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Biomedical subjects

B Goldwasser

Publications and source records attributed to B Goldwasser.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Reconstruction of lower urinary tract in patients with neurogenic bladder ].

Between 1988-1993 we performed lower urinary tract reconstruction in 30 patients with neurogenic bladder. The indications for surgery included urinary incontinence and/or upper urinary tract deterioration. 18 patients with a follow-up of longer than 18 months are reported. Continence was achieved in 15 of 16 patients and stabilization or improvement of the upper tracts in 17 of 18 patients. There was no mortality, and morbidity was the same as in similar series. Despite its complexity, lower urinary tract reconstruction in patients with neurogenic bladder brings major improvement in quality of life and in preservation of renal function. We recommend such operations in properly selected patients.

Follow-Up Studies↗
PubMed1994

Silver halide fiber optic radiometric temperature measurement and control of CO2 laser-irradiated tissues and application to tissue welding.

Tissue heating by laser irradiation has attained importance in many clinical applications. Accurate temperature measurements of laser-irradiated tissues are difficult to achieve, and experiments have produced conflicting results. Fiber optic radiometry allows temperature measurement of laser-irradiated tissues by remote sensing of the emitted infra red (IR) radiation. We have developed an IR fiber optic radiometer capable of accurate tissue temperature measurements (+/- 0.2 degrees C) and utilized it to monitor and control the heating of tissues by CO2 laser irradiation. Tissue temperature control of +/- 2.5 degrees C was achieved. This system was used to control tissue temperature during CO2 laser-assisted welding of urinary bladders in rats. The strength of the welds was recorded for different welding temperatures. A temperature of 55 degrees C was found to be optimal.

Animals↗
PubMed1994

Malignant peripheral primitive neuroectodermal tumor (PNET) of the kidney.

We describe a 61-year-old patient with primitive neuroectodermal tumor (PNET) arising from the kidney. Despite intensive treatment including surgery, combination chemotherapy and radiotherapy, rapid progression of the tumor was encountered and the patient died within six months with widespread disease. This appears to be the first recorded case of PNET of the kidney.

Fatal Outcome↗
PubMed1994

Ureteral substitution using the isolated interposed vermiform appendix in a patient with a single kidney and transitional cell carcinoma of the ureter.

A patient with a single kidney presented with ureteral obstruction caused by a combination of primary transitional cell carcinoma of the ureter and extrinsic involvement of the ureter by a second primary malignant retroperitoneal lymphadenopathy. Due to the complexity of the case, we chose to perform a partial ureterectomy and used a method of ureteral substitution using the interposed vermiform appendix in combination with a psoas hitch. Application of the psoas hitch may allow the use of the appendix in most cases in which ureteral substitution becomes necessary. Antireflux mechanism is easily achieved with the appendix using the split cuff nipple technique. Finally, the use of the appendix allows complete retroperitonealization of the anastomoses to both ureter and bladder. We anticipate that the appendix will be used more commonly in the future as a ureteral substitute as more urologists become more comfortable with it through its use in various reconstructive procedures.

Aged↗
PubMed1994

Raz bladder neck suspension in women younger than sixty-five years compared with elderly women: three years' experience.

OBJECTIVE: To verify the efficacy of Raz bladder neck suspension in producing cure of genuine stress incontinence (GSI) in women younger than sixty-five years compared with elderly women, and to find out whether or not elderly patients are more prone to failure with this technique. METHOD: We reviewed our results with this procedure in 67 women younger than sixty-five years (group I) compared with 21 elderly women (group II). Seventeen patients in group I and 4 patients in group II had bladder neck suspension for grade I-II incontinence, and 50 patients in group I and 17 in group II had additional cystocele repair by the four-corner technique. Rectocele repair and vaginal hysterectomy were also performed when indicated. RESULTS: With a mean follow-up period of 18.2 months for group I and 16.8 months for group II, 57 women (85.1%) in group I were completely cured of stress incontinence, 6 (8.9%) had marked improvement, and 4 (6.0%) had recurrence, while in group II, 19 (90.4%) were completely cured, 1 (4.8%) had marked improvement, and 1 (4.8%) had recurrence. Namely, in group I, 94 percent of the patients were either cured or improved, as compared with 95.2 percent in group II (P = 0.6; Fisher's exact test). Postoperative complications were few, and there was no permanent urinary retention. CONCLUSION: We conclude that, in a relatively short-term follow-up, Raz bladder neck suspension is equally successful in curing stress urinary incontinence in young and elderly females.

