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Biomedical subjects

R C Cohen

Publications and source records attributed to R C Cohen.

At least 19 recordsLinked to original sources
PubMed2001

Urethral trauma in children.

We report our 12-year experience in the management of urethral injuries in nine children, six boys and three girls. The most common mechanisms of injury were motor vehicle accidents, followed by straddle injuries. All the injuries in boys involved the anterior urethra, and in girls the proximal or mid-urethra. There were associated injuries in five, including three pelvic fractures. All children were investigated with a retrograde urethrogram. Four were treated non-operatively with insertion of a urethral catheter. Of the remaining five, one had drainage of a penile haematoma, one cystourethroscopy, two insertion of urinary and suprapubic catheters, and one open cystotomy and passage of a guide wire with antegrade passage of a urethral catheter. Complications included one urinary tract infection, one urethral fistula, one urethrovaginal fistula, and two urethral strictures. Final outcome was satisfactory in all nine children.

Adolescent↗
PubMed2001

Laparoscopic varicocelectomy with preservation of the testicular artery in adolescents.

PURPOSE: The aim of this study was to determine if laparoscopic varicocelectomy (LV) with preservation of the testicular artery (TA) is a satisfactory alternative to standard open surgical techniques in adolescents. METHODS: Between June 1993 and June 1999 left LV was performed on 40 boys, median age, 12 years (range, 9 to 16 years). Selection for surgical correction included size of the varicocele, symptoms, and clinical or ultrasound assessment for testicular hypotrophy. Eight patients had undergone previous left-sided inguinal surgery, 5 of these for varicocele. Three laparoscopic ports were used. The TA was identified and preserved with the aid of a Doppler flow transducer ("Smart Needle"). All the testicular veins were ligated and divided. The inferior epigastric (IE) veins also were ligated in 19 patients. The operating time was a mean of 1 hour. The postoperative follow-up for a median of 19.5 months (range, 3 to 36 months) included clinical and ultrasound assessment. RESULTS: Preoperative assessment confirmed left-sided testicular hypotrophy 35 patients (88%). Thirty-eight varicoceles were stage 3, and 2 were stage 2. Testicular discomfort was present in 13 patients. Complete correction of the varicocele was achieved in 33 (83%). At a mean of 5 months after LV open repair in 7 patients confirmed a dilated cremasteric vein connecting to the IE veins. Ligation of the IE veins at the time of LV was associated with a persistent varicocele in 3 of 19 patients (16%), similar to the nonligated group, 4 of 21 patients (19%). Five patients (12.5%) had a mild hydrocele. The left testicular volume increased 30% to 50% in 28 patients (70%) at a median of 6.5 months after repair. Testicular atrophy did not occur in any patients. The majority of patients went home within 6 hours of surgery. CONCLUSIONS: The laparoscopic technique with preservation of the TA is an acceptable alternative to open surgical treatment of varicoceles. Further, it eliminates the risk of testicular atrophy and is the technique of choice when previous inguinal surgery has been performed. Ligation of IE veins was not associated with a decrease in the persistence of varicocele postoperatively.

Adolescent↗
PubMed1999

Laparoscopic bladder 'wrap' technique for repair of vesicoureteric reflux in a porcine model.

PURPOSE: The aim of this study was to determine if vesicoureteric reflux (VUR) can be successfully corrected laparoscopically by a bladder "wrap" technique in a pig model. METHODS: In 15 female piglets (mean weight, 22.5 kg) bilateral VUR was created by an open technique (11 grade 3, 2 each of grades 2 and 4). Eight weeks later (range, 4to 16 weeks) VUR was confirmed by fluoroscopic cystogram, and unilateral laparoscopic correction was performed. The contralateral ureter was used as a control. The bladder was emptied, and a 3F ureteric catheter was inserted on the repair side. Four 11-mm ports were inserted transperitoneally. The ureter was dissected to the ureterovesical junction (UVJ). Commencing at the UVJ, 2 (n = 9) or 3 (n = 6) black silk sutures were placed through the bladder muscle on either side of the ureter creating a bladder wrap around the distal 2 to 4 cm of ureter. At a mean of 16 weeks (range, 4 to 24 weeks) cystograms were repeated. The animals were killed the bladder and ureters underwent histopathology examination. RESULTS: VUR was corrected in 12 animals (80%). There was persistence of VUR in 2 and ureteric obstruction in 1. The wrap was intact in all animals. CONCLUSIONS: Laparoscopic correction of VUR by the bladder wrap technique is successful in pigs. Long-term follow-up studies will determine if this will be a satisfactory alternative surgical treatment for correction of VUR in children.

