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Biomedical subjects

B F Schwartz

Publications and source records attributed to B F Schwartz.

29 records · Page 2Linked to original sources
PubMed1999

Imaging characteristics of indinavir calculi.

PURPOSE: Indinavir sulfate is an effective protease inhibitor of the human immunodeficiency virus type 1. Use is associated with a significant incidence of crystallization and stone formation in the urinary tract, and these calculi are not visible on plain radiographs. Previously all urinary stones, including uric acid and matrix, were believed to be radiodense on computerized tomography (CT). We conducted a retrospective study to evaluate the radiographic appearance of indinavir calculi. MATERIALS AND METHODS: Retrospective chart review of 36 patients taking indinavir sulfate and presenting with renal colic was performed with attention to presentation, urinalysis, radiographic evaluation and management. Specifically, imaging characteristics on CT were addressed. RESULTS: All patients complained of ipsilateral flank pain and 35 had nausea and/or vomiting. Of 30 patients with dysuria or urgency the majority had hematuria, and most had pyuria and/or proteinuria. No stones were visualized on abdominal radiography. Diagnosis was confirmed on 1 of 13 excretory urograms and 4 of 11 renal ultrasounds. None of 12 CT scans was diagnostic of renal lithiasis. CONCLUSIONS: Indinavir sulfate is a protease inhibitor with poor solubility and significant urinary excretion. Crystallization and stone formation are demonstrated in as many as 20% of patients taking the medication. Most patients present with flank pain, nausea or vomiting and hematuria. Previously CT was thought to identify all urinary calculi with clarity but it cannot reliably confirm the presence of indinavir calculi.

Adult↗
PubMed1999

Percutaneous access techniques in renal surgery.

Percutaneous renal surgery is continually being improved, refined, and embraced by urologists worldwide. With the advent of extracorporeal shock wave lithotripsy (ESWL), many percutaneous techniques have been abandoned or forgotten. We are learning, however, that ESWL is not a panacea for all urinary calculi and different methods need to be used to obtain stone-free patients. We discuss the history, anatomy, techniques, and specific problems and complications ofpercutaneous renal surgery specifically relating to renal stone disease.

Dilatation↗
PubMed1999

Historical perspectives and current advancements in the bacteriology and medical therapy of struvite urinary stone disease.

Struvite calculi have afflicted man for thousands of years. Despite recent advances in surgical technology to treat these disabling stones, high recurrence rates and inability to remove all stone fragments remain significant problems. Previous non-surgical alternatives have been disappointing because of low success rates, increased side effects or poor tolerability. New research in this area continues to provide insight into origins of lithogenesis and non-invasive therapy for calculi caused by infection.

Bacteria↗
PubMed1999

Complications of retrograde balloon cautery endopyelotomy.

PURPOSE: Adult ureteropelvic junction obstruction is increasingly managed with endoscopic techniques. Retrograde balloon cautery endopyelotomy is quick, requires minimal hospital stay and allows most patients a rapid return to work. The complication rate of retrograde balloon cautery endopyelotomy ranges from 13 to 34%, with vascular injury in 0 to 16% of patients. We report 5 uncommon complications, including 4 vascular injuries, that clinicians should be familiar with when using this technique. MATERIALS AND METHODS: We reviewed 52 retrograde endoscopic endopyelotomy procedures performed during a 5-year period. There were 5 uncommon complications. RESULTS: Accessory lower pole renal artery injuries occurred in 3 patients, 1 of whom presented 12 days after endopyelotomy. Embolization was successfully performed in all 3 cases and none had subsequent hypertension. In 1 case a right ovarian vein laceration was not evident on preoperative or postoperative angiography. Emergency post-embolization abdominal exploration revealed a 2 mm. injury to the right ovarian vein before entering the right renal vein close to the ureteropelvic junction incision. Nephrectomy and ovarian vein ligature were curative. In 1 case the electrocautery wire broke intracorporeally after firing, resulting in a bobby pin-like configuration. Successful removal was accomplished by twisting the catheter and wrapping the wire around the tip, enabling atraumatic removal. CONCLUSIONS: Retrograde balloon cautery endopyelotomy is an emerging technology with potential adverse outcomes. The complications we noted are complex and potentially life threatening. Awareness of these complications may help avoid poor outcomes and expedite appropriate treatment.

Adolescent↗
PubMed1998

Home flow rates in evaluation of lower urinary tract symptoms in men.

We wanted to determine if 5-second home flow rates can be used in the evaluation in men with lower urinary tract symptoms (LUTS). Fifty previously untreated men with LUTS were evaluated by history and physical examination, international prostate symptom score (IPSS) questionnaire, and two methods of uroflowmetry. Each participant underwent three formal uroflow measurements using the Dantec UD5500 Mk2 machine and subjective 5-second home uroflow measurements twice daily for 7 days. The reliability of each test as well as correlation coefficients between the two methods of uroflowmetry were determined. The reliability for the average of the 14 home flow rates was 0.99 and the reliability for any single home flow was 0.82. Reliability for the average of three uroflows in measuring Qmax, Qave, flow times, and volume are 0.91, 0.91, 0.86, and 0.79, respectively. If single measurements are used, the values are 0.77, 0.78, 0.68, and 0.56. Home flow average is significantly different from Qmax and Qave (p < .001). No significant correlation was found between any of the uroflowmetry measurements or home flow average and IPSS or bother score. Home flows rates and uroflowmetry are reliable tests. There is a weak correlation between average home flows and Qmax and Qave. The greatest use of home flow rates probably lies in follow-up of patients who had either medical or surgical intervention for LUTS.

Adult↗
PubMed1997

The use of an external vacuum device to augment a penile prosthesis.

