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Biomedical subjects

T E Ahlering

Publications and source records attributed to T E Ahlering.

At least 37 records · Page 2Linked to original sources
PubMed1992

Angiographic embolization of renal stab wounds.

Nonoperative management of renal stab wounds following complete radiographic assessment has become an accepted if not preferred therapeutic option. Selected injuries, however, including renal artery branch injuries, often require surgical intervention and result in partial or total nephrectomy. We report our experience with 16 renal branch arterial injuries secondary to street stabbing during the last 10 years that were managed with angiography and embolization techniques. Angiography with embolization was the initial treatment in 11 patients, while 5 had undergone emergency surgical intervention initially because of hemodynamic instability. Subsequently, gross hematuria recurred in the latter 5 patients and they were managed angiographically. Overall, 14 of 16 patients had prompt hemostasis documented either on the post-embolization angiogram or by clinical assessment. In 2 patients bleeding was increased but partial nephrectomy ultimately was required. Complications included nontarget embolization in 2 patients: 1 subsequently had hypertension and 1 had no untoward effect as a result of this complication. We conclude that angiography with transcatheter embolization techniques provides a safe and effective means of managing renal artery branch injuries secondary to stab wounds.

Adolescent↗
PubMed1992

Salvage surgery plus androgen deprivation for radioresistant prostatic adenocarcinoma.

We report on 34 patients with persistent local radiation resistant prostate cancer who underwent salvage surgical resection and hormonal deprivation. Initially, salvage prostatectomy was done in 11 patients but in 1 disease recurred locally and cystectomy was performed, for a total of 24 patients undergoing cystoprostatectomy. There were no postoperative complications in the prostatectomy group and the average postoperative stay was 7.6 days (range 6 to 12 days). Of 11 patients 4 (36%) are completely continent. There were 2 complications in the cystoprostatectomy group (1 small bowel obstruction and 1 prolonged ileus). The average postoperative stay without complication was 11 days (range 7 to 16 days). Of the 34 patients 24 (71%) are alive without radiographic evidence of disease, including 2 with detectable prostate specific antigen values at a mean of 53 months after surgery (range 25 to 93 months). Of the patients 3 (9%) are alive with radiographically evident recurrent disease (mean 53 months, range 49 to 77 months) and 7 (21%) are dead of disease (mean 52 months, range 20 to 120 months).

Adenocarcinoma↗
PubMed1992

Late local complications after definitive radiotherapy for prostatic adenocarcinoma.

Definitive radiation treatment of prostatic adenocarcinoma has been reported to produce good long-term local disease control, and distant disease failure is almost always associated with good local palliation. We examined late local complications in patients who died with recurrent prostate cancer after definitive radiotherapy as compared to patients treated with hormonal deprivation alone for advanced disease. Between 1979 and 1989 the tumor registry listed 33 men in whom definitive radiotherapy failed documented by bone scan or biopsy and 54 men who were managed with palliative hormonal therapy for noncurable disease. A complication was defined as a local problem requiring a procedure or hospitalization. Overall 23 of the radiotherapy cases (70%) had a local complication as compared to 16 of the patients (30%) who underwent only hormonal therapy. Local complications after radiotherapy included urethral stricture (10 cases), prostatic obstruction (8), hematuria (4), radiation cystitis (3), ureteral obstruction (2) and rectosigmoid radiation injury (4). Local complications after hormonal therapy consisted of prostatic obstruction (11 cases), ureteral obstruction (3) and hematuria (3). The radiotherapy group had 2 urinary and 2 fecal diversions, and the hormonal therapy group had none. In summary, we found a higher risk of late local complications in patients who had recurrence and died with metastatic prostate cancer after definitive radiotherapy, as compared to patients who only received hormonal therapy. These results question the belief that patients with distant disease in whom radiotherapy fails enjoy good long-term local palliation.

Adenocarcinoma↗
PubMed1992

Experience with fossa recurrence of renal cell carcinoma.

We describe the surgical management and followup of 11 patients with local recurrence of renal cell carcinoma in the renal fossa, 10 of whom demonstrated no evidence of distant metastatic disease at the time of recurrence. Average interval to recurrence was 31 months from nephrectomy, with the majority of patients presenting with symptoms of weight loss, fatigue and lumbar discomfort. A total of 13 resections of recurrent carcinoma was performed with 3 immediate postoperative complications, including a retroperitoneal abscess, jejunal necrosis requiring resection and a duodenal obstruction requiring duodenojejunostomy. There were 2 postoperative deaths, 2 patients died of disseminated disease at 8 and 22 months, and 3 died of causes unrelated to cancer recurrence at 4 months, 6 months and 10 years. Four patients were without disease at a followup of 35, 46, 48 and 211 months. We include in this review a report on 1 patient who maintains a disease-free survival of 17 years after resection of a recurrent spindle cell carcinoma. We conclude that an aggressive surgical approach to recurrent renal cell carcinoma within the renal fossa can produce long-term disease-free survival and is justified when compared to the results reported for chemotherapy.

