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Biomedical subjects

D E Patterson

Publications and source records attributed to D E Patterson.

At least 19 recordsLinked to original sources
PubMed1992

Primary radiologic realignment of membranous urethral disruptions.

A forty-two-year-old man with a traumatic, membranous urethral disruption underwent initial suprapubic catheter urinary diversion followed by a primary realignment twenty-one days after injury. Realignment was accomplished radiologically using an anterograde guide wire engaged by a retrograde stone basket and subsequent Foley catheter placement over the wire. The patient has remained totally continent, having partial erections, two years after injury, with no further intervention.

Adult↗
PubMed1992

Transurethral microwave thermotherapy for prostatism: early Mayo Foundation experience.

As part of a multicenter investigative trial, transurethral microwave thermotherapy of the prostate was used in 60 men with symptomatic benign prostatic hypertrophy. A single office treatment on the Prostatron, a device that provides concurrent microwave heating of the prostate and conductive cooling of the urethra, was well tolerated and caused no major adverse events. Symptomatic improvement, especially the decrease in nocturia and urgency, was dramatic, and urinary flow was improved at 6 weeks. Continued follow-up suggests that further improvement will be achieved and that transurethral microwave thermotherapy has a role in the treatment of benign prostatic hypertrophy.

Academic Medical Centers↗
PubMed1992

A prospective randomized comparison of epidural infusion of fentanyl and intravenous administration of morphine by patient-controlled analgesia after radical retropubic prostatectomy.

In a prospective, randomized study, continuous infusion of epidural fentanyl citrate (group E) was compared with patient-controlled intravenously administered morphine sulfate (group P) for analgesia in 66 men after radical retropubic prostatectomy. Although both methods provided satisfactory analgesia, the mean comfort level scores were lower (that is, greater comfort) in group E than in group P at all observation times. The difference in mean resting comfort level scores between groups E and P was statistically significant (P < or = 0.05) at 9 of the 11 observation times. In addition, significant differences in comfort level scores were noted at 8 of the 11 observation times during deep breathing, 5 of 11 during coughing, and 3 of 9 during ambulation. Maximal and minimal comfort level scores recorded by each patient during the course of the study were significantly lower (that is, less pain) in group E than in group P for all four categories of activity. The percentage of patients who reported no pain was significantly higher in group E than in group P at 9 of 11 observation times during resting and 5 of 11 observation times during deep breathing. No significant differences were noted in side effect profiles or duration of hospital stay. In summary, when two effective methods of analgesia used after radical retropubic prostatectomy were compared prospectively, patients who received epidural infusion of fentanyl were more comfortable than those with patient-controlled intravenous administration of morphine, as evidenced by lower mean, maximal, and minimal comfort level scores and a greater proportion of patients with complete relief of pain.

Aged↗
PubMed1990

Ureteroscopy in children.

The development of ureteroscopy has led to a dramatic change in the management of ureteral stones as well as other ureteral pathological conditions in adults. Until recently, size limitations have prevented the technique from being used in small children. We have used ureteroscopy for diagnosis and therapy in 4 children less than 10 years old. There was no significant morbidity from the procedure in our patients.

Child↗
PubMed1990

Safety of same-day sequential extracorporeal shock wave lithotripsy and dissolution of gallstones by methyl tert-butyl ether in dogs.

Passage of stone fragments after extracorporeal shock wave lithotripsy (ESWL) of gallstones has resulted in biliary colic, duct obstruction, and pancreatitis in some patients. Rapid dissolution of these fragments with methyl tert-butyl ether (MTBE) may prevent such side effects and achieve complete clearance of gallstones within hours rather than several months to a year or longer. This study examines the safety of same-day ESWL fragmentation and MTBE dissolution of surgically implanted human gallstones in 15 dogs. The animals were randomly assigned to one of four treatment groups to assess MTBE absorption from the gallbladder and to observe hematology and chemistry profiles after 0, 400, and 1,200 shock waves from a lithotriptor followed by MTBE dissolution therapy. They were sacrificed either immediately after treatment (12 dogs) or 2 weeks later (3 dogs). The results demonstrated that although ESWL causes moderate trauma to the gallbladder, this did not result in increased MTBE absorption or histologic evidence of mucosal disruption. Blood profiles demonstrated an increase in only the level of aspartate aminotransferase. The three dogs that were sacrificed 2 weeks after the combined treatment had no residual evidence of gallbladder injury or remaining stone material. In all animals, severe injury occurred where shock waves passed through lung or air-filled colon. This study suggests that same-day sequential fragmentation of gallstones by ESWL followed by dissolution of stone fragments with use of MTBE may be associated with only mild to moderate and reversible gallbladder trauma and can rapidly achieve clearance of gallstones.

