Training in invasive procedures for infectious diseases specialists.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
G J Fuchs
Publications and source records attributed to G J Fuchs.
Fitting growth curve models to longitudinal data with missing observations.
We discuss the analysis of growth curve data with missing or incomplete information. The approach is to fit subject-specific models and then to carry out an analysis in terms of the estimated parameters. This achieves reduction of data and eliminates the need for special considerations for subjects with missing data. Although there is no perfect substitute for complete data, our approach provides a way to handle missing data using a straightforward application of well-known statistical methodology.
Cephalometry↗
[Flexible endoscopy of the upper urinary tract. A new minimally invasive method for diagnosis and treatment].
Retrograde intrarenal surgery (RIRS) utilizing flexible, actively deflectable instruments has become a valuable asset in the diagnosis of upper urinary tract pathology and the treatment of stone disease. Flexible endoscopic surgery of the proximal ureter and in the intrarenal collecting system constitutes the natural extension of rigid instrumentation in the upper urinary tract. At our institution retrograde ureteral and intrarenal surgery has become an +integral part of our diagnostic and therapeutic armamentarium. This is documented by almost 300 treatments and diagnostic procedures performed in the upper urinary tract over the past 3 years.
Carcinoma, Transitional Cell↗
Giant prostatic fossa with misleading radiographic features.
The long-term complication of a perforation of the prostatic capsule during transurethral resection of the prostate is described. Calcifications in a giant prostatic fossa led to initially misleading radiologic findings.
Aged↗
Current state and future developments of noninvasive treatment of human urinary stones with extracorporeal shock wave lithotripsy.
Extracorporeal shock wave lithotripsy has now been in clinical use for 8 years and it has replaced other treatment techniques for the majority of surgical calculi in the upper urinary tract. For the first time it provides a completely noninvasive method for the treatment of renal and ureteral stones. The current range of its indications includes approximately 70 per cent of nonselected urinary stone patients. An additional 25 per cent of the patients with more complex stones in the upper urinary tract can receive treatment with the lithotriptor combined with endourological procedures. More recent additions to the range of clinical routine applications with the original lithotriptor have been its use on common bile duct stones combined with endosurgical or radiological manipulations. With a modified kidney lithotriptor gallstones have been treated successfully, which has led to the development of a multipurpose device for biliary and urinary stones.
Humans↗
Extracorporeal shock-wave lithotripsy of bile duct calculi. An interim report of the Dornier U.S. Bile Duct Lithotripsy Prospective Study.
A multi-institutional study to evaluate the efficacy, clinical application, and safety of extracorporeal shock-wave lithotripsy (ESWL) with the Dornier HM-3 or HM-4 lithotripter for bile duct calculi (BDC) was initiated in September, 1987. Symptomatic patients who entered into this prospective trial had BDC in the common bile duct and/or the intrahepatic, cystic or lobar ducts of the liver that were inaccessible or untreatable by papillotomy or percutaneous stone extraction. The study excluded gallbladder stones. Nasobiliary (54.4%) or transhepatic catheters (10.5%) and T-tube or cholecystostomy tubes (17.5%) or combinations (14.0%) permitted access for radiographic contrast to allow fluoroscopic monitoring of stone position and fragmentation. Exclusion criteria included pregnancy, failure to localize the stone, disturbances of coagulation, pacemakers, or vascular aneurysms or large bones that lie in the focal axis of the shock waves. Eleven institutions treated 42 patients (23 male, 19 female) with BDC; age range was 25 to 95 years (mean +/- SD, 73.5 +/- 13.8) and ASA risk category was 1 to 4 (mean, 2.3 +/- 0.8). Fourteen patients (33.3%) had a single BDC; 28 had 2 to 8 stones (mean, 2.7 +/- 1.8) ranging in size from 6 mm to 30 mm (mean, 18.5 +/- 6.4). The majority (66.7%) of patients were postcholecystectomy. The 42 patients received 57 ESWL treatments consisting of 600 to 2400 shocks per treatment (mean, 1924 +/- 289) at 12 to 22 kV (mean, 18.5 +/- 1.9) administered over 20 to 125 minutes (mean, 52.9 +/- 20.8). General anesthesia was used in 32% of the treatments; the majority were treated with epidural or regional block (42.1%), local infiltration (28.1%), or intravenous sedation (38.6%). Fifteen patients (35.7%) required two ESWL treatments. Stone fragmentation occurred in 94.6% of evaluable patients and in 90.4% of ESWL treatments, respectively; however, BDC fragments remained in 59.5% of patients 24 hours after treatment (diameter less than or to 3 mm, 12%; 4 to 9 mm, 16%; greater than or equal to 10 mm, 68%). Some patients (50%) required adjunctive procedures to achieve stone removal that included endoscopic extraction (n = 10; 47.6%), biliary lavage (n = 8; 38.1%), endoscopic bile duct prosthesis (n = 1; 4.8%), and operation (n = 2; 9.5%). ESWL treatment complications during hospitalization were observed in 15 patients (35.7%) and were present in four (9.5%) at discharge. Complications included macrohematuria (5%), biliary pain (15%), biliary sepsis (5%), hemobilia (10%), ileus (2.5%), and adverse pulmonary changes (7.5%). One patient developed pancreatitis before ESWL at ERCP that resolved prior to discharge.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Case history of a prune-belly syndrome with extracorporeal shock wave lithotripsy treatment of allograft nephrolithiasis.
