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Biomedical subjects

M A Keating

Publications and source records attributed to M A Keating.

68 records · Page 4Linked to original sources
PubMed1988

Use of dermal graft and free urethral graft in penile reconstruction.

From 1979 to 1987 we treated 28 patients with severe penile malformations who required a dermal graft to straighten the shaft and a free graft to construct a urethra. In 10 patients the 2 grafts were placed simultaneously with good results. In 15 patients the dermal graft was placed initially and a urethral graft was placed over it later. In 3 patients the urethroplasty has not been done yet. No complications resulted from the combined use of dermal and urethral free grafts. The principle of "graft on graft" can be applied successfully to correct certain severe penile problems. Indications, technique and results are presented.

Adolescent↗
PubMed1988

Neurourological implications of the changing approach in management of occult spinal lesions.

Occult lesions of the spine in children are a rare but recognizable cause of neurogenic dysfunction involving the lower extremities, and lower urinary and gastrointestinal tracts. We report the preoperative and postoperative urodynamic findings in 40 children with varying spinal abnormalities. Of these patients 28 were neonates or infants (average age 8.7 months) and 12 were older children (average age 11.7 years). Preoperative urodynamic testing revealed normal function in 18 of 28 children (64 per cent) in the younger age group in contrast to 1 of 12 (8 per cent) in the older age group. Of the 10 infants with abnormal studies postoperative urodynamic findings returned to normal in 6, while 2 others remained abnormal but were improved. In contrast, of 11 older children with abnormal preoperative evaluations 3 (27 per cent) reverted to normal postoperatively. The neurourological changes seen in these occult lesions are variable, may occur at any age, are progressive and are potentially reversible by surgical correction but this reversibility diminishes with age.

Adolescent↗
PubMed1988

Rectal necrosis after pelvic crush injury.

A case is described in which transmural necrosis of the rectum occurred following a severe pelvic crush injury in an obese man. The necrosis presumably resulted from occlusion of both internal iliac arteries, disruption of the pelvic collateral circulation, and as a result of direct rectal contusion.

Adult↗
PubMed1987

Hamartoma of the bladder in a 4-year-old girl with hamartomatous polyps of the gastrointestinal tract.

We report on a girl with hamartomatous intestinal polyps and a large mass that involved most of the posterior wall of the bladder, which on microscopic examination had the characteristics of a hamartoma. Hamartomas are among the rarest of bladder tumors. Our case is only the third reported under this designation, although 3 other cases may fall into this category. Of the 6 patients 4 have been children. Although most polypoid bladder tumors in children are rhabdomyosarcomas of the botryoid type, our case illustrates that rarely other lesions are similar grossly. Recognition of these lesions has clinical implications with regard to therapy and prognosis.

Child, Preschool↗
PubMed1987

Initial experience with extracorporeal shock wave lithotripsy in children.

The clinical experience is presented of 4 United States centers at which extracorporeal shock wave lithotripsy was used for the treatment of renal calculi in 38 children 12 months to 16 years old. Patient characteristics, treatment specifics and followup data are detailed. Complete fragmentation of calculi was obtained in 97 per cent of those treated, with a 5 per cent complication rate. This experience demonstrates that with proper safeguards, extracorporeal shock wave lithotripsy can be performed safely and effectively in the pediatric population.

Adolescent↗
PubMed1986

Preputial unfurling to correct the buried penis.

Recognition of the buried penis is necessary both to ensure its proper management and to avoid performance of a standard circumcision, which can result in penile degloving. We describe a simple technique of unfurling the prepuce which provides adequate functional and cosmetic replacement for the penile shaft skin.

Humans↗
PubMed1986

An algorithm for the management of ureteral calculi.

We evaluated 158 patients with ureteral calculi (28 impacted in the ureteropelvic junction, 42 in the upper, 29 middle and 36 lower third of the ureter, and 23 in the intramural tunnel) treated by extracorporeal shock wave lithotripsy, percutaneous ultrasonic lithotripsy, ureteroscopic methods, chemolysis or surgery. Of the patients 92.5 per cent were treated successfully by endourological methods. Twelve patients (7.5 per cent) required an operation. Extracorporeal shock wave lithotripsy was successful in 61 per cent of the patients without placement of a ureteral stent and in 100 per cent in whom stent placement or stone dislodgement was successful. Ureteroscopic removal was successful in 52 of 56 patients with lower third and intravesical tunnel ureteral calculi. An algorithm for ureteral calculi management is developed, which emphasizes stent bypass and extracorporeal shock wave lithotripsy for upper third or ureteropelvic junction calculi, ureteroscopic removal or stent bypass with extracorporeal shock wave lithotripsy for middle third calculi, and ureteroscopic techniques for lower third and intramural tunnel calculi. Percutaneous ultrasonic lithotripsy, chemolysis and surgery are recommended as complementary methods.

