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J A Karam

Publications and source records attributed to J A Karam.

10 recordsLinked to original sources

Impact of training level of urology residents on the detection of prostate cancer on TRUS biopsy.

The objective of this study is to evaluate the performance of urology residents at each training level in detecting prostate cancer with transrectal ultrasound-guided (TRUS) biopsy. The inclusion criteria were: (1) prostate-specific antigen (PSA) 4-10 ng/ml; and (2) 10-12 cores per biopsy session. Data from repeat biopsy sessions were excluded. Overall prostate cancer detection rate for 170 patients was 39.4%. PSA, digital rectal examination (DRE), and prostate volume were predictors of cancer detection. There were no significant differences in overall cancer detection rates, PSA, DRE, or prostate volume between resident levels. In conclusion, urology residents at all levels of training perform equally well at detecting cancer using TRUS prostate biopsy technology.

Aged↗

Elevated biliary calmodulin during gallstone formation: the role of bile acids.

Hepatic bile synthesis is altered during experimental gallstone formation. In response to cholesterol, there is a hydrophobic shift in hepatic bile acid synthesis and hypersecretion of phospholipids. These changes decrease the vesicular capacity for cholesterol and favor crystallization. The mechanism for these changes in hepatic bile formation is unknown. Calmodulin (CaM), a Ca2+ receptor protein involved in cellular secretion, regulates gallbladder transport and may play an important role in alterations of hepatic bile formation during cholelithiasis. We hypothesized that biliary CaM activity is altered during gallstone formation and may be associated with changes in bile acid and phospholipid synthesis. Prairie dogs were fed either control (N = 22) or 1.2% cholesterol-enriched (N = 26) diets for one to six weeks. Cholecystectomy was performed; the common bile duct was cannulated, and hourly bile samples were collected. CaM was measured in bile and gallbladder tissues by radioimmunoassay. Bile samples were analyzed for cholesterol, phospholipids, total bile acids, total protein, calcium, and individual bile acid composition. Compared to controls, gallstone animals had elevated hepatic bile levels of CaM, phospholipids, and cholesterol. Hydrophobic bile acid synthesis was also stimulated, with increased levels of taurochenodeoxycholic acid (TCDCA) and decreased taurocholic acid (TCA). Gallbladder bile demonstrated similar changes. Although gallbladder bile CaM levels were increased, tissue levels were unchanged, suggesting that increased CaM concentration is a hepatic phenomenon. Hepatic bile CaM activity correlated linearly with TCDCA concentration (r = 0.64, P < 0.004) and phospholipid hypersecretion (r = 0.53, P < 0.03). The relationship between biliary CaM and increased concentrations of TCDCA and phospholipids suggests a role for CaM in alterations of hepatocyte secretion that may promote gallstone formation.

Animals↗

Apical and basolateral Ca(2) channels modulate cytosolic Ca(2)+ in gallbladder epithelia.

Gallstone formation is associated with altered gallbladder (GB) ion transport and increased concentration of GB bile Ca2+. Recent studies show that increased cytosolic Ca2+ ([Ca2+]i) stimulates GB Cl- secretion. However, the mechanism by which extracellular Ca2+ ([Ca2+]e) enters the cytosol remains unclear. We tested the hypothesis that entry of [Ca2+] into cytosol occurs via apical and basolateral membrane Ca2+ channels. Prairie dog GBs were mounted in Ussing chambers, standard electrophysiologic parameters were recorded, and unidirectional Cl- fluxes (J, microEq x cm(-2) x hr(-1) were measured using 36Cl at various mucosal Ca2+ in the absence or presence of mucosal lanthanum (La3+), a non-diffusible Ca2+ channel blocker. Serosal [Ca2+]e was maintained at trace levels. In the absence of mucosal La3+, short circuit current (Isc) showed a positive correlation with mucosal [Ca2+]e as represented by a second order polynomial equation (y = 4.1 + 2.5x - 0.73x(2), r = 0.68, P < 0.001). In contrast, unidirectional mucosa to serosa Cl flux (JCl/ms) was inversely correlated with [Ca2+] (y = 47.9 - 8.7x + 0.9x(2), r = 0.51, P <.05) Addition of 1 mM mucosal La3+ blunted the effects of [Ca2+]e on electrophysiologic parameters and JCl/ms. However, basolateral repletion with 5 mM Ca2+ reverses the blocking effects of La3+ on JCl/ms. These data suggest that [Ca2+]e enters the cytosol via apical and basolateral Ca2+ channels. We conclude that GB apical Ca2+ channels may represent a pathway for biliary Ca2+ entry into the cell and therefore may represent an important regulatory pathway for GB ion transport during gallstone formation.

