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Biomedical subjects

L Persky

Publications and source records attributed to L Persky.

At least 19 recordsLinked to original sources
PubMed1992

Reduced urosepsis in a veterans' hospital.

A three-year study of infecting organisms in a 600-bed university hospital revealed that despite an overall high incidence of urinary sepsis by resistant organisms only a small portion (3.5%) occurred on the urology service. Possible explanatory causes for this low infection rate included avoidance of cross infection from known pools of resistant organisms, short hospital stays, and close adherence to strictly aseptic techniques in handling patient's tubes and collecting devices. Simple measures provided protection from costly, debilitating disease.

Adult↗
PubMed1992

Conversion from external appliance wearing or internal urinary diversion to a continent urinary reservoir (Florida pouch I and II): surgical technique, indications and complications.

A total of 20 patients with diversion requiring an external appliance or internal urinary diversion underwent conversion to a continent urinary reservoir (Florida pouch I or II). All patients subsequently reported an improvement in the quality of life and expressed satisfaction with the new urinary diversion procedure. Of the patients 15 (75%) previously had an ileal conduit, while 1 (5%) had undergone ureterosigmoidostomy, 1 (5%) had cutaneous ureterostomy, 1 (5%) had a suprapubic tube, 1 (5%) had a sigmoid conduit and 1 (5%) had a cecal conduit. After the original diversion 3 patients (15%) had recurrent urinary infections, 3 had complications related to the stoma and external appliance (stenosis and skin dermatitis) and 5 (25%) had ureteral obstruction in 7 ureters. A total of 17 patients with conduits (85%) underwent conversion via different surgical technical aspects depending on the status of the intestinal segment from the conduit and the function of the ureteral reimplantation: in 14 the conduit was discarded or was used only to patch the newly created Florida I colonic pouch, while in 6 the conduit was preserved and 9 ureterointestinal reimplantations were left undisturbed (Florida pouch II). Among 7 ureters preoperatively obstructed (original diversion), reimplanting them into the pouch failed to prevent further renal damage in 5 (71%). Three renal units required nephrectomy, 2 kidneys deteriorated and 2 recovered renal function after percutaneous balloon dilation and stenting. Among 31 preoperatively nonobstructed renoureteral units (original diversion), 22 were reimplanted into the colonic reservoir. One of these units (4.2%) became obstructed postoperatively and 3 (13.5%) presently have reflux. The 10 reimplantations left undisturbed in the detubularized conduit drain satisfactorily without postoperative obstruction and in 6 reflux has not been demonstrated. Renal function (serum creatinine) is preserved in all patients but 15 (75%) have hyperchloremia of mild degree. Two patients (10%) have acidosis and 1 (5%) of these had low red blood cell folic acid. Conversion of an external or internal diversion to a continent colonic urinary reservoir (Florida pouch I or II) can be successful and improve the quality of life of the patient. The functioning renal units that were preoperatively obstructed were associated with a high failure rate (71%) after reimplantation. Metabolic alterations will require long-term followup, and are particularly worrisome in children and young adults.

Adolescent↗
PubMed1991

Management of auto-emasculation in the psychotic state.

We report 2 cases of self-inflicted penile amputations, which offered differing surgical options and contrasting surgical results due to varying time delays. In 1 case repair was done immediately, while repair in the other case was delayed by 3 days due to the psychotic state of the patient. The psychiatric backgrounds of such episodes are discussed, as well as the techniques of repair and reconstruction.

Adult↗
PubMed1991

Results, complications and surgical indications of the Florida pouch.

