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Biomedical subjects

A R Mundy

Publications and source records attributed to A R Mundy.

144 records · Page 8Linked to original sources
PubMed1983

A trial comparing the Stamey bladder neck suspension procedure with colposuspension for the treatment of stress incontinence.

Fifty-one women with urodynamically proven genuine stress incontinence were alternately allocated to either colposuspension or a Stamey-type bladder neck suspension. One year after operation 89% of the patients who had had a colposuspension were subjectively cured and 73% were objectively normal. In the Stamey procedure group these figures were 76 and 40% respectively. The Stamey procedure is a quicker, simpler and a lesser procedure but has a higher incidence of post-operative voiding difficulties and residual urge symptoms. Colposuspension is to be preferred for the younger, healthier patient. The Stamey procedure is useful in the elderly, obese or unfit patient or the patient who has had multiple previous surgical attempts at a cure.

Adult↗
PubMed1982

A pilot study of hydroxyurea in hormone "escaped" metastatic carcinoma of the prostate.

Twenty-two patients with metastatic carcinoma of the prostate no longer responsive to hormonal therapy with stilboestrol 1 mg tds have been studied in a Phase II clinical trial of hydroxyurea 80 mg/kg body weight every third day after discontinuing their hormonal therapy. There was a partial objective response in 22.7%, a stable state response in 13.6% and a subjective response in a further 31.8%. The patients who showed a response to treatment survived longer than those who did not show a response and with a better quality of life. The response rate was higher in patients who started treatment without significant delay after diagnosis of relapse. Metastatic disease responded better than the primary tumour. Side effects were not a significant problem.

Aged↗
PubMed1982

Hypertension and thromboembolism in idiopathic retroperitoneal fibrosis.

Of 36 patients with idiopathic retroperitoneal fibrosis treated surgically, 8 have died and 26 have suffered 67 post-operative complications during 1 to 24 years of follow-up. Four patients died as a consequence of hypertension. Hypertension and thromboembolism accounted for 49% of the post-operative complications in 69% of the patients who developed complications. Attention to these 2 factors is at least as important as prevention of recurrent obstructive uropathy.

Adult↗
PubMed1982

Neuropathic vesicourethral dysfunction in children. A trial comparing clean intermittent catheterisation with manual expression combined with drug treatment.

Forty-three children with overt neurological disease and neuropathic vesicourethral dysfunction were entered into a trial comparing clean intermittent catheterisation (CIC) with manual expression combined with drug treatment (non-CIC). The 22 children in the CIC group showed a significantly greater improvement in continence than the 21 children in the non-CIC group (P less than 0.001) without a significant increase in the incidence of urinary tract infections. Neither form of treatment is effective in reducing the risk of deterioration of renal function due to the combination of detrusor-sphincter dyssynergia and vesicoureteric reflux. Neither form of treatment improves continence in the presence of gross sphincter weakness or gross impairment of bladder compliance.

Bethanechol Compounds↗
PubMed1982

Videourodynamic evaluation of neuropathic vesicourethral dysfunction in children.

The findings of the videourodynamic (VUD) assessment of the vesicourethral dysfunction of 103 children with neurological disease are described. Detrusor-sphincter dyssynergia was the main determinant of voiding efficiency and the most important cause of impaired renal function. Storage efficiency was mainly determined by the behaviour of the bladder neck during the filling phase. The response to treatment of the child's incontinence was largely determined by the detrusor compliance. Detrusor contractility was found to be of 2 types distinguishable by several physical and functional characteristics rather than by amplitude alone. This may be of more than just academic and semantic importance. VUD studies are essential if conservative treatment modalities are to be rationally and selectively employed.

Adolescent↗
PubMed1981

Endocrine function of the heterotopic pancreatic allotransplant in dogs. I. Normal and rejection.

After heterotopic pancreatic allotransplantation in dogs and in the absence of rejection there was a fasting normoglycemia with a marked hyperinsulinemia. On intravenous glucose tolerance testing and intravenous glucagon testing, the blood sugar response of dogs receiving no immunosuppression was normal but the response in dogs receiving immunosuppressive therapy was exaggerated. There was a marked increase in the insulin response compared with normal animals whether or not immunosuppressive therapy was administered. The first endocrine even during allograft rejection seemed to be a drop in the pancreatic insulin reserve as demonstrated by plasma insulin results during a glucagon test; occurring 2 to 3 days before clinically overt rejection. This was also found on glucose tolerance testing. A rise in the fasting plasma insulin occurred next, 1 to 2 days before a rise in the fasting blood sugar. As the rejection process progressed, the plasma insulin levels subsequently dropped until the death of the animal. If, during a rejection process, the blood sugar did not rise above 150 mg/100 ml and the plasma insulin level did not drop below the lower limit of normal the rejection was usually reversible with intravenous methylprednisolone.

Animals↗
PubMed1981

Endocrine function of the heterotopic pancreatic allotransplant in dogs. II. Immediate post-transplant period.

Pancreatic endocrine function was investigated in dogs after heterotopic pancreatic allotransplantation. A marked hyperinsulinemia was found in peripheral venous blood within the first 60 min postoperatively. This was associated with hypoglycemia and hypokalemia occurring within the next 2 to 3 hr resulting eventually in death. The hypoglycemia could be corrected by parenteral dextrose and potassium given during the first 2 hr postoperatively or prevented by parenteral hydrocortisone given at the time of transplantation.

