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S Josephson

Publications and source records attributed to S Josephson.

At least 19 recordsLinked to original sources
PubMed2002

Antenatally detected, unilateral dilatation of the renal pelvis: a critical review. 1. Postnatal non-operative treatment 20 years on--is it safe?

BACKGROUND: Non-operative postnatal treatment of antenatally detected hydronephrosis, consistent with pyelo-ureteral obstruction, has functioned well during follow-ups of up to 17 years. However, doubts are still expressed and, admittedly, the final verdict on this new policy is still remote. The purpose of this review is to define the state of art and to serve as a background for future randomized clinical trials, which still are missing. METHODS AND MATERIAL: From the literature, 6 patient series were chosen based on the following criteria: publication during the 1990s to allow for a longer follow-up and better diagnostic tools; consecutive patient series; and compliance with a 50-point form. Data, from 593 kidneys, were then pooled. Result of the compilation: Four hundred and seventy-four kidneys, with differential function >40%, were allocated to expectancy and followed for 2-144 (mean 23) months. Four hundred and twenty-five (90%) were successful, independent of presence of caliectasis. Forty-nine (10%) had delayed pyeloplasty, after which declined function mostly improved / normalized - similar to 108 kidneys with early pyeloplasty because of an initial differential function <40%. Hydronephrotic size and isotope wash out rate did not predict outcome. CONCLUSIONS: These figures agree with other reports: few cross-overs and functional recovery also after delayed operations. Thus, so far, with a caveat for future deterioration, expectancy seems safe and promising, in unilateral and probably in bilateral cases with normal function, although perhaps not in solitary kidneys. Hopefully, this review, together with a forthcoming communication on long-term risks and urgent research needs, will help to design future randomized clinical trials.

Female↗
PubMed2002

Antenatally detected, unilateral dilatation of the renal pelvis: a critical review. 2. postnatal non-operative treatment--long-term hazards, urgent research.

BACKGROUND: Even after two decades, there is still much discussion about the postnatal treatment of antenatally detected, isolated pelvic dilatation (consistent with pyelo-ureteral junction obstruction). A recent review concluded that non-operative expectancy seemed safe - even after 17 years in certain cases. However, the final outcome, i.e. when these children have reached old age, is remote. OBJECTIVE: This review takes stock of conceivable long-term hazards and evaluates prognosticating tools, and offers a basis for protocols for future randomized controlled trials. Long-term hazards: Symptoms in this context are generally considered ominous. In the antenatally detected cases, i.e. primarily asymptomatic, symptoms have been reported but they were not necessarily combined with renal damage. Hydronephroses, so mild, that they are written off, may deteriorate later on (indeed insidiously), although probably seldom. Urgent research: A predictor of outcome is eagerly pursued but hard to obtain, due to the difficulty in defining true obstruction in compliant systems such as the urinary one. Ordinary diagnostics offer no help, but there are promising innovations: constant pressure/flow assessment (flow necessary to keep a preset intrapelvic pressure), NAG/creatinine in pelvic urine, and TGFbeta-1 in voided urine. Renal microstructure, sometimes severely damaged early (which disagrees with the good results with expectancies) could possibly herald future deterioration. CONCLUSION: Adverse developments should be meticulously documented and published swiftly, so policy can be changed if necessary, before it is too late. Cognizance of their existence, not necessarily frequency and statistics, is then first order. Efforts to design prognosticating tools has also high priority.

Female↗
PubMed1998

Experimental partial ureteric obstruction in newborn rats. X. Renal function and morphology after unobstruction.

Partial obstruction of the left ureter was created in newborn rats. Unobstruction was performed after 2 or 7 days. The investigations were carried out at 9 weeks of age--under slight hydropenia to institute an element of stress. Unobstruction was successful. On the unobstructed side, there were nevertheless impairments as compared to controls: urine osmolality (-32%), free water reabsorption (-44%), potassium excretion (-34%), renal blood flow (-36%) and glomerular filtration (-36%). On the intact contralateral side, tubular changes were the only signs of an attempt to compensate. Thus, consistent renal damage remained despite a very early unobstruction. Furthermore, the changes were similar to those we observed during long-term permanent obstruction. The injury seems to be established within a very short time and imitates the probable development seen in the affected fetus: after start of production, the urine is confronted by the preformed obstruction at the pyeloureteral junction. A high-pressure-prone system is built up and is not reversed, until the pelvis has become dilated and thus capable to buffer urinary flow peaks. Thereafter, no further deterioration occurs except in specific conditions. If clinically applicable, these observations implicate that there is no advantage with surgical intervention, even when performed early in fetal life, and there is no need for swift intervention, as the damage does not progress after its establishment. Most of the cases probably do not require surgery at all, unless pain, obvious functional impairment or urinary tract infection supervene.

