Biomedical subjects

H Lottmann

Publications and source records attributed to H Lottmann.

34 records · Page 2Linked to original sources

PubMed1998

[Etiological work-up of complex voiding disorders (CVD) in boys; evaluation of the imaging strategy based on a retrospective study of 58 files].

The strategy of radiological investigations in males with severe voiding disorders has not been clearly established. To define the most effective strategy, a retrospective study of 58 files of boys investigated for severe voiding disorders (excluding neurogenic bladder) was performed. The following investigations were performed in this series: intravenous urography (IVU) completed by voiding cystourethrogram (VCUG) (41%), VCUG alone or associated with urinary ultrasound (30%), IVU alone (20.5%) ultrasound alone (1.5%) and ultrasound completed by VCUG or IVU (7%). When prescribed first, VCUG was always sufficient for accurate diagnosis; in contrast, a second investigation was usually necessary when IVU (66%) or ultrasound (80%) were performed first. The interpretability of the voiding urethrogram was also higher with VCUG (90%) than with IVU (66%); the sensitivity was 94% for VCUG and only 69% for IVU and 8% for ultrasound. This study confirms that VCUG combined with urinary ultrasound is the most reliable way to radiologically investigate male severe voiding disorders.

Adolescent↗

PubMed1998

[Surgical repair of male epispadias by the Cantwell-Ransley procedure: technical aspects and functional results in a series of 40 patients].

From 1989 to 1997, 40 patients underwent primary (n = 29) or a secondary (n = 11) epispadias repair according to the Cantwell Ransley Procedure. 23 patients had bladder exstrophy, 6 had penopubic epispadias, and 11 had penile epispadias. The mean age at surgery was 5 years (1-28 years); 23 patients were prepubertal and 17 were postpubertal. The procedure associated an IPGAM meatoplasty, ventral transposition of the urethra, and dorsal rotation and approximation of the corpora with (16) or without (24) caverno-cavernostomy. With a mean follow-up of 4 years, 19 patients (47.5%) achieved a good cosmetic and functional result after a single procedure. 18 patients (45%) developed complications that required minor revision (8 patients) or a more major procedure (10 patients). Finally 3 patients (7.5%) had a complete failure. 3 patients also had a loss of continence (complete in one case) after the procedure. The complication rate was slightly higher in the postpubertal group (58%) than in the prepubertal group (47%). A prior urinary diversion did not increase the complication rate. All 17 patients in the postpubertal group reported satisfactory erections. All 16 patients who had minor to major urethral complications had previously undergone transection of the urethral plate. Overall 35 patients (87.5%) achieved a satisfactory cosmetic and functional result. The Cantwell Ransley procedure is an excellent procedure for the repair of male epispadias. However the complication rate is significant, mainly related to previous operations compromising the blood supply to the posterior penile urethra.

Adolescent↗

PubMed1998

[Reconstruction of bladder exstrophy: retrospective study of 57 patients with evaluation of criteria in favor of the acquisition of continence].

In order to evaluate the results of staged surgical reconstruction in terms of urinary continence, spontaneous voiding and preservation of the upper urinary tract, we reviewed the charts of 42 boys and 15 girls treated at Hôpital Saint-Joseph for bladder exstrophy between 1965 and 1995. All patients underwent staged repair, associating bladder closure, bladder neck plasty, then genitoplasty, including bladder augmentation in 7 cases (12%). Criteria for good outcome in terms of continence are defined and factors influencing outcomes are reviewed. A total of 38 patients (67%) achieved good or acceptable urinary continence (22 or 39% and 16 or 28%, respectively). Outcome was poor in 19 patients, including 13 (23%) who underwent secondary urinary diversion. Bladder stones, which developed in 13 patients (23%), were the commonest long-term complication of bladder exstrophy reconstruction. Ten patients who underwent pelvic osteotomies ultimately had better continence and 9 are dry. Bladder neck reconstruction was performed at a later age overall (mean 10 years). Repeat bladder neck reconstruction was generally associated with poor results. The technique of bladder neck reconstruction did not appear to influence outcome. This retrospective study confirms that a carefully planned surgical reconstruction for bladder exstrophy can lead to satisfactory long-term urinary continence in most patients. Factors contributing to successful results include early bladder closure, pelvic osteotomy, adequate bladder neck reconstruction with bladder neck suspension in girls, and a motivated child and family. Alternatives to surgical reconstruction should be discussed. Ultimate predictors of outcome in bladder exstrophy repair are difficult to ascertain.

