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Biomedical subjects

J R Woodside

Publications and source records attributed to J R Woodside.

At least 37 records · Page 2Linked to original sources
PubMed1984

Adult respiratory distress syndrome complicating percutaneous nephrolithotripsy.

In an otherwise healthy thirty-six-year-old man adult respiratory distress syndrome developed following percutaneous nephrolithotripsy. Absorption of a large volume of irrigating solution occurred during the procedure and resulted in respiratory compromise, neither of which was appreciated intraoperatively. Close intraoperative monitoring of irrigation fluid input and output is necessary, and if a significant discrepancy develops, we believe the procedure should be terminated and diuresis instituted. In a difficult procedure, consideration should be given to establishing a maximum operating time and shortened if patient risk factors so warrant.

Adult↗
PubMed1984

Management of penile incarceration.

A case of penile incarceration is presented. Two steel bushings compromising the penile vascular supply in a young man were removed with the aid of a carbide disk dental drill. Management of this case is described, and guidelines for managing similar cases of penile incarceration are discussed.

Adult↗
PubMed1984

Urodynamic evaluation of incontinence in patients undergoing modified Campbell radical retropubic prostatectomy: a prospective study.

A prospective urodynamic study was performed on 17 consecutive patients undergoing a modified Campbell radical retropubic prostatectomy for prostatic carcinoma. There was 1 postoperative death, leaving 16 evaluable patients. Patients were evaluated preoperatively and at 6 weeks, 3 months and 6 months postoperatively. The only urodynamic parameter 6 months postoperatively that differed significantly from the preoperative value was the functional urethral length, 1.6 and 4.3 cm., respectively. The incidence of clinical and/or urodynamic urinary incontinence preoperatively was 19 per cent and 6 months after the procedure it was 87 per cent. The incontinence rate did not correlate with the pathological stage or histological grade of the tumor. There was a strong trend toward improvement of continence with time but all patients who were incontinent 6 months postoperatively and followed for more than 1 year remained incontinent. While this incontinence rate is the highest reported, we believe that it reflects detailed patient interviews and objective fluoroscopic evidence of urethral urinary loss. These results and those of others suggest that modification of the technique of radical prostatectomy to produce a functional urethral length of at least 2.8 cm. may be desirable.

Carcinoma↗
PubMed1984

Unilateral pulmonary edema (down lung syndrome) following urological operation.

We present 2 cases of unilateral pulmonary edema. The physiology of pulmonary ventilation and perfusion in relation to positioning for a urological operation is discussed. The lateral decubitus position can compromise down lung mechanics and result in unilateral pulmonary edema in situations when volume overload exists.

Adolescent↗
PubMed1984

Suprapubic endoscopic vesical neck suspension (Stamey procedure) for control of urinary incontinence in a woman following cauda equina injury.

Suprapubic endoscopic suspension of the vesical neck is a popular and effective procedure for the treatment of stress urinary incontinence in women. A woman who suffered a traumatic cauda equina injury had areflexic detrusor dysfunction with normal intravesical filling pressure. The patient had moderate proximal urethral dysfunction resulting in incontinence despite an adequate intermittent self-catheterization regimen and treatment with an alpha-sympathomimetic drug. Following suprapubic endoscopic vesical neck suspension she has remained totally continent on intermittent self-catheterization.

Adolescent↗
PubMed1984

Central depletion of catecholamines--importance of hypertension and anesthesia.

The importance of the brain noradrenergic sympathetic nervous system in blood pressure control during anesthesia with halothane and enflurane was investigated in normotensive and hypertensive rats. Central noradrenergic neurons were destroyed by instillation of 6-hydroxydopamine (6-OHDA) into the cerebral ventricle of both normotensive Wistar rats and spontaneously hypertensive rats (SHR). One week later, arterial and venous lines were placed in the rats under anesthesia; the rats were allowed to recover; and blood pressure and plasma renin activity were measured while the rats were awake. Anesthesia then was induced with 1.3 vol% halothane (Wistar n = 8, Wistar 6-OHDA n = 10, SHR n = 8, SHR 6-OHDA n = 6) or 2.2 vol% enflurane (Wistar n = 6, Wistar 6-OHDA n = 10, SHR n = 8, SHR 6-OHDA n = 6). A control group (Wistar n = 10, Wistar 6-OHDA n = 6, SHR n = 8, SHR 6-OHDA n = 6) was treated identically, but remained unanesthetized throughout the experiment. The untreated normotensive and hypertensive rats received no intraventricular injections. After 1 hr of stable anesthesia, plasma renin activity was measured again, and saralasin, a competitive inhibitor of angiotensin II, was infused to determine the importance of the renin--angiotensin system in blood pressure control. Treatment with 6-OHDA resulted in a 60-90% depletion of norepinephrine in the medulla and hypothalamus. Normotensive Wistar rats treated with 6-OHDA responded to halothane and enflurane anesthesia in a manner similar to untreated normotensive rats. In contrast, hypertensive animals treated with 6-OHDA and then anesthetized with halothane had a significantly greater decrease in blood pressure than untreated hypertensive rats (100 +/- 4 mm Hg vs 125 +/- 4 mm Hg, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

Renovascular hypertension: effect of halothane and enflurane.

