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Biomedical subjects

C Reitelman

Publications and source records attributed to C Reitelman.

15 recordsLinked to original sources
PubMed1995

Adolescent varicocele.

Currently, we recommend varicocele repair in adolescents when (1) the results of semen analysis are abnormal, (2) the volume of the left testis is at least 3 mL less than that of the right, (3) the response of either luteinizing hormone or FSH to Gn-RH stimulation is supranormal, (4) bilaterally palpable varicoceles are detected, or (5) a large symptomatic varicocele is present. When surgery is necessary, the Palomo approach significantly decreases the risk of operative failure and has facilitated "catch-up" growth of the left testis that is comparable to that after artery-sparing procedures. It is important to note that there is potential for impaired fertility whenever a palpable varicocele is present. Unfortunately, no test or group of tests can predict with absolute certainty whether an adolescent with a varicocele will be fertile or infertile. Therefore, it is important to observe untreated patients until they complete their families. Patients who are unwilling or unable to adhere to the follow-up protocol may be candidates for surgical intervention.

Adolescent↗
PubMed1994

Early cystometrograms can predict the response to intravesical instillation of oxybutynin chloride in myelomeningocele patients.

Recent reported experiences with intravesical medications in neurogenic bladder patients prompted us to evaluate this form of therapy in 28 myelomeningocele patients who could not tolerate oral anticholinergic agents or did not have adequate control on these agents. A pretreatment cystometrogram was performed followed by intravesical administration of oxybutynin chloride, with a repeat cystometrogram 3 hours later. Patients then began twice daily intravesical oxybutynin for a minimum of 4 months. The mean bladder capacity increased by 41%, the mean intravesical pressure decreased by 47% and compliance improved. Five patients achieved continence and 62% had less wetting while on intravesical therapy. The immediate posttreatment cystometrogram was predictive of the response to intravesical therapy on followup studies. Unfortunately, patient compliance was poor, with only 13 of the 28 patients remaining on therapy for the duration of the study.

Administration, Intravesical↗
PubMed1992

Color flow imaging in children with clinically suspected testicular torsion.

32 boys with symptoms of an acute scrotum had testicular sonography with color flow imaging (CFI). Patients ranged in age from 4-15 years (avg = 11 yrs). Symptoms were present from 12 h to 5 days (avg = 42 hrs). CFI correctly predicted presence or absence of testicular perfusion in 11 boys who had surgical exploration of the scrotum. 8 of these 11 patients had hemorrhagic infarction of the testicle, 1 had torsion of the appendix epididymis, 1 had epididymitis, and 1 had bilateral incomplete torsions with normal testicular perfusion. The remaining 21 patients did not have an operation. At least a 1 year follow-up of all patients has shown no clinical evidence of testicular atrophy to suggest a missed diagnosis of torsion. Absence or markedly decreased testicular flow was easily identified and indicates testicular ischemia/infarction. Conversely, hyperemia of the testis and/or epididymis is usually associated with trauma or infection. However, incomplete torsion or spontaneous detorsion may demonstrate normal testicular flow on CFI. Only close correlation of clinical symptomatology and gray scale findings with CFI can identify these patients, who remain at high risk for subsequent complete torsion and infarction.

Adolescent↗
PubMed1991

Vesical neck reconstruction in patients with epispadias-exstrophy complex.

The achievement of satisfactory continence in the management of patients with the epispadias-exstrophy complex remains a challenge. Between 1971 and 1989, 22 children underwent vesical neck reconstruction at our hospital. Satisfactory continence was achieved in 17 of the 22 patients (77%), including 8 (36%) who are continent after a single vesical neck reconstruction and 9 of 13 who achieved continence after additional and/or adjunctive procedures. Additions and/or adjunctive procedures included revision of the vesical neck reconstruction, bladder augmentation and/or placement of an artificial urinary sphincter. We conclude that vesical neck reconstruction with or without additional and/or adjunctive procedures can result in an acceptable continence rate in patients with the epispadias-exstrophy complex.

Adolescent↗
PubMed1990

Experience with 81, 1-stage hypospadias/chordee repairs with free graft urethroplasties.

