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Biomedical subjects

A D Perlmutter

Publications and source records attributed to A D Perlmutter.

At least 55 records · Page 3Linked to original sources
PubMed1980

The changing role of cystoscopy in the pediatric patient.

Cystoscopy is used too often in the pediatric patient and frequently is without diagnostic or therapeutic benefit to the child. Cystoscopy is of little proved benefit in the evaluation and treatment of recurrent cystitis, primary enuresis and most cases of hematuria. In children initially diagnosed with vesicoureteral reflux therapeutic determinations generally can be made on the basis of response to appropriate antimicrobial therapy and from uroradiographic findings. Cystoscopy remains a valuable tool to evaluate urinary obstruction and severe congenital defects, such as intersex and cloacal anomalies, and to help place percutaneous suprapubic tubes for bladder cycling before urinary undiversion and for urodynamic evaluation.

Child↗
PubMed1980

Experiences with urinary undiversion in children with neurogenic bladder.

Six children have undergone reconstruction of the urinary tract 14 months to 14 years after supravesical diversion for neurogenic bladder dysfunction. Five are continent: 4 by intermittent catheterization and 1 by voiding to completion. One child is just beyond infancy and wets but is not yet on a systematic program. One boy was considered a technical failure despite incontinence because of progressive hydronephrosis from a non-compliant bladder but he subsequently had an augmentation cystoplasty. Urinary undiversion into a neurogenic bladder is an acceptable option as an alternative to ileal conduit revision or for reasons of patient preference, provided bladder storage capacity is adequate at acceptably low resting pressures, without incontinence.

Adolescent↗
PubMed1980

Management of ureteropelvic obstruction in the first year of life.

From July 1971 until December 1978 we treated 19 male and 5 female children less than 1 year old for ureteropelvic junction obstruction. Diagnosis was based on high dose excretory urography with delayed films. Ultrasound was performed in some cases to confirm hydronephrosis. Cystoscopy and retrograde pyelography were not required. Of 32 obstructed kidneys 27 were repaired by dismembered reduction pyeloureteroplasty. Of 8 patients with bilateral involvement 3 underwent unilateral repair only because of lesser contralateral obstruction and 1 underwent unilateral nephrectomy. Of the 27 repairs 20 were protected by nephrostomy or pyelostomy drainage plus a small caliber silicone rubber or polyvinyl stent. Of the 6 non-stented repairs 2 had delayed opening of the repair. A frozen section renal biopsy aided in a decision to repair the kidney in 4 of 6 instances and in 10 other instances a renal biopsy was obtained for prognostic purposes. There were no secondary nephrectomies, although 2 boys required reoperations for a successful result. Instillation pyelography with fluoroscopic monitoring was used to determine when the tubes could be removed. Generally, we removed the stent 4 or 5 days postoperatively and the nephrostomy at a variable time after demonstration of patency of repair. In this group of small children pyelostomy or nephrostomy and intubation of the repair are useful additions to the surgical technique to prevent obstruction of the tiny and delicate infant ureter by anastomotic edema or kinking of the repair.

Drainage↗
PubMed1980

Urinary tract reconstruction and the abnormal bladder.

The principles and techniques of urinary tract reconstruction in children with abnormal bladders, including psychogenic vesical dysfunction, myogenic vesical dysfunction, contracted bladder, and neurogenic vesical dysfunction, are discussed. Factors influencing the decision to perform urinary undiversion are evaluated.

Abdominal Muscles↗
PubMed1980

Extended urethroplasty in hypospadias. A description and evaluation of a two-stage technique.

Dissatisfaction with the functional or cosmetic complications associated with one-stage repairs of hypospadias has resulted in the search for alternative surgical approaches. One such procedure, a two-stage technique for correction of chordee and subsequent urethroplasty, is described; in this procedure, recurrent chordee may be corrected at interval surgery prior to urethroplasty.

Adolescent↗
PubMed1979

A one-stage surgical approach to ectopic ureterocele.

Whenever a ureterectomy for treatment of ectopic ureterocele is appropriate total extravesical excision avoiding a ureteral stump is the preferred approach to avoid a pyoureter or alternating diverticulum and possible surgical complications from an intravesical procedure in small infants and children with large and distorting ectopic ureteroceles.

Child↗
PubMed1979

Unusual aspects of urinary calculi in children.

