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Biomedical subjects

L Zinman

Publications and source records attributed to L Zinman.

At least 19 recordsLinked to original sources
PubMed2000

Optimal management of the 3- to 6-centimeter anterior urethral stricture.

The optimal management of anterior urethral stricture that does not respond to an endoscopic urethrotomy or is found to be unsuitable for excision and anastomotic repair remains controversial. Genital skin island onlay flaps or buccal mucosal grafts are presently the most dependable single stage procedures used for strictures more than 3 cm in length. Nonhirsute penile island fasciocutaneous flaps constitute the most durable substitution technique for pendulous stricture disease, with long-term studies reporting 90% to 96% success. The complex proximal bulb and bulbomenbraneous stricture with a compromised proximal fibrous avascular bed is ideally managed with either a penile or scrotal island flap or some combination of partial urethral excision with a dorsally placed genital skin island. The buccal mucosal onlay graft is a promising addition to this reconstructive paradigm, and early outcomes have been favorable. The graft is presently used for bulbar strictures, avoiding the transsphincteric on pendulous location, or a compromised recipient bed. The present standard of care for proximal bulb strictures is wide bulbospongiosal mobilization, partial urethral excision, a floor strip anastomosis, and placement of an augmenting flap on the graft in a dorsal location.

Humans↗
PubMed1997

Extragenital muscular myocutaneous and fasciocutaneous flaps in urethral reconstruction.

Urethral strictures are fibrotic sequelae of inflammatory or traumatic injuries of the urethral epithelium and corpus spongiosa that result in a variety of obstructive lesions. To help resolve these difficult and challenging strictures, fistulas, and obliterative defects of the urethra, the author has borrowed many flaps from the ubiquitous bank of extragenital axial flaps presently in use for trunk and limb reconstruction, alone or in combination with free skin grafts. This article discusses and describes five extragenital flap techniques used in a variety of high-risk urethral strictures.

Humans↗
PubMed1988

Control of bleeding in upper urinary tract and retroperitoneal surgery.

Surgery of the upper urinary tract and the retroperitoneal spaces is a constant invitation to potentially serious bleeding. An adequate well-organized exposure of the pathologic condition involved, detailed knowledge of the regional anatomy and its variations, careful gentle dissection of the major vessels, and a calm disposition of the surgeon are the critical factors in preventing intraoperative hemorrhage. Unexpected bleeding is at times unavoidable, and the urologic surgeon should have a well-prepared method for managing hemorrhage during each procedure. Temporary control with gauze packs, sponge sticks, or the surgeon's finger should be the initial step in the control of serious hemorrhage, and this will virtually stop most bleeding. The subsequent period should be used to communicate with the anesthesiologist, who must replace the blood already lost and forewarn the blood bank of future needs. The surgeon is obligated to improve exposure of the bleeding site, dissect out the vessel involved, obtain any additional necessary lighting and suction equipment, and call for a colleague to help secure the vascular rent while applying continued proximal and distal tamponade. Because serious intra-operative hemorrhage can be encountered by even the most skilled surgeon, consultation with an experienced colleague should be looked on as an integral part of the armamentarium for the optimal care of the urologic patient.

Absorption↗
PubMed1987

Long-term results of resection of renal cell cancer with extension into inferior vena cava.

From July 2, 1971 to April 1, 1985, 47 patients (median age 63 years) with renal cell cancer extending into the renal vein or inferior vena cava were evaluated and treated. Two-thirds of the tumors occurred in men and three-fourths were found in the right kidney. Of the 44 patients operated on 35 had no evidence of preoperative metastatic disease at operation. The patients were divided into ideal, favorable and unfavorable subgroups. The adjusted 5 and 10-year survival rates in the former 2 groups (32 patients) were 68.8 and 60.2 per cent, respectively. In contrast, 12 patients with nodal involvement or metastases had an adjusted median survival time of 1.2 years with no survival extending beyond 4.8 years. We believe that an extended operation for renal cell cancer with involvement of the vena cava is warranted and provides reasonable long-term survival in properly selected patients.

Aged↗
PubMed1986

Right colocystoplasty for bladder replacement.

Total bladder replacement by an ileoascending colonic segment with adjunctive use of intermittent self-catheterization and secondary insertion of an artificial sphincter has been selectively employed in a group of male patients undergoing cystectomy for localized invasive bladder cancer and disabling interstitial cystitis. This bowel segment offers a capacious reservoir, an effective antireflux barrier, and a consistent tension-free colourethral or coloprostatic anastomosis. Mucous plug catheter obstruction is rarely a problem in this reservoir during the early postoperative course.

