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Biomedical subjects

B H Stewart

Publications and source records attributed to B H Stewart.

At least 91 records · Page 5Linked to original sources
PubMed1977

Partial nephrectomy in the treatment of renal adenocarcinoma.

During a 20-year period 17 patients underwent partial nephrectomy as primary curative therapy for renal adenocarcinoma. In 15 patients (88 per cent) partial nephrectomy was performed satisfactorily in situ with free margins of resection. Eleven patients are alive (65 per cent) and only 3 (17 per cent) died of recurrent malignant disease. There was no operative mortality and postoperative complications were minimal. A review of the literature reveals that partial nephrectomy is an effective form of therapy for patients with bilateral renal carcinoma or carcinoma occurring in a solitary kidney.

Adenocarcinoma↗
PubMed1977

The role of adjunctive nephrectomy in patients with metastatic renal cell carcinoma.

The results of therapy for 78 patients with disseminated renal cell carcinoma are evaluated. Symptoms related to the primary tumor were noted in only 28 per cent of the patients and were not difficult to manage in those patients not undergoing nephrectomy. Adjuctive nephrectomy, therefore, is a more appropriate term than palliative nephrectomy when referring to removal of the primary tumor as part of an aggresive combined therapeutic approach. Of patients receiving an adjunctive nephrectomy those with osseous metastases only had a better 1-year survival rate (36 per cent) than those with metastases to other sites (18 per cent). Complete regression of metastases was noted in 12 per cent of patients treated with medroxyprogesterone acetate and adjunctive nephrectomy. The role of adjunctive nephrectomy combined with embolic infarction, hormonal therapy, chemotherapy and/or immunotherapy is discussed.

Adenocarcinoma↗
PubMed1977

Immunotherapy of disseminated renal cell carcinoma with transfer factor.

Ten patients with disseminated renal cell carcinoma have been treated with transfer factor as an immunostimulant. In 5 patients with metastatic disease evident at the time of initial diagnosis treatment involved removal of the primary tumor followed by transfer factor therapy. Of these patients 3 had a temporary stabilization of metastatic disease. Three patients with recurrent metastatic disease after previous nephrectomy were treated, 2 of whom showed a temporary stabilization of metastatic disease. There were 2 additional patients without clinically evident metastases but at a high risk for recurrent disease who were treated and remain free of disease. We used 5 immunologic parameters to evaluate the clinical effects of transfer factor. No objective clinical regression was noted in any patient treated with measurable disease.

Adenocarcinoma↗
PubMed1977

CT-guided antegrade pyelography and percutaneous nephrostomy.

Percutaneous antegrade pyelography and percutaneous nephrostomy can be easily performed using CT guidance. CT provides cross-sectional images which facilitate accurate needle placement into the renal pelvis. CT is capable of detecting subtle density differences within the tissues so that even renal pelvises which do not contain contrast material and are not dilated can be accurately punctured. In addition to these procedures, CT accurately displays the perinephric space so that assessment of complications is possible. Four of five attempted percutaneous nephrostomies and two antegrade pyelograms were successfully performed using CT gudance.

Aged↗
PubMed1977

Renal revascularization in patients with severe atherosclerosis of the abdominal aorta or a previous operation on the abdominal aorta.

Renal revascularization has been performed in six patients in whom severe atherosclerosis or previous operative procedures on the abdominal aorta precluded the performance of a standard aortorenal bypass graft. Splenorenal anastomoses were performed in three patients, superior mesenterorenal anastomosis in one patient, long saphenous vein iliorenal anastomosis in one patient, and renal autotransplantation in one patient. Successful renal revascularization with preservation of renal function was accomplished in all patients. The natural history of severe atherosclerotic renovascular disease has demonstrated the relatively frequent occurrence of arterial thrombosis and renal failure in patients with solitary kidneys. Occasionally, the presence of severe aortic disease precludes the use of standard aortorenal bypass grafting. Fortunately, as reported herein, alternate methods of revascularization are available whereby renovascular hypertension can be corrected and renal function preserved, with minimal operative risk.

Adult↗
PubMed1977

Splenorenal bypass in the treatment of renal artery stenosis.

