Biomedical subjects
Publications and source records attributed to J M Pierce.
100 patients, referred for urodynamic study, have had several cystometrograms performed at each examination, and the effect of filling at different rates and in different positions has been assessed. This has included pressure measurements carried out during "physiological" bladder filling. Bladder instability was found to be a highly consistent phenomenon, its detection being independent of filling rate or position of filling.
Thirty-five consecutive patients with progressive systemic sclerosis were prospectively evaluated for evidence of Sjögren's syndrome. Six of the 35 (17%) were judged to have the disorder. This is a higher prevalence than in most reports, but much lower than that recently reportedly by Alarcón-Segovia and associates (7). An additional 17 of the 35 patients (48%) had significant fibrosis in the absence of sufficient mononuclear cell infiltrates to confirm the diagnosis of Sjögren's syndrome. This group had particularly aggressive scleroderma with serious visceral features, and five died after a short duration of illness. No significant abnormalities were found in biopsies from six patients with the mixed connective tissue disease syndrome, five with Raynaud's phenomenon alone, or in 29 autopsy control subjects who had no evidence of connective tissue disease. Fibrosis in the absence of mononuclear infiltration in minor salivary glands of patients with progressive systemic sclerosis indicates a poor prognosis.
Ureterostomy in situ is a simple technique for supravesical urinary diversion. Although it was described a few years ago, it has not gained wide acceptance. From our experience and with slight modifications, we believe there is a place for this procedure as a method of temporary urinary diversion.
Despite modern methods in evaluating renal masses a small percentage of cases remain elusive to preoperative diagnosis. The authors discuss ten renal masses with heterogeneous pathology seen at their service within the last two years. An outline of the difficulties in arriving at a correct preoperative diagnosis is discussed. The clinical findings and pathology encountered are evaluated.
Selective renal arteriography was done in 5 patients with transitional cell carcinoma of the renal pelvis and upper ureter. In 2 cases, the presence of tumor vessels was unequivocally diagnostic. In the remaining 3 cases, the arteriographic changes were not as prominent but were suggestive of neoplasm and were helpful in differentiating other causes of filling defects in the collecting system.
An arterio-infundibular-venous fistula complicating partial nephrectomy was embolized successfully via transfemoral catheterization of the right renal artery using autologous muscle. The use of autologous material occluded this vascular malformation with preservation of renal function in the remaining portion of the kidney. The technique was lifesaving since this patient was in critical condition and could not tolerate an operation.
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Four months after a cadaver kidney transplant, kidney stones were found in the renal allograft. Three major predisposing causes of nephrolithiasis were found in the patient, including hyperparathyroidism, renal tubular acidosis, and urinary tract infection. Hypercalcemia was corrected by parathyroidectomy. During the subsequent three years there was no enlargement of the renal stones and adequate kidney function was maintained. Renal tubular acidosis was not severe and seemed to be related to chronic rejection. Urinary tract infection was readily corrected with antibiotics and did not recur after the immediate post-transplant period. Surgical therapy for nephrolithiasis involving a kidney allograft was defferred since urinary flow was not obstructed. This course of management is recommended for use in patients with calculi complicating renal transplantation.
We evaluated bone marrow acid phosphatase in 30 patients as another parameter in staging prostatic carcinoma. This method is reliable and useful as part of the staging precedures. No falsely positive results were found and the procedure provided the only indication of metastatic diseases in 4 cases.
The development of obstructive jaundice associated with the formation of a renal pseudocyst in 2 patients undergoing pyeloplasty on the right side is discussed. We emphasize the importance of proper drainage of the retroperitoneal area to prevent this complication.
A review is presented on the anatomy of nerves involved in penile erections, with respect to their exit from the pelvis. More detailed information is required. A road map of these nerves as they approach, traverse and exit from the urogenital diaphragm is needed, which would allow the surgeon to properly design the stricture repair operation. Case reports are presented that suggest that the membranous urethra and urogenital diaphragm can be incised posteriorly in the midline without destroying the penile erection. Since subjective evaluation of penile erection may be misleading a method for objective evaluation is required. Further information regarding the effect on potency of the various types of operations involving the urogenital diaphragm for membranous-prostatic urethral strictures needs to be carefully accumulated.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.