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Biomedical subjects

H H Meyhoff

Publications and source records attributed to H H Meyhoff.

12 recordsLinked to original sources

[CT in preoperative assessment of renal tumors?].

The value of CT-scanning as part of the preoperative morphological investigation of patients with renal tumours was calculated in a material of 28 patients. In eight patients, operative treatment was not found to be indicated. In the 20 patients in whom operation was undertaken, the operative and histological findings were compared with the findings on CT-scanning. In cases of disagreement, the CT-scanning findings were reassessed. It was found that interpretation of the CT-scan was accurate in 40% of the cases while minor disagreements were present in 25% but these did not have any significance for the indications for operation. In the remaining 35% considerable disagreement was found between the CT-scan and the operative or histological findings such as invasion of neighbouring organs, cysts interpreted as solid tumours with necrosis and as regards interpretation of the retroperitoneal glands. The present authors consider that CT-scanning provides an important supplement to the conventional morphological investigation of renal tumours with intravenous urography and radiography of the thorax. CT-scanning appears to be preferable to ultrasonic scanning in cases which are difficult to review and where expert interpretation of ultrasonic findings is not available. In addition, routine preoperative biopsy of the tumour guided by ultrasound is recommended together with peroperative biopsy for freeze microscopic examination prior to nephrectomy.

Adult

Dissociation of urethral and anal sphincter activity in neurogenic bladder dysfunction.

In 53 patients with suspected neurogenic bladder dysfunction carbon dioxide cystometry was done in combination with urethral and anal sphincter electromyography. Complete dissociation between the reflex activity of the 2 sphincters was found in 25 per cent of the patients and only 58 per cent of the patients had identical reflex activity. It is concluded that anal sphincter electromyography is highly unreliable in the diagnosis of urethral sphincter dysfunction.

Adolescent

Urinary incontinence in the female. The value of detrusor reflex activation procedures.

One hundred consecutive female patients with urinary incontinence were investigated with CO2 cystometry including detrusor reflex activation procedures such as postural change and ability to suppress self-induced detrusor contractions. Detrusor hyperreflexia was seen in 20 patients during bladder filling in the supine position, and in an additional 35 patients after detrusor reflex activation procedures. Four different types of detrusor hyperreflexia are described based on the cystometric findings. In 38 patients treated with parasympatholytics, 66% showed a good result independent of the type of detrusor hyperreflexia.

Carbon Dioxide

Evoked response of the bulbocavernosus reflex.

The bulbocavernosus reflex can be elicited either by penile or urethral stimulation. The mean signal transit time after electrostimulation of the dorsal penile nerve to evoked response in the anal sphincter (35 msec) was only half the signal transit time after stimulation in the posterior urethra (60 msec). Thus, the modified bulbocavernosus reflex elicited either by squeezing the glans penis or by pulling a urethral balloon catheter represents two different reflexes with differenct afferent and probably different intraspinal pathways. In the clinic it is therefore important, when testing the bulbocavernosus reflex, to report how it is elicited.

Adult

Palpatory estimation of liver size. Within- and between-observer variation.

A study based upon 23 patients revealed substantial within- and between-observer variation, when 14 senior and junior surgeons under blindfold conditions were requested to measure the distance from the thoracic cage to the lower border of the liver in the midclavicular and midsternal lines. Clinical decisions should accordingly not rely heavily upon a palpatory estimate of liver size.

Adult

Effects of clonidine (Catapresan) on urethral pressure.

Effects of clonidine (Catapresan) on urethral closure pressure profile were investigated in five patients with minor urologic complaints. Plasma norepinephrine was measured as an index of sympathetic nervous activity. Intravenous injection of clonidine resulted in a pronounced fall in maximum urethral pressure. Plasma norepinephrine concentration decreased as expected. There was a statistically significant correlation between changes in plasma norepinephrine and urethral pressure after clonidine. These findings are discussed in relation to the known effects of alpha-adrenoceptor blocking drugs on urethral pressure. Clonidine may be useful in the treatment of some patients with functional infravesical obstruction.

Adult

Are doctors able to assess prostatic size?

The between-observer variation was evaluated through three independent estimates of preoperative prostatic weight in each of 40 patients. Error in the estimates was of considerable magnitude irrespective of size of prostates. Experienced urologists did not attain a more reliable estimate than unexperienced doctors. Only about 2/3 of estimates were correct within a range of +/- 25 g. However, there was a statistically significant correlation between estimated and actual operative prostatic weight.

Clinical Competence

Sphincterotomy treatment for biliary tract stones. A retrospective review.

A series of 106 patients with biliary tract stones is reported. The patients underwent supraduodenal choledochotomy, with an attempt to carry out conventional sanitation of the biliary tract, before a transduodenal sphincterotomy was done. Indication for sphincterotomy was mainly presence of wedged papillary stones or multiple common duct stones. Of the entire series, 52 attended for follow-up study after a period of at least 2 years postoperatively, and underwent intravenous cholangiography, 51 patients had papillary stones removed via the sphincterotomy. Stones were missed in 8 of 102 patients, but were passed spontaneously in 2 patients during the observation period. Postoperative mortality was high (10%)--4 patients developed a fatal pancreatitis. It is concluded that the procedure of sphincterotomy allows certain identification and removal of wedged papillary stones, but does not always allow that missed stones will be passed spontaneously. The possible significance of transpapillary drainage in the subsequent development of pancreatitis is considered.

Acute Disease