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Biomedical subjects

L B Talner

Publications and source records attributed to L B Talner.

At least 37 records · Page 2Linked to original sources
PubMed1988

Protective effects of corticosteroids in contrast material anaphylaxis.

A prospective, randomized study of the potential protective effects of corticosteroids administered as pretreatment against contrast material (CM) reactions is reported. Patients (n = 6,763) from multiple institutions received either a single dose of steroids (32 mg of oral methylprednisolone, approximately 2 hours before CM challenge), a double dose (32 mg approximately 12 hours and 2 hours before CM challenge), or placebo. All contrast injections were with ionic media and were given intravenously. The two-dose (but not the one-dose) corticosteroid regimen provided significant protection. The effect on reaction incidences of a number of historical variables is also tabulated.

Anaphylaxis↗
PubMed1987

Pretreatment with corticosteroids to alleviate reactions to intravenous contrast material.

The x-ray contrast mediums used over the past three decades have been salts of iodinated acids administered in highly hypertonic concentrations. We conducted a multiinstitutional randomized study of the protective effects of pretreatment with corticosteroids against reactions to intravenous contrast material. We gave 6763 patients two doses of oral corticosteroids (methylprednisolone, 32 mg) approximately 12 hours and 2 hours before challenge with contrast material, one dose of oral prednisolone approximately 2 hours before challenge, or placebo in the same dosages. The two-dose corticosteroid regimen, but not the one-dose regimen, significantly reduced the incidence of reactions of all types (P less than 0.05) except a category of reactions dominated by hives, for which the reduction approached significance (P = 0.055). In recent years, several relatively expensive monomeric nonionic iodinated compounds having approximately half the osmolality of the corresponding ionic compounds and a lower reaction rate have become available. With our two-dose corticosteroid regimen, the incidence of reactions necessitating therapy in patients receiving the ionic medium approximated that reported in an unblinded nonrandomized study of patients receiving a newer intravenous nonionic medium without corticosteroid pretreatment. We conclude that the much less expensive ionic medium, if administered with corticosteroid pretreatment, may serve as a reasonable alternative to intravenous nonionic medium, without loss of safety.

Administration, Oral↗
PubMed1984

Lysis of osteoblastic lesions in prostatic cancer: a sign of progression.

Osteoblastic metastases from prostatic cancer often increase in density after successful endocrine treatment. Regrowth of malignancy, at the time of relapse, may cause osteolytic changes in previously stable sclerotic lesions. Four illustrative case reports are presented. Fading of sclerotic lesions on radiographs, accompanied by bone destruction, signifies disease progression.

Adenocarcinoma↗
PubMed1984

Percutaneous nephrostomy.

This article highlights the indications, techniques, and complications of percutaneous nephrostomy. The authors' comments are based on their experience with more than 200 patients.

Catheterization↗
PubMed1983

Papillary morphology in adult human kidneys and in baby and adult pig kidneys.

The morphology of the renal papillae was studied by inspection in a series of: (1) Hampshire/Duroc piglet kidneys; (2) Danish Landrace adult pig kidneys, and (3) kidneys obtained at necropsy from adult patients. In both man and pig two main types of papillae were found: (1) a single or 'simple' papilla which drains one renal lobe, and (2) a fused or 'compound' papilla which drains two or more renal lobes. Compound papillae were found most frequently in the Hampshire/Duroc kidneys and least frequently in the human kidneys. In all three groups compound papillae were found most frequently in the upper pole. Intrarenal backflow during retrograde pyelography in the piglet kidney at intrapelvic pressures of 30-35 mm Hg (moderate) and of 70-75 mm Hg (high) was related to the morphology of the individual papilla. Both types of papilla could be divided into an open type containing at least two round or oval orifices of the papillary ducts and a closed type with small, often slit-like orifices. At moderate intrapelvic pressure intrarenal backflow occurred mainly in the open compound papillae whereas at high intrapelvic pressure it occurred in nearly all open compound papillae and in about 50% of the open simple papillae. It is concluded that papillary morphology plays an important role in the predominant upper polar occurrence of intrarenal backflow/intrarenal reflux during micturition cystography and in the higher frequency of intrarenal backflow in the mid-zone than in the lower pole in adult human beings.

Aged↗
PubMed1983

Intrarenal backflow and renal perfusion during increased intrapelvic pressure in excised porcine kidneys.

The effect of increased intrapelvic pressure on renal perfusion was examined by simple magnified angiography of freshly excised artificially perfused kidneys of adult Danish Landrace pigs. In all kidneys control angiography was performed at normal intrapelvic pressure (0-5 mmHg). Intrapelvic pressure was raised by retrograde ureteral perfusion of saline in 9 kidneys. Repeat angiography was performed at an intrapelvic pressure of 30-35 mmHg (4 kidneys), 50-55 mmHg (5 kidneys) or 0-5 mmHg (4 kidneys). Angiography demonstrated a delay in arterial filling in kidneys with increased intrapelvic pressure. Perfusate flow measurements showed a corresponding fall in perfusion flow. Retrograde ureteral perfusion was repeated at similar pressures using contrast medium. Intrarenal backflow (IRB) was demonstrated in all 9 kidneys with elevated intrapelvic pressure. IRB localized to 84 per cent of the compound papillae and to 40 per cent of the simple papillae, and was independent of the level of elevated intrapelvic pressure. One-third of the papillae with IRB had absent or markedly decreased arterial filling in the corresponding lobe at angiography. A third retrograde ureteral perfusion was done with a mixture of barium sulphate and gelatin in 4 kidneys. Light microscopy demonstrated that the primary pathway for IRB was canalicular. The contrast medium entered the interstice by three routes: (1) Tubular leakage in the papilla and the corticomedullary region, (2) tears originating in the papilla itself and (3) tears in the calyceal fornix with extension into the parenchyma.

