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Biomedical subjects

C P Sundaram

Publications and source records attributed to C P Sundaram.

12 recordsLinked to original sources
PubMed2000

Health-related quality of life and morbidity in patients receiving brachytherapy for clinically localized prostate cancer.

Health-related quality of life must be a factor when treatment options are discussed with a patient. Quality of life is measured by validated questionnaires that include generic and disease-targeted measures. Urinary and rectal symptoms and sexual function are evaluated after treatment for prostate cancer. Quality of life is adversely affected in the early post-brachytherapy period primarily by the urinary morbidity. Urinary symptoms peak 2 months after treatment and decline thereafter, although severe long-term urinary toxicity occurs in 3% to 12% of patients. Urinary symptoms are generally treated with alpha-blocker and anticholinergic drugs, but 2% to 5% of patients require transurethral resection of the prostate to relieve persistent obstruction. However, 6 months after treatment, overall satisfaction is excellent, and the majority of patients would recommend the procedure to a friend.

Brachytherapy↗
PubMed2000

Flexible ureteroscopes: a single center evaluation of the durability and function of the new endoscopes smaller than 9Fr.

PURPOSE: Flexible ureteroscopes smaller than 9Fr are widely used in endourology. We systematically evaluated the functional durability of these instruments in the clinical setting. MATERIALS AND METHODS: We performed ureteronephroscopy 92 consecutive times in 84 patients at our hospital using a flexible Storz model 11274AA,double dagger Circon-ACMI model AUR-7, section sign Wolf model 7325.172 parallel and Olympus model URF/P3 ureteroscope paragraph sign. Preoperatively and postoperatively we evaluated all flexible ureteroscopes for luminosity, irrigant flow at 100 mm. Hg, number of broken image fibers and active deflection range. During the procedure a record was kept of the duration that the endoscope remained in the urinary tract, average irrigation pressure, method of insertion, various devices used within the working channel, need for lower pole access, and surgeon overall impression of visibility and maneuverability. RESULTS: The luminosity and irrigant flow of all endoscopes remained relatively unchanged during consecutive applications, while active deflection deteriorated 2% to 28%. Endoscopes were used for an average of 3 to 13 hours before they needed repair. The most fragile part of these instruments was the deflection unit. CONCLUSIONS: Small diameter flexible ureteroscopes are effective for diagnosing and treating upper urinary tract pathology but improved durability is required. Currently they represent a highly effective but high maintenance means of achieving retrograde access to the ureter and kidney with a need for repair after only 6 to 15 uses.

Equipment Design↗
PubMed1999

Urolithiasis associated with protease inhibitors.

OBJECTIVE: We evaluated the radiographic characteristics as well as the clinical management of urolithiasis induced by systemic therapy with indinavir sulfate, a protease inhibitor utilized in the treatment of HIV infection. PATIENTS AND METHODS: Fifteen consecutive HIV-positive male patients (average age 41.3 years) who presented with urolithiasis while being treated with indinavir sulfate (average time 11.1 months) were studied. RESULTS: All patients presented with flank pain, and eight had gross hematuria. All but one patient had microscopic hematuria. The location of the stones was the kidney in three, the proximal ureter in four, and the distal ureter in nine. One patient had both a renal and a proximal ureteral stone. The stones were radiolucent on CT imaging in five patients and could not be seen in five. In the five cases in which a stone was not definitely identified, a diagnosis of urolithiasis was established on the basis of ureteral obstruction and periureteral/renal streaking noted on CT. Treatment included observation with hydration in eight patients, ureteral stent placement in two patients, ureteroscopy in three patients, and extracorporeal shockwave lithotripsy in two patients. Stones were analyzed in five patients and proved to be 100% indinavir in three and a mixture of indinavir, calcium oxalate monohydrate, and calcium oxalate dihydrate in two. CONCLUSIONS: Urolithiasis is a recognized complication of treatment with indinavir sulfate. Pure indinavir stones cannot be seen on CT unless intravenous contrast medium is utilized. Mixed calcium and indinavir stones can occur and may be radiopaque. The majority of HIV-positive patients with symptomatic urolithiasis can be treated conservatively with hydration. Metabolic evaluation of these patients with identification and correction of factors predisposing to stone formation may minimize future recurrences. Administration of this effective medication thus can continue uninterrupted.

Adult↗
PubMed1998

An effective technique to facilitate radiographic stone visualization with an internal stent during shock wave lithotripsy.

PURPOSE: We describe a simple method to assist stone localization during shock wave lithotripsy in the presence of a Double J stent. MATERIALS AND METHODS: A 4F whistle tip ureteral catheter is passed alongside a previously inserted 6F Double J stent. The tip of the ureteral stent is positioned in the lower or mid third of the ureter. Contrast material is injected through the ureteral catheter during lithotripsy to assist stone localization. RESULTS: This technique has been successful in localization of poorly opacified renal stones during lithotripsy. CONCLUSIONS: Radiolucent and poorly calcified renal stones can be easily localized during shock wave lithotripsy, despite the presence of a Double J stent. No special catheters or stents are required for this technique.

