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Biomedical subjects

M Spevak

Publications and source records attributed to M Spevak.

15 recordsLinked to original sources
PubMed2001

Characterization of patients presenting with male factor infertility in an equal access, no cost medical system.

OBJECTIVES: Demographic information on patients presenting for the diagnosis and treatment of male factor infertility has been limited in the past by the paucity of subspecialty trained providers and concentrated sequential patient information. Previously reported studies looking at the characteristics of patients being evaluated for male subfertility may represent a selected subset of patients able to access these services. The changes in the diagnostic modalities available in the 1990s and new diagnostic categories may also affect the characterization of patients seen with the diagnosis of male factor infertility. METHODS: A retrospective analysis was performed using a centralized database of patient records at a single military male infertility clinic. Seven hundred consecutive patients were studied to obtain information on patient and spouse age, race, length of subfertile period, medical history and examination, and laboratory evaluation. A single provider categorized the etiology of male factor infertility after the evaluation. RESULTS: The mean patient age was 36 years (range 17 to 68). The mean spouse age was 31.2 years (range 19 to 50). The mean subfertile period was 5.5 years (range 0.5 to 35). Of the 700 patients, 51% were white, 10% African American, 2% Hispanic, and 37% other/unknown. Eleven percent of the patients were active smokers. The most common etiologic category groups describing male subfertility were previous vasectomy (56%), varicocele (14%), idiopathic infertility (8%), and nonobstructive azoospermia (6%). CONCLUSIONS: An equal access, no cost medical system mirrors the demographics of the military population served. The clinical characteristics of patients presenting with male factor infertility have changed significantly during the past 30 years. Obstruction from a previous vasectomy is now the most common presenting complaint of patients visiting an infertility clinic. Vasectomy reversal may be more frequently requested when the cost is not a factor in providing fertility services. Idiopathic male factor infertility occurs in less than 10% of patients.

Adolescent↗
PubMed2001

The development of erectile dysfunction in men treated for prostate cancer.

PURPOSE: Erectile dysfunction is a common side effect in men treated for prostate cancer. Previously published studies document the incidence of erectile dysfunction in men treated for prostate cancer to be between 20% and 88%. To our knowledge a prospective evaluation focused on the development of erectile dysfunction in men treated for prostate cancer has not elucidated components of its chronology or risk factors. MATERIALS AND METHODS: A centralized prospective database of 2,956 patients diagnosed with prostate cancer at a single institution was studied in regard to pretreatment and posttreatment erectile dysfunction. Of these 2,956 patients 802 had sufficient information regarding erectile function and comprise our study population. Factors analyzed in regard to treatment and erectile dysfunction include treatment modality, that is radical prostatectomy, external beam radiation therapy and watchful waiting, and ethnicity, patient age, clinical stage and tumor histological grade. RESULTS: No significant difference was noted in the posttreatment erectile function between patients treated with radical prostatectomy or external beam radiation (10% versus 15%). Patients selecting watchful waiting had the lowest risk of erectile dysfunction. Clinical stage and race were significant predictors for the development of erectile dysfunction in the watchful waiting and external beam radiation treatment groups. CONCLUSIONS: Erectile dysfunction develops in greater than 80% of patients treated for prostate cancer. External beam radiation has the same risk for erectile dysfunction as radical prostatectomy.

Adult↗
PubMed2001

Changing trends in partial nephrectomy at Walter Reed Army Medical Center.

