Biomedical subjects

J Mandell

Publications and source records attributed to J Mandell.

At least 91 records · Page 5Linked to original sources

PubMed1989

Lower pole ureteropelvic junction obstruction and incomplete renal duplication.

The rare finding of lower pole ureteropelvic junction obstruction and incomplete renal duplication is discussed in 5 children. The children were divided into 2 groups, with short (less than 0.5 cm.) and long (greater than 4 cm.) lower ureteral segments. Short ureteral segment obstruction was managed by total excision of the narrow ureteral segment and end-to-side pyeloureterostomy. Obstructions associated with long lower ureteral segments were treated by excising the ureteropelvic junction and performing a standard Anderson-Hynes pyeloplasty. A thorough preoperative evaluation is helpful for successful management.

Child↗

PubMed1989

Sonographic diagnosis of abnormal fetal genitalia.

Sonographic fetal gender determination is undertaken as part of many prenatal ultrasound examinations. We describe three abnormalities of the fetal phallus, two that were related to family history and one that was associated with other genitourinary tract abnormalities of the fetus. Examination of the fetal genitalia is an important part of the sonographic examination, particularly when there is a genitourinary fetal anomaly or a family history of abnormal genitalia, because the external genitals are a part of the genitourinary tract that can occasionally be malformed. Caution is advisable in the sonographic gender determination in these cases.

Adult↗

PubMed1989

Clean, intermittent catheterization of infants with neurogenic bladder.

Clean, intermittent catheterization was instituted in 38 babies with myelodysplasia who were thought to be at risk for upper urinary tract deterioration because of neurogenic bladder dysfunction. There were 19 patients 2 weeks to 12 months of age, 11 were 1 to 2 years of age, and 8 were older than 2 years. Effectiveness of clean, intermittent catheterization was determined by maintenance of upper urinary tract stability. Upper urinary tracts improved or remained stable in 13 of 16 infants (81%) with reflux and 16 of 18 infants (89%) with detrusor-sphincter dyssynergia. Bacteriuria was present in 16 (42%), with only 2 infants (5%) having a febrile episode; no infant required hospitalization because of urinary tract infections. No further complications were identified in infants who were cleanly and intermittently catheterized. Most families found clean, intermittent catheterization of their infants easy to master and not stressful, and their children adjusted to it at an early age.

Bacteriuria↗

PubMed1988

Surgical correction of external genitalia and lower genitourinary tract of markedly virilized child.

Three children who were seen with marked androgenization, including clitoromegaly, labial fusion, and absent vaginal introitus are presented. In each, the vagina was found to be entering at the level of the posterior urethra. Vaginoplasty was performed in each child utilizing a transperineal "pull through" technique. Reduction clitoroplasty was performed in 1 patient. The advantages and optimal timing of these techniques are discussed.

Adolescent↗

PubMed1988

Ureteropelvic junction obstruction in the neonate.

The widespread use of maternal ultrasonography has resulted in an increasing number of asymptomatic newborns being diagnosed with hydronephrosis. A total of 89 neonates with hydronephrosis secondary to ureteropelvic junction obstruction have been referred for evaluation and treatment during the last 6 years. In the majority the condition was diagnosed readily with ultrasonography, voiding cystography and excretory urography. Twenty-five per cent underwent more quantitative assessment using nuclear renal imaging. Only 2 patients (8 per cent) had a percutaneous study. Early reconstruction was performed in 75 per cent of the patients and it proved to be safe and effective. Twenty-three neonates were followed nonoperatively. One patient (4 per cent) demonstrated clinical deterioration necessitating later surgical intervention. Careful surveillance is mandatory in all infants followed nonoperatively.

Female↗

PubMed1988

Congenital progressive hydronephrosis in mice: a new recessive mutation.

We describe a new autosomal recessive mutation, congenital progressive hydronephrosis (cph), that arose in the C57BL/6J inbred mouse strain. The clinical, histopathological, biochemical and radiographic characteristics, and the genetic linkage of this new mutation are discussed. Our studies indicate that the homozygous mutant mice have progressive bilateral upper urinary tract obstruction leading to azotemia and death of renal failure. The anatomical site of obstruction appears to be at the level of the ureteropelvic junction. Genetic mapping studies have localized the cph gene to the distal half of chromosome 15. The cph mouse strain provides a reproducible model for analysis of the onset and development of obstructive uropathic conditions in the neonatal period.

Animals↗

PubMed1988

The surgical management of megaureters in duplex systems: the efficacy of ureteral tapering and common sheath reimplantation.

We describe 6 children with renal duplication associated with megaureter(s) who underwent ureteral tapering and common sheath reimplantation. Of the patients 4 had complete duplication with reflux into 1 or both ureters and 2 had incomplete duplication with a short distal segment that was obstructed at the ureterovesical junction. All obstructed or refluxing ureteral segments were dilated to a degree that tapering was required at the time of common sheath reimplantation. Megaureter repair in the presence of a duplicate collecting system proved to be safe and reliable.

