Biomedical subjects
Publications and source records attributed to H Burko.
A 5-year-old boy developed acute colitis followed by stricture formation as a result of a detergent enema. The acute phase of the caustic induced colitis was reproduced in the dog and the rat using full strength and diluted detergent enemas. The severity of the experimental colitis was shown to be directly related to the concentration of the detergent.
Experience with the diagnostic evaluation and operative management of 38 hypertensive patients having bilateral renal revascularization is presented. Twenty-four patients had atherosclerotic occlusions and 14 had fibromuscular dysplasia. Renal vein renin assays (RVRA) and/or split renal function studies (SRFS) were performed in 37 of the 38 patients before operation. Although RVRA was negative in 29 percent and SRFS negative in 31 percent, 24 of 26 patients (92 percent) having both tests done had at least one positive study. Twenty-one patients had simultaneous bilateral repairs and 12 had staged bilateral reconstructions. The incidence of technical failures in these two groups was 21 and 9 percent, respectively. Excluding three uncorrected technical failures and two patients with recurrent branch renal artery lesions, 90 percent of patients with atherosclerosis and all patients with fibromuscular dysplasia had a favorable blood pressure response to operation. This study supports the use of both RVRA and SRFS in the diagnostic evaluation of hypertensive patients with renal artery stenosis. If these functional tests lateralize to one side, repair of that side only is recommended. If the functional studies do not lateralize, operation is suggested only when hypertension is severe and is not controlled readily with medications. In this circumstance reconstruction of the side that appears to be diseased most severely is recommended. Contralateral repair is undertaken only when hypertension persists and when repeat functional studies lateralize to the unoperated side.
Explore the source record for details and available documents.
A comparison of lesions discovered by selective renal arteriograms with abnormalities observed on abdominal aortograms was made in 100 consecutive hypertensive patients. Twenty-one lesions not seen on aortograms were found by selection. Eight patients with a normal aortogram had lesions. An abnormality was discovered in at least one study in 58 patients. The increased rate of lesion detection by selective studies outweighs the slight risk of complications.
In the 25-year period 1950-1975 forty-four patients with pheochromocytoma were observed at Vanderbilt University Affiliated Hospitals. Bilateral adrenal tumors occurred in 3 patients (6.8%) and extra-adrenal tumors occurred in 7 others (16%), 33 patients (75%) had single tumors arising in one of the adrenal glands; in one of these 5 years after operation, a malignant tumor developed in the same renal fossa. Five of the 44 patients (11.3%) proved to have malignant tumors and died with metastases. In 11 patients in the earlier years of this study the clinical diagnosis was not made and the tumor was identified by the pathologist at autopsy. There was a single postoperative fatality among the 33 patients in whom the clinical diagnosis was made. Seventy per cent of all survivors with benign tumors have remained normotensive during followup periods of one to 20 years.
Patient dissatisfaction with prolonged bed rest and the discomfort caused by pressure dressings led to the following evaluation. Alternate application of pressure dressings and band-aids to femoral artery puncture sites was performed in 754 arteriographic examinations. The application of pressure dressings for 16-24 hours, especially in hypertensive patients, was found to be justified by a significant reduction in delayed bleeding requiring further medical attention. A minimum application time of 8 hours is supported because all instances of delayed bleeding occurred within 8 hours of the procedure. Arterial thrombosis is not affected by the use of pressure dressings. The rationale for recommendation of bed rest is largely anecdotal and is supported by almost all experienced angiographers responding to our questionnaire.
Fourteen patients with 16 pheochromocytomas were studied arteriographically over a seven year period. Abnormalities identified the tumor site in 15 instances, but only a single subtle change was present in six of these. Renal artery stenosis was present in eight instances and was significant initially in at least one patient and may become significant in others. A hypertensive response to the study occurred in one-half the patients even though most had received adrenergic blocking drugs. Phentolamine remains the drug of choice in treatment.
Congenital megalourethra, an anomaly of the penile urethra, is discussed, and 15 cases from the English literature are reviewed. The relationship of this anomaly to other abnormalities of the genitourinary system is stressed.
Three patients with Menetrier's disease and protein-losing gastropathy who were studied during a 12 year period have been presented. The characteristic findings which differentiate them from patients with hypertrophic hypersecretory gastropathy, including the Zollinger-Ellison syndrome, are: 1) hypertrophy of gastric mucosa with giant rugal folds involving the fundus, cardia and body of the stomach but sparing the antrum; 2) muscosal hypertrophy consisting of gastric mjcus-secreting cells while parietal cells and chief cells are diminished in number and may be absent from many microscopic sections; 3) gastric secretion of large volume containing excess mucus, low to absent hydrochloric acid and protein concentration 5 or 6 times normal (1.7 mg/ml); 4) hypoalbuminemia and hypoglobulinemia due to loss of serum proteins fron gastric mucosa into the gastric lumen; 5) rare association with gastric ulcer. Unlike the Zollinger-Ellison syndrome none of our patients had duodenal ucler or multiple endocrine adenomatosis or a family history of these conditions. We have found no authenticated reports in the literature which document a relationship of Menetrier's disease ( as defined above) with multiple endocrine adenomatosis. Menetrier's disease with protein-losing gastropathy is a potentially lethal disorder of unknown cause with no specific treatment. Resection of the site of gastric protein losses as first done by Waugh is logical and effective. One of our three patients died in hospital before gastrectomy was done. Two others have done well for 11 months and 12 years, respectively, after total gastrectomy with Roux-en-Y esophagojejunostomy and Hunt-Lawrence jejunal pouch.
The diagnosis of right-sided Bochdalek hernias is diffucult. Problems encountered in diagnosis include delayed radiographic manifestations and stimulation of inflammatory disease. The case is presented of a neonate in whom a right-sided diaphragmatic hernia masqueraded as inflammatory disease of the chest.
One-hundred and eight autologous saphenous veins were used to construct an aortorenal bypass in 94 patients and were followed from five months to nine years. There were three operative deaths. Twelve grafts thrombosed. In seven patients the thrombosis was demonstrated in the early postoperative period. In the other five patients an early postoperative arteriogram was not done, the thrombosis was first demonstrated arteriographically 4(1/2)-9 months following operation. In the latter patients it is impossible to determine when the thrombosis occurred. No graft demonstrated to be patent in the early postoperative period was subsequently found to be thrombosed. Therefore it is likely that almost all thromboses occurred in the immediate postoperative period and were the result of technical errors in the arterial reconstruction. A total of 130 followup arteriograms were done in 75 patients with 89 patent grafts. Long term, serial followup arteriograms were done in 29 patients with 39 vein grafts. Three different patterns were observed: 1) the vein graft maintained its initial size and configuration (62%); 2) the vein graft underwent uniform dilatation throughout its length (20%); and 3) the dilatation progressed to aneurysmal proportions (5%). Significant suture line stenosis developed in one patient who also had recurrent renovascular hypertension. Progression of severity of "apparently insignificant" stenosis or development of a new lesion in the contralateral renal artery was observed in 12 of the 29 patients (41%). These patients serve to emphasize the fact that nephrectomy is ill-advised in patients with renovascular hypertension except under the most demanding circumstances. Finally, there is an urgent need for a careful comparative study of the grafts that are currently being used to construct aortorenal bypasses.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.