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Biomedical subjects

T M Maling

Publications and source records attributed to T M Maling.

14 recordsLinked to original sources

A comparison of different doses of non-ionic contrast media in i.v. urography.

This study attempts to find out what is the appropriate dose of non-ionic contrast media to provide an acceptable study at the lowest possible cost. 139 adults with normal renal function were studied. Four different dose regimes were employed and a standardised set of I.V.U. films were obtained. These were reviewed by two independent assessors who were unaware of the dose regime used. Each I.V.U. was scored on a modified Fry regime. This survey showed a clear relationship between quality and dosage.

Body Weight

A protocol for the investigation of infants and children with urinary tract infection.

An investigation protocol, designed to reduce invasive procedures to a minimum, is described for the detection of reflux nephropathy in infants and children. Intravenous urography and voiding cysto-urethrography is necessary in patients up to the age of 2 years presenting with urinary tract infection, but in children over 2 years of age the protocol limits the investigation to an intravenous urogram unless this is abnormal. A review of this policy after 5 years has indicated that it is appropriate provided that children who continue to have infections have further evaluation including a voiding cysto-urethrogram.

Child

Urinary tract obstruction and renal failure due to uterine prolapse.

Three women are described in whom obstructive uropathy was found secondary to uterine prolapse. Two of these patients had severe renal failure. It is important to exclude this condition in any woman presenting with renal functional impairment. Potentially damaging urinary tract obstruction should be considered in every patient with a uterine prolapse.

Female

Renal vein renin concentration in the hypertension of unilateral reflux nephropathy.

Hypertension is a frequent complication of reflux nephropathy. The cause of this hypertension is unknown. Our study was undertaken to assess the possible role of the renin-angiotensin system in the hypertension associated with unilateral reflux nephropathy. We selected for study 17 normotensive and 12 hypertensive patients with strictly unilateral reflux nephropathy. There were 3 normotensive and 2 hypertensive patients with a renal vein renin ratio exceeding 1.5. Of these 3 normotensive patients 1 had evidence from divided renal function studies to suggest functional renal ischemia. No consistent evidence was obtained to support the concept that the renin-angiotensin system has a primary role in the non-malignant hypertension of unilateral reflux nephropathy.

Angiotensin II

Diagnosis of gross vesico-ureteric reflux using ultrasonography.

A simple non-invasive ultrasonic technique which identifies gross vesico-ureteric reflux (VUR) in adults is described. It is based on the time position (TP)-mode (or M-mode) of ultrasound imaging. This method warrants assessment as a possible screening procedure for gross VUR in newborn children.

Dilatation, Pathologic

Renal trauma and persistent hypertension.

A study has been made to assess the incidence of hypertension in patients who have suffered an episode of renal trauma sufficiently severe to cause haematuria. Sixty-three patients were studied and 63 age- and sex-matched controls were also studied. At follow-up, 6-138 months after injury, 13 of the patients who had suffered renal trauma and 12 of the control subjects had a diastolic blood pressure above 99 mm Hg. Three patients showed significant reduction in the size and volume of the previously damaged kidney. In this group, renal trauma did not appear to be associated with an increased risk of permanent hypertension.

Acute Disease

The pathogenesis of reflux nephropathy (chronic atrophic pyelonephritis).

The relationship between vesico-ureteric reflux and coarse renal scarring (atrophic pyelonephritis) has been studied in swine. Scars were observed to develop where reflux took place into the kidney substance via the renal papillae (intrarenal reflux). They were confined to these regions and were similar in size, distribution and other features peculiar to those found in the human from early childhood onwards. Intrarenal reflux was found to be related to the pressure within the urinary tract as well as to vesico-ureteric reflux. Infection was not an essential factor in scar-formation, but it appeared to intensify the scarring process. The histological findings were a progressive focal interstitial fibrosis confined to the zones of intrarenal reflux, extending from the capsule to the papillary tip, and varying in severity with pressure, time and the extent of intrarenal reflux. Nephron and tubular damage accompanied all grades of fibrosis, with the possible exception of the earliest. In many respects the histological changes closely resemble those due to obstruction, except they are focal in distribution. Added features are the early peripheral lymphocytic aggregations and interstitial fibrosis which appear to suggest that some "irritant"--possibly urine--reaches the interstitium and drains away via the lymphatic system. Many of the phenomena observed were strikingly similar to those present in children with the more severe grades of vesico-ureteric reflux. In some cases a mixture of generalized obstructive nephropathy and focal scarring developed; in others focal scarring took place with normal papillae elsewhere. The results are readily reproducible. The basic questions as to whether it is bladder pressure, or infection, or a mixture of the two which is responsible for scar-formation are discussed.

Adult