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D S Elliott

Publications and source records attributed to D S Elliott.

At least 37 records · Page 2Linked to original sources
PubMed1999

Salvage of the head of the radius after fracture-dislocation of the elbow. A case report.

We describe a patient with a Mason type-III fracture of the head of the radius associated with traumatic dislocation of the elbow. The radial head was intact throughout its circumference despite being completely detached from the shaft and devoid of any soft-tissue attachments. Severe comminution of the radial neck prevented reconstruction by internal fixation and precluded prosthetic replacement of the head. The head was fixed to the shaft with a tricortical iliac-crest bone graft which replaced the neck. Two years later, the patient had a stable elbow with flexion from 10 degrees to 130 degrees. Radiologically, the head of the radius appeared to be viable and the bone graft had incorporated.

Bone Transplantation↗
PubMed1998

The artificial urinary sphincter in the female: indications for use, surgical approach and results.

Female urinary incontinence is a common problem. Among the many treatment options a few patients may be suitable candidates for the artificial urinary sphincter (AUS). The indications for placement of an AUS are much more common in males: however, we review the indications, technique and potential complications of the AUS in the female population. Although few indications exist for the placement of an AUS in women, if proper patient selection is made, with strict adherence to proper surgical technique, it can be a suitable treatment option for those suffering from sphincteric incontinence.

Female↗
PubMed1998

The use of non-absorbable suture in the fixation of patellar fractures: a preliminary report.

We describe the use of a non-absorbable, braided, polyester suture, 5 Ti-Cron (Davis and Geck, Gosport, Hampshire), for the fixation of patellar fractures as an alternative to stainless steel wire. Seven patients had their fractures fixed with this material and all progressed to union with good restoration of knee function. The ease of use of the suture allowed accurate reduction of the fractures and reduced operative and tourniquet time. None of the patients suffered significant complications from the procedure although two patients required removal of the suture because of knot symptoms. This was easily performed under local anaesthetic on an out-patient basis. We believe that non-absorbable suture is a good substitute for stainless steel wire and reduces the need for a second procedure for wire removal.

Adult↗
PubMed1998

Postprostatectomy urinary incontinence: a comparison of the cost of conservative versus surgical management.

OBJECTIVES: Post-radical prostatectomy stress incontinence occurs in up to 20% of patients. Postprostatectomy incontinence is initially treated with undergarments, pads, or drip collectors. Patients with persistent leakage are often treated with a transurethral bulking agent (Contigen) or placement of an artificial genitourinary sphincter (AGUS). We have compared the direct costs of each treatment at our institution over 10 years. METHODS: The Mayo Clinic estimating office provided the Medicare and non-Medicare charges for patients receiving both collagen injection (outpatient) and AGUS placement (2-day hospitalization) during August 1995. The Mayo Store provided the current price of all undergarments, pads, and drip collectors carried. Two local grocery stores provided the cost of Depends undergarments. RESULTS: The following items were the least expensive carried at the Mayo Clinic Store: Entrust undergarments, Active Style pads, and Conveen drip collectors at $0.99, $0.52, $1.05 each, respectively. The average cost of Depends undergarments was $0.52 each. The cost of wearing 5 of the least expensive undergarments or pads per day for 10 years is $9497. The average estimated Medicare and non-Medicare cost for outpatient (general anesthesia) collagen injection is $4300 and $5625, respectively. The average Medicare and non-Medicare cost for AGUS placement is $15,400 and $20,300, respectively. Factoring in our current 22.4% reoperation rate, the average per patient Medicare and non-Medicare cost for AGUS placement is $18,850 and $24,847, respectively. CONCLUSIONS: The cost of the AGUS placement compares favorably with the cost of transurethral collagen injection (under general anesthesia) in patients requiring several (more than three) collagen injection treatments or requiring the continued use of undergarments after collagen injection. Whereas the cost of transurethral collagen injection, when effective, compares favorably with conservative treatment, AGUS placement is significantly more expensive than conservative management for almost all patients except the exceedingly rare patient wearing more than 9 undergarments or pads per day. When the psychosocial benefit of urinary continence is considered, however, transurethral injection of collagen or AGUS placement often becomes the preferred treatment.

