Biomedical subjects
W H Boyce
Publications and source records attributed to W H Boyce.
Management of the papillae during intrarenal surgery.
The intersegmental nature of renal incisions is axiomatic. Deviation from the intersegmental plane is hazardous. If divided along intra-arterial planes papillae appear to heal with little structural or functional impairment.
Recurrent urolithiasis following anatrophic nephrolithotomy.
Analysis of 18 patients who suffered recurrent urolithiasis after anatrophic nephrolithotomy is presented. These patients form a subgroup of 80 patients who underwent 100 consecutive extensive anatrophic nephrolithotomies between 1967 and 1972. Careful documentation of the 18 patients who had recurrent calculi was done in an effort to delineate the causative factors. The recurrence interval varied from less than 6 months to more than 8 years during an over-all followup period of 9.94 years. Marked differences in the characteristics between 14 male and 4 female patients were noted. In the male patients a significant relationship among recurrent staghorn calculi, anomalous urinary drainage and Pseudomonas urinary tract infections was noted. The female patients had recurrent or persistent urinary tract infections or undiagnosed metabolic problems as the primary reason for the recurrent urolithiasis.
Debility, recurrent fever, hydronephrosis and upper caliceal deformity in a 72-year-old man.
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Ultrasonic velocimetry in resection of renal arteriovenous fistulas and other intrarenal surgical procedures.
The Doppler velocimetry is considered to be useful frequently and indispensable occasionally for intrarenal surgery. Current equipment is relatively inexpensive, the operation is technically simple and maintenance is minimal. The instrument provides an instantaneous appraisal of the precise location of a blood vessel and some characteristics of blood flow with a facility unlikely to be achieved with any other technique. It is important that the limitations of current instruments be appreciated since the concepts of the procedure and current instrumentation are deceptively conductive to expectations beyond their capability.
Intrarenal surgery, Animal model I.
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Healing properties of the renal papilla. Animal model II.
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Transrectal ultrasonography in the evaluation of patients with prostatic carcinoma.
There were 53 patients with biopsy-proved prostatic carcinoma evaluated by the usual modalities, in addition to ultrasonography. Of this group 23 patients underwent radical prostatectomy and ultrasonography was helpful in assessing tumor involvement around the seminal vesicles. Tumor response to hormonal therapy was detectable readily with ultrasonic imaging but tumor reactivation was not apparent consistently.
Bilateral staghorn calculi--patient evaluation and management.
A total of 44 patients (17 men and 27 women) with simultaneous bilateral staghorn calculi underwent anatrophic nephrolithotomy with caliceal reconstruction. Excluding patients with urinary tract infection alone all but 3 had identifiable metabolic abnormalities that required treatment postoperatively. Based on numbers of kidneys operated upon the stone recurrence rate was 8.8 per cent for men and 7.4 per cent for women. No patient has required an operation for recurrent stone disease.
Re: anatrophic nephrolithotomy: experience with a simplification of the Smith and Boyce technique.
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Urinary beta 2-microglobulin excretion and renal lithiasis.
We assessed beta 2-microglobulin excretion in 42 active calcium oxalate stone-formers, 16 active struvite stone-formers, 4 active uric acid stone-formers, 14 inactive stone-formers and 21 non-stone-forming controls. The average excretion value was within normal limits for all groups and no significant differences existed. These observations coupled with previous findings of increased low molecular weight urinary proteins in active calcium oxalate stone-formers suggest the existence of specific alterations in tubular function in this specific group.
Calcium-binding proteins and renal lithiasis.
The present study consists of measuring calcium-binding activity in urine obtained from 17 metabolically active noninfectious calcium oxalate stone formers, six inactive calcium oxalate stone formers, two active uric acid stone formers, one active cystine stone former, and seven nonstone-forming controls. Twenty-four hour specimens were obtained from each patient and were ultrafiltered, utilizing a series of membranes to concentrate all macromolecules of molecular weight less than 50,000 daltons. The concentrated specimen was separated by gel filtration chromatography, and each fraction was analyzed for calcium-binding activity utilizing the chelex resin binding assay. Total urinary calcium binding protein activity was significantly greater in the active calcium oxalate stone formers when compared with either inactive calcium oxalate stone formers (P less than 0.025) or nonstone-forming controls (P less than 0.05). The number of uric acid and cystine stone formers was too small to make meaningful comparisons. Urinary excretion of calcium binding appears to be related to stone activity and may be specific for calcium stone formers. Their influence on stone formation deserves further study.
