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Biomedical subjects

C G Bratt

Publications and source records attributed to C G Bratt.

18 recordsLinked to original sources
PubMed1991

Relationship between urease-producing bacteria, urinary pH and encrustation on indwelling urinary catheters.

In 11 patients with long-term indwelling catheters the amount of catheter encrustation and urinary pH were measured and the urine regularly cultured over a prolonged period of time (median of 7 periods of 3 weeks). The mean urinary pH was related to the persistent presence of urease-producing micro-organisms (P. mirabilis) and urinary pH governed the precipitation of catheter encrustation. The critical pH appeared to be around 6.8. In patients with a mean urinary pH below this level the encrustation was minute (less than or equal to 2.9 mg phosphate). In patients with a mean urinary pH above 6.8 it was considerable but with a marked interindividual variation (35.5-138.7 mg phosphate). The composition of the encrustation was also strongly pH-related, with a much higher proportion present as magnesium ammonium phosphate in patients with a mean urinary pH above 6.8. The persistent presence of urease producers was not associated with a high pH or a more pronounced precipitation of phosphate in all patients. The amount of encrustation thus appears to depend not only on the presence of urease-producing micro-organisms but also on individual factors such as urinary composition.

Aged↗
PubMed1988

Long-term followup of maximum concentrating ability and glomerular filtration rate in adult obstructed kidneys after pyeloplasty.

We investigated 34 patients with obstructed kidneys preoperatively and 8 to 10 years postoperatively concerning the separate glomerular filtration rate and maximum concentration ability. The mean glomerular filtration rate for the obstructed kidneys was approximately 10 per cent lower compared to that for the contralateral kidneys preoperatively and at followup. Although the mean value for obstructed kidneys was not improved at followup, kidneys with a decreased glomerular filtration rate preoperatively improved significantly after pyeloplasty. The maximum concentration ability was low preoperatively for the obstructed kidneys compared to the contralateral kidneys. The lowest maximum concentration ability was found in patients with a history of repeated upper urinary tract infections. At followup marked improvement was noted, which was most obvious for kidneys with severely reduced concentration ability preoperatively. However, the restoration was not total. There was a positive correlation between the improvement in glomerular filtration rate and improvement in maximum concentration ability.

Adult↗
PubMed1987

Intrapelvic pressure and caliceal dilatation in the evaluation of intermittent hydronephrosis.

We investigated 10 patients with suspected unilateral hydronephrosis and normal or minimal widening of the calices or renal pelvis on routine urography by high rate perfusion of the renal pelvis and simultaneous intrapelvic pressure measurement. All affected kidneys had reduced renal function (26 +/- 7 ml. per minute per 1.73 body surface area) evaluated from total and separate glomerular filtration rate studies using 51chromium-ethylenediaminetetraacetic acid clearance technique and isotope renography. Four patients without signs of obstruction operated upon because of renal calculi were used as controls with separate glomerular filtration rates greater than 40 ml. per minute per 1.73 body surface area bilaterally. The drainage function of the renal pelvis was studied by diuresis renography, simultaneous intrapelvic pressure measurement and fluoroscopy during infusion of roentgen contrast medium at a constant rate of 10.5 ml. per minute. The caliceal dilatation was calculated from planimetrical measurement of defined calices. The intrapelvic pressure gradually increased in all kidneys to a maximum value varying from 25 to 81 cm. water (average 47 +/- 15). In the control kidneys the intrapelvic pressure varied from 10 to 18 cm. water (average 14 +/- 3). Significant dilatation of the caliceal system did not occur until intrapelvic pressure values above 25 cm. water were measured. Caliceal dilatation and maximal intrapelvic pressure were correlated significantly to each other at a correlation coefficient of 0.95. Intrapelvic pressure flow measurement with contrast medium and roentgen film exposure at the time of increased pressure proved to be a useful method to diagnose outflow obstruction. The test was of particular value in cases of clinically suspected intermittent hydronephrosis, giving more reliable information than conventional renography and diuretic urography. The test could be used even when the glomerular filtration rate was decreased, thereby providing information on the presence of obstruction in cases when conventional renography and diuresis urography sometimes fail.

Adult↗
PubMed1986

125I-hippuran absorption from the human renal pelvis.

