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Biomedical subjects

R S Davis

Publications and source records attributed to R S Davis.

17 recordsLinked to original sources

Bacillus Calmette-Guerin and interleukin-2 for treatment of superficial bladder cancer.

A total of 22 patients with bladder cancer received bacillus Calmette-Guerin (BCG) and interleukin-2. Significant bladder tumor remissions were noted in 15 of 17 patients (88%). Of 5 patients with carcinoma in situ 1 was noncompliant and he died of carcinoma in situ. The other 4 patients are in remission. BCG alone was instilled in 22 additional patients with superficial bladder cancer. The remission rates were encouraging. Of the 22 patients 13 (59%) had remission of the bladder tumor. A half dose of BCG (60 mg.) is adequate when given weekly for 6 weeks. Maintenance therapy is important as noted in both of our clinical arms. BCG and interleukin-2 therapy results in a higher remission rate.

BCG Vaccine

Extracorporeal shock-wave lithotripsy in patients with spinal cord dysfunction.

Patients with spinal cord dysfunction are at an increased risk for urolithiasis. A retrospective study was undertaken to determine the effectiveness of extracorporeal shock-wave lithotripsy (ESWL) in this population. Thirteen kidneys received 19 treatments averaging 2,350 shocks per renal unit. All but one of the stones showed good fragmentation; however, none of the patients was stone-free at three months. Four of 9 patients with long-term follow-up were stone-free at five to fifteen months. Our poor stone-free rate is similar to that found in other studies of patients with spinal cord dysfunction. ESWL was well tolerated in this population, however, the clearance of stones is poor and delayed.

Adult

Brugia malayi microfilaraemia in mice: a model for the study of the host response to microfilariae.

Microfilariae of Brugia malayi were obtained from the peritoneal cavities of infected gerbils and were then injected intravenously into mice. A sub-periodic, nocturnal microfilaraemia was produced. The level of microfilaraemia was proportional to the number of parasites injected, with approximately 1-3% of microfilariae being found in the peripheral circulation. The duration of microfilaraemia was proportional to the number of parasites injected; it subsided by 30 days after injection of 104 microfilariae but was still present at a low level 120 days after injection of 2 x 105 microfilariae. A transient splenomegaly developed after injection of microfilariae. Histopathological examination revealed large numbers of microfilariae free in the lumens of pulmonary small blood vessels and without any accompanying inflammatory reaction. Lesser numbers of microfilariae were seen in the cardiac blood and hepatic and renal blood vessels for the first few days after injection. There was cellular proliferation in the splenic white pulp and vascular congestion of the red pulp. Microfilariae labelled with 51Cr were injected intravenously; 57% of radioactivity was found in the lungs, 8.5% in the liver and 2.9% in the spleen. Mice developed immediate hypersensitivity reactions to B. malayi antigen by 4 weeks after injection, but Arthus and delayed hypersensitivity reactions were not seen at any time. when mice which had been injected 5 months previously were challenged with a 2nd injection of microfilariae, there was an accelerated clearance of parasites over 2 weeks and a marked peripheral blood eosinophilia developed. In contrast with natural infections, in which the continuous production of microfilariae complicates assessment, this model provides a system in which factors controlling the circulation of microfilariae in the bloodstream can be studied independently.

Animals

Schistosomiasis presenting with testicular enlargement in elderly male.

An eighty-eight-year-old Puerto Rican presented with painless enlargment of one testicle which proved histologically to be due to Schistosoma mansoni. Intratesticular ovum deposits were not associated with inflammation, granulomas, or infarction, but marked sclerosing periorchitis was present. The case illustrates a very rare form of presentation of schistosomiasis which should be considered in the differential diagnosis of unilateral testicular enlargement in patients from an endemic area, despite the fact that orchiectomy will usually be necessary to establish a definitive histopathologic diagnosis.

Aged

Lymphatic network of kidney. II. Effect of diuretics on intrarenal renin release.

The individual effects of chlorothiazide, furosemide, and mannitol on renin activity in renal lymph have been studied in dogs. Elevation of renin activity in lymph is noted following infusion with either chlorothiazide or furosemide, while a reduction of renin activity in renal lymph is noted after mannitol infusion. The importance of elevated sodium levels in the proximal end of the distal tubule and its effects on renin release in kidney interstitium is stressed. More work is advocated to elucidate fully the role of renin when released intrarenally.

Angiotensin I

Anterior transperitoneal approach for treatment of urolithiasis.

