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Biomedical subjects

D L McCullough

Publications and source records attributed to D L McCullough.

At least 37 records · Page 2Linked to original sources
PubMed1994

Inguinal lymphadenectomy and primary groin reconstruction using rectus abdominis muscle flaps in patients with penile cancer.

OBJECTIVES: The use of deep inferior epigastric artery (DIEA) rectus abdominis muscle flaps in conjunction with inguinal lymphadenectomy to treat patients with squamous cell carcinoma (SCC) of the penis having high-volume inguinal lymph node metastases causing skin breakdown and secondary infection is described. METHODS: Three patients with invasive SCC of the penis who had extensive unilateral inguinal nodal metastases with skin breakdown and secondary infection underwent pelvic lymphadenectomy and attempted wide resection of the superficial and deep inguinal lymph nodes. One patient had unresectable deep inguinal metastases and received postoperative radiation therapy. A DIEA rectus abdominis muscle flap was utilized to close the resulting groin defect. RESULTS: Pathologic analysis demonstrated no pelvic lymph node metastases in any of the patients, superficial inguinal lymph node metastases in 1, and superficial and deep inguinal lymph node involvement in 2. All wounds healed well. The 2 patients with deep inguinal metastases experienced local disease progression. One patient died 7 months postoperatively of complications from chronic renal failure but had no evidence of tumor recurrence or wound problems. Another patient died of recurrent disease. CONCLUSIONS: A rectus abdominis muscle flap may be a useful adjunct for managing certain patients with penile cancer and extensive suppurative inguinal lymph node metastases.

Biopsy, Needle↗
PubMed1993

Transurethral ultrasound-guided laser-induced prostatectomy: National Human Cooperative Study results.

Between November 1990 and March 1992, 150 patients at 10 United States institutions were treated with transurethral ultrasound-guided laser-induced prostatectomy (TULIP) for the relief of bladder outlet obstruction secondary to benign prostatic hypertrophy. The TULIP system incorporates ultrasound visualization with a 90-degree angle, side-firing laser to effect coagulation necrosis of prostate tissue. The overall preoperative prostate volume in this TULIP study was 40 cc and all types of prostatic enlargement, including median lobe obstruction, were treated. There were no intraoperative complications, with no hemorrhage or post-transurethral resection syndrome, and no blood transfusions were required. Hospital stay averaged 1.7 days and 83% of the patients went home after a 1-night stay. We evaluated 63 patients at 6 months after the TULIP procedure. Mean symptom scores decreased from 18.8 to 6.1, for a 68% improvement. The mean peak flow increased from 6.7 ml. per second preoperatively to 11.9 ml. per second, for a 78% improvement. Overall, 87% of the patients exhibited at least 50% improvement in either the symptom score or peak flow parameter, while 49% of the patients demonstrated at least a 50% improvement in both parameters.

Equipment Design↗
PubMed1992

Transurethral laser prostatectomy in the canine model.

A technique for performing transurethral prostatectomy was devised using a Neodymium:Yttrium Aluminum Garnet laser in a canine model. Six dogs underwent transurethral laser prostatectomy following establishment of a perineal urethrostomy. The efficacy of the prostatectomies was judged by retrograde urethrography, transrectal prostate ultrasonography, cystoscopy, and histologic examination. The method of applying laser energy while holding the tip of the fiberoptic light guide 2-3 mm away from the prostate was ineffective; with power ranging from 40 to 70 watts, this technique resulted mainly in coagulation necrosis and removal of only a small amount of tissue. However, placing the tip of the light guide in direct contact with the prostate and using power from 70 to 100 watts produced impressively large prostatectomy defects by tissue vaporization. We conclude that this newly devised technique for transurethral prostatectomy in the canine model can be performed safely and effectively using a Neodymium:Yttrium Aluminum Garnet laser (Neodymium:YAG).

Aluminum Silicates↗
PubMed1992

Stone therapies.

Explore the source record for details and available documents.

Humans↗
PubMed1992

Tetrodotoxin protects against acute ischemic renal failure in the rat.

