Biomedical subjects

Jeff Pugach

Publications and source records attributed to Jeff Pugach.

4 recordsLinked to original sources

PubMed2006

Lack of usefulness of positioned instillation of contrast cystogram after injection of dextranomer/hyaluronic acid.

PURPOSE: Positioned instillation of contrast cystograms have been touted as possibly being more sensitive than standard cystograms for evaluation of vesicoureteral reflux. We performed positioned instillation of contrast cystograms intraoperatively, immediately after the injection of dextranomer/hyaluronic acid to treat vesicoureteral reflux, to determine whether they might be predictive of operative success and obviate the need for the standard postoperative voiding cystourethrogram, which is usually performed at 3 months. MATERIALS AND METHODS: Patients with vesicoureteral reflux and no confounding conditions were treated with dextranomer/hyaluronic acid and subsequent positioned instillation of contrast cystogram while under the same anesthesia between November 2003 and March 2005. The results of this intraoperative cystogram were compared to the results of the postoperative voiding cystourethrogram performed 3 to 4 months later. RESULTS: A total of 61 patients met the inclusion criteria and underwent positioned instillation of contrast cystogram after dextranomer/hyaluronic acid injection. Only 53 patients (86 ureters) completed the necessary postoperative evaluation. Positioned instillation of contrast cystogram added 4 minutes to the procedure and required about 4 seconds of fluoroscopy per ureter evaluated. The overall success rate for correcting reflux was 84% (72 of 86 ureters cured). None of the 14 ureters with persistent postoperative reflux was identified by intraoperative cystogram, and 3 patients were misidentified as having reflux despite cure confirmed postoperatively. Intraoperative positioned instillation of contrast cystogram was predictive of treatment failure 0% of the time (sensitivity 0%). There were no complications. CONCLUSIONS: Positioned instillation of contrast cystogram performed immediately after injection of dextranomer/hyaluronic acid was not useful in predicting which patients would have persistent reflux postoperatively. Patients are best served with the extant protocol of conventional cystography 3 to 4 months postoperatively.

Adjuvants, Immunologic↗

PubMed2003

Infant vesicoureteral reflux: a comparison between patients presenting with a prenatal diagnosis and those presenting with a urinary tract infection.

OBJECTIVES: To evaluate the severity, laterality, and gender distribution of infant vesicoureteral reflux (VUR) and its potential impact on renal outcome, we compared patients presenting fetally (FDR group) and those presenting with a urinary tract infection (INF group). METHODS: A retrospective review of 202 patients with the diagnosis of VUR before 6 months of age was performed. The grade of VUR, gender, laterality, initial renal scarring, breakthrough urinary tract infections, new renal scarring, and surgical intervention were compared between the INF group (n = 146) and FDR group (n = 56). RESULTS: The male/female ratio in the FDR group was 1.67:1 compared with 0.60:1 in the INF group. The FDR group had more unilateral VUR than the INF group (P <0.001), and no significant difference was found between the two groups in terms of VUR grade distribution (P = 0.13), percentage of initial damage (28% of FDR patients versus 23% of INF patients), or clinical course. In either group, boys and girls exhibited a very similar distribution of grade and renal damage. CONCLUSIONS: Our findings do not support the commonly held belief that fetally diagnosed reflux is an overwhelmingly male, bilateral, and high-grade phenomenon. Few differences were observed between infants diagnosed fetally and those diagnosed subsequent to urinary tract infection. Once diagnosed, from either group, infant reflux has neither great morbidity nor a frequent need for surgery.

Age Factors↗

PubMed2003

Safety and efficacy of extracorporeal shock wave lithotripsy in infants.

PURPOSE: Extracorporeal shock wave lithotripsy (ESWL) in older children appears to have comparable results when compared to adults, no study has focused on its use in younger children. We reviewed our ESWL experience in children under age 3.5 years to evaluate its safety, and define optimal treatment parameters. METHODS: We retrospectively reviewed consecutive medical and diagnostic imaging records from three ESWL centers, pertaining to 34 children under 3.5 years of age (36 renal units-RU). The children were from two distinct populations served exclusively by the three centers. We analyzed patient presentation, etiology, age, weight, stone size, preoperative interventions, energy settings, number of shock waves, number of treatments, success (stone fragments < 2 mm), and complications. We performed all forty-nine procedures under general anesthesia and modified the Dornier MFL 5000 table and the Dornier HM3 gantry to improve coupling and localizing of the calculi. RESULTS: In each population, we noted similar presentations, etiologies, and treatment parameters. Patient age ranged from 6 to 40 months (mean 23.4 months). Stone size ranged from 4 mm to 22 mm diameter (average 13 mm). ESWL parameters included an average of 2210 shocks (range 900-3400) at average of 20.9 kV (range 19 kV-25 kV). Preoperative ureteral stent placement was not shown to be beneficial. Our one and multiple treatment ESWL success rates were 66% and 86%, respectively. No major acute or long-term complications occurred. CONCLUSIONS: We successfully performed ESWL using treatment parameters similar to adults in 86% of children under 3.5 years without major complications. Modifications of the positioning device improved coupling and localization in smaller patients. Routine preoperative ureteral stenting for large stones is not recommended.

Child, Preschool↗

PubMed2002

The renal length nomogram: multivariable approach.

PURPOSE: We built a multivariate renal length nomogram based on ultrasound measurements in pediatric patients with normal renal anatomy. MATERIALS AND METHODS: Included in the study were 707 children 1 week to 18 years old without vesicoureteral reflux, urinary obstruction or other known anatomical anomalies. Renal length was compared among subgroups of children. Multivariate regression approach was used to model renal length, incorporating important demographic variables. RESULTS: Subgroup comparisons of renal lengths showed diverse patterns of renal length differences in children with various demographic characteristics. In addition to age, factors significant in the multivariate nomogram model of renal length included gender, race, weight and height. CONCLUSIONS: These results show that renal length is not only age dependent, but also significantly correlates with other important demographic variables. Variability in renal length can be better described by multivariate analysis. The multivariate approach provides clinically useful information regarding renal outcomes in individuals. The ability to compare renal length among patient subgroups receiving different interventions adds additional usefulness to this approach.

Adolescent↗