Biomedical subjects

David E Rapp

Publications and source records attributed to David E Rapp.

30 records · Page 2Linked to original sources

PubMed2005

Necrotic pancreatic graft causing acute urinary retention.

Urologic complications are frequently encountered after pancreas transplantation with a graft duodenocystostomy. Urinary infections, hematuria, and irritative voiding symptoms are some of the most frequent complications with a bladder-drained pancreas allograft. While voiding dysfunction is common in these patients due to underlying neuropathy, to our knowledge, we report the first case of obstructive uropathy in a female due to retained necrotic graft material.

Adult↗

PubMed2005

The core learning objectives education model: an approach to the teaching of core concepts in the clinical clerkship.

INTRODUCTION AND OBJECTIVE: The classical approach to the undergraduate medical clerkship has several limitations, including variability of clinical exposure and method of examination. As a result, the clerkship experience does not ensure exposure to and reinforcement of the fundamental concepts of a given specialty. MATERIALS AND METHODS: This article reviews the classic approach to clerkship education within the undergraduate medical education. Specific attention is placed on clinical exposure and clerkship examination. RESULTS: We describe the introduction of the Core Learning Objective (CLO) educational model at the University of Chicago Section of Urology. This model is designed to provide an efficient exposure to and evaluation of core clerkship learning objectives. CONCLUSIONS: The CLO model has been successfully initiated, focusing on both technical and clinical skill sets. The proposed model has been introduced with positive initial results and should allow for an efficient approach to the teaching and evaluation of core objectives in clerkship education.

Clinical Clerkship↗

PubMed2004

Use of botulinum-A toxin for the treatment of refractory overactive bladder symptoms: an initial experience.

OBJECTIVES: To define the role of botulinum toxin type A (botulinum-A) intradetrusor injections in the treatment of patients with symptoms of bladder overactivity in whom previous anticholinergic therapy has failed. METHODS: Thirty-five patients (29 women and 6 men) with frequency, urgency, and/or urge incontinence received 300 U of botulinum-A toxin injected transurethrally at 30 sites within the bladder. Patients were evaluated at 3 weeks and 6 months after treatment by completion of the short forms of the Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6), as well as questions assessing global response to the treatment. RESULTS: After 3 weeks, the mean IIQ-7 score decreased from 19.4 to 13.9 (P = 0.0006) and the mean UDI-6 score decreased from 16.8 to 12.8 (P = 0.0003). Overall, 21 (60%) of 35 patients reported slight to complete improvement of voiding symptoms after 3 weeks. Among the initial responders followed up for 6 months, the mean IIQ-7 score improved from 20.6 to 15.1 (P = 0.008) and the mean UDI-6 score improved from 16.9 to 13.5 (P = 0.008). Mild hematuria, pelvic pain, and dysuria were seen in 7 patients, lasting for 3 days or less after the procedure. CONCLUSIONS: Botulinum-A toxin injections may provide improvement in symptoms associated with bladder overactivity in a subset of patients. Improvement may be seen for at least 6 months after treatment. The procedure was well tolerated with minimal side effects. Additional study to define the role of injections in a broad group of patients with irritative voiding symptoms is warranted.

Adult↗

PubMed2004

Malignant B-cell lymphoma in renal cyst wall.

Renal cysts are frequently found in adults older than 50 years of age. Bosniak type III and IV cysts are commonly associated with malignancy, but most Bosniak I and II lesions are benign, and the optimal management has not been clearly defined. Although computed tomography and ultrasound examinations have improved diagnostic accuracy, some masses will remain indeterminate and require more invasive evaluation. We report a patient with a Bosniak type II renal cyst associated with malignant B-cell lymphoma in the cyst wall diagnosed after laparoscopic renal exploration.

Humans↗

PubMed2004

En bloc stapling of renal hilum during laparoscopic nephrectomy and nephroureterectomy.

