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Biomedical subjects

Sean P Elliott

Publications and source records attributed to Sean P Elliott.

At least 19 recordsLinked to original sources
PubMed2007

Rat bite fever and Streptobacillus moniliformis.

Rat bite fever, caused by Streptobacillus moniliformis, is a systemic illness classically characterized by fever, rigors, and polyarthralgias. If left untreated, it carries a mortality rate of 10%. Unfortunately, its nonspecific initial presentation combined with difficulties in culturing its causative organism produces a significant risk of delay or failure in diagnosis. The increasing popularity of rats and other rodents as pets, together with the risk of invasive or fatal disease, demands increased attention to rat bite fever as a potential diagnosis. The clinical and biological features of rat bite fever and Streptobacillus moniliformis are reviewed, providing some distinguishing features to assist the clinician and microbiologist in diagnosis.

Animals↗
PubMed2006

Management of severe urethral complications of prostate cancer therapy.

PURPOSE: We present our management of urethral stenosis and rectourinary fistula resulting from prostate cancer therapy. We concentrated on cases refractory to minimally invasive treatment, such as dilation, urethrotomy, and urinary and/or fecal diversion. MATERIALS AND METHODS: In our prospectively collected urethral reconstruction database we identified patients who underwent reconstruction of urethral stenosis or rectourinary fistula who also received prior treatment for prostate cancer. We documented demographics, prostate cancer pretreatment characteristics, prostate cancer therapy type, urethral reconstruction type and success. RESULTS: A total of 48 patients met the inclusion criteria, including 16 with rectourinary fistula and 32 with urethral stenosis. Urethral complications followed prior radical prostatectomy, brachytherapy, external beam radiotherapy, cryotherapy, thermal ablation and any combination of these procedures. Stenosis repair was successful in 23 of 32 cases (73%) and it differed little between anterior and posterior urethral stenosis. Repair was accomplished by anastomotic urethroplasty in 19 cases, flap urethroplasty in 2, perineal urethrostomy in 2 and a urethral stent in 9. Prior external beam radiotherapy was a risk factor for urethral reconstruction failure. Fistula repair was successful in 14 of 15 patients (93%), excluding 1 who died postoperatively. The complexity of fistula management was dictated by fistula size and the presence or absence of coincident urethral stenosis. CONCLUSIONS: Urethral stenosis or rectourethral fistula following prostate cancer therapy can be managed by urethral reconstruction, such that normal voiding via the urethra is maintained, rather than abandoning the urethral outlet and performing heterotopic diversion. This can be accomplished with an acceptable rate of failure, given the complexity of the cases.

Aged↗
PubMed2006

Nonoperative management outcomes of isolated urinary extravasation following renal lacerations due to external trauma.

PURPOSE: Urinary extravasation is a common finding in grade 4 and 5 renal injuries. To date there has been little written about the natural course of urinary extravasation following renal trauma. We reviewed data on the outcomes of urinary extravasation in the traumatized kidney when managed nonoperatively. MATERIALS AND METHODS: A retrospective review of the prospectively entered urological trauma database from San Francisco General Hospital was performed from 1979 to 2005. All patients with urinary extravasation after sustaining traumatic injury to the kidney as seen on computerized tomography were included in analysis. RESULTS: A total of 61 patients with urinary extravasation were identified. Of these patients 27 (44%) were treated operatively (26 of 27 underwent immediate and 1 of 27 underwent delayed open surgery). All (100%) operatively treated patients underwent renal exploration and repair at primary surgical management of associated abdominal and/or vascular injuries. Open surgical exploration resulted in nephrectomy in 5 of 27 (19%) patients. Of the 34 (56%) patients treated nonoperatively only 3 (9%) had persistent, nonprogressing urinary extravasation by computerized tomography 3 to 7 days after injury. All 3 (100%) of these patients underwent uncomplicated endoscopic ureteral stent placement followed by complete resolution of urinary extravasation. CONCLUSIONS: Nonoperative management of urinary extravasation in patients sustaining traumatic injury to the kidney without associated abdominal or vascular injury is safe and results in resolution in more than 90%. In patients with persistent urinary leakage endoscopic ureteral stent placement may be needed and is successful.

