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Biomedical subjects

R S Waldbaum

Publications and source records attributed to R S Waldbaum.

At least 19 recordsLinked to original sources
PubMed1998

Microfocal prostate cancer: biopsy cancer volume does not predict actual tumour volume.

OBJECTIVE: To determine whether microfocal prostate cancer on needle biopsy predicts clinically insignificant disease in men undergoing radical prostatectomy. PATIENTS AND METHODS: The records of 726 men who underwent radical prostatectomy between January 1990 and September 1995 were reviewed; 83 men had pre-operative prostatic needle biopsies which revealed microfocal prostate cancer. In these men, tumour volume (length) in the biopsy was compared to the percentage of tumour in the total prostatectomy specimen, and the pathological stage and clinical outcome reviewed. RESULTS: Of the 83 men with microfocal prostate cancer on biopsy 75 (90%) had clinically significant disease. Pre-operative variables were of no use in identifying patients with clinically insignificant tumour volumes. When comparing those with microfocal tumour and those without at one institution, 69% had organ-confined (pT2) disease and 31% had capsular penetration (pT3), compared with 61% and 39%, respectively (P < 0.05). Additionally, the positive surgical margin rate for those with microfocal tumour was only 6%, compared with 26% for those without microfocal disease (P < 0.05). Biochemical failures during the median follow-up period of 24 months occurred in 6% of the men with microfocal cancer and in 15% of those undergoing total prostatectomy (P < 0.05). CONCLUSIONS: Microfocal prostate cancer determined from the needle biopsy does not predict clinically insignificant disease.

Aged↗
PubMed1995

The influence of prostate size on cancer detection.

OBJECTIVES: To determine if cancer detection rates vary with prostate size using a sextant core biopsy pattern. METHODS: We reviewed 1021 transrectal ultrasound (TRUS)-guided sextant pattern prostate biopsies to determine if cancer detection varied based on prostate size. Prostate size was determined using a computer generated elliptical estimation method. Sextant core biopsies were taken, and the patients divided into groups based on estimated size of the prostate and biopsy outcome. Large prostates were those that were estimated by TRUS as 50 cc or more. Prostates were considered small if they were less than 50 cc. Groups were compared based on size and biopsy outcome. RESULTS: Adenocarcinoma was detected in 33% (334 of 1021) of the patients. Large prostates were noted in 34% (346 of 1021), of which 23% (80 of 346) had cancer detected by sextant biopsy. Small prostates were noted in 66% (675 of 1021), of which 38% (254 of 675) had cancer detected. The difference in cancer detection in large and small glands using a sextant pattern was statistically significant (P < 0.01). Patients with positive biopsies had significantly smaller prostate sizes (40 cc +/- 26) when compared with those with negative biopsies (51 cc +/- 33) (P < 0.01). Only 14% (8 of 58) of patients with gland sizes 100 cc or greater had positive sextant biopsies while 49% (118 of 239) with prostates 25 cc or less had cancer detected. Multivariate statistical analysis was used to control for differences in age, prostate-specific antigen (PSA), PSA density, TRUS findings, and digital rectal examination between the large and small prostate groups. The difference in cancer detection persisted (P < 0.05) CONCLUSIONS: Currently no evidence exists to support differing cancer rates based on gland size alone. Our cancer detection rate using a sextant pattern was higher in men with prostates less than 50 cc, and patients diagnosed with cancer had significantly smaller prostates than those with a negative sextant biopsy. Our data suggest that significant sampling error may occur in men with large glands, and more biopsies may be needed under these circumstances. The effects of tumor volume, focality, and specimen size in relation to overall gland size may contribute to these findings.

Adenocarcinoma↗
PubMed1994

Embolization to control iatrogenic ureteral hemorrhage: a case report.

Gross hematuria following percutaneous or endourological intervention is well known and widely documented. We report an unusual case of angiographically documented hemorrhage from a ureteral branch that was injured by cystoscopic removal of a Double-J stent, and subsequent successful transcatheter embolization. This case demonstrates the important role of angiographic diagnosis and therapy in the management of iatrogenic hemorrhage.

Aged↗
PubMed1991

Identification of asymptomatic renal cell carcinomas utilizing modern radiographic techniques.

