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At least 289 records · Page 16Linked to original sources

Left upper lobe bronchus reimplantation for nonpenetrating thoracic trauma.

Trauma to the tracheobronchial tree has been diagnosed and treated with increasing frequency over the last several decades. However, most reports have dealt with management of injuries to the trachea and main stem bronchi, as approximately 80% of blunt tracheobronchial injuries occur within this area. With few exceptions, injury to the lobar bronchi has resulted in thoracotomy and lobectomy. We describe a patient with an injury to the left upper lobe bronchus who presented with delayed obstruction of the airway by fibrogranulation tissue. A successful segmental resection of the bronchial occlusion with reimplantation was performed, thereby preserving the patient's otherwise normal left upper lobe. This case demonstrates that resection and reimplantation of an injured lobar bronchus are feasible, even in a delayed setting.

Adolescent↗

Further experience with split-cuff nipple ureteral reimplantation in urinary diversion.

PURPOSE: The intermediate followup results with split-cuff nipple ureteral reimplantation in larger numbers of urinary diversion patients are reviewed. MATERIALS AND METHODS: Split-cuff nipple ureteroenteric anastomosis was performed in 98 ureters of 51 adult patients. Mean duration of followup was 23 months (range 3 to 62). Two minor variations in technique compared to the original report are presented. RESULTS: Urinary reflux was prevented in 97.6 and 96.8% of cases at 1 and 2-year followup, respectively. Ureteroenteric anastomotic obstruction occurred in 3.1% of ureters by 3 months postoperatively. No cases of anastomotic leak or later obstruction occurred. Four episodes of acute pyelonephritis occurred in the early postoperative period. CONCLUSIONS: The split-cuff nipple ureteral reimplant technique in urinary diversion continues to provide excellent results with low rates of reflux or obstruction. The 2 described minor technical modifications further simplify the procedure.

Adult↗

Voiding efficiency after ureteral reimplantation: a comparison of extravesical and intravesical techniques.

The purpose of our study was to examine postoperative changes and recovery in voiding efficiency after intravesical and extravesical ureteral reimplantation. Retrospective review was performed of 188 cases. Inclusion criteria were the presence of primary vesicoureteral reflux and the absence of previous lower urinary tract surgery. Voiding efficiency after ureteral reimplantation was assessed based on post-void residual volume measurements. It was found that postoperative voiding efficiency of patients in the extravesical unilateral group was similar to that in the intravesical group, while the extravesical bilateral group had a statistically significantly higher proportion of patients with transient voiding inefficiency. A statistically higher proportion of those in the extravesical bilateral group also required some form of urinary catheter drainage for a longer period. However, on more prolonged followup all evaluable patients in the 3 groups fully regained voiding efficiency.

Adolescent↗

Preliminary results of laser tissue welding in extravesical reimplantation of the ureters.

One exciting potential use of laparoscopic technology is the extravesical reimplantation of the ureters. We have assessed the efficacy of laser-activated fibrinogen solder to close vesical muscle flaps over submucosal ureters (Lich-Gregoir technique) in a canine model. Four dogs were subjected to unilateral flap closures via a protein solder (indocyanine green and fibrinogen) applied to the bladder serosa and exposed to 808 nm. continuous wave diode laser energy. Contralateral reimplantation was performed using 4-zero vicryl muscle flap closures (controls). At 7, 14 and 28 days postoperatively, intravenous pyelograms confirmed bilateral ureteral patency. At intravesical pressures above 100 cm. H2O, there was no evidence of wound disruption in either group. Nondisrupted wound closures were sectioned and strained until ultimate breakage to determine tensile strength. At each study interval the laser-welded closures withstood greater stress than the controls. Although these data represent single tissue samples and are not amenable to statistical analysis, laser-welded closures appeared to be stronger at each study interval. In conclusion, laser-welded vesical wound closures appear at least as strong as suture closures in the canine model.

Animals↗

Modified extravesical ureteral reimplantation in pediatric renal transplantation: 5 years of experience.

Numerous surgical procedures have been described to reimplant the ureter into the bladder during renal transplantation. Since November 1985 we have used a modified extravesical technique in 19 children. At the time of transplantation patient age ranged from 2 to 17 years (average age 10 years). Of these patients only 2 received a cadaveric kidney. Postoperative followup ranged from 4 to 54 months (average 32 months). No immediate or delayed urological complications were noted, and all but 1 graft has continued to function. This procedure is not only expeditious and safe but it also eliminates a long cystostomy suture line and requires a short ureteral length. Urinary leakage and ureteral obstruction, 2 of the most common urological complications, have not been observed in our patients. Although further experience and longer followup are required, this technique has become our procedure of choice for ureteral reimplantation in children undergoing renal transplantation.

Adolescent↗

125iodine reimplantation for locally progressive prostatic carcinoma.