Dissolution versus surgical treatment of nephrolithiasis.
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Heterozygous cystinuria and calcium oxalate urolithiasis.
Many variables are known to be associated with the formation of calcium oxalate urolithiasis but none is essential for the initiation or growth of stones. It is likely that the predisposition to stone formation is related to multiple factors. We herein describe still another metabolic state that seems to predispose to calcium oxalate stone disease, namely heterozygosity for cystinuria. Cystine screening tests were done on 24-hour urine specimens obtained from 126 patients in whom recurrent calcium oxalate stones form and 84 controls and quantitative amino acid determinations were done on all positive specimens. Of those studied 17 of 126 stone patients and 1 of 84 controls were heterozygous cystinurics. A test of the differences between the relative frequencies of cystinuria heterozygotes in the 2 groups with Fisher's exact test revealed them to be highly significant (p less than 0.001). Our study indicates that carrier status for 1 of the cystinuria genes predisposes to calcium oxalate stone formation but, like other factors related to urolithiasis, it is not a necessary cause of stone disease.
Childhood urolithiasis.
Between 1965 and 1976, 54 children with urolithiasis were evaluated and treated. Age, sex, race distribution, patient symptomatology, stone localization and type are outlined. The relationship of stone formation to urinary infection and/or genitourinary anomalies is reviewed, and treatment and recurrence patterns are studied.
Biochemical profiles of stone-forming patients: a guide to treatment.
A formal protocol, controlled metabolic evaluation is essential to the most effective treatment of any patient with renal calculi, regardless of the crystalline composition of the stone. The design of the protocol and of the data sheets should be compatible with ease of diagnosis and selection of corrective therapeutic measures. These data also serve as a reference to monitor response to treatment. Treatment is highly individualized with the objective to reduce all potentially crystallizable ions to basal levels. If this is difficult to accomplish certain ratios of ions are brought to as near normal values as possible.
Results of urinary diversion in patients with myelomeningocele.
Among 481 children with myelomeningocele seen at the North Carolina Baptist Hospital since 1949, 46 have undergone a urinary diversion procedure, as follows: ileal loop in 43; sigmoid loop in two; and transverse colon conduit in one. The indications for diversion were incontinence in 28, urinary infection or pyelonephritis in 27, and hydronephrosis, pyelocaliectasis, and reflux in 12 patients. No deaths resulted from the diversionary procedures. One patient required early surgical revision and seven patients required late surgical revision. Two patients have since died, 44 have been followed for an average of 7.9 years, 15 for more than 10 years. Overall, of 26 patients with normal prediversionary intravenous pyelograms (IVP's), 88% now have normal or nearly normal IVP's; of 14 patients with abnormal prediversionary IVP's, 79% now have normal, improved, or unaltered IVP's. Renal function has remained normal in all 44 patients, and renal calculi have developed in 10 patients. Ileal loop diversion appears to convert a high-pressure system into a low-pressure system, thereby helping to prevent further renal damage. This procedure tends to stabilize, rather than improve, urinary-tract function. For these children already so incapacitated by their basic disease, this goal is acceptable, particularly since it also provides continence and independence from parental nursing.
Low molecular weight urinary proteins and renal lithiasis.
Twenty-four hour urine specimens were obtained from 20 active calcium oxalate stone formers, 20 inactive calcium oxalate stone formers, 8 struvite stone formers, and 9 non-stone forming controls. Proteins with molecular weights less than 50,000 daltons were concentrated by ultrafiltration and separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Fourteen of the 17 active calcium oxalate stone formers had low molecular weight urinary proteins (less than 35,000 daltons) present in their urine whereas none of the inactive stone formers or struvite stone formers had similar patterns. Only one of the nine control patients had similar proteins present.