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L L Keeler

Publications and source records attributed to L L Keeler.

6 recordsLinked to original sources

Von Hippel-Lindau disease and renal cell carcinoma in a 16-year-old boy.

Von Hippel-Lindau disease is a rare autosomal dominant disorder. Kidney lesions occur in the majority of cases, with renal cell carcinoma noted in 40% and renal cysts in 60%. Renal cell carcinoma in von Hippel-Lindau disease is usually bilateral and occurs at an earlier age than in patients with sporadic renal cell carcinoma. We report on a 16-year-old boy who, to our knowledge, is the youngest patient to present with von Hippel-Lindau disease and renal cell carcinoma. Controversy currently exists regarding the nature of renal cysts in von Hippel-Lindau disease and the optimal therapeutic approach (that is radical versus parenchymal sparing surgery). We review the histology of renal cysts and carcinoma, and discuss the rationale for selecting parenchymal sparing surgery.

Adolescent

The MPL-9000.

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Anesthesia

Spontaneous rupture of a bladder diverticulum.

A case of spontaneous rupture of an acquired bladder diverticulum is presented. Diagnosis was made preoperatively and full recovery followed surgical treatment. A review of the literature revealed 9 other cases of spontaneous rupture. Bladder outlet obstruction and urinary tract infection were present in the majority of cases. In the past misdiagnosis and delayed treatment led to significant mortality. However, the prognosis currently is better due to the use of broad-spectrum antibiotics, better radiological imaging studies, and earlier diagnosis and treatment.

Aged

Is colony count necessary?

Evidence presented herein suggests that: (1) If the Gram stain of the spun urinary sediment is negative, there is no need to do a culture, sensitivity test, and colony count since significant bacteriuria and urinary infection are not present. There are very few false negative results. (2) Since there are many false positive Gram stains, the test is not specific. A positive Gram stain of the spun urinary sediment does not mean that bacteriuria is present. (3) The test is very sensitive in that practically all bacteriuric subjects had a positive Gram stain. (4) Because the Gram stain of the spun urinary sediment is so sensitive, a positive spun urinary sediment and culture should be treated regardless of the colony count.

Bacteriological Techniques