We treated 13 patients with a second 125iodine implant for local recurrence of prostatic carcinoma. All patients had biopsy proved palpable recurrence without evidence of distant metastases. Full doses of irradiation were used (median matched peripheral dose 170 Gy.). Six patients had complete regression of palpable recurrence, 2 had partial regression, 2 had no apparent response and 3 were unevaluable for local response. Actuarial freedom from local disease progression at 5 years was 51%. Despite a relatively high rate of local disease control the actuarial rate of distant metastases reached 100% at 6 years after reimplantation. There were 2 severe rectal complications and 4 instances of mild to moderate urinary incontinence among the 13 patients. Local regression of recurrent prostatic carcinoma may be achieved with 125iodine reimplantation but most patients still had distant metastases.

Brachytherapy↗

Complications of pregnancy in women after reimplantation for vesicoureteral reflux.

The physiological changes of the urinary tract during pregnancy place women at increased risk of urological problems during that time. To evaluate how patients after ureteral reimplantation fared during this high risk period we contacted 67 women who had undergone ureteroneocystostomy with a minimum of 15 years of followup. Only those who underwent an operation for primary vesicoureteral reflux were included. Of the women 30 had been pregnant with 64 total pregnancies. During pregnancy 17 of the 30 women (57 per cent) had 1 or more urinary tract infections and 5 (17 per cent) had 1 or more episodes of pyelonephritis. There were 8 spontaneous abortions and 1 severe ureteral obstruction requiring cutaneous drainage until after delivery. There appears to be an increased risk of urinary infection and fetal loss in pregnant women who have undergone ureteral reimplantation as children. More frequent urinary screening and aggressive therapy during pregnancy are recommended in this high risk group.

Abortion, Spontaneous↗

The surgical management of megaureters in duplex systems: the efficacy of ureteral tapering and common sheath reimplantation.

We describe 6 children with renal duplication associated with megaureter(s) who underwent ureteral tapering and common sheath reimplantation. Of the patients 4 had complete duplication with reflux into 1 or both ureters and 2 had incomplete duplication with a short distal segment that was obstructed at the ureterovesical junction. All obstructed or refluxing ureteral segments were dilated to a degree that tapering was required at the time of common sheath reimplantation. Megaureter repair in the presence of a duplicate collecting system proved to be safe and reliable.

Adolescent↗

Vascular integrity of the distal ureter following combined tapering and cross trigonal reimplantation.

Massive unilateral hydroureteronephrosis was created in 20 female dogs by ligating the urographically normal prevesical ureter. Over a 14-day period the obstructed ureter dilated to an average of 15.3 mm. A ureteral tapering procedure was performed by lateral darting and posterior folding of the resultant flap, followed by a cross-trigonal reimplantation. One anastomotic stricture resulted; in the remaining 19 animals, ureteral peristalsis was restored, the ureteral diameter was reduced 61.9 per cent and hydronephrosis was resolved. Histological studies on the tapered segments of these 19 animals showed that the subadventitial blood supply was preserved with fibrotic occlusion of the folded flaps. These results demonstrate that no significant vascular compromise after ureteral tapering and cross-trigonal reimplantation occurs. Success rates comparable to those of conventional ureteral tailoring can be achieved by this technically simplified form of reconstructive surgery.

Animals↗

Urethral lengthening and reimplantation for neurogenic incontinence in children.

We describe our experience with a urethral lengthening-reimplantation operation for the correction of incontinence in 13 myelomeningocele children, 11 of whom had failed to achieve continence on a program of intermittent clean catheterization. The procedure involves lengthening the urethra by formation of a bladder tube, which is reimplanted back into the bladder through a submucosal tunnel. This procedure allows a catheter to be passed but prevents urine from leaking. All of the operated cases are included. All of the children are out of diapers and socially dry. Followup ranged from 8 to 36 months and the problems encountered are described.

Adolescent↗

The antireflux ureteroileal reimplantation in children and adults.

We report on 6 patients with 11 ureters who underwent antireflux ureteroileal reimplantation as part of various reconstructive procedures. A success rate of 82 per cent (9 ureters) was obtained. Our preliminary report shows that the ureteroileal reimplantation represents a satisfactory alternative for urinary diversion and undiversion or a vesical augmentation procedure with the small bowel.

Adolescent↗

Transverse advancement ureteral reimplantation: pull-through alternative in megaloureter.

A modification of the transverse advancement ureteral reimplantation technique suitable for megaloureter operation is described. After dividing the ureter extravesically at or near the ureteral hiatus and after adequate mobilization or manipulation (tailoring), the ureter is pulled through into the bladder. A limited mucosal incision is then made and routine transverse advancement reimplantation is done. The technique is suitable for cases when extravesical exposure of the ureter is considered necessary and obviates the need for intravesical ureteral mobilization.

