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Biomedical subjects

W R Fair

Publications and source records attributed to W R Fair.

At least 271 records · Page 15Linked to original sources
PubMed1976

Influence of vesico-ureteral reflux on the response to treatment of urinary tract infections in female children.

3 groups of female children, comprising a total of 169 patients, were followed through successive episodes of urinary tract infection with respect to recurrence of infection. Group A consisted of 66 patients with no evidence of vesico-ureteral reflux. Group B comprised 42 patients with demonstrated vesico-ureteral reflux. The infections in these patients were treated with medical therapy alone and the reflux was not corrected. Group C consisted of 61 children who had surgical correction of vesico-ureteral reflux. While Groups B and C were not strictly comparable, the data indicate that there was no demonstrable difference in the rate of urinary tract infection among the 3 groups. Following short-term specific antibacterial therapy of a new infection, about 20% of children in each group were "cured", i.e., had no further infections during the 12 months or more that they were subsequently followed by the authors. Patients with less severe grades of reflux treated by medication alone (Group B) experienced no greater rate of reinfection than those children presenting with infections in the absence of vesico-ureteral reflux. In those children whose infections could not be adequately controlled by antimicrobial therapy, and those patients with severe (Grade III) reflux, surgery was performed to eliminate the vesico-ureteral reflux. The data also reinforced the concept that correction of reflux does not eliminate the need for constant vigilance and proper treatment of recurrent infections even after successful surgery has been carried out.

Child↗
PubMed1976

Clinical and laboratory studies into the pathogenesis of malacoplakia.

Three cases of malacoplakia are described. Electron microscopic studies revealed intact bacteria or bacteria in varying states of degradation within phagolysosomes of the malacoplakic macrophages. Michaelis-Gutmann bodies arise within the phagolysosomes. These findings suggest that the bacteria incorporated within the phagolysosomes persist as dense amorphous aggregates which later become encrusted with calcium phosphate crystals to form the laminated Michaelis-Gutmann bodies. Possible explanations for the unusual macrophage response in malacoplakia are: (1) infection with an unusual strain of bacteria, (2) an immunological abnormality affecting intracellular killing of organisms, and (3) an abnormality affecting intracellular digestion of organisms. In considering each of the possibilities, we have been unable to detect any unusual strain of infecting organisms in association with malacoplakia, and in vitro studies have revealed normal T lymphocyte response to mitogen and normal monocyte bactericidal capacity. According to the history, each patient had reason to have a compromised immune status; in only one, however, was this demonstrated.

Adult↗
PubMed1976

Physical and chemical determinations of prostatic secretion in benign hyperplasia, prostatitis, and adenocarcinoma.

With a view to detecting early biochemical changes in diseased prostate glands, polyamines, zinc, cholesterol, and physical measurements of pH and specific gravity were determined in expressed prostatic secretion. The pH of prostatic secretion from normal men was found to be higher than previously reported in the literature. The other measured substances and specific gravity were found to be decreased in prostatitis whereas the specific gravity was markedly elevated in those patients with adenocarcinoma. Clarification of physicochemical studies on prostate secretion may lead to a system of better monitoring the course of prostate disease.

Adenocarcinoma↗
PubMed1975

Management of children with urinary tract infections: the Stanford experience.

Two hundred seventy-eight female children with urinary tract infections have been evaluated at Stanford division of urology. All children were followed up for a period of not less than twelve months. Age of onset of infection, clinical presentation, and nature of infecting organisms were observed. The group consisted of 144 children without ureteral reflux and 134 children with ureteral reflux. Sixty-one of the female children with ureteral reflux had ureteral reimplantation, while 73 received medical treatment alone. A study of infection rates in each of the three groups of children indicated a similar infection rate, although those children with reflux experienced a higher incidence of clinical pyelonephritis. Correction of ureteral reflux did not alter the infection rate; however, infections after surgical correction were generally of a type usually associated with children without reflux. Twenty-nine children had urethral dilatation, and the infection rate prior to and following urethral dilatation indicated a similar rate of infection pre- and posturethral dilatation. One hundred nonrefluxing kidneys were observed radiologically: 97 were normal and 3 showed clubbing and scarring. Of 110 refluxing renal units observed, 62 were clubbed and scarred and 48 were normal. Following surgical correction of reflux, renal clubbing and scarring were not observed in previously normal renal units. Of those renal units found to be abnormal at time of surgery, 66 per cent showed progression of clubbing and scarring after surgical correction of reflux. It was observed that the greater the degree of reflux present, the higher the incidence of renal damage. This study suggests that children who experience recurrent urinary tract infections who do not have ureteral reflux are seldom at renal risk; similar children who do have ureteral reflux are at risk unless the infections are controlled or the reflux either disappears or is corrected surgically.

Anti-Infective Agents, Urinary↗
PubMed1975

Renal perfusion/excretion determination renogram: a new tool in the diagnostic evaluation of renovascular hypertension.

