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J Kellogg Parsons

Publications and source records attributed to J Kellogg Parsons.

At least 19 recordsLinked to original sources
PubMed2006

Metabolic factors associated with benign prostatic hyperplasia.

CONTEXT: Benign prostatic hyperplasia poses a significant public health problem, but its etiology remains unclear. Obesity and associated abnormalities in glucose homeostasis may play a role in benign prostatic hyperplasia development by influencing prostate growth. OBJECTIVE: The objective of this study was to determine whether obesity, fasting plasma glucose concentration, and diabetes are associated with radiologically determined prostate enlargement, an objective measure of benign prostatic hyperplasia. DESIGN: This study was a cross-sectional analysis with robust variance estimates to account for multiple measures over time in the same individuals. SETTING: This prospective cohort study was composed of community volunteers. PATIENTS: Patients studied were 422 adult men enrolled in The Baltimore Longitudinal Study of Aging. MAIN OUTCOME MEASUREMENTS: Total prostate volume as determined by pelvic magnetic resonance imaging was measured. RESULTS: Among 422 participants, 91 (21.6%) had prostate enlargement (defined as total prostate volume >/= 40 cc) at first visit. Compared with men of normal weight [body mass index (BMI) < 25 kg/m(2)], the age-adjusted odds ratio (OR) for prostate enlargement for overweight men (BMI, 25-29.9 kg/m(2)) was 1.41 (95% CI, 0.84-2.37), for obese men (BMI, 30-34 kg/m(2)) was 1.27 (95% CI, 0.68-2.39), and for severely obese men (BMI >/= 35 kg/m(2)) was 3.52 (95% CI, 1.45-8.56) (P = 0.01). Men with elevated fasting glucose (>110 mg/dl) were more likely to have an enlarged prostate than men with normal fasting glucose (</=110 mg/dl) (OR, 2.98; 95% CI, 1.70-5.23), as were men with a diagnosis of diabetes (OR, 2.25; 95% CI, 1.23-4.11). CONCLUSIONS: Obesity, elevated fasting plasma glucose, and diabetes are risk factors for benign prostatic hyperplasia.

Adult↗
PubMed2006

Primary squamous cell carcinoma in unreconstructed exstrophic bladder.

Bladder exstrophy is associated with an increased incidence of primary adenocarcinoma of the bladder. We report a rare case of squamous cell carcinoma occurring in the unreconstructed, exstrophic bladder of a 53-year-old woman treated with radical cystectomy and radiochemotherapy. This case represents the oldest patient to present with squamous cell carcinoma of an unreconstructed exstrophic bladder. We discuss the potential mechanisms of carcinogenesis in this patient, noting how they may potentially differ from those in a patient with a reconstructed bladder.

Bladder Exstrophy↗
PubMed2006

Multidisciplinary, inpatient directly observed therapy for HIV-1-infected children and adolescents failing HAART: A retrospective study.

Children and adolescents with HIV-1 infection and elevated viral loads are at risk for disease progression. When outpatient adherence efforts fail to reduce viral loads, we have chosen to hospitalize patients for directly observed antiretroviral therapy. A retrospective chart review was performed for patients who were admitted for adherence concerns to a rehabilitation facility from December 1, 2000 to December 1, 2003. Differences in CD4 count and viral load at admission, prior to discharge and 6 months after discharge were evaluated using the Wilcoxon signed-ranks test. Nineteen admissions were included in the analysis. Compared to the mean CD4 count at admission (262), the mean CD4 counts at discharge (492) and 6 months after discharge (429) were significantly higher (p < 0.001 and p = 0.01, respectively). Similar results were observed for change in CD4 percentage. Compared to the mean viral load at admission (log 5.7), the mean viral loads at discharge (log 4.7) and 6 months after discharge (log 5) were significantly lower (p < 0.001 and p < 0.004). The majority of admissions (74%) involved a change in highly active antiretroviral therapy (HAART) regimen. In conclusion, hospitalization for directly observed therapy of HIV-1-infected children and adolescents with elevated viral loads and nonadherence resulted in an immediate and sustained (up to 6 months) reduction in viral load and increase in CD4 count.

Adolescent↗
PubMed2005

Can a baseline prostate specific antigen level identify men who will have lower urinary tract symptoms later in life?

