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Biomedical subjects

A Greenstein

Publications and source records attributed to A Greenstein.

At least 19 recordsLinked to original sources
PubMed1996

Do reported micturition symptoms on the American Urological Association Questionnaire correlate with 24-hour home uroflowmetry recordings?

PURPOSE: Patient subjective descriptions of micturition habits using the American Urological Association (AUA) symptom index were compared with uroflowmetry recordings obtained during a 24-hour period. MATERIALS AND METHODS: In a prospective study, the AUA questionnaire was given twice to 42 men. All micturitions during a typical 24-hour period were continuously recorded by a home uroflowmetry system. Daytime frequency, strength and intermittency of the stream, and nocturia were calculated from the recorded data, which were correlated with the matching questionnaire answers. RESULTS: Except for nocturia, there was no correlation between the answers and recorded findings. CONCLUSIONS: Men are unable to quantify correctly their own clinical status. The study results cast doubt on the validity of the self-administered AUA survey to reflect clinical micturition.

Aged↗
PubMed1995

Perinuclear anti-neutrophil cytoplasmic antibody and refractory pouchitis. A case-control study.

Refractory pouchitis (RP) is a debilitating complication of ileal pouch reservoirs that affects approximately 2.5% of patients. Although the cause of RP is unknown, it is frequently hypothesized that it reflects underlying Crohn's disease. Since perinuclear anti-neutrophil cytoplasmic antibody (pANCA) is found in approximately 70% of ulcerative colitis patients but only rarely in Crohn's disease patients, it may help distinguish Crohn's disease from ulcerative colitis. Therefore, to test whether RP reflects "missed" Crohn's disease, we determined the ANCA status of 26 patients with RP. The pANCA was positive in 42% of cases [50% of Kock pouch cases and 33% of ileoanal pull-through (IAPT) cases] and 57% of matched control subjects without pouchitis (N = 42, P = NS). Moreover, 3/6 (50%) of IAPT RP subjects whose signs and symptoms most suggested Crohn's disease tested positive for pANCA. When compared to controls, IAPT cases exhibited significantly more preoperative extraintestinal manifestations (EIMs) of inflammatory bowel disease (P < 0.05). The presence of preoperative EIMs was 100% predictive of postoperative EIMs (P < 0.05). Review of pouch biopsies from cases of RP revealed no pathognomonic histologic features of Crohn's disease. These data confirm our previous suggestion that RP does not reflect underlying Crohn's disease but may be associated with the EIMs of inflammatory bowel disease.

Adult↗
PubMed1995

Visually stimulated erection in castrated men.

Sexual interest and activity decrease following castration. We determined by objective criteria the erectile status of 16 men who were sexually active before castration for prostatic cancer. Castration was achieved by orchiectomy or hormonal manipulation. Patients answered a questionnaire regarding the medical status and erectile function before and after castration, and the blood level of testosterone was assessed. During viewing of an erotic videotape penile circumference and erection quality were monitored. Four patients (25%) achieved functional erection. Mean serum free testosterone levels in men who achieved erection were 1.125 +/- 0.362 pg./ml. (standard deviation) and 0.628 +/- 0.098 pg./ml. in those not achieving functional erection (p < 0.001). No statistically significant difference was noted in age, interval since castration, co-morbidity score or method of castration between the men who did and did not achieve erection.

Aged↗
PubMed1995

Cardiac arrhythmias during nonsynchronized extracorporeal shock wave lithotripsy.

PURPOSE: We evaluated the occurrence of cardiac arrhythmias during nonsynchronized extracorporeal shock wave lithotripsy. MATERIALS AND METHODS: A total of 125 nonsynchronized shock wave lithotripsy treatments was performed using a spark plug lithotriptor. RESULTS: Asymptomatic unifocal ventricular premature contractions occurred during 23 treatments (18.4%) and were more frequent during therapy on the right side (p < 0.05). Among patients undergoing multiple sessions only 1 exhibited ventricular premature contractions during treatment. No correlation was demonstrated between ventricular premature contractions and patient age, gender, presence of heart disease, stone size and location within the collecting system (kidney or ureter), presence of a ureteral catheter or nephrostomy tube, mode of anesthesia or number of shock waves. CONCLUSIONS: Nonsynchronized shock wave lithotripsy can be accomplished safely in most patients.

