Biomedical subjects
Publications and source records attributed to C F Firlit.
A patient with an ileal conduit diversion after cystectomy for carcinoma of the bladder is seen with cirrhosis and portal hypertension. Massive bleeding from the peristomal varices developed. Our experiences with conservative treatment is outlined.
Urodynamic studies were done on 50 children with voiding pattern abnormalities, characterized by daytime incontinence, damp pants, nocturnal enuresis, frequency and recurrent urinary tract infections. These studies included cystometry, uroflowmetry and pelvic floor/external urethral sphincter electromyography. Of the 50 children studied 37 were treated with various pharmacological agents based on 8 recognized urodynamic patterns. Thirty-one children (84 per cent) became totally asymptomatic while on pharmacotherapy and 4 (11 per cent) demonstrated marked improvement in clinical symptoms during the course of this study. Appropriately directed urodynamic studies and treatment with specific pharmacological agents can treat (retrain) effectively children with voiding pattern abnormalities.
Voiding abnormalities are encountered frequently in pediatric patients. Symptoms of daytime incontinence, frequency and nocturnal enuresis in any combination may indicate underlying neurophysiologic detrusor imbalance. Incomplete evaluation of these symptoms can result in inappropriate medical therapy or even ineffective operations. Within the preceding 7 months 34 children with hard-core voiding abnormalities were evaluated with urodynamic techniques. Several categories of abnormal voiding patterns were identified, including the hyperactive external sphincter, uninhibited pediatric neurogenic bladder, detrusor hyperreflexia secondary to chronic cystitis, hyperactive external sphincter with hypotonic bladder and the hyperactive external sphincter with detrusor irritability. All patients received specific pharmacotherapy based on presenting signs and symptoms, and voiding pattern abnormality. Of the 24 patients who have been treated in this manner and were evaluated 83.5% have had complete remission of symptoms while on therapy, the remainder being improved but still having occasional symptoms. The technique and data demonstrate that children with hard-core voiding abnormalities can achieve rehabilitation with urodynamic assessment.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Forty-two children with voiding pattern abnormalities (wetting, incontinence, inappropriate voiding) were evaluated by urodynamic techniques. All patients were urologically evaluated and carefully appraised of the mechanics of the urodynamic testing procedure. All patients demonstrated good cooperation in an anxiety-free atmosphere. Twenty-three abnormal bladder types were identified and characterized. Specific pharmacologic and urologic modalities were applied to achieve improved or normal micturition.
Our experience with the use of ileal conduits as receptors of renal homografts in 5 of 41 transplant recipients during the preceding 4 years is described. These 5 chronic renal failure patients were between 6 months and 17 years old, and had unsalvageable bladders that required an ileal conduit at an elective time before transplantation. The causes of renal failure in these children included dysplasia and chronic urinary tract infection. In an attempt to retard the rate of renal insufficiency all patients underwent multiple operative procedures on the lower urinary tract. Two cadaveric and 3 kidneys from living relatives were transplanted. One infant (6 months old) died of severe fluid and electrolyte imbalance 5 days post-transplantation. Of the remaining patients 3 are now 2 to 3 1/2 years post-transplantation and exhibit normal homograft function, and 1 died recently of chronic rejection. All conduits functioned well without evidence of ureteroileal obstruction, significant infection or stomal stenosis.
Simultaneous recording of intravesical pressure, urine flow rate and anal sphincter electromyography was undertaken in 25 children with a variety of urological problems. Urethral pressure profile measurement was obtained in 3 of these patients and was used as an adjunct to cystometry alone in 5 others. The diagnostic patterns that emerged were useful in selecting specific pharmacologic and surgical therapeutic measures.
