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Biomedical subjects

J J Horan

Publications and source records attributed to J J Horan.

At least 19 recordsLinked to original sources
PubMed1994

Randomized comparison of balloon dilation and transurethral incision for treatment of symptomatic benign prostatic hyperplasia.

The concept of relieving the symptoms of benign prostatic hyperplasia (BPH) by dilating the urethral has existed for centuries. Thirty patients with a clinically estimated prostate gland size of 25 g or less were randomized to either balloon dilation (BDP) or transurethral incision of the prostate (TUIP). The mean pretreatment Madsen-Iverson symptom scores in the two groups were 15.0 +/- 4.9 (SD) and 15.4 +/- 4.4, respectively. The early response rates were 87% fo BDP and 86% for TUIP, with the mean symptom scores declining to 3.4 +/- 2.8 after dilation and 4.2 +/- 6.6 after incision. Among the 14 patients who initially responded to BDP, 2 have been lost to follow-up, 1 died of unrelated causes at 17 months with no urinary symptoms, 2 remain in response at 32 and 38 months, and the other 9 (75% of those available for evaluation) have developed recurrences. Among the 12 patents who responded to TUIP, 2 have been lost to follow-up, 8 remain in response at 14 to 48 months, and 2 (20%) developed recurrences by 44 months of follow-up. In the short term, both BDP and TUIP are effective for treating bladder outlet obstruction in men with relatively small prostates. However, the effect of dilation appears to be less durable than that of incision.

Aged↗
PubMed1993

Analysis of solid renal dysplasia by flow cytometry: malignant potential?

Renal nodular blastema/nephroblastomatosis is a recognized precursor of Wilms tumor. It also has been shown that nodular renal blastemata are seen in association with dysplastic renal parenchyma secondary to obstructive uropathy (i.e., ureteroceles or ectopic ureters). In an attempt to improve our understanding of the critical relationship between renal dysplasia and neoplasia, we performed flow cytometric evaluation on 16 paraffin-embedded specimens of dysplastic kidneys removed during the period 1984-1989. All nephrectomy specimens were associated with obstruction, either duplex collecting systems (10), ectopic ureters (2) or posterior urethral valves (2), or vesicoureteral reflux (2). One specimen was found to contain nodular renal blastema. No evidence of malignancy was found in any specimen. A specimen of normal kidney and two of Wilms tumor (favorable histology) were studied for comparison. Nuclear deoxyribonucleic acid (DNA) ploidy studies were performed on single dissociated nuclei after deparaffinization and staining with propidium iodide. All dysplastic specimens, including the specimen with nodular renal blastema, demonstrated a diploid pattern of DNA as did the specimens of normal renal tissue. The Wilms tumor specimens demonstrated a diploid and a tetraploid pattern. In view of the fact that Wilms tumor may demonstrate diploid DNA patterns on flow cytometry, the findings of diploid patterns on all specimens of solid dysplasia militate against but do not eliminate the possibility of malignant degeneration.

DNA↗
PubMed1993

Acute scrotal swelling in Henoch-Schonlein syndrome: evaluation with testicular scanning.

Acute scrotal swelling may accompany Henoch-Schonlein syndrome and may be the presenting manifestation mimicking testicular torsion. Two patients with scrotal involvement were recently evaluated with nuclear imaging to assess testicular perfusion. One patient had normal perfusion, and the other had increased perfusion. Scan results allowed expectant management and avoided the need for exploratory surgery to rule out testicular torsion.

Acute Disease↗
PubMed1993

Extracorporeal membrane oxygenation: an adjunct in the management of the neonate with severe respiratory distress and congenital urinary tract anomalies.

