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Biomedical subjects

S Karasick

Publications and source records attributed to S Karasick.

At least 19 recordsLinked to original sources
PubMed1995

Improved quality of life and sexuality with continent urinary diversion in quadriplegic women with umbilical stoma.

Quality of life issues prompted us to offer continent urinary diversion to quadriplegic women who required cystectomy for end-stage neurogenic vesical dysfunction complicated by urethral destruction as a result of chronic indwelling catheterization. Three women with spinal cord injury (SCI) and resultant quadriplegia of 5 to 15 years duration underwent continent urinary diversion. Preoperative evaluation and urodynamic studies in each showed a bladder capacity of less than 150mL, bilateral vesicoureteral reflux, recurrent febrile urinary tract infections, an incompetent urethral sphincter, and incontinence around an indwelling catheter in all three patients. Although highly motivated, these women showed minimal dexterity and were unable to perform urethral self-catheterization. Each was opposed to having an incontinent abdominal urinary stoma. The urinary reservoir was created from 30cm of detubularized right colon. The continence mechanism used an intussuscepted and imbricated ileocecal valve. The umbilicus was chosen as the urostomy site because of cosmetic appearance and ease of catheterization for a patient with minimal dexterity. Follow-up ranged from 18 to 30 months. Reservoir capacity ranged from 550 to 800mL without evidence of reflux or stomal leakage. The incidence of symptomatic autonomic dysreflexia and urinary tract infection decreased postoperatively in all patients. Of the two women who were sexually active, the frequency of activity increased from 8 to 15 episodes per month in one and 3 to 4 episodes per month in the other. Both reported improved sexual enjoyment. Body image and satisfaction with urologic management increased in all three patients. In conclusion, continent urinary diversion in selected quadriplegic patients is a reasonable alterative to incontinent intestinal urinary diversion. The umbilical stoma provides an excellent cosmetic result which patients with minimal dexterity are able to catheterize easily. Continent urinary diversion in women results in improved self-image, quality of life, and enables greater sexual satisfaction.

Adult↗
PubMed1995

Intraoperative endo-luminal ultrasound evaluation of urethral diverticula.

The imaging accuracy of a catheter-based endo-luminal ultrasound system was compared to traditional imaging techniques for surgical treatment of urethral diverticula in 7 women and 1 man. At surgical repair the urethra was catheterized directly with a 6.2F or 9F (12.5 or 20 MHz.) catheter-based ultrasound transducer, generating a 360-degree transaxial real-time image. The endo-luminal ultrasound images were compared with preoperative voiding cystourethrography (7 patients), transvaginal ultrasound examinations (3) and double balloon urethrograms (2). Surgical diverticulectomy was then done with endo-luminal ultrasound monitoring. Intraoperatively, all diverticula were well visualized by endo-luminal ultrasound, which demonstrated improved identification of the size and orientation of urethral diverticula, sludge within the diverticula, the extent of periurethral inflammation, diverticular wall thickness, and the distance between the diverticular wall and urethral lumen. In 3 patients the urethral connections of the diverticula were exceptionally well visualized. Comparison with traditional imaging revealed 2 false-negative and 1 false-positive voiding cystourethrograms, 1 false-negative transvaginal ultrasound study and 1 false-negative double balloon urethrogram. Intraoperative monitoring of the urethra enabled precise anatomical dissection, eliminated all diverticular components, and prevented inadvertent urethral and bladder neck injury. Urethral endo-luminal ultrasound is a valuable new adjunct in the evaluation of a variety of urethral abnormalities. This new ultrasound application permits visualization of the precise size, location, orientation and characteristics of urethral diverticula and surrounding tissues. Through enhanced imaging, surgical repair is facilitated. Further application of this technique should increase the diagnostic accuracy of urethral imaging beyond radiographic techniques currently available.

Catheterization↗
PubMed1995

Trends in use of barium enema examination, colonoscopy, and sigmoidoscopy: is use commensurate with risk of disease?

