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Biomedical subjects

M I Resnick

Publications and source records attributed to M I Resnick.

At least 91 records · Page 5Linked to original sources
PubMed1997

Protease inhibitors and urolithiasis.

PURPOSE: We discuss the specific urological abnormalities associated with protease inhibitor therapy. MATERIALS AND METHODS: We report on a human immunodeficiency virus positive patient who was on protease inhibitor therapy and presented with renal colic. RESULTS: The stone passed spontaneously. Stone analysis was not consistent with any known composition of urinary calculus. CONCLUSIONS: The positive effects of protease inhibitors in human immunodeficiency virus positive patients mandate that the urological community become familiar with these drugs and the specific urological complications as the use of these drugs becomes widespread.

Adult↗
PubMed1997

The role of gamma-glutamyl transpeptidase in the preoperative metastatic evaluation of renal cell carcinoma.

PURPOSE: We evaluated gamma-glutamyl transpeptidase as an indicator of metastatic disease in patients with renal cell carcinoma. MATERIALS AND METHODS: We reviewed the records of 53 patients with metastatic renal cell carcinoma, and compared serum alkaline phosphatase and gamma-glutamyl transpeptidase with the site of metastases. These results were then compared to those in 29 patients with clinically localized renal cell carcinoma. RESULTS: Overall gamma-glutamyl transpeptidase was elevated in 37 patients (69.8%) with metastatic disease, while alkaline phosphatase was elevated in 16 (30.2%, p < 0.025). Gamma-glutamyl transpeptidase was increased in more patients with hepatic metastases only than alkaline phosphatase (p < 0.025) and in all groups it was a better predictor of metastases than alkaline phosphatase. Gamma-glutamyl transpeptidase was also increased in significantly more patients with metastatic renal cell carcinoma (37 of 53) compared to 1 of the 27 with localized renal cell carcinoma (p < 0.001). CONCLUSIONS: Gamma-glutamyl transpeptidase was increased in a large percent of patients with metastatic renal cell carcinoma, and it was normal in the majority with localized renal cell carcinoma. We conclude that gamma-glutamyl transpeptidase should be included as well as alkaline phosphatase in the preoperative metastatic evaluation of patients with renal cell carcinoma. Elevated gamma-glutamyl transpeptidase should prompt a search for bone as well as liver metastases.

Adolescent↗
PubMed1997

Transrectal ultrasound versus digital rectal examination for the staging of carcinoma of the prostate: results of a prospective, multi-institutional trial.

PURPOSE: We determined the accuracy of transrectal ultrasonography versus digital rectal examination in staging the local extent of biopsy proved carcinoma of the prostate. MATERIALS AND METHODS: A National Institutes of Health funded network was developed to perform prospective, multi-institutional trials. A total of 386 patients judged by the investigators to be candidates for radical prostatectomy underwent transrectal ultrasonography with recording of data according to a numerical analog for construction of receiver operating characteristic curves. The results of digital rectal examination were similarly recorded. After radical prostatectomy whole mount histology was performed on all surgical specimens, and pathological findings were correlated with preoperative transrectal ultrasound and digital rectal examination results. RESULTS: The calculated area under the curve for transrectal ultrasound in predicting extracapsular tumor extension was 0.69 compared to 0.72 for digital rectal examination (p = 0.64), while that for predicting seminal vesicle invasion was 0.74 and 0.69, respectively (p = 0.36). There was a nonstatistically significant trend for improved accuracy of both examinations as tumor volume increased. Transrectal ultrasound was more accurate for staging posterior cancers than for those in the anterior portion of the prostate. CONCLUSIONS: Neither transrectal ultrasound nor digital rectal examination proved to be superior to each other for staging the local extent of prostate cancer. No imaging modality or examination that depends on gross architectural changes is likely to have a high degree of accuracy in detecting microscopic extension of extracapsular tumor frequently observed in radical prostatectomy specimens.

Adenocarcinoma↗
PubMed1997

Use of polyglycolic acid mesh to support parenchymal closure following partial nephrectomy.

PURPOSE: We describe the use of absorbable mesh for closure of a large parenchymal defect created by partial nephrectomy. MATERIALS AND METHODS: A circular piece of polyglycolic acid mesh was measured to approximate the diameter of the parenchymal defect and the edges were sutured to the renal capsule in a running fashion. RESULTS: This technique has been used in 3 patients without complications. This approach has been particularly helpful for repairing large and irregular renal parenchymal defects. CONCLUSIONS: Use of polyglycolic acid mesh is effective for rapid, hemostatic closure of the kidney in association with partial nephrectomy.

Aged↗
PubMed1997

Transrectal prostate ultrasonography: variability of interpretation.

