Biomedical subjects

C C Schulman

Publications and source records attributed to C C Schulman.

At least 19 recordsLinked to original sources

PubMed1992

A hypothesis for the higher incidence of vesico-ureteral reflux and primary megaureters in male babies.

The authors propose a new explanation for the male preponderance in cases with prenatally diagnosed vesico-ureteral reflux and primary megaureters. The theory is based on conclusions drawn from the characteristics of 4 patients (3 perinatal cases and 1 occurring in a 14-year-old boy) presenting with unusual anomalies of the lower urinary tract. In this hypothesis, the male preponderance could be related to an abnormal dilatation of the posterior urethra occurring during the embryological development of the male urethra. The dilatation leads to a flap valve mechanism and to a functional obstruction of the bladder outlet and finally to secondary dilatation of the upper urinary tract. This obstruction may be transitory; reflux and megaureters found in utero or after birth could be considered as sequellae of this phenomenon.

Adolescent↗

PubMed1992

Endoscopic treatment of vesicoureteral reflux.

Since 1985 we treated 180 cases of vesicoureteral reflux with endoscopic injection of polytetrafluoroethylene (Teflon). Follow-up, from 1985 to 1990, was available for 256 refluxing ureters (93% primary reflux, 7% secondary after reimplantation or neurogenic bladder). The distribution according to the grade was the following: Grade I: 26 cases (always associated with higher grade contralateral reflux), Grade II: 94 cases, Grade III: 97 cases, Grade IV: 28 cases and Grade V: 11 cases. For primary reflux, correction was observed after a single injection in 87% of the cases and 93% after a second injection. So far no long-term morbidity and complications have been observed. The procedure is simple, reliable and successful. We are aware of the ongoing discussion about the safety of the polytetrafluoroethylene paste, particularly in children, and are waiting for the ideal substance preferably prepared from the patient's own tissue.

Child↗

PubMed1992

Verrucous carcinoma of the penis: importance of human papillomavirus typing for diagnosis and therapeutic decision.

One case of penile verrucous carcinoma (Buschke-Löwenstein tumor) undergoing anaplastic transformation and containing human papillomavirus type 6 is presented. The viral genome is detected by in situ hybridization using biotin-labeled cDNA probes. The clinical, histological and virologic criteria of verrucous carcinoma are discussed in comparison to giant condyloma and highly differentiated squamous cell carcinoma. The importance of viral typing determination for further diagnostic and therapeutic procedures is emphasized.

Aged↗

PubMed1992

The ureterovesical junction in children: sonographic findings after surgical or endoscopic treatment.

We retrospectively analyzed pre- and postoperative sonographic and medical records of 335 children who had surgical or endoscopic treatment at the ureterovesical junction, in order to determine normal and atypical sonographic appearances. Normal sonographic findings after ureteral reimplantation include thickening of the posterior bladder wall, pseudodiverticular sacculations, bladder asymmetry, and transitory hydroureteronephrosis. Short-term or persistent (lasting more than 1 month) hydroureteronephrosis, urinoma, hematoma, bladder lithiasis, and diverticula were abnormal findings, occurring in 17% of the patients. After partial ureteronephrectomies, visualization of the residual ureter on sonograms was not possible in cases without complications; in one patient, reflux of fluid dilated the residual ureter and made the ureter visible on sonograms. After endoscopic incisions, the masslike appearance of a collapsed ureterocele was observed. Submucosally injected Teflon always appeared as a curvilinear hyperechoic area with an acoustic shadow. Marked acute or persistent hydroureteronephrosis or ectopic intracavitary Teflon particles were observed in 2% of patients. Granuloma formation was considered likely in 5% of the patients when the area of injected Teflon material was longer than 12 mm on sonograms. Submucosally injected collagen appeared less echogenic than Teflon and showed no acoustic shadowing. The various normal sonographic appearances after treatment must be known in order to distinguish them from significant abnormalities. In patients with anatomic anomalies, such as short-term or persistent hydroureteronephrosis, urinoma, hematoma, and lithiasis, complementary uroradiologic examinations may be necessary to clarify the diagnosis.

Adolescent↗

PubMed1991

Computerized analysis of smooth muscle fibers in potent and impotent patients.

Reduction or dysfunction of the intracavernous smooth muscle fibers can provoke impotence. Computerized digital image analysis of corpus cavernosum biopsies was performed in potent and impotent patients to quantify the percentage of smooth muscle fibers. In 5 normal patients the smooth muscle area represented 40 to 52% of the specimen, in 20 patients with cavernous dysfunction it was 10 to 36% and in 10 patients with arterial disease it was 13 to 25%. This method appears to be important to understand better certain mechanisms of impotence and to approach the potential treatment.

Adolescent↗

PubMed1991

Renal duplications: the impact of perinatal ultrasound on diagnosis and management.

