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At least 1,135 records · Page 63Linked to original sources
PubMed2001

Early diuresis renogram findings predict success following pyeloplasty.

PURPOSE: We sought to determine whether drainage across the ureteropelvic junction, as indicated by diuretic renography 3 months after pyeloplasty, is an adequate predictor of surgical success. MATERIALS AND METHODS: The medical records of 150 children who underwent pyeloplasty from 1986 to 1995 were reviewed. After excluding nonevaluable cases a total of 127 renal units remained for investigation. Preoperatively each renal unit was examined with a standardized (well-tempered) furosemide stimulated renal scan. Postoperatively 60 renal units were evaluated with standardized diuretic renal scans at 3 and 12 months, 33 renal units at 3 months only and 34 renal units at 12 months only. Surgical success was defined by half-time less than 20 minutes on a standardized diuretic renogram. RESULTS: Of the 33 renal units with a single postoperative study at 3 months 32 (97%) had halftime less than 20 minutes on diuretic renography. The remaining patient in this group with half-time greater than 20 minutes showed 60% improvement in half-time and did not require reoperation. Excluding those without delayed followup, surgical success was obtained in 93 of the 94 (99%) renal units. Among the 60 renal units evaluated with 2 postoperative renal scans success was noted in 48 (80%) and 59 (98%) at 3 and 12 months, respectively. Stenosis did not recur in 48 renal units with half-time less than 20 minutes 3 months after repair. In 1 case that had been treated for postoperative urinoma half-time was greater than 40 minutes at 3 months and repeat pyeloplasty was required. CONCLUSIONS: Half-time less than 20 minutes 3 months after pyeloplasty predicts surgical success. Most renal units that improve but still have half-times greater than 20 minutes on an early diuretic renogram will demonstrate continued improvement in drainage patterns at 12 months. Those renal units that show no improvement at 3 months may require reoperation and those with half-time less than 20 minutes at 3 months do not require further evaluation.

Child↗
PubMed1986

Dynamics of the ureterovesical junction: interaction between diuresis and detrusor instability at the ureterovesical junction in pigs.

In pigs under general anesthesia, the mutual relation between ureterovesical flow and detrusor activity was evaluated with juxtavesical ureteral perfusion pressure measurements and cystometry. At constant bladder filling volume ureterovesical perfusion could provoke detrusor activity, which was positively related to the perfusion rate, and which disappeared after perfusion was stopped. During such involuntary detrusor activity ureterovesical perfusion pressure might increase significantly more than intravesical pressure. It is concluded that ureterovesical flow causes distension of detrusor muscle bundles around the ureteric hiatus, which may trigger local and general detrusor activity in an unstable bladder. During such detrusor activity, due to forces in the bladder wall, resistance to outflow from the upper urinary tract could be significantly more impaired than is reflected by the increase of intravesical pressure at cystometry. The clinical implications are discussed.

Animals↗
PubMed1979

Idiopathic hydronephrosis--the diuresis renogram: a new non-invasive method of assessing equivocal pelvioureteral junction obstruction.

A new method to evaluate patients with equivocal obstruction of the pelvioureteral junction is described. It involves the performance of a standard 131iodine-hippuran renogram followed by a second renogram 3 minutes after an intravenous injection of the diuretic, frusemide. When the 2 results are inspected together it is found that the patients can be separated into 4 groups: 1) normal, 2) obstructed, 3) atonic and 4) partially obstructed. The results in 23 children and 27 adults with suspected obstruction of the pelvioureteral junction are presented. Obstruction was confirmed in 18 patients and excluded in 32. The correlation between the renogram results and clinical, radiological and operative findings is discussed. The technique is simple, accurate and non-invasive, and it is recommended after excretory urography before proceeding to more invasive tests.

Adult↗
PubMed1986

Cleansing the blood. Hemodialysis, peritoneal dialysis, exchange transfusion, charcoal hemoperfusion, forced diuresis.

ECDR can be a valuable adjunct to the therapy of pediatric poisonings. Careful consultation with a medical toxicologist and a nephrologist will be useful in reaching the decision as to which poisonings lend themselves to ECDR and which method is most appropriate for the specific case. Avoid advice that amounts to, "if you are not certain, dialyze." While the risks of many ECDR techniques are acceptable in major medical centers, it may not be good medicine to superimpose any morbidity from ECDR upon the poisoned patient when there can be little expectation of drug removal. It is wise to phrase your questions to consultants carefully. The question: "can this substance be dialyzed (hemoperfused, plasmaphoresed, etc.)?" is loaded and the answer frequently will be "yes!" The more proper questions are: "how much drug can be removed by ECDR, how long will the method take, how will this affect the present condition of the patient?" Clearly, a risk: benefit ratio must always be considered. There are lists of substances that "can" be removed by ECDR. It is more difficult to judge how much of the body burden is removed by such methods. Digoxin "can" be dialyzed, but it is not quantitatively removed from the body and there is no accepted benefit from ECDR in this instance. The volume of distribution is a useful guide to determine which substances may be removed quantitatively by ECDR. The exaggerated claims to increased plasma clearance of a hemoperfusion device may not be meaningful if the distribution space is large and plasma levels are correspondingly low. Finally, many of the advantages and disadvantages of ECDR are not likely to change markedly as a result of technology. We currently have very efficient machines for ECDR. It is the chemical characteristics of some toxic substances that limit the more global role of ECDR in poisoning. Serologic therapy, such as specific Fab antibody fragments for use in digoxin poisonings or the exciting work by Russell and colleagues using affinity chromatography to purify specific antibody fragments from horse serum, may be applicable to numerous intoxications. This approach, used in combination with ECDR or alone, will undoubtedly influence the future growth of clinical toxicology.

Body Fluid Compartments↗
PubMed2003

Social and environmental enrichment enhances sensitivity to the effects of kappa opioids: studies on antinociception, diuresis and conditioned place preference.

Previous studies have reported that social and environmental enrichment can have a marked impact on the functional maturation of the central nervous system and may influence an organism's sensitivity to psychotropic drugs. The purpose of the present study was to examine the effects of social and environmental enrichment on sensitivity to drugs possessing activity at the kappa opioid receptor. Rats were obtained at weaning and randomly assigned to one of two housing conditions: isolated rats were housed individually with no visual or tactile contact with other rats; enriched rats were housed in groups of four in large cages and given various novel objects on a regular basis. After 7 weeks under these conditions, the effects of spiradoline, U69,593 and nalorphine were examined in the warm water, tail-withdrawal procedure. The effects of spiradoline were also examined on urine output and in the conditioned place preference procedure. Enriched rats were more sensitive to the antinociceptive effects of all the opioids examined in the tail-withdrawal procedure, and were more sensitive to the effects of spiradoline on urine output and in the conditioned place preference procedure. Following the conclusion of these tests, housing conditions were reassigned, such that isolated rats were transferred to enrichment cages, and enriched rats were transferred to isolation cages. After 7 weeks under these new conditions, the two groups were equally sensitive to the antinociceptive effects of spiradoline, indicating that the effects of the initial housing conditions were, in part, reversible. Collectively, these data suggest that enriched rats are more sensitive than isolated rats to the effects of kappa opioids, and that the kappa opioid receptor system is sensitive to social and environmental manipulations after weaning.

Analgesics↗