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Biomedical subjects

R A Straffon

Publications and source records attributed to R A Straffon.

At least 37 records · Page 2Linked to original sources
PubMed1986

Jejunal conduit urinary diversion.

The clinical course of 14 patients undergoing jejunal conduit urinary diversion between 1971 and 1985 is reviewed. Indications for use of jejunum rather than ileum or colon for diversion included radiation changes of the ileum, concurrent colonic neoplasms or injury, concerns about collateral blood supply of the colon and multiple adhesions. There were 2 operative deaths. Followup in the remaining 12 patients was 1 to 116 months (mean 34 months). All of the patients had satisfactory postoperative renal function. Eight patients (67 per cent) experienced a total of 13 complications. Only 3 patients (25 per cent) suffered the electrolyte imbalance characteristic of jejunal conduit syndrome, representing the only complication directly attributable to the use of jejunum. The jejunal conduit is a viable alternative form of urinary diversion in patients in whom the use of other intestinal segments is undesirable because of previous irradiation, surgery or concurrent disease processes. Although jejunal conduits carry an increased risk of electrolyte imbalance, the use of short jejunal loops and prophylactic oral electrolyte replacement therapy can minimize the occurrence of this complication.

Adult↗
PubMed1985

Cutaneous ureterostomy in children--long-term followup.

From 1963 to 1983, 45 children with benign disease underwent urinary diversion with cutaneous ureterostomy. Patient selection for cutaneous ureterostomy was predicted on the presence of at least 1 dilated ureter. Followup ranged from 4 months to 20 years, with a mean of 7.9 years. Of the patients 29 (64 per cent) had a minimum followup of 5 years and 18 (40 per cent) were followed for more than 10 years. Postoperative complications, results of followup excretory urography and the ultimate fate of these children were analyzed. The results demonstrate the usefulness of cutaneous ureterostomy as a permanent form of urinary diversion in selected children.

Adolescent↗
PubMed1985

The role of intraoperative consultation.

The urologist who has completed an approved residency training program and has been certified by the American Board of Urology is well prepared to meet the daily challenges presented by the practice of urologic surgery. In spite of this careful preparation, there are times in the operating room when intraoperative consultation is needed and will be of great help in managing the surgical problem encountered. Although intraoperative consultation is probably not used as often as it should be, it is the author's hope that the reader of this symposium will be a better consultant in the operating room when called and will also feel more comfortable about calling for help when it is needed.

Humans↗
PubMed1984

Radical cystectomy without radiation therapy for carcinoma of the bladder.

A review of a 20-year experience of radical cystectomy identified 99 patients who had not undergone preoperative radiation therapy. The 5-year survival rate of patients with clinical high stage lesions (T3, T4a) was 40 per cent. Life-table analyses showed that survival rate in this group was comparable with that reported for other groups receiving preoperative radiation therapy. The pelvic recurrence rate was 9 per cent and was frequently related to either urethral or nodal disease. Unquantifiable patient selection factors may well limit the reliability of these results.

Actuarial Analysis↗
PubMed1983

Preservation of the ureteral blood supply in rat renal transplantation.

A new technique of preserving ureteral blood supply in heterotopic rat renal transplantation is described. This entails leaving an intact gonadal artery in continuity with the donor aortic stump, which is anastomosed to the recipient aorta. Comparison of this technique with conventional methods wherein the spermatic artery is ligated revealed a marked decrease in the incidence of ureteral complications with the former. Preservation of adequate blood supply to the ureter in experimental rat renal transplantation provides more consistent results and lessens the risk of unnecessary animal loss.

Animals↗
PubMed1983

Prognostic indicators in renal adenocarcinoma.

From 1968 to 1978, 246 patients underwent surgical exploration for renal adenocarcinoma at our clinic. Of these patients 241 had complete tumor excision and 5 had biopsy only. Correlation of the clinical and pathological data of these patients with the clinical course identified prognostic parameters. Disease progression was uncommon when the tumor was contained within the capsule of the kidney (9 of 80 patients). Perinephric tumor extension indicated a worse prognosis (11 of 40 patients with progression) that was not altered significantly by the presence of renal vein involvement (17 of 35 patients with progression). Inferior vena caval involvement or regional lymph node metastases worsened the prognosis markedly, with 8 of 11 and 8 of 9 patients demonstrating progressive disease, respectively. The worst prognosis was seen in patients with metastatic disease at operation (66 of the 71 patients dying of the disease by the end of followup). The disease was classified according to the tumor, node and metastasis system of the American Joint Committee and a stage grouping system has been suggested.

