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Biomedical subjects

R M Ehrlich

Publications and source records attributed to R M Ehrlich.

At least 109 records · Page 6Linked to original sources

Wilms tumor, misdiagnosed preoperatively: a review of 19 National Wilms Tumor Study I cases.

This study establishes the difficulty in making specific diagnoses in children with retroperitoneal tumors when only excretory urograms are used in diagnosis. Complementary use of excretory urography and ultrasonography should make the number of preoperative errors less by separating cases of Wilms tumor from those with cystic disease. This investigation underscores the hazards inherent in the use of preoperative irradiation and chemotherapy, since some children with benign disease are likely to receive inappropriate therapy.

Child↗

Ureteral obstruction secondary to metastatic tumors.

Carcinoma metastatic to the ureter is uncommon, only 160 patients having been reported upon to date. During a ten year period, 82 patients with ureteral obstruction, secondary to metastatic disease, were seen at the UCLA Hospital. A critical analysis of the records of these patients revealed important clinical and diagnostic criteria to aid in the evaluation and treatment of extrinsic ureteral obstruction. Tumors of the cervix, prostate, breast and colon-rectum were the most common primary lesions to metastasize to the ureter. Subtle changes in urinary symptoms or in laboratory values should alert the physician to the possibility of ureteral involvement. Early detection of metastatic ureteral obstruction prior to the ravages of uremia may allow time for more aggressive use of adjuvant therapeutic modalities that would, at a later stage of the disease, be ineffectual or contraindicated.

Adult↗

Nocturnal intragastric infusion of glucose in management of defective gluconeogenesis with hypoglycemia.

Three children with defective gluconeogenesis and hypoglycemia were treated with frequent daytime feeding and continuous intragastric infusion of glucose at night. By this technique, the blood glucose level was maintained at or slightly above the physiological range. Secondary lacticacidemia, hyperlipidemia, hyperuricacidemia, and coagulation defects all improved. Weight and height velocity increased dramatically. Strength and sense of well-being improved. Nocturnal intragastric infusion of glucose is now the management of choice for children with defective gluconeogenesis and hypoglycemia.

Body Weight↗

Gray scale ultrasound of the scrotum.

Clinical differentiation of the various pathological conditions which affect the scrotal contents can be difficult. The value of gray scale ultrasonography was assessed prospectively in 55 patients (110 testes) with specific clinical presentations and was compared to the reported results of other noninvasive imaging procedures. The homogeneous texture of the testes and the coarser pattern of the epididymal region were normally more clearly separable with gray scale signal processing. In this series, a clear differentiation of the origin of an abnormality was possible in 80% of the cases. A negative sonogram was highly reliable. However, the benefits of scrotal ultrasonography can only be evaluated after consideration of the clinical setting and alternative noninvasive diagnostic modalities.

Epididymitis↗

Magnesium: not essential for renal preservations by initial perfusion and hypothermic storage.

Experimental observations regarding the role of divalent magnesium ion in hypothermic renal preservation have presumed the inclusion of this substance in synthetic preservation media. Retrospective analysis of the validity and application of these experimental data and consideration of the problems related to precipitation of magnesium salts in "intracellular" perfusates has instigated investigation related to the necessity of including this ingredient in our previously described hyperosmolar intracellular electrolyte solutions. Omission of magnesium chloride from these perfusates has not adversely affected ultimate renal function in canine kidneys preserved for 2 and 3 days following perfusion and storage in these solutions. The absolute necessity of including magnesium in these solutions in order to effect successful renal preservation is challenged.

Animals↗

Post-transplant hypertension. Normoreninemic severe hypertension treated by bilateral nephrectomies.

In a nineteen-year-old male in whom severe and protracted hypertension developed after a successful renal transplantation, the removal of the diseased kidneys resulted in restoration of normal blood pressure. Prenephrectomy blood samples obtained from the venous drainage of all three renal veins demonstrated no evidence for excessive renin secretion, nor was a significant difference in renin activity found between any two kidneys. It is postulated that the patient may be a clinical variant of the experimental form of renal hypertension with normoreninemia. Alternatively, the remnant kidneys may be implicated to produce a nonrenin pressor substance.

Adolescent↗

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↗

Testis tumors associated with congenital adrenal hyperplasia: a continuing diagnostic and therapeutic dilemma.

A 9-year-old boy with documented congenital adrenal hyperplasia owing to a deficiency in C21 hydroxylation is described. Precocious virilization and testicular asymmetry were noted when he was 5 years old. Both of these conditions persisted despite progressively larger doses of replacement steroid therapy. The right testis was 3 times larger than the left testis and serum testosterone was well within the adult male range. A right inguinal orchiectomy was performed. Pathologic diagnosis was interstitial cell tumor. A review of the literature emphasizes the continuing dilemma of separating interstitial cell tumors from hypertrophy of adrenal rest tissue in the presence of congenital adrenal hyperplasia. Possible methods of distinction are discussed.

Adrenal Hyperplasia, Congenital↗

Scrotal thermography.

An easily detectable, ipsilateral increase in scrotal infrared emission leading to a difference of at least 2.8 degrees C (5 degrees F) between abnormal and normal sides was recorded in 15 of 18 patients subsequently found to have an intrascrotal tumor, inflammation, or varicocele. It was impossible to distinguish between these disorders on the basis of thermographic findings. In four patients a significant increase in heat was found in the absence of positive physical findings. One had metastasizing seminoma, two had feminizing interstitial cell tumors, and one had varicocele that resulted in depressed spermatogenesis. Hycroceles tended to produce infrared emission equivalent to or less than that of the contralateral normal side.

Adolescent↗