PubMed Health⌕ Search

Biomedical subjects

G Raviv

Publications and source records attributed to G Raviv.

At least 19 recordsLinked to original sources
PubMed1995

Testicular seminoma: clinical significance of nuclear deoxyribonucleic acid ploidy pattern as studied by flow cytometry.

PURPOSE: We evaluated the clinical significance of deoxyribonucleic acid (DNA) ploidy pattern as a predictor of prognosis in patients with testicular seminoma. MATERIALS AND METHODS: Flow cytometric nuclear DNA analysis was performed on archival specimens from 65 patients with pure seminoma who underwent radical orchiectomy between 1970 and 1992. RESULTS: A total of 42 specimens (65%) exhibited a DNA diploid pattern, while 23 (35%) were DNA aneuploid. Diploidy was manifested in 73% of the stage I tumors versus 31% of stage II cancers (p = 0.004). No correlation was found between ploidy and histological type, size or local extension of the tumor. Tumor progression was observed in 5 patients, exclusively displaying aneuploid histograms (p = 0.0017), and 3 of them subsequently died of the disease. CONCLUSIONS: DNA ploidy pattern may provide important prognostic information for patients with testicular seminoma.

Adult↗
PubMed1995

Reconsidering the necessity of ipsilateral adrenalectomy during radical nephrectomy for renal cell carcinoma.

OBJECTIVES: Ipsilateral adrenalectomy is traditionally advocated as part of radical nephrectomy performed for renal cell carcinoma. The current study addresses the controversy of whether ipsilateral adrenalectomy should be performed routinely during radical nephrectomy. METHODS: A total of 225 patients were treated surgically for renal cell carcinoma over an 18-year period. Of these patients, 158 underwent nephrectomy and simultaneous ipsilateral adrenalectomy and the other 67 had sparing of the ipsilateral adrenal gland. A retrospective analysis of the medical records and assessment of the clinical and the pathologic data were performed. Rates of survival and progression were evaluated in a subgroup of 109 patients, further subdivided into 54 patients who underwent concomitant adrenalectomy and 55 patients with the ipsilateral adrenal preserved during surgery. RESULTS: Histopathologic abnormalities were detected in seven adrenal specimens (4.4%); however, only 3 patients (1.9%) had involvement of the adrenal by renal cell carcinoma. All cases of adrenal involvement were detected by the preoperative imaging modalities. Ipsilateral adrenalectomy did not improve the outcome in comparison to adrenal preservation. CONCLUSIONS: In view of the rarity of ipsilateral adrenal metastasis, the questionable prognostic merits of concomitant adrenalectomy, and the availability of accurate imaging modalities, we conclude that ipsilateral adrenalectomy is not necessary in the majority of the patients undergoing radical nephrectomy for renal cell carcinoma.

Adenoma↗
PubMed1995

Pitfalls in the detection of urinary extravasation following major urinary tract reconstructive surgery.

Urinary extravasation may complicate the postoperative course of urinary tract reconstructive surgery. Early diagnosis of extravasation is critical in the postoperative management. In this study we assessed prospectively the various diagnostic techniques employed in the detection and documentation of urinary extravasation in 76 consecutive patients who underwent major urinary tract reconstructive surgery. Assessment included measurements of the volume of the fluid obtained from the drains, analysis of serum to fluid creatinine ratio, detection of intravenously injected indigo dye and traditional radiographic evaluation. Urinary extravasation was detected in 7 patients (9.2%). Increased creatinine ratio had the highest diagnostic accuracy: 97.3%, sensitivity 71.4% and specificity 100%. Various radiological investigations had accuracy of 96%, sensitivity 85.7% and specificity 97.1%. The combined use of these methods detected all cases of urinary extravasation with sensitivity, specificity and total accuracy of 100%. Fluctuations in the volume of fluid in the drains and intravenous injection of indigo dye had lower accuracy, sensitivity and specificity and added very little to the workup. We conclude that radiological investigations and creatinine ratio analysis are highly accurate complementary methods for the early detection and monitoring of urinary extravasation following reconstructive urinary tract surgery.

Creatinine↗
PubMed1994

Malignant peripheral primitive neuroectodermal tumor (PNET) of the kidney.

We describe a 61-year-old patient with primitive neuroectodermal tumor (PNET) arising from the kidney. Despite intensive treatment including surgery, combination chemotherapy and radiotherapy, rapid progression of the tumor was encountered and the patient died within six months with widespread disease. This appears to be the first recorded case of PNET of the kidney.

Fatal Outcome↗
PubMed1994

Enhanced cytologic detection of early stage mouse bladder tumor following induction of uroepithelial cell shedding.

Previous studies from our laboratory have shown that some Escherichia coli endotoxins are capable of inducing massive normal urothelial cell shedding. In the present study we investigated whether endotoxin-induced shedding improves cytologic detection of early stage mouse bladder cancer. Mouse bladder tumor (MBT-2) cells were implanted intravesically in the submucosa of C3H female mice. Ten to 21 days later the bladders were irrigated with saline followed by instillation of endotoxin. The bladder contents of each mouse were aspirated and examined cytologically together with the bladder wash specimen. Shedding of epithelial cells was observed in only 32% of the saline irrigated specimens compared with 93% after endotoxin instillation (p < 0.00001). Analysis showed an overall accuracy rate of 39% after saline barbotage versus 78% following endotoxin administration (p < 0.00001). These results indicate that intravesical instillation of specific bacterial endotoxin significantly increases the extent of cytologic detection of early stage superficial bladder cancer.