Adult↗
PubMed1994

Ureteropelvic junction obstruction: relation of etiology and age at surgical repair to clinical outcome.

Ureteropelvic junction (UPJ) obstruction is a congenital anomaly either caused by intrinsic narrowing of the upper ureter or by extrinsic pressure on the ureter caused by aberrant vessels or fibrous bands. We reviewed 121 cases of pyeloplasties performed in our department for UPJ obstruction. The cases were grouped by age and by the underlying pathology. Postoperative urographic evaluation showed that dismembered pyeloplasty was successful in 98.4% of the patients, with no significant difference between age groups. Persistence or recurrence of preoperative symptoms occurred in some patients (16.6%). Extrinsic obstruction of the ureter was associated with better postoperative clinical results and less recurrence of symptoms.

Adolescent↗
PubMed1994

Symptomatic heterotopic splenic tissue in the left renal fossa.

Renal fossa heterotopic splenic tissue is characteristically asymptomatic and is usually an incidental finding that has been reported to mimic renal or adrenal tumors. However, symptoms related directly to the splenic tissue do occur. We present an unique case with simultaneous occurrence of an accessory spleen and splenosis which were diagnosed following intentional radiological investigations conducted to evaluate flank pain which was probably related to the presence of the heterotopic spleens. CT complemented by isotopic liver-spleen scan is the radiological modality of choice in the diagnosis of renal fossa splenosis. However, MRI may significantly contribute to the evaluation by accurate delineation of blood supply and surgical separation planes.

Adult↗
PubMed1993

[Primary retroperitoneal extra-gonadal germ cell tumor].

Malignant retroperitoneal tumors are relatively rare. The most likely diagnosis by a surgeon encountering a retroperitoneal mass is metastatic disease, but primary retroperitoneal malignant disease or benign tumor should also be considered. The most common primary retroperitoneal tumors are lymphoma and sarcoma. Primary extragonadal germ cell tumors constitute 1-2% of all germ cell tumors, most of which are found in the mediastinum and retroperitoneum. We report the successful treatment of a 20-year-old man whose primary retroperitoneal extragonadal germ cell tumor was treated by chemotherapy and surgery.

Adult↗
PubMed1993

Localized renal cell carcinoma treated by radical nephrectomy. Influence of pathologic data and the importance of DNA ploidy pattern on disease outcome.

BACKGROUND: The course of patients with renal cell carcinoma may be considerably different. Approximately 50% with presumed localized disease have metastases after nephrectomy. Pathologic stage at diagnosis, histologic grade, and histologic type have been considered the most important predictors of prognosis. Nevertheless, subsets of patients within a specified stage and grade may have considerable differences in disease progression and survival. METHODS: Flow cytometric nuclear DNA analysis was used to study pathologic Stage I or II renal cell carcinoma in 54 patients who underwent radical nephrectomy between 1974 and 1983. RESULTS: Sixty-three percent of the tumors were diploid, and 37% aneuploid. A DNA diploid pattern was more common among Stage I tumors than Stage II tumors (69% versus 33%; P < 0.04). Progression occurred in 31% of the diploid tumors, whereas among the aneuploid group the progression rate reached 59% (P < 0.06). Considered as a single indicator, DNA ploidy pattern was strongly associated with patient survival. Ten years after surgery 79% of the patients who had diploid tumors and 50% of those with aneuploid tumors were alive (P < 0.02). CONCLUSIONS: Nuclear DNA ploidy may serve as an important prognostic variable for patients with early stage renal cell carcinoma.

Adolescent↗
PubMed1993

Is it justified to avoid radical cystoprostatectomy in elderly patients with invasive transitional cell carcinoma of the bladder?