Animals↗
PubMed1981

Endocrine function of the heterotopic pancreatic allotransplant in dogs.

After pancreatectomy and heterotopic pancreatic allotransplantation in dogs, there was a pattern of endocrine activity similar to that found following a combination of pancreatic denervation and total transposition of the pancreatic venous effluent from the portal of the systemic venous circulation. Denervation of the pancreas alone or total venous transposition alone did not mirror these results. The mechanism of the effect of these two factors is discussed.

Animals↗
PubMed1981

The urological complications of 1000 renal transplants.

Two hundred and one urological complications have been diagnosed and treated in 123 transplant recipients in a series of 1000 consecutive renal transplant operations (overall incidence 12.5%). Obstructive uropathies and urinary fistulae accounted for 95% of these complications and all of the mortality (22%). Details of management and patient and graft survival are given. A relationship between mortality from a urological complication and steroid dosage was found. A 30% incidence of recurrent or secondary urological complications was also noted with correspondingly worsened prognosis. Early diagnosis followed by early aggressive surgical treatment is advocated.

Adolescent↗
PubMed1980

Short term suppression of hyperacute renal allograft rejection in presensitised dogs with prostacyclin.

One of the main features of hyperacute renal allograft rejection in presensitised dogs is platelet aggregation within the kidney as detected by light microscopy and renal arterio-venous platelet counts. Graft failure, as determined by reduction and ultimate cessation of renal blood flow and urine production, can be abrogated in the short term by prostacyclin which is the most potent inhibitor of platelet aggregation yet discovered. After 4 h of extracorporeal perfusion, by which time all control kidneys had been rejected, all prostacyclin treated kidneys had normal or above normal blood flow rates, were producing urine and were similar histologically (light microscopy) to 4-hour autografts.

Animals↗
PubMed1980

Experimental assessment of prostacyclin in the harvesting of kidneys for transplantation.

Prostacyclin is a potent vasodilator and the most potent inhibitor of platelet aggregation yet discovered. A possible role for prostacyclin in the harvesting of kidneys in experimental canine transplantation has been investigated. Prostacyclin gives a 52.6% increase in renal blood flow prenephrectomy despite inducing a 23% drop in mean arterial blood pressure, without changing the rate of urine output. There is an associated drop in renal vascular resistance of 50.2% and an increase in renal blood volume of 25%. The value of heparin treatment before donor nephrectomy is confirmed as it improves the flow of flushing solution through the kidney after nephrectomy and improves red blood cell washout from the kidney. Prostacyclin and heparin together improve these parameters further. After a warm ischemic period of 45 min, autotransplanted kidneys in dogs pretreated with prostacyclin had normal renal function within 48 hr as judged by the serum creatinine whereas untreated dogs had permanent impairment of function.

Animals↗
PubMed1980

Bladder transection for urge incontinence associated with detrusor instability.

Twenty-three adults with incapacitating urge incontinence associated with urodynamically proven detrusor instability were treated by bladder transection after conventional non-operative treatment had failed. The operative technique is described. Subjective normality was restored in 78% of patients and objective evidence of improvement is documented.

Adult↗
PubMed1979

Urinary hydroxyproline excretion in carcinoma of the prostate. A comparison of 4 different modes of assessment and its role as a marker.

Urinary hydroxyproline (HP) excretion has been estimated without prior dietary restriction in 33 patients with carcinoma of the prostate and expressed as either 24-h HP output or as the hydroxyproline/creatinine (HP/Cr) ratio in 24-h urine sample, an early morning urine sample or a spot urine sample. The early morning urine hydroxyproline/creatinine ratio (EMU HP/Cr) appears to be the most accurate and avoids the disadvantages of formal dietary restriction and prolonged urine collection. The rest is useful in monitoring the responses to treatment of a patient with bony metastatic disease and relapse of a patient when his tumour ceases to be hormone sensitive. Furthermore, changes in EMU HP/Cr occur earlier than changes in other clinical or investigative variables, giving the test predictive value.

Aged↗
PubMedDate not supplied

A preliminary report on a new hydraulic sphincter for controlling urinary incontinence.

A new pressure-regulated artificial urinary sphincter (AUS) has been developed which overcomes many of the deficiencies of earlier devices. This implantable AUS comprises a circular occluder cuff and the means to inflate and deflate through a pressure-regulated valve. The device is made from medical-grade silicone rubber and filled with radio-opaque isotonic fluid. A few days before surgery the implant is coated on the outside with an antibiotic-loaded silicone rubber solution. Tests have shown that the regulated pressure was very easily adjusted in situ by injecting or withdrawing the hydraulic fluid through a hypodermic needle penetrating a self-sealing filling port. When set, the regulated pressure remained very stable. The mechanism by which cuff pressure was increased to overcome stress incontinence worked well. Of the five earlier devices (AUS Mk I) implanted, none has survived without mechanical failure. The two latest implants (Mk II), which were rigorously tested for defects before implantation, have been more successful.

Adolescent↗