Adult↗
PubMed1991

Study of antireflux nipple valves of Kock ileal urinary reservoir. Experimental investigation in dogs.

To better assess the construction, maintenance, and function of the Kock ileal urinary reservoir with its continent antirefluxing nipple valves, laboratory investigations in dogs were done simultaneously with clinical trials in humans in 1983. Fifteen dogs underwent creation of hemi-Kock ileal reservoirs (without the efferent valve and limb) that were anastomosed to their bladders as enterocystoplasties. The afferent antirefluxing nipple valves were intussuscepted after 7 cm of underlying mesentery had been removed. The nipples were further stabilized with metal and absorbable (Polysorb) staples and Marlex collars. The right ureters were anastomosed to the afferent limb of the reservoirs with the contralateral systems left intact as controls. Ten dogs were able to be followed at the vivaria for twelve to thirty-six months and then studied. All nipple valves remained intact, viable, and nonrefluxing without revision. All kidneys remained histologically normal except those in dogs with dilated ureters secondary to ureteroileal stenosis with concurrent calculi formation. Calculi formed on exposed metal staples and Marlex. The absorbable staples were found to promote appropriate healing and were never the nidus for stone formation. It appears that the intussuscepted nipple valve (with its mesentery removed) is reproducible and functionally reliable in preventing reflux. It also appears these valves can histologically preserve diverted kidneys if the upper urinary tract drainage is normal and calculi are minimized. The proper placement of staples and the elimination of Marlex-anchoring collars are indicated to minimize calculi.

Anastomosis, Surgical↗
PubMed1991

Modified Indiana pouch.

The modified continent Indiana pouch is based upon the terminal 8 to 12 cm. of ileum and 26 to 30 cm. of right colon. Our modifications include complete detubularization of the colonic segment with an easier appendectomy, a transcolonic ureteral reimplantation that is technically simple and reinforced plication of the ileocecal junction. This procedure was performed in 70 patients (ages 27 to 85 years) with followup ranging between 3 and 24 months. There have been 5 hospitalizations for urinary tract infections or gastrointestinal complications. Open surgical revision (4%) has been necessary for incontinence in 1 case, for a redundant ileal limb and difficult catheterization in 1, and for ureteral stenosis in the mid portion of the left ureter in 1. A revision procedure is pending for inadequate reservoir volume. Endoscopic meatotomy of ureterocolonic junction strictures has been necessary in 2 cases. All patients are continent day and night with easy catheterization of volumes ranging between 400 and 800 cc. The modified Indiana pouch should be considered for any patient requiring cutaneous urinary diversion because of a low complication and revision rate, and an excellent continence rate.

Adult↗
PubMed1991

Radiographic assessment of blunt renal trauma.

Recent reports in the urologic literature suggest that radiographic evaluation of normotensive blunt trauma patients with microscopic hematuria is no longer necessary. Several facilities, however, including the Los Angeles County-University of Southern California Medical Center continue to routinely perform intravenous pyelography in this setting. To further evaluate whether this practice is indicated, we retrospectively reviewed the records of 337 patients seen at our facility between May, 1986 and December, 1989 following blunt trauma with resultant microscopic hematuria but no shock. All patients were radiographically assessed with an intravenous pyelogram. Of the 337 studies, 30 (9%) had an abnormal result, including 28 renal contusions, 1 ureteropelvic junction (UPJ) disruption, and 1 non-functioning kidney (which on further evaluation revealed a congenitally absent kidney). A total of 1 significant urologic injury was identified. Thus, only one injury (0.3%) would have been missed if a policy of observation was followed in this group of patients. Our data support other reports in the urologic literature that radiographic staging is not necessary in managing blunt trauma patients with microscopic hematuria but no shock.

Adolescent↗
PubMed1991

The modified Indiana pouch.

The modified continent Indiana pouch is based upon the terminal 8-12 cm of ileum and 26-28 cm of right colon. Our modifications include complete detubularization of the colonic segment with an easier appendectomy, a transcolonic ureteral reimplantation that is technically simple, and reinforced plication of the ileocecal junction. This procedure was performed in 70 patients (ages 27-85 years) with follow-up ranging between 3-24 months. There have been five hospitalizations for urinary tract infections or gastrointestinal complications. Three open surgical revisions (4%) have been necessary: one for incontinence, one for a redundant ileal limb and difficult catheterization and one for ureteral stenosis in the mid-portion of the left ureter. One revision is pending for inadequate reservoir volume. Two endoscopic meatotomies of ureterocolonic junction strictures have been necessary. All patients are continent day and night, enjoy easy catheterization of volumes ranging between 400 and 800 cc. The modified Indiana pouch should be considered for any patient requiring cutaneous urinary diversion because of a low complication and revision rate and an excellent continence rate.