Adolescent↗
PubMed2006

Miniature intravesical urethral lengthening procedure for treatment of pediatric neurogenic urinary incontinence.

PURPOSE: Resistance to flow in a fluid conduit is proportional to tube length divided by the radius to the fourth power (Poiseuille's law). We report the results of a miniature intravesical urethral lengthening procedure where outlet resistance is increased by minimizing the diameter of the intravesical urethral tube. MATERIALS AND METHODS: Nine pediatric patients with preoperative intractable incontinence underwent the miniature intravesical urethral lengthening procedure along with continent catheterizable stoma (9 patients) and bladder augmentation (8). The intravesical portion of the urethral lengthening was 3 cm (traditionally 6 cm), and the urethra was tubularized around an 8Fr feeding tube (traditionally a 16Fr catheter). After the tubularized caudal portion was tunneled under the trigone the cephalad part of the urethra was placed as an onlay to the posterior bladder wall without ureteral reimplantation. RESULTS: At a mean followup of 31 months (range 10 to 47) 8 patients reported dry intervals of 3 hours or more, with minor leak per urethra only if they were overdue on the catheterization schedule. Mean postoperative abdominal leak point pressure was 71 cm H(2)O (range 28 to 116). Upper tracts were well preserved in all patients. One patient required bladder neck closure for intractable incontinence. CONCLUSIONS: The miniature intravesical urethral lengthening procedure requires minimal bladder tissue and is easy to perform. It appears to be an effective alternative in bladder neck reconstructive techniques, avoiding the need for ureteral reimplantation due to its small size, while functioning as a pop-off valve when the bladder is overly full. This procedure should be avoided in patients who lack a trigonal bar.

Adolescent↗
PubMed2006

Ureteral injuries: external and iatrogenic.

Both iatrogenic and traumatic ureteral injuries are rare. However, a high index of suspicion is warranted for ureteral injuries because ureteral injuries are associated with increased morbidity. The urologist should be familiar with several methods for identifying ureteral injuries and should make evaluations tailored to the clinical situation. Most ureteral injuries are short transections and can be repaired with debridement and ureteroureterostomy in the proximal and mid-ureter or ureteroneocystostomy in the distal ureter.

Humans↗
PubMed2005

Bursting strength with various methods of renal artery ligation and potential mechanisms of failure.

BACKGROUND AND PURPOSE: Vascular control is crucial during laparoscopic ligation of the renal vessels. Intracorporeal suture ligation has been replaced by easier methods, such as specialized clip appliers and automatic stapling devices; nevertheless, the optimal application and margin of safety of such devices have yet to be determined. We sought to address this question by measuring the bursting strength of arteries ligated with several standard devices. MATERIALS AND METHODS: One end of an adult porcine artery (3-7-mm diameter) was occluded with a titanium clip, self-locking polymer clip, or laparoscopic linear cutting stapler. Comparisons were made with one or two clips and with different distal cuff lengths (i.e., flush or 2 mm). The open end was secured to a pulsatile infusion pump. Leak/failure pressures were measured using a digital barometer. RESULTS: The mean bursting pressures for the clips were above physiologic arterial pressures (1220-1500 mm Hg). However, the vessels closed with the stapler leaked at a lower mean pressure (262 mm Hg). Failure of titanium or self-locking polymer clips was the result of vessel retraction into and behind the clip, while staple- line leakage occurred between individual staples. Bursting pressures with the titanium and self-locking polymer clips was unaffected by the number of clips or length of vascular cuff. CONCLUSIONS: All tested methods of vascular control performed well at physiologic pressures, suggesting that safety is not increased with traditional maneuvers such as additional clips or longer cuff length.