The absorption of 125I-hippuran from human renal pelvis was studied peroperatively in 18 patients with obstruction at the pelviureteric junction. Three types of experiment were included: absorption during induced diuresis, absorption at a constant intrapelvic pressure of 30 cm. H2O, and excretion of the indicator by the contralateral kidney. Total and separate glomerular filtration rate were measured using 51Cr-EDTA clearance technique and isotope renography. Distal tubular function was evaluated as maximum concentration ability. During induced diuresis the intrapelvic pressure increased to an average maximum value of 31.6 cm. H2O. The excretion of isotope from the contralateral kidney varied from one to 44% of the given dose. A significant correlation (r = 0.87) between the maximum intrapelvic pressure obtained and the amount of isotope excreted from the contralateral kidney was demonstrated. At a constant intrapelvic pressure of 30 cm. H2O the excretion of isotope from the contralateral kidney varied from two to 26% of the dosage given. The low value probably depended on the impaired function of the obstructed kidney. Our results show the existence of a significant reflux from the renal pelvis of small molecules, which was affected by renal function, intrapelvic pressure and volume.

Adult↗
PubMed1986

Influence of intrapelvic pressure on excretion of sodium from human hydronephrotic kidneys.

The influence on urinary excretion of sodium (NNa . V) of intrapelvic pressure, urinary flow, and mean arterial blood pressure during forced diuresis was evaluated in 12 patients with unilateral hydronephrosis. Total and divided renal functions were measured using 51Cr-EDTA clearance and isotope renography. The amount of sodium, excreted by the obstructed kidney, decreased with higher maximum intrapelvic pressure and increased with higher differences between the mean arterial blood pressure and maximum intrapelvic pressure. The higher the concentrating ability, the lower the amount of sodium excreted by the obstructed kidney. There was a highly significant negative correlation between maximum intrapelvic pressure and urinary flow, but no correlation between mean arterial blood pressure and maximum intrapelvic pressure. Thus, obstructed kidneys with normal concentrating ability have the same excretion of sodium as the nonobstructed contralateral kidney during forced diuresis. Obstructed kidneys with decreased concentrating ability on the other hand excrete comparatively more sodium. This is probably due to a defect in sodium resorption.

Adult↗
PubMed1984

Late results after surgical correction of pyeloplasty failure in idiopathic hydronephrosis.

Late results after a secondary pyeloplasty because of failure of the initial procedure were evaluated by glomerular filtration rate and drainage function studies in 15 patients. Total and separate glomerular filtration rates were measured using the 51chromium-ethylenediaminetetraacetic acid clearance technique and isotope renography. The drainage function of the renal pelvis was evaluated from the isotope renogram. Secondary pyeloplasty was performed 1 to 15 years (mean 8.0 years) after the first procedure because of obstruction, which was verified by diuretic urography and isotope renography. Our results show that a secondary pyeloplasty can be performed after failure of the primary procedure. Functional results 3 to 15 years after reoperation were equally good as after uncomplicated primary pyeloplasty.

Adult↗
PubMed1984

Functional characteristics of idiopathic hydronephrosis.

The functional characteristics of idiopathic hydronephrosis were studied in 171 patients. Conventional renography and measurement of the glomerular filtration rate were performed in all subjects, 137 (79%) of whom had normal parenchymal function despite severely reduced drainage function. Proximal tubular function, measured by determination of beta 2-microglobulin excretion was not reduced. Distal tubular function, evaluated as the maximum concentration ability, was not reduced in 35 of the 89 patients studied. During urography and diuresis renography were both useful tools for verifying the presence of obstruction in doubtful cases. Intrapelvic pressure was measured during constant perfusion at a rate of 7.5 ml/min and during furosemide-induced diuresis. The basal intrapelvic pressure varied from 6 to 10 cm H2O and was not increased in any kidney regardless of the degree of duration of obstruction. During perfusion, the pressure increased and varied from 28 to 52 cm H2O. During diuresis, an increase in pressure above 20 cm H2O was registered only in obstructed kidneys with a normal urinary concentrating ability. The pressure rise never exceeded 20 cm H2O during diuresis in obstructed kidneys with complications such as calculi of previous episodes of upper urinary tract infection. From these studies it is concluded that, besides cases with complications such as urinary tract infection and renal calculi, surgery should be offered to patients with idiopathic hydronephrosis with reduced urinary concentrating ability. In doubtful cases with wide pelves, renography and urography during increased diuresis can be used provided kidney function is not reduced. When kidney function is reduced, a pressure increase above 20 cm H2O during constant perfusion at a rate of 7.5 ml/min indicates obstruction.

