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Biomedical subjects

J R Woodside

Publications and source records attributed to J R Woodside.

At least 19 recordsLinked to original sources
PubMed1991

Intensive, focused utilization management in a teaching hospital. An exploratory study.

A 3-month study was performed in a teaching hospital to determine the impact of intensive, focused utilization management on the average length of stay and average total charges in a carefully defined group of indigent patients. Prompt admission review was performed, the treatment plan ascertained, and a physician advisor notified. The attending physician was informed by a physician advisor of the patient's financial class, and assistance with expediting patient care and discharge planning was offered. Daily concurrent review monitored the treatment and discharge plans. The study compared 73 patients with a control group of 191 patients of similar financial class and diagnosis related groups (DRGs) for the immediately preceding 3 months. Compared with the control patients, the study patients experienced a 23% decrease in average length of stay and 16% decrease in average total charges. This study indicates that an intensive utilization management effort in a teaching hospital can be effective without compromising the quality of care.

Hospital Bed Capacity, 500 and over↗
PubMed1991

The incontinent myelodysplastic patient.

Urinary incontinence is a socially devastating aspect of the lives of many myelodysplastic children. Incontinence results from abnormal bladder storage function, urethral sphincteric incompetence, or both. Unfortunately, the vesicourethral dysfunction in an individual patient cannot be discerned from the level of the vertebral defect or the coexisting neurologic deficits. Therefore, thorough urodynamic assessment is required to identify altered physiology precisely and to guide rational treatment. Our therapeutic armamentarium includes external devices, intermittent self-catheterization, pharmacologic therapy, prosthetics, electrical stimulation, biofeedback, and innovative surgical procedures. Comprehensive evaluation, thoughtful tailoring of therapy to the individual patient, and a commitment by the urologist to indefinite follow-up will enable most patients to attain social continence while preserving renal function.

Child↗
PubMed1990

Large perirenal hematoma after extracorporeal shock-wave lithotripsy.

We report a case of a large perirenal hematoma following extracorporeal shock-wave lithotripsy (ESWL) that resulted in compromised renal blood flow and function and necessitated open surgical drainage. Caution is advised and close follow-up recommended in patients who have taken aspirin-containing compounds, are elderly, have hypertension, or exhibit a significant drop in hematocrit following ESWL.

Aged↗
PubMed1990

Urodynamic evaluation of patients with continent urinary diversion using cecal reservoir and intussuscepted ileocecal valve.

Patients requiring bladder removal for malignant disease have undergone continent urinary diversion employing the ileocecal segment, using the cecum to construct a reservoir and an intussuscepted ileocecal valve as the continence mechanism. Five of these patients have been studied urodynamically and radiographically in the postoperative period. Incontinence was found to be minimal and related only to a prolonged catheterization interval. Passive filling pressure and peristaltic pressure remained low in all patients and was lower than the nipple valve pressure in 4 of 5 patients. A transient increase in reservoir pressure at capacity with peristalsis exceeded the nipple peristaltic pressure in 1 patient and was associated with a small volume of incontinence. This resolved with a shortened catheterization interval. Reflux was not found in any subject studied. These studies indicate that the cecal segment can be used to construct a continent urinary reservoir that provides satisfactory function for the patient while maintaining an acceptable pressure volume relationship.

Aged↗
PubMed1988

Chronic vasculitis causing unilateral ureteral stenosis.

We report a case of chronic vasculitis causing unilateral ureteral stenosis as an isolated phenomenon in an otherwise healthy forty-three-year-old man. Other causes of chronic vasculitis and ureteral stenosis are reviewed.

Adult↗
PubMed1988

Urodynamic evaluation of patients with spinal stenosis.

Spinal stenosis, which may be congenital/developmental or acquired in origin, is a narrowing of the spinal canal, nerve root canals, or intervertebral foramina. Compression of the spinal cord or nerve roots may lead to structural neuronal damage, neuronal ischemia or edema, and axonal transport block. The most frequent symptom in patients with spinal stenosis is back pain and some have classic neurogenic claudication. We have performed urodynamic evaluations in 2 patients with combined cervical and lumbar spinal stenosis. A girl with achondroplastic dwarfism had urgency incontinence and detrusor hyperreflexia. An adult man with acquired degenerative spinal stenosis had difficulty voiding and findings compatible with the cauda equina syndrome.

