Biomedical subjects
Publications and source records attributed to J C Hammonds.
The results of teaching the technique of clean intermittent self-catheterisation (CISC) to 20 elderly patients (aged 65-81 years) are reported. The patients were followed up for a maximum of 4 years. The use of this technique in the management of selected elderly patients with lower urinary tract dysfunction is discussed.
Pyelorenal reflux and irrigant extravasation secondary to raised intrapelvic pressure during percutaneous nephrolithotomy account for a significant percentage of the operative morbidity. The effect of irrigant flow rate, height of irrigant reservoir, diameter of Amplatz sheath and lithotripsy on intracavitary pressures has been studied in an in vitro model. The elevation of pressures produced by these variables suggests that percutaneous techniques should be modified.
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The advent of percutaneous nephrolithotomy (PCN) and ureteroscopy, in combination with stone disruption techniques, has dramatically altered the management of upper urinary tract stone disease. These advances are not necessarily confined to the teaching centres. The problems encountered introducing these techniques in a District General Hospital and their impact on the surgical management of upper urinary tract stones is presented.
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The appearance of pyroninophilic immunologically activated lymphocytes in the urine may be one of the earliest indications of acute rejection of a renal allograft. In a study of 50 allograft recipients there were 33 episodes of rejection within 1 month postoperatively. The presence of activated lymphocytes in the urine correlated with a clinical and biochemical diagnosis of rejection in 29 cases (88 per cent). In 20 cases (69 per cent) the activated lymphocytes were present at least 24 hours (median 2 days) before rejection was diagnosed by other means. In 2 patients (4 per cent) activated lymphocytes appeared in the urine without evidence of rejection, while 4 of 33 patients had rejection diagnosed and treated in the absence of lymphocyturia, for a false negative rate of 12 per cent. The 33 rejection episodes were treated by prednisolone and azathioprine. In 19 cases suppression of rejection correlated with the disappearance of pyroninophilic lymphocytes within 5 days, while in 10 persistent rejection was accompanied by persistent lymphocyturia. The presence of activated lymphocytes in the urine is a valuable early index of impending rejection in the transplanted kidney, and may be used with other clinical and biochemical criteria to detect the need for increased immunosuppression.
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Experience of the embolisation of hypernephromas with 95% ethanol is described in 10 patients. An initial technique using 95% ethanol diluted with contrast has been modified. A single injection of 15 ml of undiluted 95% ethanol through a balloon occlusion catheter is now recommended. We conclude that this is a quick, easy and safe method of embolising hypernephromas.
The management and results of a series of 200 consecutive patients, aged 70 years and over, who were treated by prostatectomy are reported. The mean age was 76 years. Significant cardiovascular and pulmonary disease was present in 51%. Transurethral prostatectomy was performed in 58%, the others being treated by open methods. In spite of the old age and associated problems and a rejection rate for operation of 5.5%, mortality within 1 month of surgery was only 2.5%. But as expected, there was post-operative morbidity particularly from pulmonary and cerebrovascular causes. However, most patients stayed in hospital for between 6 and 10 days only, with an average of 7.3 days after transurethral surgery. Management is discussed in relation to the general condition, size of the gland and the care in a specialised urology unit adapted to the treatment of this type of patient.
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The advent of selective internal urethrotomy under direct vision has enabled precision endoscopic surgery to be undertaken on a wide range of urethral strictures. A multi-centre survey of 197 cases involving 322 urethrotomy procedures from 5 urological departments in England is reported. The overall results after a follow-up of up to 4 years suggest that there is no indication for further procedures currently existing in 160 (81%) of those cases subjected to selective internal urethrotomy. The additional injection of triamcinalone acetate into the strictured area prior to urethrotomy is recommended in resistant cases. The procedure of selective internal urethrotomy is, in our opinion; the best primary method for the treatment of urethral stricture, and it is hoped this will reduce the indications for anastomotic or substitution urethroplasty.
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Fragments of human renal carcinoma tissue have been co-cultured with mouse calvaria. In 9/13 cases significant bone resorption occurred whilst in no case did control kidney cause significant resorption. When bone resorption did occur, it could be reduced by inclusion of indomethacin in the culture medium. In some cases when theophylline was included in culture medium to prevent cyclic AMP breakdown, there was enhancement of tumour-induced bone resorption. Control studies without tumour showed that none of the experimental treatments had a direct effect on bone. Radioimmunoassay of prostaglandin E (PGE) levels in pooled culture media showed that tumour fragments produced appreciable amounts of PGE, and that this production was lowered by indomethacin and increased by theophylline. It is concluded that the bone resorption induced by these tumours is due to a prostaglandin, and that prostaglandin production may be controlled by changes in cyclic AMP metabolism.
167 patients with T1 bladder transitional cell tumours treated by transurethral resection or cystodiathermy are reviewed. The overall crude survival was 83.2% in 3 years and 71.8% in 5 years. 7.8% of the patients developed an invasive tumour and these patients had an unfavourable initial tumour with moderate or poor differentiation and high or moderate mitotic rate. High or moderate pleomorphism was particularly unfavourable. Multiple tumours did as well as single ones but more of them had invasion of the lamina propria and a larger number were treated by either radiotherapy or cystectomy.
73 patients with primary hyperparathyroidism are reviewed. The elevated serum calcium was the main diagnostic index but estimation of the parathyroid hormone was useful confirmatory evidence when raised. A normal level does not exclude the diagnosis being found in 32% of patients. Intravenous methylene blue was a useful adjunct to surgery. 95% of the patients had relief of their hypercalcaemia after a single operation. 78% of patients had stones and there was a marked reduction in further stone formation after surgery.
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