Biomedical subjects
Publications and source records attributed to J M Fitzpatrick.
Phytotherapeutic agents constitute a large part of the market for the pharmacological treatment of symptomatic BPH. At present, these agents are being used on an empirical basis with some success in relieving symptoms. They have not been shown to have any effect on objective indices. Several agents are presently undergoing randomized trials.
Stereotactic localization and fine-needle aspiration are new procedures for the management of non-palpable mammographic abnormalities. In this prospective study, stereotactically guided cytology with immediate reporting was performed before biopsy in a consecutive series of 166 patients with screen-detected non-palpable abnormalities. All specimens were obtained by multiple stereotactically guided passes with a 22-G Franzén needle and graded as: 1, acellular or inadequate; 2, benign; 3, atypical, probably benign; 4, probably malignant; or 5, malignant. After definitive surgery all tumours were staged according to the Union Internacional Contra la Cancrum classification. Of 71 patients with malignancy, 56 were correctly diagnosed by cytology before operation. Twelve patients with malignancy had grade 1 cytology and 50 of the 52 with grade 2 cytology had benign disease. This study confirms that stereotactic cytology is a valuable diagnostic test in a breast-screening programme.
Haemodynamic changes in partial unilateral ureteric obstruction (PUUO) may be related to altered prostaglandin synthesis. In 12 dogs the left ureter was partially obstructed for 5 weeks. In six dogs the ureter was reimplanted into the bladder and to investigate the effect of this procedure on the contralateral side the other six animals underwent ipsilateral nephroureterectomy. Renal blood flow (RBF) was measured by the distribution of radiolabelled microspheres. Changes in urinary prostaglandin (PG) concentrations were validated by renin activity using angiotensin I. Reduced left RBF during obstruction was associated with increased thromboxane A2 synthesis (P < 0.01). Increased RBF to the non-obstructed side was associated with elevated PGE2 formation (P < 0.05). Elevated angiotensin I levels (P < 0.01) corresponded to maximal increases in PG synthesis. Reimplantation of the obstructed kidney did not exert a direct effect on contralateral RBF or PG concentration. Haemodynamic changes in PUUO in vivo are associated with alterations in renal PGs.
Renal cell carcinoma is a tumor, the prognosis and behavior of which remain poorly understood. Proliferating cell nuclear antigen levels have been shown to act as an independent prognostic variable in a variety of malignancies. Proliferating cell nuclear antigen was evaluated in 59 cases of renal cell carcinoma, and the results were correlated with existing clinicopathological variables and survival. Proliferating cell nuclear antigen index (percentage of tumor cells positive for proliferating cell nuclear antigen) did not correlate with stage, grade or ploidy. To assess survival, tumors with proliferating cell nuclear antigen indexes of greater than and less than 60% were compared. The 24 patients with a high index (greater than 60%) had a significantly worse survival than did 35 with a low index (less than 60%, p < 0.001). Therefore, the prognostic potential of proliferating cell nuclear antigen in renal cell carcinoma is promising and may be of clinical value in the management of patients with renal cell carcinoma.
This paper describes a novel technique using the blood flow tracer C14-iodoantipyrine to measure ureteric blood flow in anesthetized Sprague-Dawley rats. The ureters were divided into five equal segments, and the blood flow was measured using a modification of the Fick principle. There was a gradient down the ureter with a significant difference between upper (159 ml./100 gm./min.) and lower (83 ml./100 gm./min.) ureteric segmental blood flows. This technique may allow the role of ureteric ischemia to be investigated in a variety of disease states.
This paper addresses the concept of nurse performance, its measurement and its differentiation by programme of preparation. It is evident from the research conducted to date that a variety of methodologies have been used to explore and compare nurse performance. The process of direct observation, however, has been selected to a lesser degree, and it is argued that its potential has yet to be realized. Further, in recognition of the methodological challenges inherent within research of this nature it is suggested that nurse performance should be explored from a variety of perspectives, using a multi-method research design. Significantly, educational preparation as a potential discriminator of performance has been explored only to a limited extent and studies carried out in the United States predominate. In view of recent nurse education changes in the United Kingdom and the introduction of Project 2000, empirical work comparing outcomes of the different courses of pre-registration preparation is urgently required. The authors are currently engaged in a comparative study of outcomes of pre-registration nurse education programmes funded by the English National Board for Nursing, Midwifery and Health Visiting. This paper draws upon the literature reviewed to date.
OBJECTIVE: To determine the pathophysiological changes in upper urinary tract motility and calculus transit which may occur following JJ stent insertion. MATERIALS AND METHODS: The acute and chronic effects of JJ stent placement were studied in 24 canine renal units. Intrarenal and intraureteric pressures and motility were measured, in addition to transit times for complete passage of synthetic calculi from the upper ureter into the bladder. RESULTS: Acute effects included raised renal intrapelvic pressure, reduced pelvic and ureteric motility and delayed calculus transit time. Prolonged JJ stent placement was associated with return of intrapelvic pressure to normal but persistent changes in both renal and ureteric motility and also calculus transit time. CONCLUSION: In situ JJ stents impair upper urinary tract motility and experimental calculus transit time and may delay passage of ureteric calculi or calculus fragments following extracorporeal shock wave lithotripsy.
The concept of adynamic ureteric obstruction following balloon dilatation was explored in 12 female mongrel dogs. Upper ureteric segments were dilated to 15 french at 10 atm for 3 min. Pressure and motility in the dilated segments were compared to that proximal and distal to the dilated segment prior to, immediately after, and at 2 and 6 weeks after dilatation. Immediately after dilatation the dilated segment and proximal pelvi-ureter showed a rise in baseline pressure from 2.5 +/- 0.3 and 1.9 +/- 0.3 to 32 +/- 4.6 and 37.2 +/- 5.7 mm Hg, with an associated decrease in the amplitude of contractions. Distal ureteric pressure/motility was unaffected at this point. At 2 weeks, the motility of the pelvis, dilated segment and distal ureter was diminished. Nephrostograms showed hydronephrosis and dilated upper ureteric segments with extravasation in 2 animals. At 6 weeks there was residual dilatation but motility of the dilated segment, and that of the proximal pelvi-ureter and distal ureter had returned to normal.
