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Biomedical subjects

W H Bush

Publications and source records attributed to W H Bush.

At least 55 records · Page 3Linked to original sources
PubMed1990

Treatment of systemic reactions to contrast media.

Serious systemic reactions caused by currently used ionic and nonionic contrast material are the anaphylactoid (allergic-like) reaction and the vagal reaction. Each likely has more than one etiology, and certain patients are at higher risk for developing such a reaction. The urologist and radiologist must be able to differentiate between the clinical manifestations of the anaphylactoid (asthma-like) reaction and the vagal (bradycardia and hypotension) reaction. Specific treatment for the anaphylactoid reaction is low-dose epinephrine; specific treatment for the vagal reaction is intravenous fluid and high-dose atropine.

Anaphylaxis↗
PubMed1989

Ureteropelvic junction obstruction: treatment with percutaneous endopyelotomy.

The authors review their experience with percutaneous endopyelotomy in the treatment of ureteropelvic junction obstruction. Twenty-four patients with symptoms of ureteropelvic junction obstruction underwent excretory urography, which revealed nonspecific narrowing in several cases. Angiography was performed in 14 patients suspected of having a vessel crossing at the junction, but such a vessel was found in only four, who subsequently underwent dismembered pyeloplasty. One patient was treated with decompression, but later required endopyelotomy. Nineteen patients underwent percutaneous endopyelotomy; in 11 of them, dilation with a balloon catheter was required to ensure complete disruption of the stenosis. After 6-36 months follow-up, 17 of the 19 patients were asymptomatic with no obstruction and two were asymptomatic with mild obstruction.

Adult↗
PubMed1988

Endopyelotomy for primary repair of ureteropelvic junction obstruction.

A total of 12 patients underwent primary repair of ureteropelvic junction obstruction between November 1, 1985 and December 31, 1986. Ten patients underwent percutaneous incision of the ureteropelvic junction (endopyelotomy) as the initial effort to correct the obstruction. Two patients with ureteropelvic junction obstruction associated with an aberrant lower pole renal artery underwent dismembered pyeloplasty (Anderson-Hynes) via a flank incision. Of the 10 patients who underwent endopyelotomy 8 (80 per cent) have shown radiographic improvement. Radiographic stability of the obstructed ureteropelvic junction was demonstrated in the remaining 2 patients. No patient exhibited evidence of increased obstruction or decreased renal function. No patient required prolonged or rehospitalization for complications, and none required additional endoscopic or surgical procedures. All patients have remained clinically well after the initial release from the hospital.

Adult↗
PubMed1987

Extracorporeal shock-wave lithotripsy (ESWL) of pelvic kidney calculus. Use of C-arm fluoroscopy for correct patient positioning.

Extracorporeal shock-wave lithotripsy (ESWL) is the preferred treatment modality for renal and upper ureteral calculi. It is usually reserved, however, for urinary tract calculi above the iliac crest of the bony pelvis. A calyx calculus in a pelvic kidney was successfully treated with ESWL by using a C-arm fluoroscope to simulate the exact direction of the shock waves. The patient was then positioned so that the shock waves entered below the sacrosciatic notch. This same technique of exact patient positioning may have application in the treatment of some lower ureteral calculi.

Adult↗
PubMed1987

Radiation dose to patient and personnel during extracorporeal shock wave lithotripsy.

Radiation dose to the patient and personnel was determined during extracorporeal shock wave lithotripsy treatment of 60 patients. Surface radiation dose to the patient's back from the fluoroscopy unit on the side with the kidney stone averaged 10 rem (100 mSv.) per case, although the range was wide (1 to 30 rem). The surface dose from the opposing biplane x-ray unit was less, averaging 5.5 rem (55 mSv.) per case but again with a wide range (0.1 to 21 rem). Exit dose at the lower abdomen averaged 13 mrem. (0.13 mSv.) per case and estimated female gonad dose averaged 100 mrem. (1.2 mSv.). Radiation dose to personnel working in the extracorporeal shock wave lithotripsy suite averaged less than 2 mrem. (0.02 mSv.) per case, making it a procedure that is safe in regard to radiation exposure.

Adult↗
PubMed1986

Caliceal calculi.

Primary nonobstructive caliceal calculi were removed by nephrostolithotomy in 51 patients. Among the patients with caliceal stones indications for removal included pain in 36 (71 per cent), associated infection in 11 (21 per cent), progressive stone growth in 2 (4 per cent), hematuria in 1 (2 per cent) and flight status eligibility in 1 (2 per cent). Over-all, 300 patients have undergone percutaneous removal of upper urinary tract calculi, with a 97 per cent success rate. Successful removal was completed percutaneously in 49 patients (96 per cent). One patient remains asymptomatic with retained caliceal fragments and surgical stone removal was required in 1 additional patient. Complications occurred in 4 patients (8 per cent). One patient underwent transcatheter embolization of an intralobar artery to control renal bleeding. Three patients required placement of an internal Double-J ureteral stent to permit resolution of ureteral edema. Following recovery 34 of 36 patients (95 per cent) reported complete resolution of the preoperative pain for which the calculus was removed. Two patients had persistent urinary infection. The remaining patients reported no residual complaints. These observations suggest that pain and discomfort occasionally may be associated with nonobstructive caliceal calculi. Removal of caliceal calculi may permit resolution of associated discomfort in more than 90 per cent of all carefully selected patients.

Adult↗
PubMed1986

In-bath filming during extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy (ESWL) is now the preferred method for treating most renal calculi. We designed a cassette and grid holder and a technique for filming in the water bath. The excellent film quality permits initial localization of small or faint calculi and confirmation of satisfactory fragmentation during ESWL. The technique facilitates patient treatment and throughput and should reduce the repeat treatment rate.

