Biomedical subjects
Publications and source records attributed to R H Whitaker.
Despite advances in radiological imaging techniques, the ideal management of antenatally diagnosed hydronephrosis remains controversial. A map, showing diagnostic and management pathways, has been designed in an attempt to provide maximum information from the most appropriate and minimum number of investigations.
Although health services in the USA and the UK are very different, American practice and ideas have had some impact on the NHS, particularly in the recent white paper. This account by Derek Mechen and Ronald Whitaker of the problem facing hospitals in Chicago is not only interesting in itself but also has a bearing on discussions about the future of the NHS.
Explore the source record for details and available documents.
An insulated diathermy hook was used to destroy the posterior urethral valve in 10 boys. The technique needs no anaesthetic, no endoscopic equipment, no perineal urethrostomy and only occasional catheter drainage of the bladder. It is performed in the X-ray department, where the efficacy of the procedure can be checked immediately with a further cystogram. The results are compared with those in 7 other boys whose valves were destroyed by conventional endoscopic means.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A total of 216 patients with voiding disorders were treated with oxybutynin and the effects and side effects were studied. The drug is effective in a wide variety of disorders. Good results were obtained in 66% of patients who had no previous treatment and in 46% of patients who had taken various drugs before. It was just as effective in all age groups. Twenty-three per cent of patients experienced side effects and 10% were unable to tolerate the drug. It is concluded that oxybutynin is an effective drug in the treatment of unstable bladder and disorders such as catheter-induced spasms.
Results and complications are reported in 67 boys who underwent a modified MAGPI procedure for hypospadias between 1981 and 1986. Excellent cosmetic and functional results were achieved in 91% of the patients. Some degree of chordee can be corrected by this procedure but severe degrees of chordee were associated with an increased complication rate.
Nineteen cases of idiopathic urethritis affecting male children are presented. Details of the symptoms and the course of the illness are given along with recommendations regarding management. Symptoms usually occurred in a recurrent pattern and lasted, on average, 2 years. The diagnosis was made on clinical grounds after bacterial infection had been excluded; urethroscopy was used to confirm the diagnosis when necessary. The prognosis was generally good, although no specific treatment is available.
The presenting symptoms, number of previous urinary tract infections, grade of reflux and incidence of renal scarring, together with an analysis of the need for reimplantation of the ureters, were assessed retrospectively in 222 patients with vesicoureteric reflux. The grade of reflux was found to be as severe in patients presenting after a single urinary tract infection as in those presenting after more than one infection. Regardless of whether patients presented with mild, moderate or severe symptoms, the degrees of reflux and renal scarring remained similar. There was no relationship between the severity of presenting symptoms and the eventual need for ureteric reimplantation. All children should be investigated when they present for the first time with a urinary tract infection, irrespective of age, sex or severity of symptoms.
This is a retrospective study of 190 patients with neural-tube defects for whom there were precise data, both on sensory levels (to pin-prick) and on the presence or absence of congenital renal anomalies. There were 17 renal anomalies, of which three were renal agenesis, five horseshoe kidneys, eight ureteral duplications and one simple ureterocele. There was a consistent pattern of congenital renal anomalies in relation to the extent of the neurological lesion, as measured by the sensory level. Renal agenesis was associated with a sensory level in the dermatomes T5 to T8, horseshoe kidneys with a T9 to L1 level and ureteral duplications predominantly with a sensory level in the sacral dermatomes.
In 190 patients with neural tube defects the sensory levels to pin prick were compared with the incidence and distribution of congenital renal anomalies. 17 such anomalies comprised 3 examples of renal agenesis, 5 horseshoe kidneys, 8 ureteral duplications and one simple ureterocele. The pattern of anomalies showed that renal agenesis was associated with a sensory level in the dermatomes T5-8, horseshoe kidneys with T9-L1 and duplications predominantly with the sacral dermatomes.
Silastic foam dressing is useful after more complex types of hypospadias surgery. It immobilises and protects the penis, avoids excessive swelling and allows early mobility of the patient. Details of its application and use are described.
A modified hook has been developed for the destruction of posterior urethral valves. This hook is safe and effective, and avoids the use of an anesthetic in the child. The effectiveness of the valve ablation is seen immediately radiologically and clinically.
The hypothesis that undescended testis is caused by an excess of maternal oestrogen in pregnancy has been tested indirectly in a case-control study comparing mothers of boys with undescended testis (83) and mothers of normal boys (129) born on the same day. The study concentrated on the gestation of the boys, but also investigated the mother's previous obstetric history and postnatal events in the boys. The hypothesis predicted that there should be an excess of nausea, vomiting and hypertension in mothers of cases, but in fact the pregnancies of the case and control mothers were similar in all respects except one. The exception was the increased liability of the mothers of cases to threatened abortion. Mothers of cases also had an increased tendency to miscarry in previous conceptions, a reduced number of deliberate terminations and evidence of decreased fertility. An alternative hypothesis is suggested which would explain these findings. This is that placental function is impaired in the gestation of affected boys and the secretion of human chorionic gonadotrophin is reduced. This leads to changes in fetal testicular function and possible maldescent. Those born with undescended testis were more likely to present to a general practitioner with illness in the first three years after birth and this difference was mainly due to asthma, eczema, jaundice and feeding difficulties.
Explore the source record for details and available documents.
Explore the source record for details and available documents.