Search PubMed⌕ Search

Biomedical subjects

A Zisman

Publications and source records attributed to A Zisman.

At least 55 records · Page 3Linked to original sources
PubMed2000

Predicting CAP in patients with intermediate PSA using modified PSA indices.

OBJECTIVES: To test a new PSA index: peripheral zone fraction PSA (PSA-PZ) and evaluate its' predictive value in patients with intermediate PSA. METHODS: Fifty seven of 273 patients with serum PSA 4-10 ng/ml had CAP (21%). Total prostate volume and transition zone volume were calculated. Different cut-off points were used to calculate specificity, sensitivity, efficacy, positive and negative predictive values for PSA, PSAD, PSA-TZ and PSA-PZ (PSA-PZ= serum PSA((Total gland volume-TZ volume)/(Total gland volume)) RESULTS: The distribution of PSA-PZ is presented. PSA-PZ is shown to be effective in DRE negative patients with serum PSA 4-10 ng/ml. For patients with PSA-PZ (1.5 ng/ml the biopsy may be spared with no cancer being missed. CONCLUSIONS: The mathematical formula for PSA-PZ is straightforward and easy to use. Its application is convenient in the clinical setting. We suggest the use of PSA-PZ mainly in DRE negative patients having large glands and serum PSA between 4-10.

Aged↗
PubMed2000

Immune and genetic therapies for advanced renal cell carcinoma.

Although we have witnessed advances in many aspects of cancer research and therapy in recent years, the ability to cure the majority of patients with advanced renal cell carcinoma (RCC) remains elusive. At the same time, it has become increasingly apparent that a better understanding of the genetic alterations and immune dysregulations in RCC will play a key role in finding a treatment. Therefore, clinical trials directed at specific genetic alterations and studies exploiting components of the immune system are being conducted. These studies provide new hope for an improved outlook for patients presenting with advanced RCC. The future prospects of RCC therapy will be, without doubt, built on the foundation of current investigative efforts in gene and immune therapy. This article reviews the current role of immunotherapy and gene therapy in the management of metastatic RCC. Finally, current clinical trials focusing on gene and immune therapies are listed.

Journal Article↗
PubMed1999

Ureteral catheterization and patient mobilization: is bed restriction mandatory?

OBJECTIVES: We determined whether patient mobilization influences ureteral catheter position in the collecting system. METHODS: 26 consecutive patients (28 renal units) who underwent ureteral catheterization for the purpose of retrograde pyelography or the relief of ureteral obstruction, were included. The position of the catheter's tip within the collecting system and versus the vertebrae was determined for each patient in the baseline supine position; standing upright, and supine again after walking a distance of 5 m. Catheteral displacement was determined by comparing its position in the upright and supine post-walking postures to its original position with the patient supine before any maneuver was undertaken. RESULTS: Assuming the upright position caused an average downward displacement of ureteral catheters by 7.8 mm (ranges 36 mm downward to 14 mm upward displacements, p = 0.0014). In the supine posture following a 5-meter walk, the catheters were downward displaced by 0. 36 mm on average (ranges 12 mm downward and 30 mm upward displacements p = 0.8). None of the ureteral catheters migrated below the uretero-pelvic junction during any phase of the above maneuvers. CONCLUSION: The position of ureteral catheters remains unchanged within the collecting system when patients stand or walk for 5 m. Therefore, mandatory bed restriction is not justified in patients with ureteral catheters.

Adolescent↗
PubMed1999

Prostate-specific antigen induces proliferation of peripheral blood lymphocytes and cytokine secretion in benign prostate hypertrophy patients.

PURPOSE: The etiology of benign prostatic hypertrophy (BPH) is still obscure. Data supporting an interaction connecting prostate hyperplasia and immune dysregulation is accumulating lately. The aim of the study was to assess the cellular immune responses to PSA by measuring the in vitro potential of PSA to induce proliferation and cytokine secretion in peripheral blood lymphocytes (PBLs) of BPH patients. MATERIALS AND METHODS: PBLs were extracted from fresh blood of 36 BPH patients and 11 age-matched controls. The PBLs were incubated with PSA. Proliferation of the cultured PBLs was determined by thymidine incorporation. Secretion of cytokines to the culture medium was measured either by biological assay (IL-2) or by ELISA (IL-4, IL-10, IFNgamma, TNFalpha). RESULTS: Twelve of the 36 BPH patients responded to PSA, whereas none of the 11 controls responded (p = 0.04). The proliferative response of PBLs from BPH patients was significantly higher as compared to PBLs of controls (p = 0.03). The mean total prostate volume and the transition zone volume were 51% and 54% bigger, respectively, among the responders to PSA as compared to the nonresponders (p < 0.05), whereas the mean serum PSA level did not differ significantly. PBLs of BPH patients secreted significantly higher levels of TNFalpha, both spontaneously and in response to PSA, as compared to controls (p = 0.003). CONCLUSIONS: These findings show that PSA is able to induce proliferation of PBLs in vitro in BPH patients. Moreover, the higher spontaneous and PSA-induced secretion of TNFalpha in BPH patients may reflect a role for this proinflammatory cytokine in vivo. Based on these observations, we suggest that autoimmune dysregulation might have a role in BPH.

