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Biomedical subjects

B Goldwasser

Publications and source records attributed to B Goldwasser.

At least 109 records · Page 6Linked to original sources

The effect of ultrasonic disintegration on the outcome of percutaneous nephrolithotripsy.

Concern has been expressed regarding the use of ultrasonic lithotripsy in the percutaneous treatment of renal calculi with the suggestion that high rates of retained stones may be experienced. Evaluation of 89 patients with stones confined to the renal pelvis treated both with and without ultrasonic lithotripsy were evaluated with regard to stone size, retained fragments, stone composition and previous renal surgery. It is felt that it is not the use of ultrasonic lithotripsy that leads to longer hospitalization and retained fragments, but rather the size of the renal calculi and the complexity of arrangement.

Evaluation Studies as Topic↗

Evaluation of the relative inhibitory potential of fractionated urinary macromolecules.

UNLABELLED: Ultrafiltration membranes of 10,000 d, 1,000 d and 500 d were used to remove urinary macromolecules from the urine of normal subjects and from the urine of stone forming patients. The filtrated urines were examined for their residual inhibitory potential for calcium-oxalate precipitation, by the discrimination method of Sarig et al. (D.I. test). The results of testing the filtrate were complementary to the information gained by analyses of retentates obtained in successive ultrafiltration. The method has an inherent advantage because the manipulation of solids retained on membranes may inadvertantly modify their inhibitory potential. At least two distinct groups of inhibitors were found in 20 normal urines. The first group has MW above 10,000 d while the second group of inhibitors has MW in the range of 500-1,000 d. The mean of the D.I. values increased dramatically from the normal range (less than 0.6) to the stone former range (greater than 1.1) (p less than 0.001) after the 500 d filtration. Some of the normal urines, even after the 500 d filtration, still had a degree of inhibitory potential. This inhibitory potential may be related to the inorganic compounds which were found in the urines. The inhibitory activity of macromolecules with MW above 10,000 d and below 500 delta was negligible in 7 stone formers (SF) urines. The relative contribution of 500-1,000 d macromolecules is the highest both in SF and normal urines. CONCLUSIONS: 1) inhibitors in human urine are of wide range in MW; 2) stone formers and normals differ in the level of inhibitor activity at all MW ranges; especially in above 10,000 d and below inhibitors.

Calcium Oxalate↗

Ureterocutaneous fistulas secondary to urinary calculous disease.

Fistulas of the ureter are uncommon and are usually secondary to trauma or iatrogenic in nature. Spontaneous rupture of the ureter is rare, usually ending in a periureteral abscess. Two cases of spontaneous rupture of the ureter secondary to calculous disease resulting in ureterocutaneous fistulas are described.

Aged↗

Examination of the urinary potential of hyperuricosuric patients to retard calcium oxalate precipitation.

In the present study it has been found that hyperuricosuric calcium oxalate (CaOx) stone formers do not differ from idiopathic CaOx stone formers in their urines' potential to retard in vitro precipitation of CaOx. On the other hand, urines of hyperuricosuric patients with no history of CaOx stone formation have the same potential to inhibit CaOx precipitation as those of normal controls. Reduction of urinary uric acid concentrations by either incubation of specimens with sodium urate or by treatment of hyperuricosuric patients with allopurinol had no effect on the urines' potential to retard CaOx precipitation.

Allopurinol↗

Ileourethral fistula following cystectomy: a rare complication.

Fistulae between the urinary and intestinal tracts of adult male patients usually result from trauma, inflammatory diseases, necrosis and infiltration of a neoplasm of either the bladder, prostate or colon, or radiation therapy. We report 2 patients who developed an ileourethral fistula following cystectomy which had been performed for carcinoma of the bladder in 1 patient and leukoplakia of the bladder in the other. The diagnosis of an ileourethral fistula was established by retrograde urethrography and a barium follow-through study. Computed tomography performed in 1 patient showed a tumor mass in the pelvis.

Aged↗

Change in inhibitory potential in urine of hyperuricosuric calcium oxalate stone formers effected by allopurinol and orthophosphates.

Allopurinol and orthophosphates were used in the treatment of 25 hyperuricosuric calcium oxalate stone formers. Their urines were tested by the Discriminating Index method, which measures the potential of a urine to retard calcium oxalate precipitation in vitro. The tests were performed before any treatment was begun and about 10 days after the commencement of drug intake. An insignificant effect by allopurinol and a markedly significant effect of orthophosphates on Discriminating Index were found. In a few of the patients, allopurinol seemed to cause a decrease in the urine's potential to retard calcium oxalate precipitation. Therefore the effect of allopurinol in 11 hyperuricosuric patients with no history of calcium oxalate stone formation was tested. In 5 of the 11 patients, the urine's potential to retard calcium oxalate precipitation decreased to levels similar to those of calcium oxalate stone formers. The results of this study suggest that hyperuricosuric calcium oxalate stone formers suffer from the same yet-undefined etiology of stone formation as other calcium oxalate stone formers. The results also question the role of uric acid in calcium oxalate stone formation and the efficacy of allopurinol in preventing this disease. It is suggested that allopurinol may even be related to stone formation in some patients.