Adolescent↗

PubMed1998

[Ureteropyelostomy for obstructed duplicated ureter an easy and reliable operation in infants].

AIM: Ureteropyelostomy is one of the surgical options to treat obstructed duplicated ureter. We retrospectively analysed the results of this procedure in a group of young children with prenatal diagnosis. MATERIAL AND METHODS: Between 1992 and 1996, 11 children underwent ureteropyelostomy for obstructed functioning duplicated ureter using the following procedures. 7 cases were revealed by prenatal ultrasound and 4 by acute pyelonephritis; an ureterocele was identified in 7 cases. The mean age at surgery was 6 months for the whole group (3-46 weeks), while in the subgroup of prenatal diagnosis, it was 8 weeks (3-9 weeks). The follow-up ranged from 6 months to 4 years. RESULTS: There were no postoperative complications. None of the anastomoses needed revision, and the conserved segments maintained their functioning appearance, on follow-up. 3 children needed a subsequent ureterovesical reimplantation for urinary tract infections due to reflux in the lower segment ureter. DISCUSSION: Ureteropyelostomy is of great interest for the management of the obstructed dilated upper pole ureter revealed by prenatal diagnosis. This specific group of children needs early management to avoid septic complications and ureteropyelostomy is an easy and reliable method at this young age.

Humans↗

PubMed1998

[Surgical aspects of renal transplantation in children].

Review of a series of 90 renal transplantations performed in 86 children revealed 3 cases of early or late mortality and 28 cases of major surgical complications, predominantly vascular (13 cases) and urological complications (12 cases). The time to onset, the diagnosis and the management of these complications are reviewed. This study again emphasizes the importance of graft selection (donor age) and the value of living related donor renal transplantation.

Adolescent↗

PubMed1998

[Long-term evaluation with DMSA-Tc 99m scintigraphy of renal parenchymal involvement in children after shockwave extracorporeal lithotripsy].

OBJECTIVES: This study evaluated the long-term effects of extra-corporeal shock-wave lithotripsy (ESWL) on the renal parenchyma of children using DMSA-Tc 99m scintigraphy. MATERIAL AND METHODS: Between November 1989 and April 1997, twenty-three children wee treated for renal stones using a SONOLITH 3000 lithotriptor (Technomed-Corp. Evaluation of treatment and its consequences was based on clinical examination, conventional imaging and comparison with DMSA-TC 99m renal scintigraphy performed the day before and at least 6 months after treatment. RESULTS: The success rate (fragmented and eliminated stones) was 90% at 6 months. Long-term follow-up did not reveal any alteration of blood pressure or renal function. Scintigraphic examinations did not demonstrate any significant parenchymal lesions attributable to treatment. CONCLUSION: Extracorporeal shock wave lithotripsy is effective in adults and young children. Its safety on the renal parenchyma was demonstrated during this study. However, evaluation of larger series with the use of other lithotriptors is necessary before reaching any definitive conclusions.

Adolescent↗

PubMed1996

[Renal scintigraphy: a major test for urologic diseases in children].

The number of asymptomatic uropathies detected by ultrasound has increased dramatically with antenatal diagnosis. Some of them only threaten the renal parenchyma and require surgery. Therefore, screening for patients at risk is a major challenge. During the initial evaluation and follow up of a dilated system, MAG3 scans evaluate and quantify the physiologic significance of a radiologically detected anatomic abnormality by measuring the relative renal function and wash out of the radiopharmaceutical. Moreover, DMSA scans show renal functional abnormalities due to pyelonephritis or dysplasia associated with vesicoureteral reflux or obstructive uropathy. With a low radiation burden, renal scintigraphy is now a major imaging modality for uropathies in pediatrics.