PURPOSE: To assess replacement of barium enema examination with colonoscopy in relation to age- and sex-related risk factors, place of service, physician specialty, and cost. MATERIALS AND METHODS: Between 1985 and 1992, 894,777 insurance claims for barium enema examination and lower gastrointestinal endoscopy were retrospectively examined. Changes in use were investigated. Use of proctosigmoidoscopy and flexible sigmoidoscopy, two office-based endoscopic procedures, was also examined. RESULTS: Use of diagnostic colonoscopy increased from 191 to 406 services per 100,000 persons; colonoscopy with biopsy, from 77 to 183 services; and colonoscopy with lesion removal, from 77 to 202 services. Barium enema examination use declined from 929 to 511 services per 100,000 persons; diagnostic proctosigmoidoscopy, from 854 to 193 services; and diagnostic flexible sigmoidoscopy, from 656 to 620 services. Increases in use of colonoscopy in patients aged younger than 40 years were greater than overall increases. CONCLUSION: Colonoscopy has been replacing barium enema examination as the initial colorectal examination since 1985. Increased use of colonoscopy in patients with lower risk of neoplasia suggests that indications have become overly broad.

Adult↗
PubMed1995

Esophageal strictures: findings on barium radiographs.

An esophageal stricture is a narrowing of the lumen due to inflammation or tumor. Lack of distensibility is characteristic of stricture, which may be diffuse or localized and which may have abrupt or tapered margins. The purpose of this essay is to illustrate the imaging features of various types of strictures, focusing on their value in differential diagnosis.

Barium Sulfate↗
PubMed1994

Prospective comparison of external sphincter balloon dilatation and prosthesis placement with external sphincterotomy in spinal cord injured men.

The purpose of our investigation was to compare external sphincterotomy, the traditional method of treatment of detrusor-external sphincter dyssynergia (DESD), with two newer methods, balloon dilatation or internal stenting of the external sphincter. Sixty-one spinal cord injured (SCI) men were prospectively evaluated. The indications for treatment were DESD and voiding pressure greater than 60 cmH2O demonstrated during video-urodynamic study. Twenty patients were treated with balloon dilatation of the external sphincter, 26 with an internal stent prosthesis, and 15 with traditional external sphincterotomy. Age and duration of SCI were similar among the three treatment groups. A significant decrease in both voiding pressure and residual urine from presurgery levels persisted during the follow-up period of 3 to 26 months (mean, 15 months) in all three groups. Bladder capacity remained constant, renal function improved or stabilized, and autonomic dysreflexia (AD) improved in all three groups. Balloon dilatation and prosthesis placement are associated with a significantly shorter length of surgery (p = 0.045), length of hospitalization (p = 0.005), decrease in hospitalization cost (p = 0.01), and decrease in hemoglobin postoperatively (p = 0.046) when compared to external sphincterotomy. Complications of stent insertion included device migration (three patients) and secondary bladder neck obstruction (two patients). In the balloon dilatation group, three recurrent sphincter obstructions, one case of bleeding requiring transfusion, and one case of bulbous urethral stricture occurred. After external sphincterotomy, two patients developed recurrent obstruction, two required blood transfusion, and 1 patient noted erectile dysfunction. Balloon dilatation and prosthesis placement both proved to be as effective as external sphincterotomy in the treatment of DESD.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Functional urethral closure with pubovaginal sling for destroyed female urethra after long-term urethral catheterization.

OBJECTIVE: To assess the pubovaginal sling as therapy for correction of the destroyed female urethra secondary to long-term indwelling Foley catheter management of neurogenic vesical dysfunction. METHODS: Fourteen women with neurologic disease and a patulous and nonfunctioning urethra underwent pubovaginal sling functional urethral closure. The purpose of the procedure is to achieve a dry perineum. Greater tension is applied to the sling suspension for urethral closure than is normally used to ensure continence for patients exhibiting intrinsic sphincter dysfunction without neurogenic vesical dysfunction. RESULTS: Two patients with adequate bladder capacity and compliance underwent only a pubovaginal sling suspension. They were subsequently managed with intermittent catheterization. In 5 patients, a sling operation in conjunction with enterocystoplasty was accomplished. In 5 patients, a sling procedure with an ileocystostomy and a cutaneous urostomy (bladder chimney) was utilized. In 2 patients, suprapubic tube drainage was established at the time of pubovaginal sling placement. All patients have achieved continence, without the need for absorbent pads, with follow-up time of six to sixty months (mean, 24 months). Abdominal wall herniation has not developed in any patient. CONCLUSIONS: The pubovaginal sling cured incontinence and has resulted in a dry perineum with few problems. The sling procedure may be superior to transabdominal or transvaginal bladder neck closure without the risk of fistula formation.