Animals↗
PubMed2005

Bacteriuria management and urological evaluation of patients with spina bifida and neurogenic bladder: a multicenter survey.

PURPOSE: We assessed how groups at spina bifida clinics evaluate and manage the urinary tract in patients with spina bifida, neurogenic bladder and bacteriuria. MATERIALS AND METHODS: A survey was mailed to all 169 clinics listed by the Spina Bifida Association of America. Survey items addressed baseline and surveillance evaluation, criteria used to assess urinary tract health and approaches to treatment in patients with spina bifida and neurogenic bladder. RESULTS: Of the 169 clinics personnel at 59 (35%) responded to the survey. Almost half of the respondents had an established protocol or standard of care. At most clinics the use of ultrasound (93%), voiding cystourethrograms (85%) and urodynamic testing (76%) was supported but not renal isotopic studies (14%) or excretory urograms (2%) for baseline evaluation. At all clinics ultrasound was supported for routine surveillance but there was no consensus for other imaging modalities. Assessment of clinic approaches to the evaluation and management of bacteriuria demonstrated variable results, although at most clinics fever, flank pain, dysuria, and changes in urinary pattern were identified as being consistent with true infection. Groups at clinics following their protocol or standard of care showed no significant differences in their approach compared to those at clinics lacking a protocol or standard of care. CONCLUSIONS: No consensus exists for the evaluation and management of bacteriuria in patients with spina bifida and neurogenic bladder at clinics specializing in the care of such patients, even at those with established standards of care. A clear need exists for an established, national set of evidence based guidelines to assist medical decision making in this high risk population and, thus, improve care.

Bacteriuria↗
PubMed2004

Obstructive lower urinary tract symptoms correlate with erectile dysfunction.

OBJECTIVES: To examine whether the severity of lower urinary tract symptoms (LUTS), when controlled for other factors, is related to erectile dysfunction (ED) in the male veteran population. Early evidence suggests that LUTS may be associated with ED in men. METHODS: A total of 181 male veterans were prospectively entered into the study. They completed the Sexual Health Inventory for Men (SHIM) and International Prostate Symptom Score (IPSS) questionnaires. Of the 181 men, 144 also underwent uroflowmetry, including determination of the postvoid residual urine volume. Demographic and medical history data were recorded. Pearson correlation coefficients and multiple linear regression analysis were used to examine the relationship between LUTS and ED, as well as the effects of age and comorbidities. RESULTS: The correlation coefficient (r) for the SHIM score with the total IPSS was -0.17 (P = 0.023); with the obstructive IPSS, it was -0.20 (P = 0.006); and with the irritative IPSS, -0.05 (P = 0.492). Age was the only other factor with a statistically significant correlation with the SHIM score (r = -0.23, P = 0.002). Multiple linear regression modeling showed obstructive IPSS (P = 0.001) and depression (P = 0.017) to be the only statistically significant predictors of the SHIM score. A consistent negative correlation was found between obstructive IPSS and the SHIM score across age groups, with the strongest effect for men aged 60 to 70 years (r = -0.412, P = 0.003). CONCLUSIONS: Obstructive LUTS correlated with, and were predictive of, ED, even after controlling for age and comorbidities. Although age correlated with ED, it did not add to the power of the multiple linear regression model composed of obstructive IPSS and depression.

Adult↗
PubMed2004

Self-inflicted male urethral foreign body insertion: endoscopic management and complications.

