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Biomedical subjects

D E Neal

Publications and source records attributed to D E Neal.

At least 217 records · Page 12Linked to original sources
PubMed1990

Ultrasonography in the differentiation of complicated and uncomplicated acute pyelonephritis.

Differentiation of uncomplicated pyelonephritis versus complicated pyelonephritis has always been problematic. No clear physical signs or symptoms are diagnostic. To study differences between the two, we retrospectively reviewed charts of patients admitted to Charity Hospital, New Orleans, with febrile urinary tract infections. Criteria for inclusion were pyuria, positive urinary culture, and signs or symptoms of pyelonephritis. All patients underwent renal ultrasonography (US) before other diagnostic tests. US identified a potential emergency (hydronephrosis or abscess) in 11 of 98 patients (11.2%). The only significant contributing factor was the presence of diabetes mellitus, which was present in five of 11 emergent conditions and eight of 73 of the remainder (P = 0.003). US is inexpensive, easily obtainable in the emergency room, and sensitive enough to screen patients with pyelonephritis for complications. However, we believe it is mandatory in diabetics, because of the high incidence of abnormalities in this population.

Acute Disease↗
PubMed1990

Clean intermittent self-catheterisation in 172 adults.

We report the results of clean intermittent self-catheterisation (CISC) in 172 adults (68 male, 104 female). Seven patients were unable or unwilling to master the technique and 145 still remain on CISC, representing a total experience of 6981 patient-months. Ten patients required readmission: 5 for retraining and 5 for complications (average hospital stay 2.4 days); 123/163 patients catheterised themselves every 3 to 4 h and 92 were continent on CISC; of the 107 patients incontinent prior to starting CISC, 101 were improved; 70 patients had no infections whilst on CISC, the mean infection rate being 1 per 14 patient-months; 29% of patients experienced persistent urethral bleeding; 156/163 patients were satisfied or very satisfied with CISC and 140 found the technique easy or very easy; 76 patients had never visited their GP for a urinary problem whilst using CISC and the mean rate was 1 visit per 8 patient-months. CISC is an easily learnt technique that is safe and acceptable to patients, and one which places few extra burdens on hospital or community resources.

Adolescent↗
PubMed1990

Acquired venous disease of the lower urinary tract.

Thrombosis of the vena cava, femoral veins or iliac veins can result in the formation of large collateral veins in the pelvis and retroperitoneum which are often asymptomatic but which may cause severe bleeding and produce major difficulties in urological management. Such abnormalities are a rare cause of urological symptoms but may be difficult to diagnose unless a high index of suspicion is maintained. Three patients are reported who developed significant urological problems as a consequence of acquired venous disease; the use of ultrasound, venography and CT in the diagnosis of this condition is described.

Adolescent↗
PubMed1990

Measurement of voiding pressures on ambulatory monitoring: comparison with conventional cystometry.

A series of 20 patients underwent conventional medium fill cystometry (CMG) and ambulatory monitoring during natural bladder filling (AM). The measurement of voiding pressures by the 2 techniques was compared. The maximum subtracted detrusor contraction pressure recorded during CMG (50 +/- 30 cm H2O) was significantly less than that recorded during AM (86 +/- 35 cm H2O). Voiding pressures during natural filling are greater than those observed during conventional urodynamic studies: this finding may have important implications in the definition of bladder outflow obstruction.

Adult↗
PubMed1990

Cell cycling in bladder carcinoma determined by monoclonal antibody Ki67.

Current methods of predicting prognosis in transitional cell carcinoma of the bladder fail to provide consistently reliable information about future tumour behaviour. The monoclonal antibody Ki67 recognises an antigen present in actively dividing cells and Ki67 reactivity has been shown to correlate with conventional prognostic indicators in several tumours. In this study, Ki67 antibody was used to determine the proportions of cells undergoing active division in 26 transitional cell carcinomas of the bladder. The proportion of cells stained in muscle invasive tumours (12.3 +/- 5.4%) was significantly greater than in superficial tumours (4.3 +/- 1.9%) and poorly differentiated tumours showed significantly greater proportions of cells staining compared with well or moderately well differentiated tumours. These results show that Ki67 reactivity correlates with high tumour stage and poor differentiation. Ki67 staining provides an easy method of determining tumour cell turnover that might provide additional prognostic information.

Antibodies, Monoclonal↗
PubMed1990

Vasoactive intestinal peptide stimulation of human renal adenylate cyclase in vitro.

