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Biomedical subjects

A R Stone

Publications and source records attributed to A R Stone.

At least 19 recordsLinked to original sources
PubMed1992

Tamm-Horsfall protein as a marker in interstitial cystitis.

It has been suggested that immunohistochemical staining for Tamm-Horsfall protein in bladder epithelium may be a marker for interstitial cystitis. Of bladder biopsies from 14 interstitial cystitis patients only 3 demonstrated positive staining for Tamm-Horsfall protein within the mucosa, whereas 2 of 11 control biopsies showed positive Tamm-Horsfall protein results. In addition, staining in 4 ureteral specimens from interstitial cystitis patients and 4 controls was negative in all cases. An effort to detect this protein in enterocystoplasty specimens also showed a negative pattern. Our study does not confirm the Tamm-Horsfall protein as permeating either the bladder epithelium in interstitial cystitis or bowel mucosa in enterocystoplasty. This finding does not necessarily mean that these surfaces are not permeable to substances of smaller molecular size, nor does it define whether this is of importance in the etiology of interstitial cystitis. However, it does suggest that this technique does not allow detection of a marker for the disease.

Adult↗
PubMed1992

The hemodynamics of vacuum constriction erections: assessment by color Doppler ultrasound.

Duplex ultrasound with pulsed Doppler and color flow sonography were used to image the penis and conduct blood flow velocity studies in 5 patients. Cavernous body cross sectional area, cavernous artery diameters and peak systolic velocities were measured in the flaccid shaft, after transient exposure to negative pressure in a vacuum constriction device, and with a vacuum constriction device band applied to the tumescent shaft. We found that exposure to vacuum transiently increased central cavernous arterial blood flow velocities compared to baseline values in all patients. After a trial of a vacuum constriction device and application of the constricting band cavernous body cross sectional areas doubled. Despite increased cavernous arterial diameters in 4 of 5 patients and increased blood flow in all patients after vacuum-induced tumescence alone, we could not visualize arterial inflow in the penile shaft once the constricting band was in place. Color Doppler ultrasound can detect cavernous artery systolic flow as low as 2 to 9 cm. per second. Our data suggest that the erectile state maintained distal to the vacuum constriction device band is low flow and relatively ischemic.

Aged↗
PubMed1992

Lymphocyte function in patients with interstitial cystitis.

To determine whether there is a primary immunological disorder involved in the etiology of interstitial cystitis, we compared the in vitro function of peripheral blood lymphocytes from 10 patients with interstitial cystitis to those from 10 healthy female controls. The lymphocytes were isolated and incubated in either cell culture medium alone, cell culture medium supplemented with the mitogen phytohemagglutinin or cell culture medium with autologous sterile filtered urine, the latter to detect any immunogenic potential of urine in this disease. We studied the relative proliferation of the phenotypes CD2, CD4, CD8, CD19, CD14 and CD56 by immunofluorescence and flow cytometry. To detect activation of T lymphocytes we also studied expression of HLA-Dr and interleukin-2 receptors. There was no difference in the rate of proliferation of the various lymphocyte phenotypes between the 2 groups in any of the culture media. Similarly, there was no difference between the 2 groups in the degree of lymphocytic activation after incubation. Furthermore, incubation in the presence of autologous urine caused no increase in activation above that seen in control cultures. We also assessed the production of the lymphokines interleukin-1, interleukin-2 and interferon-gamma in the supernatant fluid of the cell cultures. There was no difference in the production of these immunoregulatory cytokines between the control and patient groups, and again urine did not act as a mitogen in either group. We conclude from this study that there is no primary immunological disorder evident in patients with interstitial cystitis, and that the urine does not act as a stimulant to the immune system. This finding casts severe doubt on any theory suggesting that interstitial cystitis is an autoimmune disease or that urine contains an autoantigen causing the disease.

Adult↗
PubMed1991

Cellular immunity in interstitial cystitis.

It has been suggested that interstitial cystitis is an autoimmune disease. The evidence for this hypothesis, based on studies of humoral immune factors, has been contradictory. We assessed the immune response in interstitial cystitis by evaluating lymphocyte populations in the peripheral blood and bladder tissue of interstitial cystitis patients. The lymphocyte phenotypes in peripheral blood were entirely normal, including the CD4 (cluster designation nomenclature) and CD8 subsets, and the CD4:CD8 ratio. Bladder lamina propria showed a predominance of CD4 over CD8 lymphocytes in interstitial and other forms of cystitis. Bladder epithelium showed a similar pattern in bacterial or mechanical cystitis but specimens from patients with interstitial cystitis had a predominance of CD8 cells. The findings of normal lymphocyte populations in the peripheral blood are not supportive of an autoimmune mechanism in the disease. The findings in bladder tissue show that the urothelium is not involved in the inflammatory reaction, as is the lamina propria, and they would suggest, therefore, that the initiating factor does not originate from the bladder lumen. The CD8 predominance in the urothelium along with a CD4 predominance in the lamina propria may form a characteristic pattern for the diagnosis of interstitial cystitis and merits further study.

