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Biomedical subjects

K A Kropp

Publications and source records attributed to K A Kropp.

At least 19 recordsLinked to original sources
PubMed1996

Proximal ureteral stent migration: an avoidable complication?

PURPOSE: The parameters responsible for proximal ureteral stent migration were quantitated. MATERIALS AND METHODS: We compared 16 patients seen between 1990 and 1993 with stent migration to 32 patients whose stents did not migrate. RESULTS: The stent indwelling time and number of stents with a proximal curl of less than 180 degrees were similar between the groups. More patients with migration had stents that were shorter than the ideal length, with a distal curl of less than 180 degrees and a proximal curl in the upper calix versus the renal pelvis. CONCLUSIONS: A shorter than ideal stent, inadequate distal curl and a proximal curl in the upper calix appear to be significant factors in the process of stent migration.

Case-Control Studies↗
PubMed1995

Use of ileal urinary diversion in conjunction with intraoperative radiotherapy.

Intraoperative radiotherapy (IORT) was introduced in the 1970s as a new modality of cancer therapy. It has been especially useful after local irradiation or surgical failure. We report on the use of IORT in 13 patients with pelvic tumors requiring urinary diversion. All 13 were managed with ileal conduits. Despite the associated problems of prior abdominal procedures (11/13 patients), prior external beam radiation to the pelvis (11/13 patients), systemic chemotherapy (4/13 patients), and prolonged operative time (> 10 hours), perioperative mortality (1/13) and morbidity rates were low. We conclude that in cases of prior colonic resection and pelvic radiation, potentially irradiated ileum can be safely used for urinary diversion.

Aged↗
PubMed1995

Prostate cancer.

Explore the source record for details and available documents.

Humans↗
PubMed1994

Photochemical ablation of intestinal mucosa for bladder augmentation.

Complications associated with enterocystoplasty include mucus production, electrolyte abnormalities, infections, stones and cancer at the vesicoenteric anastomosis. Removal of the intestinal mucosa with subsequent urothelialization may obviate these problems. We describe a unique approach whereby photodynamic therapy is used to de-epithelialize an ileal segment before augmentation. Enterocystoplasty was performed in 32 female Fischer 344 rats using a 1.5 cm. patch of terminal ileum. Of the 32 rats 24 survived at least 6 weeks before euthanasia. The experimental group (10 rats) received hematoporphyrin derivative intravenously 24 hours before surgery. The ileal patch was treated with red light for 20 minutes and then used for augmentation. There were 3 control groups, including 1 group of 5 rats that underwent augmentation alone, while the other 2 groups were augmented but received either light treatment (4 rats) or hematoporphyrin derivative (5 rats). Histological analysis revealed urothelialization of the augments treated with hematoporphyrin derivative and light, which did not occur in the controls. The preoperative and postoperative bladder capacities increased substantially in all groups. Mucus production and bacterial colonization were reduced while stone formation increased in the treated animals.

Animals↗
PubMed1994

Conservative management of suspected bladder rupture after augmentation enterocystoplasty.

Bladder rupture after augmentation enterocystoplasty is a potentially life-threatening condition. We reviewed our experience with 13 patients who presented to our institution with 15 episodes of sudden onset of abdominal pain and rebound tenderness, and were diagnosed on clinical grounds to have peritonitis secondary to a suspected bladder augmentation rupture. (Three patients had had similar episodes treated previously elsewhere with abdominal exploration and repair of an augmentation rupture.) These episodes were initially managed with hospitalization, bladder drainage with an indwelling catheter, intravenous antibiotics and serial abdominal examinations. Cystogram and/or computerized tomography was diagnostic in only 3 of 7 cases in which it was performed. In 13 of 15 instances signs and symptoms of peritonitis quickly resolved, and intermittent catheterization was resumed after a mean of 12 days. In the remaining 2 patients delayed surgical repair of a bladder rupture was done in 1, and exploration and repair of an incarcerated internal hernia were done in 1. Although prompt abdominal exploration is the gold standard for suspected bladder augmentation rupture, treatment of peritonitis as bladder rupture in patients with a bladder augmentation by nonoperative techniques was successful in 87% of episodes.