1. A direct action of vasoactive intestinal peptide (VIP) upon human kidney was sought by measurement of renal adenylate cyclase in tissue homogenates and plasma membranes isolated from tissue samples excised for therapeutic reasons. 2. VIP (1 microM) produced a mean stimulation of adenylate cyclase activity of 3.5-fold compared to basal values in cortical plasma membranes; comparative stimulations of 2.8-fold and 27.3-fold were obtained with 1 microM-glucagon and 1 microM-h(1-34) parathyroid hormone respectively. 3. Half-maximal stimulation of human renal cortical plasma membrane adenylate cyclase was observed with a mean value of 35 nM-VIP. 4. The stimulation of renal adenylate cyclase by VIP appeared to be specific because stimulation by glucagon was additive to that obtained with VIP, and the VIP receptor antagonist (4 Cl-D-Phe6, Leu17)-VIP inhibited the VIP-dependent stimulation of adenylate cyclase activity.

Adenylyl Cyclases↗
PubMed1989

Characterization and quantitation of the epidermal growth factor receptor in invasive and superficial bladder tumors.

Epidermal growth factor receptors (EGFr) have been measured on primary human bladder tumor membranes by 125I-EGF ligand binding. High affinity receptors were detected on both superficial (Kd 0.2-1.45 nM; mean, 0.86 nM; median, 0.88 nM) and invasive tumors (Kd 0.19-2.38 nM; mean, 0.9 nM, median, 0.79 nM). There was one class of binding sites and EGFr concentration was quantified by competitive binding and Scatchard analysis. The EGFr was further characterized and shown to be cleaved at the major autophosphorylation site by a calcium-activated mechanism. Thus the EGFr from primary bladder tumors exhibits similar biochemical characteristics to those in established cell lines. Tumors classified as invasive on the basis of muscle invasion had higher EGFr levels [EGF binding, 99 +/- 252 (SD) fmol/mg protein; median, 21; n = 24] than superficial tumors (12 +/- 12 fmol/mg protein; median, 11; n = 23) or normal bladder mucosa (9 +/- 12 fmol/mg protein; median, 6; n = 6) (P = 0.05). When the two largest subgroups of superficial and invasive tumors were compared (15 pTa, 16 T3), the invasive tumors had significantly higher EGFr levels (P less than 0.05). EGFr may therefore be involved in mechanisms of tumor progression. EGFr may be a target for selective therapy with EGF-linked drugs in a subset of invasive bladder cancers.

Aged↗
PubMed1989

Outcome of elective prostatectomy.

OBJECTIVES: To determine the symptomatic and urodynamic outcome of elective prostatectomy and to establish whether the outcome is influenced or can be predicted by preoperative urodynamic measurements. DESIGN: Prospective non-randomised study with follow up at a mean of 11 months after operation. Most men were assessed jointly by a urologist and a general practitioner. SETTING: Department of urology in a teaching hospital serving a large district population. PATIENTS: 253 Men listed for elective prostatectomy because of symptoms and low urinary flow rates (less than 15 ml/s) and excluding those already on a waiting list or with acute urinary retention, clinically apparent prostatic cancer, and neurological or cerebrovascular disease; 217 (86%) were followed up. INTERVENTION: Elective prostatectomy. MAIN OUTCOME MEASURE: Classification on the basis of relief of symptoms assessed by patients and urologist and general practitioner and of symptom scores obtained by questionnaire. RESULTS: Of the 217 men followed up, 171 (79%) had a satisfactory subjective review and 155 (72%) had a satisfactory review and also low symptom scores. An unsatisfactory outcome was associated with preoperative symptoms of urge incontinence, small prostatic size and resected weight, low voiding pressures, and low urethral resistance. Preoperative maximum urinary flow rates did not predict outcome. Men with poor outcome could be classified into two groups: those with irritative symptoms who were more likely before operation to have had urge incontinence and detrusor instability and men with symptoms of poor urinary flow who were more likely before operation to have had a small prostate, low voiding pressures, and low urethral resistance. In patients in the second group flow rates or voiding pressures improved little after operation. Men with stable detrusors and either low urethral resistance or low voiding pressures were less likely to do well after prostatectomy, but despite these associations preoperative urodynamic measurements were unable to predict outcome accurately. CONCLUSIONS: Prostatectomy was satisfactory in relieving symptoms and improving urodynamic measurements in most men, but even in those with classic symptoms and low urinary flow rates a substantial minority experienced little improvement afterwards and urodynamic measurements did not accurately predict outcome in individual patients.

Follow-Up Studies↗
PubMed1989

Urodynamic investigation of the ileal conduit: upper tract dilatation and the effects of revision of the conduit.