Adenocarcinoma↗
PubMed1983

Surgical treatment of renal artery aneurysms.

Twenty-seven patients have undergone surgical treatment of renal artery aneurysms and the classification, radiographic features and complications of these aneurysms are reviewed. Aortorenal bypass is the preferred method of in situ revascularisation. Extracorporeal microvascular branch arterial reconstruction is reserved for patients with complex intrarenal aneurysms. Removal of the aneurysm with preservation of the involved renal unit is possible in most cases.

Adolescent↗
PubMed1983

Enhancement of recovery in postischemic acute renal failure with captopril.

This study tested the ability of the converting enzyme inhibitor, captopril, to lessen the severity of acute renal failure following temporary occlusion of the renal artery. In the control group, 11 dogs were anesthetized with halothane, and the left kidney was isolated through a midline incision. The renal artery, vein, and ureter were then clamped for 120 min. Immediately after occlusion, the kidney was flushed with 40 ml of saline at 34 degrees C. When the clamp was released, a contralateral nephrectomy was performed and the animal allowed to recover. Serum creatinine and blood urea nitrogen levels were followed on a daily basis thereafter. Thirteen captopril-treated dogs were treated in the same fashion except that captopril (1.25 ml/kg, i.v.) was given prior to the 120-min period of renal ischemia. Three of 11 (27%) control dogs survived, whereas 10 of 13 (77%) captopril-treated animals survived (P less than 0.05). Serum creatinine (5.4 +/- 2.5 mg/dl) and serum urea nitrogen (96 +/- 33 mg/dl) peaked on day 8 in the captopril-treated group and were consistently lower than in the untreated group. These observations suggest that captopril is useful when temporary interruption of the renal circulation is encountered, such as in renal autotransplantation, cadaveric renal transplantation, and renal revascularization. These data also suggest that inhibition of the renin-angiotensin system may lessen the severity of acute renal failure following renal ischemia.

Acute Kidney Injury↗
PubMed1982

A critical review of immunotherapy of disseminated renal adenocarcinoma.

Sixty patients with renal adenocarcinoma have been treated with five different immunotherapy trials consisting of 1) Transfer Factor (TF), 2) TF and Bacillus Calmette-Guerin (BCG), 3) TF, BCG, Chloroethyl-cyclohexy-nitrosurea (CCNU) and megestrol acetate (Megase), 4) BCG, CCNU, and Megase, or 5) BCG. Using strict response criteria for measurable disease, objective responses were seen in 14-22% of cases. While this nonspecific immunotherapy of renal adenocarcinoma has been associated with documented regression of metastases, response rates are similar to that obtained with hormonal therapy alone. Objective responses support the concept of further trials in this disease with more sophisticated immunotherapy.

Adenocarcinoma↗
PubMed1982

Inferior venacavography in the preoperative assessment of renal adenocarcinoma.

Although inferior venacavography has been suggested as a routine test for patients with renal adenocarcinoma we have used urographic criteria of a large and/or medially placed tumor, and/or decreased visualization of the affected kidney to select patients for inferior venacavography. Of 235 patients with renal adenocarcinoma undergoing excretory urograms 64 of 76 (84 per cent) with gross renal vein involvement and 72 of 151 (47 per cent) without renal vein involvement had at least 1 criterion. All 20 patients with inferior vena caval thrombi and excretory urograms had at least 1 criterion. High dose selective renal angiography identified successfully a renal vein thrombus in 11 patients, 4 with inferior vena caval thrombi, while the renal vein was not visualized in 7 with renal vein involvement and 1 with an inferior vena caval thrombus. Inferior venacavography identified correctly an inferior vena caval thrombus in 16 patients. With the correct preoperative identification in 19 of 22 patients with inferior vena caval thrombi our criteria for inferior venacavography are outlined.

Adenocarcinoma↗
PubMed1982

Surgical treatment of renovascular disease in the solitary kidney: results in 43 cases.

Renal revascularization was performed on 43 patients with vascular disease involving a solitary kidney. Revascularization was undertaken as treatment for severe hypertension in 35 patients and to preserve renal function in 8. There were 2 operative deaths (4.7 per cent) and 3 major complications (7 per cent). No patient suffered acute renal failure after revascularization. Followup ranges from 6 months to 14 years (mean 6 years). The postoperative serum creatinine is improved in 26 patients (63 per cent), unchanged in 9 (22 per cent) and increased in 6 (15 per cent). Of 35 patients with hypertension the blood pressure is cured in 18 (51 per cent) and improved in 14 (40 per cent); there were 3 (9 per cent) failures. In selected patients with renal artery disease involving a solitary kidney revascularization can provide effective treatment of hypertension and stabilization or improvement of renal function.

