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Biomedical subjects

W H Bush

Publications and source records attributed to W H Bush.

At least 73 records · Page 4Linked to original sources
PubMed1985

Percutaneous ultrasonic versus surgical removal of kidney stones.

Kidney stones may be removed without using a surgical incision by a combination of techniques and skills recently developed in the fields of urology and radiology. Percutaneous access to the kidney is established under fluoroscopic control. A guide wire placed into the renal pelvis allows a nephroscope to be inserted and the collecting system visualized. A long hollow metal probe is advanced through the nephroscope and placed in contact with the stone. This probe conducts the ultrasonic energy. The stone absorbs the energy and breaks into fine granules which are evacuated by suction. Percutaneous lithotomy was performed upon 300 of 302 consecutive patients bearing stones which required removal. Targeted calculi were successfully removed from 97 per cent of these patients. Eighty-one per cent had complete stone removal at the primary procedure; 57 patients required additional percutaneous manipulations under local or general anesthesia. The previous 100 patients with kidney stones underwent surgical removal of the calculi. Complications associated with percutaneous stone removal included postoperative fever, delayed urinary bleeding, ureteral edema, symptomatic urinary extravasation and water intoxication. Only 16 patients with complications required prolonged hospitalization or readmission. No complications required surgical management; no deaths occurred. Anesthetic times were similar for both groups, averaging 152 +/- 4 (S. E. M.) minutes for PL and 193 +/- 8 minutes for SL. Hospital recovery days averaged 5.7 +/- 0.3 for PL and 8.4 +/- 0.5 for SL (p less than 0.01). Associated costs averaged $7,203 +/- 255 for PL and $8,849 +/- 660 for SL (p less than 0.01). The number of narcotic administrations per patient (days one to five postoperatively) averaged 9.9 +/- 0.7 for the PL group and 16.8 +/- 0.8 for the SL group (p less than 0.01). The average patient in the PL group felt capable of full activity 2.0 +/- 0.2 weeks after stone removal, whereas no patient who experienced previous SL recalls a recovery period of less than three weeks (p less than 0.01). Most upper urinary tract calculi may be removed cost-effectively using a percutaneous approach. Patients may expect a rapid convalescence with diminished pain.

Humans↗
PubMed1984

Balloon catheter angioplasty. Which patients with renovascular hypertension are candidates?

Balloon catheter dilation of a stenotic renal artery can cure or enable easy medical control of renovascular hypertension when vessel narrowing is caused by fibromuscular dysplasia or an isolated atherosclerotic plaque in the main renal artery. This procedure is recommended instead of surgery for these lesions when primary medical management of hypertension fails.

Adult↗
PubMed1984

Radiation exposure to patient and urologist during percutaneous nephrostolithotomy.

Radiation exposure to the patient and urologist was determined during 60 procedures for percutaneous removal of calculi from the upper collecting system. For male patients the average radiation dose at the surface of the testis was 160 mrem (1.6 mSv.). Surface dose to the female patient at the ovary level averaged 580 mrem (5.8 mSv.). Radiation doses to the small field or region of fluoroscopy on the skin surface anterior to the kidney averaged 25 rem (0.25 Sv.). Radiation exposure to the urologist at collar level averaged 10 mrem (0.1 mSv.) per case. Patient gonad doses from percutaneous nephrostolithotomy are similar to those from a 7-view excretory urogram. Patient surface exposures at the nephrostomy are comparable to skin doses from standard angiographic procedures. The exposure to the urologist is similar to that from other interventional fluoroscopic procedures and is within acceptable limits. Appropriate use of radiological technology and shielding can keep radiation exposures during percutaneous nephrostolithotomy within acceptable limits for patients and physicians.

Adult↗
PubMed1984

Ultrasonic lithotripsy of a large staghorn calculus.