The more liberal use of ultrasonography and computed tomography has made more common the incidental discovery of renal masses. The charts of 105 patients surgically treated for renal cell carcinoma at a teaching hospital from 1983 to 1987 were reviewed. The incidence of incidentally found asymptomatic tumors was 47% (49/105 patients). Of the incidentally found tumors, 55% were stage I and only 14% were stage III; for symptomatic patients, 39% of tumors were stage I and 27% were stage III. This study also found that the classical triad of pain, hematuria, and flank mass was present in only 3.8% (4/105) of patients. Tumors found incidentally will usually be of lower pathologic stage and may carry a better prognosis.

Carcinoma, Renal Cell↗
PubMed1986

Kaposi's sarcoma of the penis in a patient with the acquired immune deficiency syndrome.

We report a case of secondary Kaposi's sarcoma of the penis and the acquired immune deficiency syndrome. Recognition of the penile lesion as being secondary Kaposi's sarcoma is paramount, since the clinical course appears to be dependent upon systemic disease. Local therapy is reserved for palliation upon disease recurrence.

Acquired Immunodeficiency Syndrome↗
PubMed1977

Angiographic patterns of posttraumatic renal scarring.

Evaluation of 19 patients with a history of renal trauma revealed three angiographic features helper in the diagnosis of posttraumatic renal scarring: (1) a cup-shaped renal contour defect characterized by smooth margins, infolding of the renal cortex, and extension of the calyces to the edge of the defect; (2) occlusion of an extra- or intrarenal artery associated with a distal avascular zone of infarction; and (3) a grossly heterogeneous nephrogram characterized by scattered islands of renal tissue separated by broad or narrow avascular scars. Limited pathologic correlation suggests that the cup-shaped contour defect reflects subcapsular hemorrhage and that the mottled, heterogeneous nephrogram reflects a shattered kidney.

Adult↗
PubMed1976

Spontaneous rupture of renal pelvis.

A seventy-seven-year-old female with progressive abdominal sighs for twenty-four hours was found to have had a spontaneous rupture of the renal pelvis with massive urinary extravasation.

Abdomen, Acute↗
PubMed1976

Parasitic lumbar arterial blood supply in renal angiomyolipoma.

A young woman with azotemia was found to have an angiomyolipoma which had parasitic blood supply from a lumbar artery. Parasitic lumbar arterial blood supply from a lumbar artery. Parasitic lumbar arterial blood supply has previously been considered a strong indication of malignancy. Since this benign lesion had not invaded the adjacent retroperitoneal structures, the phenomenon tends to confirm the postulate that parasitic blood supply to a lesion may occur through hypertrophy of small anastomotic channels normally present between adjacent vessels but not normally seen in angiography.

Adult↗
PubMed1975

Benign mesothelial tumor of bladder.

Two cases of benign mesothelial tumor of the bladder are presented, one causing urinary retention following surgery for stress incontinence and the other a softball-sized fibroma with a fifteen-year follow-up.

Female↗
PubMed1975

Use of procine zenografts in treatment of Fournier's gangrene.

The use of procine xenografts as a biologic dressing has become increasingly popular, particularly in cases of extensive tissue loss, as in severe thermal injuries. It not only minimizes protein and fluid loss, acts as a barrier to infection, but also prevents conversion of second-degree burns through its ability to control existing infection. In this case, it was used successfully to treat Fournier's gangrene. We believe it significantly eased and shortened the patient's hospital stay and enabled us to apply autogenous split thickness skin grafts sooner than with conventional modes of wound care.

Adult↗
PubMed1975

Tubular duplication of the rectum with a rectourethral fistula.

An infant with pneumaturia and fecaluria was found to have a rectal duplicatation with a fistula between the duplicated rectum and the urethra. Rectal duplication, although rare, should be considered in cases of bizarre lower bowel symptoms in children. Correction in our case was effected by exclusion of the duplicated segment along with removal of its mucosal lining and division of its urethral fistula. The termination of the duplicated rectum in the urinary tract, as in cases of imperforate anus, suggests a related embryologic mechanism for the 2 types of anomalies.

Colon↗