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Biomedical subjects

J J Leal

Publications and source records attributed to J J Leal.

10 recordsLinked to original sources
PubMed1994

Pneumothorax during laparoscopic Nissen fundoplication.

We present a case of 100% pneumothorax in a 41-yr-old man with a history of gastritis and gastroesophageal reflux scheduled for Nissen fundoplication. The patient was anaesthetized, and insufflation of the abdominal cavity with carbon dioxide was performed uneventfully. There was an increase in the peak inspiratory pressure and wheezing was noted with a decrease in the arterial oxygen saturation to 91%. An obstructive pattern was noted on the end tidal carbon dioxide monitor. The patient also had decreased breath sounds in the left lung field. The endotracheal tube was withdrawn 1.5 cm with equal breath sounds noted in both lung fields, but the wheezing persisted. At the end of the case the trocars were removed and the abdomen was deflated. The arterial oxygen saturation increased to 94% while breathing F1O2 of 1.0. A chest roentgenogram showed a 100% left pneumothorax. A left chest tube was placed with immediate improvement of the arterial oxygen saturation to 100%. We recommend monitoring of arterial oxygen saturation, peak inspiratory pressures, and excursion of the chest for early diagnosis and prompt treatment of pneumothorax during laparoscopic procedures.

Adult↗
PubMed1993

A new technique for renal biopsy: the transurethral approach.

An 18 gauge needle sheathed in an 8F catheter can be advanced into an upper calix through the lumen of a transurethrally placed 10F catheter and used to biopsy the renal cortex. The transurethral biopsy technique is less painful, less invasive and simpler than the open or laparoscopic approach, and it can be used as an extension of cystoscopic examination to avoid percutaneous biopsy.

Biopsy, Needle↗
PubMed1992

A new procedure for biopsy of a solid renal mass: transurethral approach under fluoroscopic control.

Cystoscopically placed, fluoroscopically guided catheters were used to biopsy 3 solid renal tumors. One kidney had a renal cell carcinoma and 2 had transitional cell carcinoma invading the renal parenchyma, including 1 that had undergone various ureteroscopic biopsy techniques that failed to yield a diagnosis. The transurethral technique offers an alternative to open, laparoscopic or percutaneous biopsy in selected patients.

Aged↗
PubMed1988

Percutaneous removal of renal and ureteral stones with and without concomitant transurethral manipulation by a urologist using antegrade and retrograde techniques without a radiologist's assistance.

Single-stage percutaneous removal of 59 ureteral and 72 renal stones, with or without transurethral manipulation, was performed in 84 of 85 consecutive patients without the assistance of a radiologist. The Hawkins-Hunter retrograde nephrostomy technique was modified by anchoring the catheter in the renal parenchyma, which prevented displacement from the targeted calix by the puncturing needle. Retrograde nephrostomy (76 patients) or percutaneous puncture (7) was established, for a combined access rate of 99 per cent in 83 patients (2 of the 85 had prior tube placement). Only 1 patient (early in the series in 1982) required an open operation because of percutaneous access failure. Tomography showed that the targeted calculi were removed completely from 61 of 66 patients (92 per cent) with uncomplicated stones and 13 of 19 (68 per cent) with complicated stones. The patients left with fragments have remained asymptomatic for a mean followup of 2.6 years. Because the concomitant use of transurethral and percutaneous approaches to stone removal was facilitated by retrograde nephrostomy, all 59 ureteral stones were removed completely from 46 patients. The mean postoperative hospital stay was 2.6 days for 66 patients with uncomplicated stones and 8.2 days for 19 with complicated stones. The Hawkins-Hunter retrograde nephrostomy technique is the preferred method to establish the tract; it facilitates simultaneous transurethral stone manipulation and the assistance of a radiologist is not essential for safe and effective nephrostolithotomy.

Adult↗
PubMed1987

A new application for the removal of caliceal renal stones with the rigid ureteropyeloscope.

Stone migration into the kidney can result in failure to remove a ureteral stone with a ureteroscope. A new application with the rigid ureteropyeloscope was used to remove a ureteral stone that had migrated into a lower renal calix. Under fluoroscopic control a 9F catheter was advanced next to the stone through the emptied sheath of the ureteropyeloscope whose tip was in the upper ureter. Then a basket was placed through the catheter and was used to trap and remove the stone.

Adult↗
PubMed1985

A new technique for the transurethral or percutaneous removal of renal stones.

This new technique uses a cystoscopically placed torque guide wire and catheters to deliver a stone basket to the renal calix containing the stone. Under fluoroscopic control the basket, placed through a 9F catheter, is used to dislodge and capture the stone. The stone-containing basket and catheter then are removed transurethrally or percutaneously. This procedure was used to remove small caliceal stones in 3 patients undergoing ureteral stone manipulation, and it facilitated the percutaneous removal of a larger stone in the upper pole infundibulum in 1 patient.

Adult↗
PubMed1977

Adsorption of naturally occurring polymers onto calcium oxalate crystal surfaces.

The adsorption of proteins and mucopolysaccharides on calcium oxalate crystals was measured by solution depletion. Anionic protein adsorption was found to be sensitive to calcium ion concentration. Adsorption of fibrinogen was anomalously large in the presence of 0.01 M Ca2+. Adsorption of cationic protein (histone) was sensitive to oxalate ion concentration. A small alteration in adsorption of protein as a result of pH or temperature change was also observed. Plots of adsorption versus concentration were interpreted in terms of a Langmuir adsorption isotherm. The derived Langmuir adsorption parameters were then used to investigate the contribution of protein, by physical adsorpti, to the quantity of matrix in urinary stones. It was concluded that physical adsorption can account for the deposition of part but not all of the matrix in calcium oxalate stones. It was also concluded that physical adsorption of mucopolysaccharides by calcium oxalate crystals could explain the inhibition of growth and aggregation of calcium oxalate crystals seen with in vitro precipitation systems. Recalculation of published data indicates that adsorption of protein on dental enamel (calcium hydroxyapatite) results in approximately the same extent of surface coverage as adsorption on calcium oxalate crystals, but protein has a much lower affinity for dental enamel than for calcium oxalate crystals.

Adsorption↗