Biomedical subjects
Publications and source records attributed to J E Wickham.
In a selected series of 14 patients, upper tract urothelial tumours were excised with preservation of the ipsilateral kidney. The 5-year survival rate was 83%. The ipsilateral local recurrence was 5/14 (36%) but in 4 cases salvage surgery was effective and in 2 cases a functioning kidney was still preserved. The results of conservative surgery and its indications are discussed.
Kidneys preserved with cold Collins' solution only function satisfactorily if there is no significant preceding period of warm ischaemia. This paper reports an attempt to provide protection to renal function during such a warm ischaemic episode using the nucleotide inosine. In these experiments inosine given intravenously to dogs followed by 15 min of warm renal ischaemia and by either 12 or 24 h of cold preservation with Collins' solution did not protect renal function against the warm ischaemic insult.
Corrosion casts were made of 27 human cadaveric kidneys. The anatomy so displayed suggests that to avoid intrarenal vascular damage, incisions for nephrolithotomy should be radial, peripheral and, wherever possible, posterior.
This study examines the effect of antifibrinolytic therapy on the incidence of secondary haemorrhage following endoscopic surgery. One hundred consecutive patients were allocated randomly to treatment and control groups. The incidence of secondary haemorrhage was reduced from 56% in the control group to 24% in the treatment group.
This study describes the effect of the 4 most commonly used methods of intrarenal access on renal function and morphology in the dog at 48 h. The extended sinus approach was associated with no functional or parenchymal loss; the radial paravascular approach was followed by a 20% decrease in function and no significant parenchymal loss; the anatrophic intersegmental nephrotomy caused a 30% functional decrease with a significant parenchymal loss; the bivalve nephrotomy was associated with a 50% loss of function and considerable parenchymal loss and distortion.
The functional effects of nephrolithotomy performed with ischaemia and cooling have been studied in a series of 29 operations performed on patients with a solitary kidney. There was temporary post-operative functional deterioration in every patient, but this was followed by rapid and satisfactory recovery, often with functional improvement, in 27 out of the 29 cases. Only 2 patients showed minor functional deterioration, but both benefited clinically from their surgery and remain well. No patient required permanent dialysis support. A previous study by Wickham (1979) has shown satisfactory results from 250 cases of nephrolithotomy performed with ischaemia and cooling, but in these cases it was not possible to assess the degree of compensation provided by the non-operated kidney. The study of patients undergoing surgery to solitary kidneys obviates the question of contralateral functional compensation.
In patients with severely decreased renal function due to stone disease, dialysis has been suggested as an alternative to surgery. We reviewed 19 patients with creatinine clearances of 20 ml/min or less in whom nephrolithotomy was undertaken. Mean clearances increased significantly from 12.9 to 25.4 ml/min (P less than 0.01). No patient required long-term dialysis. Points in technique that contribute to this improvement in function are discussed.
The use of the EMI CT 5005 scanner in patients with renal calculus disease is described. This investigation was found to be a useful aid in the accurate localisation of calculi within the renal collecting system prior to surgery.
The diagnosis and management of benign fibrous ureteric polyps are discussed. A pre-operative diagnosis is suggested by a long history of loin pain or haematuria, both, in a younger patient with the radiological findings of ureteric obstruction or a radiolucent ureteric filling defect. The diagnosis is confirmed at operation by opening the ureter and exposing characteristic fronds of polyps arising from a common base. It is suggested that management should be conservative local excision and not nephroureterectomy, as previously practised.
A non-invasive test of nephron function, the renal parenchymal transit time (P.T.T.) index, is shown to be as accurate as antegrade pressure measurements in diagnosis of renal outflow obstruction. It is more sensitive than conventional methods of demonstrating the associated obstructive nephropathy. P.T.T. is useful in following the effects of surgery, or of temporising, in patients with confirmed or potential outflow tract obstruction. Renal radionuclide P.T.T. analysis gives the functional information essential for the management of patients in whom intravenous urography reveals a dilated renal pelvis.
Unperfused, saline-perfused and inosine-perfused rat kidneys were subjected to various times of warm ischaemia with and without resumption of blood flow. Tissues were examined with a transmission electron microscope. Inosine has a protective effect on the epithelial cells of the proximal convoluted tubules, where microvilli are less damaged by ischaemia than those of the proximal convoluted tubular cells of the control animals. Three is also a much higher ratio of autophagic vacuoles to lysosomes present in cells of inosine-treated kidneys, reflecting their ability to sequester and digest organelles damaged during ischaemia and thus protect themselves from degradation products. A major effect of inosine seems to be the preservation of the organelles and rush border of the cells of the proximal tubule during warm ischaemia.
The use of the intravenously administered nucleotide inosine is described for the protection of function in the human kidney undergoing ischaemic renal surgery. The treatment of 7 patients is described. The simplicity of the technique is emphasised.
Standard intravenous urography is not a reliable method of demonstrating pelviureteric junction obstruction. Frusemide urography enables 3 groups to be defined on the basis of the percentage increase in the size of the renal pelvis after the diuretic. These groups are clinically significant.
Further improvements have been made in the technique of human prostatic lymphoscintigraphy, allowing better anatomical localisation of the areas of uptake of activity. A single median injection into the capsule of 99mTc labelled antimony sulphide colloid has been found to give as good imaging as 2 injections on either side of the midline. By placing markers on the umbilicus, pubic symphysis and both anterior superior iliac spines, a "pelvic grid" can be superimposed on the antero-posterior view. Further help with accurate localisation may be attained by taking 3 views; antero-posterior, postero-anterior and lateral, in 9 instances, prostatic injection was performed without any sedation or anaesthesia. The resulting scintigrams were indistinguishable in quality from those of anaesthetised patients.
Laboratory and clinical experiments were done to measure the pressure in tube drains. It was found that the fluid in drains connected to floor bags exerted a negative pressure equal to the height of the fluid column in the tube. There was no negative pressure when the drain opened into a urostomy bag at wound level. It is suggested that this negative pressure might tend to maintain a urinary fistula once a leak in the suture line has begun.
The time to full mobility and total analgesic requirements have been assessed in 40 patients undergoing renal surgery by the oblique loin incision or the posterior lumbotomy approach. By these criteria the lumbotomy group fared better than patients who had oblique incisions. We consider lumbotomy to be a valuable incision which should be in the repertoire of every urologist.
A simple method for demonstrating prostatic lymphatic drainage by transrectal injection of 99mTc labelled antimony sulphide colloid into the prostatic capsule has been developed. This technique may be readily applied in clinical practice with obvious potential in the assessment and follow-up of patients with carcinoma of the prostate.
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