Adult↗
PubMed1991

A comparative study of the ileal conduit, Kock pouch and modified Indiana pouch.

Between July 1986 and July 1988, 55 urinary diversion procedures were performed: 18 ileal conduits, 12 Kock pouches and 25 Indiana pouches. The different forms of urinary diversion were compared for patient selection, operative technical demands, postoperative complications, perioperative renal function, and short-term followup including re-hospitalizations, revisions, and pouch function. Patient selection was the same for the ileal conduit and Indiana pouch patients. Kock pouch patients were more highly selected for youth and health status. The operative technical demands of the ileal conduit and Indiana pouch were similar. The average operative time and blood loss for cystectomy and ileal conduit was 5:27 hours and 1290 cc's versus 5:30 hours and 1201 cc's for the Indiana pouch group. Postoperative complications and changes in renal function were similar among all three groups except for an increase in urinary anastomotic leaks in heavily irradiated ileal conduit patients. The ileal conduit patients required no re-hospitalizations or revisions; the Indiana pouch group had four re-hospitalizations and no revisions; the Kock pouch group had nine re-hospitalizations and three revisions. The day and night-time continence rate was 100% in both the Indiana and Kock pouch groups. The Indiana pouch has similar technical demands as the ileal conduit, has similar postoperative complications as the ileal conduit or Kock pouch, and functions well with a low revision rate. We conclude that the modified Indiana pouch can be just as safely and effectively accomplished in any patient requiring an ileal conduit.

Adult↗
PubMed1989

A comparative study of the ileal conduit, Kock pouch and modified Indiana pouch.

Between July 1986 and July 1988, 55 urinary diversions were performed, including 18 ileal conduits, and 12 Kock and 25 Indiana pouch procedures. The different forms of urinary diversion were compared for patient selection, operative technical demands, postoperative complications, perioperative renal function and short-term followup, including rehospitalizations, revisions and pouch function. Patient selection was the same for the ileal conduit and Indiana pouch groups. Kock pouch patients were more highly selected for youth and health status. The operative technical demands of the ileal conduit and Indiana pouch were similar. The average operative time and blood loss for cystectomy and ileal conduit were 5 hours 27 minutes and 1,290 cc versus 5 hours 30 minutes and 1,201 cc for the Indiana pouch group. Postoperative complications and changes in renal function were similar among all 3 groups except for an increase in urinary anastomotic leaks in heavily irradiated ileal conduit patients. The ileal conduit patients required no rehospitalizations or revisions, the Indiana pouch group had 4 rehospitalizations and no revisions, and the Kock pouch group had 9 rehospitalizations and 3 revisions. The day and nighttime continence rate was 100% in the Indiana and Kock pouch groups. The Indiana pouch has similar technical demands as the ileal conduit, similar postoperative complications as the ileal conduit or Kock pouch, and functions well with a low revision rate. We conclude that the modified Indiana pouch can be accomplished safely and effectively in any patient requiring an ileal conduit.

Adult↗
PubMed1989

Vena caval resection in bulky metastatic germ cell tumors.

We describe the operative management and followup of vena caval resection in 12 patients with thrombosis of the inferior vena cava secondary to bulky metastatic (stage B3 or IIC) germ cell tumors. All patients received induction chemotherapy (10 platinum-based) followed by retroperitoneal lymph node dissection. The inferior vena cava was resected from just below the renal veins to the bifurcation of the iliac veins. Complete resection of retroperitoneal disease was accomplished in all patients. Five patients had postoperative complications, including 2 small bowel obstructions, 1 prolonged ileus and 2 persistent lymphatic leaks. Mean hospital stay was 37 days (range 27 to 49 days) versus 12 days (range 8 to 16 days) for noncomplicated recoveries. No long-term sequelae related to the vena caval resection have occurred with followup of 24 to 80 months. Seven patients are without disease, with a mean followup of 36 months (range 24 to 60 months). We conclude that en bloc vena caval resection for thrombosis of the vena cava allows for complete resection and simplifies the procedure with acceptable morbidity.

Adolescent↗
PubMed1988

The hemi-Kock augmentation ileocystoplasty: a low pressure anti-refluxing system.

