Biomedical subjects

E V Kramolowsky

Publications and source records attributed to E V Kramolowsky.

32 records · Page 2Linked to original sources

PubMed1988

The value of testosterone deprivation in stage D1 carcinoma of the prostate.

The question of whether hormonal manipulation is effective in the treatment of stage D1 carcinoma of the prostate has yet to be determined conclusively. To study this question a retrospective review was conducted of 68 patients with stage D1 disease. Of the patients 22 underwent immediate orchiectomy, 24 delayed orchiectomy and 11 exogenous antiandrogen treatment (8 immediate and 3 delayed treatment), and 11 had no androgen deprivation. The patients were placed into 2 groups consisting of those receiving immediate hormonal deprivation (30) and those having treatment at the time of bone metastasis or who are as yet untreated (38). The minimum followup was 60 months. The median interval to progression to bone metastasis was 43 months in the delayed treatment group compared to 100 months in the immediate hormonal deprivation group. This difference was statistically significant (p equals 0.0087). Likewise, the median period from diagnosis to death was 90 months in the delayed treatment group and 150 months in the immediate treatment group. This difference was not significant (p equals 0.1110). Thus, orchiectomy or adequate androgen deprivation from our data significantly prolongs the interval to bone metastasis in patients with metastatic prostate cancer limited to the pelvic lymph nodes. The apparent increased length of survival of the immediate treatment group lacks statistical confirmation.

Aged↗

PubMed1988

Advances in endosurgery. Treatment of ureteral-enteric anastomotic strictures.

The described endourologic technique of incision and dilation of a ureteral-intestinal stricture is effective in most patients. Indeed, with the outlined treatment regimen, less than 30 per cent of patients with ureteral-intestinal anastomotic strictures will eventually require open surgical revision. Further advances in the use of lasers or the endourologic positioning of free tissue grafts may further improve the success rate of the endoscopic approach.

Dilatation↗

PubMed1987

Percutaneous transperineal placement of gold 198 seeds for treatment of carcinoma of the prostate.

Thirty-one patients have been treated for carcinoma of the prostate with 198Au seeds placed transperineally using transrectal ultrasonic guidance. Twenty patients have been followed postoperatively for periods ranging from 3 to 31 months, with an average follow-up time of 12 months. Cumulative dose of radiation to the prostate calculated by dosimetry was either 9,000 rads or 15,000 rads. Serial transrectal ultrasound examinations performed on these patients showed a decrease in prostate size in all patients within 6 months of treatment, with a statistically significant decrease observed between the third and sixth months. No significant difference in amount or rate of tumor regression was noted when tumor stage and grade were correlated to volume decrease after treatment. Patients who received the larger doses of radiation (15,000 rads) showed a significantly greater rate of decline in prostatic volume than those who received 9,000 rads. Seven patients underwent prostate biopsy between 12 and 18 months after treatment; six biopsies showed residual tumor. Complications after treatment included urinary retention because of prostatic edema (three), radiation urethritis (three), and rectal ulceration (one). Transperineal placement of 198Au is well tolerated and offers an alternative to external beam radiation for treatment of carcinoma of the prostate.

Adenocarcinoma↗

PubMed1987

Ureteral perforation during ureterorenoscopy: treatment and management.

Ureterorenoscopy has become a popular diagnostic and therapeutic tool for the modern urologist but this procedure is not without complications and risks. The technique may result in perforation of the ureter and subsequent stricture formation in some cases. In this study a ureteral perforation rate of 17 per cent was noted after 142 ureteroscopic procedures, with stricture formation occurring in 5 per cent. The type of dilation, reason for the procedure or placement of a postoperative stent did not seem to affect the formation of stricture but the location of the injury appeared to be significant. Of those injuries not requiring immediate surgical repair perforations within the pelvis (6 of 11) led to strictures more often than those beyond the pelvis (1 of 9). Treatment of the strictures with either an open repair or percutaneous antegrade dilation was successful.

Dilatation↗

PubMed1987

Endourological management of ureteroileal anastomotic strictures: is it effective?

Ureteroileal stenosis represents a serious postoperative threat to the obstructed kidney and open revision in these patients often is difficult. We evaluated 9 patients with 10 ureteroileal strictures who were treated with semirigid fascial dilators (1), balloon dilation (4) or a combination of balloon dilation and percutaneous intraureteral surgery (4). All 5 patients who had semirigid fascial or balloon dilation alone had early recurrence of the strictures. However, in 4 patients dilation in conjunction with percutaneous intraureteral incision of the stricture through a flexible choledochonephroscope resulted in short-term resolution of each ureteroileal stricture. However, by 6 months these strictures had recurred in 50 per cent of the patients.

Constriction, Pathologic↗

PubMed1987

Use of local anesthesia for extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy is being performed at many centers with the use of either general or epidural anesthesia. We report our experience with 39 patients treated by extracorporeal shock wave lithotripsy under local anesthesia. These patients tolerated the procedure well and had good fragmentation of the stones. Of the patients 18 were treated on an outpatient basis. In selected patients local anesthesia offers an alternative that can decrease the risk of anesthesia, and reduce the cost and hospital stay associated with extracorporeal shock wave lithotripsy.

Adolescent↗

PubMed1987

Extracorporeal shock wave lithotripsy in children.

