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Biomedical subjects

A I Sagalowsky

Publications and source records attributed to A I Sagalowsky.

At least 19 recordsLinked to original sources
PubMed1995

Lymphoproliferative disease presenting as obstructive uropathy after renal transplantation.

Lymphoproliferative disorders occur with a greater frequency in recipients of solid organ transplants. Unlike in the general population, these tumors tend to arise in extranodal sites and are often confined to a single organ. We report on a patient with lymphoproliferative disease confined to the hilum of the renal allograft. The only clinical clue to the presence of the tumor was an increase in the serum creatinine secondary to ureteral obstruction by the mass.

Humans↗
PubMed1995

Early results with split-cuff nipple ureteral reimplants in urinary diversion.

PURPOSE: A split-cuff nipple technique was developed for ureteral reimplantation in urinary diversion. MATERIALS AND METHODS: Ureteroenteric anastomosis was performed with a uniform split-cuff nipple technique in 46 ureters of 24 adult patients undergoing various forms of conduit or continent urinary diversion. The outcome of 42 reimplants in 22 patients (mean followup 22.5 months, minimum 10) was analyzed. The technique is described in detail. RESULTS: Reflux was prevented in 97.6% and 95% of cases at initial and 2-year followup, respectively. Neither anastomotic leakage nor obstruction occurred. There were 2 episodes of pyelonephritis in the early postoperative period. Results are compared with those in the literature of ureteroenteric anastomoses in general and of various split-cuff nipple techniques. CONCLUSIONS: The technique is easy to perform. Favorable early results warrant continued use of the procedure. Long-term followup in a larger number of patients is indicated.

Adult↗
PubMed1992

Testicular tumors in men with human immunodeficiency virus.

During a 2-year period 5 men positive for the human immunodeficiency virus (HIV) presented with 6 testis tumors among a total of 3,015 men seen at our hospital acquired immunodeficiency syndrome (AIDS) clinic. This testis tumor incidence of 0.2% is 57 times that of the United States average of 3.5 cases per 100,000 men. Two patients were only HIV positive and 3 others already had AIDS-related complex for 2 to 15 months at the time of tumor diagnosis. Tumor histology was mixed germ cell tumor in 4 patients, pure seminoma in 1 and Burkitt's lymphoma in 1. Patients underwent routine staging evaluations. Three patients had low stage mixed germ cell tumor (clinical stage 1 or 2A) and underwent retroperitoneal lymphadenectomy, which revealed pathological stage 1 or 2A disease in 1 and 2, respectively. These patients did not receive adjuvant chemotherapy. Two patients had advanced mixed germ cell tumor (clinical stage 2C) or Burkitt's lymphoma (clinical stage 4) and received combination chemotherapy from the onset. Outcome was evaluated with regard to progression of HIV disease and tumor status. The 2 patients who were only HIV positive remained so for 9 and 48 months. The 3 patients with AIDS-related complex had progression to AIDS within 1 to 9 months and 2 of these patients died 1 1/2 and 7 months after tumor diagnosis. All 3 patients with resected low stage disease had tumor recurrence within 1 to 9 months and were begun on platinum-based combination chemotherapy. The risk of false low clinical staging and early tumor progression may be higher in HIV positive men than in other testis tumor patients. Patient ability to tolerate chemotherapy and to obtain a satisfactory tumor response appeared to be primarily related to lack of progression of HIV disease to frank AIDS.

AIDS-Related Complex↗
PubMed1991

Long-term patient survival after cystectomy for regional metastatic transitional cell carcinoma of the bladder.

The records of 280 patients who underwent pelvic lymphadenectomy and radical cystectomy for transitional cell carcinoma of the bladder between 1971 and 1986 were reviewed. A total of 42 patients had either 1 (stage pN1) or more than 1 (stage pN2) positive lymph nodes (20 and 22 patients, respectively). The over-all 3-year survival rate for patients with positive lymph nodes was 27%, and it was 30 and 18.5% for stages pN1 and pN2 disease, respectively. Kaplan-Meier survival curves revealed a sustained survival advantage for stage pN1 over pN2 disease for the first 3 years (p less than 0.05) but the difference was not significant at 5 years of followup. Eleven patients with negative lymph nodes but local extension of tumor into the prostatic stroma and/or ducts had a 5-year survival rate of 36%, which equaled the survival of 49 stage pT3b,pN0 cancer patients in the same series. Surgical mortality for the entire population of 280 patients was 2.1% and there was no increase in mortality or morbidity among the node positive patients. Based on the findings of improved survival of stages pN1 and pT3b,N0 cancer patients compared to stage pN2 cancer patients, the tumor, nodes and metastasis classification offers more specific prognostic information than does a single designation of Jewett stage D disease.

Adult↗
PubMed1990

Predictors of residual mass histology after chemotherapy for advanced testis cancer.