Adult↗
PubMed1991

Can histological assessment predict the outcome in interstitial cystitis?

In a retrospective study we compared the outcome of 39 patients with interstitial cystitis to the histological findings at initial diagnostic bladder biopsy. The degree of inflammation and fibrosis and the mast cell counts were assessed on each biopsy. The prognostic relevance of the clinical features of age, duration of symptoms, frequency, nocturia, pain and bladder capacity was assessed. The study showed no statistical correlation between the severity of histological findings at diagnosis and the eventual outcome of the disease. Over 50% of patients with severe histological abnormalities responded to conservative treatment. Although the majority of patients with mild pathological changes responded to conservative treatment, some did require surgical intervention. The clinical features of pain, nocturia and bladder capacity showed significant differences between the 2 patient groups. However, the former 2 features are subject to many variables and the latter probably has too wide a range to be useful as a prognostic indicator. Only the response of patients to conservative treatment will indicate those who are not being helped and who may eventually require surgical treatment.

Cell Count↗
PubMed1991

Treatment of voiding complaints and incontinence in painful bladder syndrome.

The treatment of voiding complaints and incontinence in painful bladder syndrome requires careful attention to detail. As the exact nature of these conditions is unknown, no single modality is effective, and multiple treatments may be required. A sympathetic and supportive physician is necessary in all these cases.

Humans↗
PubMed1990

Recurrent interstitial cystitis following cystoplasty: fact or fiction?

The severity of symptoms in interstitial cystitis may necessitate surgical treatment in approximately 10% of the patients. Substitution cystoplasty provides satisfactory results in most of these cases, while avoiding the need for urinary diversion. It has been suggested that interstitial cystitis may affect the bowel segment used in this form of operation. We studied bowel segments removed from cystoplasties in 5 patients with interstitial cystitis and compared these to bowel used for lower urinary reconstruction for other disorders in 6 patients. All segments showed varying degrees of inflammation, fibrosis and mastocytosis but there was no difference between the 2 groups for these features. We conclude that inflammation and fibrosis is the usual reaction of bowel to exposure to urine, and they do not represent a specific spread of interstitial cystitis in those patients. However, this reaction does mimic the histological appearance of interstitial cystitis in the bladder and may suggest a model for this disease.

Adult↗
PubMed1990

Neobladders: clinical management and considerations for patients receiving chemotherapy.

Continent catheterizable urinary reservoirs and orthotopic bladder substitutes are complex surgical endeavors. The goal is preservation of renal function, reliable continence, and storage intervals acceptable to the patient. The construction requires familiarity with bowel segments and may increase operative time for radical cystoprostatectomy by 30% to 50%. Patients with continent reservoirs have improved body image, work habits, and sexual and interpersonal relationships. Experience with patients with dysfunctional neurogenic bladders previously converted to Bricker urostomies now undiverted to continent reservoirs indicates an overall increase in physical activity and self-satisfaction. These patients are tolerant of reoperations to maintain independence from wet urostomies. Undoubtedly, the expectations of bladder cancer patients will differ from those of young adults with neurogenic bladder, but we have found that when all options are presented patients will seek out therapy that least alters their body image. Therefore, patient selection becomes an important factor in determining the success of continent reservoirs. Patients must have the dexterity and motivation to catheterize the urinary reservoir, irrigate for mucus and, in cases of orthotopic bladder replacement to urethra, accept the need for artificial sphincter placement in 30% to 40% of cases. Management of the neo-bladders requires additional consideration of several practical and theoretic points for both the surgeon and medical oncologist: 1. Patients with diffuse carcinoma in situ or transitional cell carcinoma at the bladder neck or prostatic urethra should undergo simultaneous urethrectomy excluding orthotopic bladder replacement. 2. Ten percent to 40% of patients undergoing radical cystoprostatectomy for transitional cell cancer will have concomitant underdiagnosed adenocarcinoma of the prostate; patient prognosis will remain defined by the stage and grade of the bladder cancer. 3. Patients may have a tendency toward dehydration because of increased loss of free water through bowel transit. 4. Absorption of chloride, ammonium, and hydrogen ions may cause hyperchloremic acidosis, especially in face of imparied renal function. 5. Because of the potential for drug absorption across reservoir mucosa, patients receiving chemotherapy may require Foley catheterization with irrigation in addition to intravenous hydration. 6. Creatinine clearance is unsuitable for studying the renal function of reservoir patients because urine passes through the intestinal segment where creatinine is absorbed; glomerular filtration is better estimated by nuclear scanning with the reservoir emptied. 7. Most reservoirs will remain colonized with bacteria. 8. Antibiotic prophylaxis for the patient with temporary impairment of immune function during chemotherapy may be necessary. 9. Mucus may entrap bacteria serving as a host defense; its production may diminish with time from construction. All patients should be capable of performing reservoir irrigations to manage mucus obstruction.(ABSTRACT TRUNCATED AT 400 WORDS)