Aged↗
PubMed1999

Relaxation of micro indentations in calcium oxalate urinary stones.

PURPOSE: We define energy requirements for stone micro indentation as a quantifiable event equivalent to in vivo energy delivery and investigate the change in indentation characteristics with time. MATERIALS AND METHODS: The 7 stones extracted from 7 patients were cut, embedded in resin and polished. Multiple micro indentations were performed on each stone section using a diamond Vickers micro indentor with a 500x light microscope and video system. The resulting indentations were observed by optical and scanning electron microscopy as a function of time. Organic matrix content was determined by dissolving stones in ethylenediaminetetraacetic acid solution. RESULTS: The energy requirement for stone indentation varies among stones (median range 43.6 to 109.9 kg/mm2) and at different locations in the same stone. Indentations relaxed by 10 to 70% during the first 2 weeks after indentation. Stones with a high organic matrix content were ductile and the phenomenon of indentation relaxation was pronounced. Brittle, low matrix stones relaxed to a lesser extent. CONCLUSIONS: The relaxation phenomena may have a practical implementation when considering repeat shock wave lithotripsy. A significant fraction of the energy invested in a stone which did not cause fracture or critical cracks is lost within 1 to 2 weeks after the procedure, particularly in elastic stones with a high organic matrix content. We suggest that the preferred interval for repeat shock wave lithotripsy be less than 2 weeks.

Calcium Oxalate↗
PubMed1997

[Incomplete penile amputation: diagnostic and therapeutic challenge].

Traumatic penile amputation is a severe injury associated with a potential for multidisciplinary dysfunction. Since such injuries are rare, diagnostic and therapeutic experience is minimal. While complete penile amputation is a straight-forward diagnosis, incomplete amputations are not as evident and diagnosis may be delayed. The therapeutic endpoint includes restoration of an acceptable appearance of the phallus and a urethral meatus that allows normal voiding. Other objectives include re-establishment of sexual potency and fertility. As in other amputations, the treatment of choice is meticulous microsurgical replantation, including re-anastomosis of dorsal and cavernosal arteries, the deep dorsal vein, the urethra and nerves, as well as suturing the tunica albuginea. While appropriate cosmetic results and normal voiding can be achieved in most cases, potency is less frequently achieved due to neurological deficit leading to impaired erection and loss of sensation. Penile amputation is thus a complex therapeutic challenge, as meticulous anatomic reconstruction of blood vessels and nerves is essential for restoration of function. Since incomplete penile amputation may be overlooked when other more obvious injuries draw attention, this injury should be suspected in all cases of penetrating injury of the male genitalia. We present a 17-year-old man who sustained an incomplete penile amputation in a traffic accident.

Accidents, Traffic↗
PubMed1997

The role of endoscopic retrograde cholangiopancreatography in management of patients recovering from acute biliary pancreatitis in the laparoscopic era.

BACKGROUND: Traditionally an episode of acute biliary pancreatitis (ABP) is an indication for direct imaging of the biliary tree. The optimal approach may vary according to local expertise, and endoscopic retrograde cholangiopancreatography (ERCP) is the most common. The fact that the incidence of choledocholithiasis in patients recovering from ABP varies between 3 and 33% raises a question about the necessity of visualizing the biliary tree in all patients recovering from ABP. METHODS: In order to evaluate this policy, we reviewed 48 ERCPs performed on patients recovering from ABP who were scheduled for laparoscopic cholecystectomy (LC). We checked the correlations between ERCP findings and the severity of pancreatitis, biochemistry values (which were sampled during the acute phase), and ultrasonographic (US) findings. RESULTS: The ERCP demonstrated common bile duct (CBD) stones in 11 (22.9%) patients. US finding of a dilated CBD and maximal aspartate transaminase (AST) values higher than 90 units/l were significantly correlated with CBD stones (a relative risk [RR] of 2.95 with a 95% confidence interval [CI] for a dilated CBD and RR of 3.89 with a 95% CI of 1.18-12.80 for an AST value higher than 90 units/l). No other parameters were significantly correlated with CBD stones. CONCLUSION: We, therefore, recommend performing a preoperative ERCP only on patients who present with an ultrasonographic finding of CBD dilatation. The correlation to high AST is still to be proven.