One hundred and seven patients underwent continent urinary diversion using an extended, detubularized right colonic segment as the urinary reservoir and the distal part of the ileum as a continent catheterized efferent system. This reservoir allows the accommodation of a large volume of urine; urodynamics in 28 patients demonstrated a maximum reservoir capacity varying between 550 and 1,200 milliliters (an average of 747 milliliters). The reservoir maximal volume and pressure remains unchanged in six patients studied urodynamically three to four years postoperatively. Maximal reservoir pressures ranged between 10 and 58 centimeters of H2O (an average of 35 centimeters). Of 201 ureterocolonic reimplantations, four ureters were initially reimplanted using a modified Le Duc procedure, 26 ureters were subsequently managed using the Goodwin transcolonic approach and 165 reimplantations were done with a direct (nontunneled) mucosa to mucosal anastomosis. The over-all success rates with each of the three techniques (absence of reflux and obstruction) have been 75.0, 84.7 and 87.4 per cent, respectively. However, the incidence of obstruction was 13.3 per cent for the tunneled and 4.2 per cent for the non-tunneled reimplantations. Six megaureters underwent imbrication and direct reimplantation, and three of these became obstructed. One patient died of pulmonary embolism. Medical and surgical complications markedly predominated in the group who underwent simultaneous cystectomies, and in this group, the over-all complication rate was comparable with that for previously reported series with ileal conduits. The double row plication of the distal part of the ileum and ileocecal valve allows easy catheterization every four to six hours and 105 patients (97.2 per cent) remained continent between catheterizations. The stoma is covered using a small gauze, cap or sterile adhesive strip. This protects clothing from mucus production by the stoma and an occasional episode of urinary dribbling. Seven patients required reoperation for correction of incontinence or other complications. Our satisfactory experience with these patients makes this technique an excellent approach to achieving continent urinary diversion.

Adolescent↗
PubMed1990

The overlooked, retained Double J stent.

A series of 4 patients with long overlooked, retained ureteral stents is presented to illustrate the variable, unpredictable, and at times, hazardous course of such patients. These cases are cited to re-emphasize the need for careful documentation, observation, and follow-up of patients in whom stents are placed.

Adolescent↗
PubMed1990

A continent colonic urinary reservoir: the Florida pouch.

A total of 92 patients underwent continent urinary diversion with an extended, detubularized right colonic segment as the urinary reservoir and the distal ileum as a continent catheterizable efferent system. In this series 65 patients were followed for 6 to 46 months (average 17 months). Our reservoir allows the accommodation of a large volume of urine; urodynamic studies in 28 patients demonstrated a maximum reservoir capacity varying between 550 and 1,200 cc (average 747 cc). Maximal reservoir pressures ranged from 10 to 58 cm. water (average 35 cm. water). Of the 127 ureterocolonic reimplantations 4 ureters were initially reimplanted with a modified Le Duc procedure, 26 ureters were managed subsequently with the Goodwin transcolonic approach and 91 reimplantations were done with a direct (nontunneled) mucosa-to-mucosa anastomosis. The overall success rates with each of the 3 techniques (absence of reflux and obstruction) were 75, 88.6 and 90.1%, respectively. Six megaureters underwent imbrication and direct reimplantation, and 3 of these (50%) became obstructed. Two converted ileal conduits were opened at the antimesenteric edge and were patched to the reservoir while the ureteroileal anastomosis was left undisturbed. One patient (1.5%) died of pulmonary embolism. Medical and surgical complications occurred only in the group who underwent simultaneous cystectomy and the over-all rate of complication was comparable to previous series with ileal conduits. The double row plication of the distal ileum and ileocecal valve allows for easy catheterization every 4 to 6 hours and 63 patients (97%) remain continent between catheterization. Four patients (6%) required reoperation for correction of incontinence or other complications. Our satisfactory experience with these patients makes this technique an excellent approach to achieving continent urinary diversion.

Colon↗
PubMed1989

Penile ecthyma gangrenosum. Complication of drug addiction.

We present a case of ecthyma gangrenosum involving the penis in an IV drug abuser probably resulting from direct arterial septic embolization from a femoral injection site. An increased awareness of this condition is essential because misdiagnosis has been reported in up to 100 percent of cases. Prompt diagnosis is essential to begin appropriate therapy.

Adult↗
PubMed1988

Prevention of the development of a vesicovaginal fistula.