Adult↗
PubMed1994

Prostatic fluid analysis in spinal-cord-injured patients with recurrent urinary tract infections.

OBJECTIVE: Recurrent urinary tract infections are common in spinal-cord-injured patients. Our study was designed to evaluate the association of bacteria colony counts, white blood cell (WBC) count, and antibody-coated bacteria analyzed in urethral and prostatic samples in hospitalized spinal-cord-injured patients with recurrent urinary tract infections. METHODS: Thirty-three patients were studied and 4 noninfected patients served as controls; 17 patients were paraplegic and 20 were quadriplegic. Mean patient age was 34.8 years and mean follow-up period was ninety-three days. During the surveillance period, 19 of the 33 patients had relapsing infections (same organism), while 14 had reinfections (new organism). A modified Foley catheter was used to seal the bladder neck, so that urethral and prostatic samples could be obtained. RESULTS: Bacteria colony counts and WBC counts did not correlate with relapsing infection. However, significantly more patients with relapsing infection (8/19) had antibody-coated bacteria in their prostatic fluid than patients with reinfection (1/13) (P < 0.05). CONCLUSIONS: The presence of antibody-coated bacteria in prostatic fluid is associated with relapsing urinary tract infections and not with reinfection.

Adult↗
PubMed1994

Use of automatic insulin injector for intracorporeal injection in erectile dysfunction.

Intracorporeal injection of vasoactive drugs for the treatment of impotence may be problematic in patients with limited dexterity or psychogenic inhibitions of self-injection. Already in common use for diabetic patients is an easy-to-use automatic injector device, with rapid and simple loading and operating. This economical and handy gadget is adapted to accept standard disposable syringes. We have found it useful also for painless self-injection of intracorporeal vasoactive drugs for the treatment of erectile dysfunction.

Aged↗
PubMed1994

Characteristics of men interested in evaluation of erectile dysfunction.

Erectile dysfunction is a common disorder. However, not all dysfunctional men want to pursue evaluation. To delineate the characteristics of men interested in evaluation of erectile dysfunction, we conducted a mailed survey of 1031 randomly selected male veterans aged 30-99 years. We received 427 completed surveys. Using logistic regression, we found loss of sexual pleasure, loss of stiffness and duration of erection, and the ability to have orgasm to be predictors of which men were interested in evaluation of erectile dysfunction. Age, functional status, availability of a partner, marital status, sexual interest, partner's sexual interest, and duration of dysfunction were not significantly different between men interested and not interested in evaluation of erectile dysfunction.

Adult↗
PubMed1992

Transdermal scopolamine in prevention of post open prostatectomy bladder contractions.

In a prospective randomized double-blind study among 50 males undergoing surgery we evaluated the possible role of transdermally applied scopolamine (Scopoderm) in the prevention of post open prostatectomy bladder contraction and pain. Patients were evaluated by subjective report of their pain, urination sensation while having indwelling catheter, amount of narcotic administration, and bladder pressure measurements. No significant differences were noted with regard to the occurrence of pain or overall analgesia requirements. However, on postoperative day 2, a significant decrease in analgesia requirements was found among the treated patients. We suggest that the use of Scopoderm may lead to a reduced demand for narcotics by patients from postoperative day 2 onward.

Administration, Cutaneous↗
PubMed1992

The effect of polyethylene glycol-superoxide dismutase administration on histological damage following spermatic cord torsion.

Oxygen free radicals generated during the ischemic/reperfusion period have been suggested as a possible cause for tissue damage in different organs. In this study we address the question of whether administration of polyethylene glycol-superoxide dismutase, an oxygen free radical scavenger, can alleviate histological damage associated with testicular torsion. The study included 67 Sprague-Dawley rats. In 60 rats the left testicle was rotated 720 degrees clockwise through a scrotal incision. Torsion duration was 3 hours. Five minutes before and 5 minutes after detorsion the testicle color was evaluated and scored. The remaining 7 rats underwent a sham operation. After randomization 8,000 units per kg. polyethylene glycol-superoxide dismutase were injected intraperitoneally in the treated group 1 hour before detorsion. After 14 days histological evaluation was performed on both testicles of 58 rats (2 rats died before the evaluation). No statistically significant difference was demonstrated between the treatment (28 rats) and the control groups (30 rats). Testicular color after detorsion correlated with the histological damage.