Child↗

PubMed1996

[Primary vesico-ureteral reflux. Current data and perspectives].

Primary vesicoureteral reflux is a frequent condition threatening the renal parenchyma. This severe disease can lead to renal dysplasia and scarring. When revealed by acute urinary tract infection, parenchymal damage has, in most cases, already occurred so medical or surgical care comes too late. Ideally, the population should be screened at birth for vesicoureteral reflux, but unfortunately, no biological test is yet available. At the present time, it would be reasonable to propose cystography to "at risk" populations, first in newborns with pyelocaliceal dilation detected antenatally then in siblings of patients treated for vesicoureteral reflux. Bladder dysfunction, also often associated with primary vesicoureteral reflux, should be identified early and treated. Finally there are several, often opposing, patterns of clinical expression. Antenatally detected vesicoureteral reflux predominates in the male population. Congenital parenchymal lesions, even in the absence of urinary tract infection, are associated with a small capacity hyperactive bladder. Primary vesicoureteral reflux in the school-age girl is associated with post-infectious renal scarring and with a large bladder incompletely emptied during micturition. Early diagnosis, screening of high-risk populations and prevention of infection together with better management of bladder dysfunction should help reduce the incidence of parenchymal damage due to primary vesicoureteral reflux.

Anti-Infective Agents, Urinary↗

PubMed1996

Characterization of Borrelia burgdorferi sensu lato strains isolated from Ixodes ricinus in Mecklenburg-Vorpommern, Germany.

Epidemiological studies in Mecklenburg-Vorpommern have shown a high prevalence of Borrelia burgdorferi-infected ticks. A total of 17 B. burgdorferi sensu lato strains were isolated from ticks and investigated by Western blots (immunoblot) with eight monoclonal anti-bodies against different epitopes of the outer surface protein A (OspA). Except for one, all strains could be classified using this system. The majority of strains belonged to the B. garinii-associated OspA serotypes 3, 5 and 6. Three isolates were classified as OspA serotype 2 (B. afzelii). B. burgdorferi sensu stricto strains (OspA serotype 1) as well as B. garinii-associated OspA serotype 4 were not present.

Animals↗

PubMed1995

[Extracorporeal shockwave lithotripsy in children. Study of the effectiveness and renal consequences in a series of eighteen children].

17 children from 18 months to 16 years old were treated by ESWL for calculi of the upper urinary tract using a Sonolith 3000 lithotriptor. 31 calculi (5 to 60 mm) have been treated on 16 renal units and 3 pelvic ureters. The renal parenchyma of all treated kidneys was considered normal on preoperative ultrasound and IVU; 8 patients had a preoperative DMSA. The treatment required 1 to 4 sessions delivering 400 to 3000 shocks per session and 400 to 6000 shocks per treatment at 14 kV. Within three months post treatment, 14 patients (88.23%) were stone free and 3 patients had residual fragments (2 needed further surgical extraction). With a follow up of three months to five years, all patients have a normal blood pressure, serum creatinine and sterile urine. In no instance, IVU or ultrasound revealed a lesion imputable to ESWL. Seven patients had a DMSA six months or more after the last session; 4 of these were normal but the three other patients had a loss of function and an heterogeneous fixation on the treated side. These preliminary results confirm that ESWL is efficient for upper urinary tract calculi destruction in children. However ESWL seems to be susceptible to induce parenchymal damage, detected by DMSA, whose incidence and long term effects particularly on blood pressure need further evaluation.

Adolescent↗

PubMed1991

[Varicocele in children and adolescents. Review of a series of 58 cases].

5 to 25% of male adolescents present with a varicocele; only those cases inducing serious discomfort or affecting the development of the testis require surgical treatment. Nevertheless, the results of surgery are disappointing, with a high recurrence rate. Based on a better knowledge of testicular venous drainage, it appears that conventional high ligation of the spermatic vein (s) might not be sufficient to cure varicocele. Fifty-eight patients were operated upon using four different procedures. Only complete, proximal ligation of all of the visibly dilated veins seems to prevent recurrences with a follow-up of at least one year. However, out of eleven cases treated with this original procedure, one patient, already operated upon twice without success, developed secondary atrophy.

