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M S Pearle

Publications and source records attributed to M S Pearle.

45 records · Page 3Linked to original sources
PubMed1995

Laparoscopic pneumodissection: initial clinical experience.

OBJECTIVES: We evaluated the efficacy of a new laparoscopic dissecting instrument that fires intermittent bursts of high-pressure carbon dioxide to separate tissue along natural planes. METHODS: The pneumodissector (PD) was used in 2 patients undergoing laparoscopic procedures. Serum creatinine and bicarbonate were measured before and after the procedure, and arterial blood gases were measured before, during, and after use of the PD. Subjective assessment of the ease of dissection with the PD by the first assistant was recorded. RESULTS: Acidosis and hypercarbia were not observed with use of the PD. The PD facilitated dissection along the iliac vessels, around the kidney, and in the renal hilum. CONCLUSIONS: The PD is a feasible method for rapid, blunt dissection during laparoscopic procedures.

Adolescent↗
PubMed1995

Extracorporeal shock-wave lithotripsy of middle ureteral stones: are ureteral stents necessary?

OBJECTIVES: To ascertain whether insertion of a ureteral stent improves the outcome of middle ureteral (overlying the pelvic bone) stones treated with extracorporeal shock-wave lithotripsy (ESWL). METHODS: Thirty-three patients with middle ureteral stones were treated with ESWL at our institution between October 1991 and October 1994. Twenty-six patients were available for follow-up; 14 patients were treated with stent bypass, 8 were treated in situ, and 4 patients were treated after percutaneous nephrostomy (PCN). All patients were treated initially on an unmodified Dornier HM-3, and all but 4 patients were treated in the prone position on a modified Stryker frame. Follow-up consisted of a plain abdominal radiograph, intravenous urogram, occasionally a retrograde urogram, and a telephone interview. RESULTS: The overall stone-free rate for ESWL alone was 73%, and the efficiency quotient was 69. The stone-free rates after a single treatment for the stent bypass, in situ, and PCN groups were 71%, 63%, and 75%, respectively. Overall, 4% of patients required retreatment, 19% of patients required an auxiliary procedure, and 8% of the patients required hospital or emergency room admissions for renal colic. For stones 10 mm or greater (9), stone-free rates after one treatment for the stent bypass, in situ, and PCN groups were 33%, 33%, and 67%, respectively; for stones less than 10 mm (17), success rates were 82%, 80%, and 100%, respectively. CONCLUSIONS: Pretreatment stinting provides no advantage over in situ ESWL for middle ureteral calculi (Fisher's exact test, P = 1.0). ESWL is a reasonable initial therapy for middle ureteral stones less than 10 mm.

Adult↗
PubMed1995

Evaluation of optimal stent size after endourologic incision of ureteral strictures.

The stent size necessary to promote optimal ureteral healing after an endoureterotomy is not known. We compared healing of an endoureterotomy over a 7F indwelling ureteral stent with healing over a 14F endopyelotomy stent. A midureteral stricture was created in each of 25 anesthetized female minipigs using an electrified stone basket passed retrograde. Six weeks later, the stricture was incised with a 24F cutting balloon device. Twenty pigs were randomized to receive a 7F or a 14F stent; four control pigs received neither incisions nor stents. At 1 week, a radiograph was performed to confirm proper stent position, and the stents were removed. At 3 months, a retrograde ureterogram was performed, and the ureters were examined grossly and harvested for histologic studies. Two of the ten pigs in each study group developed a recurrent stricture. The use of a 14F stent provided no advantage over the use of a smaller, more easily positioned 7F stent.

Animals↗
PubMed1995

Laparoscopic retropubic auto-augmentation of the bladder.

The small capacity or contracted bladder is a difficult management problem. The goal of bladder augmentation is to create a storage structure with an adequate capacity and low pressure. Bladder auto-augmentation creates a large bladder diverticulum by partially excising the detrusor muscle. We report our initial experience with an extraperitoneal approach to laparoscopic auto-augmentation in a patient with a small contracted bladder. This is a technically feasible operation but longer clinical followup is necessary to determine its durability in the management of the small contracted bladder.

Adult↗
PubMed1995

Laparoscopic pneumodissection: a unique means of tissue dissection.

PURPOSE: To study the acute and chronic tissue effects of using high pressure CO2 to dissect tissues during laparoscopic procedures. MATERIALS AND METHODS: A 5-mm. laparoscopic pneumodissector, capable of delivering brief bursts of high pressure CO2 (20 to 100 psi), was discharged on a variety of porcine tissues including the renal hilum. Acute and chronic histological sections, intraoperative blood gases and perioperative renal scans were obtained. RESULTS: The only tissue with significant acute damage was the spleen. Acute changes in other tissues were minimal; long-term studies revealed no discernible damage to these same tissues. Intraoperative blood gases revealed no significant changes in the serum pCO2 or pH. Likewise, there was no renal damage discernible by renal scans. CONCLUSIONS: Pneumodissection at 50 psi is a safe method for dissecting the porcine kidney and the vessels of the renal hilum. Clinical studies are pending.

