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D Pode

Publications and source records attributed to D Pode.

At least 37 records · Page 2Linked to original sources
PubMed1997

Life-threatening retroperitoneal hematoma caused by anticoagulant therapy for myocardial infarction after SWL.

Extracorporeal shock wave lithotripsy, the primary treatment for renal and ureteral stones, is an elective procedure with a low rate of complications, although most patients have macrohematuria which lasts for a few hours, and as many as 25% develop a renal or perirenal hematoma. Therefore, SWL is not performed during anticoagulant therapy, and any blood dyscrasias should be corrected prior to the procedure. We present a case of a patient who had an acute myocardial infarction after SWL, was treated with anticoagulation and emergency coronary angioplasty, and subsequently developed a life-threatening retroperitoneal hemorrhage. Cessation of anticoagulation with fluid support and drainage of a pleural effusion eventually resulted in complete recovery.

Angioplasty↗
PubMed1997

[Radical retropubic prostatectomy].

Radical prostatectomy may cure most patients in whom the malignant tumor has not invaded through the prostatic capsule. Advances in surgical technique and accumulation of experience have decreased the complication rate significantly. Long-term results of surgical treatment are now better than those of other forms of treatment; hence radical prostatectomy is now recommended for men with life expectancies longer than 10 years. Between 1988 and 1995, 164 men with clinical stages T1 or T2 adenocarcinoma were admitted for radical prostatectomy. Most were not offered a nerve-sparing procedure, so as to allow wider, more complete resection. Those who wanted preservation of sexual function underwent the nerve- preserving procedure. In 6 patients operation was discontinued when metastases to the mac lymph nodes were detected and in 1 when invasion of the pelvic wall was found, 157 underwent radical prostatectomy. Preoperative biopsy revealed a low-grade lesion (Gleason 2-4) in 19.1%, intermediate grade (Gleason 5-6) in 61.8% and high-grade (Gleason 7-9) in 19.1%; however, pathologic grading revealed that only 7.0% had grade 2-4 tumor, 60.5% grade 5-6 and 32.5% grade 7-9. Pathologic staging revealed T2 tumor in 58%, T3 in 38.8% (including microscopic invasion of the capsule or seminal vesicles); microscopic lymph node metastases were found in 3.2%. Tumor invasion through the capsule was found in only 2 of 13 treated with neoadjuvant androgen blockade, compared with 40% in those who did not receive this treatment. There was no operative mortality and only 14.7% has complications. All had urinary incontinence immediately after operation, but regained continence after an average of 4-5 months, 24 were incontinent for more than 12 months, but most of them had only mild stress incontinence. Most patients were impotent after the procedure. There was tumor recurrence, diagnosed by rise in serum PSA, in 26 during an average followup of 26.4 months (range 3-93). Cure rate of prostatic cancer by radical prostatectomy may be increased by improved preoperative staging methods and better patient selection; long term follow up is required for determining cure rate.

Aged↗
PubMed1995

The expression of the imprinted H19 and IGF-2 genes in human bladder carcinoma.

The imprinted H19 gene is highly expressed in human embryos, fetal tissues and is nearly completely shut off in adults. However, it is reexpressed in a number of tumors including bladder carcinoma, demonstrating that H19 RNA is an oncofetal RNA. Tumors induced by injection of bladder carcinoma cell lines express H19 in contrast to the cells before injection. These observations support the notion of a positive correlation between H19 expression and bladder carcinoma. Loss of imprinting of H19 and IGF-2 was observed in samples of human bladder carcinoma.

Animals↗
PubMed1995

Detection of bladder tumors by immunostaining of the Lewis X antigen in cells from voided urine.