An anterior transperitoneal incision was used to remove stones from 20 kidneys in 18 patients (2 bilateral). Our experience with 35 kidneys operated upon by this method (15 previously reported) has been favorable. Use of percutaneous nephropyelostomy tubes to drain obstructed kidneys in septic patients has permitted all procedures to be done under non-emergency conditions. Careful alignment of x-ray equipment and adjustment of exposure technique in the operating room before induction of anesthesia result in consistently good quality preoperative and intraoperative roentgenograms. The transperitoneal approach has afforded good access to the anterior portion of the renal pelvis even in those patients who have had previous operations on the kidney by the flank approach. Additional intra-abdominal procedures done at the same operation have included urinary diversion by ileal loop, revision of previous ileal loop, ureterolithotomy, pyeloureteroplasty, partial nephrectomy, cholecystectomy and appendectomy. The procedures done with the patients in the supine position have been well tolerated even in patients with serious coincident medical diseases.

Abdomen

Serological diagnosis of bancroftian and malayan filariasis.

A study was undertaken to define the sensitivity and specificity of serological tests in bancroftian and malayan filariasis and correlate the findings with clinical disease. Sera were collected from subjects on three different islands in the Philippines: one endemic for bancroftian filariasis, another endemic for malayan filariasis and the third without endemic filariasis. Antibodies were measured, using rugia malayi as the source of antigen. Antibodies against adult worms measured by indirect immunofluorescence were found at a titer of 1:8 or greater in all patients with bancroftian or malayan filariasis but not in the control subjects. There was no relationship of antibody titer to clinical status. Antibodies against microfilariae were measured by indirect immunofluorescence and microfilarial agglutination. A high correlation was observed between the two methods. These antibodies were found in only one quarter, approximately, of patients with filariasis. Microfilarial antibodies were found more commonly in those patients with chronic lymphatic obstruction. It is concluded that measurement of antibodies to adult worms is a useful indicator of infection while microfilarial antibodies are correlated with disease.

Agglutination Tests

An unusual presentation of carcinoma of the lung: 26 patients with cervical node metastases.

Carcinoma of the lung should be considered in the search for an unknown primary lesion when there is evidence of cervical lymph node involvement. Of 1,686 patients with a final diagnosis of bronchogenic carcinoma seen during a 10-year period at the University of Louisville Hospitals, 26 presented one or more clinically positive cervical nodes. The frequency of lung cancer in such instances varies from 1.5% (in the present report) to 32%, possibly because the term "cervical node" is used without clarification. More precise description of such metastases is urged.

Carcinoma, Bronchogenic

Anterior transperitoneal approach for removal of renal stones.

An anterior transperitoneal approach was used for removal of stones from 15 kidneys in 13 patients. Exposure of the anterior portion of the pelvis was readily accomplished making excellent exposure of the interior of the kidney possible. Minimal urinary drainage was noted postoperatively. The operative procedures done with the patients in the supine position were well tolerated.

Adult

Percutaneous nephropyelostomy in the management of acute pyohydronephrosis.

Percutaneous nephropyelostomy using the posterolateral approach was employed together with antibiotics and other supportive therapy as the initial step in the treatment of acute pyohydronephrosis, with gratifying results. Percutaneous nephropyelostomy is recommended as the procedure of choice for this specific clinical emergency.

Acute Disease

Transpubic repair of vesicourethrovaginal fistula.

A patient with recurrent urinary vaginal fistula involving bladder, bladder neck, and urethra was treated by transpubic approach. This afforded excellent exposure for careful repair of the urologic defects. Difficulty with ambulation during the first few weeks postoperatively may be related to removal of larger segment of pubic bone than is usually reported.

Evaluation Studies as Topic

Wallace method of ureteroileal anastomosis.

The Wallace technique for ureteroileal anastomosis was used in 28 consecutive patients requiring urinary diversion. Details of the surgical technique are reported. The method is found to be appropriate for children and adults, for primary ureteroileal anastomosis, or for revision of previous ureteroileal anastomosis done by other techniques, and for patients with one or two ureters. Its continued use appears to be indicated.

Adult

Recent advances in the diagnosis and management of blunt renal trauma.

Experience with 207 cases of blunt renal trauma is reviewed. We have found that renal scans and selective renal arteriography are the most informative diagnostic tests. However, in a small community setting we suggest use of an infusion urogram and a retrograde pyelogram. Our accuracy rates with these 4 diagnostic tests are listed and selected cases are illustrated. We believe that if exploration is warranted, kidney salvage rates will be improved because of an accurate assessment of the extent of renal injury.

Accidents, Traffic

Cadaver donor nephrectomy.

Optimal preservation of renal and ureteral structure and function is attempted by maintenance of renal circulation during heart-beating cadaver nephrectomy. Modifications of Ackermann's en bloc procedure for removal of cadaver kidneys are suggested to adapt this procedure to the heart-beating cadaver situation.

Cadaver