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Biomedical subjects

D B Glazier

Publications and source records attributed to D B Glazier.

At least 19 recordsLinked to original sources
PubMed2001

Utility of biofeedback for the daytime syndrome of urinary frequency and urgency of childhood.

OBJECTIVES: To evaluate in a preliminary study the utility of biofeedback for the treatment of the daytime syndrome of urinary frequency and urgency of childhood, a benign, self-limited condition with symptoms that can last for months or years. Observation is a commonly recommended approach to this syndrome because medications and other forms of therapy are often not effective. METHODS: During a 2-year period, 89 children (34 boys and 55 girls) presented with this syndrome. Patient age ranged from 4 to 11 years, and duration of symptoms ranged from 1 to 38 months. All children were evaluated with a history, physical examination, urinalysis and culture, and renal and bladder ultrasound scanning. After the evaluation, the parents were offered either observation or surface patch electromyography biofeedback for the problem. RESULTS: Overall, 84 parents (94.3%) selected biofeedback for their child. After 1 month of biofeedback, 34.5% of children were able to achieve a 2 to 4-hour voiding interval. After 2 to 4 months of biofeedback, another 51.2% of patients experienced the same improvement. Overall, 85.7% of children who underwent biofeedback had symptom improvement. In 14.3% of children, no symptom improvement was noted after 4 months of biofeedback and these children were considered nonresponders. CONCLUSIONS: The results of this study suggest that biofeedback may be a treatment option for this disorder and warrants further investigation.

Activities of Daily Living↗
PubMed2001

Evaluation of prostate volume by transrectal ultrasonography for use in a brachytherapy program.

OBJECTIVES: To evaluate two methods of measuring the prostate volume using transrectal ultrasonography. The measurements were performed in vivo at preplanning and again preoperatively in connection with brachytherapy. The accurate measurement of the prostate volume is important in a brachytherapy program for treatment planning. METHODS: A total of 43 patients with biopsy-proven prostate cancer underwent prospective determination of the prostate volume, by one physician, using transrectal ultrasonography. Volume calculations were made at the preplanning and preoperative settings, both by a hand-held rectal probe using the prolate ellipsoid formula and by a mounted probe in a stepping device using the planimetric method. RESULTS: The coefficient of variation between the preplanning and preoperative prostate volumes with the probe holder was less than 3% compared with the hand-held probe, which was greater than 10%. The difference between the median values at the preplanning and preoperative settings by serial planimetry was 2.5 cm(3) (range 0.2 to 9.4). The difference in the median volumes between the preplanning and preoperative ellipsoid calculations was 6.7 cm(3) (range 0.3 to 38.7). The difference between the median values with the ellipsoid volume was significant (P <0.001). The Pearson correlation coefficient for all values using the planimetric method was 0.92 versus 0.58 for the ellipsoid method. The correlation coefficient was significantly greater for the planimetric method (P <0.001). CONCLUSIONS: On the basis of these data, planimetric prostate volume determination, by a single ultrasonographer, is an accurate and reproducible method with applicability to a brachytherapy program.

Brachytherapy↗
PubMed2000

Lesch-Nyhan syndrome presenting as acute renal failure secondary to obstructive uropathy.

Lesch-Nyhan syndrome is a rare genetic disorder characterized by mental retardation, self-mutilation, choreoathetosis, and hyperuricemia. The disease is caused by a mutation in the hypoxanthine-guanine phosphoribosyltransferase gene and is transmitted as a sex-linked recessive disorder. Since hyperuricemia is the primary metabolic problem caused by a hypoxanthine-guanine phosphoribosyltransferase mutation, urologic evaluation and treatment is often necessary for children with this disease. We report a 3-year-old boy who presented with anuric renal failure secondary to bilateral obstructing uric acid calculi. The evaluation of T lymphocytes revealed a hypoxanthine-guanine phosphoribosyltransferase mutation consistent with Lesch-Nyhan syndrome. The diagnosis and urologic management of this disorder is discussed.

Acute Kidney Injury↗
PubMed1999

The fate of cryopreserved sperm acquired during vasectomy reversals.

PURPOSE: Intraoperative sperm banking has been recommended during vasectomy reversal. These specimens are maintained as insurance for possible future intracytoplasmic sperm injection. We evaluated the fate of specimens collected intraoperatively from 48 vasectomy reversal patients. MATERIALS AND METHODS: Of 75 men 48 (64.0%) agreed to intraoperative sperm banking during vasectomy reversal. A total of 135 vials of epididymal sperm, 81 vials of testicular tissue and 13 vials of vasal sperm were cryopreserved. RESULTS: Among couples who stored sperm 10 (20.8%) voluntarily discarded the specimens within 4 months of vasectomy reversal. Specimens from 31 couples (64.5%) remain in storage. Seven couples (14.6%) have used frozen sperm for intracytoplasmic sperm injection. In 3 of these couples the men were azoospermic after surgery, 2 men had 10,000 to 15,000 sperm per ml. in the ejaculate with limited motility and 2 had 1 to 2 million sperm per ml. with limited motility. The 7 women who underwent intracytoplasmic sperm injection ranged between 37 and 39 years old, which was older than the mean age of the remaining study group (32.7 years). With intracytoplasmic sperm injection fertilization was achieved in all cases and 20 of 47 eggs (42.5%) developed into embryos. Of 7 women 4 achieved biochemical pregnancies (57.1%) and 2 (28.6%) delivered newborns with epididymal sperm. Natural pregnancy occurred in 7 of 16 vasectomy reversal couples (43.7%) who were followed at least 18 months postoperatively but the time to pregnancy averaged 1 year. CONCLUSIONS: Cryopreservation of sperm collected at vasectomy reversal is recommended for patients undergoing vasoepididymostomy or vasovasostomy. The couples who used the cryopreserved sperm for intracytoplasmic sperm injection included husbands whose postoperative ejaculate remained azoospermic or severely oligospermic and wives who were approaching 40 years old. Only a limited number of couples (14.6% of the study group) have used the cryopreserved sperm but the delivered newborn rate (28.6%) was comparable to other intracytoplasmic sperm injection data. The natural pregnancy rate after vasectomy reversal was 43.7% but the time to pregnancy after surgery was lengthy (average 1 year). These findings may be helpful for counseling couples who are planning vasectomy reversal surgery and may be considering intraoperative sperm banking.

