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D D Morehouse

Publications and source records attributed to D D Morehouse.

At least 19 recordsLinked to original sources
PubMed1996

Effectiveness and safety of the Dornier compact lithotriptor: an evaluative multicenter study.

PURPOSE: We evaluated the efficacy and safety of the Dornier compact lithotriptor for management of renal stones. MATERIALS AND METHODS: We administered 191 treatments to 169 patients with renal stones on 176 occasions with the patient under combined parental sedation and analgesia. The Dornier Compact lithotriptor is mobile and ultrasound guided, and uses an electromagnetic energy source. RESULTS: A total of 22 patients required a second treatment (13%), 123 (72.8%) were stone-free, 26 (15.4%) had fragments less than 4 mm. large, 16 (9.5%) had stone fragments larger than 4 mm, and 4 (2.4%) required auxiliary therapy (treatment failures). The side effects were mostly mild to moderate, with nausea and/or vomiting reported in 26 patients (14%), colic or pain in 66 (39%), ureteral obstruction in 2, steinstrasse in 7 (4%) and fever in 1. Our clinical results indicate that extracorporeal shock wave lithotripsy was effective for treatment of stones in the kidney, with a low incidence of complications and adverse effects. The lithotriptor used is much smaller, less expensive and user friendly with no installation requirements, rendering it mobile. CONCLUSIONS: The success rate with newer generation devices compares well with results obtained using other stationary and larger versions.

Adult↗
PubMed1995

Early experience with extracorporeal shockwave Dornier lithotriptor "compact".

One of the latest developments in extracorporeal shockwave lithotripsy (SWL) is a combination of an electromagnetic energy source with an upgraded parallel online ultrasound imaging for localization. The device is compact, requiring no significant installation or site preparation. Furthermore, it increases the margin of safety of SWL by virtue of the continuous ultrasound monitoring. A hundred sessions of SWL were performed on 88 patients using the Dornier Compact machine. Ninety three renal units having an average of 1.7 stones were treated (two had upper ureteric stones). Of the 135 stones, 2 (1.5%) were radiolucent and 4 (3%) were of faint opacity. Intravenous sedation was used in all patients except one 13-year-old patient, who required general anesthesia. Patients received an average of 2409 shocks per session, and the maximum power setting ranged from 1 to 6 (average 4.7). A plain film was obtained immediately before and after treatment. Early adverse effects were uncommon, and all were mild. Patients were followed by plain films at 2 weeks and 3 months. In 35 sessions (25 solitary and 10 multiple stones), the stones were considered completely fragmented; in 63 sessions, the stones (43 solitary and 20 multiple) were judged to be partial fragmented; and 2 sessions (solitary stones) resulted in poor fragmentation. The mean (+/- SD) stone dimension in the group with complete fragmentation was 9 +/- 4.8 (range 2-24) mm, compared with 11 +/- 6.3 (range 2-38) mm in those with no or partial fragmentation (P = 0.0095). After 2 weeks, 23 of 69 systems (33%) were stone free, while 46 showed residual stones.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Safety and effectiveness of Lithostar shock tube C in the treatment of urinary calculi.

Over 14 years of clinical use of extracorporeal shockwave lithotripsy (SWL), great technical modifications resulted in the development of many second-generation lipthotripters. The Siemens Lithostar machine, with its standard shockwave tube, was introduced in 1986. The objective of this study was to assess the safety and effectiveness of the newly proposed Lithostar shock tube C in the treatment of urinary calculi. Between July 1992 and August 1993, 319 patients (214 males and 105 females, average 49.7 years) with 433 renal or ureteral stones or both were treated at five centers in Canada and the United States. Most of the stones (72%) were located in the kidneys, while 28% were located in the ureters. Most (81%) of the treated sides (side = kidney and ureter) presented with single stones, 11% presented with two stones, and 8% presented with three or more stones. The average stone burden was 13.6 mm. The average duration of treatment for the whole population of patients was 39.3 minutes using an average number of shockwaves of 3633 in a minimum and maximum energy setting of 0.11 and 3.82, respectively. The majority of treatments (92%) were performed without anesthesia. Fragmentation was achieved in 93.5% of treatments, with a 3-month stone-free rate of 62.5% and a success rate (stone free or fragment < 5 mm) of 72%. Auxiliary procedures were necessary in conjunction with 108 treatments, and most of them were in form of catheter/stent placement. Treatment applied on a separate occasion to different stones but in the same collecting system (either a kidney or a ureter) were considered retreatments.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Current indications and technique of two-stage repair for membranous urethral strictures.

At present, the indications for two-stage repair for membranous urethral strictures are limited. However, there are situations where two-stage reconstruction is the procedure of choice. It certainly should be considered in those patients who present with marked scarring in the perineum from previous attempts at urethral reconstruction or from the initial trauma, such as might be encountered following perineal burns or gunshot wounds. It is also successful in those patients in whom the anterior urethra has previously been damaged and cannot be mobilized or is not healthy enough to permit a tension-free end-to-end anastomosis and in patients who have perineal abscesses, infected fistulae, or infected urethral diverticula with or without calculi. The technique selected in these complicated cases must ensure adequate drainage of infected material as well as provide an excellent blood supply for the graft.

Humans↗
PubMed1988

Management of posterior urethral rupture: a personal view.

