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Biomedical subjects

D K Montague

Publications and source records attributed to D K Montague.

At least 19 recordsLinked to original sources
PubMed1992

False diagnoses of venous leak impotence.

Tests for erectile dysfunction using intracavernous injections of vasoactive drugs are currently popular and have resulted in frequent diagnoses of venous leak impotence. Tests used to make this diagnosis, however, have not been validated by study in control subjects. We present 2 cases of false diagnoses of venous leak impotence. Anxiety mediated through the sympathetic nervous system may block the action of intracavernous smooth muscle relaxants. The resulting incidence of false diagnoses of venous leak impotence is unknown.

Adult↗
PubMed1992

Early experience with the controlled girth and length expanding cylinder of the American Medical Systems Ultrex penile prosthesis.

A prospective study was done to evaluate length expansion characteristics of the AMS Ultrex penile prosthesis cylinder intraoperatively and in the early postoperative period. A total of 50 patients 30 to 74 years old (mean age 55.2 years) underwent implantation of this device. Intraoperative changes in the pubis to mid glans distance between deflation and inflation ranged from 1 to 4 cm. (mean 1.9). Postoperative followup measurements were obtained in 46 patients at 1 to 15 months (mean 4). There was a 1 cm. decrease in the amount of postoperative length expansion for 6 patients, while length expansion increased by 1 cm. for 12 and for 28 the postoperative length expansion was the same as the intraoperative length expansion.

Adult↗
PubMed1992

The artificial urinary sphincter (AS 800): experience in 166 consecutive patients.

The artificial urinary sphincter model AS 800 was implanted in 166 patients with incontinence of various etiologies. Followup ranged from 6 to 94 months, with a mean of 41.6 months. Patient age ranged from 5 to 84 years, with a mean age of 59.4 years. There were 10 female patients (6%) and 156 male patients (94%). The cuff was implanted around the bladder neck in 27 patients (16%) and around the bulbous urethra in 139 (84%). A total of 40 reoperations (27 revisions and 13 device removals) was performed in 32 of 166 patients (19.3%). There were 13 mechanical device failures (7.8%), 11 cuff erosions (6.6%) and 2 periprosthetic infections (1.2%). Total or near total continence was achieved in 125 patients (75.3%), while 25 (15.1%) had improved urinary control.

Adolescent↗
PubMed1991

Infusion pharmacocavernosometry and nocturnal penile tumescence findings in men with erectile dysfunction.

Infusion pharmacocavernosometry and nocturnal penile tumescence findings were compared in 50 men with erectile dysfunction of either organic or psychogenic etiology. Of the men 29 had abnormal and 21 had normal nocturnal penile tumescence. Infusion pharmacocavernosometry parameters (equilibrium pressure, maintenance flow rate and 30-second pressure fall) were compared to nocturnal penile tumescence status (normal versus abnormal). When traditional normal values were used for infusion pharmacocavernosometry parameters poor correlation with nocturnal penile tumescence status was found. When new cutpoints for infusion pharmacocavernosometry parameters were chosen a stronger correlation was noted. This study suggests that when vasoactive drugs are injected intracavernously for diagnostic purposes, anxiety and/or the absence of sexual stimulation following the injection may prevent complete cavernous smooth muscle relaxation resulting in falsely abnormal values. Therefore, over reliance on infusion pharmacocavernosometry as a single test for evaluation and treatment decisions concerning erectile dysfunction should be avoided.

Adult↗
PubMed1991

Resection of inferior vena cava tumor thrombi from renal cell carcinoma.

Renal cell carcinoma is an unusual cancer with the propensity to invade not only the renal vein but to propagate into the inferior vena cava (IVC) as a tumor thrombus. Experience has recently confirmed that MRI will be valuable in evaluating the extent of the tumor thrombus. The surgical techniques used to remove the thrombus are dependent on the extent of the cancer. For lesions involving the infrahepatic IVC, only proximal and distal control of the IVC are necessary. For a thrombus involving the intrahepatic IVC, isolation of the suprahepatic IVC, hepatic circulation, and infrahepatic IVC or cardiopulmonary bypass can be used. For the large thrombus in the supradiaphragmatic IVC or atrium, cardiopulmonary bypass either with or without deep hypothermic circulatory arrest is appropriate. In a review of 48 cases with renal cell carcinoma with IVC tumor thrombi, the tumor thrombus was removed intact in 58 per cent and in multiple fragments ("piece-meal") in 42 per cent of the patients. Cardiac bypass has been used in 26 cases with 22 undergoing deep hypothermic circulatory arrest. The postoperative mortality of 48 cases between 1965 and 1987 was 4 per cent. Removal of the most complicated and extensive renal cell carcinoma tumor thrombi is now technically feasible. In patients with large tumor thrombi, however, the ultimate outlook remains poor in the absence of effective systemic adjuvant therapy.

Carcinoma, Renal Cell↗
PubMed1991

Renal cell carcinoma with inferior vena cava tumor thrombi.