Animals↗
PubMed1997

Experimental partial ureteric obstruction in newborn rats. IX. Renal morphology and function after 1 year of obstruction.

Unfortunately, the nonoperative treatment of hydronephrosis, in wide use today, cannot be evaluated until after many decades. Long-term animal experiments offer a peekhole into the future. Partial obstruction of the left ureter was created in newborn rats. Its effects were studied after 1 year. In order to stress the system, the investigations were performed under hydropenic conditions. On the obstructed side, the renal pelvis was considerably enlarged; however, the microstructure of the kidney was only slightly affected. Renal blood flow was decreased (-17%) due to a rise in vascular resistance. Filtration was less affected (-9%), probably as a result of increased filtration fraction. Water excretion, including that of free water, was increased (+59%) due to a decreased reabsorption. Potassium excretion was decreased (-59%) either due to increased reabsorption and/or decreased secretion. Sodium excretion followed a similar pattern (-24%) although without statistical significance. The contralateral side compensated for the ipsilateral decreases in blood flow and filtration. Ipsilateral tubular functions were not compensated for, which indicates an acute situation that is reaffirmed by the finding of a normal hematocrit and serum osmolality/electrolytes. The changes in tubular functions were thus considered to be due to the hydropenic stress, but inescapably an incompetent concentration capacity exists. The changes in the obstructed kidney were thus moderate, some of which were fully compensated for, but, most important, all were nonprogressive. The study supports the nonoperative treatment of these patients, provided that the follow-up guarantees catch-up of the exceptional cases that deteriorate, especially during infancy.

Animals↗
PubMed1996

Experimental partial ureteric obstruction in newborn rats. VIII. Contralateral kidney weight after release of the obstruction.

In unilateral kidney disease, it has been suggested that the ipsilateral state could be estimated by measuring contralateral kidney size; thus, a contralateral increase should reflect an ipsilateral impairment and vice versa. This could easily be performed using ultrasound. In our experiments with partial obstruction of one ureter (created in 1- to 3-day-old rats), a consistent and stable contralateral kidney hypertrophy occurred. However, after unobstruction, the hypertrophy persisted for at least a 6-week observation period, despite the disappearance of hydronephrosis and presence of a normal weight of the ipsilateral kidney. This would undeniably hamper the diagnostic utility of kidney size determination. To find out whether or not the hypertrophy ever disappears, we have performed studies after 6, 9 and 15 weeks. (1) The weight of the unobstructed kidney was found normal except after 15 weeks. The microstructure was normal except for some minor changes. (2) The contralateral kidney was significantly heavier than controls at all checkpoints (+10, +13 and +6%). No significant regression occurred over the observation period. (3) Furthermore, the weights of both kidneys were interrelated, but the slopes were positive; thus, the contralateral hypertrophy was not greater the lesser the ipsilateral kidney weight. The reasons for the persistence of contralateral hypertrophy are discussed. The present findings do not support the idea of documenting improvement by measuring contralateral kidney size. However, repeat studies in the same individual may prove to be more sensitive and are therefore recommended until further notice.

Age Factors↗
PubMed1994

Renal tissue endothelin in long-term complete ureteric obstruction in the young rat.

Complete obstruction of one ureter was created in 3-week-old weanling rats. The endothelin concentration in the renal tissue was measured by radioimmunoassay. In the obstructed kidney, a substantial increase was observed, after 1 week +90%, after 2 weeks +55%, and after 4 weeks +145% compared to the control rat kidneys. The endothelin-1/endothelin-3 ratio was found to be considerably raised, indicating a predominance of the vasoconstrictor effects of the--with reference to vasoactivity--bi-potential endothelin. Its contribution to vasoconstriction and to glomerular destruction in obstructive nephropathy is discussed.

Animals↗
PubMed1993

Post-natal management of antenatally detected, bilateral hydronephrosis.

