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Biomedical subjects

B Lytton

Publications and source records attributed to B Lytton.

At least 73 records · Page 4Linked to original sources
PubMed1977

Intraoperative localization of renal calculi during nephrolithotomy by ultrasound scanning.

An ultrasound B-scan probe has proved to be useful in the intraoperative localization of renal calculi. The probe is small, readily available and produces an anatomical cross-sectional image of the kidney. The use of a 10 MHz. frequency probe enables 2 to 3 mm. stones to be detected readily. Calibration of the screen and the use of a fine needle inserted into the kidney under ultrasound control provide for precise 3-dimensional localization of the stone to facilitate its removal. The method has been successful in accomplishing the complete removal of small stones or residual fragments in 7 of 11 patients in whom it has been used. The method requires some experience in the use of the probe and in the interpretation of the ultrasound image.

Adult↗
PubMed1977

Renal cortical blood flow distribution in obstructive nephropathy in rats.

To examine the role of intrarenal hemodynamics in in obstructive nephropathy, we determined cortical blood flow distribution (CBFD) in rats with bilateral ureteral occlusion (BUO) and unilateral ureteral occlusion (UUO) during and after release of obstruction. Prior to release of obstruction of 24 hours' duration, we found that outer cortical perfusion decreased by 20+/-5% in both BUO and UUO rats. Furthermore, one hour after release of BUO, there was rapid normalization of CBFD associated with a modest return of glomerular filtration rate (GFR), an almost complete return of renal blood flow (RBF), and a marked postobstructive diuresis. In contrast, after release of UUO, we observed that outer cortical perfusion remained decreased by 21+/-31%, both GFR and RBF remained markedly depressed, and no diuresis occurred. These data demonstrate (1) marked ischemia of the outer cortex in both BUO and UUO during obstruction, (2) a rapid return of CBFD to a normal pattern after release of BUO, but (3) persistent outer cortical ischemia following release of UUO.

Animals↗
PubMed1977

Antibiotic treatment of renal carbuncle.

Renal carbuncles in seven young males were successfully treated with long-term administration of penicillinase-resistant antibiotics. Selective renal arteriography provided an accurate means of diagnosis and permitted a trial of medical therapy. All patients experienced a prompt and sustained clincial remission; surigical exploration was thus obviated in all but one instance, in which post-treatment radiographic changes persisted.

Adolescent↗
PubMed1976

Bacterial prostatitis: treatment with trimethoprim-sulfamethoxazole.

Fifteen patients with chronic bacterial prostatitis were treated with trimethoprim-sulfamethoxazole for three months. In 60 per cent of the patients a recurrence of chronic bacterial prostatitis developed during a follow-up period of from one to two and one-half years. It appears that factors other than a diffusion barrier to effective antimicrobial agents into the prostatic gland are responsible for the persistence of chronic bacterial infections of the prostate.

Bacterial Infections↗
PubMed1976

Influence of rejection on graft survival after renal transplantation.

The clinical course was reviewed of 102 renal allograft recipients between December 1967 and December 1973. Only 4 of 21 patients (19 per cent) who had 2 or more episodes of rejection during the first 2 months had a functioning graft at the end of 1 year, compared to 24 of 30 patients (83 per cent) who had no rejection episodes. A similar trend was seen 2 to 6 months after transplantation. During the first 2 years vigorous immunosuppressive therapy for rejection in the first few months resulted in 12 deaths (44 per cent) of 27 patients. Subsequent to this immunosuppressive therapy was modified and grafts were removed if there was not a prompt recovery of function after treatment, which resulted in a significant decrease in mortality rate to 16 per cent. There also was improvement in the over-all survival of patients with functioning grafts from 37 to 56 per cent. Serious complications and mortality could be related to high dosage of steroids and severe leukopenia. A white blood count of less than 1,000 mm.3 on 3 successive days was associated with a mortality rate of 52 per cent, compared to 15 per cent in those without leukopenia. Serious consideration should be given to early graft removal in patients who have 2 or more episodes of rejection in the first few months after transplantation, particularly when there is not a prompt improvement in renal function after immunosuppressive therapy. High doses of steroids (greater than 1 mg. per kg. for more than 26 days during the first 60 days) should be avoided to decrease morbidity and mortality rates from serious infections. The results of histocompatibility (HL-A) matching in 72 donor-recipient pairs indicated an improved graft survival when there was a match of 2 or more antigens, which is supported by the results recently reported by the Transplant Registry. The results of mixed lymphocyte reactions in 20 live donor-recipient pairs showed a marked improvement in graft survival when there was less than 20 per cent stimulation and it appeared that this reaction was of more important prognostic significance than the results of histocompatibility (HL-A) matching in these patients.

Azathioprine↗
PubMed1976

Management of urinary fistulas after renal transplantation.

Urinary fistulas developed in 13 of 134 patients after renal transplantation. Bladder fistulas originating from the anterior suture line in 6 patients were satisfactorily managed by urethral or paravesical drainage. Fistulas arising from the donor ureter were best treated by surgical repair using the recipient's own ureter. Caliceal fistulas in 3 patients were successfully treated with nephrostomy drainage. A favorable outcome was achieved in 11 of the 13 patients, with closure of the fistula and preservation of renal function.

Female↗
PubMed1976

Urologic complications of inflammatory bowel disease.