Presented herein are initial experiences with the RP/ED renogram, a unique radioisotope differential split function study, which can be performed with a minimum of discomfort to the patient. This test should totally supplant the existing renogram and, with additional experience, may replace the use of split function studies in the evaluation of renovascular hypertension.

Adolescent↗
PubMed1975

Urinary polyamine levels in the diagnosis of carcinoma of the prostate.

Urinary excretion of the basic polyamine, spermidine, was significantly elevated in patients with prostatic carcinoma as compared to a control group of patients, Of 44 urine specimens from patients with prostatic malignancy 31 had spermidine levels more than 2 mg. per 24 hours, while only 3 of 13 urine specimens from the control groups had levels in excess of this value. The increase in spermidine appeared to be correlated with the histologic grading of the tumor, that is 30 of 34 specimens from patients with grade II, III or IV carcinoma had excessive spermidine excretion and only 1 of 10 urine specimens from patients with grade I tumors had similiar spermidine elevations. High spermidine levles were found in tumors localized to the prostate and in 7 of 8 patients with negative pelvic and para-aortic lymph node biopsies. This study raises the possibility that urinary spermidine determinations may aid in the development of a biochemical screening test for prostatic neoplasms.

Aged↗
PubMed1975

The selective in vivo incorporation and metabolism of radioactive putrescine in the adult male rat.

Putrescine (1,4, diaminobutane), a known precursor of the polyamines, spermine, and spermidine, was studied as a possible vehicle for a radioisotope scan of the prostate and other tissues rich in polyamines. Male Sprague-Dawley rats received intravenous injections (2.3 muCi/100 gm) of 3H putrescine dihydrochloride (specific activity, 107 muCi/muM). One hour after injection the ventral prostate and pancreas showed uptake of radioactivity that was three and four times greater than that of the liver, respectively. The ratio of the amount of radioactivity in the ventral prostate compared with that of abdominal wall musculature was 8:1. The pancreas-to-muscle ratio was 10:1. At 1 hr the ventral prostate contained 0.6% (0.9%/gm wet wt) of the total injected radioactivity and the pancreas, 0.5% (1.2%/gm wet wt) of the injected dose. More than 90% of the radioactivity in the rat ventral prostate, 6 hr after intravenous injection of 14C-putrescine dihydrochloride, was found to be in the form of spermine and spermidine, thus confirming previous in vitro biosynthetic studies.

Abdominal Muscles↗
PubMed1974

Urinary tract infections in children. Part II--Roentgenologic aspects.

Roentgen findings in 107 girls under the age of ten years who had proven recurrent urinary tract infections were analyzed. From the excretory urograms done on these children, renal and pelvocalyceal outlines were accurately traced. Subsequently, renal length and parenchymal thickness at multiple points were measured. The presence or absence and grade of reflux were determined by voiding cystourethrography. Finally, the clinical history was correlated with the roentgen findings. With three exceptions, scarring and clubbing in the presence of infection occurred only in refluxing renal units. Kidneys exposed to a higher grade of reflux more frequently showed scarring and clubbing (p<0.001). Seventeen out of 40 renal units either developed or had increase in clubbing and scarring while the patients were being followed. After surgical correction of reflux, 16 of 24 previously clubbed and scarred kidneys showed progression of the lesions, usually within 24 months after operation. All children whose kidneys showed progression after surgical operation had experienced an episode of acute urinary infection with chills and fever before operation. No significant difference existed in the age at clinical onset of infection in patients with ureteral reflux with or without roentgen evidence of clubbing and scarring. This study documents the close relationship between clubbing and scarring and reflux in the presence of urinary infection in infants and children.

Age Factors↗
PubMed1974

Urinary tract infections in children. Part III--Treatment of ureterovesical reflux.

Of 134 girls with demonstrable ureterovesical reflux, 61 (105 ureters) had the reflux surgically corrected with an overall surgical cure rate of 97 percent. In the remaining 73 children (112 ureters), the reflux was treated conservatively with medical management alone. During the follow-up period no significant differences were demonstrated in the overall incidence of urinary tract infection; two years following corrective operation or medical treatment more than 50 percent of both medically and surgically treated children were still experiencing infections. A pronounced decrease, however, occurred in the incidence of clinical pyelonephritis among the surgically treated group. Following correction of reflux, the incidence of pyelonephritis was similar in both medically and surgically treated cases and was approximately the same as that found in a comparable group of children without reflux. In approximately two-thirds of refluxing renal units in which there was evidence of clubbing and scarring before medical or surgical therapy, deterioration progressed during the follow-up period. In most of these cases infection control was felt to be inadequate with episodes of clinical pyelonephritis occurring during the period of medical management, or, in the surgically treated group, occurring just before corrective operation and the scar appearing within two years after operation. The majority of renal units in which calyceal clubbing and parenchymal scarring was present had the most severe grades of reflux.

Adolescent↗