Biomedical subjects
J J Kaufman
Publications and source records attributed to J J Kaufman.
Non-invasive low-intensity pulsed ultrasound accelerates bone healing in the rabbit.
The effect of ultrasound (US) on the rate of fibula osteotomy healing in 139 mature New Zealand white rabbits was assessed in this study. Bilateral midshaft fibular osteotomies were made using a 1-mm Gigli saw. US was noninvasively applied to one limb for 20 minutes daily, while the contralateral limb served as a control. A 2.5-cm PZT transducer was applied to both limbs, with the treated limb receiving a 200-microseconds burst of 1.5-MHz sine waves repeated at 1.0 kHz. The incident intensity was approximately 30 mW/cm2. Animals were killed at intervals between 14 and 28 days. Maximum strength increases (significant to p less than or equal to 0.01) ranged from 40 to 85% from postoperative day 14 to 23. On day 28, no significant difference in ultimate strength was noted. From day 17 through day 28, all US-treated fractures were as strong as intact bones (p less than or equal to 0.005). On the other hand, the ultimate strength of the control osteotomies attained intact values only by day 28. These results indicate that biomechanical healing is accelerated by a factor of nearly 1.7. This occurs with an overall acceleration of the healing curve in this fresh fracture model. If noninvasive low-intensity pulsed sine wave ultrasound can significantly accelerate bone repair in clinical application with an in-home treatment of 20 minutes daily, then US may be a useful adjunct for fracture care with a concomitant impact on patient morbidity.
Successful use of transureteroureterostomy to salvage ureterosigmoidostomy after anastomotic failure.
Four cases are presented of patients who had undergone ureterosigmoidostomy and in whom a unilateral ureteral anastomotic complication developed that was salvaged subsequently by a transureteroureterostomy. Although other forms of urinary diversion are now being utilized routinely in many centers, the ureterosigmoidostomy is still being employed worldwide, and urologic surgeons need to be versed in its potential problems and how to correct them.
Unique urinary-fecal calculus after cystectomy and ureterosigmoidostomy.
A 36-year-old m an had stage B1 bladder cancer-treated by cystectomy and ureterosigmoidostomy. Postoperatively, a urinary leak was managed successfully by transureteroureterostomy and temporary colostomy. In succeeding years a large calculus developed in the region where the bladder had been and it also involved the sigmoid colon. The huge stone was removed successfully. A nonabsorbable suture was found in the center of the stone. This is a unique complication of ureterosigmoidostomy.
Urethral gap in complete disruption of membranous urethra.
In patients with complete disruption of the membranous urethra treated initially with placement of a suprapubic cystostomy, delayed synchronous retrograde and voiding cystourethrograms failed to demonstrate accurately the distance between the two urethral ends. Radiographic exposure obtained during synchronous instrumentation of the anterior and posterior urethra in the anesthetized patient was the most precise method of defining the extent of the urethral gap. Any surgical decision should be based on this type of investigation. In most cases of pelvic crush injuries, the severed membranous urethra probably remains attached in close proximity to the distal segment, thus directing the redescent of the prostate and bladder base in the presence of a contracting pelvic hematoma.
The effect of verapamil in reducing the severity of acute tubular necrosis in canine renal autotransplants.
Calcium channel blockade has been shown to prevent warm renal ischemic damage. The ability of verapamil to decrease the severity of acute tubular necrosis (ATN) after 24-hr cold storage and autotransplantation was studied in a randomized paired study of 12 dogs. Experimental animals pretreated with intraarterial verapamil and flushing of the harvested kidney with cold intracellular solution containing verapamil demonstrated significantly (P less than .05) greater renal function preservation over their matched controls. A subsequent nonpaired study of 6 dogs treated only with flushing of the harvested kidney with perfusate containing verapamil demonstrated no significant preservation advantage over controls. We conclude that verapamil, administered prior to the ischemic event, can enhance the protective effect of hypothermia and decrease the severity of ATN in ischemically injured kidneys.
Nephrocolic fistula: a complication of percutaneous nephrostolithotomy.
Percutaneous nephrostolithotomy has proved to be a safe and effective approach to the management of upper tract calculi, which is associated with a low rate of significant complications. Bowel perforation is an unusual complication of this technique. We report a case of a nephrocolic fistula following percutaneous nephrostolithotomy, and discuss the diagnosis and management of this rare complication.
The Kock pouch as a urinary reservoir. Pitfalls and perspectives.
The Kock continent urinary reservoir is a feasible alternative to traditional methods of urinary diversion in properly motivated patients who are anxious to exchange a convenient external appliance for frequent reservoir catheterization. The major shortcomings are increased operative time, loss of a long segment of small bowel, and an approximate 10 percent incidence of major reoperation. Long-term results are unknown. Facility with the operation requires extensive experience and attention to detail. Most complications are related to inadequate fixation of the intussuscepted valves and improper placement of a short terminal segment in the abdominal wall. Early repair of malfunctioning valves and distal segments that are difficult to catheterize is essential to prevent more severe acute complications. Whether the Kock pouch will replace the standard methods of urinary diversion must be determined by more extensive clinical experience and long-term results.
The use of collagenase in the treatment of Peyronie's disease.
Purified clostridial collagenase was administered intralesionally in 31 men with Peyronie's disease. Within 4 weeks of treatment 20 patients showed an objective improvement. Pain was eliminated in 13 of 14 patients with this complaint at presentation within the same 4-week period. The ability to have intercourse was restored in 3 of 4 patients with this problem. Except for a small corporeal rupture at the site of injection in 1 patient, no significant untoward effects were noted. During the mean 9.8-month followup 1 recurrence of bending was noted.