PURPOSE: To evaluate the change in indications, frequency, complications, and outcome in patients undergoing partial nephrectomy at a single institution during a 25-year period. MATERIALS AND METHODS: A retrospective chart review was performed for patients who underwent partial nephrectomy at Walter Reed Army Medical Center from 1970 to 1995. A total of 309 patient records were reviewed for patient age, sex, and primary diagnosis. A more detailed analysis was performed on 47 records of patients who underwent partial nephrectomy from 1986 to 1996. RESULTS: The number of partial nephrectomies declined from the 1970s to the 1990s, demonstrating the trend away from nephron-sparing surgery for benign disease. Partial nephrectomies for renal cell carcinoma increased during the same period. Fifty-seven percent (12 of 21) of patients from 1986 to 1996 underwent partial nephrectomy for incidentally discovered renal tumors. Complications occurred in 25% (11 of 44) of patients, with acute renal insufficiency occurring in 4.5% (2 of 44). Twenty-two of 25 patients who underwent partial nephrectomy for renal cell carcinoma were followed for a mean of 45.6 months. The cancer-specific 5-year survival rate for partial nephrectomy was 88.1%. CONCLUSION: Trends in nephron-sparing surgery showed a movement away from performing ablating surgery for benign disease and toward nephron-sparing surgery for renal masses. Despite a higher complication rate, the curative ability of partial nephrectomy is similar to that of radical nephrectomy.

Adult↗
PubMed1999

Oral trazodone is not effective therapy for erectile dysfunction: a double-blind, placebo controlled trial.

PURPOSE: The unusual side effect of priapism associated with the antidepressant trazodone has led researchers to evaluate its use for the treatment of erectile dysfunction. Previous studies have shown nearly 70% efficacy in patients. Unfortunately, these studies have been anecdotal, retrospective or of combination therapy with yohimbine. A placebo controlled, fixed dose, double-blind crossover study was performed to evaluate the safety and efficacy of oral trazodone for the treatment of erectile dysfunction. MATERIALS AND METHODS: A total of 51 patients with at least 3 months of complete erectile dysfunction were randomized in a double-blind fashion to receive 50 mg. trazodone or placebo at bedtime. Evaluation consisted of a history, physical examination and laboratory studies, including hormonal evaluation, nocturnal penile tumescence evaluation, penile Doppler ultrasound and the Index of Sexual Satisfaction. Patients were followed at monthly intervals with an in clinic interview. After a 3-month treatment interval patients were reevaluated with index scores and crossed over after a 3-week washout period. Study end points included patient diary evaluations and index scores at the beginning of the study interval and the end of the first treatment period. RESULTS: Of the 51 patients who enrolled in the study 48 completed both phases. Mean patient age was 65 years (range 31 to 80). After the first 3-month treatment interval 19% of patients receiving trazodone had improved erections compared to 24% receiving placebo (p < 0.50). Of the trazodone group 35% had improvement in sex drive compared to 20% of the placebo group (p < 0.36). Mean Index of Sexual Satisfaction scores changed after treatment from 31.7 to 27.5 for the trazodone group (p < 0.50) and from 28.5 to 30.8 for the placebo group (p < 0.49). Side effects included drowsiness in 31% of the patients, dry mouth in 1% and fatigue in 19%. CONCLUSIONS: Trazodone is no more effective than placebo in improving erections and sexual function in patients with severe physiological erectile dysfunction.

Administration, Oral↗
PubMed1998

Cancer and male factor infertility.

With the increasing success of multimodality anticancer therapy, most men of reproductive age will survive their malignancy. Reproductive function is a principal concern of these men. Health-care providers are shifting the focus of oncologic care toward improving the quality of life in cancer patients, particularly with regard to fertility. For unknown reasons, fertility and sexual function are adversely affected in men with germ cell tumors and Hodgkin's disease prior to the initiation of therapy. Despite these pretreatment abnormalities, fertility potential remains good. Cancer therapy utilizing physical and chemical treatment methods can temporarily or permanently damage spermatogonia, resulting in azoospermia and infertility. Recovery of spermatogenesis can take up to 10 years after therapy. Alternative treatment regimens can preserve reproductive function while maintaining high therapeutic efficacy. Surgical treatment should be directed toward maintaining the neurovascular mechanisms responsible for seminal emission and ejaculation. With new developments in assisted reproductive techniques, even cancer patients with severe oligoasthenospermia can father children. These techniques have not been found to increase the incidence of major or minor birth defects.

Gonadal Disorders↗
PubMed1998

Efficacy and safety of transurethral alprostadil in patients with erectile dysfunction following radical prostatectomy.

PURPOSE: A retrospective analysis of the MUSE clinical trial was performed to evaluate the efficacy and safety of transurethral alprostadil in patients with erectile dysfunction after radical prostatectomy. MATERIALS AND METHODS: Patients received doses of transurethral alprostadil in the clinic and those for whom a suitable dose was determined were treated at home with active drug or placebo for 3 months. Patients had undergone radical prostatectomy no less than 3 months before study entry. RESULTS: Of the 384 patients in whom radical prostatectomy was identified as a cause of erectile dysfunction 70.3% had an erection believed sufficient for intercourse in the clinic and 57.1% on active medication had sexual intercourse at least once at home. The product of clinic and home success rates (70.3 x 57.1%) was an overall success rate (the likelihood of active treatment to lead to intercourse at home) of 40.1%. The frequency of most adverse effects of radical prostatectomy was comparable to that of other organic etiologies of erectile dysfunction (1,127 patients). The percentage of patients with hypotension in the clinic was lower after radical prostatectomy compared to other erectile dysfunction etiologies (0.8 versus 4.2%, p < 0.001) but the percentage of patients with urethral pain/burning was higher (18.3 versus 10.4%, p = 0.027). No urinary tract infection, fibrosis or priapism occurred in the post-radical prostatectomy patients. CONCLUSIONS: Transurethral alprostadil is a well tolerated and efficacious method of treating erectile dysfunction after radical prostatectomy, although psychological changes associated with cancer and surgery may limit home response. The severe neurovascular deficit associated with prostatectomy neither limits the efficacy of transurethral alprostadil nor increases the risks.

Adult↗
PubMed1997

Intracranial metastatic adenocarcinoma of the prostate presenting as visual disturbance.

We report two cases of intracranial metastatic adenocarcinoma of the prostate that presented with visual disturbance. The two patients had no prior history of prostate cancer and both underwent invasive neurosurgical procedures. Progressive neurological decline mandated craniotomy in one patient and the other patient underwent transphenoidal surgery for biopsy. Androgen deprivation therapy was instituted postoperatively for both patients when prostate cancer was determined to be the source of the metastatic lesions.

Abducens Nerve↗
PubMed1997

The effect of human chorionic gonadotropin on methotrexate concentration in the rat testes.

PURPOSE: We analyzed the effect of human chorionic gonadotropin (hCG) on drug concentrations in testicular interstitial fluid and whole testis tissue samples in rats receiving hCG prior to methotrexate (MTX) administration and in animals that did not receive hCG. MATERIALS AND METHODS: Adult male Sprague-Dawley rats were injected subcutaneously with 200 i.u. hCG (Goldline Laboratories, Ft. Lauderdale, FL.). Controls were injected subcutaneously with normal saline (0.2 cc). Sixteen hours after injection, each rat was given methotrexate (Methotrexate LPF, Immunex Corp. Seattle WA.) via a carotid artery cannula in a dose of 30 mg./kg. Methotrexate (MTX) levels were collected 60 minutes post infusion time in 27 rats and 90 minutes post infusion in 27 rats. MTX levels were measured in serum, testicular interstitial fluid and testicular tissue. MTX levels were measured using high performance liquid chromatography (HPLC). RESULTS: A significantly higher concentration of MTX was found in testicular interstitial fluid (TIF) in rats injected with hCG when specimens were collected 60 minutes post infusion. MTX levels in TIF had reversed 90 minutes post infusion with higher levels found in control rats. Tissue levels of MTX demonstrated no significant difference at either 60 or 90 minutes in the hCG treated animals or controls. CONCLUSION: Our results suggest that hCG effects the tissue distribution of MTX within the testis. Human chorionic gonadotropin may have this effect on the testicular microvasculature by 1) selectively increasing capillary permeability, 2) increasing lymphatic flow within the testes or 3) increasing testicular blood flow.

Animals↗
PubMed1996

The tailored low dose fluoroscopic voiding cystogram for familial reflux screening.