Administration, Intravesical↗
PubMed1994

Ureteropelvic junction obstruction: relation of etiology and age at surgical repair to clinical outcome.

Ureteropelvic junction (UPJ) obstruction is a congenital anomaly either caused by intrinsic narrowing of the upper ureter or by extrinsic pressure on the ureter caused by aberrant vessels or fibrous bands. We reviewed 121 cases of pyeloplasties performed in our department for UPJ obstruction. The cases were grouped by age and by the underlying pathology. Postoperative urographic evaluation showed that dismembered pyeloplasty was successful in 98.4% of the patients, with no significant difference between age groups. Persistence or recurrence of preoperative symptoms occurred in some patients (16.6%). Extrinsic obstruction of the ureter was associated with better postoperative clinical results and less recurrence of symptoms.

Adolescent↗
PubMed1993

[Primary retroperitoneal extra-gonadal germ cell tumor].

Malignant retroperitoneal tumors are relatively rare. The most likely diagnosis by a surgeon encountering a retroperitoneal mass is metastatic disease, but primary retroperitoneal malignant disease or benign tumor should also be considered. The most common primary retroperitoneal tumors are lymphoma and sarcoma. Primary extragonadal germ cell tumors constitute 1-2% of all germ cell tumors, most of which are found in the mediastinum and retroperitoneum. We report the successful treatment of a 20-year-old man whose primary retroperitoneal extragonadal germ cell tumor was treated by chemotherapy and surgery.

Adult↗
PubMed1993

Localized renal cell carcinoma treated by radical nephrectomy. Influence of pathologic data and the importance of DNA ploidy pattern on disease outcome.

BACKGROUND: The course of patients with renal cell carcinoma may be considerably different. Approximately 50% with presumed localized disease have metastases after nephrectomy. Pathologic stage at diagnosis, histologic grade, and histologic type have been considered the most important predictors of prognosis. Nevertheless, subsets of patients within a specified stage and grade may have considerable differences in disease progression and survival. METHODS: Flow cytometric nuclear DNA analysis was used to study pathologic Stage I or II renal cell carcinoma in 54 patients who underwent radical nephrectomy between 1974 and 1983. RESULTS: Sixty-three percent of the tumors were diploid, and 37% aneuploid. A DNA diploid pattern was more common among Stage I tumors than Stage II tumors (69% versus 33%; P < 0.04). Progression occurred in 31% of the diploid tumors, whereas among the aneuploid group the progression rate reached 59% (P < 0.06). Considered as a single indicator, DNA ploidy pattern was strongly associated with patient survival. Ten years after surgery 79% of the patients who had diploid tumors and 50% of those with aneuploid tumors were alive (P < 0.02). CONCLUSIONS: Nuclear DNA ploidy may serve as an important prognostic variable for patients with early stage renal cell carcinoma.

Adolescent↗
PubMed1993

Massive hematuria due to extramedullary plasmacytoma invading the bladder.

Bladder involvement by extramedullary plasmacytoma is a rare condition. A 46-year-old woman with known IgA-lambda multiple myeloma who developed this condition is described. The patient suffered from massive hematuria, which led to hypovolemic shock. Prompt supportive treatment by blood transfusions, fulguration of the bleeding mucosa and continuous bladder irrigation stopped the bleeding. Subsequent bladder irradiation lead only to partial response of the tumor.

Female↗
PubMed1993

Quantitative changes in platelet counts following major urological pelvic surgery.

Postperative quantitative changes in platelet counts have been reported following various extensive surgical procedures. It is generally accepted that reactive thrombocytosis at levels less than 1,000,000/mm3 is a benign condition and is not associated with increased risk of postoperative thrombohemorrhagic complications. The role of prophylactic treatment with platelet inhibitors in these situations is controversial. We assessed retrospectively the timing and the extent of postoperative thrombocytosis in 85 consecutive patients following major urological pelvic surgery and evaluated its possible clinical significance to hemorrhagic and thromboembolic complications, in view of the coincidence of multiple potential risk factors for thromboembolism in these patients. 73 (85.9%) patients demonstrated marked postoperative changes of platelet counts. In 12 patients (14.1%) we found only minor fluctuations in platelet counts throughout the postoperative period. Two distinct groups of 26 and 47 patients respectively could be identified among these 73 patients, who differed in the rate and extent of changes in platelet counts. Those fluctuations were characterized by an early decrease in platelet levels (mean percentage change of 40 and 60% in groups I and II respectively). This was followed by a gradual increase leading to delayed thrombocytosis (mean percentage change of 225 and 305% in groups I and II respectively). Thromboembolic complications were diagnosed in 5 patients. The occurrence of thromboembolism preceded any significant increase in platelet counts in all 5 patients. There was no correlation between the timing of thromboembolic complications and timing and extent of the change in platelet count. We conclude that reactive thrombocytosis following major urological pelvic surgery is a frequent innocuous finding and is not associated with hemorrhagic or thromboembolic complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Endometriosis of the bladder].