PURPOSE: The current study was designed to compare the interpretation of the individual performing transrectal ultrasound examination (operator) with experienced individuals who interpreted the examination with and without the availability of clinical data. Inter-observer and intra-observer variability was compared to determine the reproducibility and reliability of the study. MATERIALS AND METHODS: All patients undergoing radical prostatectomy for treatment of localized carcinoma of the prostate underwent a transrectal ultrasound examination before the procedure. The sonogram was interpreted by the operator and reviewers. The radical prostatectomy specimen was examined pathologically and the staging as determined by ultrasound was compared with the pathological findings. RESULTS: Ultrasound operator accuracy for extracapsular extension and seminal vesicle invasion was 0.70 and 0.74, respectively, compared with the accuracy of the reviewers, which ranged from 0.59 to 0.75 and 0.44 to 0.74 for extracapsular extension and seminal vesicle invasion, respectively. In general, blinded reviews were less accurate than unblinded reviews but this was only statistically significant for 2 reviewers. CONCLUSIONS: Although for most reviewers the addition of clinical data did not improve the accuracy of the interpretation, an advantage was noted for the operator, that is, the individual performing the examination. In general, the technical quality of the examination was related to the accuracy of the readings.

Humans↗
PubMed1997

The role of open stone surgery in the management of urolithiasis.

The establishment of extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy, and ureteroscopy as the primary treatment modalities for almost all renal and ureteral calculi has greatly diminished the role of open stone surgery. We reviewed our most recent experiences with open stone surgery to determine the current indications and to establish what role open surgery plays in the management of urolithiasis. We conducted a retrospective review of all patients undergoing open stone surgery during a consecutive 60-month period from 1991 through 1995 at three university-affiliated hospitals. Hospital and office charts, operative notes and records, and pertinent radiographic studies were reviewed. Of the 780 therapeutic stone procedures performed, 42 were open surgical procedures (5.4%), including pyelolithotomy [15], anatrophic nephrolithotomy [14], ureterolithotomy [7], and radial nephrolithotomy [6]. The most common indications for open stone surgery were complex stone burden, previous treatment failures with less-invasive modalities, anatomical abnormalities involving the renal collecting system, and patient comorbid medical problems. The stone-free rate following open surgery was 93%. There were five complications. Based on our experience, we discuss our current indications for open stone surgery.

Adult↗
PubMed1997

Comparison of the ileal conduit to the continent cutaneous diversion and orthotopic neobladder in patients undergoing cystectomy: a critical analysis and review of the literature.

In recent years, many investigators have devised innovative urinary diversions to improve the quality of life of patients requiring urinary diversions after cystectomy. In this article, we report a literature review in which we compare the outcomes of patients receiving an ileal conduit to those receiving either a continent cutaneous diversion or an orthotopic neobladder. In this discussion, we analyze the data in the literature that pertains to quality of life, incontinence rates, and metabolic complications. We conclude that although the newer urinary diversions are promising, randomized prospective trials comparing patients receiving these diversions to those receiving an ileal conduit need to be performed.

Aged↗
PubMed1996

CWR22: the first human prostate cancer xenograft with strongly androgen-dependent and relapsed strains both in vivo and in soft agar.

Most patients' prostate cancers respond to androgen deprivation but relapse after periods of several months to years. Only two prostate cancer xenografts, LNCaP and PC-346, have been reported to be responsive to androgen deprivation and to relapse subsequently. Both of these tumors shrink slightly, if at all, and relapse less than 5 weeks after androgen withdrawal. After androgen withdrawal, the human primary prostate cancer xenograft CWR22 regresses markedly, and prostate-specific antigen (PSA) falls up to 3000-fold in the blood of mice. PSA usually returns to normal. In some animals, the tumor relapses and is then designated CWR22R. In these animals, PSA starts to rise approximately 2-7 months, and tumor begins to grow 3-10 months after castration. Animals with CWR22 need to be euthanized because of large tumors 6-12 weeks after the transplantation of CWR22. Androgen withdrawal prolongs life approximately 3-4-fold.

Agar↗
PubMed1996

Urolithiasis and cystic fibrosis.

PURPOSE: We determined whether cystic fibrosis patients are at increased risk for the development of urolithiasis. MATERIALS AND METHODS: Telephone interviews were conducted with 201 cystic fibrosis patients older than 15 years to identify those with a history of urolithiasis. Histories were confirmed by chart review, and only patients with urolithiasis documented by excretory urography, renal ultrasound or spontaneous passage of a stone were included. RESULTS: A total of 11 patients (5.5%) had documented urolithiasis, with 2 or more episodes in 7. Mean age at initial episode was 27.0 years (range 19 to 33). CONCLUSIONS: Cystic fibrosis patients may be at increased risk for urolithiasis compared to age-specific prevalence rates for stone disease in the general population.

