reasonable preferences regarding treatment. It is concluded that the findings do not support the denial of the right of self-determination to adolescents in health-care situations on the basis of a presumption of incapacity. Further, children as young as 9 appear able to participate meaningfully in personal health-care decision making.

OBJECTIVE: To evaluate the efficacy and safety of 500 mg bid and 1500 mg bid levetiracetam as adjunctive therapy for refractory partial seizures in a double-blind, randomized, placebo-controlled, parallel-group, multicenter trial. METHODS: The authors studied patients with uncontrolled partial seizures (minimum 12 per 12 weeks), regardless of whether they became secondarily generalized, for 38 weeks. A 12-week baseline was followed by random assignment to adjunctive therapy with placebo (n = 95), levetiracetam 1000 mg/day (n = 98), or levetiracetam 3000 mg/day (n = 101). Upward titration over 4 weeks was followed by 14 weeks of fixed dose treatment, and concluded with an 8-week medication withdrawal period or entering a follow-up study. RESULTS: Of 294 patients randomized, 268 completed the study. Partial seizure frequency during the entire evaluation period (primary efficacy variable) was lower with levetiracetam compared to placebo (p </= 0.001 for both groups). More patients responded (defined as minimum 50% reduction in partial seizure frequency) to levetiracetam than placebo, with rates of 33. 0% in the 1000 mg/day and 39.8% in the 3000 mg/day group, compared to 10.8% in the placebo group (p < 0.001). Of 199 patients receiving levetiracetam, 11 became seizure free; no patient became seizure free in the placebo group. Treatment-emergent adverse events (>/=10%), mostly mild to moderate in severity, with incidences higher than placebo were asthenia, dizziness, flu syndrome, headache, infection, rhinitis, and somnolence. CONCLUSION: Adjunctive therapy with levetiracetam was effective and well tolerated in controlling partial seizures.

Importance: Large language models (LLMs) have shown promise in their performance on both multiple-choice and open-ended medical reasoning examinations, but it remains unknown whether the use of such tools improves physician diagnostic reasoning. Objective: To assess the effect of an LLM on physicians' diagnostic reasoning compared with conventional resources. Design, Setting, and Participants: A single-blind randomized clinical trial was conducted from November 29 to December 29, 2023. Using remote video conferencing and in-person participation across multiple academic medical institutions, physicians with training in family medicine, internal medicine, or emergency medicine were recruited. Intervention: Participants were randomized to either access the LLM in addition to conventional diagnostic resources or conventional resources only, stratified by career stage. Participants were allocated 60 minutes to review up to 6 clinical vignettes. Main Outcomes and Measures: The primary outcome was performance on a standardized rubric of diagnostic performance based on differential diagnosis accuracy, appropriateness of supporting and opposing factors, and next diagnostic evaluation steps, validated and graded via blinded expert consensus. Secondary outcomes included time spent per case (in seconds) and final diagnosis accuracy. All analyses followed the intention-to-treat principle. A secondary exploratory analysis evaluated the standalone performance of the LLM by comparing the primary outcomes between the LLM alone group and the conventional resource group. Results: Fifty physicians (26 attendings, 24 residents; median years in practice, 3 [IQR, 2-8]) participated virtually as well as at 1 in-person site. The median diagnostic reasoning score per case was 76% (IQR, 66%-87%) for the LLM group and 74% (IQR, 63%-84%) for the conventional resources-only group, with an adjusted difference of 2 percentage points (95% CI, -4 to 8 percentage points; P = .60). The median time spent per case for the LLM group was 519 (IQR, 371-668) seconds, compared with 565 (IQR, 456-788) seconds for the conventional resources group, with a time difference of -82 (95% CI, -195 to 31; P = .20) seconds. The LLM alone scored 16 percentage points (95% CI, 2-30 percentage points; P = .03) higher than the conventional resources group. Conclusions and Relevance: In this trial, the availability of an LLM to physicians as a diagnostic aid did not significantly improve clinical reasoning compared with conventional resources. The LLM alone demonstrated higher performance than both physician groups, indicating the need for technology and workforce development to realize the potential of physician-artificial intelligence collaboration in clinical practice. Trial Registration: ClinicalTrials.gov Identifier: NCT06157944.

