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Biomedical subjects

Raj S Pruthi

Publications and source records attributed to Raj S Pruthi.

At least 19 recordsLinked to original sources
PubMed2007

Uroscopy by Hippocrates and Theophilus: prognosis versus diagnosis.

PURPOSE: In antiquity the visual examination of urine (uroscopy) is well documented. Uroscopy gradually evolved from a prognostic indicator to a diagnostic tool. Comparison of the uses of uroscopy by Hippocrates (400 BC) and Theophilus (700 AD) illustrates this transformation. MATERIALS AND METHODS: We reviewed medical and historical literature as well as the translated works of Hippocrates. RESULTS: Although Hippocrates was one of the first physicians to use urine to interpret human body functioning, urine was mainly used as a means for prognosis and prediction of outcomes of illness. In his text De Urinis Theophilus introduced an innovative doctrine and used uroscopy for diagnosis of illnesses. In this respect uroscopy became a paradigm for later diagnostic strategies and is considered an important milestone in the history of clinical diagnosis. CONCLUSIONS: Hippocrates' writings displayed uroscopy used in examination of illness. However, he considered it in the context for accurate prognoses. Theophilus treated uroscopy in a sophisticated objective manner and attempted to use uroscopy in an orderly, systemic method to accurately diagnose illness. It was through these approaches to uroscopy that Theophilus became one of the physicians who contributed to the birth of medieval medical studies.

Diagnostic Techniques, Urological↗
PubMed2007

Watchful waiting for solid renal masses: insight into the natural history and results of delayed intervention.

PURPOSE: We describe the short-term outcomes of patients whose renal masses were managed expectantly (ie watchful waiting) to provide insight into the natural history of small renal tumors. Additionally, this study examined the effects of delayed intervention in patients who required intervention after a period of expectant management. MATERIALS AND METHODS: A total of 43 patients with 46 renal masses underwent planned expectant management of enhancing solid or cystic (Bosniak IV) renal masses. A subset of these patients (13) who underwent eventual intervention was also examined. Outcomes with regard to age, gender, growth rate, subsequent interventions and clinical followup are reported. RESULTS: At a mean followup of 36 months 74% of patients had tumor growth with a mean (median) growth rate of 0.70 (0.35) cm per year. None of the patients had significant symptoms, disease progression or cancer specific death. There were 4 patients (10%) who died of other causes. The 13 patients undergoing eventual intervention were younger than those who did not undergo intervention (56 vs 72 years, respectively, p = 0.0006). Patients undergoing eventual intervention tended to have a higher tumor growth rate than those on continued observation (0.90 vs 0.61 cm per year, respectively, p = 0.1486). In patients undergoing eventual intervention 12 of 14 (87%) tumors were renal cell carcinoma. All were stage pT1, and 12 of 13 patients were alive after a mean followup of 41 months (1 patient died of other causes 30 months after surgery). No patient had up-staging of disease secondary to delay. CONCLUSIONS: Watchful waiting for renal masses is a reasonable option for appropriately selected patients, especially those with competing comorbidities. Delayed intervention does not appear to adversely impact pathological outcomes.

Adult↗
PubMed2007

A prospective evaluation of the short-term impact and recovery of health-related quality of life in men undergoing radical prostatectomy.

