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D M Newman

Publications and source records attributed to D M Newman.

At least 37 records · Page 2Linked to original sources
PubMed1988

Extracorporeal shock wave lithotripsy-induced perirenal hematomas.

Subcapsular or perirenal bleeding is the most commonly experienced adverse effect directly attributable to externally applied shock waves. The first consecutive 3,620 extracorporeal shock wave lithotripsy treatments with the HM3 Dornier lithotriptor at our institution resulted in 24 hematomas in 21 patients, for an incidence of 0.66 per cent. Various factors associated with treatment were examined. The number of shock waves (up to 2,000) and voltage up to 24 kv. did not correlate with the development of hematoma. Coagulation studies were normal in all patients with hematomas. There was no correlation of patients size and weight, or stone size, number or location with the occurrence rate of perinephric hematoma. Patients with pre-existing hypertension, particularly those with unsatisfactory control of hypertension, had a significantly increased incidence of perinephric hematoma. The incidence of hematoma in hypertensive patients was 2.5 per cent and it increased to 3.8 per cent in patients with unsatisfactory control of hypertension. Therefore, pre-existing hypertension is a significant risk factor in the occurrence of post-extracorporeal shock wave lithotripsy bleeding. The incidence of perinephric hematoma also was increased in patients with pre-treatment urinary tract infection and those who underwent simultaneous bilateral treatment. Management of post-extracorporeal shock wave lithotripsy bleeding generally is conservative although a third of the patients required transfusion.

Female↗
PubMed1987

Comparison of results and morbidity of percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy.

Two new therapies, percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy, are revolutionizing the treatment of upper urinary tract calculi. We report the success and morbidity rates in 110 patients undergoing percutaneous nephrostolithotomy and 982 patients treated with extracorporeal shock wave lithotripsy. Staghorn calculi were excluded from this series. The over-all success rate (free of stones plus small asymptomatic residual fragments) was comparable with both modalities (percutaneous nephrostolithotomy 98 per cent and extracorporeal shock wave lithotripsy 95 per cent), although the presence of residual fragments was more common in kidneys treated with extracorporeal shock wave lithotripsy (24 versus 7 per cent). Patient morbidity as measured by temperature elevation, length of postoperative stay, pain and blood loss was significantly less (p less than 0.05) with extracorporeal shock wave lithotripsy than with percutaneous nephrostolithotomy. Re-treatment rates were similar with both procedures, and tended to increase in relation to increasing stone size and stone number. Post-treatment ancillary procedures (cystoscopy and stone manipulation, and percutaneous nephrostomy) were used more frequently with extracorporeal shock wave lithotripsy. Because of its efficacy and low morbidity, we conclude that extracorporeal shock wave lithotripsy is the treatment of choice for upper urinary tract calculi less than 2 cm. in diameter. However, percutaneous nephrostolithotomy will continue to have a primary role in the management of larger stones and cystine stones, and it will be used as a secondary procedure after unsuccessful extracorporeal shock wave lithotripsy treatments. In addition, because of the complimentary nature of these 2 new technologies certain complex stones, such as staghorn calculi, may be handled best by a combination of the 2 techniques.

Fever↗
PubMed1987

Management of upper ureteral calculi with extracorporeal shock wave lithotripsy.

The results of 471 extracorporeal shock wave lithotripsy treatments in 465 patients with solitary ureteral stones managed by several different techniques are reported. In situ treatment was performed in 123 cases without instrumentation and in 47 after placement of a ureteral catheter. Retrograde stone manipulation was performed in 245 cases immediately before extracorporeal shock wave lithotripsy and an additional 56 were manipulated with ureteral stent placement at least 1 week before extracorporeal shock wave lithotripsy. The success rate was significantly greater if the stone was manipulated into the kidney before extracorporeal shock wave lithotripsy. Significantly less energy (p less than 0.0001) was required for complete disintegration if the stone was free floating in the kidney. The need for subsequent procedures was significantly less (p less than 0.0001) for stones manipulated successfully into the kidney. Complications were infrequent, with the most common being ureteral perforation in 5.1 per cent of the cases, all of which were managed conservatively. Extracorporeal shock wave lithotripsy is the treatment of choice for proximal ureteral calculi because it is less morbid than percutaneous approaches and provides significantly better results than ureteroscopy. An attempt at manipulation of proximal ureteral calculi back into the kidney should be made before extracorporeal shock wave lithotripsy.

Adolescent↗
PubMed1987

Extracorporeal shock-wave lithotripsy.

Analysis of our data clearly demonstrates that morbidity, secondary treatment, post-treatment manipulations, and failure of treatment increase as the stone size increases because of the increased stone fragment burden. Patients whose stone burden was less than 2 cm clearly had less morbidity. Composition of the stone may also alter the success of treatment (with cystine, calcium oxalate monohydrate, and brushite stones being resistant to treatment). However, post-treatment morbidity and complications were observed in all categories. Perirenal hematomas are unpredictable by current preoperative testing. Obstruction with pain can occur any time after treatment but usually occurs within the first 48 hours in the majority of patients. Only 1 per cent of our patients required hospitalization in another institution after discharge. Ambulatory ESWL requires that staff at the facility or a urologist be able to observe and appropriately follow the patient for 24 to 48 hours after treatment.

