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Biomedical subjects

H W Johnson

Publications and source records attributed to H W Johnson.

At least 19 recordsLinked to original sources
PubMed1992

Intestinal obstruction complicating pregnancy.

Intestinal obstruction is a rare but serious complication of pregnancy with significant maternal and fetal mortality. The reported incidence of intestinal obstruction complicating pregnancy varies widely, from 1 in 66,431 to 1 in 1,500 deliveries. A retrospective review of 66 cases of intestinal obstruction complicating pregnancy and the puerperium, including 2 cases from our institution, revealed that the most common causes of mechanical obstruction were adhesions (58%), volvulus (24%), and intussusception (5%). Seventy-seven percent of the patients with obstruction due to adhesions had undergone previous abdominal or pelvic surgery. Presenting symptoms and signs were similar to those of the nonpregnant patient; abdominal pain was present in 98% of patients, vomiting in 82%, and tenderness to palpation in 71%. In 82% of patients, obstruction was evident on radiographic evaluation. Prompt management of obstruction is essential; the median length of time from admission to laparotomy in the 66 patients was 48 hours. Bowel strangulation requiring resection was present in 23% of patients. Thirty-eight percent of patients completed term pregnancies after operative resolution of obstruction; total maternal mortality was 6%, and total fetal mortality 26%. Thus, both mother and fetus are at risk when intestinal obstruction complicates pregnancy. Clinical suspicion of the presence of obstruction and aggressive intervention are required to decrease the morbidity and mortality of this rare complication of pregnancy.

Female↗
PubMed1992

A comparison of two continent catheterizable vesicocutaneous techniques.

In a rabbit model we describe and compare two continent catheterizable diversion techniques for which the bladder is intact and the stoma is situated in the lower abdomen. Both mechanisms are formed from a short segment of ileum; one utilizes the principles of the encircling loop technique as described by Koff and the second, the Kock principle (intravesical nipple). Both models were evaluated for the following parameters: ease of catheterization (87%, 79% respectively), continence (91%, 86% respectively), and ease of construction. We present evidence that both techniques are applicable to the clinical setting.

Animals↗
PubMed1992

Tisseel in hypospadias repair.

Tisseel (Immuno AG, Vienna, Austria), a fibrin sealant, adhesive and hemostatic agent made up of sterilized human and bovine components, was used in hypospadias repairs. The incidence of fistula and significant edema and the duration of hospitalization were all reduced in 30 patients who underwent modified Mustardé repairs in which Tisseel was used when compared with a matched group of 30 repairs without Tisseel. In addition, the rate of complications in fistula repairs and complex revisions was reduced when Tisseel was used on urethral suture lines and under all skin flaps.

Edema↗
PubMed1990

Augmentation ileocystoplasty in children with myelodysplasia.

Over the past 8 years 20 children suffering from myelodysplasia were selected to undergo augmentation ileocystoplasty for urinary incontinence refractory to treatment by clean, intermittent catheterization and anticholinergic agents, or as part of urinary undiversion. The children ranged in age from 5 to 17 years, and the follow-up ranged from 6 months to 7 years. Three children underwent undiversion, two had vesicostomy closure and six had bladder outlet repair at the time of augmentation. In one patient, surgery was technically impossible. Postoperatively 16 children were fully continent on clean, intermittent catheterization and anticholinergic medication. Three boys failed to achieve satisfactory continence. Delayed perforation, a potentially serious complication, occurred in two patients several months postoperatively.

Adolescent↗
PubMed1989

Wilms tumorlet, nodular renal blastema and multicystic renal dysplasia.

We reviewed 60 cases of multicystic renal dysplasia collected during a 10-year period. Differentiated nonproliferative nodular renal blastema occurred in 6.7 per cent of the cases, which is similar to the incidence of nodular renal blastema in kidneys of other infants with congenital obstructive uropathy. A unique case of cystic dysplasia containing nodular renal blastema and Wilms tumorlet indicates the possibility that a persistently proliferative nephroblastomatous lesion may rarely occur.

Child↗
PubMed1989

Undiversion in patients with meningomyelocele.

Since 1981, 12 patients with neurogenic bladder due to meningomyelocele who had had previous ileal conduit urinary diversions underwent assessment for undiversion. Two important criteria for undiversion were motivation and a reconstructable bladder. Four patients either did not fulfil these criteria or refused surgery. Eight patients (six females and two males) underwent undiversions. Uretero-ureteral anastomosis was achieved in 13 ureters and ureteroneocystostomy in 2; transureteroureterostomy was necessary in 1 ureter. Augmentation cystoplasty and vesicourethropexy were important in establishing continence postoperatively; these procedures were not performed in two patients whose undiversion failed early in the series. The evolution of an investigation protocol, surgical technique and final approach to this complex problem are discussed.

Anastomosis, Surgical↗
PubMed1988

Testicular adhesion: a potential complication from wedge testicular biopsy in childhood leukemia.

Elective bilateral wedge testicular biopsy is frequently performed in childhood acute lymphoblastic leukemia. Acute and delayed complications of this procedure are rarely encountered. We report on two children with testicular adhesions 16 and 20 months postsurgery. In each instance there were resultant diagnostic and management difficulties. The possible cause and potential side effects of testicular adhesions are discussed.

Adhesiveness↗
PubMed1988

Dicentric Y chromosome and mixed dysgenesis.