OBJECTIVE: To prospectively evaluate the acute and short-term effects of radical retropubic prostatectomy (RRP) on health-related quality of life (HRQoL) using a validated generic HRQoL instrument that measures overall health status, as although there is increasing interest in the HRQoL of patients being treated for prostate cancer, most studies have focused on long-term outcomes. PATIENTS AND METHODS: In all, 121 men undergoing RRP for clinically localized prostate cancer were prospectively evaluated for short-term HRQoL using an acute Short Form-12 version-2 Physical and Mental Health Survey Acute Form before and serially each week from 1 to 6 weeks after RRP. The physical (PCS) and mental component score (MCS) were calculated from the questionnaires at each time and the data analysed by random coefficient modelling. Separate models were fitted for MCS and PCS using covariates of race, age, estimated blood loss (EBL), time after RRP, and their interaction terms. RESULTS: The PCS initially declined and improved linearly. and the baseline level was not achieved by 6 weeks, but modelling lines showed an expected return to baseline at 7-8 weeks for all patients. Age had a significant relationship with the PCS; older men (>60 years) scored higher, and their PCS remained significantly higher after RRP than younger men (< or =60 years) until 5 weeks. EBL also had a significant relationship with PCS; men with an EBL of >500 mL had a significantly lower PCS at 1 week and this remained significantly lower than for men with an EBL of < or = 500 mL until approximately 7 weeks. The MCS improved immediately after RRP and remained higher throughout the study than at baseline. Race was the only covariate for which there were significant differences in the MCS. The MCS was significantly lower at baseline for African-Americans than for Caucasian Americans, and remained lower until 6 weeks after RRP. CONCLUSIONS: There were significant changes in HRQoL during in the short-term after RRP. Younger men and those with a higher EBL might have a slower recovery of the PCS after RRP. African-Americans had a slower increase in MCS and might have a different initial emotional or mental health response to RRP than have Caucasians.

Black or African American↗
PubMed2006

Phase II trial of celecoxib in prostate-specific antigen recurrent prostate cancer after definitive radiation therapy or radical prostatectomy.

OBJECTIVES: Recent evidence has shown that cyclooxygenase-2 (COX-2) inhibitors have potent antitumor activity in prostate cancer both in vitro and in vivo. However, human trials are absent. This study evaluated the efficacy of the COX-2 inhibitor celecoxib in prostate-specific antigen (PSA) recurrent prostate cancer after radiation therapy (X-ray therapy or XRT) or radical prostatectomy. METHODS: Forty patients who had biochemical relapse after XRT or radical prostatectomy were treated with celecoxib 400 mg twice per day. Follow-up PSA levels were obtained at 3, 6, 12, and 18 months and subsequently every 6 months thereafter. Data were evaluated by calculating PSA doubling times and by calculating the slope of the curve of log(PSA) versus time to assess rate of PSA increase before and after celecoxib treatment for each patient. RESULTS: Thirty-six of 40 (90%) patients had a slowing effect on their rate of PSA after 3 months, including 11 of 40 with a decline and 8 of 40 with stabilization of PSA. Short-term responses at 3 months continued at 6, 12, 18 months. Comparison of rate of PSA increase before versus after celecoxib treatment showed significant flattening of slope of log(PSA) versus time from pretreatment for each of the time points. There was no significant change in testosterone levels, suggesting an androgen-independent mechanism. CONCLUSIONS: COX-2 inhibitors may have an effect on serum PSA levels in patients with biochemical progression after XRT or radical prostatectomy. These results suggest that COX-2 inhibitors may help delay or prevent disease progression in these patients and thereby help extend the time until androgen deprivation therapy.

Aged↗
PubMed2006

Large presacral schwannoma after radical prostatectomy.

A 56-year-old man presented with long-standing, mild urinary frequency 6 years after radical prostatectomy. Pathologic assessment showed presence of organ confined prostate cancer (pT2a), Gleason 6 (3+3). Since the time of surgery, PSA level was undetectable and the patient remained without evidence of recurrent disease. However, digital rectal examination revealed the presence of a very large mass palpable on the anterior rectal wall. Therefore, the patient underwent abdominal/pelvic MRI which demonstrated presence of a solid, well-circumscribed pelvic mass extending from the level of the sacrum posteriorly to the anterior abdominal wall. Histologic examination of percutaneous biopsy of the mass was suggestive of schwannoma. The patient underwent laparotomic excision of the mass, which was confirmed to be a schwannoma, with its characteristic slender spill cells and elongate nuclei. No intra-operative complication was reported. The patient has no evidence of recurrence with complete resolution of urinary symptom one year after surgery.

Biopsy↗
PubMed2006

Characterization of biochemical recurrence after radical prostatectomy.

