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C Servadio

Publications and source records attributed to C Servadio.

At least 37 records · Page 2Linked to original sources
PubMed1994

Rapid tumour recurrence following cessation of long-term treatment with intravesical thiotepa.

OBJECTIVE: To report tumour recurrence related to cessation of long-term therapy with thiotepa. PATIENTS AND METHODS: A group of 12 patients with low grade (I-II), low stage (TA-T1) transitional cell carcinoma of the bladder were included in the study. All patients had been treated with intravesical thiotepa for a period ranging from 24 to 71 months and none had had a recurrence for a period of between 15 and 51 months. After referral to this department all the patients were withdrawn from thiotepa therapy. RESULTS: All the patients developed bladder tumours within 6 months of cessation of therapy. The recurrent tumours were grade II in 10 patients and grade III in two patients. Eight patients had stage TA and four had stage T1. All responded to bacille Calmette-Guérin therapy and none had tumour recurrence on follow up at 24 months. CONCLUSION: Meticulous follow-up of patients is indicated soon after the cessation of long-term therapy with thiotepa.

Administration, Intravesical↗
PubMed1994

A comparison between digitally-guided fine needle aspiration and ultrasound-guided transperineal core needle biopsy of the prostate for the detection of prostate cancer.

OBJECTIVE: To prospectively examine the accuracy of fine needle aspiration (FNA) for the detection of prostate cancer. Ultrasound-guided core needle biopsy of the prostate was used as the standard to which the FNA results were compared. PATIENTS AND METHODS: One-hundred patients who had been referred for urological evaluation were suspected of having prostate cancer on the basis of digital rectal examination (DRE) and/or transrectal ultrasound (TRUS). All were further evaluated by digitally guided transrectal FNA and by TRUS-guided transperineal core needle biopsy. RESULTS: Prostate cancer was identified in 54 patients by core needle biopsy and in 45 by FNA. The sensitivity of FNA was 81% and both specificity and positive predictive value were 98%. CONCLUSION: FNA is easily performed, has negligible morbidity and offers prompt results. These data suggest that FNA is a reasonable initial diagnostic procedure for the detection of prostate cancer. Core needle biopsy may be reserved for patients with negative cytology who are clinically suspected of having prostate cancer. In selected patients, FNA may be used as an alternative to core needle biopsy for diagnosis, treatment planning and follow-up.

Aged↗
PubMed1994

Can the vacuum test be used as a diagnostic method for determining the degree of severity of erectile dysfunction?

We performed the vacuum test (VT) using the Osbon Erec Aid System on 224 patients with erectile dysfunction (ED). The age range was 26-78 years. The vacuum procedure was performed three times at intervals of 2-8 days, using the negative pressure device (NPD). Negative pressure was created for 3-5 minutes, followed by the removal of the cylinder; the tension ring was left in place for an additional 1-2 minutes. During each procedure, we observed color and temperature changes in the glans penis and changes in the tumescence and maximal rigidity of the penis (MRP); dynamic changes in MRP were noted again 1-2 minutes after the procedure. For comparison and verification, we carried out parallel tests: nocturnal penile tumescence (NPT), penile brachial index (PBI), and Doppler penile ultrasound (DPU). On completion of the investigation, we found that 10.3% had mild ED, 38.5% moderate ED, and 41.5% severe ED. The parallel tests confirmed the diagnosis reached by VT. Thus, changes after vacuum procedures together with local symptoms can serve as criteria for determining the degree of severity of ED.

Adolescent↗
PubMed1994

Reduced semen quality caused by chronic abacterial prostatitis: an enigma or reality?

OBJECTIVE: To investigate whether there is an inter-relationship between chronic abacterial prostatitis and potential infertility. DESIGN: As part of the eligibility studies for hyperthermia treatment for chronic abacterial prostatitis patients, a large number of chronic prostatitis patients were referred to us from peripheral outpatient clinics. Sperm analysis was a routine portion of the eligibility studies. To exclude bacterial prostatitis, urine cultures, expressed prostatic secretion, and semen cultures were performed. The patient population was not differentiated on the basis of those suffering from either nonbacterial prostatitis or prostatodynia according to the commonly accepted classification. The control group was the laboratory normal standard group. SETTING: Normal human volunteers in an academic and clinical research environment. PATIENTS: The first group includes 86 patients suffering from long-standing (1 to 20 years) chronic abacterial prostatitis, according to the commonly accepted classification, with a mean age of 39.9 +/- 9.5 years. The second group includes 101 normal fertile men with a mean age of 31.4 +/- 5.5 years. INTERVENTIONS: The routine semen analysis performed included biochemical tests of seminal plasma, bacteriology, and light microscopy. MAIN OUTCOME MEASURE: The original hypothesis was based on a reduction in semen quality in these patients caused by chronic abacterial prostatitis. Measurements for sperm motility parameters, morphology characteristics, prostate markers, and white blood cells (WBC) were designed accordingly. RESULTS: Statistical comparisons of the two groups showed that several sperm motility parameters, morphology characteristics, prostate markers, and WBC are outside of the normal value ranges in the chronic abacterial prostatitis group. In addition, there is a correlation between the duration of the disease and two important sperm analysis variables: increased prostatic markers and appearance of sperm morphological defects. CONCLUSION: From the results obtained, the high incidence of secondary infertility in these patients may be explained.