The records of 15 patients with Stage B3 or B2/C germ cell testis tumors who underwent full surgical debulking of a residual mass after completion of chemotherapy were reviewed retrospectively to look for predictors of residual mass histology. The density, character, and change in volume of the retroperitoneal mass on computerized tomography before and after chemotherapy were compared with the histology in the primary tumor and in the residual mass. One of 6 patients without teratoma in the primary tumor had a 97 percent reduction in the mass which contained residual teratoma. Two patients with residual seminoma had a 50 percent decrease in tumor volume, and both patients died of tumor progression despite salvage chemotherapy. Two patients with pure seminomas had only residual fibrosis in masses that decreased in volume by 77 and 75 percent, respectively. One of these masses was discrete and the other was diffuse. Seven of 9 patients (78%) with teratoma in the primary tumor had either teratoma (4 of 9, 44%) or carcinoma (3 of 9, 33%) in the residual mass, and the change in mass volume ranged from a 93 percent decrease to a 540 percent increase in size. All 7 patients with residual teratoma and/or carcinoma remain free of disease after observation or further chemotherapy. For the entire series, the mass density and character did not correlate consistently with the primary tumor or residual mass histology. Residual fibrosis alone or teratoma and/or carcinoma were seen with least (0 to 50%) and greatest (more than 90%) decreases in mass volume.

Adolescent↗
PubMed1987

Functional characteristics of the Camey ileal bladder.

We studied postoperatively 14 men who underwent urinary diversion with a Camey ileal bladder in association with radical cystoprostatectomy. Clinical and urodynamic evaluations revealed that the ileal bladder provides a moderate pressure reservoir (mean pressure at capacity 37 cm. water) and offers the patient reliable daytime continence. The mean capacity of 362 ml. allows for a voiding interval of 2.2 hours but it is not adequate for storage of urine produced through the night, so that nocturnal enuresis results universally. Even after 2 years of followup the tubular-shaped ileal reservoir maintained physiological contraction waves of segmentation and peristalsis typical of human ileum. Voiding is accomplished by abdominal straining and an intraluminal pressure of more than 50 cm. water is required to maintain the urine flow. Mean peak flow rate was 19 ml. per second. Reflux was prevented successfully in 86 per cent of the renal units. Metabolic acidosis was seen in 43 per cent of the patients. While the ileal bladder falls short of being the ideal form of continent urinary diversion, it offers a psychologically attractive technique to selected and highly motivated male patients faced with the need for urinary diversion.

Aged↗
PubMed1987

Experience with the ileal bladder (Camey procedure) and cecoileal reservoirs for continent urinary diversion.

I have reviewed our own experience with the ileal bladder and with cecal and cecoileal reservoirs, along with the reported experiences of other investigators. Both of these major classes of diversion offer continent nonrefluxing storage of urine. I advise patients who are candidates for either type of procedure to weigh the prospect of urethral voiding (but enuresis with the ileal bladder) v a continent abdominal stoma that requires self-catheterization of variable difficulty with a cecoileal reservoir. The perfect urinary diversion does not exist. Greater experience in time and numbers is required to know if the newer procedures reviewed here are even as good as the ileal conduit. However, the potential for greater preservation of renal function and significantly improved quality of life cannot be denied.

Acidosis↗
PubMed1986

Further experience with ileocecal conduit urinary diversion.

Ileocecal conduit urinary diversion was performed on 18 patients. Over-all surgical complications were few. Creation of a sutured ileal intussusception across the ileocecal valve prevented reflux in 9 of 12 patients (75 per cent) followed for 8 to 25 months. A stapling technique prevented reflux in all 5 patients followed for 8 to 12 months. These modifications may allow chronically reliable nonrefluxing urinary diversion along with the previously recognized advantages of the ileocecal segment.

Aged↗
PubMed1985

Endocrine therapy for prostate cancer.

Prostate cancer consists of epithelial and stromal elements that are heterogeneous with regard to androgen dependence. Nearly 80% of patients with symptomatic metastatic prostate cancer obtain prompt objective and subjective response to androgen deprivation. Surgical castration remains an effective form of therapy, has low morbidity, and obviates compliance problems with medical regimens. New LH-RH analogs offer complete medical androgen deprivation, appear as effective as estrogen therapy at 2-year follow-up, and have significantly lower cardiovascular side effects. Thus, LH-RH analogs may replace estrogen therapy for the medical management of metastatic prostate cancer. Androgen deprivation therapy has not been proved to prolong the survival of patients with prostate cancer. The optimal timing for initiation of endocrine therapy in these patients remains controversial. Techniques for predicting androgen dependence of prostate cancer are still evolving and are not yet applicable on a widespread clinical basis.

Adrenal Glands↗
PubMed1984

Prospective evaluation of renal allograft dysfunction with 99mtechnetium-diethylenetriaminepentaacetic acid renal scans.

A prospective, single-blinded study was done to determine the ability of serial 99mtechnetium-diethylenetriaminepentaacetic acid scans to diagnose renal allograft rejection. Among 28 transplant recipients 111 renal scans were obtained 1 day postoperatively and every 3 to 4 days thereafter for 3 weeks in all patients retaining an allograft. Computer-generated time-activity blood flow curves were analyzed semiquantitatively for the 1) interval between curve peaks of the allograft and iliac artery, 2) renal transit time and 3) renal washout of radionuclide. Excretory function was assessed by degree and interval to appearance of radionuclide in the calices and bladder. Deterioration of renal blood flow and excretion compared to the initial scan was considered rejection. Of 52 scans performed during clinical rejection 47 (90.4 per cent) were interpreted as showing rejection (sensitivity). Of 53 scans interpreted as showing rejection 47 (88.7 per cent) were positive for clinical rejection. The remaining 6 patients (initial false positive results) suffered clinical rejection within 24 to 72 hours. We conclude that 99mtechnetium-diethylenetriaminepentaacetic acid renal scans are useful in the differential diagnosis of renal allograft dysfunction.

Clinical Trials as Topic↗