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Biomedical subjects

R B Nadler

Publications and source records attributed to R B Nadler.

At least 19 recordsLinked to original sources
PubMed1998

Retrospective analysis of the effect of crossing vessels on successful retrograde endopyelotomy outcomes using spiral computerized tomography angiography.

PURPOSE: Using spiral computerized tomography (CT) angiography, we sought to evaluate the incidence of a crossing vessel in a group of adults with primary ureteropelvic junction obstruction who had previously undergone successful retrograde endopyelotomy. MATERIALS AND METHODS: A total of 16 patients who had undergone successful Acucise balloon incision endopyelotomy for ureteropelvic junction obstruction, all with followup greater than 2 years, underwent a spiral CT angiogram with intravenous contrast material to identify those with a crossing vessel. Contrast enhanced CT was performed with dual phase technique on a Somatom-Plus-S CT scanner using prototype software. After 180-degree linear interpolation of the projection data, transaxial images of the affected kidney were reconstructed. In addition, at the time of the study all patients completed analog followup pain scales and quality of life assessment questionnaires. RESULTS: Among the 16 patients 6 (38%) had anterior or posterior crossing vessels based on spiral CT angiography. No patient had both types. By analog pain scale patients had 80% mean improvement in pain (range 63 to 100). CONCLUSIONS: In our series nearly 40% of patients with anterior or posterior crossing vessels had a long-term (greater than 2 years) successful outcome with retrograde endopyelotomy. Endopyelotomy continues to be our initial mode of therapy among adults with primary ureteropelvic junction obstruction. In our opinion the adverse influence of the crossing vessel is not sufficient to justify the added expense of preoperative angiography, spinal CT or endoluminal ultrasound.

Adult↗
PubMed1998

Simultaneous bilateral percutaneous nephrolithotomy with subarachnoid spinal anesthesia.

We report our experience performing simultaneous bilateral percutaneous nephrolithotomy (SBPN) in four patients with large stone burdens in both kidneys. We modified the previously described approach by combining SBPN with subarachnoid Duramorph (preservative-free morphine sulfate) in an effort to decrease postoperative discomfort and shorten the duration of hospitalization. These patients (study group) were then compared with a contemporary group of four patients with similar bilateral stone burdens who underwent staged bilateral percutaneous nephrolithotomies (PCNs) (control group). The comparison showed a marked advantage in hospital stay (4.8 days for the study group v 11 days for the control group) and postoperative narcotic requirement (27.5 mg of meperidine for the study group v 533 mg for the control group). All four patients were rendered stone free. This method of treatment for large bilateral renal calculi with the addition of subarachnoid Duramorph resulted in less postoperative discomfort, less morbidity, and a more rapid recovery than staged PCN or sandwich PCN/SWL/PCN.

Adult↗
PubMed1998

Quality of life in metastatic prostate cancer among men of lower socioeconomic status: feasibility and criterion related validity of 3 measures.

PURPOSE: Identification of metastatic disease progression is often difficult but important. Previous studies of quality of life in metastatic disease have been limited by the small number of respondents who were not white or of lower socioeconomic status. Quality of life assessment is generally done using self-administration techniques but this method is of limited usefulness for patients of low socioeconomic status, many of whom have limited reading abilities. We evaluated the feasibility and validity of interviewer administration of 3 quality of life instruments for patients of low socioeconomic status with metastatic prostate cancer. MATERIALS AND METHODS: We used instruments previously validated with self-administration methodology, including the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire-30, Functional Assessment of Cancer Therapy-General Scale and Quality of Life Index. Subjects were men with metastatic prostate cancer with stable (78) or progressive (32) disease at 4 Veterans Affairs medical centers and 1 other site. Of the patients 94% were Veterans Affairs patients and more than 60% were black. RESULTS: Each quality of life instrument required less than 10 minutes of interviewer administration and was able to discriminate between patients with stable versus progressive disease on several health status domains. CONCLUSIONS: These data support the feasibility and validity of quality of life measurement in patients of low socioeconomic status with metastatic prostate cancer. Consideration should be given to adding quality of life instruments to patient encounter even among low socioeconomic status, low literacy populations.

Aged↗
PubMed1997

Primitive neuroectodermal tumor of the kidney--another enigma: a pathologic, immunohistochemical, and molecular diagnostic study.

Primitive neuroectodermal tumor (PNET), the second most common type of sarcoma in the first two decades of life, rarely presents as an organ-based neoplasm. Rather, it is seen typically in the soft tissues of the chest wall and paraspinal region. We report a case of primary PNET of the kidney in a 17-year-old girl who presented with abdominal pain, hematuria, and an abdominal mass. Nodules and sheets of monotonous-appearing primitive round cells and the formation of rosettes focally were the principal microscopic features. The tumor cells were uniformly immunoreactive for vimentin, cytokeratin, neuron-specific enolase, and 013 (CD99). In addition, the characteristic translocation of PNET and Ewing sarcoma, t(11;22)(q24;q12), was detected by polymerase chain reaction (PCR). Eight previous examples of renal PNET have been reported in the literature in the past 2 years, but only three of these cases have had complete immunohistochemical evaluation with the demonstration of 013 positivity. To our knowledge the present case is the only one to date demonstrating the recurrent translocation t(11;22)(q24;q12) by PCR. Assuming that the previous cases in the literature are bona fide examples of PNET, the kidney may be another site of predilection for this usual soft-tissue neoplasm. We are once again confronted with the dilemma about the nature of the progenitor cell.

