The Experts below are selected from a list of 303 Experts worldwide ranked by ideXlab platform
Thomas K. Rosvanis - One of the best experts on this subject based on the ideXlab platform.
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Transurethral electrical bladder stimulation: initial results.
The Journal of Urology, 1992Co-Authors: Ross M. Decter, Pauline Snyder, Thomas K. RosvanisAbstract:AbstractTransurethral electrical bladder stimulation to rehabilitate the neurogenic bladder initially proposed by Katona has been promoted in the United States by Kaplan and Richards since the mid 1980s. Encouraged by their results, 2½ years ago we instituted a program patterned on their experience. Since January 1989 we performed transurethral electrical bladder stimulation in 21 patients ranging in age from 4 months to 26 years. The cause of the neurogenic bladder was myelomeningocele in 16 patients, Lipomeningocele in 4 and an incomplete spinal cord injury in 1. The stimulation was performed using equipment supplied by Kaplan and Richards, and the stimulation protocol followed their recommendations. The treatments were delivered in daily sessions of 90 minutes with about 20 sessions in a series. Of the patients 11 have undergone 1, 6 have finished 2 and 4 have completed 3 series of stimulation.The ultimate objective of the program is to achieve volitional voiding. To reach that goal the stimulation mus...
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Transurethral electrical bladder stimulation: initial results.
The Journal of urology, 1992Co-Authors: Ross M. Decter, Pauline Snyder, Thomas K. RosvanisAbstract:Transurethral electrical bladder stimulation to rehabilitate the neurogenic bladder initially proposed by Katona has been promoted in the United States by Kaplan and Richards since the mid 1980s. Encouraged by their results, 2 1/2 years ago we instituted a program patterned on their experience. Since January 1989 we performed transurethral electrical bladder stimulation in 21 patients ranging in age from 4 months to 26 years. The cause of the neurogenic bladder was myelomeningocele in 16 patients, Lipomeningocele in 4 and an incomplete spinal cord injury in 1. The stimulation was performed using equipment supplied by Kaplan and Richards, and the stimulation protocol followed their recommendations. The treatments were delivered in daily sessions of 90 minutes with about 20 sessions in a series. Of the patients 11 have undergone 1,6 have finished 2 and 4 have completed 3 series of stimulation. The ultimate objective of the program is to achieve volitional voiding. To reach that goal the stimulation must engender a bladder contraction that must then be perceived and ultimately controlled. Of our patients 20 (95%) achieved bladder contractions during stimulation, including 12 (60%) who had either a definite (7) or probable (5) sense of these contractions. To date, only 1 patient has started the biofeedback program to attempt to modify detrusor activity and he is presently wet on clean intermittent catheterization. Parents of 5 other children report minor positive changes in the child's perception of the bladder activity. Three patients noticed an improvement in the bowel program, although the effect only lasted during the month of stimulation in 1. Cystometrograms were performed before each series of treatments. Of the 10 patients with serial studies 2 had significant increases in bladder capacity and 3 demonstrated a clinically significant decrease in the end filling pressures. We have seen limited encouraging results from transurethral electrical bladder stimulation. This is a time-consuming, labor intensive program, and the parents and patients need to be informed of the actual potential for dramatic improvements.
Ross M. Decter - One of the best experts on this subject based on the ideXlab platform.
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Transurethral electrical bladder stimulation: initial results.
The Journal of Urology, 1992Co-Authors: Ross M. Decter, Pauline Snyder, Thomas K. RosvanisAbstract:AbstractTransurethral electrical bladder stimulation to rehabilitate the neurogenic bladder initially proposed by Katona has been promoted in the United States by Kaplan and Richards since the mid 1980s. Encouraged by their results, 2½ years ago we instituted a program patterned on their experience. Since January 1989 we performed transurethral electrical bladder stimulation in 21 patients ranging in age from 4 months to 26 years. The cause of the neurogenic bladder was myelomeningocele in 16 patients, Lipomeningocele in 4 and an incomplete spinal cord injury in 1. The stimulation was performed using equipment supplied by Kaplan and Richards, and the stimulation protocol followed their recommendations. The treatments were delivered in daily sessions of 90 minutes with about 20 sessions in a series. Of the patients 11 have undergone 1, 6 have finished 2 and 4 have completed 3 series of stimulation.The ultimate objective of the program is to achieve volitional voiding. To reach that goal the stimulation mus...
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Transurethral electrical bladder stimulation: initial results.
