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Biomedical subjects

B Morag

Publications and source records attributed to B Morag.

At least 37 records · Page 2Linked to original sources
PubMed1994

The impact of fetal screening on indications for cystourethrography in infants.

To evaluate cystourethrography in the era of fetal screening, we evaluated retrospectively the clinical and imaging findings of all children up to the age of 1 year who underwent a cystourethrogram in a 5-year period (1987-1992). There were 292 children, 64 neonates (< 1 month, 51 boys, 13 girls) and 228 infants (1 month-1 year, 111 boys, 117 girls). Hydronephrosis detected prenatally and confirmed after birth by US was the indication for cystourethrography in 88 children (72 boys, 16 girls). This 4.5 to 1, male to female ratio is very unusual compared to children with urinary tract infection, the great majority of whom are girls. The findings based on imaging studies in these 88 children with hydronephrosis included 31 with vesicoureteral reflux (VUR) (in 4 this was secondary), 23 with obstruction at the ureteropelvic junction (UPJ), 13 with multicystic dysplastic kidney, 2 with obstruction at the ureterovesical junction, 1 with ectopic ureterocele and 1 with posterior urethral valves, both the latter without reflux. Eleven children had normal postnatal studies and six children were lost to follow-up. Urinary tract infection (UTI) was the indication in 163 children (62 boys, 101 girls). Forty-one children were examined for other causes. Although most cases of hydronephrosis were detected on fetal screening, UTI was still the most common indication for cystourethrography and some significant abnormalities were found in these symptomatic children.

Female↗
PubMed1993

Mycoplasma cells stimulate in vitro activation of plasminogen by purified tissue-type plasminogen activator.

In an in vitro direct assay with tissue-type plasminogen activator (tPA), plasminogen and the chromogenic substrate S-2251, the ability of Mycoplasma fermentans KL4 to stimulate tPA-mediated activation of plasminogen to plasmin was studied. Mycoplasma cells markedly enhanced the activation of plasminogen by tPA in a concentration-, temperature- and pH-dependent manner. Nonidet P-40 (0.01%), sonication, and freezing and thawing of the cells substantially increased the stimulatory effect of mycoplasma on tPA activity. In contrast, the activation of plasminogen by urokinase was refractory to mycoplasma cells. The mycoplasma-mediated stimulation of tPA activity was prevented by epsilon-aminocaproic acid (EACA), a lysine analogue known to block lysine-binding sites (LBS) in plasminogen and tPA. Among several Mycoplasma fermentans strains tested, incognitus strain demonstrated the highest stimulation activity. These results suggest that mycoplasma cells interact with LBS in tPA and plasminogen to enhance plasminogen activation.

Enzyme Activation↗
PubMed1993

Renal artery stenosis secondary to neurofibromatosis in children: detection by Doppler ultrasound.

Renal artery stenosis was diagnosed in two adolescents with neurofibromatosis using Doppler ultrasound. The diagnosis was confirmed by angiography. The renal vascular lesion in neurofibromatosis usually affects the proximal segment of the artery, which is the part most optimally visualized by ultrasound. We suggest that Doppler ultrasound of the renal arteries may be a useful technique in the investigation of hypertensive children with neurofibromatosis.

Adolescent↗
PubMed1993

Vesicoureteral reflux and lower urinary tract injury: the possible role of suprapubic cystostomy.

Incidental vesicoureteral reflux was noted frequently during routine cystographic evaluation of patients who suffered vesicourethral trauma and who were managed by suprapubic cystostomy. Based on this observation we designed a retrospective study to document the prevalence of vesicoureteral reflux among 30 consecutive patients following vesicourethral trauma. In 9 patients drainage was instituted by urethral catheter and in 21 by suprapubic cystostomy. Of the latter 21 patients 10 (47.6%) had evidence of vesicoureteral reflux on cystography, which was associated with complete rupture of the urethra in 9 (90%). No patient who was treated initially with a urethral catheter had evidence of vesicoureteral reflux on cystography. We conclude that the prevalence of vesicoureteral reflux is significantly affected by the coexistence of severe vesicourethral injury and the presence of suprapubic cystostomy. The significance of this observation is in the potential risk of ascending upper urinary tract infections due to the hazardous combination of vesicoureteral reflux and frequent recurrent lower urinary tract infections. Presence of vesicoureteral reflux in these patients may necessitate a prophylactic antibiotic regimen. The specific mechanisms that lead to increased prevalence of vesicoureteral reflux in patients following severe vesicourethral injury are not defined by our results. However, we propose a multifactorial concept that may explain our observation.