Renal cell carcinoma is a unique neoplasm because of its common propensity to propagate into the renal vein and inferior vena cava (IVC) as tumor thrombus. Historically, the surgical difficulties encountered in removal of these cancers limited the ability of a single institution to obtain experience with large numbers of instances. Between January 1956 and July 1987, 68 patients with renal cell carcinoma extending into the IVC or right atrium underwent radical nephrectomy with vena cava thrombus extraction at the Cleveland Clinic. Twenty-five patients had partial resection of the IVC with reconstruction. Fifteen patients had partial resection and reconstruction of the IVC; however, because of narrowing of the infrarenal IVC, persisting bland thrombus in the proximal IVC or iliac veins or concern regarding postoperative pulmonary emboli, the infrarenal IVC was either ligated or clipped. Seven patients underwent cavectomy with division of the IVC. A right atriotomy was performed upon 14 patients and cardiopulmonary bypass was used in 20 patients, with 17 also having deep hypothermic circulatory arrest. The tumor thrombus was removed intact in 64 per cent of the patients and in multiple small fragments ("piecemeal") in 36 per cent of the patients. The mortality rate was 7 per cent. Survival was examined relative to extent of vena caval thrombus. Patients with extension into the atrium had a significantly worse prognosis than those with other levels of vena caval involvement. Other factors, such as lymph node status, perinephric fat involvement, resection of IVC and intact or "piecemeal" extraction, did not influence the survival rate. Patients with pre-existing metastases preoperatively had an extremely poor survival rate. The techniques now available for surgical resection of all levels of tumor thrombus of the IVC make resection feasible in most patients. In our opinion, the addition of deep hypothermic circulatory arrest has been a significant advance.

Carcinoma, Renal Cell↗
PubMed1990

Intracavernous injection therapy: analysis of results and complications.

Experience with 100 patients who used intracavernous injection therapy with a combination of papaverine with or without phentolamine for 29 months is analyzed in detail. The largest group of patients had vasculogenic erectile failure (56%). At the end of followup 50% of the patients were no longer performing injection. Those who discontinued injection therapy were slightly older and had more vasculogenic erectile failure. The nonfibrotic complications were mild in all instances and did not result in discontinuation of injection therapy. These complications consisted of small hematomas in 20.9% of the patients, mild discomfort in 13.6% and mild liver enzyme abnormalities in 9.8%. No episode of priapism or infection occurred during therapy. Fibrotic complications consisted of nodules or plaques, and correlated significantly with the number of months on injection and the number of injections. At 12 months the fibrotic complication rate was 31 +/- 8.6%. Our study suggests caution regarding the long-term complication rate of intracavernous injection therapy with these compounds and underscores the importance of routine followup examinations. While injection therapy is an effective form of treatment for erectile failure, it is not a satisfactory alternative for many patients and is associated with a significant fibrotic complication rate.

Drug Therapy, Combination↗
PubMed1989

Intracavernous injections of papaverine and phentolamine: correlation with penile brachial index.

Eighty-two patients were evaluated for erectile failure with a comprehensive history, physical examination, hormonal testing, noninvasive Doppler examination (PBI), and nocturnal penile tumescence (NPT). After these studies all patients received intracavernous injection with a combination of papaverine (50 mg) and phentolamine (1.66 mg), and both tumescence and rigidity were monitored. Rigidity response was compared with the PBI. The number of patients with a poor rigidity response in each PBI category were: 3 of 5 with a PBI of less than 0.6 (vasculogenic), 7 of 11 with a PBI of 0.6-0.75 (ambiguous), and 25 of 66 with a PBI of 0.75-1.0 (normal). These results indicate only a marginally significant association between PBI and intracavernous injection. The procedure was safe with no long-term sequelae from injection observed, and no surgical intervention was required. Complications of injections included reversible priapism in 11 patients (13.4%), transient dizziness in 10 patients (12.2%), and hematoma in 5 patients (6.2%). This study suggests that intracavernous injection with a drug combination may be a more sensitive screening test for vasculogenic impotence than noninvasive Doppler studies because it more closely simulates the erectile response.

Adult↗
PubMed1989

Conservative surgery for renal cell carcinoma: a single-center experience with 100 patients.

