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Biomedical subjects

S G Docimo

Publications and source records attributed to S G Docimo.

18 recordsLinked to original sources
PubMed1996

Testicular descent and ascent in the first year of life.

Ascent of the intrascrotal testis to an undescended position has been described, but it remains controversial. A case of a 1-year-old with bilateral ascended testes is presented. These testes were documented by a pediatric urologist to have been intrascrotal on two prior occasions. The right testis was intra-abdominal, and the left was peeping at the internal ring. Ascent has generally been seen in older children with a history of retractile testis and has never been reported to result in a testis located in an intra-abdominal position. This represents a rarely reported early testicular ascent, the mechanism of which is different than that of older children.

Cryptorchidism↗
PubMed1996

Bladder exstrophy from childhood into adult life.

Exstrophy of the bladder is rare and the incidence of bladder exstrophy is calculated to be from 1 per 30,000 to 50,000 live births with male to female ratio ranging from 1.5-5 to 1(1-4). It was found that persistence or overgrowth of the cloacal membrane on the lower anterior abdominal area, prevents normal mesenchymal ingrowth. This causes divergence of the lower abdominal muscular structures and forces the genital ridges to fuse caudal to the cloacal membrane. The stage of ingrowth of the urorectal septum at the time of rupture determines whether one will produce an exstrophic urinary tract alone (classic bladder exstrophy or epispadias) or cloacal exstrophy with the hindgut interposed between the hemibladders.

Adolescent↗
PubMed1996

Telesurgical consultation.

PURPOSE: We evaluated the feasibility of "telesurgical" consultation during laparoscopic surgery. Telesurgical consultation is a distinct application of telemedicine in which a surgeon at a primary operating site can consult another experienced surgeon or colleague for complex and/or unexpected problems encountered during surgery. MATERIALS AND METHODS: Telesurgical consultation was used in 6 complex laparoscopic cases, including upper pole nephrectomy, diagnostic laparoscopy with inguinal hernia repair, orchiectomy, gastric augmentation with bladder suspension, bladder reconstruction and ureteral lithotomy. RESULTS: In each case an experienced laparoscopic surgeon at the primary operative site consulted a surgical specialist at the remote site who had expertise in the particular procedure being performed. All procedures were accomplished successfully without intraoperative or post-operative complications. CONCLUSIONS: Complex laparoscopic procedures that normally require a surgical specialist can be performed successfully by an experienced laparoscopic surgeon consulting a remote specialist via the tele-operative system.

Adolescent↗
PubMed1995

Concealed umbilical stoma: description of a modified technique.

PURPOSE: We describe a technique for creating a concealed umbilical stoma. MATERIALS AND METHODS: The base of the umbilicus is used as a superiorly based skin flap that is incorporated into the spatulated stoma. Six patients have undergone diversion using this technique. The stoma was constructed from appendix in 4 cases, stomach in 1 and tapered ileum in 1. RESULTS: All patients achieved an easily catheterizable hidden umbilical stoma, are dry on clean intermittent catheterization and have had no stomatitis or peristomal hernia. CONCLUSIONS: This technique for creating a concealed umbilical stoma preserves the native appearance of the umbilicus and combines a superior cosmetic result with an easily catheterizable stoma.

Adolescent↗
PubMed1995

Ureteral graft in urological reconstruction: clinical experience and review of the literature.

We report 7 cases in which grafts of ureter were used as tube and patch segments in urethral reconstruction and formation of a continent catheterizable stoma. The ureteral grafts survived without long-term stricture in all cases. Meticulous preparation of the graft and recipient bed is required for success, as previously demonstrated experimentally. When available, ureter is an excellent source of tissue for urological reconstruction.

Adolescent↗
PubMed1995

Laparoscopic orchidopexy in the prune belly syndrome: a case report and review of the literature.

The management of the testicles in the prune belly syndrome can be problematic after the neonatal period. Laparoscopic orchidopexy has been used for the intra-abdominal testis with success. A case of bilateral laparoscopic orchidopexy in a child with prune belly syndrome is presented. The testes were brought to the scrotum without division of the spermatic vessels, taking advantage of the extensive intra-abdominal dissection possible laparoscopically. This case demonstrates that therapeutic laparoscopic procedures are possible in the prune belly syndrome and that laparoscopic orchidopexy may have promise in older affected children or in those requiring no other concomitant surgery.

Cryptorchidism↗
PubMed1995

Laparoscopic bladder augmentation using stomach.

