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Biomedical subjects

J G Gregory

Publications and source records attributed to J G Gregory.

At least 37 records · Page 2Linked to original sources
PubMed1982

Impotence: the surgical approach.

Techniques are now available to restore erectile potency. Several prosthetic devices have been developed that afford a high degree of reliability. The inflatable prosthesis is cosmetically superior, but it is associated with the highest mechanical complication rate. Penile revascularization is a technique with great potential, but the methodology at this point requires further development. Surgeons involved with the treatment of impotency must acquire both the surgical skills required by the operative techniques as well as a philosophical approach to the psychological aspects involved in such therapy. Restoration of penile rigidity can, for some men, mean a new lease on life, but in the improperly selected patient a surgical success may be associated with utter patient dissatisfaction.

Counseling↗
PubMed1981

Aggressive management of bilateral renal cell carcinoma.

We review 4 cases of bilateral renal cell carcinoma. Treatment included extracorporeal surgery with subsequent autotransplantation in 2 patients and radical nephrectomy combined with contralateral partial nephrectomy in the remaining 2 patients. Absence of recurrence as well as length of patient survival supports this aggressive therapy.

Adenocarcinoma↗
PubMed1981

The management of vesicoureteral reflux in the pediatric neurogenic bladder.

An integrated method of management has been used in 29 children with neurogenic bladders and vesicoureteral reflux. Radiological followup reveals that resolution or improvement of reflux occurred in 48 per cent of the renal units managed by close observation only, 48 per cent managed by intermittent catheterization, 75 per cent managed by vesicostomies and 100 per cent in which the ureters were reimplanted. As in the non-neurogenic bladder successful management of reflux and prevention of upper tract deterioration can be achieved by conservative management as well as by ureteroneocystostomy. A protocol of management is outlined.

Child↗
PubMed1980

Correlation of antibody-coated bacteria with intravenous pyelogram in children with refluxing and nonrefluxing units.

A fluorescent technique for detecting immune globulins on the surface of urinary bacteria has been used to differentiate upper from lower urinary tract infections. In an attempt to correlate positive fluorescence with deteriorative changes on the intravenous pyelogram, a total of 79 pediatric patients was studied. Twenty-three had ileal conduits with freely refluxing urine. The remaining 56 children had intact urinary tracts. Thirty of these had vesicoureteral reflux. Urine cultures were studied in conjunction with fluorescent antibody determinations. In patients with significant bacteriuria good correlation was seen with the presence of bacterial fluorescence and positive renal changes. This correlation was 88 per cent in patients with bowel conduits, 71 per cent in patients with vesicoureteral reflux, and 38 per cent in patients without reflux. Possible false positive and false negative results were relatively low, each occurred in 10 per cent of the specimens examined. It is concluded that the combindation of urinary tract infection and positive bacterial fluorescence is seen when upper tract deterioration has occurred and is seen most frequently in association with urinary reflux. In these instances aggressive therapy is often indicated.

Adolescent↗
PubMed1980

Acute epididymitis in boys: a 5-year retrospective study.

A retrospective study was undertaken of 25 children with epididymitis seen at our pediatric hospital during the last 5 years. The symptoms and signs in these patients were evaluated, as well as the results of urinalysis, urine culture, excretory urogram, scrotal scan, exploration and white blood count. The presence of underlying urological problems was particularly sought for and found to be rare prior to epididymitis. The treatment and results are reviewed.

Acute Disease↗
PubMed1979

Scrotal scanning: present value and limits of interpretation.

Forty-three testicular scans have been performed on 38 patients presenting with various scrotal symptoms. Scan diagnosis correlated correctly with the clinical findings in 86 per cent of cases. The most common cause of false positive testicular scan was found to be hydrocele. The mechanism responsible for this observation has been explored in a rat model. A false negative diagnosis was made in 2 cases owing to a small retracted scrotum in 1 patient and a markedly late discovered torsion in the second.

Adolescent↗
PubMed1979

The role of intraoperative angiography in salvaging bovine grafts for hemodialysis.

Bovine grafts used in hemodialysis frequently need declotting. Success of the declotting procedure usually is dependent upon relieving outflow obstruction. Intraoperative angiography was done during 22 declotting procedures and outflow obstructions were detected in 14 grafts. Of these 5 grafts had clinically unsuspected clots, residual to the initial declotting attempt. Four grafts had stenotic areas at the site of the venous anastomosis, which were corrected subsequently by patch grafts. Two grafts had stenotic areas in the graft owing to an infolding of the intima covered with an organized blood clot. In 2 grafts the veins draining the grafts were stenotic for a considerable length and needed revision. In 1 graft there was stenotic change at the site of the arterial anastomosis, which required revision. Of the 14 grafts 11 have remained functioning for an additional 6 to 18 months after relief of obstruction.

