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Biomedical subjects

Muta M Issa

Publications and source records attributed to Muta M Issa.

At least 19 recordsLinked to original sources
PubMed2007

Initial experience with the radiotracer anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid with PET/CT in prostate carcinoma.

UNLABELLED: Conventional imaging techniques have serious limitations in the detection, staging, and restaging of prostate carcinoma. Anti-1-amino-3-(18)F-fluorocyclobutane-1-carboxylic acid (anti-(18)F-FACBC)is a synthetic l-leucine analog that has excellent in vitro uptake within the DU-145 prostate carcinoma cell line and orthotopically implanted prostate tumor in nude rats. There is little renal excretion compared with (18)F-FDG. The present study examines anti-(18)F-FACBC uptake in patients with newly diagnosed and recurrent prostate carcinoma. METHODS: Fifteen patients with a recent diagnosis of prostate carcinoma (n = 9) or suspected recurrence (n = 6) underwent 65-min dynamic PET/CT of the pelvis after intravenous injection of 300-410 MBq anti-(18)F-FACBC followed by static body images. Each study was evaluated qualitatively and quantitatively. Maximum standardized uptake values were recorded in the prostate or prostate bed, and within lymph nodes at 4.5 min (early) and 20 min (delayed), and correlated with clinical, imaging and pathologic follow-up. Time-activity curves were also generated for benign and malignant tissue. RESULTS: In the 8 patients with newly diagnosed prostate carcinoma who underwent dynamic scanning, visual analysis correctly identified the presence or absence of focal neoplastic involvement in 40 of 48 prostate sextants. Pelvic nodal status correlated with anti-(18)F-FACBC findings in 7 of 9 patients and was indeterminate in 2 of 9. In all 4 patients in whom there was proven recurrence, visual analysis was successful in identifying disease (1 prostate bed, 3 extraprostatic). In 3 of these patients, (111)In-capromab-pendetide had no significant uptake at nodal and skeletal foci. Malignant lymph node uptake in both the staging and restaging patients was significantly higher than benign nodal uptake. Though uptake faded with time, in all 6 patients with either lymph node metastases or recurrent prostate bed carcinoma, there was intense persistent uptake at 65 min. CONCLUSION: Anti-(18)F-FACBC is a promising radiotracer for imaging prostate carcinoma. Radiotracer uptake was demonstrated in primary and metastatic disease. Future research should investigate the mechanism of radiotracer uptake in normal and pathologic tissue and develop a clinical imaging strategy for initial staging and restaging.

Aged↗
PubMed2006

The value of digital rectal examination as a predictor of prostate cancer diagnosis among United States Veterans referred for prostate biopsy.

BACKGROUND: As digital rectal examination (DRE) remains an essential part of a routine physical examination, it is important to understand its diagnostic value in different circumstances. AIM: To quantify sensitivity, specificity and predictive value of DRE as a predictor of biopsy-confirmed prostate cancer in the US Veteran population. METHODS: The study group included 628 consecutive patients who underwent transrectal biopsy for suspected prostate cancer due to abnormal digital examination of the prostate, elevated serum prostate specific antigen (PSA) or both. The DRE results reported in this study are documented during physical examinations that were performed after referral for biopsy. The relation between DRE results and positive biopsy was examined while taking into consideration demographic and clinical patient characteristics. RESULTS: Among men with normal PSA the adjusted odds ratio (OR) reflecting the association between abnormal DRE and positive prostate biopsy was 0.53 with a 95% confidence interval (CI) from 0.27 to 1.06. In the presence of a moderately elevated (4.1-10 ng/mL) PSA, the OR was 1.07 (0.72-1.60). When serum PSA exceeded 10 ng/mL, the OR was 2.15 (1.12-4.43). The positive predictive value of an abnormal DRE varied widely from as high as 81% to as low as 14% depending on the other patient characteristics. DISCUSSION: These results indicate that DRE results are most informative when evaluated in conjunction with other clinical and demographic information.

Adult↗
PubMed2006

Informed versus uninformed consent for prostate surgery: the value of electronic consents.