Animals↗
PubMed1999

Adverse outcome of congenital diaphragmatic hernia is determined by diaphragmatic agenesis, not by antenatal diagnosis.

BACKGROUND/PURPOSE: The authors studied their congenital diaphragmatic hernia (CDH) cases retrospectively to ascertain if classical CDH and diaphragmatic agenesis (DA) have separate clinical manifestations, whether antenatally diagnosed cases behave differently from those not diagnosed antenatally, and if antenatal diagnosis before 25 weeks carries a worse prognosis. METHODS: The authors performed a retrospective review of 23 infants with CDH treated at their institution between January 1996 and March 1999. The patients were divided into 3 groups that were analyzed: DA and classical CDH, antenatally diagnosed and nonantenatally diagnosed, and antenatally diagnosed before 25 weeks and after 25 weeks. RESULTS: There were 8 cases of DA and 11 cases of classical CDH. Four infants died without operation and could not be classified. Neonates with DA had significantly longer mean duration of preoperative stabilization compared with classical CDH (5.25+/-2.76 days v 1.36+/-1.0 days) and postoperative mechanical ventilatory support (15.7+/-3.0 days v 4.9+/-3.0 days). Fifty percent of DA patients died; all classical CDH patients survived. Twelve cases were diagnosed antenatally, 6 before 25 weeks' gestation. Antenatally diagnosed cases had no statistically significant difference in mortality rates from those not diagnosed antenatally; 50% of those diagnosed before 25 weeks survived. CONCLUSIONS: DA cases require more preoperative preparation and postoperative ventilation and have a bad prognosis compared with classical CDH. Antenatal diagnosis of CDH does not convey a different prognosis. Fifty percent of CDH patients with antenatal diagnosis before 25 weeks survive.

Diaphragm↗
PubMed1999

Cisapride in the control of symptoms in infants with gastroesophageal reflux: A randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To evaluate the efficacy of cisapride in the treatment of uncomplicated gastroesophageal reflux in children younger than 36 months of age. STUDY DESIGN: A total of 95 patients satisfied the entry criteria and were randomly assigned to double-blind treatment with either cisapride (n = 50), 0.2 mg/kg 4 times daily, or placebo (n = 45) for 2 weeks. At the end of the 2-week treatment period, symptom diary and parental evaluation with repeat 24-hour pH study were performed. RESULTS: Sixty-eight patients completed the trial (38 in the cisapride group and 30 in the placebo group). There were no significant differences in the symptoms of crying, vomiting, or gagging; the overall symptom intensity score; or parental global evaluations. There was a significant difference (P <.03) in the percent time pH <4, the number of reflux episodes lasting more than 5 minutes, and the duration of the longest episode. No significant difference was demonstrated for the number of episodes with pH <4 or the reflux score. CONCLUSIONS: Cisapride was no better than placebo for relief of symptoms in children with uncomplicated gastroesophageal reflux. A beneficial effect was demonstrated in the cisapride group in relation to the measured parameters for esophageal acid exposure time.

Administration, Oral↗
PubMed1997

Ureteroceles in children: an ongoing challenge.

The treatment of ureteroceles in children requires an individualised approach. Antenatal diagnosis is the ideal, so that postnatal urinary antibiotic prophylaxis and appropriate investigations can be organised. Postnatal investigations should assess both upper and lower urinary tract. Renal and bladder ultrasound and radiographic micturating cystourethragraphy under antibiotic cover will both detect vesicoureteric reflux and assess any bladder outlet obstruction due to the ureterocele. Renal function, particularly of the upper moiety, is best evaluated by technetium Tc99m dimercaptosuccinic acid renal scan. Both function and obstruction can be quantitated by the Tc99m-mercaptoacetyltriglycine isotope scan with intravenous volume expansion (10 ml/kg) and furosemide diuresis (1 mg/kg). Intravenous urography provides the best anatomic information when the upper moiety is functional. The surgical management is based on the clinical situation, which is often variable, and therefore needs to be tailored for each patient. The general principles include restoration of anatomy to as near normal as possible and preservation of functional renal tissue.