Urinary calculous disease is unusual in children in the United States. During the last 5 years (1972 to 1977) we have examined and treated 35 children with urinary calculi. The predisposing factors to calculus formation have been established in 20 children. Metabolic screening, although mandatory, has proved unrewarding in the evaluation of children with urinary calculi. Obstructive uropathy, immobilization, urinary stasis and infection, previously undiagnosed urologic anomalies, steroid therapy, milk-alkali syndrome, iatrogenic disease and endemic disease have contributed to stone formation. The management of children with urinary calculi generally parallels that of adults but reflects a need for caution when performing transurethral extraction of lower ureteral calculi. Reduction in dairy product intake, fluid diuresis and frequent changes in position may provide adequate prophylaxis against urinary calculi in children who must be immobilized.

Adolescent↗
PubMed1979

Experiences with urinary undiversion in children with neurogenic bladder.

Six children have undergone reconstruction of the urinary tract 14 months to 14 years after supravesical diversion for neurogenic bladder dysfunction. Five are continent: 4 by intermittent catheterization and 1 by voiding to completion. One child is just beyond infancy and wets but is not yet on a systematic program. One boy was considered a technical failure despite incontinence because of progressive hydronephrosis from a non-compliant bladder but he subsequently had an augmentation cystoplasty. Urinary undiversion into a neurogenic bladder is an acceptable option as an alternative to ileal conduit revision or for reasons of patient preference, provided bladder storage capacity is adequate at acceptably low resting pressures, without incontinence.

Adolescent↗
PubMed1978

Short stay surgery in pediatric urology.

Short stay surgery represents an innovation in the delivery and cost of medical care. The short stay surgical unit at the Children's Hospital of Michigan has provided urologic care for 311 children during the most recent 12 months of its operation. Eighteen patients (5.7 per cent) required postoperative hospitalization. No children have required rehospitalization after discharge from the short stay unit. Short stay surgery in pediatric urology has resulted in more economic and efficient use of hospital facilities and has decreased cost per procedure. Morbidity has not increased. Short stay surgery is well accepted by the child, parent and referring physician, and has not posed problems for the operating surgeons. Short stay urologic surgery is safe and applicable to many diagnostic and therapeutic urologic surgical procedures.

Adolescent↗
PubMed1978

The role of adjunctive drug therapy for intermittent catheterization and self-catheterization in children with vesical dysfunction.

Thirty-nine children with vesical dysfunction were managed with clean intermittent catheterization. Most children achieved effective urinary continence, the majority with the help of adjunctive drug therapy to relax the detrusor, contract the bladder neck or both. Intermittent catheterization had a generally favourable effect on infection, reflux and hydronephrosis. Intermittent catheterization in childhood is a perferred alternative to urinary diversion in cases of neurogenic bladder dysfunction.

Adolescent↗
PubMed1977

Progressive penile amputation. Tourniquet injury secondary to hair.

In the past three years we have treated 5 cases of penile strangulation secondary to entrapment by human hair in the coronal groove. All patients had been circumcised and were between fourteen months and five years of age. Total urethral transection occurred in 2 children. Their presentation and our method of management are discussed.

Amputation, Traumatic↗
PubMed1976

Reduction cystoplasty in prune belly syndrome.

Reduction cystoplasty is a useful procedure to treat a large, poorly functioning bladder in boys with prune belly syndrome who are candidates for urinary tract reconstruction. The technique includes elliptical resection of all anomalous urachal tissue and sufficient detrusor dome to reduce bladder capacity to average size and to create a spherical detrusor. Improved detrusor function and a satisfactory of excellent result can be expected.

Abdominal Muscles↗
PubMed1976

Renal abscess: a changing concept.

Gram-negative organisms are not the most prevalent bacterial species found in renal abscesses. We postulate an ascending pathway for establishment of gram-negative abscesses. Voiding cystourethrography should be used in search of reflux. Surgical treatment remains the standard but early diagnosis may increase the effectiveness of parenteral antibiotics as definitive therapy.

Abscess↗
PubMed1976

Diagnostic features of tumors of the lower thoracic sympathetic chain.

Four cases of sympathetic neural tumors of the most inferior portion of the thoracic sympathetic chain are presented. The location of each tumor was such that a primary adrenal tumor might have been considered. However, each tumor was associated with erosion of the ipsilateral lower ribs or vertebral pedicles. Such radiologic findings indicate a primary posterior mediastinal tumor and primary exploration should be transthoracic.

Adrenal Cortex Neoplasms↗