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J H Lumerman

Publications and source records attributed to J H Lumerman.

5 recordsLinked to original sources
PubMed2000

Alternative or additional diagnoses on unenhanced helical computed tomography for suspected renal colic: experience with 1000 consecutive examinations.

OBJECTIVES: To determine the incidence and spectrum of significant alternative or additional diagnoses established or suggested on unenhanced helical computed tomography (CT) in a large series of patients with suspected renal colic. METHODS: One thousand consecutive unenhanced helical CT examinations were performed for suspected renal colic. All official CT reports were retrospectively reviewed, which was followed by review of all available relevant follow-up radiology reports. A selected image and chart review was also performed. RESULTS: Ureteral calculi were identified on 557 examinations, findings consistent with a recently passed stone were discovered on 67 examinations, and 275 CT examinations were unremarkable. An alternative or additional diagnosis was established or suggested on 101 examinations, including in 26 patients with concurrent ureteral calculi. There were 62 genitourinary and 39 nongenitourinary tract diagnoses. Eighty-seven of the diagnoses could be confirmed on retrospective image review combined with patient follow-up. There were two false-positive diagnoses for significant, alternative pathologic findings. CONCLUSIONS: A wide spectrum of significant, alternative, and additional genitourinary and nongenitourinary diagnoses can be reliably established or suggested on unenhanced helical CT performed for suspected renal colic. These abnormalities were identified in 10% of cases in this series of 1000 consecutive CT examinations.

Adult↗
PubMed1999

Heightened suspicion and rapid evaluation with CT for early diagnosis of partial renal infarction.

BACKGROUND AND OBJECTIVE: Although renal infarction has been well studied and clearly defined, it remains greatly underdiagnosed, resulting in significant morbidity. Acute segmental renal infarction is a diagnosis even more problematic, as the problem can appear insidiously and masquerade as other entities including stone, infection, and even tumor. The clinical manifestations and evaluation of partial renal infarction in our patients were reviewed. PATIENTS AND METHODS: Seven patients presenting to the emergency department who were subsequently found to have partial renal infarction were identified from the 5-year records of a single institution. Patients were evaluated for presenting complaints, physical findings, temperature, and blood pressure. Laboratory analysis consisted of a complete blood count (CBC); measurements of creatinine, lactate dehydrogenase (LDH), aspartate transaminase/alanine transaminase (AST/ALT), and alkaline phosphatase; and urinalysis. The sequence of the work-up was recorded, as well as time to diagnosis. The etiology of infarction was identified for all patients. RESULTS: All seven patients were eventually discovered to have partial renal infarction as a result of dysrhythmia (N = 4), mural thrombus (N = 2), or septic emboli (N = 1). The average time to diagnosis was 65.2 hours with a range of 9.5 to 168 hours. The chief complaint was flank pain (N = 3), nonspecific abdominal pain (N = 2), left lower-quadrant pain (N = 1), and mental status change (N = 1). The presenting signs and symptoms included abdominal tenderness (N = 4), nausea and vomiting (N = 4), temperature >100.5 degrees F (N = 3), and hypertension (N = 3). Laboratory studies revealed a white cell count >11,000/microL in six, microhematuria in four, proteinuria in four, elevated LDH in all patients, elevated AST/ALT in two, and elevated alkaline phosphatase in one. The work-up varied by presentation, but definitive diagnosis was made by CT in all five patients scanned and by angiography in two. Angiography confirmed the CT findings in four of the five patients. CONCLUSION: In evaluating partial renal infarction, a strong clinical suspicion is necessary. We found a history of dysrhythmia or other cardiac disease, the presence of abdominal or flank pain, fever with an elevated white cell count, and an elevated LDH to be clinically significant, and their presence should alert the clinician to the possibility of renal infarction. Once a degree of suspicion exists, early evaluation with CT should speed the diagnosis and effect decreased morbidity.

Adolescent↗
PubMed1999

Complete renal embolization as an alternative to nephrectomy.

PURPOSE: Simple nephrectomy is technically demanding in patients with recurrent inflammation or bleeding. It is also unwise to subject patients in poor health to the rigors of an extensive operative procedure. We report our experience with complete renal embolization as a safe and reliable alternative to surgical nephrectomy. MATERIALS AND METHODS: Eight patients underwent complete renal embolization as an alternative to nephrectomy. Patients were given antibiotics intravenously before and after embolization. Six patients with indwelling nephrostomy tubes received post-embolization instillation of 80 mg. gentamicin before tube removal. Narcotic analgesics were also given as needed for pain control. Post-embolization hospital course was noted. RESULTS: The indications for embolization included hydronephrotic, poorly functioning kidneys with pain in 5 cases, and recurrent bleeding from angiomyolipoma, bleeding after percutaneous resection of renal pelvic transitional cell carcinoma with metastases and spontaneous renal bleeding after hemodialysis in 1 each. Embolization was successful in 4 men and 4 women with a mean age of 58.8 years. In 6 patients severe flank pain required narcotic analgesics. One patient complained of nausea, 6 had fever and 6 had leukocytosis. In 1 case thrombosis of a limb of an aortobifemoral bypass graft required thrombectomy. Median hospital stay was 2.5 days. At a mean followup of 30.6 months presenting symptoms had resolved in all cases without hypertension, renal failure or abscess. CONCLUSIONS: Complete renal embolization is a viable alternative to nephrectomy in patients with poorly functioning kidneys who present with pain or bleeding and in those who are poor operative candidates. This procedure is safe, reliable and minimally invasive with few long-term sequelae, and it is well tolerated.

Adolescent↗
PubMed1998

Pubovaginal sling using polypropylene mesh and Vesica bone anchors.

OBJECTIVES: To report preliminary results from a modified pubovaginal sling procedure using polypropylene mesh as the sling suspended by nonabsorbable sutures anchored to the pubic tubercle with Vesica bone anchors. METHODS: Thirty-five women with type III stress urinary incontinence (SUI) (with or without associated urethral hypermobility) or type II SUI with additional risk factors such as obesity, chronic obstructive pulmonary disease, or failed prior incontinence-correcting procedures underwent this modified pubovaginal sling procedure. Postoperative voiding status was evaluated during office follow-up visits and telephone surveys. RESULTS: With a mean follow-up of 8.4 months (range 2 to 18), 32 women (91.4%) were dry, 1 improved, and 2 remained incontinent. The pubovaginal sling procedure was the only operation performed in 46% of patients, with a mean operative time of 72 minutes, a mean estimated blood loss of 137 mL, and a mean hospital period of 2.3 days. Patients on whom concomitant gynecologic procedures were performed had a mean duration of surgery of 122 minutes, a mean estimated blood loss of 202 mL, and a mean hospitalization period of 2.9 days. Thirteen women had preoperative urgency that persisted in 31% of patients. De novo urgency developed in 3 patients. Seven women required prolonged suprapubic tube drainage but no patient remained in permanent retention. There has been no infection or erosion. CONCLUSIONS: Our experience with this modified pubovaginal sling procedure using polypropylene mesh and Vesica bone anchors showed excellent results with greater technical ease, minimal morbidity, and decreased hospitalization period when compared to a traditional pubovaginal sling performed in our hands. Additional follow-up will be needed to assess long-term efficacy.

Adult↗