Adult↗
PubMed1993

[Repeated self-catheterization of the bladder].

41 adults with urinary retention of various etiologies (including 10 after cystoplastic surgery) were treated by clean, intermittent, self-catheterization (CISC) for a mean of 37 months. Most learned the technique in the outpatient clinic. 4 needed assistance in performing CISC by family members. None stopped the treatment. In 72% there was no discomfort or only mild discomfort. 39% had acute UTI in the preceding year. We conclude that emptying the bladder by CISC is effective and easy to learn. Although patients are initially reluctant, most adapt well to the technique and morbidity is relatively low.

Humans↗
PubMed1993

[Treatment of erectile dysfunction with vacuum constriction device].

The vacuum constriction device (VCD) is a noninvasive mechanical device which may produce an erection by creating a vacuum of up to 250 mm Hg and with a rubber ring to maintain this state by constricting the base of the penis. We tested the VCD on 150 men who presented with organic and psychogenic impotence in our outpatient clinic between the years 1986 and 1992. Of the 150 men, 113 (75%) achieved an adequate erection with the VCD. However, only 72 patients agreed to buy the device and use it regularly. During follow-up of from 3 months to 5 1/2 years (mean 25 months), 65 men were using the VCD regularly and reported satisfying intercourse at least once every 2 weeks. Complications were minimal and consisted of mild numbness of the penis in 7 patients, mild cyanosis in 17, and 10 cases of painless ecchymoses and petechiae which disappeared without any treatment. From our experience, the VCD appears to be a safe, inexpensive, and easy method for impotent men to engage in sexual intercourse without, of course, eliminating other therapeutic options, including surgery.

Adult↗
PubMed1993

Seminal vesicle congestion as a cause of postprostatectomy dysuria.

A series of benign prostatic hypertrophy patients were routinely evaluated, including transrectal echography, before and at regular intervals following surgery. Five patients had persistent symptoms of dysuria at 14-30 months after surgery. There was no infection, residual urine or malignancy to explain their symptoms. The seminal vesicles (SVs) were severely dilated on transrectal echography, a finding which was definitely not present on initial examination. The patients were treated by transrectal echo-guided aspiration of the SVs by the perineal approach. The fluid aspirated was examined, and antibiotics were directly injected into the SVs. In 4 of the patients, there was a dramatic relief of symptoms with prolonged improvement. In only 1 case, following transurethral resection, there was but slight improvement. Dilated, obstructed SVs after prostatectomy, clearly diagnosed on transrectal echography, may be the cause of persistent irritative urinary symptoms. Treatment can be instituted by echo-guided aspiration of the fluid with simultaneous injection of a potent antibiotic, resulting in probable immediate relief.

Aged↗
PubMed1993

[Value of determining prostate specific antigen in follow-up of prostatic cancer].

The value of measuring serum prostate specific antigen (PSA) in monitoring cases of prostatic cancer was studied in 239 patients. 30 patients with benign prostatic hyperplasia served as controls. The patients were treated by radical prostatectomy, radiotherapy or chemotherapy. In the controls PSA levels were elevated in 60%, indicating that PSA measurement is not specific for prostatic cancer. Among 35 patients before and after radical prostatectomy, in those without disease progression, PSA levels were repeatedly low, but were elevated in all with progression. Among 25 patients after radiation and in 28 before and after radiation, low PSA levels were found in all those, without disease progression. High PSA levels, or a rise in levels after irradiation, preceded local growth or metastatic spread. In the 95 patients with metastatic spread who received hormone-and/or chemo-therapy, low PSA levels following initiation of treatment, were a favorable prognostic indicator, with a sensitivity of 100%. High levels, or a rise of levels after initiation of treatment indicated disease progression. The rise in PSA levels preceded clinical evidence of progression by 0 to 30 months. We conclude that serum PSA is a valuable marker for following patients with prostatic cancer.

Biomarkers, Tumor↗
PubMed1993

Bilateral asynchronous renal cell carcinoma: treatment approach.

Two hundred patients underwent nephrectomy for renal cell carcinoma (RCC) at our service in 1978-89. During follow-up four patients developed RCC in the remaining kidney and underwent a parenchymal preserving procedure as curative treatment (one enucleation, and three partial nephrectomies). The interval between the nephrectomy and the diagnosis of asynchronous RCC was 50-84 months (mean 65 months). None of the patients needed dialysis after the operation, and creatinine level in all remained between 1.6 and 1.9 mg. One patient died from a heart attack 8 years after the partial nephrectomy, two patients have no evidence of disease 24 months and 76 months after enucleation and partial nephrectomy, respectively. The fourth patient, who had resection of metastatic lesion in the scalp 36 months before the partial nephrectomy, is alive 34 months after the procedure but has lately developed recurrence in the scalp. Although relatively rare, it is important to be aware of the possible asynchronous development of RCC in the contralateral kidney after nephrectomy for RCC. In such cases, parenchymal preserving procedure (enucleation, partial nephrectomy) is an alternative that should be considered to improve the quality of life and to avoid the need for dialysis.

Aged↗
PubMed1992

[Immunotherapy for metastatic renal cell carcinoma: treatment with PLAK cells and low-dose interleukin-2].

During the past 5 years publications from the NIH (Rosenberg et al.) and other centers have reported encouraging results in the treatment of metastatic renal cell carcinoma. Adoptive immunotherapy was applied, using lymphocytes activated by interleukin-2 (LAK cells) plus high doses of interleukin (IL-2) systemically. The mean clinical response rate was 20-35%. Severe lifethreatening adverse reactions to high doses of IL-2 were noted, although they were all of short duration. Laboratory findings of Novogrodsky et al. from Beilinson Medical Center, Israel showed that oxidizing mitogens can induce lymphocyte activation (PLAK cells). Further studies suggested that a combination of such activated cells with low doses of IL-2 could produce effective toxicity to tumor cells without the need for high doses of IL-2 which could be very toxic for the patient. In the past year we treated 7 patients with PLAK cells and IL-2. 4 completed the treatment, of whom 1 responded partially (regression of more than 50% of lung metastases), 1 is stable and in 1 liver metastases regressed but metastases in lumbar vertebrae and in the pelvis progressed. 1 patient died a month after discharge from hospital, probably due to rapid progression of the disease. Our protocol follows that of the Phase II clinical study of 40 patients treated at the Rogosin Institute, New York Hospital--Cornell Medical Center. The mean clinical response rate was 23.6%. Toxicity of IL-2 is dose-dependent. In this protocol, the low doses of IL-2 gave significantly fewer adverse reactions.

Adult↗
PubMed1992

Neodymium:YAG laser treatment of bladder neck contracture following prostatectomy.

A total of 21 patients with postprostatectomy bladder neck contracture underwent treatment with Nd:YAG laser irradiation. A new 800-microns hemispherical optical quarz fiber was used in contact technique to produce linear incisions in the scarred tissue. Within 11.2 months, median of follow-up, there was improvement in the obstructive voiding symptoms in all the patients. Two patients who had still mild contracture in the first follow-up cystoscopy were managed successfully with a second treatment. Endoscopic application of laser energy in the contact mode enables the immediate vaporization and disintegration of the fibrous area and secondary reepithelization of the bladder neck without scarring.

Aged↗
PubMed1992

The development of vascular supply of normal rat prostate during the sexual maturation: an angiographic study.

Vascular distribution of small blood vessels and capillaries using India ink angiography was studied in normal rat prostate from puberty up to full sexual maturation. The study included both macroscopic observation of the lobular vascular irrigation and the histological assessment of the periacinar capillary network. The topographical distribution of the main prostate branches was found to be different among the rat prostate lobes. The ventral lobe seems to be better irrigated than the dorsal one. The former being supplied by two parallel vascular systems, one irrigating the median two-thirds of the ventral lobe, whereas the remaining external one-third was found to be conjointly irrigated from the pericapsular branches of the fat pads. The blood vessels of the dorsal and lateral lobes emerged radially from a periurethral circle, with the dorsal branches ending blindly in the connective tissue of the pelvic cavity, whereas the lateral prostate was also conjointly irrigated by a dual vascularization from the pericapsular fat pad and the periurethral circle branch. The histological study revealed quantitative differences between the periacinar capillaries of both ventral and dorsal lobes. The capillary density was found to be age dependent and directly proportional to the acinar size. Small acini were less well irrigated by capillaries than were the larger ones. The number of capillaries per acinar area increased progressively toward the maturation (day 90); thereafter, their number remained constant. Both prostate lobes showed identical patterns. The heterogeneous vascular networks among the rat prostatic lobes might offer an additional clue for their distinctive morphophysiological characteristics, which most probably play a role in various pathogenetic processes.

Angiography↗
PubMed1992

Fifteen years' experience of combined hormone/chemotherapy in metastatic prostate cancer.