Animals↗
PubMed1992

Voiding by increased abdominal pressure in male spinal cord injury patients--long term follow up.

We reviewed the long term follow up of five spinal cord injury patients with detrusor areflexia who emptied their bladder using high abdominal pressure. Ages ranged from 29 to 58 years, and the mean time elapsed from injury was 18.9 years. The bladder pressure during voiding ranged from 95 to 160 cm of water. One patient developed vesicoureteral reflux and hydronephrosis. Long term monitoring is suggested in patients who use high abdominal pressure for bladder emptying.

Abdomen↗
PubMed1992

T lymphocyte subsets and function in the peripheral blood of patients with urological cancer.

The phenotypic distribution and immune reactivity of T lymphocyte subpopulations from peripheral blood of 50 patients with urological cancer were determined. Included were 36 patients with bladder transitional cell carcinoma, 7 patients with renal cell carcinoma and 7 patients with prostatic carcinoma. Thirty-eight age-matched patients with benign urological disease served as controls. A depression in immune competence was found in the group of male patients with infiltrating bladder cancer. In more than 50% of the patients with infiltrating bladder carcinoma, the T helper (CD4) subset was reduced with a concomitant inversion in the CD4/CD8 ratio and impairment in the T cell function as determined by the ability to proliferate upon phytohemagglutinin and concanavalin stimulation. Patients with superficial bladder carcinoma, as well as those with renal cell carcinoma had an immune profile similar to that of the control group. The group of patients with prostatic carcinoma had higher mean CD4/CD8 ratios than the control group, resulting from decreased suppressor/cytotoxic cells. Our results have indicated that the characterization of T cell subset and lymphocyte activity correlated well with the histopathologic state of patients with bladder carcinoma. Thus, the determination of the CD4/CD8 ratio may prove a valuable method for monitoring patients with bladder carcinoma, in addition to serial urine cytology, random urothelial biopsies and flow cytometry.

Adenocarcinoma↗
PubMed1991

Characterization of peripheral blood T-cell subpopulation of bladder cancer patients.

The levels of immune reactivity of peripheral and blood T-lymphocytes were evaluated in 37 bladder cancer patients and 31 age-matched controls. T-lymphocyte subsets were quantified by monoclonal antibodies, and the immune reactivity was measured using stimulation with phytohemagglutinin (PHA), concanavalin A (ConA), and pokeweed mitogen (PWM). Comparing the patients before and after treatment revealed significant changes in the stimulation index of proliferative response to PHA, PWM, in the PWM% (the patient response compared to the control), and in the percent of T8 cells from the total count of blood lymphocytes. Further significant differences were found among the disease stages in the numbers of T3, T4 lymphocytes subpopulations and the total lymphocyte count. A significant interaction was found between the treatment and patient's sex regarding the T4:T8 ratio. Also, a higher prevalence of T4:T8 less than 1 was found among the patients compared to the controls before and after treatment regardless of the disease stage. This T4:T8 less than 1 ratio can serve as an indicator of immune competence in bladder transitional cell carcinoma patients.

Aged↗
PubMed1991

The role of oxygen free radicals and prostaglandins in reperfusion injury to warm ischemic kidneys.

