Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

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A brief investigation was made of various enzymes such as urease in conjunction with a wetting agent, ficin, steapsin, and hyaluronidase as aides in the :in vitro" dissolution of calculi in "G"⁷ solution. This investigation indicated that a more effective solvent was needed. / Master of Science

Conclusion This series of investigations demonstrated how we can apply our knowledge to improve the treatment outcome of ESWL. Based on clinical information, such as age, suitable candidates for ESWL can be identified, and hence better application of ESWL can be achieved. With an understanding of the benefits and limitations of imaging (NCCT and intravenous urography), treatment success can be predicted, and better treatment plans for patients can be formulated. A policy of more liberal use of analgesia during ESWL can also help to improve the treatment outcomes of patients. Finally, with the use of different assessment methods, the true impact of various new technologies or treatment protocols can be assessed, and the results can lead to better understanding of ESWL and also improvement in the treatment outcomes. / Materials and Methods In a retrospective review of treatment information of 2192 patients, the effect of age on stone-free rates after ESWL was assessed. Next, in a prospective study, the role of stone parameter, measured using non-contrast computerized tomography (NCCT), in predicting the treatment outcomes of upper ureteric stones was examined. The general applicability of caliceal pelvic height (CPH) in determining the treatment outcomes for lower caliceal stones for three different lithotriptors was assessed in the third study. In another retrospective comparative study, the effect on treatment outcomes of additional usage of intravenous analgesic during ESWL, as compared to oral analgesic premedication alone, was analyzed. Finally, the feasibility of the use of two statistical methods, logistic regression and matched-pair analysis, in comparing the treatment results of different lithotriptors was investigated. / Objectives Despite the initial success of extracorporeal shock wave lithotripsy (ESWL), the performance of the contemporary machines has never been as good as that of the first-generation machine. Therefore, a series of studies was conducted to advance the current knowledge of ESWL and investigate possible ways to further optimize the treatment outcomes. / Results We found that the stone-free rate after ESWL for older patients with renal stones, but not for those with ureteric stones, was significantly lower than that of younger patients. Stone parameters measured using NCCT, namely, mean stone density, stone volume, and skin-to-stone distance, were significant predictive factors for successful ESWL for upper ureteric stones. However, caliceal pelvic height, measured by intravenous urography, was a significant predictor of treatment outcomes of lower caliceal stones for only the Piezolith 2300 lithotriptor, and not the other two types of lithotriptors. The additional usage of intravenous analgesic improved the effectiveness quotient and hence treatment outcomes of ESWL. Finally, both logistic regression and matched-pair analysis were found to be feasible approaches for the comparison of the performance of different lithotriptors. / Chi-Fai Ng. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 224-243). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.

Doctor of Medicine / Publications 1-49 represent studies that I have undertaken myself or conjointly over a 34 year period to investigate a variety of issues relating to diseases of the kidney and urinary tract in children. The studies were carried out at the Royal Alexandra Hospital for Children, Camperdown when I was Clinical Superintendent from 1968 - 1970; The Department of Paediatrics, University of Minnesota, Minneapolis, USA when I was Overseas Research Fellow of the Post Graduate Foundation in Medicine, University of Sydney, 1970 - 1972, then as Staff Physician in Nephrology at the Royal Alexandra Hospital for Children, Camperdown, 1972 - 1977, and then Head of that Department at the Hospital until 1995 and then as an Honorary Staff Specialist at that hospital. Some of the studies were done conjointly with members of the Renal Unit of Royal Prince Alfred Hospital where I hold an Honorary appointment and others conjointly with members of the Renal Unit of Prince Henry Hospital, Little Bay. I was appointed Clinical Associate Professor to the Department of Paediatrics and Child Health, University of Sydney in 1993. In 1966 paediatric nephrology was in the early phase of development as a medical subspecialty. There was no definitive textbook, the first was published in 1975 (Pediatric Nephrology, Ed. Mitchell I. Rubin. Williams and Wilkins.). In the preface to the 2nd edition of Renal Disease (Blackwell) in 1967 the editor D.A.K. Black noted that he had included a chapter on paediatric aspects which had been planned for the 1st edition in 1962 but ”it could not be arranged”. In the chapter on Renal Disease in Children the author, D.Macauly, comments that the mortality rate of acute renal failure in children was 50%. When I joined the resident staff of the Royal Alexandra Hospital for Children in 1966, children with renal disease were