PURPOSE: We evaluated the documentation of informed consent for 2 common prostate operations using current, conventional, paper based consent forms. Based on the results of the review the conventional paper based consent system was replaced with a new, standardized electronic consent system. MATERIALS AND METHODS: We retrospectively reviewed the consent forms obtained for transurethral resection of the prostate and radical prostatectomy procedures during the 6-year period 1995 to 2000 at Atlanta Veterans Affairs Medical Center. Analysis focused on the basic elements of informed consent, including a description of the proposed treatment, and the purpose, benefits, risks and alternatives. Based on these findings we standardized the procedure specific information contained in consent forms and stored it electronically in a central network accessible to all urology providers throughout the medical center. RESULTS: Of the 222 total procedures 204 consent forms were available for review. Senior residents, junior residents and physician assistants obtained consent for 42.2%, 30.9% and 25.5% of procedures, respectively. Information on the purpose and benefits of treatment was missing in 4.4% of cases and deficient in 22.6%. General or procedure specific risks were documented inconsistently in 0% to 96% of cases. Alternative treatment options were missing in 49% of the consent forms and they were significantly deficient in the remaining 51%. Prognosis and surgical risks were documented variably for each procedure. For example, in the radical prostatectomy group 79 patients (88.8%) had appropriate documentation regarding the potential for significant blood loss and yet only 23 (25.8%) had documented consent for blood transfusion. Following the implementation of a new standardized electronic consent program 96.1% of the patients surveyed preferred the new system. CONCLUSIONS: Conventional nonstandardized consent forms have significant deficiencies and errors. The new system of electronic informed consent is standardized, legible and understandable, and it assists providers in fully informing patients about the treatment, risks, benefits and alternative therapies, thereby supporting ethical and legal standards, and improving the quality of care. In our opinion standardized electronic informed consent should be the new standard of care.

Humans↗
PubMed2006

Successful penile preservation surgery for large proximal penile carcinoma: 7-year follow-up.

We report the case of a 49-year-old man who presented with a 2-month history of a progressively enlarging squamous cell carcinoma on the skin of the proximal penile shaft. The patient refused penectomy and requested penile preservation. He was treated with wide surgical excision of the tumor, followed by a full-thickness vascularized scrotal skin flap. The treatment proved curative, with excellent cosmetic and functional results. The patient is without evidence of disease recurrence 7 years after therapy.

Carcinoma, Squamous Cell↗
PubMed2006

Comparison of camera-based 99mTc-MAG3 and 24-hour creatinine clearances for evaluation of kidney function.

OBJECTIVE: The 24-hour creatinine clearance is the standard clinical technique for measuring kidney function; however, this measurement is cumbersome and inconvenient for patients. We hypothesized that a camera-based technetium-99m mercaptoacetyltriglycine (MAG3) clearance obtained simultaneously with a standard MAG3 scan would correlate well with the 24-hour creatinine clearance and could serve as a simple marker of kidney function. MATERIALS AND METHODS: Data were obtained from a retrospective analysis of 28 patients with varying degrees of kidney dysfunction and 85 subjects evaluated for kidney donation. The MAG3 clearance was calculated using a camera-based technique without blood or urine sampling. The creatinine clearance was measured using the plasma creatinine and a 24-hour urine collection. The MAG3 and creatinine clearances were corrected for body surface area, and clearance values in healthy subjects and patients were compared using the paired Student's t test. The linear association between the MAG3 and creatinine clearances was expressed by Pearson's correlation coefficient. RESULTS: The mean MAG3 clearance in the potential kidney donors was 321 +/- 95 mL/min/1.73 m2 (95% CI, 171-546 mL/min/1.73 m2), significantly higher than the mean creatinine clearance of 152 +/- 51 mL/min/1.73 m2 (79-278 mL/min/1.73 m2, p < 0.001). The mean MAG3 clearance in patients was 153 +/- 70 mL/min/1.73 m2 (32-316 mL/min/1.73 m2) and was also significantly higher than the mean creatinine clearance of 74 +/- 36 mL/min/1.73 m2 (21-138 mL/min/1.73 m2, p < 0.001). The ratio of the mean creatinine clearance to the mean MAG3 clearance was essentially the same for volunteers and patients, 0.47 and 0.48, respectively. The Pearson's correlation between the MAG3 and creatinine clearances was 0.80 (0.72-0.86). CONCLUSION: The camera-based 99mTc-MAG3 clearance correlates well with the 24-hour creatinine clearance and can provide a simple and convenient index of kidney function.