We performed 81, 1-stage hypospadias/chordee repairs with preputial free graft urethroplasty between January 1981 and July 1988 using a modified Horton-Devine technique. Of the free grafts 37 were fashioned as patches, 42 as tubes, and 4 as a combination patch and tube. Of the patients 58 (72%) underwent single or multiple dorsal plications, in addition to the usual procedures, to correct chordee completely. A total of 35 patients (43%) required a second procedure: 28 (34%) for persistent fistula and 7 (9%) for stricture. These reoperations were typically minor outpatient procedures. All patients had an excellent functional and cosmetic outcome. Although the need for reoperation unfortunately is high, we believe the use of free grafts allows for a better functional and cosmetic outcome because the secondary torsion and bulkiness of the penile shaft caused by the vascular pedicle are eliminated. This is especially noticeable in patients with a small penis.

Child, Preschool↗
PubMed1990

Management of obstructing ectopic ureteroceles.

Ectopic ureteroceles are a common pediatric urologic problem requiring thoughtful management decisions. Although management algorithms have been proposed, they should serve only as a framework for therapy. More important is a thorough understanding of the problem and its implications. The authors discuss their management approach and provide several cases illustrating the spectrum of problems presented by ectopic ureteroceles and the variety of management options.

Female↗
PubMed1988

Gene expression in renal growth and regrowth.

To elucidate the molecular events associated with postnatal and compensatory renal growth, the expression of growth/differentiation genes (c-fos, c-myc, c-H-ras, c-K-ras), a stress-related gene (HSP70) and a structural gene (collagen type IV, alpha 1 and 2) were examined. Northern analysis of messenger ribonucleic acid from the newborn mouse reveals high levels of expression of HSP70, c-H-ras, and c-K-ras during the first week of life. By day 40 HSP70-related and c-H-ras expression decreases somewhat, c-K-ras remains unchanged and collagen type IV, which encodes for the renal glomerular basement membrane, expression decreases significantly. During compensatory renal growth increased expression of HSP70, c-H-ras and c-K-ras occurs. The results seem to indicate that growth/differentiation genes may be necessary for continued cell growth (hypertrophy) in postnatal and compensatory renal growth, and that collagen type IV formation continues up through week 2 of postnatal growth consistent with the interval of glomerular basement membrane formation.

Animals↗
PubMed1987

Diagnosis and surgical correction of the pediatric varicocele.

We reviewed our experience with the diagnosis and management of varicoceles in 40 patients 9 to 18 years old. Of the patients 29 underwent varicocelectomy and 11 are being managed conservatively with periodic followup. The results of therapy and criteria for surgical intervention are discussed.

Adolescent↗
PubMed1987

Complications of artificial urinary sphincter around intestinal segments in reconstructed exstrophy patients.

Nine patients 15 to 28 years old underwent placement of the artificial urinary sphincter around an internal intestinal urinary reservoir. A total of 15 complications was experienced in 8 patients and 13 secondary procedures were necessary. Eight patients are completely continent and 1 has nighttime enuresis. The most common complication encountered was reduction in bowel luminal circumference underlying the sphincter cuff.

Adolescent↗
PubMed1987

Prognostic variables in patients with transitional cell carcinoma of the renal pelvis and proximal ureter.

Recent technological advances in urological endoscopic surgery of the renal pelvis and proximal ureter via ureteroscopy or percutaneous nephroscopy have made it possible to consider parenchymal-sparing procedures in patients with transitional cell carcinoma. To define the role of these procedures in the management of renal pelvic or proximal ureteral transitional cell carcinoma we analyzed retrospectively 31 patients who underwent nephroureterectomy for transitional cell carcinoma of the renal pelvis and/or proximal ureter. High grade upper urinary tract transitional cell carcinoma and a history of metachronous or synchronous bladder transitional cell carcinoma were independent adverse prognostic factors. However, patients with low grade upper urinary tract transitional cell carcinoma and no evidence of a urothelial field change had a 100 per cent 5-year survival rate. It would appear that parenchymal-sparing endoscopic techniques should be regarded with caution in patients with either high grade transitional cell carcinoma of the renal pelvis and proximal ureter or a history of bladder cancer.

Adolescent↗
PubMed1986

The urological manifestations of epidermolysis bullosa.

Epidermolysis bullosa is a rare skin disorder that may at times involve the respiratory, gastrointestinal and genitourinary systems. We report 3 cases of epidermolysis bullosa involving the urinary tract. The radiographic evaluation of this entity and its relationship to other forms of obstructive uropathy are discussed along with a management plan for patients with genitourinary involvement owing to epidermolysis bullosa.

Epidermolysis Bullosa↗