The Journal of urology, 1992Co-Authors: Ross M. Decter, Pauline Snyder, Thomas K. RosvanisAbstract:Transurethral electrical bladder stimulation to rehabilitate the neurogenic bladder initially proposed by Katona has been promoted in the United States by Kaplan and Richards since the mid 1980s. Encouraged by their results, 2 1/2 years ago we instituted a program patterned on their experience. Since January 1989 we performed transurethral electrical bladder stimulation in 21 patients ranging in age from 4 months to 26 years. The cause of the neurogenic bladder was myelomeningocele in 16 patients, Lipomeningocele in 4 and an incomplete spinal cord injury in 1. The stimulation was performed using equipment supplied by Kaplan and Richards, and the stimulation protocol followed their recommendations. The treatments were delivered in daily sessions of 90 minutes with about 20 sessions in a series. Of the patients 11 have undergone 1,6 have finished 2 and 4 have completed 3 series of stimulation. The ultimate objective of the program is to achieve volitional voiding. To reach that goal the stimulation must engender a bladder contraction that must then be perceived and ultimately controlled. Of our patients 20 (95%) achieved bladder contractions during stimulation, including 12 (60%) who had either a definite (7) or probable (5) sense of these contractions. To date, only 1 patient has started the biofeedback program to attempt to modify detrusor activity and he is presently wet on clean intermittent catheterization. Parents of 5 other children report minor positive changes in the child's perception of the bladder activity. Three patients noticed an improvement in the bowel program, although the effect only lasted during the month of stimulation in 1. Cystometrograms were performed before each series of treatments. Of the 10 patients with serial studies 2 had significant increases in bladder capacity and 3 demonstrated a clinically significant decrease in the end filling pressures. We have seen limited encouraging results from transurethral electrical bladder stimulation. This is a time-consuming, labor intensive program, and the parents and patients need to be informed of the actual potential for dramatic improvements.
Pauline Snyder - One of the best experts on this subject based on the ideXlab platform.
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Transurethral electrical bladder stimulation: initial results.
The Journal of Urology, 1992Co-Authors: Ross M. Decter, Pauline Snyder, Thomas K. RosvanisAbstract:AbstractTransurethral electrical bladder stimulation to rehabilitate the neurogenic bladder initially proposed by Katona has been promoted in the United States by Kaplan and Richards since the mid 1980s. Encouraged by their results, 2½ years ago we instituted a program patterned on their experience. Since January 1989 we performed transurethral electrical bladder stimulation in 21 patients ranging in age from 4 months to 26 years. The cause of the neurogenic bladder was myelomeningocele in 16 patients, Lipomeningocele in 4 and an incomplete spinal cord injury in 1. The stimulation was performed using equipment supplied by Kaplan and Richards, and the stimulation protocol followed their recommendations. The treatments were delivered in daily sessions of 90 minutes with about 20 sessions in a series. Of the patients 11 have undergone 1, 6 have finished 2 and 4 have completed 3 series of stimulation.The ultimate objective of the program is to achieve volitional voiding. To reach that goal the stimulation mus...
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Transurethral electrical bladder stimulation: initial results.
The Journal of urology, 1992Co-Authors: Ross M. Decter, Pauline Snyder, Thomas K. RosvanisAbstract:Transurethral electrical bladder stimulation to rehabilitate the neurogenic bladder initially proposed by Katona has been promoted in the United States by Kaplan and Richards since the mid 1980s. Encouraged by their results, 2 1/2 years ago we instituted a program patterned on their experience. Since January 1989 we performed transurethral electrical bladder stimulation in 21 patients ranging in age from 4 months to 26 years. The cause of the neurogenic bladder was myelomeningocele in 16 patients, Lipomeningocele in 4 and an incomplete spinal cord injury in 1. The stimulation was performed using equipment supplied by Kaplan and Richards, and the stimulation protocol followed their recommendations. The treatments were delivered in daily sessions of 90 minutes with about 20 sessions in a series. Of the patients 11 have undergone 1,6 have finished 2 and 4 have completed 3 series of stimulation. The ultimate objective of the program is to achieve volitional voiding. To reach that goal the stimulation must engender a bladder contraction that must then be perceived and ultimately controlled. Of our patients 20 (95%) achieved bladder contractions during stimulation, including 12 (60%) who had either a definite (7) or probable (5) sense of these contractions. To date, only 1 patient has started the biofeedback program to attempt to modify detrusor activity and he is presently wet on clean intermittent catheterization. Parents of 5 other children report minor positive changes in the child's perception of the bladder activity. Three patients noticed an improvement in the bowel program, although the effect only lasted during the month of stimulation in 1. Cystometrograms were performed before each series of treatments. Of the 10 patients with serial studies 2 had significant increases in bladder capacity and 3 demonstrated a clinically significant decrease in the end filling pressures. We have seen limited encouraging results from transurethral electrical bladder stimulation. This is a time-consuming, labor intensive program, and the parents and patients need to be informed of the actual potential for dramatic improvements.