Adult↗
PubMed1998

Epidermolysis bullosa: a review of the associated urological complications.

PURPOSE: Epidermolysis bullosa is a devastating rare disorder that rarely presents with urological complications. We report our experience with and review the literature on this disorder. MATERIALS AND METHODS: Two brothers with epidermolysis bullosa presented to our center with severe dysuria and urinary tract obstruction caused by meatal stenosis. The obstruction was temporarily relieved by meatotomy but recurrent obstructive skin blistering with severe dysuria required ureterosigmoidostomy for palliation of symptoms. RESULTS: Both children tolerated ureterosigmoidostomy well with 1 requiring bicarbonate supplementation for metabolic acidosis. Ureterosigmoidostomy greatly improved quality of life, and both children have complete symptom relief. CONCLUSIONS: Epidermolysis bullosa is usually a severe illness associated with a poor prognosis. Crippling urological symptoms may develop due to recurrent skin blistering causing severe dysuria and secondary obstruction. Ureterosigmoidostomy, despite its complications, provides significant palliation for patients with recalcitrant symptoms.

Child, Preschool↗
PubMed1998

Lessons learned about contralateral reflux after unilateral extravesical ureteral advancement in children.

PURPOSE: The development of contralateral reflux after unilateral antireflux surgery has spawned interest and controversy regarding etiology and management issues. We evaluate our experience to understand better the issues surrounding contralateral reflux. MATERIALS AND METHODS: We retrospectively reviewed the records of all children seen in a 7-year period who underwent unilateral extravesical ureteral advancement performed by one of us (M. R. Z.) at our institution. RESULTS: A total of 43 children a mean of 50.5 months old underwent unilateral reimplantation. The male-to-female ratio was 12:31. In 12 children contralateral reflux had resolved preoperatively. Overall contralateral reflux developed in 5 patients (11.6%) after unilateral extravesical ureteral advancement. In 1 child in whom new onset contralateral reflux developed on 1 side reflux resolved by 10 months with observation. In 8 of the 12 children (66%) with a history of resolved contralateral reflux there was no recurrence. In 4 of the 12 children recurrent contralateral reflux completely resolved by 14 months postoperatively with only observation. In these 4 patients initial reflux had been grades II and IV in 2 each. To date all fully evaluable reflux in children with previous contralateral reflux recurred has resolved. CONCLUSIONS: The recurrence of contralateral reflux after unilateral reimplantation that is expected in a small number of children resolves in the majority, if not in all, with conservative management. We believe that children should not be offered bilateral reimplantation for unilateral reflux and a history of resolved contralateral reflux. If contralateral reflux recurs, it will most likely resolve with time.

Child, Preschool↗
PubMed1998

Elective aortic surgery with minimal banked blood.

It has been a historical supposition that aortic surgery, even in an elective setting, has been associated with the transfusion of large amounts of blood products. We feel that this assumption is now dated, and in fact far fewer patients now receive allogenic blood products. To assess this assumption, we carried out a retrospective chart review of all patients who underwent elective aortic surgery over an 18-month period from April 1994 to October 1995. Factors analyzed included type of procedure, blood loss, amount of Cell Saver blood replaced, need for autologous blood transfusion, and need for allogenic blood transfusion. Sixty-seven patients underwent elective aortic surgery with either an aortic tube graft (23), an aortobiiliac graft (25), or an aortobifemoral graft (19). The male:female ratio was 48:19, with a mean age of 67 years (range, 42-85 years). Mortality and morbidity were 4.4 per cent and 8.9 per cent, respectively. The average blood loss per patient was 770 cc. Cell saver was used in 65 patients, with the average amount of blood returned being 542 cc. Overall, 73 per cent of patients did not require allogenic blood transfusion, and 58 per cent did not need any type of transfusion. Of those who stored autologous blood prior to operation, none required allogenic blood perioperatively. With the new advances in autologous blood transfusion both by predeposit and salvage transfusion, we have greatly reduced the need for transfusion of allogenic blood products in patients undergoing major aortic surgery. This is reassuring, and although increasing short-term cost, will reduce the morbidity-infectious, noninfectious, and immunologic-associated in prior decades with allogenic blood transfusions. We strongly recommend the use of Cell Saver techniques, and also, where possible, patients should be encouraged to donate their own blood prior to major aortic procedures for future transfusion.

Adult↗
PubMed1997

Mitral valve myxoma.

Cardiac myxomas arising from the mitral valve are extremely rare. We describe the case of an asymptomatic 49-year-old woman who was found to have a 3.6 x 4.0-cm myxoma originating from the atrial side of the anterior mitral leaflet. The lesion was successfully treated by surgical excision and mitral valve replacement. A review of the literature regarding this rare lesion is presented.

Female↗