Allopurinol↗

Squamous cell carcinoma presenting 10 years after cystectomy for leukoplakia.

Leukoplakia of the bladder is widely accepted as a precancerous lesion. We describe a patient in whom squamous cell carcinoma presented as an enterourethral fistula 10 years after cystectomy for leukoplakia of the bladder. During cystectomy we left most of the prostate and posterior urethra intact to preserve potency. In view of this case we recommend that in patients with bladder leukoplakia in whom ablative surgery is being contemplated a complete cystoprostatectomy be performed and a urethrectomy be considered seriously.

Adult↗

Solcoderm in the treatment of genital and perianal condylomata acuminata.

Solcoderm, a new topical agent, was used in the treatment of genital and anal cutaneous condylomata in 11 patients. This is a relatively inexpensive form of treatment, which may be used in any office practice setting with no need for anesthesia and very few side effects. The success rate of 100% warrants its further use in the treatment of this disease entity.

Acetates↗

Percutaneous venography and occlusion in the management of spermatic varicoceles.

Spermatic venography was performed in 140 patients; the main indications were subfertility and abnormal spermatogenesis. Of these 140 patients, 113 had positive examinations, with 33 of them having bilateral varicoceles. Of 146 total varicoceles demonstrated, 42 were found on the right side; the advantage of using the jugular vein approach in both the diagnosis and percutaneous treatment of these cases is stressed. Of the 146 varicoceles, 128 were successfully occluded using spring coils. Because of the frequency of bilateral subclinical varicoceles, spermatic venography and percutaneous embolization is recommended in all men with subfertility and oligoteratoasthenospermia.

Adolescent↗

Rhabdomyosarcoma of the cord: ultrasonic evaluation.

A rare case of paratesticular rhabdomyosarcoma in a young adult is described, emphasizing the role of ultrasonic preoperative examination in evaluating the consistency and extension of the scrotal mass for surgical management.

Adult↗

Prophylactic antimicrobial treatment in transurethral prostatectomy. How long should it be instituted?

Eighty-one patients with proved preoperative sterile urine and undergoing transurethral resection of the prostate were studied. The patients were divided into 3 groups: group A received sulfamethoxazole-trimethoprim (ST) preoperatively and postoperatively for ten days; group B received ST in 2 divided doses, one pre- and one postoperatively; group C received no prophylaxis. In groups A and B, we found urinary infection in 3.8 per cent of patients compared with 32 per cent in group C. Performing prostatic chip cultures, we found that most urinary infections were unrelated to a prostatic source. When the prostate was infected, 75 per cent had infected urine postoperatively. We believe that prophylactic antimicrobial treatment should be given to all patients undergoing transurethral prostatectomy. However, it seems that immediate perioperative treatment suffices.

Aged↗

Management of unilateral reflux by ipsilateral ureteroneocystostomy--is it sufficient?

The records of 105 patients who had undergone unilateral reimplantation for ipsilateral reflux were reviewed. Patient age, grade of preoperative reflux, completely duplicated collecting systems, preoperative findings of contralateral dilatation of the lower ureter or radiographic evidence of pyelonephritis had no predictive value in regard to the appearance of postoperative contralateral reflux. Of the 105 patients 16 had postoperative contralateral reflux: neurogenic problems were found later in 3, reflux resolved spontaneously within 18 months postoperatively in 9, 1 remains in followup and 3 have undergone repeat operations, for a rectified rate of treatment failure of 3 of 102 (2.9 per cent).

Adolescent↗

Urinary infections following transurethral resection of bladder tumors--rate and source.

The incidence of urinary infection and its source after transurethral resection of bladder tumors were investigated. Patients undergoing transurethral prostatectomy constituted the control group. All patients had proved preoperative sterile urine and did not receive any antimicrobial treatment. The incidence of urinary infection following transurethral resection of bladder tumors was 19.4 per cent, with an incidence of positive tumor chip cultures of 3.2 per cent. The incidence of urinary infection after transurethral prostatectomy was 32 per cent, with an incidence of positive prostate chip cultures of 8 per cent. We concluded that the source of urinary infection following transurethral resection of bladder tumors and transurethral prostatectomy in most cases is not from within the tissue but rather from perioperative manipulations.

Humans↗