PURPOSE: Despite the recognition of fatigue as a common and distressing symptom during cancer treatment, there are few evidence-based interventions available to manage such fatigue. The purpose of this multi-institutional pilot study was to explore the effects of a home-based moderate walking exercise intervention on fatigue, physical functioning, emotional distress, and quality of life (QOL) during breast cancer treatment. DESCRIPTION OF STUDY: Fifty-two women were recruited from five university hospital outpatient departments for this pilot study with an experimental design. Subjects were randomly assigned to the walking program or to usual care during adjuvant chemotherapy or radiation therapy for breast cancer. Symptoms, physical functioning, and QOL were measured at baseline, midtreatment, and at the end of treatment. RESULTS: Women who exercised at least 90 minutes per week on 3 or more days reported significantly less fatigue and emotional distress as well as higher functional ability and QOL than women who were less active during treatment. CLINICAL IMPLICATIONS: A home-based walking exercise program is a potentially effective, low-cost, and safe intervention to manage fatigue and to improve QOL during adjuvant chemotherapy or radiation therapy for breast cancer. This health-promoting self-care activity needs further testing in large randomized clinical trials.

Kaposiform hemangioendothelioma (KH) is a rare tumor of childhood often associated with Kasabach-Merritt phenomenon (KMP) and occasionally lymphangiomatosis. Although generally considered distinct from other vascular neoplasms, its rarity has precluded a thorough study of its immunophenotypic profile and long-term behavior. Thirty-three cases of KH were reviewed and immunostained for alpha-smooth muscle actin, various endothelial markers (CD31, CD34, vWf, FLI1), a platelet marker (CD61), and the juvenile hemangioma-associated markers GLUT-1 and Lewis Y antigen (LeY). In addition, the presence of HHV-8 was evaluated by RT-PCR. The patients (20 males and 13 females) ranged in age from 2 weeks to 20 years (mean 3 years 9 months). Tumors developed on the extremities (17 cases), head/neck (8 cases), and other sites (8 cases) and affected both superficial and deep soft tissue. Those in the skin presented as slightly raised blue-red lesions. More than half of the patients presented with KMP (14 of 25). Tumors consisted of irregular, infiltrating nodules of compressed vessels, which modulated between areas resembling a capillary hemangioma and Kaposi sarcoma (KS). Endothelial cells in nodules were CD31, CD34, and FLI1 positive but negative for GLUT1 and LeY. Scattered "epithelioid" or glomeruloid islands featuring endothelium associated with clusters of plump alpha-smooth muscle actin-positive pericytes, stippled hemosiderin, and CD61-positive fibrin thrombi likely represent the morphologic sites of platelet consumption. Small and large lymphatic channels occurred in 22 of 33 cases and were typically seen peripheral or deep to the main tumor mass. HHV-8 transcripts were not identified (0 of 3 cases). Follow-up information was available in 22 patients (range 8 months to 15 years; mean 2 years) and indicated that 3 died of disease, 8 were alive with disease, and 10 were alive without residual disease. Two patients developed regional perinodal soft tissue involvement, but none developed distant metastases. KH is a lesion having both a vascular and lymphatic component. Its common association with KMP probably relates in part to unique architectural features that favor turbulent blood flow and platelet activation. KH can also be reliably separated from JH by GLUT-1 and LeY immunostaining, indicating differences in the morphologic and functional attributes of the endothelium between the two lesions. The absence of HHV-8 in KH underscores a different pathogenesis from Kaposi sarcoma. Our study, the largest to date, emphasizes that mortality is due to KMP and not metastatic disease, which appears limited to regional perinodal soft tissue. Given this behavior, its continued classification as a vascular tumor of intermediate malignancy is warranted.

MOTIVATION: In microarray studies gene discovery based on fold-change values is often misleading because error variability for each gene is heterogeneous under different biological conditions and intensity ranges. Several statistical testing methods for differential gene expression have been suggested, but some of these approaches are underpowered and result in high false positive rates because within-gene variance estimates are based on a small number of replicated arrays. RESULTS: We propose to use local-pooled-error (LPE) estimates and robust statistical tests for evaluating significance of each gene's differential expression. Our LPE estimation is based on pooling errors within genes and between replicate arrays for genes in which expression values are similar. We have applied our LPE method to compare gene expression in naïve and activated CD8+ T-cells. Our results show that the LPE method effectively identifies significant differential-expression patterns with a small number of replicated arrays. AVAILABILITY: The methodology is implemented with S-PLUS and R functions available at http://hesweb1.med.virginia.edu/bioinformatics

