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Biomedical subjects

G W Kaplan

Publications and source records attributed to G W Kaplan.

At least 19 recordsLinked to original sources
PubMed1996

Preservation of continence after posterior sagittal surgery.

PURPOSE: An animal study was performed to evaluate the effect of posterior sagittal pararectal mobilization on anorectal sphincter function. MATERIALS AND METHODS: We initially divided 11 juvenile pigs into 3 groups: group 1-anesthesia alone (3), group 2-posterior sagittal incision alone (4) and group 3-posterior sagittal incision with unilateral pararectal dissection (4). Two animals in group 1 subsequently underwent posterior sagittal incision with circumferential pararectal dissection (group 4). The anal canal was preserved intact in all animals. Anorectal sphincter manometry was performed preoperatively, and 2, 4, 8 and 12 weeks postoperatively. Electromyography was performed 12 weeks postoperatively. Anorectal sphincter muscle complexes were harvested for histological examination. RESULTS: All animals had postoperative bowel continence. Postoperatively manometry revealed no difference from preoperative measurements in all study groups (p = 0.90). Electromyography and histological examination of the anorectal sphincters were normal in all but 2 animals. Denervation injury and histological atrophy were detected after repair of inadvertent enterotomy in 1 animal following unilateral pararectal dissection, and polyphasic motor unit potentials implying reinnervation were detected in another after circumferential pararectal mobilization. CONCLUSIONS: These results indicate that posterior sagittal incision and unilateral pararectal mobilization cause no permanent injury to the anorectal sphincter. However circumferential pararectal dissection or repair of a rectal injury may cause measurable changes in sphincter function.

Animals↗
PubMed1995

Extracorporeal membrane oxygenation in the neonate with congenital renal disease and pulmonary hypoplasia.

Extracorporeal membrane oxygenation (ECMO) is an effective treatment modality for the newborn with refractory hypoxemia. Oligohydramnios can be associated with congenital renal disease (CRD) and can result in respiratory insufficiency from pulmonary hypoplasia, delayed lung maturation, and persistent pulmonary hypertension of the newborn. In this retrospective study, the authors reviewed the outcome of four children with CRD who required ECMO in the neonatal period. Between October 1987 and December 1995, ECMO was used in four newborns with CRD and pulmonary hypoplasia unresponsive to maximal medical management. The causes of CRD were urinary obstruction (2), renal dysplasia (1), and vesicoureteral reflux (1). Neonatal survivors of ECMO with CRD had regular follow-up with a nephrologist, urologist, and pediatrician. Developmental history, assessment of renal function, and a nutritional evaluation were recorded on each visit. The follow-up period ranged from 6 months to 5 years. All patients with CRD were successfully weaned from ECMO. One child died, at 1 month of age, because of renal failure. The estimated glomerular filtration rates in the three survivors were 20, 24, and 60 mL/min/1.73 m2. Growth and development have been delayed in two patients. Based on the author's experience, ECMO may improve the survival of neonates with pulmonary hypoplasia and CRD. Factors associated with successful long-term outcome include (1) renal disease amenable to surgical correction, (2) aggressive nutritional support, and (3) a reliable social support system.

Abnormalities, Multiple↗
PubMed1995

Ketoconazole for prevention of postoperative penile erection.

OBJECTIVES: To determine if ketoconazole, an inhibitor of testosterone synthesis, can prevent postoperative spontaneous erections in patients undergoing penile surgery. METHODS: Ketoconazole was administered to 8 patients, aged 14 to 42 years, who underwent penile surgery. All patients received ketoconazole 400 mg orally three times daily starting on the day of surgery. Liver function tests were obtained preoperatively and after the completion of treatment. RESULTS: Ketoconazole successfully prevented erections in all patients. None of the patients demonstrated liver function abnormalities. CONCLUSIONS: Ketoconazole is a reliable method to prevent postoperative penile erection. With the proper monitoring of liver function tests and the avoidance of drug interactions, ketoconazole therapy also appears to be safe.

Adolescent↗
PubMed1995

Fibrous hamartoma of infancy: a report of two cases in the genital region.

OBJECTIVES: Fibrous hamartoma of infancy (FHI) is an uncommon subcutaneous proliferative lesion usually found in the upper portions of the body, particularly in males during the first 2 years of life. We report 2 cases of FHI in the genital region. METHODS: We retrospectively reviewed the charts of children treated at Children's Hospital and Health Center, with FHI located in the genital region. RESULTS: We report 2 cases of FHI in the genital region, 1 involving the scrotum and 1 the labium majus. CONCLUSIONS: FHI should be considered in the differential diagnosis of genital masses in children. The histologic features are characteristic, local excision of the tumor is curative, and the local recurrence rate is low.

