Biomedical subjects
Publications and source records attributed to A T Evans.
Increased interest and use of urodynamic testing have led many clinicians to rely on the results for patient care. Numerous shortcomings and possible sources of error have been identified. Well trained personnel, properly structured examination rooms and understanding of the potential pitfalls in urodynamics are essential to proper medical management of patients with micturition problems.
Giant uterine fibroids are those weighing greater than 25 lb (11.4 kg). Such a fibroid may appear as a solitary tumor or as a conglomerate mass of uterine fibroids presenting as a single uterine tumor. The challenge of these tumors lies in their proper surgical management. Combined preoperative and postoperative mortality is approximately 15%. The paucity of recent reports encountered in the literature of uterine fibroids of this magnitude reflects their rarity.
A case of abdominal aortic aneurysm which presented as retroperitoneal fibrosis followed by fatal disseminated intravascular coagulation is reported. A diagnostic aortogram should be considered in all cases of apparent idiopathic retroperitoneal fibrosis.
A young female Labrador Retriever-type dog had a 4 1/2-month history of respiratory distress, which eventually became severe, leading to cyanosis. Physical examination suggested an upper airway obstructive lesion, which was confirmed by bronchoscopy and radiography to be a mass in the thoracic portion of the trachea. The mass was removed surgically and, on histologic examination, was found to be an osteochondroma. Six months after surgical extirpation, there was no indication of recurrence of tumor.
Three young unrelated dogs were diagnosed as having the canine counterpart of Ebstein's anomaly, an eponymic term for a cardiac malformation in man. All of the dogs had systolic murmurs in the tricuspid area, and all had radiographic evidence of cardiac enlargement, particularly of the right atrium. Electrocardiography indicated atrial disease or right atrial enlargement and right ventricular conduction defects. The defect was confirmed by means of cardiac catheterization in all 3 dogs. Open heart surgery was performed on 2 of the dogs--plastic reconstruction of the tricuspid annulus and placement of a prosthetic valve in 1 and closure of an atrial septal defect in the other; both of these dogs died (1 day and 1 month after surgery).
Four Collie littermates had multiple cardiac and diaphragmatic anomalies. Ventricular septal defect was found in 3, pulmonic stenosis in 2, atrial septal defect in 1, mitral regurgitaion in 1, and pericardial diaphragmatic hernia in 3. Five additional littermates died within 72 hours of birth but were not necropsied. On the basis of available evidence, it was believed that the defects were congenital but not hereditary.
Five dogs and 1 cat had pulmonary artery banding for ventricular septal defect and congestive heart failure. An umbilical tape band constricted the pulmonary artery to one-third its original diameter, increased the right ventricular pressure, and decreased the left ot right shunt. Five animals had remission of clinical signs; 1 dog died of right ventricular failure due to a band that had been applied too tightly. The results indicated pulmonary artery banding is helpful in reduction of clinical signs, due to increased flow to the lungs from ventricular septal defect.
The general features and problems of renal vein thrombosis in children are first discussed. The records of 11 children with this condition, 7 ill neonates and 4 older children with burns, are then reviewed, indicating the clinical course of the disease, how they were treated, the results, and pathological findings. From this study, the natural history is assembled and a protocol for treatment is proposed. Supportive therapy is necessary in all cases to correct dehydration and sepsis. Many children will develop a consumptive coagulopathy. Others will develop pulmonary emboli associated with thrombosis of the inferior vena cava. Anticoagulation should be achieved for these two conditions. Nonvisualization of affected renal units upon initial urographic examination virtually assures an atrophic, functionless kidney later. Nephrectomy will be required because of hypertension, persistent infection, and scarring. Thrombectomy may be attempted when bilateral nonvisualization on urography is associated with a positive venacavogram.
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A recent 25-year experience with patients treated for carcinoma of the uterine cervix who subsequently had bladder tumors is presented. Of the 3,091 patients treated 2,674 had received radiotherapy and 8 suffered vesical malignancies of varied histopathological type 6 months to 20 years after irradiation. This incidence rate is 299.9 per 100,000, which is 57.6 times that of the general female population. Benign radiation reactions of the bladder and the possible etiology of radiation-induced bladder cancers are discussed.
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An analysis of 27 cases of primary retroperitoneal tumors and a review of the literature are presented. Techniques available for the diagnosis of these neoplasms are discussed. Sarcoma is the most common histopathologic type. A painful abdominal mass is the characteristic presentation. Echography, angiography and carbon dioxide pneumography may provide specific diagnostic information but further histopathologic correlation is needed. Angiography should guide the surgical approach routinely. Surgical excision is the treatment of choice for all tumors except for the lymphomas, which are radiosensitive. Radiotherapy has liberal application in the treatment of other histopathologic types.
Our increasingly inefficient, cumbersome, often ineffective and time-consuming manual mental cataloguing and retrieving system indicated to us that there must be a better technique available. However, our search of existing systems failed to reveal any matching our needs. Therefore, we developed a 4-category system for cataloguing and retrieving urologic materials. Our program is divided into 3 sections: 1) index, 2) catalogued data and 3) computer programs. We have used this system for more than a year and believe that it has satisfied our original requirements. It is easily adaptable to changes of information, allows for identification of unlimited types of material, offers thorough and accurate data retrieval techniques and is economical now that the expense of organizing the system is behind.
The cardiovascular effects of gallamine triethiodide and succinylcholine chloride were studied in Beagle dogs during controlled halothane anesthesia. Small but significant increases in heart rate and mean arterial presssure were observed 1 minute after intravenous injection of succinylcholine chloride. Intravenous injection of gallamine triethiodide did not produce significant cardiovascular changes.
A heretofore unreported complication from an indwelling catheter is presented. A catheter bulb became incarcerated in a bladder diverticulum and was misdiagnosed subsequently as an incarcerated umbilical hernia. The probable pathophysiological mechanism by which this event occurred is discussed.
Of 38 pediatric cases of ileoconduit urinary diversion of myelomeningocele, 4 with renal calculi are presented. An increased risk of renal calculus formation may be imposed on children with myelomeningocele with ileoconduit urinary diversion especially so in functionally and anatomically abnormal kidneys and in chronic renal infection with urea-splitting bacteria. It is not clear why the ileoconduit procedure should increase the incidence of renal calculi in such children.
A case of squamous cell carcinoma of the bladder occurring at the ureterovesical junction in a renal transplant recipient is presented. References are made to ureteral obstruction in transplanted kidneys, the broader field of squamous cell carcinoma of the bladder in non-transplanted patients and the relationship of malignancy to transplantation. We anticipate that an ever increasing number of these unusual cases will be forthcoming in the urological literature as renal transplantation develops.