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Biomedical subjects

R Witherington

Publications and source records attributed to R Witherington.

At least 19 recordsLinked to original sources
PubMed1992

Hypoplasia of urinary bladder.

Three female patients with hypoplasia of the urinary bladder and associated congenital anomalies are described. All were first seen in early infancy with significant obstructive uropathy and were managed by early loop cutaneous ureterostomy. All have survived to adulthood and 2 patients have received a kidney transplant into an ileal conduit; 1 patient continues to do well with cutaneous ureterostomy only. Pathogenesis, management, and long-term outcome are discussed.

Abnormalities, Multiple↗
PubMed1991

Application of smooth Teflon clip to inferior vena cava during radical cystectomy to prevent postoperative pulmonary embolism.

Between 1976-1986, a smooth Teflon clip was applied to the inferior vena cava of 56 patients who underwent radical cystectomy for bladder cancer. The purpose of the clip is to narrow the lumen of the inferior vena cava so that large emboli will be trapped and thus prevented from reaching the lungs. These 56 patients were compared with a group of 26 historical controls who underwent radical cystectomy without application of such a clip between 1967-1976. One patient (1.8%) whose vena cava was clipped had a pulmonary embolus which was fatal. Four (15.4%) of the 26 control patients had postoperative pulmonary emboli, the embolic event being fatal in 3 (11.5%). Application of the smooth Teflon clip to the inferior vena cava significantly lessens the incidence of pulmonary embolism following radical cystectomy.

Cystectomy↗
PubMed1991

Vacuum devices for the impotent.

Vacuum constriction devices for the treatment of impotence achieve entrapment of blood in the penis following mechanically produced tumescence. Following application, blood flow is sustained, and the majority of users can achieve either an erection or an erection-like state that is satisfactory for intercourse. Properly motivated men can use these devices long-term without serious side effects. The devices are particularly effective in the management of partial impotence; they represent an attractive alternative to surgical procedures upon the penis, intracavernosal injection of vasoactive drugs, and sexual abstinence.

Erectile Dysfunction↗
PubMed1991

Mechanical devices for the treatment of erectile dysfunction.

Almost all men with erectile dysfunction can be successfully treated. External erection devices are safe and effective for the management of partial impotence. If external devices fail to produce adequate penile engorgement or if they cannot be used, invasive treatments are available. Penile implants remain the gold standard for the management of erectile impotence, especially complete impotence. A satisfaction rate of 80 to 90 percent can be expected with all of the currently available implants. Attention to surgical detail and proper patient selection usually produce an excellent functional and anatomic result.

Clinical Protocols↗
PubMed1990

Torsion of the spermatic cord in adults.

Intravaginal torsion of the spermatic cord is seen typically in the peripubertal period. At our hospital 33 patients with intravaginal torsion were seen between 1970 and 1986, and 13 (39%) were more than 20 years old. Because of delay in seeking treatment or error in initial diagnosis proper treatment often was late in these 13 adults. This delay in treatment allowed for a testicular salvage rate of only 38%. Increased awareness by physicians that torsion often occurs in adults plus an accurate history and evaluation may allow for a higher testicular salvage rate in this age group.

Adult↗
PubMed1990

In situ dissection of cadaver kidneys.

Major anatomic injuries occurred in 18 of 151 (12%) en bloc kidneys. No injuries occurred among the in situ kidneys. The rates of delayed graft function were equal. All the kidneys removed by the in situ method were removed by one surgeon (ALH). The results are good enough to recommend the technique even without a randomized study.

Brain Death↗
PubMed1989

Vacuum constriction device for management of erectile impotence.

A mechanical device for treatment of impotence based on the concept of entrapment of blood in the penis following vacuum-assisted tumescence is described and more than 15,000 units have been marketed. A total of 1,517 users who acquired the device between 1974 and 1987 completed a questionnaire concerning the system. Of these patients 92 per cent either achieved an erection or an erection-like state that was satisfactory for intercourse and 77 per cent had intercourse at least every 2 weeks. No serious ill effect from use of the device has been reported a and it is particularly effective in the management of partial impotence. In selected patients the device is an alternative to either surgical placement of a penile prosthesis, intracavernous injection of vasoactive drugs or sexual abstinence.

Adult↗
PubMed1988

Suction device therapy in the management of erectile impotence.

The ErecAid System is based on the simple concept of entrapment of blood in the penis following vacuum-assisted penile engorgement by proximally placed elastic constriction bands. The SYNERGIST Erection System is a semirigid external appliance shaped like a condom that is left on the penis after vacuum tumescence has been achieved. Both devices can be used safely by any man who feels that he has an impotence problem, and the outcome is fairly predictable. These devices seem to be especially effective in men with partial impotence, and they offer the impotent man an alternative to surgical placement of penile prosthesis, a surgical revascularization procedure, intracavernosal injection of vasoactive drugs, or sexual abstinence. These devices appear to be safe and relatively inexpensive ways for the impotent man to make his penis rigid enough to engage in sexual intercourse. An impotent man who selects suction-device therapy may still be able to use other forms of treatment should he need or choose it.

