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J N Macaluso

Publications and source records attributed to J N Macaluso.

16 recordsLinked to original sources
PubMed1997

Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association.

PURPOSE: The American Urological Association convened the Ureteral Stones Clinical Guidelines Panel to analyze the literature regarding available methods for treating ureteral calculi and to make practice policy recommendations based on the treatment outcomes data. MATERIALS AND METHODS: The panel searched the MEDLINE data base for all articles related to ureteral calculi published from 1966 to January 1996. Outcomes data were extracted from articles accepted after panel review. The data were then meta-analyzed to produce outcome estimates for alternative treatments of ureteral calculi. RESULTS: The data indicate that up to 98% of stones less than 0.5 cm. in diameter, especially in the distal ureter, will pass spontaneously. Shock wave lithotripsy is recommended as first line treatment for most patients with stones 1 cm. or less in the proximal ureter. Shock wave lithotripsy and ureteroscopy are acceptable treatment choices for stones 1 cm. or less in the distal ureter. CONCLUSIONS: Most ureteral stones will pass spontaneously. Those that do not can be removed by either shock wave lithotripsy or ureteroscopy. Traditional blind basket extraction, without fluoroscopic control and guide wires, is not recommended. Open surgery is appropriate as a salvage procedure or in certain unusual circumstances.

Humans↗
PubMed1995

Gold-tip laser sleeve for a bare fiber.

A gold-tip laser sleeve for a bare laser fiber has been used for Nd:YAG laser irradiation of the prostate in both the canine model and a pilot clinical series. In the animal model, irradiation was undertaken using the Ablaser catheter through an open suprapubic cystotomy, and the procedure was monitored by video endoscopy via a perineal urethrostomy. Intraprostatic heating profiles were determined using real-time interstitial thermometry. As long as no carbonization occurred, irradiation with higher wattage resulted in higher intraprostatic temperatures. The "popcorn effect" caused a superficial temperature reduction but did not alter the ability of thermal conduction to heat deeper in the prostate. A small series of patients has been treated, with good results.

Aged↗
PubMed1995

Ungated Medstone outpatient lithotripsy.

Ungated lithotripsy has raised the specter of possible cardiac arrhythmias. We reviewed ungated outpatient lithotripsy performed on 82 patients to evaluate the incidence of arrhythmias encountered and time saved. All patients were chosen in a random nonselected, prospective fashion. All treatments were performed on a mobile Medstone 1050 STS lithotriptor. The incidence of arrhythmias was 21%. All but 2 arryhthmias were benign and all reversed with gating. No arrhythmias occurred during treatment of right ureteral stones. In the left ureter only 1 patient had benign premature ventricular contractions during treatment. Arrhythmias occurred at 20 to 24 kv. in 20% of patients with right renal stones and 31% with left renal stones. All arrhythmias resolved with gating. No arrhythmias were encountered at an energy level of less than 20 kv. There was no evidence of electrocardiographic changes up to 1 hour after treatment. Pharmacological manipulation to maintain a heart rate of 100 may allow a treatment time of approximately 24 minutes. With ungating the rate may reach 120, allowing for a treatment time of approximately 20 minutes. In this series average ungated lithotripsy time was 36 minutes. In comparison, the average treatment time in 20 patients undergoing gated lithotripsy was 38.7 minutes. It is not clear from this study whether persistent ungated lithotripsy would have precipitated any life threatening arrhythmias since our practice has been to terminate the procedure and re-gate the shocks at the first sign of any persistent change in cardiac rhythm. Our data indicate that ungated lithotripsy with the Medstone device is safe when simple monitoring rules are followed.

Ambulatory Care↗
PubMed1994

Nephrolithiasis Clinical Guidelines Panel summary report on the management of staghorn calculi. The American Urological Association Nephrolithiasis Clinical Guidelines Panel.

The American Urological Association Nephrolithiasis Clinical Guidelines Panel recommendations for managing struvite staghorn calculi are based on a comprehensive review of the treatment literature and meta-analysis of outcome data from the 110 pertinent articles containing viable, unduplicated data. The panel concluded that the 3 most significant outcome probabilities are those of being stone-free, undergoing secondary unplanned procedures and having associated complications. Panel guideline recommendations for most standard patients are that neither shock wave lithotripsy monotherapy nor open surgery should be a first-line treatment choice but that a combination of percutaneous stone removal and shock wave lithotripsy should be used.

Humans↗
PubMed1993

An innovative approach to management of lower third ureteral calculi.