BACKGROUND: This study sought to characterize the variables that predict postoperative prostate-specific antigen doubling time (PSADT) and biochemical recurrence time (RT) in patients who have failed radical prostatectomy (RP). METHODS: A total of 477 patients underwent RP at our institution for clinically localized prostate cancer. Of these patients, 64 (13.4%) demonstrated evidence of postoperative biochemical failure. PSADT and biochemical RT were calculated for all patients. PSADT and RT were correlated with clinical variables including preoperative PSA level, patient age, race, prostate weight and with pathologic characteristics of the operative specimen using uni- and multivariate analyses. In addition, PSADT and RT were also correlated with each other and with the time to postoperative adjuvant therapy. RESULTS: Median postoperative PSADT for patients who recurred after radical prostatectomy was 9.7 months. Postoperative PSADT was predicted by lymph node involvement (p < 0.001) and Gleason grade (p = 0.06). Rapid PSADT also correlated with institution of postoperative adjuvant therapy (p = 0.003). Median biochemical RT for all patients was 6.7 months. Gleason grade and pathologic stage were found to be predictors of RT (p < 0.002). Postoperative PSADT did not correlate with RT (r = 0.08; p = 0.53). PSADT and RT were not different between Caucasian- versus African-Americans. CONCLUSIONS: These results serve to better characterize our cohort of patients who have evidence of biochemical recurrence after radical prostatectomy. Aggressiveness of recurrent disease (i.e. PSADT) seems to be predicted by lymph node involvement and higher pathologic grade. Furthermore, the lack of correlation of RT and PSADT suggests that early recurrences are not necessarily aggressive tumors: conversely, aggressive recurrences may occur at any point in the postoperative period. This information may aid in the postoperative treatment of recurrent disease and help to better define those patients who are at higher risk for developing clinical recurrence and who would benefit from greater vigilance during the postoperative period.

Aged↗
PubMed2006

The use of erythropoietin in patients undergoing radical prostatectomy: effects on hematocrit, transfusion rates and quality of life.

OBJECTIVE: It was the aim of this study to prospectively study the effects on hematocrit levels, transfusion rates and quality of life (QOL) indices in men preoperatively supplemented with recombinant erythropoietin (rEPO) undergoing radical prostatectomy for clinically localized prostate cancer. METHODS: Thirty men undergoing radical prostatectomy were randomized either to receive rEPO (n=25) or to serve as controls (n=25). Outcome measurements obtained preoperatively, as well as 10 days and 6 weeks postoperatively included serum hematocrit levels, transfusion rates and QOL indices (using SF-12 validated questionnaires). RESULTS: The rEPO group had a significant increase in preoperative hematocrit (median increase=4 points; p=0.002). Although there were no significant differences in hematocrit at 10 days, the rEPO had a significantly higher hematocrit value at 6 weeks (p=0.0086). No differences were observed in transfusions rates between groups (4% in each group). SF-12 mental and SF-12 physical scores were not different between the two groups at any time point. CONCLUSION: Preoperative administration of rEPO significantly increases preoperative and postoperative hematocrit levels. However, no differences were observed with regard to transfusion rates or postoperative QOL indices despite these higher hematocrit values.

Adult↗
PubMed2005

Impact of race, age, income, and residence on prostate cancer knowledge, screening behavior, and health maintenance in siblings of patients with prostate cancer.