Adult↗
PubMed1979

Urolithiasis in children.

A 10-year review of stones in children at the St. Louis University Hospitals is presented. Stones related to infection were seen most often and urinary diversion secondary to congenital abnormalities of the urinary tract was the most frequent predisposing cause. The morbidity of stones in children is high.

Adolescent↗
PubMed1979

Vascular-induced erectile impotence in renal transplant recipients.

The incidence and pathogenesis of sexual dysfunction were studied in 16 male renal allograft recipients. In 9 patients with bilateral renal transplants in whom both internal iliac arteries were occluded nocturnal erections were absent and a penile arterial pulse could not be palpated. Of 7 patients with 1 renal allograft 4 demonstrated penile nocturnal tumescence and the penile pulse could be palpated in 5. Since interruption of pelvic arterial blood supply appears to contribute to impotence in renal transplant recipients consideration should be given to the use of the external iliac artery for arterial anastomosis. Two patients were treated successfully with an inflatable penile prosthesis.

Adult↗
PubMed1977

Comparison of intermittent catheterization and supravesical diversion in children with meningomyelocele.

A comparison in terms of renal preservation as evidenced by urography is made between children with meningomyelocele on intermittent catheterization and children who had undergone diversion. Followup in the former group is only 2 1/2 years but at this time those patients on catheterization are doing as well and probably better than children who had undergone diversion and the quality of life for them is better.

Humans↗
PubMed1977

Osteomyelitis of the pubic symphysis after urologic surgery.

Osteomyelitis represents a pyogenic infection of the bone and marrow. The diagnosis is based on specific criteria and often is difficult to make. Herein we present 2 cases initially thought to represent osteitis pubis but subsequently proved to be osteomyelitis and compare the 2 entities with emphasis on differential diagnosis and treatment. Despite certain differentiating characteristics the correct diagnosis is often uncertain without histologic examination. Since the treatment of these 2 entities is quite different equivocal cases should undergo surgical exploration and bone curettage. This procedure will enable definite diagnosis to be made and proper treatment to be instituted.

Curettage↗
PubMed1977

Changing attitudes toward urinary dysfunction in myelodysplasia.

Alternative methods to supravesical urinary diversion in myelodysplastic children, which protect the upper urinary tracts and provide urinary continence, are now available in the form of prosthetic devices and intermittent clean catheterization with or without ancillary pharmacologic agents. We believe that these alternatives deserve a trial before proceeding to supravesical urinary diversion. Short-term evaluation indicated improvements and stability in most urinary tracts treated by these methods but we recognized that, just as with the ileal conduit diversion, a longer period of followup is required before definite statements can be made about the long-term results. However, if the criteria of sterile urine and bladder emptying at physiological pressure ranges are strictly met we would suspect a favorable outcome.

Child↗
PubMed1977

Oxalate stone disease after intestinal resection.

There have been 543 jejuno-ileal bypass patients screened for the presence of urinary calculi 1 to 6 years postoperatively. Of these patients 9 per cent have had 1 to 2 calculi during the followup and 3 per cent have had multiple calculi. Ninety-four per cent of the recovered calculi consisted entirely of calcium oxalate. Seven patients had a history of stones before the bypass, 6 of whom have had additional stones postoperatively. To define the conditions associated with stone formation in these patients measurements of serum and urinary oxalate concentration, urinary calcium oxalate saturation, urinary crystal size distribution, and the rates of intestinal oxalate absorption and urinary crystallization have been performed on patients who did and did not have stones postoperatively. On the basis of these studies it appears that the patients in whom stones formed differ from those in whom they did not form only in the rate of urinary crystallization and in the number of large crystal particles present in the urine. Evaluation of current therapeutic modalities in terms of the capability to correct these stone-forming characteristics and to reduce actual calculus formation reveals that the only successful regimen is that which includes an extreme reduction of oxalate ingestion.

Follow-Up Studies↗
PubMed1977

Jejunal intussusception following small bowel bypass for morbid obesity.

In 600 patients who have undergone small bowel bypass for the treatment of morbid obesity, we have encountered three patients who developed intussusception in the bypassed intestine. Diagnosis in these cases has been difficult but in two patients with surgical marker clips applied to the transected fixed jejunum as well as to the adjacent mesocolon, diagnosis was made easier by the radiographic finding of separation of these clips. Clinical symptoms are difficult to evaluate and valuable time may be wasted before a diagnosis is arrived at. Once a diagnosis is made, operation with either reduction or resection of the area of intussusception should be carried out with refixation of the bowel to the mesocolon and reapplication of surgical marker clips. These marker clips are of great value in the diagnosis of intussusception occurring in the bypassed loop.

Adult↗