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Biomedical subjects

D Holden

Publications and source records attributed to D Holden.

At least 37 records · Page 2Linked to original sources
PubMed1993

Onset, natural history and outcome in idiopathic adult motor neuron disease.

Cases of adult-onset idiopathic motor neuron disease (MND) identified from January 1970 through December 1986 were studied in a defined area of California. The patients were followed prospectively throughout the illness in 99% of cases. Among 708 cases aged 25-74 years at onset, the most common type (86%) was typical, sporadic amyotrophic lateral sclerosis (SporALS). The risk of bulbar onset and shorter survival times increased with age in both men and women. About 4%, mainly younger men, experienced unusually long courses with milder paralysis, but could not be identified early in the illness. They probably represent one extreme of the ALS spectrum rather than a distinct subtype. Familial ALS (FamALS) was diagnosed in 7%. It developed earlier in life but ran a slightly longer course, which suggests a different disease process. Overall there was a statistically significant predominance of males, especially in 17 cases (2%) of progressive muscular atrophy (PMA). There were 26 cases (4%) classified as primary lateral sclerosis (PLS). Progressive bulbar palsy was not found; that diagnosis usually denotes merely the bulbar onset of ALS.

Adult↗
PubMed1993

Detection of Aspergillus fumigatus by polymerase chain reaction.

Aspergillus fumigatus is an opportunistic nosocomial pathogen causing an often fatal pneumonia, invasive aspergillosis (IA), in immunosuppressed patients. Oligonucleotide primers were used to amplify a 401-bp fragment spanning the 26S/intergenic spacer region of the rDNA complex of A. fumigatus by the polymerase chain reaction (PCR). The primers were highly sensitive and specific: as little as 1 pg of A. fumigatus genomic DNA could be detected, and the primers only amplified DNA from A. fumigatus and not any other fungal, bacterial, viral, or human DNA tested. Using the PCR, we were able to detect A. fumigatus DNA in lung homogenates from immunosuppressed mice experimentally infected with A. fumigatus but not from immunosuppressed uninfected controls. There was 93% correlation between the culture results and the PCR results. In a retrospective clinical study, the sensitivity of the PCR for the detection of A. fumigatus in clinical samples was confirmed by positive amplification in three of three culture-positive respiratory samples from confirmed cases of IA. Because isolation of Aspergillus spp. may reflect contamination and colonization without infection, the feasibility of using the PCR was evaluated by analyzing culture-negative samples from both immunosuppressed patients at high risk for IA and immunocompetent patients with other lung infections. Only 2 of 10 patients were culture negative and PCR positive in the high-risk group, and 2 of 7 patients were culture negative and PCR positive in the immunocompetent group. The results indicate that PCR detection might be a valuable adjunct to current laboratory methods to diagnose IA.

Adult↗
PubMed1991

Management of staghorn stones using a combination of lithotripsy, percutaneous nephrolithotomy and Solution R irrigation.

The treatment of staghorn and partial staghorn calculi remains complex despite modern methods of stone removal. We describe the results following treatment of 112 stones. Three methods were used: percutaneous nephrolithotomy, extracorporeal shockwave lithotripsy and Solution R irrigation, either alone or in combination; 57 stones (55.8%) were completely cleared, with Solution R irrigation helping to achieve complete clearance in 6 of these. A further 24 stones were not completely cleared (small asymptomatic fragments less than 3 mm remained). A satisfactory outcome (stone-free or asymptomatic fragments less than 3 mm) was achieved in 81 stones (79%).

Adolescent↗
PubMed1991

Relationship between bladder morphology and long-term outcome of treatment in patients with high pressure chronic retention of urine.

A group of 32 men undergoing bladder outflow surgery for high pressure chronic retention (HPCR) of urine were studied prospectively. At the time of treatment marked morphological changes in the bladder wall were demonstrated histologically, but after a mean follow-up of 42.9 months residual urine had decreased significantly and renal function had improved or stabilised in 28 patients (84%). Four patients deteriorated but in 3 of these another potential cause for loss of renal function was present. The majority of patients have a good long-term prognosis following treatment for HPCR.

Adult↗
PubMed1990

Identification of urinary stone composition by pulsed dye laser.

Stones were recovered from the urinary tract and their composition determined by X-ray diffraction before exposure to a pulsed dye laser beam. The resultant fluorescent emissions were recorded using a scanning reticon and they appeared to be specifically related to the composition of each stone. This technique has a practical application as it may allow identification of the composition of urinary tract stones in vivo, and so indicate the best mode of lithotripsy.