Adolescent↗

PubMed1988

Immediate versus delayed coronary grafting after streptokinase treatment. Postoperative blood loss and clinical results.

Of all patients with acute evolving myocardial infarction treated surgically at Duke University Medical Center between 1984 and 1986, 27 patients given high doses (greater than 1.5 million units) of streptokinase preoperatively were studied. Eleven patients who received streptokinase had coronary bypass grafting 12 hours after thrombolytic therapy (early hours), eight patients between 12 and 72 hours (delayed), and eight patients beyond 72 hours (late hours). Seventeen patients who underwent coronary bypass grafting within 6 hours of the onset of symptoms, without preoperative streptokinase, were included as control patients. Only the patients having early operation had significantly greater postoperative blood loss; postoperative use of red blood cells; fresh-frozen plasma; cryoprecipitate; prolonged postoperative prothrombin time; and prolonged partial thromboplastin time. Patients having delayed or late operations did not differ significantly from patients not receiving streptokinase. Only the interval between time of streptokinase administration and operation could account for the coagulopathy and the postoperative bleeding complications in the early group. Patients in the early group had a higher in-hospital mortality (27% versus 6% for the non-streptokinase group) and major noncardiac morbidity (36% versus 12% for the non-streptokinase group). Patients in the delayed and late groups had minimal postoperative complications and no mortality. Observations were not explained by differences in total ischemic time, number of angioplasty failures, or number of patients with cardiogenic shock between the early group and the non-streptokinase group. Postoperative bleeding and massive use of blood products seemed to be contributory factors: Two of three deaths in the patients having early operations were associated with clinical suspicion of tamponade. Patients undergoing coronary bypass grafting within 12 hours of streptokinase therapy appear to be a high-risk group in a more emergent, uncontrolled clinical setting and require aggressive monitoring and correction of coagulopathy.

Blood Coagulation Disorders↗

PubMed1988

Antidepressants in the treatment of post-psychotic depression in schizophrenia: drug interactions and other considerations.

Adjunctive imipramine has been found to be useful in the treatment of a substantial number of patients with syndromally defined post-psychotic depressions. This paper examines the clinical effects of the combined anticholinergic activity of imipramine, when added to ongoing fluphenazine decanoate/benztropine treatment, in such patients. Little additional anticholinergic impact of the imipramine was observable beyond that already attributable to the benztropine, and no significant relationships were found between a clinical measure of peripheral anticholinergic activity and either global clinical outcome or antidepressive efficacy. This paper also reports on the concentrations of imipramine and its metabolites in plasma under the conditions of this therapeutic trial. The changes in relative concentrations of imipramine and metabolites with time were consistent with the concept that fluphenazine competes with tricyclic metabolism. The relationship of plasma imipramine and desipramine to clinical improvement in this group of secondary depressions did not parallel previously reported relationships of these antidepressant molecules to clinical outcome in primary depressions.

Adult↗

PubMed1988

Complications of urinary tract undiversion.

The complications of urinary tract undiversion can be divided into those associated with patient selection, choice of techniques, and early and late surgical difficulties. Patient selection must take into account the original reason for diversion (incontinence, hydronephrosis, reflux, or renal functional impairment), current renal function and bladder dynamics, upper urinary tract anatomy, and psychosocial considerations. Technical considerations require versatility and ingenuity on the part of the surgeon. Although direct uroepithelium-to-uroepithelium continuity is ideal, this often cannot be accomplished. A variety of techniques including transureteroureterostomy, psoas hitch of the bladder, bladder augmentation, ileocecal and colon interposition, and autotransplantation can be used to facilitate the refunctionalization of the urinary tract. One must monitor the patient postoperatively for potential early and late complications. Meticulous attention to surgical details will help minimize these. The ultimate goal is to achieve stable renal function and urinary continence.

Adolescent↗

PubMed1988

Complications of hypospadias repair.

Hypospadias is one of the more common and one of the most challenging problems in urologic surgery. The past two decades have ushered in an era of new operations and variations of older ones, which, when coupled with technical advancements and improvements in management, have redefined the aims of the surgeon, who now strives to create a "normal" penis with a minimum of complications. Minimization of complications is contingent on selection of an operation properly tailored to the individual's anatomy. To this end, the surgeon's armamentarium must include a variety of repairs and familiarity with the limitations and potential complications inherent in each. After describing the principles of surgical selection, technique, and postoperative management used in our institution, this article deals primarily with the avoidance and management of the immediate and long-term complications of hypospadias surgery.

Bandages↗

PubMed1987

Small bowel augmentation in children with neurogenic bladder: an initial report of urodynamic findings.