We present a case of bladder augmentation with stomach, via a laparoscopic approach. The patient was a 17-year-old girl with sacral agenesis and a poorly compliant bladder. A wedge of stomach, based on the right gastroepiploic pedicle, was obtained using a stapled technique. The bladder was opened and the gastric segment was sutured in place. A needle suspension was also carried out. Three months later, the patient was dry and catheterizing every 4 hours. Laparoscopic bladder augmentation is technically feasible and, in the properly selected patient, may be the preferred technique for creation of a compliant high-volume urinary reservoir.

Adolescent↗
PubMed1995

The results of surgical therapy for cryptorchidism: a literature review and analysis.

PURPOSE: The literature was reviewed to consolidate the diverse success rates reported for orchiopexy. MATERIALS AND METHODS: A total of 64 articles pertaining to 8,425 undescended testicles was reviewed and found to contain evaluable data. Success was defined as scrotal position and lack of atrophy. RESULTS: Success rates by anatomical testicular position were 74% for abdominal, 82% for peeping and 87% for canalicular testes, and 92% for those located beyond the external ring. Success rates by procedure were 89% for inguinal, 67% for Fowler-Stephens, 77% for staged Fowler-Stephens, 81% for transabdominal, 73% for 2-stage and 84% for microvascular orchiopexy. CONCLUSIONS: The significant failure rate for proximal testes suggests that efforts to improve orchiopexy should continue.

Child↗
PubMed1995

Laparoscopic orchiopexy for the high palpable undescended testis: preliminary experience.

PURPOSE: We attempted to apply laparoscopic orchiopexy to the high palpable testis. MATERIALS AND METHODS: Nine patients (12 testicles) were treated who ranged from 13 months to 13 years old. Laparoscopic techniques were used to mobilize the spermatic vessels and transfer the testis into the scrotum. RESULTS: Unilateral cases were completed in an average of 2.6 hours and bilateral cases in 3.0 hours with no complications. Tests maintained an intrascrotal position with no atrophy during a followup of 1 to 12 months. CONCLUSIONS: Laparoscopic orchiopexy for the high palpable undescended testis is possible with minimal morbidity and good short-term results.

Child↗
PubMed1995

A heterotopic autoinnervated urinary neosphincter.

Twenty-six female adult New Zealand white rabbits underwent surgical denervation of a gracilis muscle to study the possibility of developing an autologous neosphincter innervated by the pudendal nerve. The study was conducted in 2 phases. In both Phase I and Phase II, the study group had the motor nerve to the gracilis, a branch of the obturator nerve and the pudendal nerve coapted in the perineum. The control group was left denervated. In Phase I, all muscle flaps were wrapped around the urogenital sinus. In Phase II, the muscle flaps were returned to their anatomic location. With bulbocavernosus reflex testing, 89% of the reinnervated group and 60% of the denervated group from Phase I and 86% of the reinnervated group and none of the denervated group from Phase II had a contractile response in the muscle flap. In Phase II, histologic examination of the gracilis muscle was suggestive of an early change in muscle myofiber physiology from fast twitch to slow twitch in the reinnervated group only. In the rabbit, a transplanted vascularized muscle flap, cross-innervated by the pudendal nerve has a reproducible response to bulbocavernosus reflex testing. This suggests that a transplanted muscle might be able to assume some of the characteristics of the voluntary urinary sphincter. The rabbit is a useful model in which to investigate the potential of the heterotopic neosphincter.

Animals↗
PubMed1993

Candida epididymitis: newly recognized opportunistic epididymal infection.

Epididymitis is common, yet it is rarely associated with fungal pathogens. We report a case of Candida albicans epididymitis in a diabetic which was ultimately treated by orchiectomy. Opportunistic infections of the genitourinary tract in immunosuppressed patients are becoming more prevalent; examples include fungal infections in patients with acquired immune deficiency syndrome or after organ transplant. The fact that opportunistic organisms can invade the epididymis and produce infection suggests that in cases of persistent epididymitis, which have failed to respond to conventional therapy, more aggressive diagnostic procedures should be considered. Needle aspiration with cultures for fungus and viral organisms should be performed. This is especially true in patients with preexisting chronic illness or an immune compromised state.

Aged↗
PubMed1992

Cutaneous ureterostomy in adults.