Animals↗
PubMed1989

Extended resection for locally advanced primary adenocarcinoma of the rectum.

To determine the perioperative mortality and morbidity and the longterm prognosis of patients undergoing extended pelvic resections for localized advanced primary adenocarcinoma of the rectum, the authors reviewed their experience with 65 patients operated on between 1956 and 1984. Local invasion without distant metastasis was present in all patients at operation and en bloc resection of all involved organs was performed with intent of cure. Average age at operation was 61 years; 15 (23 percent) were men and 50 (77 percent) were women. Operations included abdominoperineal resection in 37 patients (57 percent), low anterior resection in 20 patients (31 percent), and Hartmann procedure in 8 patients (12 percent). Additionally, 34 of 42 women (81 percent) with intact uteri underwent en bloc hysterectomy, 37 of 48 women (77 percent) with intact ovaries had oophorectomy, and 25 of 50 women (50 percent) had partial vaginal resection. Seventeen of the 65 patients (26 percent) had a cystectomy, and 2 patients had a portion of small intestine resected in continuity with their tumor. Pathologic examination revealed lymph node involvement in 29 patients (45 percent) and histologic confirmation of adjacent organ extension in 37 patients (57 percent). There were no perioperative deaths, the average survival was 5.7 years, and 25 patients (38 percent) were alive after a mean follow-up period of 9.3 years. Overall five-year survival was 52 percent. Forty patients died during the follow-up period, with 26 (65 percent) of the deaths attributable to either recurrent carcinoma (25 patients) or a new primary lesion (1 patient). The cumulative probability of tumor recurrence at five years was 39 percent.

Adenocarcinoma↗
PubMed1989

Extracorporeal shock-wave lithotripsy and methyl tert-butyl ether for partially calcified gallstones.

To explore the possibility that gallbladder stone fragments might be able to be safely dissolved using methyl tert-butyl ether immediately after extracorporeal shock-wave lithotripsy (ESWL), a feasibility study in 8 patients with one to four partially calcified gallbladder stones was performed. The gallstones averaged 2.2 cm in diameter (range 1.3-3 cm) and contained layered or diffuse calcium detectable by computed tomography scan only (7 patients) or plain film (1 patient). After a 5F (1.7 mm) pigtail catheter was placed percutaneously into the gallbladder, ESWL fragmentation was performed using a renal stone lithotriptor. The patients were under general anesthesia and in the prone position on a support gantry designed for gallbladder stone ESWL. Following ESWL, methyl tert-butyl ether was infused and aspirated via the gallbladder catheter until no further stone material was radiologically detectable or could be dissolved. After 8-26 h (mean = 13 h) of methyl tert-butyl ether therapy, no radiologically detectable gallstones remained in 6 of 8 patients. Shell fragments of three peripherally calcified stones in 1 patient and the densely calcified, predominantly pigment stone in a second patient were refractory to combined therapy. Both ESWL and treatment with methyl tert-butyl ether were well tolerated in all patients, although bile leakage after catheter removal occurred in 3 patients, one of whom was treated by cholecystectomy. Additional measures to prevent bile leakage may be advisable if these two modalities are to be used in tandem. We found no evidence, however, that predissolution stone fragmentation with ESWL predisposed the gallbladder to either mucosal damage by methyl tert-butyl ether or increased absorption of it.

Aged↗
PubMed1989

Impact of endourology on diagnosis and management of upper urinary tract urothelial cancer.

The technique of transurethral ureteropyeloscopy was used in 43 patients with upper urinary tract urothelial tumors. Diagnosis was confirmed in 19 of 22 renal pelvic tumors (86 per cent) and 19 of 21 ureteral tumors (90 per cent). The major complication rate in this series is low (7 per cent) and did not appear to influence unfavorably subsequent management or outcome. A total of 21 patients underwent conservative endourological management of the upper tract tumor. The local recurrence rate was 20 per cent (1 of 8) for renal pelvic tumors and 15 per cent for distal ureteral tumors (2 of 13). The technique of ureteropyeloscopy should be added to the standard diagnostic regimen for the investigation of upper tract filling defects and conservative endourological techniques can be used safely for management of selected cases of upper tract urothelial tumor.

Aged↗
PubMed1988

Long-term followup in patients with cystine urinary calculi treated by percutaneous ultrasonic lithotripsy.

