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Biomedical subjects

A I Sagalowsky

Publications and source records attributed to A I Sagalowsky.

At least 19 recordsLinked to original sources
PubMed1995

Lymphoproliferative disease presenting as obstructive uropathy after renal transplantation.

Lymphoproliferative disorders occur with a greater frequency in recipients of solid organ transplants. Unlike in the general population, these tumors tend to arise in extranodal sites and are often confined to a single organ. We report on a patient with lymphoproliferative disease confined to the hilum of the renal allograft. The only clinical clue to the presence of the tumor was an increase in the serum creatinine secondary to ureteral obstruction by the mass.

Humans↗
PubMed1995

Early results with split-cuff nipple ureteral reimplants in urinary diversion.

PURPOSE: A split-cuff nipple technique was developed for ureteral reimplantation in urinary diversion. MATERIALS AND METHODS: Ureteroenteric anastomosis was performed with a uniform split-cuff nipple technique in 46 ureters of 24 adult patients undergoing various forms of conduit or continent urinary diversion. The outcome of 42 reimplants in 22 patients (mean followup 22.5 months, minimum 10) was analyzed. The technique is described in detail. RESULTS: Reflux was prevented in 97.6% and 95% of cases at initial and 2-year followup, respectively. Neither anastomotic leakage nor obstruction occurred. There were 2 episodes of pyelonephritis in the early postoperative period. Results are compared with those in the literature of ureteroenteric anastomoses in general and of various split-cuff nipple techniques. CONCLUSIONS: The technique is easy to perform. Favorable early results warrant continued use of the procedure. Long-term followup in a larger number of patients is indicated.

Adult↗
PubMed1994

Factors influencing adrenal metastasis in renal cell carcinoma.

The factors predisposing to adrenal metastasis in renal cell carcinoma were reviewed in 695 cases. The overall incidence of adrenal metastasis was 4.3%. The risk of adrenal metastasis correlated with tumors that were on the left side, large and replacing the entire kidney, upper pole in location and of advanced T stage. Nevertheless, microscopic and/or contralateral adrenal metastasis was noted in patients with smaller, lower pole or mid renal tumors. Of 30 patients with adrenal metastasis 9 (30%) had clinical evidence of widespread disease. Among the patients who underwent complete surgical resection 14% had either positive lymph nodes or other non-adrenal metastases. Of the patients undergoing resection 81% died, with a mean postoperative survival of 27 months. Sustained disease-free survival was noted in 3 patients (0.43% of the entire series) whose complete pathological staging was pT1-3b, N0, M0. The need and benefit of adrenalectomy during surgery for renal cell carcinoma are extremely limited.

Adrenal Gland Neoplasms↗
PubMed1994

Primary leiomyosarcoma of the seminal vesicle.

A case of leiomyosarcoma of the seminal vesicle is described in a 68-year-old man. Digital rectal examination and pelvic computed tomography (CT) scan disclosed a large pelvic mass in the region of the prostate, whereas magnetic resonance imaging (MRI) suggested that the mass arose from the right seminal vesicle. Biopsy of the mass revealed a high-grade malignancy, thus a radical cystoprostatectomy was performed. Pathologic examination revealed a leiomyosarcoma arising from the right seminal vesicle. The patient is well and free of recurrent disease 13 months following surgery.

Aged↗
PubMed1994

The assessment and management of renal vascular hypertension after kidney transplantation.

The clinical setting that suggests transplant renal artery stenosis, its various forms, and the involvement of the renin-angiotensin system in its pathogenesis has been reviewed. Both captopril-enhanced renography and pulse duplex Doppler ultrasound are useful noninvasive screening tests for renal artery stenosis. Some form of angiography remains essential in defining the extent of the lesion and in planning therapy. Percutaneous transluminal angioplasty is the first-line therapy for most cases. Open surgical repair provides the most definitive treatment but has greater morbidity. Medical therapy alone is appropriate in patients with significant chronic allograft rejection or other comorbidities that preclude intervention for the renal artery stenosis.

Humans↗
PubMed1993

Fate of renal allografts transplanted in patients with urinary diversion.

Fifty-five kidneys were transplanted into 50 patients with supravesical urinary diversion at 16 transplant centers between 1970 and 1991. Of the 32 males and 18 females, 40 were adults (> or = 18 years) and 10 were less than 18 years old at the time of first transplant. Mean follow-up was 7.8 years. At last follow-up, 94% of recipients were alive and 73% of the kidneys were functioning. Fifteen kidneys were lost: 9 to rejection, 3 to noncompliance, and 3 patients died with a functioning kidney. Ten (18%) transplants were followed by surgical complications. Twenty-four (44%) were followed by medical complications of which urinary tract infection was most common. Recipients age 18 or younger had more urinary tract infections than older patients. No patient had urinary stones and no patient required medical treatment for metabolic abnormalities. We conclude that drainage of kidney transplants into a supravesical urinary diversion is an effective treatment for end-stage renal disease patients without adequate urinary bladders.

Adult↗
PubMed1992

Testicular tumors in men with human immunodeficiency virus.