Adult↗
PubMed1995

Analysis of prostatic fluid: evidence for the presence of a prospective marker for prostatic cancer.

In an endeavor to identify marker(s) for prostatic cancer, proteins in prostatic fluids were analyzed by two-dimensional (2-D) gel electrophoresis. The fluids were obtained from five males who had no prostate lesions and five patients each with benign prostatic hyperplasia (BPH) and prostatic carcinoma (PCA). The specimens were collected directly over a mixture of protease inhibitors and centrifuged, and the supernatants were lyophilized and solubilized in sodium dodecyl sulfate mix. Identical amounts of proteins were pooled according to donors' prostate disease and the resulting samples were subjected to 2-D gel analysis employing the ISO-DALT system. The electrophoretograms were developed by silver or double stain. The samples of each group exhibited distinctive profiles with the exception of similar relative positions of major protein spots. A predominant protein occurring as several charge variants was consistently present in prostatic fluids of patients with PCA. This protein appeared to be a previously unknown constituent that we have called protein D (molecular weight approximately 22 kDa and isoelectric point approximately 4), and was undetectable in the fluids of "normal" men and patients with BPH. An analysis of pooled, unprocessed urine from PCA patients revealed that perhaps this protein is excreted in urine in very low quantities. These results strongly suggest that the potential of this protein as a marker for prostatic cancer should be further explored.

Biomarkers, Tumor↗
PubMed1995

Prostate Cancer Clinical Guidelines Panel Summary report on the management of clinically localized prostate cancer. The American Urological Association.

PURPOSE: The American Urological Association convened the Prostate Cancer Clinical Guidelines Panel to analyze the literature regarding available methods for treating locally confined prostate cancer, and to make practice policy recommendations based on the treatment outcomes data insofar as the data permit. MATERIALS AND METHODS: The panel searched the MEDLINE data base for all articles from 1966 to 1993 on stage T2 (B) prostate cancer and systematically analyzed outcomes data for radical prostatectomy, radiation therapy and surveillance as treatment alternatives. Outcomes considered most important were survival at 5, 10 and 15 years, progression at 5, 10 and 15 years, and treatment complications. RESULTS: The panel found the outcomes data inadequate for valid comparisons of treatments. Differences were too great among treatment series with regard to such significant characteristics as age, tumor grade and pelvic lymph node status. The panel elected to display, in tabular form and graphically, the ranges in outcomes data reported for each treatment alternative. CONCLUSIONS: In making its recommendations, the panel presented treatment alternatives as options, identifying the advantages and disadvantages of each, and recommended as a standard that patients with newly diagnosed, clinically localized prostate cancer should be informed of all commonly accepted treatment options.

Humans↗
PubMed1995

Imaging of the prostate. Benign prostatic hyperplasia.

Imaging studies of the prostate and urinary tract in patients with BPH include ultrasonography, intravenous urography, urethrography, CT scans, and MR imaging. Ultrasound can assess for upper tract changes, determine post void residuals, estimate prostatic volume, and demonstrate zonal anatomy and internal changes within the prostate. Intravenous urography is indicated for patients with hematuria, urinary tract stones, and other atypical histories. Urethrography provides information in the post prostatectomy patients with residual symptoms. CT scans and MR imaging are expensive and have no routine use in evaluating patients with BPH.

Humans↗
PubMed1995

Indications and techniques for urologic evaluation of the trauma patient with suspected urologic injury.

Injury to the urinary tract occurs in 3% to 10% of patients suffering from blunt or penetrating trauma. Timely assessment of these patients is fundamental in minimizing associated morbidity and mortality rates. We introduce a review of the current treatment of patients with suspected injury to the urinary tract in which we focus on the appropriate diagnostic approach and current advances in the field. This review is divided into sections concentrating on injuries to the kidneys, bladder, and urethra. Pertinent anatomy, mechanism of injury, classification of injury, and indications for evaluation are addressed in each section. Illustrative case studies are also provided to complement relevant teaching points.

Adolescent↗
PubMed1995

Focal inflammation of the corpus cavernosum in a diabetic man due to acute occlusion of the cavernous artery.

Inflammation of the penile corpus cavernosum is an unusual condition most often associated with an infectious process. We report on a diabetic man with localized inflammation of the corpus cavernosum resulting from acute occlusion of the cavernous artery. Diagnosis was made by exclusion and ultimately confirmed by penile angiography. Conservative measures led to resolution of this process.

Acute Disease↗