Biomedical subjects
Publications and source records attributed to J M Fitzpatrick.
Initial experience with the rigid ureteroscope showed that despite ureteral dilation and guide wire followers, introduction of the ureteroscope can be difficult due to bladder mucosa catching on the instrument. A simple, cheap disposable device using a modified ureteric catheter is presented that overcomes this problem.
A controlled study was performed to determine the effect of oxybutinin on incontinence in spina bifida patients on clean, intermittent self catheterisation. Cure or significant improvement was achieved in 66.6% of the patients. Bladder capacity was increased and filling pressure reduced during treatment.
The rapid development of new methods for the treatment of renal calculi requires an animal model to assess the efficacy of stone treatment in vivo. This requires the implantation of human calculi large enough to be easily imaged radiologically. Most previous models have required multiple operative procedures and ureteric obstruction which has confused results. This study demonstrates the one-stage insertion of human calculi into the canine renal pelvis through a nephrostomy which does not affect the collecting system or cause any significant functional or structural damage to the kidney.
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The use of the Doppler probe to localise the intrarenal vessels was assessed in 15 dogs. This prevented the need for renal artery clamping and radial nephrotomies were placed in silent areas on the renal surface. Functional studies were performed post-operatively at 48 h and 1 month, using creatinine clearance, microfil casts and cast angiography. There was no significant loss of function when three or six radial nephrotomies were made and the Doppler accurately localised sites for nephrotomy between the intrarenal arteries and veins which were undamaged.
A follow-up of 406 traumatic spinal cord injuries admitted from 1967 to 1982 is presented. Forty patients died, only two (5% of deaths and 0.5% of the series) from renal complications. Twenty-seven died from pulmonary or cardiovascular causes, complete and cervical lesions being the most significant factors in mortality. Early and continued active urological treatment aimed at the provision of low pressure bladder drainage to protect the upper tract. The management and results are critically discussed.
In 64 men with prostatic carcinoma, calcium excretion per litre of glomerular filtrate (Cae) was persistently lower in those with bone secondaries than in those with soft tissue involvement only, despite a normal range of serum calcium in both groups. In three patients who showed an improvement in their bony metastases on bone scan 6 months after starting treatment, the Cae values had increased slightly but still remained in the low range. In a further five who showed no improvement on bone scan, Cae values were lower than before. In patients with prostatic carcinoma, Cae is an indicator of early changes in calcium homeostasis. It may also provide an objective indication of progression of bone secondaries.
Much interest has been expressed in flexible cystourethroscopy, which has obvious potential advantages. In this study it was compared to rigid endoscopy in 25 patients. It was found to be a painless procedure, but not as accurate in diagnosing vesical lesions as the rigid endoscope.
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Results from a retrospective analysis of 139 patients with recurrent superficial bladder tumors treated by intravesical epodyl are reviewed. Of patients who had complete clearance of tumor from the bladder 95 per cent became free of disease within 12 months of starting intravesical therapy. No patient who had persistent tumors at 2 years was free of tumor subsequently. The majority of complete responders who suffered recurrences did so within 3 years and 80 per cent of a small series of patients who remained free of tumor after 3 years and then stopped treatment continued to be free of tumor for a further 2 years. Failure to respond within 12 months or early invasion of the submucosa on biopsy (stage P1b tumors) was associated with poor survival. In patients who underwent salvage cystectomy the demonstration that 35 per cent had involved metastatic lymph nodes and 38 per cent had invasion of muscle is a clear indication of the dangers of delaying radical treatment once the patient has failed to respond completely to intravesical therapy.
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".
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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.
Thirty-four patients were studied following transurethral prostatectomy with glycine irrigation during and soon after the operation. Three cases developed hyponatraemia and this was accompanied by severe hyperoxaluria with raised urinary glycolate. This could be a hazard if urinary volume were allowed to fall.
Kidneys preserved with cold Collins' solution only function satisfactorily if there is no significant preceding period of warm ischaemia. This paper reports an attempt to provide protection to renal function during such a warm ischaemic episode using the nucleotide inosine. In these experiments inosine given intravenously to dogs followed by 15 min of warm renal ischaemia and by either 12 or 24 h of cold preservation with Collins' solution did not protect renal function against the warm ischaemic insult.
This study describes the effect of the 4 most commonly used methods of intrarenal access on renal function and morphology in the dog at 48 h. The extended sinus approach was associated with no functional or parenchymal loss; the radial paravascular approach was followed by a 20% decrease in function and no significant parenchymal loss; the anatrophic intersegmental nephrotomy caused a 30% functional decrease with a significant parenchymal loss; the bivalve nephrotomy was associated with a 50% loss of function and considerable parenchymal loss and distortion.
Seventy-seven patients were treated for incontinence after prostatectomy for benign prostatic hypertrophy. Forty-six patients had detrusor instability and 28 had stable bladders. No cause for the incontinence was found in 3 patients. The majority of the group had sphincter damage (74%). Conservative treatment other than drugs was all that was required in 22 patients, but drugs such as Eskornade, imipramine or emepronium were used in a further 19. Some symptomatic improvement occurred in 53% of these 19 patients. Surgery was required in 38 cases (relief of obstruction endoscopically in 11, insertion of prosthetic devices in 27). Endoscopic treatment rarely effected a cure, but the results with prostheses were satisfactory, a cure or improvement occurring in 65% of the patients, with a low complication rate.
Fifty-five patients with diffuse pain due to bone metastases from prostate carcinoma were treated by pituitary ablation (53 with intrasellar Yttrium 90 and 2 with intrapituitary alcohol instillation). The provisional criteria of the British Prostate Group were used to assess results. Post-operatively, 44 patients (80%) were significantly free of pain and 12 of them were completely pain-free. In only 11 cases (20%) was there no relief of pain. Of the 39 patients who required narcotics before ablation, only 12 required them post-operatively. Pituitary ablation with Yttrium 90 has an important place in the relief of pain in advanced carcinoma of the prostate, although survival is not increased.