managed by general paediatricians. There was no active program for the treatment of children with acute or chronic renal failure. A small number of kidney biopsies had been performed by Dr Trefor Morgan who, together with Dr Denis Wade, had taught me the technique while I was a resident medical officer at the Royal Prince Alfred Hospital in the preceding year. With the guidance and support of Dr S.E.J. Robertson and Dr C. Lee, Honorary Medical Officers, and Dr R.D.K. Reye, Head of the Department of Pathology, I began performing kidney biopsies on children at the request of the paediatrician in charge. In the same year, encouraged again by Doctors Robertson and Lee, and by J.C.M. Friend and J. Brown, I introduced peritoneal dialysis for the treatment of children with acute renal failure, a technique which I had also been taught by Dr Trefor Morgan whilst I was a resident at Royal Prince Alfred Hospital. Dr Robertson encouraged me to present my experience in percutaneous renal biopsy in children at the Annual Meeting of the Australian Paediatric Association in 1968 and this study became the first paper I published in relation to disease of the urinary tract in children (1). In 1970 I was granted an Overseas Research Fellowship by the Post Graduate Foundation in Medicine, University of Sydney, to enable me to undertake a fellowship in the Department of Paediatrics at the University of Minnesota. I had the great fortune in undertaking studies in the new discipline of paediatric nephrology and related research under the guidance of Dr A. F. Michael, Dr R.L.Vernier and Dr A. Fish. I acquired the techniques of immunopathology and electron microscopy. On my return to Australia I established a Department of Nephrology at the Royal Alexandra Hospital for Children. I introduced immunofluorescent and electron microscopic studies for the kidney biopsies that I continued to perform and, with the support of Dr R.D.K. Reye, I provided the official reports of these studies until 1990. As a result these studies became part of the histopathologic service provided by the hospital. I continue to be consulted concerning the interpretation of some electron microscopic findings in renal tissue. With the assistance of Dr J.D. Harley I set up a laboratory in the Children’s Medical Research Foundation to continue and expand the studies I had commenced during my Fellowship. Establishing a dialysis and transplant program for children with end stage renal disease (ESRD) was extremely time consuming. At that time most children with ESRD died. The program was initially established jointly with the Renal Unit at Royal Prince Alfred Hospital in 1972 and eventually dialysis facilities were established at the Children’s Hospital using predominantly peritoneal dialysis. By 1978 the existence of the Unit was well known in the general community and articles appeared in the press. One prompted the late Sir Lorimer Dods, the first Professor of Paediatrics in Australia to write to me congratulating me on what I had achieved. He remarked “I have just read with special interest Shaun’s review in the SMH of some of your recent achievements in the field of renal failure in infancy and childhood and want to offer you my personal congratulations on all that you have achieved and are achieving in this area of paediatrics which, in my little world of yesterday, meant nothing more than progressive and unrelenting fatal illness”. Taking part in the development of a relatively new discipline led me to study a number of areas. I encouraged trainees to write reports concerning clinical observations and eventually I was joined by Fellows whom I encouraged and supported to study a number of different areas to ensure that children were being cared for in an environment of strong and open enquiry. This led to studies on investigations of chronic renal failure which Dr Elisabeth Hodson pursued and studies on urinary tract infection in small children for which Dr Jonathon Craig was awarded a PhD. As I had been a contributor and co-author in a number of these studies they have been included in my list of publications. As a result of this diversity I have listed the publications in 9 sections. The overall theme is to study diseases of the renal tract in children and treatments used to understand the processes and ensure the most effective treatment. Some published abstracts of papers presented at scientific meetings have been included to clarify invitations I received to prepare reviews and chapters on various subjects and my involvement in some conjoint studies. I was author or coauthor of several book chapters, reviews, editorials and certain published studies to which I was invited to contribute as a result of my primary studies and these I have included as “Derivative References”numbered 50-76.

Bibliography :leaves 149-172. / vii, 172,[60] leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / The investigations centre on the use of [beta]-aminothiols (cysteine, cysteamine and penicillamine) to decrease endogenous oxalate production by forming adducts with glyoxylate, the immediate precursor of oxalate. They indicate that cysteine delivery drugs like OTC have the potential to aid in management of calcium oxalate stone disease, thereby reducing endogenous oxalate production and urinary oxalate excretion. / Thesis (Ph.D.)--University of Adelaide, Dept. of Physiology, 1995?

