PubMed Health⌕ Search

Biomedical subjects

D P Stables

Publications and source records attributed to D P Stables.

At least 19 recordsLinked to original sources
PubMed1978

Role of the renin-angiotensin system in post-transplantation hypertension in patients with multiple kidneys.

To define the role of the renin-angiotensin system in post-transplantation hypertension we studied 12 hypertensive recipients of renal transplants. The patients received saralasin acetate, an angiotensin II antagonist, while on a normal sodium diet and again after seven days of sodium restriction. In six patients with only one kidney, saralasin did not lower blood pressure on either diet; salt depletion did not lower systolic or diastolic blood pressures. In six patients with more than one kidney, salt depletion also did not lower blood pressure; however, salt depletion plus saralasin lowered their systolic pressures from a mean (+/- S.E.M.) of 146 +/- 9 to 128 +/- 8 mm Hg, and mean diastolic pressures fell from 103 +/- 5 to 89 +/- 5 (P less than 0.001). In four of five patients renal-vein renin activity was greater in one or more host kidneys than in the transplant kidney (or kidneys). Although pre-transplant blood pressure was the same in both groups, post-transplantation hypertension is more likely to be angiotensin II-dependent in patients with more than one kidney.

Adolescent↗
PubMed1978

Percutaneous nephrostomy: a series and review of the literature.

A series of 53 percutaneous nephrostomies and a literature review of 516 such procedures are presented. The selection of patients with supravesical urinary obstruction, urinary fistulas, and renal calculi is discussed, and the concept is advanced that percutaneous nephrostomy is more than a temporizing preoperative procedure. The available techniques are compared; modified instrumentation for balloon catheter insertion, a combination of fluoroscopic with real-time ultrasound guidance, and some additional principles of subsequent management are introduced. Successful results can be expected in over 90% of percutaneous nephrostomies, with major complications limited to 4% and minor complications to 15%. The limitations of percutaneous nephrostomy and the role of surgical nephrostomy are discussed.

Adolescent↗
PubMed1978

Optimal technique of renal arteriography in living renal transplant donors.

Sixty consecutive living related renal donors were evaluated retrospectively with regard to the adequacy of their preoperative angiograms. Comparison of the original radiologic reports and the surgical findings revealed no errors in the prediction of the number and length of renal arteries of the transplanted kidneys. The optimal arteriographic technique is defined in the context of the information required by the surgeon: it is concluded that selective renal arteriography, although often advocated, is seldom necessary if the standard anteroposterior view of the abdominal aortic injection is supplemented by oblique and occasionally other views in selected cases.

Adolescent↗
PubMed1977

The radiology of ex vivo renal perfusion and autotransplantation.

The radiologic findings in 16 patients subjected to ex vivo renal perfusion and autotransplantation are reviewed. Preoperative excretion urography and renal arteriography are essential to define ureteral and arterial anatomy; renal scintiangiography and renography are useful for baseline studies. Plain radiographs should be obtained during nephrolithotomy. Intraoperative renal arteriography should be reserved for patients who require more precise definition of vascular anatomy or verification of adequate repair after a difficult dissection. Postoperative scintiangiography is required on the first day to exclude arterial occlusion. Renography and urography to evaluate autotransplant anatomy and function should be deferred for about 3 weeks, unless there is clinical evidence of a complication.

Angiography↗
PubMed1977

The application of fast screen-film systems to excretory urography.

Rare earth and barium fluorochloride screen-film combinations of different relative speeds were compared to conventional calcium tungstate systems in patients undergoing excretory urography under controlled conditions. Radiographs were ranked by subjective impressions of detail, contrast, mottle, motion unsharpness, overall quality, and acceptablility. Compared to a medium speed calcium tungstate screen/film combination (assigned a speed of 1), screen-film systems in the 2-5 speed range offered improvement in overall quality due to diminished respiratory motion unsharpness at the cost of some loss of detail and increase in mottle. Other advantages and disadvantages of fast screen-film systems are discussed.

Humans↗
PubMed1976

Spontaneous renal hemorrhage.

This report of 9 cases of spontaneous renal hemorrhage illustrates the wide variety of responsible conditions that may be found in a small series and the tendency for some of these conditions to coexist. In particular, all 3 patients with a bleeding diathesis had an associated anatomic lesion, and it was concluded that this group of patients required aggressive radiologic investigation. Three main clinical presentations were identified: sudden severe flank pain, symptomless hypertension, and a palpable mass with few or no symptoms. The radiologic signs are reviewed with emphasis on a recently described sign of streaky retroperitoneal fat. Treatment is discussed briefly.

