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Biomedical subjects

R B Smith

Publications and source records attributed to R B Smith.

At least 361 records · Page 20Linked to original sources
PubMed1978

Replacement of the ureter by small intestine: clinical application and results of the ileal ureter in 89 patients.

Partial or total replacement of the ureter by small intestine was performed at the University of California/Los Angeles Hospital and affiliated hospitals 94 times in 92 patients from 1954 to 1978. Indications included recurrent calculi, ureteral stricture, fistula, congenital obstruction of the ureter and ureteral carcinoma with a solitary kidney. A special use has been for undiversion of an ileal conduit. Followup evaluation was possible in 95 per cent of the patients and ranged from 6 months to 23 years. Thirty-six patients were followed for more than 5 years. The operation was judged successful in 81 per cent of the cases. Serum creatinine was unchanged or decreased in 75.7 per cent and the pyelogram was unchanged or showed decreased dilatation in 84.6 per cent of the patients. Although reflux was seen in 40 of 55 patients who had cystograms 39 (97.5 per cent) were considered to be treated successfully. Indications for and results of the operation are discussed. The procedure is recommended as optimal therapy for carefully selected situations when the normal urinary tract cannot be used.

Carcinoma↗
PubMed1977

Why educate the diabetic?

There is a need for better education of diabetics. This leads to better quality care by the patient, and better quality of care by health professionals. Economic advantages of patient education are discussed.

Adolescent↗
PubMed1977

Intermittent sigmoid volvulus in the younger age groups.

Sigmoid volvulus is a well-recognized clinical entity, occurring more commonly in the male in middle or old age. In younger age groups the diagnosis is therefore often delayed. We report here 11 patients of an average age of 31 years (range 12-57 years), with a preponderance of females (7 : 4), who have presented to us in the past 2 years with intermittent sigmoid volvulus. The average age at onset of initial symptoms was 26 years. All had the diagnosis confirmed radiologically by colonoscopy or at operation. The diagnostic features of the condition are described.

Adult↗
PubMed1977

Pharmacokinetics of orally administered hydroflumethiazide in man.

Hydroflumethiazide plasma and urine levels were measured fluorometrically following the oral administration of 100-mg doses (2 X 50 mg tablets) to each of 12 healthy, adult male subjects. The plasma level data as a function of time were fit to a one-compartment open model using a nonlinear regression digital computer program. The means of the individual apparent absorption and disposition rate apparent absorption and disposition rate constants were 0.770+/-0.46 hr(-1) (t1/2=0.9 hr) and 0.358+/-0.17 hr(-1) (t1/2=1.94 hr), respectively, with a 0.49+/-0.26 hr lag time in absorption. The same parameter estimates obtained by fitting the mean plasma concentration-time curve were 0.461+/-0.15 hr(-1), 0.357+/-0.13 hr(-1), and 0.39+/-0.09 hr for the apparent absorption and disposition rate constants and the lag time, respectively. The closeness of the parameter estimates and the lack of intravenous data preclude unequivocal assignment of the rate constants to the absorption or disposition processes. Nevertheless, the disposition of hydroflumethiazide is clearly a rapid process. The means of the individual peak plasma levels and times to peak were 0.301+/-0.94 microgram/ml and 2.12+/-0.59 hours, respectively. The mean area under the plasma level-time curve was 1.95+/-0.78 microgram-hr/ml and 46.7+/-20.0% of the administered dose was recovered in the 24-hour urine. The mean renal clearance of hydroflumethiazide was 453.4+/-256.6 ml/min.

Administration, Oral↗
PubMed1977

Renal failure associated with vesicoureteral reflux.

In a review of over 600 charts with a major diagnosis of vesicoureteral reflux only 21 were found to have coexisting azotemia. Nine of 11 patients treated surgically with technically successful operations had either improvement or stabilization of their renal function. All such cases had moderate degrees of azotemia (creatinine of less than 3.5 mg. per 100 ml.). Surgery is recommended in cases of gross reflux and in cases with evidence of parenchymal damage, before deterioration in renal function has become irreversible.

Adolescent↗
PubMed1977

Renal rupture after transplantation.

Nine instances of spontaneous allograft rupture have been identified in a series of 325 renal transplantations. Repair of the graft was accomplished in 4 cases. One graft functioned for five and one-half years, one kidney was removed immediately because of uncontrolled hemorrhage, and two grafts were subsequently removed because of rejection. Immediate nephrectomy was performed in 5 cases of irreversible rejection. The duration of ischemia and method of preservation appeared to have no etiologic importance. Evidence of severe acute rejection was present in all 9 cases. The recent increase in graft rupture parallels the increasing frequency of severe early acute rejection reactions.

Adult↗
PubMed1977

Augmentation enterocystoplasty: a critical review.

Augmentation cystoplasty appears to offer a successful long-term solution for patients with small contracted bladders of almost any etiology. If proper indications are observed the procedure is well tolerated. With refined urodynamic diagnostic techniques our over-all failure rate of 35 per cent can be expected to decrease. Contraindications of the procedure include azotemia (creatinine clearance less than 40 cc per minute), vesical malignancy, neurogenic bladder with spastic pelvic floor (that cannot be modified) and young boys (mucus problems). In addition, patients with a strong psychiatric history should be approached with caution. The non-functional contracted bladder in which the cause of prior diversion is unclear or was performed because of an apparent outflow obstruction that spontaneously has been corrected by rest during the period of supravesical diversion also should be approached with care.

Adolescent↗
PubMed1977

Inflammatory fibrous histiocytoma presenting as a renal pelvic and bladder mass.

The first case of simultaneous presentation of a bladder and renal pelvic malignant fibrous histiocytoma is reported. Although only a small percentage of fibrous histiocytomas are malignant the lesion is extremely aggressive. Radiotherapy and chemotherapy have been used but only sporadic remissions have been reported. If the tumor is localized wide surgical excision is recommended.

Adult↗
PubMed1977

Latent adenocarcinoma in renal cysts.

A case is presented in which repeat examination of a benign cyst disclosed a latent adenocarcinoma near the cyst wall. Since statistically there is a greater incidence of tumor associated with cyst and since there is a 90% accuracy rate in the diagnosis of cystic lesions it appears that reinvestigation seems justified in some cases, especially if there is a change in or new development of symptoms.

Adenocarcinoma↗
PubMed1977

Insulin aggravated postural hypotension.

In a 76-year-old diabetic with symptomatic postural hypotension during the mornings, this was greatly improved by changing his time of insulin administration from 7.30 a.m. to 11.30 a.m.

Aged↗
PubMed1977

Bridging the management-employee gap.

The chief executive willing to experiment with new ways to reach employees should consider four programs used to good effect in a west coast hospital. The benefits match the efforts expended.

California↗