Adult↗
PubMed1993

Intra-arterial thrombolytic therapy: a combined approach with angioplasty and/or minor surgery.

Low-dose intra-arterial treatment was performed in 124 patients who underwent a total of 142 procedures. The series included 87 occluded arteries and 55 occluded grafts. In only 29 instances (21%) was thrombolysis alone sufficient. In another 77 procedures (54%) the thrombolysis was followed by either angioplasty or minor surgery. In the remaining 36 treatments (25%) lysis of the occlusion failed. A successful end result of combined treatment was achieved in 67 of 77 (87%) procedures. Including the 29 patients in whom thrombolysis alone sufficed, a total of 96 of the 142 procedures (67%) were successful, with the overall success rate being better in grafts (78%) than in arteries (61%). The suprainguinal lesions had a significantly better response compared to the infra-inguinal ones. The evaluation of all procedures was done at the time of discharge from hospital. Complications were related either to local or systemic hemorrhage or distal embolization. Death related to treatment occurred in three patients.

Adult↗
PubMed1991

A radiometric assay for aspartoacylase activity in human fibroblasts: application for the diagnosis of Canavan's disease.

A new sensitive method for measuring aspartoacylase activity in human skin fibroblasts using [3H]N-acetyl-L-aspartic acid (NAA) is described. Optimal assay conditions and kinetic parameters for enzyme activity were determined. The enzyme was found to have maximal activity at pH 8.5, and the Michaelis constant for the substrate N-acetylaspartate was 1.8-2.0 mmol/l. Aspartoacylase activity in control cultured human fibroblasts was 9.2 +/- 1.8 nmol/h per mg protein, compared with 1.1 +/- 0.2 in seven Canavan patients and 3.5 +/- 0.9 in four patients' parents. This method for determining aspartoacylase activity is advantageous to the previously described spectrophotometric method since it is rapid, more sensitive and has less nonspecific interference. It is possible that application of this technique to cultured ammniotic and chorionic villi cells may be used for prenatal diagnosis of Canavan's disease.

Acetates↗
PubMed1991

Revascularisation for a poorly functioning solitary kidney.

Renovascular disease in a solitary kidney is a difficult and challenging problem. In six patients, with a mean age of 62 years, revascularisation was undertaken. In four of them, one to three attempts at PTA were made before the operation but all were unsuccessful. The preoperative mean serum creatine (Cr) was 3.52 mg% (range 2.5-5.5). The stenoses were caused by atherosclerosis in five cases and fibromuscular dysplasia (FMD) in one. Two methods of revascularisation were used: aortorenal bypass with saphenous vein (three patients) or PTFE (two patients), and transaortic renal endarterectomy with a venous patch (one patient). One patient with an aortic aneurysm underwent simultaneous aortic repair with a PTFE graft. There was no mortality or major complications in our series and no patient suffered acute tubular necrosis (ATN) after surgery. The mean follow-up period was 51 months (15-84 months). Postoperative Cr and blood pressure improved in all patients. Four patients no longer required any medication and the other two only needed reduced doses of antihypertensive drugs. Based on our experience of patients with poor single kidney function, we do not recommend PTA in this specific group of patients and suggest an aggressive surgical approach, which can effectively improve solitary kidney function, thus eliminating further haemodialysis.

Anastomosis, Surgical↗
PubMed1990

Aortobronchial fistula as a complication of surgery for correction of congenital aortic anomalies.

An aortobronchial fistula is a rare condition that is invariably fatal if not diagnosed and surgically treated. Aortic aneurysms, both atherosclerotic and infective, were the main causes in the originally described cases. However, thoracic cardiovascular surgery has recently become the predominant cause. The authors describe two such patients who presented 4 1/2 and 5 years after surgery for the correction of congenital anomalies. Both patients had severe hemoptysis, and angiography helped establish the diagnosis of an aortobronchial fistula. This diagnosis should be considered in patients with hemoptysis and a history of thoracic surgery.

Adult↗
PubMed1989

Femoral neuropathy: the role of computed tomography in diagnosis and management in 27 patients.

