Biomedical subjects
Publications and source records attributed to D M Barrett.
A patient with bilateral localized amyloidosis of the ureters is described. This is the first case to be reported in which anuria was the presenting symptom, the second case with bilateral involvement and the thirteenth case of amyloidosis localized to the ureter. Careful urologic and hematologic followup is indicated.
The records of 34 patients who underwent ureterosigmoidostomy after pelvic irradiation were reviewed and the incidence of complications was found to be similar to that in other series of ureterosigmoidostomy without prior irradiation. No difference was established between the use of linac or cobalt 60 therapy in relation to postoperative complications. No conclusions could be reached concerning the effect of the preoperative dose of radiotherapy on the operation because of the small number of patients but it did appear that the incidence of postoperative complications was great after doses in excess of 5,000 rads. Ureterosigmoidostomy after pelvic irradiation is considered to be a feasible procedure with doses of less than 5,000 rads.
An operation was required in 78 children with vesical diverticula in the absence of bladder outlet obstruction. Virtually all diverticula were located in juxtaposition to the ureteral orifice and were associated with vesicoureteral reflux in all but 6 of 89 diverticulum-ureteral units. Upper tract changes were seen on excretory urography in 78 per cent of the refluxing units. The surgical procedure of choice was diverticulectomy and ureteroneocystostomy, which yielded a high degree of success. Diverticulectomy alone and vesical neck revision were rarely indicated.
The great diversity of the various forms of renal cystic disease results in a formidable diagnostic challenge to the roentgenologist and clinician alike. Until recently, adequate diagnosis required surgical exploration or biopsy, or both, to establish benignity or to confirm the suspicion of a more esoteric form of renal cystic disease. Now, however, with refinements in excretory urography with tomography, bolus and infusion nephrotomography, selective renal arteriography, percutaneous aspiration of cysts, and sonography, the accuracy of a clinical diagnosis of cystic disease has approached that of surgical exploration and biopsy. In addition these noninvasive techniques eliminate the morbidity and mortality associated with surgical procedures.
There appears to be a spectrum of psychogenic urinary retention that is seen mostly in women. The degrees of psychiatric disorder and bladder disorder do not necessarily coincide. Some patients with psychogenic retention may have one acute episode temporally related to psychologic trauma. Others may present with problems related to large residual volumes such as recurrent urinary tract infection or incontinence. All patients require complete neurologic, urologic, and psychiatric evaluation. Permanent urethral catheterization is avoided if possible. Intermittent self-catheterization should be used during periods of psychotherapy and bladder training. Patients with neurogenic bladder, as determined by urodynamic studies, should be managed by bladder training and the use of pharmacologic agents when indicated.
Twelve patients with ureteral diverticula encountered in a 25-year period are presented. Although the potential for the development of such lesions may arise from congenital maldevelopments, we believe that in the natural history much depends on the abnormal hydrodynamic states that may be acquired in childhood or adult life. Ureteral diverticula are frequently asymptomatic, requiring no treatment.
Surgical management of 100 children with abnormalities related to ureteral duplication is reviewed. In general, separation of the distal portions of the double ureters is avoided, at least during the initial procedure, because this maneuver represents a significant risk to the blood supply and hence to the integrity of the remaining ipsilateral ureter. Complete ureteral duplication with vesicoureteral reflux is best managed initially by reimplantation of the duplex unit. On the other hand, upper segment heminephrectomy with subtotal ureterectomy is the initial treatment of choice for ureters ending ectopically with or without ureterocele.
Explore the source record for details and available documents.
The Euplotes crassus macronuclear DNA molecule containing the conjugation-specific conN1 gene has been sequenced, along with a cDNA clone. The results indicate that the conN1 gene encodes a protein similar to the transcription elongation factor TFIIS proteins identified in other eukaryotes.
BACKGROUND: The current, arbitrarily defined gold standard for the diagnosis of H. pylori infection requires histologic examination of two specially stained antral biopsy specimens. However, routine histology is potentially limited in general clinical practice by both sampling and observer error. The current study was designed to examine the diagnostic performance of invasive and non-invasive H. pylori detection methods that would likely be available in general clinical practice. METHODS: The diagnostic performance of rotating clinical pathology faculty using thiazine staining was compared with that of an expert gastrointestinal pathologist in 38 patients. In situ hybridization stains of adjacent biopsy cuts were also examined by the expert pathologist for further comparison. Receiver operator characteristic (ROC) analysis was performed to evaluate whether the diagnostic performance of the expert pathologist differed depending upon the histologic method employed. A similar analysis was made to evaluate the diagnostic performance of pathology trainees relative to the expert. In the absence of an established invasive gold standard, non-invasive testing methods (rapid serum antibodies, formal Elisa antibodies and carbon-14 urea breath testing) were evaluated in 74 patients by comparison with a gold standard defined using a combination of diagnostic tests. RESULTS: Using either rapid urease testing of biopsy specimens or urea breath testing as the gold standard for comparison, the diagnostic performance of the rotating clinical pathology faculty was inferior to that of the expert gastrointestinal pathologist especially with regard to specificity (e.g., 69 percent for the former versus 88 percent, with the latter relative to rapid urease testing). Although interpretation of in situ hybridization staining by the expert appeared to have an even higher specificity, ROC analysis failed to show a difference. The mean ROC areas for thiazine and in situ hybridization staining for trainee pathologists relative to the expert were 0.88 and 0.94, respectively. In untreated patients, urea breath testing had a sensitivity and specificity of 100 percent as compared with thiazine staining with a sensitivity of 83 percent and a specificity of 97 percent. Post-therapy, breath testing had a sensitivity of 100 percent but a specificity of only 86 percent as compared with invasive testing with a sensitivity and specificity of 100 percent. Rapid serum antibody testing and formal Elisa antibody testing agreed in 93 percent of cases (Kappa 0.78) with the rapid test being correct in three of the four disagreements. CONCLUSIONS: The current study illustrates a number of realities regarding H. pylori diagnosis. There is no diagnostic gold standard in general clinical practice. Accurate interpretation of specially stained slides is a learned activity with a tendency towards overdiagnosis early on. Urea breath testing is likely to be the diagnostic method of choice for untreated patients in general clinical practice although antibody testing is almost as accurate. Rapid antibody tests are at least as accurate as formal Elisa antibody tests. Urea breath testing is useful for confirming cure after therapy, but false-positive results may occur in some patients.