PURPOSE: Radionuclide voiding cystography is generally advocated as a screening study to detect familial reflux. We assessed the efficacy of tailored low dose fluoroscopic voiding cystography for this purpose. MATERIALS AND METHODS: We evaluated 10 boys and 10 girls 9 months to 10 years old (mean age 5 years) who were siblings of patients known to have reflux. The technique used a low dose fluoroscopic system. A tailored voiding cystographic protocol was designed to minimize gonadal radiation dose. RESULTS: Absence of reflux was confirmed in 10 patients. Mean fluoroscopy time was 19 seconds (range 14 to 22), resulting in mean gonadal radiation exposure of less than 1.5 mrad., which is comparable to the lowest reported doses with the radionuclide technique. After reflux was demonstrated in 10 patients the study was immediately converted to a standard fluoroscopic imaging technique to define lower tract anatomy and quantitate reflux, avoiding a second study. CONCLUSIONS: Tailored low dose fluoroscopic voiding cystography appears to be a practical approach for the assessment of familial reflux.

Child↗
PubMed1992

[Clinical manifestations of spinal lesions in dysraphic malformations of the caudal neuropore in children].

Disorders in the development of the spine and the spinal cord in the caudal neuroporus region significantly contribute to the morbidity and the lasting invalidity of children. Clinical investigations of the malformations manifest through different forms of body abnormalities, ranging from asymptomatic forms of "spina bifida occultae" to the severe forms of open "meningomyelocele". The nature and the level often cannot be detected before the development of the structural changes in the course of growth and development of the child, which can hardly be treated later. At the Department of Child Surgery in Novi Sad 12 infants were surgically treated in the last 5 years, while 30 children were surgically and conservatively treated after the detection of the clinical and subclinical manifestations of dysraphism. The indications for the surgical treatment were open meningomyelocele as well as those subclinical forms indicating the development of the tethered corn syndrome, hydrocephalus and tumefactions in the lumbosacral region. Moreover the study points to the significance of certain clinical features and investigations in the diagnosis of spinal dysraphism.

Cauda Equina↗
PubMed1991

Reliability and validity of the Florida Sexual History Questionnaire.

The Florida Sexual History Questionnaire (FSHQ) is a brief 20-item questionnaire designed to assess male sexual dysfunction. The validity and reliability of the scale were examined in 33 diabetic impotent males and 58 nondiabetic, age-equivalent nonimpotent males. The FSHQ was found to have high internal consistency and split-half reliability and significantly discriminated between nonimpotent and impotent subjects. Among diabetic impotent subjects, some of the test items were correlated significantly with physiological measures of sexual functioning. However, the FSHQ failed to discriminate between diabetics diagnosed as having organic or psychogenic impotence. This latter finding is discussed within the context of recent suggestions that it may not be possible to draw a clear dichotomy between organic and psychogenic impotence.

Adult↗
PubMed1989

Metabolism of tumor regression from angiogenesis inhibition: 31P magnetic resonance spectroscopy.

31P NMR spectroscopy was used to analyzed the in vivo metabolism of reticulum cell sarcoma of mice. The ratio of high- to low-energy phosphates ATPB/(Pi + PME) was measured to reflect the relative metabolic state in the tumor. Of the 34 mice studied, 26 were treated with an antiangiogenesis regimen of heparin and cortisone. Eighty-two percent of the tumors treated eventually decreased in volume (P less than 0.01). Volumes and spectroscopic information of 20 tumors were analyzed. Although the average untreated volume was similar to the volume after 3 days of treatment, the average ATPB/(Pi + PME) ratio rose from 0.34 +/- 0.10 to 0.47 +/- 0.07 (P = 0.02). However, after 6 days of treatment, the volume significantly decreased (P less than 0.0001) but the ratio did not significantly rise further (P = 0.06). The rise in the high-energy phosphate preceded a significant decrease in volume of the tumors. In addition, the replenishment of high-energy stores with tumor regression coincided with the histologic findings of a decrease in the number of tumor cells, a decrease of the mitotic index, and a decrease of the number of necrotic cells present with ongoing treatment. Our data suggest that noninvasive methods of assessing early biochemical response of tumor regression may be possible.

Animals↗