Extracorporeal shock wave lithotripsy has proved to be an effective method of treating upper urinary tract calculi. We report on 14 patients 17 years old or younger who were treated with the Dornier lithotriptor. Special adjustments of the gantry and water level, as well as shielding of the lungs, were necessary in those children less than 135 cm. in height or 30 kg. in weight. Hospital stay averaged 2.5 days and ranged from 1 to 6 days. There were no major intraoperative complications. Postoperative pulmonary edema developed in 1 patient and only 3 required parenteral analgesics for postoperative pain control. Of the 12 patients for whom a 3-month followup is available 10 are free of stone. One patient required ureterolithotomy for removal of impacted stone fragments. We conclude that extracorporeal shock wave lithotripsy is a safe and effective method of treating renal calculi in children.

Adolescent↗

PubMed1987

Extracorporeal shock wave lithotripsy for the treatment of urinary calculi in the elderly.

Renal calculus in the elderly patient is associated with the same symptoms and risks as in other patient populations. With the recent development of extracorporeal shock wave lithotripsy (ESWL), many older patients can now be treated for renal calculi. The Department of Urology at the University of Iowa Hospitals and Clinics has performed 107 ESWL treatments on a total of 96 patients over 70 years of age. This represents over 12% of all patients treated at our institution. No deaths related to ESWL treatment have occurred in this group, nor has increased morbidity been observed in comparison to all patients treated. In spite of the increased age and associated medical problems of this patient population, ESWL offers a safe and effective means of treating upper tract urinary calculi in the geriatric age group.

Aged↗

PubMed1986

Bedside flexible cystoscopy: an approach to the critically ill patient.

A 15F flexible fiberoptic choledochonephroscope was used to perform bedside flexible cystoscopy in 5 critically ill patients. All 5 patients were receiving pressor agents, and 4 were intubated and dependent on a respirator. A ureteral stent was placed in the renal pelvis in 3 patients. The flexible endoscope enables the urologist to bring diagnostic and therapeutic cystoscopy directly to the bedside.

Aged↗

PubMed1986

Extracorporeal shock wave lithotripsy. Noninvasive treatment for urinary stones.

As with many new treatments in medicine, time will determine the place of extracorporeal shock wave lithotripsy (ESWL) in management of urinary calculi. It may be that a combination of methods will prove most effective. However, at the present time, ESWL provides a noninvasive means of fragmenting calculi so that stones that were previously manageable only by invasive techniques potentially can be passed from the urinary tract. ESWL is a 30- to 45-minute treatment that yields a 50% to 75% stone-free rate at three months after the procedure. Of course, interpretation of success rates can vary on the basis of patient selection and the size, position, and composition of the stone. At this point, ureteroscopy and cystoscopic stone basketing remain the treatments of choice for low ureteral stones. Nonetheless, ESWL is an exciting new weapon in our battle against stone disease.

Adolescent↗

PubMed1984

The frozen section in lymphadenectomy for carcinoma of the prostate.

From January 1969 through August 1982 we performed 257 pelvic lymph node dissections for staging of carcinoma of the prostate. One or more lymph nodes were submitted for frozen section in 100 cases (39 per cent): 43 (43 per cent) had positive nodes on frozen and permanent sections, while frozen section was negative in 57 (57 per cent). Of the latter 57 cases (16 per cent) had positive nodes on paraffin sectioning of all tissue submitted. Thus, in our series there was a 16 per cent chance of overlooking metastatic disease at the time of pelvic lymph node dissection even with the aid of intraoperative frozen sections.

False Negative Reactions↗

PubMedDate not supplied

The interaction between electrosurgical generators, endoscopic electrodes, and tissue.

Endoscopic monopolar and bipolar devices were compared during cutting and coagulation. It was observed on appropriate animal models that the initial resistance (impedance) values recorded correspond to the normal tissue impedance at the electrode. The subsequent impedance values increase 25 to 50 ohms for the coagulator which relates to tissue desiccation and for the cutting electrodes the impedance increases greater than 1000 ohms during the arcing process. At similar power settings, typical monopolar generators produce maximum power at 300 to 500 ohms while typical bipolar generators produce maximum power at 25 to 100 ohms. With impedances greater than 1000 ohms, monopolar generators are capable of higher power output than are bipolar generators. Since cutting is a high impedance process, bipolar cutting electrodes do not perform as intended with typical bipolar generators. Therefore, bipolar cutting electrodes should be employed with a monopolar generator or a generator designed specifically for their use.

Animals↗

PubMedDate not supplied

Direct-current potentials created by arcing during monopolar radiofrequency electrosurgery.

Muscle and nerve stimulation during radiofrequency electrosurgery has been a well-known phenomenon for over 50 years. However, as electrosurgery expands into new procedures, such as tissue ablation in the heart, the mechanism of the potentially deleterious stimulation becomes more important. This article presents data showing that large DC currents are generated during electrosurgery and that these potentials increase with increasing sparking at the active electrode. The data also show DC potentials generated by various generators, different operation modes (cut, coagulation, fulguration), and operations on tissues of various impedances.

Electric Conductivity↗

PubMedDate not supplied

A simple and inexpensive method for measuring electrosurgical variables.

A simple circuit that demodulates the high-frequency output of an electrosurgical generator to proportional DC values can be employed to monitor generator voltage and electrosurgical current. An example of the use of the circuit in a urologic application is given. Employing this monitoring circuit, quantitative comparisons of electrosurgical equipment and performances can be made.

Electricity↗