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Biomedical subjects

B Goldwasser

Publications and source records attributed to B Goldwasser.

At least 73 records · Page 4Linked to original sources
PubMed1991

Chronic hematocele complicating renal failure and hemodialysis.

A patient with a recent history of genitourinary tuberculosis, chronic renal failure and hemodialysis presented with a slow growing scrotal swelling that had enlarged during the last 3 years. Physical examination and sonography were suspicious for testicular tumor, and surgical exploration and inguinal orchiectomy were performed. Ultimately the mass proved to be a chronic hematocele, a rare complication of uremic coagulopathy and hemodialysis. Because hematocele may clinically and sonographically resemble a testicular tumor, the proper management of a complex multiseptated scrotal mass without obvious history suggestive of hematocele is surgical exploration and orchiectomy. Awareness of this common presentation may obviate orchiectomy.

Adult↗
PubMed1991

Cystourethrometric findings in patients with detubularized right colonic segment for bladder replacement.

Urodynamic evaluation was performed in 13 men 4 to 18 months after cystoprostatectomy and bladder replacement using a detubularized right colonic segment. All patients are continent by day and only 3 are incontinent during the night to a degree that necessitates use of a condom catheter. Two patients awaken every 2 to 3 hours to void and the remainder have nocturia comparable to normal men of their age. The residual volume was 0 to 70 ml. The urethral closure pressure was normal, and in 3 patients studied preoperatively and postoperatively no significant change was observed other than shortening of the profile length. Maximal flow rates were normal although the pattern was intermittent. In 2 patients no cystoplasty contractions were recorded and in all but 2 patients the amplitude of the contractions was less than 40 cm. water. Simultaneous bladder and urethral pressure recordings during bladder filling demonstrated no change in urethral pressure in 10 patients. Although creation of a reservoir with a low pressure and careful preservation of the infraprostatic urethra are important for continence in these patients, we believe that the absence of normal sacral route reflexes after cystoprostatectomy is an important contributing cause to nocturnal incontinence.

Colon↗
PubMed1991

Increased urinary mucus production: a sequela of cystography following enterocystoplasty.

Early postoperative urinary mucus secretion was evaluated in 13 consecutive patients who underwent lower urinary tract reconstruction with incorporation of bowel segments, and the effect of intravesical infusion of sodium diatrizoate and meglumine diatrizoate in aqueous solution (Urografin 30%) was assessed. The mean volume of urinary mucus extracted before and immediately after cystography increased from 1.4 to 9.6 ml., respectively (p less than 0.0001). We conclude that mucus excretion increases significantly immediately following cystography during the early postoperative period. During that critical time cystography may cause potential hazards of mucus retention and catheter obstruction, which should be anticipated and treated promptly.

Adult↗
PubMed1991

[Intestinal motility and its variations in replacement bladder and intestine].

Urinary reservoirs replacing the bladder are made of intestine. The digestive tract motor activity is regulated by hormonal and neurologic mechanisms. The purpose of this work is the comparison of the motor activity in intact bowel with that of the new urinary reservoir during and after an oral intake. The modifications of pre- and post-prandial motor activities are recorded simultaneously in duodenum and neobladder by 4 patients with a tubular entero-cystoplasty (Camey I); standard meal (570 Kcal) triggers a similar activity in both segments. The modifications induced by an oral intake are then recorded by 14 patients with various reservoirs (ileum, ileum-cecum, cecum) and with different shapes (tubular or non-tubular). The compliance of non-tubular colic or ileocolic reservoirs appears greater than that of ileal reservoirs, even after detubularization. After oral intake, basal pressure and motor activity increase clearly in ileal bladders and much less in colic or ileocolic bladders. Nocturnal leak observed in many urinary reservoirs may be linked to the persistence of an intense motor activity in the neobladder with a marked increasing during the second part of the night.

Circadian Rhythm↗
PubMed1990

Hydration feature of urinary compounds. Evidence for molecular abnormality in calcium oxalate urolithiasis.

Proton-relaxation-time measurements were performed on lyophilized urine samples collected from 11 recurrent calcium oxalate stone-formers, 9 uric acid stone-formers, 9 patients with various urological disorders, and 20 normal individuals. The T1 and T2 relaxation times were determined using a Bruker PC Multispec at 20 MHz at 37 degrees C for measurements of lyophilized sample and thereafter during gradual controlled rehydration. The prolongation of the relaxation times as a function of rehydration was found to differ significantly (P less than 0.005) between, on the one hand, the calcium oxalate stone-formers and, on the other hand the normal, uric-acid stone-formers, and patients with other urological disorders. Water compartmentalization was then calculated according to the fast proton diffusion model. At most of the experimental points during rehydration process, significantly (P less than 0.001) less water was bound to the compounds of urine from calcium oxalate stone-formers than that obtained from normal individuals. The variations in the bound hydration water may have been associated with possible changes in the structure or configuration of the compounds present in the urine of the different groups. The results reflect differences in the urinary content and/or properties of normal subjects and calcium oxalate stone-formers, and indicate that the mechanism of bound water relaxation is in some way specific to the pathophysiological state of urine.

Adult↗
PubMed1990

[Delayed spontaneous rupture of the bladder following augmentation enterocystoplasty].

