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Biomedical subjects

L H Banowsky

Publications and source records attributed to L H Banowsky.

At least 55 records · Page 3Linked to original sources
PubMed1977

The role of adjunctive nephrectomy in patients with metastatic renal cell carcinoma.

The results of therapy for 78 patients with disseminated renal cell carcinoma are evaluated. Symptoms related to the primary tumor were noted in only 28 per cent of the patients and were not difficult to manage in those patients not undergoing nephrectomy. Adjuctive nephrectomy, therefore, is a more appropriate term than palliative nephrectomy when referring to removal of the primary tumor as part of an aggresive combined therapeutic approach. Of patients receiving an adjunctive nephrectomy those with osseous metastases only had a better 1-year survival rate (36 per cent) than those with metastases to other sites (18 per cent). Complete regression of metastases was noted in 12 per cent of patients treated with medroxyprogesterone acetate and adjunctive nephrectomy. The role of adjunctive nephrectomy combined with embolic infarction, hormonal therapy, chemotherapy and/or immunotherapy is discussed.

Adenocarcinoma↗
PubMed1977

Renal revascularization in patients with severe atherosclerosis of the abdominal aorta or a previous operation on the abdominal aorta.

Renal revascularization has been performed in six patients in whom severe atherosclerosis or previous operative procedures on the abdominal aorta precluded the performance of a standard aortorenal bypass graft. Splenorenal anastomoses were performed in three patients, superior mesenterorenal anastomosis in one patient, long saphenous vein iliorenal anastomosis in one patient, and renal autotransplantation in one patient. Successful renal revascularization with preservation of renal function was accomplished in all patients. The natural history of severe atherosclerotic renovascular disease has demonstrated the relatively frequent occurrence of arterial thrombosis and renal failure in patients with solitary kidneys. Occasionally, the presence of severe aortic disease precludes the use of standard aortorenal bypass grafting. Fortunately, as reported herein, alternate methods of revascularization are available whereby renovascular hypertension can be corrected and renal function preserved, with minimal operative risk.

Adult↗
PubMed1977

Splenorenal bypass in the treatment of renal artery stenosis.

A retrospective study is presented of our experience from 1962 to 1976 with the splenorenal bypass procedure in the treatment of 32 patients with renovascular hypertension. The over-all results were 53 per cent of the patients cured, 28 per cent improved and 19 per cent failures. Improved results were noted when the splenorenal bypass was performed in relation to specific operative indications. The results were somewhat better in men than in women and poor results were obtained in children. Intraoperative and early postoperative complications were minimal. There were 2 postoperative deaths, for a hospital mortality rate of 6.3 per cent. Late complications were limited to splenic artery graft stenoses, which developed in 3 patients (9.4 per cent). When performed in relation to specific clinical and operative indications the splenorenal bypass is believed to represent an excellent means to achieve safe and effective renal revascularization.

Adolescent↗
PubMed1977

Splenorenal bypass in the treatment of stenosis of the renal artery.

The over-all results obtained with splenorenal bypass in the treatment of 32 patients with renovascular hypertension were 17 patients cured, nine patients improved and six failures. Improved results were noted when splenorenal bypass was performed in relation to specific operative indications. The results were somewhat better for men than for women; however, poor results were obtained in children. Intraoperative and early postoperative complications were minimal, and there were two postoperative deaths. Late complications were limited to stenoses of the splenic artery graft which developed in three patients. When performed in relation to specific clinical and operative indications, splenorenal bypass represents an excellent means of achieving safe and effective renal revascularization.

Adolescent↗
PubMed1976

Management of extensively destroyed ureter: special reference to renal autotransplantation.

Renal autotransplantation has been attempted 6 times in 4 patients for the correction of extensive ureteral disease. Indications in these patients include trauma secondary to ureterolithotomy and spinal fusion, and failed supravesical diversionary procedures. Included in our report is the first case of autotransplantation associated with ureterosigmoidostomy. Renal autotransplantation is an effective method to restore or preserve renal function in patients with extensive ureteral damage or disease. However, the procedure should not be considered in poor risk patients with good contralateral renal function or in patients in whom standard reparative procedures are possible. The hazard is real of vascular spasm, poor perfusion and ultimate autograft failure in kidneys with advanced chronic pyelonephritis and/or inflammation involving the renal pedicle. Autotransplantation should be considered only as a last resort in such patients.