Ambulatory Surgical Procedures↗
PubMed1998

An implantable mechanical urinary sphincter: a new nonhydraulic design concept.

OBJECTIVES: We present data concerning an artificial implantable mechanical urinary sphincter that was designed to eliminate the inherent problems of the current hydraulic artificial urinary sphincter (American Medical System [AMS] 800). Our goal was to design a sphincter that creates urethral compression similar to the AMS 800 but creates the force without the use of fluid, thereby eliminating as much as 50% of the reoperations seen with the AMS 800, which occur because of fluid-related malfunctions. METHODS: An implantable artificial mechanical sphincter consisting of a compressive coil encompassed in a polytetrafluoroethylene sheath was devised and tested in 6 live mongrel dogs to establish compressive force versus bladder pressure data, so as to provide data to create a mechanical sphincter for use in humans. RESULTS: A direct relationship between bladder leakage pressure and cable tension force was demonstrated in all 6 experimental animals, thereby creating a mathematical equation that can be used by mechanical engineers to design a mechanical sphincter for use in humans. CONCLUSIONS: This study demonstrated that a mechanical urinary sphincter can be created that will provide continence and eliminate the problems associated with the hydraulic aspect of the AMS 800. In doing so, nearly 50% of the reoperations seen with the current AMS 800 can be eliminated, thereby improving the quality of life of patients for whom an artificial urinary sphincter is indicated.

Animals↗
PubMed1998

Mayo Clinic long-term analysis of the functional durability of the AMS 800 artificial urinary sphincter: a review of 323 cases.

PURPOSE: We determine the long-term durability of the AMS 800* artificial urinary sphincter in the correction of severe urinary incontinence, and evaluate mechanical versus nonmechanical failure and reoperation rates before (1983 to 1987) and after (1988 to present) the introduction of the narrow backing occlusive cuff design. MATERIALS AND METHODS: From January 1983 to October 1994 more than 400 patients received an AMS 800 artificial urinary sphincter placed by 1 surgeon and 323, mean age 60.4 years, met study requirements for review. Mean followup was 68.8 months (range 18 to 153). Only patients with a minimum of 18 months of followup were included in the study. Of the 313 men and 10 women in the study group sphincters were placed at the urethra in 272 and at the bladder neck in 51. All patients were followed from surgery to the date of sphincter failure. Etiology of the failures was recorded and divided into mechanical versus nonmechanical sphincters placed before and after the introduction of the narrow backing cuff. RESULTS: Overall, 58 of the 139 patients (42%) in the pre-narrow backing cuff group versus 31 of the 184 (17%) in the narrow backing cuff group required a first reoperation. Mechanical failure occurred in 29 cases (21%) with the pre-narrow backing and 14 (7.6%) with the narrow backing cuff. Nonmechanical failure developed in 24 cases (17%) with the pre-narrow backing and 17 (9%) with the narrow backing cuff. Ultimately 437 operations were required in the 323 patients, of whom 234 (72%) required no further surgical intervention at a mean followup of 68.8 months. CONCLUSIONS: Technological advances in the design and construction of the AMS 800 have dramatically decreased the reoperation and failure rates. These advances and improved surgical techniques provide an excellent long-term solution and increased continence in correctly selected patients with urinary incontinence.

Female↗
PubMed1997

Long-term followup and evaluation of primary realignment of posterior urethral disruptions.