Humans↗
PubMed1989

Ureteral stones: the results of primary in situ extracorporeal shock wave lithotripsy.

The use of a Siemens Lithostar* for in situ disintegration of 212 ureteral stones in 207 patients was evaluated. Followup data were available on 133 patients (136 stones). Of the stones 121 (88.1 per cent) have been cleared with in situ extracorporeal shock wave lithotripsy alone. These results strongly suggest that in situ extracorporeal shock wave lithotripsy is an effective and noninvasive method to treat ureteral stones.

Female↗
PubMed1988

Mechanism of upper tract dilatation in patients with thick walled bladders, chronic retention of urine and associated hydroureteronephrosis.

The mechanism of upper tract dilatation in patients with obstructive uropathy associated with thick walled trabeculated bladders and painless retention of urine has been determined in 9 cases by simultaneous measurement of renal pelvic and bladder pressures under baseline conditions and after administration of different stresses to the urinary tract. Under basal conditions no pelvic pressure increase was observed during detrusor contraction or other alteration of lower urinary tract pressure. However, after the flow in the upper tract was increased by oral water load, intravenous furosemide or direct pelvic perfusion, pelvic pressures were markedly elevated and reflected accurately any change in intravesical pressure. Under such conditions, pelvic pressures frequently exceeded 40 cm. water. These observations provide an explanation for the increasing size of the upper tract and a clarification of the mechanism whereby renal function might gradually deteriorate in these patients.

Aged↗
PubMed1985

Platelet count in radiation bowel disease: an aid to diagnosis.

This study reports the results of serial observations of simple haematological indices (haemoglobin concentration, white cell count and platelet count) in 25 patients who developed radiation bowel disease as a late complication of pelvic radiotherapy for malignancy. It is compared with a control group of 25 women patients who received pelvic radiotherapy but did not develop radiation bowel disease. There is a highly significant elevation in the platelet count (P less than 0.0001) at a time when the patients develop radiation bowel disease. The platelet count returns to normal after successful excision of the disease but the elevation recurs if further radiation disease develops in the urinary or gastrointestinal tracts. It is suggested that the platelet count may have a useful role in the diagnosis of radiation bowel disease.

Female↗
PubMed1985

Pressure changes in the dilated upper urinary tract on perfusion at varying flow rates.

The conventional Whitaker test assesses the pressure response to a constant perfusion rate of 10 ml/min. Twenty-eight kidneys were perfused at increasing flow rates up to 20 ml/min. Nine became obstructed at rates of 12 to 20 ml/min. The feasibility of such a high urine output has been tested and confirmed. The standard Whitaker test may therefore miss some cases with potentially obstructive hydronephrosis, the effects of which may be deleterious to renal function.

Adolescent↗
PubMed1984

Renal pelvic pressures in human chronic obstructive uropathy.

Resting renal pelvic pressure and premicturition bladder pressure have been measured by direct percutaneous puncture in 12 male patients with established chronic obstructive uropathy related to high pressure chronic retention. In 10 technically satisfactory cases the subtracted renal pelvic pressure was less than the intrinsic bladder pressure, showing that upper tract dilatation and diminished renal function in these patients were not due to direct extension of high resting bladder pressure into the upper tract. The mean resting upper tract pressure in chronic human obstructive uropathy was 10.7 cm of water.

Chronic Disease↗
PubMed1984

Shortening of the first metatarsal as a complication of metatarsal osteotomies.

There have been few reports of shortening of the first ray of the foot because of damage to the physis of the first metatarsal during the performance of metatarsal osteotomy for residual metatarsus adductus. In a retrospective study of twenty-seven feet in twenty patients who underwent this procedure, eight feet in seven patients were noted to have some degree of residual shortening of the first ray. This is an incidence of 30 per cent. The follow-up period after osteotomy ranged from two years to seven years and four months (average, four years). We could find no clear correlation between the occurrence of shortening and the patient's age at osteotomy, sex, or race, or the etiology of the adduction for which the osteotomy had been done. A clear correlation was found, however, with the surgical technique that had been employed. In two of the eight feet with a short first ray, the osteotomy had been done within the physis of the first metatarsal. In the other feet the procedure had employed an osteotomy site close to the physis or extensive periosteal dissection, or both. The results in our patients implicate subperiosteal dissection of the first metatarsal as an important, previously unreported cause of damage to the physis and of the resultant shortening. We recommend radiographic determination of the relationship of the osteotomy site to the physis before dissection is performed.

Child↗