12E7 Antigen↗
PubMed1997

Incisional hernia after laparoscopic nephrectomy with intact specimen removal: caveat emptor.

PURPOSE: We report 5 cases of postoperative incisional hernia after laparoscopic nephrectomy with intact removal of the specimen. MATERIALS AND METHODS: During the last 5 years 29 patients underwent laparoscopic nephrectomy with intact removal of the resected specimen due to a large kidney and/or malignancy. Of these 29 patients 5 had a postoperative incisional hernia at the site of intact removal, including 3 with renal tumors and 2 with large polycystic kidneys due to adult onset autosomal dominant polycystic kidney disease. The records of these patients were reviewed to determine any specific factors that might relate to the development of this complication. RESULTS: An incisional hernia developed at the wound site in 5 patients (17%) 41 to 73 years old (mean age 53.4). Average body mass index for the patients was 34.2 (range 26 to 47). Average weight and size were 542 gm. and 20.3 x 10.3 cm., respectively, for the 3 resected malignant specimens and 1,975 gm. and 23.8 x 16.5 cm., respectively, for the 2 benign kidneys. A transverse lower flank muscle cutting incision (average 10.4 cm.) was performed to remove the resected kidney. Incisional hernias appeared after an average of 6.6 weeks postoperatively. Risk factors for a postoperative hernia included obesity in 80% of the patients, chronic renal insufficiency due to autosomal dominant polycystic kidney disease in 40%, postoperative pulmonary complication in 40% and metastatic cancer in 20%. CONCLUSIONS: Our experience has led us to avoid a lower flank port connecting incision for specimen removal. Instead we changed to a midline or subcostal incision in these patients. In addition, we believe that with the availability of the impermeable organ entrapment sacks there is less need for intact specimen removal even for renal tumors. Currently large benign kidneys (autosomal dominant polycystic kidney disease) are morcellated in situ to a suitable size for entrapment, while renal tumors are entrapped and morcellated directly. Presently our only indication for intact removal is in the case of a renal pelvic or caliceal transitional cell cancer.

Adult↗
PubMed1997

A comparison of perspectives on prostate cancer: analysis of utility assessments of patients and physicians.

BACKGROUND: Quality-of-life considerations are important in metastatic prostate cancer. In this study, we interviewed physicians and patients about their assessments and expectations on quality of life as metastatic prostate cancer progresses. METHODS: Physicians and patients made utility assessments of three hypothetical health states for metastatic disease using the time trade-off technique. Scores were bounded on a scale from 0.0 (death) to 1.0 (perfect health). RESULTS: Patients rated each of the health states as less desirable than the physicians. CONCLUSIONS: Physicians and patients differ in their perspectives on expected quality of life with metastatic prostate cancer. Our results emphasize the need to assess patients' utilities directly.

Decision Making↗
PubMed1996

Acucise endopyelotomy: assessment of long-term durability.

PURPOSE: We evaluated the long-term efficacy of Acucise endopyelotomy. MATERIALS AND METHODS: A total of 28 patients with 28 ureteropelvic junction obstructions was reevaluated 2 or more years after Acucise endopyelotomy (mean 32.5 months). Subjective analysis was done with analog pain scales and objective analysis was performed with diuretic renal scintigraphy. RESULTS: Subjective followup was available for all 28 patients, and 17 (61%) had a favorable response with 36% totally free of pain and 25% markedly improved. Among 26 patients with objective followup (93%) 21 (81%) had a patient ureteropelvic junction based on a diuretic renal scan with a half-time of less than 10 minutes or a normal Whitaker test. Among all regularly followed patients failure occurred uniformly within 1 year. CONCLUSIONS: Acucise endopyelotomy is an effective and durable method for treating ureteropelvic junction obstruction.

Adolescent↗
PubMed1996

Delayed infection of a pelvic lymphocele following pelvic lymphadenectomy.

Pelvic lymphocele is an infrequent complication of pelvic surgery, usually presenting shortly after surgery. We report a case of an infected pelvic lymphocele presenting more than 1 year after a staging pelvic lymphadenectomy for adenocarcinoma of the prostate. This case illustrates that late infection of pelvic lymphoceles can occur following a pelvic lymphadenectomy and radical prostatectomy.

Adenocarcinoma↗
PubMed1996

Who is best benefited by radical prostatectomy?

The last few years have taught us much about prostate cancer. We now recognize that prostate cancer, even if it is of low stage and low grade, is a relentlessly progressive disease, especially if found in men with prolonged (greater than 15 years) life expectancy. We now know that serum PSA is a valid endpoint after radical prostatectomy to definitively assess its ability to eradicate prostate cancer. We are learning better how to use a variety of clinical parameters to predict pathologic stage, and we are in the process of developing other markers that may be exploited to predict which patients with early-stage prostate cancer have surgically curable lesions. From these observations it is reasonable to conclude that the best candidates for radical prostatectomy are young men (those with 10 to 20 years of life expectancy) with impalpable, clinically organ-confined low- or moderate-grade prostate cancers.