PURPOSE: We evaluated the relationship between baseline prostate specific antigen (PSA) and subsequent lower urinary tract symptom development during 3 decades in unselected men in the Baltimore Longitudinal Study of Aging. MATERIALS AND METHODS: Urinary questionnaires were used to evaluate lower urinary tract symptoms in 704 men during 3 decades. The number of repeat evaluations was 1 to 18. We divided subjects into age groups of younger than 50 and 50 to 69.9 years at the time of the first PSA evaluation. Subjects were divided into 3 PSA groups based on initial PSA below the 25th, 25th to 75th and above the 75th percentile. A mixed effects Poisson model was used to test whether there was a significant relationship between PSA grouping and symptom score with time. RESULTS: There was no statistically significant difference in symptom score distribution across PSA percentiles in men younger than 50 years (p = 0.87) or 50 to 69.9 years old (p = 0.59). When age was used as an independent variable in the model, there was no statistically significant relationship between baseline PSA and symptom score (p = 0.38). CONCLUSIONS: These data suggest that PSA is not a useful predictor of the development of lower urinary tract symptoms in unselected, asymptomatic men.

Adult↗
PubMed2005

Serum testosterone and the risk of prostate cancer: potential implications for testosterone therapy.

OBJECTIVE: A potential risk of testosterone replacement therapy is an increase in the incidence of prostate cancer, but it is unclear whether higher levels of serum testosterone are associated with a higher risk of prostate cancer. We prospectively evaluated serum androgen concentrations and prostate cancer risk. METHOD: Included were 794 members of the Baltimore Longitudinal Study of Aging. We estimated the rate ratio (RR) of prostate cancer by entering serial measures of serum total testosterone, dehydroepiandrosterone sulfate, sex hormone binding globulin, calculated free testosterone, and free testosterone index (FTI) into a Cox proportional hazards regression model with simple updating. RESULTS: Higher calculated free testosterone was associated with an increased age-adjusted risk of prostate cancer {RRs by quartile: 1.00, 1.52 [95% confidence interval (95% CI), 0.93-2.50], 1.16 (95% CI, 0.61-2.20), 2.59 (95% CI, 1.28-5.25); P(trend) = 0.03}, which persisted after excluding measures in men <45 years of age [RRs by quartile: 1.00, 1.33 (95% CI, 0.78-2.25), 1.26 (95% CI, 0.68-2.33), 1.89 (95% CI, 0.99-3.61); P(trend) = 0.03]. Compared to men with eugonadal FTI (> or = 0.153), men with hypogonadal FTI had a decreased risk of prostate cancer (RR, 0.51; 95% CI, 0.31-0.82). CONCLUSION: Higher levels of calculated serum free testosterone are associated with an increased risk of prostate cancer. These findings suggest that men receiving testosterone therapy should be regularly monitored for prostate cancer and underscore the need for prospective trials of testosterone therapy incorporating incidence of prostate cancer as a primary safety end point.

Case-Control Studies↗
PubMed2004

Complications of abdominal urologic laparoscopy: longitudinal five-year analysis.

OBJECTIVES: To analyze complications of abdominal laparoscopic surgery of the urinary tract at a single institution during a 5-year period. METHODS: From 1996 to 2000, we identified 894 abdominal laparoscopic procedures performed at a single institution: 600 nephrectomies (live donor, simple, radical, nephroureterectomy, and partial), 112 pyeloplasties, 61 renal biopsies, 35 retroperitoneal lymph node dissections, 31 renal cyst ablations, 18 adrenalectomies, and 37 other abdominal procedures. The charts were retrospectively reviewed for complications, which were classified as operative, postoperative, or medical. Complications were correlated with patient age and American Society of Anesthesiologists score. Statistical analysis was performed with Fisher's exact test and chi-square tests. RESULTS: A total of 118 complications (13.2%) occurred. Two patients (0.2%) died. As a result of operative complications, the procedure of 13 patients (1.5%) was converted to an open one. As a result of postoperative complications, 13 (1.5%) underwent operative and 6 (0.7%) nonoperative intervention. The most common intraoperative complications were vascular (n = 23), adjacent organ (n = 10), and bowel (n = 9) injuries. The most common postoperative complications were neuromuscular pain (n = 12), hematoma (n = 11), urine leak (n = 7), and wound infection (n = 7). The differences in the annual complication rates for all procedures did not attain statistical significance (P = 0.5). Among all procedures, excluding live donor nephrectomy, complications of any kind correlated with a greater patient American Society of Anesthesiologists score (P = 0.01). CONCLUSIONS: Rather than decreasing, the overall incidence of laparoscopic complications did not change significantly during a 5-year period at our institution. The factors contributing to this observation likely included the progression of inexperienced individual surgeons through the learning curve, the introduction of new, more sophisticated laparoscopic procedures, and stable rates of patient comorbidity. This experience may represent the average complication rate for urologic laparoscopy at a large-volume, academic training center.

Adrenalectomy↗
PubMed2004

Appendiceal cystadenoma mimicking a cystic renal mass.