Human rhinoviruses (HRVs) are well-recognised causes of common colds and associated upper respiratory tract complications such as sinusitis and otitis media. This article reviews information linking HRV infection to illness in the lower respiratory tract. HRVs are capable of efficient replication in vitro at temperatures present in the tracheobronchial tree and have been shown to cause productive infection, elaboration of cytokines and chemokines, and up-regulation of cell surface markers in human bronchial epithelial cells. In situ hybridisation studies have proven that HRV infection occurs in the tracheobronchial tree following experimental infection. Clinical studies report that HRV infection is the second most frequently recognised agent associated with pneumonia and bronchiolitis in infants and young children and commonly causes exacerbations of pre-existing airways disease in those with asthma, chronic obstructive pulmonary disease or cystic fibrosis. HRV infection is associated with one-third to one-half of asthma exacerbations depending on age and is linked to asthma hospitalisations in both adults and children. Limited information implicates HRV infection as a cause of severe lower respiratory tract illness in older adults and in highly immunocompromised hosts, particularly bone marrow transplant recipients. More information is needed about the pathogenesis of HRV infection with regard to lower respiratory tract complications in these diverse patient groups. Given the large unmet medical need associated with HRV infections, safe and effective antiviral agents are needed for both prevention and treatment of these infections.

Arsenic is widely distributed throughout the animal and plant kingdoms and our environment where sources can be natural or anthropogenic. Agricultural uses of arsenic have declined recently, but it still has well-defined roles in industry. Small amounts of arsenic are metabolized in a variety of ways and are largely rapidly methylated and excreted by man and animals. Poisoning can occur and may follow an acute or chronic course. Toxic manifestations in man occur at the cellular level and may appear in many organ systems. Specific effects can often be demonstrated in the skin and in the vascular and nervous systems. Other toxic effects appear to include carcinogenesis, mutagenesis, and teratogenesis.

ABSTRACT Data are presented for changes in absolute radioactivity levels and labelling indices (LI) in three tissues: jejunum, colon and dorsal skin in the mouse during conditions of repeated (every 3 hr for 168 hr) 3 H‐TdR (5 μCi) injections. The lengths of S and the cell cycle were estimated. The crypt and mucosal transit times were evaluated. There is a slowly cycling subpopulation in the crypt which may be the goblet cell precursors or a crypt stem cell population. The skin LI data cannot be fitted by a single straight line and the procedure of continuously handling or injecting the animals appears to result in a disturbance of the steady state. The liquid scintillation data for all samples showed some consistent and surprisingly large fluctuations and a clear deviation from linear uptake with increasing time.

This article explores characteristics and crime scene behavior of 20 sexually sadistic serial murderers. The pairing of character pathology with paraphilic arousal to the control and degradation of others is examined as it manifests itself in their murders. Commonalities across murders and across murderers are highlighted, i.e., the execution of murders that are well-planned, the use of preselected locations, captivity, a variety of painful sexual acts, sexual bondage, intentional torture, and death by means of strangulation and stabbing.

Routine daily laboratory testing of hospitalized patients reflects a wasteful clinical practice that threatens the value of health care. Choosing Wisely initiatives from numerous professional societies have identified repetitive laboratory testing in the face of clinical stability as low value care. Although laboratory expenditure often represents less than 5% of most hospital budgets, the impact is far-reaching given that laboratory tests influence nearly 60% to 70% of all medical decisions. Excessive phlebotomy can lead to hospital-acquired anemia, increased costs, and unnecessary downstream testing and procedures. Efforts to reduce the frequency of laboratory orders can improve patient satisfaction and reduce cost without negatively affecting patient outcomes. To date, numerous interventions have been deployed across multiple institutions without a standardized approach. Health care professionals and administrative leaders should carefully strategize and optimize efforts to reduce daily laboratory testing. This review presents an evidence-based implementation blueprint to guide teams aimed at improving appropriate routine laboratory testing among hospitalized patients.

The proximal interphalangeal joint is commonly injured in vigorous sports, but often the severity of the injury is not appreciated and the onset of treatment delayed for weeks or months. In an eight-year period, 143 athletic injuries to the proximal interphalangeal joint required surgery; these cases are reviewed. The anatomy of the joint, the indications for surgery, the details of operative technique and postoperative management, and the results are discussed in the various clinical categories of injury to the joint: articular fractures, fracture-dislocations, compound dislocations, collateral-ligament ruptures, boutonnière deformities, hyperextension deformities, and pseudo-boutonnière deformities. Early surgical repair of the injuries gives good results in those young athletes who are cooperative and well motivated and who have the benefits of supervised rehabilitation. Surgical reconstruction yields satisfactory results even in the athletic injuries that receive attention late; the results are better than those following comparable industrial and occupational injuries to the proximal interphalangeal joints in older patients. The importance of this joint in future athletic competition and in later life makes the correct diagnosis and early treatment imperative.

