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D J Culkin

Publications and source records attributed to D J Culkin.

At least 19 recordsLinked to original sources
PubMed1992

Evaluation of a new tumor marker for localized prostate cancer.

Adenocarcinoma associated antigen (ACAA) is a large molecular weight protein that is normally found in low serum levels. Recent data have revealed elevations in patients with adenocarcinomas, including prostate cancer. To evaluate the relationship of ACAA levels with prostate cancer, we measured the cytosol content in malignant and nonmalignant prostate tissue and compared these results to those of the standard markers, prostatic acid phosphatase (PAP) and prostatic specific antigen (PSA). Enzyme solid phase immunoassay was used to quantitate PSA and ACAA levels, and the enzymatic method was used to measure PAP. Wedge resection from the right and left posterior lobes of 50 fresh radical retropubic prostatectomy specimens were used for cytosol analysis. All foci of within each prostate gland were carefully mapped by a single pathologist. When all malignant wedges (N = 74) were compared to all the benign wedges (N = 21), only the PSA levels showed significant elevation (p less than 0.02). However, when benign and malignant tissue from the same prostate were available for comparison, both PSA (N = 17) and ACAA (N = 16) showed significant elevations in the cytosol of the malignant tissue (p less than 0.002 and p less than 0.03, respectively). Although not statistically significant, the cytosol PAP did show a consistent trend to be greater in malignant tissue. It appears that there is an association of increased cytosol ACAA and PSA with prostate cancer.

Acid Phosphatase↗
PubMed1992

Ureteral injury in abdominal vascular reconstructive surgery.

Iatrogenic ureteral injuries in vascular reconstructive surgery are rarely reported. We present a case of ureteral transection during repair of an aortic aneurysm in a patient with a previously placed aortobifemoral graft. In reported series of surgical ureteral injuries, 17 of 381 injuries occurred during vascular procedures. A review of the literature and management scheme for ureteral complications in the presence of prosthetic vascular grafts is presented in light of current endourologic materials and techniques.

Abdomen↗
PubMed1992

Acquired immunodeficiency syndrome manifesting as prostate nodule secondary to cryptococcal infection.

We report the first case of acquired immunodeficiency syndrome (AIDS) presenting as prostate nodularity secondary to mycotic granulomatous prostatitis which mimicked prostatic cancer on digital rectal examination. Transrectal ultrasonography revealed hypoechoic areas in the peripheral zone, which on biopsy specimen were found to represent cryptococcal infection. Subsequent serologic evaluation of the patient confirmed human immunodeficiency virus (HIV) positivity and later AIDS developed in the patient.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Anatomic, functional, and pathologic changes from internal ureteral stent placement.

The anatomic, hydrodynamic, functional, and pathologic changes associated with unilateral internal ureteral stenting were evaluated in 20 female canines. Selective glomerular filtration rates (GFR) were measured with technetium 99m diethylenetriamine pentaacetic acid (DTPA) renal scans (N = 14) prior to and several weeks after unilateral internal stent placement. Cystometry and cystography were done at weekly intervals to determine if reflux occurred and to measure the intravesical pressure to produce this reflux (N = 16). Ureteral lumenal capacities of mid 6-cm ureteral segments of stented and unstented ureters were compared. The mid-ureteral lumenal volumes were three times greater in the stented ureters (p < 0.002). There were no significant differences in the selective GFR before and after stenting. Low-pressure vesicoureteral reflux occurred at a mean intravesical pressure of 13.7 cm of water and was present in 84.6 percent (11/13) of the canines whose stents did not migrate or obstruct from encrustation. There were no significant alterations in serum chemistries or blood counts. Fluoroscopic imaging also showed ineffective ureteral peristalsis. This study confirms that internal ureteral stents cause vesicoureteral reflux and significant lumenal dilation without altering renal function.

Animals↗
PubMed1991

Ureteral stump carcinoma incidentally found at cystectomy for bladder cancer.

We report on a sixty-five-year-old man with hematuria secondary to superficial bladder cancer. Because of previous urethral trauma, a complete transurethral resection of his bladder tumor could not be done. He, therefore, underwent cystectomy, at which time we incidentally found a transitional cell carcinoma of the left ureteral stump that had been left from a previous left nephrectomy for a World War II-related injury. This case underscores the importance of a thorough investigation of the complete urinary tract in a patient with hematuria or other urinary tract symptoms even if an obvious cause is found for his symptoms.

Aged↗
PubMed1991

Ultrasound guided percutaneous renal biopsy using an automatic core biopsy system.

With real-time ultrasound visualization and an automatic core biopsy system 23 percutaneous renal biopsies were performed with the use of local anesthesia in 22 patients. Adequate tissue for diagnosis was obtained in all 23 cases, with 1 patient undergoing bilateral renal biopsy and 1 requiring repeat biopsy. One patient had an asymptomatic perirenal hematoma and 1 experienced a single episode of transient gross hematuria. There were no major complications. The use of an automatic core biopsy system guided by real-time ultrasound is an important technique that may be added to the urological armamentarium.

Anesthesia, Local↗
PubMed1991

Bladder cancer in spinal cord injury patients.

