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Biomedical subjects

M L Stoller

Publications and source records attributed to M L Stoller.

107 records · Page 6Linked to original sources
PubMed1992

Pyonephrosis: diagnosis and treatment.

A series of 23 confirmed cases of pyonephrosis initially treated by percutaneous nephrostomy drainage were reviewed. Presentation was extremely variable, ranging from sepsis to asymptomatic bacteriuria. Fever, flank pain and leukocytosis were often absent. Ultrasonography was diagnostic in only 3 of 12 patients. In all, 17 patients had associated nephrolithiasis, and 5 patients ultimately required nephrectomy. Renal urine cultures were positive in 16 of 21 instances, with multiple organisms found in 8 of 21, and added bacteriological data not provided by bladder urine cultures in 11 cases. A pre-existing history of urinary tract infection, hypertension and malignancy was common. Percutaneous drainage was a safe, quick and effective diagnostic and therapeutic method.

Adult↗
PubMed1991

Unusual appendiceal pathology presenting as urologic disease.

We report on 3 cases of unusual appendiceal pathology presenting as urologic disease: 2 cases were benign mucoceles and 1 a malignant mucocele or cystadenocarcinoma of the appendix. Two cases presented as pelvic masses causing urinary frequency and the third with fever and hydronephrosis. The appendix must remain in the differential diagnosis for both acute and chronic disease processes.

Appendix↗
PubMed1991

Management of upper tract calculi in patients with tubularized urinary diversions.

In a retrospective review of patients with urinary diversion who presented to our stone center during a 3.5-year period 9 underwent 20 procedures for suspected stone episodes. Eventual outcome was excellent in all but 1 patient. In particular, all attempts at retrograde trans-stomal manipulation were successful. We present our cases, and note the technical considerations and management principles. Frequently, these patients are best served by a combination of percutaneous antegrade, trans-stomal retrograde and/or extracorporeal shock wave lithotripsy.

Adult↗
PubMed1991

Magnetic resonance imaging of renal calculi: an in vitro study.

Extracorporeal shock wave lithotripsy (ESWL) has been established as a standard method of urinary stone treatment. Poor fragmentation with an increased rate of complications has been noticed with certain calculi types (calcium oxalate monohydrate and cystine). In devising appropriate pre-operative strategies, it would be useful to know the calculi composition. We have investigated the in vitro utility of using magnetic resonance imaging (MRI) in analyzing urinary calculi. Our in vitro analysis found no difference in signal characteristics between calculi of varying composition. The absence of signal can be understood from a molecular basis. We conclude that MRI will not offer any assistance in characterizing the composition of urinary calculi.

Humans↗
PubMed1990

The effect of extracorporeal shock wave lithotripsy on the microbiological flora of urinary calculi.

To determine whether extracorporeal shock wave lithotripsy can sterilize infection stones and, thus, decrease the recurrence rate we investigated its impact on the microbiological flora of staghorn calculi. Fragments from 17 staghorn calculi retrieved percutaneously were divided into paired sets. One set was fractured by extracorporeal shock wave lithotripsy at 18 kv. and with increasing numbers of shock waves up to 1,000. One set was fractured mechanically with a surgical clamp. Bacterial cultures were then compared between the 2 groups. Of the 17 staghorn calculi 10 showed significant bacterial growth (59%). The number of colony-forming units was not significantly different between stones fragmented by lithotripsy and those that were mechanically fractured. Furthermore, exposing fragments to an increasing number of shock waves did not alter the colony count. We conclude that extracorporeal shock wave lithotripsy has no discernible effect on the microbiological flora of infected staghorn calculi.

Colony Count, Microbial↗
PubMed1990

Pyoderma gangrenosum presenting as Fournier's gangrene.

We report a case of pyoderma gangrenosum presenting as Fournier's gangrene. Although both processes have a similar presentation effective management is markedly different. Whereas broad-spectrum antibiotics and aggressive surgical débridement are necessary to control Fournier's gangrene, immediate institution of corticosteroids and local wound care are indicated for pyoderma gangrenosum.

Adult↗
PubMed1990

Fungal bezoars of the upper urinary tract.

We report our experience with 6 cases of upper tract fungal bezoars involving 9 renal units-3 bilateral aspergillomas and 3 Candida bezoars. The Aspergillus bezoars were notably more morbid: 2 patients required nephrectomy after failure of medical therapy, whereas the 3 unilateral Candida bezoars all resolved with medical therapy and endourological access. In 1 patient whose aspergilloma was resistant to amphotericin B the investigational drug itraconazole proved effective. These opportunistic infections, seen increasingly in immunocompromised patients, can present a difficult management problem. A combined approach is necessary, including medical therapy with topical and systemic antifungal agents, and endourological access for extraction, lavage and debulking.

Adult↗
PubMed1989

The accuracy of a catheterized residual urine.

Residual urine is important in the evaluation of the urological patient. The gold standard to obtain this information is a catheterized specimen. We examined the accuracy of a catheterized value to ascertain whether the bladder was emptied completely. After the bladder was catheterized 10 ml. radiocontrast material were instilled into the bladder to allow radiographic documentation of complete evacuation. We found that 26 per cent of 515 patients evaluated had residual urine after routine attempts were made to evacuate the bladder fully. We conclude that a single residual urine estimate may be inaccurate and one should not always base therapeutic decisions upon any single such measurement.

Adult↗
PubMed1988

Extracorporeal shock wave lithotripsy performed on woman with a cardiac pacemaker.

A 73-year-old woman with a sick sinus syndrome and a 3-year-old ventricular demand pacemaker underwent extracorporeal shock wave lithotripsy without incident. There was no damage or malfunction of the pacemaker during or acutely after this therapy. The lithotriptor had no difficulty in sensing all paced or spontaneous ventricular complexes.

Aged↗
PubMed1987

Constrictive penile band injury: anatomical and reconstructive considerations.

Cases of constrictive penile band injury are seen often in the emergency room, and most require only removal of the constriction and conservative management. Occasionally, patients present with long-standing constriction, necrosis of the penile tissue and urethral injury. We report 2 such cases. We believe that a thorough understanding of the penile anatomy, aggressive debridement, skin grafting and temporary urinary diversion are essential for successful management of these severe cases.

Adult↗
PubMed1986

Sensitivity of 99mtechnetium-dimercaptosuccinic acid for the diagnosis of chronic pyelonephritis: clinical and theoretical considerations.

Radioisotopic renal imaging proved to be much more sensitive than excretory urography in diagnosing renal parenchymal damage in 6 children with acute febrile urinary tract infections. This increased sensitivity may affect clinical management. More importantly, it may change the interpretation of scientific studies evaluating the natural history and treatment of vesicoureteral reflux.

Child↗
PubMed1985

Spermatic cord torsion: diagnostic limitations.

To distinguish spermatic cord torsion from other intrascrotal pathology, scrotal ultrasound and radionuclide scanning have been highly recommended on the basis of both clinical and experimental studies. We review the data from six patients in whom ultrasound or nuclear medicine examination was misleading. We emphasize that history, physical examination, and urinalysis remain the cornerstones of the diagnosis of spermatic cord torsion. Scrotal ultrasound and nuclear medicine scans are useful adjuncts and are reassuring when in agreement with the clinical picture. However, they are not 100% sensitive or specific, and a negative study should not prevent emergency operative exploration of a clinically suspicious lesion.

Adolescent↗