Richard A. Postlethwait - One of the best experts on this subject based on the ideXlab platform.
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Initiating, Developing and Evaluating a Comprehensive Spinal Defects Clinic: A Clinical Report
Pediatric neurosurgery, 2010Co-Authors: Philipp R. Aldana, Richard A. Postlethwait, David L. Wood, Hector E. JamesAbstract:Objective: The Division of Pediatric Neurosurgery of the University of Florida College of Medicine – Jacksonville developed a multidisciplinary clinic for the better management of pediatric patients with spinal defects. The purpose of this report is to assist neurosurgeons in those regions and countries where there are no spinal defects clinics (SDC). Methods: We induced a staged process to develop a comprehensive multidisciplinary clinic for pediatric patients with spinal defects: phase I – during December 2003 to June 2004, the organizational planning, multiinstitutional recruitment of health care personnel and location of clinic space occurred; phase II – the SDC sessions initiated in June 2004 and have consequently been held on a monthly basis; phase III – this consisted of a quality improvement program during which parents/caregivers were surveyed. Results: Between June 2004 and February 2009, 139 patients/families were evaluated. Diagnoses included: myelomeningocele (102), Lipomeningocele (18), meningocele (1), myelocystocele (3), spina bifida occulta (9), spinal trauma (2), spasticity of cerebral origin (2), spinal arachnoid cyst (1) and syringomyelia (1). During this period, 110 parents/caregivers were questioned on how the SDC assisted in the care of their child. A total of 62% (of 53 responders) indicated the SDC allowed them to be better informed about their child’s medical conditions and short/long-term health care plans, 52% stated health care needs were better coordinated than prior to their participation in the SDC, and 26% responded that the initiation of the clinic had reduced their medical care travel. Conclusions: Pediatric neurosurgeons may take the lead in organizing a multidisciplinary clinic for the betterment of these children. Multidisciplinary care settings facilitate health care delivery and lead to better patient care as perceived by parents/caregivers.
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Primary treatment with temporary subcutaneous peritoneal shunts for postoperative spinal cerebrospinal fluid fistulas.
Journal of Neurosurgery: Pediatrics, 2006Co-Authors: Hector E. James, Richard A. PostlethwaitAbstract:Object The authors describe a series of attempts to treat with minimally invasive surgery cerebrospinal fluid (CSF) fistulas that develop following operations of the spine for congenital anomalies. Methods Sixteen patients in whom CSF fistulas developed following repair of congenital spinal disorders (nine Lipomeningoceles, one arachnoid cyst, two myelocystoceles, three tethered cords after myelomeningocele repair, and one scoliosis surgery) underwent placement of a temporary subcutaneous peritoneal shunt. The CSF fistulas resolved in all instances. Two patients required revision of the shunts prior to resolution of the fistula and subsequent shunt removal. Three patients suffered a lumbar wound or shunt infection, which necessitated shunt removal. Subsequent to the removal, the infection resolved and there was no recurrence of the CSF leak. Fourteen patients had their shunts completely removed within 1 year of placement. Two patients did not have their shunts removed because parental consent for the addi...
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Primary treatment with temporary subcutaneous peritoneal shunts for postoperative spinal cerebrospinal fluid fistulas.
Journal of neurosurgery, 2006Co-Authors: Hector E. James, Richard A. PostlethwaitAbstract:The authors describe a series of attempts to treat with minimally invasive surgery cerebrospinal fluid (CSF) fistulas that develop following operations of the spine for congenital anomalies. Sixteen patients in whom CSF fistulas developed following repair of congenital spinal disorders (nine Lipomeningoceles, one arachnoid cyst, two myelocystoceles, three tethered cords after myelomeningocele repair, and one scoliosis surgery) underwent placement of a temporary subcutaneous peritoneal shunt. The CSF fistulas resolved in all instances. Two patients required revision of the shunts prior to resolution of the fistula and subsequent shunt removal. Three patients suffered a lumbar wound or shunt infection, which necessitated shunt removal. Subsequent to the removal, the infection resolved and there was no recurrence of the CSF leak. Fourteen patients had their shunts completely removed within 1 year of placement. Two patients did not have their shunts removed because parental consent for the additional surgery was not given. Postoperative subcutaneous CSF fistulas of the spine can be successfully treated using temporary subcutaneous peritoneal shunts. This procedure reduces hospital stay and obviates the need for more extensive or multiple surgical interventions.