Adult↗
PubMed1993

Cost containment in the use of low-osmolar contrast agents: effect of guidelines, monitoring, and feedback mechanisms.

PURPOSE: To describe a program for controlling intravenous use of low-osmolar contrast agents (LOCAs). MATERIALS AND METHODS: The department of radiology at the authors' institution adopted a policy of selective use of intravenously administered LOCAs. Clinical indications for LOCA use were specified after consultation with the administration, risk managers, legal department, and ethics committee of the hospital. The guidelines were then publicized throughout the department and hospital, and a contrast agent data form was developed to collect data on all cases. Monitoring mechanisms were instituted. RESULTS: Over the next 23 months, 11,373 patients received intravenous iodinated contrast agents, of whom 28.1% were deemed to be at high risk and were given LOCAs. Monthly tracking showed no evidence of a trend toward increasing use of LOCAs. CONCLUSION: Clear definition of use guidelines, close monitoring, and feedback can stabilize LOCA use at acceptably low levels.

Adult↗
PubMed1992

Giant cell tumor of tendon sheath: spectrum of radiologic findings.

Giant cell tumor of tendon sheath is the second most common tumor of the hand. It can also occur in larger joints. Radiologic features include a soft-tissue mass with or without osseous erosion. Less commonly, it can cause periostitis or permeative osseous invasion; it may rarely calcify. The entire imaging spectrum of this lesion is presented, with emphasis on atypical appearances which can mimic other lesions.

Adolescent↗
PubMed1992

Imaging of uterine leiomyomas.

Advances in the medical and surgical treatment of uterine leiomyomas have stimulated interest in the imaging of these common tumors. The purpose of this essay is to illustrate the appearance of leiomyomas on images obtained with various techniques. The advantages of each technique in particular clinical circumstances are discussed.

Female↗
PubMed1991

Hysterosalpingography.

During the past decade, there has been a dramatic increase in the number of women seeking infertility evaluation. Hysterosalpingography (HSG) is an invaluable procedure for evaluating internal architecture of the female reproductive tract. Utilizing HSG, it may be possible to minimize the use of invasive procedures, such as hysteroscopy and laparoscopy, in defining such problems as peritubal adhesions, leiomyomas, and congenital anomalies. This review re-emphasizes the wide range of available information and advantages of HSG which can be extremely useful in the diagnosis and management of infertile patients.

Female↗
PubMed1989

Peritubal adhesions in infertile women: diagnosis with hysterosalpingography.

We studied the efficacy of hysterosalpingography in the detection of peritubal adhesions without tubal occlusion by using laparoscopy as the gold standard for the diagnosis. Peritubal adhesions were diagnosed on hysterosalpingography by using the following radiographic criteria alone or in combination: (1) convoluted fallopian tube, (2) loculation of spillage of contrast medium into the peritoneal cavity, (3) ampullary dilatation, (4) peritubal halo effect (double-contour appearance of the tubal wall), and (5) vertical fallopian tube. The first 100 patients with the diagnosis of adhesions on hysterosalpingography who also had laparoscopy were included in the study. Seventy-five patients had the diagnosis confirmed on laparoscopy, resulting in a 25% false-positive diagnosis of adhesions with hysterosalpingography. Thirty-nine (52%) of these 75 patients had one radiographic finding alone, and 20 of these patients had loculation of spillage of contrast medium. Although the patients with adhesions tended to have two or more of the radiographic findings, the difference was not statistically significant. The most frequent radiographic findings found in combination were convoluted fallopian tube and loculation of spillage of contrast medium. These findings suggest that hysterosalpingography can be the diagnostic procedure of choice in the initial investigation of infertility due to peritubal adhesions.