PURPOSE: We analyzed the long-term results of treatment of posterior urethral disruptions with immediate primary realignment. MATERIALS AND METHODS: A total of 57 patients with posterior urethral disruptions (56 complete and 1 partial) underwent primary urethral realignment within 6 hours after injury. Pelvic fractures were present in 52 patients. In all cases the actual operating time for realignment was 1.25 hours or less. All patients were evaluated postoperatively for incontinence, impotence and strictures. Mean followup was 10.5 years (range up to 40 years) after injury and 53 patients were available for long-term followup. RESULTS: Erections-42 of 53 patients (79%) reported no erectile dysfunction, 7 (13%) reported decreased quality of erection but required no treatment and 4 (7.5%) had erectile dysfunction requiring treatment. Incontinence-2 of 53 patients (3.7%) reported mild post-realignment stress incontinence. Both patients did not need treatment for incontinence or protective padding. Strictures-18 of 53 patients (34%) had evidence of post-realignment strictures and required no further urethral dilation or surgical intervention. Mean followup for these 18 patients was 12 years 2 months. A total of 36 patients (68%) had post-realignment strictures; however, 23 (43.4%) were considered to have mild strictures that were observed or easily managed with in-office dilation. Mean followup for these patients was 8.5 years. Of the 53 patients 13 (24.5%) had more significant strictures that required a repeat procedure using general anesthesia. A total of 20 procedures was required to treat the 13 patients. Of the 20 procedures done using general anesthesia 16 (80%) were completed on an outpatient basis. The remaining 4 patients required urethroplasty. Mean followup of the 13 patients was 11 years 9 months. CONCLUSIONS: Immediate primary realignment resulted in negligible intraoperative morbidity, and acceptably low incidences of impotence, incontinence and symptomatic strictures.

Adolescent↗
PubMed1996

Long-term follow-up of endoscopically treated upper urinary tract transitional cell carcinoma.

OBJECTIVES: This report focuses on the long-term follow-up of patients with endoscopically treated upper tract transitional cell carcinoma (TCC) to determine the effectiveness of endoscopic therapy. METHODS: From May 1983 to April 1994, 44 patients with TCC of the upper urinary tract underwent conservative endourologic treatment with either electrocautery fulguration or neodymium:yttrium-aluminum-garnet laser at our institution. The mean follow-up period was 5 years (range, 3 months to 11 years). RESULTS: Renal pelvic tumor sizes ranged from 0.4 to 4.0 cm (mean, 1.5) and ureteral tumors from 0.2 to 1.0 cm (mean, 0.5). The majority of tumors were of pathologic grade 3 or less, and all were Stage T2 or less. Seventeen of 44 patients (38.6%) had local tumor recurrence (mean time to recurrence, 12.8 months; range 1.5 to 64). Mean recurrence time was 7.3 months for renal pelvic tumors and 17.8 months for ureteral tumors. Nineteen of 44 patients (43.2%) developed bladder tumors. The overall 5-year disease-free rate was 57%. No recurrent tumor was shown to have increased in grade, and one recurrent tumor was proved to have progressed in stage. Six patients (14%) ultimately required a nephroureterectomy for recurrence. There were no major complications as a result of endoscopic therapy. Six patients (14%) died of the effects of metastatic TCC, 5 of whom had known muscle invasive bladder TCC. CONCLUSIONS: Endourologic techniques and the conservative treatment of upper urinary tract TCC is an evolving field and can be safely and effectively used as a first-line treatment for upper tract TCC in selected patients.

Aged↗
PubMed1994

Metastatic testicular choriocarcinoma and secondary hyperthyroidism: case report and review of the literature.

We report on a 16-year-old boy with metastatic testicular choriocarcinoma, increased levels of human chorionic gonadotropin and profound hyperthyroidism bordering on thyroid storm. Hyperthyroidism was secondary to elevated human chorionic gonadotropin, with a thyroid-stimulating hormone effect. Management consisted of suppressive therapy for the symptoms of thyrotoxicosis until chemotherapy achieved control of the primary tumor and elevated levels of human chorionic gonadotropin. Review of the urological literature demonstrated a lack of recognition of this potentially serious paraneoplastic syndrome and its management.