Urodynamic studies of the ileal conduit were performed in 36 patients with normal upper urinary tracts (controls) and in 32 who had progressive upper tract dilatation within 6 years preceding the study. In controls the conduit emptied mainly by means of low pressure, to-and-fro activity. In contrast, high frequency, high amplitude peristaltic activity was found commonly in patients with upper tract dilatation, such activity being consistent with obstruction of the distal conduit. Of the 32 patients with upper tract dilatation 17 underwent reoperation on the conduit as well as postoperative urodynamic studies. Among these 17 patients a decrease was observed in basal pressure in the conduit postoperatively compared to preoperatively (5 +/- 4 and 12 +/- 6 cm. water, p less than 0.001). A decrease also was found postoperatively in the frequency (4 +/- 6 and 36 +/- 28 per hour, p less than 0.001) and amplitude (34 +/- 47 and 61 +/- 28 cm. water, p less than 0.001) of peristaltic activity. Radiological improvement in the appearance of the upper urinary tracts was found in 9 patients (53 per cent) postoperatively. These findings support the hypothesis that upper tract dilatation in certain patients with an ileal conduit may be caused by high pressure activity in the presence of free ureteral reflux. Such abnormalities, which are probably the result of obstruction of the distal conduit, may be detected by means of urodynamic evaluation and may be corrected by revision of the conduit.

Adult↗
PubMed1989

Ambulatory monitoring of bladder and detrusor pressure during natural filling.

We have developed a system to perform fully ambulatory monitoring studies of the bladder. Bladder and rectal pressures are recorded during natural filling of the bladder for up to 6 hours. This system has been evaluated in 19 studies performed on 15 patients. The mean duration of the studies was 3 hours 51 minutes (standard deviation +/- 1 hour 3 minutes) and the mean number of voids per patient was 3.8 +/- 2.2. Visual inspection of the recorded data showed that subtraction of the rectal trace from the bladder trace provided a useful detrusor trace when subjects were ambulant as well as resting. When ambulant, movement caused typical peak-to-peak pressure variability in the bladder and rectal traces of approximately 30 +/- 20 cm. water (mean and standard deviation of peak-to-peak pressure for typical ambulant 5-minute sections for each patient), which after subtraction was reduced on the detrusor trace to 10 +/- 5 cm. water. The equivalent figures when resting were 9 +/- 5 cm. water, subtracting to less than 5 cm. water for the detrusor. Further measurements also were calculated for the whole of each trace. The system provided good quality recordings and should prove useful in future evaluations of natural fill urodynamic studies.

Adult↗
PubMed1989

Epidermal growth factor receptor in human bladder cancer: a comparison of immunohistochemistry and ligand binding.

Epidermal growth factor receptors were measured in biopsies from patients with newly diagnosed bladder cancer. Two methods to detect these receptors were compared: immunohistochemical staining of frozen sections, and a ligand binding study using radiolabeled epidermal growth factor and tumor cell membranes. We studied 101 patients by immunohistochemistry and 47 patients by both methods. An association was found between immunohistochemical positivity for epidermal growth factor receptors and high tumor stage (p less than 0.001). Thus, most of the muscle invasive tumors were positive (35 of 49, 71 per cent) and more stage pT1 tumors were positive (8 of 18, 44 per cent) than were stage pTa tumors (5 of 34, 15 per cent, p less than 0.05). The ligand binding study was slightly more sensitive in detecting receptors than immunohistochemistry (30 of 47, 64 per cent and 25 of 47, 53 per cent, respectively). Greater amounts of receptors were found in muscle invasive tumors compared to tumors not invading muscle (p less than 0.05). A significant association was found between the 2 methods in the detection of receptors (p less than 0.001) and no discrepancies were found between the 2 methods in tumors containing high levels of receptors. Immunohistochemistry provides a satisfactory method to detect receptors in tumors with high levels of receptors, although ligand binding is more sensitive in tumors with low levels of receptors.

Adult↗
PubMed1989

Ambulatory monitoring of bladder pressures in patients with low compliance as a result of neurogenic bladder dysfunction.

A group of 28 patients with neurogenic bladder dysfunction and low bladder compliance was studied using medium fill cystometry (CMG) and ambulatory monitoring (AM) during natural bladder filling. The aims of the study were to compare the 2 techniques and to determine if ambulatory monitoring might be useful in predicting upper tract dilatation. AM demonstrated significantly lower end filling pressures compared with CMG. Phasic detrusor contractions were found more commonly during AM and the frequency of phasic detrusor contractions during AM was associated significantly with poor compliance identified during CMG. Patients with upper tract dilatation had significantly greater residual urine volumes, higher pressure rises during CMG and higher frequencies of phasic detrusor contractions compared with those patients with normal upper tracts. The high pressures seen at the end of a medium fill CMG were not found during AM and therefore are unlikely to be the underlying explanation of upper tract dilatation in such patients.

Adolescent↗