Adult↗
PubMed1983

Late results of pyeloplasty for idiopathic hydronephrosis in adults.

A series of 91 cases of unilateral obstruction of the pelviureteric junction is reviewed. Primary nephrectomy was performed in 13 cases (14%) because of severe hydronephrosis and renal function less than 10% that of the normal kidney. Pyeloplasty was performed according to Anderson-Hynes in 74 cases and with a Culp-De Weerd flap in four cases. Nephrostomy was performed concomitantly with the pyeloplasty in 14 cases. The parenchymal function was normal before pyeloplasty in 78% of the 78 kidneys, though the drainage function was severely impaired in 76 of the kidneys and moderately impaired in two. Urine cultures were positive before pyeloplasty in two patients, and 13 of the treated kidneys contained calculi. Follow-up examination was performed 5 to 12 years (mean 8.5 years) after pyeloplasty in all 78 patients. Of the 17 kidneys with preoperatively impaired parenchymal function, 12 (71%) showed improvement. The drainage function was improved in 68 (91%) of the 75 studied kidneys. Persistently impaired drainage function after pyeloplasty was found only in kidneys with infection secondary to retrograde passage of a ureteral catheter for treatment of postoperative urinary leakage. Urinary infection occurred in 11 of the 33 cases with such leakage. Retrograde ureteral catheterization thus favoured the occurrence of urinary infection. Its importance as a risk factor for severe infection was shown by the necessity for secondary nephrectomy in three cases. Since nephrostomy tended to reduce the incidence of urinary leakage, and thereby the need for indwelling ureteral catheter, and since nephrostomy as such was not associated with urinary infection, we recommend its use in the management of idiopathic hydronephrosis.

Adult↗
PubMed1981

Proximal tubular function in human hydronephrotic kidneys.

Proximal tubular was evaluated on the basis of the excretion rate of urinary beta-2-microglobulin of each kidney in 15 patients with unilateral hydronephrosis. Total and divided renal function was measured with 51chromium ethylenediaminetetraacetic acid clearance, isotope renography and a concentration test. Total renal function was normal in all patients. Parenchymal function, measured by renography, was reduced in 2 hydronephrotic kidneys and both patients had had upper urinary tract infections. The ability to concentrate urine was impaired in 10 hydronephrotic kidneys. These patients had renal calculi or had had upper urinary tract infections. The urinary beta-2-microglobulin excretion was normal in all hydronephrotic kidneys, indicating an intact proximal tubular function in these patients.

Adolescent↗
PubMed1981

Reimplantation of the ureter in prostatic carcinoma associated with bilateral ureteric obstruction.

Bilateral ureteric obstruction from prostatic carcinoma is not uncommon. A number of techniques for urinary diversion have been used in selected patients when uraemia develops. Reimplantation of the ureter(s) as an alternative to urinary diversion has been carried out in 21 patients over a 7-year period. In 6 of these patients bilateral reimplantation was done. In another 6 patients reimplantation of the ureter was not possible and cutaneous ureterostomy was carried out. The overall survival time was 10.6 months. In 13 patients living more than 6 months post-operatively, survival time was 1.8 years. Most patients had severe uraemia and advanced (clinical stage III or IV) prostatic carcinoma. The immediate management of these patients is outlined and the importance should be considered is stress. It is concluded that, whenever possible, ureteric reimplantation should be considered for relieving ureteric obstruction in patients selected for active treatment.

Aged↗
PubMed1981

Scintillation camera renography with 99mTc-DTPA and 131I-Hippuran.

Two different indicators for scintillation camera renography, 99mTc-DTPA and 131I-Hippuran, were compared directly in 37 patients. Quantitative data were obtained by means of a small digital computer. 99mTc-DTPA gave better kidney image quality, but also higher background than 131I-Hippuran. The two indicators gave renographic curves of slightly different shape, those after DPTA being flatter, but estimations of separate kidney function were not significantly different. Early kidney uptake of indicators was roughly proportional to glomerular filtration rate, but with a wide scatter.

Adolescent↗
PubMed1980

Diuretic urography in the assessment of obstruction of the pelvi-ureteric junction.