OBJECTIVE: This study evaluates self-reported changes in knowledge of prostate cancer (CaP), CaP screening behavior and other health-related activities in men whose brothers have been diagnosed with prostate cancer and to characterize those demographic subgroups of siblings at particular risk of failure to change their behavior. METHODS: 112 men were surveyed to self-assess their knowledge of CaP both before and after their brother's diagnosis. In addition, siblings were questioned with regard to other health-related behaviors before and after their brother's diagnosis. Demographic characteristics including age, race, income, and area of residence were also reported. Results were analyzed to determine how a brother's diagnosis with CaP affects changes in prostate cancer knowledge, screening behavior and other health related activities in these high-risk patients. RESULTS: The impact of a brother's diagnosis of CaP affects only 40% of siblings with regard to CaP knowledge. This knowledge appears to translate into increased screening behavior and other-health-related activity in these men. Unfortunately, more than half of men have no change in CaP knowledge and correspondingly no change in screening behavior. Siblings who are older, earn less, and live in rural areas have a lower baseline knowledge of CaP and are less likely to improve their self-assessed knowledge. On regression analysis, correlates of improvement in CaP knowledge included (1) those discussing with their primary physician (OR=6.6), (2) Caucasians (OR=2.7) and (3) non-smokers (OR=3.1). Improvements in prostate cancer knowledge were found to be predictive of subsequent participation in CaP screening and annual physical exams. CONCLUSIONS: Increased attention should be paid to siblings of CaP patients in efforts to improve their knowledge and thereby participation in screening as these patients are at an increased risk of development of this disease. Efforts should be made to educate siblings who are older, of lower income, African American, and rural residents with regard to CaP, as these subgroups appear less likely to change their knowledge and screening behavior despite their sibling's diagnosis.

Age Factors↗
PubMed2005

Initial incision of lateral pelvic fascia and early ligation of vascular pedicles during radical prostatectomy: potential to reduce positive margin rates.

OBJECTIVE: To report on our experience with a recently published technique to reduce positive margin (PM) rates (involving early incision of the lateral pelvic fascia, early release of the prostate and Denonvilliers' fascia off the rectum), with the additional modification of early ligation of the lateral vascular pedicles during radical retropubic prostatectomy (RP), as reducing PM rates continues to be an important oncological goal in RP. PATIENTS AND METHODS: One hundred consecutive men (mean age 61 years, pretreatment prostate-specific antigen level 8.9 ng/mL, and estimated blood loss 502 mL) underwent RP by one surgeon. The initial dissection involves early incision of the lateral pelvic fascia and developing the plane between the prostate and underlying rectum, before any apical dissection. This incision can be made medial to the neurovascular bundles in a nerve-sparing procedure. After this plane is developed, the lateral vascular pedicles to the prostate are also divided. Once these same manoeuvres are used contralaterally, the prostate is lifted off of the rectum and held in place only by the apex and bladder neck. The apical/urethral dissection is then carried out conventionally, followed by dissection/transection of the seminal vesicles and the bladder neck. RESULTS: The pathological stage included T2a (11%), T2b (69%), T3a (17%), T3b (3%), and N+ (2%); 20 patients had capsular penetration, at the posterolateral (in 15) and anterior aspect (in five) of the gland. The PM rate for the 100 consecutive patients was 13%, with PMs at the apex in 10, the base in two and posterolateral gland in one. No patient had a PM at the site of capsular penetration. When patients were stratified by low-moderate risk (pT2 and Gleason sum < or = 7) vs high risk (pT3 or Gleason sum > 7), the PM rates were 7.9% and 29.2%, respectively. CONCLUSIONS: Initial dissection of the lateral pelvic fascia, including developing a "perirectal pocket", and early ligation of the lateral pedicles, resulted in a low PM rate during RP. This experience supports the previous observations that early development of the pre-rectal fat plane may allow for more precise dissection below all layers of Denonvilliers' fascia and with a wider margin of periprostatic tissue.

Aged↗
PubMed2005

Cyclooxygenase-2: a therapeutic target for prostate cancer.

The discovery and elucidation of prostaglandin (PG) pathways, particularly the molecular and clinical role of cyclooxygenase-2 (COX-2) function, has been found to have an important role in neoplasia. Current understanding of the role of COX-2 activity and therefore the potential clinical usefulness of COX-2-specific inhibitors in prostate cancer will be discussed herein. The discovery of PG pathways, the molecular and clinical roles of COX-2 function, and the corresponding application to neoplasia were reviewed in the scientific literature from 1960 through the present time. In addition, thorough review of recent abstract presentations at scientific meetings (American Urological Association and American Society of Clinical Oncology annual meetings from 1998 to the present) was undertaken regarding the potential role of COX-2 in urologic cancers. Reduced apoptosis, increased angiogenesis, and immunosuppression are just some of the known sequelae of COX-2 overexpression, and each effect could have an important role in tumor formation and progression. Preclinical research and pilot clinical studies in prostate cancer to date have been promising. We are just beginning to understand the molecular mechanisms and clinical effects of COX-2 function and its inhibition and the potential for COX-2-specific inhibitors to affect tumor biology and growth, and thereby serve as antitumor drugs in therapeutic and chemopreventive roles in prostate cancer. The absence of complete scientific understanding in these areas presents an exciting opportunity for innovative and important scientific study.