Child↗
PubMed1995

Correlation of renal biopsy and radionuclide renal scan differential function in patients with unilateral ureteropelvic junction obstruction.

To understand better the relationship among radionuclide renal scan differential function, renal histology and the outcome of pyeloplasty we performed ipsilateral renal biopsies in a series of patients undergoing primary pyeloplasty. A total of 17 consecutive patients with unilateral ureteropelvic junction obstruction underwent renal biopsy at the time of pyeloplasty. Biopsies were examined systematically after sections were stained with hematoxylin and eosin, periodic acid, Schiff, Jones modified silver or Masson trichrome stains, and they were reviewed by 1 pathologist. Biopsy results were correlated with preoperative and postoperative radionuclide renal scan differential functions. Patient age ranged from 1 month to 7 years (mean 19.8 months). Renal biopsy was abnormal in 6 kidneys, of which 5 had a preoperative differential function of less than 33%. None of these kidneys had evidence of postoperative improvement in renal function on followup scans despite a technically successful result. All remaining 11 kidneys had normal biopsies and a preoperative differential function of greater than 44%. We conclude from these data that patients with ureteropelvic junction obstruction with a differential function of less than 35% have a high probability of significant histological changes on biopsy and a low probability of postoperative improvement in differential function.

Biopsy↗
PubMed1995

Imaging of common problems in pediatric urology.

Many imaging modalities are available to study children with urologic disorders. Ultrasonography, renal scintigraphy, and voiding cystourethrography are best for study of patients with infection and antenatal hydronephrosis; intravenous urography, for hematuria and wetting; ultrasonography and CT, for tumor; and CT, for trauma.

Abdominal Injuries↗
PubMed1995

Distal hypospadias.

Distal hypospadias, where the urethral meatus is located subcoronal or more distal, is one of the most common congenital anomalies in males. The embryology and etiology of hypospadias, timing of repair, surgical techniques, anesthesia for and complications of hypospadias repair are reviewed.

Humans↗
PubMed1995

Pediatric genitourinary trauma.

Trauma is the leading cause of death in children in the United States, and blunt trauma is responsible in most cases. The kidney is the urogenital organ most frequently injured. Renal injuries are classified on a scale of I to V. Only grades IV and V injuries need operative intervention. CT is the preferred diagnostic imaging modality in most instances. Cystography and urethrography are necessary to diagnose bladder and ureteral injuries. Genital injuries sometimes are produced by sexual abuse, and the clinician must be alert to this possibility.

Accidents, Traffic↗
PubMed1995

Hematuria in children. A practical approach.

The investigation of hematuria in children should never be allowed to pose a greater risk to the child's health than does the problem itself. For this reason, angiography and cystoscopy are rarely employed in the evaluation. The evaluation of the child should proceed methodically and rest firmly on a well-taken history and results of physical examination. The microscopic examination of the urinary sediment is the cornerstone of the evaluation process and can itself suggest the origin of the hematuria. Red cell casts, if present, indicate glomerulonephritis and obviate further urologic evaluation. Genitourinary imaging should be tailored to each clinical situation.

Algorithms↗
PubMed1995

Neonatal circumcision.

Circumcision remains the most common operation performed in males in the United States. When performed by an experienced operator, circumcision is usually a safe and simple operation. The medical benefits of circumcision appear to exceed the risks of the procedure. The history, embryology, indications, techniques, and complications of neonatal circumcision are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Fertility index analysis in cryptorchidism.

We report on 226 male patients with cryptorchidism 6 months to 16 years old who underwent open testis biopsy at orchiopexy or orchiectomy at Children's Hospital and Health Center from 1986 to 1990. A total of 355 specimens was obtained. Tissues were preserved in Bouin's solution and examined on light microscopy for fertility index measurements. Several biopsies prepared using Bouin's preserved paraffinized tissue and glutaraldehyde preserved semi-thin cut tissue were found to have comparable fertility index measurements. Of 184 patients with unilateral undescended testes 87 also underwent biopsy on the contralateral descended testis. A total of 42 patients had bilateral undescended testes. Age matched comparisons were made between fertility index measurements of the undescended testes and those previously reported of normal testes. Additional case matched comparisons of fertility indexes were made in those children who underwent biopsy of the undescended testis and its descended mate. Statistical analysis was performed using the independent Student t-test. When comparing undescended to descended testes, there was no significant difference in the fertility index of patients 1 year old or younger but fertility index differences were statistically significant in all of the other age groups. Fertility index measurements were significantly decreased from normal expected values in all age groups with unilateral cryptorchidism and in all but the 13 to 18-month-old group with bilateral cryptorchidism. The fertility index in the descended testis was similar to previously reported normal testis measurements in boys between 13 months and 6 years old. Our data suggest that potential fertility in the cryptorchid testis may be significantly impaired compared to normal testicular fertility regardless of patient age at the time of discovery of the undescended testis. The fertility index of the descended mates of unilateral undescended testes may also be somewhat impaired in certain age groups. Orchiopexy in the first year of life may be indicate to preserve available fertility potential.