Tetrodotoxin has been reported to cause prolonged systemic hypotension without resultant ischemic damage. We tested its ability to protect the kidney during 60 minutes of warm ischemia in uninephrectomized rats. Protection was observed when tetrodotoxin was given intravenously at two microgram./kg. and four microgram./kg. as assessed by serial plasma blood urea nitrogen and creatinine measurements over two weeks. Tetrodotoxin was protective when given immediately before or immediately after the ischemic period. The renal protection of tetrodotoxin was not due to its effects on renal nerves as renal denervation did not protect the kidney from the ischemic damage. The renal protective effects of four microgram. tetrodotoxin/kg. were similar to those of four mg. captopril/kg. but the combination of the two was paradoxically without effect. We tested whether tetrodotoxin and captopril chemically antagonized each other, but in the presence of tetrodotoxin, captopril was still a potent inhibitor of the conversion of angiotensin I to angiotensin II. These results indicate that tetrodotoxin could be useful in elucidating the sequence of events associated with ischemic-reperfusion renal injury and in identifying ways of preserving renal function during renal surgery.

Acute Kidney Injury↗
PubMed1992

Altered neutrophil permeability following shock wave exposure in vitro.

Human neutrophils were exposed to varying numbers of shock waves using the Dornier XL-1 experimental lithotripter. Cellular changes were observed with as few as 60 shock waves generated with 20 KV at a frequency of one per second. A graded reduction in cell numbers and cell viability was observed up to 300 SW. With exposure to 140 SW or above a decrease in mean cell size occurred. When cells were shocked in the presence of adriamycin or after loading with fluorescein, flow cytometry revealed that influx of extracellular components and efflux of cytoplasmic components had occurred. An ultrastructural and functional analysis of cells exposed to 60 SW, where cellular disruption and loss of viability were minimal, revealed several types of cellular changes which may precede SW-induced cell death. Electron microscopic examination revealed in some cells a loss of staining intensity. Plasma membrane rupture and leakage of cytoplasmic components were occasionally evident. The adherence of shocked cells to glass, and the spreading of cells that had adhered, were also reduced. From these studies, it is concluded that cellular permeability and other vital cellular functions in neutrophils are perturbed by SW exposure.

Cell Adhesion↗
PubMed1991

Intraoperative renal ultrasonography: a useful adjunct to partial nephrectomy.

Several evolutionary changes in ultrasonographic instrumentation, including miniaturization of transducers and marked improvement in resolution, have made intraoperative renal ultrasonography a valuable adjunct for intrarenal surgery. We investigated its use in 6 patients undergoing partial nephrectomy for treatment of renal cell carcinoma. In addition, 14 kidneys with renal tumors were scanned immediately after radical nephrectomy and the specimens were subjected to simulated partial nephrectomy. Transverse and longitudinal real-time sonographic images were obtained with a 5 MHz. sector scanner or a 7.5 MHz. convex array transducer. With ultrasonography to define tumor extent and location, negative surgical margins were obtained in all 6 individuals undergoing partial nephrectomy. A negative surgical margin was obtained in 13 of the 14 radical nephrectomy specimens subjected to simulated partial nephrectomy. A small satellite lesion was not identified and not resected in 1 of the radical nephrectomy specimens. We found that intraoperative renal ultrasonography helps to identify the location and extent of deep intraparenchymal lesions. It also provides a guide for a more accurate nephrotomy, which facilitates the attainment of negative resection margins during partial nephrectomy.

Carcinoma, Renal Cell↗
PubMed1991

A comparison of anatrophic nephrolithotomy and percutaneous nephrolithotomy with and without extracorporeal shock wave lithotripsy for management of patients with staghorn calculi.

A retrospective study was conducted comparing anatrophic nephrolithotomy (10 cases), percutaneous nephrolithotomy alone (4 cases) or percutaneous nephrolithotomy combined with extracorporeal shock wave lithotripsy (23 cases) for the treatment of large staghorn calculi. A comparison based on collecting system anatomy demonstrated that anatrophic nephrolithotomy resulted in a greater stone-free rate, shorter hospitalization and lower costs while complication rates were similar. Anatrophic nephrolithotomy should still be considered a viable treatment option, especially for patients with large branched calculi in complex collecting systems.

Adult↗
PubMed1990

The combined effects of shock waves and cisplatin therapy on rat prostate tumors.