Equipment Design↗
PubMed1987

Ulcer of the trigone: a late complication of cervical cerclage.

Since the introduction of cervical cerclage for management of the incompetent cervix, few late complications of the procedure have been reported. We report a late complication of cervical cerclage manifested as a trigonal ulcer. Trigonal erosion by the knot of a mersilene ligature that had been placed around the cervix 22 years previously caused the ulcer. Endoscopic removal of the offending ligature allowed complete healing.

Female↗
PubMed1987

The 'acute' scrotum. Lesions that require immediate attention.

An "acute" scrotum may result from an interesting and fairly predictable array of diseases. A good history and physical examination remain paramount in evaluation. Scrotal ultrasonography and testicular radionuclide scanning are important additions to our diagnostic armamentarium and should be used whenever possible. Unfortunately, the equipment and expertise needed to perform these useful examinations are not always readily available. If these tests cannot be done promptly and rapidly, treatment should be instituted without delay. Most lesions that cause an acute scrotum should be treated expeditiously, since careful treatment can greatly reduce patient discomfort, morbidity, and even mortality. Additionally, testicular salvage often depends on early and appropriate management.

Epididymitis↗
PubMed1986

Risk factors for bladder cancer in a cohort exposed to aromatic amines.

Occupational and nonoccupational risk factors for bladder cancer were analyzed in a cohort of 1385 workers with known exposure to a potent bladder carcinogen, beta-naphthylamine. Bladder cancer was approximately seven times (95% confidence interval [CI] = 3.9, 12.4) more likely in exposed rather than nonexposed individuals, yet, otherwise, the groups were generally similar in other exogenous or hereditary risk factors. A total of 13 cases of bladder cancer were identified. After the first year of a screening program involving 380 members of the cohort, 9 of the 13 cases of bladder cancer and 36 persons with atypical bladder cytology, histology, or pathology were compared with 335 noncases for distributions of different variables. Occupational variables were significant in a multivariate model that controlled for age, cigarette smoking history, and source of drinking water. The estimated odds ratio for the association for bladder cancer and the duration of employment, when controlling of these other variables, is 4.3 (95% CI = 1.8, 10.3). In addition to the occupational factors, age was significant in the multivariate analysis. Other potential risk factors, such as consumption of coffee or artificial sweeteners, use of phenacetin, or decreased use of vitamin A were not found to be significantly different in cases and noncases.

1-Naphthylamine↗
PubMed1985

Risk assessment of a cohort exposed to aromatic amines. Initial results.

A cohort of 1,385 workers potentially exposed to carcinogenic amines was evaluated to determine the extent of its risk for bladder cancer. The cumulative incidence of bladder cancer was determined from death certificates, from interviews with community urologists, and from a screening program. A total of 13 confirmed cases of bladder cancer were identified at the conclusion of the first year of study. The entire cohort has approximately a fourfold excess risk of bladder cancer; however, black workers with more than 10 years of employment had a risk ratio of 111 (based on three cases). The onset of disease occurred, on the average, 15 years earlier in these black workers than in the general U.S. population. The cumulative incidence of bladder cancer increased with the duration of employment, ranging from 0.4% for workers with five or fewer years of employment to 36% for those with greater than 20 years. No significant differences were found between cases and noncases for cigarette smoking, coffee drinking, use of artificial sweeteners, or prior employment in high-risk occupations. More cases of bladder cancer are expected in this cohort because many members have not yet achieved the average latency found for the confirmed cases.

Adolescent↗
PubMed1979

A review of 117 partial nephrectomies.

In this review of 117 consecutive partial nephrectomies calculi associated with infection was the most common indication for the operation. Other indications included congenital anomalies, trauma, arteriovenous malformations and tumor. Partial nephrectomy has been shown to be a relatively safe procedure, with a mortality rate of 1.7 per cent. However, considerable morbidity occurred when stone and/or infection persisted postoperatively. We herein emphasize that total intraoperative removal of calcareous debris, appropriate treatment of associated infection and avoidance of nephrostomy tubes are important to a successful postoperative result. Partial nephrectomy as a method to remove stones confined to or originating in a diseases calix appears unsurpassed.

Adolescent↗
PubMed1979

The Denis-Browne hypospadias repair revisited.

Sixty-four cases of hypospadias repair by the Denis-Browne technique are reviewed. A urethrocutaneous fistula was the most common postoperative complication. Other less frequent complications were urethral stricture, residual chordee and improper location of the urethral meatus. These complications were corrected adequately and the results were satisfactory in all patients. This technique is simple, sound and trustworthy.

Child, Preschool↗