Correlation between the growth inhibitory effects, partition coefficients and teratogenic effects of lipophilic acids.
The inhibition of cell duplication by many lipophilic acids was measured in Bacillus subtilis and in the following mammalian cell lines, the human epithelial-type cell lines HeLa, strain R and strain L-132, the human fibroblast cell line VA-13, and the rat glial cell line C. The results were correlated to the partition coefficient and the distribution coefficient (= apparent partition coefficient at pH 7.2) of the compounds, using octanol/water partition coefficients and pKa values either from the literature or measured for this work. For B. subtilis, the logarithm of the inhibitory potency of most compounds increases linearly with the logarithm of the partition coefficient. Exceptional high potencies were observed for compounds that can efficiently delocalize the charge of the negative ion over the whole molecule. Most compounds inhibit tissue cultures at least as potently as they inhibit B. subtilis. But some compounds are significantly more potent in tissue cultures than would have been expected from the B. subtilis data; such compounds (analgesics/antipyretics, anti-inflammatory compounds, butyrate, norepinephrine) presumably inhibits mammalian cells by specific reactions with certain cell components. However, most compounds inhibit the different cell lines to a similar degree, indicating no cellular specificity; exceptions to this rule are chlorambucil, chlortetracycline and dexamethasone. Many of the lipophilic acids that are potent inhibitors of mammalian cell replication are also teratogenic. Exceptional compounds may not reach the embryo. We propose that a number of other lipophilic acids that are potenta inhibitors and to which humans are frequently exposed should be tested for their teratogenic effect.
Why Marshall-Marchetti operation works . . . or does not.
Vesicourethral suspension operations fail (1) when preoperative evaluation is insuffcient, leading to improper selection of patients; and (2) for technical reasons when anatomy is uncorrected (suture malplacement, suture breakage, and failure to release adhesions) or when anatomy is corrected (periurethral fibrosis, fistula, stone or granuloma formation on nonabsorbable suture, and overcorrection). Vesicourethral suspension operations work by changing urethrotrigonal anatomy, creating a new equilibrium of forces acting on the bladder neck and urethra.
Effects of preliminary normothermic flushing on hypothermic renal preservation.
Flushing of harvested kidneys with hypothermic perfusates is presumed to cause inappropriate circulation due to vasospasm. Effects of initial normothermic flushing prior to hypothermic flushing and cold preservation were tested in canine kidneys. Analysis of the perfusion characteristics revealed that a brief initial flushing with solutions at 37 degrees C. eliminates vasoconstriction and even facilitates subsequent hypothermic flushing. In amounts not exceeding 100 cc. it was not deleterious to transplant function. Larger volumes of normothermic flushing were proved to cause endothelial injury and resulted in poor transplant survival.
Renovascular hypertension: the UCLA experience.
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In situ flushing of donor kidneys: its technique and rationale.
In situ flushing of kidneys through an isolated segment of aorta was done on mongrel dogs. The 500 cc cold perfusate at 3 to 4C (delivered in 6 minutes) effectively cooled the kidneys to about 15C. This simplified technique of in situ flushing, its usefulness and rationale are discussed.
Urethral compression procedure for the treatment of male urinary incontinence.
We believe that there still is a place for passive compression of the bulbous urethra in the treatment of male urinary incontinence after prostatectomy or sphincterotomy. The procedure is simple to do and it is relatively free of complications. However, since it provides only passive resistance and cannot compensate for sudden increases in intravesical pressure, stress incontinence of minor degree is not uncommon. In our series of 184 cases 61 (33 per cent) became completely dry, required no protection and voided with a good stream and without residual urine. Another 51 patients had some stress incontinence but were pleased with the results so that 61 per cent derived definite benefit from the operation. There were 20 (11 per cent) major complications in this series. With recent modifications of the technique and the prosthesis the complication rate has been reduced to 7 per cent in the last 50 cases. The opportunity to adjust the compression postoperatively by injection provides advantages over other passive compression procedures.
Replacement of the ureter by small intestine: clinical application and results of the ileal ureter in 89 patients.
Partial or total replacement of the ureter by small intestine was performed at the University of California/Los Angeles Hospital and affiliated hospitals 94 times in 92 patients from 1954 to 1978. Indications included recurrent calculi, ureteral stricture, fistula, congenital obstruction of the ureter and ureteral carcinoma with a solitary kidney. A special use has been for undiversion of an ileal conduit. Followup evaluation was possible in 95% of the patients and ranged from 6 months to 23 years. Thirty-six patients were followed for more than 5 years. The operation was judged successful in 81% of the cases. Serum creatinine was unchanged or decreased in 75.7% and the pyelogram was unchanged or showed decreased dilatation in 84.6% of the patients. Although reflux was seen in 40 of 55 patients who had cystograms 39 (97.5%) were considered to be treated successfully. Indications for and results of the operation are discussed. The procedure is recommended as optimal therapy for carefully selected situations when the normal urinary tract cannot be used.
Familial pheochromocytoma: a report of 2 cases in a kindred.
A kindred with 2 current cases of pheochromocytoma is reported. The proband had classical features of adrenal medullary hyperfunction, in addition to Raynaud's phenomenon. After surgical removal of the right adrenal gland, containing a pheochromocytoma and a small paraganglioma, the patient was free of symptoms. The 12-year-old son of the proband was discovered to have relatively asymptomatic sustained hypertension on routine examination. Biochemical and radiological tests confirmed the diagnosis of a left adrenal pheochromocytoma, which was removed successfully.
Pheochromocytoma and vasodepressor response to saralasin.
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