Animals↗
PubMed1994

Comparison of retrograde endo-pyelotomy and endo-balloon rupture of the ureteropelvic junction in a porcine model.

Excellent results and durable success have been achieved with antegrade and retrograde endo-pyelotomy for treating primary and secondary ureteropelvic junction obstruction. Recently, a 30F dilating balloon was used to rupture the ureteropelvic junction (ENDOBRST) with encouraging results. While balloon distention of the ureteropelvic junction is a technically simpler procedure than endo-pyelotomy, clinical and laboratory data comparing the 2 methods are lacking. In an acute and chronic animal study we compared endo-pyelotomy via a ureteral cutting balloon incision to balloon rupture (that is 30F) of the normal ureteropelvic junction in each of 20 female farm pigs. Eight pigs were harvested acutely after treatment, and a macroscopic and histological examination of the treated ureteropelvic junction was completed. In 11 chronic pigs after endo-pyelotomy a 7F double pigtail ureteral stent was placed bilaterally and then removed after 6 weeks. Evaluation in the chronic group consisted of a furosemide washout renogram and retrograde pyelogram immediately preoperatively and 6 weeks after stent removal. The animals were likewise harvested 6 weeks after stent removal. One control pig underwent passage of the balloon cutting catheter and balloon dilating catheters without activation or dilation, respectively. Ureteral stents were placed bilaterally for 6 weeks and the pig was otherwise treated similarly to the other chronic study animals. In the acute group all ureters after endo-pyelotomy demonstrated retroperitoneal extravasation of contrast material. At harvest the ureters had been cleanly incised along a length of 3 to 4 cm. through the adventitial layer. In contrast, the balloon treated ureters showed free retroperitoneal extravasation in only half of the animals. Among the balloon treated ureters 7 of 8 had a linear tear of varying length (1 to 5 cm.) involving all but a thin adventitial layer of tissue. Histologically, the endo-pyelotomy ureters demonstrated a clean, linear transmural incision with virtually no destruction of surrounding tissue in 6 cases. In the remaining 2 cases an incision into but not completely through the muscular layer was observed. The balloon treated ureters showed a perforation through the muscular wall in 7 cases. However, periureteral hemorrhage and urothelial loss were common findings. In the chronic group infection and continued urine extravasation from the endo-pyelotomy site resulted in a 45% mortality rate. Of the surviving 6 pigs 83% of the balloon treated and 67% of the endo-pyelotomy pigs had a patent ureteropelvic junction by retrograde pyelogram and renogram. Histologically, the 2 sides were indistinguishable, with both showing mild fibrosis and chronic inflammation.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1994

Touch preparation cytological evaluation of radical prostatectomy specimens.

The failure of current histological techniques to predict local failure and disease progression after radical prostatectomy is supported by substantial evidence. Moreover, the characterization of histological findings is hampered by the lack of uniform interpretation. We report a prospective study of 92 patients undergoing radical prostatectomy for clinical stages A and B prostate cancer in which the technique of touch preparation cytological analysis of surgical margins is compared to the standard histological approach. We evaluated 47 pathological stage B, 43 stage C and 2 stage D specimens. Specimens initially assigned to pathological stage B were upstaged to stage C on review by 1 blinded pathologist in 19 of 65 cases (29%). Overall, 15 of 47 histological stage B specimens (32%), 20 of 43 histological stage C specimens (47%) and 2 of 2 histological stage D specimens (100%) had malignant cells identified on the margins by touch preparation cytology. Postoperative mean followup of 7 months (range 0.4 to 26) revealed that 7 of 14 nonstage D cancer patients (50%) with elevated serum prostate specific antigen levels had positive cytology results, including 1 with histologically confirmed organ-confined disease. Among the stage C specimens cytology was more likely to be positive if there was concomitant seminal vesicle invasion. Correlation of this information with eventual patient course during the long term will be necessary to assess its role in patient management.

Aged↗
PubMed1993

Necrotizing cavernositis secondary to periodontal abscess.

Spontaneous cavernositis is a distinctly uncommon entity. Corporeal infection and abscess formation have been described in association with priapism, cavernosography, intracavernous injection therapy, trauma and penile prostheses. We report a case of acute necrotizing cavernositis in a diabetic patient, which presumably originated with hematogenous seeding from a periodontal abscess. Isolation of typical oral pathogens from corporeal cultures provides bacteriological evidence of a dental source for the corporeal infection.

Abscess↗