A total of 8 cases of bladder cancer in spinal cord injury men (4 quadriplegics and 4 paraplegics) was seen at 3 medical centers since 1985. All 8 men had a hyperreflexic bladder and 3 of them had associated detrusor-sphincter dyssynergia. Upper tract changes were noted in 4 patients: 2 with distal ureterectasis and 2 with mild hydronephrosis. Only 1 of these men did not have historical films with which to compare results. Histology was transitional cell carcinoma in 6 men and squamous cell carcinoma in 2. Four patients presented with muscle invasion and 1 presented with diffuse carcinoma in situ involving the penile urethra. Three patients presented with superficial transitional cell carcinoma and 2 of them had progression to muscle invasion within 6 and 11 months. All but 2 of the patients with invasive disease underwent a radical operation and urinary diversion. Although followup is short (range 6 to 17 months), 5 patients are well with no evidence of disease and of the 3 who died 2 had no evidence of disease. We found a lower incidence of bladder cancer and a decreased percentage of squamous cell carcinoma than in previous reports, which may reflect an improvement in the lower tract management of these patients. Survival with appropriate bladder cancer treatment appears to correlate well with that of the ambulatory population.

Adult↗
PubMed1991

Unresectable calcified bladder tumor: hemiacidrin irrigation as an adjunct to resection.

Radiographic calcification of urothelial malignancies is an uncommon finding. To our knowledge, calcification of transitional cell carcinoma of the bladder preventing transurethral resection has not been reported previously. We report a case of an initially unresectable radiopaque bladder tumor and discuss the successful, conservative management with continuous bladder irrigation with hemiacidrin followed by complete transurethral resection.

Calcinosis↗
PubMed1991

Incidental ileal carcinoid associated with multiple urologic malignancies.

Although associated primary neoplasms frequently occur with carcinoid tumors, associated nonendocrine urologic malignancies are uncommonly encountered. We report the first case of an incidental ileal carcinoid associated with bilateral renal cell carcinoma and prostatic adenocarcinoma.

Adenocarcinoma↗
PubMed1990

Separate annular strictures of the rectosigmoid colon secondary to unsuspected prostate cancer.

Rectal involvement from prostate cancer occurs in 1.5-11% of cases. A rarer presentation is that of a separate metastasis to the high rectosigmoid colon causing an annular stricture. We present our experience with six such cases who presented with gastrointestinal symptoms. Two of the cases had undergone intestinal resections. All 6 patients had radiographic evidence of an annular stricture in the rectosigmoid area. Retrospective review revealed evidence of metastatic disease in all cases in the form of abnormalities in one or more of the following: intravenous urography, radionuclide bone scan, liver spleen scan, acid phosphatase, or alkaline phosphatase. The mean survival was 9.3 months. This rare presentation of prostate cancer may be difficult to distinguish from primary colorectal cancer and therefore needs to be ruled out to avoid intestinal resections.

Aged↗
PubMed1990

Female urinary retention.

The urodynamic results in 68 females with urinary retention were reviewed. There were two groups: 39 patients with neurologic causes for retention, and 29 patients in whom possible causes for retention included: psychological history (15 patients), gynecologic pathology, and urinary tract infection. Nine patients in the neurogenic group and 13 patients in the non-neurogenic group had undergone urethral dilatation with no improvement. Upper urinary tract evaluation was unremarkable. Detrusor failure was the prominent bladder pattern in both groups. In the neurogenic group, low pressure detrusor activity was also present in 10 patients, 3 of whom had sphincter dyssynergia. Flow rate, surface electromyography, and bethanechol supersensitivity test could not help differentiate neurogenic from non-neurogenic detrusor failure. The notation of abnormal bladder sensation did significantly differ between the groups, but was of limited accuracy as an indicator of neurogenic retention. Self-intermittent catheterization was the most effective treatment for both groups, with some patients voiding adequately in follow-up. Although no one test can accurately differentiate neurogenic from nonneurogenic female urinary retention, careful neurourologic evaluation will help guide us to more appropriate management.

Bethanechol↗
PubMed1990

Fournier's gangrene in children.

Necrotizing fasciitis of the genitalia is a rare urologic emergency that is especially uncommon in children. We report a case of Fournier's gangrene in a four-year-old boy and analyze the data from 55 previously reported cases. Pediatric cases have been successfully managed with a more conservative surgical approach and have had a significantly lower mortality rate than adult cases.

Child, Preschool↗
PubMed1990

Acute urinary retention in a child with appendiceal abscess: diagnostic dilemma.

Rarely do children with appendiceal abscess present with acute urinary retention as the only sign or symptom. This presentation may delay diagnosis and definitive therapy, thereby causing additional morbidity and possible mortality. We report the eighth case of acute urinary retention in a child associated with an appendiceal abscess.

Abscess↗
PubMed1990

Maxi-pouch: a new technique for ileal conduit conversion to continent urinary reservoir.

We present an alternative technique for conversion of an ileal conduit to a continent urinary diversion that uses a combination of ileal and ileocolonic substitutions. Filling pressure studies and radiography of the pouch, endoscopy and excretory urography revealed a reservoir capacity of 850 cc, no reflux, normal urinary tracts and no uninhibited contractions. In complex cases of neuropathic and nonneuropathic bladders or patients who have undergone cystectomy and have an unacceptable lower urinary tract for undiversion, we propose this technique of continent urinary reservoir as an alternative.

Adult↗