Biomedical subjects
Publications and source records attributed to R A Appel.
Urethrovesical anastomotic obliterative strictures are uncommonly reported sequelae of radical retropubic prostatectomy. We report a method to re-establish endoscopically continuity between the bladder and urethra after this complication.
Explore the source record for details and available documents.
Endometriotic ureteral obstruction is an uncommon but serious event often unrecognized until hydronephrotic renal atrophy has occurred. A case of bilateral endometriotic ureteral obstruction treated with danazol (Danocrine) is reported, and the literature is reviewed.
Megalourethra is a rare congenital malformation characterized by dilatation of the penile urethra. We review 6 previously unreported cases and 35 cases reported in the literature. The distinction between scaphoid and fusiform megalourethra seems arbitrary, and the disorder is better viewed as a spectrum rather than as 2 distinct entities. Significant concomitant upper urinary tract abnormalities may be present in any patient with megalourethra, a fact that should lead to the routine investigation of the upper urinary tract in all patients with this developmental anomaly.
Explore the source record for details and available documents.
We studied the long-term effects of membrane-active antiarrhythmic agents on chronic ventricular arrhythmias in patients who have survived prehospital cardiac arrest. Among 16 patients treated with a dose-adjusted, plasma level-monitored antiarrhythmic regimen, eight have survived for longer than 12 months and eight have had recurrent cardiac arrests (RCAs). Monthly Holter monitor tapes (HM) recorded during the 4 months before the eight RCAs were compared with monthly HM tapes matched for time of entry and duration of follow-up in the eight patients who did not have RCAs. Transient or persistent complex ventricular ectopic depolarizations (VEDs) have been recorded on 47 of the 63 monthly HM tapes (75%). The difference between VEDs in the RCA patients (mean 153 VEDs/hr, median 19 VEDs/hr) and VEDs in the patients who have not had RCA (mean 122 VEDs/hr, median 8 VEDs/hr) was not significant (p less than 0.2); nor was there a predictable relationship between therapeutic plasma levels of antiarrhythmic agents and the frequency and complexity of chronic asymptomatic VEDs (therapeutic levels--mean 104 VEDs/hr, median 6 VEDs/hr; subtherapeutic levels--mean 184 VEDs/hr, median 21 VEDs/hr). Differences were not significant (p greater than 0.1). In contrast, all eight RCA patients had unstable plasma levels (21 of 31 determinations subtherapeutic) while six of the eight patients who have not had RCA had consistently therapeutic levels (p less than 0.01). Thus, adequate plasma levels of antiarrhythmic agents may protect against RCA, despite failure to suppress VEDs predictably. The apparent dissociation between predictable suppression of chronic VEDs and protection against RCA suggests that clinical effectiveness of these agents may not be best measured by their effect on chronic VEDs.