CHAFETZ, MORRIS E. M.D.; BLANE, HOWARD T. Ph.D.; ABRAM, HARRY S. M.D.; GOLNER, JOSEPH M.S.W.; LACY, ELIZABETH M.S.W.; McCOURT, WILLIAM F. M.D.; CLARK, ELEANOR M.S.W.; MEYERS, WILLIAM A.M. Author Information

No AccessJournal of Urology1 Jan 1945Conservative Surgery in Certain Benign Tumors of the Ureter1 Samuel A. Vest Samuel A. VestSamuel A. Vest View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)70122-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1945 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByUZZO R and NOVICK A (2018) NEPHRON SPARING SURGERY FOR RENAL TUMORS: INDICATIONS, TECHNIQUES AND OUTCOMESJournal of Urology, VOL. 166, NO. 1, (6-18), Online publication date: 1-Jul-2001.PALOU J, SALVADOR J, MILLÁN F, COLLADO A, ALGABA F and VICENTE J (2018) MANAGEMENT OF SUPERFICIAL TRANSITIONAL CELL CARCINOMA IN THE INTRAMURAL URETER: WHAT TO DO?Journal of Urology, VOL. 163, NO. 3, (744-747), Online publication date: 1-Mar-2000.Patel A and Fuchs G (2018) NEW TECHNIQUES FOR THE ADMINISTRATION OF TOPICAL ADJUVANT THERAPY AFTER ENDOSCOPIC ABLATION OF UPPER URINARY TRACT TRANSITIONAL CELL CARCINOMAJournal of Urology, VOL. 159, NO. 1, (71-75), Online publication date: 1-Jan-1998.Patel A, Soonawalla P, Shepherd S, Dearnaley D, Kellett M and Woodhouse C (2018) Long-term Outcome After Percutaneous Treatment of Transitional Cell Carcinoma of the Renal PelvisJournal of Urology, VOL. 155, NO. 3, (868-874), Online publication date: 1-Mar-1996.Jarrett T, Sweetser P, Weiss G and Smith A (2018) Percutaneous Management of Transitional Cell Carcinoma of the Renal Collecting System: 9-Year ExperienceJournal of Urology, VOL. 154, NO. 5, (1629-1635), Online publication date: 1-Nov-1995.Gerber G and Lyon E (2018) Endourological Management of Upper Tract Urothelial TumorsJournal of Urology, VOL. 150, NO. 1, (2-7), Online publication date: 1-Jul-1993.Schoenberg M, Van Arsdalen K and Wein A (2018) The Management of Transitional Cell Carcinoma in Solitary Renal UnitsJournal of Urology, VOL. 146, NO. 3, (700-702), Online publication date: 1-Sep-1991.Soloway M (2018) Editorial CommentsJournal of Urology, VOL. 141, NO. 6, (1301-1301), Online publication date: 1-Jun-1989.Reitelman C, Sawczuk I, Olsson C, Puchner P and Benson M (2018) Prognostic Variables in Patients with Transitional Cell Carcinoma of the Renal Pelvis and Proximal UreterJournal of Urology, VOL. 138, NO. 5, (1144-1145), Online publication date: 1-Nov-1987.Ziegelbaum M, Novick A, Streem S, Montie J, Pontes J and Straffon R (2018) Conservative Surgery for Transitional Cell Carcinoma of the Renal PelvisJournal of Urology, VOL. 138, NO. 5, (1146-1148), Online publication date: 1-Nov-1987.Droller M (2018) Editorial CommentJournal of Urology, VOL. 138, NO. 5, (1148-1149), Online publication date: 1-Nov-1987.Brookland R and Richter M (2018) The Postoperative Irradiation of Transitional Cell Carcinoma of the Renal Pelvis and UreterJournal of Urology, VOL. 133, NO. 6, (952-955), Online publication date: 1-Jun-1985.Soloway M (2018) Editorial CommentJournal of Urology, VOL. 133, NO. 6, (955-955), Online publication date: 1-Jun-1985.Marshall F and Walsh P (2018) In situ Management of Renal Tumors: Renal Cell Carcinoma and Transitional Cell CarcinomaJournal of Urology, VOL. 131, NO. 6, (1045-1049), Online publication date: 1-Jun-1984.Murphy D, Zincke H and Furlow W (2018) Management of High Grade Transitional Cell Cancer of the Upper Urinary TractJournal of Urology, VOL. 125, NO. 1, (25-29), Online publication date: 1-Jan-1981.Werth D, Weigel J and Mebust W (2018) Primary Neoplasms of the UreterJournal of Urology, VOL. 125, NO. 5, (628-631), Online publication date: 1-May-1981.Grossman H (2018) The Late Recurrence of Grade I Transitional Cell Carcinoma of the Ureter After Conservative TherapyJournal of Urology, VOL. 120, NO. 2, (251-252), Online publication date: 1-Aug-1978.Dagen J, Rohrer G, Abt A and Rohner T (2018) Flank Pain and Hematuria in a Man with Superficial Bladder TumorsJournal of Urology, VOL. 120, NO. 3, (345-348), Online publication date: 1-Sep-1978.Lieber M and Lupu A (2018) High Grade Invasive Ureteral Transitional Cell Carcinoma with a Congenital Solitary Kidney: Long-term Survival after Ureterectomy and Radiation TherapyJournal of Urology, VOL. 120, NO. 3, (368-369), Online publication date: 1-Sep-1978.Mondschein L, Sutton A and Rothfeld S (2018) Leiomyoma of the Ureter in a Child: The First Reported CaseJournal of Urology, VOL. 116, NO. 4, (516-518), Online publication date: 1-Oct-1976.Davides K and King L (2018) Fibrous Polyps of the UreterJournal of Urology, VOL. 115, NO. 6, (651-653), Online publication date: 1-Jun-1976.Strong D, Pearse H, Tank E and Hodges C (2018) The Ureteral Stump after NephroureterectomyJournal of Urology, VOL. 115, NO. 6, (654-655), Online publication date: 1-Jun-1976.Petković S (2018) Epidemiology and Treatment of Renal Pelvic and Ureteral TumorsJournal of Urology, VOL. 114, NO. 6, (858-865), Online publication date: 1-Dec-1975.Brown H and Roumani G (2018) Conservative Surgical Management of Transitional Cell Carcinoma of the Upper Urinary TractJournal of Urology, VOL. 112, NO. 2, (184-187), Online publication date: 1-Aug-1974.Uhlíř K (2018) Hemangioma of the UreterJournal of Urology, VOL. 110, NO. 6, (647-649), Online publication date: 1-Dec-1973.Colgan J, Skaist L and Morrow J (2018) Benign Ureteral Tumors in Childhood: A Case Report and a Plea for Conservative ManagementJournal of Urology, VOL. 109, NO. 2, (308-310), Online publication date: 1-Feb-1973.Petković S (2018) A Plea for Conservative Operation for Ureteral TumorsJournal of Urology, VOL. 107, NO. 2, (220-223), Online publication date: 1-Feb-1972.Kim K, Leiter E and Brendler H (2018) Primary Tumors of the UreterJournal of Urology, VOL. 107, NO. 6, (955-958), Online publication date: 1-Jun-1972.Hawtrey C (2018) Fifty-Two Cases of Primary Ureteral Carcinoma: a Clinical-Pathologic StudyJournal of Urology, VOL. 105, NO. 2, (188-193), Online publication date: 1-Feb-1971.Bloom N, Vidone R and Lytton B (2018) Primary Carcinoma of the Ureter: A Report of 102 New CasesJournal of Urology, VOL. 103, NO. 5, (590-598), Online publication date: 1-May-1970.Crum P, Sayegh E, Sacher E and Wescott J (2018) Benign Ureteral PolypsJournal of Urology, VOL. 102, NO. 6, (678-682), Online publication date: 1-Dec-1969.Beck A, Heslin J, Milner W and Garlick W (2018) Primary Tumors of the Ureter: Diagnosis and ManagementJournal of Urology, VOL. 102, NO. 6, (683-688), Online publication date: 1-Dec-1969.Newman D, Allen L, Wishard W, Nourse M and Mertz J (2018) Transitional cell Carcinoma of the Upper Urinary TractJournal of Urology, VOL. 98, NO. 3, (322-327), Online publication date: 1-Sep-1967.Gibson T (2018) Local Excision in Transitional Cell Tumors of the Upper Urinary TractJournal of Urology, VOL. 97, NO. 4, (619-622), Online publication date: 1-Apr-1967.Barroso C, Florence T and Scott C (2018) Bilateral Papillary Carcinomas of the Ureters: Presentation of a Case and 2-Year Followup ReportJournal of Urology, VOL. 96, NO. 4, (451-454), Online publication date: 1-Oct-1966.Roen P and Kandalaft S (2018) Primary Benign Mesodermal Ureteral TumorJournal of Urology, VOL. 96, NO. 6, (890-891), Online publication date: 1-Dec-1966.Carroll G (2018) Bilateral Transitional Cell Carcinoma of the Renal PelvisJournal of Urology, VOL. 93, NO. 