Spontaneous jejunal intussusception after open radical nephrectomy.
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Humans↗
Biomedical subjects
Rajveer S Purohit
Publications and source records attributed to Rajveer S Purohit.
Stone clustering of patients with cystine urinary stone formation.
OBJECTIVES: To explore the history of symptomatic cystine stone formation. Cystinuria is a genetic defect that may result in the formation of recurrent cystine calculi. METHODS: Thirty-four patients with cystinuria were retrospectively evaluated for treatment patterns, medical prophylaxis, and renal outcome. Patients were offered a conservative surgical regimen and routine radiographic and laboratory follow-up and were encouraged to use medical prophylaxis. A Poisson regression model was used to analyze the patterns of stone formation. RESULTS: The mean age at presentation and at last follow-up was 18 and 38 years, respectively. Patients underwent a total of 249 procedures, with an average of 7.3 procedures per patient, including 37% percutaneous nephrolithotomies; 25.7% shock wave lithotripsy procedures; 22.1% ureteroscopies; 12.9% open lithotomies; and 1.6% nephrectomies. In 29% of patients, unilateral surgery only was required. With a conservative treatment regimen, no patient developed renal insufficiency or failure. The overdispersion estimated from the Poisson model was 5.03 (P <0.001) if patients were evaluated from birth to last follow-up and 2.06 (P <0.001) if followed from first presentation to last-follow-up, suggesting a clustering of stone events. Overdispersion was moderately related to increased age (older than 34 years). CONCLUSIONS: The results of our study showed that patients with cystinuria develop symptomatic calculi in clusters, with a slight predominance of stone formation after the age of 34. The cause of the stone clustering is unclear. Renal function can be preserved with a conservative surgical treatment protocol. Contemporary medical prophylaxis may be ineffective.
Adolescent↗
Update of staging and risk assessment for prostate cancer patients.
PURPOSE OF REVIEW: This paper will review the current staging system for prostate adenocarcinoma patients, and will also review new information that can be combined with clinical and pathological staging in order to assess a patient's risk of success or failure of treatment. RECENT FINDINGS: There has been significant stage migration of prostate cancer patients in the past 15 years, such that patients are currently being diagnosed younger, with lower clinical stages and serum prostate-specific antigen levels, and a lower risk of metastatic disease than previously. The incorporation of the results of extended prostate biopsy schemes, with stage, grade and serum prostate-specific antigen levels, improves the risk assessment of newly diagnosed prostate cancer patients. New imaging techniques, such as transrectal ultrasound Doppler flow and magnetic resonance spectroscopy hold promise for improving risk assessment. Molecular biomarkers may improve risk assessment in the future, although none are currently approved by the US Food and Drug Administration for this indication. Gene chip arrays may further refine risk assessment and assist with the identification of therapeutic targets. SUMMARY: There has been significant stage migration of prostate cancer patients in the prostate-specific antigen era. Incorporating biopsy information into nomograms and risk assessment equations improves upon clinical staging and risk assessment. New imaging techniques, molecular markers and gene chip arrays hold promise for future risk assessment.
Adenocarcinoma↗
A prospective comparison of 3 diagnostic methods to evaluate ejaculatory duct obstruction.
PURPOSE: Various diagnostic tests are available to evaluate patients with ejaculatory duct obstruction (EDO). However, the most accurate diagnostic technique, defined as the one that best predicts a successful outcome after ejaculatory duct resection, is unclear. We prospectively performed transrectal ultrasound (TRUS) and 3 other tests in men with EDO and determined their relative value in this diagnosis. MATERIALS AND METHODS: Patients with suspected EDO on clinical evaluation that included TRUS proceeded to further intraoperative evaluation with duct chromotubation, seminal vesicle aspiration and seminal vesiculography. A comparative analysis of findings from each technique was performed and the success of subsequent transurethral resection procedures was assessed. RESULTS: All 25 patients had evidence of EDO on diagnostic TRUS, a finding that merited further evaluation with other modalities. However, TRUS findings correlated poorly with those of the other diagnostic tests. Obstruction on TRUS was confirmed in only 52%, 48% and 36% of vesiculography, seminal vesicle aspiration and duct chromotubation studies, respectively. A better correlation was observed between the dynamic tests of duct chromotubation and seminal vesiculography. Based on all diagnostic tests only 12 patients (48%) proceeded to duct resection, of whom 10 (83%) showed significant improvement in semen analysis parameters or clinical symptoms after the procedure. CONCLUSIONS: A comparative analysis of 4 diagnostic techniques suggests that TRUS alone has poor specificity for EDO evaluation. Incorporating dynamic tests into the algorithm of EDO diagnosis may decrease unnecessary duct resection procedures and improve the success of the resection procedures that are indicated.
Adolescent↗
Laterality of symptomatic cystine calculi.
OBJECTIVES: To evaluate patterns of laterality in cystine stone formation to determine whether phenotypic expression of this genetic disease is distributed equally in each kidney. Cystinuria is a genetic defect that may result in the formation of recurrent cystine calculi. Significant nongenetic factors may play a role in the manifestation of this disease. METHODS: Thirty-four patients seen in the Stone Center at the University of California, San Francisco were retrospectively evaluated for treatments and patterns of symptomatic stone formation between 1989 and 2002. A conservative surgical regimen and routine radiographic examinations were used. Treatments were used as a surrogate for development of symptomatic calculi. RESULTS: The mean age at last follow-up was 38.2 years. The mean age at presentation was 18 years. The 34 patients underwent a total of 249 procedures, averaging 7.3 procedures per patient. Of the 34 patients, 29% required only unilateral surgery and formed unilateral symptomatic calculi exclusively (P <0.0001) during their lifetime. Of the 10 patients with unilateral stone formation, 2 (20%) were female and 8 (80%) were male. Of the 24 patients with bilateral stone formation, 12 (50%) were female and 12 (50%) were male. Of the 10 patients with unilateral stone formation, 6 developed left-sided calculi and 4 developed right-sided calculi. CONCLUSIONS: A subset of one third of patients with cystine stone formation will develop unilateral calculi exclusively during their lifetime. Understanding why the contralateral side did not form stones may provide insight into novel prophylactic regimens. The etiology of symptomatic unilateral cystine nephrolithiasis is unknown, but anatomic and external triggers should be considered.
Adult↗
Imaging clinically localized prostate cancer.
At this time there is no highly sensitive and specific widespread radiographic test for local staging of prostate cancer. Future developments will likely require a combination of imaging modalities with utilization guided by risk-stratification models (Table 4). Staging data for all imaging tests discussed in this article are summarized in Tables 5 and 6. Clinically, conventional gray-scale TRUS remains the most frequently used tool because of its utility in guiding prostatic biopsies. Modifications of TRUS--including power and color Doppler, 3D imaging, and new ultrasound contrast agents and elastography--show promise in increasing the accuracy of ultrasound. Endorectal MRI may have some value for staging selected patients. The addition of prostatic MRS, which images the differential activity of metabolites, may increase the specificity of MRI. Newer techniques with finer voxel resolution may prove to be clinically useful. A large well-designed study evaluating the utility of MRI/MRS is currently being planned. Cross-sectional imaging of the pelvis with either MRI or CT should be used selectively as should radionuclide bone scans. Similarly, ProstaScint scans should be ordered selectively, either before or after primary therapy, rather than routinely in all patients.
Antibodies, Monoclonal↗