Acute Disease↗
PubMed1997

A genetic sequence change in the 3'-noncoding region of the androgen receptor gene in prostate carcinoma.

OBJECTIVE: We intended to identify structural changes in the hormone-binding domain and C-terminal region of the androgen receptor (AR) gene in carcinoma of prostate specimens. METHODS: Twelve prostate cancer specimens from prostate resections were analyzed for the presence of mutations in the E-H exons and part of the 3'-untranslated region of the AR cDNA, using RT-PCR and direct sequencing. RESULTS: A polymorphic sequence spanning 17 nucleotides was identified in the 3'-untranslated region of the AR cDNA from one prostate carcinoma tissue, suggesting the presence of a somatic mutation. No mutations were identified in the coding sequence of the hormone-binding domain of the AR cDNA. CONCLUSION: These results suggest that AR mutations are probably uncommon molecular events in the early stages of prostate cancer.

Adenocarcinoma↗
PubMed1997

Transrectal ultrasonographically assisted radical retropubic prostatectomy.

Radical prostatectomy is associated with difficulty in determining the division site of the urethra adjacent to the apical region of the prostate. We present the results of a feasibility clinical trial in three patients to determine whether intraoperative transrectal ultrasonography may assist during radical retropubic prostatectomy. Using this technique the apex is readily identified and a detailed view of the urethral stump could be obtained. In one case residual apical tissue was identified and excised. The creation of the vesicourethral anastomosis was documented and its water tightness was demonstrated. We conclude that transrectal ultrasonography can be performed during radical retropubic prostatectomy and may be helpful in selected cases.

Adenocarcinoma↗
PubMed1997

Postejaculation serum prostate-specific antigen level.

OBJECTIVE: This study was carried out to determine whether ejaculation may modify the serum prostate-specific antigen (PSA) level and to investigate whether postejaculation serum PSA may play a role in male hypofertility work-up. METHODS: Serum PSA concentration was determined before and 1 h after ejaculation in 18 healthy men (group A) and in 16 men with male-factor infertility (group B). PSA change (delta) was recorded and analyzed. RESULTS: Postejaculation serum PSA differed significantly from basal levels (p = 0.0037 by the Wilcoxon signed rank test). Following ejaculation, a rise was noticed in 74% of subjects. The median relative change in PSA concentration was 54%. No difference in respect to mean, median and relative change was observed between study groups. In two cases (6%), PSA rose from normal level to more than 4 ng/ml. CONCLUSION: A significant postejaculation serum PSA elevation does occur, it is thus recommended that men abstain from ejaculation for 24 h prior to PSA sampling. Postejaculation PSA was not found to significantly correlate with hypofertility.

Adult↗
PubMed1996

[Transrectal ultrasound-controlled needle aspiration of a prostatic cyst].

Prostatic cysts are common and are usually acquired and asymptomatic. Congenital prostatic cysts, which may originate from the wolffian system or from remnants of the Muellerian duct, are rare and may cause obstructive symptoms in young adults. Due to the availability of transrectal ultrasonography an increased number of cases of prostatic cysts are being diagnosed. We report a 36-year-old man with a congenital prostatic cyst which caused increasing pain during ejaculation and decreased the force of the urinary stream. It was diagnosed by ultrasonography and treated successfully by ultrasound-controlled, transrectal needle aspiration. There was immediate, complete disappearance of symptoms and no complications.

Adult↗
PubMed1996

[Percutaneous choledochoscopic electrohydraulic lithotripsy].

Treatment of biliary stones impacted in the distal, common bile duct is a technical challenge. We report 2 consecutive patients, a woman aged 80 years and a man aged 64, in whom all operative attempts failed. In both, the stone was removed by percutaneous, choledochoscopic, electrohydraulic lithotripsy in a single session. To the best of our knowledge these are the first such cases reported in Israel.

Aged↗
PubMed1996

Is male gender a risk factor for conversion of laparoscopic into open cholecystectomy?

BACKGROUND: Based on a clinical observation that the conversion rate of laparoscopic cholecystectomy (LC) to open cholecystectomy (OC) is higher in males, we decided to review our records and to verify whether a significant difference in conversion rates exists between sexes. METHODS: A retrospective study on conversion rates of elective laparoscopic cholecystectomy (LC) into open cholecystectomy (LC) in relation to gender was carried out in 329 patients: 267 females and 62 males. RESULTS: Our data revealed that the probability of conversion is fivefold greater in males than females, 21% vs 4.5%, respectively (p = 0.0001). We attribute this striking difference to significantly more adhesions p = 0.0002) and anatomical difficulties (p = 0.003) in males during LC, leading to conversion. CONCLUSIONS: We conclude that conversion of LC to OC is more prevalent among males and is probably attributable to a greater incidence of anatomical difficulties.

Cholecystectomy↗