Fallopian Tube Diseases↗
PubMed1989

The value of hysterosalpingography before reversal of sterilization procedures involving the fallopian tubes.

Knowledge of the length of the uterine end of the fallopian tube and the presence of tubal adhesions and fistulas is important when surgical reversal is undertaken in patients who have had tubal ligation. We retrospectively studied hysterosalpingograms in 127 such patients to determine their value in providing this information. The ligation was performed by using the Pomeroy technique in 57 patients. Sixty-one patients had bipolar electrocautery, six had Falope rings inserted, and three had Hulka clips applied. In all cases, the uterine ends of the tube were visualized to a point of obstruction. The sites of occlusion after Pomeroy ligation were midtubal (46%), cornual (16%), proximal ampullary (16%), proximal isthmic (14%), and intramural (8%). After the electrocautery procedure, the sites of occlusion were proximal isthmic (45%), intramural (20%), midtubal (19%), cornual (15%), and proximal ampullary (1%). When Falope rings and Hulka clips were used, the most frequent site of occlusion was midtubal (50%). Tubal adhesions, consistent with successful occlusion, were detected in 16 patients on the basis of a small confined area of extravasation of contrast material at the site of ligation. Tuboperitoneal fistulas, identified by the presence of contrast material spilled from the uterine end of the tube into the peritoneal cavity, were detected in five patients. Our results show that hysterosalpingography is a useful technique for determining the status of the uterine end of the fallopian tube after ligation when reversal of ligation is planned.

Female↗
PubMed1985

Salpingitis isthmica nodosa in female infertility.

A retrospective study was undertaken to evaluate the radiologic appearance of salpingitis isthmica nodosa (SIN) in the fallopian tubes of 150 consecutive patients having hysterosalpingograms performed almost exclusively for primary and secondary infertility. SIN was observed in 13 of these 150 patients. The characteristic radiologic features of this condition are minute loculations of contrast medium adjacent to the tubal lumen which range in size up to 2 mm in diameter and are clustered together over a tubal length of 1 to 2 cm. Although the most frequent site of occurrence is in the proximal isthmic portion of the tube, there is occasional involvement of the distal isthmus and even the interstitial portion of the adjacent uterine cornu. Associated tubal abnormalities in this condition such as hydrosalpinx and tubal occlusion help explain the increased incidence of tubal pregnancy and infertility in patients with SIN.

Adult↗
PubMed1984

A possible explanation of the pathogenesis of osteochondritis dissecans.

We present a case in which osteochondritis dissecans of the lateral femoral condyle was associated with a torn discoid lateral meniscus. To our knowledge, this is the first reported case of this association in the radiographic and orthopedic literature. Previous trauma is suggested to play an important role in the development of both lesions.

Adolescent↗
PubMed1983

Renal positional changes in spinal-cord-injured patients.

Spinal-cord injured patients can have urinary tract changes related to their conditions. Altered renal position and vertical axis have not previously been identified. The urograms of 55 paralyzed patients were reviewed and compared with normal controls. Statistically significant differences (p less than 0.001) were noted in the position of the kidneys with respect to the renal angle and distance of the lower poles to the midline. No significant difference was noted between patients who were paraplegic vs. those who were quadriplegic. The more medial and vertical positioning of the kidneys was believed to be due to the psoas muscle atrophy in the spinal-cord-injured patients.

Adolescent↗
PubMed1983

"Micro-gallbladder"--a clue to cystic fibrosis.

We report a patient with cystic fibrosis and biliary symptoms who demonstrates a tiny gallbladder on oral cholecystography and ultrasonography which should suggest the diagnosis of cystic fibrosis. The term "micro-gallbladder" has been introduced to describe the type of gallbladder seen in cystic fibrosis patients with biliary disease.

Adult↗