Adult↗
PubMed1986

Extracorporeal shock wave lithotripsy experience in children.

Extracorporeal shock wave lithotripsy treatment for calculi of the upper urinary tract was performed in 15 children between 3 and 17 years old. Success was achieved in 93 per cent of the cases (72 per cent were free of stone and 21 per cent had insignificant fragments). No major complications were encountered in the series.

Adolescent↗
PubMed1986

Extracorporeal shock wave lithotripsy in patients with a solitary kidney.

Extracorporeal shock wave lithotripsy was used to treat 68 patients with renal calculi in a solitary kidney. Epidemiological information, including stone number, size and location, was similar to that of other patients treated with extracorporeal shock wave lithotripsy. Renal function as measured by serum creatinine changed negligibly in the majority of the patients. Three patients had transient serum creatinine elevations greater than 2 mg. per dl. that were caused by obstruction from stone fragments. There were 2 perirenal hematomas that required transfusion. One patient required retrograde manipulation of a ureteral stone before extracorporeal shock wave lithotripsy, while 6 required stone manipulations after therapy for steinstrasses. Of 59 patients evaluable after extracorporeal shock wave lithotripsy 58 (98.3 per cent) had a successful result: 38 (64.4 per cent) were completely free of stones and 20 (33.9 per cent) had clinically insignificant residual fragments. Extracorporeal shock wave lithotripsy is effective and safe in a solitary renal unit. We believe that in most patients it is the procedure of choice. Attention to fever, urine output and fragment size perioperatively is crucial.

Adolescent↗
PubMed1986

Ureteral stone management: emerging concepts.

A total of 206 procedures was performed on 193 patients with ureteral calculi. The success rate was 62 per cent for stones proximal to the pelvic brim and 94 per cent for stones distal to the pelvic brim (87 per cent success over-all). Of the procedures 61 were done for fragments lodged in the ureter following extracorporeal shock wave lithotripsy. Ureteroscopy was done in 147 cases. Our current management concepts (including extracorporeal shock wave lithotripsy) for proximal and distal ureteral calculi are presented.

Adult↗
PubMed1986

Cost analysis of extracorporeal shock wave lithotripsy relative to other surgical and nonsurgical treatment alternatives for urolithiasis.

The impact and associated costs of new urolithiasis treatment methods, including extracorporeal shock wave lithotripsy (ESWL), were examined in a series of 1781 patients treated between March 1, 1983, and February 28, 1985. An accounting cost methodology was used to derive estimates of direct and indirect hospital costs, as distinct from charges billed to the patient. The average hospital cost per case for ESWL was lower by 27% and significantly different (P less than 0.05) than the average cost for surgically treated patients. The difference in cost between ESWL and percutaneous lithotripsy was not statistically significant. The invasiveness of the treatments studied was directly related to length of hospital stay and cost. Projecting our findings to the entire urolithiasis population of the United States, we estimate that the usage of ESWL, if applied only to patients who would otherwise receive surgery, could result in an annual hospital cost savings of $124,436,520. We conclude that although the institutional cost of acquiring ESWL is high, its application results in a significant cost savings for patients previously requiring surgery, it is no more expensive than percutaneous stone removal, and it has the advantage of being less invasive than any other treatment method. The potential national savings in health care costs may not be realized if the indications for this less invasive technology are defined more broadly than are those for open surgical procedures, as seems likely, and unless limits are placed on the number of lithotripters made available nationally. Indications for ESWL need to be clearly defined based on careful studies of risks, potential benefits, and costs.

Accounting↗
PubMed1980

The myth of goiter in pregnancy.

A common belief is that pregnancy causes goiter. Forty-nine matched pairs each consisting of a pregnant and a nonpregnant woman were examined by means of a blind, multiple-observer design. In 22 pairs the pregnant woman had the larger thyroid, whereas in 20 pairs the opposite was true. In six pairs the thyroid glands were not palpable, and in one pair the thyroid glands were of equal size. Five pregnant and three nonpregnant women had clinically significant goiters. None of the differences was statistically significant. No significance appeared when the data were controlled for race, age, body weight, or family history of thyroid disease. Therefore, goiter in pregnancy should be considered to be a pathologic condition in an iodine-replete population.

Female↗
PubMed1976

Use of radioisotope scan in evaluation of intrascrotal lesions.

There were 98 patients with a variety of intrascrotal lesions studied with a radioisotope 99mtechnetium-pertechnetate scanning technique. Retrospective analysis in 50 patients subjected to an operation revealed a 94 per cent accuracy of the scan in the differential diagnosis of testicular torsion and epididymitis as compared to a clinical accuracy of 48 per cent. In 7 patients with a scan diagnosis of epididymo-orchitis with abscess the diagnosis was confirmed during the operation or by followup examination. While the scan has been a simple, safe, rapid and reliable technique to differentiate acute and subacute lesions, it has proved to be of limited diagnostic significance in cases of chronic intrascrotal lesions and carcinoma.

Adolescent↗