This is a case history of a prune-belly syndrome with multiple urologic disorders leading to a renal transplant due to a chronic renal failure at age 8. After four allograft pyelolithotomies he was referred to us with a staghorn stone in the same graft. He was successfully treated with extracorporeal shock wave lithotripsy and a percutaneous nephrostomy and is now stone-free.
Child↗
[Complications of extracorporeal shockwave lithotripsy].
The authors reviewed treatments performed worldwide using extracorporeal shock wave lithotripsy since its introduction in West Germany in 1980 to determine the efficacy of this treatment modality and its potential risks. The prevention of complications related to patients or shock wave energy are discussed, as well as the cardiovascular complications related to immersion, prevention of lesions to nearby organs, treatment of ESWL-induced bleeding, treatment of post-ESWL ureteral obstruction, prevention and treatment of infection, and long-term biological effects. Currently, less than 5% of patients are excluded from treatment with ESWL due to technical reasons or increased risk of periprocedural complications. Patients with cardiac pacemakers have been treated safely. Calcifications of the ipsilateral renal artery or aorta are considered only relative contraindications. However, certain technical limitations exist; i.e., the Dornier HM-3 cannot support patients weighing more than 135 kg., and patient height is also a limiting factor. There is an impressively low incidence of complications related to the energy of the shock wave. The severity and extent of damage are dose- and pressure-dependent. The potential for induction of cardiac arrhythmias secondary to the shock wave exists; however, effective prevention is achieved by coupling the shock wave discharge to the electrocardiogram. Complications of immersion are also extremely rare and can be avoided by careful preoperative evaluation. Damage to nearby organs such as pulmonary, gastric, duodenal or colonic contusions, constitute a very infrequent complication. Elevations of liver enzymes have also been noted post-lithotripsy. However, all these changes were transient and had no significant clinical consequences. Management of post-ESWL ureteral obstruction is by endourological procedures.(ABSTRACT TRUNCATED AT 250 WORDS)
Bacterial Infections↗
Transvaginal parametrial needle biopsy for detection of postirradiation recurrent cancer of the cervix.
During the 27-year period from 1956 to 1982, transvaginal parametrial needle biopsies were performed on 76 patients clinically suspected of harboring postirradiation recurrent cervical cancer without mucosal lesions suitable for biopsy under direct vision. Needle biopsies indicated cancer in 41 patients, resulting in 20 abdominal explorations. Eleven of these patients underwent total pelvic exenteration. Three patients survived longer than 5 years. Among 35 patients whose biopsies did not suggest cancer, eight proved to be false-negative as demonstrated by later progression of local and systemic disease. The remaining 27 patients in whom biopsies showed negative results were cured by radiation therapy. Bleeding, easily controlled by vaginal packing, occurred in one patient; in another, a pelvic abscess was drained 7 days after the biopsy. The authors conclude that when judiciously performed, transvaginal parametrial needle biopsy has a high diagnostic yield (89%) with minimal morbidity (2.6%). Its application during the careful observation of patients suspected to harbor recurrence may increase the operability rate and may offer selected patients a chance for cure by radical pelvic surgery.
Adult↗
The in vitro and in vivo effects of extracorporeal shock waves on malignant cells.
The in vitro cytotoxic effect of extracorporeal shock waves (ESW) on renal cell carcinoma (RCC) cells was compared to the effect on normal human embryonic kidney (NHEK) cells. In the in vitro studies cell samples were brought into the second focal point and exposed to different numbers of shock wave impulses. The four parameters of RCC tumor cell injury which were measured, i.e., cell viability, cell growth, cell attachment and electron microscopic evidence of damage, were augmented with increasing SW levels. At 2,000 shock waves (SW) a significant decrease in RCC viability, cell growth and cell attachment was seen compared to the NHEK cells. In the in vivo experiment a FANFT induced bladder tumor was transplanted into the right hind legs of C3H/He mice and the tumors were exposed to 1,400 SW. Preliminary data showed that 1,400 SW at day 12 post transplant significantly inhibited tumor growth. Combining 1,400 SW with cis-diamminedichloroplatinum (4 mg/kg) did not enhance the tumor inhibitory effect of each individually. Doxorubicin (5 mg/kg) and 1,400 SW produced a significant synergistic tumor inhibitory effect.