Perinatal urology is a rapidly expanding field in pediatric urology bringing significant changes in the diagnosis and management of congenital uropathies. Renal duplication was detected by antenatal and perinatal ultrasound in 19 cases (22 duplicated systems). In most cases, no precise diagnosis could be established in utero (4 of 13), but this lack of accuracy is of little clinical significance since all newborns with suspected uropathies undergo complete urological investigations in the perinatal period. Voiding cystogram demonstrated reflux in 11 of 22 cases. On postnatal urography a functioning upper pole was demonstrated in 11 of 22 kidneys. There were 12 ureteroceles: in 8 a nonfunctioning upper pole was removed, while 3 were endoscopically incised with good functional improvement and 1 was reimplanted. Early recognition of congenital uropathies in association with duplication by prenatal ultrasound significantly improves patient care allowing early postnatal relief of obstruction by less invasive methods and before infection or persistent obstruction worsens the prognosis.

Congenital Abnormalities↗

PubMed1990

Study of human penile venous system and hypothesis on its behavior during erection.

To determine the role of the venous outflow restriction during human erection, we compared intracavernous pressure with deep dorsal vein pressure in 6 normal subjects during papaverine-induced erection and penile saline infusion. In addition, flows necessary to produce and maintain erection were measured in 10 cadavers before and after resection of the deep dorsal vein alone or together with ligation of the cavernous veins. Elongation of tunica albuginea was measured at the crural and mid portions of the penis. At rigidity there was complete blockage of the venous return through the emissary veins. The venous outflow through the cavernous veins was reduced but still persisted. The distention of the tunica albuginea was less important at the crural portion than at the distal portion and could explain why the cavernous veins were not blocked completely.

Blood Pressure↗

PubMed1990

Role of the bulbocavernosus muscles on the mechanism of human erection.

The role of the human bulbocavernosus muscles on the intracavernous pressure and on the venous return were investigated during artificial erection. Contractions of these muscles were voluntary or produced by dorsal nerve stimulation. During such contractions, elevations in intracavernous pressure and a decrease in the erectile flow rates to produce and to maintain the erection were observed. These results demonstrate involvement of the bulbocavernosus muscles in the process of penile rigidity and suggest that they could participate in the mechanism of rigidity during intercourse.

Adult↗

PubMed1990

Use of Biopty gun for corpus cavernosum biopsies.

Needle biopsy of the corpus cavernosum with the Biopty gun system has been performed in impotent patients. This technique is cost-effective, rapid, safe, relatively harmless and effective in obtaining erectile tissue to identify the presence of intracavernous structures (smooth muscle cells, collagen, arteries and nerves). It can certainly replace the open method, but we have to determine its place in the assessment of impotent patients.

Biopsy, Needle↗

PubMed1990

Transrectal ultrasound in the diagnosis and staging of prostatic carcinoma.

In this retrospective study we try to evaluate the benefit of transrectal ultrasonography of the prostate in the diagnostic, the screening and the preoperative staging of prostatic carcinoma. Five hundred and sixty-six patients with histologically proved prostatic carcinoma were evaluated. For the diagnosis, our specificity was 80%. The specificity of preoperative staging was 85% concerning the extraprostatic extension of the tumor. The screening seems to be of poor interest.

Humans↗

PubMed1990

Shock wave monotherapy of staghorn calculi.

From June 1987 to October 1988, 52 staghorn calculi were treated without anesthesia by shock wave lithotripsy with the second-generation lithotriptor, Lithostar Siemens. 36 calculi were evaluated. Multiple sessions (n = 1-6) were necessary according to the size of the stone. The mean hospital stay for complete treatment was 7 days. Double-J stenting was used in 45% of the patients with calculi of less than 40 mm and in 81% of the patients with calculi of greater than 40 mm. After 3 months, 50% of the patients with calculi of less than 40 mm were free of stones, as were 43% of the patients with calculi greater than 40 mm. After 9 months, the stone-free rate rose to 75%. At 3 months, the success rate (stone free or residual fragments of less than 4 mm) is 87.5% and rose to 92% at 9 months. Two severe complications were observed: one patient with acute infected hydronephrosis with sepsis and one with perirenal hematoma. Shock wave lithotripsy monotherapy of staghorn calculi is possible in multiple treatment sessions. Double-J stenting is mandatory in most of the cases but, even in this condition, anesthesia is not necessary.

Humans↗

PubMed1990

Shockwave treatment of ureteric stones in situ with second-generation lithotriptor.

During a 17-month period we treated in situ 334 patients with ureteric stones with a second-generation electromagnetic lithotriptor. Anxiety and discomfort were relieved with diazepam and pethidine chloride only. Ureteral stenting was used in 8.1% of upper, 36.4% of mid- and 5.7% of lower ureteric stones. The retreatment rate was 15%, but no patient had more than 3 sessions. The success rate of the treatment at 3 months was 88% for upper, 65% for mid- and 83% for lower ureteric stones. Open surgery had to be performed in 5 cases and ureteroscopies in 6 cases.

Diazepam↗

PubMed1990

Vesicoureteral reflux in children: endoscopic treatment.