Colon↗
PubMed1986

Ileocecal segment for temporary and permanent urinary diversion.

The ileocecal conduit and its antirefluxing component have functioned well and have prevented many of the upper-tract complications associated with other forms of diversion. Its future role remains to be determined. Today, continent forms of diversion, such as the Koch pouch and the continent ileocecal reservoir, are being studied and are becoming popular. A continent antirefluxing form of urinary diversion is the ideal we are striving to achieve.

Cecum↗
PubMed1980

Renal artery revascularization. Restoration of renal function.

Fifteen patients with nonfunctioning kidneys and complete main or segmental renal artery occlusion that was discovered on angiographic investigation for hypertension underwent renal artery revascularization. Renal blood flow was restored in all patients. Of these patients, 13 experienced excellent recovery of renal function, one patient had slight return of function, and one patient showed no evidence of improvement. Histologic evidence of intact viable glomeruli, angiographic appearance of collateral circulation, and the presence of proximal occlusion with a patent distal renal artery were necessary for successful results. Revascularization of the ischemic nonfunctioning kidney with restoration of renal function is preferable to nephrectomy when all appropriate criteria are satisfied.

Adult↗
PubMed1980

Diabetic renal transplantation.

Fifty-three juvenile onset diabetics have received 59 renal allografts: 31 from living related donors and 27 from cadaveric donors. The average patient age was 34 years and the duration of diabetes was 27 years at the time of transplantation. Patient survival rates for living related recipients at 1 and 2 years were 97 and 94 per cent, respectively. Patient survival rates for cadaveric recipients at 1 and 2 years were 85 and 66 per cent, respectively. Renal allograft survival rates for living related recipients were 81 per cent at 1 year and 71 per cent at 2 years. Cadaveric renal allograft survival rates were 22 per cent at 1 year and 20 per cent at 2 years. The role of pre-transplant coronary angiography relative to patient selection and a recent decrease in our perioperative mortality are discussed.

Cadaver↗
PubMed1980

Antirefluxing ileocecal conduit.

The surgical techniques for the antirefluxing ileocecal conduit, particularly suited for urinary diversion, and for the add-on ileocecal loop, designed to salvage a malfunctioning ileal conduit, are outlined.

Cecum↗
PubMed1978

Ureteral reconstruction in renal transplantation.

The complications associated with ureteral reconstruction in renal transplantation produce significant morbiditiy and mortality rates. We have evolved a combined intravesical-extravesical nonstented ureteroneocystostomy and have used it in 100 consecutive transplants, 50 of which were in high-risk diabetic recipients. No instances of urinary extravasation, fistula formation, disruption of the ureterovesical anastomosis, ureteral solughing, or ureterovesical obstruction have occurred in this series. The lack of urologic complications utilizing this technique offers reduced morbidity and mortality to transplant recipients.

Adolescent↗
PubMed1978

The angiography of intrarenal leiomyoma.

A patient with a leiomyoma of the kidney was studied by ultrasound, intravenous pyelography and angiography. Only three renal leiomyomas have been investigated by angiography. The angiographic features of our patient's tumor differed from these others, being much more vascular with multiple tortuous vessels and an inhomogeneous capillary phase.

Adult↗
PubMed1977

Revascularization of the chronic totally occluded renal artery with restoration of renal function.

Nine patients with non-functioning kidneys and complete renal artery occlusion discovered on arteriographic investigation for hypertension underwent renal artery revascularization with successful restoration of renal blood flow. Of these patients 7 experienced recovery of renal function and 2 showed no evidence of improvement. One patient had a creatinine clearance of 38 cc per minute from the revascularized kidney 2 years postoperatively. Predictive determinants of salvageable renal parenchyma were the histologic evidence of intact viable glomeruli and the angiographic features of a rich perihilar collateral circulation in the presence of a proximal occlusion with a patent distal renal artery.

Acute Kidney Injury↗
PubMed1976

Hepatorenal artery bypass in the management of renovascular hypertension.

Infrequently, when the aorta cannot be used for a standard renal bypass operation because of a previous aortic operation, severe degenerative atherosclerosis or complete aortic thrombosis, a unilateral (hepatic) or bilateral (hepatic and splenic) visceral bypass should be contemplated. Patients with abdominal aortic aneurysms extending above the renal arteries might benefit from concomitant bilateral visceral bypass procedures followed by aortic replacement during the same operative session. The hepatic circulation with its common anatomic variations, indications, surgical technique and effects of hepatorenal artery bypass on the renal and hepatic circulation are discussed.

Female↗