Humans↗
PubMed1997

Long-term follow-up of patients receiving injection therapy for erectile dysfunction.

OBJECTIVES: During the last decade, vasoactive intracavernosal pharmacotherapy (VIP) has been used extensively for the treatment of erectile dysfunction. However, there is concern about high discontinuation rates and the possibility of long-term complications. Because of few long-term studies on VIP, we investigated efficacy, side effects, satisfaction index, and drop-out rate for injection therapy in patients who started treatment more than 5 years ago. METHODS: Questionnaires were mailed to 108 patients who were started on VIP more than 5 years ago, between November 1984 and July 1989. The hospital records and data from the 100 responders (93%) were reviewed. RESULTS: Only 32% of the patients continue to use VIP. Most (56%) of those who discontinued did so during the first year. The patients cited one or more of the following reasons for discontinuation: desire for a permanent modality of therapy (29%), lack of a suitable partner (26%), fear of needles (23%), poor response (23%), fear of complications (22%), and lack of sexual spontaneity (21%). This study, which has one of the longest follow-up periods in the literature, has significant new findings in three areas: discontinuation rates fall after 2 years, long-term complications are relatively minor, and patients who discontinue therapy are significantly older or have a poor initial impression of VIP. Paradoxically, discontinuing VIP was apparently unrelated to side effects or etiology of erectile dysfunction, and 82% of patients would still recommend VIP to a friend. CONCLUSIONS: This study conclusively shows that because of high initial satisfaction and relatively minor side effects, VIP should remain as one of the initial options for long-term treatment of erectile dysfunction. However, despite seemingly doing well, patients often discontinue therapy, and therefore should be followed closely so that alternative therapy can be offered.

Adult↗
PubMed1997

Biopsy Gleason score: how does it correlate with the final pathological diagnosis in prostate cancer?

OBJECTIVE: To evaluate the role of the Gleason score of needle biopsies of the prostate in predicting the final pathological staging of patients with carcinoma of the prostate treated by radical prostatectomy. PATIENTS AND METHODS: The records of 466 patients with carcinoma of the prostate treated by radical prostatectomy were reviewed, comparing the Gleason scores of the core-needle biopsies with the Gleason score and final pathological staging of the surgical specimens. RESULTS: The biopsy grade was the same as that of the prostatectomy specimen in 54% of the patients. The most common discordance was the upgrading of well-differentiated tumours in 75% of the patients. When the biopsy grade was compared with the surgical pathological stage, 49% of low- and 82% of high-grade lesions in the biopsy had capsular penetration by tumour or locally advanced disease (Stage C and D1). CONCLUSION: Well-differentiated tumours on the biopsy core are not predictive of organ-confined disease, but a poorly differentiated lesion is a good indicator of extracapsular extension of the cancer.

Biopsy, Needle↗
PubMed1997

Failure to obtain durable results with collagen implantation in children with urinary incontinence.

PURPOSE: We studied the efficacy and durability of injection of glutaraldehyde cross-linked bovine collagen for treating urinary incontinence in children. MATERIALS AND METHODS: From April 1994 to July 1995, 12 boys and 8 girls 4 to 18 years old (mean age 9.5) underwent endoscopically directed collagen injections into the bladder neck. Followup ranged from 9 to 23 months (mean 15.2). The etiology of incontinence included myelodysplasia in 12 patients, exstrophy/epispadias in 4, and epidural abscess, sacral agenesis, imperforate anus and posterior urethral valves in 1 each. RESULTS: Collagen was injected once in 9 patients, twice in 10 and 3 times in 1. Injected volume ranged from 3 to 18 cc (mean 7.3). Followup urodynamic studies were available for 10 patients. Leak point pressure increased from 28.7 to 34.9 cm. water. One patient (5%) was dry, 5 (25%) had improvement, 10 (50%) had transient improvement for 2 to 90 days (mean 52) and 4 (20%) remained incontinent. Five children underwent bladder neck sling procedures. In 1 patient transient sciatic nerve irritation developed due to gluteal hematoma. CONCLUSIONS: The previously reported high success rate of collagen injection for urinary incontinence in children is unsupported by this study. Improvement in continence was temporary or inadequate in the majority of patients. Collagen therapy may only delay the need for surgery for managing organic urinary incontinence in children.

Adolescent↗
PubMed1997

Bladder stone causing renal failure.

We describe a 62-year-old man with a large bladder calculus causing bilateral ureteral obstruction. Diagnosis was delayed despite the patient's history of recurrent urinary infections. This case report illustrates the importance of radiological evaluation of patients presenting with recurrent urinary infections. To our knowledge, only three previous reports of bladder stone causing renal failure have been published.

Diagnosis, Differential↗
PubMedDate not supplied

Extracorporeal shock wave lithotripsy: a comprehensive review.

Extracorporeal shock wave lithotripsy (ESWL) has revolutionized treatment of urolithiasis since its introduction in the 1980s. The great majority of renal and ureteral stones can be successfully treated with ESWL. Complications can be minimized with maximal efficacy if patient selection is optimum.

Anesthesia↗