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J Ben-Chaim

Publications and source records attributed to J Ben-Chaim.

35 records · Page 2Linked to original sources
PubMed1995

Applications of osteotomy in the cloacal exstrophy patient.

During the last 18 years we treated 22 patients with cloacal exstrophy of whom 13 were referred for further treatment after initial treatment elsewhere. One patient underwent cystectomy with ileal conduit urinary diversion soon after birth and 9 of the remaining 21 underwent initial closure without osteotomy. Of these 9 patients significant complications developed in 8 (89%) after bladder closure, including dehiscence in 6 (1 underwent 2 unsuccessful closures), a vesicocutaneous fistula and postoperative ventral hernia in 1, and bladder prolapse in 1. In contrast, complications developed in only 2 of the 12 patients (17%) who underwent osteotomy at the time of initial closure, including bladder dehiscence in 1 and significant prolapse in 1. Patients who underwent osteotomy and those who did not were similar in terms of the size of omphalocele, presence of myelomeningocele and time of primary closure. We also found that osteotomy or failed closure has no effect on the eventual continence of cloacal exstrophy patients. While osteotomy is not the only variable involved in successful cloacal exstrophy closure, our results indicate the need for osteotomy in these patients to increase the success rate at the time of initial bladder closure.

Child↗
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↗
PubMed1995

Does the use of the ileocecal region in reconstructive urology cause persistent diarrhea?

The ileocecal region (ICR) is used extensively in reconstructive urological surgery. To evaluate whether resection of the ICR may cause protracted diarrhea, 50 patients undergoing ileocecal resection were studied. Fifty patients undergoing left colectomy for cancer were used as controls. No significant change in bowel habits was noted in the control group. Among patients undergoing ICR resection 42% had transient loosening of stools 2 weeks after surgery which improved within 3 months. Twelve months after surgery only 6 patients with solid stools preoperatively had loose stools, and none suffered diarrhea. In conclusion, in the patients studied after resection of the ICR diarrhea gradually resolved. More work is necessary to study other potential metabolic consequences of such resection.

Adult↗
PubMed1993

Is it justified to avoid radical cystoprostatectomy in elderly patients with invasive transitional cell carcinoma of the bladder?

BACKGROUND: Although radical cystectomy is accepted by most urologists as the treatment of choice for invasive carcinoma of the bladder and age alone is not considered a contraindication for radical surgery, many consider radical major operations to be unsuitable for elderly patients. METHODS: The authors compared the results of radical cystectomy in 42 elderly patients to those in patients 69 years old or younger and to a group of 21 elderly patients, matched by stage of disease and severity of medical problems, who received alternative treatment. RESULTS: The overall operative mortality rate was 6.3% (seven patients). Three (4.3%) postoperative deaths in the younger group and four (9.5%) deaths among elderly patients were recorded. The operative morbidity and mortality did not differ significantly between those two groups (P = 0.1). Among the patients who received alternative therapy, 13 (61.9%) died within the first 6 months, and only 3 survived more than 12 months. Morbidity was encountered in 97% of these patients. CONCLUSIONS: The authors showed that radical cystectomy is a relatively safe procedure for elderly patients. The elderly patient who is thought to be unsuitable for surgery not only is deprived of his right to definite curative therapy but also is exposed to higher morbidity and mortality and worse quality of life than are those who undergo operations. The authors conclude that it is unjustified to avoid radical cystectomy in the elderly population on the basis of age alone.

Adult↗
PubMed1993

The significance of ureteral obstruction in invasive transitional cell carcinoma of the urinary bladder.

Ureteral obstruction is a frequent complication of transitional cell carcinoma (TCC), known as a poor prognostic sign and indicative of advanced disease. We investigated retrospectively the medical records of 122 consecutive patients who suffered from invasive TCC of the urinary bladder during a 6-year period. Unilateral or bilateral ureteral obstruction was found in 66 patients (54.1%). High stage (T3-T4) and grade (III-IV) tumors were correlated with ureteral obstruction in 89.4% and 83.3% respectively compared to 67.9% and 66.1%, respectively, among patients with normal upper tracts (P < 0.001); 10.6% of the patients with ureteral obstruction had low stage disease, and all of them proved to have involvement of the ureteral orifices on the affected side. The 5-year survival rate of patients with and without ureteral obstruction was 32.2% and 65.9%, respectively (P < 0.001). The presence of ureteral obstruction, particularly in the absence of intravesical involvement of the ureteral orifices, signified a high stage, muscle invasive, and often metastatic tumor in more than 90% of the patients. Ureteral obstruction was an accurate criterion for poor prognostic and was associated with significantly lower, overall and stage-specific, survival rates, despite of radical surgery. We conclude that evidence of ureteral obstruction is an important staging standard and significant prognostic indicator in transitional cell carcinoma of the urinary bladder.

Aged↗
PubMed1993

Vesicoureteral reflux and lower urinary tract injury: the possible role of suprapubic cystostomy.

Incidental vesicoureteral reflux was noted frequently during routine cystographic evaluation of patients who suffered vesicourethral trauma and who were managed by suprapubic cystostomy. Based on this observation we designed a retrospective study to document the prevalence of vesicoureteral reflux among 30 consecutive patients following vesicourethral trauma. In 9 patients drainage was instituted by urethral catheter and in 21 by suprapubic cystostomy. Of the latter 21 patients 10 (47.6%) had evidence of vesicoureteral reflux on cystography, which was associated with complete rupture of the urethra in 9 (90%). No patient who was treated initially with a urethral catheter had evidence of vesicoureteral reflux on cystography. We conclude that the prevalence of vesicoureteral reflux is significantly affected by the coexistence of severe vesicourethral injury and the presence of suprapubic cystostomy. The significance of this observation is in the potential risk of ascending upper urinary tract infections due to the hazardous combination of vesicoureteral reflux and frequent recurrent lower urinary tract infections. Presence of vesicoureteral reflux in these patients may necessitate a prophylactic antibiotic regimen. The specific mechanisms that lead to increased prevalence of vesicoureteral reflux in patients following severe vesicourethral injury are not defined by our results. However, we propose a multifactorial concept that may explain our observation.