Adult↗
PubMed1976

Stress incontinence: conservative therapy with sympathomimetic drugs.

There were 77 women with mild to moderate stress urinary incontinence treated with the sympathomimetic agent, phenylpropanolamine hydrochloride, combined with chlorpheniramine maleate and isopropamide iodide in a sustained release capsule (Ornade). The majority of these patients achieved significant improvement 3 months to 3 years after beginning therapy. A trial of conservative therapy is advisable for stress incontinence, especially when symptoms are mild or when the patients are in a poor risk category. Similar management of post-prostatectomy stress incontinence in men was disappointing. However, the occasional excellent results in patients with mild symptoms appear to justify a trial of conservative therapy before considering operative intervention in this group of patients.

Administration, Oral↗
PubMed1976

Effect of high doses of methylprednisolone on the isolated, perfused canine kidney.

The administration of methylprednisolone (MP) (2.125-4.125 G) To the cryoprecipitated plasma perfusate of 41 canine kidneys preserved with hypothermic pulsatile perfusion is associated with increased vascular resistance, decreased plasma flow, and rising perfusion pressure that become more pronounced over periods up to 20 hr. The magnitude of the increase in renal resistance is directly related in a bimodal fashion to the dose of MP and to the interval following drug administration. The increase in renal resistance is generally irreversible (three or four cases) under conditions of high MP dosage (2.125 g) administered for 4 hr or longer. Severe histological changes occurred in kidneys perfused with MP 20 hr or longer. These changes were primarily glomerular changes consisting of necrosis of capillary loops, occlusion of Bowman's space, basement membrane thickening, and endothelial cell damage; tubular changes consisting of occlusion of tubular lumens and tubular epithelial cell damage; and arteriolar changes consisting of occlusion primarily of afferent arterioles with dense eosinophilic material. These studies demonstrate that the administration of high doses of MP can produce irreversible hemodynamic and histological changes in the isolated, perfused kidney and may preclude its use in pretreating kidneys for transplantation.

Animals↗
PubMed1976

Renal autotransplantation: current perspectives.

Autotransplantation, with or without an extracorporeal renal operation, has been done 39 times in 37 patients. Indications for the procedure included severe ureteral injury in 4 patients, failed supravesical diversion in 2, renal carcinoma in a solitary kidney in 1, renovascular hypertension in 1 and donor arterial reconstruction before renal transplantation in 29. Success was obtained in all but 2 procedures, both of which involved previously operated kidneys with severe inflammation and adhesions involving the renal pelvis and pedicle. Based on our experience and a review of currently available literature we believe that renal autotransplantation and extracorporeal reconstruction can provide the best solution for patients with severe renovascular and ureteral disease not correctable by conventional operative techniques. The technique can be of particular value in removing centrally located tumors in solitary kidneys and in preparing donor kidneys with abnormal arteries for renal transplantation. The role of autotransplantation in the management of advanced renal trauma and calculus disease is less clear. A long-term comparison of patients treated by extracorporeal nephrolithotomy versus conventional lithotomy techniques will be necessary before a conclusion is reached in these disease categories.

Female↗
PubMed1976

Revascularization of the kidney after occlusion of the aorta and both renal arteries.

A patient who developed acute renal artery thrombosis as a complication of distal abdominal aortic occlusion is described. Because of the presence of an extensive collateral arterial supply, the right kidney survived and revascularization was accomplished successfully with a saphenous vein graft interposed between the superior mesenteric and the right renal arteries. Criteria for revascularization of renal artery occlusion are presented, with emphasis on the importance of collateral circulation and the elective correction of distal aortic thrombosis.

Aortic Diseases↗
PubMed1976

Septicemia in renal transplant recipients.

Thirty-six renal transplant recipients with 47 episodes of septicemia were studied carefully at the bedside, in the laboratory, and, all too frequently, at autopsy. Gram-negative bacilli were the pathogens most commonly responsible, folloed in order of frequency by gram-positive cocci, polymicrobic etiologic agents, Listeria monocytogenes, and fungi. Infections of the transplant site (urinary tract or transplant wounds) caused septicemia in 51% of the cases. Other portals of entry included the lung, the abdomen, the meninges, the endocardium, and miscellaneous sites. The outcome of septicemia was fatal in 36% of the episodes. There was a significantly higher mortality for episodes of septicemia associated with pneumonia, persistent bloodstream infection, leukopenia, metastatic abscesses, clinical shock, and acute respiratory failure. The high mortality of septicemia in renal allograft recipients demands that extremely careful attention be given to subtle clinical clues denoting the onset and predicting the course of the disorder.