Animals↗
Treatment of ureteral calculi by extracorporeal shock-wave lithotripsy. UCLA experience.
One hundred sixteen patients underwent extracorporeal shock-wave lithotripsy (ESWL) for ureteral stones. In 108 patients, the stones were manipulated pre-ESWL whereas 8 patients underwent ESWL without prior stone manipulation. Ureteral lubrication using a 2% Xylocaine jelly solution greatly facilitated the retrograde advancement of the calculus or the passage of ureteral catheters alongside the stone. ESWL disintegrated all but 4 stones for an overall success rate of 96.6 per cent. It is considered that the combination of retrograde ureteral stone repositioning and ESWL is a highly successful alternative in the management of ureteral calculi.
Adult↗
Monotherapy of staghorn renal calculi: a comparative study between percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy.
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Adult↗
Ultrasonic lithotripsy in the ureter.
With the increasing range of indications for extracorporeal shock-wave lithotripsy, "easy" cases of ureteroscopic stone removal have vanished. Clinical experience with ureterolitholapaxy has proved the method safe, effective, and reliable in the hands of the experienced urologist.
Endoscopy↗
The treatment of uric acid calculi with extracorporeal shock wave lithotripsy.
A review of the first 1000 patients treated with extracorporeal shock wave lithotripsy (ESWL) at UCLA revealed 21 patients with uric acid renal or ureteric calculi. Using the combination of ESWL and oral urinary alkalinisation, 16/21 patients (76%) were stone-free at follow-up 3 months later and 19 patients were stone-free at 5 months. ESWL and urinary alkalinisation are complementary methods for the non-invasive treatment of uric acid renal calculi.
Adult↗
Extracorporeal shock wave lithotripsy: impact on the radiology department of a stone treatment center.
Extracorporeal shock wave lithotripsy (ESWL) was performed on 925 patients (1,222 treatments) for 446 calyceal, 345 pelvic, 172 ureteral, and 108 staghorn calculi. ESWL necessitated 6.3 KUB and 1.2 renal ultrasound studies per treatment session. Intravenous urography was required in 6% of patients after ESWL. Percutaneous nephrostomy tube placement was performed by the radiologists in 10% of patients. Procedures related to nephrostomy tube placement included percutaneous nephrolithotripsy, tube changes, nephrostography, and stone fragment irrigations and retrievals. Staghorn calculi treatment with ESWL required the most procedures by radiologists (34% for partial staghorn and 56% for complete staghorn) compared with 3%, 8%, and 11% for calyceal, pelvic, and ureteral stones, respectively. In all, 8,478 radiologic examinations and procedures were performed pertaining to ESWL. This is approximately 35 studies per day. While this number may be high because it represents the early experience of the authors with ESWL, the impact on the radiology department can be substantial.
Adolescent↗
Calcification of ureteral stent treated by extracorporeal shock wave lithotripsy.
A patient with stones presented with large calcifications of the J ends of a Double-J stent that had been placed in the ureter for an obstructing ureteral stone 1 month previously. The J end located in the renal pelvis was treated with extracorporeal shock wave lithotripsy and the calcification was disintegrated completely. This noninvasive procedure appears to be the method of choice in the treatment of such complications.
Calcinosis↗
Laparoscopic approaches to transitional cell carcinomas of the upper urinary tract.
Traditionally transitional cell tumors of the upper urinary tract are treated by nephroureterectomy. In circumstances where low functional renal reserve necessitates renal parenchymal preservation, endoscopic or percutaneous treatment may be an option for low grade and stage lesions. In this article, the role of laparoscopic surgery as an alternative modality to open surgery is discussed. Techniques of laparoscopic nephroureterctomy are described and different approaches (transperitoneal, retroperitoneal, and gasless hand-assisted) are contrasted. The limitations imposed on laparoscopic treatment by the requirement of adherence to oncological principles of tumor containment and excision of the intramural ureter, are outlined. Laparoscopic nephroureterectomy, although technically demanding, has been shown to be a feasible procedure. Benefits of the laparoscopic approach include shortened hospital stay and early return to daily activities. It is unclear at this time whether these immediate advantages over open surgery will yield comparatively efficacious long term outcomes.
Activities of Daily Living↗