Adult↗
PubMed2006

Clinical and economic outcomes in patients treated for enlarged prostate.

BACKGROUND: Benign prostatic hyperplasia (BPH), also referred to as enlarged prostate, is a highly prevalent condition in men aged 50 years or older. It is a progressive disease with significant morbidity from complications. OBJECTIVE: The purpose of this study was to assess the likelihood of having acute urinary retention (AUR) and prostate surgery after initiating therapy with an alpha blocker or 5-alpha reductase inhibitor in a real-world setting. STUDY DESIGN: This was a retrospective study of patients who were treated for BPH between January 1, 2003, and November 30, 2003, in a large, national managed care claims database. Outcomes measures of interest included rate of AUR, prostate surgery, and surgical complications. RESULTS: There were 2959 patient records with a diagnosis of BPH who were taking prostate medications in the database. Eighty-nine percent of patients were receiving alpha blocker therapy, whereas 11% of patients were receiving 5-alpha reductase inhibitors. Overall, the 1-year AUR rate was 12.1%, and the prostate surgery rate was 5.8%. Patients who initiated 5-alpha reductase inhibitor therapy only were less likely to have AUR or surgery compared with patients taking alpha blockers, although surgical differences did not reach statistical significance (P = .0576). Overall, the surgical complication rate was 49.4%, and the rate of AUR within 180 days of prostate surgery was 30.6%. Rates of prostate surgery, AUR, and surgical complications all increased with age. CONCLUSION: Patients receiving 5-alpha reductase inhibitor therapy alone were less likely to have AUR compared with patients receiving alpha blockers and tended to be less likely to have surgery (P = .054).

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed2006

An assessment of the diagnosed prevalence of diseases in men 50 years of age or older.

OBJECTIVE: A lack of focus on certain men's health problems has led to significant morbidity and mortality in aging men. Managed care must begin to focus on the conditions that are most prevalent in this fast-growing population in an effort to improve the quality of care. To assist in achieving this goal, a naturalistic retrospective study assessing the prevalence of the 10 leading disorders in men older than the age of 50 was conducted, with an additional focus on men eligible for Medicare. METHODS: Claims data were obtained from the Integrated Health Care Information Solutions National Managed Care Benchmark database (Waltham, Mass), that includes data from 30 health plans covering more than 25 million lives, and from the Centers for Medicare & Medicaid Services, representing men from a 5% random sample of Medicare-eligible patients. Men older than 50 years of age were included in the study. The prevalence of all diseases was determined in the 2003 calendar year for each population. Prevalence was calculated by dividing the number of diagnosed cases of a disease by the total person-time observations within the 2003 period. RESULTS: The results indicate that cardiovascular (ie, coronary artery disease [CAD], hypertension, and arrhythmias), urological (ie, enlarged prostate and prostate cancer), and musculoskeletal disorders (ie, osteoarthritis and bursitis) comprise 70% of the 10 leading diseases. CAD and hypertension ranked first and second across all age categories, whereas enlarged prostate ranked fourth. In men older than 50, diabetes ranked third, whereas cataracts ranked third in Medicare-eligible men. CONCLUSION: The diseases identified in this study have the potential to cause significant clinical and economic implications when poorly treated or undertreated. Therefore, there is a need to institute early treatment for these conditions before they progress and require more extensive and costly interventions.

Aged↗
PubMed2005

mtDNA mutations increase tumorigenicity in prostate cancer.