A retrospective study is presented of our experience from 1962 to 1976 with the splenorenal bypass procedure in the treatment of 32 patients with renovascular hypertension. The over-all results were 53 per cent of the patients cured, 28 per cent improved and 19 per cent failures. Improved results were noted when the splenorenal bypass was performed in relation to specific operative indications. The results were somewhat better in men than in women and poor results were obtained in children. Intraoperative and early postoperative complications were minimal. There were 2 postoperative deaths, for a hospital mortality rate of 6.3 per cent. Late complications were limited to splenic artery graft stenoses, which developed in 3 patients (9.4 per cent). When performed in relation to specific clinical and operative indications the splenorenal bypass is believed to represent an excellent means to achieve safe and effective renal revascularization.

Adolescent↗
PubMed1977

Splenorenal bypass in the treatment of stenosis of the renal artery.

The over-all results obtained with splenorenal bypass in the treatment of 32 patients with renovascular hypertension were 17 patients cured, nine patients improved and six failures. Improved results were noted when splenorenal bypass was performed in relation to specific operative indications. The results were somewhat better for men than for women; however, poor results were obtained in children. Intraoperative and early postoperative complications were minimal, and there were two postoperative deaths. Late complications were limited to stenoses of the splenic artery graft which developed in three patients. When performed in relation to specific clinical and operative indications, splenorenal bypass represents an excellent means of achieving safe and effective renal revascularization.

Adolescent↗
PubMed1977

Experience with a urinary sphincter prosthesis.

From February 1974 through April 1975, ten patients have had a Scott urinary sphincter prosthesis implanted for the relief of urinary incontinence. In nine of the patients, incontinence was due to trauma of the sphincter, and in one patient, incontinence was due to a neurogenic bladder. Four patients have been totally continent following operation and, thus far, have not required additional operative procedures. Two additional patients were continent after the initial implant, but incontinence recurred because of mechanical failure of the device. Both patients are again continent following replacement of the defective portion of the prosthesis. Four patients have been classified as failures. Infection was the cause of failure in three of these patients, and in the fourth patient with a neurogenic bladder, failure was due to uncontrollable detrusor hyperreflexia.

Adult↗
PubMed1976

Complications of renal cyst exploration versus renal mass aspiration.

This report presents a comparison of the complications of surgical exploration with unroofing and renal cyst puncture. Two hundred fifty-five patients were operated on, with a mortality rate of 1 per cent and a morbidity rate of 28 per cent. The complications in 63 patients examined by mass aspiration included a morbidity rate of 6.4 per cent and no mortality. The possibilities of over-looking carcinomas through cyst aspiration are weighed against the demonstrated morbidity of surgical exploration and found to be much less significant. The authors recommend that an asymptomatic renal mass that radiographically appears to be a cyst and is unaccompanied by urine changes or clinical stigmata of renal neoplasia be treated by cyst aspiration and not subjected to surgical exploration.

Diagnosis, Differential↗
PubMed1976

Further experience with intravesical dimethyl sulfoxide in the treatment of interstitial cystitis.

Intravesical dimethyl sylfoxide has given satisfactory symptomatic relief in 75 per cent of patients with interstitial cystitis so treated. The treatment is simple and inexpensive, and can be safely administered as an office procedure. Objective improvement in the endoscopic appearance of the disease, with improvement in bladder capacity, was noted in 80 per cent of the patients in our series. Further work with dimethyl sulfoxide is indicated in the treatment of interstitial cystitis, as well as a variety of other genitourinary disorders.

Adult↗
PubMed1976

Partial cystectomy in the treatment of primary and secondary carcinoma of the bladder.

We reviewed 50 patients who had undergone partial cystectomy for primary carcinoma of the bladder. Specific indications and operative technique are discussed. The 5-year survival rate was 67% for patients with stages O and A disease, 53% for stage B and 20% for stages C and D1. Survival was improved for patients with tumors on the posterior bladder wall. Patients in whom free margins of resection were accomplished for unifocal disease had longer survival, with a diminished propensity for developing recurrent bladder cancer. There was no hospital mortality and postoperative complications were minimal. An additional 12 patients underwent partial cystectomy for adjacent carcinomas secondarily invading the bladder with less favorable results.