The present study was designed to determine whether the administration of superoxide dismutase (SOD) can alleviate ischemic kidney damage and whether there is a relationship between oxygen free radicals and thromboxane (Tx). In 17 dogs, the right kidney was removed and the vascular pedicle of the left kidney was clamped for 75 min. Prior to reperfusion, the ischemic kidney was rinsed with 5 mg SOD and an additional 20 mg SOD was infused systemically. Blood samples were drawn from the renal vein before ischemia and after reperfusion to determine serum levels of thromboxane B2 (TxB2). All eight untreated dogs died within 1 week of renal failure, and the nine treated dogs demonstrated transient renal failure, with a significant difference (P less than 0.001) being found between the two groups. A significant difference (P less than 0.001) in TxB2 levels was found in the untreated dogs before and after ischemia and between the two groups following reperfusion. Animals that are treated with SOD after the ischemic event has occurred but before reperfusion exhibit a favorable clinical course in terms of survival and renal function. Tx synthesis in the kidney can be blocked by the administration of SOD.

Animals↗
PubMed1991

Effect of implanted epidural stimulator on lower urinary tract function in spinal-cord-injured patients.

A spinal cord stimulator was implanted in the epidural space in 33 spinal-cord-injured patients for the treatment of severe extremity spasticity. We prospectively evaluated the effect of the stimulator on the lower urinary tract in these patients. Urodynamic evaluation was performed preoperatively, and in 23 patients 3 months to 1 year after implantation. Postoperative changes in the lower urinary tract function were noted in 6 patients. One patient converted from detrusor areflexia to detrusor hyperreflexia, and 1 patient converted from detrusor hyperreflexia to detrusor areflexia. Four patients demonstrated changes in the duration of detrusor contraction and external sphincter dyssynergia. In 2 of these 4 patients, the changes in the duration of detrusor contraction and external sphincter dyssynergia were related to the activation and deactivation of the stimulator. Urodynamic parameters did not change significantly following implantation in the remaining 17 patients. We conclude that epidural stimulator implanted for the treatment of spasticity may alter the lower urinary tract function. Patients with postoperative changes in the lower tract function should be evaluated with the stimulator activated and deactivated.

Adult↗
PubMed1990

Clinical importance of prostatic measurements in follow-up of GnRH analogue-treated prostatic carcinoma patients.

Thirteen patients with advanced adenocarcinoma of the prostate were treated with buserelin-a gonadotropin-releasing hormone (GnRH) analogue. Follow-up period extended to thirty-six months during which 8 patients were considered either responsive or stabilizing, in terms of pain relief and clinical tumor regression, and 5 were categorized as suffering from progressive disease. Urinary symptoms were ameliorated in the majority of cases (11/12). Prostatic size was measured by rectal ultrasound, an accepted accurate new modality. In 12 patients a decrease in size was demonstrated, and only in 1 progressive case the prostate grew larger on a six-month follow-up. Thus prostatic size and clinical responsiveness are not correlated. The clinical value of recording urinary symptomatology and measuring prostatic size in prostatic carcinoma patients is discussed with regard to the latest communications that GnRH analogues acting by decreasing testosterone levels, can cause amelioration in benign prostatic hypertrophy (BPH) cases, too. It is suggested that prostatic size has little clinical value concerning tumor responsiveness in the follow-up of patients with prostatic carcinoma.

Adenocarcinoma↗
PubMed1990

Transurethral incision of the bladder neck and prostate.

Between March 1983 and December 1988, 66 men 50 years old and older with symptomatic bladder outlet obstruction underwent transurethral incision of the bladder neck and prostate. Patients selected for incision had a small, clinically benign, prostate and peak urinary flow rate of less than 15 ml. per second. Preoperative and postoperative evaluation included symptom questionnaires and uroflowmetry. A single midline incision was made extending from the bladder neck to the verumontanum. Results were available in 64 of the 66 men who underwent the procedure with a mean followup of 2.24 years. Mean symptom scores decreased from 9.66 preoperatively to 4.59 postoperatively (p less than 0.001) and peak urinary flow rates increased from 7.4 to 14.7 ml. per second (p less than 0.0001). Antegrade ejaculation was preserved in 83.3% of the men who preoperatively had antegrade ejaculation. Subsequent transurethral resection of the prostate was required in 5 patients (7.6%). With a mean followup of greater than 2 years transurethral incision of the bladder neck and prostate was effective in treatment of bladder outlet obstruction caused by a small prostate while maintaining antegrade ejaculation in the majority of patients.

Follow-Up Studies↗