Lithotripsy in the treatment of urinary calculi.
Explore the source record for details and available documents.
Endoscopy↗
Biomedical subjects
D R Webb
Publications and source records attributed to D R Webb.
Methotrexate in the treatment of steroid-dependent asthma.
A 63-year-old woman with refractory psoriatic arthritis and asthma, requiring intermittent steroid therapy, was treated with methotrexate (MTX). Her arthritis responded rapidly and it was noted that her asthma required no further steroid therapy. Six patients with established steroid-dependent asthma were then treated with 7.5 to 15.0 mg of MTX per week, after protocols used to treat psoriasis and rheumatoid arthritis. Five patients reduced their steroid usage while on MTX. Side effects were minimal while taking MTX. It was concluded that MTX may have a role in reducing cortisone requirements in steroid-dependent asthma.
Asthma↗
Extracorporeal shock wave lithotripsy: the first 50 patients treated in Britain.
Fifty patients have been treated for upper tract urinary calculi by extracorporeal shock wave lithotripsy (ESWL) at the Devonshire Hospital lithotripter centre since November 1984. The average stay for an inpatient was 3 X 7 days. All patients suffered minimal postoperative discomfort and nearly all resumed normal activity within one day after discharge. Complications requiring auxiliary procedures were few. The procedure was found to be safe, cost effective, extremely well received by patients, and superior to all other methods of removing renal stones. This study confirms that treatment by ESWL is a specialised urological procedure that requires operators who are also trained in open, percutaneous, and ureteroscopic surgery and with a back up of a radiological team skilled in percutaneous renal puncture.
Adult↗
Bitolterol and albuterol metered-dose aerosols: comparison of two long-acting beta 2-adrenergic bronchodilators for treatment of asthma.
In this double-blind, parallel, single-dose study, bitolterol mesylate aerosol (three sprays, 1.11 mg) and albuterol aerosol (two sprays, 180 mcg) were compared for efficacy of bronchodilation in 120 adolescent and young adult patients with moderate to severe asthma. All patients required regular medications for asthma control. None was steroid dependent. Both medications gave effective bronchodilation within 5 min with maximum effect at 30 to 60 min. Mean percent increase in forced expiratory volume in 1 sec (FEV1) over baseline was higher for bitolterol than for albuterol at all test times up to 8 hr after a dose at which time 20% mean percent increase of FEV1 over baseline was still present in the bitolterol-treated patients. With albuterol mean percent increase in FEV1 fell to 15% over baseline at 5 hr after a dose. Differences in FEV1 increase between the two treatment groups were statistically significant at 4 to 8 hr after a dose. Patients with baseline FEV1 less than 50% of predicted normal had a response to bitolterol that was higher than that observed with albuterol treatment (p less than 0.1). Mean maximum percent increase in FEV1 and median duration of bronchodilation were greater with bitolterol than with albuterol, but the differences were not statistically significant. Both bitolterol aerosol and albuterol aerosol were demonstrated to be safe, effective, and long-acting bronchodilating agents. Both bitolterol and albuterol administered by aerosol had a rapid onset, and the maximum degree of bronchodilation was comparable. However, at the doses studied, bitolterol produced significantly higher increase in FEV1 over baseline at longer times after medication than did albuterol.
Adolescent↗
Percutaneous nephrolithotripsy: a functional and morphological study.
Percutaneous removal of renal calculi requires a nephrostomy track, irrigation and lithotripsy. The purpose of this study is to investigate the effects of these procedures on renal function and anatomy. Renal access was obtained through a small left subcostal incision and a 22 Ch nephrostomy track was formed by fine parenchymal puncture and serial dilation in 15 dogs. Three liters of glycine solution were perfused through these tracks. In a further 16 dogs, human calculi were placed transparenchymally in the renal pelvis and disintegrated under vision through the Wolf nephroscope using an ultrasonic probe in 8 and electrohydraulic probe in 8. Assessments were made in all animals at 48 hours or 6 weeks by creatinine clearance, microfil casts, contrast radiography and ex-situ conventional and digital subtraction angiography. There was no significant urinary leakage or bleeding from the nephrostomy track at 48 hours. There was a small track hematoma and at 6 weeks a surface dimple and fine linear parenchymal scar. There was no ureteric or pelvic damage. Microfil casts showed small track defects at 48 hours resolving to a fine scar at 6 weeks. All angiograms were normal. Some IVU's displayed minor track defects at 48 hours but all were normal at 6 weeks. Corrosion casts and subtraction angiography demonstrated no significant vascular defects. Creatinine clearance showed no significant difference between experimental and control sides. Occasionally, intra pelvic scatter of fine calculus fragments was seen at 48 hours but none was detectable at 6 weeks. Transparenchymal nephrostomy, irrigation and nephrolithotripsy caused initial minor anatomical defects that rapidly resolved and were not associated with any loss of renal function.
