Biomedical subjects
J Miskowiak
Publications and source records attributed to J Miskowiak.
Ultrasonic diagnosis and transurethral incision of ureterocele with hydronephrosis.
In a 65-year-old woman with right-sided loin pain, ultrasonography revealed a grossly dilated and obstructed right pyelogram due to a 50-mm ureterocele. After transurethral lateral incision of the ureterocele, there was complete recovery without vesicoureteric reflux. Ultrasonography is advantageous in diagnosing acute urinary-tract obstruction, and transurethral incision is useful in the acute treatment of ureterocele.
Continuous intestinal dialysis for uraemia by intermittent oral intake of non-absorbable solutions. An experimental study.
A new approach to intestinal dialysis was investigated in a normal person and in a patient with chronic uraemia and a renal creatinine clearance of 10 ml/min. Both subjects drank 1-1.5 l non-absorbable solutions of polyethylene glycol or mannitol every fourth hour. The solutions stayed in the intestines for about four hours in the normal person and for 1.5 to 3 hours in the patient. The patient's intestinal clearances were 6-10.4 ml/min for creatinine, 4 ml/min for uric acid and 10.7-15.4 ml/min for phosphate, which compares favourably to those from 12 hours weekly haemodialysis. Continuous intestinal dialysis was well tolerated and the results indicate that this might be a useful way of treating uraemia if conventional methods are unavailable.
[Urethral stricture].
The incidence of urethral stricture has increased since the introduction of gonorrhoea to Europe in the 15th century. Nowadays, transurethral instrumentations and catheterisations are responsible for the majority of the urethral strictures. The mechanism is inflammatory or traumatic lesion of the urethral epithelium causing extravasation of urine and fibrosis. The symptoms often suggest to infravesical obstruction. The diagnosis is made from the patient's history in combination with flowmetry, ante- and/or retrograde urethrography, external ultrasound examination or urethral calibration and is verified at urethroscopy. Dilatation is relatively simple but seldom curative and carries a considerable morbidity. Urethrotomy is very common but also hampered with a high rate of recurrence. A technique where urethrotomy is followed by intermittent self-catheterisation or implantation of a selfexpanding wire netting seems promising but needs further investigation. Reconstructive operations in form of a free or pedicled skin island patch, skin tube graft, endourethral free split skin graft, multistaged urethroplasty, meatoplasty and excision of prostatomebraneous stricture are followed by cure in 50-95% of the cases.
Long-term results of carbon dioxide laser treatment of meatal condylomata acuminata.
A group of 74 men who underwent carbon dioxide laser treatment of meatal condylomata were observed for an average of 18 months. The cure rate after 1 treatment of isolated meatal lesions was 78%; the presence of external lesions lowered the rate to 32% and additional external and urethral warts to 25%. Following multiple treatments all but 6 patients were cured; 83% of the recurrences developed within 3 months. One urethral and 6 meatal strictures occurred more than 3 months after treatment; 9 patients had a spraying stream many years after treatment and 2 complained of frequency.
[EMLA cream (lidocaine/prilocaine) versus infiltration analgesia with carbocaine (mepivacaine) in vasectomy].
The analgesic efficacy of EMLA cream was compared with infiltration with 1% carbocaine in 13 bilateral vasectomies. Twelve patients preferred infiltration analgesia. EMLA analgesia was only effective in the skin, and had to be supplemented as the incision reached subcutaneous tissue.
[Esophageal varices: physiopathology and treatment. The role of the lower esophageal sphincter].
Development of esophageal varices depends on local esophageal factors and portal gradient, vascular resistance in the azygos vein or presence of other portosystemic collaterals. Esophageal varices are found in the lamina propria of lower esophageal sphincter (LES), the pressure of which exceeds the normal portal pressure. Factors reducing LES pressure promote development of varices and enlarge these. Contraction of LES leads to reduction of the variceal and azygos flows, decrease in the pressure gradient across the varix wall and diminishes the varices. Pharmacological contraction of LES arrests the endoscopically proved bleeding from esophageal varices. Manipulation of LES pressure appears to be a genuine alternative to the current methods of treatment of the bleeding esophageal varices.