Child↗

Unusual complications of transvesical ureteral reimplantation.

Four of 8 cases that represent unusual and infrequent complications of the transvesicle Politano-Leadbetter ureteral reimplantation technique are reported. Approximately 90 per cent of ureteral reimplantations for vesicoureteral reflux may be done satisfactorily as a transvesical procedure but combining it with an extravesical approach of the ureter when necessary or indicated will serve to correct any conceivable congenital, acquired or iatrogenic lesion of the lower ureteral segment. The extravesical approach should be used if there is any difficulty in performing the procedure transvesically or if the patient has undergone previous attempts at antireflux operation. Obstructive complications may occur in either the early or late postoperative period. When discovered, surgical correction is usually indicated. We strongly advocate strict adherence to the surgical technique involved and meticulous postoperative followup of these patients.

Child↗

Simplified Politano-Leadbetter's ureteral reimplantation associated with psoas-hitch technique using a new clamp.

We developed a simplified Politano-Leadbetter ureteral reimplantation associated with the psoas-hitch technique in 10 female patients, aged between 22 and 80 years, who were affected by pelvic ureteral pathology. After the standard ureteral mobilization through an intravesical and extravesical approach, the ureter was brought through the new hiatus and through the new submucosal tunnel to the new meatus in just one step using a new right-angled clamp in which the grasp is effective only in the last 0.5-cm part of the tip. The follow-up ranged from 1 to 3 years and did not reveal any postoperative complications. This technique avoids the damage to the submucosal tunnel and reduces the operating time of ureteral reimplantation.

Adult↗

Effects of dimethylthiourea, melatonin, and hyperbaric oxygen therapy on the survival of reimplanted rabbit auricular composite grafts.

Microvascular reconstruction currently offers the best chance of survival for an ear segment reimplanted after amputation. Unfortunately, this technique is possible only when ear and scalp vessels remain intact. Direct reattachment of the amputated segment as a composite graft is less reliable because survival is poor for grafts larger than 2 cm in diameter. However, if survival could be improved, direct reattachment would be an attractive alternative in situations in which microsurgical revascularization is not possible. Certain pharmacologic agents have been shown to enhance the survival of composite grafts. This study demonstrated that hyperbaric oxygen, dimethylthiourea, and melatonin significantly affected the survival of reimplanted auricular composite grafts at day 7. However, by day 21 the average percentage of survival for all groups approached 13% to 14%. Dimethylthiourea had the most beneficial effect on survival early in the postoperative period, whereas the hyperbaric oxygen group demonstrated the poorest survival.

Animals↗

[Primary vesicoureteral reflux and extravesical ureteral reimplantation in chidren].

PURPOSE: to assess the results of the Lich-Gregoire procedure in the treatment of primary vesicoureteral reflux (VUR). MATERIALS AND METHODS: In a 2.5-year period, 141 children with primary VUR underwent a vesicoureteral reimplantation using the Lich-Gregoire procedure in 101 patients (158 ureters) and the Cohen procedure in 48 patients (68 ureters). Patients were evaluated retrospectively in a non randomized fashion and data were recorded about: age, indications for surgery, days with the bladder catheter, length of stay, and short and long-term complications. RESULTS: The control average time was 1.71 years (from 8 months to 3.5 years). A) Early complications. No obstruction was seen in this series. Five children (8.6 of the bilaterally simultaneously operated) showed urinary retention, but only three needed replacement of the bladder catheter and only one of them needed temporary clean intermittent catheterization. Nausea, vomiting, pain and hematuria were sporadic and limited in time. B) Late complications. The long-term results were good (95%). Seven ureters (4.4%) had persistent VUR and 3 children (6.7% of the unilateral cases) had contralateral VUR. Only 3 ureters needed a new surgical treatment (2%) for persistent ipsilateral VUR. Short and long-term complications, days with bladder catheter and length of stay in the hospital were significantly smaller in the group of patients operated with Lich-Gregoire procedure than in patients operated with the Cohen technique. CONCLUSIONS: The Lich-Gregoire procedure is a technique associated with shorter postoperative hospitalization and less discomfort, pain and hematuria than the intravesical technique. Both techniques were effective in correcting VUR. Extravesical reimplantation can cause transitory bladder dysfunction in a small percentage of the bilateral cases.

Child↗

Temporary reconstruction of the lower jaw by condylar reimplantation. Case report.

An alternative method to temporary lower jaw reconstruction with a reconstruction plate prosthesis is described. To prevent penetration of an alloplastic condyle transplant through the skull base, and to restore joint function, we have reimplanted the resected condyle after its fixation to the reconstruction plate. Postoperatively, there have been no complications. Joint function has been almost completely restored. The reimplanted condyle has been investigated after 28 months. It has undergone remarkable changes.

Bone Plates↗