From January 1956 to March 1987, 100 patients underwent a conservative (parenchyma-sparing) operation as curative treatment for renal cell carcinoma at our clinic. This series includes 56 patients with bilateral (28 synchronous and 28 asynchronous) and 44 with unilateral renal cell carcinoma; in the latter category the contralateral kidney was either absent or nonfunctioning (17 patients), functionally impaired (17), involved with a benign disease process (6) or normal (4). The pathological tumor stage was I in 75 patients, II in 9, III in 10 and IV in 6. A nephron-sparing operation was performed in situ in 86 patients and ex vivo in 14. Postoperatively, 93 patients experienced immediate function of the operated kidney, while 7 required dialysis (4 temporary and 3 permanent). The incidence of dialysis was greater after ex vivo than in situ surgery (p equals 0.0005). The mean postoperative serum creatinine level in 97 patients with renal function was 1.7 mg. per dl. (range 0.9 to 4.6 mg. per dl.). The over-all actuarial 5-year patient survival rate in this series is 67 per cent including death of any cause and 84 per cent including only deaths of renal cell carcinoma. Survival was improved in patients with stage I renal cell carcinoma (p less than 0.05). Survival also was improved in patients with unilateral renal cell carcinoma (p less than 0.05) and fewer patients in this category had recurrent disease postoperatively (p less than 0.0005). Nine patients (9 per cent) had local tumor recurrence postoperatively and 5 of these were rendered free of tumor by secondary surgical excision. Conservative surgery provides effective therapy for patients with localized renal cell carcinoma in whom preservation of renal function is a relevant clinical consideration.

Actuarial Analysis↗
PubMed1989

Penile prostheses. An overview.

Penile prosthesis implantation in selected patients can achieve very gratifying results. Satisfactory surgical results can be obtained in a high percentage of cases, and if the patient and his partner are well informed preoperatively, patient and partner satisfaction can also be very good.

Erectile Dysfunction↗
PubMed1988

Penile prostheses.

Explore the source record for details and available documents.

Erectile Dysfunction↗
PubMed1987

Erectile dysfunction in men with diabetes mellitus.

During a fourteen-month period, 497 men were evaluated for a primary complaint of erectile dysfunction. The initial evaluation consisted of a history taken in a conventional manner and supplemented by a patient-completed sexual function questionnaire, a physical examination, and serum testosterone, serum prolactin, and nocturnal penile tumescence studies. When appropriate, additional evaluations, including penile vascular studies, two-hour oral glucose tolerance tests, and psychiatric consultation were obtained. Abnormal glucose metabolism was present in 161 men (32%). Five men (1%) had insulin-dependent diabetes mellitus (IDDM), 80 men (16%) had noninsulin-dependent diabetes mellitus (NIDDM), 55 men (11.1%) had newly diagnosed noninsulin-dependent diabetes mellitus, and 21 men (4.2%) had impaired glucose tolerance tests. One hundred forty-seven of these men (91.3%) had organic pattern impotence, and 14 (8.7%) had psychogenic pattern impotence.

Adult↗
PubMed1987

Periprosthetic infections.

A retrospective review of all patients undergoing implantation of a penile prosthesis or an artificial urinary sphincter was done. A total of 15 infections occurred in 556 prosthesis recipients, for an infection rate of 2.7 per cent. More than 50 per cent of the infections were caused by staphylococcal organisms. All infections became evident within 1 year after implantation except for 1 that was not apparent until 2 1/2 years later. Infections were not more common in diabetics compared to nondiabetics.

Anti-Bacterial Agents↗
PubMed1986

Endoscopic transurethral suspension of bladder neck and urethra. Experimental trials of new procedure in dogs.

An endoscopic, transurethral suspension of the female urethra and bladder neck is achieved by placing sutures through the anterior urethral wall up to the anterior abdominal fascia. The sutures are placed under direct endoscopic vision using a specially designed suture passer. In 8 female dogs a mean increase in urethral length of 1.81 cm (SEM 0.21 cm) was obtained immediately postoperatively. Reevaluation three months postoperatively demonstrated the mean increase to be 1.56 cm (SEM 0.11 cm). Cystoscopy and postmortem dissection demonstrated integrity of the repair in all 8 dogs. A clinical trial in stress incontinent women is suggested.

Animals↗
PubMed1986

Routine endocrine screening in impotence.

Routine hormonal screening (serum testosterone and prolactin) of 300 men presenting with a primary complaint of impotence resulted in detection of endocrine dysfunction in 5 men (1.7%). Four patients had hypogonadism, and 1 patient had a prolactin-secreting pituitary adenoma. The cost of screening these men for endocrine dysfunction was $34,722.00. Despite this cost and the low yield of endocrine disease detection, routine determination of serum testosterone and prolactin provides useful information to the clinician evaluating impotent men and when abnormal, indicates the need for thorough endocrine evaluation.

Adenoma↗
PubMed1986

Cost-effective evaluation of impotence.

Two hundred consecutive men presenting with a chief complaint of impotence have been evaluated with a protocol involving one or two outpatient visits. The initial evaluation for all patients consisted of a history taken in a conventional manner and supplemented by a patient-completed sexual function questionnaire, physical examination, serum testosterone and prolactin, and two-night nocturnal penile tumescence studies. Following the initial evaluation the patients were placed in one of three categories: (1) organic impotence, (2) functional impotence, (3) ambiguous impotence (mixed functional and organic impotence or organic impotence of undetermined etiology). Patients in the latter group underwent additional testing including penile vascular studies, two-hour oral glucose tolerance test, and psychiatric consultation. With this protocol, patients can be efficiently and effectively evaluated as outpatients with costs ranging from +250 to +450.

Cost-Benefit Analysis↗