Antineoplastic Agents↗
PubMed2004

Hand-assisted laparoscopic nephrectomy: prospective evaluation of the learning curve.

PURPOSE: Laparoscopic nephrectomy (LN) has recently become an emerging standard for extirpative surgery of the kidney. LN has historically proven to have a steep learning curve with longer operative times until a surgeon gains adequate laparoscopic experience. Hand-assisted laparoscopic nephrectomy (HALN) is fast becoming a commonly used procedure to remove kidneys as it may have a reduced learning curve compared to standard LN. To date no prospective studies have evaluated the learning curve of HALN with regard to improvements in operative times and technical difficulty. We prospectively evaluated the learning curve for HALN in a residency training program as it compares to open nephrectomy. MATERIALS AND METHODS: HALN was performed in 30 consecutive patients for various indications. The senior urology resident functioned as the primary surgeon and the same attending surgeon was present throughout all cases. All participating residents had to have performed at least 15 open nephrectomies to serve as an internal, personal reference. Difficulty scores were obtained at the completion of the case from the resident surgeon comparing HALN to open nephrectomy, which ranged from 1 to 5. Operative times, estimated blood losses and lengths of stay were obtained at the time of surgery and hospitalization. RESULTS: Median difficulty score was equivalent to open nephrectomy for the first case but decreased significantly by case 4 (p = 0.0006). Median operative times decreased significantly from 178 minutes in the first cases to 85 minutes by case 6 (p = 0.0002). Estimated blood loss and length of hospitalization did not differ significantly. CONCLUSIONS: HALN has a relatively short learning curve reflected by the rapid decrease in difficulty scores and operative times by case 4. Similar results may be expected when training practicing urologists to perform HALN.

Adult↗
PubMed2004

Partial nephrectomy with fibrin glue repair: measurement of vascular and pelvicaliceal hydrodynamic bond integrity in a live and abbatoir porcine model.

PURPOSE: Some of the challenges during partial nephrectomy include control of bleeding and repair of the pelvicaliceal system. Fibrin tissue sealants have recently been used to achieve hemostasis and collecting system closure in open and laparoscopic partial nephrectomy. However, there exist little data regarding the intrinsic strength of the bond, especially when applied to the vasculature and the urinary collecting system of the transected kidney. We examined the hydrodynamic bond integrity of a commercially available fibrin tissue sealant in a live porcine animal model undergoing partial nephrectomy. MATERIALS AND METHODS: Open partial nephrectomy was performed in 19 porcine renal units. Collecting system entry was confirmed by methylene blue instillation into the proximal ureter. Fibrin tissue sealant was used to repair 16 renal units, that is 8 kidneys hardened in vivo for 10 minutes and 8 hardened in vivo for 60 minutes. In an additional 3 renal units monopolar electrocautery was used to achieve hemostasis (no fibrin glue used). The strength of vasculature repair was performed by infusing saline into the renal artery (renal vein ligated) and measuring pressure at bond rupture. Similarly the integrity of pelvicaliceal repair was evaluated by retrograde infusion of saline into the collecting system via the proximal ureter and measurement of pressure at bond rupture. RESULTS: Fibrin tissue sealant was successful in achieving prompt hemostasis and it was subjectively superior to cautery alone with regard to bleeding control. Mean renal vascular and pelvicaliceal burst pressure for fibrin sealant treated kidneys was 378 (median 420) and 166 mm Hg (median 170), respectively. There was no significant difference in 10 vs 60-minute hardening times in treated kidneys. In comparison, vascular and pelvicaliceal burst pressure for nontreated (cautery alone) kidneys was 230 (median 220) and 87 mm Hg (median 90), respectively. CONCLUSIONS: Commercially available fibrin tissue sealants can provide supraphysiological renal parenchyma and collecting system sealing pressures after partial nephrectomy. This information supports the potential use of fibrin sealants during open and laparoscopic partial nephrectomy.