Adult↗
PubMed1976

Traumatic renal artery occlusion: 21 cases.

Sixteen cases of unilateral and 5 cases of bilateral traumatic renal artery occlusion caused by avulsion or thrombosis are presented. The injury typically follows automobile-pedestrian accidents to young male subjects. Associated extrarenal injuries are usual but non-pedicle renal injury is infrequent. Suspicion of the unilateral injury depends upon recognition of absence of visible excretion at urography. The clue to bilateral occlusion is anuria. Diagnosis is confirmed by urgent arteriography. Hematuria was absent in 24 per cent and the injury was missed at laparotomy in 29 per cent of the initial explorations. Renal function was salvaged by arterial reconstruction in 2 cases, 12 hours and 5 months after injury respectively. Hypertension developed in 50 per cent of the cases and was generally mild.

Abdominal Injuries↗
PubMed1976

Renal cell carcinoma: unusual systemic manifestations.

A series of cases is presented which illustrates unusual aspects in the presentation, diagnosis, and management of renal cell carcinoma. The entire "classic triad" of flank pain, gross hematuria, and palpable mass was not present at the time of diagnosis in any of the patients. Moreover, in only three patients did the initial clinical findings raise the suspicion of renal cell carcinoma. A diagnosis of polycystic kidney disease, cardiac failure, glomerulonephritis, analgesic abuse, and perirenal hemorrhage obscured the primary diagnosis in the other five patients. In four patients the tumor was probably present from 3 to 12 years before detection. These findings emphasize that knowledge of the hematologic, humoral, immunologic and vascular abnormalities induced by this tumor may provide a clue to early diagnosis. The systematic use of excretion urography, nephrotomography, ultrasonography, renal scanning, renal arteriography and cyst puncture then may allow the accuracy of radiologic diagnosis of this tumor to approach 100%. Lastly, the therapy of choice for this tumor is radical nephrectomy. Excision of apparently solitary metastases also may sometimes be feasible. However, partial nephrectomy to remove tumor in a solitary kidney was performed in one patient to avoid the need for end-stage kidney treatment. Where nephrectomy renders the patient anephric, chronic hemodialysis and renal transplantation should be considered as potential measures to sustain life. While hormonal agents, chemotherapy, and radiation therapy sometimes provide palliation, their use generally has been disappointing.

Adenocarcinoma↗
PubMed1976

Radiopaque suppositories.

The authors describe the radiographic appearance of several commonly used rectal suppositories. Such drugs are sufficiently opaque to be seen on abdominal radiographs and may simulate excreted urographic contrast medium or stones. Errors in interpretation can be avoided by asking the patient about rectal medication or by taking lateral or delayed films.

Adult↗
PubMed1976

Unilateral absence of excretion at urography after abdominal trauma.

The unilateral absence of excretion at urography is particularly significant in the context of prior abdominal trauma. Of 23 such cases studied, 17 involved traumatic main renal artery occlusion; only 1 of these 17 kidneys was salvaged. Since earlier diagnosis may improve surgical results, urography should be abbreviated in favor of renal angiography, to differentiate renal artery occlusion from other renal injuries, agenesis, and preexisting renal disease. Clinical and plain radiographic features provide few clues. Renal venography, ultrasonography, and retrograde ureteropyelography should be used only as secondary procedures. The role of renal scintiangiography remains to be determined.

Abdominal Injuries↗
PubMed1976

Renal carbuncle: unusual cause of postpartum febrile morbidity.

Obstetricians should be alert for medical problems disguised as postpartum complications. A patient with renal carbuncle which presented as postoperative fever is described. The lesion was treated by percutaneous drainage. A brief summary of the differential diagnosis of renal abscess is presented.

Abscess↗
PubMed1975

Permanent nephrostomy via percutaneous puncture.

A technique to convert a standard temporary percutaneous nephrostomy to prolonged or permanent nephrostomy diversion with Foley catheters up to 16F in diameter is described herein. The method has been used for up to 22 months of drainage and is likely to be of principal benefit in the management of obstructive nephropathy in adults when the primary lesion is not readily amenable to repair. There have been no serious complications in our 4 cases.

Animals↗