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Biomedical subjects

M L Ritchey

Publications and source records attributed to M L Ritchey.

At least 91 records · Page 5Linked to original sources
PubMed1992

Surgical complications after nephrectomy for Wilms' tumor.

We reviewed the charts of 1,910 children enrolled in the Third National Wilms' Tumor Study who underwent primary nephrectomy. Four hundred and ninety-five surgical complications occurred in 379 children (19.8 percent). Patients with inoperable tumors, bilateral renal tumors, peroperative therapy and those who refused treatment were excluded from this review. The most common complication was intestinal obstruction, which occurred in 132 patients (6.9 percent). This was followed by extensive intraoperative hemorrhage (112 patients), defined as blood loss exceeding 50 milliliters per kilogram of body weight. Intraoperative injuries to other visceral organs (including intestine, liver and spleen) occurred in 21 children and extensive vascular injuries were reported in 27 patients. There were nine deaths attributed to surgical complications (0.5 percent), only one of which was intraoperative. Survival of patients with complications was similar to patients without complications when stratified by histologic study and stage. Factors associated with the development of surgical complications included advanced local tumor stage at diagnosis, intravascular tumor extension and resection of other visceral organs at the time of nephrectomy. Complete removal of the tumor is important, but not at the expense of radical removal of adjacent structures, because of gross appearances at operation. They are often not invaded by the tumor, but rather are compressed, distorted or adherent without tumor infiltration. Identification of these groups will aid the surgeon in choosing the appropriate management for these patients at high risk. When initial exploration and precise surgical staging indicate that only a formidable operation will achieve total excision, shrinkage of the tumor with selective use of chemotherapy or radiotherapy, or both, may facilitate removal and decrease surgical morbidity. Preoperative therapy may also be the preferred approach for children with extensive intravascular tumor.

Actuarial Analysis↗
PubMed1991

Complications of the Heitz-Boyer urinary diversion: case report of late development of malignancy.

We report on 3 patients with bladder exstrophy followed for more than 15 years after having undergone Heitz-Boyer urinary diversion. One patient had adenocarcinoma at the ureterocolonic anastomoses 16 years after diversion. To our knowledge this is the first reported case of a malignancy developing after a Heitz-Boyer procedure. The other 2 patients had significant problems with urinary incontinence and recurrent urinary tract infections. Initial success with this form of urinary diversion can be followed by significant long-term complications.

Adenocarcinoma↗
PubMed1991

Viability and functional characteristics of enterocystoplasty after ligation of the vascular pedicle.

A canine model was developed to evaluate the effect of ligation of the mesenteric blood supply of enterocystoplasty. In 5 dogs with an ileocystoplasty and 6 with a gastrocystoplasty the blood supply was interrupted 4 months postoperatively. Re-exploration 2 to 8 weeks later revealed sufficient collateral blood flow to maintain integrity of the bowel wall and none of the animals had urine leak or other signs of perforation. Two animals had a significant decrease in the size of the cystoplasty. Intraoperative measurements of bowel viability after pedicle ligation were not predictive of the outcome. The functional outcome after pedicle division seems to be variable and probably reflects how well the patch has been vascularized before interruption of the blood supply. The augmented bladder may remain viable if sufficient time has elapsed to allow revascularization of the intestinal segment before its mesenteric blood supply is divided.

Animals↗
PubMed1991

Anastomotic obstruction after stapled enteroanastomosis.

We have recently treated two cases of anastomotic obstruction after side-to-side stapled enteroanastomosis. Complete obstruction of a stapled small-bowel anastomosis has not been reported to our knowledge. The mechanism of the obstruction appears to be the healing together of the cut edges of viable bowel beyond the inverted stapled lines. An alternative method of constructing the functional end-to-end enteroanastomosis that is offered is intended to prevent the occurrence of postoperative anastomotic obstruction.

Adolescent↗
PubMed1990

Pediatric urological complications with intraoperative radiation therapy.

Intraoperative radiotherapy with variable energy electrons has been used as a supplemental boost to treat 6 children with locally advanced retroperitoneal malignancies. Of the patients 4 had treatment-related injuries to portions of the urinary tract within the intraoperative and external radiation fields. Three patients had significant renal impairment requiring surgical correction. The pathogenesis and management of treatment-induced injury to the urinary tract are discussed.

Adolescent↗
PubMed1990

Renal vein involvement with nephroblastoma: a report of the National Wilms' Tumor Study-3.

The records of children enrolled in the National Wilms' Tumor Study-3 who had Wilms' tumor and thrombosis into the renal vein were reviewed. There were 164 patients with gross involvement of the extrarenal vein and 47 patients with microscopic involvement, an incidence of 11.3% (211 of 1,865 evaluable patients). Two-year survival rates were 90, 79 and 72% for stages II, III and IV, respectively. The most important predictors of survival were histologic pattern and stage. Complete en bloc excision of the tumor and thrombus continues to be the most effective initial management.