Severe respiratory distress is the major cause of perinatal mortality associated with congenital urinary tract anomalies or severe obstructive uropathy, and is often accompanied by oligohydramnios. In the past the prognosis in these high risk cases was extremely poor. We review our recent experience in 3 neonates with severe respiratory distress and congenital urinary tract anomalies who were successfully managed with extracorporeal membrane oxygenation, of whom 2 had posterior urethral valves and 1 had bilateral solid renal dysplasia. The use of extracorporeal membrane oxygenation for life threatening respiratory distress in the neonate associated with congenital uropathy is not limited to our experience. A review of the National Neonatal Extracorporeal Membrane Oxygenation Registry for neonates with urological indications for extracorporeal membrane oxygenation revealed 10 interventions with 9 survivors, for a survival rate of 90%. Extracorporeal membrane oxygenation may provide cardiopulmonary support during a period of immature circulation, allowing pulmonary parenchymal and vascular maturation as well as preventing iatrogenic barotrauma.

Extracorporeal Membrane Oxygenation↗
PubMed1990

Ureteral obstruction associated with prostate cancer: the outcome after percutaneous nephrostomy.

We retrospectively reviewed the outcome of 37 prostate cancer patients with ureteral obstruction treated by percutaneous nephrostomy. The over-all survival was 57% at 1 year and 29% at 2 years (median survival time 21 months). The 1 and 2-year survival rates of 15 patients with no prior hormonal therapy were 73 and 47%, respectively, while those of patients who had previously received hormonal therapy were 48 and 19%, respectively. Median survival times of these groups were 24 months and 12 months, respectively. Of 12 patients who had severe renal failure before percutaneous nephrostomy (serum creatinine greater than or equal to 6.9 mg. per dl.) 9 had an adequate return of renal function (serum creatinine less than 3 mg. per dl.) after drainage and 58% survived more than 1 year (median survival time 22 months). Percutaneous nephrostomy is safe and effective in relieving ureteral obstruction and reasonable survival can be achieved even in patients with renal failure. Percutaneous nephrostomy should be considered strongly in these patients.

Aged↗
PubMed1989

The detection of renal carcinoma extension into the renal vein and inferior vena cava: a prospective comparison of venacavography and magnetic resonance imaging.

Accurate preoperative evaluation of the inferior vena cava and renal vein in patients with renal cell carcinoma is mandatory to plan a successful surgical approach. The presence of venous extension may alter transfusion and anesthetic requirements, as well as require the addition of a vascular surgeon to the operative team. Venacavography traditionally has been considered the most reliable method to identify tumor thrombus, although magnetic resonance imaging has been proposed as a possible noninvasive alternative. We compared prospectively the accuracy of these 2 methods in 44 consecutive patients with renal cell carcinoma who subsequently underwent nephrectomy. Of the 44 patients 11 (25%) had tumor extension into the inferior vena cava and 17 (39%) had involvement of the renal vein at operation. Venacavography and magnetic resonance imaging correctly identified 9 of the 11 patients (82%) with inferior vena caval thrombus. When the results of both tests were combined, all 11 cases of vena caval extension were identified. Venacavography was slightly more sensitive (71%) in identifying the presence of renal vein thrombus than magnetic resonance imaging (65%) but these differences were not statistically significant. Magnetic resonance imaging better localized the thrombus within the renal vein. We conclude that venacavography and magnetic resonance imaging offer equal diagnostic accuracy in the identification of venous extension of renal cell carcinoma. The combination of both tests results in higher diagnostic yield than either test alone. Neither test by itself is reliable in the presence of a large, bulky adenopathic lesion that compresses the inferior vena cava.

Adult↗
PubMed1979

Improving exposure component and generalization potential of stress inoculation for pain.

Stress inoculation for pain involves education about the psychological dimensions of pain, training in a number of coping skills, and practice in applying these skills during exposure to the noxious stimulus. In a previous study the exposure component (which involved six practice sessions) proved ineffective; moreover the efficacy of the other components was not repeated on the generalization measures. The present study compared three variations in the exposure component and found that training with a single practice session on the cold pressor task proved more helpful than training with no practice at all, which in turn was no worse than training with six practice sessions. Moreover, therapeutic attention to generalization resulted in increased pain tolerance on the pressure algometer task.

Behavior Therapy↗
PubMed1976

Lead poisoning caused by glazed pottery: case report.

A case of severe lead poisoning is described. This was caused by the ingestion of fruit drink prepared and stored in lead-glazed jugs. Results of tests to measure the extractability of lead from the jugs are given.

Acetates↗