Adolescent↗
PubMed1994

The management of proximal hypospadias using a 1-stage hypospadias repair with a preputial free graft for neourethral construction and a preputial pedicle flap for ventral skin coverage.

A total of 77 patients with proximal hypospadias underwent a 1-stage hypospadias repair using a preputial free graft for neourethral construction and a preputial pedicle flap for ventral skin coverage. Of the patients 84% achieved excellent functional and cosmetic results with 1 procedure.

Follow-Up Studies↗
PubMed1994

Is urinary tract screening necessary for patients with cerebral palsy?

Patients with cerebral palsy are prompted to seek urological evaluation when urinary tract infection, socially unacceptable incontinence or hematuria occurs. We attempted to determine the prevalence of urinary tract structural changes by prospectively screening on sonography the kidneys and bladder of 90 patients 1 to 25 years old (mean age 8 years) who had cerebral palsy with or without urological symptoms. Uncooperative patients or those who would require sedation were excluded. Of the patients 66 were incontinent and used diapers, 18 were completely dry and 6 had nocturnal enuresis with daytime dryness. Sonographic abnormalities were detected in 7 patients, including renal size discrepancy in 2 (1 with severe scoliosis and 1 with a history of renal artery thrombosis), mild to moderate hydronephrosis with thickened bladders suggestive of neurogenic bladder dysfunction in 3 and a nonvisualized kidney in 2. However, repeat sonography confirmed 2 normal kidneys in the latter patients. Thus, urinary tract abnormalities were detected unexpectedly in 2% of patients studied. This relatively low proportion suggests that routine urinary tract screening in cerebral palsy patients may not be warranted.

Adolescent↗
PubMed1994

The incidence of the cremasteric reflex in normal boys.

The presence or absence of the cremasteric reflex was documented in 225 normal male subjects ranging in age from birth to 12 years. The reflex was initiated by stroking the skin of the inner aspect of the thigh. The cremasteric reflex was present in 48 of 100 newborns (48%), 32 of 71 subjects (45%) between 1 and 30 months old, and all 54 boys older than 30 months. The presence of the cremasteric reflex may be clinically significant in boys with suspected cryptorchidism or acute scrotal inflammation.

Acute Disease↗
PubMed1994

An alternative approach to myelodysplasia management: aggressive observation and prompt intervention.

We have adopted an approach to the management of myelodysplasia patients which is contrary to that most commonly supported by the existing literature. We screen patients shortly after birth with ultrasound, urine culture and serum creatinine, and then follow patients at 3 to 6-month intervals with similar studies. Cystography and urodynamics are done only as required clinically or by a change in the sonogram. Clean intermittent catheterization is indicated for continence or medical reasons. With this approach of aggressive observation and prompt intervention, we observed a rate of renal deterioration (diminished function on renal scan or parenchymal loss on imaging studies) of 5%. Renal deterioration was associated statistically with urinary tract infections and reflux. Patients started on clean intermittent catheterization for medical indications had greater risk for renal deterioration than those started on it for continence. Renal deterioration occurred with equal frequency between patients with abnormal and normal urodynamic studies, that is urodynamics did not predict renal deterioration. Our data show a rate of renal deterioration similar to other reports. We believe that aggressive observation with prompt intervention for problems once identified represents a reasonable alternative to managing patients with myelodysplasia.

Adolescent↗
PubMed1994

Preoperative laparoscopic localization of the nonpalpable testis: a critical analysis of a 10-year experience.

Laparoscopy was performed on 107 patients 8 months to 18.5 years old (mean age 46.9 months) with 119 nonpalpable testes. The procedure accurately determined the location of the gonad in 95.3% of the patients, while 16 were spared formal surgical exploration with the laparoscopic visualization of blind-ending spermatic vessels and vasa deferentia. Additionally, patency of the internal inguinal ring, determined laparoscopically, was an accurate predictor of testicular salvageability. We advocate the use of laparoscopy for all boys with a nonpalpable gonad in conjunction with operative intervention if necessary.

Adolescent↗