ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05245.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—Increasing numbers of patients infected with the Human Immunodeficiency Virus (HIV) will be encountered in surgical practice. The risk of exposure to the virus during urological surgery is unknown. In an attempt to quantify the risk and to identify procedures that require change, 427 consecutive urological operations were prospectively assessed for contamination of the surgeon's skin, face and mucous membranes by potentially infected body fluids. Contamination occurred in 136 procedures (32%), of which 37 of 123 (30%) were open operations and 99 of 304 (33%) were endoscopic. Contamination of the face and eyes accounted for 46% (46 of 99 operations) of the contamination occurring in endoscopic surgery. Attention must be paid to reducing exposure of the surgeons' skin to patients' body fluids. The surgeons' eyes should be protected by modification of urological techniques and equipment to avoid spillag

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05246.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—The results of the diagnosis, management and treatment of 50 consecutive patients presenting with renal pelvic dilatation suggestive of pelviureteric junction obstruction are presented. Modern assessment methods were used to investigate both pre‐operative status and also the results of management of the 37 obstructed and 13 non‐obstructive patients. The role and influence of the new assessment techniques on clinical decision making are disc

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05247.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—The dietary habits of renal calcium stone patients were investigated both by dietary history and by 4‐day food records and compared with the dietary habits of control subjects, matched on the basis of age, sex, social and professional status. The method using 4‐day records seemed to be more precise, judged by the correlation to the urinary output of nutrients. There was no difference in the daily intake of major nutrients between stone formers and controls, but a higher ingestion of vitamin C in controls and a larger consumption of alcohol among stone formers. In contrast to some epidemiological evidence, there were no significant differences in consumption of animal protein when stone formers were matched for social class. Despite a similar total intake of calcium, the stone formers excreted more calcium in the urine, probably reflecting a higher intestinal absorption of calcium. There seem to be only marginally different dietary habits between stone formers and carefully matched control subjects. Differences in the urinary output of minerals and electrolytes are mainly due to variations in gastrointestinal u

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05248.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—A group of 110 consecutive renal stone formers were screened for distal renal tubular acidosis (RTA) using morning fasting urinary pH (mfUpH) levels followed by a short ammonium chloride loading test in patients with levels above 6.0. In 14 patients (12.7%) a renal acidification defect was noted; 13 had incomplete and 1 had complete distal RTA. Distal RTA was found particularly in recurrent stone formers (17%), and especially in those with bilateral stone disease, where a distal renal tubular acidification defect was found in 50%.We have been unable to differentiate primary from secondary RTA in renal stone formers. Regardless of whether the acidification defect is primary or secondary to stone formation, however, all renal stone formers with distal RTA can expect to benefit from prophylactic alkaline therapy and it is recommended that the screening procedure, which is easy to use in daily clinical practice, is applied to all stone formers and not restricted to patients with recurrent stone diseas

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05249.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—The effect of glycosaminoglycans on urinary stone formation was evaluated using a mixed suspension, mixed product removal (MSMPR) crystallisation system together with scanning electron microscopy (SEM) to examine the resulting crystals. Chondroitin sulphate was found to decrease the nucleation rate and to promote both the growth rate and suspension density. Results obtained with hyaluronic acid, although inconclusive, are similar to those given by chondroitin sulphate. Heparin sodium salt had a powerful inhibitory effect on both the nucleation rate and the suspension density, the effect increasing in proportion to the heparin concentration. SEM examination showed that the octahedral habit of calcium oxalate dihydrate was modified by the addition of heparin sodium salt and confirmed that the average crystal size in the presence of chondroitin sulphate and hyaluronic acid was significantly greater than the control or that found in the presence of heparin sodium sal

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05250.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—Percutaneous nephrolithotomy entails a potential risk of radiation injury to the surgeon if undertaken regularly. The results of 55 consecutive cases of PCN are presente

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05251.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—A group of 128 consecutive patients was identified on whom renal isotope studies had been performed during the first 2 months after renal transplantation and within 7 days of transplant biopsy. The prospective renogram and biopsy reports were reviewed and graded into 4 categories: severe rejection, predominant rejection, predominant acute tubular necrosis (ATN) and pure ATN. Two extreme patterns of renogram were identified: a sharp rise with a fast decline in the first min, attributed to ATN, and a slowly rising curve with no early peak occurring in severe rejection although not specific to this condition. There was a continuous intermediate spectrum. There was no inter‐observer variation in gradings at the 2 ends of the spectrum. In the middle part the difference between 2 independent observers never exceeded more than 1 grade.There was good correlation between the biopsy and renogram gradings, with a discrepancy of more than 1 grade in only 5 patients; 2 of these, with severe rejection on the renogram, showed predominant ATN on biopsy, but the final clinical diagnosis was severe rejection (false positive biopsies). Two patients with biopsies showing severe rejection had a sharp initial up‐slope in the renograms but a slower down‐slope (over 4 min compared with 1 min in true ATN). With better definition of the criteria these renograms would not have been graded as ATN. There was 1 patient in whom no satisfactory explanation for the discrepancy was found (presumed false positive renogram). When properly defined criteria are used to interpret renograms, this simple test is at least as reliable as renal biopsy in differentiating ATN from rejection in the early post‐transplant period, especially in the presence of anuria or severe

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05252.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—A total of 96 cases of renal carcinoma with distant metastasis at the time of diagnosis was studied. The patients were classified into 4 groups: Group O (16) in whom nephrectomy was not performed, Group A (51) who died due to carcinoma within 1 year of nephrectomy, Group B (25) who died due to carcinoma 1 to 3 years after nephrectomy, and Group C (4) who survived for 3 years or more after nephrectomy.Six clinical measurements were evaluated: haemoglobin, ESR, α2globulin, temperature, weight and C reactive protein. In addition, performance status, the number of organs with metastases, number of metastatic lesions and tumour growth rate were measured.The results showed that in patients surviving for 1 year or more after nephrectomy, there was an abnormality in the results of 3 or less of the 6 clinical measurements, performance was 0 or 1, and the carcinoma had metastasised to only one organ. In addition, it was found that the growth of metastatic lesions in patients who survived for 3 years or more was much slower than in the other patients. Nephrectomy was found to be effective in only 27% of our cases and we consider that careful deliberation should be made pre‐operatively as to whether nephrectomy is really necessary in patients with metastasis. The decision should be made on the basis of the results obtained in the 6 clinical measurements given a

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05253.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—A transrectal ultrasound technique is described for imaging the bladder neck and urethra. A group of 25 continent female volunteers was examined initially; 59 incontinent women were then studied pre‐operatively and again 6 months after either a Burch colposuspension, Pereyra operation or ox fascial sling to determine the ultrasonic characteristics of successful surg

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05254.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY