PubMed Health⌕ Search

Biomedical subjects

M Aron

Publications and source records attributed to M Aron.

At least 37 records · Page 2Linked to original sources
PubMed1999

Percutaneous suprapubic cystolithotripsy for vesical calculi in children.

BACKGROUND: The majority of vesical calculi in adults can now be treated per-urethrally with the use of ultrasonic or pneumatic lithotripsy. However, the use of these devices is restricted in pediatric patients by the narrow caliber of the urethra. A percutaneous suprapubic approach to the bladder circumvents the problem of urethral caliber in these situations. PATIENTS AND METHODS: Thirty-eight children presenting with bladder stones underwent percutaneous suprapubic cystolithotripsy (PCCL) between November 1989 and April 1996. The age ranged from 1.5 to 7 years. The stone size ranged from 0.8 to 2.4 cm. Seven of these were recurrent stones, and five of the patients were female. The procedure was done under general anesthesia, and the equipment was the same as for upper tract endourology. The bladder was distended with saline and a suprapubic puncture made. The nephroscope was introduced after tract dilation and the stone removed, intact if small or after fragmentation if >1 cm. The procedure was done without fluoroscopy. A suprapubic catheter was left in for 48 hours. RESULTS: All patients had an uneventful recovery following stone removal. The average hospital stage was 3 days. Here, the access provided by percutaneous suprapubic cystostomy has been combined with the experience gained in upper-tract endourology to perform procedures that would otherwise require open operation because of nonavailability of urethral access. CONCLUSION: Extension of endourologic procedures to the lower tract reduces morbidity and hospital stay and thus the cost of treatment. Percutaneous suprapubic cystolithotripsy, in our experience, is a safe and cost-effective alternative to open surgery in children.

Child↗
PubMed1999

Retroperitoneoscopic management of infected cysts in adult polycystic kidney disease.

Conservative measures are the mainstay of therapy in adult polycystic kidney disease (APKD). Pain, infection and obstructive uropathy are the major indications for intervention. Chronic pain has been treated with narcotic analgesics, needle aspiration of dominant cysts, and open renal cyst decortication. Laparoscopic cyst decortication, by either transperitoneal or retroperitoneal access, is a new emerging option with similar efficacy to open surgery and less morbidity. Cyst infection in these patients responds poorly to commonly used antibiotics. Patients with refractory cyst infection may even require nephrectomy. Herein, we present 2 cases with APKD that were treated by retroperitoneoscopic decortication for painful and infected cysts. Both patients showed prompt and sustained improvement in symptoms, with minimal morbidity and short convalescence. This approach has not hitherto been described for infected cysts in APKD. The retroperitoneoscopic route should be preferred in the presence of infected cysts so as to prevent intraperitoneal contamination.

Adult↗
PubMed1999

Stenturia: An unusual manifestation of spontaneous ureteral stent fragmentation.

Two patients presented with passage of worm-like stent fragments in the urine. The first had undergone attempted percutaneous removal of left renal calculus and ureteral stenting 4 months prior to presentation. The second had left-sided stent placement for obstructive anuria on account of bilateral renal calculi 3 months earlier. The stents had fragmented into multiple pieces over a mean indwelling time of only 3.5 months. Apart from calculus disease, both patients had documented urinary tract infection. Stent fragmentation is a relatively rare (0.3%) but major complication. However, spontaneous excretion of these fragments has not been hitherto reported. These cases of rapid stent disintegration highlight the need for closer monitoring of the indwelling stents, especially in patients with calculus disease and associated persistent infection. In such patients the stent should probably be changed within 3 months.

Adult↗
PubMed1999

Cutaneous metastases in renal cell carcinoma.