We describe the removal of an infected 9 cm. staghorn calculus by ultrasonic lithotripsy in a man with a solitary kidney and a pyelocolonic conduit, who had undergone 2 prior operations on the involved kidney. Lithotripsy was performed through the conduit with the patient under epidural anesthesia in 3 staged procedures. Subsequently, the patient underwent successful urinary undiversion. Recent advances in the technical equipment available for the management of stone disease have reduced substantially patient morbidity associated with renal stone surgery in the previously operated kidney.

Adult↗
PubMed1984

Ultrasonic renal lithotripsy. Single-stage percutaneous technique and adjuvant radiological procedures.

Single-stage percutaneous ultrasonic disintegration and removal of renal calculi was attempted in 67 patients (80 calculi) and proved successful in 65 (97%). Extraction was achieved during the initial session in 52 patients (78%) and required either an adjuvant radiological procedure or repeat nephroscopy in 13. Single-stage removal combines the skills of the radiologist and urologist and is successful in the majority of cases.

Adult↗
PubMed1984

Ultrasonic destruction of kidney stones.

Kidney stones may be removed without using a surgical incision by a combination of techniques and skills recently developed in the fields of urology and radiology. Percutaneous access to the kidney is established under fluoroscopic control. A guide wire placed into the renal pelvis allows a nephroscope to be inserted and the collecting system visualized. A long hollow metal probe is advanced through the nephroscope and placed in contact with the stone. This probe conducts the ultrasonic energy. The stone absorbs the energy and breaks into fine granules, which are evacuated by suction.Twenty-three consecutively seen patients presenting with 27 upper urinary tract calculi for which removal was indicated underwent successful percutaneous ultrasonic lithotripsy. Fifteen stones were located in the renal pelvis, eight in a calix, three at the ureteropelvic junction and one in the upper ureter. One infected staghorn calculus was removed. Two complications resulted in extended hospital stays, but in no patients were surgical incisions required. Of the 23 patients, 9 had previously had a surgical lithotomy. The authors believe that most renal and upper ureteral calculi for which removal is indicated may be extracted percutaneously with the aid of the ultrasonic lithotriptor. The patients may expect a rapid convalescence with diminished pain.

Adult↗
PubMed1982

Microvascular management of multiple renal arteries in transplantation.

We transplanted 8 kidneys with multiple vessels into 8 recipients using microvascular techniques to reconstruct renal arteries. Three living related combinations underwent implantation of small polar vessels (end-to-side) into the main renal artery and 1 underwent conjoined (side-to-side) anastomosis of 2 equal-sized renal arteries to form a common ostium. Additional techniques were used to manage 4 cadaver kidneys with multiple renal vessels. These included anastomosis of the lower pole artery to the inferior epigastric artery, end-to-end reanastomosis of the severed branch renal artery, separate anastomoses of 2 renal arteries to 2 branches of the hypogastric artery, and placement of 2 pediatric cadaver kidneys en bloc by anastomosis of the infrahilar aorta into the external iliac artery, and anastomosis of the infrahilar vena cava to the external iliac vein. Vascular patency (confirmed by angiography) was uniform for all anastomotic vessels. No hypertensive problems developed. In 2 cases ureteral leakage occurred, which leads us to advise caution when contemplating intrahilar vascular reconstruction of short left multiple renal arteries. Recent advances in technology of microvascular surgery have enabled dependable reconstruction of multiple renal vessels in living related and cadaver donor kidneys.

Adult↗
PubMed1981

Celiac plexus block: a roentgenographic, anatomic study of technique and spread of solution in patients and corpses.

Techniques for blocking the celiac plexus were evaluated by conventional posteroanterior and lateral x-rays and computed tomography (CT) in 20 patients with intractable pain due to carcinoma of the pancreas and by determining spread of injected dye at the time of autopsy in three corpses. The results showed that (a) the site for insertion of the needles should not be more than 7.5 cm lateral to the spinous process of a lumbar vertebra, (b) needles should be placed bilaterally, (c) the depth to which needles are inserted is greater than previously recommended, and (d) at least 25 ml of solution should be injected through each needle.