OBJECTIVES: A study was made to determine the sensitivity and specificity of immunostaining of the Lewis X antigen in exfoliated urothelial cells from voided urine, for the detection and surveillance of bladder tumors. METHODS: Three consecutive voided urine specimens were obtained from 101 patients, 78 of whom were under surveillance because of a history of bladder tumors, and 23 were being evaluated because of hematuria or irritative urinary symptoms. Indirect immunoperoxidase staining of two urine samples was done on cytocentrifuge slides, using the P12 monoclonal antibody against the Lewis X antigen. The diagnosis of the presence of urothelial tumor was made if more than 5% of the cells showed a typical red-brown staining. Cytopathologic examination of the third urine specimen was done according to Papanicolaou. Each patient underwent cystoscopy, and biopsies were obtained whenever there was endoscopic evidence of bladder tumors or carcinoma in situ. RESULTS: Cystoscopy and biopsies revealed transitional cell carcinoma in 32 patients, whereas 69 patients had no evidence of bladder tumors. Immunocytology of one urine sample showed true-positive results in 26 of the 32 patients with bladder tumors, corresponding to a sensitivity of 81.25%. When two samples were examined, a sensitivity of 97% and a specificity of 85.5% were obtained. When the results of cytology and immunocytology were combined, sensitivity reached 100%. High-grade and low-grade transitional cell tumors were detected with equal efficiency. CONCLUSIONS: The use of P12 monoclonal antibody for evaluation of Lewis X reactivity in cytologic preparations from multiple voided urine specimens can improve the sensitivity of noninvasive detection of bladder cancer. The technique may ultimately replace cystoscopy in monitoring therapeutic response and tumor recurrence.

Biomarkers, Tumor↗
PubMed1995

Bacteriuria following extracorporeal shock-wave lithotripsy in patients whose urine was sterile before the procedure.

During 10 months at our hospital, 413 patients underwent extracorporeal shock-wave lithotripsy (ESWL). The occurrence of complications was examined in the 126 (30.5%) of these patients who had sterile urine before the procedure and who had neither indwelling catheters nor stents. No patient received prophylactic antibiotics. After ESWL, nine patients (7%) developed bacteriuria, which was usually transient and required no therapy. Seven of the nine cases developed within 2 weeks of ESWL. In no case did other complications follow bacteriuria. Patients in whom bacteriuria was suspected because of fever all proved to have sterile urine. Our results indicate that patients whose urine is sterile before ESWL do not need antimicrobial prophylaxis.

Adolescent↗
PubMed1995

[Cystinuria and urolithiasis].

Cystinuria is a hereditary metabolic disorder which causes urinary lithiasis. Patients with cystinuria present at an earlier age (17 years), and with larger stones than patients with other types of urinary stones. As a result of frequent formation of new stones and multiple operations, many patients suffer from obstructive nephropathy and deterioration of kidney function. During the past decade we treated and followed 51 patients with cystine urolithiasis from 39 families. Screening disclosed another family member with cystinuria in 56% of the cases. The diagnosis of cystinuria was only made an average of 2 years after a patient first presented. In the group 12 kidneys had been removed due to various complications and in 7 kidneys there was significant deterioration of function. Each patient underwent a mean of 5.8 surgical interventions, including open operations, extra-corporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotripsy (PCNL) and urethroscopy, but most still had residual stone fragments. To prevent complications from cystine urolithiasis every effort should be made to detect the disease early, including screening of families of patients with cystinuria and close follow-up of all family members. Early detection of stones, before they become large makes noninvasive treatment with ESWL possible, whereas large stones require PCNL. Patients should be urged to maintain high urine outputs and to continue uninterrupted treatment with penicillamine or tiopronin, and urinary alkalinization.

Cystinuria↗
PubMed1994

[Congenital urethral strictures].

We present 12 patients with presumed congenital urethral stricture (mean age at diagnosis 20 years). They complained of various urological symptoms, including dysuria, transient urinary retention, urgency and reduced flow. The time from onset of symptoms to diagnosis averaged 18 months. The strictures were presumed congenital because no patient had a history of urethral infection or of instrumentation, and all the strictures were at the proximal bulbar urethra, as has been described for congenital, bulbar, urethral stricture. We treated 5 patients initially by internal urethrotomy, of whom 2 required transurethral dilatation at follow-up. 7 others were treated initially by transurethral dilatation, 4 of whom required more than 1 treatment. Follow-up has averaged 21 months. In 8 of 10 patients the maximal urinary flow at latest follow-up is greater than 20 ml/sec.

Adult↗
PubMed1994

Obstruction of urethral stents by mucosal overgrowth.

Urethral strictures are difficult to cure. In 1988, a new treatment was reported, consisting of dilation or incision of the stricture followed by implantation of a specially designed stent meant to allow the urethral epithelium to heal and cover the stent while preventing shrinkage of the scar and reappearance of the stricture. Two cases are reported here in which implantation of the stent resulted in a foreign-body reaction and obstruction of the lumen of the urethra. The area obstructed was reopened by transurethral removal of the reactive tissue. The long-term effect of this reaction on the patency of the urethra is still unknown.