Augmentation cystoplasty is a useful adjunct in the treatment of the neurogenic bladder. After preoperative urodynamic and clinical assessment, 10 children with neurogenic bladders underwent small bowel augmentation. Presenting clinical problems included incontinence and hydronephrosis. Urodynamic studies after small bowel augmentation demonstrated that bladder capacity increased an average of 184 per cent. Maximum intravesical pressures diminished considerably compared to preoperative values and no patient suffered significant uninhibited contractions. Nine children are totally dry and 1 has stress incontinence. Our initial findings demonstrate the efficacy of small bowel augmentation in the treatment of lower urinary tract neurogenic dysfunction owing primarily to alterations in detrusor function.

Adolescent↗

PubMed1987

Bilateral neonatal torsion.

Extravaginal neonatal torsion of the spermatic cord, although rare, is being recognized with increasing frequency. Bilateral neonatal torsion is even more uncommon. Only 1 previous case of asynchronous neonatal torsion has been reported. Controversy exists concerning the urgency of exploration as well as the need for contralateral orchiopexy, since some reports suggest that the contralateral testicle is not at risk for torsion. We present 4 consecutive cases of bilateral neonatal torsion seen between 1966 and 1986. Two cases were asynchronous, 1 of which with a previously normal-appearing contralateral gonad was rendered anorchid. In the other patient a testicle was salvaged by prompt intervention. We have adopted a policy of prompt exploration with contralateral orchiopexy in all cases of unilateral neonatal torsion. Treatment of the ipsilateral testicle is determined by operative findings.

Humans↗

PubMed1987

Urinary tract infection in children: putting radiology in its place.

Bacterial infection of the child's urinary tract can be viewed as a phenomenon in which bacterial virulence factors outweigh host resistance mechanisms. Structural abnormalities that compromise the host account for only a small part of the picture, but it is important to discover these abnormalities, and uroradiologic examinations can do this superbly. There are many ways to image the kidneys and the lower urinary tract, but more important than debating which of these tests to use is deciding who should be studied, why, and when, and what it means when an abnormality is discovered.

Bacterial Infections↗

PubMed1987

Neonatal hydronephrosis in the era of sonography.

During a 6-year period (1979-1985), 142 neonates with significant hydronephrosis were seen. Seventy-eight percent of the cases were discovered on fetal screening during obstetric sonography. Maternal/fetal intervention was virtually never indicated and most babies were asymptomatic. The most common conditions found were obstruction of the ureteropelvic junction (41%), obstruction of the distal ureter (usually primary megaureter) (23%), upper-pole hydronephrosis associated with duplex anomalies (13%), and posterior urethral valves (10%). Seventeen neonates with multicystic dysplastic kidney were seen (three per year or one for every eight with hydronephrosis). In comparison, during the 30-year period, 1947-1977, 146 neonates with significant hydronephrosis were seen. Most cases were discovered because the patients had signs and/or symptoms--either an abdominal mass (an enlarged kidney or bladder) or urosepsis. The three most common conditions were obstruction of the ureteropelvic junction (22%), posterior urethral valves (19%), and ectopic ureterocele (14%). During this period, 53 neonates with multicystic dysplastic kidney were discovered (two per year or one for every three with hydronephrosis). The dramatic increase in the number of neonates found to have hydronephrosis is primarily due to the widespread use of obstetric sonography and concomitant fetal screening. The pattern of causes before 1979 represented the incidence of symptomatic lesions. The current pattern more accurately reflects the true incidence of congenital anomalies of the urinary tract.

Humans↗

PubMed1986

Pre- and postnatal ultrasonographic diagnosis of congenital obstructive uropathies.

Ultrasonography has proved particularly effective in evaluating the neonate with an abdominal mass, poor renal function, and an abnormal perinatal ultrasound scan. As a noninvasive, nonionizing, and relatively inexpensive examination, it can often make the preliminary diagnosis, streamline the work-up, and be used for follow-up studies.

Female↗

PubMed1986

Congenital obstructive uropathies. Pre- and postnatal treatment.

The evolution of sonographic techniques that allow accurate prenatal diagnosis of obstructive uropathies has led to consideration of specific therapeutic options in the care of such lesions. After briefly reviewing historical developments, the authors examine recent clinical experience with the prenatal treatment of congenital obstructive uropathies and consider possible clinical criteria for selecting appropriate candidates for such interventions.

Animals↗

PubMed1985

Single-stage hypospadias repair using the operating microscope.

Because of the continuing trend toward earlier repair of hypospadias, improved visualization of tissues is important. We have reviewed 33 consecutive hypospadias repairs performed using the operating microscope. Complications included three strictures (9.1%) and five fistulae (15.1%). The microscope proved most useful in resident teaching, allowing both surgeon and assistant to visualize optimally the tissues.

Child↗