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514 NORTH CAROLINA MEDICAL JOURNAL September, 1954 Recovery was uneventful and the patient was discharged on February 23, 1953. Comment From a number of the cases reviewed in the literature it would seem that in most instances the treatment of choice should be nephro-ureterectomy, as recommended by Dodson(6). This case is unique in that it was possible to resect the tumor mass and anastomose the ureter to the dome of the bladder, thereby saving the kidney on the involved side. The location and character of the tumor, and the long, tortuous ureter, plus the early diagnosis, made this possible. Dobson has referred to one such case. Senger and Furey(2) listed 12 cases with local excision and reanastomosis with end-to-end methods. Because of the poor follow-up, these cases were not evaluated. It is therefore our intention to follow this case. Senger and Furey pointed out that an average of 20.6 months elapses between the onset of symptoms and the diagnosis. In this case the diagnosis was made less than one month—21 days. An increased awareness on the part of the medical profession to the importance of such signs and symptoms characteristic of ureteral tumors, such as hematuria, fluid, abdominal pain, and abdominal mass, would no doubt decrease the above figure. Dr. George M. Bullard, the referring physician, is to be commended for realizing the seriousness of hematuria in any patient. Addendum Since this paper was written the patient was re-admitted to the hospital on March 15, 1954, because of a pulmonary hemorrhage which he had had the previous night. The laboratory findings were as follows: The hemoglobin was 74 per cent, red blood cell count 3,750,000, and white cell count 9,900. Urinalysis revealed a ?jH of 6.0, no albumin and no sugar, 2 to 3 red blood cells and an occasional white cell per high powTer field, and an occasional hyaline cast. A serologic test for syphilis was negative. Examination of the sputum disclosed no acid fast bacilli. Electrocardiographic tracing was within normal limits. Roentgen studies revealed marked generalized pulmonary emphysema and dorsum rotundum. An oval homogenous area of increased density measuring 2.5 by 5.5 cm. in diameter was visualized in the right para-tracheal region on a level with the aortic knob. This area was not definitely visualized in the lateral view. The right hilar shadow was slightly prominent. There was a heterogenous infiltration with a honeycomb appearance in the right middle lobe. A slight amount of apical pleural thickening was present. Calcification was evident in the aortic knob. Moderately prominent hypertrophic changes were noted in the dorsal spine. The mass noted in the right paratracheal area most likely represents an enlarged lymph node; a less likely possibility would be a double aortic arch. With this finding, plus the prominence of the right hilus and the infiltrative change in the right middle lobe, a neoplasm must be the first consideration. A doubtful possibility is bronchiectasis and pneumonitis, with secondary lympha-denopathy. A bronchoscopic examination was done at Memorial Hospital in Chapel Hill and a biopsy specimen was removed from the right middle lobe orifice. Histologic examination showed an epidermoid carcinoma which Dr. R. M. Peters thought was primary instead of metastatic. The patient is now receiving roentgen therapy for the pulmonary condition. References 1. Scott, W. W. (Rochester, N. Y.): Review of Primary Carcinoma of the Ureter, Presenting 2 Cases, J. Urol. 50:45-64 (July) 1943. 2. Senger, F. L., and Furey, C. A., Jr.: Primary Uureteral Tumors with a Review of the Literature Since 1943, J. Urol. 69:243-258 (Feb.) 1953. 3. Keen. M. R.: Primary Ureteral Tumors, J. Urol. 69:231-242 (Feb.) 1953. 4. Soloway, H. M.: Primary Carcinoma of the Ureter, J. Intern at. Coll. Surgeons 16:141-151 (Aug.) 1951. 5. Bowen, J. A., and Atherton, L.: Primary Carcinoma of the Ureter, J. Internal. Col. Surgeons 16:160-164 (Aug.) 1951. 6. Dodson, A. I.: Urological Surgery, ed. 2, St. Louis, C. V. Mosby Co., 1950. Medical Costs As all costs have rocketed with inflation, it seems to me that we have been too passive while the high costs of medical care have been singled out for attention. They have not kept pace with bread, milk, shoes, or the very magazines decrying the medical care costs. We have been negligent in pointing out that the cost of sickness is only partly medical care, largely hospital care. The cost of hospital care has gone up far more than that of physicians' services. The reason for the inflationary rise in the hospital bill is the inflationary rise in labor costs which constitute about seventy-five per cent of the hospital bill. It is somehow the duty of the profession, not in mere defense, but in the interests of accuracy and adjustment of public thinking to present the true facts.—Hodges, F. T.: Address to members of the House of Delegates of the Montana Medical Association assembled as the Administrative Body of Montana Physicians' Service, Billings, Montana, September, 1953.