During a 2-year period 5 men positive for the human immunodeficiency virus (HIV) presented with 6 testis tumors among a total of 3,015 men seen at our hospital acquired immunodeficiency syndrome (AIDS) clinic. This testis tumor incidence of 0.2% is 57 times that of the United States average of 3.5 cases per 100,000 men. Two patients were only HIV positive and 3 others already had AIDS-related complex for 2 to 15 months at the time of tumor diagnosis. Tumor histology was mixed germ cell tumor in 4 patients, pure seminoma in 1 and Burkitt's lymphoma in 1. Patients underwent routine staging evaluations. Three patients had low stage mixed germ cell tumor (clinical stage 1 or 2A) and underwent retroperitoneal lymphadenectomy, which revealed pathological stage 1 or 2A disease in 1 and 2, respectively. These patients did not receive adjuvant chemotherapy. Two patients had advanced mixed germ cell tumor (clinical stage 2C) or Burkitt's lymphoma (clinical stage 4) and received combination chemotherapy from the onset. Outcome was evaluated with regard to progression of HIV disease and tumor status. The 2 patients who were only HIV positive remained so for 9 and 48 months. The 3 patients with AIDS-related complex had progression to AIDS within 1 to 9 months and 2 of these patients died 1 1/2 and 7 months after tumor diagnosis. All 3 patients with resected low stage disease had tumor recurrence within 1 to 9 months and were begun on platinum-based combination chemotherapy. The risk of false low clinical staging and early tumor progression may be higher in HIV positive men than in other testis tumor patients. Patient ability to tolerate chemotherapy and to obtain a satisfactory tumor response appeared to be primarily related to lack of progression of HIV disease to frank AIDS.

AIDS-Related Complex↗
PubMed1991

Long-term patient survival after cystectomy for regional metastatic transitional cell carcinoma of the bladder.

The records of 280 patients who underwent pelvic lymphadenectomy and radical cystectomy for transitional cell carcinoma of the bladder between 1971 and 1986 were reviewed. A total of 42 patients had either 1 (stage pN1) or more than 1 (stage pN2) positive lymph nodes (20 and 22 patients, respectively). The over-all 3-year survival rate for patients with positive lymph nodes was 27%, and it was 30 and 18.5% for stages pN1 and pN2 disease, respectively. Kaplan-Meier survival curves revealed a sustained survival advantage for stage pN1 over pN2 disease for the first 3 years (p less than 0.05) but the difference was not significant at 5 years of followup. Eleven patients with negative lymph nodes but local extension of tumor into the prostatic stroma and/or ducts had a 5-year survival rate of 36%, which equaled the survival of 49 stage pT3b,pN0 cancer patients in the same series. Surgical mortality for the entire population of 280 patients was 2.1% and there was no increase in mortality or morbidity among the node positive patients. Based on the findings of improved survival of stages pN1 and pT3b,N0 cancer patients compared to stage pN2 cancer patients, the tumor, nodes and metastasis classification offers more specific prognostic information than does a single designation of Jewett stage D disease.

Adult↗
PubMed1990

Predictors of residual mass histology after chemotherapy for advanced testis cancer.

The records of 15 patients with Stage B3 or B2/C germ cell testis tumors who underwent full surgical debulking of a residual mass after completion of chemotherapy were reviewed retrospectively to look for predictors of residual mass histology. The density, character, and change in volume of the retroperitoneal mass on computerized tomography before and after chemotherapy were compared with the histology in the primary tumor and in the residual mass. One of 6 patients without teratoma in the primary tumor had a 97 percent reduction in the mass which contained residual teratoma. Two patients with residual seminoma had a 50 percent decrease in tumor volume, and both patients died of tumor progression despite salvage chemotherapy. Two patients with pure seminomas had only residual fibrosis in masses that decreased in volume by 77 and 75 percent, respectively. One of these masses was discrete and the other was diffuse. Seven of 9 patients (78%) with teratoma in the primary tumor had either teratoma (4 of 9, 44%) or carcinoma (3 of 9, 33%) in the residual mass, and the change in mass volume ranged from a 93 percent decrease to a 540 percent increase in size. All 7 patients with residual teratoma and/or carcinoma remain free of disease after observation or further chemotherapy. For the entire series, the mass density and character did not correlate consistently with the primary tumor or residual mass histology. Residual fibrosis alone or teratoma and/or carcinoma were seen with least (0 to 50%) and greatest (more than 90%) decreases in mass volume.

Adolescent↗
PubMed1987

Functional characteristics of the Camey ileal bladder.

We studied postoperatively 14 men who underwent urinary diversion with a Camey ileal bladder in association with radical cystoprostatectomy. Clinical and urodynamic evaluations revealed that the ileal bladder provides a moderate pressure reservoir (mean pressure at capacity 37 cm. water) and offers the patient reliable daytime continence. The mean capacity of 362 ml. allows for a voiding interval of 2.2 hours but it is not adequate for storage of urine produced through the night, so that nocturnal enuresis results universally. Even after 2 years of followup the tubular-shaped ileal reservoir maintained physiological contraction waves of segmentation and peristalsis typical of human ileum. Voiding is accomplished by abdominal straining and an intraluminal pressure of more than 50 cm. water is required to maintain the urine flow. Mean peak flow rate was 19 ml. per second. Reflux was prevented successfully in 86 per cent of the renal units. Metabolic acidosis was seen in 43 per cent of the patients. While the ileal bladder falls short of being the ideal form of continent urinary diversion, it offers a psychologically attractive technique to selected and highly motivated male patients faced with the need for urinary diversion.

Aged↗