Biomedical subjects
Publications and source records attributed to M Dunn.
Seventeen patients with hydronephrosis were treated by nephroplasty and pyeloplasty. This combination proved to be a simple and effective way of reducing intrarenal dilatation and encouraging dependent drainage from the lower pole calices.
Two cases of benign tumours complicating ureterosigmoidostomy are described. The latent period between diversion and the development of tumour is long and careful follow-up of patients with ureterosigmoidostomy is recommended. It would seem highly probable that adenomatous polyps developing at the site of anastomosis may, if undetected, undergo malignant change to adenocarcinoma. All of the tumours recorded following ureterosigmoid diversion have been associated with a nipple type ureterocolic anastomosis and mucosa-to-mucosa anastomosis may possibly prevent this complication.
The possibility of ureteric duplication should always be considered in children presenting with urinary infection. A high degree of suspicion should be present during X-ray investigation. Surgery is nearly always required to cure the problem, vesicoureteric reflux requiring reimplantation and a ureterocoele involving both uncapping and reimplantation techniques. Heminephroureterectomy is rarely required except in cases of bizarre ectopic opening in which incontinence is the presenting feature and the associated renal segment is dysplastic. Ureteropyelostomy is required for the rare situation of saddle reflux in the bifid ureter of incomplete duplication. It is occasionally employed for complete duplication, but it must be stressed that the primary defect is always at the lower end of the ureter and such bypass surgery must be combined with a ureterectomy and, when necessary, reimplantation of the remaining ureters.
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Fifty-five consecutive male patients aged 18-77 with chronic retention of urine were investigated urodynamically. All were shown to have obstructed micturition. Inflow cystometry defined two groups, one with high-pressure and one with low-pressure filling. Recent-onset enuresis and upper-tract dilatation as seen on radiography were significantly associated with high-pressure bladder filling. Postoperative studies showed that patients with high-pressure filling on preoperative cystometryhad a better response to outflow-tract surgery. The poor response of the patients with low-pressure filling was due to a high incidence of inadequate detrusor contraction leading to persistent residual urine. Thus urodynamic studies may be used to indicate which patients are likely to benefit from prostatectomy and, after the operation, whether the obstruction has been relieved.
Electrical alternans concomitant with pericardial effusion has been considered a pathognomonic sign suggestive of a large effusion with cardiac tamponade, particularly if there is P wave alternans as well as QRS alternans. However, the mechanism of this phenomonon remains controversial. A patient with pericardial effusion secondary to adenocarcinoma of the lung with metastases, pericardial effusion, electrical alternans, and cardiac tamponade was studied by echocardiography, right and left heart catheterization, and pericardiocentesis. Hemodynamic data were consistent with cadiac tamponade. The echocardiogram demonstrated a large anterior and posterior pericardial effusion. Noncongruous motion of the septum and posterior wall was pericardial effusion. Noncongruous motion of the septum and posterior wall was recorded at a rate equal to the heart rate. In addition, congruous motion of the septum and posterior wall was recorded at a rate that was half the heart rate and corresponded to the electrical alternans. The congruous movement disappeared after pericardiocentesis, as did the electrical alternans. The electrical alternans is synchronous with and due to the pendulous movement of the heart within the pericardial sac, as demonstrated by echocardiogram and cineangiograms.
A retrospective study of 32 adult patients undergoing ureteric reimplantation for reflux has been carried out. Reflux and reimplantation in relation to urolithiasis, pregnancy, renal failure, hypertension and bladder neck obstruction have been discussed. Eighty-four per cent of patients with primary reflux had pyelonephritic scarring compared with only 34% of patients where reflux was secondary. Reimplantation has been technically successful in preventing reflux in every patient in this series, with 18 patients (65%) becoming symptom free. Pyelonephritis, hypertension and renal failure were not significantly improved but no progressive changes were observed in the follow-up period after reimplantation.
Sixty-three patients with squamous cell carcinoma of the penis have been reviewed. The 3 year survival was 77%, and the 5 year survival was 59%. Prognosis was related to both clinical staging and histological grading. Stage I and II carcinomas were best treated by surgery alone. Stage III and IV carcinomas were best treated by local amputation of the penis combined with radiotherapy to the inguinal nodes. Surgery as a primary treatment for clinically positive nodes was successful in less than half the cases treated, and in this series was always followed by wound infection and lymphoedema. Tender, enlarged inguinal lymph nodes should be observed for up to 3 months following primary treatment, as a large percentage of these nodes are inflammatory and subside spontaneously.