2, (132-135), Online publication date: 1-Feb-1965.Harvard B and Evans J (2018) Simultaneous Bilateral Transitional Cell Carcinoma of the Renal PelvisJournal of Urology, VOL. 91, NO. 1, (14-19), Online publication date: 1-Jan-1964.Utz D, Brunsting C and Harrison E (2018) Bilateral Ureteral and Vesical Carcinomas Occurring Asynchronously: Report of a CaseJournal of Urology, VOL. 88, NO. 4, (488-493), Online publication date: 1-Oct-1962.Wogalter H (2018) Ureteral Polyp: 19 Year HistoryJournal of Urology, VOL. 86, NO. 5, (528-531), Online publication date: 1-Nov-1961.Arduino L (2018) Conservative Surgery for Ureteral PolypsJournal of Urology, VOL. 85, NO. 6, (924-927), Online publication date: 1-Jun-1961.Campbell Colston J (2018) Followup Report on a Case of Bilateral Papillary Carcinoma of the Renal PelvisJournal of Urology, VOL. 83, NO. 4, (355-359), Online publication date: 1-Apr-1960.Brock D (2018) Benign Polyp of UreterJournal of Urology, VOL. 83, NO. 5, (572-574), Online publication date: 1-May-1960.Compere D, Begley G, Isaacks H, Frazier T and Dryden C (2018) Ureteral PolypsJournal of Urology, VOL. 79, NO. 2, (209-214), Online publication date: 1-Feb-1958.Hamm F and Weinberg S (2018) Experimental Studies of Regeneration of the Ureter Without IntubationJournal of Urology, VOL. 75, NO. 1, (43-51), Online publication date: 1-Jan-1956.Brodny M and Hershman H (2018) Pedunculated Hemangioma of the UreterJournal of Urology, VOL. 71, NO. 5, (539-543), Online publication date: 1-May-1954.Baker W and Graf E (2018) Tumors of the UreterJournal of Urology, VOL. 70, NO. 3, (390-409), Online publication date: 1-Sep-1953.Jeppesen F (2018) Lymphangioma of the UreterJournal of Urology, VOL. 70, NO. 3, (410-414), Online publication date: 1-Sep-1953.Senger F and Furey C (2018) Primary Ureteral Tumors with a Review of the Literature Since 1943Journal of Urology, VOL. 69, NO. 2, (243-258), Online publication date: 1-Feb-1953.Creecy A (2018) Carcinoma of the UreterJournal of Urology, VOL. 68, NO. 3, (591-602), Online publication date: 1-Sep-1952.Morley H, Shumaker E and Gardner L (2018) Intussusception of the Ureter Associated with a Benign PolypJournal of Urology, VOL. 67, NO. 3, (266-271), Online publication date: 1-Mar-1952.St. Martin E, O'Brien H and Mitchell J (2018) Multiple Tumors of the Urinary TractJournal of Urology, VOL. 64, NO. 2, (426-437), Online publication date: 1-Aug-1950.Long J (2018) Primary Carcinoma of the UreterJournal of Urology, VOL. 61, NO. 1, (23-28), Online publication date: 1-Jan-1949.O'conor V (2018) The Treatment and Prognosis of Papillary Tumors of the Renal Pelvis and UreterJournal of Urology, VOL. 61, NO. 3, (488-492), Online publication date: 1-Mar-1949.Baker W (2018) Conservative Surgery of the Upper Urinary Tract, Journal of Urology, VOL. 60, NO. 2, (197-215), Online publication date: 1-Aug-1948.Burford C, Glenn J and Burford E (2018) Primary Carcinoma of the Ureter: With Report of two CasesJournal of Urology, VOL. 60, NO. 2, (337-344), Online publication date: 1-Aug-1948.Moore T (2018) Transureteropyelostomy and Transuretero-Ureter-Ostomy: The Indications and Operative TechniqueJournal of Urology, VOL. 60, NO. 6, (859-873), Online publication date: 1-Dec-1948.Fagerstrom D (2018) Proliferative Tumors of the Ureter and Renal Pelvis, with Further Observations on the Significance of "Epithelial Cell Nests": Six Case ReportsJournal of Urology, VOL. 59, NO. 3, (333-357), Online publication date: 1-Mar-1948. Volume 53Issue 1January 1945Page: 97-121 Advertisement Copyright & Permissions© 1945 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel A. Vest More articles by this author Expand All Advertisement PDF DownloadLoading ...