We report the first case of appendiceal mucinous cystadenoma associated with the kidney. A 57-year-old man with chronic renal failure presented with a right renal mass. During laparoscopic nephrectomy, frozen analysis of a tubular structure extending from the mass showed appendiceal tissue. The mass, appendix, and what was believed to be the right kidney were removed. Pathologic examination demonstrated mucinous cystadenoma of the appendix. No renal tissue was identified, but the patient refused further treatment. This case demonstrates that mucinous cystadenomas arising from retroperitoneal structures might mimic renal neoplasms and should be considered in the differential diagnosis of cystic renal masses.

Adrenal Gland Neoplasms↗
PubMed2004

Effect of methylprednisolone on return of sexual function after nerve-sparing radical retropubic prostatectomy.

OBJECTIVES: To determine whether postoperative methylprednisolone improves the recovery of sexual function after nerve-sparing radical retropubic prostatectomy. METHODS: We randomized men undergoing bilateral nerve-sparing radical retropubic prostatectomy by a single surgeon to receive 6 days of placebo or methylprednisolone beginning on postoperative day 1. At 3, 6, and 12 months postoperatively, we assessed potency with the abbreviated International Index of Erectile Function questionnaire and urinary continence with participant-reported pad use. We used the chi-square test, Fisher's exact test, and the two-sample t test with equal variances for comparisons between study groups. RESULTS: No operative complications occurred and 70 (100%) of 70 participants experienced normal wound healing. The odds of being potent for participants who received methylprednisolone (n = 34) compared with those who received placebo (n = 36) did not significantly differ at 3 (odds ratio 0.29, 95% confidence interval 0.08 to 1.05), 6 (odds ratio 0.63, 95% confidence interval 0.17 to 2.4), or 12 (odds ratio 1.18, 95% confidence interval 0.29 to 4.8) months. The mean International Index of Erectile Function scores did not significantly differ at 3 (P = 0.08), 6 (P = 0.50), or 12 (P = 0.71) months. At 12 months, 74% of the methylprednisolone and 71% of the placebo participants were potent (P = 0.8). The proportions of participants who were continent did not differ significantly at 3 (P = 0.89), 6 (P = 0.25), or 12 (P = 0.49) months. At 12 months, 96% of the methylprednisolone and 100% of the placebo participants were continent. CONCLUSIONS: At doses sufficient to produce a systemic anti-inflammatory effect, postoperative methylprednisolone was not associated with improved potency at up to 12 months after bilateral nerve-sparing radical retropubic prostatectomy in men 40 to 60 years old.

Adenocarcinoma↗
PubMed2004

The historical origins of interstitial cystitis.

PURPOSE: We identify early descriptions of interstitial cystitis and trace its evolution as a clinical entity during the 19th century. MATERIALS AND METHODS: Primary and secondary source documents relating to interstitial cystitis, bladder inflammation and bladder stones were reviewed. RESULTS: What is believed to be the earliest published record of interstitial cystitis appeared in an 1836 textbook by the Philadelphia surgeon Joseph Parrish, who documented a syndrome of chronic frequency, urgency, dysuria and pelvic pain he called "tic doloureux of the bladder." Tic doloureux was a contemporaneous diagnosis used to describe painful, idiopathic disorders of nerves. Parrish attributed this term to his mentor, Dr. Phillip Syng Physick, who applied it to patients with severe lower urinary tract symptoms with no discernible etiology, with the most common etiology during the 19th century being bladder stones. A review of archival material from the Philadelphia College of Physicians indicates that by 1808 Physick had developed a concept of bladder inflammation, a "bladder ulcer," that produced lower urinary tract symptoms in the absence of bladder stone. CONCLUSIONS: By 1808 Philip Syng Physick had described an inflammatory condition of the bladder producing the same lower urinary tract symptoms as a bladder stone. By 1836 he had expanded this concept to include a chronic frequency, urgency and pain syndrome occurring in the absence of demonstrable etiology. We propose that these are the earliest known descriptions of bladder inflammation and interstitial cystitis.

Cystitis, Interstitial↗
PubMed2004

Complexed prostate specific antigen (PSA) reduces unnecessary prostate biopsies in the 2.6-4.0 ng/mL range of total PSA.