Doctor of Medicine / Publications 1-49 represent studies that I have undertaken myself or conjointly over a 34 year period to investigate a variety of issues relating to diseases of the kidney and urinary tract in children. The studies were carried out at the Royal Alexandra Hospital for Children, Camperdown when I was Clinical Superintendent from 1968 - 1970; The Department of Paediatrics, University of Minnesota, Minneapolis, USA when I was Overseas Research Fellow of the Post Graduate Foundation in Medicine, University of Sydney, 1970 - 1972, then as Staff Physician in Nephrology at the Royal Alexandra Hospital for Children, Camperdown, 1972 - 1977, and then Head of that Department at the Hospital until 1995 and then as an Honorary Staff Specialist at that hospital. Some of the studies were done conjointly with members of the Renal Unit of Royal Prince Alfred Hospital where I hold an Honorary appointment and others conjointly with members of the Renal Unit of Prince Henry Hospital, Little Bay. I was appointed Clinical Associate Professor to the Department of Paediatrics and Child Health, University of Sydney in 1993. In 1966 paediatric nephrology was in the early phase of development as a medical subspecialty. There was no definitive textbook, the first was published in 1975 (Pediatric Nephrology, Ed. Mitchell I. Rubin. Williams and Wilkins.). In the preface to the 2nd edition of Renal Disease (Blackwell) in 1967 the editor D.A.K. Black noted that he had included a chapter on paediatric aspects which had been planned for the 1st edition in 1962 but ”it could not be arranged”. In the chapter on Renal Disease in Children the author, D.Macauly, comments that the mortality rate of acute renal failure in children was 50%. When I joined the resident staff of the Royal Alexandra Hospital for Children in 1966, children with renal disease were managed by general paediatricians. There was no active program for the treatment of children with acute or chronic renal failure. A small number of kidney biopsies had been performed by Dr Trefor Morgan who, together with Dr Denis Wade, had taught me the technique while I was a resident medical officer at the Royal Prince Alfred Hospital in the preceding year. With the guidance and support of Dr S.E.J. Robertson and Dr C. Lee, Honorary Medical Officers, and Dr R.D.K. Reye, Head of the Department of Pathology, I began performing kidney biopsies on children at the request of the paediatrician in charge. In the same year, encouraged again by Doctors Robertson and Lee, and by J.C.M. Friend and J. Brown, I introduced peritoneal dialysis for the treatment of children with acute renal failure, a technique which I had also been taught by Dr Trefor Morgan whilst I was a resident at Royal Prince Alfred Hospital. Dr Robertson encouraged me to present my experience in percutaneous renal biopsy in children at the Annual Meeting of the Australian Paediatric Association in 1968 and this study became the first paper I published in relation to disease of the urinary tract in children (1). In 1970 I was granted an Overseas Research Fellowship by the Post Graduate Foundation in Medicine, University of Sydney, to enable me to undertake a fellowship in the Department of Paediatrics at the University of Minnesota. I had the great fortune in undertaking studies in the new discipline of paediatric nephrology and related research under the guidance of Dr A. F. Michael, Dr R.L.Vernier and Dr A. Fish. I acquired the techniques of immunopathology and electron microscopy. On my return to Australia I established a Department of Nephrology at the Royal Alexandra Hospital for Children. I introduced immunofluorescent and electron microscopic studies for the kidney biopsies that I continued to perform and, with the support of Dr R.D.K. Reye, I provided the official reports of these studies until 1990. As a result these studies became part of the histopathologic service provided by the hospital. I continue to be consulted concerning the interpretation of some electron microscopic findings in renal tissue. With the assistance of Dr J.D. Harley I set up a laboratory in the Children’s Medical Research Foundation to continue and expand the studies I had commenced during my Fellowship. Establishing a dialysis and transplant program for children with end stage renal disease (ESRD) was extremely time consuming. At that time most children with ESRD died. The program was initially established jointly with the Renal Unit at Royal Prince Alfred Hospital in 1972 and eventually dialysis facilities were established at the Children’s Hospital using predominantly peritoneal dialysis. By 1978 the existence of the Unit was well known in the general community and articles appeared in the press. One prompted the late Sir Lorimer Dods, the first Professor of Paediatrics in Australia to write to me congratulating me on what I had achieved. He remarked “I have just read with special interest Shaun’s review in the SMH of some of your recent achievements in the field of renal failure in infancy and childhood and want to offer you my personal congratulations on all that you have achieved and are achieving in this area of paediatrics which, in my little world of yesterday, meant nothing more than progressive and unrelenting fatal illness”. Taking part in the development of a relatively new discipline led me to study a number of areas. I encouraged trainees to write reports concerning clinical observations and eventually I was joined by Fellows whom I encouraged and supported to study a number of different areas to ensure that children were being cared for in an environment of strong and open enquiry. This led to studies on investigations of chronic renal failure which Dr Elisabeth Hodson pursued and studies on urinary tract infection in small children for which Dr Jonathon Craig was awarded a PhD. As I had been a contributor and co-author in a number of these studies they have been included in my list of publications. As a result of this diversity I have listed the publications in 9 sections. The overall theme is to study diseases of the renal tract in children and treatments used to understand the processes and ensure the most effective treatment. Some published abstracts of papers presented at scientific meetings have been included to clarify invitations I received to prepare reviews and chapters on various subjects and my involvement in some conjoint studies. I was author or coauthor of several book chapters, reviews, editorials and certain published studies to which I was invited to contribute as a result of my primary studies and these I have included as “Derivative References”numbered 50-76.