Fifteen percent of couples are subfertile — that is, they have less-than-normal fertility. In approximately 30 percent of the cases, an important abnormality is identified in only the man, and in another 20 percent abnormalities are detected in both partners. Thus, there is a male factor in infertility in half of the couples. The evaluation should begin with a complete history taking, physical examination, and appropriate laboratory tests. Unfortunately, even after a thorough evaluation, the cause of a man's lack of normal fertility usually remains unknown. Since it is very difficult to develop a rational treatment plan to correct a . . .

Alves, Wayne M PHD1; Colohan, Austin R T MD2; O'Leary, Thomas J PHD3; Rimel, Rebecca W RN, NP, MBA4; Jane, John A MD, PhD5 Author Information

OBJECTIVES/HYPOTHESIS: Auditory neuropathy is a relatively recently described pattern of hearing loss characterized by preservation of outer hair cell function despite absent brainstem auditory evoked responses. Intact outer hair cell function is demonstrated by the presence of otoacoustic emissions and/or a measurable cochlear microphonic on electrocochleography, whereas no synchronous neural activity (absent action potentials) is seen on acoustically evoked brainstem auditory evoked response testing. The study reviews the authors' experience with six patients diagnosed with auditory neuropathy, four of whom have undergone cochlear implantation. MATERIALS AND METHODS: A retrospective review of all medical and audiological charts at the University of Virginia Hospitals (Charlottesville, VA) was performed to identify patients who have undergone cochlear implantation or have been diagnosed with auditory neuropathy, or both. RESULTS: Six patients with hearing loss attributable to auditory neuropathy were identified, four of whom have undergone cochlear implantation. Causes varied, including congenital, infectious, and idiopathic origins. Adults demonstrated subjective auditory perception on promontory stimulation, whereas no repeatable brainstem auditory evoked response waveforms could be demonstrated on pediatric promontory stimulation testing. Patients with implants demonstrated implant-evoked brainstem auditory evoked responses and improved audiological performance. CONCLUSIONS: The six cases presented in the study represent varied causes and, probably, varied sites of lesions of auditory neuropathy. Promontory stimulation has been valuable, particularly in adults. Cochlear implantation allows the opportunity to provide a supraphysiological electrical stimulation to the auditory nerve, with the hope of reintroducing synchronous neural activity. Greater confidence and enthusiasm for cochlear implantation in appropriately selected patients with auditory neuropathy are gained through experience with such diverse cases.

Severe resistance to subcutaneous insulin but sensitivity to intravenous insulin persisted for 15 months in a 17-year-old diabetic girl. Heat-labile insulin-degrading activity was present in the patient's ketotic sera and in the 100,000 g fraction (soluble fraction) of adipose tissue. Serum-degrading activity was not inhibited by N-ethylmaleimide. The soluble fraction also degraded glucagon and B chain but not growth hormone or myoglobin. It was inhibited by incubation with the patient's nonketotic sera, normal sera, or Trasylol. Glutathione-insulin-transhydrogenase (GIT) activity was 66% of normal. The biopsy of adipose tissue at remission showed a normal level of insulin- and glucagon-degrading activity. The activity was eluted from Sephadex G200 as a single peak and had properties consistent with those of the insulin-specific protease (ISP). The increased degrading activity present during insulin resistance had properties not shared with ISP, suggesting the presence of an uncharacterized protease.

Percutaneous screw fixation of acetabular fractures with CT guidance: preliminary results of a new technique.S B Gay, C Sistrom, G J Wang, D A Kahler, T Boman, N McHugh and H T GoitzAudio Available | Share