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Biomedical subjects

J E Wickham

Publications and source records attributed to J E Wickham.

At least 91 records · Page 5Linked to original sources
PubMed1983

Elective percutaneous nephrolithotomy in 50 patients: an analysis of the technique, results and complications.

Elective percutaneous nephrolithotomy in 50 consecutive patients is reviewed. Of the 50 patients 24 had never had a renal operation. Radiological puncture, dilation and subsequent placement of a nephrostomy tube were done in a single session when possible. An adequate tract was formed in 84 per cent of the cases. Of 42 patients who presented for endoscopic lithotomy 71 per cent had completely successful removal of the calculi. The mean hospital stay was 8.3 days.

Endoscopy↗
PubMed1983

Laser fragmentation of renal calculi.

Pulsed Nd YAG lasers will fragment all types of urinary calculi rapidly in air. The fragments are much smaller than with any other technique. Large stones can be split into a few discrete fragments which may prove to be an advantage in that the fragments could then be extracted without leaving multiple small fragments behind. Certain pulsed lasers can be transmitted through fine, flexible glass fibres which are small enough to pass through any sized instrument channel. There is therefore an immediate possibility of using this type of laser in the bladder with carbon dioxide instead of an irrigant. Further experiments are planned in order to investigate the possibility of using this mode of laser in the kidney percutaneously.

Endoscopy↗
PubMed1983

Transurethral ureteroscopic retrieval of ureteric stones.

This report documents our initial experience in the transurethral retrieval of ureteric stones using the rigid ureteroscope. Ten patients are included. Half of the stones were located in the lower one-third of the ureter and half in the upper two-thirds. They varied in size from 5 to 10 mm in diameter. Seven were successfully extracted at the first attempt using stone baskets under direct vision. Of the remaining 3, one was retrieved at a second ureteroscopy, one was fragmented and subsequently passed and one required percutaneous nephroscopy for its removal from the renal pelvis. It is concluded that transurethral ureteroscopy offers a safe alternative to both open ureterolithotomy and blind manipulation.

Adult↗
PubMed1983

Percutaneous pyelolysis.

Pelvi-ureteric junction obstruction has been treated in 3 patients using a percutaneous modification of the Davis intubated ureterostomy technique. A 10-French tube is introduced into the obstructed upper ureter through a percutaneous nephrostomy puncture. Full thickness incision of the upper ureter and pelvi-ureteric junction is then carried out using a standard endoscopic urethrotome. The splint tube and diverting proximal nephrostomy remain in situ for 1 month. Good drainage was established in 2 cases following de-tubing. Further cases are under study.

Adult↗
PubMed1983

Percutaneous nephroscopy: a review of the physical properties, suitability and cost of the instruments.

The physical properties, suitability and cost of six instruments used for elective percutaneous renal endoscopy have been evaluated. Three were rigid and three were flexible. The optics, flow rate and accessories of the rigid instruments have been demonstrated to be superior to the flexible instruments. Flexible instruments, however, were used in 15% of our 70 elective percutaneous operations. The 21-Charr cystoscope was adequate for extracting smaller calculi, but it was necessary to use the Storz and Wolf rigid nephroscopes when ultrasonic disruption was required. Based on our data, improvements and modifications to both flexible and rigid instrument design are suggested.

Costs and Cost Analysis↗
PubMed1983

Ruptured renal artery aneurysm in a solitary kidney.

The incidence of renal artery aneurysm in a solitary kidney has not been previously documented in the literature. A case of aneurysmal rupture into a pelvicalyceal system of a solitary kidney, successfully treated by primary vascular reconstruction under the cover of inosine and synchronous pelviureteric repair, is reported.

Adult↗
PubMed1982

Renal accumulation of ammonia: the cause of post-ischaemic functional loss and the "blue line".

The "blue line", a dark discoloration at the corticomedullary junction, is a constant finding after a significant period of renal ischaemia. In this study, it has been shown to be caused by packing of all of the peritubular capillaries at the corticomedullary junction with red blood cells. Five rats and 10 dogs were alkalinised by replacing their drinking water with 2% sodium bicarbonate for 2 weeks pre-operatively, in order to inhibit the glutaminase enzyme system and thereby decrease ammonia accumulation during ischaemia. Five rats and 6 dogs were used as unprotected controls. All animals were subjected to 60 min warm ischaemia. Renal function was significantly protected in the alkalinised rats (P less than 0.002) and dogs (P less than 0.001), with the serum creatinine rising to a maximum of 0.21 +/- 0.03 mmol/l in the alkalinised rats and 0.18 +/- 0.04 mmol/l in the alkalinised dogs. There was no "blue line" in the alkalinised animals. It is suggested that the "blue line" plays a central role in post-ischaemic renal failure. Prevention of ammonia formation by alkalinisation protects against ischaemic renal damage and the formation of the "blue line".

Ammonia↗
PubMed1981

Percutaneous nephrolithotomy.

A new method of removing calculi from the renal collecting system, in which the large and traumatic incision in the loin currently used is unnecessary, was attempted in 31 patients. Small dilators were introduced over a guide wire through a nephrostomy tube into the renal pelvis and a catheter inserted. The track was dilated in stages and two days later the nephrostomy tube was removed and a cystoscope introduced into the interior of the kidney. A stone basket was introduced down the operating channel of the cystoscope and maneuvered to secure the stone; the cystoscope, stone basket, and stone were then removed. The procedure failed in 11 of the 31 patients, in five because the needle could not be placed accurately initially and in six because the stone could not be removed despite the establishment of a nephrostomy track. In the remaining 20 patients the procedure was successful. This procedure is far less traumatic than the conventional operation. With the development of a flexible nephroscope and an ultrasonic stone disintegrator it will be possible also to remove larger stones and stones in the peripheral calices using this method.

Cystoscopy↗
PubMed1981

Percutaneous nephrolithotomy.

Small mobile stones in the major renal collecting system can be extracted through a percutaneous tract. Initially the radiologist performs a conventional percutaneous needle nephrostomy and inserts a pigtail catheter into the renal pelvis. Over the next week the tract formed is serially dilated to a size large enough to pass a cystoscope into the kidney. The calculi are trapped by a stone basket and removed. The many advantages of this relatively atraumatic procedure are discussed.

Catheterization↗
PubMed1981

Inosine in ischaemic renal surgery: long-term follow-up.

Inosine, a purine nucleotide, has been used in 33 patients as a method of preventing ischaemic renal damage. The long-term results have been reviewed with a mean follow-up of 28 months. Inosine was administered either intra-arterially or intravenously. Renal function was assessed by serum creatinine, creatinine clearance and divided function renography. Inosine afforded satisfactory protection in ischaemic periods of up to 60 min, particularly if pre-operative function was normal. It was less reliable if pre-operative function was poor or in ischaemic periods greater than 60 min. Inosine is a helpful aid in ischaemic renal surgery.

Adolescent↗
PubMed1981

Conservation surgery of renal carcinoma: the EIRSS experience.

Seventy-two patients with renal carcinoma (RC) in a solitary kidney or bilateral synchronous tumours underwent parenchyma-sparing excision of their neoplasms. This was performed in situ in 51 and extracorporeally in 21 kidneys, with a complication rate respectively of 17 and 43%. The 5-year survival rates were 78% for unilateral disease, 48% for bilateral synchronous and 38% for bilateral asynchronous disease. Survival correlated with P category, grade and diameter of the tumour. Vascular invasion and spindle cells indicated a poor prognosis; the position of the tumour, oncocytic elements, calcification, lymphocytic infiltration or the predominance of clear cell or granular cells did not influence survival.

Adult↗