Biomedical subjects
Publications and source records attributed to A J Ball.
Five patients with symptomatic renal angiomata are described. All presented with heavy haematuria and unilateral ureteric obstruction without evidence of a mass distorting the renal architecture. Renal angiomata are most easily diagnosed by selective renal angiography. They may be treated by intraarterial embolization, avoiding the need for major ablative surgery.
The origin of this unusual variant of carcinoma of the prostate has provoked discussion ever since its first description in 1967. This is of both embryological interest and therapeutic importance. Four cases have been reviewed, and all have demonstrated immunohistochemical features consistent with an origin from prostatic tissue. In addition, three had evidence of disseminated disease which responded well to androgen ablation. It is concluded that the term endometrioid carcinoma is of descriptive value only, and these tumours are a variant of primary duct prostatic carcinoma. Patients should be treated by androgen ablation when metastases are present.
We present a case of a large renal arteriovenous fistula associated with an adenocarcinoma. The clinical and radiological findings are presented together with a brief review of the literature.
Changes in the concentrations of 11 serum proteins following surgery for a variety of conditions have been investigated. Protein changes were analogous to those observed after injury or trauma, but showed differences in the detailed behaviour of the pattern of change. Marked increases in the concentrations of five acute-phase reactant proteins (APRP) were seen, with maximum concentrations usually being reached 2 days after surgery in patients who made an uncomplicated recovery from their operations. Considerable differences were observed between the patterns of change of APRP in patients who developed complications during recovery and in patients who made an uncomplicated recovery from surgery. Concentrations of C-reactive protein and alpha-1 antichymotrypsin (ACT) were much higher in the patients who developed complications, with ACT concentrations providing the clearest separation between the groups. The main factor influencing the changes in APRP during the recovery period appeared to be the development of sepsis. Preoperative concentrations of APRP had no prognostic value for identifying patients at risk of developing complications. The study suggests that the localisation of inflamed tissue involved in the disease processes may influence the detailed behaviour of the acute-phase reactant proteins.
The value of postoperative bladder irrigation with the antiseptic agent chlorhexidine was assessed in a randomized prospective controlled study of men after transurethral operations. In patients with sterile preoperative urine the incidence of postoperative bacteriuria was 12.8 per cent, compared to 36.7 per cent in control patients. The difference is significant (chi-square 5.54, p less than 0.02). On the other hand, chlorhexidine irrigation did not eliminate pre-existing infection. Small amounts of chlorhexidine were demonstrated in the blood of some patients. There was no evidence of damage to the bladder and no toxic side effects.
Urothelial biopsies from ureters intubated with silicone (11) and other polymer (13) double J stents revealed features of mucous metaplasia in 12/24 cases. These changes were associated with encrustation of the stents and occurred principally in stone-forming patients.
A pre- and postoperative five-year follow-up study on 83 patients undergoing elective prostatectomy for benign hypertrophy revealed good overall symptomatic results in 70 (84%). Hesitancy and a poor stream were improved more often than were frequency and nocturia. A high preoperative voiding pressure was significantly associated with a good result; less satisfactory results tended to be associated with a higher preoperative flow rate.
Metastatic carcinoma of the prostate is a common cause of spinal cord compression. In this review of 37 men who underwent laminectomy for this condition this was the first presentation of previously undiagnosed cancer in 11 (29%). One year after decompression 17 (50%) were alive. Twenty patients (59%) could walk after laminectomy. All but 8 were relieved of pain and bladder function was improved in 13 (38%). Those ambulant before laminectomy (7) and those with occult prostate cancer did particularly well. Poor results were associated with a rapid onset of paraparesis and pre-operative progression to paraplegia. A delay in diagnosis was detrimental to outcome. A high index of suspicion in patients with carcinoma of the prostate is essential so that early diagnosis can be made before paraplegia is established. Carcinoma of the prostate must always be excluded in men with cord compression of unknown aetiology.
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Of 46 patients who underwent optical urethrotomy for differing strictures of the urethra, 41 (89.1%) remained free of stricture symptoms at follow up 6 years later. The initial effectiveness of this procedure in improving stricture symptoms is sustained in the long term.
The hypothesis that a generalized defect in beta-adrenoceptor function characterized asthma and atopy has been proposed by Szentivanyi. Such a defect may be intrinsic to the beta-adrenoceptor mechanism or could be attributed to circulating factors which interfere with the binding of catecholamines to beta-adrenoceptors. This study shows that sera from a proportion of the asthmatic population studied contain beta-adrenoceptor blocking activity and that the degree of inhibition correlates with some of the clinical indices of asthma.
Indwelling ureteric stents have been used for upper urinary tract drainage in 17 patients. The advantages over traditional methods in terms of endoscopic insertion, avoidance of external diversion and potentially lengthy periods of drainage are described. Patients requiring ureteric splintage following open procedures can also benefit from internal stenting rather than external drainage. Withdrawal is performed as a minor out-patient endoscopic procedure.
In a 7-year period 137 men with urethral stricture underwent optical urethrotomy. Over 91% were relieved of their stricture symptoms and required no further treatment, including 41 patients in whom the follow-up period exceeded 4 years. The surgical technique is outlined. Strictures with the best prospect of cure were short and single. Optical urethrotomy is confirmed as the treatment of choice in strictures of the male urethra.
The follow-up of 28 patients with urinary incontinence treated with periurethral Teflon injection revealed significant improvement in 53.6% and complete cure in 21.4%. Patients most likely to benefit were those with weak sphincters and stable detrusors. The method is quick and safe and requires only a brief hospital stay. It is suitable for patients in whom conventional operative techniques have failed or in whom surgery is best avoided on medical grounds.
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Explore the source record for details and available documents.
Post-coital cystitis was treated by an advancement urethroplasty in 41 patients. Twenty-eight patients were either cured or obtained significant relief of symptoms. These encouraging results indicate that a urethroplasty should be considered in suitable cases when conservative methods of treatment have failed, and especially in patients whose urethral meatus lies in an intravaginal position.