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Biomedical subjects

R K Rhamy

Publications and source records attributed to R K Rhamy.

At least 37 records · Page 2Linked to original sources
PubMed1979

Use of the umbilical area for placement of a urinary stoma.

Children with myelodysplasia are best managed in medical centers by a team consisting of a urologist, an orthopedist, a neurosurgeon, a pediatrician, a social worker, an orthotic technician and physical therapists. A co-operative approach aids in the selection of a urinary diversion stoma site which will not interfere with the multiple orthopedic procedures these children must undergo. The urologic and orthopedic complications and benefits of 24 patients with umbilical stoma are compared with 24 patients with matched right lower quadrant stoma. The incidence of urologic complications is equal, while the orthopedic advantages manifest by the first group vastly outweigh the problems encountered in the second group. We advocate the use of a midline stoma site for urinary diversion in children with myelodysplasia.

Child↗
PubMed1979

Revascularization of the poorly functioning kidney.

The effect of renal vascularization on renal function in kidneys with poor preoperative excretory function is summarized in this report. Twenty-five patients with kidneys having preoperative creatinine clearance of less than 30 ml/min, as determined during split renal function studies (SRFS), which were revascularized for treatment of secondary renovascular hypertension and then were reevaluated by repeat SRFS form the basis of this report. There were 13 male and 12 female patients. The type of renal artery lesion was atherosclerotic in 21 patients and fibromuscular dysplastic in four patients. Eight individuals had total renal artery occlusion. Significant contralateral renal artery disease was present in 15 patients (60%). Preoperative creatinine clearances in the affected kidneys ranged from 0.27 ml/min (mean, 16 +/- 9 ml/min). after operation, creatinine clearances ranged from 0 to 72 ml/min (mean, 32 +/- 16 ml/mn). Fifteen of the 16 kidneys with preoperative creatinine clearances less than 20 ml/min had improvement in renal function following revascularization (P less than 0.01). Improvement (60%) or cure (36%) in hypertension followed revascularization in 24 of the 25 patients. The most dependable predictor of successful management of both hypertension and retrieval of renal function in these patients was the arteriographic demonstration of a patent distal vessel without evidence of severe intrarenal stenoses. These results support an aggressive attitude toward the use of revascularization in the operative treatment of such patients with renovascular hypertension, even when the residual excretory function is minimal or absent.

Adult↗
PubMed1978

Anaerobic infection as a consequence of transrectal prostatic biopsy.

Reports on large series of prostatic needle biopsies have revealed many and varied complications but none has described anaerobic bacteremia as a complication. Herein are reported 2 such cases, with a discussion of the etiology various altered host factors and therapeutic modalities important to anaerobic infections. The consideration of anaerobic infection in the febrile patient after transrectal prostatic biopsy is emphasized.

Abscess↗
PubMed1978

The congenitally dilated prostatic utricle.

A case of utricular dilatation in a child with recurrent urinary tract infection and associated genitourinary anomalies is presented. The embryology of the utricle and the relationship of the dilated utricle to the müllerian duct regression factor are discussed. Clinical sequelae, diagnosis and management are outlined briefly.

Abnormalities, Multiple↗
PubMed1978

Splenic cysts in the differential diagnosis of suprarenal masses.

Splenic cysts are uncommon and their preoperative diagnosis is suspected rarely from the clinical presentation. The urologist should be aware that on an excretory urogram these cysts appear as suprarenal masses, suggesting adrenal enlargement. Two recent cases are presented, with a discussion of their classification, incidence, diagnostic evaluation and therapy.

Adolescent↗
PubMed1978

Hypertension secondary to complete occlusion of the renal artery.

In summary, we feel the results of this study support an aggressive approach toward the diagnostic evaluation and operative management of patients with renovascular hypertension secondary to complete occlusion of the renal artery. Further, the frequent presence of contralateral disease and the progressive nature of renal artery occlusions represent a significant threat to renal function. Since renal function is frequently compromised but potentially retrievable by revascularization, nephrectomy should be employed only when hypertension is difficult to control, revascularization is impossible, and excretory function in the affected kidney is minimal.

Aged↗
PubMed1977

Surgical experience with Cushing's disease.

During the period 1952 to 1976 at Vanderbilt University Hospital 119 patients with pituitary-dependent hypercortisolism or Cushing's disease were studied. The less severe cases, which constitute a majority, were treated by pituitary irradiation with endocrinologic cure or improvement in two-thirds of the treated patients. Bilateral total adrenalectomy was reserved for the most severe cases and for failures of pituitary irradiation. In 29 patients with total bilateral adrenalectomy there was one postoperative death. Two of 28 survivors had incomplete relief of hypercortisolism and required additional therapy for its control. One patient with recent operation is improved and another with early improvement died suddenly at home three months after operation. The 24 other adrenalectomized patients, followed 6 months to 20 years, were considered endocrinologic cures of Cushing's disease. One patient in the group who had not received pituitary irradiation developed signs of expanding pituitary tumor after adrenalectomy (Nelson's syndrome) with satisfactory response to radiation therapy.

Adolescent↗
PubMed1977

Bilateral renal artery stenosis and renovascular hypertension.

Experience with the diagnostic evaluation and operative management of 38 hypertensive patients having bilateral renal revascularization is presented. Twenty-four patients had atherosclerotic occlusions and 14 had fibromuscular dysplasia. Renal vein renin assays (RVRA) and/or split renal function studies (SRFS) were performed in 37 of the 38 patients before operation. Although RVRA was negative in 29 percent and SRFS negative in 31 percent, 24 of 26 patients (92 percent) having both tests done had at least one positive study. Twenty-one patients had simultaneous bilateral repairs and 12 had staged bilateral reconstructions. The incidence of technical failures in these two groups was 21 and 9 percent, respectively. Excluding three uncorrected technical failures and two patients with recurrent branch renal artery lesions, 90 percent of patients with atherosclerosis and all patients with fibromuscular dysplasia had a favorable blood pressure response to operation. This study supports the use of both RVRA and SRFS in the diagnostic evaluation of hypertensive patients with renal artery stenosis. If these functional tests lateralize to one side, repair of that side only is recommended. If the functional studies do not lateralize, operation is suggested only when hypertension is severe and is not controlled readily with medications. In this circumstance reconstruction of the side that appears to be diseased most severely is recommended. Contralateral repair is undertaken only when hypertension persists and when repeat functional studies lateralize to the unoperated side.

Adult↗
PubMed1976

Renal carcinoma discovered incidentally by arteriography during evaluation for hypertension.

Since June 1, 1971 patients undergoing evaluation for hypertension have been evaluated with rapid sequence excretary urography, abdominal aortography and selective renal arteriography. Renal venous assays have been done in selected patients. Through July 31, 1974, 812 arteriographic studies in new hypertensive patients have been done. In 6 of these patients renal tumors were discovered by arteriography only and were not suggested by symptoms, urinalysis nor diagnosed on hypertensive excretory urography. This high incidence surprised us and we hope others will review their arteriographic series of hypertensive patients.

Adenocarcinoma↗
PubMed1976

Pheochromocytoma: present diagnosis and management.

In the 25-year period 1950-1975 forty-four patients with pheochromocytoma were observed at Vanderbilt University Affiliated Hospitals. Bilateral adrenal tumors occurred in 3 patients (6.8%) and extra-adrenal tumors occurred in 7 others (16%), 33 patients (75%) had single tumors arising in one of the adrenal glands; in one of these 5 years after operation, a malignant tumor developed in the same renal fossa. Five of the 44 patients (11.3%) proved to have malignant tumors and died with metastases. In 11 patients in the earlier years of this study the clinical diagnosis was not made and the tumor was identified by the pathologist at autopsy. There was a single postoperative fatality among the 33 patients in whom the clinical diagnosis was made. Seventy per cent of all survivors with benign tumors have remained normotensive during followup periods of one to 20 years.

Adolescent↗
PubMed1975

Fluorescent products and polyunsaturated fatty acids of human testes.

Lipid soluble fluorescent pigments from human testis were fractionated by silicic acid column chromatography and silica gel thin layer chromatography. Fluorescence analyses revealed a family of at least 3 compounds with similar fluorescence properties, including excitation and emission maxima, reversible fluorescence quenching by alkaline pH, and fluorescence quenching by heavy metal chelation. These fluorescence characteristics strongly indicated the presence of the conjugated Schiff base fluorophore-N=C-C=C-N-. The chromatographic separations employed enabled a more definitive fluorescence characterization of the lipid soluble pigments known to accumulate late in tissues with age and as a result of lipid peroxidation. Total lipids and fatty acid composition of the total lipids were determined. Polyenoic acids constituted about 40% of the total fatty acids. Histological examination of the tissues revealed some degeneration and edema, but significant spermatogenesis and normal complement of Leydig cells.

Age Factors↗
PubMed1975

Anaphylaxis manifested by hypotension alone.

Three instances of life-threating adverse reations to intravenous contrast media and penicillin have been presented. Hypotension was the major presenting sign, and was prolonged and relieved only by copious dluid therapy. In 1 case the onset of hypotension was delayed for an hour. Urologists should be aware of the variety and proper treatment of drug reactions.

Adult↗