Animals↗
PubMed1983

Detection of ureteral obstruction on radionuclide bone scans.

The kidneys are nearly always visible on a routine radionuclide bone scan. To assess the reliability of the bone scan in detecting ureteral obstruction, 220 bone scans and excretory urograms were compared in 53 patients followed serially for prostatic cancer. There were 15 kidneys obstructed on excretory urograms. Only nine were diagnosed as obstructed on the bone scans. Seven of the nine cases of unilaterally obstructed kidneys were detected, whereas only two of the six kidneys in three patients with bilateral obstruction were correctly diagnosed. The results indicate that unilateral obstruction is more likely to be detected, whereas bilateral obstruction is more likely to be missed, on bone scans. Therefore, the routine radionuclide bone scan is an unreliable test for ureteral obstruction.

Bone Neoplasms↗
PubMed1983

Lupus cystitis: primary bladder manifestations of systemic lupus erythematosus.

Clinical and radiographic findings of cystitis are reported in six patients with systemic lupus erythematosus. All patients had clinical manifestations of cystitis; radiography showed the bladder capacities were reduced and the bladder walls were thickened and irregular. Ureterohydronephrosis was found in some patients. Abnormal clinical and roentgenographic findings were reversed with high-dose corticosteroid therapy. These patients had concomitant widespread multisystem manifestations, especially of the central nervous system and gastrointestinal tract. No explanation for the bladder findings could be found other than lupus erythematosus. Urinary bladder involvement may be a primary manifestation of systemic lupus erythematosus, sometimes overshadowed by other major organ system disease. Corticosteroids appear to reverse most of the acute manifestations but the long-term prognosis is not known and may not be favorable.

Adrenal Cortex Hormones↗
PubMed1982

Limitations of renal function scanning in acute obstruction.

This study was designed to determine if technetium-99m penicillamine (TPEN), could be used to predict recoverable function in dogs with acute obstruction. Renal accumulation of TPEN was measured in four control dogs, in four dogs with acute obstruction lasting 7-14 days, and in the same four dogs following a variable recovery period of 15-63 days. The relative renal uptake of TPEN in vivo showed good agreement with the relative uptake in vitro and both measurements correlated closely with the relative inulin clearances in the normal and in the post obstructed kidneys. The uptake of TPEN in the obstructed kidney following 7-14 days of obstruction averaged 6.8% of the total renal uptake. After relief of the obstruction and a variable recovery period the relative uptake of TPEN in the post obstructed kidney had increased to a mean of 29.5%. These results indicate that TPEN scans should not be used during acute obstruction to predict recoverable function. The observations noted in the study almost certainly apply to similar chelating agents such as dimercaptosuccinic acid (DMSA) and probably to other renal radiopharmaceuticals as well.

Animals↗
PubMed1982

Pyelorenal backflow during retrograde pyelography in normal and ischemic porcine kidneys. A radiologic and pathoanatomic study.

Retrograde pyelography was performed in 14 kidneys of anesthetized baby pigs to study the phenomenon of pyelorenal backflow. In this model, a constant retrograde perfusion rate of 10 ml/min was used which resulted in a progressive increase in pelvic pressure. The experiments were done on normal and ischemic kidneys. Pyelosinous backflow developed in twelve kidneys at an average intrapelvic pressure of 197 mm Hg and was independent of renal ischemia. Intrarenal backflow was observed only in kidneys which had been ischemic for 60 min and after 2 h of hypotension, or in postmortem kidneys. Intrarenal backflow in one or two papillae occurred at an intrapelvic pressure of 125 mm Hg. At higher intrapelvic pressures there was more intense and widespread intrarenal backflow. Histologic examination revealed tears in the calyceal fornix in cases with pyelosinous backflow. If intrarenal backflow was present there was parenchymal necrosis, interstitial Ferritin (added to the contrast material) in the papilla and in the corticomedullary junction, and tears leading from the pelvic cavity into the renal parenchyma.

Animals↗
PubMed1981

Double-blind trial of oral 1,25-dihydroxy vitamin D3 versus placebo in asymptomatic hyperparathyroidism in patients receiving maintenance haemodialysis.

Fifty-seven patients who had been receiving maintenance haemodialysis for a mean of 4.6 years were given 0.25-0.5 microgram oral 1,25-dihydroxy (1,25-(OH)2) vitamin D3 or a placebo in a double-blind manner for one to two years. In patients with normal radiographs (mean plasma parathyroid hormone concentration 205 microliterEq/ml) 1,25-(OH)2 vitamin D3 prevented the development of the radiological appearances of hyperparathyroidism. In patients with abnormal radiographs (mean plasma parathyroid concentration 709 microliterEq/ml) 1,25-(OH)2 vitamin D3 arrested or reversed the radiological changes of hyperparathyroidism. Nevertheless, the response was slow and the concentration of the hormone remained considerably raised (mean 445 microliterEq/ml). It is concluded from these results that giving 1,25-(OH)2 vitamin D3 to patients receiving maintenance haemodialysis who have normal hand radiographs or minimal erosions is beneficial. In patients with more advanced hyperparathyroidism parathyroidectomy should be considered unless there is a rapid response.

Adult↗