PubMed Health⌕ Search

Biomedical subjects

E C Muecke

Publications and source records attributed to E C Muecke.

At least 19 recordsLinked to original sources
PubMed1994

Congenital renal arteriovenous malformation in pregnancy presenting with hypertension.

Congenital renal arteriovenous malformations (AVMs) are rare, with approximately 50 cases reported in the literature. Typically, they are small (1 to 2 cm) and the majority present with hematuria and symptoms and signs of congestive heart failure. Review of the literature revealed only 4 cases reported in pregnant patients and their presentation was with hematuria and rupture of the AVM. We present a case of a young female patient with a 6 cm congenital renal AVM who was otherwise asymptomatic until her first pregnancy, when she developed and presented with symptoms of hypertension and an abdominal bruit. Her symptoms persisted postpartum. Hematuria and rupture of the AVMs were not part of her clinical course. A partial nephrectomy was curative.

Adult↗
PubMed1993

Changing trends in the management of prostatic disease in a single private practice: a 5-year followup.

Evaluation and management services provided by the practicing urologist have changed dramatically during the last few years. This is particularly evident in the approach to men with bladder outlet symptoms and in those in whom the diagnosis of prostate cancer is a distinct possibility. The impact of medical management/observation of symptomatic benign prostatic hypertrophy, as well as the influence of prostate specific antigen, transrectal ultrasound and biopsy, radical prostatectomy and hormonal agents in a 3-man private clinical practice is analyzed. The records of 2,206 patients new to the practice who presented with a variety of prostate-related complaints from July 1, 1986 to June 30, 1991 were reviewed. Of these patients 1,822 (82%) were evaluated for presumed benign bladder outlet symptoms. During year 1 of the study, ending on June 30, 1987, 28% of the presumed benign prostatic hypertrophy patients were treated with transurethral prostatectomy, compared to only 8% of such patients in 1991. In contrast, alpha-blocking agents were used to treat 21% of these patients in 1991. Transrectal ultrasound biopsy currently accounts for 87% of all prostatic biopsies, increasing 4-fold during 5 years. Radical prostatectomy has increased 6-fold during the course of the study. Administration of a luteinizing hormone-releasing hormone analogue has supplanted orchiectomy and estrogen therapy for the treatment of disseminated disease, as witnessed by a 4-fold increase in its use. While it is recognized that these trends are presently applicable to our local metropolitan region, they may reflect practice patterns in similar demographic groups, as well as predict future tendencies nationwide.

Adrenergic alpha-Antagonists↗
PubMed1985

Epispadias: contending with continence.

Forty-seven patients with epispadias not associated with bladder exstrophy were treated at our institution over the last half decade. There were 8 female and 39 male patients, 37 of whom had retrosymphyseal epispadias. Of the 20 male patients with subsymphyseal epispadias and incontinence 13 had a fair to excellent result. Of the 7 females with retrosymphyseal epispadias and incontinence, all but 1 came to urinary diversion. An analysis of our data suggests that premature operative intervention precludes obtaining maximal functional and cosmetic results. In addition, the discrepancy in our overall success rate utilizing a one-stage technique versus a staged procedure favored by others may support the latter.

Adolescent↗
PubMed1985

Exstrophy of bladder: evolution of management.

Eighty-nine patients with bladder exstrophy were seen at our institution over the last fifty years. There were 63 males and 26 females. Cloacal exstrophy constituted 9 per cent of our experience. Twenty-seven patients underwent primary urinary diversion with subsequent genital reconstruction early on in our series. Of the 57 children operated on since 1951, 50 were judged eligible for and underwent a planned multistaged reconstruction. We realized a 50 per cent success rate. The majority of failures were diverted into an ileal conduit for persistent incontinence.

Asia↗
PubMed1984

Renal cell carcinoma extending into the inferior vena cava: the prognostic significance of the level of vena caval involvement.

The records of 24 patients with renal cell carcinoma involving the inferior vena cava who were free of metastatic disease at presentation were reviewed retrospectively. The over-all 2-year survival for the group was 45.8 per cent, with a mean survival of 38.9 months. When the group was analyzed according to the level of extension of the vena caval thrombus marked differences in the rate of survival and of incidence of local progression of disease were found. The 10 patients with an infrahepatic vena caval thrombus had a 2-year survival rate of 80 per cent and a mean survival of 61.4 months. Two patients (20 per cent) had extension of tumor into the perinephric fat and none had involvement of the regional lymph nodes. The 14 patients with a vena caval thrombus extending to the level of the hepatic veins or beyond had a 2-year survival rate of 21 per cent and a mean survival of 22.9 months. Tumor was present in the regional lymph nodes and/or perinephric fat in 9 of these patients (64 per cent). These results suggest that the level of vena caval involvement by tumor thrombus in patients with renal cell carcinoma has prognostic significance.

Aged↗
PubMed1980

Penile flow index utilizing a Doppler pulse wave analysis to identify penile vascular insufficiency.

A Doppler ultrasound probe was used in 42 men to evaluate penile circulation. Twenty-six patients had confirmation of vascular anatomy by pelvic arteriography. The average penile acceleration (peak velocity over pulse rise time) relative to the radial artery acceleration was expressed as the penile flow index. Eleven potent men had a penile flow index of 3.4 plus or minus 0.4 standard error, while 13 impotent men with vascular disease on arteriography had a penile flow index of 21.7 plus or minus 5 standard error (p less than 0.01). Patients with intermediate penile flow index values had variable degrees of erectile failure. This relatively simple, non-invasive technique identifies a vascular component of impotence, thus aiding in the selection of appropriate management.

Erectile Dysfunction↗
PubMed1979

A 20-year experience with ileal conduits: the fate of the kidneys.