Twenty adult patients with urographic evidence of unilateral, moderately wide renal pelves were examined by routine and diuretic urography. Planimetry of the corresponding calyx system of the two examinations was performed. An increase in size by more than 20 per cent following osmotic diuresis indicated an obstruction of the pelvi-ureteric junction in kidneys with moderately wide renal pelves. Diuretic urography may be useful to diagnose obstruction as a cause of moderately wide renal pelves and to assess operative results.

Adult↗
PubMed1980

Priapsim: evaluation of treatment with special reference to saphenocavernous shunting in 26 patients.

In the past, idiopathic priapism was not treated at all or was conservatively managed by measures including aspiration and irrigation of the corpora cavernosa. Restoration of erectile function rarely resulted. Various venous bypass procedures have been tried since Grayhack, McCullough, O'Connor & Trippel in 1964 described the technique of saphenocavernous shunting in idiopathic priapism. Over a ten-year period 31 instances of priapism were seen in 30 patients. In 26 cases the priapism was classified as idiopathic. Saphenocavernous shunting was done in these 26 patients. At follow-up seven of them were potent. Our data indicate that alcoholism may be an aetiologic factor in idiopathic priapism, since 15 of the 26 men had a history of massive alcohol consumption. Idiopathic priapism should be regarded as a surgical emergency, and a venous shunt should be performed.

Adult↗
PubMed1979

Maximum urinary concentration ability in patients with idiopathic hydronephrosis.

The maximum urinary concentration ability and renal parenchymal function of each kidney were investigated in 34 patients with unilateral hydronephrosis. The ability to concentrate urine was not reduced in 10 hydronephrotic and 24 contralateral kidneys. The concentration ability was moderately reduced in 14 hydronephrotic and 10 non-hydronephrotic kidneys and severely impaired in 10 hydronephrotic kidneys. A reduced concentration ability was found almost entirely in hydronephrosis complicated with upper urinary tract infection or renal calculi. Hydronephrotic kidneys without these complications showed a normal concentration ability in 10 of 11 cases. Parenchymal function was reduced in only 10 hydronephrotic kidneys, 7 of which had had upper urinary tract infections and 3 of which had renal stones. It is our opinion that uncomplicated cases of unilateral hydronephrosis should not be operated upon unless necessitated by signs and symptoms. Measurement of the maximum urinary concentration ability might be helpful in setting the correct indication for surgery in borderline cases.

Adult↗
PubMed1977

Renal function in patients with hydronephrosis.

The glomerular filtration rate and pelvic drainage function were reinvestigated after 3-5 years in 50 patients with hydronephrosis secondary to functional obstruction in the pelvic-ureteric junction. Pyeloplasty by the Anderson-Hynes' technique had been performed in 28 kidneys, while 12 patients were not operated upon and 10 had had a nephrectomy. The glomerular filtration rate was determined with the clearance technique and isotope renography. 16 out of 28 kidneys subjected to pyeloplasty and 11/12 non-operated kidneys had a normal renal parenchymal function at the first investigation in spite of severely disturbed drainage function. In the non-operated series the renal parenchymal function was unchanged in 11 patients. Deterioration was observed in 1 kidney, probably because of chronic pyelonephritis. Uncomplicated cases of pelvic-ureteric junction obstruction should not be operated upon unless necessitated by symptoms. A yearly control programme including a renal function test and plain films of the upper urinary tract is recommended for these patients.

Adult↗
PubMed1976

Selection of patients for surgical correction of urinary incontinence after prostatic surgery.

It has been suggested that patients with urinary incontinence after prostatic surgery should be accepted for operative correction only if there is no urethral stricture, no urinary infection, and a normal cystometrogram. To study the frequency of these contra-indications, 37 patients suffering from incontinence after suprapubic enucleation of benign prostatic adenomas were examined. Urethral strictures were found in 16 patients, recurrent urinary infection in 16, and an abnormal cystometrogram in 9. Only 13 patients were found to fulfill all three criteria for operative correction. The validity of the criteria is discussed on the basis of our experience from 13 patients operated upon with a free fascial sling. Ten of them were cured or improved. Three patients remained incontinent; these 3 patients were the only ones in the operated series who did not fulfull the suggested criteria for correction. Thus, so far, the criteria seem to be justifiable.

Adenoma↗