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Biomedical subjects

M H Solomon

Publications and source records attributed to M H Solomon.

At least 19 recordsLinked to original sources
PubMed1995

Prostate cancer: US-guided percutaneous cryoablation. Work in progress.

PURPOSE: To present early results of cryosurgical ablation of prostate cancer with an ultrasound-guided percutaneous technique. MATERIALS AND METHODS: Cryosurgery was performed in 210 patients; near complete 3- and 6-month follow-up data were available for 130. Androgen ablation therapy was used to decrease the size of the prostate gland for optimal freezing. Prostate-specific antigen (PSA) and prostatic biopsy studies were performed at 3, 6, and 12 months. RESULTS: Gland volume decreased from 29 cm3 +/- 14.1 to 20.4 cm3 +/- 8.4 (P < .0001) after androgen ablation. Rates of positive biopsy findings at 3, 6, and 12 months were 7.7%, 3.3%, and 2.3%, respectively. Serious complications were minimal and included no deaths, urethrorectal fistulas in five patients, and total incontinence in three. Mean PSA levels decreased from 12.6 +/- 16.1 preoperatively to 0.35 +/- 0.75 at 3 months, 0.54 +/- 1.1 at 6 months, and 0.43 +/- 0.78 at 12 months (persistent cancers excluded). CONCLUSION: These preliminary results demonstrate that cryosurgery can cause necrosis of prostate cancer. Long-term results and randomized trials are necessary to determine if this means longer disease-free intervals and increased patient survival compared with results of current therapeutic methods.

Aged↗
PubMed1993

The role of transrectal ultrasound-guided staging biopsy and androgen ablation therapy prior to radical prostatectomy.

Radical prostatectomy is the most common therapy for localized prostate cancer. Unfortunately, resection is associated with positive surgical margins in 35-50% of cases. We report the use of ultrasound-guided staging biopsies to stage tumors preoperatively with greater accuracy. We also report the use of androgen ablation therapy (AAT) as an adjunct to radical prostatectomy in an attempt to downstage tumors preoperatively and decrease the incidence of positive margins. Between 1 June 1991 and 31 July 1992, 131 patients underwent radical prostatectomies, 119 of whom underwent AAT before surgery and 12 of whom did not. Specimens were examined for the presence of positive surgical margins, extracapsular extension, and perineural invasion. Cases pretreated with AAT had a 9.2% positive surgical margin rate compared with 33% in untreated subjects. Extracapsular extension was seen in 22 of 119 (18.5%) of AAT, and 5 of 12 (41.7%) of non-AAT, cases. Perineural invasion was nearly 3 times less likely in AAT patients. Moreover, perineural invasion was significantly less marked in AAT patients. We present a subset of 11 patients who were definitively proven as pathologic stage C cancer by transrectal ultrasound (TRUS)-guided needle biopsy. These cases had prostate cancer intermixed with fatty tissue and pigmented seminal vesicle epithelium, elements not found in the prostate. In this selected stage C subset, gland shrinkage, evidence of downstaging, and tumor obliteration were seen after AAT. We conclude that TRUS-guided staging biopsy can definitively stage prostate cancer as stage C when tumor is intermixed with extraprostatic elements, and AAT appears to decrease the incidence of positive surgical margins by tumoral necrosis and selective perineural kill. We believe that these findings demonstrate the antitumor effects of AAT and deserve further scrutiny in a large randomized clinical trial.

Androgen Antagonists↗
PubMed1993

Hormone ablation therapy as neoadjuvant treatment to radical prostatectomy.

Two hundred consecutive patients with presumed localized prostate cancer had radical prostatectomy alone (n = 119) or were treated for an average period of 3 months with combination therapy using the antiandrogen flutamide and one luteinizing hormone-releasing hormone (LHRH) agonist (Lupron or Zoladex). The positive margins decreased from 35.3% in the group undergoing prostatectomy alone to 11.5% in the group of men who received combination therapy before radical prostatectomy. In 41 apical tumors, the incidence of positive margins decreased from 50% in the control group to 18.6% in the combination therapy group. In stage C disease, the incidence of positive tumor showed a tendency to decrease with the extended duration of endocrine treatment with a rate of 37.5% after 3 months and 16.7% after 6 months. Whether the decreased incidence of positive surgical margins will all translate into prolonged survival remains to be verified by long-term follow-up of these patients. However, the initial results obtained in the present study are very encouraging.

Aged↗
PubMed1991

Transrectal ultrasound, digital rectal examination, and prostate-specific antigen: preliminary results of an early detection program for prostate cancer.

Three hundred and ninety eight self-referred men with no histories of prostate problems were followed once each year for up to four years to determine the feasibility of early prostate cancer detection by digital rectal examination, transrectal ultrasound, and prostate-specific antigen. Evaluation of prostate-specific antigen was based on a polyclonal level of normal of 2.6 nanograms per milliliter by the Yang assay. Biopsies were performed when indicated by either transrectal ultrasound or digital rectal examination. The overall cancer detection rate for the four year period was 6.3 percent. A 3:1 cancer detection advantage of transrectal ultrasound over digital rectal examination was shown. Transrectal ultrasound and prostate-specific antigen each detected 92 percent of the proven cancers, and were complementary when either test was normal, together detecting 100 percent of the cancers. Thirty two percent (8/25) of all cancers were detected by digital examination, with digital exam having no predictive power after two study years. Prostate-specific antigen as an initial screening test for early prostate cancer may identify a suspicious group, whom may further be evaluated by transrectal ultrasound and digital exam. Results of this study lend credibility to the large scale randomized screening study proposed by the U.S. National Institutes of Health in which prostate-specific antigen and digital rectal examination are to be used as initial tests for prostate cancer detection.