Algorithms↗
PubMed1986

Ureteroscopy: the initial experience.

A prospective study of our first 81 cases of ureteroscopy using extended length rigid endoscopes was performed. Of 55 stone manipulations attempted in 51 patients by 6 endoscopists 38 (69 per cent) were successful. Analyzed sequentially, removal was successful in 12 of 23 attempts (52 per cent) among the initial 40 patients and in 26 of 32 (81 per cent) among the subsequent 41 patients. Of 11 calculi larger than 1 cm. and of 23 positioned above the iliac vessels 7 (64 per cent) and 11 (48 per cent), respectively, were removed successfully. Disimpaction by ureteroscopic manipulation combined with extracorporeal shock wave lithotripsy was successful in 4 cases of upper ureteral calculi not treatable by extracorporeal shock wave lithotripsy alone. Diagnostic and therapeutic uses of the ureteroscope in addition to treatment of ureteral calculi have included the delineation of ureteral filling defects (9 patients), fulguration of known low grade tumors (4) and dilation of ureteral strictures (5). In 10 patients information was obtained endoscopically that was not possible by standard diagnostic techniques. The direct visual approach to the ureter has distinct advantages over blind ureteral instrumentation.

Adult↗
PubMed1985

Vascular invasion as a prognosticator of metastatic disease in nonseminomatous germ cell tumors of the testis. Importance in "surveillance only" protocols.

Forty-five nonseminomatous germ cell carcinomas of the testis were evaluated retrospectively to define the biologic features associated with the occurrence of metastatic disease. A statistical analysis of several pertinent clinical and pathologic factors was performed. The factors evaluated included: duration of symptoms before diagnosis, serum level of alpha-fetoprotein, serum or urinary level of human chorionic gonadotropin, testicular weight, extent of local tumor (pathologic T stage), and vascular invasion at the primary site. In each case, metastases were documented by a retroperitoneal node dissection, other biopsies, or by chest films. In 29 tumors with vascular invasion, 25 patients were seen with metastatic disease. In 16 tumors without vascular invasion, 3 patients demonstrated metastasis. The presence or absence of vascular invasion was strongly correlated with concomitant lymph node involvement or subsequent appearance of other metastatic disease (chi-square = 17.19). Additionally, vascular invasion in bifactoral++ analysis with tumor size and pathologic T stage proved a significant prognosticator even in low-staged (chi-square = 8.48) and small tumors (chi-square = 8.13). The implications of these findings, both as an adjunct to the staging of nonseminomatous germ cell tumors and in the management of clinical Stage I lesions, are discussed.

Adolescent↗
PubMed1982

Clinical laboratory comparison of a slide blood culture system with a conventional broth system.

The recovery of bacteria and fungi from blood cultures was compared in conventional tryptic soy broth (TSB) bottles and in TSB bottles with an agarcoated slide attachment. A total of 2,662 sets of blood cultures, including 413 that were positive (15.5%), were evaluated. Significantly more gram-positive and gram-negative bacteria were recovered in the slide culture bottles than in conventional bottles (299 versus 253 isolates). Growth of gram-positive organisms and fungi was detected in the slide culture bottles 24 to 48 h earlier than in the TSB bottles. In addition, 76% of the isolates in the slide culture system were detected on the agar slide. In comparison, only 40% of the isolates in the TSB bottles were detected initially by blind subculturing. The incidences of contamination were 2.7% (71 cultures) for the slide culture system and 1.5% (39 cultures) for the TSB bottles.

Bacteria↗
PubMedDate not supplied

The acute pediatric scrotum.

The acute pediatric scrotum is a common clinical condition that can present a diagnostic dilemma for even the most experienced physician. The issue of primary importance in each case is to ensure testicular viability through proper evaluation, prompt diagnosis, and surgical intervention if necessary. A review of the various etiologies of acute scrotal disorders in children aids in the formulation of a logical and systematic approach to their accurate diagnosis and management.

Acute Disease↗