The effects of focused high energy shock waves (SW) generated by the Dornier experimental XL-1 lithotripter alone or in combination with cisplatin (CDDP) on the AT-2 prostate tumor were examined. They were assessed by measuring 1) clonogenic cell survival 24 hours after treatment, 2) tumor growth delay, and 3) the number of lung metastases. The survival of clonogenic cells was reduced 38% by exposure to 2000 SW and tumor growth was delayed by 1.5 days. The limb bearing the tumor was excised in all animals when the tumor reached seven cm.3 The subsequent occurrence of lung metastases in three out of 13 unshocked animals and two out of 14 shocked animals indicated that SW did not promote the dissemination of tumor cells. At doses of one to four mg. CDDP/kg. body weight, SW exposure increased the effectiveness of the chemotherapy measured by a clonogenic assay. The fractional survival was 0.62 after 2000 SW alone, 0.23 with four mg. cisplatin/kg. alone and 0.10 after the combination treatment. At higher doses of CDDP, there was no added effect of SW over that of CDDP therapy alone. Tumor growth to one cm.3 was delayed by seven days after treatment with four mg. CDDP/kg., in comparison to untreated controls. SW exposure combined with CDDP treatment delayed the time taken for the tumor to reach one cm.3 by 13 days in comparison with untreated controls. However, the combination treatment increased animal mortality from 9% with CDDP alone to 29%. These results indicate that SW could be used focally to enhance the cell killing effects of CDDP.

Animals↗
PubMed1989

Angiomyolipoma arising in the renal sinus: a difficult radiologic diagnosis.

We report a case of angiomyolipoma (AML) occurring in the renal sinus evaluated by intravenous urography (IVU), renal ultrasound (US), angiography, and computed tomography (CT). Imaging features of this lesion are identical to AMLs elsewhere, but preoperative diagnosis was complicated by the unusual occurrence of the tumor in this location in a patient with abdominal pain. Accurate preoperative diagnosis will allow tumorectomy or conservative management.

Female↗
PubMed1989

Extracorporeal shock-wave lithotripsy in hemophiliac patient.

We report on a patient with hemophilia A who underwent successful extracorporeal shock-wave lithotripsy without incident. We are aware of two other reported cases in the literature. The relative risks of alternative methods of stone management and the indications and risks of blood product therapy in this condition are reviewed.

Hemophilia A↗
PubMed1989

Lumbar ureteral shunt--an unusual cause of ureteral obstruction.

In a neurosurgical patient with a lumbar ureteral shunt in place for many years ureteral obstruction and hydronephrosis developed. The shunt tubing was removed surgically from the ureter leaving a portion of the shunt in the subarachnoid space without sequelae. Historically, most patients undergoing this type procedure had an ipsilateral nephrectomy performed at the time of shunt placement; however, this patient did not. It is important to be aware of this "antique" procedure as it may cause urologic complications.

Adult↗
PubMed1989

The role of open stone surgery since extracorporeal shock wave lithotripsy.

Of 893 stone procedures 37 (4.1 per cent) performed during the first 19 months after extracorporeal shock wave lithotripsy was instituted at our medical center were open operations. Procedures included ureterolithotomy in 23 patients (with simultaneous pyelolithotomy in 1), anatrophic nephrolithotomy in 8, pyelolithotomy in 3 (with concomitant pyeloplasty in 2), partial nephrectomy in 2 and nephrolithotomy with a bowel segment inlay in 1. The most common reasons for electing an open operation were unsuccessful endoscopic stone manipulation, presence of anatomical obstruction in the intrarenal collecting system or ureter, morbid obesity and underlying medical problems precluding lengthy repeated endourological procedures. Over-all surgical results were excellent. Our study indicates that patients who presently require an open stone operation have complex calculous disease associated with a variety of anatomical and physiological problems. Despite this finding good results may be attained.

Adult↗
PubMed1989

Selective elevation of urinary enzyme levels after extracorporeal shock wave lithotripsy.

Urinary enzyme testing has been used by many investigators to diagnose and monitor various types of renal injury. Three urinary enzymes, N-acetyl-beta-glucosaminidase, beta-galactosidase and gamma-glutamyl transferase were monitored in 17 patients before and after a single, unilateral extracorporeal shock wave lithotripsy treatment. Stones were in the renal pelvis or calices except for 1 treated in situ in the proximal ureter. Urine specimens were collected before extracorporeal shock wave lithotripsy and at 1, 3, 5, 7, 10, 14, 21 and 28 days after treatment. N-acetyl-beta-glucosaminidase and beta-galactosidase levels increased significantly after treatment (p less than 0.05). Gamma-glutamyl transferase levels increased after treatment but this was not statistically significant. All enzyme levels were highest on days 1 and 3 after lithotripsy and returned to baseline by day 28. Factors associated with post-treatment enzyme elevation included female sex, a lower pre-treatment creatinine clearance and stone size greater than 1 cm. These findings indicate that there is a transient selective increase in urinary enzyme excretion after extracorporeal shock wave lithotripsy.

Acetylglucosaminidase↗