Adolescent↗
PubMed1975

Testis tumors: review of 125 cases at the Cleveland Clinic.

One hundred twenty-five cases of testicular tumor are reviewed. The prognostic significance of clinical features, certain laboratory test results, and histologic type are evaluated, and treatment results are presented. The most important prognostic clinical feature is the presence or absence of clinically evident metastases. The urinary gonadotropin levels are useful prognostically, but the intravenous pyelogram and lymphangiogram are statistically unreliable. The presence of tumor in retroperitoneal lymph nodes influenced survival only in the patients with embryonal carcinoma. Tumor type influenced survival more than any other pathologic factor. Vascular invasion, local extension, and Leydig cell hyperplasia did not correlate with tumor behavior in germinal neoplasms. Patients with clinical Stage IA or IB teratocarcinoma had an 85 per cent survival rate with a wide variety of treatment.

Adult↗
PubMed1975

Ureteral involvement in genitourinary tuberculosis: review of 20 cases encountered over three years.

Genitourinary tuberculosis continues to be a significant worldwide problem. In the southwestern United States, this is particularly true among Indians and Spanish-Americans who, in the experience of the authors, frequently present with advanced and neglected disease. The possibility of silent development or progression of ureteral strictures while on antituberculous medication demands routine urographic evaluation of all patients in whom pulmonary tuberculosis is diagnosed. A large percentage of patients with ureteral tuberculosis undergo stricture formation or progression while on chemotherapy, and require reconstructive ureteral surgery if renal destruction is to be avoided.

Adolescent↗
PubMed1975

Bilateral testicular tumors of germ cell origin.

Four cases of primary testicular tumor of germ cell origin are reported. Three cases were bilateral, while the remaining case involved a unilateral tumor in a non-twin brother of 1 patient with bilateral tumors. Because of the increased likelihood of a second primary tumor developing in a patient who has had a malignant germinal cell tumor and because the changes may be subtle, localized to the testis and occur after a tumor-free interval of many years, careful examination of the contralateral testis and long-term followup are indicated even when systemic chemotherapy for malignancy has been used. This is the seventh time familial occurrence of testis tumors in non-twin brothers has been reported but the first time that one of the brothers had bilateral tumors.

Adolescent↗
PubMed1975

Bladder neck contracture and urethral stricture as complications of renal transplantation.

From 1963 to July 26, 1974, 211 men underwent renal transplantation at our clinic. Urethral strictures were present prior to the initial transplant in 4 patients (1.8 per cent) and developed in the post-transplant period in 13 patients (6.1 per cent). Postoperative bladder neck contractures occurred in 2 patients (0.9 per cent). Repeated urethral dilations and surgical procedures on the lower urinary tract were generally well tolerated. Infectious problems were the most common secondary complications. No patient or allograft was lost as a direct result of the lower tract obstruction or its treatment. The greatest morbidity occurred in those patients who had a combination of urethral stricture and/or bladder neck contracture, uremia, previous or current immunosuppression and the absence of urine flowing through the urinary tract. This combination occurred most often in the patient who experienced failure of the first allograft and was being prepared for a second or third transplant. To avoid potentially serious urologic complications, male patients should have a repeat lower urinary tract evaluation and definitive correction of existing obstruction before re-transplantation is considered.

Humans↗
PubMed1975

The fate of cadaver renal allografts contaminated before transplantation.

Through the routine use of cultures from saline slush transport solution and the initial and final organ perfusates, 14 of 81 cadaver allografts (17.3%) were found to have been contaminated before transplantation. Gram negative organisms, cultured from 5 of the 14 contaminated allografts, resulted in the recipient's death on the first encounter with this problem and the loss of two other allografts. Early antibiotic therapy begun even without evidence of overt infection appeared to prevent any further deaths or graft loss in those whose allografts were contaminated and yielded an overall survival comparable to that of uncontaminated allografts. Without such an approach to the study of perfused cadaver allografts and the management of them when found to be contaminated, this type of infection may go undetected and contribute to allograft and patient loss.

Adolescent↗