Experiences with various methods of using intestinal segments for bladder augmentation and urinary undiversion, as well as with clinical applications of the Kock continent ileostomy for urinary diversion have led us to develop the hemi-Kock augmentation ileocystoplasty for selected patients requiring a nonrefluxing bladder augmentation. In 6 of 7 patients this bladder augmentation technique fulfilled the requirement for a low pressure nonrefluxing reservoir. Renal function has been preserved and electrolyte problems have not occurred. Nocturnal incontinence has been eliminated. Although 2 of 7 patients required surgical revision patient acceptance has been excellent. Prerequisites to implementing this approach are appropriate patient selection and familiarity with the surgical principles of the continent ileal reservoir.

Adult↗
PubMed1988

Management of adult sarcomas of the bladder and prostate.

Historically, survival of patients with adult pelvic sarcoma of the bladder and prostate has been poor. Between November 1974 and November 1984 we treated 11 patients with leiomyosarcoma: 7 with primary bladder and 4 with prostate tumors. Patients with nonbulky disease underwent surgical resection and were observed if the margins and nodes were negative. Patients with positive surgical margins or nodes were treated adjunctively with external beam radiotherapy, 4,500 to 5,000 rad, and chemotherapy. Patients with bulky disease were treated with preoperative chemotherapy with or without radiotherapy followed by an exenterative operation. Of the 11 patients 9 are without evidence of disease with a mean followup of 61 months (range 35 to 96 months). One patient was lost to followup after 4 months and 1 died of disease after 11 months. Three patients with rhabdomyosarcoma were treated and 1 had no evidence of disease 24 months after therapy. Two patients died at 4 and 18 months.

Adolescent↗
PubMed1988

A comparative study of perioperative complications with Kock pouch urinary diversion in highly irradiated versus nonirradiated patients.

To define the nature and risk of complications associated with Kock pouch urinary diversion after high dose radiation (more than 4,500 rad), we analyzed the clinical course of 44 irradiated patients and a comparable group of 42 selected retrospectively from the nonirradiated patient cohort. Of the 42 patients in the irradiated group 18 had received 4,500 to 5,700 rad and 24 had received 6,000 to 8,700 rad. With standard statistical methods we found no difference between the irradiated and control groups when compared for age, sex ratio, followup interval, surgical procedure, operative time or estimated blood loss. There were 2 operative mortalities in the irradiated and 1 in the control groups. In the immediate postoperative period there was no difference between the irradiated and control groups when compared for hospital stay, incidence of urine leak or fascial dehiscence. The irradiated group had 8 urine leaks (20 per cent) and 3 patients (7.5 per cent) required surgical repair. The control group had 5 urine leaks and 1 patient (2.3 per cent) required repair. Diarrhea severe enough to require further hospitalization or medication was significantly more frequent in the irradiated group (18 versus 2 per cent) but the postoperative stay was not significantly different (13 versus 11 days). We conclude that Kock pouch urinary diversion may be performed safely in highly irradiated patients.

Combined Modality Therapy↗
PubMed1987

A new in vivo model to study invasion and metastasis of human bladder carcinoma.

An animal model to investigate the invasive and metastatic properties of human bladder transitional cell carcinoma (HTCC) was established. Two long-term HTCC cell lines (RT4 and EJ) and one HTCC cell line derived in our laboratory (LD-71) were tumorigenic when injected s.c. into nude mice but had little potential to invade locally or metastasize before the animals succumbed to tumor burden. Experimental lung metastases were, however, observed in approximately 60% of animals given injections of RT4 or EJ cell lines in the tail vein. The cells were also implanted transurethrally into the urinary bladders of athymic mice. RT4 cells, which were originally isolated from a superficial papillary tumor, produced histologically noninvasive tumors after transurethral inoculation with no evidence of metastasis. In contrast EJ cells, which were originally isolated from a more aggressive tumor, produced invasive tumors in nude mouse bladders and metastasized to the lungs spontaneously. The invasive cell line LD-71 was weakly tumorigenic and was successfully implanted into the bladder on only one of five attempts. The human origin of the implanted tumors was documented by Southern blot analysis using human repetitive DNA as a probe. The results indicate that the site of injection strongly influences the behavior of the resulting tumors and that intravesical implantation of these HTCC cell lines produces pathological expression of invasiveness and metastatic potential.

Animals↗
PubMed1985

Hyperammonemic coma due to Proteus infection.

Hyperammonemic coma without liver disease or associated deficiencies in urea cycle enzymes is rare. We report a case and discuss the pathophysiological findings of hyperammonemic coma secondary to Proteus mirabilis urinary tract infection.

Ammonia↗
PubMed1985

Emphysematous pyelonephritis: a 5-year experience with 13 patients.

Emphysematous pyelonephritis is a life-threatening necrotizing renal infection characterized by the production of gas. Of 8,105 admissions to our diabetes service during the last 5 years we identified 13 cases. The patients were managed aggressively with fluids and antibiotics, followed by immediate nephrectomy. The mortality rate is 40 to 50 per cent, primarily owing to sudden septic complications.

Adult↗