We report a case of endometriosis of the bladder in a 32-year-old healthy woman suffering from longstanding suprapubic pain, and urinary urgency and frequency. The disease, which is uncommon, usually has a high morbidity rate and is difficult to diagnose. A high level of suspicion is necessary for diagnosis, since neither the clinical presentation, nor imaging procedures are pathognomonic for endometriosis.

Adult↗
PubMed1992

[Artificial sphincter for urinary incontinence].

During the past 4 years 21 patients underwent implantation of the model AS-800 artificial urinary sphincter, 4 of whom underwent simultaneous implantation of an inflatable penile prosthesis. The mean age was 48 years (range 33-73). Incontinence was neurogenic in 12 (57%) and a complication of urologic surgery (mainly prostatectomy) in 9 (43%). In 8, in whom intermittent self-catheterization was planned, the sphincter cuff was implanted around the bladder neck, and in the other 13, around the bulbar urethra. The immediate postoperative course was uneventful in 18 (85%), but 2 (10%) had urinary tract infection and 1 had urinary retention. During a mean follow-up of 20 months (range 1-36), 19 (90%) were found to be continent (in 2 of them the cuff had had to be changed to a smaller size due to tissue atrophy), and 1 had suffered from urgency incontinence which disappeared with anticholinergic medication. In 2 with incontinence due to neurogenic bladder, the sphincter had became infected and had had to be removed; 1 of these 2 had undergone simultaneous augmentation cystoplasty. This experience resulted in a change in our policy: we now implant the sphincter and perform augmentation cystoplasty in 2 separate stages. We find implantation of the artificial urinary sphincter very effective treatment for urinary incontinence.

Adult↗
PubMed1992

A 20-year experience with treatment of ectopic ureteroceles.

Between 1970 and 1990 a total of 37 patients (female-to-male ratio 3.6:1) was diagnosed and treated at our institution for ectopic ureterocele. Urinary tract infection was the most frequent mode of presentation (59%). Of the patients 54% were less than 3 years old at operation. Transurethral incision of ectopic ureterocele served only as a decompressive procedure for acutely ill infants and was followed with a high incidence (80%) of resultant vesicoureteral reflux. The elective surgical policy was individualized based on renal function and presence of vesicoureteral reflux. Overall results within the various groups were generally satisfactory regarding eradication of urinary tract infections, preservation of renal function and continence or treatment of vesicoureteral reflux. Upper pole heminephrectomy and partial ureterectomy were performed in 14 patients with 3 (21%) requiring reoperation, including only 2 (14%) subsequent reimplantations. Thus, we believe that an expectant approach to the lower urinary tract is well recommended in the majority of the patients with a poorly functioning ipsilateral renal segment. A modified technique of total reconstruction, performing only partial ureterectomy with double barrel reimplantation, was successful in 7 patients.

Child↗
PubMed1992

Low loop cutaneous ureterostomy and subsequent reconstruction: 20 years of experience.

Between 1970 and 1990 we constructed low loop cutaneous ureterostomies in 50 patients with grossly dilated collecting systems. Patient age ranged from 6 days to 3 years. The indication for all urinary diversions was an anomaly of the lower urinary tract associated with marked ureteral dilatation considered to require decompression because of either urinary tract infections or renal functional impairment. Clinical and radiological followup was maintained between establishment of the cutaneous ureterostomy and complete reconstruction, and revealed marked improvement indistinguishable from that obtained by high diversions. Undiversion was performed after 3 to 69 months, usually simultaneously with definitive correction of the underlying anomaly. The main advantage of our presented technique is the opportunity to resect the distal ureteral limb and to perform simple ureteroneocystostomy using the proximal limb. Besides its technical simplicity, this technique obviates possible complications that may be attributed to ureteral anastomosis and compromised blood supply, thus, it is well recommended.

Child, Preschool↗
PubMed1991

Long-term results of simple and radical nephrectomy for renal cell carcinoma.

From 1974 to 1983, simple and radical nephrectomies were performed at the Chaim Sheba Medical Center (Tel Hashomer, Israel) for renal cell carcinoma. The authors reviewed 109 cases that were followed for a period ranging from 5 to 14 years. Simple nephrectomy was performed in 55 patients, and 54 patients underwent radical nephrectomy. The selection of the surgical procedure was based on the surgeon's preference and not on the basis of clinical stage, age, or sex. The surgical results and survival rates were assessed according to the pathologic stage of the tumors. Among patients with Stage I tumor, radical nephrectomy produced better survival rates at 5 and 10 years (P = 0.03); however, when the non-cancer deaths were excluded, the difference in survival was not statistically significant. For Stage I tumors the survival free of disease at 5 years was better for the radical nephrectomy group, but this difference was not statistically significant. No difference was noticed in the local recurrence rate between the two groups. Nephrectomy in patients with Stage IV disease did not alter survival regardless of the type of operation.

Aged↗