Urologic complications occurred in 54 of 233 patients with inflammatory bowel disease followed during a 15-year period. Urinary calculi, enterovesical fistulas and ureteral obstruction were the most common problems. Urinary tract complications may arise many years after primary bowel disease has been diagnosed. Symptoms frequently may be absent or obscured by those of the gastrointestinal disorder. We recommend that urologic evaluation be included periodically in the long-term management of patients with inflammatory bowel disease.

Adult↗
PubMed1976

The management of renal injuries.

Of 161 traumatic renal injuries analyzed for the period 1962-1975, 154 were due to blunt trauma and seven to penetrating wounds (5 gunshot wounds and 2 stab wounds). All the latter were treated by surgical exploration. Fifty-five patients had moderate injuries and 20 had severe injuries from nonpenetrating wounds and were managed without operation except for 10 cases that required surgical intervention. Of the patients with blunt trauma, 5% required nephrectomy, which is similar to the results reported with immediate operation. The other 79 patients (51%) with nonpenetrating injuries had only a renal contusion and were treated by bedrest and early ambulation. Conservative treatment is thus recommended for the more severe renal injuries; operative intervention is reserved for specific indications. The results of this approach are equal to those achieved by early surgical repair without subjecting a significant number of patients to an unnecessary operation.

Accidents, Traffic↗
PubMed1976

Reflux and trapping.

Although functional ureteral obstruction results in a decrease in the rate of antegrade urine flow, urine may still traverse the obstructed segment in a retrograde direction. Decreased musculature is found in the obstructing area. The combination of these processes results in reflux with trapping. This process has been demonstrated radiographically at both the ureterovesical and the ureteropelvic junctions.

Child, Preschool↗
PubMed1976

Compensatory renal adaptation after progressive renal ablation.

A quantitative study of compensatory adaptation in renal growth, function, and blood flow after progressive renal ablation was performed in the rat. Four weeks after surgery, renal mass increased 31% in control animals (Group A), 81% in nephrectomized rats with 50% ablation of total renal mass (Group B), and 168% in rats subjected to 75% ablation of total renal mass (Group C). Whole animal glomerular filtration rate (GFR) was reduced to 68% of control levels after nephrectomy (Group B), while renal blood flow (RBF) was 81% of control. Similarly, RBF was 68% of control in Group C with ablation of 75% of renal mass, while GFR was reduced to 49% of control. Since the adaptive increases in RBF exceeded those of GRF, the filtration fraction fell from 0.39 in Group A to 0.35 in Group B, and to 0.29 in Group C. Mean nephron GFR (whole animal GFR per total number of glomeruli) was 47 nl per min in Group A and increased 60% to 76 nl per min in Group B and 136% to 112 nl per min in Group C. Compensatory changes in mean nephron blood flow (RBF per total number of glomeruli) exceeded those of nephron filtration rate. Mean nephron blood flow increased from 215 nl per min in Group A to 404 nl per min in Group B (88%) and to 724 nl per min in Group C (237% over contol). These data indicate that the compensatory changes in growth, function, and blood flow after resection of renal mass correlate with the amount of tissue removed. Changes in RBF parallel but exceed those of mass and function, especially after extensive renal ablation. No apparent limitation to the compensatory response was seen under the conditions of this study.

Adaptation, Physiological↗
PubMed1976

Stress Urinary Incontinence.

Stress urinary incontinence (SUI) was studied in 125 women who were subjected to simultaneous urodynamic and radiologic evaluation. This included cystometry, urethral pressure profiles, measurement of effective urethral length, estimation of urethral mobility, and alterations in the urethrovesical angles during stress. The most common abnormality was a hypermobility of the proximal urethra with loss of its intraabdominal position during stress, associated with changes in the urethrovesical angle. Fixation of the posterior urethra, loss of effective urethral length, low resting urethral pressure, and true neurovesical dysfunction were also found in some of the patients. Uninhibited bladder contractions were found in 22% of cases, but in most instances they were the result of SUI and ceased after surgical repair.

Adolescent↗
PubMed1975

Pressure measurements in ileal conduits.

To study the dynamic properties of ileal conduits and to attempt to diagnose obstruction at an early point in time, that is prior to the development of conduit or upper urinary tract dilatation, a continuously perfused catheter technique was used to measure pressures within the conduit during filling and emptying, and to measure the resistance to flow at the stomal level. The mean values of residual urine, resting pressure, voiding pressure and stomal profile pressure were significantly higher in obstructed than in non-obstructed conduits. However, there was an overlap between values in each parameter, thus necessitating analysis of the entire pressure data in any given case. The data also show that even a small increase in residual urine above normal, 4.0 plus or minus 0.9 cc, may be an indication of early obstruction and that stomal caliber does not necessarily correlate with the degree of obstruction.

Child, Preschool↗
PubMed1975

Rejection episodes and patient and graft survival after renal transplantation.

The occurrence of acute rejection episodes following renal transplantation was correlated with one-year patient mortality and graft failure rates in a series of 102 consecutive transplant recipients. Twenty-one patients had two or more rejection episodes in the first two months post transplantation; 17 of these expired or lost their kidney compared to only 5 of 28 patients with no rejection episodes in this time period. Similarly, of the 14 patients who developed a second rejection episode 2--6 months post transplantation, 8 died or lost the graft compared to only 2 of 21 patients who had no rejection episodes in this time period. Thus, the development of a second rejection episode early after transplantation necessitating treatment with high dose prednisone therapy carries an ominous prognosis and suggests that serious consideration must be given to graft removal and subsequent retransplantation.

Cell Biology↗