BACKGROUND: Although radical cystectomy is accepted by most urologists as the treatment of choice for invasive carcinoma of the bladder and age alone is not considered a contraindication for radical surgery, many consider radical major operations to be unsuitable for elderly patients. METHODS: The authors compared the results of radical cystectomy in 42 elderly patients to those in patients 69 years old or younger and to a group of 21 elderly patients, matched by stage of disease and severity of medical problems, who received alternative treatment. RESULTS: The overall operative mortality rate was 6.3% (seven patients). Three (4.3%) postoperative deaths in the younger group and four (9.5%) deaths among elderly patients were recorded. The operative morbidity and mortality did not differ significantly between those two groups (P = 0.1). Among the patients who received alternative therapy, 13 (61.9%) died within the first 6 months, and only 3 survived more than 12 months. Morbidity was encountered in 97% of these patients. CONCLUSIONS: The authors showed that radical cystectomy is a relatively safe procedure for elderly patients. The elderly patient who is thought to be unsuitable for surgery not only is deprived of his right to definite curative therapy but also is exposed to higher morbidity and mortality and worse quality of life than are those who undergo operations. The authors conclude that it is unjustified to avoid radical cystectomy in the elderly population on the basis of age alone.

Adult↗
PubMed1993

The significance of ureteral obstruction in invasive transitional cell carcinoma of the urinary bladder.

Ureteral obstruction is a frequent complication of transitional cell carcinoma (TCC), known as a poor prognostic sign and indicative of advanced disease. We investigated retrospectively the medical records of 122 consecutive patients who suffered from invasive TCC of the urinary bladder during a 6-year period. Unilateral or bilateral ureteral obstruction was found in 66 patients (54.1%). High stage (T3-T4) and grade (III-IV) tumors were correlated with ureteral obstruction in 89.4% and 83.3% respectively compared to 67.9% and 66.1%, respectively, among patients with normal upper tracts (P < 0.001); 10.6% of the patients with ureteral obstruction had low stage disease, and all of them proved to have involvement of the ureteral orifices on the affected side. The 5-year survival rate of patients with and without ureteral obstruction was 32.2% and 65.9%, respectively (P < 0.001). The presence of ureteral obstruction, particularly in the absence of intravesical involvement of the ureteral orifices, signified a high stage, muscle invasive, and often metastatic tumor in more than 90% of the patients. Ureteral obstruction was an accurate criterion for poor prognostic and was associated with significantly lower, overall and stage-specific, survival rates, despite of radical surgery. We conclude that evidence of ureteral obstruction is an important staging standard and significant prognostic indicator in transitional cell carcinoma of the urinary bladder.

Aged↗
PubMed1993

Massive hematuria due to extramedullary plasmacytoma invading the bladder.

Bladder involvement by extramedullary plasmacytoma is a rare condition. A 46-year-old woman with known IgA-lambda multiple myeloma who developed this condition is described. The patient suffered from massive hematuria, which led to hypovolemic shock. Prompt supportive treatment by blood transfusions, fulguration of the bleeding mucosa and continuous bladder irrigation stopped the bleeding. Subsequent bladder irradiation lead only to partial response of the tumor.

Female↗
PubMed1993

Vesicoureteral reflux and lower urinary tract injury: the possible role of suprapubic cystostomy.

Incidental vesicoureteral reflux was noted frequently during routine cystographic evaluation of patients who suffered vesicourethral trauma and who were managed by suprapubic cystostomy. Based on this observation we designed a retrospective study to document the prevalence of vesicoureteral reflux among 30 consecutive patients following vesicourethral trauma. In 9 patients drainage was instituted by urethral catheter and in 21 by suprapubic cystostomy. Of the latter 21 patients 10 (47.6%) had evidence of vesicoureteral reflux on cystography, which was associated with complete rupture of the urethra in 9 (90%). No patient who was treated initially with a urethral catheter had evidence of vesicoureteral reflux on cystography. We conclude that the prevalence of vesicoureteral reflux is significantly affected by the coexistence of severe vesicourethral injury and the presence of suprapubic cystostomy. The significance of this observation is in the potential risk of ascending upper urinary tract infections due to the hazardous combination of vesicoureteral reflux and frequent recurrent lower urinary tract infections. Presence of vesicoureteral reflux in these patients may necessitate a prophylactic antibiotic regimen. The specific mechanisms that lead to increased prevalence of vesicoureteral reflux in patients following severe vesicourethral injury are not defined by our results. However, we propose a multifactorial concept that may explain our observation.

Adult↗
PubMed1993

Conservative treatment of a vesicocervical fistula resulting from Shirodkar cervical cerclage.

A case of a vesicocervical fistula caused by Shirodkar cervical cerclage and presenting as total urinary incontinence is reported. The patient was managed conservatively by bladder drainage alone with complete resolution of the fistulous tract. This rare complication is avoidable if the bladder is adequately dissected from the cervix during placement of the cerclage suture.

Adult↗