Published papers (M.D.)--Dept. of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, 2005. / Title from title screen (viewed June 28, 2007). Submitted in fulfilment of the requirements for the degree of Doctor of Medicine to the Dept. of Paediatrics and Child Health, Faculty of Medicine. Includes bibliographical references. Also issued in print.

Made available in DSpace on 2014-06-11T19:35:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-01-25Bitstream added on 2014-06-13T20:26:53Z : No. of bitstreams: 1 damasio_pcg_dr_botfm.pdf: 945182 bytes, checksum: c3d13c8adb85760aedcb14fc34f0ccd3 (MD5) / A itíase urinária é a terceira causa mais comum de afeção do trato urinário. A orientação dietética e o tratamento medicamentoso específico são importantes na recorrência da litíase e, portanto, mudar a dieta e seguir o tratamento farmacológico específico pode prevenir a sua recorrência. Avaliar a influência da orientação nutricional e do tratamento medicamentoso na recorrência da litíase urinária. A partir do nosso registro de pacientes com litíase recorrente foram selecionados 57 que tiveram pelo menos 5 anos de seguimento. Intervenção: Durante o acompanhamento dos pacientes foram avaliados os seguintes parâmetros: questionário clínico, investigação metabólica e avaliação por imagem (ultra-sonografia e/ou raio-X simples de abdome). Todos os pacientes foram orientados a controlar a ingestão de proteína (entre 0,8 a 1g/Kg peso corporal/dia) e adequar a ingestão de cálcio (entre 800 a 1000 mg/dia), levando-se em consideração o registro alimentar de 3 dias. A restrição de sal (menor que 5 g/dia) foi realizada tendo como referência a variação do sódio excretado na urina de 24h. Durante o acompanhamento os pacientes receberam ainda orientações dietéticas e farmacológicas específicas de acordo com o distúrbio metabólico identificado. 56% dos pacientes eram sexo masculino e a média do IMC no pré-tratamento foi de 27,8 kg/m², observando-se uma correlação positiva entre o número médio de cálculos formados por ano no pré-tratamento e IMC (p=0,012) Notamos uma diminuição significativa do cálcio, sódio e ácido úrico na urina de 24 horas no pós tratamento em comparação ao período inicial. Observamos um aumento significativo do citrato na urina de 24 horas no pós-tratamento. O nº de cálculos formados durante seguimento de 5 anos, diminuiu significativamente em relação ao pré tratamento... / Urinary tract lithiasis is the third most common cause of urinary tract affection. Dietary factors have great importance in the formation of urolithiasis; therefore, changing the diet and specific pharmacological treatment can prevent its recurrence. Evaluate the influence of clinical therapy associated to nutritional orientation in the recurrence of urolithiasis. From our registry of patients with recurrent lithiasis we selected 57 who had at least 5-years of follow-up. We used the protocol composed by 2 non-consecutive urine samples of 24h and was performed: Ca, Na, uric acid, citrate, oxalate, Mg and urinary volume assessments. In the pre treatment the lithiasis clinical questionary and after five years was care out using abdomen x-ray and/or ultrasound. Individualized dietary orientation consisted of: to increase fluid intake (enough to form ≥ 2 L / day); sodium ingestion <5 g / day and protein intake range between 0.8 - 1 g / kg body weight / day, and the adequate calcium intake (800 to 1000 mg / day). During the follow-up of patients, specific and individualized dietary orientation was performed according to the diagnosed metabolic disorder. Patients received specific pharmacological treatment according to the metabolic alteration. 54% were male. In average the BMI was 27 kg / m2. It was observed that according to BMI classification, the patients were overweight. Urinary excretion of calcium, uric acid and sodium decreased significantly after 5 years of follow-up. The number of stones formed in the 5- year follow-up decreased significantly compare to pre treatment. Individualized dietary orientation and pharmacological... (Complete abstract click electronic access below)