Adolescent↗
PubMed1994

Cyclosporine versus azathioprine: a 5-year followup of 200 consecutive cadaver renal transplant recipients.

When cyclosporine was introduced as an immunosuppressive agent, there was concern that cyclosporine could be detrimental to long-term renal allograft function and survival. In response to this concern, we report a 5-year followup of 200 consecutive renal transplant recipients among whom initial immunosuppression and risk factors were similar except for the substitution of cyclosporine for azathioprine in the second 100 recipients. The azathioprine and cyclosporine groups had similar 1-year (89% versus 91%) and 5-year (74% versus 80%) patient survival rates. Cyclosporine treated patients had superior 1-year (83% versus 58%) and 5-year (61% versus 29%) graft survival rates. At the 5-year interval, cyclosporine treated grafts had an elevated, yet stable, mean serum creatinine level compared to azathioprine treated grafts. Despite ongoing mild renal dysfunction in cyclosporine treated grafts, cyclosporine does not induce an inexorable decrease in graft function and continues to provide long-term graft survival superior to azathioprine.

Azathioprine↗
PubMed1992

A new technique for bladder washing.

We describe a simple adaptation of the Water Pik (Teledyne Water Pik, Fort Collins, Colorado) irrigating device which allows vigorous, direct-vision agitation of the bladder wall. Three groups of mongrel dogs were subjected to cystoscopy and either syringe barbotage, half-speed Water Pik irrigation, or full-speed Water Pik irrigation of the bladder wall. Transitional cell counts were then done on centrifuged aliquots of each bladder wash specimen. The average number of transitional cells per high-power field were similar between the control group and the syringe barbotage group (2.5 and 1.5 respectively). However, both the half-speed and the full-speed Water Pik groups demonstrated statistically higher cell counts (5.7 and 13.7) when compared to both the controls and syringe barbotage groups. We conclude that Water Pik irrigation is an effective method to increase cell yield in bladder wash specimens.

Animals↗
PubMed1991

Urodynamic evaluation of the continence mechanism following urethral lengthening--reimplantation and enterocystoplasty.

In an attempt to create continence in myelomeningocele children we performed urethral lengthening/submucosal reimplantation, a form of bladder neck reconstruction, to create a valve allowing catheterizable access to the bladder. We present the urodynamic findings of 23 patients 4 to 89 months (mean 43.1 months) after bladder neck reconstruction and enterocytoplasty to determine the continence mechanism of this 1-way valve and characteristics of the augmented bladder. Standard cystometrograms with simultaneous pressure recording of the submucosal portion of the neourethra were undertaken with a 10F, triple lumen, urethral pressure profile catheter. Baseline pressures in the submucosal neourethra were higher than in the bladder (mean 25.3 versus 13.4 cm, water, p less than 0.001). Submucosal tunnel and bladder pressures paralleled throughout filling, with mean tunnel pressures remaining greater at the time of first (53.6 versus 45.5 cm. water, p less than 0.01) and peak (62.9 versus 55.8 cm. water, p greater than 0.05) cystoplasty contractions. Bladders augmented with detubularized ileum had fewer significant contractions (greater than 40 cm. water) than other types of cystoplasties (36% versus 92%) and over-all they had first and peak contractions at greater volumes and lesser magnitude. We conclude that continence following urethral lengthening/reimplantation results from an anatomical arrangement allowing transmission of dynamic bladder pressure changes to the submucosal neourethra and that urethral pressure exceeds bladder pressure throughout filling. Additionally, our data suggest that detubularized ileum provides a large capacity, low pressure reservoir suitable for augmentation.

Adolescent↗
PubMed1990

Management of urinary incontinence by bladder tube urethral lengthening and submucosal reimplantation.

We reviewed the first 25 urethral lengthening and reimplantation procedures done at our institution in 24 patients. All patients had failed to achieve dryness on medical or surgical therapy for total urinary incontinence. A total of 32 patients had neurogenic incontinence. The patients were followed for 1.5 to 7 years. Late complications included catheterization difficulties, vesicoureteral reflux, febrile urinary tract infection, calculi and peritonitis. Reoperations were required in 19 patients primarily because of our initial failure to recognize the necessity of providing a low pressure, high capacity reservoir. The reoperation rate on the continence mechanism was low. Of 24 patients 20 are continent and require no pads or diapers.