In the patient with metastatic carcinoma, urinary diversion is usually achieved with indwelling ureteral stents or placement of a percutaneous nephrostomy tube. Most forms of surgical diversion carry an unacceptable morbidity rate, especially in the debilitated patient. Over a fifteen-year period (1974-1989), 29 adult patients with pelvic malignancy (32 ureters) underwent palliative cutaneous ureterostomy. This previously reported technique involves transverse nephropexy and construction of a stoma using a small skin flap. Indications included ureteral obstruction or severe urinary tract symptoms. Hydroureter, often considered a precondition for this procedure, was not present in several patients and was not a prerequisite to success. Complications related to the procedure included one postoperative death due to stroke, one death due to uremia and sepsis, and one instance of severe renal arterial stenosis resulting in renal failure. Preservation of renal function was possible in the 10 patients known to have survived from one to thirteen years postoperatively; only 3 patients eventually required stomal revision. By adherence to the surgical techniques described, the usually high incidence of stomal stenosis was avoided. Our experience reveals that although the indications for cutaneous ureterostomy are limited, this procedure can provide an alternative to permanent nephrostomy drainage or to a higher risk intestinal urinary diversion in carefully selected patients with a reasonable life expectancy.

Aged↗
PubMed1991

Pulmonary development in the fetal lamb: morphometric study of the alveolar phase.

The alveolar stage of intra-uterine lung development was analyzed morphometrically in 18 fetal lambs at 112, 124, 142, or 148 (term) days of gestation. The right lungs were fixed at uniform distending pressure and the tissue embedded in Epon for light microscopy. Over the whole period, right lung volume (VL) increased more rapidly than body weight to reach a mean value of 185 cm3 at term. The increase in VL was greatest between 112 and 124 days gestation. Throughout the period of study the distal lung consisted of alveolar-like air-spaces lined by walls with a single capillary system. Despite this mature morphology, further differentiation took place as established by two independent measurements. First, interalveolar wall thickness decreased from 4.12 +/- .03 microns at 112 days to 2.55 +/- .02 microns at term. Secondly, alveolar surface area increased at a greater rate than lung volume (as VL 1.06), suggesting a moderate increase in surface complexity, but not a subdivision of existing air-spaces. This latter finding was supported by numerical density values which remained fairly constant. We conclude that throughout this period active growth involves the addition of alveolar units of basically similar size. This is a similar process to the one noted previously in postpneumonectomy compensatory growth.

Animals↗
PubMed1991

Effect of in utero vesicostomy on pulmonary hypoplasia in the fetal lamb with bladder outlet obstruction and oligohydramnios: a morphometric analysis.

A model of early gestation bladder outlet obstruction and oligohydramnios in the fetal lamb is characterized by small, immature lungs (pulmonary hypoplasia). The current study examines how in utero relief of urinary tract obstruction produced early in gestation modifies pulmonary hypoplasia. Bladder obstruction was created at 60 days gestation in fetal sheep (term = 140 days); 11 fetuses then underwent in utero decompression at 95 to 100 days; six were left obstructed. Five normal fetuses served as controls and two underwent sham obstruction and vesicostomy. All were delivered and sacrificed near term (135 days), the right lung was inflation-fixed and its volume determined. Relative volumes of alveoli, alveolar ducts, and tissue, alveolar surface area, and alveolar numerical density were estimated morphometrically. Kidneys were examined histologically. In all animals persistent bladder obstruction produced oligohydramnios. Bladder obstruction to term produced pulmonary hypoplasia with a mean right lung volume-to-body weight ratio (LV:BW) of 14.3 cc./kg. (normal = 36.4, p less than 0.001). Structural immaturity was evidenced by an airspace fraction of only 57% (normal = 68%, p less than 0.05). Kidneys in these animals were not dysplastic; there was hydronephrosis or evidence of spontaneous urinary decompression. In eight of the 11 animals, decompression improved the LV:BW ratio to 28.4 cc./kg. (vs. obstructed, p less than 0.001; vs normal, p less than 0.05) and normalized maturity. All had increased amniotic fluid at delivery; kidneys in 7/8 animals were normal, and the other had moderate hydronephrosis. One of the 11 animals had normal kidneys, oligohydramnios, immature lungs, but with normal volume. Oligohydramnios was present in the other two of 11 fetuses despite successful decompression and they had markedly dysmorphic kidneys and profoundly hypoplastic and immature lungs (LV:BW 5.1 cc./kg.). Even after 35 days (25% gestation) of obstruction, in utero urinary tract decompression permits better lung growth and maturation than in persistently obstructed animals. The degree of renal damage from obstruction appears to be a critical determinant in the correction of pulmonary hypoplasia.

Animals↗
PubMed1989

Congenital midureteral obstruction.