OBJECTIVES: To evaluate the safety and advisability of en bloc mass stapling of the renal pedicle during difficult laparoscopic nephrectomy to avoid conversion to an open procedure. METHODS: A retrospective chart review was performed of 433 consecutive patients undergoing laparoscopic simple or radical nephrectomy or laparoscopic nephroureterectomy between August 1998 and July 2003 by two surgeons. In all cases of en bloc hilar ligation, a stapler was deployed across the renal hilum without individual dissection of the renal artery and vein. RESULTS: The overall incidence of en bloc ligation was 6.0% (26 of 433 patients). The reasons for en bloc ligation were a difficult hilar dissection and/or the appearance of the renal hilum in 21 cases and urgent ligation secondary to bleeding in 5 cases. No correlation was found between surgeon experience and the frequency of en bloc ligation. No immediate or short-term complications related to this method of hilar division were observed with a mean follow-up of 26 months. CONCLUSIONS: In this study, no cases of arteriovenous fistula development occurred after en bloc stapling of the renal pedicle. Long-term follow-up is needed, because arteriovenous fistula development may be a late complication of nephrectomy. Although we do not advocate the generalized use of en bloc division of the renal pedicle, early data suggest that en bloc stapling can be performed to avoid conversion to an open procedure with no related short-term complications.

Arteriovenous Fistula↗

PubMed2004

Use of biopsy sheath to improve standardization of renal mass biopsy in tissue-ablative procedures.

PURPOSE: We used a biopsy sheath to standardize and improve biopsy specimens obtained during laparoscopic cryoablation. MATERIALS AND METHOD: Tru-Cut biopsy was performed using a resized sheath in three patients undergoing laparoscopic cryoablation of renal masses. RESULTS: All three biopsy specimens were sufficient for pathologic evaluation and representative of the tissue mass. CONCLUSIONS: The application of a biopsy sheath to standardize the depth of needle penetration during Tru-Cut biopsy provides better results and minimizes false-negative studies.

Biopsy, Needle↗

PubMed2004

Percutaneous placement of permanent metal stents for treatment of ureteroenteric anastomotic strictures.

PURPOSE: To evaluate the efficacy of permanent metal stent placement in the treatment of ureteroenteric anastomotic strictures following failed balloon dilation or laser endoureterotomy. PATIENTS AND METHODS: Metal stents were placed in six ureteroenteric anastomotic strictures in four patients presenting with recurrent obstruction after balloon dilation or laser endoureteromy. Patients were evaluated at 1 week postoperatively with antegrade ureterography and at 3 to 6 months with renal ultrasound or CT scans. Serum creatinine assays and physical examination were performed at serial postoperative clinic visits. RESULTS: At 1-week follow-up, antegrade studies demonstrated a patent anastomosis in all six strictures. With a mean follow-up of 10 months (range 7-12 months), no stricture recurrence has been seen. All patients have been clinically stable, without episodes of pyelonephritis, flank pain, or need for indwelling stents or nephrostomy tube placement. Serum creatinine concentrations have been stable in all patients. CONCLUSIONS: Metal stents offer a useful treatment option in patients who develop ureteroenteric anastomotic strictures after urinary diversion. Further, such stents may be used in patients failing balloon dilation or laser endoureterotomy. Further study to assess the long-term durability of metal stent placement is needed.

Anastomosis, Surgical↗

PubMed2004

Management of caliceal diverticula.

Although most caliceal diverticula are asymptomatic, they can be associated with pain, and concomitant calculi are common. When treatment is indicated, a variety of surgical options are available, although the management is often a challenge even to the most experienced surgeon. We review the indications, surgical options, and outcomes for the treatment of caliceal diverticula.

Diverticulum↗

PubMed2004

A different look.

Explore the source record for details and available documents.

Cultural Characteristics↗

PubMed2004

Eliminating knot tying during warm ischemia time for laparoscopic partial nephrectomy.