The management of urethral injury continues to be controversial and no one policy has received universal acceptance. This review describes the current three-step approach which we use for the investigation and management of this serious injury. This approach has evolved during the management of a large number of these injuries over the past 22 years. It is relatively simple and can be expected to give a high success and low complication rate. We believe that many of the complications encountered following the management of this injury are avoidable.

Cystostomy↗
PubMed1988

Injuries to the urethra and urinary bladder associated with fractures of the pelvis.

The posterior urethra or urinary bladder may be injured in patients who sustain fractures of the bony pelvis. It is important to assess the urethra radiologically by retrograde urethrography before introducing a urethral catheter to avoid missing a urethral injury or causing further damage. The author's approach to the immediate management of urethral injury is suprapubic cystostomy. The urethra may be repaired later after other injuries have healed. With this approach the incidence of permanent impotence and incontinence will be low and the stricture cure rate high. If the urethra has not been injured, a catheter is introduced and cystography performed to rule out bladder injuries. If the bladder is ruptured, the area is explored, the perivesical space drained and urinary drainage is provided by either a suprapubic cystostomy or a urethral catheter.

Fractures, Bone↗
PubMed1982

Blunt renal trauma: the value of a conservative approach to major injuries in clinically stable patients.

A 10-year retrospective study of 393 cases of blunt renal trauma was carried out to evaluate the use of a conservative approach to therapy in clinically stable patients with major renal injuries. Injuries were minor in 357 patients who were successfully treated conservatively. Major injuries occurred in 36 patients; 28 were treated conservatively. Of the 28, 17 had no complications. Seven required total or partial nephrectomy to control bleeding and four had drainage, one with marsupialization of a large renal cyst, 1 year after injury. The authors advocate conservative treatment of major blunt renal injuries in clinically stable patients.

Adolescent↗
PubMed1981

Development of anergy to delayed-type hypersensitivity antigens following renal allotransplantation.

A study is reported of patients receiving 180 renal allotransplants and at risk for 1 or more years who had pretransplant and posttransplant skin tests using delayed type hypersensitivity (DTH) recall antigens. Pretransplant skin testing revealed an incidence of 14% anergic patients prior to a first transplant, and 35% were anergic prior to a second allograft. There was a statistically significant correlation between pretransplant anergy and age, as well as a significant correlation between pretransplant anergy and time of dialysis-dependent uremia. The conversion to the anegic state posttransplant in those patients with surviving allografts increased annually for the first 5 years as a linear function, with 69% of the population at risk with their first transplant exhibiting anergy by 5 years. In those patients receiving second renal transplants, all were anergic by 4 years posttransplant. In vitro tests of lymphocyte function using mitogen stimulation did not reveal significant differences between anergic and responsive patients. In this series of 180 allografts there were 14 late deaths. Eleven of these were in anergic patients and in 10 instances were related to sepsis or malignancy. Three patients who were skin-test responsive at the time of death died from cardiovascular causes. It is concluded that there is an increasing risk of the development of anergy to DTH antigens posttransplant and that the type of late mortality may be marked by this hyporeactive state.

Adult↗
PubMed1979

Late hypertension following renal allotransplantation.

Post-transplant hypertension has been observed in 98 renal allograft recipients who had good renal function and whose follow-up was more than 15 months. The role of the original diseased kidneys as well as the role of the renal pressor system was studied with emphasis on late hypertension. Post-transplant hypertension was found to be a multifactorial phenomenon with frequency decreasing as a function of prolonged graft survival. Renal artery stenosis was an infrequent but significant cause of hypertension and was found in 10 of 29 arteriograms performed. Renin studies performed in 34 hypertensive patients and in a control group of 11 recipients showed that elevation of plasma renin activity and of plasma aldosterone level is frequent but difficult to interpret, particularly when a renal artery stenosis is observed. These investigations may be useful in recognizing the role of retained diseased kidneys in sustaining hypertension. Plasma aldosterone was found elevated in nearly all of the patients. The role of corticosteroids and the similarity of post-transplant hypertension, in some cases, with the one kidney model of experimental hypertension are discussed.

Adolescent↗
PubMed1979

Results of retransplantation in individuals who received two successive cadaver kidneys.

At the Royal Victoria Hospital in Montreal, 22 patients received two successive cadaver renal transplants. The results were analysed to determine which factors have the best predictive value for success or failure in renal retransplantation. The fate of a second cadaver renal allograft was found to be about the same as the first if the initial transplant has been lost because of rejection and not technical failure. The duration of survival of the initial transplant serves as the best guide to potential outcome of retransplantation after rejection of the initial graft.

Adolescent↗
PubMed1978

Donor pretreatment in an unselected series of cadaver renal allografts.

In a single center, an unselected non-exclusion series of 78 consecutive cadaver renal allografts in 76 recipients was studied. Since 1971, using kidneys obtained from donors pretreated with large doses of cyclophosphamide and methylprednisolone, excellent clinical results with 2-year graft-survival of 70% 5-year graft survival of 66% have been obtained. The improvement in results is believed to be aided by the reduction in allograft immunogenicity due to short-term donor pretreatment. In this series, poor tissue-matching grades are notable, heavily transfused patients are few, 33 patients were high risk, and 43 patients were presensitized. In spite of these negative selection factors, the results obtained in this pretreated series, with 18% of graft losses due to rejection, are superior to those obtained in patients who did not receive pretreated allografts during the same time period, with 34% of graft losses due to rejection, and 2-year and 5-year graft survivals of 57% and 53%, respectively.

Adolescent↗