26 children, with antenatally detected, isolated, bilateral hydronephrosis (thus consistent with pelvi-ureteric junction obstruction), were investigated for up to 7 years. The aim was to avoid operation. 34 kidneys were never operated on. Despite initially often severe hydronephrosis and poor isotope wash-out on the renogram, half of the kidneys improved or even normalized during follow-up. The final glomerular filtration rate (GFR) was always normal or almost normal. 18 kidneys came to surgery, because of poor filtration, symptoms or social reasons. At the end of the follow-up, GFR was normal in all but 2 kidneys. In a subgroup of the kidneys, with initially severe reduction in filtration, half were operated on and half were not; at the end, the GFR was normal in all of the non-operated kidneys (and in all but 1 of the operated kidneys). Total GFR was at the end normal or almost normal also in the children with persistingly filtration-reduced kidneys (always unilaterally), because of compensation by the contralateral, although hydronephrotic kidney. Thus, in this study the renographic parameters were not very helpful in predicting the prognosis. There was no consistent difference between operative and non-operative treatments on final filtration. Also hydronephrotic kidneys possessed a substantial capacity for contralateral compensation. It is concluded that the initial approach to bilateral, antenatally diagnosed hydronephrosis may safely be non-operative. This allows time for the clear expression of sustained impairment of renal filtration requiring surgical intervention.

Child↗
PubMed1992

Body dysmorphic disorder. Diagnostic issues and related disorders.

This article reviews diagnostic issues about body dysmorphic disorder and discusses its relationship to other disorders. Diagnostic and symptomatic overlap with obsessive-compulsive disorder is explored; associated features, course of illness, presumed etiology, and treatment outcome are compared; and similarities and differences are reviewed. Other illnesses with similar features, such as anorexia nervosa, social phobia, and the disorders associated with cosmetic surgery are mentioned. These findings are discussed in light of the development of DSM-IV diagnostic criteria.

Adolescent↗
PubMed1992

Partial ureteric obstruction in weanling rats. II. Long-term effects on renal function and arterial blood pressure.

A partial obstruction of the left ureter was created in weanling (3-week-old) rats. Renal function was studied after 7-9 weeks and compared to that in age-matched controls. Arterial blood pressure was found substantially increased. During normal hydration, the hydronephrotic kidney had low excretions of urine, potassium, osmoles and, especially, sodium. The contralateral, intact side showed no compensatory traits. On volume expansion, the hydronephrotic kidney demonstrated an unimpaired reacting capacity, leading to normalization of urine, sodium and osmole excretions and even to supernormal renal blood flow, glomerular filtration and potassium excretion. On the intact side, the excretion of potassium was increased like that on the hydronephrotic one, while excretions of urine, sodium and osmoles were increased even more. The fact that the intact kidney handled most of the urine excretion was interpreted as the result of a mechanism protecting the obstructed kidney from additional pressure insults while homeostasis was maintained. The arterial hypertension may result from the combination of retention of fluid and sodium by the hydronephrotic kidney and the absence of compensation by the intact kidney during normal hydration--like that in everyday life. The functional changes during normal hydration were generally more severe than those we found after obstruction in neonatal and adult rats, in which arterial hypertension was never observed. The clinical implication would be that the kidney may be less tolerant to pressure rises during the infant year. Changes due to obstruction are known to occur rapidly, but after that neither progress nor reverse.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

Biologically active and amidated cecropin produced in a baculovirus expression system from a fusion construct containing the antibody-binding part of protein A.

A synthetic antibody-binding part derived from protein A from Staphylococcus aureus was used as a fusion partner in a eukaryotic expression system employing Autographa californica nuclear polyhedrosis as a vector. This, in conjunction with an efficient signal sequence, facilitated the purification of the antibacterial peptide cecropin A from the medium of Spodoptera frugiperda cells infected with a recombinant virus. In order to increase further the concentrations of fusion protein, Trichoplusia ni larvae were used as host. Cecropin A could be obtained after cleavage of the fusion protein with CNBr. Biological activity as well as the correct structure including the C-terminal amide group was shown using electrophoresis with detection of antibacterial proteins and mass spectroscopy.

Amino Acid Sequence↗
PubMed1991

Cognitive-behavioral therapy for panic: an open study.

This paper reports results of an open prospective study of 26 patients who met DSM-III criteria for panic disorder or agoraphobia with panic attacks. Cognitive-behavioral treatment alone produced clinically and statistically significant improvement in panic symptoms, including both full-blown and limited symptom episodes. In addition, the treatment produced improvement in associated symptoms of phobic avoidance and generalized anxiety. This work provides further preliminary indication of the usefulness of cognitive-behavioral strategies as an alternative to medication in symptom-oriented treatments.

Adult↗