Adolescent↗
PubMed1990

Effects of hypothermia on testicular ischemia.

The ischemic effects of prolonged testicular torsion have been well documented; however, prevention or arrest of the damaging effects of prolonged ischemia has been incompletely studied. Two groups of Sprague-Dawley rats were subjected to varying lengths of bilateral testicular ischemia. Group I underwent normothermic ischemia for two, four, and six hours. Likewise, Group II underwent similar time periods of ischemia, however, after thirty minutes of normothermic ischemia the scrotum of each animal was placed into an ice bath maintained at 4C. Two weeks postoperatively, bilateral orchiectomy was performed. Histology of the testes of the two groups was compared. Neither group revealed significant destruction of the germinal epithelium after two hours of ischemia. Group I revealed only 25% preservation of the germinal epithelium at four hours and only 8% preservation at six hours of ischemia. In contrast, Group II which received ice showed 90% preservation of germinal epithelium at four hours and 85% preservation at six hours of ischemia. We conclude that external ice application significantly preserves seminiferous tubules at four and six hours of ischemic injury in the rat testicle.

Animals↗
PubMed1989

Cyclosporine versus azathioprine: a review of 200 consecutive cadaver renal transplant recipients.

Most renal transplant centers report an increase in graft survival when cyclosporine is used as a primary immunosuppressant. We report the outcome of 200 consecutive cadaver renal transplant recipients among whom initial immunosuppression and risk factors were similar except for the substitution of cyclosporine for azathioprine in the second 100 recipients. Azathioprine-treated recipients had significantly increased (p less than 0.05) mean hospital stays (31.9 versus 18.3 days), incidence of first rejection episodes (85 versus 31) and methylprednisolone dose (3.38 versus 0.06 gm. per patient). Cyclosporine-treated recipients had a significantly higher 1-year mean serum creatinine level (1.85 versus 1.56 mg. per dl.) and 1-year actual graft survival (83 versus 58 per cent). Despite mild nephrotoxicity, cyclosporine is superior to azathioprine as a primary immunosuppressant in cadaver kidney transplantation.

Azathioprine↗
PubMed1986

Urethral lengthening and reimplantation for neurogenic incontinence in children.

We describe our experience with a urethral lengthening-reimplantation operation for the correction of incontinence in 13 myelomeningocele children, 11 of whom had failed to achieve continence on a program of intermittent clean catheterization. The procedure involves lengthening the urethra by formation of a bladder tube, which is reimplanted back into the bladder through a submucosal tunnel. This procedure allows a catheter to be passed but prevents urine from leaking. All of the operated cases are included. All of the children are out of diapers and socially dry. Followup ranged from 8 to 36 months and the problems encountered are described.

Adolescent↗
PubMed1984

Percutaneous catheter drainage in treatment of urinary extravasation.

In the last two decades there has been a rapid growth in the percutaneous manipulation of the genitourinary tract. We would like to present 2 patients in whom CT-guided percutaneous drainage of urinary extravasation was employed successfully and review the pertinent literature.

Adult↗
PubMed1983

A retrospective analysis of the use of ureteral stents in children undergoing ureteroneocystotomy.

Ureteral reimplantation is used widely for the correction of ureterovesical reflux. To determine the effect of ureteral stents we reviewed the charts of 63 children undergoing ureteral reimplantation for reflux. Of this group 31 patients had the ureterovesical anastomosis stented while 32 did not. Morbidity and operative failure were comparable in both groups. Our results do not support the use of ureteral stents in patients undergoing ureteroneocystotomy for primary ureterovesical reflux.

Adolescent↗
PubMed1983

Surgical approaches to renal and ureteral calculi.

Surgery for the removal of renal or ureteral calculi can be made easier by the selection of the best surgical incision. After a discussion of preoperative considerations, the author describes the advantages and disadvantages of the surgical exposures for the removal of these stones.

Humans↗