Antineoplastic Agents↗
PubMed1989

The clinical application of aspiration deoxyribonucleic acid flow cytometry to neurologically impaired men entering an electroejaculation program.

For the neurologically impaired patient electroejaculation with a rectal probe can furnish sperm for artificial insemination. However, documentation of pregnancies in this patient group has been limited. Deoxyribonucleic acid flow cytometry has been shown to be a reproducible quantitative method with which to evaluate spermatogenesis. We assessed the ability of deoxyribonucleic acid flow cytometry on testicular aspirates to predict the quality of sperm production in 13 men undergoing electroejaculation. Semen analysis was performed on antegrade and retrograde specimens. Deoxyribonucleic acid histograms from testicular aspirates were evaluated for the relative proportions of haploid, diploid and tetraploid cells. These ratios were compared to the means reported for our own series of 25 patients who at vasovasostomy had sperm intraoperatively and to the similar figures from a group of 10 accident victims. Five patients had normal testicular ploidy compartments defined as within 2 standard deviations from control means. Of the 5 patients 4 had normal sperm counts and motilities (30 per cent or greater). Two patients have contributed sperm for artificial insemination; 1 has resulted in pregnancy. Three patients had moderately abnormal (2 to 4 standard deviations) testicular ploidy classes. These patients had adequate sperm counts but low motilities (5 per cent or less). Of the 5 patients with markedly abnormal (greater than 4 standard deviations) histograms 4 remained azoospermic despite repeated attempts at electroejaculation. Our data support the use of deoxyribonucleic acid flow cytometry on testicular aspirates as a predictor of which patients might succeed and those who are unlikely to succeed in an electroejaculation program.

Adult↗
PubMed1989

The split-cuff ureteral nipple reimplantation technique: reliable reflux prevention from bowel segments.

The split-cuff nipple ureteral implantation technique is described in 18 patients undergoing lower urinary tract reconstruction or supravesical diversion. This technique provides a simple and reliable antireflux mechanism into large and small bowel segments. No reflux or upper tract deterioration was seen initially, and only 1 case of mild reflux has occurred after 30 months of followup.

Follow-Up Studies↗
PubMed1989

Treatment and complications of Fournier's gangrene.

Ten patients with Fournier's gangrene were seen over an 11-month period; 3 had indwelling urethral catheters, 3 had preceding perineal infection and 6 had a history of alcohol abuse. An average of 2.1 operations was required per patient and the average hospital stay was 41 days. The mortality rate was 20%; 7 patients developed acute renal failure and 5 developed adult respiratory distress syndrome. Early treatment of these complications should help to reduce the mortality of this disease.

Acute Kidney Injury↗
PubMed1979

Prostatic lymphoscintigraphy.

Techniques of prostatic lymphoscintigraphy using 99mTc phytate (TP) and 99mTc antimony sulphide colloid (ASC) have been evaluated in 30 patients. The most successful technique was a superficial perianal injection of ASC. In general, definition of the regional lymph nodes lacked the precision and clarity that would be required for the technique to be used in staging of prostatic or other pelvic tumours; further development of the technique is recommended.

Adult↗
PubMed1978

Intramural oesophageal haematoma complicating anticoagulant therapy.

A case of intramural oesophageal haematoma complicating anticoagulant therapy is described. Severe chest pain and complete obstruction of the oesophagus resulted. Early fibreoptic endoscopy facilitated the diagnosis. The condition resolved spontaneously with conservative management. A similar case has not been previously reported.

Aged↗