Cutaneous metastasis from renal cell carcinoma is believed to be rare. We present our experience with 10 (3.3%) cases seen in the last 12 years among 306 cases of renal adenocarcinoma treated at our center. There were 9 males and 1 female. Age ranged from 30 to 65 years (average 45 years). 5 patients had skin metastases at the time of presentation (stage IV). In one of them the skin nodule, rather than urologic symptoms, was the presenting complaint. 5 patients presented with skin metastasis during follow-up after nephrectomy. The average time to skin metastasis was 51 months for patients in stage I and 13 months in stage IIIb. The scalp was the most common site of metastasis followed by chest and abdomen. 90% of patients had secondaries in at least one other site, most commonly in lungs (4 cases) and bones (5 cases). 4 patients were treated with interferon-alpha 6 MIU, subcutaneously, three times a week for varying periods from 3 to 4 months but there was no response. In conclusion, cutaneous secondaries from RCC, though uncommon, are not very rare. A few patients may present with a skin mass before detection of the renal tumor. Patients with low-stage disease at presentation may also develop cutaneous secondaries, therefore a prolonged follow-up is required. The commonest site for cutaneous metastasis from RCC is the scalp and face. Most patients had at least one other site of systemic metastasis, hence they were not candidates for curative therapy. Interferon therapy was not helpful. Mean survival after detection of cutaneous metastasis was 7 months.

Carcinoma, Renal Cell↗
PubMed1999

Lower ureteral obstruction due to a persistent umbilical artery.

A 32-year-old lady presented with primary infertility and a 1-year history of recurrent left-flank pain. She was found to have left lower ureteric obstruction on intravenous urography. No specific cause for the obstruction could be determined preoperatively. The patient underwent open extraperitoneal surgery to determine the cause and to treat the obstruction. A 4-mm vessel was seen crossing over the ureter at the site of narrowing. It was the persistent umbilical artery traced in continuity from the internal iliac artery. The vessel was resected, and the ureter was reimplanted into the bladder. Extrinsic obstruction of the distal ureter because of aberrant or persistent vessels has been infrequently reported. Such reports predominantly refer to children, and the diagnosis is usually made at laparotomy, frequently following previous failed attempts at endourological management.

Adult↗
PubMed1999

Medullary thyroid carcinoma with melanin production--a case report.

Melanin production in medullary thyroid carcinomas is rare. The present case illustrates melanin and other atypical features of medullary carcinoma of the thyroid in a fifty year old female. The diagnosis was suggested on the cytomorphological features seen on fine needle aspiration cytology smears. On histo-pathological examination the tumor was extensively pigmented with frequent mitosis. Amyloid was conspicuously scarce. Confirmation of diagnosis was done by immunohistochemical positivity for calcitonin and HMB-45 on tissue sections. The case is being presented in view of its rarity and distinct immunoreactivity. Review of literature is done and the implications of such dual positivity in the histogenesis and divergent phenotype of this tumor are discussed.

Antigens, Neoplasm↗
PubMed1998

Intralesional sclerotherapy in the management of hemangiomas of the glans penis.

PURPOSE: We studied the role of sclerotherapy in the management of glans penis hemangiomas. MATERIALS AND METHODS: Four patients with hemangiomas of the glans penis were treated on an outpatient basis with intralesional injections of 30% hypertonic saline. RESULTS: In all 4 patients the lesions regressed and all were satisfied with the outcome. CONCLUSIONS: Intralesional sclerotherapy is a cost-effective modality for the treatment of glans penis hemangiomas, especially in developing countries and at peripheral hospitals where expensive laser equipment may not be available.

Adolescent↗
PubMed1998

Nephroplication and nephropexy as an adjunct to primary surgery in the management of giant hydronephrosis.

OBJECTIVE: To study the role of nephroplication and nephropexy as an adjunct to primary surgery in the management of giant hydronephrosis, with an aim to reduce stasis and improve drainage, thus preventing consequent complications. PATIENTS AND METHODS: Adjunctive nephroplication and nephropexy were performed in 20 renal units of 16 patients with giant hydronephrosis treated between January 1992 and March 1997. Twelve patients had unilateral and four had bilateral pelvi-ureteric junction obstruction. Four patients had elevated serum creatinine levels. All patients were treated with definitive surgery for the underlying disease and an adjunctive nephroplication and nephropexy was performed at the same time. RESULTS: Eighteen of the 20 renal units with giant hydronephrosis showed an improvement in function and drainage as well as in pelvicalyceal system dilatation, while one remained unchanged and one deteriorated. None of the patients developed renal stones or pyelonephritis. Of the four patients with azotaemia, three showed definite improvement to normal levels while one stabilized. CONCLUSIONS: Nephroplication and nephropexy of giant hydronephrotic kidneys are useful adjunctive procedures to reduce pelvicalyceal system stasis and to improve drainage, thereby preventing subsequent stone formation, infection and deterioration in renal function.