During the last 20 years 242 patients have undergone ileal conduit urinary diversion at our hospital. Although only 11 per cent of the renal units showed damage after the ileal conduit there was a progressive risk of renal deterioration with increasing time and obstruction was its major cause.

Adolescent↗
PubMed1978

Anaerobic bacteriuria in renal transplantation.

Renal allograft recipients were studied prospectively utilizing improved culture techniques to investigate anaerobic bacteriuria. The study population was compared with a population of patients with chronic renal insufficiency and end stage renal disease. The over-all incidence of anaerobic urinary tract infection was 7.5 per cent while the over-all incidence of aerobic urinary tract infection was 23.5 per cent. Patients with cadaver renal transplants during the early postoperative period had the highest incidnece of both anaerobic (42.9 per cent) and aerobic (71.4 per cent) urinary tract infection of all groups. The potential association between significant anaerobic bacteriuria during the first postoperative month and poor prognosis for cadaver renal allografts merits further investigation.

Adolescent↗
PubMed1978

Prepubertal diagnosis of steroid 5 alpha-reductase deficiency.

The diagnosis of 5 alpha-reductase deficiency was proven in two prepubertal patients with male pseudohermaphroditism (MPH). Both had a 46-XY karyotype and were reared as females; one child had been castrated in infancy. Clitoromegaly, urogenital sinus, and short vaginal pouch were present in both; inguinal gonads were palpable in one. The diagnosis was made biochemically by observing characteristic changes in five parameters: 1) abnormally high testosterone to dihydrotestosterone (T:DHT) ratio after hCG stimulation (35 and 53 vs. normal, 11 +/- 3), 2) abnormally high 5 beta-T metabolites in urine (8.1 and 6.0 vs. normal, less than 1),3) deficient conversion of T to DHT during [3H] T infusion (0.3 and 0.4% vs. normal, 5.3 +/- 3), 4) deficient conversion of [14 C] T to 5 alpha-reduced metabolites by nongenital skin fibroblasts (2.2 and 1.9 pmol/microgram DNA/nmol substrate vs. 68.4+/- 7.8 Pmol/microgram DNA/nmol substrate in normal controls), and 5) deficient conversion of [14C]T to DHT in genital skin slices. The fact that this syndrome represents a defect in T metabolism rather in in T binding is demonstrated by the observation that binding of [3H]DHT to cytosol of skin fibroblasts was normal (4.2 dpm/micrograms DNA vs. normal male values of 3.7 +/- 0.64). Thus, the present report suggests that 5 alpha-reductase deficiency can be diagnosed during childhood and even after castration by metabolic studies of nongenital skin fibroblasts and determination of the conversion ratio of [3H]T to [3H]DHT in plasma.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed1977

Computed tomography in urologic patients: preliminary assessment.

Computed tomography (CT) body scanning has specific application to the precise diagnosis of urologic disease. The advantage of visualizing the density of normal and abnormal tissue provides new accuracy in evaluation of renal, retroperitoneal, and pelvic masses. The penetration of the pelvic cavity allows the urologist to assess local, nodal, and skeletal involvement from prostatic and bladder neoplasms in a single diagnostic examination. Cost/efficacy analysis and the role of computed tomography in patient managment must await further review and experience.

Abscess↗
PubMed1977

Myelolipoma of the adrenal: two cases with ultrasound and CT findings.

Myelolipoma of the adrenal gland is a rare tumor composed of varying proportions of fat and bone marrow elements. In about half of the reported cases with radiologic findings the mass was radiolucent, indicating the presence of fat; the remainder were of soft tissue density or calcified. Arteriography is of limited value in diagnosis, since myelolipomas are typically avascular. With the advent of gray scale ultrasound and computed tomography (CT), fat can be detected in lesions which do not appear radiolucent on radiographs. Two cases of myelolipoma are reported in which ultrasound showed a markedly echogenic mass, an appearance chracteristic of lipomatous tumors. In the second case, the mass was of soft tissue density on radiographs, markedly echogenic on sonogram, and definitively fatty on CT scan. Ultrasound and CT are valuable techniques for making a preoperative diagnosis of this tumor.

Adrenal Gland Neoplasms↗
PubMed1975

Use of Boari flap in lower ureteral injuries.

We review our experience with the Boari flap to correct distal ureteral injuries. Satisfactory results were obtained in 15 of 21 patients. We believe this procedure should be considered as an alternative to transureteroureterostomy, autotransplantation, and ileal interposition for short or long distal ureteral defects.

Adolescent↗
PubMed1975

Horseshoe kidneys: a 40-year experience.

The results presented show that horseshoe kidney is a non-fatal anomaly of renal development that can be managed successfully by standard urologic procedures. Most clinical problems are caused by hydronephrosis and renal calculi. Careful attention to the anatomy, vasculature and drainage from renal pelves at the time of operation will assure good postoperative results. The Foley Y-V pyeloplasty is a highly effective procedure for relief of ureteropelvic junction obstruction in horseshoe kidneys. As with other genitourinary anomalies the presence of a horseshoe kidney should prompt a thorough urologic evaluation.

Adolescent↗
PubMed1975

A review of 100 renal and perinephric sonograms with anatomic diagnoses.

Sonography is a non-invasive safe, convenient, quick and pain-free diagnostic modality, which can differentiate fluid masses from solid tumors and give a 3-dimensional representation of organs and masses in the retroperitoneum by biplanar sections. Sonography depends on the fact that high frequency sound has many characteristics of light and is, in fact, a sophisticated method of transillumination. A review of the first 100 consecutive patients who had sonography and anatomic diagnosis of the renal or perinephric abnormality shows the versatility and potentials of sonography. Of these 100 sonograms of renal and perinephric abnormalities 92 were correct by anatomic diagnosis.

Abscess↗