Although penile prostheses are highly effective in the treatment of erectile dysfunction, a small percentage of patients are dissatisfied. Serendipitously, a patient in this group found that using an external vacuum device to augment his prosthetic erection provided a dramatic objective improvement in his erection and increased his overall satisfaction with intercourse. Patients who had tried the combination of external vacuum device and penile prosthesis simultaneously were identified from our penile prosthesis population as well as the Osbon Medical Systems database. Telephone interviews were conducted to determine efficacy, satisfaction, and side effects from the combination. Twelve patients completed the telephone survey. Four patients had semirigid and eight had inflatable penile prostheses. After using the vacuum device to augment the erection, all reported increased rigidity and patient/partner satisfaction, and 11 of 12 described improved length and girth. Minimal complications were noted. Concomitant use of an external vacuum device and penile prosthesis was safe in this select population. The combination may be indicated in patients with penile prostheses who are dissatisfied with size and/or rigidity, and in those who refuse or who are poor candidates for prosthesis revision.

Aged↗
PubMed1996

Prognostic value of BHCG and local tumor invasion in stage I seminoma of the testis.

Approximately 10-15% of patients with stage 1 pure seminoma of the testis have an elevated preorchiectomy serum beta human chorionic gonadotropin level [1-4]. The prognostic significance of this elevation is unknown. We performed a multi-institutional retrospective review of 332 men with stage I pure seminoma of the testis and evaluated the prognostic significance of this elevation and the prognostic value of local invasion of the primary tumor. Twenty-five of 191 evaluable patients (13%) had elevated preorchiectomy beta human chorionic gonadotropin. All normalized postoperatively and are alive without evidence of disease with a median follow-up of 50 months (range 1-124 mo). Of 191 patients, 190 (99.5%) are alive and free of disease. One patient underwent salvage chemotherapy for a chest recurrence, and he is alive and free of disease at 72 months. We conclude that elevated preorchiectomy serum beta human chorionic gonadotropin level and local invasion of the primary tumor do not portend a poor prognosis in patients with clinical stage I pure seminoma of the testis.

Chorionic Gonadotropin, beta Subunit, Human↗
PubMed1996

The role of cystoscopy before radical prostatectomy.

OBJECTIVE: To determine the role of pre-operative cystoscopy in men undergoing radical prostatectomy for clinically localized adenocarcinoma of the prostate. PATIENTS AND METHODS: One hundred men undergoing radical prostatectomy for clinically localized adenocarcinoma of the prostate were evaluated for coexisting bladder pathology from a retrospective review of their charts and records. RESULTS: Four of 100 men undergoing radical prostatectomy for clinically localized prostate cancer were found to have synchronous bladder tumours. Two of these had superficial low-grade transitional cell carcinoma (TCC), one had a poorly differentiated invasive TCC and the last was found to have an inverted papilloma during radical retropubic prostatectomy. The patient with invasive disease died before the initiation of definitive therapy. The other three men are free of disease 2 years after diagnosis and treatment. CONCLUSION: Because of the low cost and minimal morbidity of pre-operative flexible cystoscopy, we recommend that this procedure be performed on the operating table before prostatectomy. In patients with gross or microscopic haematuria, a significant history of smoking, a prior history of urothelial malignancy or symptoms of bladder outlet obstruction, cystoscopy would be best performed before surgery in an out-patient setting.

Adenocarcinoma↗
PubMed1996

A randomized prospective comparison of antibiotic tissue levels in the corpora cavernosa of patients undergoing penile prosthesis implantation using gentamicin plus cefazolin versus an oral fluoroquinolone for prophylaxis.

PURPOSE: We performed a prospective randomized trial comparing the efficacy, safety and cost of parenteral antibiotics and oral fluoroquinolones for prophylaxis in penile prosthesis surgery. MATERIALS AND METHODS: We prospectively randomized 20 consecutive patients undergoing penile prosthesis surgery to receive ofloxacin orally or gentamicin and cefazolin parenterally followed by cephradine orally. Intraoperatively corpora cavernosa tissue and simultaneous peripheral serum samples were evaluated for antibiotic levels. Median followup was 16 months (range 8 to 21, mean 15.35). RESULTS: There were no implant losses or reoperations and complications were comparable in the 2 groups. The difference in mean serum-to-tissue ratios of ofloxacin versus the combination of cefazolin and gentamicin was statistically significant (p < 0.03). The minimum inhibitory concentrations of ofloxacin met or exceeded those of the 2 most common offending organisms, Staphylococcus epidermidis and Escherichia coli, in 80% of patients, which was comparable to the results of the parenteral regimen. Cost savings of the medications alone were more than $250,000 in the ofloxacin group. By eliminating a hospital stay of the 25,000 cases of penile prosthesis placement in the United States yearly a total cost savings of more than $36 million would be realized. CONCLUSIONS: When oral ofloxacin is given for prophylaxis in penile implant surgery, the procedure may be performed on an outpatient basis and health care dollars are saved.

Administration, Oral↗
PubMed1991

Diagnosis of fetal anterior abdominal wall defects by use of ultrasonography.

Omphalocele and gastroschisis involve protrusion of intestine through a defect in the abdominal wall. It is important to differentiate between the two because of a difference in the incidence of associated anomalies and of chromosomal abnormalities. The distinguishing characteristics are the location of umbilical cord insertion, the echogenicity of the contents of the protruding mass and, usually, the presence or absence of a sac surrounding the mass. Early detection is critical so that decisions can be made about the possibility of surgical correction and the outcome of the pregnancy. We describe an omphalocele detected by ultrasonography in the 20th week of gestation during a routine prenatal check-up.

Abdominal Muscles↗