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Biomedical subjects

R A Straffon

Publications and source records attributed to R A Straffon.

At least 73 records · Page 4Linked to original sources
PubMed1978

Experimental bladder substitution using a biodegradable graft of natural tissue.

A controlled canine experimental study has been performed to test the application of a biodegradeable graft to vesical augmentation. The graft, after providing initial bladder enlargement, is progressively reabsorbed while serving as a foundation for the regeneration and healing of the layers of the bladder remnant. Follow-up studies at 1 year revealed no urinary infection, calculi, extravasation of urine, or rejection of the material. Normal bladder capacities were maintained throughout the study and the reconstructed bladders functioned normally. The biodegradable graft was equally successful when applied either to a histologically normal bladder remnant, or to a pathological bladder of intramural fibrosis. These results suggest that this material may be well suited to clinical bladder substitution in humans.

Animals↗
PubMed1978

Multilocular cysts of kidney: a diagnostic dilemma.

Multilocular cyst of the kidney is a rare pathologic entity occurring in both children and adults. Although diagnosis cannot be firmly established preoperatively, the use of intravenous pyelography, angiography, ultrasonography, and delta scan may aid in its diagnosis. Because of the difficulty in accurate diagnosis and the documented association with renal neoplasia, we recommend exploration and possible nephrectomy as the treatments of choice.

Diagnosis, Differential↗
PubMed1978

Avascular necrosis following renal transplantation. Experience with 449 allografts with and without high-dose steroid therapy.

From January 1, 1971, to January 1, 1976, 173 renal allografts were transplanted into 146 patients. Intravenous methylprednisolone (IVMP) was given to all mismatched recipients in a dose of 1 Gm. on the day of transplant and in varying amounts during acute allograft rejection. In 7 patients, 4.8 per cent of 146 patients and 4 per cent of 173 allografts, with a minimum follow-up of fifteen months avascular necrosis of one or more joints developed with an average of 9.4 months after transplantation and a range of five to eighteen months. The total dose of IVMP given to the patients with aseptic necrosis varied between 3 and 18 Gm. from the time of transplantation until the onset of skeletal symptoms. This incidence was nearly identical to the 5 per cent of 242 patients and 4.3 per cent of 276 renal allografts from the same center performed between January 1, 1963, and January 1, 1971, when intravenous steroid pulse therapy was not utilized. Since January, 1971, total joint replacement of the hip or knee were performed in 4 of the 7 affected patients six to sixteen months after the onset of symptoms. Renal function remained stable after surgery in all 4 patients. Virtually normal range of motion was present within three months after surgery. Although the controversy of steroid therapy in the pathogenesis of avascular necrosis still exists, judicious use of high-dose IVMP therapy does not appear to increase its incidence. Early surgery is recommended when the radiologic evidence confirms the clinical findings of avascular necrosis in order to ameliorate pain, correct restriction of movement, and promote full rehabilitation.

Adolescent↗
PubMed1978

Ruptured human renal allograft. Pathogenesis and management.

From January, 1963, to January, 1977, 4 cases of acute allograft rupture occurred in 474 renal transplants performed at the Cleveland Clinic, an incidence of 0.8 per cent. Rupture developed between the fifth and sixteenth day after transplantation during a period when the patients required dialysis because of poor allograft function. All patients had surgical exploration and successful repair of the laceration. Biopsies in each case at the site of laceration revealed findings consistent with acute allograft rejection. The rejections were mild in 2 cases, moderate in one, and severe in another. Two kidneys failed to sustain function, and the patients were returned to chronic hemodialysis two to five months later. None required a nephrectomy. The other two kidneys are functioning well, with serum creatinine values of 1.3 and 1.5 mg./100 ml. one year after allograft rupture. Since rupture of a renal allograft does not appear to increase the intensity of rejection nor does it represent a severe type of rejection, transplant nephrectomy can be avoided unless hemorrhage is uncontrollable from the site of laceration.

Adult↗
PubMed1978

Mortality and morbidity in pretransplant bilateral nephrectomy: analysis of 305 cases.

