Biomedical subjects
Publications and source records attributed to V Srinivas.
We report a retrospective study of 18 patients with renal sarcomas seen between 1950 and 1980. Renal sarcomas are highly malignant neoplasms and the over-all prognosis is poor, with only 2 long-term survivors in this series. Radical nephrectomy seems to be the treatment of choice.
The specific red cell adherence test appears promising to predict which superficial bladder tumor(s) ultimately will become invasive. However, presently the test cannot be quantitated and, thus, cannot be standardized. We describe a technique for the quantitative analysis of ABO(H) isoantigens in bladder tumors, which should help to standardize the test for prospective clinical trials.
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Retroperitoneal fibrosis is a rare disease but is important surgically because it can produce ureteral obstruction and renal failure. A wide variety of inflammatory, infective and neoplastic conditions can result in secondary retroperitoneal fibrosis and it is essential to look carefully for an underlying neoplastic condition in all cases of retroperitoneal fibrosis. Idiopathic retroperitoneal fibrosis occurs predominantly in men and results in some form of renal failure in 75% of patients. The classic triad of medial deviation of ureters, ureteral narrowing at L4-5 and proximal hydronephrosis is usually seen in high-dose intravenous pyelograms and the ease of retrograde ureteral catheterization is often diagnostic. Management depends on the degree of renal impairment, with laparotomy, multiple biopsies and ureterolysis being the treatment of choice. Steroids are beneficial, if used early, and the prognosis is excellent if there is no underlying malignant condition.
The terminal hexosamines of bovine pituitary lutropin are thought to contain a sulfate moiety. In order to test this, a biosynthetic approach was adopted. When rat and buffalo (bovine) pituitaries were incubated with radioactive 35SO4(2-) for 2 h in vitro it was observed that radioactivity test incorporated into trichloroacetic acid-precipitable proteins. When the radioactive proteins were treated with an anti-sheep lutropin serum, radioactivity was found in the immunoprecipitate. The incorporation into rat lutropin like material was very marginal while it was very significant in the case of buffalo lutropin.
Although uremia is the major cause of death in more than 30 per cent of patients with Laurence-Moon-Biedl syndrome, little attention has been paid to this rare syndrome in the urologic literature. We herein report on 3 patients with this syndrome.
About 38 cases of carcinoma in a female urethral diverticulum have been reported previously. We report the first case of a transitional cell carcinoma arising in a female urethral diverticulum containing a calculus. The clinical features mimic a simple urethral diverticulum with a calculus and if biopsies are not done routinely a tumor can be missed easily.
Resting hemodynamic indices and exercise tolerance were measured during atrial synchronized (VAT) and asynchronous ventricular pacing (VOO) in 35 patients with implanted pacemakers which could be externally programmed to function in either pacing mode. Cardiac output and mean systemic arterial pressure were significantly greater during VAT pacing (VAT: 4.5 +/- 1.2 1/min, 115 +/- 28 mmHg; VOO: 3.7 +/- 0.8 1/min 105 +/- 25 mmHg respectively), although there was no difference in pulmonary artery end-diastolic pressure. Maximal exercise performance was assessed using the Bruce protocol in both pacing modes. Neither the patient nor the supervising physician was aware of the preselected pacing mode; a second physician monitored the electrocardiogram and blood pressure but influenced the point of exercise termination only if a potentially dangerous arrhythmia or hypotension occurred. Blood pressure responses were superior and atrial rates lower during VAT pacing. In all but five patients, exercise tolerance was improved by VAT pacing. This amounted to 33 percent or more in 23/35 patients. This improvement was shown to be maintained in the 20 patients who had repeat exercise tests several weeks later. Ventricular arrhythmias, hypotension, and lightheadedness frequently complicated exercise during asynchronous pacing but occurred rarely with atrial synchronized pacing. Resting hemodynamic indices did not predict the extent of improvement gained by physiological pacing.
The diagnosis of renal angiomyolipoma has always been difficult to make preoperatively. When the clinical and radiologic features are highly suggestive of an angiomyolipoma, the surgeon may resort to open renal frozen-section biopsy in an attempt to avoid unnecessary radical nephrectomy. The authors report two cases of renal angiomyolipoma that highlight the diagnostic problems of the tumour and the difficulty in differentiating it from renal adenocarcinoma. This is a major problem for urologists in centres where facilities for computerized axial tomography are unavailable.
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Renal artery embolism presents a diagnostic challenge because the condition is rare and it often mimics other more common abdominal problems. A conservative approach is favoured by most urologists but management is still controversial. The authors present a case of unilateral renal artery embolism that illustrates the difficulties and delay in making a diagnosis. It also highlights the efficacy of anticoagulants in restoring adequate function in a kidney that had been totally nonfunctioning and partially ischemic for longer than 18 hours.
Echocardiography detected asymmetric septal hypertrophy (ASH) in five of 200 adults being assessed for aortic valve surgery. Four of these were among 119 patients with dominant aortic stenosis, which was severe in three. ASH was confirmed at the time of aortic valve replacement in two of these patients; the third declined operation. The finding of ASH in only one of 81 patients with free aortic reflux is consistent with chance association. While the same explanation could apply to the higher prevalence in those with aortic stenosis, it may be that a long-standing pressure overload can trigger inappropriate septal hypertrophy in predisposed individuals.
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