OBJECTIVE: To evaluate the cause, diagnosis, management and complications of self-inserted urethral foreign bodies in men, reviewing a 17-year experience. PATIENTS AND METHODS: From November 1986 to January 2004, 17 men were treated for self-inflicted urethral foreign bodies; the records were analysed retrospectively for presentation, diagnosis, management and complications. RESULTS: In all 17 patients the foreign bodies were clearly palpable. Objects included speaker wire, an AAA battery, open safety pins, a plastic cup, straws, a marble, and a cotton-tipped swab. The most common symptom was frequency with dysuria, but there was sometimes gross haematuria and urinary retention. The cause for inserting the foreign body varied; psychiatric disorder was the most common, followed by intoxication, and erotic stimulation was the cause in only five patients. All patients had diagnostic imaging; plain pelvic images were sufficient in 14, ultrasonography or computed tomography was needed in three. Endoscopic retrieval was successful in all but one patient, where a perineal urethrotomy was required. The most common complications were mucosal tears and false passages. Urethral strictures were associated with multiple attempts to insert the foreign body. CONCLUSION: Self-inflicted urethral foreign-body insertion in men is unusual. A radiological evaluation is necessary to determine the exact size, location and number of foreign bodies. Endoscopic retrieval is usually successful, and antibiotic coverage is necessary. A psychiatric evaluation is recommended for all patients, with appropriate medical therapy when indicated. Late manifestation has included urethral stricture disease, and a close follow-up, albeit difficult in these patients, is desirable.

Adolescent↗
PubMed2004

A bitter pill: attempting change in a pediatric morning report.

OBJECTIVE: To assess and address participants' dissatisfaction with departmental morning report (MR). METHODS: Three consecutive MR sessions were observed, and those data, in combination with findings from the literature, were used to guide creation of a quantitative survey. The survey was administered to all faculty and housestaff. Survey items addressed the educational focus, leadership, and format of MR and the value of specific educational conferences. Subsequently, 2 interventions were developed to increase participants' level of satisfaction with MR. The interventions' effect was measured 1 year later using a second survey. RESULTS: Eighty-two percent of housestaff and 43% of faculty responded to the first survey. Our findings are contrary to those in the literature. For example, respondents rated the presence of all faculty at MR as desirable, and both subspecialty and general pediatric contributions were considered important. Housestaff assigned greater educational value to all teaching conferences than did faculty. Similarly, housestaff believed more strongly than faculty that MR leadership should be changed. A follow-up survey demonstrated a decrease in mean perceived value of MR after our interventions. CONCLUSIONS: Despite aggressive research, we failed to identify the source of participants' dissatisfaction. Although our interventions were based on research data and reflected participants' perceptions and concerns related to MR, they were not supported by the faculty. This demonstrates the inherent difficulties in changing an "institution" such as MR. Thus, examination of MR goals and satisfaction by individual training programs should be conducted within the confines of the conference's preexisting structure, without attempt to apply literature-driven expectations.

Attitude of Health Personnel↗
PubMed2003

Long-term followup of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction.

PURPOSE: We investigate whether the short-term success rate (greater than 90%) of buccal mucosa free grafts in the bulbar urethra is sustained in the long term. MATERIALS AND METHODS: In 60 patients a ventrally placed buccal mucosa graft was used for repair of bulbar urethral strictures. Of these patients 49 had undergone previous attempt at repair (urethroplasty in 4, internal urethrotomy in 45). Mean graft length was 4.8 cm. In 9 patients a distal penile fasciocutaneous flap was also used for repair of concomitant penile urethral stricture. In 8 of the 9 patients the buccal mucosa graft was combined with end-to-end urethroplasty and 2 buccal mucosa grafts were used in tandem in 1. Followup was at least 1 year in all cases (mean 47 months, range 12 to 107). Failure was defined as an obstructive voiding pattern with radiographic or cystoscopic evidence of recurrent stricture. RESULTS: Bulbar stricture repair was successful in 54 patients (90%) and 4 of the remaining 6 responded to 1 internal urethrotomy for a long-term success rate of 97%. Preoperative clinical characteristics were not significantly different between those who experienced success or failure. CONCLUSIONS: Long-term outcome analysis of ventrally placed buccal mucosa onlay grafts for bulbar urethral strictures demonstrates a durable success rate of 90%. This rate can be improved (97%) with the judicious use of internal urethrotomy.