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-Present] |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1954 |
Identifier | NCHH-17-015 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 15 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-015.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-015 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | keep |
Description
Fixed Title * | Page 514 |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1954 |
Identifier | NCHH-17-015-0540 |
Form General | Periodicals |
Page Type | all; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolina151954medi_0540.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 15 |
Issue Number | 10 |
Page Number | 514 |
Health Discipline | Medicine |
Full Text | 514 NORTH CAROLINA MEDICAL JOURNAL September, 1954 Recovery was uneventful and the patient was discharged on February 23, 1953. Comment From a number of the cases reviewed in the literature it would seem that in most instances the treatment of choice should be nephro-ureterectomy, as recommended by Dodson(6). This case is unique in that it was possible to resect the tumor mass and anastomose the ureter to the dome of the bladder, thereby saving the kidney on the involved side. The location and character of the tumor, and the long, tortuous ureter, plus the early diagnosis, made this possible. Dobson has referred to one such case. Senger and Furey(2) listed 12 cases with local excision and reanastomosis with end-to-end methods. Because of the poor follow-up, these cases were not evaluated. It is therefore our intention to follow this case. Senger and Furey pointed out that an average of 20.6 months elapses between the onset of symptoms and the diagnosis. In this case the diagnosis was made less than one month—21 days. An increased awareness on the part of the medical profession to the importance of such signs and symptoms characteristic of ureteral tumors, such as hematuria, fluid, abdominal pain, and abdominal mass, would no doubt decrease the above figure. Dr. George M. Bullard, the referring physician, is to be commended for realizing the seriousness of hematuria in any patient. Addendum Since this paper was written the patient was re-admitted to the hospital on March 15, 1954, because of a pulmonary hemorrhage which he had had the previous night. The laboratory findings were as follows: The hemoglobin was 74 per cent, red blood cell count 3,750,000, and white cell count 9,900. Urinalysis revealed a ?jH of 6.0, no albumin and no sugar, 2 to 3 red blood cells and an occasional white cell per high powTer field, and an occasional hyaline cast. A serologic test for syphilis was negative. Examination of the sputum disclosed no acid fast bacilli. Electrocardiographic tracing was within normal limits. Roentgen studies revealed marked generalized pulmonary emphysema and dorsum rotundum. An oval homogenous area of increased density measuring 2.5 by 5.5 cm. in diameter was visualized in the right para-tracheal region on a level with the aortic knob. This area was not definitely visualized in the lateral view. The right hilar shadow was slightly prominent. There was a heterogenous infiltration with a honeycomb appearance in the right middle lobe. A slight amount of apical pleural thickening was present. Calcification was evident in the aortic knob. Moderately prominent hypertrophic changes were noted in the dorsal spine. The mass noted in the right paratracheal area most likely represents an enlarged lymph node; a less likely possibility would be a double aortic arch. With this finding, plus the prominence of the right hilus and the infiltrative change in the right middle lobe, a neoplasm must be the first consideration. A doubtful possibility is bronchiectasis and pneumonitis, with secondary lympha-denopathy. A bronchoscopic examination was done at Memorial Hospital in Chapel Hill and a biopsy specimen was removed from the right middle lobe orifice. Histologic examination showed an epidermoid carcinoma which Dr. R. M. Peters thought was primary instead of metastatic. The patient is now receiving roentgen therapy for the pulmonary condition. References 1. Scott, W. W. (Rochester, N. Y.): Review of Primary Carcinoma of the Ureter, Presenting 2 Cases, J. Urol. 50:45-64 (July) 1943. 2. Senger, F. L., and Furey, C. A., Jr.: Primary Uureteral Tumors with a Review of the Literature Since 1943, J. Urol. 69:243-258 (Feb.) 1953. 3. Keen. M. R.: Primary Ureteral Tumors, J. Urol. 69:231-242 (Feb.) 1953. 4. Soloway, H. M.: Primary Carcinoma of the Ureter, J. Intern at. Coll. Surgeons 16:141-151 (Aug.) 1951. 5. Bowen, J. A., and Atherton, L.: Primary Carcinoma of the Ureter, J. Internal. Col. Surgeons 16:160-164 (Aug.) 1951. 6. Dodson, A. I.: Urological Surgery, ed. 2, St. Louis, C. V. Mosby Co., 1950. Medical Costs As all costs have rocketed with inflation, it seems to me that we have been too passive while the high costs of medical care have been singled out for attention. They have not kept pace with bread, milk, shoes, or the very magazines decrying the medical care costs. We have been negligent in pointing out that the cost of sickness is only partly medical care, largely hospital care. The cost of hospital care has gone up far more than that of physicians' services. The reason for the inflationary rise in the hospital bill is the inflationary rise in labor costs which constitute about seventy-five per cent of the hospital bill. It is somehow the duty of the profession, not in mere defense, but in the interests of accuracy and adjustment of public thinking to present the true facts.—Hodges, F. T.: Address to members of the House of Delegates of the Montana Medical Association assembled as the Administrative Body of Montana Physicians' Service, Billings, Montana, September, 1953. |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-015.pdf |
Document Sort | all; nchh-17 |
Article Title | Transitional Cell Carcinoma Of The Lower Ureter Report Of A Case |
Article Author | Ralph E. Brooks |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-015 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | keep |
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