A total of 130 patients with symptomatic lower third ureteral calculi underwent 136 treatments by 43 accredited urologists. These treatments were performed at a fixed lithotripsy site and 16 mobile sites using the Medstone lithotriptor from December 1990 through January 1992. The average stone size was 8.16 x 5.14 mm. A total of 126 patients underwent a single treatment and 4 underwent multiple treatment sessions. Of the 126 patients undergoing monotherapy 10 (8%) were lost to followup, while 101 of the remaining 116 evaluable patients (87%) were stone-free with a single treatment. The 15 patients in this subgroup who were considered failures and the 4 patients who underwent multiple treatments had overall larger stone sizes. The preoperative stent placement rate was only 32%. The treatments were well tolerated by the patients. Our report confirms a high efficacy rate with the second generation bathless lithotriptor for management of lower third ureteral calculi. The importance of a stable and qualified technical team cannot be overemphasized.

Equipment Design↗
PubMed1993

External urinary diversion: pathologic circumstances and available technology.

A wide variety of uropathologic circumstances may necessitate intervention. All urologic interventions depend on two simple rules for success. The first is visualization (via direct-vision endoscopy or videovision endoscopy, usually in combination with external imaging via fluroscopy), as failure to visualize the area of pathology properly may compromise or doom the procedure. The second is adequate access to the urinary tract via the endoscope, which is ensured by wire, catheter, or other appropriate access device. Failure of proper access dooms interventional urologic, uroradiologic, and endourologic procedures to failure.

Endoscopy↗
PubMed1991

Extracorporeal shock wave lithotripsy: an outpatient procedure.

At many centers circumstances have dictated that extracorporeal shock wave lithotripsy (ESWL*) be performed on an outpatient (that is same-day surgery or 1-day stay) basis. At our center, Louisiana Lithotripter, Inc., which is a privately owned ESWL unit located at Tulane University Hospital, we have had the opportunity to treat patients in the inpatient and outpatient setting since inception. Since our first ESWL treatment on December 18, 1985 we have treated more than 2,500 patients. Additionally, our unit was named an American Urological Association Training Center in October 1986, resulting in more than 200 urologist, nurse and technician trainee visits. The first 1,779 cases through December 31, 1988 have been thoroughly reviewed. The rate of outpatient ESWL has increased from 22% of the first 100 cases to more than 90% of the last 100. The cumulative over-all rate reached 70%. Currently, more than 95% of our cases are planned as same-day procedures. Safe and effective outpatient ESWL is able to be performed with first generation technology, paving the way for appropriate clinical application to newer technological modalities.

Ambulatory Care↗
PubMed1989

The use of the Magnetip double-J ureteral stent in urological practice.

The Magnetip* double J type ureteral stent has been used in a wide variety of clinical urological settings. We reviewed the use of the stent in 50 patients. In 45 patients stents were placed in conjunction with extracorporeal shock wave lithotripsy, stone manipulation, obstruction due to pregnancy or malignancy, pyeloplasty and ureteroneocystostomy. In 83 per cent of the attempts the stent was placed successfully. Retrieval with the Magnetriever* was accomplished in 86 per cent of the cases (100 per cent in female and 76 per cent in male patients). Details of stent use are described.

Adult↗
PubMed1985

Priapism: review of 34 cases.

One hundred ninety-seven cases of priapism have been recorded in the medical files of Charity Hospital Louisiana in New Orleans from 1938-1982. One hundred seventy-two adults and 25 children were registered in this series. Ninety-three per cent of the patients with priapism were black, and 86 patients of this group underwent 93 surgical procedures. The cases of 34 patients treated between July 1, 1981, and December 31, 1982, were thoroughly reviewed. Sixteen patients had a previous history of priapism. Average delay between onset of symptoms and presentation to the hospital for treatment was thirty hours. Sickle cell screens were obtained in 28 patients and were positive in 17. Twenty-nine patients were initially treated conservatively, with 17 priapisms eventually resolving, but the remaining 12 patients required surgical intervention. Overall, 50 per cent of the 34 patients had surgery. All of the surgical cases resolved satisfactorily with the Winter procedure. Complications with this procedure were uncommon, but postoperative bandaging was the chief cause of morbidity. Follow-up for at least six months revealed comparable sexual potency (80-83%) in either conservatively or surgically managed patients.

Adult↗
PubMed1985

Priapism.

Explore the source record for details and available documents.

Adult↗
PubMed1985

Glomus tumor of glans penis.

Glomus tumor is an infrequent skin lesion and a rare lesion on the male genitalia. This is the second reported case of this lesion on the penis.

Adult↗