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Biomedical subjects

P Gleich

Publications and source records attributed to P Gleich.

30 records · Page 2Linked to original sources
PubMed1985

Renal pedicle injury in patients with multiple injuries.

In a study of 41 patients seen over 24 years, renal pedicle injuries were associated with life-threatening multiple system injuries and the immediate surgical management of these associated injuries by general surgeons took precedence over that of the renal pedicle injury. The result was the delayed diagnosis of the renal pedicle injury with loss of function of the kidney. In an effort to improve the renal salvage rate aggressive management of renal pedicle injuries with immediate radiologic evaluation and early surgical treatment was instituted in 1969. The records of 41 renal pedicle injuries from 1959 to 1983 were evaluated. Blunt external trauma was the cause in 76%. All 41 patients had multiple system injuries, averaging 3.7 associated injuries per patient, with 35 (85%) having a laparotomy for intra-abdominal injuries and an overall mortality rate of 44%. Conservative management was followed in 13 patients, with injury to the renal artery in nine and a branch of the renal artery in four, with a renal loss/delayed nephrectomy rate of nine of nine (100%) renal artery injuries. Immediate surgical management was performed in 23 patients, with injury to the renal artery in nine, the renal artery and renal vein in four, a branch of the renal artery in two, and the renal vein in eight, with a renal salvage rate of seven of 21 (33%) renal artery and/or vein injuries. Five patients died on admission or on the operating room table. A significant renal salvage rate resulted from immediate radiologic evaluation and early surgical treatment of renal artery/vein injuries compared to zero salvage rate with conservative management.

Abdominal Injuries↗
PubMed1985

Renal trauma found during laparotomy for intra-abdominal injury.

Whether renal injury found during a laparotomy for intra-abdominal injury should have surgical or nonsurgical management is controversial. Five hundred twenty-one renal injuries were found during laparotomy for such injury in 513 patients. Blunt external trauma was the cause in 88%. A modified operating room table enabled performance of immediate intravenous pyelogram during the laparotomy. More severe degrees of renal injury (laceration, rupture, pedicle injury) were present in 135 (26%) of the renal injuries. Immediate surgical management of 102 more severe renal injuries resulted in nephrectomies in 37 (36%), delayed renal surgery in one (0.9%), and renal salvage in five of 18 (27%) main renal artery and/or vein injuries. Nonsurgical management of the remaining 23 resulted in nephrectomies in three (13%), delayed renal surgery in six (26%), total renal loss in seven of seven (100%) main renal artery injuries and an overall nephrectomy/total renal loss rate of 39%. With immediate surgical management of the more severe degrees of renal injury there was a slight increase in the salvage of kidneys and a marked decrease in delayed renal surgery and morbidity.

Abdominal Injuries↗
PubMed1985

Male genital injuries from external trauma.

External trauma from a variety of causes, some unusual and bizarre, affect the male genitalia. Certain injuries are more common, have more severe consequences, or their management may be controversial. Seventy male genital injuries from external trauma are reported and include vacuum cleaner injuries, fracture of penis and the tourniquet syndrome.

Accidents, Traffic↗
PubMed1984

Unipapillary kidney: a case report and literature review.

The congenital variant of the unipapillary kidney is associated with an abnormal contralateral kidney and frequently with anomalies of other systems as well. An additional case is presented and a review of the literature is discussed.

Child↗
PubMed1984

Management of the neurogenic bladder in 413 children.

During the last 10 years the management of the neurogenic bladder in children has changed from indwelling urethral catheterization or urinary diversion to intermittent catheterization or artificial sphincter implantation. Neurogenic bladder dysfunction in 413 children was caused by myelomeningocele in 323, traumatic paraplegia in 47, spastic quadriplegia in 11, sacral agenesis in 18 and spinal cord disease in 14. Management included indwelling urethral catheterization in 27 children, urinary diversion in 193, intermittent catheterization in 84, an artificial sphincter in 11 and undiversion in 6. No single treatment was completely effective or without significant complications.

Catheters, Indwelling↗
PubMed1984

Clean intermittent catheterization in the management of the neurogenic bladder in children.