Adenocarcinoma↗
PubMed1996

Antegrade collagen injection for stress incontinence after radical prostatectomy: technique and early results.

This article describes the technique and early results of antegrade collagen injection into the bladder neck and proximal urethra of men with stress incontinence postprostatectomy. Twenty men underwent collagen injection under general anesthesia. Follow-up ranges from 5 to 15 months, with a mean of 9.5 months. A mean of 14.5 cc of collagen was injected (range 5-25 cc). According to a subjective self-grading system, preoperative and postoperative urodynamics, and pad usage before and after treatment, significant improvement was seen in 14 patients (70%), and subjective cure was reported by 5 (25%). Six patients (30%) had no subjective or objective improvement after the injection. The antegrade collagen injection technique is a promising and simple method of correcting postprostatectomy stress urinary incontinence. Further study and longer follow-up is necessary to determine its precise role in the treatment of men with this problem.

Aged↗
PubMed1996

Early results with antegrade collagen injection for post-radical prostatectomy stress urinary incontinence.

PURPOSE: Results of retrograde transurethral collagen injection for treatment of stress urinary incontinence have been generally disappointing for men with intrinsic sphincter deficiency following radical prostatectomy. We describe a new technique of antegrade transvesical collagen injection using suprapublic percutaneous bladder access. MATERIALS AND METHODS: Between October 1994 and January 1996, 20 patients underwent antegrade collagen injection for post-radical prostatectomy stress urinary incontinence. Evaluation by pad test, urodynamics and subjective scores was performed before and after injection. RESULTS: At a mean followup of 8.5 months 9 of 20 patients (45%) had significant subjective improvement and 5 (25%) were totally dry. CONCLUSIONS: Antegrade collagen injection is a promising and simple method of correcting post-radical prostatectomy stress urinary incontinence. Further study and longer followup are necessary to determine its precise role in the treatment of this condition.

Aged↗
PubMed1995

Evaluation of percentage of free serum prostate-specific antigen to improve specificity of prostate cancer screening.

OBJECTIVE: To evaluate measurement of percentage of free prostate-specific antigen (PSA) in serum to improve the specificity of prostate cancer screening in men with serum PSA levels between 4.1 and 10.0 ng/mL. DESIGN: Retrospective, nonrandomized analysis using a research assay for measuring free PSA in frozen serum from men with a spectrum of prostate sizes and digital rectal examination results. SETTING: General community outpatient prostate cancer screening program at a university center. PATIENTS: One hundred thirteen men aged 50 years or older, 99% of whom were white, with serum PSA concentrations of 4.1 to 10.0 ng/mL, including 63 men with histologically confirmed benign prostatic hyperplasia, 30 with prostate cancer with an enlarged gland, and 20 with cancer with a normal-sized gland. All study volunteers had undergone prostatic ultrasonography and biopsy. MAIN OUTCOME MEASURES: Percentage of free PSA in serum and percentage of free PSA cutoff that maintained at least 90% sensitivity for prostate cancer detection. RESULTS: Median percentage of free PSA was 9.2% in men with cancer and a normal-sized gland, 15.9% in men with cancer and an enlarged gland, and 18.8% in men with benign prostatic hyperplasia (P < .001). The percentage of free PSA cutoff was higher in men with an enlarged gland and in those with a palpably benign gland. In men with an enlarged, palpably benign gland, a free PSA cutoff of 23.4% or lower detected at least 90% of cancers and would have eliminated 31.3% of negative biopsies. CONCLUSIONS: Measurement of percentage of free serum PSA improves specificity of prostate cancer screening in selected men with elevated total serum PSA levels and can reduce unnecessary prostate biopsies with minimal effects on the cancer detection rate; however, further studies are needed to define optimal cutoffs. Final evaluation of PSA screening also must consider the ability of current treatments to improve the prognosis of screen-detected prostate cancer.

Aged↗
PubMed1995

Fascial closure of laparoscopic port sites: a new technique.

The laparoscopic operative procedure is not complete until the port sites are closed with a fascial suture. Herein, we report a simple new technique that uses a venous catheter for suture placement and direct laparoscopic visualization to secure the abdominal wall fascia and peritoneum.

Fasciotomy↗
PubMed1995

Surgeon's workshop: antegrade collagen injection: new technique for postprostatectomy stress incontinence.

Intraurethral collagen injection has become a recognized modality to treat stress urinary incontinence. The results of this procedure using the traditional retrograde endoscopic approach have generally been disappointing for men with sphincteric incontinence after radical prostatectomy. We describe a new technique of antegrade collagen injection utilizing suprapubic percutaneous bladder access to achieve simultaneous antegrade and retrograde endoscopic views of the bladder neck. This new injection technique is a promising and simple method of correcting postprostatectomy stress urinary incontinence.

Collagen↗