PURPOSE: Rapid intracorporeal suturing represents a challenge when performing laparoscopic partial nephrectomy (LPN). During warm ischemia time (WIT) knot tying is a major time-consuming step. We present our technique of eliminating knot tying during LPN and the outcomes of our initial series. MATERIALS AND METHODS: Between October 2002 and October 2003, 32 patients underwent LPN for clinical T1a renal tumors. Our technique includes initial placement of a 5Fr ureteral catheter for collecting system irrigation. The renal hilum is clamped, the tumor is sharply excised and freehand suturing of the collecting system and renal parenchyma is performed using 2-zero and zero polyglactin sutures prepared with an absorbable clip (LapraTy, Ethicon Endosurgery Inc., Piscataway, New Jersey) at the terminal end. Once the suture is passed an additional clip is used to cinch it down, obviating the need for knot tying. This technique is used for closure of the collecting system as well as for placement of parenchymal compressive sutures over bolsters. Subsequent testing for watertightness with methylene blue solution is performed. RESULTS: Pathological mean tumor size was 2.1 cm (range 0.3 to 4.2). Mean operative time was 224.2 minutes (range 105 to 396). In 21 cases (65.6%) the collecting system was entered, necessitating further suturing. Mean WIT was 33.1 minutes (range 13 to 55) and mean estimated blood loss was 222.7 cc (range 5 to 600). No postoperative bleeding or urine leaks were encountered in this series. CONCLUSIONS: The use of LapraTy clips as an alternative to knot tying in LPN is safe and efficient. It simplifies the procedure and allows completion of the necessary suturing tasks during an acceptable WIT.

Adult↗

PubMed2004

Neobladder-vaginal fistula after cystectomy and orthotopic neobladder construction.

OBJECTIVE: To determine the potential surgical and clinical factors that contribute to the development of neobladder-vaginal fistula (NVF) after cystectomy and orthotopic neobladder (ONB) construction in women. PATIENTS AND METHODS: Of 37 patients who had vaginal-sparing cystectomy, the records of four who developed a NVF after radical cystectomy and ONB construction were reviewed. Retrospective clinical and surgical information was collected, including patient demographics, tumour pathology, surgical technique, presenting symptoms, and method and efficacy of surgical repair. RESULTS: In two of the four patients who developed a NVF a small injury to the anterior vaginal wall was noted during surgery and closed primarily. All patients presented with severe urinary incontinence. The NVF was diagnosed after cystoscopy and/or speculum examination. Three of the four patients had an attempted surgical repair, including one obturator flap interposition, one rectus flap interposition, and one primary two-layer closure. To date, one patient is fistula-free and two were subsequently converted to an ileal conduit or continent cutaneous diversion because the fistula recurred. The fourth patient developed a NVF in association with local tumour recurrence and underwent conversion to an ileal conduit. CONCLUSION: The development of a NVF is a significant complication after cystectomy. Inadvertent injury to the vaginal wall is an important predisposing factor to subsequent NVF development. The repair of a NVF is often difficult; upon diagnosis, conversion to a continent cutaneous urinary diversion may be considered.

Aged↗

PubMedDate not supplied

Well-differentiated papillary mesothelioma occurring in the tunica vaginalis of the testis with contralateral atypical mesothelial hyperplasia.

Well-differentiated papillary mesothelioma (WDPM) occurs rarely in the paratesticular region, with only a handful of published case reports. Often presenting with recurrent hydrocele, WDPM is a multifocal mesothelial proliferation with a predominantly indolent clinical course. Accordingly, pathologic distinction of this lesion from true malignant mesothelioma is crucial, although it may be difficult because of the variability of associated histologic features. In addition, rare cases of WDPM have progressed to malignant mesothelioma, leading to its classification as a tumor of low malignant potential. Here, we report a case of multifocal WDPM occurring in the tunica vaginalis and tunica albuginea, with contralateral atypical mesothelial hyperplasia, a potentially premalignant lesion.

Adult↗