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Biomedical subjects

B H Stewart

Publications and source records attributed to B H Stewart.

At least 55 records · Page 3Linked to original sources
PubMed1982

Left renal venous hypertension "nutcracker" syndrome. Managed by direct renocaval reimplantation.

Since 1978 a diagnosis of left renal venous hypertension has been established in 3 patients. All 3 had otherwise unexplained left flank and abdominal pain, 2 had left renal gross hematuria, and 2 were found to have ureteral and peripelvic varices demonstrated by selective renal venography. All were found to have mild to moderate pressure gradients between the left renal vein and vena cava, presumably due to compression of the left renal vein between the aorta and overlying superior mesenteric artery. Direct left renocaval reimplantation was performed in all cases, with resection of the collateral varices that were present in 2 cases. Severe unrelenting pain was the primary indication for surgery in all cases, rather than hematuria. All remain asymptomatic one to four years after surgery.

Adult↗
PubMed1982

Surgical treatment of renovascular disease in the solitary kidney: results in 43 cases.

Renal revascularization was performed on 43 patients with vascular disease involving a solitary kidney. Revascularization was undertaken as treatment for severe hypertension in 35 patients and to preserve renal function in 8. There were 2 operative deaths (4.7 per cent) and 3 major complications (7 per cent). No patient suffered acute renal failure after revascularization. Followup ranges from 6 months to 14 years (mean 6 years). The postoperative serum creatinine is improved in 26 patients (63 per cent), unchanged in 9 (22 per cent) and increased in 6 (15 per cent). Of 35 patients with hypertension the blood pressure is cured in 18 (51 per cent) and improved in 14 (40 per cent); there were 3 (9 per cent) failures. In selected patients with renal artery disease involving a solitary kidney revascularization can provide effective treatment of hypertension and stabilization or improvement of renal function.

Adult↗
PubMed1981

Diminished operative morbidity and mortality in renal revascularization.

From 1974 to 1980, one hundred consecutive patients with atherosclerotic renovascular disease underwent revascularization. There were two operative deaths and eight postoperative complications. This low operative morbidity is attributed to preoperative screening, correction of existing coronary or cerebrovascular disease, and reliance on methods of revascularization that obviate operation on a badly diseased aorta. The results in 78 patients with renovascular hypertension were 40% cured, 51% improved, and 9% failed. In 22 patients in whom revascularization was performed to preserve renal function, the postoperative serum creatinine levels were improved in 19 patients, remained stable in two patients, and increased in one patient.

Adult↗
PubMed1981

Renal subcapsular hematoma: a diagnostic and therapeutic dilemma.

Subcapsular renal hematomas have been found in 14 hypertensive patients between 17 and 66 years old. In 11 patients with chronic lesions hypertension improved more often with nephrectomy (7 of 7 cases) than with a conservative operation (2 of 4 cases). Non-operative management of acute hematoma resulted in radiographic resolution and improvement of hypertension in 3 of 3 patients. Awareness of the clinical features and judicious use of diagnostic modalities enable proper management of subcapsular renal hematomas in most cases.

Adolescent↗
PubMed1981

Experience with extracorporeal renal operations and autotransplantation in the management of complicated urologic disorders.

Renal autotransplantation with or without an extracorporeal renal operation was performed 45 times upon 43 patients. Twenty-one patients underwent renal autotransplantation as surgical treatment for renovascular hypertension, all of whom are cured or have improved postoperatively. Sixteen renal autotransplants were performed upon 14 patients with extensive ureteral disease, 14 of which were successful. Six patients with carcinoma centrally located in a solitary kidney underwent extracorporeal partial nephrectomy and autotransplantation. Three of these patients are alive with functioning autografts and are tumor-free from one to five years postoperatively. Two patients with multiple recurrent renal calculi were successfully treated by extracorporeal pyelolithotomy and autotransplantation with pyelovesicostomy. An extracorporeal renal operation and autotransplantation can provide the best solution for selected urologic problems not correctable by conventional methods.

Humans↗
PubMed1980

Anatrophic nephrolithotomy for removal of staghorn or branched renal calculi.

Forty anatrophic nephrolithotomies were performed in 38 patients between November, 1965, and December, 1977, to remove staghorn or branched renal calculi. Thirty-six (95 per cent) of the patients' preoperative urine cultures were infected, and postoperatively 35 of the cultures (88 per cent) were sterile. Magnesium ammonium phosphate calculi were present in the majority of patients (67 per cent). In 6 patients (15 per cent) transient nephrocutaneous fistulas developed. Thirty-six of the 40 renal units (90 per cent) had improved or stable intravenous pyelograms postoperatively. The patients had been followed for an average of twenty months (four to one hundred and twelve months). In 6 patients (15 per cent) recurrent renal calculi developed, and 3 patients (8 per cent) had residual calculi during this period.

Adult↗
PubMed1980

Renal revascularization in patients with total occlusion of the renal artery.

A total of 15 patients with renovascular hypertension underwent revascularization of totally occluded renal arteries. Preoperative clinical assessments suggesting renal salvageability include urographic visualization of the involved kidney, renal length greater than 9 cm., filling of the distal renal arterial tree on angiography and elevated renal vein renin levels. Postoperatively, hypertension was cured or improved in 14 patients and there was 1 failure. Over-all renal function improved in 9 of 10 patients with preoperative azotemia and stabilized in the remaining 5 patients. Revascularization can be done successfully in properly selected patients with complete renal artery occlusion, with control of hypertension and reversal of renal failure.

Adult↗
PubMed1980

Surgical management of branch renal artery disease: in situ versus extracorporeal methods of repair.

