Biomedical subjects
G W Leadbetter
Publications and source records attributed to G W Leadbetter.
Challenges and commitments.
Explore the source record for details and available documents.
Re: Internal urethrotomy in girls and its impact on the urethral intrinsic and extrinsic continence mechanisms.
Explore the source record for details and available documents.
Staging of renal cell carcinoma: cost-effectiveness of routine preoperative bone scans.
The use of bone scans in the evaluation of renal cell carcinoma has become routine in many centers. In a retrospective analysis of 42 patients undergoing radical nephrectomy for renal cell carcinoma, we analyzed the cost-effectiveness of routine preoperative bone scans. Although these scans accurately predict metastatic disease to bone, they are not cost-effective as a routine preoperative tool because they do not alter outcome. In selected patients with bone pain and no other positive staging studies, preoperative bone scans may be of value in the decision to perform extirpative surgery.
Urolithiasis from stapler anastomosis.
The simplicity of operation and versatility and speed of automatic stapling devices in the creation of ileal loops have been amply documented. Three cases of stone formation in the ileal loop, secondary to encrustation about the staples, are reported herein, and the modification to the surgical technic which would obviate this problem is presented.
Ureterosigmoidostomy and carcinoma of the colon.
The etiology for development of colon carcinoma associated with ureterosigmoidostomy seems to be related to the urine. The incidence of colon carcinoma associated with ureterosigmoidostomy is 500 times greater than in the normal population, indicating about a 5% life time risk. The development time of these lesions varies from 6 to 50 years postoperatively but it is significantly less in patients more than 40 years old. The possibility exists that colon carcinoma may develop in primary sigmoid urinary diversion conduits or sigmoid internal conduits to either bladder or bowel. No reported bowel carcinoma has developed in an ileal urinary diversion. Followup examination should include stools for blood every 3 months after 2 years, an excretory urogram yearly after 5 years, sigmoid or colonoscopy every 5 years and barium enema every 5 years. If the patient has hematochezia or the excretory urogram demonstrates ureteral obstruction sigmoid or colonoscopy and a barium enema should be done.
Incidence of later ureteral obstruction after antireflux surgery in infants and children.
Forty infants and children who underwent antireflux surgery for primary reflux had long-term follow-up with intravenous pyelograms (IVP). The IVPs were evaluated for the incidence of late ureteral obstruction. Although 4 cases (5.5 per cent) of early ureteral obstruction were noted, no instances of late ureteral obstruction were found. After antireflux surgery, patients should have a follow-up IVP within the first six months to rule out the possibility of early ureteral obstruction. The need for performing periodic IVPs for many years postoperatively, when obstruction is absent in the immediate postoperative period, is questioned.
Ureterosigmoidostomy and carcinoma of the colon.
The etiology for the development of colon carcinoma associated with ureterosigmoidostomy seems to be related to the urine. The incidence of colon carcinoma associated with ureterosignoidostomy is 500 times greater than in the normal population, indicating a 5 per cent lifetime risk. The development time of these lesions varies from 6 to 50 years postoperatively but development time is significantly less in patients more than 40 years old. The possibility exists that colon carcinoma may develop in primary sigmoid urinary diversion conduits or sigmoid internal conduits to either bladder or bowel. No reported bowel carcinoma has developed in an ileal urinary diversion. Follow-up evaluation should include stools for blood every 3 months after 2 years, excretory urogram yearly after 5 years, sigmoid or colonoscopy every 5 years and barium enema every 5 years. If the patient has hematochezia or the excretory urogram demonstrates ureteral obstruction sigmoid and colonoscopy should be done.
Absence of vesicoureteral reflux after stone basket manipulation. Reflections on iatrogenic reflux.
Twenty-four patients were studied after cystoscopic basket manipulation for distal ureteral calculi. Voiding cystourethrograms or cystograms were obtained at varying intervals post-operatively to detect evidence of vesicoureteral reflux. Reflux did not develop in any of the patients. In comparison with other known causes of iatrogenic reflux, stone basket manipulation does not appear to interfere with anatomic factors which normally prevent incompetence of the ureterovesical valvular mechanism.