Antibiotic Prophylaxis↗
PubMed1996

Endoscopic laser division of an esophageal web in a child.

The authors report the first successful endoscopic laser division of a congenital esophageal web in a child in whom dilatation had failed. Laser lysis is minimally invasive and should be attempted before surgery is considered.

Dilatation↗
PubMed1995

Intraneural ganglion of the common peroneal nerve in a 4-year-old boy.

The case history of a 4-year-old boy with an intraneural ganglion of the common peroneal nerve is presented. These lesions are rare, more commonly affect males, and typically present with a painful foot-drop. A mass is often palpable adjacent to the neck of the fibula. Our patient has made a good recovery after surgery.

Child, Preschool↗
PubMed1994

Postnatal diagnosis and outcome of urinary tract abnormalities detected by antenatal ultrasound.

OBJECTIVES: To determine the incidence of urinary tract abnormalities detected by antenatal ultrasound; the value of fetal renal measurements in predicting significant uropathy; and the nature and clinical outcome of fetal uropathy. DESIGN AND SETTING: A retrospective analysis of babies with urinary tract abnormalities detected before birth who were born at or referred to a teaching hospital. PATIENTS: One hundred and twenty-five babies born between June 1989 and November 1992. Sixty-nine babies were born at Westmead hospital and 56 were born elsewhere and referred to Westmead Hospital for investigation. RESULTS: The incidence of uropathy detected before birth among babies born at the teaching hospital was 5.1 per 1000 births. In 60% of these babies, significant abnormalities were confirmed after birth (3.1 per 1000 births). We found a significance of 71% and a specificity of 89% for fetal measurements in predicting significant uropathy. Among all 125 babies the most common abnormalities were pelviureteric junction (PUJ) anomalies (34%), minimal hydronephrosis (26%), ureteric reflux (18%) and multicystic kidney (7%). Pyeloplasty has been performed in 23 (46%) of the 52 kidneys with PUJ anomalies. Renal parenchymal abnormality was detected in four of 22 kidneys with ureteric reflux (18%). Of these four, all were exposed to Grade IV or V ureteric reflux but none had been infected. CONCLUSIONS: Antenatal ultrasound is a sensitive, though nonspecific, tool for the non-invasive identification of congenital abnormalities of the urinary tract, which are common and frequently asymptomatic after birth. Although ureteric reflux may not be predicted from renal measurements, the degree of fetal hydronephrosis indicates the likelihood of obstructive abnormality and, thus, the extent of postnatal investigation required.

Female↗
PubMed1993

Continuous epidural analgesia in newborn infants undergoing major surgery.

Providing safe, effective analgesia for newborn infants undergoing major surgery remains a challenge to pediatric anesthetists and surgeons. Continuous epidural analgesia (CEA) has been shown to provide safe and effective analgesia in infants and children; however, there is little reported use in neonates. We review our experience of CEA in 14 newborn infants (32 to 40 weeks gestation) aged 4 hours to 35 days undergoing major surgery, as well as a further 6 ex-preterm (25 to 29 weeks gestation) infants aged 2 to 5 months at time of surgery. In all cases effective analgesia was achieved for up to 69 hours without complication. All infants were awake and extubated uneventfully at the completion of surgery, which lasted 5 hours in one case. None of the infants developed respiratory depression or prolonged apnea. The technique has been widely accepted by surgeons, neonatal nursing staff, and neonatologists.

Analgesia, Epidural↗
PubMed1993

Splenic injury in children: a 10 year experience.