Male Wistar rats were anesthetized at 6 weeks of age and a silver clip placed around the renal artery to produce renovascular hypertension. The rats were allowed to grow on a normal sodium diet for the next 6-9 weeks. Using diethyl ether anesthesia, arterial and venous cannulae were placed and the animals allowed to awaken in restraining cages. The group of rats was divided into three groups: awake (n = 7), halothane 1.3 vol% (n = 9), and enflurane 2.2 vol% (n = 8). The protocol consisted of a 1-h control awake period, 1 h of stable anesthesia (one group received no anesthesia), and 30-min iv infusion of saralasin, a competitive inhibitor of angiotensin II. Plasma renin activity (PRA) and plasma catecholamines were measured after 1 h of stable anesthesia and after the saralasin infusion. In additional rats treated identically, radiolabelled microspheres were used to measure cardiac output and regional blood flows during halothane (n = 7) or enflurane (n = 6) anesthesia. Principal responses were as follows: mean arterial pressure (MAP) was 193 +/- 4 mmHg awake and decreased to 114 +/- 3 mmHg and 135 +/- 3 mmHg with halothane and enflurane, respectively. Saralasin decreased MAP in the awake group to 176 +/- 3 mmHg and to 69 +/- 3 mmHg and 96 +/- 5 mmHg with halothane and enflurane, respectively. PRA in the awake rats was 7.24 +/- 1.3 ng X ml-1 X h-1. PRA increased with halothane but decreased with enflurane. Plasma catecholamines were decreased markedly by saralasin and by both anesthetic agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗
PubMed1983

EMG biofeedback for functional bladder-sphincter dyssynergia: a case study.

The present study utilized EMG biofeedback in the treatment of functional bladder-sphincter dyssynergia, a learned incoordination of bladder and urethral sphincter activity during voiding. The condition is usually associated with a history of painful urination due to bladder infections, surgery, or harsh toilet training. The subject was an 8-year-old girl with chronic diurnal urinary frequency, urge incontinence, and nocturnal enuresis. Treatment consisted of intensive instruction in alternately tensing and relaxing her lower pelvic musculature, as well as relaxing during voiding. These exercises were accompanied by EMG biofeedback from perianal and perivaginal surface electrode sites. Home practice consisted of the tense-relax exercise, relaxation during voiding, and self-monitoring and record-keeping. There were 17 sessions over a period of 9 months. No medication was used. Marked reduction (to normal levels) in diurnal urgency and frequency occurred by the 3rd week of therapy, and complete recovery of normal function, including nocturnal continence without waking, occurred by the 13th therapy session, 5 months after therapy began. Follow-up 1 year after therapy revealed that these gains were being maintained. Pre- and posttherapy urodynamic studies corroborated the achievement of normal urinary function.

Biofeedback, Psychology↗
PubMed1983

Central nervous system lesion causing urethral instability and urinary incontinence.

We report on a girl in whom urinary incontinence developed after surgery for a cerebral arteriovenous fistula. Urodynamic evaluation demonstrated periodic decreases in urethral pressure and external anal sphincter electromyographic activity. These episodes were associated with entry of radiographic contrast material into the urethra and urinary incontinence. Treatment with ephedrine sulfate prevented entry of urine into the proximal urethra and resulted in complete daytime continence, despite persisting urodynamic evidence of urethral and electromyographic abnormalities.

Arteriovenous Fistula↗
PubMed1983

Familial juvenile type III spinal cord arteriovenous malformation: urodynamic findings.

Two sisters with juvenile type III spinal cord arteriovenous malformations were studied urodynamically. Micturitional dysfunction was prominent in the clinical presentation of both cases. Although both patients had similar lesions 1 demonstrated detrusor-sphincter dyssynergia and detrusor hyperreflexia, while the other showed only detrusor hyperreflexia. This is the first report of a familial occurrence of juvenile type III arteriovenous malformation and of the associated urodynamic findings.

Adolescent↗
PubMed1983

Upper urinary tract deterioration in patients with myelodysplasia and detrusor hypertonia: a followup study.

