Biomedical subjects
Publications and source records attributed to H N Whitfield.
Factors in the aetiology of bladder instability in women with recurrent cystitis are analysed. A multifactorial approach to patient management is advocated and supported by a treatment failure rate of only 3.6% with these patients over a mean follow-up of nearly 2 years.
Forty-five patients have been treated surgically for obstructive azoospermia. Fifteen underwent reversal of vasectomy and 40% of the wives became pregnant. Thirty had epididymovasostomy, and in only 2 (6.5%) did the sperm count become normal, although a few poorly motile sperms appeared in the ejaculate in a further 4 patients. Congenital abnormalities of the vasa in 7 cases and post-inflammatory blocks in 4 cases were examples of obstructive azoospermia due to well defined causes. However, in half of the patients (15 cases) the cause was obscure although it was associated with sinusitis, bronchitis or bronchiectasis (Young's syndrome). The results of pulmonary function tests in 30 cases, and electron microscopic studies of cilia from epididymes (10 cases) and bronchial mucosa (2 cases) indicated that the basic abnormality might be malfunction of the microtubules which appeared to be ultrastructurally normal in most cases. One case appeared to be associated with dietary deficiency, and correction of diet coincided with a successful result of surgery.
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In 20 patients with pelvi-ureteric junction obstruction the results of quantification of the change in renal pelvis size during high-dose intravenous urography with a diuretic, pressure/flow studies, standard renography and deconvolution analysis of the gamma camera renogram have been compared. The results of high-dose intravenous urography and pressure/flow studies correlated well. Renography was unreliable in diagnosing obstruction unless deconvolution analysis of the gamma camera renogram was used to differentiate those showing an obstructive uropathy from those with an obstructing nephropathy.
Phenoxybenzamine, an alpha-adrenergic blocking drug has been evaluated in the treatment of 14 children with neuropathic bladder dysfunction. The majority of children treated showed significant reductions of residual urine and urethral closure pressure. A useful clinical response in terms of improved bladder control was obtained in over half the patients. Children with mild radiological changes in the upper urinary tracts showed radiological improvement but those with marked changes did not improve. The drug is generally well tolerated but side-effects of postural hypotension, lethargy and nausea may occur.
Rats were given 10 or 20 mg of inosine dissolved in 1 ml of 0.9% saline, or a control solution of 1 ml of 0.9% saline, intravenously 10 or 20 min before induction of left renal warm ischemia for 60 min. Further groups of rats were treated with 20 mg inosine or with saline alone 20 min before longer periods of warm ischeamia of 90 and 120 min duration. All animals had immediate contralateral nephrectomy. In all inosine-treated groups the mean plasma creatinine was lower than in their respective control groups and these differences were statistically highly significant.
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Fourteen patients suffering from voiding disorders of various aetiologies were taught the art of intermittent self-catheterization. The rationale of this form of treatment is discussed and it is suggested that this regime may play a useful role in the management of patients who are not amenable to surgery or other forms of treatment.
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34 upper urinary tract pressure/flow studies were carried out in 24 children. Obstruction was reliably diagnosed in 8 studies, and excluded in 21. This technique may provide information of clinical value in the patient with upper urinary tract dilatation.
Urodynamic studies have been carried out in 10 boys with the prune belly syndrome. In spite of gross radiological changes the condition is compatible with normal voiding dynamics. Filling cystometrograms show a marked shift to the right. Pressure/flow studies may demonstrate an unbalanced voiding mechanism which can be treated by urethrotomy. Following urethrotomy urethral pressure profiles showed a significant fall, flow rates increased and residual urine volumes were reduced. Urological treatment in the prune belly syndrome should be directed at producing a bladder which empties well: a balanced voiding mechanism. Urodynamic investigations are helpful in achieving this aim. Residual urine determination and flow rates should be used in routine follow-up. Urethrotomy to lower bladder outflow resistance is advocated as one of the first steps in treating the unbalanced voiding mechanism that is often found in the prune belly syndrome.
11 patients underwent 12 prolonged bladder distensions for bladder instability. In no case did the cystometrogram revert from an unstable to a stable pattern, through 6 patients noted symptomatic improvement which was attested as moderate by 2 and marginal by 4.
Alpha blockade at a dose which produces minimal cardiovascular effects causes a significant fall in the urethral pressure profile in man. No change in profile height has been seen following the administration of a beta blocking drug in a dose producing cardiovascular changes of a similar order of magnitude.
Urodynamic findings, and in particular measures of outflow obstruction in a consecutive series of 156 women presenting with recurrent increased frequency and dysuria, have been analysed. Poor correlation between these various measures has been demonstrated; at most only 8% of these patients have demonstrable outflow obstruction. More than a quarter of the patients had bladder instability.
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Gastric adaptation was impaired immediately after the performance of complete vagotomy in a series of 20 acute experiments in the dog. Preliminary isolation of the intact vagi in 10 of these animals produced alterations in adaptation similar to those seen after vagal division. It is concluded that alterations in gastric adaptation are not a reliable intraoperative aid to complete vagotomy. These findings may be significant in the interpretation of all intraoperative tests for vagotomy.
123 patients underwent 320 extracorporeal shock wave lithotripsy (ESWL) sessions with the Wolf 'Piezolith 2200' lithotripter. The overall success rate, judged by adequate stone fragmentation into particles of 2 mm or less as seen on X-ray, was 92%. Few complications occurred. The lithotripter was easy to operate, and treatment was painless.