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Biomedical subjects

O Lindell

Publications and source records attributed to O Lindell.

28 records · Page 2Linked to original sources
PubMed1989

Early experiences with continent bladder substitution.

Since January 1987 a total of 14 patients have undergone continent bladder replacement procedure. The bladder substitute was constructed of ileum (ileal neobladder) in three patients, of an ileocaecal segment (Mainz pouch) in five patients while in six patients a segment of ascending colon (Mayo pouch) was used. Nine male patients underwent a complete bladder substitution after cystoprostatectomy. In five patients a bladder augmentation was performed. Four of these patients were female. They were subjected to subtotal cystectomy which left only one cm of the bladder neck, while the ureters were reimplanted into the pouch. Seven of the nine patients with total bladder substitution are continent during the day and seven at night. All patients in the bladder augmentation group are continent day and night, but one of them has to empty his bladder by intermittent catheterization. Because of stenosis at the ureterocolonic anastomosis, reoperation was performed on two patients more than one year after the primary operation. Except for these two patients, who required surgical revision, the initial results are encouraging and patient acceptance has been excellent.

Adult↗
PubMed1987

Salvage cystectomy. Review of 19 cases.

Nineteen salvage cystectomies were performed during a period of 17 years, either on patients who failed definitive radiation therapy of bladder carcinoma or on those with massive bleeding or incapacitating irritative bladder symptoms after irradiation. In 16 cases a single-stage and in 3 a two-stage procedure was used. The postoperative hospital mortality rate was 11%. Early complications developed in 63%, late complications in 47% of the patients. The 5-year survival rate was 5%. In 11 cases, widespread transitional cell carcinoma was the cause of death. With more accurate preoperative tumor staging and subsequent patient selection, better results can be obtained by this procedure. A proposal for the treatment of patients with T3 bladder cancer is made.

Aged↗
PubMed1986

99mTc-DTPA and 99mTc-DMSA renal gamma imaging in the surveillance of patients with conduit urinary diversion.

We studied renal anatomy and function using 99mTc-2-3 dimercaptosuccinic acid (DMSA) and 99mTc-diethylenetriaminepentaacetic acid (DTPA) in 27 patients with conduit urinary diversion. In this condition, free ureteral reflux is often associated with bacteriuria, and these factors are thought to precipitate progressive renal deterioration. Gamma-camera images provided valuable information concerning the structure of the renal parenchyma, the function of individual kidneys and possible ureteral obstruction, thus helping us to decide whether or not to instigate further treatment. The information gained using renal gamma imaging with 99mTc-DTPA and 99mTc-DMSA was complementary and partly overlapping. We preferred the use of 99mTc-DTPA because of its ability to visualise the ureters and the region of ureteroconduit anastomosis. Using diuretic medication, we were able to differentiate true ureteral obstruction from atony in 9 patients using 99mTc-DTPA.

Adult↗
PubMed1986

Mucosal morphology of ileal conduits with particular reference to urinary infections.

Mucosal biopsies were obtained for histological and electron microscopical studies from 20 patients with ileal urinary conduits. Special interest was focused on problems of urinary tract infections and their possible role in the pathogenesis of these changes. Chronic inflammation with mild to total villous atrophy was found as well as reduction in the amount of mucosal glands. Ultrastructurally the main cellular elements of the ileal epithelium and mucosa were preserved. The age of the conduit did not seem to be decisive in the histological findings. Also recurrent infections could not be shown to be responsible for the changes in the conduit mucosa. In irradiated patients, fibrotic changes in the lamina propria of the conduit mucosa were apparent and the microvilli especially short and scanty.

Adult↗
PubMed1986

The effect of phenylpropanolamine on female stress urinary incontinence.

In a randomized double-blind manner, 43 women with grade I and II stress urinary incontinence were treated with either phenylpropanolamine p.o. 50 mg twice daily (Rinexin, 1 tablet b.i.d.) or placebo during two weeks. Urethral CO2 profilometry, with recording of maximum urethral closure pressure (MUCP) and functional urethral length (FUL), and subjective response were considered for effect evaluation. The subjective response of Rinexin was highly significant (p = 0.01) above that of placebo. Clinical improvement was reported by 15 of 21 women on Rinexin and by 8 of 22 women on placebo. A significant increase in MUCP, 14%, was registered in women on Rinexin treatment. This increase was more pronounced in the grade I than in the grade II incontinent women. No statistically significant correlations were obtained between subjective response and increase in MUCP. An increase in FUL was recorded in both two treatment groups, but no statistically significant difference between them was obtained. Adverse drug reactions were rare. No changes in blood pressure occurred. Based on the present study, Rinexin (1 tablet b.i.d.) is an effective and safe medication for female grade I and II stress incontinence and is also recommended as adjunctive therapy to physiotherapy before Teflon injection or operation.

Adult↗
PubMed1986

Single-stage versus two-stage diversion-cystectomy in treatment of bladder cancer: a comparative study.

We have compared the results of 26 single-stage and 16 two-stage diversion-cystectomies performed for bladder carcinoma at the Helsinki University Central Hospital, Finland in the period December 1974-April 1983. All the patients underwent pre-cystectomy radiation. An ileal conduit urinary diversion was used in every patient. No benefit relative to surgical mortality or early and late complications seemed to be derived from using the staged procedure. The single-stage operation, in addition to sparing the patients the inconveniences of the second operation, saves social expenditure by reducing the total length of hospital stay and the total operating time. The two-stage procedure should, however, be considered for fragile patients and those with serious operative risk factors.

Adult↗
PubMed1986

Ileal conduit urinary diversion: a review of 148 patients.

A series of 148 ileal conduit urinary diversions is described. In 127 patients (86%) the operation was done because of malignant neoplastic disease, whereas in 21 patients the underlying disease was benign. 77% of the patients had bladder carcinoma. Simultaneous cystectomy was performed in half of the cases. The mortality of the procedure was 9.5%. Postoperative complications occurred early in 36% and late in 49% of patients. Most of the complications could be treated conservatively but 25 patients required re-operation(s) for early and 35 for late complications. The treatment of patients with urinary leakage and the reason for the high incidence of upper urinary tract deterioration (50%) is discussed in detail.

Adolescent↗
PubMed1985

Upper urinary tract transitional cell carcinoma after total cystectomy for bladder cancer.

During a 17-year-period from 1967 to 1983, 110 total cystectomies for transitional cell bladder cancer have been performed in our clinic. During the postcystectomy period, upper urinary tract urothelial cancer developed in seven patients (6.4%). In every case a multifocal, low stage transitional cell cancer had been found in the bladder. The time between the cystectomy and discovery of the upper tract tumour varied from less than three months to almost 13 years. In five cases the first sign of occurrence of the tumour was malignant conduit urine cytology, in two macroscopic haematuria with subsequent malignant cells in urine. In one patient bilateral renal pelvic tumours were found. Five patients could be surgically treated. The need for regular conduit urine cytological studies at short intervals in patients with multifocal low stage and high grade transitional cell carcinoma in the cystectomy specimen is emphasised.

Aged↗