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Biomedical subjects

V F Marshall

Publications and source records attributed to V F Marshall.

At least 19 recordsLinked to original sources

Temporal variation of the merozoite surface protein-2 gene of Plasmodium falciparum.

Extensive polymorphism of key parasite antigens is likely to hamper the effectiveness of subunit vaccines against Plasmodium falciparum infection. However, little is known about the extent of the antigenic repertoire of naturally circulating strains in different areas where malaria is endemic. To address this question, we conducted a study in which blood samples were collected from parasitemic individuals living within a small hamlet in Western Irian Jaya and subjected to PCR amplification using primers that would allow amplification of the gene encoding merozoite surface protein-2 (MSP2). We determined the nucleotide sequence of the amplified product and compared the deduced amino acid sequences to sequences obtained from samples collected in the same hamlet 29 months previously. MSP2 genes belonging to both major allelic families were observed at both time points. In the case of the FC27 MSP2 family, we observed that the majority of individuals were infected by parasites expressing the same form of MSP2. Infections with parasites expressing 3D7 MSP2 family alleles were more heterogeneous. No MSP2 alleles observed at the earlier time point were detectable at the later time point, either for the population as a whole or for individuals who were assayed at both time points. We examined a subset of the infected patients by using blood samples taken between the two major surveys. In no patients could we detect reinfection by a parasite expressing a previously encountered form of MSP2. Our results are consistent with the possibility that infection induces a form of strain-specific immune response against the MSP2 antigen that biases against reinfection by parasites bearing identical forms of MSP2.

Alleles

Management of recurrent urinary stress incontinence by the Marshall-Marchetti-Krantz vesicourethropexy.

We studied 114 women who underwent the Marshall-Marchetti-Krantz vesicourethropexy as a secondary procedure for recurrent stress incontinence. Of 99 patients for whom data were available the first operation consisted of vaginal procedures only in 57 (group 1) and suprapubic procedures somewhat related to our method of vesicourethropexy in 42 (group 2). The success rate for group 1 was 80 per cent, while it was 90 per cent for group 2. Cured and improved rates were similar (95 to 96 per cent, respectively). Significant complications occurred in 12.6 per cent of the patients. The high success rate combined with a reasonably long followup indicates that a repeat Marshall-Marchetti-Krantz vesicourethropexy certainly is warranted and can be expected to provide a good result in at least 90 per cent of the cases.

Adult

Hemospermia.

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Blood

Primary management of urinary stress incontinence by the Marshall-Marchetti-Krantz vesicourethropexy.

To evaluate clearly the Marshall-Marchetti-Krantz cystourethropexy in defined populations we did a retrospective study of 151 women who underwent the procedure as a first attempt to correct stress incontinence. Of 140 patients for whom data were available 126 (90 per cent) were cured, 12 (8.6 per cent) were improved and 2 (1.4 per cent) failed. Preoperative cystoscopy was normal in 83 women (67.5 per cent). The most common abnormality was inflammatory change (82.5 per cent). Preoperative findings failed to correlate with postoperative irritative symptoms, indicating that surgical correction of documented mechanical instability is warranted. Concurrent medical problems, such as obesity and chronic obstructive pulmonary disease, were not associated with failures. Significant complications occurred in 11.4 per cent of the patients but there were no deaths. In view of a 90 to 98 per cent success rate with long-term followup (average 45.7 months) the Marshall-Marchetti-Krantz operation should be considered the procedure of choice in cases of primary stress incontinence. In addition, comparisons with other well defined groups and with modifications of the original procedure will be facilitated.

Adult

The bladder mucosal graft technique for hypospadias repair.

A technique for the repair of severe hypospadias is described. The essential features include: chordee release and cosmetic repair of the previously tethered penis; the construction of a new urethra using bladder mucosa in a subcutaneous tunnel; and an oblique anastomosis of the graft and true urethra as deep within the shaft of the penis as possible. One stricture has developed utilizing this technique. The remainder of the children appear to have obtained a good result. Meatal stenosis requiring dilatation remains a minor problem. The use of bladder mucosal grafts in cases in which previous repairs have failed or when adequate foreskin for urethral reconstruction is lacking is feasible and has been successfully performed in adults. The combination of a chordee release and bladder mucosal inlay graft as a single-stage procedure in a small child had not yet been attempted.

Child

The survival of patients with bladder tumors treated by surgery: comparative results of an old and a recent series.

A review of a large number of patients with bladder tumors treated primarily by an operation during approximately 4 decades indicates that survival of patients with papillomas and superficial carcinomas essentially was unchanged. Recently, patients with invasive cancers who have been treated have enjoyed a modest improvement in the 5-year survival rate, which was at least in part the result of a diminished postoperative mortality rate.

Carcinoma, Papillary

Vesicovaginal fistulas on one urological service.

Of 92 vesicovaginal fistulas 57 (62 per cent) were closed, at least temporarily, with 1 or more operations. Functional closure was not attempted in 23 per cent of the cases and failed in 15 per cent. Various techniques were used in these cases. The favorite method involved a combination of colpocleisis, splitting the posterior wall of the bladder suprapubically and a temporary cystostomy on low pressure suction. Five patients (5.4 per cent) died postoperatively.

Aged

Radical retroperitoneal surgery: a 25-year experience.

A review of 210 radical retroperitoneal excisions performed through an abdominal or flank thoracoabdominal incision showed these procedures to be relatively safe. The flank approach had less morbidity and provided better exposure of the renal hilus and suprarenal areas. Pulmonary complications in the flank thoracoabdominal incision were reduced by closing the thorax with an indwelling pleural drainage tube. The flank thoracoabdominal approach is suitable for all radical retroperitoneal excision when extensive bilateral renal exposure is not needed.

Adolescent

An extended view of renal autotransplantation in humans.

Early cases of renal autotransplantation have resulted in 2 postoperative deaths in high risk patients, 1 nephrectomy with cure of high blood pressure, 1 cure of hypertension, 3 greatly reduced hypertensions and 2 highly successful bridgings for ureteral avulsions. Anticipated improvements in selection, especially for patients with hypertension, may widen applications in institutions in which homotransplantation is familiar.

Adenocarcinoma

Early detection but delayed appearance of a bladder tumor.

Herein is described a case of bladder cancer first detected by urinary cytology 20 years before a definite cystoscopic diagnosis could be established. To our knowledge, this represents the longest such interval on record. The case indicates the reliability of Papanicolaou studies of the urine, especially when tumor cells are identified.

Autopsy

Indications for surgery on renal artery aneurysms.

Indications for an operation on renal artery aneurysms include patients 1) with a rupture or an impending rupture, 2) with a possibility of pregnancy, 3) with hypertension and renin differentials suggesting remediable disease and 4) with functional or symptomatic impairment traceable to the aneurysm proper. If the aneurysm is calcified some temporization may be justified, although this observation alone should be only of secondary importance. The size of the aneurysm is likewise generally of secondary value. Of course, the patient's picture and expectancy need balancing in the decision. Conservative management in other situations is acceptable, particularly for the elderly.

Adult