OBJECTIVE: To compare the performance of complexed prostate-specific antigen (cPSA) to total PSA (tPSA) and percentage free PSA (f/tPSA) in the diagnosis of prostate cancer for the tPSA range 2.6-4.0 ng/mL. PATIENTS AND METHODS: Consecutive men scheduled for prostate biopsy were enrolled prospectively at 14 different sites in two multicentre studies in Europe and the USA. Serum obtained before biopsy was tested with the ACS:180 and Immuno 1 tPSA and cPSA assays (Bayer Diagnostics, Tarrytown, NY, USA) and the Access fPSA and tPSA assays (Beckman, Inc., San Diego, CA, USA). Receiver operating characteristics (ROC) curves were generated to compare the diagnostic performance of tPSA, cPSA and f/tPSA. RESULTS: Of 316 men with a tPSA of 2.6-4.0 ng/mL, 82 (26%) were diagnosed with prostate cancer on biopsy. ROC analysis of all 316 men showed an area under the curve (AUC) for cPSA of 0.63, significantly greater than the AUC for tPSA of 0.56 (P = 0.008). At a sensitivity of 95%, threshold values of 2.3 ng/mL for cPSA and 2.73 ng/mL for tPSA provided specificities of 20.1% and 9.8%, respectively. f/tPSA was only available for 205 of the 316 (65%) men and the AUC for cPSA was 0.63, and did not significantly differ from the f/tPSA AUC of 0.64 (P = 0.58). CONCLUSIONS: As a single test, cPSA provides improved specificity over tPSA and comparable specificity to f/tPSA for detecting prostate cancer, and may reduce the number of unnecessary prostate biopsies in the 2.6-4.0 ng/mL tPSA range.

Adult↗
PubMed2003

Rectus abdominis vaginoplasty after anterior exenteration for urologic malignancy.

INTRODUCTION: Vaginal resection is occasionally required in female patients who undergo anterior exenteration for invasive lower urinary tract malignancy. We have used a rectus abdominis myocutaneous flap to reconstruct the vagina and perineum after extensive local resection of bladder and urethral carcinoma. TECHNICAL CONSIDERATIONS: Either a left or right rectus flap is used. Once anterior exenteration, partial vaginectomy, and urinary diversion are completed, the median infraumbilical incision is extended superiorly to form an elliptical skin paddle centered over the superior half of the muscle. The superior epigastric vessels are ligated, the cephalad end of the muscle is divided at the level of the costal margin, and the flap is progressively elevated out of the rectus sheath by sequentially dividing the lateral perforating nerves and vessels. As the muscle is elevated, the inferior epigastric pedicle is carefully preserved and followed inferiorly to its origin from the external iliac artery. Once a length of muscle sufficient for it to reach the perineum is mobilized, the flap is carried transpelvically. For complete vaginal reconstruction, the flap may be inverted into a tube, with the cephalic portion anchored to the perineum. Alternatively, the skin paddle may be used to fill tissue defects in the vagina and pelvic floor. The anterior abdominal wall fascia and skin edges at the donor site are closed primarily. We have successfully applied this technique in 4 patients who underwent anterior exenteration for invasive bladder and urethral carcinoma. CONCLUSIONS: Rectus abdominis vaginoplasty is a viable surgical option for reconstruction after anterior exenteration with vaginal resection for invasive cancer of the bladder and urethra.

Adenocarcinoma, Clear Cell↗
PubMed2003

Urinary stone size: comparison of abdominal plain radiography and noncontrast CT measurements.

BACKGROUND AND PURPOSE: To compare urinary stone size as measured by abdominal plain radiography (AXR) with stone size as measured by noncontrast three-dimensional spiral CT in patients with acute renal colic. PATIENTS AND METHODS: Patients presenting to the emergency room of a single institution with urinary stones that were visible on both AXR and noncontrast spiral CT were identified. Two radiologists blinded to the clinical outcomes separately and randomly reviewed all films and measured maximum longitudinal (craniocaudal) and transverse (anteroposterior) stone diameters. The two-tailed paired Student's t-test was used to compare the sizes of each stone on AXR and CT. RESULTS: Over a 1-year period, 22 patients were identified with a total of 31 urinary stones visible on both AXR and CT. Nineteen stones were located in the kidney, three in the midureter, and nine in the distal ureter. The mean stone size by AXR was 6.1 mm (range 2-13 mm; SD +/- 1.95) in the longitudinal axis and 5.3 mm (range 2-11 mm; SD +/- 1.50) in the transverse axis. The mean stone size by CT was 6.9 mm (range 3-12 mm; SD +/- 1.95) in the longitudinal axis and 6.1 mm (range 2-11 mm; SD +/- 1.50) in the transverse. The differences between AXR and CT measurements did not attain significance in either the longitudinal (p = 0.67) or the transverse (p = 0.25) axis. CONCLUSIONS: A CT scan provides estimates of stone size that are consistently greater than those of AXR in both the longitudinal and transverse axes. However, for stones between 2 and 13 mm in maximum diameter, these differences do not attain significance. In patients with a history of radiopaque stones in this size range, therefore, AXR may provide useful size data for clinical decision-making without concern about significant disparities between the two modalities. As AXRs are more expeditiously obtained, incur less direct costs, and expose patients to significantly lower doses of radiation than CT scans, they remain a useful adjunctive study in the work-up of nephrolithiasis.

Adult↗