We report on 6 patients with myelodysplasia who had undergone previously urodynamic evaluation that demonstrated detrusor hypertonia. At the time of the initial studies no patient had vesicoureteral reflux or significant upper urinary tract dilatation. Subsequently, upper urinary tract deterioration and/or vesicoureteral reflux developed in all patients and persisting detrusor hypertonia was demonstrated on followup urodynamic testing. Marked clinical and radiographic improvement followed treatment by intermittent catheterization with concomitant pharmacologic therapy. Our experience indicates that detrusor hypertonia can lead to ureteral complications in patients with previously radiographically normal upper urinary tracts. We believe that detrusor hypertonia should be treated with anticholinergic medication, frequently in conjunction with intermittent catheterization. The clinical presentation of upper tract deterioration after many years of normality, and occurring as late as the mid teenage years, demonstrates that these patients require prolonged and careful urologic and radiographic followup.

Adolescent↗
PubMed1983

Mild unilateral proteinuria and renal vein thrombosis associated with oral contraceptive usage.

A previously healthy 15-yr-old female taking oral contraceptives presented with acute, isolated, unilateral renal vein thrombosis as documented by arteriography and venography. Mild proteinuria (760 mg/24 hr) was localized solely to the thrombosed kidney by selective ureteral collections. The case illustrates an oral contraceptive associated renal vein thrombosis in the absence of either inferior vena cava thrombosis, bilateral proteinuria, or the nephrotic syndrome. This patient's proteinuria and clinical course suggest that nephrotic syndrome is a cause of renal vein thrombosis rather than an effect of renal vein thrombosis. The finding of localized, unilateral proteinuria is discussed.

Acute Disease↗
PubMed1982

Segmental renal artery emboli treated with low-dose intra-arterial streptokinase.

Herein we describe a sixty-one-year-old man with unilateral segmental renal artery emboli treated with renal intra-arterial streptokinase infusion. The initial infusion rate was 9,000 units/hr. which was decreased to 5,000 units/hr. over the next six hours. Periodic arteriography demonstrated progressive lysis and virtual complete resolution after fifty-two hours of infusion. Intravenous pyelogram (IVP) six weeks later showed almost complete return of functional compared with IVP obtained six years earlier. We have demonstrated successful clot lysis at an infusion rate of 5,000 units/hr., compared with reported rates of 25,000 units/hr. and without the frequently utilized initial large intravenous bolus. Such low-dose streptokinase infusion should, theoretically, limit the incidence of recognized dose-related complications and permit its use in clinical settings where higher dosages are contraindicated. Intra-arterial streptokinase therapy seems particularly suitable for the high surgical risk patient and in arterial lesions not amenable to surgery. The availability of this potentially efficacious therapy suggests that aggressive diagnostic studies be pursued early in patients suspected of having an acute renal arterial embolus.

Embolism↗
PubMed1982

Urinary lactic dehydrogenase and serum C-reactive protein as means of localizing the site of urinary tract infection in patients with ileal conduits.

Many patients with ileal conduit urinary diversion have infected urine but far fewer have clinical pyelonephritis. A noninvasive diagnostic test to distinguish renal bacteriuria from conduit colonization in these patients would seem desirable. Urine total lactic dehydrogenase and lactic dehydrogenase isoenzymes, and serum C-reactive protein have been useful to distinguish pyelonephritis from cystitis in patients with intact urinary tracts. We used these tests in patients with ileal conduits who had urine containing more and less than 10(5) organisms per ml. All patients had elevated urine total lactic dehydrogenase-5 isoenzyme, and serum C-reactive protein. No statistically significant difference in any of these parameters existed between the groups. These results may indicate that all patients with conduits have pyelonephritis but only intermittently demonstrate bacteriuria, or that the conduit mucosa contributes lactic dehydrogenase to the urine. However, it does not appear that these tests alone can distinguish accurately renal bacteriuria from conduit colonization.

Adolescent↗
PubMed1982

Neurogenic pulmonary edema associated with autonomic dysreflexia.

Neurogenic pulmonary edema is associated with a variety of central nervous system injuries and results from a massive centrally mediated sympathetic discharge. Another syndrome characterized by sympathetic overactivity is autonomic dysreflexia, which occurs in patients with spinal cord injury above T4 to T6. We describe a patient with a cervical spinal cord injury who had intense, prolonged autonomic dysreflexia following external sphincterotomy, which culminated in pulmonary edema. Traction on an over-inflated Foley catheter balloon was the stimulus for autonomic dysreflexia and deflation of the balloon resulted in prompt resolution of autonomic dysreflexia and pulmonary edema. The pathophysiology of neurogenic pulmonary edema and autonomic dysreflexia is discussed.

Adult↗