Adolescent↗
PubMed1998

Obstructive jaundice: a unique presentation of primary obstructive megaureter.

A case of giant hydronephrosis leading to obstructive jaundice due to primary obstructive megaureter in an adult is the subject of this presentation. Giant hydronephrosis due to primary obstructive megaureter in adults is uncommon. This is also the first case of obstructive jaundice due to primary obstructive megaureter reported in the literature. The patient was initially treated with a percutaneous nephrostomy till the jaundice resolved. This was followed by definitive surgery in the form of ureteral tailoring and reimplantation along with nephroplication and nephropexy, with a successful outcome.

Adult↗
PubMed1997

Cardiac binding in experimental heart failure.

BACKGROUND: Cardiomyoplasty is a potential therapy for heart failure. Its benefits are attributed to systolic augmentation (dynamic cardiomyoplasty) and prevention of cardiac dilatation (static cardiomyoplasty). To evaluate the static component, we used an artificial membrane for cardiac binding in a canine model of heart failure. METHODS: Intracoronary doxorubicin was administered weekly for 4 weeks to induce heart failure in 10 dogs, each of which was assigned to one of two treatment groups: (1) no treatment, or (2) cardiac binding. Hemodynamic data were obtained at operation and at 7 weeks after operation. Echocardiography was performed weekly. RESULTS: Left ventricular end-diastolic pressure and diameter, and right ventricular end-diastolic diameter increased in group 1 (from 9.6 +/- 6.1 to 19.6 +/- 2.3 mm Hg, p = 0.009; from 3.9 +/- 0.4 to 5 +/- 0.3 cm, p = 0.0013; and from 1.6 +/- 0.2 to 1.9 +/- 0.3 cm, p = 0.0036, respectively). Ejection fraction fell in group 1 from 0.60 +/- 0.10 to 0.40 +/- 0.04 (p = 0.0009) and in group 2 from 0.56 +/- 0.02 to 0.40 +/- 0.04 (p = 0.0001), but the difference between groups was not significant. CONCLUSION: Cardiac binding reduces the ventricular dilatation associated with heart failure without exacerbating left ventricular dysfunction.

Animals↗
PubMed1997

Cardiovascular response to sudden strenuous exercise: an exercise echocardiographic study.

We studied the response in left ventricular (LV) internal dimensions and posterior wall thickness during the performance of sudden strenuous exercise without warm-up (SSE) and sudden strenuous exercise with warm-up (SSEw) in 15 healthy, untrained college-aged males (26 +/- 5.0 yr). Measurements of left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), stroke dimension (SD = LVEDD-LVESD), fractional shortening (FS = SD/EDD) and posterior wall thickness (PWT) were obtained from continuous 2-D targeted on M-mode echocardiography. Continuous EKG and blood pressure were obtained at rest and during the final 10 s of SSE (30 s of upright leg cycle ergometry of 400 W at 80 rpm). SSEw was preceded by warm-up exercise (6 min of graded leg cycle exercise of 2-min stages initial load 30 W, increasing in 30-W increments at 60 rpm, followed immediately by SSE). Our findings revealed that there were no significant differences in the LV internal dimensions (LVEDD, LVESD, FS, PWT), HR max, RPP max, ECG, and MAP max between SSE and SSEw. Sudden strenuous exercise without warm-up is not associated with a reduced LV function. The results of this study are contradictory to previous findings that have suggested that SSE is associated with transient global left ventricular (LV) dysfunction.

Adult↗
PubMed1990

The use and effectiveness of elbow splints in the Rett syndrome.

Incessant hand to mouth movements are often noted as part of the movement disorder of the hands in the Rett syndrome (RS). Elbow splints were designed to inhibit this behavior and prevent further injury to the hands. A study of eight RS patients was conducted to determine the effectiveness of splinting. Results were very positive and indicated increased socialization, increased interaction with the environment, decreased hand to mouth movements, and decreased hand wringing behavior.

Child Behavior Disorders↗