Mutations in the mtDNA have been found to fulfill all of the criteria expected for pathogenic mutations causing prostate cancer. Focusing on the cytochrome oxidase subunit I (COI) gene, we found that 11-12% of all prostate cancer patients harbored COI mutations that altered conserved amino acids (mean conservation index=83%), whereas <2% of no-cancer controls and 7.8% of the general population had COI mutations, the latter altering less conserved amino acids (conservation index=71%). Four conserved prostate cancer COI mutations were found in multiple independent patients on different mtDNA backgrounds. Three other tumors contained heteroplasmic COI mutations, one of which created a stop codon. This latter tumor also contained a germ-line ATP6 mutation. Thus, both germ-line and somatic mtDNA mutations contribute to prostate cancer. Many tumors have been found to produce increased reactive oxygen species (ROS), and mtDNA mutations that inhibit oxidative phosphorylation can increase ROS production and thus contribute to tumorigenicity. To determine whether mutant tumors had increased ROS and tumor growth rates, we introduced the pathogenic mtDNA ATP6 T8993G mutation into the PC3 prostate cancer cell line through cybrid transfer and tested for tumor growth in nude mice. The resulting mutant (T8993G) cybrids were found to generate tumors that were 7 times larger than the wild-type (T8993T) cybrids, whereas the wild-type cybrids barely grew in the mice. The mutant tumors also generated significantly more ROS. Therefore, mtDNA mutations do play an important role in the etiology of prostate cancer.

Adenosine Triphosphatases↗
PubMed2005

Role of transrectal ultrasonography in diagnosis and treatment of retained Foley catheter.

Retention of Foley balloon in the bladder or urethra is a troublesome complication that presents a challenge to the urologist. We describe a complicated case of Foley catheter balloon retention (and trauma) within the urethra in an orthopedic patient undergoing hemiarthroplasty. The Foley balloon failed to deflate with standard methods. We used transrectal ultrasonography to successfully diagnose and manage the case.

Aged↗
PubMed2005

Molecular classification of renal tumors by gene expression profiling.

Renal tumor classification is important because histopathological subtypes are associated with distinct clinical behavior. However, diagnosis is difficult because tumor subtypes have overlapping microscopic characteristics. Therefore, ancillary methods are needed to optimize classification. We used oligonucleotide microarrays to analyze 31 adult renal tumors, including clear cell renal cell carcinoma (RCC), papillary RCC, chromophobe RCC, oncocytoma, and angiomyolipoma. Expression profiles correlated with histopathology; unsupervised algorithms clustered 30 of 31 tumors according to appropriate diagnostic subtypes while supervised analyses identified significant, subtype-specific expression markers. Clear cell RCC overexpressed proximal nephron, angiogenic, and immune response genes, chromophobe RCC oncocytoma overexpressed distal nephron and oxidative phosphorylation genes, papillary RCC overexpressed serine protease inhibitors, and extracellular matrix products, and angiomyolipoma overexpressed muscle developmental, lipid biosynthetic, melanocytic, and distinct angiogenic factors. Quantitative reverse transcriptase-polymerase chain reaction and immunohistochemistry of formalin-fixed renal tumors confirmed overexpression of proximal nephron markers (megalin/low-density lipoprotein-related protein 2, alpha-methylacyl CoA racemase) in clear cell and papillary RCC and distal nephron markers (beta-defensin 1, claudin 7) in chromophobe RCC/oncocytoma. In summary, renal tumor subtypes were classified by distinct gene expression profiles, illustrating tumor pathobiology and translating into novel molecular bioassays using fixed tissue.

Gene Expression Profiling↗
PubMed2005

Epididymal sparing bilateral simple orchiectomy with epididymoplasty: preservation of esthetics and body image.