M M Darbey - One of the best experts on this subject based on the ideXlab platform.
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Late Effects of Early Surgery on Lipoma and Lipomeningocele in Children Less Than 1 Year Old
The Journal of urology, 1997Co-Authors: N Satar, S B Bauer, J Shefner, Mary Kelly, R. M. Scott, M M DarbeyAbstract:ABSTRACTPurpose: We attempted to assess the usefulness of urodynamic testing for diagnosing lipoma and Lipomeningocele, and the late effects of early neurosurgical intervention in children less than 1 year old.Materials and Methods: A total of 28 patients in whom spinal surgery was performed before age 1 year for correcting lipoma and Lipomeningocele underwent neurological and urodynamic evaluation preoperatively, and within 3 months and up to 14.5 years postoperatively.Results: Preoperatively 15 patients (54%) had an abnormal neurological examination and 7 had an abnormal urodynamic study. Of the 13 patients with a normal neurological examination 3 had an abnormal urodynamic study. Overall 10 patients (37%) had an abnormal urodynamic examination preoperatively. Immediately after surgery 8 patients (29%) had improvement (2 of 15 with an abnormal neurological examination and 6 of 10 with an abnormal urodynamic study), whereas the condition of 9 (32%) worsened, including 4 of the 13 who were neurologically ...
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The Effects of Delayed Diagnosis and Treatment in Patients with an Occult Spinal Dysraphism
The Journal of Urology, 1995Co-Authors: N Satar, S B Bauer, J Shefner, Mary Kelly, M M DarbeyAbstract:AbstractFrom 1987 to 1993, 21 older individuals presented for the first time with signs and symptoms that eventually led to the diagnosis of occult spinal dysraphism. Assessment consisted of a neurological examination, urodynamic studies preoperatively and postoperatively, and spinal cord imaging. Of 21 patients 18 had an abnormal neurological examination, whereas only 15 had an abnormal urodynamic study, as judged by sphincter electromyography. Radiological imaging showed that 9 patients had a tethered cord alone, 4 each had Lipomeningocele and lipoma, 2 had a bony spine abnormality and 1 each had thoracic meningocele and diastematomyelia. Of the 21 patients 19 underwent spinal surgery. Postoperatively, the neurological examination improved in 1 case (5 percent) and remained unchanged in 18 (95 percent), while urodynamic findings improved in 3 (16 percent), were unchanged in 11 (68 percent) and worsened in 5 (26 percent). Six patients had progressive deterioration and required secondary spinal surgery, w...
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The effects of delayed diagnosis and treatment in patients with an occult spinal dysraphism.
The Journal of urology, 1995Co-Authors: N Satar, S B Bauer, J Shefner, M D Kelly, M M DarbeyAbstract:From 1987 to 1993, 21 older individuals presented for the first time with signs and symptoms that eventually led to the diagnosis of occult spinal dysraphism. Assessment consisted of a neurological examination, urodynamic studies preoperatively and postoperatively, and spinal cord imaging. Of 21 patients 18 had an abnormal neurological examination, whereas only 15 had an abnormal urodynamic study, as judged by sphincter electromyography. Radiological imaging showed that 9 patients had a tethered cord alone, 4 each had Lipomeningocele and lipoma, 2 had a bony spine abnormality and 1 each had thoracic meningocele and diastematomyelia. Of the 21 patients 19 underwent spinal surgery. Postoperatively, the neurological examination improved in 1 case (5%) and remained unchanged in 18 (95%), while urodynamic findings improved in 3 (16%), were unchanged in 11 (68%) and worsened in 5 (26%). Six patients had progressive deterioration and required secondary spinal surgery, which helped only 2 (33%). These observations confirm that older children and adults with occult spinal dysraphism are more likely to present with irreversible urological and neurological findings than younger children, and so it is imperative that a diagnosis be made and treatment be instituted as early as possible.