Aged↗
PubMed1994

The clinical utility of transrectal ultrasound and digital rectal examination in the diagnosis of prostate cancer.

The development of high definition transrectal ultrasound probes has led to an increased interest in the ability of transrectal ultrasound of the prostate (TRUS) to assist in the diagnosis and management of prostate cancer. The present study was designed to examine the correlation of TRUS with digital rectal examination (DRE). The study group comprised 471 patients in whom the results of (a) DRE, (b) TRUS, and (c) histology of tissue obtained by transrectal biopsy of the prostate (TB), were all available. In those patients where both TRUS and DRE were negative, but prostate specific antigen (PSA) was greater than 10 micrograms ml-1, six random biopsies were performed. In all other cases the biopsies were TRUS directed to the suspicious lesion. There were 142 cases in whom both DRE and TRUS were negative or only mildly suspicious of malignancy. TB in these cases was positive for cancer in 17 cases (12%). In a further 126 cases, TRUS was positive for cancer, while DRE demonstrated no suspicious nodule. TB was positive in only 17 of these cases (13.5%). Similarly, in the 31 cases in which DRE was positive but TRUS was negative, TB was positive in only three cases (10%). In the 172 cases in whom both DRE and TRUS were positive, 99 biopsies were positive (57.5%). It was concluded from this study that DRE remains the most valuable single examination in the diagnosis of prostate cancer. TRUS increases the sensitivity of DRE if both are positive. When there is a discrepancy between the two examinations, the biopsy yield is low. When both are positive, a high cancer yield is obtained, TRUS having added value in directing the biopsy needle to the suspicious site. TRUS is thus a valuable adjunct to DRE in the diagnosis of prostate cancer.

Diagnosis, Computer-Assisted↗
PubMed1993

[Treatment for cryptorchidism: at or after puberty?].

The patient with a cryptorchid testis is prone to infertility and testicular malignancy. Optimal treatment of cryptorchidism has been considered orchiopexy at the second year of life. In the past 10 years, we have treated 40 patients, 11-63 years old (mean 25), who presented with a cryptorchid testis at or after puberty. Orchiectomy was performed in all, and spermatogenesis was present in only 2 of the 40. Testicular diameter was greater than 3 cm in 32 of the 38 patients with an atrophic testis. Malignant tumors were found in 6 patients (15%) at operation. A seminoma was found in 5 patients operated on at ages 21, 23, 27, 47 and 63 years, and a nonseminomatous tumor in a 31-year-old. In 2 who underwent orchiopexy at ages 9 and 17 years, respectively, testicular tumors were found at ages 27 and 31 years. We conclude that a patient with a cryptorchid testis who presents at or after puberty should undergo orchiectomy as soon as possible. The prospect for such a testis to contribute to fertility is negligible, even if its diameter is normal, whereas the risk of developing malignancy is high.

Adolescent↗
PubMed1993

Bilateral obstructing ureteral uric acid stones in an infant with hereditary renal hypouricemia.

We report on a 15-month-old boy with renal hypouricemia who presented with acute renal failure, anuria and sepsis due to bilateral obstructing ureteral uric acid stones. He was treated successfully with extracorporeal shock wave lithotripsy. Metabolic survey of 10 relatives revealed a rare hereditary disorder in 4 siblings: isolated renal hypouricemia and hyperuricosuria. To our knowledge this is the youngest reported case of hereditary renal hypouricemia and 1 of the youngest patients to be treated with extracorporeal shock wave lithotripsy.

Acute Kidney Injury↗
PubMed1992

[Prostatic specific antigen for detection and monitoring of prostatic cancer].