Made available in DSpace on 2014-06-11T19:27:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-27Bitstream added on 2014-06-13T20:36:02Z : No. of bitstreams: 1 000747190.pdf: 1418817 bytes, checksum: b247c3f9bf3c90821dabe9c5f9e0cf21 (MD5) / Há discordância na literatura quanto à necessidade da realização da microscopia de fase para avaliação da origem da hematúria (glomerular ou não glomerular), isso mostra a necessidade de mais estudos para validar as modalidades de avaliação morfológica da hematúria. Os objetivos deste trabalho foram determinar o melhor ponto de corte da porcentagem dos diferentes padrões de células dismórficas na detecção da hematúria glomerular pelo microscópio óptico convencional e contraste de fase, verificar se a presença de proteinúria ou albuminúria pode auxiliar no diagnóstico da origem da hematúria e determinar o melhor ponto de corte para este parâmetro. Foram avaliadas de maneira cega 131 amostras de urina sendo 66 amostras de portadores de glomerulopatias e 65 amostras dos portadores de litíase renal da Faculdade de Medicina de Botucatu. Utilizaram-se amostras isoladas com densidade >1007 e com mais de 5 hemácias por campo de grande aumento. Verificou-se a presença e a porcentagem de codócitos e acantócitos tanto em microscópio óptico convencional com sedimento fresco e fixado submetidos à coloração de Papanicolaou e Panótico rápido LB e sedimento urinário fresco avaliado em microscópio de contraste de fase, além de determinar o índice de proteinúria e o índice de albuminúria. Os resultados desses métodos foram comparados entre si. Realizou-se regressão linear e diagrama de Bland-Altman das hemácias dismórficas para comparar os diferentes métodos. Curvas ROC foram traçadas para determinar a área sob a curva (ASC) e o melhor ponto de corte (PC) foi determinado pela maior soma de sensibilidade e especificidade. Nesse ponto foram calculadas a sensibilidade (S) e especificidade (Es), Valor Preditivo Positivo (VPP) e Valor Preditivo Negativo (VPN). No microscópio óptico convencional com sedimento urinário fresco, a ASC do dismorfismo eritrocitário total foi a que apresentou... / There is disagreement over the literature regarding the performance of phase microscopy to assess the origin f hematuria (glomerular or nonglomerular). This shows the need for further investigation in order to validate the best form of morphological evaluation of hematuria. The aims of this study were to determine the optimal cutoff point percentage for different patterns of dysmorphic cells in the detection of glomerular hematuria by conventional optical microscopy and phase contrast microscopy, to verify whether the presence of proteinuria or albuminuria may assist in the diagnosis of hematuria and also to establish an optimal cutoff point for this parameter. One hundred thirty-one urine samples were blinded evaluated at the Faculdade de Medicina de Botucatu, 66 samples of patients with glomerulopathies and 65 samples of patients with nephrolithiasis. Isolated samples with density greater than 1007 and with more than 5 erythrocytes per high-power field were used. The presence and percentage of codocytes and acanthocytes were verified by conventional optical microscopy using fresh and fixed urinary sediment subjected to Papanicolaou and Panótico Rápido LB staining and fresh urinary sediment was evaluated by phase contrast microscopy. Proteinuria and albuminuria rates were determined. The results of these methods were compared using linear regression analysis and Bland-Altman diagram of dysmorphic red blood cells. ROC curve plots were generated to determine the area under the ROC curve (AUC) and also an optimal cutoff point with the highest sum of sensitivity and specificity. At this point, it was possible to calculate sensitivity (TPR) and specificity (ES), positive predictive value (PPV) and negative predictive value (NPV). In conventional optical microscope with fresh urinary sediment, the AUC of total dysmorphic erythrocytes showed the best result for the diagnosis of hematuria with AUC (IC 95%) ...