In 25 patients undergoing pyelolithotomy a supplementary coagulum technique has been used. Initial difficulties were found in the preparation, instillation and extraction of the coagulum, but with experience a satisfactory technique has been developed. The type of stone situation most likely to benefit from coagulum pyelolithotomy would seem to be where there is a small, mobile stone or stone fragment lying in a calix or in a wide renal pelvis.
One hundred and seventy children with vesicoureteric reflux have been reviewed. Conservative therapy was the treatment of choice in Grade I reflux. Children with Grade II and Grade II reflux treated conservatively developed progressive upper tract dilation and scarring. Unilateral reflux sometimes became bilateral. In addition, the grade of reflux could worsen in the absence of symptoms or overt infection. Cystourethroscopy was an important investigation as an aid to management: the findings of abnormal ureteric orifices in the presence of Grade II and Grade III reflux indicated early surgical treatment. Surgery was also indicated in the presence of ureteric dilatation on excretion urography aand/or micturating cystourography. Vesicouretic reimplantation gave excellent results with few complications.
A symptomatic and, where possible, urodynamic assessment has been made in 19 patients undergoing enterocystoplasty over a 16-year period. It is suggested that this operation should be considered in those cases of interstitial cystitis and irritable bladder syndrome in which all recognised medical and surgical treatment has failed.
Sixty-two patients undergoing either one-stage or two-stage skin inlay urethroplasty for stricture of the urethra have been reviewed. The success rate and incidence of complications are discussed. The technique of skin inlay urethroplasty requires a considerable degree of surgical expertise and a similar skill in clinical evaluation is required in the selection of patients for this procedure.
Cystourethroscopy is an uncomfortable and often painful investigation for children. It is distressing to the parents, and even when it is done on a day case basis it can cause considerable disruption to the family. It should therefore only be considered when it is felt that the examination will contribute to the management of the urinary problem in the child, and then only after routine assessment including physical examination, urine culture, renal function studies, excretion urography and, where indicated, micturating cystogram. In a study of 242 children who had cystourethroscopy, it was found to be of only limited value in children with enuresis, incontinence, haematuria, recurrent urinary infection and painful micturition. In some children it provided an opportunity for either indirect (from instrumentation) or formal urethral dilatation and this seemed to be associated with post-operative symptom relief in some children. Endoscopy appeared to be of most value in the management of vesicoureteric reflux, upper tract duplication and specific urethral abnormalities. In these situations the examination provided essential information which was helpful with further management of the children.
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Eighty newborn C3H/BifB/Ki strain mice received a single intraocular inoculation of 0.002--0.003 ml of 10(8.0) TCID 50/0.1 ml human adenovirus 12 (AD 12), within 24 h after birth. Forty mice survived and in seven of these (17.5%) a solid retinoblastomalike neoplasm developed between 64 and 236 days. The tumors have been successfully cultured and also transplanted subcutaneously into syngeneic hosts. Morphologically, all tumors revealed characteristic features of retinoblastoma associated with the Homer Wright type of rosettes. Bizarre giant cells were commonly detectable. Ad 12-specific T-antigens were demonstrated in both the primary and cultured tumor cells using immunofluorescent techniques. Some giant cells also showed numerous T-positive filaments. Electron microscopy disclosed poorly differentiated unipolar cells possessing a large ovoid nucleus. Many tumor cells appeared to contain a well organized solitary cilium consisting of a typical ring of nine doublets with no axial (9 + 0) in close association with a pair of centrioles. Some multinucleated giant tumor cells also contained multiple cilia-centriole complexes within their broad syncytial cytoplasm. Occasional endogenous C particle-like virions unique to murine neuroblastomas were observed for the first time in virus-induced retinal tumors. This unprecedented tumor model in a pure strain mouse adds to the range of known animals sensitive to Ad 12 oncogenesis.
Correlations of the His to ventricular (H-V) conduction time were made with the surface electrocardiogram during normal intraventricular conduction, unifascicular block (right bundle branch block), bifascicular block (left bundle branch block) and trifascicular block (right and left bundle branch block) in a patient with rate-dependent left bundle branch block who had transient right bundle branch block during recording of the His bundle electrogram. The results provide a functional confirmation of the theory that a prolonged H-V time is a manifestation of trifascicular disease.
The effect of left bundle branch block on left ventricular performance was studied in a patient with rate-dependent left bundle branch block and an otherwise normal heart. The timing of left heart events, hemodynamic pressures and indexes of left ventricular contractility were determined during normal intraventricular conduction and during left bundle branch block. The results indicate that in the normal heart left bundle branch block has no significant effect on left ventricular performance.