Fifteen years ago we embarked on a treatment protocol for prostatic cancer patients with widespread disease (Stage D2) which included both hormonotherapy (i.e., orchiectomy and diethylstilbestrol [DES] 5 mg/day--later substituted with cyproterone acetate [CPA] 0.2 g/day) and chemotherapy (cyclophosphamide and 5-fluorouracil 10 mg/kg/week). The rationale for such an approach was the universally poor results obtained from the conventional approach which advocated consecutive single-treatment schedules once the previous therapy had ceased to be effective. As such a conventional approach probably allowed the selection of new resistant cell clones, we assumed that perhaps an aggressive combined systemic therapeutic approach from the start, would give such a group of patients--already with generalized disease--a better long-term result. In retrospect, after fifteen years, the chemotherapy on a series of 50 patients so treated has been well tolerated with only minimal, temporary side effects. This regimen was continued up to five years with a reduced maintenance dose. The hormonotherapy was also well tolerated, and was fully maintained. Only 28 percent died of their disease (16% within the first 2 years); 28 percent died of other causes; 40 percent are still alive (14% with clinical disease). In only 9 cases was the chemotherapy discontinued for various reasons. No control arm was originally designed in this protocol, but the long-term results suggest that our original concept was probably valid. Further studies, with the possible use also of newer chemotherapeutic agents, may well justify considering this combined therapeutic approach when dealing with this disease in its widespread form.

Aged↗
PubMed1992

Is open prostatectomy really obsolete?

A total of 1,066 prostatectomies treated by us from 1985 to 1989 were reviewed. The necessary comprehensive data were available on 710 cases. Open (Millin's retropubic) prostatectomy (RPP) was the procedure of choice for large glands and transurethral resection (TURP) for smaller glands: 408 had had RPP and 262 TURP; 14.5 percent of the TURP group eventually needed a second procedure during a one to six-year follow-up compared with only 2.6 percent of the RPP group. Forty other patients who had been operated on elsewhere were referred to us for a second, repeat procedure; 30 also previously had had a TURP. Total hospitalization, operating time, and complications were better in the long run in the RPP group compared with the TURP group. It is believed that open prostatectomy still has a respectable place in urology and therefore, should be considered and also taught to residents for use in dealing with large glands.

Humans↗
PubMed1992

Incidental finding of rectal carcinoma during transrectal US for prostatic diseases.

During transrectal ultrasound (TRUS), rectal carcinoma was an incidental finding in seven patients among a series of 5,000 TRUS examinations. TRUS was performed in seven patients with symptoms characteristic of prostatic diseases. All seven patients underwent examination by at least one physician before TRUS and, except for abnormal prostatic findings, no tumors were detected during digital rectal examination (DRE). The tumors were clearly visualized with TRUS and were easily palpated during DREs performed after TRUS. They were large and were located mainly along the posterior and lateral walls of the rectum. All the tumors were diagnosed by means of proctoscopy; the biopsy findings were positive, and the pathologic staging indicated advanced disease: adenocarcinoma of the rectum with a minimum grade of Dukes C. It is recommended that, in addition to evaluation of scans obtained in the transverse plane, the multiplane transducer be used to evaluate the longitudinal plane of the rectum for detection of possible undiscovered tumors.

Adenocarcinoma↗
PubMed1992

Rowatinex for the treatment of ureterolithiasis.

A prospective, randomized, double-blind study was performed on 87 patients with ureterolithiasis, assessing the effect of the essential oil preparation Rowatinex (Rowa Pharmaceuticals, Ireland) for the treatment of ureterolithiasis. Forty-three patients were treated with Rowatinex and 44 patients with placebo. Despite the larger average diameter of calculi in the group of patients treated with Rowatinex, the overall stone expulsion rate was significantly higher in the Rowatinex group as compared to placebo: 81% and 59%, respectively (0.025 > p > 0.01). This higher rate of stone expulsion is observed in patients with disappearance of pretreatment ureteral dilatation (when patients with expelled stones are excluded) (0.05 > p > 0.001). Seven patients in the Rowatinex group had mild to moderate gastrointestinal disturbances; no other significant side effects were noted during the treatment in either group. We conclude that early treatment with Rowatinex for patients with ureteral stones is indicated before other more aggressive measures are considered.

Adult↗
PubMed1992

Risk factors and their effect on the results of Burch colposuspension for urinary stress incontinence.

Forty patients with urinary stress incontinence were studied and the results of Burch colposuspension evaluated. Combined detrusor instability and stress incontinence were found in 22.5% of the patients. The results of surgery showed that 87.5% of the patients (35/40) were cured of incontinence. None of the contributing risk factors of incontinence had a significant role in the outcome of surgery. In view of this, all patients with surgically amenable urinary incontinence should be considered for surgical resolution of this condition.

Adult↗