Herein are presented the techniques and their respective indications that have been found most effective in replacing the renal artery and its branches. Aortorenal bypass and, occasionally, splenorenal bypass can be tailored to achieve in situ repair of most branch renal artery lesions. Extracorporeal renal revascularization and autotransplantation have been done on onar disease. Revascularization with preservation of renal parenchyma can now be achieved in almost all patients with branch renal artery disease.

Aorta, Abdominal↗
PubMed1980

Extracorporeal renal surgery and autotransplantation: indications, techniques and results.

Renal autotransplantation and/or an extracorporeal renal operation has been done 67 times in 65 patients. The indications for operation were severe ureteral injury in 8 patients, urinary undiversion in 2, renovascular hypertension in 10, carcinoma in a solitary kidney in 3, recurrent renal colic in 1 and donor arterial reconstruction before renal transplantation in 43. Methods of renal preservation and operative repair are described. Sixty-five operations were successful and 2 operations failed because of severe perirenal fibrosis in patients undergoing urinary undiversion. Renal autotransplantation and extracorporeal reconstruction can provide the best solution for selected urologic problems not correctable by conventional methods.

Extracorporeal Circulation↗
PubMed1980

Transperitoneal live donor nephrectomy.

We review 171 anterior transperitoneal live donor nephrectomies. The transperitoneal approach provides optimum exposure for atraumatic dissection of the kidney and renal vessels. The total and major postoperative complication rates were 30.4 and 3.5 per cent, respectively. These results compare favorably to reported series of extraperitoneal live donor nephrectomies. Transperitoneal live donor nephrectomy is a safe and effective operation with low risk to the donor.

Nephrectomy↗
PubMed1979

Circulating and urinary catecholamines in pheochromocytoma. Diagnostic and pathophysiologic implications.

Three biochemical tests for the diagnosis of pheochromocytoma were evaluated in 24 patients with proved tumors and 40 patients whose clinical picture was suspect but who had no evidence of the disease. Measurement of resting, supine plasma catecholamines (by radioenzymatic assay) was more useful than either 24-hour urinary vanillylmandelic acid (VMA) or metanephrines or both. In only one of 23 patients with pheochromocytoma were plasma catecholamines within the range of those in patients without pheochromocytoma, as compared with urinary VMA in 11 of 22, urinary metanephrines in five of 22 and both metabolites in three of 22. These studies reaffirm the value of plasma catecholamines in the diagnosis of pheochromocytoma and indicate that urinary catecholamine metabolites are less useful. The poor correlation between the height of arterial pressure and circulating levels of catecholamines suggests that the regulation of arterial pressure in pheochromocytoma is complex.

Adrenal Gland Neoplasms↗
PubMed1979

Endarterectomy and patchgraft angioplasty in treatment of atherosclerotic renovascular hypertension.

From 1962 to 1978, 56 patients underwent transrenal endarterectomy as surgical treatment for renovascular hypertension. Over-all results were 39 per cent cured, 36 per cent improved, and 25 per cent failed. Criteria for selecting patients with atherosclerotic renal artery disease for surgical treatment are reviewed. Transrenal endarterectomy is a simple operation and should continue to be applied in the management of properly selected patients.

Adult↗
PubMed1979

Palatal metastases in renal cell carcinoma.

Renal cell carcinoma may metastasize early in its course and sometimes before the primary lesion becomes apparent. Two cases of renal cell carcinoma with the initial manifestation of metastases to the roof of the mouth are presented. The mode of metastases to the palate is discussed.

Adenocarcinoma↗
PubMed1979

Aortorenal reimplantation in treatment of renovascular hypertension.

From 1964 to 1977, 33 patients underwent aortorenal reimplantation as surgical treatment for renovascular hypertension. Over-all results were 13 patients cured (39 per cent), 15 patients improved (46 per cent), and there were 5 failures (15 per cent). The results were equally satisfactory in patients with atherosclerotic or fibrous renal artery disease. Postoperative arterial stenosis or occlusion occurred in 5 patients (15 per cent). Aortorenal reimplantation is an effective method of renal revascularization in properly selected patients, and long-term results are comparable with those of aortorenal bypass.

Adolescent↗
PubMed1979

Urethral pressure profiles before and after Ornade administration in patients with stress urinary incontinence.

Urethral pressure profilometry was done on 12 women with stress urinary incontinence and in 6 women with no history of incontinence, before and 1 to 2 hours after the administration of Ornade. Eleven of the 12 women with stress urinary incontinence had increases in the maximal urethral pressure of 20 per cent or more over the control value. Only 1 of the 6 control women exhibited an increase in the maximal urethral pressure of greater than 20 per cent after the administration of Ornade. It is believed that the phenylpropanolamine component of Ornade stimulates alpha-adrenergic receptors at the vesical neck and in the proximal urethra to achieve the therapeutic effect of reducing or eliminating stress urinary incontinence. This drug is preferred over ephedrine primarily because of its sustained release, allowing dosage twice a day, and because of its relative freedom from side effects.

Chlorpheniramine↗
PubMed1979

Half and total body radiation for carcinoma of the prostate.

Despite recent advances in the treatment of stage D carcinoma of the prostate many patients become refractory to all therapeutic modalities. Progressive and incapacitating pain is one of the most difficult symptoms to manage. Ten patients with severely symptomatic metastatic adenocarcinoma of the prostate have been treated with either single or sequential doses of half body radiation using 800 rad delivered by a Linac 10 mV linear accelerator. There were 15 courses of half body radiation delivered and a good to excellent response was noted in 11 instances. Results often were immediate and the duration of the response was variable. Treatment was well tolerated with no fatal complications. Half and total body radiation appears to offer significant palliation and its use with other forms of therapy warrants further investigation.

Humans↗