Antineoplastic Agents↗
PubMed1976

Management of extensively destroyed ureter: special reference to renal autotransplantation.

Renal autotransplantation has been attempted 6 times in 4 patients for the correction of extensive ureteral disease. Indications in these patients include trauma secondary to ureterolithotomy and spinal fusion, and failed supravesical diversionary procedures. Included in our report is the first case of autotransplantation associated with ureterosigmoidostomy. Renal autotransplantation is an effective method to restore or preserve renal function in patients with extensive ureteral damage or disease. However, the procedure should not be considered in poor risk patients with good contralateral renal function or in patients in whom standard reparative procedures are possible. The hazard is real of vascular spasm, poor perfusion and ultimate autograft failure in kidneys with advanced chronic pyelonephritis and/or inflammation involving the renal pedicle. Autotransplantation should be considered only as a last resort in such patients.

Adult↗
PubMed1976

Stress incontinence: conservative therapy with sympathomimetic drugs.

There were 77 women with mild to moderate stress urinary incontinence treated with the sympathomimetic agent, phenylpropanolamine hydrochloride, combined with chlorpheniramine maleate and isopropamide iodide in a sustained release capsule (Ornade). The majority of these patients achieved significant improvement 3 months to 3 years after beginning therapy. A trial of conservative therapy is advisable for stress incontinence, especially when symptoms are mild or when the patients are in a poor risk category. Similar management of post-prostatectomy stress incontinence in men was disappointing. However, the occasional excellent results in patients with mild symptoms appear to justify a trial of conservative therapy before considering operative intervention in this group of patients.

Administration, Oral↗
PubMed1976

Renal autotransplantation: current perspectives.

Autotransplantation, with or without an extracorporeal renal operation, has been done 39 times in 37 patients. Indications for the procedure included severe ureteral injury in 4 patients, failed supravesical diversion in 2, renal carcinoma in a solitary kidney in 1, renovascular hypertension in 1 and donor arterial reconstruction before renal transplantation in 29. Success was obtained in all but 2 procedures, both of which involved previously operated kidneys with severe inflammation and adhesions involving the renal pelvis and pedicle. Based on our experience and a review of currently available literature we believe that renal autotransplantation and extracorporeal reconstruction can provide the best solution for patients with severe renovascular and ureteral disease not correctable by conventional operative techniques. The technique can be of particular value in removing centrally located tumors in solitary kidneys and in preparing donor kidneys with abnormal arteries for renal transplantation. The role of autotransplantation in the management of advanced renal trauma and calculus disease is less clear. A long-term comparison of patients treated by extracorporeal nephrolithotomy versus conventional lithotomy techniques will be necessary before a conclusion is reached in these disease categories.

Female↗
PubMed1975

Testis tumors: review of 125 cases at the Cleveland Clinic.

One hundred twenty-five cases of testicular tumor are reviewed. The prognostic significance of clinical features, certain laboratory test results, and histologic type are evaluated, and treatment results are presented. The most important prognostic clinical feature is the presence or absence of clinically evident metastases. The urinary gonadotropin levels are useful prognostically, but the intravenous pyelogram and lymphangiogram are statistically unreliable. The presence of tumor in retroperitoneal lymph nodes influenced survival only in the patients with embryonal carcinoma. Tumor type influenced survival more than any other pathologic factor. Vascular invasion, local extension, and Leydig cell hyperplasia did not correlate with tumor behavior in germinal neoplasms. Patients with clinical Stage IA or IB teratocarcinoma had an 85 per cent survival rate with a wide variety of treatment.

Adult↗
PubMed1975

Bilateral testicular tumors of germ cell origin.

Four cases of primary testicular tumor of germ cell origin are reported. Three cases were bilateral, while the remaining case involved a unilateral tumor in a non-twin brother of 1 patient with bilateral tumors. Because of the increased likelihood of a second primary tumor developing in a patient who has had a malignant germinal cell tumor and because the changes may be subtle, localized to the testis and occur after a tumor-free interval of many years, careful examination of the contralateral testis and long-term followup are indicated even when systemic chemotherapy for malignancy has been used. This is the seventh time familial occurrence of testis tumors in non-twin brothers has been reported but the first time that one of the brothers had bilateral tumors.

Adolescent↗