Congenital midureteral obstruction, caused either by a ureteral valve or stricture, is an exceedingly rare entity. When encountered, it is generally misdiagnosed as either primary megaureter or ureteropelvic junction obstruction, leading to a less than optimal surgical approach. Seven children with midureteral obstruction were seen over the past 17 years. Two of the patients presented with hydronephrosis on prenatal ultrasonography, and five with urinary tract infection. In only three was the diagnosis suspected on intravenous urography and voiding cystourethrography alone. Five of the seven cases had either antegrade or retrograde pyelography, prior to or at the time of their operative procedure, and in four of these a correct diagnosis was made. Notably, in five of the seven cases, recognition of the midureteral lesion prior to the surgical incision allowed the approach to be modified and a more appropriate technique (ureteroureterostomy) to be performed. The etiology of midureteral valve and stricture has been attributed to improper recanalization, insufficient vascular supply, or persistence of ureteral folds. Three of our patients had contralateral renal dysgenesis, suggesting an underlying ureteral bud abnormality.

Child↗
PubMed1989

High failure rate of indwelling ureteral stents in patients with extrinsic obstruction: experience at 2 institutions.

The indwelling ureteral stent commonly is used to bypass 2 types of obstruction: 1) intrinsic obstruction usually due to stones or ureteropelvic junction abnormalities or 2) extrinsic compression, for example by retroperitoneal tumor. To determine the success of this intervention at 2 institutions the medical records of all patients undergoing cystoscopic placement of a stent for ureteral obstruction were reviewed. Procedures were classified by several parameters, including the type and location of the ureteral obstruction, indications for stent placement and success of the procedure. Stent failure was defined arbitrarily as clinical occlusion of the stent within 30 days of placement. X-rays were reviewed as available to measure stricture length and location in patients with extrinsic obstruction. Of the procedures at Brigham and Women's Hospital in Boston, where silicone stents are used almost exclusively, 23 perforated indwelling stents placed for intrinsic obstruction were uniformly successful. In contrast, of 24 stents placed for extrinsic obstruction 11 failed (p less than 0.0005). At Beth Israel Hospital, where polyurethane stents are used most commonly, all 21 perforated indwelling stents placed for intrinsic obstruction were successful, while 9 of 22 stents placed for extrinsic obstruction failed (5 within the first 24 hours of placement, p less than 0.0005). The only parameter that seemed to be a predictor of stent failure was luminal size, and this only in silicone catheters. The reasons for this surprising failure rate of internal stents in the face of extrinsic obstruction are not known but may be related to previous studies that describe a relationship among ureteral peristalsis, venting side holes and flow rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Pulmonary development in the fetal lamb with severe bladder outlet obstruction and oligohydramnios: a morphometric study.

The lethal feature of male newborns with severe bladder outlet obstruction and oligohydramnios is pulmonary hypoplasia. We report a fetal lamb model of bladder outlet obstruction created in the early second trimester, and morphometric analysis of the profound pulmonary hypoplasia that resulted. At 55 to 65 days of gestation 8 consecutive male fetuses underwent surgical clipping of the urethra and urachus near the abdominal wall. A sham operation was performed in 1 female fetus. The lambs were delivered by cesarean section 10 weeks later. The right lungs were immediately fixed at a distending pressure of 25 cm. water. The results of the morphometric studies were compared to control animals from our earlier study of normal fetal lamb lung development; slides for both studies were scored in a blind, randomized fashion by 1 of us (S. G. D.). Although mean body weights for the groups were similar, mean right lung volume in the operated lambs was 63.8 cM.3 compared to 158 cM.3 in the control animals and 137 cM.3 in the sham operated fetus (p less than 0.0005). Relative volume of respiratory tissue was 87 per cent in the operated animals, and 92 per cent in the controls and the sham operated fetus (p less than 0.0005). Microscopic morphometry revealed an increased relative volume of inter-alveolar tissue in the experimental animals (35 compared to 23 per cent in the normal lambs, p less than 0.05), with a corresponding decrease in relative airspace volume. Alveolar numerical density and alveolar surface density were not statistically different between the groups, although total alveolar number and surface area were substantially decreased in the operated lambs due to the reduced mean lung volume. Mean alveolar wall thickness was increased at 3.6 microM. in the operated group versus 2.1 microM. in the normal group (p less than 0.0005) and 2.8 microM. in the sham operated fetus. Thus, the lung in the lamb with severe bladder outlet obstruction is hypoplastic and immature.

Amniotic Fluid↗