The computed tomography findings in 27 patients with an ultimate diagnosis of femoral neuropathy were reviewed. Haemorrhagic disorders were responsible for the neuropathy in 10 patients, neoplasia in eight, infection in five and in the remaining four patients no abnormality was noted on CT and the aetiology remained uncertain. Unilateral enlargement of the iliopsoas muscle or a soft tissue mass involving the iliopsoas compartment was noted in the 23 patients with positive studies. The exact nature of the mass could not be determined by CT alone, but, when considered together with clinical history and examination, a definitive diagnosis was possible in most instances. Whenever necessary, percutaneous needle biopsy or drainage was performed. Computed tomography should be performed at an early stage in all patients suspected of femoral neuropathy. It accurately demonstrates and delineates retroperitoneal masses causing this condition and allows further definitive diagnostic procedures such as biopsy or drainage to be performed when necessary.

Adolescent↗
PubMed1989

Errors and pitfalls in intraarterial thrombolytic therapy.

Sixty complications occurred during 138 courses of intraarterial thrombolytic therapy in 122 patients during a 5-year period. These complications were recorded and analyzed prospectively to identify underlying errors in management. There were 31 bleeding episodes, 15 vascular complications, and 14 other complications. Twelve of the bleeding episodes occurred at the puncture site, and 19 occurred at remote sites, accounting for six of the eight deaths in the series. Management errors were clearly identified in 27 of the 60 complications. The three following patterns of errors were recognized: (1) mismanagement of bleeding (12 instances), (2) wrong patient selection (nine instances), and (3) breach of the administration protocol (six instances). The group of 27 complications with underlying management errors included seven of the eight deaths in the present series. Efforts to prevent complications from thrombolytic therapy should concentrate on the specific patterns of management errors identified. This study indicates that low-dose intraarterial thrombolytic therapy is not a low-risk alternative to surgical intervention but should be viewed as a prelude or possible alternative to surgery in selected patients despite the risks involved.

Adolescent↗
PubMed1988

Functionally reversible hepatic arteriovenous fistulas during pregnancy in patients with hereditary hemorrhagic telangiectasia.

Two patients with hereditary hemorrhagic telangiectasia (HHT) who previously had only rare episodes of epistaxis had during pregnancy congestive heart failure and signs consistent with hepatic AV shunts. These were confirmed by angiography in one patient. After delivery the patients recovered spontaneously, and within six months congestive heart failure disappeared.

Adult↗
PubMed1988

Total femoral replacement.

Between 1973 and 1983, 19 patients with sarcoma of the femur were treated by adjuvant chemotherapy, excision of the entire femur, and replacement by a total femoral prosthesis. Five patients had excellent and nine had good functional results. Twelve patients died an average of 23 months after the procedure and seven are at present disease free. This limb-saving procedure permits rapid rehabilitation, prevents severe psychological problems, and improves the quality of life.

Adult↗
PubMed1987

Percutaneous transluminal angioplasty of the distal abdominal aorta and its bifurcation.

Percutaneous transluminal angioplasty (PTA) of stenotic lesions in the distal abdominal aorta and its bifurcation was performed in 14 patients, 6 of whom were women. The stenotic segment in the aorta or aortic bifurcation was usually the only significant lesion. The double-balloon technique was used in 12 patients via bilateral femoral artery catheterizations. In 2 other patients with aortic lesions, a single large balloon sufficed. Good results were achieved in all but 1 patient, with minor complications occurring in 3 instances. The follow-up period varied from 6 months to 5 years. We believe that PTA is the procedure of choice in treating localized lesions of the distal abdominal aorta and its bifurcation, especially when distal vessels are relatively uninvolved.

Adult↗
PubMed1987

Percutaneous transluminal recanalization of common iliac artery occlusions.

Percutaneous transluminal recanalization of occluded iliac arteries was attempted in 25 patients (26 limbs). In 22, successful recanalization was achieved, although 4 patients required additional surgical thrombectomy. The remaining 4 patients had surgical bypass procedures. The early and late results of percutaneous recanalization are presented as well as the technique used. We conclude that percutaneous recanalization of iliac occlusion is an effective procedure in the majority of cases. The option of surgical treatment remains viable when the percutaneous approach is unsuccessful.

Adult↗