Management of the ureterotomy incision in 100 consecutive ureterolithotomies.
We reviewed retrospectively 100 consecutive ureterolithotomies in an attempt to determine if the choice of the ureterotomy closure significantly altered the postoperative course and morbidity rate. No dramatic difference was found when comparing ureterotomies left open, those closed loosely with interrupted sutures and those closed with continuous sutures. Parameters studied were the duration of postoperative urinary drainage, hospital stay and fever. Postoperative radiographic findings among the 3 groups are discussed.
The interaction of host immunocompetence and tumor aggressiveness in superficial bladder carcinoma.
The results of our studies suggest that in the natural history of bladder cancer intrinsic tumor aggressiveness as measured by loss of normal antigenic activity may be more relevant than intact host defenses as measured by an intact cell-mediated immune response. Our contention that tumor aggressiveness may be the more important variable fits in with the occasional success in cancer patients treated with chemotherapeutic agents that act by altering the genetic material of rapidly dividing tumor cells. Our data suggest that therapy directed at bolstering the host's immune system may not be as effective as therapy directed against molecular events within the cancer cells themselves. Unfortunately, presently available non-surgical modalities do not discriminate between aggressor (tumor) and defender (lymphocyte) cells.
Spontaneous bladder rupture: rare cause of peritonitis.
Spontaneous rupture of the urinary bladder is an uncommon, but important, cause of generalized peritonitis. It is a surgical emergency which may be rapidly fatal if diagnosis and treatment are delayed. Bladder disease or obstruction, coupled with a sudden increase in intra-abdominal pressure usually accounts for the rupture. Characteristic symptoms are acute lower abdominal pain followed by generalized peritonitis. In most cases, the rupture is intra-peritoneal.
Erythema multiforme and hematuria.
Explore the source record for details and available documents.
Immunological status as a criterion for operability of genitourinary cancers.
Delayed hypersensitivity reaction of 116 consecutive cases of urologic cancers were studied by skin tests. Ninety-one percent of those who were operable or free of diseases at least six months had positive skin reaction. All patients with inoperable or recurrent bladder, kidney, or testis tumor had negative skin reaction. All patients with operable prostatic cancer and 52% of those with inoperable prostatic cancer had positive skin reaction. Skin testing could provide useful data regarding the extent of tumor and operability. It is proposed that skin testing be included in routine preoperative evaluation of urologic cancers.
Early orchiopexy and testis tumors.
A testicular tumor developed in a twenty-year-old man who had undergone orchiopexy at age six. The case illustrates that early orchiopexy affords no protection against subsequent malignant degeneration. The importance of an inguinal approach and a high orchiectomy are stressed.
Non-operative treatment of the ruptured bladder.
Open surgical drainage is not necessary in all patients with bladder rupture. Two patients with an extraperitoneal rupture and 1 with an intraperitoneal rupture were successfully managed with urethral catheter drainage only. Our rationale and specific criteria for this treatment are presented. We believe that in selected patients urethral catheter drainage is a safe, simple and effective method of treating the ruptured bladder.
Skin testing in genitourinary carcinoma: 2-year followup.
Compound 2,4 dinitrofluorobenzene was used to sensitize 115 patients with genitourinary cancer to test their ability to be immunized with a newly encountered antigen. In general, patients in whom a cutaneous hypersensitivity response did not develop were more likely to have advanced stage tumors than patients whose immunocompetence was intact. A 2 to 3-year followup showed that patients with impaired cell-mediated immunity were more likely to undergo disease advancement than patients of similar stage whose immunity was normal. Unfortunately, these results cannot be extrapolated for application to a given patient.
Wyland F. Leadbetter 1907-1974.
Explore the source record for details and available documents.