The surgical riks were analyzed in 305 patients with end stage renal failure who underwent bilateral nephrectomy through midabdominal approach in preparation for kidney transplantation. The over-all mortality rate was 3.6 per cent. Age was the most significant risk factor in the mortality. Patients less than fifty years of age had an operative mortality rate of 3.1 per cent while those more than fifty years had an operative mortality of 11.1 per cent. Other pertinent risk factors were preoperative complications of renal failure and additional surgical procedures at the time of bilateral nephrectomy. The leading causes of death were those of cardiovascular complications and infection. The morbidity rate was 58.7 per cent being major in 18 per cent and minor in 40.7 per cent. Bilateral nephrectomy is recommended selectively in patients with (1) chronic pyelonephritis with urinary tract infection, (2) major vesicoureteral reflux, (3) immunologically active glomerulonephritis, (4) severe hypertension uncontrollable by adequate dialysis, and (5) extremely large or infected polycystic kidneys.

Abdomen↗
PubMed1978

Surgery for renal cell carcinoma extending into the inferior vena cava.

We have reviewed 26 patients with renal cell carcinoma extending into the inferior vena cava, 21 of whom underwent radical nephrectomy with either venacavotomy and tumor thrombectomy, or vena cava resection. Of 12 patients who presented with localized neoplasm 6 (50 per cent) are currently alive. Poor results were obtained in 9 patients who had preoperative metastatic disease. Over-all operative mortality was 14 per cent and morbidity was minimal, with no pulmonary emboli intraoperatively or postoperatively.

Adenocarcinoma↗
PubMed1978

Surgical treatment of renovascular hypertension in the pediatric patient.

Of 27 children who underwent surgical treatment for renovascular hypertension 16 (59 per cent) were cured, 5 (19 per cent) were improved and 6 (22 per cent) were failures. Improved results were obtained in patients with unilateral renal artery stenosis. Several reconstructive vascular procedures were used, and their relative efficacy and indications are discussed. Renovascular hypertension in children is a curable disease and revascularization with preservation of renal parenchyma should be the aim of surgical therapy in most cases.

Adolescent↗
PubMed1978

Stenosing renal artery disease in children: clinicopathologic correlation and results of surgical treatment.

From 1955 to 1977, 27 pediatric patients underwent surgical treatment for renovascular hypertension. Renal artery disease was most commonly caused by intimal or perimedial fibroplasia and occurred bilaterally in 7 patients. Overall results were 16 patients cured (59%), 5 patients improved (19%) and 6 failures (22%). The best results were obtained in children with unilateral renal artery stenosis. In recent years, ablative surgery has been largely supplanted by reconstructive vascular procedures in the treatment of this disease in children. Autogenous vascular bypass grafts have been most successful and aortorenal reimplantation may occasionally be employed. Renal autotransplantation should be reserved for children with the middle aortic syndrome or multiple lesions involving the branches of the renal artery. Splenorenal bypass and segmental resection with renastomosis have yielded poor results and are best avoided in this age group. Primary nephrectomy should only be performed in patients with renal atrophy or uncorrectable branch vessel disease. Renovascular hypertension in children is a potentially curable disease and revascularization with preservation of renal function should be the combined objectives of surgical therapy in the most cases.

Adolescent↗
PubMed1978

Long-term results in 35 HLA-identical sibling and 3 HLA-identical parent-child renal allograft recipients.

35 recipients of a renal allograft from an HLA-identical sibling followed for 3 months to nearly 15 years have had 1- and 5-year allograft survivals of 93 and 76%, respectively, levels comparable to the 90 and 80% reported at 1 and 5 years for identical twins. Although high MLC stimulation was related to graft failure, intermediate degrees of stimulation were not. The most common cause of graft failure was chronic rejection (n=4) and of death, myocardial infarction (n=3). However, overall complications such as aseptic necrosis were distinctly lower than in mismatched recipients. 3 children received an allograft from an HLA-identical parent, possible because of a shared parental haplotype, and all have excellent function from 2 to nearly 9 years after transplantation.

Adolescent↗
PubMed1978

Urological applications of computerized axial tomography.

Computerized tomography (CT scanning) of the chest and abdomen has been used as a diagnostic technique in more than 7,200 patients since 1974, 250 of whom had histological proved disorders of the genitourinary system and retroperitoneum. On the basis of this experience CT scanning has been found to be safe and effective, and offers certain advantages over conventional techniques. The number, extent and content of adrenal and renal mass lesions can be determined with relatively great accuracy. The presence and extent of metastases into the retroperitoneum, liver and chest often can be shown by CT scanning when other tests are negative. Placement of needles for aspiration, biopsy, injection of contrast medium or insertion of drainage tubes can be done accurately under computerized tomographic control. Air contrast scanning of the bladder can be of real help in staging bladder tumors, espically in obese patients. Computerized tomography in itself is non-invasive, carries a low radiation exposure comparable to other radiographic procedures and therefore, can, be valuable in following the course of patients with various diseases during and after therapy. While CT scanning will not replace other diagnostic procedures it should lead to a more judicious selection of potentially hazardous tests, such as angiography, aspiration and open biopsy.