Transurethral incision of urethral diverticulum in the female.
A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time.
Preoperative tumor localization.
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Treatment of hydrocele testis by injection of tetracycline.
In a prospective study 27 hydroceles were treated with single aspiration and injection of 500 mg tetracycline. The median observation period was 6 months (range 3-15 months). One month after therapy 9 recurrences were observed; but 5 disappeared spontaneously during the next 2 months, giving an overall success rate of 85% (95% confidence limits 66-96%). No serious complications occurred. Dilution of tetracycline in lidocaine prevented acute scrotal pain. Sclerotherapy with tetracycline is efficient, easy and inexpensive and, therefore, economical and beneficial for the patient.
[A case of snake bite requiring surgery in Denmark].
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Implantation of a pressure cuff around the subphrenic oesophagus.
The possibility of implanting a pressure cuff around the subphrenic oesophagus as a barrier to reflux was tested in six pigs. The oesophagus tolerated cuff pressures from 48 to 95 cmH2O, corresponding to intra-oesophageal pressures from 27 to 75 cmH2O. The pigs with the perioesophageal cuff swallowed a solid diet without difficulty. However, dysphagia occurred in pigs kept alive for more than a month and the main reason was malfunction of the device because of surrounding fibrosis. This problem should be solved before implantation of the device in humans is attempted.
Percutaneous introduction of double-J ureteral stents.
Insertion of percutaneous indwelling ureteral stents was performed or attempted in 10 patients with ureteral obstruction or postoperative urinary extravasation. All patients had previously sustained an unsuccessful endoscopic retrograde attempt. The percutaneous double-J stent was inserted anatomically correctly in 8 (73%) cases and was functionally successful in 7 (64%). No significant complications occurred. As the percutaneous indwelling ureteral stent offers many advantages, i.e. little discomfort to the patient and none or insignificant complications, we want to advocate for the use of this method whenever the endoscopic technique fails.
Comparison of different types of gastroplasty in the treatment of 93 morbid obese patients.
Between 1980 and 1985, three types of horizontal and one of vertical gastroplasty were employed in an attempt to find the best alternative to jejunoileal bypass in morbid obesity. Operations were tried successively, one being abandoned in favour of the next whenever unsatisfactory results were too frequent. Thus survey pertains to 93 consecutive, but previously untreated patients. The four groups were comparable with regard to inclusion criteria, preoperative degree of obesity and postoperative care. Weight losses were significantly greater in the vertical type, while there were no significant differences among the horizontal types of gastroplasty. There were few and only minor differences with regard to complications. Evidence to date seems to point to vertical gastroplasty as the best surgical treatment in morbid obesity.
Excision of rectal villous adenoma using a TA or GIA stapler.
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Cecal angiodysplasia localized by 99mtechnetium blood-pool scintigraphy and specimen venography.
Angiodysplasia of the right colon may be difficult to diagnose. The usual methods of choice, selective abdominal angiography and colonoscopy, may be impracticable or fail. When bleeding occurs, 99mtechnetium blood-pool scintigraphy is a simple and reliable method of localizing vessel leakage. We present a case of an 84-year-old woman with severely bleeding angiodysplasia, where the source of bleeding was localized by means of scintigraphy using 99mTc in vivo labeled red blood cells. After right hemicolectomy, the angiodysplastic lesion was confirmed by specimen venography utilizing a barium gelatin mixture.
Stripping of the distal ureter after nephrectomy for pelvis papilloma.
A new technique for removal of the distal ureter using a vein stripper was successfully used in eight patients after nephrectomy for pelvis papilloma. The method described is safe and shortens operating time.