Child↗
PubMed1988

Management of müllerian duct remnants in the male patient.

We evaluated 36 patients for müllerian duct remnants that were manifest in several forms. The most common type was an enlarged prostatic utricle communicating with the urethra in 22 younger patients, which was associated with hypospadias or intersex disorders in more than 90 per cent of the cases. A cystic müllerian duct remnant was the other configuration noted in 14 older patients who had normal external genitalia and often presented with a rectal mass. The diagnostic evaluation consists of voiding cystourethrography, retrograde urethrography and cystoscopy. Other useful imaging techniques are ultrasonography and computerized tomography. Careful delineation of the anatomy of the lower urinary and genital tracts will help to plan surgical therapy. Suprapubic excision was the most frequent operation and it was successful in all 18 patients in whom it was performed.

Adolescent↗
PubMed1988

Intracaval and atrial involvement with nephroblastoma: review of National Wilms Tumor Study-3.

We reviewed the records of 77 children enrolled in the National Wilms Tumor Study-3 who had involvement of the inferior vena cava with tumor thrombus. None of these patients received preoperative chemotherapy or radiotherapy. Ultrasonography and inferior venacavography were more helpful than computerized tomography in the preoperative diagnosis. The median followup for the group was 2.7 years. The 3-year survival rates for patients with intracaval involvement were determined by stage (88, 89 and 62 per cent for stages II, III and IV, respectively). The most important prognostic factor was histological type. The level of vena caval involvement had no effect on survival; all 16 patients with atrial involvement survived 3 or more years. We continue to recommend appropriate surgical excision of the tumor and thrombus when it is technically feasible.

Adolescent↗
PubMed1988

Vesical neck reconstruction in patients with epispadias-exstrophy.

Vesical neck reconstruction was performed in 50 male and 12 female patients with the epispadias-exstrophy complex. Of these patients 45 had epispadias and 17 had classical exstrophy. Patient age ranged from 3 to 27 years, with a mean age of 12.6 years. Followup after vesical neck reconstruction averaged 11.6 years. Of the 45 patients with epispadias 35 (78 per cent) and of the 17 with bladder exstrophy 13 (76 per cent) are continent, for an over-all continence rate of 77 per cent. An adequate bladder capacity was one of the most important determinants of continence. In 11 patients with a small capacity or poorly compliant bladder augmentation cystoplasty was combined with vesical neck reconstruction to increase vesical capacity and to produce complete urinary continence.

Bladder Exstrophy↗
PubMed1988

Bilateral single ureteral ectopia.

We report 11 cases of bilateral single ectopic ureter. The clinical features and surgical management are discussed. With current surgical techniques, these patients can be treated successfully.

Aged↗
PubMed1987

Adrenal tumors: involvement of the inferior vena cava.

We report 3 cases of adrenal neoplasms with extension of tumor thrombus into the vena cava. Preoperative documentation of the presence and extent of vena caval involvement is mandatory before surgical extirpation of adrenal tumors.

Adrenal Cortex Neoplasms↗
PubMed1985

Development of nongerm cell malignancies in nonseminomatous germ cell tumors.

We report 2 cases of sarcomatous transformation of mixed germ cell tumors of the testis. Both patients received cisplatin-based combination chemotherapy. Embryonal rhabdomyosarcoma, chondrosarcoma and spindle cell sarcoma were the dominant pathological patterns in the metastatic sites. Nongerm cell malignancies in mixed germ cell tumors following chemotherapy may be more common than previously described.

Adult↗
PubMed1985

Effect of vasectomy on high density lipoproteins.

Primate research has associated vasectomy with accelerated rates of atherogenesis. We have evaluated the effect of vasectomy on serum lipoprotein profiles in healthy men. There was a decrease in high density lipoprotein levels, which was greatest in men with a family history of atherosclerotic disease. With the great number of variables known to affect high density lipoprotein levels further studies are needed to determine if this change can be attributed to the vasectomy.

Arteriosclerosis↗
PubMed1984

Nephrogenic adenoma of bladder: a report of 8 cases.

Nephrogenic adenoma is an uncommon lesion of the urinary tract. Current information supports a metaplastic transformation of urothelium as the origin of this tumor. Our experience with 8 additional cases confirms the benign behavior of this lesion.

Adenoma↗
PubMed1984

Prostatic uptake of Ga-67.

Midline activity low in the pelvis seen on Ga-67 scans is frequently attributed to colonic excretion of radionuclide. We have seen two cases of infectious prostatitis with focal uptake of Ga-67 within the prostate gland. We describe a technique of using limited quantities of barium administered by enema and appropriate positional imaging, which localizes pelvic activity to the prostate.

Barium Sulfate↗