Pulse oximetry was used to detect return of pulsatile flow in 27 subjects during reactive hyperaemia following 3 min of total limb ischaemia induced by above knee tourniquet occlusion. Fourteen patients with exercise induced leg pain had 18 symptomatic limbs tested. Thirteen controls had 25 limbs tested. Return of pulsatile flow during reactive hyperaemia occurred within 20 s of tourniquet release in the 25 control limbs which was then regarded as normal. The mean time for return of pulsatile flow in 18 symptomatic limbs was 53 +/- 37 s (P < 0.05 versus controls). Three limbs had a normal value, two of which did not have peripheral vascular disease. Pulse oximetry correctly identified all 25 asymptomatic limbs and 15 of 16 patients with claudication secondary to peripheral vascular disease (PVD). This modification of the reactive hyperaemia test using the pulse oximeter is simple and quick to perform. It has potential as a non-invasive screening test for PVD, suitable for outpatient assessment.
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Edematous pancreatitis was induced in 12 male Sprague-Dawley rats using supramaximal doses of the cholecystokinin analogue cerulein (5 micrograms/kg per hour). The microvasculature of the pancreas, liver, and kidney was examined using scanning electron microscopy of microvascular corrosion casts in 12 test animals and four controls at intervals of 30 minutes, 1 hour, 2 hours, and 4 hours. Distortion of the pancreatic and hepatic microvasculature was seen as early as 30 minutes and progressed during the study period. The renal vasculature remained normal throughout. Light microscopic analysis revealed no morphologic abnormalities in the walls of the pancreatic, hepatic, or renal microvasculature. This study demonstrates that cerulein-induced pancreatitis is associated with marked distortion of the pancreatic and hepatic microvasculature; the abnormalities start early in the disease and progress during the study period.
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The protective effect of intravenous 8.4 per cent sodium bicarbonate on renal function after ischaemia was evaluated in rats subjected to 45 or 90 min warm unilateral renal ischaemia. Two groups of control animals received normal or 3 per cent saline. All solutions were given by bolus injection 3 h before ischaemia. Renal function was significantly protected in animals receiving bicarbonate. Vascular congestion of the inner stripe of the renal medulla was prevented. The survival rate in the group undergoing 90-min ischaemia was 70 per cent for animals receiving bicarbonate and nil in those given saline. Preoperative alkalinization confers significant functional and morphological protection in the ischaemic kidney.
A study in rats investigated the temporal relationship between acinar cell changes and alterations in the local microvasculature in oedematous pancreatitis produced by administration of caerulein 5 micrograms kg-1 h-1. Samples were taken from experimental and control animals after 15 min, 30 min, 1 h and 2 h of caerulein infusion. Transmission electron microscopy showed ultrastructural acinar cell changes after 15 min whereas the earliest microvascular changes were seen after 30 min. Ultrastructural alterations in the acinar cells thus preceded local microvascular changes. Microvascular distortion appears to be a consequence and not a cause of pancreatitis in the caerulein model.
Macrophages (M phi) from pre-diseased autoimmune-prone MRL mice (both MRL/+ and MRL/lpr) dramatically underproduce the cytokine interleukin-1 (IL-1) in comparison to M phi from a number of normal strains. In this study we show that IL-1 dysregulation by MRL M phi is fully expressed at birth, and that this defect does not change with time or the development of disease. We also constructed adult irradiation chimeras (consisting of A/J-->MRL and MRL-->A/J mice), and show that M phi isolated from these chimeras display a pattern of IL-1 production indistinguishable from that of the donor strain controls. Moreover, when we constructed a mixed chimera (A/J + MRL-->A/J, the A/J and MRL M phi coexisting within the same animal retained their individual patterns of IL-1 production when isolated by negative selection. Taken together, these results provide the first substantive evidence for an intrinsic defect (IL-1 dysregulation) in M phi from MRL autoimmune-prone mice.
The effect of calculi on renal and ureteric function is the result of a complex sequence of pathophysiological events triggered by obstruction. The degree of impairment of renal function resulting depends on whether the obstruction is partial or complete, is unilateral or bilateral, is complicated by infection or not and how and when it is relieved. This review will look at these interacting factors and particularly on the effects of various treatment modalities ranging from open techniques to minimally and non-invasive interventions.
The natural history of superficial bladder carcinoma has an important bearing on the outcome of response to intravesical chemotherapy or immunotherapy. It may vary in different parts of the world, but it is essential that urologists know within their own practice how tumours respond to the initial transurethral resection. Many factors influence the natural history of superficial bladder carcinoma, and some, such as poor-grade, large tumour at presentation, smoking history, poor response to initial resection, and dysplasia or carcinoma in situ, should alert the urologist to introduce intravesical therapy at an early stage.
In situ ESWL for ureteric calculi is associated with good stone clearance rates but is it without significant morbidity? A review of 189 patients with single ureteric calculi (150 upper ureter, 39 lower ureter calculi) revealed an 89% stone clearance for upper ureteral calculi and 80% stone clearance for lower ureteral calculi. However 11% of patients with upper ureteral calculi and 20% of patients with lower ureteral calculi required additional intervention for complications or failed treatment. In situ ESWL may not be the optimum therapy for all ureteric calculi especially those in the lower ureter.