The aim of this report was to review retrospectively the management of splenic trauma at a major Australian tertiary referral centre (Westmead Hospital) over a 10 year period. Forty-nine patients (0-15 years of age) with documented blunt splenic trauma were identified. The causes of splenic injury were road trauma (73%) and falls (27%). There were 22 minor injuries (Injury severity score [ISS] < 16) and 27 severe injuries (ISS > or = 16). All nine deaths were related to road trauma (mean ISS = 59). The investigation most commonly used was CT scanning (47%). Peritoneal lavage was performed in six patients (12%). Management involved non-operative care in 29 patients (57%), exploratory laparotomy alone in 5 (10%), splenic salvage in 2 (4%) and splenectomy in 13 (26%). This experience supports the view that non-operative management of splenic injury in haemodynamically stable children is safe and is the preferred treatment. Experienced assessment and meticulous observation is necessary. Laparotomy is indicated if there is continuing haemodynamic instability despite resuscitation. Operative management is aimed at splenic salvage with splenectomy being reserved for uncontrolled haemorrhage.

Accidental Falls↗
PubMed1992

Volume expanded diuretic renography in the postnatal assessment of suspected uretero-pelvic junction obstruction.

Controversy surrounds the role of 99mTc-diethylenetriamine pentaacetic acid renography in suspected uretero-pelvic junction obstruction in early life. Accordingly, we retrospectively reviewed 18 patients (28 hydronephrotic kidneys) with a mean age of 2 mo (range: 1 wk-6 mo) who underwent a total of 36 scans using intravenous volume expansion (10 ml/kg) and furosemide diuresis (1 mg/kg). Initial scans were classified as obstructed, not obstructed or indeterminate using differential renal function, furosemide washout T 1/2 and visual assessment of tracer clearance. Those initially classified as obstructed (n = 8) have been surgically confirmed. In the indeterminate (n = 6) and nonobstructed (n = 14) groups, three and two kidneys, respectively, developed obstruction on progress scans. Mean follow-up in the nonsurgical patients was approximately 9 mo (range: 4-17 mo). A total of 13 kidneys had developed obstruction by renographic criteria, and to date 12 have surgical confirmation. Our data indicate that: (1) scans classified as obstructed correlate well with surgery; (2) an initial classification of indeterminate or nonobstructed does not exclude later development of obstruction; and (3) serial scans correctly stratify children with possible uretero-pelvic junction obstruction.

Female↗
PubMed1990

Tunable far-IR laser spectroscopy of jet-cooled carbon clusters: the nu 2 bending vibration of C3.

Seven rovibrational transitions of the (01(1)0) <-- (00(0)0) fundamental bending band of C3 have been measured with high precision with the use of a tunable far-infrared laser spectrometer. The C3 molecules were produced by laser vaporization of a graphite rod and cooled in a supersonic expansion. The astrophysically important nu 2 fundamental frequency is determined to be 63.416529(40) cm-1. These measurements provide the basis for studies of C3 in the interstellar medium with far-infrared astronomy.

Astronomy↗
PubMed1990

Diagnosis and treatment of antenatal uropathies.

Thirty-five patients with significant fetal hydronephrosis detected on antenatal ultrasound had postnatal investigations which included ultrasound, 99mtechnetium diethylenetriamine pentacetic acid (99mTcDTPA) renal scans and micturating cystourethrograms. Antenatal and postnatal ultrasound were unable to determine reliably the level of obstruction causing the hydronephrosis. The 99mTcDTPA renal scan was useful in determining the necessity and timing of surgery, but could not exclude vesico-ureteric reflux. Seven patients required surgery in the neonatal period and a further seven children had surgery because of deterioration of the scan appearance on follow-up studies performed at 3, 6 and 12 months of age and then at longer time intervals. Twenty patients (almost 60%) have been managed conservatively for a mean of 28 months (range: 12 months-7 years) with no deterioration in renal function.

Female↗
PubMed1987

Traumatic oesophageal pseudodiverticulum.

Dissection of the posterior pharyngeal wall and oesophagus due to trauma has a clinical presentation similar to that of oesophageal atresia with or without tracheo-oesophageal fistula. It is important to establish the diagnosis in order to prevent unnecessary surgery.

Diagnosis, Differential↗