Biomedical subjects

Judy Kleinmann

Publications and source records attributed to Judy Kleinmann.

4 recordsLinked to original sources

PubMed2006

[Comparative morbidity for different accesses in percutaneous nephrolithotripsy].

BACKGROUND: Over the last decades percutaneous nephrolithotripsy (PCNL) has been developed as an alternative for open renal operations in the treatment of complex renal stones. Currently, different approaches are used for the collecting system. OBJECTIVES: To estimate the overall morbidity of different approaches to the collecting system during PCNL; to compare the complication rates for PCNL through the upper pole of the kidney with lower pole access and multiple access approaches. METHODS: We retrospectively reviewed 174 patients (178 renal units) who underwent PCNL. They formed three groups according to surgical access: upper pole (n = 107), lower pole (n = 51) and multiple (n = 20). Inter-group data on procedure related complications were compared. RESULTS: Postoperative fever was more frequent in the upper pole group (34%) compared to the other two groups (25% each, p < 0.49). There was a higher rate of pulmonary complications in the upper pole and multiple access groups (21% and 20%, respectively) compared with the lower pole group (2%, p=0.007). The rate of bleeding and need for blood transfusion was significantly higher in the multiple access group than in the other groups (20% vs 5% and 6%, respectively, p < 0.05). CONCLUSIONS: The upper and multiple access approaches were associated with a higher overall incidence of pleural effusion compared with the lower pole access. The incidence of bleeding and transfusion rates were similar using the upper and lower pole accesses but higher in the multiple access group. Provision of an enhanced surgical field and greater maneuverability together with 'the treatable nature of the associated complications favor an upper pole access, especially for removing a large stone burden.

Fever↗

PubMed2005

Ureteral stents: morbidity and impact on quality of life.

BACKGROUND: Stents offer a simple and effective drainage method for the upper urinary tract. However, ureteral stents are associated with frequent side effects, including irritative voiding symptoms and hematuria. OBJECTIVES: To determine the side effects associated with ureteral stents and their impact on sexual function and quality of life. METHODS: Symptom questionnaires were administered to 135 consecutive patients with unilateral ureteral stents. The questionnaire addressed irritative voiding symptoms, flank pain, hematuria, fever, loss of labor days, anxiety, sleep impairment, decreased libido, erectile dysfunction, dyspareunia, painful ejaculation, and a subjective overall impact on quality of life. The items were graded from 1 (minimal or no symptoms) to 5 (maximal symptoms). The patients were seen and questionnaires filled at 2 weekly intervals following stent insertion until stent extraction. Following removal of the stent, stent patency, impaction and migration rates were determined. Admissions to hospital and ancillary procedures to retreive stents were noted. RESULTS: The findings presented refer to questionnaire items scoring 3 or more. Dysuria, urinary frequency and urgency were reported by 40%, 50% and 55% of the patients, respectively. Flank pain, gross hematuria or fever was reported by 32%, 42% and 15% respectively. Among working patients, 45% lost at least 2 labor days during the first 14 days, and 32% were still absent from work by day 30. A total of 435 labor days were lost in the first month. Anxiety and sleep disturbance were reported by 24% and 20% respectively, and 45% of patients reported impairment in their quality of life. Decreased libido was reported by 45%, and sexual dysfunction by 42% of men and 86% of women. Stent removal necessitated ureteroscpoy in 14 patients (10.5%), due to upward migration in 11 (8.2%) and incrustration and impaction in 3. Spontaneous stent expulsion occurred in one patient. Forty-six stents (34%) were obstructed at the time of removal. Obstructed stents were associated with a longer mean dwell time as compared to the whole population, 75 versus 62 days respectively (P = 0.04). CONCLUSIONS: Ureteral stents are associated with frequent side effects and significant impact on patient quality of life. Our findings should be considered when deciding on ureteral stent insertion and dwell time.

Adult↗

PubMed2003

[Molecular markers for transitional cell carcinoma of bladder].

Superficial transitional cell carcinoma (TCC) has significant rates of recurrence and progression, therefore accurate urinary makers for early diagnosis and follow-up are essential. Urine cytology is the oldest marker, constantly used clinically and considered the "gold standard". In this review we will summarize the properties of different molecular markers for TCC and their yield compared to cytology. Briefly, the older markers--BTA stat, BTA TRAK and NMP22 are more sensitive than cytology, but their specificity is lower, especially in patients with underlying urologic pathologies. FDP (fibrinogen degradation products) analysis is rapid and the test is available clinically. It's sensitivity is higher than cytology for low grade tumors, but specificity is low. Of the newer markers, telomerase has a high sensitivity, and a specificity similar to urine cytology, but also has an increased rate of false positive results. HA-HAase (Hyaluronidase) and CK20 have promising sensitivity and specificity, but are still unavailable for clinical use. CK20 has the additional advantage of being able to detect premalignant conditions as well as predicting recurrence. The role of urinary markers in replacing cystoscopy and urine sediment cytology in the follow-up of TCC and in hematuria work up is still uncertain. It is possible that urinary markers in different panel arrays will have a role in the future for those indications and perhaps in the screening of populations at risk, such as smokers and workers exposed to occupational hazards.

Biomarkers, Tumor↗

PubMed2002

Local anesthesia for prostate biopsy by periprostatic lidocaine injection: a double-blind placebo controlled study.

PURPOSE: We determined the efficacy of anesthesia for prostate biopsy by periprostatic lidocaine injection. MATERIALS AND METHODS: A total of 90 consecutive patients undergoing prostate biopsies were randomized into lidocaine and placebo groups of 45 each in double-blind fashion. A 5 ml. dose of 1% lidocaine or 0.9% sodium chloride was injected via 23 gauge needles inserted through the transrectal ultrasound probe working channel and aimed at the prostatic neurovascular bundles bilaterally. Patients completed a symptom questionnaire applying a visual analog scale of 0-none to 10-maximal addressing pre-procedure anxiety, overall pain and discomfort throughout the procedure, pain during biopsy punctures and patient tolerance, as judged by the operator. Student's t test was used to analyze continuous variables and the chi-square test was applied for categorical data. Linear regression was done to determine intervariable influences. RESULTS: The average pain level throughout the procedure was 3.06 in the lidocaine group versus 4.15 in the control group (p = 0.04), while the pain level during biopsy punctures was 1.51 versus 3.98 (p = 0.0001) and patient tolerance was 1.06 versus 1.93 (p = 0.018). The level of discomfort throughout the procedure was lower in the lidocaine group with borderline significance (4.31 versus 5.24, p = 0.077). The lidocaine and control groups were comparable regarding average patient age (65 and 66 years, respectively). Prostate volume was similar in the 2 groups (68.5 versus 63 ml.). The median number of biopsy punctures was 7 and 8, respectively. Cancer was identified in 10 patients (22.2%) per group. CONCLUSIONS: Periprostatic lidocaine injection is an effective method of anesthesia for prostate biopsy.

Aged↗