Biomedical subjects

S. Larry Goldenberg

Publications and source records attributed to S. Larry Goldenberg.

5 recordsLinked to original sources

PubMed1999

Cuff-flow evaluation of the bladder outlet: a preliminary investigation of a non-invasive pressure-flow measurement device.

Urodynamic pressure-flow studies provide an objective means of identifying bladder outlet obstruction. However, standard tests are invasive. This study evaluates a non-invasive method of obtaining pressure-flow data. One hundred men without clinical evidence of urinary obstruction were divided into 5 age groups. Non-invasive "cuff flow" urodynamic studies were obtained in each subject. Initial Pressure (P), initial flow (Q), resistive indices (Req =P/Q(2)) and uroflow patterns were obtained. With increasing age there were higher detrusor pressures, slower flows and greater resistive indices. This is in accordance with the prevalence of asymptomatic bladder outlet obstruction in older men. Statistical analysis revealed that Req is a highly reproducible value. An age specific nomogram for clinically unobstructed men was developed. The cuff flow devices is a new and reliable means of obtaining pressure-flow data in a non-invasive manner. From the values of Req in normal unobstructed men, future trials will assess clinically obstructed subjects prior to and after treatment.

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PubMed1998

Alpha-blocker therapy for benign prostatic hyperplasia: a comparative review.

In the past decade there has been a shift in the primary approach to therapy for BPH, from surgical intervention to pharmacotherapy. Therapies with alpha-blockers, particularly long-acting selective alpha1-adrenoreceptor antagonists, has proven effective, and hence has become a popular treatment option. In randomized controlled trials, 3 alpha-adrenoreceptor antagonists -terazosin, doxazosin, and tamsulosin -have been shown to significantly improve both the mean peak urinary flow and the severity of BPH-related symptoms. There are no currently published trials comparing the clinical efficacy of these drugs. Reports from non-comparative trials suggest that the effects on symptoms and flow rates are similar. However, side effects, such as postural hypotension, asthenia, and dizziness may be less with tamsulosin. Use of tamsulosin is associated with loss of ejaculation in 4.5% of men. Until differences in efficacy are demonstrated, the choice of alpha-blocker will depend on tolerance for side effects and convenience of administration.

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PubMed1997

Hydronephrosis after simple hysterectomy for benign disease: a prospective study.

OBJECTIVES: To determine the prevalence and implications of transient asymptomatic hydronephrosis following simple hysterectomy for benign disease. METHODS: Over a 12-month period, 50 consecutive women undergoing total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were evaluated. Renal ultrasound to detect asymptomatic hydronephrosis, renal function tests and urinalysis were performed preoperatively and at 3 days and 6 weeks after surgery. RESULTS: Hydronephrosis was not identified in the early or late postoperative period in any of the 50 evaluated patients. Concomitant bilateral salpingo-oophorectomy did not have any impact on this result. CONCLUSIONS: We did not find any cases of transient asymptomatic hydronephrosis occurring after simple, uncomplicated hysterectomy for benign disease. This suggests that silent ureteral dysfunction does not occur as a result of the surgical technique itself. As such, any postoperative finding of asymptomatic hydronephrosis warrants further investigation.

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PubMed1997

Prostatism: nature of the symptoms.

Benign prostatic hyperplasia (BPH) is very common. Almost 80% of men over the age of 70 have at least histological evidence of this process. The clinical prevalence of BPH increases from 10% in the fourth decade to approximately 40% after age 70. Multiple factors are involved in the progression of BPH from a microscopic disease to pathologically enlarged prostate gland. Despite several decades of research, many questions remain unanswered regarding the pathophysiology of benign prostatic enlargement, the most appropriate means of assessing the patient with lower urinary tract symptoms (LUTS), and effective policies of prevention and treatment strategies. Careful patient evaluation, patient selection, and proper technique are undoubtedly the most important factors in ensuring a good response to therapy. Clinical practice guidelines have recently been published, to guide the clinician in management of BPH. This paper will review the subjective and objective assessment tools that are available today.

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PubMed1997

Mechanisms of androgen-independent tumor growth.

In the setting of advanced prostatic carcinoma, castration results in a high initial response rate. Unfortunately, the benefit of such therapy is usually temporary owing to the fact that surviving tumor cells generally progress to an untreatable androgen-independent condition. Progression to androgen independence is a complex process. Several hypotheses for the mechanism of androgen independence exist, including clonal selection, tumor adaptation, and the activation of previously androgen-repressed genes that substitute for androgens in maintaining the viability of tumor-causing stem cells. In this article we will discuss the theoretical concepts underlying androgen independence as well as the concepts of androgen dependence, stepwise malignant transformation, and upregulation of constitutive growth factors.

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