We report 4 cases of mixed gonadal dysgenesis with a karyotype containing a dicentric Y chromosome. All cases were mosaic with 45X and 46X, dic(Y) cell lines. Of the patients 1 had ambiguous genitalia and some features of Turner's syndrome, 2 had classical features of Turner's syndrome with normal female external genitalia and 1 had no features of Turner's syndrome but he presented with penoscrotal hypospadias, inguinal hernia and cryptorchidism. Female gender assignment and early total gonadectomy should be considered when a dicentric Y chromosome is present in cases of mixed gonadal dysgenesis.

Child, Preschool↗
PubMed1988

Bladder-outlet reconstruction in neurogenic bladder due to myelomeningocele.

In a subgroup of children with myelomeningocele, urinary incontinence cannot be managed by clean intermittent catheterization and anticholinergic medication. The authors report on 24 such children who required bladder-outlet reconstruction. Twelve boys underwent the Young-Dees/Leadbetter procedure, 8 girls underwent the Burch procedure and the remaining 4 had a combination of the two. Augmentation cystoplasty was also carried out in seven girls and one boy. Results were most favourable in the girls, with improvement in 92%, in contrast to the boys in whom only 58% were improved. Artificial sphincter placement may be a more beneficial alternative for boys.

Adolescent↗
PubMed1987

Neonatal renomegaly.

A retrospective clinical review was done to study the value of ultrasound and renography in the investigation of 100 neonates with renomegaly. Abnormalities in 73 patients were detected antenatally with ultrasonography. Of the neonates 47 had lower urinary tract pathological conditions and ultrasound was more than 90 per cent accurate in identifying the accompanying ureteral dilatation. A total of 53 neonates had upper tract anomalies (ureteropelvic junction obstruction or cystic dysplasia). With ultrasonography the degree of pyelocaliectasis in patients with ureteropelvic junction obstruction was classified as mild (22 units), moderate (13) or severe (7). Initial treatment and followup were reviewed to study the clinical course of neonates with mild to moderate degrees of pyelocaliectasis followed nonoperatively, and to determine whether the diuretic renogram had a predictive role in identifying which kidneys were most likely to deteriorate.

Dilatation, Pathologic↗
PubMed1986

Stability of Liposyn II fat emulsion in total nutrient admixtures.

Compatibility and safety of a safflower oil-soybean oil lipid emulsion (Liposyn II, Abbott) with amino acids and dextrose in total nutrient admixtures (TNAs) were studied. Sixty-two admixtures representing 31 different combinations of fat emulsion, amino acid injection, and dextrose injection were tested. Both 10% and 20% concentrations of the fat emulsion and three concentrations each of amino acid injection and dextrose injection were used; the core admixture components were placed in empty flexible plastic bags in three different sequences: fat, amino acids, dextrose; fat, then dextrose and amino acids simultaneously; and amino acids and dextrose simultaneously, then fat. One of two mixtures of electrolytes and trace metals was added to each sample at the end of mixing. Six samples were tested after one day at 25 degrees C, 35 after two days at 5 degrees C plus one day at 30 degrees C, and 21 after nine days at 5 degrees C plus one day at 25 degrees C. Multivitamin injections were added to each TNA just before the 24-hour room-temperature storage. pH, emulsion particle size, and zeta potential (electrostatic surface charge of lipid particles) were measured after visual inspection of each sample. Amino acids were separated by high-performance liquid chromatography and measured. Dextrose was measured by size-exclusion chromatography. In a controlled study of 24 dogs, six-hour infusions of TNAs containing Liposyn II 20% were administered for 14 days, after which all major organs and tissues were studied microscopically. At all storage times in the compatibility study, all TNAs retained a uniform, milk-like appearance.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
PubMed1985

Megalourethra.

We present 5 examples of megalourethra. All 5 cases were associated with the spectrum of the triad syndrome, ranging from minor hydronephrosis and undescended testis to gross hydronephrosis incompatible with survival. Initial management of this urethral defect is drainage followed later by reconstruction.

Child, Preschool↗
PubMed1979

Idiopathic retroperitoneal fibrosis in children.

A case of idiopathic retroperitoneal fibrosis in an 11-year-old boy is presented. A review of 7 previous case reports revealed that there was no characteristic presentation in this disease process and that the diagnosis usually is suspected on an excretory urogram. The treatment is primarily surgical but corticosteroids may be helpful in selective cases.

Child↗
PubMed1975

Experiences with priapism.

During a 10-year period 11 cases of priapism were treated with a saphenocavernous bypass. Uniformly good functional results were obtained if the procedure was done within 36 hours of the commencement of priapism. Prior aspiration and irrigation appear to lengthen this interval. The formation of temporary cavernovenous communication with the superficial venous system of the penis by aspiration and irrigation with large needles is demonstrated and is postulated as a mechanism by which this method of treatment alone is occasionally successful. Persisting graft patency has been associated with impotence. If erection does not occur within 3 months of the saphenous bypass the shunt should be ligated.

Anesthesia, Epidural↗
PubMed1975

A linguistic and cognitive persepctive on retardation.

The idea of critical readiness periods for both language learning and cognitive development was reviewed and related to mental subnormalities. A basic model of a synthesized theory of language and cognition was presented, and a theoretical "Basal Person" was constructed to illustrate a new perspective on retardation. The general conclusions reached were that (a) the basal person represents the lowest normal level of cognitive linguistic development, and (b) retardation can be defined in terms of impeded or disrupted development during critical readiness periods.

Age Factors↗