Autonomic Nerve Block↗
PubMed1980

Comparison of real-time cholecystosonography and oral cholecystography.

To evaluate the efficacy of real-time ultrasonography in detecting cholelithiasis, a series of outpatients and inpatients was examined by oral cholecystography and real-time cholecystosonography. In 163 patients, real-time cholecystosonography achieved a sensitivity of 0.91 and a specificity of 0.99. These values are equal to or better than those usually obtained in current B-mode cholecystosonography or some reported series of oral cholecystography. However, technically excellent and meticulously performed oral cholecystography achieves slightly better sensitivity and specificity than real-time cholecystosonography. The latter is suggested as the initial examination for hospitalized patients, those with abnormal liver function studies or gastric outlet obstruction, and pregnant women. Real-time ultrasonography should also be used when the gallbladder is not adequately opacified on initial oral cholecystography if a sequential dose examination cannot be readily accomplished.

Cholecystography↗
PubMed1980

Intercostal nerve block: a roentgenographic anatomic study of technique and absorption in humans.

Roentgenograms of iothalamate meglumine 60% (Conray) injected bilaterally into the intercostal grooves of the ninth or tenth ribs in 30 surgical patients showed extensive spread of the contrast central and peripherally from the site of injection within 30 seconds, with almost complete absorption within 10 minutes 30 seconds. The spread was visualized in two patients for diagnosis using CT (computed tomography) following injection of iothalamate. It was also confirmed by injecting liquid latex into two corpses prior to autopsy. These findings help to explain why the peak plasma level occurs more rapidly and is higher following intercostal nerve block than from other regional nerve blocks when comparable doses are injected. Also, the study revealed that the optimal site for blocking an intercostal nerve is at the angle of the rib and that the optimal needle is one with a short bevel.

Absorption↗
PubMed1980

Adverse reactions to radiographic contrast material.

Major adverse reactions to radiographic contrast media will occur more often as contrast material is now also administered during computerized tomographic (CT) scanning. Differentiation of the two major contrast reactions, the vagus reaction and the anaphylactoid reaction, is essential. Bradycardia is the key finding for identifying the vagus reaction. The vagus reaction involving hypotension and bradycardia requires treatment with large doses of atropine given intravenously. The immediate generalized reaction or anaphylactoid reaction should be treated as anaphylaxis with administration of vasopressors, fluids, steroids and antihistamines. Steroids and antihistamines given before the examination may offer protection to those high-risk patients who have had previous anaphylactoid reactions to contrast material.

Atropine↗
PubMed1979

Engineering and simulation of life sciences Spacelab experiments.

The third in a series of Spacelab Mission Development tests was conducted at the Johnson (correction of Johnston) Space Center as a part of the development of Life Sciences experiments for the Space Shuttle era. The latest test was a joint effort of the Ames Research and Johnson Space Centers and utilized animals and men for study. The basic objective of this test was to evaluate the operational concepts planned for the Space Shuttle life science payloads program. A three-man crew (Mission Specialist and two Payload Specialists) conducted 26 experiments and 12 operational tests, which were selected for this 7-day mission simulation. The crew lived on board a simulated Orbiter/Spacelab mockup 24 hr a day. The Orbiter section contained the mid deck crew quarters area, complete with sleeping, galley and waste management provisions. The Spacelab was identical in geometry to the European Space Agency Spacelab design, complete with removable rack sections and stowage provisions. Communications between the crewmen and support personnel were configured and controlled as currently planned for operational shuttle flights. For this test a Science Operations Remote Center was manned at the Ames Research Center and was managed by simulated Mission Control and Payload Operation Control Centers at the Johnson Space Center. This paper presents the test objectives, description of the facilities and test program, and the results of this test.

Animals↗