The cause of vesicovaginal fistulas after hysterectomy is not clearly understood. In an attempt to determine its cause, the records of 12 patients who had vesicovaginal fistula develop (after total abdominal hysterectomy) were compared with 12 consecutive patients who underwent total abdominal hysterectomy without fistula formation. Most of the patients who had vesicovaginal fistulas develop had excessive postoperative abdominal pain, distension or paralytic ileus, or both. Hematuria and symptoms of irritability of the bladder were also noted in the fistula group and prolonged postoperative fever and increased white blood cell count occurred more often. In contrast, the postoperative course was uncomplicated in the nonfistula group. The clinical course observed in many of the patients with vesicovaginal fistulas suggests that the patients had an unrecognized injury to the bladder resulting in urinary extravasation. It is postulated that the fistula develops when the urinoma drains into the vaginal cuff which is dependent and usually not closed. It may be possible to abort the development of many vesicovaginal fistulas by early recognition and treatment of an unsuspected bladder injury. It is suggested that patients with severe abdominal pain, distension, paralytic ileus, hematuria or symptoms of severe irritability of the bladder after abdominal hysterectomy be investigated early for a possible bladder injury.

Adult↗
PubMed1986

Staphylococcus epidermidis in diabetic urological patient.

We present 6 patients in whom prosthetic failure occurred because of sepsis owing to Staphylococcus epidermidis. Such failure occurs in grafts in other areas and is caused by the high resistance of the organism to conventional antibacterial measures. Therapy with appropriate antibiotics, that is aminoglycosides, vancomycin and rifampin, and the need for an early operation are stressed.

Adult↗
PubMed1986

Pattern of urinary symptoms in patients with metastatic bladder cancer.

In an attempt to assess the development or progression of symptoms in patients with metastatic bladder cancer we reviewed 41 patients who died of the disease but who did not undergo cystectomy. Therapy for the local tumor was used when indicated. Of the 41 patients 9 experienced worsening of symptoms, while the others were either stable or improved. Only 1 of 10 asymptomatic patients suffered symptoms during the course of the illness.

Adult↗
PubMed1986

Ileal and jejunal conduit urinary diversion.

The indications for urinary diversion have changed in recent years, and it is most often required in association with radical surgery for pelvic malignancies. Many patient with lower urinary tract dysfunction can be managed satisfactorily without diversion by use of intermittent catheterization, administration of specific pharmacologic agents, and, when necessary, implantation of artificial sphincters. For patients who require urinary diversion, the ureteroileal conduit remains the standard by which other methods should be judged. If satisfactory results are to be obtained, it is clear that meticulous attention to indications, operative technique, and careful follow-up are essential. As many of these patients have other disabilities, the management of the urinary tract must be integrated with other aspects of patient care. The introduction of the colonic conduit and recently the continent types of urinary diversion represent a search for the ideal method that has yet to be achieved.

Adenocarcinoma↗
PubMed1985

The management of civilian ureteral gunshot wounds: a review of 8 patients.

Ureteral injury is a rare consequence of abdominal gunshot wounds. We recently treated 8 patients with ureteral injuries. Failure to diagnose ureteral injury at presentation led to postoperative complications, necessitating additional operative procedures in 4 patients. However, in all 8 patients renal salvage was achieved.

Adolescent↗
PubMed1984

Incidental fetal hydronephrosis: clinical implication.

Maternal ultrasonography performed after twenty weeks of gestation is able accurately to identify and diagnose fetal hydronephrosis. We believe this finding should serve to alert the obstetrician as well as the pediatrician to potential complications which may arise at the time of delivery or immediately thereafter. Urologic evaluation and definitive surgical repair may then be performed when indicated.

Adult↗
PubMed1984

Fournier's gangrene: report of 20 patients.

Synergistic necrotizing fasciitis of the penis and scrotum was described first by Fournier and remains a rare but life-threatening disease. In Fournier's initial description the process was believed to be idiopathic. During the last 10 years we have treated 20 patients with Fournier's gangrene and a definite urologic or colorectal cause could be identified as the source of the infection in 19 (95 per cent). Despite the use of broad-spectrum antibiotics and aggressive surgical débridement the mortality rate was 45 per cent.

Adult↗
PubMed1983

Penile reconstruction with gracilis pedicle grafts.

Penile loss results from various external and self-inflicted catastrophic events. Many types of reconstructive efforts have been used successfully. Recently, bilateral pedicle grafts of the gracilis muscle have been successful and have provided serviceable results in our hands. Technique, complications and indications are discussed and illustrative cases are reported.

Humans↗