Prostatic specific antigen (PSA) can be detected in normal and benign hypertrophic prostates, as well as in prostatic cancer and its metastases. Since it appears in the serum, this glycoprotein has become an established marker for the detection and monitoring of prostate cancer. Using a radioimmunoassay (CIS--Biointernational, France), we found serum PSA levels higher than 4 ng/ml in 55 of 58 patients with prostatic cancer. The concentrations were proportional to tumor stage: significantly higher in stages C and D than in stages A and B (p less than 0.002). In all 6 cases with occult prostatic carcinoma (stage A), levels were higher than 15 ng/ml. PSA was found to be a good indicator of response to therapy, as well as a marker of tumor progression during follow-up. After radical prostatectomy serum PSA levels decreased to below 1 ng/ml. Following radiotherapy levels returned to normal within 1-6 months in 8 of 11 patients. In 21 of 23 with metastases serum PSA decreased during hormonal treatment. In 3 who responded initially to hormonal therapy, levels increased before clinical manifestation of tumor progression. We conclude that PSA is a sensitive serum marker for the diagnosis of prostatic cancer in cases of metastatic disease of unknown origin, as well as for monitoring the response to treatment of prostatic carcinoma. The use of PSA serum levels for screening for prostatic cancer is still controversial.

Antigens, Neoplasm↗
PubMed1992

Extracorporeal shock-wave lithotripsy (ESWL) monotherapy for stones in lower ureter.

Extracorporeal shock-wave lithotripsy (ESWL) has been accepted as the method of choice for most upper urinary tract calculi. However, in cases of stones in the lower ureter, ureteroscopic procedures have generally been preferred. Using the Dornier HM3 lithotriptor with modifications in the patient's position, we were able to successfully treat 155 unselected cases of lower ureteral calculi. The average stone size was 9.6 mm (range 5-23 mm). One hundred forty-three patients had stones located below the lower margin of the sacroiliac joint. These patients were placed in a supine position. The stones were visualized radiologically without use of a ureteral catheter in 78 percent of the patients; in 22 percent a ureteral catheter was inserted prior to ESWL to aid in stone localization. In 145 patients (94%) treatment was completed in one session; 10 patients (6%) required two sessions. Of the patients, 38 percent were free of stones one day after ESWL; 97 percent became stone free within three months, and only 3 patients required endoscopic manipulation, after ESWL. Twelve patients had stones in the midureter overlying the sacroileum. They were placed in the prone position, and the calculi were visualized with the aid of a ureteral catheter. All these patients became free of stones one month after treatment. There were no significant treatment-related complications except for bacteremia in 1 case. In view of the remarkable efficacy, negligible complication rate, and shorter hospital stay as compared to ureteroscopic stone manipulations, we recommend high energy ESWL as the primary monotherapy of mid and lower ureteral stones.

Adolescent↗
PubMed1992

Intravesical lidocaine: topical anesthesia for bladder mucosal biopsies.

The intravesical instillation of lidocaine solution has been used as a topical form of anesthesia for bladder biopsies. We performed 63 ambulatory procedures in which multiple cold-cup biopsies were obtained during cystoscopy. There was no need for electrocautery. All patients tolerated the procedure well and were discharged from the office immediately thereafter. There were no changes in heart rate or blood pressure during the procedures. Serum concentrations of lidocaine were measured in 10 patients at 5, 10 and 30 minutes, and they were clinically insignificant. This simple office procedure can be used for the diagnosis and followup of patients with carcinoma in situ of the bladder.

Administration, Intravesical↗
PubMed1991

[Extracorporeal shock wave lithotripsy for cystine urolithiasis].

We present 31 patients with cystine urolithiasis referred to our extracorporeal shock wave lithotripsy (ESWL) center since 1985. This group differed statistically from the other 3000 patients treated by us for urolithiasis with regard to age, stone burden, number of previous operations, and known duration of urolithiasis. The average known duration in those with cystine stones was 15 years. Of 26 patients with such a history, 22 had an average of 2 operations each. At referral, 14 had bilateral stones and among the others there were 5 nonfunctioning kidneys. Of 26 referred with a diagnosis of cystine nephrolithiasis, only 11 were being treated medically. At presentation, 31 had no stones and 1 was being treated medically. In the other 29 patients, 44 renal-ureteral units had urolithiasis. During follow-up 2 ureteral stones were discharged spontaneously and the other units were treated by ESWL, surgery and/or ureteroscopy, and percutaneous irrigation. 36/42 units were free of significant stone residue, but in 4 there were large gravel remains; 1 kidney was removed primarily and 1 kidney lost its function following prolonged obstruction after ESWL. During follow-up, of 11 patients unable to tolerate D-penicillamine and treated by urinary alkalinization alone, 3 have already formed new stones.

Cystine↗