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Biomedical subjects

T Sherwood

Publications and source records attributed to T Sherwood.

At least 19 recordsLinked to original sources

Ultrasound cystography in the diagnosis of vesicoureteric reflux.

Vesicoureteric reflux is common in children with urinary tract infection and may cause end-stage renal failure. The diagnosis is usually based on micturating cystourethrography (MCU). We describe an alternative technique using ultrasound during bladder infusion with agitated saline. Comparison of the 2 methods shows ultrasound to be 100% sensitive in the detection of grades 3 and 4 reflux. Conclusive evidence of reflux was seen in 2 cases where MCU was subsequently normal, questioning the role of MCU as the gold standard.

Adolescent

Bone scanning and plasma phosphatases in carcinoma of the prostate.

Bone scanning with 99mTc-Sn-HEDP, radiographic skeletal survey and determination of plasma acid and alkaline phosphatase values were carried out in a consecutive series of 90 untreated patients with carcinoma of the prostate. 99mTc-Sn-HEDP provided satisfactory bone imaging and was convenient in use. The addition of bone scanning to radiographic survey increases the detection rate of skeletal metatases by 16%. Radiography increases the accuracy of bone scanning by identifying false positive scans due to benign disease and false negative scans when there are diffuse symmetrical bony metastases. The plasma phosphatases alone are less accurate staging tests. The acid phosphatase data support the validity of scan positive--X-ray negative findings. Bone scan abnormalities due to secondary deposits usually precede elevation of plasma alkaline phosphatase.

Acid Phosphatase

Serial bone scanning: the assessment of treatment response in carcinoma of the prostate.

Serial bone scans and radiographic surveys were performed in 167 patients with histologically proven carcinoma of the prostate: 435 scans and surveys were performed. Nineteen of 99 patients with negative findings on diagnosis have become positive on follow-up. Forty-nine patients had positive findings on presentation; 8 have regressed on follow-up and 26 have progressed; 15 have remained unchanged. This is a sensitive method of follow-up in patients with carcinoma of prostate. Changes occurred in bone scans and skeletal surveys before any alteration in serum acid or alkaline phosphatases, symptoms of metastases or change in prostatic size in the majority of cases. The documentation of progression from MO to M1 disease presents no problems. However, problems in quantitation may arise in patients presenting with M1 disease.

Acid Phosphatase

Intravenous urography in experimental acute renal failure. Nephrograms and pyelograms in saline-loaded rats.

We studied renal opacification during intravenous urography in 20 rats subjected to glycerol-induced acute renal failure, with and without prior saline loading. Animals drinking saline suffered less severe renal impairment (mean plasma creatinine 175 mumol/l) than those drinking tap water (mean 341 mumol/l). Nephrograms occurred during intravenous urography in 19 rats at all levels of renal impairment, but were only followed by pyelograms in 8 with mild plasma creatinine elevation (mean 84 mumol/l). The occurrence of a pyelogram was determined not by whether an animal was drinking saline or tap water, but only by the level of renal impairment. The presence of the nephrogram throughout the range of functional impairment in acute renal failure argues against glomerular filtration as the principal route by which contrast medium reaches the nephron to produce this clinically very useful sign.

Acute Kidney Injury

Renal angiography problems in live kidney donors.

We compared renal angiographic and operative findings in 88 live kidney donors. Fifty patients had normal arteriograms and uneventful nephrectomies. Abnormal renal parenchymal or main artery lesions were found in eight donors (9%). These included four renal artery stenoses; the kidney distal to the lesion was used for transplanting. Thirty one patients (35%) had multiple renal arteries. Only 24 of these (77%) were diagnosed at pre-operative angiography, though on review angiogram accuracy could be raised to 94%. Except for one patient the accessory renal arteries missed at angiography were tiny twigs; the small renal infarcts caused by ligating them did not impair transplant survival. There was one serious misdiagnosis of multiple renal arteries, preventable on review of the abdominal aortogram. We condiser pre-operative angiography an essential step for the live kidney donor. It is the most accurate way of ensuring that his remaining kidney will be structurally sound. Finding multiple renal arteries has a decisive impact on management. Abdominal aortography rather than routine selective arteriography is the safe and therefore preferable approach to these patients.

Humans