Clean intermittent catheterization has been successful in the management of urinary incontinence and upper tract changes associated with a neurogenic bladder. The results of clean intermittent catheterization controlling urinary incontinence, ureteral reflux, upper tract dilatation and urinary infection in 84 children with a neurogenic bladder were evaluated for up to 3 years of followup. Of the children 41 (49 per cent) were totally incontinent and 14 (17 per cent) were slightly damp. Preexisting ureteral reflux deteriorated in 25 per cent of the patients, ceased in 35 per cent and was unchanged in 40 per cent, while pre-existing upper tract dilatation improved in 12.5 per cent and was unchanged in 87.5 per cent. On clean intermittent catheterization and antibacterial medication 90 per cent of the children had sterile urine and 7.5 per cent had 10(5) or more colonies per ml. Complications occurred on 54 occasions but were minor in nature and were corrected easily. Half of the parents, schools and children found clean intermittent catheterization very acceptable or acceptable but a quarter of the parents and patients found it unacceptable or slightly unacceptable, or were undecided. Initial management of urinary complications associated with neurogenic bladder in children has changed to the clean intermittent catheterization program, with greatly improved results compared to Credé's expression of the bladder, an indwelling urethral catheter or urinary diversion. However, the clean intermittent catheterization regimen was not effective completely, not without complications and not accepted completely by parents, schools and children.

Adolescent↗
PubMed1984

A 22-year followup of ileal conduits in children with a neurogenic bladder.

Previously, the ileal conduit had been used in children for diversion of urine from the neurogenic bladder to prevent deterioration of the upper urinary tracts and to manage urinary incontinence. Long-term results after ileal conduits in children have revealed upper tract deterioration and a high complication rate. The complications and renal deterioration rates in 139 children with ileal conduits followed up to 22 years were evaluated. Of 224 complications 114 required surgical correction. Upper urinary tract deterioration occurred in 16.5 per cent of 50 children followed for 10 or more years (mean 13.3 years). The ileal conduit has been replaced by clean intermittent catheterization, ureteral reimplantation for reflux, the artificial sphincter and undiversion in the management of neurogenic bladders in children. Long-term followup will be necessary to compare the results of these procedures to the known long-term results of the ileal conduit to determine the appropriate role of the ileal conduit in the management of children with neurogenic bladders.

Adolescent↗
PubMed1984

Simultaneous bladder and prostatomembranous urethral rupture from external trauma.

Simultaneous bladder and prostatomembranous (posterior) urethral ruptures from external trauma occur in 10 to 29 per cent of male patients with traumatic rupture of the posterior urethra. The records of 47 male patients with traumatic rupture of the posterior urethra were evaluated. A total of 8 patients (17 per cent) had simultaneous rupture of the bladder (4 extraperitoneal, 3 intraperitoneal and 1 both) and posterior urethra (5 complete and 3 partial ruptures). A fractured pelvis was present in all 8 patients, with an average of 3.1 associated injuries per patient. Both ruptures were diagnosed preoperatively in only 1 patient. In male patients with multiple injuries, including a fractured pelvis and rupture of the posterior urethra, a concomitant rupture of the bladder must be suspected and sought at surgical exploration.

Accidents, Traffic↗
PubMed1983

Intractable hematuria and formalin.

Massive hematuria, which is most frequently caused by radiation for pelvic malignancies, after treatment with cyclophosphamide or secondary to aggressive anticoagulation, represents a vexing problem for the practicing urologist. The existence of numerous therapeutic approaches results from the lack of an effective therapeutic modality. Lately, formalin seems to offer a new hope for the treatment of intractable hematuria. Analysis of published results after treatment with formalin revealed generally excellent results regarding control of hematuria. Nevertheless, the complication rate of formalin application is surprisingly high, including vesicoureteral reflux and hydroureteronephrosis as local reactions and systemically tubular necrosis with anuria. Our series of patients is presented with a detailed description of a patient who was afflicted with a vesicovaginal fistula following formalin instillation. Formalin can serve as excellent therapy for massive hematuria. If attention is paid to the concentration and to the technical details of its instillation the noxious side effects can be minimized or prevented in the majority of cases.

Cyclophosphamide↗
PubMed1976

Focal infection of aortofemoral prostheses.

A canine model of unilateral aortofemoral bypass was utilized to study periprosthetic infections in woven, knitted, and velour Dacron vascular prostheses. These studies suggest that physical configuration, porosity, and time of inoculation all are important variables when managing an infected prosthesis, although size of inoculum seems less important.

Abscess↗