From February 1983 through 1986, 15 patients (17 renal units) with cystine urinary lithiasis were treated by percutaneous ultrasonic lithotripsy. Three patients were lost to followup. Of the 13 renal units in the remaining 12 patients 7 (54 per cent) had retained stone fragments and 6 (46 per cent) were free of stones. While on medical management 7 of the 13 renal units (54 per cent) had new stones, 5 (38 per cent) remained unchanged and in 1 (8 per cent) the retained stones dissolved. The rate for reoperations was 43 per cent for the group with retained stones (3 of 7) and 17 per cent for the group that was free of calculi after percutaneous ultrasonic lithotripsy (1 of 6). Our study suggests that the optimal treatment with percutaneous ultrasonic lithotripsy should result in a patient who is free of stones.

Adolescent↗
PubMed1988

Ureteroscopy.

From early 1982 to December 1985, 317 patients underwent 346 transurethral ureteroscopic procedures at our institution. For most patients the intramural ureter was dilated with balloon dilators and all procedures were performed under fluoroscopic control. The over-all success rate for lower ureteral stone removal was 95 per cent, which increased to 97 per cent for stones treated in 1984 and 1985. Ureteroscopy is useful for the evaluation of idiopathic gross hematuria, and for the diagnosis and treatment of ureteral and renal pelvic tumors. The over-all mean hospital stay was 4.9 days and the procedure has been a significant addition to our armamentarium.

Adolescent↗
PubMed1988

A case of pediatric ureteroscopic lasertripsy.

The standard treatment for ureteral calculi in children has been open surgical removal. Recently, we removed successfully a lower ureteral calculus in a young child with ureteroscopy and the pulsed dye laser. The improvements in smaller rigid and flexible ureteroscopes, in conjunction with lasertripsy, will expand its applications in the treatment of pediatric urolithiasis.

Child, Preschool↗
PubMed1988

Neodymium:YAG laser treatment of cystitis glandularis.

We report a case of severe cystitis glandularis of the entire bladder, which caused a large retrovesical mass and bilateral hydronephrosis. Treatment included whole bladder neodymium:YAG laser therapy, a technique not previously reported for this extent of disease. The etiology, diagnosis, treatment and malignant potential of cystitis glandularis are discussed.

Adult↗
PubMed1988

Successful repair of an unusual hernia associated with traumatic pubic diastasis.

A 70-year-old man had an unusual type of supravesical small bowel hernia associated with herniation of the bladder through a traumatic diastasis of the pubic symphysis. The diastasis was closed with prosthetic mesh through a preperitoneal approach. In patients in whom a scrotal hernia develops after a previous pelvic fracture, especially those with evidence of a pubic diastasis, an unusual type of hernia should be suspected. A preperitoneal surgical approach best reveals the anatomy and allows appropriate repair. The best procedure for prevention of such hernias is primary reduction of any substantial pubic diastasis, but operative intervention is not indicated in all patients.

Aged↗
PubMed1987

Percutaneous renal calculus removal in an extracorporeal shock wave lithotripsy practice.

The introduction of extracorporeal shock wave lithotripsy and transurethral ureteroscopy have altered markedly the incidence of standard surgical and percutaneous stone removal procedures. To help define the present role of percutaneous procedures in our practice we evaluated our indications, results and the clinical course of 143 patients who were treated primarily with percutaneous methods during 1 year in which extracorporeal shock wave lithotripsy also was available. The complexity of these residual percutaneous cases necessitated repeat endoscopic or fluoroscopic stone removal procedures in 20 per cent and ancillary extracorporeal shock wave lithotripsy in 22 per cent, and led to a slightly higher complication rate than in our previous percutaneous series. Despite the effectiveness of extracorporeal shock wave lithotripsy, percutaneous methods still are necessary for comprehensive therapy of upper tract urolithiasis.

Body Height↗
PubMed1986

Indwelling ureteral stents: percutaneous management of complications.

Complications of indwelling ureteral stents were managed percutaneously in 13 patients. These complications consisted of three fractured, three heavily encrusted, and seven migrated stents. While most ureteral stent malfunctions are routinely managed with retrograde techniques, the percutaneous approach allows effective clinical management in selected cases in which extensive renal stone material or brittle intrarenal stent fragments are present or when previous surgery or ureteral strictures do not permit a retrograde approach. Fluoroscopically guided removal of migrated stents and percutaneous endoscopic techniques, for complex cases such as those requiring stone removal, were successful and without complications.

Adult↗