Biomedical subjects
Publications and source records attributed to H Huland.
Several findings suggest, that other mechanisms than pelvic relaxation are involved in female stress urinary incontinence. Some aspects of diagnosis are given as well as basic principles in surgical treatment are discussed. The pathophysiology, methods of diagnosis and therapy indicate, that stress urinary incontinence is no longer a gynecological but an urological disease.
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Intrarenal blood flow distribution was measured in normal and hypoperfused dog kidneys by xenon-133 washout measurement in one kidney vary slightly in contrast to those done in different kidneys. In normal kidneys the ratio of compartment I (CI) flow to whole renal flow -- i.e., the CI fraction--as measured by the xenon-133 washout curves is almost identical with the distribution of radioactive microspheres in the outer three-fourths of renal cortex (= SI). In hypoperfused dog kidneys, both techniques demonstrate redistribution of blood flow due to reduction predominantly in the CI fraction and the SI zone. The CI fraction is smaller than the microsphere distribution in zone SI in 3 of 5 hypoperfused kidneys. This is explained on the basis of increased cortical flow inhomogeneity in the hypoperfused kidneys.
Changes in cortical blood flow were measured simultaneously with radioactive microspheres and the xenon-133 washout method in 6 dogs after 24 h of unilateral complete ureteral obstruction and in 6 dogs after 90 min of unilateral ischemia and compared with the blood flow in the contralateral kidney. Predominant reduction in cortical blood flow after 24 h of ureteral obstruction is accompanied by severe differences in the perfusion pattern of different areas in the renal cortex, thus that some areas have almost no detectable blood flow. This finding supports the thesis of renal ischemia causing at least cortical hydronephrotic atrophy.
A review of renal rejection is given. The immunology, morphology, clinical presentation, diagnosis and therapy of hyperacute, accelerated, acute and chronic rejection is given. Own data are given showing that repeated bedside renograms and repeated bedside sonograms are extremely helpful in confirming the rejection diagnosis especially in anuric patients. New fast fixation method is described, so morphological workup can be done within 4 h after renal biopsy is taken.
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Ultrasonography is very useful for judging the position and course of renal transplants. With this method extra- and intrarenal complications can be detected very accurately. The sonographic examination is quite harmless and puts little strain on the patient. It can be carried out a few days after the operation. This initial sonogram, obtained as early as possible, makes it easier to recognize and to interpret later changes more promptly and correctly. The results of sonographic examinations in 18 patients with renal transplants are presented. They show that a normal sonogram reliably excludes extrarenal complications such as fluid collection or obstruction as well as rejection of the transplant. All cases of rejection correlated to clearly abnormal sonographic findings.
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The causes of the high incidence of vesicoureteral reflux in 161 patients with end stage renal disease was studied. In about half of these patients with pyelonephritis, reflux in combination with urinary tract infections is the cause of renal failure. Reflux is therefore found more often in this specific group. The incidence of reflux correlates with the duration of uremia. Reflux also is more common in patients with little or no diuresis. Theories of reflux into the "unused ureter" are discussed.
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In 34 dogs the effect of a 90-min period of warm ischemia on renal perfusion and function was studied with and without (Sar1, Ile8) angiotensin II treatment. In the first 3 h after the release of renal arterial occlusion, a significant influence of the angiotensin II antagonist on changes in postischemic vascular resistance, intrarenal hemodynamics and renal function could be demonstrated, all being well preserved in the treated group.
The bladder neck suspension technique according to Stamey and Pereyra are described. 89% of 50 patients with stress urinary incontinence were cured regardless of previous operations. The technique proved to be simple and effective even if scarring from previous operations are present. There is no compression of the urethra. The bladder neck suspension should be widely used to cure stress urinary incontinence in the female.