Adult↗
PubMed1982

Lymphadenectomy in renal adenocarcinoma.

From 1968 to 1978, 241 patients underwent radical nephrectomy for renal adenocarcinoma. The regional lymph nodes were resected in 102 patients with disease localized to the kidney, including 1) resection of all nodal tissue from the diaphragm to aortic bifurcation, 2) resection of ipsilateral nodes from the renal pedicle to the inferior mesenteric artery or 3) incidental lymph node resection. Of 9 patients with evidence of lymph node metastases only 1 remained free of disease 7 years postoperative. This patient had only a single hilar lymph node as evidence of metastatic disease. A limited rather than an extended lymphadenectomy is a suggested addition to a radical nephrectomy in patients with locally resectable renal adenocarcinoma without evidence of distant lymph node or parenchymal metastases.

Adenocarcinoma↗
PubMed1981

Diminished operative morbidity and mortality in renal revascularization.

From 1974 to 1980, one hundred consecutive patients with atherosclerotic renovascular disease underwent revascularization. There were two operative deaths and eight postoperative complications. This low operative morbidity is attributed to preoperative screening, correction of existing coronary or cerebrovascular disease, and reliance on methods of revascularization that obviate operation on a badly diseased aorta. The results in 78 patients with renovascular hypertension were 40% cured, 51% improved, and 9% failed. In 22 patients in whom revascularization was performed to preserve renal function, the postoperative serum creatinine levels were improved in 19 patients, remained stable in two patients, and increased in one patient.

Adult↗
PubMed1981

Renal lithiasis and hyperparathyroidism: diagnosis, management and prognosis.

From 1969 to 1979, 448 patients underwent parathyroid exploration for presumed hyperparathyroidism. Of these patients 184 had associated renal calculus disease, 72 of whom (16 per cent) had metabolically active stone disease. Of these 72 patients 48 had adenomas, 18 had hyperplasia and 6 had normal glands. Of those patients with assessable disease none with adenomas has had recurrent calculi, whereas calculi continued to form in 45 per cent of the patients with hyperplastic glands and in 50 per cent of those with normal glands. Although most patients with adenomas had persistent calcium elevations 13 were identified with only intermittent hypercalcemia. Serum parathormone calcium elevations 13 were identified with only intermittent hypercalcemia. Serum parathormone served to confirm the presence of parathyroid pathology. Urinary calcium levels were of no diagnostic benefit.

Adenoma↗
PubMed1981

Renal subcapsular hematoma: a diagnostic and therapeutic dilemma.

Subcapsular renal hematomas have been found in 14 hypertensive patients between 17 and 66 years old. In 11 patients with chronic lesions hypertension improved more often with nephrectomy (7 of 7 cases) than with a conservative operation (2 of 4 cases). Non-operative management of acute hematoma resulted in radiographic resolution and improvement of hypertension in 3 of 3 patients. Awareness of the clinical features and judicious use of diagnostic modalities enable proper management of subcapsular renal hematomas in most cases.

Adolescent↗
PubMed1981

The current status of surgical therapy for renal artery disease.

The first reports of surgically curable hypertension in the late 1930s led to enthusiasm among clinicians for removing kidneys with arterial stenosis in hypertensive patients. The development of vascular surgical techniques in the 1950s made it possible to achieve successful renal revascularization in many of these cases. However, the cause and effect relationship between a stenotic renal artery lesion and hypertension was poorly understood and many patients treated surgically had no improvement of blood pressure postoperatively. Continued experience in this field during the past two decades has significantly improved our understanding of the natural history and functional significance of renovascular disorders. Patients with renovascular hypertension can now be identified with a high degree of accuracy and successful renal revascularization is possible in most cases. Nevertheless, multiple factors must be weighed in determining whether medical or surgical therapy is more appropriate for a given patient. These include the causal relationship of renovascular disease to hypertension, the adequacy of blood pressure control with medical therapy, the natural history of untreated renovascular disease with particular regard for the risk of sustaining impaired renal function, the medical condition of the patient, the morbidity and results of surgical therapy, and the availability of other therapeutic options such as percutaneous transluminal dilatation.

Adult↗