Endoscopic correction of vesicoureteral reflux in children has been increasingly used in the last years with encouraging results. During a 4-year period 152 children were treated by endoscopic injection of Teflon. A follow-up, ranging from 3 months to 5 years, was available for 173 refluxing ureters. For primary reflux, correction was observed after a single injection in 87% of the cases and in 93% after a second injection in some failures. In duplication, the technique is somewhat more difficult but the results quite satisfactory with 58% success after one injection, increasing to 74% after a second injection. The limitations of these techniques are underlined, the major concern being the safety of the injectable Teflon particles, eliciting a foreign-body granulomatous reaction with the potential hazard of distant migration. So far no long-term morbidity and complications have been observed with the use of Teflon to correct reflux. Extensive pathological study in 7 children submitted to ureteral reimplantation for failure of endoscopic correction showed a typical encapsulated granulomatous reaction below the intramural ureter, but particles of Teflon were noted in only one hypogastric ganglion when the Teflon was injected outside of the bladder. There is a need for finding an ideal substance for endoscopic injection, preferably prepared from the patient's own tissue allowing simple and safe correction of vesicoureteral reflux in children.

Child, Preschool↗

PubMed1990

[Peptide innervation of the penis].

Immunoreactive (IR) vasoactive intestinal polypeptide (VIP) and neuropeptide Y (NPY) nerve fibers processes have been observed in venous and arterial tunicae and in intracavernous smooth muscles of the human penis taken at autopsy or during surgery using light and electron microscopic immunohistochemical techniques. Numerous IR-VIP and IR-NPY nerve fibers were mostly concentrated in the inner part of the adventitia close to the media of the arterial and venous vessels. In the corpora cavernosa and in the corpus spongiosum, IR-VIP and IR-NPY nerve processes were intermingled between the smooth muscle fibers around the sinusoid spaces. The density of the staining was much more important for NPY than for VIP. Positive soma were not observed in the penis. At ultrastructural level, post embedding immunogold technique, IR-VIP and IR-NPY were localized exclusively in large dense granules of nerve terminals. This peculiar distribution of IR-VIP and IR-NPY nerve fibers suggested that it could participate in regulating arterial and venous blood flow and intracavernous smooth muscle tone in the mechanism of flaccidity and erection of the penis.

Humans↗

PubMed1989

Effect of phentolamine on venous return in human erection.

A group of 25 patients underwent Doppler penile blood examination and cavernometry before and after 5 mg of phentolamine injected intracavernously. The organic or psychogenic nature of impotence was determined by psychological testing, the intracavernous injection of papaverine, hormonal evaluation, neurological examination, Doppler penile blood flow measurement and cavernometry for vascular investigations. The intracavernous injection of phentolamine had no effect on the venous return and it provoked penile arterial dilatation. The erectile angle, which was also measured, was less evident than after the injection of papaverine. The results confirmed the fact that an increase in arterial inflow alone is not sufficient to induce a rigid erection in man.

Humans↗

PubMed1989

Deep dorsal vein arterialisation in vascular impotence.

A series of 12 patients with vasculogenic impotence (4 arterial lesions; 8 arterial and venous lesions) underwent deep dorsal vein arterialisation after pre-operative assessment by a multidisciplinary approach. Cumulative graft patency was 58% (7 of 12 patients) up to 21 months but only 4 patients developed almost normal erections. Digital angiography, with and without the intracavernous injection of papaverine, was performed during follow-up to determine the vascular physiological status. At flaccidity, the corpora cavernosa were never opacified in the absence of a venocorporeal shunt. The penile glans was always visualised. Opacification of the deep dorsal vein and the circumflex system decreased with penile rigidity, resulting from their compression between Buck's fascia and the tunica albuginea. Intracavernous pressure recorded before and after the surgical procedure showed a marked increase when a caverno-venous shunt was performed. Hypervascularisation of the glans occurred in 2 cases. The relevance of this new surgical technique and its functional mechanism are discussed.

Adult↗

PubMed1989

Extracorporeal shock wave lithotripsy for urinary stone disease: clinical experience with the electromagnetic lithotriptor 'Lithostar'.

400 urinary stone patients were treated with the electromagnetic lithotriptor Siemens 'Lithostar': 66.3% had renal stones and 33.7% had ureteral stones. Ninety percent of the treatments were performed under intravenous sedation only: 14.5% of the patients had more than one session. After 3 months more than 80% of the patients with a single stone smaller than 1.5 cm and 46% of the patients with stones larger than 2.5 cm were 'stone-free'.

Adult↗

PubMed1989

[Reliability of endorectal echography of the prostate in the screening and staging of prostatic cancer].

1433 transrectal ultrasonographies were performed for prostatic disease. In 453 cases, histopathologic correlation was obtained and compared to digital rectal examination and transrectal ultrasonography done after the clinical examination. The sensitivity of digital rectal examination was 91% and the specificity was 85%. The sensitivity and the specificity of ultrasonography were respectively 95 and 81%. 4 prostatic cancers, not suspected by digital rectal examination, were diagnosed by ultrasound (0,9%). The total number of subclinical cancer was 9 (2%). Interest of ultrasound compared to digital rectal examination concerns less than 1% of the total number of controlled patients. The staging of local extension of prostatic cancer is better by ultrasound than by the digital rectal examination. On 9 cases of clinical unsuspected extracapsular invasion, 6 were diagnosed by ultrasound.

Humans↗