Abattoirs↗
PubMed2003

Reducing time to oral diet and hospital discharge in patients undergoing radical cystectomy using a perioperative care plan.

OBJECTIVES: To outline our current perioperative treatment of patients undergoing radical cystectomy and urinary diversion, which uses advancements in perioperative care to allow for early institution of an oral diet and early hospital discharge, and thereby overall improvement in patient recovery and outcome after this procedure. METHODS: Forty consecutive patients underwent radical cystectomy and urinary diversion with curative intent from 2001 to 2002. A care plan was followed for all patients and included improvements in preoperative, intraoperative, and postoperative care. The preoperative care included limited outpatient bowel preparation with sodium phosphate solution and patient education. Operative modifications included reduced incision length, initial preperitoneal dissection, and the use of internal surgical stapling devices. The postoperative care included the use of prokinetic agents, early nasogastric tube removal, the use of non-narcotic analgesics, and early institution of an oral diet. The outcomes with regard to time to institution of an oral diet, tolerance of a regular diet, and hospital discharge were assessed. RESULTS: The mean surgical time was 3.9 hours, and the mean estimated blood loss was 573 mL. The mean time to the institution of a clear liquid diet was 2.0 days and to a regular diet was 4.2 days. The mean time to hospital discharge was 5.1 days. No statistically significant differences were found in the time to resumption of a regular diet or to discharge between patients undergoing ileal conduits versus orthotopic ileal neobladders. Only 1 patient had any gastrointestinal dysfunction (ileus), and this patient was discharged on postoperative 7. No patient had any delayed complications involving problems with diet intolerance or other gastrointestinal dysfunction. The results of the current series were compared with those of historical controls. CONCLUSIONS: Advancements in preoperative, intraoperative, and postoperative management have together been successfully used in our patient population to reduce morbidity and improve recovery with regard to the early institution of an oral diet and early hospital discharge.

Adult↗
PubMed2003

Cyclooxygenase-2 as a potential target in the prevention and treatment of genitourinary tumors: a review.

PURPOSE: Recent years have seen a dramatic expansion in our discovery and knowledge of the molecular mechanisms of cancer development and progression. The discovery and elucidation of prostaglandin pathways, in particular the molecular and clinical role of cyclooxygenase (COX)-2 function, has had important application to neoplasms. Current understanding of the role of COX-2 activity and, thereby, the potential clinical usefulness of COX-2 specific inhibitors as they apply to urological oncology are discussed. MATERIALS AND METHODS: The discovery of prostaglandin pathways, the molecular and clinical role of COX-2 function, and the corresponding application to neoplasms were reviewed in the scientific literature (MEDLINE from 1960 to the present). In particular, a thorough review of the current literature and recent abstract presentations at scientific meetings was done regarding the potential role of COX-2 in urological cancers (MEDLINE from 1960 to the present, and American Urological Association and American Society of Clinical Oncology annual meeting abstracts from1998 to the present). RESULTS: Decreased apoptosis, increased angiogenesis and immunosuppression are just some of the known sequelae of COX-2 over expression and each effect may have an important role in tumor formation and progression. Preclinical research and pilot clinical studies in urological oncology, in particular prostate, bladder and kidney cancer, have proved to be quite promising to date. CONCLUSIONS: Currently we are just beginning to understand the molecular mechanisms and clinical effects of COX-2 function and inhibition, and the potential for COX-2 specific inhibitors to affect potentially tumor biology and growth and, thereby, serve as antitumor drugs with therapeutic and chemopreventive roles for urological cancers. The absence of complete scientific understanding in these areas provides a generous opportunity for innovative and important scientific study.

Animals↗