Humans↗
PubMed1986

Impact of extracorporeal shock wave lithotripsy on percutaneous stone procedures.

Extracorporeal shock wave lithotripsy (ESWL) is now the primary urologic treatment for symptomatic renal calculi; it is responsible for a substantial decrease in percutaneous stone removal procedures. Three hundred patients treated since ESWL became available are compared with the preceding 300 patients who were treated percutaneously. Since it became available, ESWL has been used alone on over 90% of patients. The cost of ESWL (average $7500) is similar to that of percutaneous removal procedures, and it causes less morbidity. Percutaneous techniques are still necessary before ESWL is performed (2%) for patients with a large number of stones or staghorn calculi, especially when there is obstruction. Percutaneous techniques alone (2%) may be necessary, especially if high-grade ureteropelvic junction obstruction is present. After ESWL, percutaneous drainage or retrieval of stone fragments may be required (2%). The need for interventional uroradiology persists, although its role is changing. For optimal patient care, the radiologist should provide the urologist with imaging consultation, radiation protection advice, and continued assistance in the less frequently used, though still essential, percutaneous calculus removal techniques.

Adolescent↗
PubMed1985

Cystic pheochromocytoma.

Computed tomography is the preferred imaging modality for adrenal lesions, particularly pheochromocytoma. Central hemorrhagic degeneration of a pheochromocytoma can cause the mass to resemble a benign adrenal cyst. Such a case is illustrated and the preoperative evaluation discussed.

Adrenal Gland Diseases↗
PubMed1985

Kidney stone removal: percutaneous versus surgical lithotomy.

Percutaneous removal of most urinary tract calculi may be performed as a 1-stage effort with techniques and skills developed recently in the specialties of urology and radiology. Ultrasonic fragmentation of most calculi was done to permit their extraction. Percutaneous ultrasonic lithotripsy was performed on 250 consecutive (a single exception) patients bearing stones that required removal. Targeted calculi were removed successfully from 97 per cent of these patients. One patient required surgical lithotomy. The previous 100 patients with stones underwent surgical lithotomy with 96 per cent success. Complications of percutaneous ultrasonic lithotripsy appeared equitable with those of surgical lithotomy. Of the patients who underwent percutaneous ultrasonic lithotripsy 6 (6 per cent) required extended hospital days or additional procedures for management of complications. None of these patients required a surgical incision. Anesthesia times were similar for both groups--average 159 plus or minus 4 (standard error) minutes for percutaneous ultrasonic lithotripsy and 193 plus or minus 8 minutes for surgical lithotomy. Hospital recovery days averaged 5.5 plus or minus 0.3 for percutaneous ultrasonic lithotripsy and 8.4 plus or minus 0.5 for surgical lithotomy (p less than 0.01). Associated costs averaged $7,203 plus or minus 55 for lithotripsy and $8,849 plus or minus 660 for lithotomy (p less than 0.01). The number of narcotic administrations per patient (days 1 to 5 postoperatively) averaged 9.88 plus or minus 0.70 for lithotripsy and 16.82 plus or minus 0.78 for lithotomy (p less than 0.01). The average patient who underwent percutaneous ultrasonic lithotripsy felt capable of full activity 2.0 plus or minus 0.2 weeks following stone removal, whereas no patient who underwent previous surgical lithotomy recalls a recovery period of less than 3 weeks (p less than 0.01). We believe that most upper urinary tract calculi may be removed cost-effectively with a percutaneous approach. Compared to surgical lithotomy, percutaneous ultrasonic lithotripsy may result in rapid convalescence with diminished pain.

Adolescent↗
PubMed1985

Percutaneous removal of caliceal calculi.

Of 170 patients who underwent percutaneous nephrostolithotomy, 61 had stones located in a calix. Direct access to the calix containing the calculus optimizes removal. Special maneuvers during and after percutaneous stone removal (e.g., parallel-tract push and loop snare retrieval system) facilitate removal of caliceal calculi from more difficult locations; 46% of patients with caliceal calculi required adjuvant radiologic techniques. Complete calculus removal was achieved in 90% of patients with caliceal calculi.

Adult↗
PubMed1985

Upper ureteral calculi: extraction via percutaneous nephrostomy.

Symptomatic calculi in the upper ureter are usually removed using surgical and endoscopic techniques. Extraction via percutaneous nephrostomy was successful in 35 of 37 patients using sequentially the techniques of retrograde catheter push, basket sheath exchange, and steerable loop-snare. In 12 patients, the calculus was dislodged into the renal pelvis by the retrograde ureteral catheter; extraction was then easily done. Stone basket retrieval was used for an additional 17 patients. A steerable loop-snare was necessary in six other patients when basket retrieval failed.

Adult↗
PubMed1985

Radiation dose to personnel during percutaneous renal calculus removal.

Radiation dose to the radiologist and other personnel was measured during 102 procedures for percutaneous removal of renal calculi from the upper collecting system. A mobile C-arm image intensifier was used to guide entrance to the kidney and stone removal. Average fluoroscopy time was 25 min. Exposure to personnel was monitored by quartz-fiber dosimeters at the collar level above the lead apron. Average radiation dose to the radiologist was 10 mrem (0.10 mSv) per case; to the surgical nurse, 4 mrem (0.04 mSv) per case; to the radiologic technologist, 4 mrem (0.04 mSv) per case; and to the anesthesiologist, 3 mrem (0.03 mSv) per case. Radiation dose to the uroradiologic team during percutaneous nephrostolithotomy is similar to that from other interventional fluoroscopic procedures and is within acceptable limits for both physicians and assisting personnel.

Fluoroscopy↗