Adolescent↗
PubMed2003

Ureteral injuries from external violence: the 25-year experience at San Francisco General Hospital.

PURPOSE: We review our 25-year experience with traumatic ureteral injury, for which the approach to management differs from the far more common iatrogenic injury. MATERIALS AND METHODS: Review of our trauma data base disclosed 36 patients with 38 ureteral injuries (33 penetrating [24 gunshot, 9 stab wounds] and 5 blunt) from 1977 to 2003, a period during which we treated approximately 4,000 traumatic genitourinary injuries. RESULTS: The site of injury was the upper ureter in 70%, mid in 8% and distal in 22%. Major intra-abdominal injuries were often associated, but hematuria and hypotension were not consistent findings (75% and 50%, respectively). Excretory urograms performed in 24 patients was diagnostic in only 40%. Computerized tomography and retrograde pyelogram were diagnostic in 4 of 4 and 1 of 1 injuries, respectively (100%). Overall, diagnosis was by radiographic findings in 13 of the 36 injuries (36%) and by laparotomy in 23 (64%). Management was with stenting in 2 patients, primary closure in 12, ureteroureterostomy in 12, ureteroneocystostomy in 5, transureteroureterostomy in 1, Boari flap in 1 and nephrectomy in 1. The complication rate was 18%. CONCLUSIONS: Although traumatic ureteral injury is rare these patients are often critically ill and delay in diagnosis will increase the risk of complications. Contrast enhanced imaging in patients who are not undergoing laparotomy for associated injury should not be limited to those with hematuria and hypotension since these are not entirely sensitive. Most injuries are short segment loss in the upper ureter and can be repaired with debridement and tension-free anastamosis.

Humans↗
PubMed2003

Forssman synthetase expression results in diminished shiga toxin susceptibility: a role for glycolipids in determining host-microbe interactions.

Forssman glycolipid (FG), the product of Forssman synthetase (FS), is widely expressed among nonprimate mammalian species. Here, we describe a molecular and genetic relationship between FG expression and Shiga toxin (Stx) susceptibility. We have isolated the FS cDNA from human, canine, and murine cells. Whereas the murine and canine FS genes express a functional enzyme, the human FS cDNA was found to express a protein that lacks FS activity, despite a high degree of sequence identity with the enzymatically active murine and canine FS genes. In order to examine the relationship between FG expression and Stx susceptibility, Vero cells were transfected with the three FS orthologues or a vector control. Complementation with the human FS cDNA had no effect on Stx susceptibility, whereas stable expression of the canine and murine FS resulted in markedly decreased susceptibility to toxin. Among individual cells, an inverse correlation between FG expression and Stx binding was demonstrated. Moreover, only strongly FG-reactive cells were capable of growing in the presence of Stx. These cells were found to have high levels of FG expression and a correspondingly diminished GbO(3) content. We conclude that expression of a functionally active FS modifies Stx receptor glycolipids to FG and results in markedly decreased susceptibility to toxin. We speculate that inactivation of the FS gene during primate evolution may account, at least in part, for the marked susceptibility of human cells to Stx.

Amino Acid Sequence↗
PubMed2003

Teen smoking cessation help via the Internet: a survey of search engines.

The objective of this study was to assess Web sites related to teen smoking cessation on the Internet. Seven Internet search engines were searched using the keywords teen quit smoking. The top 20 hits from each search engine were reviewed and categorized. The keywords teen quit smoking produced between 35 and 400,000 hits depending on the search engine. Of 140 potential hits, 62% were active, unique sites; 85% were listed by only one search engine; and 40% focused on cessation. Findings suggest that legitimate on-line smoking cessation help for teens is constrained by search engine choice and the amount of time teens spend looking through potential sites. Resource listings should be updated regularly. Smoking cessation Web sites need to be picked up on multiple search engine searches. Further evaluation of smoking cessation Web sites need to be conducted to identify the most effective help for teens.

Adolescent↗