Analysis of Variance↗

Converting gallbladder absorption to secretion: the role of intracellular calcium.

BACKGROUND: Experimental cholelithiasis is associated with elevated biliary calcium concentration and altered gallbladder absorption. Recent studies showed that extracellular calcium ([Ca2+]ec) plays a role in regulating gallbladder ion transport. The extent to which intracellular calcium ([Ca2+]ic) mediates the changes in gallbladder ion transport is not clear. We hypothesize that [Ca2+]ic is an important regulator of gallbladder ion transport. METHODS: Prairie dog gallbladders were mounted in Ussing chambers, standard electrophysiologic parameters were recorded, and unidirectional Na+, Cl- and H2O fluxes were measured before and after mucosal exposure of 10-5 mol/L calcium ionophore A23187 was performed. RESULTS: A23187 caused an increase in transepithelial short-circuit current and potential difference and a decrease in transepithelial resistance. A23187 inhibited mucosa to serosa Cl- flux and stimulated serosa to mucosa Na+ flux, resulting in increased net Cl- secretion and decreased net Na+ absorption. A23187 converted H2O from absorption to secretion. Transepithelial short-circuit current effect of A23187 was delayed by indomethacin pretreatment and was completely blunted by low bathing Ca2+. CONCLUSIONS: This is the first demonstration that increased [Ca2+]ic converts the gallbladder from its normal absorptive state to a secretory one. Furthermore [Ca2+]ic appears to regulate ion transport through mechanisms that are partially prostaglandin-dependent. Studies are necessitated to define possible links between gallbladder secretion of Cl- and H2O and mucus hypersecretion, a well-described phenomenon associated with cholesterol gallstone formation.

Animals↗

Vaginal evisceration.

An 89-year-old woman had small intestinal prolapse through the vagina while straining at stool. She had had a vaginal hysterectomy 24 years earlier. Resuscitation, reduction, and repair resulted in survival.

Aged↗

Massive infestation by Ascaris lumbricoides of the biliary tract: report of a successfully treated case.

This is a report of a 25 years old black woman from the city of São Paulo, Brazil, who developed acute obstructive cholangitis of Ascaris lumbricoides with septicemia and multiple hepatic abscesses. The patient had sickle cell trait and normal delivery 3 months ago. Massive infestation of the biliary tract by Ascaris lumbricoides was diagnosed by abdominal ultrasonography and endoscopic retrograde cholangiography. Sixty worms were removed from the common bile duct and hepatic abscesses were drained by surgery. The infectious process was polymicrobial. The patient's recovery was complete after a long evolution with a wide spectrum antibiotic therapy. New surgeries were needed to remove residual worms in the biliary tract. The diagnostic methods, clinical-biochemical features and also the clinical and surgical management are presented. The biliary ascariasis pathophysiology is commented.

Adult↗

A cost/benefit analysis of patient education.

This article's purpose was to report the effects of a formalized patient education program in reducing implications and healthcare expenditures. In our current healthcare environment, caregivers must evaluate each service or treatment rendered in light of its impact or outcome. Impact or outcome must refer to a positive influence on the person receiving the service or treatment. In addition, in our era of extreme pressures to contain healthcare expenditures, the resultant benefit should be that of economic as well as therapeutic yield. The regulation of hospitals by a prospective payment system compels healthcare administrators to scrutinize available resources with a commitment to offer quality programs in patient care. How much healthcare can the consumer afford? Responsible cost benefit analysis will give healthcare providers a strong stance to justify programs. Using a study of pediatric patients with the same diagnosis and initial treatment, the authors evaluate the cost/benefit of a patient-education intervention. Two groups of patients, one with the patient education and the other without, are evaluated as to their utilization of healthcare services resulting from noncompliant behavior. There is less of an incidence of complications with the formalized patient-education program. In deriving a benefit to cost ratio of over seven to one, the effectiveness of the program was demonstrated. People assuming responsibility for their own health are a benefit to society at large.

Cost Control↗