Voiding abnormalities are encountered frequently in pediatric patients. Symptoms of daytime incontinence, frequency and nocturnal enuresis in any combination may indicate underlying neurophysiologic detrusor imbalance. Incomplete evaluation of these symptoms can result in inappropriate medical therapy or even ineffective operations. Within the preceding 7 months 34 children with hard-core voiding abnormalities were evaluated with urodynamic techniques. Several categories of abnormal voiding patterns were identified, including the hyperactive external sphincter, uninhibited pediatric neurogenic bladder, detrusor hyperreflexia secondary to chronic cystitis, hyperactive external sphincter with hypotonic bladder and the hyperactive external sphincter with detrusor irritability. All patients received specific pharmacotherapy based on presenting signs and symptoms, and voiding pattern abnormality. Of the 24 patients who have been treated in this manner and were evaluated 83.5 per cent have had complete remission of symptoms while on therapy, the remainder being improved but still having occasional symptoms. The technique and data demonstrate that children with hard-core voiding abnormalities can achieve rehabilitation with urodynamic assessment.
Explore the source record for details and available documents.
Congenital urinary tract anomalies are common causes of renal insufficiency and failure in children. Frequently, the hydroureteronephrosis and/or bladder damage from previous reconstructive procedures is so severe that supravesical diversion is required. Renal transplantation in these cases is sometimes avoided because of implied urologic and infectious complications, and the early loss of the homograft. Nevertheless, newer techniques have been developed for transplantation in patients with end stage renal disease and defunctionalized bladders. Herein is described the use of defunctionalized bladders as receptors of renal homografts in 5 of 42 transplant recipients seen during the last 4 years.
Urinary cytology from 29 pediatric renal homograft recipients was evaluated for the presence of polyribosomal-rich (pyroninophilic) lymphocytes during an 8-month period. Seven episodes of acute (cell-mediated) rejection occurred in 21 cadaveric renal recipients. No episodes of rejection occurred during this period in the living-related recipients. Each episode of rejection was associated with significant polyribosomal-rich lymphocyturia 5 to 11 days before the onset of clinical rejection as diagnosed by conventional methodology. In addition, significant lymphocyturia occurred 1 to 3 days before and simultaneous with a sustained elevation in serum creatine. Falsely positive assays demonstrating occasional to 1 plus (less than 10 per cent) ribosomal-rich lymphocyturia occurred in 10 of 29 patients. None of these falsely positive-reacting patients demonstrated acute rejection. In our experience the urinary assay for polyribosomal-rich lymphocytes proved to be an early indicator of acute rejection. It is hoped that by early institution of antirejection therapy based on this parameter homograft rejection may be aborted or its severity diminished.
The testicular capsule of the human has been prepared for the first time as an isolated tissue suitable for pharmacological investigation. Cholinergic and adrenergic agents caused a contraction of the isolated testicular capsule. In addition, periodic spontaneous contractions of the isolated testicular capsule had been observed in the absence of any added pharmacological agents. The present experiments have demonstrated that the testicular capsule contains smooth muscle, thereby offering a reasonable anatomical explanation for spontaneous and drug-induced contractions of the testicular capsule. Therefore, it appears likely that the rhythmic contractions and relaxations of the testicular capsule provide a pumping action capable of explaining the transport of non-motile sperm out of the testes into the epididymis where they can attain their motility.
Intermittent catheterization was used as a method to achieve reflex voiding and a catheter-free status in 111 chronic spinal cord injury patients. Of this group 70 patients achieved reflex (automatic) voiding within 90 days, or a mean of 19 days. Five patients required transurethral incision of the external urethral sphincter after achievement of automatic voiding because of elevated residual urine. Chronic urinary tract infection persisted in 16 per cent of the patients after completion of the program. No sequelae occurred because of the coexistent urinary tract infection. An 18-month followup disclosed stability in renal function and appearance of pyelograms. Urethral, scrotal and bladder complications secondary to chronic indwelling urethral catheters have been eliminated in these patients. Patient endorsement and enthusiasm have been spectacular and have overwhelmingly contributed to an ongoing, successful program.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.