Animals↗
Antigen-specific factors: an overview.
Explore the source record for details and available documents.
Animals↗
GAT antigen-specific suppressor factors.
Explore the source record for details and available documents.
Animals↗
Anaesthesia for extracorporeal shock wave lithotripsy.
The anaesthetic considerations of patients presenting for extracorporeal shock wave lithotripsy are described. Regional anaesthesia with sedation may be preferable to general anaesthesia for patients undergoing this form of therapy. If regional anaesthesia is contra-indicated, general anaesthesia using controlled ventilation with muscle relaxation, supplemented with a narcotic and a low concentration of volatile anaesthetic has been found to be a suitable alternative. The additional epidural preparation time has to be balanced against the benefits of easier patient transfer, especially during multi-stage procedures, and better postoperative analgesia. The epidural catheter can be left in situ in patients who require multiple treatments or who may experience severe ureteric pain as the resulting 'sand mass' is passed. Epidural space localisation using a 'loss of resistance to saline' technique is recommended, in order to avoid the possible risk of damage to the spinal cord and emerging nerves (due to the presence of an air-water interface). Patients with cardiac insufficiency need special consideration, in view of the effects of immersion on right and left heart filling pressures.
Adult↗
A strategy for management of upper tract calculus disease.
Extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and ureterorenoscopy now mean that approximately 98% of all renal and 85% of all ureteric calculi can be treated effectively, without recourse to open operative intervention, in centres possessing the necessary equipment and expertise. Experience with these techniques allows us to propose a strategy for the surgical treatment of upper tract stone disease.
Humans↗
Simple aid to ureteroscopy.
Initial experience with the rigid ureteroscope showed that despite ureteral dilation and guide wire followers, introduction of the ureteroscope can be difficult due to bladder mucosa catching on the instrument. A simple, cheap disposable device using a modified ureteric catheter is presented that overcomes this problem.
Catheterization↗
A canine model for the investigation of human calculus disease.
The rapid development of new methods for the treatment of renal calculi requires an animal model to assess the efficacy of stone treatment in vivo. This requires the implantation of human calculi large enough to be easily imaged radiologically. Most previous models have required multiple operative procedures and ureteric obstruction which has confused results. This study demonstrates the one-stage insertion of human calculi into the canine renal pelvis through a nephrostomy which does not affect the collecting system or cause any significant functional or structural damage to the kidney.
Animals↗
Purification and partial characterization of a monoclonal "second order" suppressor factor specific for L-glutamic acid60-L-alanine30-L-tyrosine10.
A GAT-specific "second order" suppressor T cell factor (TsF2) from the hybridoma 762 B3.7 has been purified and biochemically characterized. The protein has a m.w. of approximately 66,000, an isoelectric point of 6.8 to 6.9, and elutes from a reversed phase HPLC column in two peaks, one in 55% acetonitrile, the other in 70% propanol. Amino acid analysis of both forms gave similar molar ratios, suggesting that the two forms are closely related and may differ mainly in the degree of posttranslational modification. SDS-PAGE electrophoresis under reducing conditions gave two chains of the apparent m.w. of 42,000 and 35,000.
Animals↗
Chemical identification of a prostaglandin-induced T suppressor (PITS).
Prostaglandin E1 is known to block the activation and function of immunocompetent cells. Previous studies from this laboratory have established that one pathway where prostaglandin E1 acts involves the stimulation of a glass-wool adherent T-suppressor cell. Prostaglandin stimulates this suppressor cell to release a suppressor lymphokine(s), termed the prostaglandin-induced T cell-derived suppressor (PITS). We report here the further characterization of this factor using high-pressure liquid chromatographic analyses, precursor labeling studies, and bioanalysis, all of which indicate that this factor contains a leukotriene.
Animals↗
Purification and analysis of isoforms of soluble immune response suppressor (SIRS).