Adult↗
PubMed1993

Conservative treatment of a vesicocervical fistula resulting from Shirodkar cervical cerclage.

A case of a vesicocervical fistula caused by Shirodkar cervical cerclage and presenting as total urinary incontinence is reported. The patient was managed conservatively by bladder drainage alone with complete resolution of the fistulous tract. This rare complication is avoidable if the bladder is adequately dissected from the cervix during placement of the cerclage suture.

Adult↗
PubMed1993

Bladder neck closure with an Indiana stoma outlet as a technique for continent vesicostomy.

A continent vesicostomy was performed upon two patients. The opened right colonic segment was used to augment the bladder and the ileocecal portion to create a continent abdominal stoma according to the technique used in the Indiana pouch. One patient had complete obstruction of the urethra 1 centimeter distal to bladder neck. The second patient was a paraplegic with an contractile bladder and complete outlet incontinence who was reluctant to perform transurethral self-catheterization. After postoperative follow-up evaluation of 36 and 22 months, respectively, both patients are completely continent day and night on self-catheterization every six hours with preserved function of the upper part of the tract.

Colon↗
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

Deletions in the regulatory or kinase domains of protein kinase C-alpha cause association with the cell nucleus.

We have constructed expression plasmids carrying protein kinase C (PKC) cDNAs with deletions in the coding region. Two truncated molecules, consisting only of the kinase domain of PKC-alpha, were generated by removing parts of the cDNA coding for the regulatory region. Another mutant molecule was created by deleting 95 amino acids from the C-terminal part of the molecule. The full-length cDNA coding for PKC-alpha and its deletion constructs was expressed in COS cells. Using cell fractionation experiments and immunofluorescence staining, we demonstrate here that in contrast to the cytosolic localization of full-length PKC-alpha, the truncated forms, coding only for the kinase domain, were found exclusively in the cell nucleus. Further subfractionation of nuclei isolated from these transfected cells indicated partial association with the nuclear envelopes. Expression of the cDNA lacking the C-terminal part of the molecule in COS cells encoded a truncated molecule that was found both in the cytosol and in the nucleus. We also show that translocation of full-length PKC-alpha molecules to the cell nucleus occurred in response to phorbol ester treatment. Thus, it appears that accumulation of PKC-alpha in the nucleus results either by phorbol ester activation or by deletions of specific regions of the molecule. A molecular mechanism for the nuclear translocation of phorbol ester-activated PKC-alpha or its truncated molecules is suggested.

Amino Acid Sequence↗
PubMed1992

The protein kinase C-related PKC-L(eta) gene product is localized in the cell nucleus.

The tumor promoters phorbol esters are thought to induce changes in cell growth and gene expression by direct activation of protein kinase C (PKC). However, the molecular mechanisms by which PKC molecules transduce signals into the cell nucleus are unknown. In this study, we provide evidence for a direct target for phorbol esters in the nucleus. We demonstrate that the new PKC-related family member, PKC-L, recently isolated by us, is expressed specifically in the cell nucleus. Localization of PKC-L in the cell nucleus is shown both by immunofluorescence staining and by subcellular fractionation experiments of several human cell lines, including the human epidermoid carcinoma line A431. Treatment of these cells by phorbol esters does not induce the down-regulation of PKC-L, in contrast to their effect on classical PKC family members. This is the only PKC isoenzyme described so far that resides permanently and specifically in the cell nucleus. PKC-L may function as an important link in tumor promoting, e.g., as a nuclear regulator of gene expression that changes the phosphorylation state of transcriptional components such as the AP-1 complex.

Cell Nucleus↗
PubMed1992

Etiology of acute scrotum at surgical exploration in children, adolescents and adults.

Between January 1970 and December 1989, 171 patients underwent scrotal exploration for acute scrotum (an acute painful swelling of the scrotum or its content), at our hospital. Of 70 children scrotal explorations, torsion of appendages was found in 33 cases (47%). Torsion of testis was found in 24 patients (34%). Of the 84 adolescent scrotal explorations performed, 72 (86%) had torsion of testis, and 8 (9%) had torsion of appendages. Of 17 adults, torsion of testis was found in 15 cases (88%). These results clarify that unnecessary explorations are much more common in children (66%) than in adolescents and adults (14%). We therefore suggest using radionuclear scans and/or Doppler ultrasound to facilitate clinical diagnosis in the children group.

Acute Disease↗
PubMed1991

Increased serum alkaline phosphatase activity: a possible indicator of renal damage.

Increased levels of serum alkaline phosphatase (ALP) (E.C.3.1.3.1.) were observed in 25 patients with various urological conditions involving the kidneys: malignancy, complicated nephrolithiasis, and surgical and percutaneous manipulations. Other possible sources for increased ALP level, mainly hepatic and osseous, were excluded by history, laboratory tests, and liver and bone imaging. Studies of isoenzymes of ALP did not show a distinctive pattern. ALP levels returned to the normal range by treating the underlying lesions involving the kidney: nephrectomy, complete removal of stones, or removal of nephrostomy. The increase in serum ALP activity may be derived from the injury to the brush border membrane of the renal tubular cells. Renal function impairment and contrast media induced nephrotoxicity may also be responsible for the increased serum ALP. Serum ALP may be a marker for involvement of the kidneys in pathological processes and an indicator of complete treatment. This clinical observation is worthy of further study.

Adult↗