Adolescent↗

PubMed1990

[Varicocele in childhood and adolescence. Evaluation apropos of a series of 58 cases].

5 to 25% of the male adolescents present with a varicocele; only those cases inducing serious discomfort or affecting the development of the testis require surgical treatment. Nevertheless the results of surgery are disappointing with a high recurrence rate. Based on a better knowledge of the testicular venous drainage, it appears that the conventional high ligation of the spermatic vein(s) might not be sufficient to cure the varicocele, fifty-eight patients were operated upon using four different procedures. Only a complete and proximal ligation of all of the visibly dilated veins seems to prevent recurrences with a follow-up of at least one year. However, out of eleven cases treated with this original procedure, one patient, already operated upon twice without success, developed secondary atrophy.

Adolescent↗

PubMed1987

[Unilateral bladder neck incision: endoscopic treatment of bladder neck obstruction. Results in 100 patients].

Endoscopic diathermy unilateral incision of the bladder neck was carried out in 100 consecutive male patients. This procedure was performed for bladder neck obstruction and small benign prostate. The operative details of this technique are given. Follow-up after 2 months revealed excellent symptomatic and urodynamic results. Morbidity was low. Results remain stable after 13 +/- 9 months. One patient needed a transurethral resection of the prostate. Retrograde ejaculation occurred in 5% of the patients. Unilateral bladder neck incision is a simple procedure safe, and easy to learn, with a low risk of retrograde ejaculation. It is the operation of choice for small benign prostate, bladder neck obstruction and young patients.

Adult↗

PubMed1985

[Reconstructive microsurgery of the vas deferens. Experimental study of suture materials].

Microsurgery is the procedure of choice for vasectomy reversal. The aim of this study was two compare two different suture materials for vasovasectomy - a nonresorbable material (nylon 10/0 with a BV 6 needle), which is widely used, and a resorbable material (polyglycolic acid, also with a BV 6 needle), which has not yet been evaluated for this use. 28 Sprague-Dawley rats were operated on under microscope. Two groups were then compared, group A with nylon (n = 14) and group B with polyglycolic acid (n = 14). In each group, 8 animals had a vas deferens section and 6 had a previous vasectomy by ligature. Ten days postoperatively, the patency rate of the anastomosis was evaluated by the presence of sperm on both sides of the suture line. The contractility was assessed by mechanical stimulation. The existence of a sperm granuloma was considered as indicative of a non functional anastomosis. Three days later a fertility test was performed, lasting three months, and the number of litters was checked. The rats were sacrificed after three months, and each vas deferens was examined histologically or by electron microscope. The macroscopic results were: 57% patent anastomoses in group A and 77% in group B. 16% patent anastomoses after ligature in group A (n = 6) and 75% in group B (n = 6). The pregnancy rate was 54% in group A and 77% in group B. After previous ligation, the corresponding figures were 20% and 83% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1985

[Vulvar cysts disclosed in a neonate. Apropos of 6 cases].

The authors report six cases of vulvar cysts in female neonates. Careful examination of the vulva normally leads to correct diagnosis of this rare lesion, but a few additional examinations may be helpful. Simple puncture without anesthesia is generally sufficient for a successful treatment of this benign and isolated tumor. The authors go on to discuss the embryological, histological and histochemical aspects, and review the literature.

Cysts↗

PubMedDate not supplied

[Reconstructive microsurgery of the deferens duct. Experimental study of suture material].

The choice of optimal suture material for reconstructive microsurgery of the deferens duct was investigated in the rat. The study was performed on normal deferens ducts and those dilated by proximal ligatures. The absorbable thread (10.0) studied provided a more satisfactory morphological and functional result than a non-absorbable single-filament thread of identical caliber. These findings suggest that this material should be used in clinical practice.

Animals↗