Delayed spontaneous rupture of the urinary bladder following augmentation enterocystoplasty is a serious life-threatening complication of uncertain etiology. Multiple factors are believed to contribute to the mechanism of bladder perforation. Ruptured augmented bladders share a common urodynamic pattern of high leak point pressure of the urethra, with sensory and mechanical tolerance of high filling pressure. This combination seems to be the main predisposing factor for spontaneous perforation. Other risk factors, including catheter trauma during intermittent self-catheterization, urinary retention due to mucus retention or noncompliance with the catheterization protocol, chronic infection, and decreased sensation of bladder filling, may play roles in the mechanism of rupture. Clinically, patients present with sepsis, abdominal pain and distension, ileus, fever, oliguria and peritoneal irritation. The diagnosis is made on low pressure cystography, although failure of cystography to demonstrate extravasation is not unusual. Aggressive surgical treatment consists of immediate exploration, primary repair of the perforation, drainage of the perivesical space, suprapubic cystostomy and broad-spectrum antibiotics. Longterm management includes a strict intermittent catheterization schedule, anticholinergic therapy and urodynamic evaluation. Failure to achieve a low pressure storage reservoir by conservative means entails an increased risk of recurrent perforation. In such cases further surgical intervention should be considered. We present a 21-year-old paraplegic man 5 months after augmentation enterocystoplasty who required operation because of spontaneous rupture of the augmented bladder. Spontaneous delayed rupture of the bladder should be considered in the differential diagnosis of acute abdomen in patients after augmentation enterocystoplasty. Early surgical treatment and subsequent monitoring of the low pressure reservoir are recommended.

Adult↗
PubMed1990

Augmentation of existing ileal and colonic conduits and stomal revision.

Repeated stomal revisions due to stomal stenosis can cause a short conduit. Augmentation of the conduit with a new isolated ileal loop, leaving the well-functioning ureteroenteric anastomoses intact, is indicated in these cases. We describe two patients with ileal and colonic conduits in whom the procedure was successfully performed.

Adult↗
PubMed1989

Role of linear tomography in evaluation of patients with nephrolithiasis.

One hundred twenty-four consecutive patients with suspected or known nephrolithiasis were referred for evaluation by linear tomography. Renal calculi were detected in 98 patients (79%). Linear tomography revealed more renal calculi than did preliminary KUB films in 46 patients (37%), although in only 10 cases (8%) was the tomogram positive if the KUB was negative. Exact quantification of the numbers and locations of renal stones is important in patients to be managed metabolically, and in those being evaluated in advance of or following percutaneous or extracorporeal lithotripsy.

Humans↗
PubMed1989

Clinical application and results of ureteral ileal substitution.

Three cases in which an ileal segment was used to replace the ureter are reported. Indications included irreparable damaged ureters in two of the cases and recurrent calculi with extrinsic ureteral obstruction in one. Excellent results were noted, and at 18 months follow-up renal function was unchanged, pyelographic appearance was improved and the patient with stone disease had no recurrent or residual stones.

Anastomosis, Surgical↗
PubMed1988

Implantation of model AMS 700 penile prosthesis: long-term results.

The American Medical Systems inflatable penile prosthesis has undergone periodic design changes to improve device reliability and longevity while maintaining a high degree of patient and partner satisfaction. Previous data reported from this institution did not consider these frequent design changes and the assessment of device reliability incorporated consecutive cases involving several different designs. This study was designed to evaluate followup data on 120 patients who received the model 700 inflatable penile prosthesis, permitting assessment of device reliability of a single design. Two groups were evaluated: a pre-fix group of 57 patients and a post-fix group of 63 patients. Over-all, 11.7 per cent of the total group required revision (21 per cent of the pre-fix and 3.2 per cent of the post-fix groups). Careful life-table analysis of the results with the current model 700 device (post-fix) reveals that this model has a 97 per cent chance of maintaining normal mechanical function for 3 years. Further assessment of these patients in the future will provide additional data on long-term reliability of this design.

Erectile Dysfunction↗
PubMed1988

Long-term followup of patients less than 30 years old with transitional cell carcinoma of bladder.

A review of our records between 1970 and 1986 identified 22 patients with transitional cell carcinoma of the bladder who were less than 31 years old. Of these patients 7 were less than 20 years old (group 1) and 15 were 20 to 30 years old (group 2). The tumors usually were of low grade and low stage. Patients in group 1 had no recurrences, whereas 6 patients (40 per cent) in group 2 had recurrences. Upstaging occurred in 2 patients with tumor recurrence. It would appear that while transitional cell carcinoma of the bladder in patients less than 20 years old has a more favorable prognosis, in patients 20 to 30 years old the prognosis is poorer and similar to that observed in older patients.

Adolescent↗
PubMed1988

The transvesical approach for the removal of distal ureteral calculi.

Our experience with a modification of transvesical ureterolithotomy in 12 patients in whom endourological extraction failed is presented and the technique is described. Successful removal of stones was achieved in all patients with 1 significant postoperative complication of a perivesical hematoma, which was drained percutaneously. Excretory urography and voiding cystourethrography at 3 months and 1 year postoperatively demonstrated no ureteral stricture or vesicoureteral reflux. When removal of distal ureteral stones by endourological means or extracorporeal shock wave lithotripsy fails, we recommend transvesical ureterolithotomy as an easy and rapid approach that necessitates minimal dissection away from blood vessels and avoids manipulation or displacement of the ureteral orifice.

Adult↗
PubMed1988

Leiomyosarcoma of the ureter.

Primary ureteral tumors occur relatively infrequently compared to tumors of the kidney and bladder. Smooth muscle tumors of the ureter are very rare and only 9 cases of leiomyosarcoma have been reported in the literature. The treatment of choice is total nephroureterectomy with en bloc excision of the tumor. Prognosis is unfavorable as indicated by the short survival of the reported cases.

Adult↗