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Delivery of Health Care↗
Biomedical subjects
E M Reisman
Publications and source records attributed to E M Reisman.
Urolithiasis in the low birth weight infant: the role and efficacy of extracorporeal shock wave lithotripsy.
PURPOSE: Nephrolithiasis in preterm infants rarely requires surgical management. When it persists despite conservative therapy, treatment options are not clearly defined. We report a single institutional experience with extracorporeal shock wave lithotripsy (ESWL)* for the treatment of these small infants. MATERIALS AND METHODS: We treated 8 infants (mean age 13 months) with a history of prematurity and 9 persistent stones with a Dornier HM3 lithotriptor between 1996 and 1999. Mean weight was 7,700 gm. Of the infants 7 had been treated with furosemide for bronchopulmonary dysplasia and 1 presented with multiple anatomical abnormalities. Gantry modification with a wooden platform and polystyrene foam positioning was used for lung and visceral protection. Ureteral stents were placed in 5 patients before ESWL. Renal ultrasonography was performed before, and 2 and a mean of 8 weeks after ESWL. Stone risk factors in our population were investigated through a multispecialty approach. RESULTS: Average stone burden was 47.9 mm.2. A total of 9 sessions of ESWL were required for complete fragmentation of the 9 renal stones. A mean total of 2,100 shocks at a mean 16.1 kV. were administered. One patient with bilateral stones was treated in 2 separate sessions after a 4-week interval. No repeat ESWL sessions or other surgical interventions were required in any patient. Renal ultrasonography demonstrated no post-ESWL morphological changes. Practices leading to a higher incidence of neonatal nephrolithiasis at our institution were also identified. CONCLUSIONS: ESWL is effective treatment for nephrolithiasis in small infants. Short-term safety has been established but continued long-term functional followup is essential. Multifactorial etiologies of nephrolithiasis must be identified and modified promptly in the care of preterm infants.
Humans↗
Use of kidney internal splint/stent (KISS) catheter in urinary diversion after pyeloplasty.
We report on the use of a new catheter, the kidney internal splint/stent (KISS), to facilitate renal urine drainage following pyeloplasty. The catheter combines the desirable qualities of nephrostomy tube diversion, anastomotic stent, and trocar placement in a single tube. The special construction of its lumen diminishes the likelihood of obstructed drainage. Our experience using the KISS catheter with 31 patients undergoing pyeloplasty shows it provides effective internal and external urinary diversion.
Adolescent↗
Favorable experience with pre-emptive renal transplantation in children.
We retrospectively examined our experience with live-related donor kidney transplants in 66 children during the 7-year period 1984-1990. We compared the clinical courses of 26 children who did not receive any dialytic therapy prior to transplantation with 40 children who were dialyzed (27 via peritoneal dialysis and 13 via hemodialysis). We did not find any statistically significant differences in patient or graft survival between these three groups with a follow-up period of 6-87 months. Based on our results, we conclude that pre-emptive transplantation is an acceptable treatment for children who will inevitably require renal replacement therapy.
Adolescent↗
A prospective study of urologist-performed sonographic evaluation of the urinary tract in patients with prostatism.
In this study 171 consecutive patients hospitalized for prostatectomy were prospectively evaluated by urologist-performed transabdominal ultrasound. The urologist-sonographers were blinded to the results of an excretory urogram (IVP) performed and interpreted by radiologists. All significant upper tract pathology (4 renal cell carcinomas and 1 transitional cell carcinoma of the renal pelvis) identified by an IVP also was detected by ultrasonography. Of 5 clinically silent stones seen on an IVP 4 were identified by sonography. There were 13 patients (7.6%) with severe contrast medium allergies or renal failure who were readily evaluated with ultrasonography. Urologist-performed sonography can safely replace an IVP for routine evaluation of the urinary tract before prostatectomy. Moreover, sonography provided significant additional data on prostate size and post-void residual. However, the cost-effectiveness of upper tract imaging in patients before prostatectomy may be questioned.
Calcinosis↗
Brucella orchitis: a rare cause of testicular enlargement.
The differential diagnosis of the acutely enlarged testis includes numerous benign and malignant disease processes. Most are treated with radical orchiectomy due to difficulty in differentiating between these disorders preoperatively. Saving the involved testis, prevention of recurrent infectious disease in the opposite testis and prevention of systemic manifestations of testicular disease are but a few of the reasons for accurate diagnosis of the acute scrotum. We report a rare case of brucellosis presenting as an acute scrotal mass and stress the importance of accurately identifying the specific etiology of testicular pathology to prevent long-term morbidity.
Acute Disease↗
Bladder perforation secondary to clean intermittent catheterization.
Clean intermittent catheterization has been an effective treatment for the management of patients with a neurogenic bladder during the last 15 years. Reported complication rates have been low and the majority of these problems have been minor. While significant problems are seen only rarely during clean intermittent catheterization, we recently diagnosed 2 potential life-threatening complications: bladder perforation and bladder necrosis. We present our experience with these major problems associated with routine clean intermittent catheterization.
Abdomen, Acute↗