Adolescent↗
PubMed1992

Radiologic placement of peritoneal dialysis catheters: preliminary experience.

The authors percutaneously placed 45 catheters for peritoneal dialysis in 32 patients, aged 31-83 years, in a radiology department. In all patients, the procedure was modified by use of the Hawkins needle, and in response to the high frequency of extrusion of the proximal cuff, the deep cuff of the 16th and each subsequent catheter was sutured to the rectus muscle or fascia. After 17 catheters were placed, the catheter was modified with a permanent bend, or "U" neck, between the two cuffs, which were then thickened. All procedures were performed with use of local anesthesia, and all catheters were successfully placed. Acute complications included bowel perforation associated with peritonitis in one patient (2%). Delayed complications included cuff extrusion in nine patients (20%), obstruction in nine patients (20%), and peritonitis requiring removal of the catheter in three patients (7%). This study shows the feasibility of percutaneous placement of peritoneal dialysis catheters by radiologists despite the need for improved technique and equipment.

Catheterization↗
PubMed1988

Experimental Studies on Lateral Root Formation in Radish Seedling Roots: II. Analysis of the Dose-Response to Exogenous Auxin.

Application of indoleacetic acid (IAA) and other auxins causes cultured radish (Raphanus sativus L. ;Scarlet Globe') seedling root segments to produce an increased frequency (FR, no. cm(-1)) of lateral roots (LR); in the absence of auxin, segments spontaneously form about 6 LR cm(-1). A dose-response study has revealed that the increase in FR follows a biphasic Michaelis-Menten relationship with the medium concentration of the undissociated form of IAA ([IAAH](m)). The fitted curve for phase I has a maximum response level (R(max)) of 5.2 LR per centimeter above the spontaneous FR; the [IAAH](m) giving half-maximal response (C(1/2)) is 21 nanomolar. For phase II, the values for R(max) and C(1/2) are 56 LR per centimeter and 11 micromolar, respectively. The response is variable in the transition concentration region between the two phases; in that region (but not, or much less commonly, at higher or lower [IAAH](m)), LR initiation may resume or continue after the first day. At and above 100 micromolar [IAAH](m), the roots are hyperstimulated and generally fail to respond. The developmental stage of LR formed in medium with very low [IAAH](m) (10 nanomolar) is enhanced compared to LR formed in medium lacking auxin; the stage is diminished at higher auxin levels, in inverse correlation with FR. Trends in the responses to NAA and IBA were similar, but NAA required only 0.03 times the dose of IAA, while IBA required 6 times the dose of IAA. These findings may be of use in a search for possible auxin receptors involved with LR initiation.

Journal Article↗
PubMed1986

Concurrent and predictive validity of components of disordered thinking in schizophrenia.

Although the various manifestations of disordered thought have played a central role in diagnostic and theoretical considerations of schizophrenia, such symptoms have not been found specific to schizophrenia, and at best have shown weak relations to outcome. As part of a 7-year followup study of a sample of young, acute, psychotic inpatients, we explored the hypothesis that despite these poor results there might be particular components of disordered thought that might have prognostic utility and be able to discriminate narrowly defined schizophrenics. Using extant symptom scales as our models, we constructed five internally consistent scales of disordered thought from behavioral ratings made using the Psychotic Inpatient Profile--Poverty of Speech, Attentional Impairment, Incoherence, Delusions, and Hallucinations. We tested the ability of these scales to predict various aspects of outcome adaptation including outcome diagnosis. In general, the Attentional Impairment scale demonstrated the best prognostic utility, predicting poorer outcome in several domains. Paradoxically, patients diagnosed by Research Diagnostic Criteria (RDC) as definite schizophrenic at outcome had been rated as showing less attentional impairment than probable and nonschizophrenics. An examination of the pattern of correlations between Attentional Impairment and performance on cognitive tasks suggested that attentional difficulties may be related to different underlying cognitive processes in those diagnosed schizophrenic and nonschizophrenic at outcome by RDC.

Adult↗