Adenocarcinoma↗
PubMed1977

Experimental bladder substitution using biodegradable graft of natural tissue.

A controlled experimental study has been performed using a biodegradable graft of natural tissue to achieve vesical augmentation. The graft is progressively reabsorbed while normal capacity is maintained by concomitant regeneration of the layers of the bladder remnant. No significant complications were encountered, and the graft was equally successful when applied either to a histologically normal bladder or to a pathologic bladder of intramural fibrosis. This material is potentially ideal for clinical bladder substitution in humans.

Animals↗
PubMed1977

Renal autotransplantation: current perspectives.

Autotransplantation, with or without an extracorporeal renal operation, has been done 39 times in 37 patients. Indications for the procedure included several ureteral injury in 4 patients, failed supravesical diversion in 2, renal carcinoma in a solitary kidney in 1, renovascular hypertension in 1 and donor arterial reconstruction before renal transplantation in 29. Success was obtained in all but 2 procedures, both of which involved previously operated kidneys with severe inflammation and adhesions involving the renal pelvis and pedicle. Based on our experience and a review of currently available literature we believe that renal autotransplantation and extracorporeal reconstruction can provide the best solution for patients with severe renovascular and ureteral disease not correctable by conventional operative techniques. The technique can be of particular value in removing centrally located tumors in solitary kidneys and in preparing donor kidneys with abnormal arteries for renal transplantation. The role of autotransplantation in the management of advanced renal trauma and calculus disease is less clear. A long-term comparison of patients treated by extracorporeal nephrolithotomy versus conventional lithotomy techniques will be necessary before a conclusion is reached in these disease categories.

Extracorporeal Circulation↗
PubMed1977

A case of a giant pheochromocytoma.

A case of a large pheochromocytoma weighing 1,150 gm. is reported. The surgical approach to this massive tumor is discussed. Early recognition of the various clinical and metabolic manifestations of the tumor are important objectives in the cure of this potentially lethal neoplasm.

Adrenal Gland Neoplasms↗
PubMed1977

Autogenous arterial grafts in the treatment of renal artery stenosis.

Twenty-three patients who underwent renal revascularization with autogenous arterial bypass grafts for renovascular hypertension are reviewed. The arterial autograft consisted of the hypogastric artery in 19 cases and a free splenic artery graft in 4. Eighteen patients were cured (78 per cent), 4 improved (18 per cent) and there was 1 failure (4 per cent). There were no cases of graft stenosis or occlusion. Postoperative morbidity was minimal and there was no operative mortality. When such grafts are available they provide an excellent means to achieve successful long-term renal revascularization.

Adolescent↗
PubMed1977

Partial nephrectomy in the treatment of renal adenocarcinoma.

During a 20-year period 17 patients underwent partial nephrectomy as primary curative therapy for renal adenocarcinoma. In 15 patients (88 per cent) partial nephrectomy was performed satisfactorily in situ with free margins of resection. Eleven patients are alive (65 per cent) and only 3 (17 per cent) died of recurrent malignant disease. There was no operative mortality and postoperative complications were minimal. A review of the literature reveals that partial nephrectomy is an effective form of therapy for patients with bilateral renal carcinoma or carcinoma occurring in a solitary kidney.

Adenocarcinoma↗
PubMed1977

The role of adjunctive nephrectomy in patients with metastatic renal cell carcinoma.

The results of therapy for 78 patients with disseminated renal cell carcinoma are evaluated. Symptoms related to the primary tumor were noted in only 28 per cent of the patients and were not difficult to manage in those patients not undergoing nephrectomy. Adjuctive nephrectomy, therefore, is a more appropriate term than palliative nephrectomy when referring to removal of the primary tumor as part of an aggresive combined therapeutic approach. Of patients receiving an adjunctive nephrectomy those with osseous metastases only had a better 1-year survival rate (36 per cent) than those with metastases to other sites (18 per cent). Complete regression of metastases was noted in 12 per cent of patients treated with medroxyprogesterone acetate and adjunctive nephrectomy. The role of adjunctive nephrectomy combined with embolic infarction, hormonal therapy, chemotherapy and/or immunotherapy is discussed.

Adenocarcinoma↗