Biomedical subjects
Publications and source records attributed to S Raz.
A comparison is made of two groups of patients treated surgically in nonrandomized fashion for Peyronie disease. The first group was treated with excision of the plaque and dermal patch graft; the second with simple incision of the plaque and implantation of penile prostheses. Literature and personal experience comparing the two methods are discussed.
Between December 1977 and November 1978 artificial sphincters were implanted in 2 female and 19 male patients for the treatment of urinary incontinence. Etiologies for incontinence varied, including post-prostatectomy incontinence, myelodysplasia and female incontinence after unsuccessful bladder neck suspension. Over-all, 38 per cent of the patients were excellent or improved postoperatively, while 24 per cent experienced continuing unabated urinary incontinence and 24 per cent experienced urethral erosion at the site of cuff placement. The device was removed in 14 per cent of the patients when it became infected.
The American Medical Systems' inflatable anti-incontinence device is a relatively new prosthesis. Its design, function, and proper method of radiographic evaluation in the pre- and postoperative patient are discussed. Complications peculiar to this device are demonstrated.
Vesicourethral suspension operations fail (1) when preoperative evaluation is insuffcient, leading to improper selection of patients; and (2) for technical reasons when anatomy is uncorrected (suture malplacement, suture breakage, and failure to release adhesions) or when anatomy is corrected (periurethral fibrosis, fistula, stone or granuloma formation on nonabsorbable suture, and overcorrection). Vesicourethral suspension operations work by changing urethrotrigonal anatomy, creating a new equilibrium of forces acting on the bladder neck and urethra.
The use of urethral pressure profilometry in the clinical investigation of dysfunction of the female lower urinary tract is discussed. Included is a description of the use of two-channel microtip profilometry in the urethral syndrome, urinary retention, detrusor hyperreflexia, stress incontinence, and normal females. Dual-channel profilometry improves the diagnostic accuracy of urethral profile studies and aids in the understanding of lower urinary tract pathophysiology.
We believe that there still is a place for passive compression of the bulbous urethra in the treatment of male urinary incontinence after prostatectomy or sphincterotomy. The procedure is simple to do and it is relatively free of complications. However, since it provides only passive resistance and cannot compensate for sudden increases in intravesical pressure, stress incontinence of minor degree is not uncommon. In our series of 184 cases 61 (33 per cent) became completely dry, required no protection and voided with a good stream and without residual urine. Another 51 patients had some stress incontinence but were pleased with the results so that 61 per cent derived definite benefit from the operation. There were 20 (11 per cent) major complications in this series. With recent modifications of the technique and the prosthesis the complication rate has been reduced to 7 per cent in the last 50 cases. The opportunity to adjust the compression postoperatively by injection provides advantages over other passive compression procedures.
Explore the source record for details and available documents.
The left anterior descending or left circumflex coronary artery was cannulated selectively in 10 dogs. Methylprednisolone, 1 mg per kilogram of body weight, was injected into the artery and the cannula was withdrawn. The animals were then subjected to hemorrhagic shock for 90 minutes. Retransfusion to prestudy blood pressure was then accomplished. The electrocardiogram, arterial blood pressure, contractile force, and first derivative of contractile force were recorded continously both from the areas that were pretreated and those that were not, the controls. Contractile force in the control area was reduced to 32 +/- 3.2% of the preshock period after 90 minutes of shock, whereas in the pretreated area it was twice as high at the same time. Ten minutes after transfusion, the contractile force of the pretreated area exceeded the preshock level, whereas the recovery of contractile force in the control area reached only 70% of the preshock level. This study shows that intracoronary infusion of methylpredisolone can afford myocardial protection in hemorrhagic shock to a significant degree.
Computerized data on 174 male patients who underwent radical cystectomy for bladder carcinoma were studied in relationship to the incidence of urethral involvement. Simultaneous or delayed urethrectomies were done on 32 patients, 7 of whom had overt urethral carcinoma (4 per cent of the total number of male patients) and 10 of whom had carcinoma in situ (5.7 per cent of the total number of male patients). The low incidence of these 2 phenomena leads us to the conclusion that routine urethrectomy need not be done on patients undergoing radical cystectomy unless overt urethral carcinoma or positive margins are found at cystectomy. We believe that the use of urethral cytologies is crucial to the routine followup of patients who have undergone radical cystectomy for bladder cancer and should be combined with clinical followup to establish the indication for urethrectomy.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
An experiment was designed to measure accurately the primary effect of verapamil on myocardial contractility by infusion of the drug directly into the coronary artery of open-chested anesthetized dogs. A marked myocardial depressant effect, which was dose and time dependent, was noted during verapamil infusion at the infused area only. The percent decrease in contractile force ranged from 8.8 at an infusion rate (mg/min) of 0.55 X 10(-2) to 36.8 at 5.5 X 10(-2). Similar changes were observed in the first derivative of the contractile force. No changes were observed in the left ventricular systolic or end-diastolic pressure and only a mild increase in contractile force was noted in the control (noninfused) area. The depressant effect of verapamil was sustained. Recovery time after 5 min of verapamil infusion was dose dependent, ranging from 10 to 45 min. During the recovery period, an overshoot of the contractile force was observed in dogs on the higher doses only. We concluded that verapamil in clinically relevant doses has a marked negative inotropic effect of long duration and therefore should be used with caution in patients with depressed left ventricular function. Cessation of the verapamil treatment may cause a transient increase in myocardial contractility, which might be hazardous in patients with angina pectoris who have compromised coronary blood flow.
Fifty patients with neurogenic bladder dysfunction were treated with methyldopa (Aldomet). The preliminary results that are presented suggest a beneficial action in patients with upper neuron lesions. The probable mechanism of the drug's action is discussed.
Explore the source record for details and available documents.
Herein we review 2 cases of posterior urethral valves in adults. Significant secondary bladder neck obstruction occurred in both cases and required transurethral incision before the bladder outlet obstruction was relieved. The management is described of the secondary upper tract changes that occurred.
A simple and inexpensive uroflowmeter has been designed that uses a common carbon dioxide cystometer. The patient voids urine in a specially designed container connected at the bottom of the carbon dioxide source in the cystometer. After proper calibration (500 cc fluid for a 20 mm. deflection in the paper) the patient is asked to void while carbon dioxide flows through the container and the paper recording commences. Any change of volume in the container produces a change in the pressure recorded by the cystometer, which will allow us to know, following calibration, the 2 factors involved in flow: 1) volume voided and 2) time. A table of average flow is available for a quick reading of the findings only by superimposing the table on the uroflow study. The only attachment needed for the cystometer is the special container. Our results support the use of this economical new way to determine urinary flow.