Aged↗
PubMed1989

Transrectal biopsy of the prostate guided with transrectal US: longitudinal and multiplanar scanning.

One hundred forty-nine ultrasound (US)-guided transrectal biopsies of the prostate were performed with an 18-gauge needle mounted in a spring-loaded firing device. Two probes were used, one with its sector transducer placed at the tip of the probe and the other with its sector transducer placed at an angle of 45 degrees. All biopsies provided a diagnostic tissue core. Histologic examination of biopsy specimens showed that 78 lesions were cancerous, 17 were dysplastic, and 54 were benign. Two patients developed fever; one of these received oral antibiotics after onset of the fever. Hospitalization was not required for either patient. The authors conclude that US-guided transrectal biopsy is a safe and valuable diagnostic tool.

Biopsy, Needle↗
PubMed1986

Prostatic evaluation by transrectal sonography: criteria for diagnosis of early carcinoma.

Over a 7-month period, from a total of 417 transrectal ultrasound (US) studies, 45 transperineal biopsies of the prostate were performed in the radiology department. Transrectal US guidance and local anesthesia were used. Twenty-two of 32 hypoechoic lesions, located within the peripheral zone tissue of the gland, were proved by histologic study to be cancerous. Hyperechoic lesions were all histologically benign hyperplasias. The patients experienced no major complications necessitating hospitalization or increased length of hospital stay as a result of the procedure.

Adult↗
PubMed1985

Transrectal ultrasound in the diagnosis of prostate cancer: location, echogenicity, histopathology, and staging.

Adenocarcinoma of the prostate produces specific ultrasonic findings that can be used in diagnosis. We have examined 211 patients using transrectal ultrasound in both the sagittal and axial planes. Thirty-three carcinomas were detected, and 31 histologically confirmed; 24 by needle biopsy, six by transurethral resection, one by total prostatectomy, and two by the demonstration of distant metastases. On ultrasound, all of the carcinomas were less echogenic than normal prostate. All appeared to originate in the peripheral zone of the prostate and produced asymmetry of the gland. The majority of carcinomas in this series showed capsular involvement and ten penetrated and extended beyond the prostatic capsule. The results of this series indicate that transrectal ultrasound can be used to detect cancer of the prostate gland. Ultrasound demonstrated the extent of tumor involvement and enabled accurate staging of these cancers.

Adenocarcinoma↗
PubMed1981

Urinary retention secondary to Landry-Guillain-Barré syndrome.

We report on 2 patients who presented with voiding abnormalities and were found to have the Landry-Guillain-Barré syndrome. Urodynamic evaluation documented a motor paralytic bladder with denervation of the periurethral striated muscle in 1 case. The other patient recovered before denervation could be confirmed by urodynamic study. Although a motor paralytic bladder is anticipated, based on the pathophysiology of the Landry-Guillain-Barré syndrome, it has not been documented previously in the literature.

Adult↗
PubMed1980

Bladder calculi complicating intermittent catheterization.

Bladder calculi occurred as a late complication in 4 male patients who performed satisfactorily clean, intermittent catheterization. The mechanism for stone formation in each case was a hair introduced into the bladder, which served as a nidus for incrustation. Patients on intermittent catheterization, particularly male subjects with impaired tctile discrimination, should be instructed to observe diligently for and avoid adherence of hairs to the catheter to prevent this complication.

Adolescent↗
PubMed1980

Twenty-year outcome of cutaneous vesicostomy.

Forty cutaneous vesicostomy urinary diversions were done at our hospital from 1958 to 1961. Of these cases 30 patients have been followed every 6 months or until death. The vesicostomy-related failure rate was 8.6 per cent, with new stones forming in 3 additional kidneys. Cutaneous vesicostomy provides long-term preservation of renal function in patients requiring urinary diversion. However, close followup is mandatory to ensure a good result.

Follow-Up Studies↗
PubMed1980

Urodynamic studies in anesthetized children.

Urodynamic study was done on 31 neurologically normal children with urinary infection and/or severe voiding disturbances. The evaluation was performed with the child under anesthesia because awake testing proved unsatisfactory. Detrusor contraction occurred in 29 children under anesthesia and sufficient data were obtained to identify accurately patterns of dysfunction and to initiate therapy. A method for anesthetic neurourologic study using enflurane is presented, which permits reliable and reproducible urodynamic observations to be made in patients in whom awake investigations are incomplete or unsatisfactory.

Anesthesia, Inhalation↗
PubMed1976

Kartagener's syndrome with corrected transposition. Conducting system studies and coronary arterial occlusion complicating valvular replacement.

An 18-year-old man whose sister has classic Kartagener's syndrome was found to have sinusitis, bronchiectasis, and corrected transposition with normal visceral situs. Congenital complete heart block was secondary to absence of conducting-system pathways between a small posterior atrioventricular node and the transposed His bundle and bundle branches. No anterior atrioventricular node was present. Prosthetic valvular replacement of the left-sided (morphologic right) atrioventricular valve was complicated by coronary arterial occlusion by suture, with subsequent myocardial infarction. The case appears to represent an unusual variant of Kartagener's syndrome with the abnormality of laterality being expressed as corrected transposition.

Adolescent↗