PURPOSE: We report the surgical technique and results of epididymal sparing bilateral simple orchiectomy as an esthetic alternative to standard bilateral simple orchiectomy and luteinizing hormone releasing hormone (LH-RH) agonist injection therapy in patients with prostate cancer. MATERIALS AND METHODS: The study included 91 consecutive epididymal sparing bilateral simple orchiectomy (BSO) procedures that were performed at the Atlanta Veterans Affairs Medical Center during a 25-month period. All patients had pathologically confirmed prostate cancer. A total of 52 patients (57.1%) were receiving LH-RH agonist therapy prior to the procedure and the remaining 39 (42.9%) were not. All procedures were performed in an outpatient clinic setting using spermatic cord anesthesia block as the only method of anesthesia. In the 52 patients who were on LH-RH agonist therapy prior to the procedure the overall impression/satisfaction with the procedure was evaluated using a questionnaire. RESULTS: All 91 procedures were performed at the urology outpatient clinic using local anesthesia. Mean patient age was 74.2 years (range 44 to 86). Mean serum prostate specific antigen was 58.9 ng/ml. The mean time required to perform the spermatic cord anesthesia block was 3.9 minutes (range 2 to 6) and the volume of anesthetic solution was 18.9 ml per case (range 10 to 32). Despite significant difference in testicular size between patients receiving and not receiving LH/RH agonists there were no differences in anesthesia time or anesthetic volume (3.9 and 3.9 minutes, p = 0.97, and 18.6 and 19.4 ml, respectively, p = 0.47). Mean operative time for BSO excluding anesthesia time was 36.9 minutes (range 18 to 70). Mean operative time was similar in patients receiving and not receiving LH-RH agonists (36.2 and 37.8 minutes, respectively, p = 0.39). The procedure was well tolerated, as judged by the mean intraoperative pain score during BSO of 0.2 (range 0 to 3). The majority of patients (76 or 83.5%) were pain-free during the procedure. Pain scores were similar in patients who were and were not receiving LH-RH agonists during BSO (p = 0.97). There were no adverse events. Followup data were available on 26 of the 52 patients who were receiving LH-RH agonist therapy prior to the procedure. Of them 96.2% were satisfied with the results and 84.6% preferred the procedure over medical castration therapy with LH-RH agonist therapy. CONCLUSIONS: Epididymal sparing bilateral simple orchiectomy is a simple and safe procedure that can be conveniently performed in an outpatient clinic setting using pure local anesthesia. Preservation of the epididymis and subsequent epididymoplasty is effective for maintaining the esthetic appearance of the scrotum and patient satisfaction. The procedure offers patients the convenience of 1-time surgical therapy over lifelong medical injection therapy at a significantly lower cost and without significantly compromising the esthetic appearance of the scrotum.

Adult↗
PubMed2005

Endoscopic enucleation of leiomyoma of the bladder.

A case of benign leiomyoma of the urinary bladder was discovered incidentally and treated successfully with endoscopic enucleation. We describe the technique of this new surgical approach and discuss its advantages. We recommend this minimally invasive approach over open surgical resection.

Cystoscopy↗
PubMed2005

The evolution of laser therapy in the treatment of benign prostatic hyperplasia.

The 2 basic principles of laser therapy for benign prostatic hyperplasia (BPH), based on the final tissue effect, are laser vaporization and laser coagulation. In laser vaporization techniques, higher-density laser thermal energy is used; effects range from complete tissue vaporization to incision, resection, or enucleation of the obstructing prostatic tissue. Interstitial laser coagulation (ILC) requires lower therapeutic temperatures. The urethral preservation and lack of tissue evaporation/resection with ILC make this treatment different from conventional transurethral free-beam laser prostatectomy. The Indigo(R) Optima Laser treatment system is the most widely used ILC system. Unlike other BPH laser therapies, Indigo ILC can be satisfactorily performed using pure local anesthesia in an office or outpatient setting. Favorable treatment outcomes are seen in a large percentage of patients, with minimal adverse events. Such favorable results depend on proper surgical technique and operator experience.

Journal Article↗
PubMed2004

Ex vivo expansion of CD8+CD56+ and CD8+CD56- natural killer T cells specific for MUC1 mucin.