Soluble immune response suppressor (SIRS) isolated from the T cell hybrid 393D2.6 was originally reported to exist as at least two m.w. forms and to migrate on reverse-phase high-performance liquid chromatography columns as three separate species. In experiments presented here, a further analysis of the different chromatographic forms of SIRS has been carried out. SIRS-alpha elutes from C-18 reverse-phase columns in 20% propanol. When SIRS-alpha is subjected to isoelectric focusing, three biologically active species are isolated at approximately pH7, approximately pH6, and approximately pH5 (SIRS-alpha 7, SIRS-alpha 6, and SIRS-alpha 5, respectively). SIRS-beta elutes in 30% propanol, and on isoelectric focusing the biologic activity is found only at approximately pH7 (SIRS-beta 7). Both the alpha and beta forms of SIRS have nearly identical m.w. when subjected to molecular sieve chromatography and migrate with a m.w. of 11,000. The molecular basis for these isoforms is not yet clear but is consistent with earlier studies showing two separate messenger RNA species coding for SIRS.
Animals↗
Extracorporeal shockwave lithotripsy, endourology and open surgery: the management and follow-up of 200 patients with urinary calculi.
The management and follow up of 200 consecutive patients with renal and ureteric calculi are presented. The primary treatment of 185 (92.5%) was by extracorporeal shockwave lithotripsy (ESWL), of whom three (1.6)%) with large calculi underwent percutaneous nephrolithotripsy (PCNL) prior to ESWL as a planned combined procedure. Twelve (6%) were treated by PCNL or ureterorenoscopy (URS) as their definitive treatment and three (1.5%) by conventional open renal and ureteric surgery. The average in-patient stay was 3.8 days and most returned to normal activity within one day of discharge. Of the 185 patients 102 (55%) required no analgesia after treatment by ESWL, 29 (15.6%) required parenteral analgesia and the rest were comfortable with oral non-narcotic medication. Thirty (16%) required auxillary treatment by percutaneous nephrostomy (PCN), PCNL and URS following ESWL for obstructive complications from stone particles. Two required further ESWL and one PCNL at three months for large fragments. Overall, open surgery was required for only 1% of renal calculi and 13% of ureteric stones. These results are consistant with the extensive West German experience confirming that most urinary calculi are now best managed by ESWL and endoscopic techniques. Where these facilities are available open surgery should only be necessary for less than 5% of upper urinary tract stones.
Adolescent↗
In vitro solubility and in vivo toxicity of gallium arsenide.
The in vitro solubilities of gallium arsenide (GaAs) and its metal oxides were arsenic(III) oxide greater than GaAs much greater than gallium(III) oxide. GaAs dissolution was also dependent upon the type and concentration of buffer anion. The amount of arsenic dissolved in 12 hr by various aqueous media was 0.2 M phosphate buffer greater than or equal to 0.1 M phosphate buffer greater than Krebs-Hensleit buffer greater than distilled H2O greater than HCl-KCl buffer. GaAs was apparently soluble under in vivo conditions. Blood arsenic concentrations in rats 14 days after intratracheal instillation of 10, 30, or 100 mg/kg GaAs were 5.5, 14.3, and 53.6 micrograms/ml, respectively; gallium was not detected at any doses. An increase in lung wet weight at 14 days was dose dependent with these organs retaining 17 to 42% of the dose as gallium or arsenic. Excretion of gallium and arsenic was limited to the feces. Urinary porphyrin concentrations and body weight, monitored as indices of toxicity, were significantly altered over the 14-day study. The analysis of porphyrins revealed that uroporphyrin replaced coproporphyrin as the primary urinary metabolite. Rats receiving 10, 100, or 1000 mg/kg GaAs po exhibited similar signs of toxicity. Blood arsenic concentrations at 14 days were 3.5, 6.8, and 17.6 micrograms/ml, respectively. Porphyria was increased, and body weight was decreased at 1000 mg/kg GaAs. These values were equivalent to those obtained with an intratracheal dose of 10 to 30 mg/kg GaAs. Our results showed that pulmonary and po exposure to GaAs resulted in systemic arsenic intoxication. The finding that urinary uroporphyrin concentrations were greater than coproporphyrin concentrations may serve as a sensitive indicator for GaAs exposure.
Animals↗
A 15-year follow-up of 406 consecutive spinal cord injuries.
A follow-up of 406 traumatic spinal cord injuries admitted from 1967 to 1982 is presented. Forty patients died, only two (5% of deaths and 0.5% of the series) from renal complications. Twenty-seven died from pulmonary or cardiovascular causes, complete and cervical lesions being the most significant factors in mortality. Early and continued active urological treatment aimed at the provision of low pressure bladder drainage to protect the upper tract. The management and results are critically discussed.
Adult↗
Flexible cystourethroscopy: advantages and limitations.
Much interest has been expressed in flexible cystourethroscopy, which has obvious potential advantages. In this study it was compared to rigid endoscopy in 25 patients. It was found to be a painless procedure, but not as accurate in diagnosing vesical lesions as the rigid endoscope.
Cystoscopes↗