Adult↗
PubMed1987

Pubovaginal sling procedure for the management of urinary incontinence after urethral trauma in women.

Traumatic urethral injury in women occurs less frequently than in men and urinary incontinence is a serious potential complication in women. Two female patients are described in whom post-traumatic urinary incontinence resulted from either direct trauma to the urethra or from injury to the innervation of the urethra. Both patients were treated successfully with the pubovaginal sling procedure that directly compresses an incompetent proximal urethra.

Adolescent↗
PubMed1987

Treatment of superficial papillary transitional cell carcinoma of the ureter by vesicoureteral reflux of mitomycin C.

We report 2 cases of recurrent superficial papillary transitional cell carcinoma of the bladder with right vesicoureteral reflux in which superficial papillary transitional cell carcinoma developed in the distal ureter with reflux. Both patients received intravesical mitomycin C that was delivered by the vesicoureteral reflux to the tumor sites. Diagnosis and management were facilitated through the use of ureteroscopy, which allowed for accurate pathological staging and surveillance. No systemic toxicity or change in renal function was noted in either patient and both have remained free of recurrent tumor for more than 2 years.

Administration, Intravesical↗
PubMed1987

Percutaneous removal of thoracostomy tubes.

Percutaneous techniques have previously been applied to the removal of retained subcutaneous fragments of thoracentesis catheters. The authors report the removal of two thoracostomy tubes that were entirely retracted within the thoracic cavity. Removal was achieved by adapting methods used to perform percutaneous nephrolithotomy.

Adult↗
PubMed1986

Suprapubic endoscopic vesical neck suspension for the management of urinary incontinence in myelodysplastic girls.

Urinary incontinence may be a formidable hardship in many girls with myelodysplasia. In those patients who fail treatment with intermittent self-catheterization and pharmacotherapy surgical augmentation of outlet resistance may successfully alleviate incontinence. In patients with less severe degrees of urethral sphincteric incompetence suprapubic endoscopic vesical neck suspension in conjunction with intermittent self-catheterization can be successful. Patients must be selected carefully, with particular attention directed at detecting decreased detrusor compliance. Poor detrusor compliance must be controllable or corrected before augmentation of urethral resistance to prevent postoperative upper urinary tract deterioration.

Adolescent↗
PubMed1985

Clinical evaluation of new urodynamic catheter.

A commercially available triple lumen urodynamic catheter has been utilized for urodynamic recordings in more than 650 patients. The recordings have been highly accurate and reproducible, and we recommend this catheter for those who perform liquid perfusion urodynamic studies.

Equipment Design↗
PubMed1985

Percutaneous stone removal in children.

Percutaneous removal of renal and ureteral calculi has become an established and successful procedure in adults. Stone disease in children often is metabolic or infectious in origin and multiple surgical procedures during a long interval may be required. Therefore, percutaneous stone removal could be particularly advantageous in these patients. We have performed percutaneous stone removal successfully in 7 children, none of whom required a second procedure or were discharged from the hospital with a nephrostomy tube.

Adolescent↗
PubMed1979

Sertoli cell tumor (gonadal stromal tumor) in an infant.

An 8-mo-old boy had an orchiectomy for a Sertoli cell tumor. Malignancy was suspected histologically. He underwent a retroperitoneal lymphadenectomy and no nodes contained metastases. The histologic criteria for malignancy in Sertoli cell tumors are controversial. Individual case reports of patients with these tumors are encouraged to help establish their natural history and optimum management.

Adult↗
PubMed1979

Spinal hematoma compressing cauda equina.

Epidural and subdural spinal hematomas are unusual complications of diagnostic lumbar punctures. A renal allograft recipient on anticoagulant therapy underwent lumbar puncture. Urinary retention and evidence of an S2, S3, and S4 neurologic deficit developed subsequently. A myelogram showed a defect of the posterior lumbosacral spinal canal. Urodynamic investigation demonstrated normal sympathetic innervation of the proximal urethra and impaired parasympathetic and pudendal innervation of the detrusor and external urethral sphincter, respectively.

Adult↗