Prostate cancers express MUC1, but nearly all metastatic cells lack HLA class I molecules. Thus, a lymphocyte population that can sense its antigenic environment, while also able to react to stimuli of natural killer (NK) cells, may be a more versatile effector cell population for antitumor immune responses. Herein, we report that tumor-specific MUC1 peptide, interleukin 2, and interleukin 12 act synergistically to stimulate the ex vivo expansion of CD8(+)CD56(-) T cells and CD8(+)CD56(+) natural killer T (NKT) cells from the peripheral blood mononuclear cells of prostate cancer patients, as well as healthy male and female donors. Both the CD56(+) NKT cells and CD56(-) T cells lysed allogeneic mucin-bearing target cells, as well as NK target cells, but not lymphokine-activated killer target cells. However, the CD56(+) NKT cells displayed a 2-fold greater cytolytic activity than the CD56(-) T cells. The mucin-specific cytolytic activity and NK cytolytic activities for both lymphocyte populations were independent of HLA class I and CD1 molecules. The CD56(-) T cells up-regulated CD56 with continued antigenic stimulation in the presence of interleukin 12, suggesting that CD8(+)CD56(-) T cells are NKT cells. However, CD56(+) NKT cells expand poorly to continued stimulation. All mucin-stimulated NKT cells exhibited the activated/memory CD45RO phenotype. The NKT cell lines express the alpha/beta T-cell receptor (TCR). The TCR repertoire was limited and varied with cell line, but was not the V alpha 24V beta 11 TCR typically associated with NKT cells. Whereas CD161 is generally considered a marker of NKT cells, the mucin-stimulated NKT cells did not express this marker. Thus, we have described two phenotypically distinct NKT types that do not display a biased TCR repertoire, but do display specificity for a tumor-specific peptide antigen (CTL-like activity), as well as HLA class I-deficient target cells (NK-like activity).

Adult↗
PubMed2004

Dilutional hyponatremia of TURP syndrome: a historical event in the 21st century.

OBJECTIVES: To evaluate the risk of hyponatremia and transurethral resection of the prostate (TURP) syndrome after bipolar saline TURP in patients with large-volume, benign prostatic hyperplasia and statistically significant comorbidities. METHODS: Five patients with large symptomatic benign prostatic hyperplasia and significant comorbidities underwent saline TURP. Data were collected regarding patient profile, prostate weight, operative time, and perioperative events. In particular, we studied and compared the preoperative and postoperative serum sodium concentrations and hematocrit. RESULTS: The mean age was 68 years (range 57 to 76). The mean resection weight of the prostatic chips was 49.6 g (range 37 to 62). Senior urology residents under the supervision of the university faculty performed all procedures. The average operative time was 2 hours, 22 minutes (range 98 to 175 minutes). The mean serum sodium concentration decreased by 1.6 mg/dL (from 138.4 mg/dL preoperatively to 136.8 mg/dL postoperatively). The mean hematocrit decreased by 5.60% (from 40.24% preoperatively to 34.64% postoperatively). Postoperative recovery was uneventful in all 5 patients. CONCLUSIONS: Bipolar saline TURP is safe and eliminates the risk of TURP syndrome in high-risk patients with large prostates that require lengthy resection. In addition, the system permits the faculty to spend the time needed for teaching and training urology residents without compromising patient safety.

Absorption↗
PubMed2004

The fate of the medically castrated testis: expectation versus reality.

PURPOSE: Cosmetic expectation has a major role in influencing patient choice between medical and surgical castration, and yet to our knowledge the fate of the medically castrated testis has never been accurately tested and documented in the literature. We determined the weight of testes in patients receiving medical castration and compared it to that in a control group receiving primary surgical castration. MATERIALS AND METHODS: We performed a retrospective analysis of 88 patients with prostate cancer who underwent bilateral simple orchiectomy with epididymal sparing. The study was done at Veterans Administration Medical Center, Atlanta, Georgia. All procedures were performed using local anesthesia in an outpatient clinical setting. Patients were divided into 2 groups, namely 52 receiving luteinizing hormone releasing hormone (LH-RH) agonist therapy prior to the procedure and 36 controls who were not. The weight of the testes was compared between the 2 groups. RESULTS: Median testicular weight significantly decreased following treatment with LH-RH agonist compared to the control group. Median weight of the testis was 7.0 gm (range 0.5 to 22.0) in the LH-RH agonist group compared to 15 gm (range 4.0 to 44.0) in the control group (p = 0.0049 x 10). CONCLUSIONS: Medical castration with LH-RH agonist therapy significantly decreases the weight of testes and compromises the cosmetic outcome. Since cosmetic expectation has a major role in influencing patient choice between medical and surgical castration, patients should be fully informed about the significant testicular atrophy associated with medical castration before making their decision.

Androgen Antagonists↗